ST NICHOLAS 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 , COMMUNITY CARE FAMILY CARE , CONTINUUS MEDICAID MANAGED , FIRST HEALTH NETWORK , HEALTHEOS , HEALTHSMART , HUMANA CHOICE CARE HMO , HUMANA CHOICE CARE PPO , HUMANA MEDICARE ADVANTAGE , HUMANA NATIIONAL POS HMO , HUMANA PREFERRED BHCG , INTERPLAN HEALTH GROUP , LIVE360 HSHS HEALTHY PLAN , MANAGED HEALTH SERVICES MCD , MANAGED MEDICARE NO SEQUESTRATION , MEDICA MEDICARE ADVANTAGE , 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 ," PRIVATE HEALTHCARE SYSTEMS, INC ", SECURITY HEALTH PLAN , SECURITY HEALTH PLAN OF WISCONSIN , TRILOGY , TRILOGY MEDICAID , UHC ONEIDA NATION , UNITED HEALTH ALL PAYOR , UNITED HEALTH CARE MEDICARE , UNITED HEALTH CARE OPTIONS PPO , WEA INSURANCE CORPORATION , WEA INSURANCE CORPORATION                         1 , WEA INSURANCE CORPORATION                         2 , WEA TRUST PPP/TRUST PREFERRED , WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION 
ST NICHOLAS HOSPITAL - ACUTE,N/A,216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,120,1 ,"$60,517.70 ","$39,941.68 ","$3,250.37 ","$66,199.16 ","$3,250.37 ","$60,517.70 ","$60,517.70 ","$66,199.16 ","$60,517.70 ","$51,440.05 ","$42,362.39 ","$3,250.37 ","$3,250.37 ","$57,491.82 ","$45,993.45 ","$45,388.28 ","$60,517.70 ","$51,440.05 ","$66,199.16 ","$60,517.70 ","$60,517.70 ","$42,362.39 ","$36,855.28 ","$3,250.37 ","$66,199.16 ","$64,875.18 ","$60,517.70 ", N/A ,"$51,440.05 ","$60,517.70 ","$55,676.28 ","$42,362.39 ","$60,517.70 ","$60,517.70 ","$36,855.28 ","$60,517.70 ","$41,817.73 ","$54,465.93 ","$41,345.69 ","$65,523.93 ","$47,808.98 ","$3,551.95 ","$60,517.70 ","$60,517.70 ","$64,875.18 ","$60,517.70 ","$43,572.74 ","$37,520.97 ","$43,572.74 ","$43,572.74 ","$48,414.16 "
ST NICHOLAS HOSPITAL - ACUTE,N/A,473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,120,1 ,"$15,305.70 ","$10,101.76 ","$3,250.37 ","$17,645.64 ","$3,250.37 ","$15,305.70 ","$15,305.70 ","$17,645.64 ","$15,305.70 ","$13,009.85 ","$10,713.99 ","$3,250.37 ","$3,250.37 ","$14,540.42 ","$11,632.33 ","$11,479.28 ","$15,305.70 ","$13,009.85 ","$17,645.64 ","$15,305.70 ","$15,305.70 ","$10,713.99 ","$9,321.17 ","$3,250.37 ","$17,645.64 ","$17,292.73 ","$15,305.70 ", N/A ,"$13,009.85 ","$15,305.70 ","$14,081.24 ","$10,713.99 ","$15,305.70 ","$15,305.70 ","$9,321.17 ","$15,305.70 ","$10,576.24 ","$13,775.13 ","$10,456.85 ","$17,465.66 ","$12,091.50 ","$3,551.95 ","$15,305.70 ","$15,305.70 ","$17,292.73 ","$15,305.70 ","$11,020.10 ","$9,489.53 ","$11,020.10 ","$11,020.10 ","$12,244.56 "
ST NICHOLAS HOSPITAL - ACUTE,N/A,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,120,1 ,"$11,455.16 ","$7,560.41 ","$3,250.37 ","$13,447.03 ","$3,250.37 ","$11,455.16 ","$11,455.16 ","$13,447.03 ","$11,455.16 ","$9,736.89 ","$8,018.61 ","$3,250.37 ","$3,250.37 ","$10,882.40 ","$8,705.92 ","$8,591.37 ","$11,455.16 ","$9,736.89 ","$13,447.03 ","$11,455.16 ","$11,455.16 ","$8,018.61 ","$6,976.19 ","$3,250.37 ","$13,447.03 ","$13,178.09 ","$11,455.16 ", N/A ,"$9,736.89 ","$11,455.16 ","$10,538.75 ","$8,018.61 ","$11,455.16 ","$11,455.16 ","$6,976.19 ","$11,455.16 ","$7,915.52 ","$10,309.64 ","$7,826.17 ","$13,309.87 ","$9,049.58 ","$3,551.95 ","$11,455.16 ","$11,455.16 ","$13,178.09 ","$11,455.16 ","$8,247.72 ","$7,102.20 ","$8,247.72 ","$8,247.72 ","$9,164.13 "
ST NICHOLAS HOSPITAL - ACUTE,N/A,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,120,1 ,"$23,694.57 ","$15,638.42 ","$3,250.37 ","$25,938.44 ","$3,250.37 ","$23,694.57 ","$23,694.57 ","$25,938.44 ","$23,694.57 ","$20,140.38 ","$16,586.20 ","$3,250.37 ","$3,250.37 ","$22,509.84 ","$18,007.87 ","$17,770.93 ","$23,694.57 ","$20,140.38 ","$25,938.44 ","$23,694.57 ","$23,694.57 ","$16,586.20 ","$14,429.99 ","$3,250.37 ","$25,938.44 ","$25,419.67 ","$23,694.57 ", N/A ,"$20,140.38 ","$23,694.57 ","$21,799.00 ","$16,586.20 ","$23,694.57 ","$23,694.57 ","$14,429.99 ","$23,694.57 ","$16,372.95 ","$21,325.11 ","$16,188.13 ","$25,673.86 ","$18,718.71 ","$3,551.95 ","$23,694.57 ","$23,694.57 ","$25,419.67 ","$23,694.57 ","$17,060.09 ","$14,690.63 ","$17,060.09 ","$17,060.09 ","$18,955.66 "
ST NICHOLAS HOSPITAL - ACUTE,N/A,743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,120,1 ,"$6,828.61 ","$4,506.88 ","$3,250.37 ","$8,452.77 ","$3,250.37 ","$6,828.61 ","$6,828.61 ","$8,452.77 ","$6,828.61 ","$5,804.32 ","$4,780.03 ","$3,250.37 ","$3,250.37 ","$6,487.18 ","$5,189.74 ","$5,121.46 ","$6,828.61 ","$5,804.32 ","$8,452.77 ","$6,828.61 ","$6,828.61 ","$4,780.03 ","$4,158.62 ","$3,250.37 ","$8,452.77 ","$8,283.71 ","$6,828.61 ", N/A ,"$5,804.32 ","$6,828.61 ","$6,282.32 ","$4,780.03 ","$6,828.61 ","$6,828.61 ","$4,158.62 ","$6,828.61 ","$4,718.57 ","$6,145.75 ","$4,665.31 ","$8,366.55 ","$5,394.60 ","$3,551.95 ","$6,828.61 ","$6,828.61 ","$8,283.71 ","$6,828.61 ","$4,916.60 ","$4,233.74 ","$4,916.60 ","$4,916.60 ","$5,462.89 "
ST NICHOLAS HOSPITAL - ACUTE,12100001,N/A,HC DAILY SERVICE,121,1 ,"$1,761.80 ","$1,162.79 ","$1,072.94 ","$1,761.80 ", Inpatient Medicaid ,"$20,051.00 ","$20,051.00 ", Inpatient Medicare ,"$12,283.44 ","$1,497.53 ","$1,233.26 ", Inpatient Medicaid , Inpatient Medicaid ,"$1,673.71 ","$1,338.97 ","$1,321.35 ","$15,741.00 ","$1,497.53 ", Inpatient Medicare ,"$15,741.00 ","$15,741.00 ","$1,233.26 ","$1,072.94 ", Inpatient Medicaid +4% , Inpatient Medicare , Inpatient Medicare , Inpatient Medicare +100% , Inpatient Medicaid +6% ,"$1,497.53 ", Inpatient Medicare +100% ,"$1,620.86 ","$1,233.26 ","$10,052.14 ","$10,052.14 ","$1,072.94 ","$10,052.14 ","$1,217.40 ","$1,585.62 ","$1,203.66 ", Inpatient Medicare +1% ,"$1,391.82 ", Inpatient Medicaid +6% ,"$14,843.00 ","$14,843.00 ", Inpatient Medicare ,"$14,843.00 ","$1,268.50 ","$1,092.32 ","$1,268.50 ","$1,268.50 ","$1,409.44 "
ST NICHOLAS HOSPITAL - ACUTE,16900000,N/A,HC DAILY SERVICE PROLONGED STAY,169,1 ,$535.90 ,$353.69 ,$326.36 ,$535.90 , Inpatient Medicaid ,"$20,051.00 ","$20,051.00 ", Inpatient Medicare ,"$12,283.44 ",$455.52 ,$375.13 , Inpatient Medicaid , Inpatient Medicaid ,$509.11 ,$407.28 ,$401.93 ,"$15,741.00 ",$455.52 , Inpatient Medicare ,"$15,741.00 ","$15,741.00 ",$375.13 ,$326.36 , Inpatient Medicaid +4% , Inpatient Medicare , Inpatient Medicare , Inpatient Medicare +100% , Inpatient Medicaid +6% ,$455.52 , Inpatient Medicare +100% ,$493.03 ,$375.13 ,"$10,052.14 ","$10,052.14 ",$326.36 ,"$10,052.14 ",$370.31 ,$482.31 ,$366.13 , Inpatient Medicare +1% ,$423.36 , Inpatient Medicaid +6% ,"$14,843.00 ","$14,843.00 ", Inpatient Medicare ,"$14,843.00 ",$385.85 ,$332.26 ,$385.85 ,$385.85 ,$428.72 
ST NICHOLAS HOSPITAL - ACUTE,17100001,N/A,HC DAILY INFANT SERVICE LEV 1,171,1 ,"$1,400.00 ",$924.00 ,$852.60 ,"$1,400.00 ", Inpatient Medicaid ,"$20,051.00 ","$20,051.00 ", Inpatient Medicare ,"$12,283.44 ","$1,190.00 ",$980.00 , Inpatient Medicaid , Inpatient Medicaid ,"$1,330.00 ","$1,064.00 ","$1,050.00 ","$15,741.00 ","$1,190.00 ", Inpatient Medicare ,"$15,741.00 ","$15,741.00 ",$980.00 ,$852.60 , Inpatient Medicaid +4% , Inpatient Medicare , Inpatient Medicare , Inpatient Medicare +100% , Inpatient Medicaid +6% ,"$1,190.00 ", Inpatient Medicare +100% ,"$1,288.00 ",$980.00 ,"$10,052.14 ","$10,052.14 ",$852.60 ,"$10,052.14 ",$967.40 ,"$1,260.00 ",$956.48 , Inpatient Medicare +1% ,"$1,106.00 ", Inpatient Medicaid +6% ,"$14,843.00 ","$14,843.00 ", Inpatient Medicare ,"$14,843.00 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,17200002,N/A,HC DAILY INFANT SERVICE LEV 2,172,1 ,"$1,553.00 ","$1,024.98 ",$945.78 ,"$1,553.00 ", Inpatient Medicaid ,"$20,051.00 ","$20,051.00 ", Inpatient Medicare ,"$12,283.44 ","$1,320.05 ","$1,087.10 ", Inpatient Medicaid , Inpatient Medicaid ,"$1,475.35 ","$1,180.28 ","$1,164.75 ","$15,741.00 ","$1,320.05 ", Inpatient Medicare ,"$15,741.00 ","$15,741.00 ","$1,087.10 ",$945.78 , Inpatient Medicaid +4% , Inpatient Medicare , Inpatient Medicare , Inpatient Medicare +100% , Inpatient Medicaid +6% ,"$1,320.05 ", Inpatient Medicare +100% ,"$1,428.76 ","$1,087.10 ","$10,052.14 ","$10,052.14 ",$945.78 ,"$10,052.14 ","$1,073.12 ","$1,397.70 ","$1,061.01 ", Inpatient Medicare +1% ,"$1,226.87 ", Inpatient Medicaid +6% ,"$14,843.00 ","$14,843.00 ", Inpatient Medicare ,"$14,843.00 ","$1,118.16 ",$962.86 ,"$1,118.16 ","$1,118.16 ","$1,242.40 "
ST NICHOLAS HOSPITAL - ACUTE,17300002,N/A,HC DAILY INFANT SERVICE LEV 3,173,1 ,"$1,760.00 ","$1,161.60 ","$1,071.84 ","$1,760.00 ", Inpatient Medicaid ,"$20,051.00 ","$20,051.00 ", Inpatient Medicare ,"$12,283.44 ","$1,496.00 ","$1,232.00 ", Inpatient Medicaid , Inpatient Medicaid ,"$1,672.00 ","$1,337.60 ","$1,320.00 ","$15,741.00 ","$1,496.00 ", Inpatient Medicare ,"$15,741.00 ","$15,741.00 ","$1,232.00 ","$1,071.84 ", Inpatient Medicaid +4% , Inpatient Medicare , Inpatient Medicare , Inpatient Medicare +100% , Inpatient Medicaid +6% ,"$1,496.00 ", Inpatient Medicare +100% ,"$1,619.20 ","$1,232.00 ","$10,052.14 ","$10,052.14 ","$1,071.84 ","$10,052.14 ","$1,216.16 ","$1,584.00 ","$1,202.43 ", Inpatient Medicare +1% ,"$1,390.40 ", Inpatient Medicaid +6% ,"$14,843.00 ","$14,843.00 ", Inpatient Medicare ,"$14,843.00 ","$1,267.20 ","$1,091.20 ","$1,267.20 ","$1,267.20 ","$1,408.00 "
ST NICHOLAS HOSPITAL - ACUTE,20000001,N/A,HC DAILY SERVICE ICU,200,1 ,"$4,880.60 ","$3,221.20 ","$2,972.29 ","$4,880.60 ", Inpatient Medicaid ,"$20,051.00 ","$20,051.00 ", Inpatient Medicare ,"$12,283.44 ","$4,148.51 ","$3,416.42 ", Inpatient Medicaid , Inpatient Medicaid ,"$4,636.57 ","$3,709.26 ","$3,660.45 ","$15,741.00 ","$4,148.51 ", Inpatient Medicare ,"$15,741.00 ","$15,741.00 ","$3,416.42 ","$2,972.29 ", Inpatient Medicaid +4% , Inpatient Medicare , Inpatient Medicare , Inpatient Medicare +100% , Inpatient Medicaid +6% ,"$4,148.51 ", Inpatient Medicare +100% ,"$4,490.15 ","$3,416.42 ","$10,052.14 ","$10,052.14 ","$2,972.29 ","$10,052.14 ","$3,372.49 ","$4,392.54 ","$3,334.43 ", Inpatient Medicare +1% ,"$3,855.67 ", Inpatient Medicaid +6% ,"$14,843.00 ","$14,843.00 ", Inpatient Medicare ,"$14,843.00 ","$3,514.03 ","$3,025.97 ","$3,514.03 ","$3,514.03 ","$3,904.48 "
ST NICHOLAS HOSPITAL - ACUTE,20000002,N/A,HC DAILY SERVICE CVICU,200,1 ,"$4,999.05 ","$3,299.37 ","$3,044.42 ","$4,999.05 ", Inpatient Medicaid ,"$20,051.00 ","$20,051.00 ", Inpatient Medicare ,"$12,283.44 ","$4,249.19 ","$3,499.34 ", Inpatient Medicaid , Inpatient Medicaid ,"$4,749.10 ","$3,799.28 ","$3,749.29 ","$15,741.00 ","$4,249.19 ", Inpatient Medicare ,"$15,741.00 ","$15,741.00 ","$3,499.34 ","$3,044.42 ", Inpatient Medicaid +4% , Inpatient Medicare , Inpatient Medicare , Inpatient Medicare +100% , Inpatient Medicaid +6% ,"$4,249.19 ", Inpatient Medicare +100% ,"$4,599.13 ","$3,499.34 ","$10,052.14 ","$10,052.14 ","$3,044.42 ","$10,052.14 ","$3,454.34 ","$4,499.15 ","$3,415.35 ", Inpatient Medicare +1% ,"$3,949.25 ", Inpatient Medicaid +6% ,"$14,843.00 ","$14,843.00 ", Inpatient Medicare ,"$14,843.00 ","$3,599.32 ","$3,099.41 ","$3,599.32 ","$3,599.32 ","$3,999.24 "
ST NICHOLAS HOSPITAL - ACUTE,20600002,N/A,HC DAILY SERVICE IMCU,206,1 ,"$3,570.75 ","$2,356.70 ","$2,174.59 ","$3,570.75 ", Inpatient Medicaid ,"$20,051.00 ","$20,051.00 ", Inpatient Medicare ,"$12,283.44 ","$3,035.14 ","$2,499.53 ", Inpatient Medicaid , Inpatient Medicaid ,"$3,392.21 ","$2,713.77 ","$2,678.06 ","$15,741.00 ","$3,035.14 ", Inpatient Medicare ,"$15,741.00 ","$15,741.00 ","$2,499.53 ","$2,174.59 ", Inpatient Medicaid +4% , Inpatient Medicare , Inpatient Medicare , Inpatient Medicare +100% , Inpatient Medicaid +6% ,"$3,035.14 ", Inpatient Medicare +100% ,"$3,285.09 ","$2,499.53 ","$10,052.14 ","$10,052.14 ","$2,174.59 ","$10,052.14 ","$2,467.39 ","$3,213.68 ","$2,439.54 ", Inpatient Medicare +1% ,"$2,820.89 ", Inpatient Medicaid +6% ,"$14,843.00 ","$14,843.00 ", Inpatient Medicare ,"$14,843.00 ","$2,570.94 ","$2,213.87 ","$2,570.94 ","$2,570.94 ","$2,856.60 "
ST NICHOLAS HOSPITAL - ACUTE,23300001,N/A,HC SURCHARGE ICU/HR,233,1 ,$126.50 ,$83.49 ,$64.16 ,$126.50 , N/A ,$86.70 ,$86.70 , N/A ,$75.90 ,$107.53 ,$88.55 , N/A , N/A ,$120.18 ,$96.14 ,$94.88 ,$82.23 ,$107.53 , N/A ,$82.23 ,$82.23 ,$88.55 ,$77.04 , N/A , N/A , N/A , N/A , N/A ,$107.53 , N/A ,$116.38 ,$88.55 ,$64.16 ,$77.00 ,$77.04 ,$77.00 ,$87.41 ,$113.85 ,$86.42 , N/A ,$99.94 , N/A ,$74.64 ,$74.64 , N/A ,$74.64 ,$91.08 ,$78.43 ,$91.08 ,$91.08 ,$101.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ACETYLCHOLINE 20 MG SOLR,250,1 ,$570.20 ,$376.33 ,$289.21 ,$570.20 , N/A ,$390.82 ,$390.82 , N/A ,$342.12 ,$484.67 ,$399.14 , N/A , N/A ,$541.69 ,$433.35 ,$427.65 ,$370.63 ,$484.67 , N/A ,$370.63 ,$370.63 ,$399.14 ,$347.25 , N/A , N/A , N/A , N/A , N/A ,$484.67 , N/A ,$524.58 ,$399.14 ,$289.21 ,$347.08 ,$347.25 ,$347.08 ,$394.01 ,$513.18 ,$389.56 , N/A ,$450.46 , N/A ,$336.42 ,$336.42 , N/A ,$336.42 ,$410.54 ,$353.52 ,$410.54 ,$410.54 ,$456.16 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ACETYLCYSTEINE 20 % SOLN,250,1 ,$52.20 ,$34.45 ,$26.48 ,$52.20 , N/A ,$35.78 ,$35.78 , N/A ,$31.32 ,$44.37 ,$36.54 , N/A , N/A ,$49.59 ,$39.67 ,$39.15 ,$33.93 ,$44.37 , N/A ,$33.93 ,$33.93 ,$36.54 ,$31.79 , N/A , N/A , N/A , N/A , N/A ,$44.37 , N/A ,$48.02 ,$36.54 ,$26.48 ,$31.77 ,$31.79 ,$31.77 ,$36.07 ,$46.98 ,$35.66 , N/A ,$41.24 , N/A ,$30.80 ,$30.80 , N/A ,$30.80 ,$37.58 ,$32.36 ,$37.58 ,$37.58 ,$41.76 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ASCORBIC ACID 25000 MG/50ML SOLN 50 ML VIAL,250,1 ,$145.25 ,$95.87 ,$73.67 ,$145.25 , N/A ,$99.55 ,$99.55 , N/A ,$87.15 ,$123.46 ,$101.68 , N/A , N/A ,$137.99 ,$110.39 ,$108.94 ,$94.41 ,$123.46 , N/A ,$94.41 ,$94.41 ,$101.68 ,$88.46 , N/A , N/A , N/A , N/A , N/A ,$123.46 , N/A ,$133.63 ,$101.68 ,$73.67 ,$88.41 ,$88.46 ,$88.41 ,$100.37 ,$130.73 ,$99.23 , N/A ,$114.75 , N/A ,$85.70 ,$85.70 , N/A ,$85.70 ,$104.58 ,$90.06 ,$104.58 ,$104.58 ,$116.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ATROPINE 1 % SOLN 2 ML BOTTLE,250,1 ,$162.75 ,$107.42 ,$82.55 ,$162.75 , N/A ,$111.55 ,$111.55 , N/A ,$97.65 ,$138.34 ,$113.93 , N/A , N/A ,$154.61 ,$123.69 ,$122.06 ,$105.79 ,$138.34 , N/A ,$105.79 ,$105.79 ,$113.93 ,$99.11 , N/A , N/A , N/A , N/A , N/A ,$138.34 , N/A ,$149.73 ,$113.93 ,$82.55 ,$99.07 ,$99.11 ,$99.07 ,$112.46 ,$146.48 ,$111.19 , N/A ,$128.57 , N/A ,$96.02 ,$96.02 , N/A ,$96.02 ,$117.18 ,$100.91 ,$117.18 ,$117.18 ,$130.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,AZTREONAM 1 G SOLR 1 EACH VIAL,250,1 ,$133.15 ,$87.88 ,$67.53 ,$133.15 , N/A ,$91.26 ,$91.26 , N/A ,$79.89 ,$113.18 ,$93.21 , N/A , N/A ,$126.49 ,$101.19 ,$99.86 ,$86.55 ,$113.18 , N/A ,$86.55 ,$86.55 ,$93.21 ,$81.09 , N/A , N/A , N/A , N/A , N/A ,$113.18 , N/A ,$122.50 ,$93.21 ,$67.53 ,$81.05 ,$81.09 ,$81.05 ,$92.01 ,$119.84 ,$90.97 , N/A ,$105.19 , N/A ,$78.56 ,$78.56 , N/A ,$78.56 ,$95.87 ,$82.55 ,$95.87 ,$95.87 ,$106.52 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,AZTREONAM 2 G SOLR 1 EACH VIAL,250,1 ,$541.05 ,$357.09 ,$274.42 ,$541.05 , N/A ,$370.84 ,$370.84 , N/A ,$324.63 ,$459.89 ,$378.74 , N/A , N/A ,$514.00 ,$411.20 ,$405.79 ,$351.68 ,$459.89 , N/A ,$351.68 ,$351.68 ,$378.74 ,$329.50 , N/A , N/A , N/A , N/A , N/A ,$459.89 , N/A ,$497.77 ,$378.74 ,$274.42 ,$329.34 ,$329.50 ,$329.34 ,$373.87 ,$486.95 ,$369.65 , N/A ,$427.43 , N/A ,$319.22 ,$319.22 , N/A ,$319.22 ,$389.56 ,$335.45 ,$389.56 ,$389.56 ,$432.84 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BALANCED SALTS SOLN 15 ML BOTTLE,250,1 ,$43.76 ,$28.88 ,$22.20 ,$43.76 , N/A ,$29.99 ,$29.99 , N/A ,$26.26 ,$37.20 ,$30.63 , N/A , N/A ,$41.57 ,$33.26 ,$32.82 ,$28.44 ,$37.20 , N/A ,$28.44 ,$28.44 ,$30.63 ,$26.65 , N/A , N/A , N/A , N/A , N/A ,$37.20 , N/A ,$40.26 ,$30.63 ,$22.20 ,$26.64 ,$26.65 ,$26.64 ,$30.24 ,$39.38 ,$29.90 , N/A ,$34.57 , N/A ,$25.82 ,$25.82 , N/A ,$25.82 ,$31.51 ,$27.13 ,$31.51 ,$31.51 ,$35.01 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BALANCED SALTS SOLN 30 ML BOTTLE,250,1 ,$76.95 ,$50.79 ,$39.03 ,$76.95 , N/A ,$52.74 ,$52.74 , N/A ,$46.17 ,$65.41 ,$53.87 , N/A , N/A ,$73.10 ,$58.48 ,$57.71 ,$50.02 ,$65.41 , N/A ,$50.02 ,$50.02 ,$53.87 ,$46.86 , N/A , N/A , N/A , N/A , N/A ,$65.41 , N/A ,$70.79 ,$53.87 ,$39.03 ,$46.84 ,$46.86 ,$46.84 ,$53.17 ,$69.26 ,$52.57 , N/A ,$60.79 , N/A ,$45.40 ,$45.40 , N/A ,$45.40 ,$55.40 ,$47.71 ,$55.40 ,$55.40 ,$61.56 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BENZOCAINE 20 % 20 % SOLN,250,1 ,$34.45 ,$22.74 ,$17.47 ,$34.45 , N/A ,$23.61 ,$23.61 , N/A ,$20.67 ,$29.28 ,$24.12 , N/A , N/A ,$32.73 ,$26.18 ,$25.84 ,$22.39 ,$29.28 , N/A ,$22.39 ,$22.39 ,$24.12 ,$20.98 , N/A , N/A , N/A , N/A , N/A ,$29.28 , N/A ,$31.69 ,$24.12 ,$17.47 ,$20.97 ,$20.98 ,$20.97 ,$23.81 ,$31.01 ,$23.54 , N/A ,$27.22 , N/A ,$20.33 ,$20.33 , N/A ,$20.33 ,$24.80 ,$21.36 ,$24.80 ,$24.80 ,$27.56 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BENZOCAINE-MENTHOL 20-0.5 % AERO 78 G CAN,250,1 ,$19.65 ,$12.97 ,$9.97 ,$19.65 , N/A ,$13.47 ,$13.47 , N/A ,$11.79 ,$16.70 ,$13.76 , N/A , N/A ,$18.67 ,$14.93 ,$14.74 ,$12.77 ,$16.70 , N/A ,$12.77 ,$12.77 ,$13.76 ,$11.97 , N/A , N/A , N/A , N/A , N/A ,$16.70 , N/A ,$18.08 ,$13.76 ,$9.97 ,$11.96 ,$11.97 ,$11.96 ,$13.58 ,$17.69 ,$13.42 , N/A ,$15.52 , N/A ,$11.59 ,$11.59 , N/A ,$11.59 ,$14.15 ,$12.18 ,$14.15 ,$14.15 ,$15.72 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BENZOCAINE-MENTHOL 20-0.5 % AERO 85 G CAN,250,1 ,$22.55 ,$14.88 ,$11.44 ,$22.55 , N/A ,$15.46 ,$15.46 , N/A ,$13.53 ,$19.17 ,$15.79 , N/A , N/A ,$21.42 ,$17.14 ,$16.91 ,$14.66 ,$19.17 , N/A ,$14.66 ,$14.66 ,$15.79 ,$13.73 , N/A , N/A , N/A , N/A , N/A ,$19.17 , N/A ,$20.75 ,$15.79 ,$11.44 ,$13.73 ,$13.73 ,$13.73 ,$15.58 ,$20.30 ,$15.41 , N/A ,$17.81 , N/A ,$13.30 ,$13.30 , N/A ,$13.30 ,$16.24 ,$13.98 ,$16.24 ,$16.24 ,$18.04 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BRIMONIDINE 0.2 % SOLN 5 ML BOTTLE,250,1 ,$111.05 ,$73.29 ,$56.32 ,$111.05 , N/A ,$76.11 ,$76.11 , N/A ,$66.63 ,$94.39 ,$77.74 , N/A , N/A ,$105.50 ,$84.40 ,$83.29 ,$72.18 ,$94.39 , N/A ,$72.18 ,$72.18 ,$77.74 ,$67.63 , N/A , N/A , N/A , N/A , N/A ,$94.39 , N/A ,$102.17 ,$77.74 ,$56.32 ,$67.60 ,$67.63 ,$67.60 ,$76.74 ,$99.95 ,$75.87 , N/A ,$87.73 , N/A ,$65.52 ,$65.52 , N/A ,$65.52 ,$79.96 ,$68.85 ,$79.96 ,$79.96 ,$88.84 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUDESONIDE 0.5 MG/2ML SUSP,250,1 ,$38.10 ,$25.15 ,$19.32 ,$38.10 , N/A ,$26.11 ,$26.11 , N/A ,$22.86 ,$32.39 ,$26.67 , N/A , N/A ,$36.20 ,$28.96 ,$28.58 ,$24.77 ,$32.39 , N/A ,$24.77 ,$24.77 ,$26.67 ,$23.20 , N/A , N/A , N/A , N/A , N/A ,$32.39 , N/A ,$35.05 ,$26.67 ,$19.32 ,$23.19 ,$23.20 ,$23.19 ,$26.33 ,$34.29 ,$26.03 , N/A ,$30.10 , N/A ,$22.48 ,$22.48 , N/A ,$22.48 ,$27.43 ,$23.62 ,$27.43 ,$27.43 ,$30.48 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE 0.25 % SOLN 10 ML VIAL,250,1 ,$42.07 ,$27.77 ,$21.34 ,$42.07 , N/A ,$28.83 ,$28.83 , N/A ,$25.24 ,$35.76 ,$29.45 , N/A , N/A ,$39.97 ,$31.97 ,$31.55 ,$27.35 ,$35.76 , N/A ,$27.35 ,$27.35 ,$29.45 ,$25.62 , N/A , N/A , N/A , N/A , N/A ,$35.76 , N/A ,$38.70 ,$29.45 ,$21.34 ,$25.61 ,$25.62 ,$25.61 ,$29.07 ,$37.86 ,$28.74 , N/A ,$33.24 , N/A ,$24.82 ,$24.82 , N/A ,$24.82 ,$30.29 ,$26.08 ,$30.29 ,$30.29 ,$33.66 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE 0.25 % SOLN 30 ML VIAL,250,1 ,$50.95 ,$33.63 ,$25.84 ,$50.95 , N/A ,$34.92 ,$34.92 , N/A ,$30.57 ,$43.31 ,$35.67 , N/A , N/A ,$48.40 ,$38.72 ,$38.21 ,$33.12 ,$43.31 , N/A ,$33.12 ,$33.12 ,$35.67 ,$31.03 , N/A , N/A , N/A , N/A , N/A ,$43.31 , N/A ,$46.87 ,$35.67 ,$25.84 ,$31.01 ,$31.03 ,$31.01 ,$35.21 ,$45.86 ,$34.81 , N/A ,$40.25 , N/A ,$30.06 ,$30.06 , N/A ,$30.06 ,$36.68 ,$31.59 ,$36.68 ,$36.68 ,$40.76 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 SOLN,250,1 ,$67.90 ,$44.81 ,$34.44 ,$67.90 , N/A ,$46.54 ,$46.54 , N/A ,$40.74 ,$57.72 ,$47.53 , N/A , N/A ,$64.51 ,$51.60 ,$50.93 ,$44.14 ,$57.72 , N/A ,$44.14 ,$44.14 ,$47.53 ,$41.35 , N/A , N/A , N/A , N/A , N/A ,$57.72 , N/A ,$62.47 ,$47.53 ,$34.44 ,$41.33 ,$41.35 ,$41.33 ,$46.92 ,$61.11 ,$46.39 , N/A ,$53.64 , N/A ,$40.06 ,$40.06 , N/A ,$40.06 ,$48.89 ,$42.10 ,$48.89 ,$48.89 ,$54.32 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 SOLN 50 ML VIAL,250,1 ,$52.30 ,$34.52 ,$26.53 ,$52.30 , N/A ,$35.85 ,$35.85 , N/A ,$31.38 ,$44.46 ,$36.61 , N/A , N/A ,$49.69 ,$39.75 ,$39.23 ,$34.00 ,$44.46 , N/A ,$34.00 ,$34.00 ,$36.61 ,$31.85 , N/A , N/A , N/A , N/A , N/A ,$44.46 , N/A ,$48.12 ,$36.61 ,$26.53 ,$31.84 ,$31.85 ,$31.84 ,$36.14 ,$47.07 ,$35.73 , N/A ,$41.32 , N/A ,$30.86 ,$30.86 , N/A ,$30.86 ,$37.66 ,$32.43 ,$37.66 ,$37.66 ,$41.84 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CADEXOMER IODINE 0.9 % GEL 10 G TUBE,250,1 ,$62.05 ,$40.95 ,$31.47 ,$62.05 , N/A ,$42.53 ,$42.53 , N/A ,$37.23 ,$52.74 ,$43.44 , N/A , N/A ,$58.95 ,$47.16 ,$46.54 ,$40.33 ,$52.74 , N/A ,$40.33 ,$40.33 ,$43.44 ,$37.79 , N/A , N/A , N/A , N/A , N/A ,$52.74 , N/A ,$57.09 ,$43.44 ,$31.47 ,$37.77 ,$37.79 ,$37.77 ,$42.88 ,$55.85 ,$42.39 , N/A ,$49.02 , N/A ,$36.61 ,$36.61 , N/A ,$36.61 ,$44.68 ,$38.47 ,$44.68 ,$44.68 ,$49.64 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CADEXOMER IODINE 0.9 % GEL 40 G TUBE,250,1 ,$221.28 ,$146.04 ,$112.23 ,$221.28 , N/A ,$151.67 ,$151.67 , N/A ,$132.77 ,$188.09 ,$154.90 , N/A , N/A ,$210.22 ,$168.17 ,$165.96 ,$143.83 ,$188.09 , N/A ,$143.83 ,$143.83 ,$154.90 ,$134.76 , N/A , N/A , N/A , N/A , N/A ,$188.09 , N/A ,$203.58 ,$154.90 ,$112.23 ,$134.69 ,$134.76 ,$134.69 ,$152.90 ,$199.15 ,$151.18 , N/A ,$174.81 , N/A ,$130.56 ,$130.56 , N/A ,$130.56 ,$159.32 ,$137.19 ,$159.32 ,$159.32 ,$177.02 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CAFFEINE-SODIUM BENZOATE 125-125 MG/ML SOLN,250,1 ,$190.05 ,$125.43 ,$96.39 ,$190.05 , N/A ,$130.26 ,$130.26 , N/A ,$114.03 ,$161.54 ,$133.04 , N/A , N/A ,$180.55 ,$144.44 ,$142.54 ,$123.53 ,$161.54 , N/A ,$123.53 ,$123.53 ,$133.04 ,$115.74 , N/A , N/A , N/A , N/A , N/A ,$161.54 , N/A ,$174.85 ,$133.04 ,$96.39 ,$115.68 ,$115.74 ,$115.68 ,$131.32 ,$171.05 ,$129.84 , N/A ,$150.14 , N/A ,$112.13 ,$112.13 , N/A ,$112.13 ,$136.84 ,$117.83 ,$136.84 ,$136.84 ,$152.04 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CALCIUM CHLORIDE 10 % SOLN 10 ML SYRINGE,250,1 ,$77.50 ,$51.15 ,$39.31 ,$77.50 , N/A ,$53.12 ,$53.12 , N/A ,$46.50 ,$65.88 ,$54.25 , N/A , N/A ,$73.63 ,$58.90 ,$58.13 ,$50.38 ,$65.88 , N/A ,$50.38 ,$50.38 ,$54.25 ,$47.20 , N/A , N/A , N/A , N/A , N/A ,$65.88 , N/A ,$71.30 ,$54.25 ,$39.31 ,$47.17 ,$47.20 ,$47.17 ,$53.55 ,$69.75 ,$52.95 , N/A ,$61.23 , N/A ,$45.73 ,$45.73 , N/A ,$45.73 ,$55.80 ,$48.05 ,$55.80 ,$55.80 ,$62.00 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CARBOPROST 250 MCG/ML SOLN,250,1 ,"$1,688.45 ","$1,114.38 ",$856.38 ,"$1,688.45 ", N/A ,"$1,157.26 ","$1,157.26 ", N/A ,"$1,013.07 ","$1,435.18 ","$1,181.92 ", N/A , N/A ,"$1,604.03 ","$1,283.22 ","$1,266.34 ","$1,097.49 ","$1,435.18 ", N/A ,"$1,097.49 ","$1,097.49 ","$1,181.92 ","$1,028.27 ", N/A , N/A , N/A , N/A , N/A ,"$1,435.18 ", N/A ,"$1,553.37 ","$1,181.92 ",$856.38 ,"$1,027.76 ","$1,028.27 ","$1,027.76 ","$1,166.72 ","$1,519.61 ","$1,153.55 ", N/A ,"$1,333.88 ", N/A ,$996.19 ,$996.19 , N/A ,$996.19 ,"$1,215.68 ","$1,046.84 ","$1,215.68 ","$1,215.68 ","$1,350.76 "
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CEFOTETAN 2 G SOLR 1 EACH VIAL,250,1 ,$310.85 ,$205.16 ,$157.66 ,$310.85 , N/A ,$213.06 ,$213.06 , N/A ,$186.51 ,$264.22 ,$217.60 , N/A , N/A ,$295.31 ,$236.25 ,$233.14 ,$202.05 ,$264.22 , N/A ,$202.05 ,$202.05 ,$217.60 ,$189.31 , N/A , N/A , N/A , N/A , N/A ,$264.22 , N/A ,$285.98 ,$217.60 ,$157.66 ,$189.21 ,$189.31 ,$189.21 ,$214.80 ,$279.77 ,$212.37 , N/A ,$245.57 , N/A ,$183.40 ,$183.40 , N/A ,$183.40 ,$223.81 ,$192.73 ,$223.81 ,$223.81 ,$248.68 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CHARCOAL ACTIVATED LIQD 120 ML BOTTLE,250,1 ,$100.79 ,$66.52 ,$51.12 ,$100.79 , N/A ,$69.08 ,$69.08 , N/A ,$60.47 ,$85.67 ,$70.55 , N/A , N/A ,$95.75 ,$76.60 ,$75.59 ,$65.51 ,$85.67 , N/A ,$65.51 ,$65.51 ,$70.55 ,$61.38 , N/A , N/A , N/A , N/A , N/A ,$85.67 , N/A ,$92.73 ,$70.55 ,$51.12 ,$61.35 ,$61.38 ,$61.35 ,$69.65 ,$90.71 ,$68.86 , N/A ,$79.62 , N/A ,$59.47 ,$59.47 , N/A ,$59.47 ,$72.57 ,$62.49 ,$72.57 ,$72.57 ,$80.63 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CHARCOAL ACTIVATED LIQD 240 ML BOTTLE,250,1 ,$137.95 ,$91.05 ,$69.97 ,$137.95 , N/A ,$94.55 ,$94.55 , N/A ,$82.77 ,$117.26 ,$96.57 , N/A , N/A ,$131.05 ,$104.84 ,$103.46 ,$89.67 ,$117.26 , N/A ,$89.67 ,$89.67 ,$96.57 ,$84.01 , N/A , N/A , N/A , N/A , N/A ,$117.26 , N/A ,$126.91 ,$96.57 ,$69.97 ,$83.97 ,$84.01 ,$83.97 ,$95.32 ,$124.16 ,$94.25 , N/A ,$108.98 , N/A ,$81.39 ,$81.39 , N/A ,$81.39 ,$99.32 ,$85.53 ,$99.32 ,$99.32 ,$110.36 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CIPROFLOXACIN 0.3 % SOLN 5 ML BOTTLE,250,1 ,$493.35 ,$325.61 ,$250.23 ,$493.35 , N/A ,$338.14 ,$338.14 , N/A ,$296.01 ,$419.35 ,$345.35 , N/A , N/A ,$468.68 ,$374.95 ,$370.01 ,$320.68 ,$419.35 , N/A ,$320.68 ,$320.68 ,$345.35 ,$300.45 , N/A , N/A , N/A , N/A , N/A ,$419.35 , N/A ,$453.88 ,$345.35 ,$250.23 ,$300.30 ,$300.45 ,$300.30 ,$340.90 ,$444.02 ,$337.06 , N/A ,$389.75 , N/A ,$291.08 ,$291.08 , N/A ,$291.08 ,$355.21 ,$305.88 ,$355.21 ,$355.21 ,$394.68 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % SUSP 7.5 ML BOTTLE,250,1 ,$914.70 ,$603.70 ,$463.94 ,$914.70 , N/A ,$626.94 ,$626.94 , N/A ,$548.82 ,$777.50 ,$640.29 , N/A , N/A ,$868.97 ,$695.17 ,$686.03 ,$594.56 ,$777.50 , N/A ,$594.56 ,$594.56 ,$640.29 ,$557.05 , N/A , N/A , N/A , N/A , N/A ,$777.50 , N/A ,$841.52 ,$640.29 ,$463.94 ,$556.78 ,$557.05 ,$556.78 ,$632.06 ,$823.23 ,$624.92 , N/A ,$722.61 , N/A ,$539.67 ,$539.67 , N/A ,$539.67 ,$658.58 ,$567.11 ,$658.58 ,$658.58 ,$731.76 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CLINDAMYCIN 600 MG/50ML SOLN,250,1 ,$122.25 ,$80.69 ,$62.01 ,$122.25 , N/A ,$83.79 ,$83.79 , N/A ,$73.35 ,$103.91 ,$85.58 , N/A , N/A ,$116.14 ,$92.91 ,$91.69 ,$79.46 ,$103.91 , N/A ,$79.46 ,$79.46 ,$85.58 ,$74.45 , N/A , N/A , N/A , N/A , N/A ,$103.91 , N/A ,$112.47 ,$85.58 ,$62.01 ,$74.41 ,$74.45 ,$74.41 ,$84.47 ,$110.03 ,$83.52 , N/A ,$96.58 , N/A ,$72.13 ,$72.13 , N/A ,$72.13 ,$88.02 ,$75.80 ,$88.02 ,$88.02 ,$97.80 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CLINDAMYCIN 900 MG/50ML SOLN,250,1 ,$142.25 ,$93.89 ,$72.15 ,$142.25 , N/A ,$97.50 ,$97.50 , N/A ,$85.35 ,$120.91 ,$99.58 , N/A , N/A ,$135.14 ,$108.11 ,$106.69 ,$92.46 ,$120.91 , N/A ,$92.46 ,$92.46 ,$99.58 ,$86.63 , N/A , N/A , N/A , N/A , N/A ,$120.91 , N/A ,$130.87 ,$99.58 ,$72.15 ,$86.59 ,$86.63 ,$86.59 ,$98.29 ,$128.03 ,$97.19 , N/A ,$112.38 , N/A ,$83.93 ,$83.93 , N/A ,$83.93 ,$102.42 ,$88.20 ,$102.42 ,$102.42 ,$113.80 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,COLLAGENASE 250 UNIT/GM OINT 30 G TUBE,250,1 ,"$1,118.95 ",$738.51 ,$567.53 ,"$1,118.95 ", N/A ,$766.93 ,$766.93 , N/A ,$671.37 ,$951.11 ,$783.27 , N/A , N/A ,"$1,063.00 ",$850.40 ,$839.21 ,$727.32 ,$951.11 , N/A ,$727.32 ,$727.32 ,$783.27 ,$681.44 , N/A , N/A , N/A , N/A , N/A ,$951.11 , N/A ,"$1,029.43 ",$783.27 ,$567.53 ,$681.10 ,$681.44 ,$681.10 ,$773.19 ,"$1,007.06 ",$764.47 , N/A ,$883.97 , N/A ,$660.18 ,$660.18 , N/A ,$660.18 ,$805.64 ,$693.75 ,$805.64 ,$805.64 ,$895.16 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CYCLOPENTOLATE 1 % SOLN 2 ML BOTTLE,250,1 ,$57.15 ,$37.72 ,$28.99 ,$57.15 , N/A ,$39.17 ,$39.17 , N/A ,$34.29 ,$48.58 ,$40.01 , N/A , N/A ,$54.29 ,$43.43 ,$42.86 ,$37.15 ,$48.58 , N/A ,$37.15 ,$37.15 ,$40.01 ,$34.80 , N/A , N/A , N/A , N/A , N/A ,$48.58 , N/A ,$52.58 ,$40.01 ,$28.99 ,$34.79 ,$34.80 ,$34.79 ,$39.49 ,$51.44 ,$39.04 , N/A ,$45.15 , N/A ,$33.72 ,$33.72 , N/A ,$33.72 ,$41.15 ,$35.43 ,$41.15 ,$41.15 ,$45.72 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CYCLOPENTOLATE 2 % SOLN 5 ML BOTTLE,250,1 ,$24.35 ,$16.07 ,$12.35 ,$24.35 , N/A ,$16.69 ,$16.69 , N/A ,$14.61 ,$20.70 ,$17.05 , N/A , N/A ,$23.13 ,$18.51 ,$18.26 ,$15.83 ,$20.70 , N/A ,$15.83 ,$15.83 ,$17.05 ,$14.83 , N/A , N/A , N/A , N/A , N/A ,$20.70 , N/A ,$22.40 ,$17.05 ,$12.35 ,$14.82 ,$14.83 ,$14.82 ,$16.83 ,$21.92 ,$16.64 , N/A ,$19.24 , N/A ,$14.37 ,$14.37 , N/A ,$14.37 ,$17.53 ,$15.10 ,$17.53 ,$17.53 ,$19.48 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DEXMEDETOMIDINE 200 MCG/2ML SOLN 2 ML VIAL,250,1 ,$53.15 ,$35.08 ,$26.96 ,$53.15 , N/A ,$36.43 ,$36.43 , N/A ,$31.89 ,$45.18 ,$37.21 , N/A , N/A ,$50.49 ,$40.39 ,$39.86 ,$34.55 ,$45.18 , N/A ,$34.55 ,$34.55 ,$37.21 ,$32.37 , N/A , N/A , N/A , N/A , N/A ,$45.18 , N/A ,$48.90 ,$37.21 ,$26.96 ,$32.35 ,$32.37 ,$32.35 ,$36.73 ,$47.84 ,$36.31 , N/A ,$41.99 , N/A ,$31.36 ,$31.36 , N/A ,$31.36 ,$38.27 ,$32.95 ,$38.27 ,$38.27 ,$42.52 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DEXMEDETOMIDINE 200 MCG/50ML SOLN,250,1 ,$375.30 ,$247.70 ,$190.35 ,$375.30 , N/A ,$257.23 ,$257.23 , N/A ,$225.18 ,$319.01 ,$262.71 , N/A , N/A ,$356.54 ,$285.23 ,$281.48 ,$243.95 ,$319.01 , N/A ,$243.95 ,$243.95 ,$262.71 ,$228.56 , N/A , N/A , N/A , N/A , N/A ,$319.01 , N/A ,$345.28 ,$262.71 ,$190.35 ,$228.45 ,$228.56 ,$228.45 ,$259.33 ,$337.77 ,$256.41 , N/A ,$296.49 , N/A ,$221.43 ,$221.43 , N/A ,$221.43 ,$270.22 ,$232.69 ,$270.22 ,$270.22 ,$300.24 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DEXMEDETOMIDINE 400 MCG/100ML SOLN,250,1 ,$636.10 ,$419.83 ,$322.63 ,$636.10 , N/A ,$435.98 ,$435.98 , N/A ,$381.66 ,$540.69 ,$445.27 , N/A , N/A ,$604.30 ,$483.44 ,$477.08 ,$413.47 ,$540.69 , N/A ,$413.47 ,$413.47 ,$445.27 ,$387.38 , N/A , N/A , N/A , N/A , N/A ,$540.69 , N/A ,$585.21 ,$445.27 ,$322.63 ,$387.19 ,$387.38 ,$387.19 ,$439.55 ,$572.49 ,$434.58 , N/A ,$502.52 , N/A ,$375.30 ,$375.30 , N/A ,$375.30 ,$457.99 ,$394.38 ,$457.99 ,$457.99 ,$508.88 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DEXMEDETOMIDINE 400 MCG/4ML SOLN 4 ML VIAL,250,1 ,$582.70 ,$384.58 ,$295.55 ,$582.70 , N/A ,$399.38 ,$399.38 , N/A ,$349.62 ,$495.30 ,$407.89 , N/A , N/A ,$553.57 ,$442.85 ,$437.03 ,$378.76 ,$495.30 , N/A ,$378.76 ,$378.76 ,$407.89 ,$354.86 , N/A , N/A , N/A , N/A , N/A ,$495.30 , N/A ,$536.08 ,$407.89 ,$295.55 ,$354.69 ,$354.86 ,$354.69 ,$402.65 ,$524.43 ,$398.10 , N/A ,$460.33 , N/A ,$343.79 ,$343.79 , N/A ,$343.79 ,$419.54 ,$361.27 ,$419.54 ,$419.54 ,$466.16 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DEXMEDETOMIDINE 400MCG/100ML -5% SOLN,250,1 ,$296.60 ,$195.76 ,$150.44 ,$296.60 , N/A ,$203.29 ,$203.29 , N/A ,$177.96 ,$252.11 ,$207.62 , N/A , N/A ,$281.77 ,$225.42 ,$222.45 ,$192.79 ,$252.11 , N/A ,$192.79 ,$192.79 ,$207.62 ,$180.63 , N/A , N/A , N/A , N/A , N/A ,$252.11 , N/A ,$272.87 ,$207.62 ,$150.44 ,$180.54 ,$180.63 ,$180.54 ,$204.95 ,$266.94 ,$202.64 , N/A ,$234.31 , N/A ,$174.99 ,$174.99 , N/A ,$174.99 ,$213.55 ,$183.89 ,$213.55 ,$213.55 ,$237.28 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DILTIAZEM 1 MG/ML SOLN,250,1 ,$141.60 ,$93.46 ,$71.82 ,$141.60 , N/A ,$97.05 ,$97.05 , N/A ,$84.96 ,$120.36 ,$99.12 , N/A , N/A ,$134.52 ,$107.62 ,$106.20 ,$92.04 ,$120.36 , N/A ,$92.04 ,$92.04 ,$99.12 ,$86.23 , N/A , N/A , N/A , N/A , N/A ,$120.36 , N/A ,$130.27 ,$99.12 ,$71.82 ,$86.19 ,$86.23 ,$86.19 ,$97.85 ,$127.44 ,$96.74 , N/A ,$111.86 , N/A ,$83.54 ,$83.54 , N/A ,$83.54 ,$101.95 ,$87.79 ,$101.95 ,$101.95 ,$113.28 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DINOPROSTONE 10 MG INST,250,1 ,"$1,669.85 ","$1,102.10 ",$846.95 ,"$1,669.85 ", N/A ,"$1,144.52 ","$1,144.52 ", N/A ,"$1,001.91 ","$1,419.37 ","$1,168.90 ", N/A , N/A ,"$1,586.36 ","$1,269.09 ","$1,252.39 ","$1,085.40 ","$1,419.37 ", N/A ,"$1,085.40 ","$1,085.40 ","$1,168.90 ","$1,016.94 ", N/A , N/A , N/A , N/A , N/A ,"$1,419.37 ", N/A ,"$1,536.26 ","$1,168.90 ",$846.95 ,"$1,016.44 ","$1,016.94 ","$1,016.44 ","$1,153.87 ","$1,502.87 ","$1,140.84 ", N/A ,"$1,319.18 ", N/A ,$985.21 ,$985.21 , N/A ,$985.21 ,"$1,202.29 ","$1,035.31 ","$1,202.29 ","$1,202.29 ","$1,335.88 "
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,"DIPHENHYDRAMINE 12.5 MG/5ML 5 ML, LIDOCAINE VISCOUS 2 % 5 ML, SUCRALFATE 1 GM/10ML 1 G SUSPENSION",250,1 ,$7.20 ,$4.75 ,$3.65 ,$7.20 , N/A ,$4.93 ,$4.93 , N/A ,$4.32 ,$6.12 ,$5.04 , N/A , N/A ,$6.84 ,$5.47 ,$5.40 ,$4.68 ,$6.12 , N/A ,$4.68 ,$4.68 ,$5.04 ,$4.38 , N/A , N/A , N/A , N/A , N/A ,$6.12 , N/A ,$6.62 ,$5.04 ,$3.65 ,$4.38 ,$4.38 ,$4.38 ,$4.98 ,$6.48 ,$4.92 , N/A ,$5.69 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 ,$5.18 ,$4.46 ,$5.18 ,$5.18 ,$5.76 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DORNASE ALFA 2.5 MG/2.5ML SOLN 2.5 ML PLAS CONT,250,1 ,$890.53 ,$587.75 ,$451.68 ,$890.53 , N/A ,$610.37 ,$610.37 , N/A ,$534.32 ,$756.95 ,$623.37 , N/A , N/A ,$846.00 ,$676.80 ,$667.90 ,$578.84 ,$756.95 , N/A ,$578.84 ,$578.84 ,$623.37 ,$542.33 , N/A , N/A , N/A , N/A , N/A ,$756.95 , N/A ,$819.29 ,$623.37 ,$451.68 ,$542.07 ,$542.33 ,$542.07 ,$615.36 ,$801.48 ,$608.41 , N/A ,$703.52 , N/A ,$525.41 ,$525.41 , N/A ,$525.41 ,$641.18 ,$552.13 ,$641.18 ,$641.18 ,$712.42 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DOXYCYCLINE HYCLATE 100 MG SOLR 1 EACH VIAL,250,1 ,$194.35 ,$128.27 ,$98.57 ,$194.35 , N/A ,$133.21 ,$133.21 , N/A ,$116.61 ,$165.20 ,$136.05 , N/A , N/A ,$184.63 ,$147.71 ,$145.76 ,$126.33 ,$165.20 , N/A ,$126.33 ,$126.33 ,$136.05 ,$118.36 , N/A , N/A , N/A , N/A , N/A ,$165.20 , N/A ,$178.80 ,$136.05 ,$98.57 ,$118.30 ,$118.36 ,$118.30 ,$134.30 ,$174.92 ,$132.78 , N/A ,$153.54 , N/A ,$114.67 ,$114.67 , N/A ,$114.67 ,$139.93 ,$120.50 ,$139.93 ,$139.93 ,$155.48 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,EPHEDRINE 5 MG/ML SOLN,250,1 ,$214.05 ,$141.27 ,$108.57 ,$214.05 , N/A ,$146.71 ,$146.71 , N/A ,$128.43 ,$181.94 ,$149.84 , N/A , N/A ,$203.35 ,$162.68 ,$160.54 ,$139.13 ,$181.94 , N/A ,$139.13 ,$139.13 ,$149.84 ,$130.36 , N/A , N/A , N/A , N/A , N/A ,$181.94 , N/A ,$196.93 ,$149.84 ,$108.57 ,$130.29 ,$130.36 ,$130.29 ,$147.91 ,$192.65 ,$146.24 , N/A ,$169.10 , N/A ,$126.29 ,$126.29 , N/A ,$126.29 ,$154.12 ,$132.71 ,$154.12 ,$154.12 ,$171.24 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ESMOLOL 100 MG/10ML SOLN,250,1 ,$54.15 ,$35.74 ,$27.46 ,$54.15 , N/A ,$37.11 ,$37.11 , N/A ,$32.49 ,$46.03 ,$37.91 , N/A , N/A ,$51.44 ,$41.15 ,$40.61 ,$35.20 ,$46.03 , N/A ,$35.20 ,$35.20 ,$37.91 ,$32.98 , N/A , N/A , N/A , N/A , N/A ,$46.03 , N/A ,$49.82 ,$37.91 ,$27.46 ,$32.96 ,$32.98 ,$32.96 ,$37.42 ,$48.74 ,$37.00 , N/A ,$42.78 , N/A ,$31.95 ,$31.95 , N/A ,$31.95 ,$38.99 ,$33.57 ,$38.99 ,$38.99 ,$43.32 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ESMOLOL 2500 MG/250ML SOLN,250,1 ,"$3,482.60 ","$2,298.52 ","$1,766.37 ","$3,482.60 ", N/A ,"$2,386.97 ","$2,386.97 ", N/A ,"$2,089.56 ","$2,960.21 ","$2,437.82 ", N/A , N/A ,"$3,308.47 ","$2,646.78 ","$2,611.95 ","$2,263.69 ","$2,960.21 ", N/A ,"$2,263.69 ","$2,263.69 ","$2,437.82 ","$2,120.90 ", N/A , N/A , N/A , N/A , N/A ,"$2,960.21 ", N/A ,"$3,203.99 ","$2,437.82 ","$1,766.37 ","$2,119.86 ","$2,120.90 ","$2,119.86 ","$2,406.48 ","$3,134.34 ","$2,379.31 ", N/A ,"$2,751.25 ", N/A ,"$2,054.73 ","$2,054.73 ", N/A ,"$2,054.73 ","$2,507.47 ","$2,159.21 ","$2,507.47 ","$2,507.47 ","$2,786.08 "
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ETOMIDATE 2 MG/ML SOLN,250,1 ,$51.70 ,$34.12 ,$26.22 ,$51.70 , N/A ,$35.44 ,$35.44 , N/A ,$31.02 ,$43.95 ,$36.19 , N/A , N/A ,$49.12 ,$39.29 ,$38.78 ,$33.61 ,$43.95 , N/A ,$33.61 ,$33.61 ,$36.19 ,$31.49 , N/A , N/A , N/A , N/A , N/A ,$43.95 , N/A ,$47.56 ,$36.19 ,$26.22 ,$31.47 ,$31.49 ,$31.47 ,$35.72 ,$46.53 ,$35.32 , N/A ,$40.84 , N/A ,$30.50 ,$30.50 , N/A ,$30.50 ,$37.22 ,$32.05 ,$37.22 ,$37.22 ,$41.36 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FAMOTIDINE (PF) 20 MG/2ML SOLN,250,1 ,$24.50 ,$16.17 ,$12.43 ,$24.50 , N/A ,$16.79 ,$16.79 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$15.93 ,$20.83 , N/A ,$15.93 ,$15.93 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$12.43 ,$14.91 ,$14.92 ,$14.91 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A ,$14.46 ,$14.46 , N/A ,$14.46 ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUMETANIDE 25 MG/100 ML 25 MG/100 ML SOLN,250,1 ,$24.50 ,$16.17 ,$12.43 ,$24.50 , N/A ,$16.79 ,$16.79 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$15.93 ,$20.83 , N/A ,$15.93 ,$15.93 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$12.43 ,$14.91 ,$14.92 ,$14.91 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A ,$14.46 ,$14.46 , N/A ,$14.46 ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FENTANYL 2 MCG/ML-ROPIVACAINE 0.2 % 0.2-0.2-0.9 MG/100ML-% SOLN,250,1 ,$308.30 ,$203.48 ,$156.37 ,$308.30 , N/A ,$211.31 ,$211.31 , N/A ,$184.98 ,$262.06 ,$215.81 , N/A , N/A ,$292.89 ,$234.31 ,$231.23 ,$200.40 ,$262.06 , N/A ,$200.40 ,$200.40 ,$215.81 ,$187.75 , N/A , N/A , N/A , N/A , N/A ,$262.06 , N/A ,$283.64 ,$215.81 ,$156.37 ,$187.66 ,$187.75 ,$187.66 ,$213.04 ,$277.47 ,$210.63 , N/A ,$243.56 , N/A ,$181.90 ,$181.90 , N/A ,$181.90 ,$221.98 ,$191.15 ,$221.98 ,$221.98 ,$246.64 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FERRIC SUBSULFATE 259 MG/GM SOLN 8 G BOTTLE,250,1 ,$63.65 ,$42.01 ,$32.28 ,$63.65 , N/A ,$43.63 ,$43.63 , N/A ,$38.19 ,$54.10 ,$44.56 , N/A , N/A ,$60.47 ,$48.37 ,$47.74 ,$41.37 ,$54.10 , N/A ,$41.37 ,$41.37 ,$44.56 ,$38.76 , N/A , N/A , N/A , N/A , N/A ,$54.10 , N/A ,$58.56 ,$44.56 ,$32.28 ,$38.74 ,$38.76 ,$38.74 ,$43.98 ,$57.29 ,$43.49 , N/A ,$50.28 , N/A ,$37.55 ,$37.55 , N/A ,$37.55 ,$45.83 ,$39.46 ,$45.83 ,$45.83 ,$50.92 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FERRIC SUBSULFATE 259 MG/GM SOLN 8 ML BOTTLE,250,1 ,$30.95 ,$20.43 ,$15.70 ,$30.95 , N/A ,$21.21 ,$21.21 , N/A ,$18.57 ,$26.31 ,$21.67 , N/A , N/A ,$29.40 ,$23.52 ,$23.21 ,$20.12 ,$26.31 , N/A ,$20.12 ,$20.12 ,$21.67 ,$18.85 , N/A , N/A , N/A , N/A , N/A ,$26.31 , N/A ,$28.47 ,$21.67 ,$15.70 ,$18.84 ,$18.85 ,$18.84 ,$21.39 ,$27.86 ,$21.15 , N/A ,$24.45 , N/A ,$18.26 ,$18.26 , N/A ,$18.26 ,$22.28 ,$19.19 ,$22.28 ,$22.28 ,$24.76 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FLUORESCEIN 10 % SOLN,250,1 ,$70.85 ,$46.76 ,$35.94 ,$70.85 , N/A ,$48.56 ,$48.56 , N/A ,$42.51 ,$60.22 ,$49.60 , N/A , N/A ,$67.31 ,$53.85 ,$53.14 ,$46.05 ,$60.22 , N/A ,$46.05 ,$46.05 ,$49.60 ,$43.15 , N/A , N/A , N/A , N/A , N/A ,$60.22 , N/A ,$65.18 ,$49.60 ,$35.94 ,$43.13 ,$43.15 ,$43.13 ,$48.96 ,$63.77 ,$48.40 , N/A ,$55.97 , N/A ,$41.80 ,$41.80 , N/A ,$41.80 ,$51.01 ,$43.93 ,$51.01 ,$51.01 ,$56.68 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FORMOTEROL 20 MCG/2ML NEBU,250,1 ,$75.85 ,$50.06 ,$38.47 ,$75.85 , N/A ,$51.99 ,$51.99 , N/A ,$45.51 ,$64.47 ,$53.10 , N/A , N/A ,$72.06 ,$57.65 ,$56.89 ,$49.30 ,$64.47 , N/A ,$49.30 ,$49.30 ,$53.10 ,$46.19 , N/A , N/A , N/A , N/A , N/A ,$64.47 , N/A ,$69.78 ,$53.10 ,$38.47 ,$46.17 ,$46.19 ,$46.17 ,$52.41 ,$68.27 ,$51.82 , N/A ,$59.92 , N/A ,$44.75 ,$44.75 , N/A ,$44.75 ,$54.61 ,$47.03 ,$54.61 ,$54.61 ,$60.68 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,GELATIN ADSORBABLE 12-7 MM MISC,250,1 ,$35.25 ,$23.27 ,$17.88 ,$35.25 , N/A ,$24.16 ,$24.16 , N/A ,$21.15 ,$29.96 ,$24.68 , N/A , N/A ,$33.49 ,$26.79 ,$26.44 ,$22.91 ,$29.96 , N/A ,$22.91 ,$22.91 ,$24.68 ,$21.47 , N/A , N/A , N/A , N/A , N/A ,$29.96 , N/A ,$32.43 ,$24.68 ,$17.88 ,$21.46 ,$21.47 ,$21.46 ,$24.36 ,$31.73 ,$24.08 , N/A ,$27.85 , N/A ,$20.80 ,$20.80 , N/A ,$20.80 ,$25.38 ,$21.86 ,$25.38 ,$25.38 ,$28.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,GLYCOPYRROLATE 1 MG/5ML SOLN,250,1 ,$338.25 ,$223.25 ,$171.56 ,$338.25 , N/A ,$231.84 ,$231.84 , N/A ,$202.95 ,$287.51 ,$236.78 , N/A , N/A ,$321.34 ,$257.07 ,$253.69 ,$219.86 ,$287.51 , N/A ,$219.86 ,$219.86 ,$236.78 ,$205.99 , N/A , N/A , N/A , N/A , N/A ,$287.51 , N/A ,$311.19 ,$236.78 ,$171.56 ,$205.89 ,$205.99 ,$205.89 ,$233.73 ,$304.43 ,$231.09 , N/A ,$267.22 , N/A ,$199.57 ,$199.57 , N/A ,$199.57 ,$243.54 ,$209.72 ,$243.54 ,$243.54 ,$270.60 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,HYPROMELLOSE 0.5 % SOLN 15 ML BOTTLE,250,1 ,$108.70 ,$71.74 ,$55.13 ,$108.70 , N/A ,$74.50 ,$74.50 , N/A ,$65.22 ,$92.40 ,$76.09 , N/A , N/A ,$103.27 ,$82.61 ,$81.53 ,$70.66 ,$92.40 , N/A ,$70.66 ,$70.66 ,$76.09 ,$66.20 , N/A , N/A , N/A , N/A , N/A ,$92.40 , N/A ,$100.00 ,$76.09 ,$55.13 ,$66.17 ,$66.20 ,$66.17 ,$75.11 ,$97.83 ,$74.26 , N/A ,$85.87 , N/A ,$64.13 ,$64.13 , N/A ,$64.13 ,$78.26 ,$67.39 ,$78.26 ,$78.26 ,$86.96 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,INDIGOTINDISULFONATE 8 MG/ML SOLN,250,1 ,"$1,390.55 ",$917.76 ,$705.29 ,"$1,390.55 ", N/A ,$953.08 ,$953.08 , N/A ,$834.33 ,"$1,181.97 ",$973.39 , N/A , N/A ,"$1,321.02 ","$1,056.82 ","$1,042.91 ",$903.86 ,"$1,181.97 ", N/A ,$903.86 ,$903.86 ,$973.39 ,$846.85 , N/A , N/A , N/A , N/A , N/A ,"$1,181.97 ", N/A ,"$1,279.31 ",$973.39 ,$705.29 ,$846.43 ,$846.85 ,$846.43 ,$960.87 ,"$1,251.50 ",$950.02 , N/A ,"$1,098.53 ", N/A ,$820.42 ,$820.42 , N/A ,$820.42 ,"$1,001.20 ",$862.14 ,"$1,001.20 ","$1,001.20 ","$1,112.44 "
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,INDOCYANINE GREEN 25 MG SOLR,250,1 ,$502.35 ,$331.55 ,$254.79 ,$502.35 , N/A ,$344.31 ,$344.31 , N/A ,$301.41 ,$427.00 ,$351.65 , N/A , N/A ,$477.23 ,$381.79 ,$376.76 ,$326.53 ,$427.00 , N/A ,$326.53 ,$326.53 ,$351.65 ,$305.93 , N/A , N/A , N/A , N/A , N/A ,$427.00 , N/A ,$462.16 ,$351.65 ,$254.79 ,$305.78 ,$305.93 ,$305.78 ,$347.12 ,$452.12 ,$343.21 , N/A ,$396.86 , N/A ,$296.39 ,$296.39 , N/A ,$296.39 ,$361.69 ,$311.46 ,$361.69 ,$361.69 ,$401.88 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,INSULIN REGULAR 100 UNITS/100 ML NS SOLN,250,1 ,$289.20 ,$190.87 ,$146.68 ,$289.20 , N/A ,$198.22 ,$198.22 , N/A ,$173.52 ,$245.82 ,$202.44 , N/A , N/A ,$274.74 ,$219.79 ,$216.90 ,$187.98 ,$245.82 , N/A ,$187.98 ,$187.98 ,$202.44 ,$176.12 , N/A , N/A , N/A , N/A , N/A ,$245.82 , N/A ,$266.06 ,$202.44 ,$146.68 ,$176.04 ,$176.12 ,$176.04 ,$199.84 ,$260.28 ,$197.58 , N/A ,$228.47 , N/A ,$170.63 ,$170.63 , N/A ,$170.63 ,$208.22 ,$179.30 ,$208.22 ,$208.22 ,$231.36 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,IPRATROPIUM 0.03 % SOLN 30 ML BOTTLE,250,1 ,$379.65 ,$250.57 ,$192.56 ,$379.65 , N/A ,$260.21 ,$260.21 , N/A ,$227.79 ,$322.70 ,$265.76 , N/A , N/A ,$360.67 ,$288.53 ,$284.74 ,$246.77 ,$322.70 , N/A ,$246.77 ,$246.77 ,$265.76 ,$231.21 , N/A , N/A , N/A , N/A , N/A ,$322.70 , N/A ,$349.28 ,$265.76 ,$192.56 ,$231.09 ,$231.21 ,$231.09 ,$262.34 ,$341.69 ,$259.38 , N/A ,$299.92 , N/A ,$223.99 ,$223.99 , N/A ,$223.99 ,$273.35 ,$235.38 ,$273.35 ,$273.35 ,$303.72 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LEVALBUTEROL 1.25 MG/0.5ML NEBU,250,1 ,$29.05 ,$19.17 ,$14.73 ,$29.05 , N/A ,$19.91 ,$19.91 , N/A ,$17.43 ,$24.69 ,$20.34 , N/A , N/A ,$27.60 ,$22.08 ,$21.79 ,$18.88 ,$24.69 , N/A ,$18.88 ,$18.88 ,$20.34 ,$17.69 , N/A , N/A , N/A , N/A , N/A ,$24.69 , N/A ,$26.73 ,$20.34 ,$14.73 ,$17.68 ,$17.69 ,$17.68 ,$20.07 ,$26.15 ,$19.85 , N/A ,$22.95 , N/A ,$17.14 ,$17.14 , N/A ,$17.14 ,$20.92 ,$18.01 ,$20.92 ,$20.92 ,$23.24 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LEVOTHYROXINE 100 MCG SOLR,250,1 ,$525.85 ,$347.06 ,$266.71 ,$525.85 , N/A ,$360.42 ,$360.42 , N/A ,$315.51 ,$446.97 ,$368.10 , N/A , N/A ,$499.56 ,$399.65 ,$394.39 ,$341.80 ,$446.97 , N/A ,$341.80 ,$341.80 ,$368.10 ,$320.24 , N/A , N/A , N/A , N/A , N/A ,$446.97 , N/A ,$483.78 ,$368.10 ,$266.71 ,$320.08 ,$320.24 ,$320.08 ,$363.36 ,$473.27 ,$359.26 , N/A ,$415.42 , N/A ,$310.25 ,$310.25 , N/A ,$310.25 ,$378.61 ,$326.03 ,$378.61 ,$378.61 ,$420.68 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LEVOTHYROXINE 200 MCG SOLR,250,1 ,"$1,000.90 ",$660.59 ,$507.66 ,"$1,000.90 ", N/A ,$686.02 ,$686.02 , N/A ,$600.54 ,$850.77 ,$700.63 , N/A , N/A ,$950.86 ,$760.68 ,$750.68 ,$650.59 ,$850.77 , N/A ,$650.59 ,$650.59 ,$700.63 ,$609.55 , N/A , N/A , N/A , N/A , N/A ,$850.77 , N/A ,$920.83 ,$700.63 ,$507.66 ,$609.25 ,$609.55 ,$609.25 ,$691.62 ,$900.81 ,$683.81 , N/A ,$790.71 , N/A ,$590.53 ,$590.53 , N/A ,$590.53 ,$720.65 ,$620.56 ,$720.65 ,$720.65 ,$800.72 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE (PF) 1 % SOLN,250,1 ,$75.65 ,$49.93 ,$38.37 ,$75.65 , N/A ,$51.85 ,$51.85 , N/A ,$45.39 ,$64.30 ,$52.96 , N/A , N/A ,$71.87 ,$57.49 ,$56.74 ,$49.17 ,$64.30 , N/A ,$49.17 ,$49.17 ,$52.96 ,$46.07 , N/A , N/A , N/A , N/A , N/A ,$64.30 , N/A ,$69.60 ,$52.96 ,$38.37 ,$46.05 ,$46.07 ,$46.05 ,$52.27 ,$68.09 ,$51.68 , N/A ,$59.76 , N/A ,$44.63 ,$44.63 , N/A ,$44.63 ,$54.47 ,$46.90 ,$54.47 ,$54.47 ,$60.52 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 0.5 % SOLN,250,1 ,$92.90 ,$61.31 ,$47.12 ,$92.90 , N/A ,$63.67 ,$63.67 , N/A ,$55.74 ,$78.97 ,$65.03 , N/A , N/A ,$88.26 ,$70.60 ,$69.68 ,$60.39 ,$78.97 , N/A ,$60.39 ,$60.39 ,$65.03 ,$56.58 , N/A , N/A , N/A , N/A , N/A ,$78.97 , N/A ,$85.47 ,$65.03 ,$47.12 ,$56.55 ,$56.58 ,$56.55 ,$64.19 ,$83.61 ,$63.47 , N/A ,$73.39 , N/A ,$54.81 ,$54.81 , N/A ,$54.81 ,$66.89 ,$57.60 ,$66.89 ,$66.89 ,$74.32 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 1 % SOLN,250,1 ,$138.40 ,$91.34 ,$70.20 ,$138.40 , N/A ,$94.86 ,$94.86 , N/A ,$83.04 ,$117.64 ,$96.88 , N/A , N/A ,$131.48 ,$105.18 ,$103.80 ,$89.96 ,$117.64 , N/A ,$89.96 ,$89.96 ,$96.88 ,$84.29 , N/A , N/A , N/A , N/A , N/A ,$117.64 , N/A ,$127.33 ,$96.88 ,$70.20 ,$84.24 ,$84.29 ,$84.24 ,$95.63 ,$124.56 ,$94.55 , N/A ,$109.34 , N/A ,$81.66 ,$81.66 , N/A ,$81.66 ,$99.65 ,$85.81 ,$99.65 ,$99.65 ,$110.72 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 2 % GEL 30 ML TUBE,250,1 ,$436.40 ,$288.02 ,$221.34 ,$436.40 , N/A ,$299.11 ,$299.11 , N/A ,$261.84 ,$370.94 ,$305.48 , N/A , N/A ,$414.58 ,$331.66 ,$327.30 ,$283.66 ,$370.94 , N/A ,$283.66 ,$283.66 ,$305.48 ,$265.77 , N/A , N/A , N/A , N/A , N/A ,$370.94 , N/A ,$401.49 ,$305.48 ,$221.34 ,$265.64 ,$265.77 ,$265.64 ,$301.55 ,$392.76 ,$298.15 , N/A ,$344.76 , N/A ,$257.48 ,$257.48 , N/A ,$257.48 ,$314.21 ,$270.57 ,$314.21 ,$314.21 ,$349.12 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 2 % GEL 4 ML TUBE,250,1 ,$9.05 ,$5.97 ,$4.59 ,$9.05 , N/A ,$6.20 ,$6.20 , N/A ,$5.43 ,$7.69 ,$6.34 , N/A , N/A ,$8.60 ,$6.88 ,$6.79 ,$5.88 ,$7.69 , N/A ,$5.88 ,$5.88 ,$6.34 ,$5.51 , N/A , N/A , N/A , N/A , N/A ,$7.69 , N/A ,$8.33 ,$6.34 ,$4.59 ,$5.51 ,$5.51 ,$5.51 ,$6.25 ,$8.15 ,$6.18 , N/A ,$7.15 , N/A ,$5.34 ,$5.34 , N/A ,$5.34 ,$6.52 ,$5.61 ,$6.52 ,$6.52 ,$7.24 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 2 % GEL 5 ML TUBE,250,1 ,$28.60 ,$18.88 ,$14.51 ,$28.60 , N/A ,$19.60 ,$19.60 , N/A ,$17.16 ,$24.31 ,$20.02 , N/A , N/A ,$27.17 ,$21.74 ,$21.45 ,$18.59 ,$24.31 , N/A ,$18.59 ,$18.59 ,$20.02 ,$17.42 , N/A , N/A , N/A , N/A , N/A ,$24.31 , N/A ,$26.31 ,$20.02 ,$14.51 ,$17.41 ,$17.42 ,$17.41 ,$19.76 ,$25.74 ,$19.54 , N/A ,$22.59 , N/A ,$16.87 ,$16.87 , N/A ,$16.87 ,$20.59 ,$17.73 ,$20.59 ,$20.59 ,$22.88 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 2 % GEL 85 G TUBE,250,1 ,$65.05 ,$42.93 ,$32.99 ,$65.05 , N/A ,$44.59 ,$44.59 , N/A ,$39.03 ,$55.29 ,$45.54 , N/A , N/A ,$61.80 ,$49.44 ,$48.79 ,$42.28 ,$55.29 , N/A ,$42.28 ,$42.28 ,$45.54 ,$39.62 , N/A , N/A , N/A , N/A , N/A ,$55.29 , N/A ,$59.85 ,$45.54 ,$32.99 ,$39.60 ,$39.62 ,$39.60 ,$44.95 ,$58.55 ,$44.44 , N/A ,$51.39 , N/A ,$38.38 ,$38.38 , N/A ,$38.38 ,$46.84 ,$40.33 ,$46.84 ,$46.84 ,$52.04 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 2 % PRSY 10 ML SYRINGE,250,1 ,$26.15 ,$17.26 ,$13.26 ,$26.15 , N/A ,$17.92 ,$17.92 , N/A ,$15.69 ,$22.23 ,$18.31 , N/A , N/A ,$24.84 ,$19.87 ,$19.61 ,$17.00 ,$22.23 , N/A ,$17.00 ,$17.00 ,$18.31 ,$15.93 , N/A , N/A , N/A , N/A , N/A ,$22.23 , N/A ,$24.06 ,$18.31 ,$13.26 ,$15.92 ,$15.93 ,$15.92 ,$18.07 ,$23.54 ,$17.87 , N/A ,$20.66 , N/A ,$15.43 ,$15.43 , N/A ,$15.43 ,$18.83 ,$16.21 ,$18.83 ,$18.83 ,$20.92 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 2 % PRSY 6 ML SYRINGE,250,1 ,$24.30 ,$16.04 ,$12.33 ,$24.30 , N/A ,$16.66 ,$16.66 , N/A ,$14.58 ,$20.66 ,$17.01 , N/A , N/A ,$23.09 ,$18.47 ,$18.23 ,$15.80 ,$20.66 , N/A ,$15.80 ,$15.80 ,$17.01 ,$14.80 , N/A , N/A , N/A , N/A , N/A ,$20.66 , N/A ,$22.36 ,$17.01 ,$12.33 ,$14.79 ,$14.80 ,$14.79 ,$16.79 ,$21.87 ,$16.60 , N/A ,$19.20 , N/A ,$14.34 ,$14.34 , N/A ,$14.34 ,$17.50 ,$15.07 ,$17.50 ,$17.50 ,$19.44 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 2 % SOLN,250,1 ,$73.80 ,$48.71 ,$37.43 ,$73.80 , N/A ,$50.58 ,$50.58 , N/A ,$44.28 ,$62.73 ,$51.66 , N/A , N/A ,$70.11 ,$56.09 ,$55.35 ,$47.97 ,$62.73 , N/A ,$47.97 ,$47.97 ,$51.66 ,$44.94 , N/A , N/A , N/A , N/A , N/A ,$62.73 , N/A ,$67.90 ,$51.66 ,$37.43 ,$44.92 ,$44.94 ,$44.92 ,$51.00 ,$66.42 ,$50.42 , N/A ,$58.30 , N/A ,$43.54 ,$43.54 , N/A ,$43.54 ,$53.14 ,$45.76 ,$53.14 ,$53.14 ,$59.04 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 4 % SOLN 50 ML BOTTLE,250,1 ,$219.85 ,$145.10 ,$111.51 ,$219.85 , N/A ,$150.69 ,$150.69 , N/A ,$131.91 ,$186.87 ,$153.90 , N/A , N/A ,$208.86 ,$167.09 ,$164.89 ,$142.90 ,$186.87 , N/A ,$142.90 ,$142.90 ,$153.90 ,$133.89 , N/A , N/A , N/A , N/A , N/A ,$186.87 , N/A ,$202.26 ,$153.90 ,$111.51 ,$133.82 ,$133.89 ,$133.82 ,$151.92 ,$197.87 ,$150.20 , N/A ,$173.68 , N/A ,$129.71 ,$129.71 , N/A ,$129.71 ,$158.29 ,$136.31 ,$158.29 ,$158.29 ,$175.88 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 4%-EPINEPHRINE 0.05%-TETRACAINE 0.5% 4-0.05-0.5 % SOLN,250,1 ,$60.60 ,$40.00 ,$30.74 ,$60.60 , N/A ,$41.54 ,$41.54 , N/A ,$36.36 ,$51.51 ,$42.42 , N/A , N/A ,$57.57 ,$46.06 ,$45.45 ,$39.39 ,$51.51 , N/A ,$39.39 ,$39.39 ,$42.42 ,$36.91 , N/A , N/A , N/A , N/A , N/A ,$51.51 , N/A ,$55.75 ,$42.42 ,$30.74 ,$36.89 ,$36.91 ,$36.89 ,$41.87 ,$54.54 ,$41.40 , N/A ,$47.87 , N/A ,$35.75 ,$35.75 , N/A ,$35.75 ,$43.63 ,$37.57 ,$43.63 ,$43.63 ,$48.48 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 4%-EPINEPHRINE 0.05%-TETRACAINE 1% SOLN,250,1 ,$51.00 ,$33.66 ,$25.87 ,$51.00 , N/A ,$34.96 ,$34.96 , N/A ,$30.60 ,$43.35 ,$35.70 , N/A , N/A ,$48.45 ,$38.76 ,$38.25 ,$33.15 ,$43.35 , N/A ,$33.15 ,$33.15 ,$35.70 ,$31.06 , N/A , N/A , N/A , N/A , N/A ,$43.35 , N/A ,$46.92 ,$35.70 ,$25.87 ,$31.04 ,$31.06 ,$31.04 ,$35.24 ,$45.90 ,$34.84 , N/A ,$40.29 , N/A ,$30.09 ,$30.09 , N/A ,$30.09 ,$36.72 ,$31.62 ,$36.72 ,$36.72 ,$40.80 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 5 % OINT 35.44 G TUBE,250,1 ,"$1,076.65 ",$710.59 ,$546.08 ,"$1,076.65 ", N/A ,$737.94 ,$737.94 , N/A ,$645.99 ,$915.15 ,$753.66 , N/A , N/A ,"$1,022.82 ",$818.25 ,$807.49 ,$699.82 ,$915.15 , N/A ,$699.82 ,$699.82 ,$753.66 ,$655.68 , N/A , N/A , N/A , N/A , N/A ,$915.15 , N/A ,$990.52 ,$753.66 ,$546.08 ,$655.36 ,$655.68 ,$655.36 ,$743.97 ,$968.99 ,$735.57 , N/A ,$850.55 , N/A ,$635.22 ,$635.22 , N/A ,$635.22 ,$775.19 ,$667.52 ,$775.19 ,$775.19 ,$861.32 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE VISCOUS 2 % SOLN 15 ML CUP,250,1 ,$8.05 ,$5.31 ,$4.08 ,$8.05 , N/A ,$5.52 ,$5.52 , N/A ,$4.83 ,$6.84 ,$5.64 , N/A , N/A ,$7.65 ,$6.12 ,$6.04 ,$5.23 ,$6.84 , N/A ,$5.23 ,$5.23 ,$5.64 ,$4.90 , N/A , N/A , N/A , N/A , N/A ,$6.84 , N/A ,$7.41 ,$5.64 ,$4.08 ,$4.90 ,$4.90 ,$4.90 ,$5.56 ,$7.25 ,$5.50 , N/A ,$6.36 , N/A ,$4.75 ,$4.75 , N/A ,$4.75 ,$5.80 ,$4.99 ,$5.80 ,$5.80 ,$6.44 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE-EPINEPHRINE 1 %-1:100000 SOLN 30 ML VIAL,250,1 ,$38.02 ,$25.09 ,$19.28 ,$38.02 , N/A ,$26.06 ,$26.06 , N/A ,$22.81 ,$32.32 ,$26.61 , N/A , N/A ,$36.12 ,$28.90 ,$28.52 ,$24.71 ,$32.32 , N/A ,$24.71 ,$24.71 ,$26.61 ,$23.15 , N/A , N/A , N/A , N/A , N/A ,$32.32 , N/A ,$34.98 ,$26.61 ,$19.28 ,$23.14 ,$23.15 ,$23.14 ,$26.27 ,$34.22 ,$25.98 , N/A ,$30.04 , N/A ,$22.43 ,$22.43 , N/A ,$22.43 ,$27.37 ,$23.57 ,$27.37 ,$27.37 ,$30.42 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE-EPINEPHRINE 1 %-1:200000 SOLN,250,1 ,$54.50 ,$35.97 ,$27.64 ,$54.50 , N/A ,$37.35 ,$37.35 , N/A ,$32.70 ,$46.33 ,$38.15 , N/A , N/A ,$51.78 ,$41.42 ,$40.88 ,$35.43 ,$46.33 , N/A ,$35.43 ,$35.43 ,$38.15 ,$33.19 , N/A , N/A , N/A , N/A , N/A ,$46.33 , N/A ,$50.14 ,$38.15 ,$27.64 ,$33.17 ,$33.19 ,$33.17 ,$37.66 ,$49.05 ,$37.23 , N/A ,$43.06 , N/A ,$32.16 ,$32.16 , N/A ,$32.16 ,$39.24 ,$33.79 ,$39.24 ,$39.24 ,$43.60 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE-EPINEPHRINE 2 %-1:200000 SOLN,250,1 ,$52.75 ,$34.82 ,$26.75 ,$52.75 , N/A ,$36.15 ,$36.15 , N/A ,$31.65 ,$44.84 ,$36.93 , N/A , N/A ,$50.11 ,$40.09 ,$39.56 ,$34.29 ,$44.84 , N/A ,$34.29 ,$34.29 ,$36.93 ,$32.12 , N/A , N/A , N/A , N/A , N/A ,$44.84 , N/A ,$48.53 ,$36.93 ,$26.75 ,$32.11 ,$32.12 ,$32.11 ,$36.45 ,$47.48 ,$36.04 , N/A ,$41.67 , N/A ,$31.12 ,$31.12 , N/A ,$31.12 ,$37.98 ,$32.71 ,$37.98 ,$37.98 ,$42.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE-PRILOCAINE 2.5-2.5 % CREA 5 G TUBE,250,1 ,$33.75 ,$22.28 ,$17.12 ,$33.75 , N/A ,$23.13 ,$23.13 , N/A ,$20.25 ,$28.69 ,$23.63 , N/A , N/A ,$32.06 ,$25.65 ,$25.31 ,$21.94 ,$28.69 , N/A ,$21.94 ,$21.94 ,$23.63 ,$20.55 , N/A , N/A , N/A , N/A , N/A ,$28.69 , N/A ,$31.05 ,$23.63 ,$17.12 ,$20.54 ,$20.55 ,$20.54 ,$23.32 ,$30.38 ,$23.06 , N/A ,$26.66 , N/A ,$19.91 ,$19.91 , N/A ,$19.91 ,$24.30 ,$20.93 ,$24.30 ,$24.30 ,$27.00 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,METRONIDAZOLE 500 MG/100ML SOLN,250,1 ,$53.05 ,$35.01 ,$26.91 ,$53.05 , N/A ,$36.36 ,$36.36 , N/A ,$31.83 ,$45.09 ,$37.14 , N/A , N/A ,$50.40 ,$40.32 ,$39.79 ,$34.48 ,$45.09 , N/A ,$34.48 ,$34.48 ,$37.14 ,$32.31 , N/A , N/A , N/A , N/A , N/A ,$45.09 , N/A ,$48.81 ,$37.14 ,$26.91 ,$32.29 ,$32.31 ,$32.29 ,$36.66 ,$47.75 ,$36.24 , N/A ,$41.91 , N/A ,$31.30 ,$31.30 , N/A ,$31.30 ,$38.20 ,$32.89 ,$38.20 ,$38.20 ,$42.44 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$26.91 ,$53.05 , N/A ,$36.36 ,$36.36 , N/A ,$31.83 ,$45.09 ,$37.14 , N/A , N/A ,$50.40 ,$40.32 ,$39.79 ,$34.48 ,$45.09 , N/A ,$34.48 ,$34.48 ,$37.14 ,$32.31 , N/A , N/A , N/A , N/A , N/A ,$45.09 , N/A ,$48.81 ,$37.14 ,$26.91 ,$32.29 ,$32.31 ,$32.29 ,$36.66 ,$47.75 ,$36.24 , N/A ,$41.91 , N/A ,$31.30 ,$31.30 , N/A ,$31.30 ,$38.20 ,$32.89 ,$38.20 ,$38.20 ,$42.44 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,MOXIFLOXACIN 0.5 % SOLN 3 ML BOTTLE,250,1 ,$569.00 ,$375.54 ,$288.60 ,$569.00 , N/A ,$389.99 ,$389.99 , N/A ,$341.40 ,$483.65 ,$398.30 , N/A , N/A ,$540.55 ,$432.44 ,$426.75 ,$369.85 ,$483.65 , N/A ,$369.85 ,$369.85 ,$398.30 ,$346.52 , N/A , N/A , N/A , N/A , N/A ,$483.65 , N/A ,$523.48 ,$398.30 ,$288.60 ,$346.35 ,$346.52 ,$346.35 ,$393.18 ,$512.10 ,$388.74 , N/A ,$449.51 , N/A ,$335.71 ,$335.71 , N/A ,$335.71 ,$409.68 ,$352.78 ,$409.68 ,$409.68 ,$455.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,MULTIVITAMIN (ADULT MVI) INJ 10 ML VIAL,250,1 ,$85.90 ,$56.69 ,$43.57 ,$85.90 , N/A ,$58.88 ,$58.88 , N/A ,$51.54 ,$73.02 ,$60.13 , N/A , N/A ,$81.61 ,$65.28 ,$64.43 ,$55.84 ,$73.02 , N/A ,$55.84 ,$55.84 ,$60.13 ,$52.31 , N/A , N/A , N/A , N/A , N/A ,$73.02 , N/A ,$79.03 ,$60.13 ,$43.57 ,$52.29 ,$52.31 ,$52.29 ,$59.36 ,$77.31 ,$58.69 , N/A ,$67.86 , N/A ,$50.68 ,$50.68 , N/A ,$50.68 ,$61.85 ,$53.26 ,$61.85 ,$61.85 ,$68.72 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NAFCILLIN 2 GM SOLR 1 EACH VIAL,250,1 ,$173.90 ,$114.77 ,$88.20 ,$173.90 , N/A ,$119.19 ,$119.19 , N/A ,$104.34 ,$147.82 ,$121.73 , N/A , N/A ,$165.21 ,$132.16 ,$130.43 ,$113.04 ,$147.82 , N/A ,$113.04 ,$113.04 ,$121.73 ,$105.91 , N/A , N/A , N/A , N/A , N/A ,$147.82 , N/A ,$159.99 ,$121.73 ,$88.20 ,$105.85 ,$105.91 ,$105.85 ,$120.16 ,$156.51 ,$118.81 , N/A ,$137.38 , N/A ,$102.60 ,$102.60 , N/A ,$102.60 ,$125.21 ,$107.82 ,$125.21 ,$125.21 ,$139.12 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 5-400-10000 OINT 3.5 G TUBE,250,1 ,$193.65 ,$127.81 ,$98.22 ,$193.65 , N/A ,$132.73 ,$132.73 , N/A ,$116.19 ,$164.60 ,$135.56 , N/A , N/A ,$183.97 ,$147.17 ,$145.24 ,$125.87 ,$164.60 , N/A ,$125.87 ,$125.87 ,$135.56 ,$117.93 , N/A , N/A , N/A , N/A , N/A ,$164.60 , N/A ,$178.16 ,$135.56 ,$98.22 ,$117.87 ,$117.93 ,$117.87 ,$133.81 ,$174.29 ,$132.30 , N/A ,$152.98 , N/A ,$114.25 ,$114.25 , N/A ,$114.25 ,$139.43 ,$120.06 ,$139.43 ,$139.43 ,$154.92 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 5-400-5000 MG-UNIT OINT 28.4 G TUBE,250,1 ,$12.00 ,$7.92 ,$6.09 ,$12.00 , N/A ,$8.22 ,$8.22 , N/A ,$7.20 ,$10.20 ,$8.40 , N/A , N/A ,$11.40 ,$9.12 ,$9.00 ,$7.80 ,$10.20 , N/A ,$7.80 ,$7.80 ,$8.40 ,$7.31 , N/A , N/A , N/A , N/A , N/A ,$10.20 , N/A ,$11.04 ,$8.40 ,$6.09 ,$7.30 ,$7.31 ,$7.30 ,$8.29 ,$10.80 ,$8.20 , N/A ,$9.48 , N/A ,$7.08 ,$7.08 , N/A ,$7.08 ,$8.64 ,$7.44 ,$8.64 ,$8.64 ,$9.60 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NEOMYCIN-POLYMYXIN-DEXAMETHASONE 3.5-10000-0.1 OINT 3.5 G TUBE,250,1 ,$51.55 ,$34.02 ,$26.15 ,$51.55 , N/A ,$35.33 ,$35.33 , N/A ,$30.93 ,$43.82 ,$36.09 , N/A , N/A ,$48.97 ,$39.18 ,$38.66 ,$33.51 ,$43.82 , N/A ,$33.51 ,$33.51 ,$36.09 ,$31.39 , N/A , N/A , N/A , N/A , N/A ,$43.82 , N/A ,$47.43 ,$36.09 ,$26.15 ,$31.38 ,$31.39 ,$31.38 ,$35.62 ,$46.40 ,$35.22 , N/A ,$40.72 , N/A ,$30.41 ,$30.41 , N/A ,$30.41 ,$37.12 ,$31.96 ,$37.12 ,$37.12 ,$41.24 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NICARDIPINE HCL IN NACL 20-0.9 MG/200ML-% SOLN,250,1 ,$631.15 ,$416.56 ,$320.12 ,$631.15 , N/A ,$432.59 ,$432.59 , N/A ,$378.69 ,$536.48 ,$441.81 , N/A , N/A ,$599.59 ,$479.67 ,$473.36 ,$410.25 ,$536.48 , N/A ,$410.25 ,$410.25 ,$441.81 ,$384.37 , N/A , N/A , N/A , N/A , N/A ,$536.48 , N/A ,$580.66 ,$441.81 ,$320.12 ,$384.18 ,$384.37 ,$384.18 ,$436.12 ,$568.04 ,$431.20 , N/A ,$498.61 , N/A ,$372.38 ,$372.38 , N/A ,$372.38 ,$454.43 ,$391.31 ,$454.43 ,$454.43 ,$504.92 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NITROGLYCERIN 200-5 MCG/ML-% SOLN,250,1 ,$44.20 ,$29.17 ,$22.42 ,$44.20 , N/A ,$30.29 ,$30.29 , N/A ,$26.52 ,$37.57 ,$30.94 , N/A , N/A ,$41.99 ,$33.59 ,$33.15 ,$28.73 ,$37.57 , N/A ,$28.73 ,$28.73 ,$30.94 ,$26.92 , N/A , N/A , N/A , N/A , N/A ,$37.57 , N/A ,$40.66 ,$30.94 ,$22.42 ,$26.90 ,$26.92 ,$26.90 ,$30.54 ,$39.78 ,$30.20 , N/A ,$34.92 , N/A ,$26.08 ,$26.08 , N/A ,$26.08 ,$31.82 ,$27.40 ,$31.82 ,$31.82 ,$35.36 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NOREPINEPHRINE 1 MG/ML SOLN 4 ML VIAL,250,1 ,$150.80 ,$99.53 ,$76.49 ,$150.80 , N/A ,$103.36 ,$103.36 , N/A ,$90.48 ,$128.18 ,$105.56 , N/A , N/A ,$143.26 ,$114.61 ,$113.10 ,$98.02 ,$128.18 , N/A ,$98.02 ,$98.02 ,$105.56 ,$91.84 , N/A , N/A , N/A , N/A , N/A ,$128.18 , N/A ,$138.74 ,$105.56 ,$76.49 ,$91.79 ,$91.84 ,$91.79 ,$104.20 ,$135.72 ,$103.03 , N/A ,$119.13 , N/A ,$88.97 ,$88.97 , N/A ,$88.97 ,$108.58 ,$93.50 ,$108.58 ,$108.58 ,$120.64 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NOREPINEPHRINE 4-0.9 MG/250ML-% SOLN,250,1 ,$157.00 ,$103.62 ,$79.63 ,$157.00 , N/A ,$107.61 ,$107.61 , N/A ,$94.20 ,$133.45 ,$109.90 , N/A , N/A ,$149.15 ,$119.32 ,$117.75 ,$102.05 ,$133.45 , N/A ,$102.05 ,$102.05 ,$109.90 ,$95.61 , N/A , N/A , N/A , N/A , N/A ,$133.45 , N/A ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$95.57 ,$108.49 ,$141.30 ,$107.26 , N/A ,$124.03 , N/A ,$92.63 ,$92.63 , N/A ,$92.63 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NOREPINEPHRINE 4-5 MG/250ML-% SOLN,250,1 ,$215.40 ,$142.16 ,$109.25 ,$215.40 , N/A ,$147.64 ,$147.64 , N/A ,$129.24 ,$183.09 ,$150.78 , N/A , N/A ,$204.63 ,$163.70 ,$161.55 ,$140.01 ,$183.09 , N/A ,$140.01 ,$140.01 ,$150.78 ,$131.18 , N/A , N/A , N/A , N/A , N/A ,$183.09 , N/A ,$198.17 ,$150.78 ,$109.25 ,$131.11 ,$131.18 ,$131.11 ,$148.84 ,$193.86 ,$147.16 , N/A ,$170.17 , N/A ,$127.09 ,$127.09 , N/A ,$127.09 ,$155.09 ,$133.55 ,$155.09 ,$155.09 ,$172.32 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,OFLOXACIN 0.3 % SOLN 5 ML BOTTLE,250,1 ,$251.60 ,$166.06 ,$127.61 ,$251.60 , N/A ,$172.45 ,$172.45 , N/A ,$150.96 ,$213.86 ,$176.12 , N/A , N/A ,$239.02 ,$191.22 ,$188.70 ,$163.54 ,$213.86 , N/A ,$163.54 ,$163.54 ,$176.12 ,$153.22 , N/A , N/A , N/A , N/A , N/A ,$213.86 , N/A ,$231.47 ,$176.12 ,$127.61 ,$153.15 ,$153.22 ,$153.15 ,$173.86 ,$226.44 ,$171.89 , N/A ,$198.76 , N/A ,$148.44 ,$148.44 , N/A ,$148.44 ,$181.15 ,$155.99 ,$181.15 ,$181.15 ,$201.28 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,OLANZAPINE 10 MG SOLR,250,1 ,$153.75 ,$101.48 ,$77.98 ,$153.75 , N/A ,$105.38 ,$105.38 , N/A ,$92.25 ,$130.69 ,$107.63 , N/A , N/A ,$146.06 ,$116.85 ,$115.31 ,$99.94 ,$130.69 , N/A ,$99.94 ,$99.94 ,$107.63 ,$93.63 , N/A , N/A , N/A , N/A , N/A ,$130.69 , N/A ,$141.45 ,$107.63 ,$77.98 ,$93.59 ,$93.63 ,$93.59 ,$106.24 ,$138.38 ,$105.04 , N/A ,$121.46 , N/A ,$90.71 ,$90.71 , N/A ,$90.71 ,$110.70 ,$95.33 ,$110.70 ,$110.70 ,$123.00 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,OXYCHLOROSENE POWD 2 G BOX,250,1 ,$21.10 ,$13.93 ,$10.70 ,$21.10 , N/A ,$14.46 ,$14.46 , N/A ,$12.66 ,$17.94 ,$14.77 , N/A , N/A ,$20.05 ,$16.04 ,$15.83 ,$13.72 ,$17.94 , N/A ,$13.72 ,$13.72 ,$14.77 ,$12.85 , N/A , N/A , N/A , N/A , N/A ,$17.94 , N/A ,$19.41 ,$14.77 ,$10.70 ,$12.84 ,$12.85 ,$12.84 ,$14.58 ,$18.99 ,$14.42 , N/A ,$16.67 , N/A ,$12.45 ,$12.45 , N/A ,$12.45 ,$15.19 ,$13.08 ,$15.19 ,$15.19 ,$16.88 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,PENTAFLUOROPROP-TETRAFLUOROETH AERO,250,1 ,$8.80 ,$5.81 ,$4.46 ,$8.80 , N/A ,$6.03 ,$6.03 , N/A ,$5.28 ,$7.48 ,$6.16 , N/A , N/A ,$8.36 ,$6.69 ,$6.60 ,$5.72 ,$7.48 , N/A ,$5.72 ,$5.72 ,$6.16 ,$5.36 , N/A , N/A , N/A , N/A , N/A ,$7.48 , N/A ,$8.10 ,$6.16 ,$4.46 ,$5.36 ,$5.36 ,$5.36 ,$6.08 ,$7.92 ,$6.01 , N/A ,$6.95 , N/A ,$5.19 ,$5.19 , N/A ,$5.19 ,$6.34 ,$5.46 ,$6.34 ,$6.34 ,$7.04 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,PENTAMIDINE 300 MG SOLR,250,1 ,$749.10 ,$494.41 ,$379.94 ,$749.10 , N/A ,$513.43 ,$513.43 , N/A ,$449.46 ,$636.74 ,$524.37 , N/A , N/A ,$711.65 ,$569.32 ,$561.83 ,$486.92 ,$636.74 , N/A ,$486.92 ,$486.92 ,$524.37 ,$456.20 , N/A , N/A , N/A , N/A , N/A ,$636.74 , N/A ,$689.17 ,$524.37 ,$379.94 ,$455.98 ,$456.20 ,$455.98 ,$517.63 ,$674.19 ,$511.79 , N/A ,$591.79 , N/A ,$441.97 ,$441.97 , N/A ,$441.97 ,$539.35 ,$464.44 ,$539.35 ,$539.35 ,$599.28 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,PHENYLEPHRINE 10 % SOLN 5 ML BOTTLE,250,1 ,$170.00 ,$112.20 ,$86.22 ,$170.00 , N/A ,$116.52 ,$116.52 , N/A ,$102.00 ,$144.50 ,$119.00 , N/A , N/A ,$161.50 ,$129.20 ,$127.50 ,$110.50 ,$144.50 , N/A ,$110.50 ,$110.50 ,$119.00 ,$103.53 , N/A , N/A , N/A , N/A , N/A ,$144.50 , N/A ,$156.40 ,$119.00 ,$86.22 ,$103.48 ,$103.53 ,$103.48 ,$117.47 ,$153.00 ,$116.14 , N/A ,$134.30 , N/A ,$100.30 ,$100.30 , N/A ,$100.30 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,PHENYLEPHRINE 2.5 % SOLN 2 ML BOTTLE,250,1 ,$138.15 ,$91.18 ,$70.07 ,$138.15 , N/A ,$94.69 ,$94.69 , N/A ,$82.89 ,$117.43 ,$96.71 , N/A , N/A ,$131.24 ,$104.99 ,$103.61 ,$89.80 ,$117.43 , N/A ,$89.80 ,$89.80 ,$96.71 ,$84.13 , N/A , N/A , N/A , N/A , N/A ,$117.43 , N/A ,$127.10 ,$96.71 ,$70.07 ,$84.09 ,$84.13 ,$84.09 ,$95.46 ,$124.34 ,$94.38 , N/A ,$109.14 , N/A ,$81.51 ,$81.51 , N/A ,$81.51 ,$99.47 ,$85.65 ,$99.47 ,$99.47 ,$110.52 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,PILOCARPINE 2 % SOLN 15 ML BOTTLE,250,1 ,$388.30 ,$256.28 ,$196.95 ,$388.30 , N/A ,$266.14 ,$266.14 , N/A ,$232.98 ,$330.06 ,$271.81 , N/A , N/A ,$368.89 ,$295.11 ,$291.23 ,$252.40 ,$330.06 , N/A ,$252.40 ,$252.40 ,$271.81 ,$236.47 , N/A , N/A , N/A , N/A , N/A ,$330.06 , N/A ,$357.24 ,$271.81 ,$196.95 ,$236.36 ,$236.47 ,$236.36 ,$268.32 ,$349.47 ,$265.29 , N/A ,$306.76 , N/A ,$229.10 ,$229.10 , N/A ,$229.10 ,$279.58 ,$240.75 ,$279.58 ,$279.58 ,$310.64 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,"POLYETHYLENE GLYCOL 236 G SOLR 4,000 ML BOTTLE",250,1 ,$95.20 ,$62.83 ,$48.29 ,$95.20 , N/A ,$65.25 ,$65.25 , N/A ,$57.12 ,$80.92 ,$66.64 , N/A , N/A ,$90.44 ,$72.35 ,$71.40 ,$61.88 ,$80.92 , N/A ,$61.88 ,$61.88 ,$66.64 ,$57.98 , N/A , N/A , N/A , N/A , N/A ,$80.92 , N/A ,$87.58 ,$66.64 ,$48.29 ,$57.95 ,$57.98 ,$57.95 ,$65.78 ,$85.68 ,$65.04 , N/A ,$75.21 , N/A ,$56.17 ,$56.17 , N/A ,$56.17 ,$68.54 ,$59.02 ,$68.54 ,$68.54 ,$76.16 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,"PEG 3350 AND ELECTROLYTES 240 G SOLR 4,000 ML BOTTLE",250,1 ,$95.20 ,$62.83 ,$48.29 ,$95.20 , N/A ,$65.25 ,$65.25 , N/A ,$57.12 ,$80.92 ,$66.64 , N/A , N/A ,$90.44 ,$72.35 ,$71.40 ,$61.88 ,$80.92 , N/A ,$61.88 ,$61.88 ,$66.64 ,$57.98 , N/A , N/A , N/A , N/A , N/A ,$80.92 , N/A ,$87.58 ,$66.64 ,$48.29 ,$57.95 ,$57.98 ,$57.95 ,$65.78 ,$85.68 ,$65.04 , N/A ,$75.21 , N/A ,$56.17 ,$56.17 , N/A ,$56.17 ,$68.54 ,$59.02 ,$68.54 ,$68.54 ,$76.16 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,POTASSIUM PHOSPHATE 45 MMOLE/15ML SOLN 15 ML VIAL,250,1 ,$149.00 ,$98.34 ,$75.57 ,$149.00 , N/A ,$102.12 ,$102.12 , N/A ,$89.40 ,$126.65 ,$104.30 , N/A , N/A ,$141.55 ,$113.24 ,$111.75 ,$96.85 ,$126.65 , N/A ,$96.85 ,$96.85 ,$104.30 ,$90.74 , N/A , N/A , N/A , N/A , N/A ,$126.65 , N/A ,$137.08 ,$104.30 ,$75.57 ,$90.70 ,$90.74 ,$90.70 ,$102.96 ,$134.10 ,$101.80 , N/A ,$117.71 , N/A ,$87.91 ,$87.91 , N/A ,$87.91 ,$107.28 ,$92.38 ,$107.28 ,$107.28 ,$119.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,POVIDONE-IODINE 10 % OINT 28.35 G TUBE,250,1 ,$10.65 ,$7.03 ,$5.40 ,$10.65 , N/A ,$7.30 ,$7.30 , N/A ,$6.39 ,$9.05 ,$7.46 , N/A , N/A ,$10.12 ,$8.09 ,$7.99 ,$6.92 ,$9.05 , N/A ,$6.92 ,$6.92 ,$7.46 ,$6.49 , N/A , N/A , N/A , N/A , N/A ,$9.05 , N/A ,$9.80 ,$7.46 ,$5.40 ,$6.48 ,$6.49 ,$6.48 ,$7.36 ,$9.59 ,$7.28 , N/A ,$8.41 , N/A ,$6.28 ,$6.28 , N/A ,$6.28 ,$7.67 ,$6.60 ,$7.67 ,$7.67 ,$8.52 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,POVIDONE-IODINE 5 % SOLN 30 ML BOTTLE,250,1 ,$61.45 ,$40.56 ,$31.17 ,$61.45 , N/A ,$42.12 ,$42.12 , N/A ,$36.87 ,$52.23 ,$43.02 , N/A , N/A ,$58.38 ,$46.70 ,$46.09 ,$39.94 ,$52.23 , N/A ,$39.94 ,$39.94 ,$43.02 ,$37.42 , N/A , N/A , N/A , N/A , N/A ,$52.23 , N/A ,$56.53 ,$43.02 ,$31.17 ,$37.40 ,$37.42 ,$37.40 ,$42.46 ,$55.31 ,$41.98 , N/A ,$48.55 , N/A ,$36.26 ,$36.26 , N/A ,$36.26 ,$44.24 ,$38.10 ,$44.24 ,$44.24 ,$49.16 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,PREDNISOLONE ACETATE 1 % SUSP 5 ML BOTTLE,250,1 ,$654.45 ,$431.94 ,$331.94 ,$654.45 , N/A ,$448.56 ,$448.56 , N/A ,$392.67 ,$556.28 ,$458.12 , N/A , N/A ,$621.73 ,$497.38 ,$490.84 ,$425.39 ,$556.28 , N/A ,$425.39 ,$425.39 ,$458.12 ,$398.56 , N/A , N/A , N/A , N/A , N/A ,$556.28 , N/A ,$602.09 ,$458.12 ,$331.94 ,$398.36 ,$398.56 ,$398.36 ,$452.23 ,$589.01 ,$447.12 , N/A ,$517.02 , N/A ,$386.13 ,$386.13 , N/A ,$386.13 ,$471.20 ,$405.76 ,$471.20 ,$471.20 ,$523.56 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,PROPARACAINE 0.5 % SOLN 15 ML BOTTLE,250,1 ,$149.20 ,$98.47 ,$75.67 ,$149.20 , N/A ,$102.26 ,$102.26 , N/A ,$89.52 ,$126.82 ,$104.44 , N/A , N/A ,$141.74 ,$113.39 ,$111.90 ,$96.98 ,$126.82 , N/A ,$96.98 ,$96.98 ,$104.44 ,$90.86 , N/A , N/A , N/A , N/A , N/A ,$126.82 , N/A ,$137.26 ,$104.44 ,$75.67 ,$90.82 ,$90.86 ,$90.82 ,$103.10 ,$134.28 ,$101.93 , N/A ,$117.87 , N/A ,$88.03 ,$88.03 , N/A ,$88.03 ,$107.42 ,$92.50 ,$107.42 ,$107.42 ,$119.36 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ROCURONIUM 100 MG/10ML SOLN,250,1 ,$126.71 ,$83.63 ,$64.27 ,$126.71 , N/A ,$86.85 ,$86.85 , N/A ,$76.03 ,$107.70 ,$88.70 , N/A , N/A ,$120.37 ,$96.30 ,$95.03 ,$82.36 ,$107.70 , N/A ,$82.36 ,$82.36 ,$88.70 ,$77.17 , N/A , N/A , N/A , N/A , N/A ,$107.70 , N/A ,$116.57 ,$88.70 ,$64.27 ,$77.13 ,$77.17 ,$77.13 ,$87.56 ,$114.04 ,$86.57 , N/A ,$100.10 , N/A ,$74.76 ,$74.76 , N/A ,$74.76 ,$91.23 ,$78.56 ,$91.23 ,$91.23 ,$101.37 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ROCURONIUM 100 MG/10ML SOLN 10 ML VIAL,250,1 ,$103.03 ,$68.00 ,$52.26 ,$103.03 , N/A ,$70.62 ,$70.62 , N/A ,$61.82 ,$87.58 ,$72.12 , N/A , N/A ,$97.88 ,$78.30 ,$77.27 ,$66.97 ,$87.58 , N/A ,$66.97 ,$66.97 ,$72.12 ,$62.75 , N/A , N/A , N/A , N/A , N/A ,$87.58 , N/A ,$94.79 ,$72.12 ,$52.26 ,$62.71 ,$62.75 ,$62.71 ,$71.19 ,$92.73 ,$70.39 , N/A ,$81.39 , N/A ,$60.79 ,$60.79 , N/A ,$60.79 ,$74.18 ,$63.88 ,$74.18 ,$74.18 ,$82.42 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ROCURONIUM 50 MG/5ML SOSY,250,1 ,$73.10 ,$48.25 ,$37.08 ,$73.10 , N/A ,$50.10 ,$50.10 , N/A ,$43.86 ,$62.14 ,$51.17 , N/A , N/A ,$69.45 ,$55.56 ,$54.83 ,$47.52 ,$62.14 , N/A ,$47.52 ,$47.52 ,$51.17 ,$44.52 , N/A , N/A , N/A , N/A , N/A ,$62.14 , N/A ,$67.25 ,$51.17 ,$37.08 ,$44.50 ,$44.52 ,$44.50 ,$50.51 ,$65.79 ,$49.94 , N/A ,$57.75 , N/A ,$43.13 ,$43.13 , N/A ,$43.13 ,$52.63 ,$45.32 ,$52.63 ,$52.63 ,$58.48 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE-EPINEPHRINE PF 0.5% -1:200000 SOLN,250,1 ,$73.10 ,$48.25 ,$37.08 ,$73.10 , N/A ,$50.10 ,$50.10 , N/A ,$43.86 ,$62.14 ,$51.17 , N/A , N/A ,$69.45 ,$55.56 ,$54.83 ,$47.52 ,$62.14 , N/A ,$47.52 ,$47.52 ,$51.17 ,$44.52 , N/A , N/A , N/A , N/A , N/A ,$62.14 , N/A ,$67.25 ,$51.17 ,$37.08 ,$44.50 ,$44.52 ,$44.50 ,$50.51 ,$65.79 ,$49.94 , N/A ,$57.75 , N/A ,$43.13 ,$43.13 , N/A ,$43.13 ,$52.63 ,$45.32 ,$52.63 ,$52.63 ,$58.48 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SCOPOLAMINE 1 MG/3DAYS PT72,250,1 ,$86.90 ,$57.35 ,$44.08 ,$86.90 , N/A ,$59.56 ,$59.56 , N/A ,$52.14 ,$73.87 ,$60.83 , N/A , N/A ,$82.56 ,$66.04 ,$65.18 ,$56.49 ,$73.87 , N/A ,$56.49 ,$56.49 ,$60.83 ,$52.92 , N/A , N/A , N/A , N/A , N/A ,$73.87 , N/A ,$79.95 ,$60.83 ,$44.08 ,$52.90 ,$52.92 ,$52.90 ,$60.05 ,$78.21 ,$59.37 , N/A ,$68.65 , N/A ,$51.27 ,$51.27 , N/A ,$51.27 ,$62.57 ,$53.88 ,$62.57 ,$62.57 ,$69.52 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM BICARBONATE 8.4 % SOLN,250,1 ,$109.50 ,$72.27 ,$55.54 ,$109.50 , N/A ,$75.05 ,$75.05 , N/A ,$65.70 ,$93.08 ,$76.65 , N/A , N/A ,$104.03 ,$83.22 ,$82.13 ,$71.18 ,$93.08 , N/A ,$71.18 ,$71.18 ,$76.65 ,$66.69 , N/A , N/A , N/A , N/A , N/A ,$93.08 , N/A ,$100.74 ,$76.65 ,$55.54 ,$66.65 ,$66.69 ,$66.65 ,$75.66 ,$98.55 ,$74.81 , N/A ,$86.51 , N/A ,$64.61 ,$64.61 , N/A ,$64.61 ,$78.84 ,$67.89 ,$78.84 ,$78.84 ,$87.60 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM BICARBONATE 8.4 % SOLN 50 ML SYRINGE,250,1 ,$96.60 ,$63.76 ,$49.00 ,$96.60 , N/A ,$66.21 ,$66.21 , N/A ,$57.96 ,$82.11 ,$67.62 , N/A , N/A ,$91.77 ,$73.42 ,$72.45 ,$62.79 ,$82.11 , N/A ,$62.79 ,$62.79 ,$67.62 ,$58.83 , N/A , N/A , N/A , N/A , N/A ,$82.11 , N/A ,$88.87 ,$67.62 ,$49.00 ,$58.80 ,$58.83 ,$58.80 ,$66.75 ,$86.94 ,$66.00 , N/A ,$76.31 , N/A ,$56.99 ,$56.99 , N/A ,$56.99 ,$69.55 ,$59.89 ,$69.55 ,$69.55 ,$77.28 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM BICARBONATE 8.4 % SOLN 50 ML VIAL,250,1 ,$160.83 ,$106.15 ,$81.57 ,$160.83 , N/A ,$110.23 ,$110.23 , N/A ,$96.50 ,$136.71 ,$112.58 , N/A , N/A ,$152.79 ,$122.23 ,$120.62 ,$104.54 ,$136.71 , N/A ,$104.54 ,$104.54 ,$112.58 ,$97.95 , N/A , N/A , N/A , N/A , N/A ,$136.71 , N/A ,$147.96 ,$112.58 ,$81.57 ,$97.90 ,$97.95 ,$97.90 ,$111.13 ,$144.75 ,$109.88 , N/A ,$127.06 , N/A ,$94.89 ,$94.89 , N/A ,$94.89 ,$115.80 ,$99.71 ,$115.80 ,$115.80 ,$128.66 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM CHLORIDE (PF) 0.9 % SOLN 10 ML BOX,250,1 ,$11.00 ,$7.26 ,$5.58 ,$11.00 , N/A ,$7.54 ,$7.54 , N/A ,$6.60 ,$9.35 ,$7.70 , N/A , N/A ,$10.45 ,$8.36 ,$8.25 ,$7.15 ,$9.35 , N/A ,$7.15 ,$7.15 ,$7.70 ,$6.70 , N/A , N/A , N/A , N/A , N/A ,$9.35 , N/A ,$10.12 ,$7.70 ,$5.58 ,$6.70 ,$6.70 ,$6.70 ,$7.60 ,$9.90 ,$7.52 , N/A ,$8.69 , N/A ,$6.49 ,$6.49 , N/A ,$6.49 ,$7.92 ,$6.82 ,$7.92 ,$7.92 ,$8.80 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,"SODIUM CHLORIDE 0.45 % SOLN 1,000 ML FLEX CONT",250,1 ,$106.00 ,$69.96 ,$53.76 ,$106.00 , N/A ,$72.65 ,$72.65 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$68.90 ,$90.10 , N/A ,$68.90 ,$68.90 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$64.52 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A ,$62.54 ,$62.54 , N/A ,$62.54 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,"ACETIC ACID 0.25 % SOLN 1,000 ML PLAS CONT",250,1 ,$106.00 ,$69.96 ,$53.76 ,$106.00 , N/A ,$72.65 ,$72.65 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$68.90 ,$90.10 , N/A ,$68.90 ,$68.90 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$64.52 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A ,$62.54 ,$62.54 , N/A ,$62.54 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DEXTROSE 10 % BOLUS,250,1 ,$106.00 ,$69.96 ,$53.76 ,$106.00 , N/A ,$72.65 ,$72.65 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$68.90 ,$90.10 , N/A ,$68.90 ,$68.90 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$64.52 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A ,$62.54 ,$62.54 , N/A ,$62.54 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DEXTROSE 5 % LACTATED RINGERS BOLUS,250,1 ,$106.00 ,$69.96 ,$53.76 ,$106.00 , N/A ,$72.65 ,$72.65 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$68.90 ,$90.10 , N/A ,$68.90 ,$68.90 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$64.52 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A ,$62.54 ,$62.54 , N/A ,$62.54 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM CHLORIDE 0.9 % NEBU,250,1 ,$76.50 ,$50.49 ,$38.80 ,$76.50 , N/A ,$52.43 ,$52.43 , N/A ,$45.90 ,$65.03 ,$53.55 , N/A , N/A ,$72.68 ,$58.14 ,$57.38 ,$49.73 ,$65.03 , N/A ,$49.73 ,$49.73 ,$53.55 ,$46.59 , N/A , N/A , N/A , N/A , N/A ,$65.03 , N/A ,$70.38 ,$53.55 ,$38.80 ,$46.57 ,$46.59 ,$46.57 ,$52.86 ,$68.85 ,$52.26 , N/A ,$60.44 , N/A ,$45.14 ,$45.14 , N/A ,$45.14 ,$55.08 ,$47.43 ,$55.08 ,$55.08 ,$61.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,"SODIUM CHLORIDE 0.9 % SOLN 1,000 ML PLAS CONT",250,1 ,$17.00 ,$11.22 ,$8.62 ,$17.00 , N/A ,$11.65 ,$11.65 , N/A ,$10.20 ,$14.45 ,$11.90 , N/A , N/A ,$16.15 ,$12.92 ,$12.75 ,$11.05 ,$14.45 , N/A ,$11.05 ,$11.05 ,$11.90 ,$10.35 , N/A , N/A , N/A , N/A , N/A ,$14.45 , N/A ,$15.64 ,$11.90 ,$8.62 ,$10.35 ,$10.35 ,$10.35 ,$11.75 ,$15.30 ,$11.61 , N/A ,$13.43 , N/A ,$10.03 ,$10.03 , N/A ,$10.03 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$13.60 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM CHLORIDE 0.9 % SOLN 250 ML FLEX CONT,250,1 ,$21.25 ,$14.03 ,$10.78 ,$21.25 , N/A ,$14.56 ,$14.56 , N/A ,$12.75 ,$18.06 ,$14.88 , N/A , N/A ,$20.19 ,$16.15 ,$15.94 ,$13.81 ,$18.06 , N/A ,$13.81 ,$13.81 ,$14.88 ,$12.94 , N/A , N/A , N/A , N/A , N/A ,$18.06 , N/A ,$19.55 ,$14.88 ,$10.78 ,$12.93 ,$12.94 ,$12.93 ,$14.68 ,$19.13 ,$14.52 , N/A ,$16.79 , N/A ,$12.54 ,$12.54 , N/A ,$12.54 ,$15.30 ,$13.18 ,$15.30 ,$15.30 ,$17.00 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM CHLORIDE 0.9 % SOLN 250 ML PLAS CONT,250,1 ,$15.60 ,$10.30 ,$7.91 ,$15.60 , N/A ,$10.69 ,$10.69 , N/A ,$9.36 ,$13.26 ,$10.92 , N/A , N/A ,$14.82 ,$11.86 ,$11.70 ,$10.14 ,$13.26 , N/A ,$10.14 ,$10.14 ,$10.92 ,$9.50 , N/A , N/A , N/A , N/A , N/A ,$13.26 , N/A ,$14.35 ,$10.92 ,$7.91 ,$9.50 ,$9.50 ,$9.50 ,$10.78 ,$14.04 ,$10.66 , N/A ,$12.32 , N/A ,$9.20 ,$9.20 , N/A ,$9.20 ,$11.23 ,$9.67 ,$11.23 ,$11.23 ,$12.48 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM CHLORIDE 10 % NEBU,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ALBUTEROL (2.5 MG/3ML) 0.083% NEBU,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BRIMONIDINE 0.2 % SOLN 10 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CHLORHEXIDINE 0.12 % SOLN,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FLUORESCEIN 0.6 MG STRP,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FLUORESCEIN 1 MG STRP,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,HYDROGEN PEROXIDE 3 % SOLN 473 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,IPRATROPIUM 0.02 % SOLN,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML SOLN,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LEVALBUTEROL 0.63 MG/3ML NEBU,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 4 % PTCH,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE HCL POWD,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE VISCOUS 2 % SOLN 100 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 400-5-5000 OINT 1 EACH BOX,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,PHENOL 89 % LIQD 1 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,POVIDONE-IODINE 10 % SOLN 22.5 ML PACKET,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,POVIDONE-IODINE 10 % SOLN 236 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,RACEPINEPHRINE 2.25 % 2.25 % NEBU,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SILVER-POTASSIUM NITRATE 75-25 % MISC,250,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM CHLORIDE BACTERIOSTATIC 0.9 % SOLN,250,1 ,$16.33 ,$10.78 ,$8.28 ,$16.33 , N/A ,$11.19 ,$11.19 , N/A ,$9.80 ,$13.88 ,$11.43 , N/A , N/A ,$15.51 ,$12.41 ,$12.25 ,$10.61 ,$13.88 , N/A ,$10.61 ,$10.61 ,$11.43 ,$9.95 , N/A , N/A , N/A , N/A , N/A ,$13.88 , N/A ,$15.02 ,$11.43 ,$8.28 ,$9.94 ,$9.95 ,$9.94 ,$11.28 ,$14.70 ,$11.16 , N/A ,$12.90 , N/A ,$9.63 ,$9.63 , N/A ,$9.63 ,$11.76 ,$10.12 ,$11.76 ,$11.76 ,$13.06 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM HYPOCHLORITE 0.5 % SOLN 473 ML BOTTLE,250,1 ,$46.65 ,$30.79 ,$23.66 ,$46.65 , N/A ,$31.97 ,$31.97 , N/A ,$27.99 ,$39.65 ,$32.66 , N/A , N/A ,$44.32 ,$35.45 ,$34.99 ,$30.32 ,$39.65 , N/A ,$30.32 ,$30.32 ,$32.66 ,$28.41 , N/A , N/A , N/A , N/A , N/A ,$39.65 , N/A ,$42.92 ,$32.66 ,$23.66 ,$28.40 ,$28.41 ,$28.40 ,$32.24 ,$41.99 ,$31.87 , N/A ,$36.85 , N/A ,$27.52 ,$27.52 , N/A ,$27.52 ,$33.59 ,$28.92 ,$33.59 ,$33.59 ,$37.32 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM HYPOCHLORITE 0.125 % SOLN 473 ML BOTTLE,250,1 ,$46.65 ,$30.79 ,$23.66 ,$46.65 , N/A ,$31.97 ,$31.97 , N/A ,$27.99 ,$39.65 ,$32.66 , N/A , N/A ,$44.32 ,$35.45 ,$34.99 ,$30.32 ,$39.65 , N/A ,$30.32 ,$30.32 ,$32.66 ,$28.41 , N/A , N/A , N/A , N/A , N/A ,$39.65 , N/A ,$42.92 ,$32.66 ,$23.66 ,$28.40 ,$28.41 ,$28.40 ,$32.24 ,$41.99 ,$31.87 , N/A ,$36.85 , N/A ,$27.52 ,$27.52 , N/A ,$27.52 ,$33.59 ,$28.92 ,$33.59 ,$33.59 ,$37.32 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM HYPOCHLORITE 0.25 % SOLN 473 ML BOTTLE,250,1 ,$46.65 ,$30.79 ,$23.66 ,$46.65 , N/A ,$31.97 ,$31.97 , N/A ,$27.99 ,$39.65 ,$32.66 , N/A , N/A ,$44.32 ,$35.45 ,$34.99 ,$30.32 ,$39.65 , N/A ,$30.32 ,$30.32 ,$32.66 ,$28.41 , N/A , N/A , N/A , N/A , N/A ,$39.65 , N/A ,$42.92 ,$32.66 ,$23.66 ,$28.40 ,$28.41 ,$28.40 ,$32.24 ,$41.99 ,$31.87 , N/A ,$36.85 , N/A ,$27.52 ,$27.52 , N/A ,$27.52 ,$33.59 ,$28.92 ,$33.59 ,$33.59 ,$37.32 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SODIUM PHOSPHATE 45 MMOLE/15ML SOLN 15 ML VIAL,250,1 ,$162.45 ,$107.22 ,$82.39 ,$162.45 , N/A ,$111.34 ,$111.34 , N/A ,$97.47 ,$138.08 ,$113.72 , N/A , N/A ,$154.33 ,$123.46 ,$121.84 ,$105.59 ,$138.08 , N/A ,$105.59 ,$105.59 ,$113.72 ,$98.93 , N/A , N/A , N/A , N/A , N/A ,$138.08 , N/A ,$149.45 ,$113.72 ,$82.39 ,$98.88 ,$98.93 ,$98.88 ,$112.25 ,$146.21 ,$110.99 , N/A ,$128.34 , N/A ,$95.85 ,$95.85 , N/A ,$95.85 ,$116.96 ,$100.72 ,$116.96 ,$116.96 ,$129.96 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,"STERILE WATER SOLN 1,000 ML BOTTLE",250,1 ,$9.55 ,$6.30 ,$4.84 ,$9.55 , N/A ,$6.55 ,$6.55 , N/A ,$5.73 ,$8.12 ,$6.69 , N/A , N/A ,$9.07 ,$7.26 ,$7.16 ,$6.21 ,$8.12 , N/A ,$6.21 ,$6.21 ,$6.69 ,$5.82 , N/A , N/A , N/A , N/A , N/A ,$8.12 , N/A ,$8.79 ,$6.69 ,$4.84 ,$5.81 ,$5.82 ,$5.81 ,$6.60 ,$8.60 ,$6.52 , N/A ,$7.54 , N/A ,$5.63 ,$5.63 , N/A ,$5.63 ,$6.88 ,$5.92 ,$6.88 ,$6.88 ,$7.64 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,"STERILE WATER (BOTTLE) SOLN 1,000 ML PLAS CONT",250,1 ,$9.55 ,$6.30 ,$4.84 ,$9.55 , N/A ,$6.55 ,$6.55 , N/A ,$5.73 ,$8.12 ,$6.69 , N/A , N/A ,$9.07 ,$7.26 ,$7.16 ,$6.21 ,$8.12 , N/A ,$6.21 ,$6.21 ,$6.69 ,$5.82 , N/A , N/A , N/A , N/A , N/A ,$8.12 , N/A ,$8.79 ,$6.69 ,$4.84 ,$5.81 ,$5.82 ,$5.81 ,$6.60 ,$8.60 ,$6.52 , N/A ,$7.54 , N/A ,$5.63 ,$5.63 , N/A ,$5.63 ,$6.88 ,$5.92 ,$6.88 ,$6.88 ,$7.64 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,"STERILE WATER SOLN 1,000 ML FLEX CONT",250,1 ,$67.65 ,$44.65 ,$34.31 ,$67.65 , N/A ,$46.37 ,$46.37 , N/A ,$40.59 ,$57.50 ,$47.36 , N/A , N/A ,$64.27 ,$51.41 ,$50.74 ,$43.97 ,$57.50 , N/A ,$43.97 ,$43.97 ,$47.36 ,$41.20 , N/A , N/A , N/A , N/A , N/A ,$57.50 , N/A ,$62.24 ,$47.36 ,$34.31 ,$41.18 ,$41.20 ,$41.18 ,$46.75 ,$60.89 ,$46.22 , N/A ,$53.44 , N/A ,$39.91 ,$39.91 , N/A ,$39.91 ,$48.71 ,$41.94 ,$48.71 ,$48.71 ,$54.12 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,STERILE WATER SOLN 10 ML VIAL,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BACTERIOSTATIC WATER SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE 0.5 % 0.5 % SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE 0.75% IN DEXTROSE 8.25% (INTRATHECAL) 0.75-8.25 % SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUMETANIDE 0.25 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE (PF) 0.5 % SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE (PF) 0.5 % SOLN 10 ML VIAL,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE (PF) 0.5 % SOLN 30 ML VIAL,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE 0.25 % SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,BUPIVACAINE-EPINEPHRINE 0.5% -1:200000 SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,CLINDAMYCIN 600 MG/4ML SOLN 4 ML VIAL,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DILTIAZEM 100 MG SOLR,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,DILTIAZEM 25 MG/5ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ENALAPRILAT 1.25 MG/ML INJ,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FAMOTIDINE 20 MG/2ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FAT EMULSION 20 % EMUL,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,FOLIC ACID 5 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,KETAMINE 10 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,KETAMINE 100 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,KETAMINE 100 MG/ML SOLN 5 ML VIAL,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LABETALOL 5 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE (PF) 2 % SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 1 % SOLN 2 ML VIAL,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 1 % SOLN 20 ML VIAL,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE 1 % SOLN 5 ML VIAL,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE-EPINEPHRINE 1 %-1:100000 SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,LIDOCAINE-EPINEPHRINE 2 %-1:100000 SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,METOPROLOL TARTRATE 5 MG/5ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,MOXIFLOXACIN 5 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,POTASSIUM PHOSPHATE (4.7 MEQ/ML K) 45 MMOLE/15ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,ROCURONIUM 50 MG/5ML SOLN,250,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,STERILE WATER SOLN 20 ML VIAL,250,1 ,$691.00 ,$456.06 ,$350.48 ,$691.00 , N/A ,$473.61 ,$473.61 , N/A ,$414.60 ,$587.35 ,$483.70 , N/A , N/A ,$656.45 ,$525.16 ,$518.25 ,$449.15 ,$587.35 , N/A ,$449.15 ,$449.15 ,$483.70 ,$420.82 , N/A , N/A , N/A , N/A , N/A ,$587.35 , N/A ,$635.72 ,$483.70 ,$350.48 ,$420.61 ,$420.82 ,$420.61 ,$477.48 ,$621.90 ,$472.09 , N/A ,$545.89 , N/A ,$407.69 ,$407.69 , N/A ,$407.69 ,$497.52 ,$428.42 ,$497.52 ,$497.52 ,$552.80 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,STERILE WATER SOLN 5 ML VIAL,250,1 ,$14.80 ,$9.77 ,$7.51 ,$14.80 , N/A ,$10.14 ,$10.14 , N/A ,$8.88 ,$12.58 ,$10.36 , N/A , N/A ,$14.06 ,$11.25 ,$11.10 ,$9.62 ,$12.58 , N/A ,$9.62 ,$9.62 ,$10.36 ,$9.01 , N/A , N/A , N/A , N/A , N/A ,$12.58 , N/A ,$13.62 ,$10.36 ,$7.51 ,$9.01 ,$9.01 ,$9.01 ,$10.23 ,$13.32 ,$10.11 , N/A ,$11.69 , N/A ,$8.73 ,$8.73 , N/A ,$8.73 ,$10.66 ,$9.18 ,$10.66 ,$10.66 ,$11.84 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,STERILE WATER SOLN 50 ML VIAL,250,1 ,$98.00 ,$64.68 ,$49.71 ,$98.00 , N/A ,$67.17 ,$67.17 , N/A ,$58.80 ,$83.30 ,$68.60 , N/A , N/A ,$93.10 ,$74.48 ,$73.50 ,$63.70 ,$83.30 , N/A ,$63.70 ,$63.70 ,$68.60 ,$59.68 , N/A , N/A , N/A , N/A , N/A ,$83.30 , N/A ,$90.16 ,$68.60 ,$49.71 ,$59.65 ,$59.68 ,$59.65 ,$67.72 ,$88.20 ,$66.95 , N/A ,$77.42 , N/A ,$57.82 ,$57.82 , N/A ,$57.82 ,$70.56 ,$60.76 ,$70.56 ,$70.56 ,$78.40 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,STRONG IODINE 5 % SOLN 14 ML BOTTLE,250,1 ,$56.20 ,$37.09 ,$28.50 ,$56.20 , N/A ,$38.52 ,$38.52 , N/A ,$33.72 ,$47.77 ,$39.34 , N/A , N/A ,$53.39 ,$42.71 ,$42.15 ,$36.53 ,$47.77 , N/A ,$36.53 ,$36.53 ,$39.34 ,$34.23 , N/A , N/A , N/A , N/A , N/A ,$47.77 , N/A ,$51.70 ,$39.34 ,$28.50 ,$34.21 ,$34.23 ,$34.21 ,$38.83 ,$50.58 ,$38.40 , N/A ,$44.40 , N/A ,$33.16 ,$33.16 , N/A ,$33.16 ,$40.46 ,$34.84 ,$40.46 ,$40.46 ,$44.96 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,STRONG IODINE SOLN,250,1 ,$37.20 ,$24.55 ,$18.87 ,$37.20 , N/A ,$25.50 ,$25.50 , N/A ,$22.32 ,$31.62 ,$26.04 , N/A , N/A ,$35.34 ,$28.27 ,$27.90 ,$24.18 ,$31.62 , N/A ,$24.18 ,$24.18 ,$26.04 ,$22.65 , N/A , N/A , N/A , N/A , N/A ,$31.62 , N/A ,$34.22 ,$26.04 ,$18.87 ,$22.64 ,$22.65 ,$22.64 ,$25.71 ,$33.48 ,$25.42 , N/A ,$29.39 , N/A ,$21.95 ,$21.95 , N/A ,$21.95 ,$26.78 ,$23.06 ,$26.78 ,$26.78 ,$29.76 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SUGAMMADEX 200 MG/2ML SOLN,250,1 ,$851.80 ,$562.19 ,$432.03 ,$851.80 , N/A ,$583.82 ,$583.82 , N/A ,$511.08 ,$724.03 ,$596.26 , N/A , N/A ,$809.21 ,$647.37 ,$638.85 ,$553.67 ,$724.03 , N/A ,$553.67 ,$553.67 ,$596.26 ,$518.75 , N/A , N/A , N/A , N/A , N/A ,$724.03 , N/A ,$783.66 ,$596.26 ,$432.03 ,$518.49 ,$518.75 ,$518.49 ,$588.59 ,$766.62 ,$581.95 , N/A ,$672.92 , N/A ,$502.56 ,$502.56 , N/A ,$502.56 ,$613.30 ,$528.12 ,$613.30 ,$613.30 ,$681.44 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SUGAMMADEX 500 MG/5ML SOLN,250,1 ,"$1,560.15 ","$1,029.70 ",$791.31 ,"$1,560.15 ", N/A ,"$1,069.33 ","$1,069.33 ", N/A ,$936.09 ,"$1,326.13 ","$1,092.11 ", N/A , N/A ,"$1,482.14 ","$1,185.71 ","$1,170.11 ","$1,014.10 ","$1,326.13 ", N/A ,"$1,014.10 ","$1,014.10 ","$1,092.11 ",$950.13 , N/A , N/A , N/A , N/A , N/A ,"$1,326.13 ", N/A ,"$1,435.34 ","$1,092.11 ",$791.31 ,$949.66 ,$950.13 ,$949.66 ,"$1,078.06 ","$1,404.14 ","$1,065.89 ", N/A ,"$1,232.52 ", N/A ,$920.49 ,$920.49 , N/A ,$920.49 ,"$1,123.31 ",$967.29 ,"$1,123.31 ","$1,123.31 ","$1,248.12 "
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML SOLN 10 ML VIAL,250,1 ,$80.53 ,$53.15 ,$40.84 ,$80.53 , N/A ,$55.20 ,$55.20 , N/A ,$48.32 ,$68.45 ,$56.37 , N/A , N/A ,$76.50 ,$61.20 ,$60.40 ,$52.34 ,$68.45 , N/A ,$52.34 ,$52.34 ,$56.37 ,$49.04 , N/A , N/A , N/A , N/A , N/A ,$68.45 , N/A ,$74.09 ,$56.37 ,$40.84 ,$49.02 ,$49.04 ,$49.02 ,$55.65 ,$72.48 ,$55.02 , N/A ,$63.62 , N/A ,$47.51 ,$47.51 , N/A ,$47.51 ,$57.98 ,$49.93 ,$57.98 ,$57.98 ,$64.42 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TETRACAINE 0.5 % SOLN 15 ML BOTTLE,250,1 ,$146.90 ,$96.95 ,$74.51 ,$146.90 , N/A ,$100.69 ,$100.69 , N/A ,$88.14 ,$124.87 ,$102.83 , N/A , N/A ,$139.56 ,$111.64 ,$110.18 ,$95.49 ,$124.87 , N/A ,$95.49 ,$95.49 ,$102.83 ,$89.46 , N/A , N/A , N/A , N/A , N/A ,$124.87 , N/A ,$135.15 ,$102.83 ,$74.51 ,$89.42 ,$89.46 ,$89.42 ,$101.51 ,$132.21 ,$100.36 , N/A ,$116.05 , N/A ,$86.67 ,$86.67 , N/A ,$86.67 ,$105.77 ,$91.08 ,$105.77 ,$105.77 ,$117.52 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TETRACAINE 0.5 % SOLN 4 ML PLAS CONT,250,1 ,$47.55 ,$31.38 ,$24.12 ,$47.55 , N/A ,$32.59 ,$32.59 , N/A ,$28.53 ,$40.42 ,$33.29 , N/A , N/A ,$45.17 ,$36.14 ,$35.66 ,$30.91 ,$40.42 , N/A ,$30.91 ,$30.91 ,$33.29 ,$28.96 , N/A , N/A , N/A , N/A , N/A ,$40.42 , N/A ,$43.75 ,$33.29 ,$24.12 ,$28.94 ,$28.96 ,$28.94 ,$32.86 ,$42.80 ,$32.49 , N/A ,$37.56 , N/A ,$28.05 ,$28.05 , N/A ,$28.05 ,$34.24 ,$29.48 ,$34.24 ,$34.24 ,$38.04 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TIMOLOL 0.5 % SOLN,250,1 ,$38.65 ,$25.51 ,$19.60 ,$38.65 , N/A ,$26.49 ,$26.49 , N/A ,$23.19 ,$32.85 ,$27.06 , N/A , N/A ,$36.72 ,$29.37 ,$28.99 ,$25.12 ,$32.85 , N/A ,$25.12 ,$25.12 ,$27.06 ,$23.54 , N/A , N/A , N/A , N/A , N/A ,$32.85 , N/A ,$35.56 ,$27.06 ,$19.60 ,$23.53 ,$23.54 ,$23.53 ,$26.71 ,$34.79 ,$26.41 , N/A ,$30.53 , N/A ,$22.80 ,$22.80 , N/A ,$22.80 ,$27.83 ,$23.96 ,$27.83 ,$27.83 ,$30.92 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TISSEEL 2 ML KIT,250,1 ,$659.05 ,$434.97 ,$334.27 ,$659.05 , N/A ,$451.71 ,$451.71 , N/A ,$395.43 ,$560.19 ,$461.34 , N/A , N/A ,$626.10 ,$500.88 ,$494.29 ,$428.38 ,$560.19 , N/A ,$428.38 ,$428.38 ,$461.34 ,$401.36 , N/A , N/A , N/A , N/A , N/A ,$560.19 , N/A ,$606.33 ,$461.34 ,$334.27 ,$401.16 ,$401.36 ,$401.16 ,$455.40 ,$593.15 ,$450.26 , N/A ,$520.65 , N/A ,$388.84 ,$388.84 , N/A ,$388.84 ,$474.52 ,$408.61 ,$474.52 ,$474.52 ,$527.24 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OINT 3.5 G TUBE,250,1 ,$977.65 ,$645.25 ,$495.86 ,$977.65 , N/A ,$670.08 ,$670.08 , N/A ,$586.59 ,$831.00 ,$684.36 , N/A , N/A ,$928.77 ,$743.01 ,$733.24 ,$635.47 ,$831.00 , N/A ,$635.47 ,$635.47 ,$684.36 ,$595.39 , N/A , N/A , N/A , N/A , N/A ,$831.00 , N/A ,$899.44 ,$684.36 ,$495.86 ,$595.10 ,$595.39 ,$595.10 ,$675.56 ,$879.89 ,$667.93 , N/A ,$772.34 , N/A ,$576.81 ,$576.81 , N/A ,$576.81 ,$703.91 ,$606.14 ,$703.91 ,$703.91 ,$782.12 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TPN-CLINIMIX E 8/14 (STANDARD ELECTROLYTES),250,1 ,$996.15 ,$657.46 ,$505.25 ,$996.15 , N/A ,$682.76 ,$682.76 , N/A ,$597.69 ,$846.73 ,$697.31 , N/A , N/A ,$946.34 ,$757.07 ,$747.11 ,$647.50 ,$846.73 , N/A ,$647.50 ,$647.50 ,$697.31 ,$606.66 , N/A , N/A , N/A , N/A , N/A ,$846.73 , N/A ,$916.46 ,$697.31 ,$505.25 ,$606.36 ,$606.66 ,$606.36 ,$688.34 ,$896.54 ,$680.57 , N/A ,$786.96 , N/A ,$587.73 ,$587.73 , N/A ,$587.73 ,$717.23 ,$617.61 ,$717.23 ,$717.23 ,$796.92 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TPN-CLINIMIX 5/20 (STANDARD ELECTROLYTES),250,1 ,$996.15 ,$657.46 ,$505.25 ,$996.15 , N/A ,$682.76 ,$682.76 , N/A ,$597.69 ,$846.73 ,$697.31 , N/A , N/A ,$946.34 ,$757.07 ,$747.11 ,$647.50 ,$846.73 , N/A ,$647.50 ,$647.50 ,$697.31 ,$606.66 , N/A , N/A , N/A , N/A , N/A ,$846.73 , N/A ,$916.46 ,$697.31 ,$505.25 ,$606.36 ,$606.66 ,$606.36 ,$688.34 ,$896.54 ,$680.57 , N/A ,$786.96 , N/A ,$587.73 ,$587.73 , N/A ,$587.73 ,$717.23 ,$617.61 ,$717.23 ,$717.23 ,$796.92 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TRANEXAMIC ACID 1000 MG/10ML SOLN 10 ML AMPULE,250,1 ,$147.60 ,$97.42 ,$74.86 ,$147.60 , N/A ,$101.17 ,$101.17 , N/A ,$88.56 ,$125.46 ,$103.32 , N/A , N/A ,$140.22 ,$112.18 ,$110.70 ,$95.94 ,$125.46 , N/A ,$95.94 ,$95.94 ,$103.32 ,$89.89 , N/A , N/A , N/A , N/A , N/A ,$125.46 , N/A ,$135.79 ,$103.32 ,$74.86 ,$89.84 ,$89.89 ,$89.84 ,$101.99 ,$132.84 ,$100.84 , N/A ,$116.60 , N/A ,$87.08 ,$87.08 , N/A ,$87.08 ,$106.27 ,$91.51 ,$106.27 ,$106.27 ,$118.08 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TRANEXAMIC ACID 1000 MG/10ML SOLN 10 ML VIAL,250,1 ,$369.00 ,$243.54 ,$187.16 ,$369.00 , N/A ,$252.91 ,$252.91 , N/A ,$221.40 ,$313.65 ,$258.30 , N/A , N/A ,$350.55 ,$280.44 ,$276.75 ,$239.85 ,$313.65 , N/A ,$239.85 ,$239.85 ,$258.30 ,$224.72 , N/A , N/A , N/A , N/A , N/A ,$313.65 , N/A ,$339.48 ,$258.30 ,$187.16 ,$224.61 ,$224.72 ,$224.61 ,$254.98 ,$332.10 ,$252.10 , N/A ,$291.51 , N/A ,$217.71 ,$217.71 , N/A ,$217.71 ,$265.68 ,$228.78 ,$265.68 ,$265.68 ,$295.20 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TRIAMCINOLONE-MOXIFLOXACIN 15-1 MG/ML SUSP,250,1 ,$156.83 ,$103.51 ,$79.54 ,$156.83 , N/A ,$107.49 ,$107.49 , N/A ,$94.10 ,$133.31 ,$109.78 , N/A , N/A ,$148.99 ,$119.19 ,$117.62 ,$101.94 ,$133.31 , N/A ,$101.94 ,$101.94 ,$109.78 ,$95.51 , N/A , N/A , N/A , N/A , N/A ,$133.31 , N/A ,$144.28 ,$109.78 ,$79.54 ,$95.46 ,$95.51 ,$95.46 ,$108.37 ,$141.15 ,$107.15 , N/A ,$123.90 , N/A ,$92.53 ,$92.53 , N/A ,$92.53 ,$112.92 ,$97.23 ,$112.92 ,$112.92 ,$125.46 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TROPICAMIDE 1%-PHENYLEPHRINE 2.5% SOLN 5 ML BOTTLE,250,1 ,$42.85 ,$28.28 ,$21.73 ,$42.85 , N/A ,$29.37 ,$29.37 , N/A ,$25.71 ,$36.42 ,$30.00 , N/A , N/A ,$40.71 ,$32.57 ,$32.14 ,$27.85 ,$36.42 , N/A ,$27.85 ,$27.85 ,$30.00 ,$26.10 , N/A , N/A , N/A , N/A , N/A ,$36.42 , N/A ,$39.42 ,$30.00 ,$21.73 ,$26.08 ,$26.10 ,$26.08 ,$29.61 ,$38.57 ,$29.28 , N/A ,$33.85 , N/A ,$25.28 ,$25.28 , N/A ,$25.28 ,$30.85 ,$26.57 ,$30.85 ,$30.85 ,$34.28 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$144.86 ,$285.60 , N/A ,$195.75 ,$195.75 , N/A ,$171.36 ,$242.76 ,$199.92 , N/A , N/A ,$271.32 ,$217.06 ,$214.20 ,$185.64 ,$242.76 , N/A ,$185.64 ,$185.64 ,$199.92 ,$173.93 , N/A , N/A , N/A , N/A , N/A ,$242.76 , N/A ,$262.75 ,$199.92 ,$144.86 ,$173.84 ,$173.93 ,$173.84 ,$197.35 ,$257.04 ,$195.12 , N/A ,$225.62 , N/A ,$168.50 ,$168.50 , N/A ,$168.50 ,$205.63 ,$177.07 ,$205.63 ,$205.63 ,$228.48 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,TRYPAN BLUE 0.06 % SOSY 0.5 ML SYRINGE,250,1 ,$284.55 ,$187.80 ,$144.32 ,$284.55 , N/A ,$195.03 ,$195.03 , N/A ,$170.73 ,$241.87 ,$199.19 , N/A , N/A ,$270.32 ,$216.26 ,$213.41 ,$184.96 ,$241.87 , N/A ,$184.96 ,$184.96 ,$199.19 ,$173.29 , N/A , N/A , N/A , N/A , N/A ,$241.87 , N/A ,$261.79 ,$199.19 ,$144.32 ,$173.21 ,$173.29 ,$173.21 ,$196.62 ,$256.10 ,$194.40 , N/A ,$224.79 , N/A ,$167.88 ,$167.88 , N/A ,$167.88 ,$204.88 ,$176.42 ,$204.88 ,$204.88 ,$227.64 
ST NICHOLAS HOSPITAL - ACUTE,25000003,N/A,VALPROATE 100 MG/ML SOLN 5 ML VIAL,250,1 ,$49.45 ,$32.64 ,$25.08 ,$49.45 , N/A ,$33.89 ,$33.89 , N/A ,$29.67 ,$42.03 ,$34.62 , N/A , N/A ,$46.98 ,$37.58 ,$37.09 ,$32.14 ,$42.03 , N/A ,$32.14 ,$32.14 ,$34.62 ,$30.12 , N/A , N/A , N/A , N/A , N/A ,$42.03 , N/A ,$45.49 ,$34.62 ,$25.08 ,$30.10 ,$30.12 ,$30.10 ,$34.17 ,$44.51 ,$33.78 , N/A ,$39.07 , N/A ,$29.18 ,$29.18 , N/A ,$29.18 ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,25800000,N/A,DEXTROSE 10 % SOLN,258,1 ,$106.00 ,$69.96 ,$53.76 ,$106.00 , N/A ,$72.65 ,$72.65 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$68.90 ,$90.10 , N/A ,$68.90 ,$68.90 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$64.52 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A ,$62.54 ,$62.54 , N/A ,$62.54 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,25800000,N/A,DEXTROSE 50 % SOLN,258,1 ,$112.55 ,$74.28 ,$57.09 ,$112.55 , N/A ,$77.14 ,$77.14 , N/A ,$67.53 ,$95.67 ,$78.79 , N/A , N/A ,$106.92 ,$85.54 ,$84.41 ,$73.16 ,$95.67 , N/A ,$73.16 ,$73.16 ,$78.79 ,$68.54 , N/A , N/A , N/A , N/A , N/A ,$95.67 , N/A ,$103.55 ,$78.79 ,$57.09 ,$68.51 ,$68.54 ,$68.51 ,$77.77 ,$101.30 ,$76.89 , N/A ,$88.91 , N/A ,$66.40 ,$66.40 , N/A ,$66.40 ,$81.04 ,$69.78 ,$81.04 ,$81.04 ,$90.04 
ST NICHOLAS HOSPITAL - ACUTE,25800000,N/A,TPN-CLINIMIX 5/15 (STANDARD ELECTROLYTES),258,1 ,$996.15 ,$657.46 ,$505.25 ,$996.15 , N/A ,$682.76 ,$682.76 , N/A ,$597.69 ,$846.73 ,$697.31 , N/A , N/A ,$946.34 ,$757.07 ,$747.11 ,$647.50 ,$846.73 , N/A ,$647.50 ,$647.50 ,$697.31 ,$606.66 , N/A , N/A , N/A , N/A , N/A ,$846.73 , N/A ,$916.46 ,$697.31 ,$505.25 ,$606.36 ,$606.66 ,$606.36 ,$688.34 ,$896.54 ,$680.57 , N/A ,$786.96 , N/A ,$587.73 ,$587.73 , N/A ,$587.73 ,$717.23 ,$617.61 ,$717.23 ,$717.23 ,$796.92 
ST NICHOLAS HOSPITAL - ACUTE,26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$515.20 ,$340.03 ,$10.04 ,$515.20 ,$10.04 ,$353.12 ,$353.12 ,$201.61 ,$309.12 ,$437.92 , N/A ,$10.04 ,$10.04 ,$489.44 ,$391.55 ,$386.40 ,$334.88 ,$437.92 ,$201.61 ,$334.88 ,$334.88 ,$360.64 ,$313.76 ,$10.04 ,$201.61 ,$197.58 ,$403.22 ,$10.64 ,$437.92 ,$453.63 ,$473.98 ,$360.64 ,$261.31 ,$313.60 ,$313.76 ,$313.60 ,$356.00 ,$463.68 ,$351.98 ,$199.56 ,$407.01 ,$10.64 ,$252.45 ,$252.45 ,$197.58 ,$252.45 ,$370.94 ,$319.42 ,$370.94 ,$370.94 ,$412.16 
ST NICHOLAS HOSPITAL - ACUTE,26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$205.85 ,$135.86 ,$17.55 ,$205.85 ,$17.55 ,$141.09 ,$141.09 ,$41.35 ,$123.51 ,$174.97 , N/A ,$17.55 ,$17.55 ,$195.56 ,$156.45 ,$154.39 ,$133.80 ,$174.97 ,$41.35 ,$133.80 ,$133.80 ,$144.10 ,$125.36 ,$17.55 ,$41.35 ,$40.52 ,$82.70 ,$18.60 ,$174.97 ,$93.04 ,$189.38 ,$144.10 ,$104.41 ,$125.30 ,$125.36 ,$125.30 ,$142.24 ,$185.27 ,$140.64 ,$40.92 ,$162.62 ,$18.60 ,$100.87 ,$100.87 ,$40.52 ,$100.87 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$618.70 ,$408.34 ,$10.04 ,$618.70 ,$10.04 ,$424.06 ,$424.06 ,$201.61 ,$371.22 ,$525.90 , N/A ,$10.04 ,$10.04 ,$587.77 ,$470.21 ,$464.03 ,$402.16 ,$525.90 ,$201.61 ,$402.16 ,$402.16 ,$433.09 ,$376.79 ,$10.04 ,$201.61 ,$197.58 ,$403.22 ,$10.64 ,$525.90 ,$453.63 ,$569.20 ,$433.09 ,$313.80 ,$376.60 ,$376.79 ,$376.60 ,$427.52 ,$556.83 ,$422.70 ,$199.56 ,$488.77 ,$10.64 ,$303.16 ,$303.16 ,$197.58 ,$303.16 ,$445.46 ,$383.59 ,$445.46 ,$445.46 ,$494.96 
ST NICHOLAS HOSPITAL - ACUTE,26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$205.85 ,$135.86 ,$17.55 ,$205.85 ,$17.55 ,$141.09 ,$141.09 ,$41.35 ,$123.51 ,$174.97 , N/A ,$17.55 ,$17.55 ,$195.56 ,$156.45 ,$154.39 ,$133.80 ,$174.97 ,$41.35 ,$133.80 ,$133.80 ,$144.10 ,$125.36 ,$17.55 ,$41.35 ,$40.52 ,$82.70 ,$18.60 ,$174.97 ,$93.04 ,$189.38 ,$144.10 ,$104.41 ,$125.30 ,$125.36 ,$125.30 ,$142.24 ,$185.27 ,$140.64 ,$40.92 ,$162.62 ,$18.60 ,$100.87 ,$100.87 ,$40.52 ,$100.87 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$193.20 ,$127.51 ,$10.04 ,$193.20 ,$10.04 ,$132.42 ,$132.42 ,$65.85 ,$115.92 ,$164.22 , N/A ,$10.04 ,$10.04 ,$183.54 ,$146.83 ,$144.90 ,$125.58 ,$164.22 ,$65.85 ,$125.58 ,$125.58 ,$135.24 ,$117.66 ,$10.04 ,$65.85 ,$64.53 ,$131.70 ,$10.64 ,$164.22 ,$148.16 ,$177.74 ,$135.24 ,$97.99 ,$117.60 ,$117.66 ,$117.60 ,$133.50 ,$173.88 ,$131.99 ,$65.18 ,$152.63 ,$10.64 ,$94.67 ,$94.67 ,$64.53 ,$94.67 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,26000005,96368,HC INFUS CONCURRENT,260,1 ,$296.70 ,$195.82 ,$10.04 ,$296.70 ,$10.04 ,$203.36 ,$203.36 , N/A ,$178.02 ,$252.20 , N/A ,$10.04 ,$10.04 ,$281.87 ,$225.49 ,$222.53 ,$192.86 ,$252.20 , N/A ,$192.86 ,$192.86 ,$207.69 ,$180.69 ,$10.04 , N/A , N/A , N/A ,$10.64 ,$252.20 , N/A ,$272.96 ,$207.69 ,$150.49 ,$180.60 ,$180.69 ,$180.60 ,$205.02 ,$267.03 ,$202.71 , N/A ,$234.39 ,$10.64 ,$145.38 ,$145.38 , N/A ,$145.38 ,$213.62 ,$183.95 ,$213.62 ,$213.62 ,$237.36 
ST NICHOLAS HOSPITAL - ACUTE,26000014,M0239,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB",260,1 ,$697.00 ,$460.02 ,$309.60 ,$697.00 ,$309.60 ,$477.72 ,$477.72 , N/A ,$418.20 ,$592.45 ,$487.90 ,$309.60 ,$309.60 ,$662.15 ,$529.72 ,$522.75 ,$453.05 ,$592.45 , N/A ,$453.05 ,$453.05 ,$487.90 ,$424.47 ,$309.60 , N/A , N/A , N/A ,$328.18 ,$592.45 , N/A ,$641.24 ,$487.90 ,$353.52 ,$424.26 ,$424.47 ,$424.26 ,$481.63 ,$627.30 ,$476.19 , N/A ,$550.63 ,$328.18 ,$341.53 ,$341.53 , N/A ,$341.53 ,$501.84 ,$432.14 ,$501.84 ,$501.84 ,$557.60 
ST NICHOLAS HOSPITAL - ACUTE,26000015,M0243,"HC INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB ADMINISTRATION",260,1 ,$903.00 ,$595.98 ,$430.90 ,$989.30 ,$450.00 ,$618.92 ,$618.92 ,$439.69 ,$541.80 ,$767.55 ,$632.10 ,$450.00 ,$450.00 ,$857.85 ,$686.28 ,$677.25 ,$586.95 ,$767.55 ,$439.69 ,$586.95 ,$586.95 ,$632.10 ,$549.93 ,$450.00 ,$439.69 ,$430.90 ,$879.38 ,$477.00 ,$767.55 ,$989.30 ,$830.76 ,$632.10 ,$903.00 ,$903.00 ,$549.93 ,$903.00 ,$623.97 ,$812.70 ,$616.93 ,$435.21 ,$713.37 ,$477.00 ,$442.47 ,$442.47 ,$430.90 ,$442.47 ,$650.16 ,$559.86 ,$650.16 ,$650.16 ,$722.40 
ST NICHOLAS HOSPITAL - ACUTE,26000016,M0245,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB AND ETESEVIMAB ADMINISTRATION",260,1 ,$867.10 ,$572.29 ,$424.88 ,$989.30 ,$450.00 ,$594.31 ,$594.31 ,$439.69 ,$520.26 ,$737.04 ,$606.97 ,$450.00 ,$450.00 ,$823.75 ,$659.00 ,$650.33 ,$563.62 ,$737.04 ,$439.69 ,$563.62 ,$563.62 ,$606.97 ,$528.06 ,$450.00 ,$439.69 ,$430.90 ,$867.10 ,$477.00 ,$737.04 ,$989.30 ,$797.73 ,$606.97 ,$867.10 ,$867.10 ,$528.06 ,$867.10 ,$599.17 ,$780.39 ,$592.40 ,$435.21 ,$685.01 ,$477.00 ,$424.88 ,$424.88 ,$430.90 ,$424.88 ,$624.31 ,$537.60 ,$624.31 ,$624.31 ,$693.68 
ST NICHOLAS HOSPITAL - ACUTE,26000017,M0247,"HC INTRAVENOUS INFUSION, SOTROVIMAB ADMINISTRATION",260,1 ,"$1,293.75 ",$853.88 ,$430.90 ,"$1,293.75 ",$450.00 ,$886.74 ,$886.74 ,$439.69 ,$776.25 ,"$1,099.69 ",$905.63 ,$450.00 ,$450.00 ,"$1,229.06 ",$983.25 ,$970.31 ,$840.94 ,"$1,099.69 ",$439.69 ,$840.94 ,$840.94 ,$905.63 ,$787.89 ,$450.00 ,$439.69 ,$430.90 ,$879.38 ,$477.00 ,"$1,099.69 ",$989.30 ,"$1,190.25 ",$905.63 ,"$1,293.75 ","$1,293.75 ",$787.89 ,"$1,293.75 ",$893.98 ,"$1,164.38 ",$883.89 ,$435.21 ,"$1,022.06 ",$477.00 ,$633.94 ,$633.94 ,$430.90 ,$633.94 ,$931.50 ,$802.13 ,$931.50 ,$931.50 ,"$1,035.00 "
ST NICHOLAS HOSPITAL - ACUTE,27000013,N/A,HC PUMP BREAST,270,1 ,$75.00 ,$49.50 ,$38.04 ,$75.00 , N/A ,$51.41 ,$51.41 , N/A ,$45.00 ,$63.75 ,$52.50 , N/A , N/A ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 , N/A ,$48.75 ,$48.75 ,$52.50 ,$45.68 , N/A , N/A , N/A , N/A , N/A ,$63.75 , N/A ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$51.24 , N/A ,$59.25 , N/A ,$44.25 ,$44.25 , N/A ,$44.25 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,27100038,N/A,HC CPAP MASK,271,1 ,$68.00 ,$44.88 ,$34.49 ,$68.00 , N/A ,$46.61 ,$46.61 , N/A ,$40.80 ,$57.80 ,$47.60 , N/A , N/A ,$64.60 ,$51.68 ,$51.00 ,$44.20 ,$57.80 , N/A ,$44.20 ,$44.20 ,$47.60 ,$41.41 , N/A , N/A , N/A , N/A , N/A ,$57.80 , N/A ,$62.56 ,$47.60 ,$34.49 ,$41.39 ,$41.41 ,$41.39 ,$46.99 ,$61.20 ,$46.46 , N/A ,$53.72 , N/A ,$40.12 ,$40.12 , N/A ,$40.12 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$54.40 
ST NICHOLAS HOSPITAL - ACUTE,27100082,N/A,HC LEV I FLUID WARMR/FILTER,271,1 ,"$2,126.00 ","$1,403.16 ","$1,078.31 ","$2,126.00 ", N/A ,"$1,457.16 ","$1,457.16 ", N/A ,"$1,275.60 ","$1,807.10 ","$1,488.20 ", N/A , N/A ,"$2,019.70 ","$1,615.76 ","$1,594.50 ","$1,381.90 ","$1,807.10 ", N/A ,"$1,381.90 ","$1,381.90 ","$1,488.20 ","$1,294.73 ", N/A , N/A , N/A , N/A , N/A ,"$1,807.10 ", N/A ,"$1,955.92 ","$1,488.20 ","$1,078.31 ","$1,294.10 ","$1,294.73 ","$1,294.10 ","$1,469.07 ","$1,913.40 ","$1,452.48 ", N/A ,"$1,679.54 ", N/A ,"$1,254.34 ","$1,254.34 ", N/A ,"$1,254.34 ","$1,530.72 ","$1,318.12 ","$1,530.72 ","$1,530.72 ","$1,700.80 "
ST NICHOLAS HOSPITAL - ACUTE,27100084,N/A,HC MEDIUM VAGINAL DILATOR,271,1 ,$43.00 ,$28.38 ,$21.81 ,$43.00 , N/A ,$29.47 ,$29.47 , N/A ,$25.80 ,$36.55 ,$30.10 , N/A , N/A ,$40.85 ,$32.68 ,$32.25 ,$27.95 ,$36.55 , N/A ,$27.95 ,$27.95 ,$30.10 ,$26.19 , N/A , N/A , N/A , N/A , N/A ,$36.55 , N/A ,$39.56 ,$30.10 ,$21.81 ,$26.17 ,$26.19 ,$26.17 ,$29.71 ,$38.70 ,$29.38 , N/A ,$33.97 , N/A ,$25.37 ,$25.37 , N/A ,$25.37 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$34.40 
ST NICHOLAS HOSPITAL - ACUTE,27100097,N/A,HC NITRIC OXIDE HR ADULT,271,1 ,$608.00 ,$401.28 ,$308.38 ,$608.00 , N/A ,$416.72 ,$416.72 , N/A ,$364.80 ,$516.80 ,$425.60 , N/A , N/A ,$577.60 ,$462.08 ,$456.00 ,$395.20 ,$516.80 , N/A ,$395.20 ,$395.20 ,$425.60 ,$370.27 , N/A , N/A , N/A , N/A , N/A ,$516.80 , N/A ,$559.36 ,$425.60 ,$308.38 ,$370.09 ,$370.27 ,$370.09 ,$420.13 ,$547.20 ,$415.39 , N/A ,$480.32 , N/A ,$358.72 ,$358.72 , N/A ,$358.72 ,$437.76 ,$376.96 ,$437.76 ,$437.76 ,$486.40 
ST NICHOLAS HOSPITAL - ACUTE,27100098,N/A,HC NITRIC OXIDE HR CARDIAC,271,1 ,$608.00 ,$401.28 ,$308.38 ,$608.00 , N/A ,$416.72 ,$416.72 , N/A ,$364.80 ,$516.80 ,$425.60 , N/A , N/A ,$577.60 ,$462.08 ,$456.00 ,$395.20 ,$516.80 , N/A ,$395.20 ,$395.20 ,$425.60 ,$370.27 , N/A , N/A , N/A , N/A , N/A ,$516.80 , N/A ,$559.36 ,$425.60 ,$308.38 ,$370.09 ,$370.27 ,$370.09 ,$420.13 ,$547.20 ,$415.39 , N/A ,$480.32 , N/A ,$358.72 ,$358.72 , N/A ,$358.72 ,$437.76 ,$376.96 ,$437.76 ,$437.76 ,$486.40 
ST NICHOLAS HOSPITAL - ACUTE,27100107,N/A,HC OXYGEN HOURLY,271,1 ,$24.00 ,$15.84 ,$12.17 ,$24.00 , N/A ,$16.45 ,$16.45 , N/A ,$14.40 ,$20.40 ,$16.80 , N/A , N/A ,$22.80 ,$18.24 ,$18.00 ,$15.60 ,$20.40 , N/A ,$15.60 ,$15.60 ,$16.80 ,$14.62 , N/A , N/A , N/A , N/A , N/A ,$20.40 , N/A ,$22.08 ,$16.80 ,$12.17 ,$14.61 ,$14.62 ,$14.61 ,$16.58 ,$21.60 ,$16.40 , N/A ,$18.96 , N/A ,$14.16 ,$14.16 , N/A ,$14.16 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$19.20 
ST NICHOLAS HOSPITAL - ACUTE,27100113,N/A,HC PAVLIK HARNESS,271,1 ,$183.00 ,$120.78 ,$92.82 ,$183.00 , N/A ,$125.43 ,$125.43 , N/A ,$109.80 ,$155.55 ,$128.10 , N/A , N/A ,$173.85 ,$139.08 ,$137.25 ,$118.95 ,$155.55 , N/A ,$118.95 ,$118.95 ,$128.10 ,$111.45 , N/A , N/A , N/A , N/A , N/A ,$155.55 , N/A ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$111.39 ,$126.45 ,$164.70 ,$125.03 , N/A ,$144.57 , N/A ,$107.97 ,$107.97 , N/A ,$107.97 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,27100126,N/A,HC SMALL VAGINAL DILATOR,271,1 ,$38.00 ,$25.08 ,$19.27 ,$38.00 , N/A ,$26.05 ,$26.05 , N/A ,$22.80 ,$32.30 ,$26.60 , N/A , N/A ,$36.10 ,$28.88 ,$28.50 ,$24.70 ,$32.30 , N/A ,$24.70 ,$24.70 ,$26.60 ,$23.14 , N/A , N/A , N/A , N/A , N/A ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$25.96 , N/A ,$30.02 , N/A ,$22.42 ,$22.42 , N/A ,$22.42 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,27100148,L3908,HC SPLINT THUMB SPICA FIT AND ADJUST,274,1 ,$105.00 ,$69.30 ,$53.26 ,$184.99 , N/A , N/A , N/A ,$82.22 ,$63.00 ,$89.25 ,$73.50 , N/A , N/A ,$99.75 ,$79.80 ,$78.75 , N/A ,$89.25 ,$82.22 , N/A , N/A ,$73.50 ,$63.95 , N/A ,$82.22 ,$80.58 ,$105.00 , N/A ,$89.25 ,$184.99 ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 ,$81.38 ,$82.95 , N/A , N/A , N/A ,$80.58 , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,27100258,N/A,HC KIT RT OXYGEN SUPPLY,271,1 ,$84.00 ,$55.44 ,$42.60 ,$84.00 , N/A ,$57.57 ,$57.57 , N/A ,$50.40 ,$71.40 ,$58.80 , N/A , N/A ,$79.80 ,$63.84 ,$63.00 ,$54.60 ,$71.40 , N/A ,$54.60 ,$54.60 ,$58.80 ,$51.16 , N/A , N/A , N/A , N/A , N/A ,$71.40 , N/A ,$77.28 ,$58.80 ,$42.60 ,$51.13 ,$51.16 ,$51.13 ,$58.04 ,$75.60 ,$57.39 , N/A ,$66.36 , N/A ,$49.56 ,$49.56 , N/A ,$49.56 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,BAG PRESSURE INFUSION 1000CC,271,1 ,$13.58 ,$8.96 ,$6.89 ,$13.58 , N/A ,$9.31 ,$9.31 , N/A ,$8.15 ,$11.54 ,$9.51 , N/A , N/A ,$12.90 ,$10.32 ,$10.19 ,$8.83 ,$11.54 , N/A ,$8.83 ,$8.83 ,$9.51 ,$8.27 , N/A , N/A , N/A , N/A , N/A ,$11.54 , N/A ,$12.49 ,$9.51 ,$6.89 ,$8.27 ,$8.27 ,$8.27 ,$9.38 ,$12.22 ,$9.28 , N/A ,$10.73 , N/A ,$8.01 ,$8.01 , N/A ,$8.01 ,$9.78 ,$8.42 ,$9.78 ,$9.78 ,$10.86 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,BLANKET WARMING PEDIATRIC,271,1 ,$24.96 ,$16.47 ,$12.66 ,$24.96 , N/A ,$17.11 ,$17.11 , N/A ,$14.98 ,$21.22 ,$17.47 , N/A , N/A ,$23.71 ,$18.97 ,$18.72 ,$16.22 ,$21.22 , N/A ,$16.22 ,$16.22 ,$17.47 ,$15.20 , N/A , N/A , N/A , N/A , N/A ,$21.22 , N/A ,$22.96 ,$17.47 ,$12.66 ,$15.19 ,$15.20 ,$15.19 ,$17.25 ,$22.46 ,$17.05 , N/A ,$19.72 , N/A ,$14.73 ,$14.73 , N/A ,$14.73 ,$17.97 ,$15.48 ,$17.97 ,$17.97 ,$19.97 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,BRA LARGE 38-10 FRONT CLOSURE,271,1 ,$66.24 ,$43.72 ,$33.60 ,$66.24 , N/A ,$45.40 ,$45.40 , N/A ,$39.74 ,$56.30 ,$46.37 , N/A , N/A ,$62.93 ,$50.34 ,$49.68 ,$43.06 ,$56.30 , N/A ,$43.06 ,$43.06 ,$46.37 ,$40.34 , N/A , N/A , N/A , N/A , N/A ,$56.30 , N/A ,$60.94 ,$46.37 ,$33.60 ,$40.32 ,$40.34 ,$40.32 ,$45.77 ,$59.62 ,$45.26 , N/A ,$52.33 , N/A ,$39.08 ,$39.08 , N/A ,$39.08 ,$47.69 ,$41.07 ,$47.69 ,$47.69 ,$52.99 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,BRA 40-42IN XL LOOP FASTENER THERAPEUTIC SUPPORT ELASTIC BANDAGE WRAP REMOVABLE DRAIN BULB HOLDER POST SURGICAL SURGI-BRA VELCRO COTTON SPANDEX LATEX FREE BREAST WHITE,271,1 ,$66.24 ,$43.72 ,$33.60 ,$66.24 , N/A ,$45.40 ,$45.40 , N/A ,$39.74 ,$56.30 ,$46.37 , N/A , N/A ,$62.93 ,$50.34 ,$49.68 ,$43.06 ,$56.30 , N/A ,$43.06 ,$43.06 ,$46.37 ,$40.34 , N/A , N/A , N/A , N/A , N/A ,$56.30 , N/A ,$60.94 ,$46.37 ,$33.60 ,$40.32 ,$40.34 ,$40.32 ,$45.77 ,$59.62 ,$45.26 , N/A ,$52.33 , N/A ,$39.08 ,$39.08 , N/A ,$39.08 ,$47.69 ,$41.07 ,$47.69 ,$47.69 ,$52.99 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,CAUTERY PENCIL SMOKE EVACUATOR W/HOLSTER,271,1 ,$51.24 ,$33.82 ,$25.99 ,$51.24 , N/A ,$35.12 ,$35.12 , N/A ,$30.74 ,$43.55 ,$35.87 , N/A , N/A ,$48.68 ,$38.94 ,$38.43 ,$33.31 ,$43.55 , N/A ,$33.31 ,$33.31 ,$35.87 ,$31.21 , N/A , N/A , N/A , N/A , N/A ,$43.55 , N/A ,$47.14 ,$35.87 ,$25.99 ,$31.19 ,$31.21 ,$31.19 ,$35.41 ,$46.12 ,$35.01 , N/A ,$40.48 , N/A ,$30.23 ,$30.23 , N/A ,$30.23 ,$36.89 ,$31.77 ,$36.89 ,$36.89 ,$40.99 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,DEVICE POSITIONING STAR TRACTION SLEEVE,271,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A ,$154.22 ,$154.22 , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 ,$146.25 ,$191.25 , N/A ,$146.25 ,$146.25 ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A ,$132.75 ,$132.75 , N/A ,$132.75 ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,MASK LARYNGEAL 5 STANDARD CURVE 12.9MM ADULT AURAGAIN SOFT DIRECT INTUBATION HIGH SEAL PRESSURE RAPID INSERTION LATEX FREE SILICONE PVC POLY CYCLOHEXYLENEDIMETHYLENE TEREPHTHALATE GLYCOL 33ML 88GM STERILE DISPOSABLE,271,1 ,$15.64 ,$10.32 ,$7.93 ,$15.64 , N/A ,$10.72 ,$10.72 , N/A ,$9.38 ,$13.29 ,$10.95 , N/A , N/A ,$14.86 ,$11.89 ,$11.73 ,$10.17 ,$13.29 , N/A ,$10.17 ,$10.17 ,$10.95 ,$9.52 , N/A , N/A , N/A , N/A , N/A ,$13.29 , N/A ,$14.39 ,$10.95 ,$7.93 ,$9.52 ,$9.52 ,$9.52 ,$10.81 ,$14.08 ,$10.69 , N/A ,$12.36 , N/A ,$9.23 ,$9.23 , N/A ,$9.23 ,$11.26 ,$9.70 ,$11.26 ,$11.26 ,$12.51 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,MASK LARYNGEAL 3 STANDARD CURVE 11MM ADULT AURAGAIN SOFT DIRECT INTUBATION HIGH SEAL PRESSURE RAPID INSERTION LATEX FREE SILICONE PVC POLY CYCLOHEXYLENEDIMETHYLENE TEREPHTHALATE GLYCOL 20ML 45GM STERILE DISPOSABLE,271,1 ,$15.64 ,$10.32 ,$7.93 ,$15.64 , N/A ,$10.72 ,$10.72 , N/A ,$9.38 ,$13.29 ,$10.95 , N/A , N/A ,$14.86 ,$11.89 ,$11.73 ,$10.17 ,$13.29 , N/A ,$10.17 ,$10.17 ,$10.95 ,$9.52 , N/A , N/A , N/A , N/A , N/A ,$13.29 , N/A ,$14.39 ,$10.95 ,$7.93 ,$9.52 ,$9.52 ,$9.52 ,$10.81 ,$14.08 ,$10.69 , N/A ,$12.36 , N/A ,$9.23 ,$9.23 , N/A ,$9.23 ,$11.26 ,$9.70 ,$11.26 ,$11.26 ,$12.51 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,MASK LARYNGEAL 4 STANDARD CURVE 12.6MM ADULT AURAGAIN SOFT DIRECT INTUBATION HIGH SEAL PRESSURE RAPID INSERTION LATEX FREE SILICONE PVC POLY CYCLOHEXYLENEDIMETHYLENE TEREPHTHALATE GLYCOL 30ML 63GM STERILE DISPOSABLE,271,1 ,$15.64 ,$10.32 ,$7.93 ,$15.64 , N/A ,$10.72 ,$10.72 , N/A ,$9.38 ,$13.29 ,$10.95 , N/A , N/A ,$14.86 ,$11.89 ,$11.73 ,$10.17 ,$13.29 , N/A ,$10.17 ,$10.17 ,$10.95 ,$9.52 , N/A , N/A , N/A , N/A , N/A ,$13.29 , N/A ,$14.39 ,$10.95 ,$7.93 ,$9.52 ,$9.52 ,$9.52 ,$10.81 ,$14.08 ,$10.69 , N/A ,$12.36 , N/A ,$9.23 ,$9.23 , N/A ,$9.23 ,$11.26 ,$9.70 ,$11.26 ,$11.26 ,$12.51 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,PAD TRACTION BOOT LATEX FREE OT1000,271,1 ,"$1,797.50 ","$1,186.35 ",$911.69 ,"$1,797.50 ", N/A ,"$1,232.01 ","$1,232.01 ", N/A ,"$1,078.50 ","$1,527.88 ","$1,258.25 ", N/A , N/A ,"$1,707.63 ","$1,366.10 ","$1,348.13 ","$1,168.38 ","$1,527.88 ", N/A ,"$1,168.38 ","$1,168.38 ","$1,258.25 ","$1,094.68 ", N/A , N/A , N/A , N/A , N/A ,"$1,527.88 ", N/A ,"$1,653.70 ","$1,258.25 ",$911.69 ,"$1,094.14 ","$1,094.68 ","$1,094.14 ","$1,242.07 ","$1,617.75 ","$1,228.05 ", N/A ,"$1,420.03 ", N/A ,"$1,060.53 ","$1,060.53 ", N/A ,"$1,060.53 ","$1,294.20 ","$1,114.45 ","$1,294.20 ","$1,294.20 ","$1,438.00 "
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,POSITIONER LUMBAR 12IN,271,1 ,$72.37 ,$47.76 ,$36.71 ,$72.37 , N/A ,$49.60 ,$49.60 , N/A ,$43.42 ,$61.51 ,$50.66 , N/A , N/A ,$68.75 ,$55.00 ,$54.28 ,$47.04 ,$61.51 , N/A ,$47.04 ,$47.04 ,$50.66 ,$44.07 , N/A , N/A , N/A , N/A , N/A ,$61.51 , N/A ,$66.58 ,$50.66 ,$36.71 ,$44.05 ,$44.07 ,$44.05 ,$50.01 ,$65.13 ,$49.44 , N/A ,$57.17 , N/A ,$42.70 ,$42.70 , N/A ,$42.70 ,$52.11 ,$44.87 ,$52.11 ,$52.11 ,$57.90 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,PROTECTOR CAST 24IN 21IN SEAL-TIGHT SHORT LEG POLYVINYL DIAPHRAGM STRETCH WATERTIGHT SEAL ADULT LATEX FREE REUSABLE,271,1 ,$43.40 ,$28.64 ,$22.01 ,$43.40 , N/A ,$29.75 ,$29.75 , N/A ,$26.04 ,$36.89 ,$30.38 , N/A , N/A ,$41.23 ,$32.98 ,$32.55 ,$28.21 ,$36.89 , N/A ,$28.21 ,$28.21 ,$30.38 ,$26.43 , N/A , N/A , N/A , N/A , N/A ,$36.89 , N/A ,$39.93 ,$30.38 ,$22.01 ,$26.42 ,$26.43 ,$26.42 ,$29.99 ,$39.06 ,$29.65 , N/A ,$34.29 , N/A ,$25.61 ,$25.61 , N/A ,$25.61 ,$31.25 ,$26.91 ,$31.25 ,$31.25 ,$34.72 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,SCRUB BETADINE 4 OZ,271,1 ,$1.70 ,$1.12 ,$0.86 ,$1.70 , N/A ,$1.17 ,$1.17 , N/A ,$1.02 ,$1.45 ,$1.19 , N/A , N/A ,$1.62 ,$1.29 ,$1.28 ,$1.11 ,$1.45 , N/A ,$1.11 ,$1.11 ,$1.19 ,$1.04 , N/A , N/A , N/A , N/A , N/A ,$1.45 , N/A ,$1.56 ,$1.19 ,$0.86 ,$1.03 ,$1.04 ,$1.03 ,$1.17 ,$1.53 ,$1.16 , N/A ,$1.34 , N/A ,$1.00 ,$1.00 , N/A ,$1.00 ,$1.22 ,$1.05 ,$1.22 ,$1.22 ,$1.36 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,STRAP 53X2IN THK3/8IN WEB HOOK AND LOOP CLOSURE HYPOALLERGENIC FOAM PAD STRONG SURGICAL 25X3IN DISPOSABLE BLACK,271,1 ,$24.26 ,$16.01 ,$12.30 ,$24.26 , N/A ,$16.63 ,$16.63 , N/A ,$14.56 ,$20.62 ,$16.98 , N/A , N/A ,$23.05 ,$18.44 ,$18.20 ,$15.77 ,$20.62 , N/A ,$15.77 ,$15.77 ,$16.98 ,$14.77 , N/A , N/A , N/A , N/A , N/A ,$20.62 , N/A ,$22.32 ,$16.98 ,$12.30 ,$14.77 ,$14.77 ,$14.77 ,$16.76 ,$21.83 ,$16.57 , N/A ,$19.17 , N/A ,$14.31 ,$14.31 , N/A ,$14.31 ,$17.47 ,$15.04 ,$17.47 ,$17.47 ,$19.41 
ST NICHOLAS HOSPITAL - ACUTE,27170000,N/A,TAPE MICROPORE 1,271,1 ,$0.61 ,$0.40 ,$0.31 ,$0.61 , N/A ,$0.42 ,$0.42 , N/A ,$0.37 ,$0.52 ,$0.43 , N/A , N/A ,$0.58 ,$0.46 ,$0.46 ,$0.40 ,$0.52 , N/A ,$0.40 ,$0.40 ,$0.43 ,$0.37 , N/A , N/A , N/A , N/A , N/A ,$0.52 , N/A ,$0.56 ,$0.43 ,$0.31 ,$0.37 ,$0.37 ,$0.37 ,$0.42 ,$0.55 ,$0.42 , N/A ,$0.48 , N/A ,$0.36 ,$0.36 , N/A ,$0.36 ,$0.44 ,$0.38 ,$0.44 ,$0.44 ,$0.49 
ST NICHOLAS HOSPITAL - ACUTE,27200005,B4087,HC MAGNA PORT G-TUBE SET,272,1 ,$58.00 ,$38.28 ,$29.42 ,$58.00 , N/A ,$34.10 ,$34.10 , N/A ,$34.80 ,$49.30 , N/A , N/A , N/A ,$55.10 ,$44.08 ,$43.50 ,$37.70 ,$49.30 , N/A ,$37.70 ,$37.70 ,$40.60 ,$35.32 , N/A , N/A , N/A , N/A , N/A ,$49.30 ,$34.80 ,$53.36 ,$40.60 ,$29.42 ,$35.30 ,$35.32 ,$35.30 ,$40.08 ,$52.20 ,$39.63 , N/A ,$45.82 , N/A ,$34.22 ,$34.22 , N/A ,$34.22 ,$41.76 ,$35.96 ,$41.76 ,$41.76 ,$46.40 
ST NICHOLAS HOSPITAL - ACUTE,27200009,C1724,HC ROTABLATOR BURR,272,1 ,"$1,895.00 ","$1,250.70 ",$961.14 ,"$1,895.00 ", N/A ,"$1,298.83 ","$1,298.83 ", N/A ,"$1,137.00 ","$1,610.75 ", N/A , N/A , N/A ,"$1,800.25 ","$1,440.20 ","$1,421.25 ","$1,231.75 ","$1,610.75 ", N/A ,"$1,231.75 ","$1,231.75 ","$1,326.50 ","$1,154.06 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.75 ", N/A ,"$1,743.40 ","$1,326.50 ",$961.14 ,"$1,153.49 ","$1,154.06 ","$1,153.49 ","$1,309.45 ","$1,705.50 ","$1,294.66 ", N/A ,"$1,497.05 ", N/A ,"$1,118.05 ","$1,118.05 ", N/A ,"$1,118.05 ","$1,364.40 ","$1,174.90 ","$1,364.40 ","$1,364.40 ","$1,516.00 "
ST NICHOLAS HOSPITAL - ACUTE,27200011,C1724,HC ROTALINK PLUS,272,1 ,"$2,417.00 ","$1,595.22 ","$1,225.90 ","$2,417.00 ", N/A ,"$1,656.61 ","$1,656.61 ", N/A ,"$1,450.20 ","$2,054.45 ", N/A , N/A , N/A ,"$2,296.15 ","$1,836.92 ","$1,812.75 ","$1,571.05 ","$2,054.45 ", N/A ,"$1,571.05 ","$1,571.05 ","$1,691.90 ","$1,471.95 ", N/A , N/A , N/A , N/A , N/A ,"$2,054.45 ", N/A ,"$2,223.64 ","$1,691.90 ","$1,225.90 ","$1,471.23 ","$1,471.95 ","$1,471.23 ","$1,670.15 ","$2,175.30 ","$1,651.29 ", N/A ,"$1,909.43 ", N/A ,"$1,426.03 ","$1,426.03 ", N/A ,"$1,426.03 ","$1,740.24 ","$1,498.54 ","$1,740.24 ","$1,740.24 ","$1,933.60 "
ST NICHOLAS HOSPITAL - ACUTE,27200034,C1729,HC CATHETER DRAINAGE,272,1 ,$564.00 ,$372.24 ,$286.06 ,$564.00 , N/A ,$386.57 ,$386.57 , N/A ,$338.40 ,$479.40 , N/A , N/A , N/A ,$535.80 ,$428.64 ,$423.00 ,$366.60 ,$479.40 , N/A ,$366.60 ,$366.60 ,$394.80 ,$343.48 , N/A , N/A , N/A , N/A , N/A ,$479.40 , N/A ,$518.88 ,$394.80 ,$286.06 ,$343.31 ,$343.48 ,$343.31 ,$389.72 ,$507.60 ,$385.32 , N/A ,$445.56 , N/A ,$332.76 ,$332.76 , N/A ,$332.76 ,$406.08 ,$349.68 ,$406.08 ,$406.08 ,$451.20 
ST NICHOLAS HOSPITAL - ACUTE,27200035,C1729,HC CATHETER DRAINAGE PLEUREX,272,1 ,"$1,092.00 ",$720.72 ,$553.86 ,"$1,092.00 ", N/A ,$748.46 ,$748.46 , N/A ,$655.20 ,$928.20 , N/A , N/A , N/A ,"$1,037.40 ",$829.92 ,$819.00 ,$709.80 ,$928.20 , N/A ,$709.80 ,$709.80 ,$764.40 ,$665.03 , N/A , N/A , N/A , N/A , N/A ,$928.20 , N/A ,"$1,004.64 ",$764.40 ,$553.86 ,$664.70 ,$665.03 ,$664.70 ,$754.57 ,$982.80 ,$746.05 , N/A ,$862.68 , N/A ,$644.28 ,$644.28 , N/A ,$644.28 ,$786.24 ,$677.04 ,$786.24 ,$786.24 ,$873.60 
ST NICHOLAS HOSPITAL - ACUTE,27200044,C1729,HC STENT BILIARY PLASTIC,272,1 ,$348.00 ,$229.68 ,$176.51 ,$348.00 , N/A ,$238.52 ,$238.52 , N/A ,$208.80 ,$295.80 , N/A , N/A , N/A ,$330.60 ,$264.48 ,$261.00 ,$226.20 ,$295.80 , N/A ,$226.20 ,$226.20 ,$243.60 ,$211.93 , N/A , N/A , N/A , N/A , N/A ,$295.80 , N/A ,$320.16 ,$243.60 ,$176.51 ,$211.83 ,$211.93 ,$211.83 ,$240.47 ,$313.20 ,$237.75 , N/A ,$274.92 , N/A ,$205.32 ,$205.32 , N/A ,$205.32 ,$250.56 ,$215.76 ,$250.56 ,$250.56 ,$278.40 
ST NICHOLAS HOSPITAL - ACUTE,27200050,C1732,HC RF ABLATION CATHETER,272,1 ,"$3,120.00 ","$2,059.20 ","$1,582.46 ","$3,120.00 ", N/A ,"$2,138.45 ","$2,138.45 ", N/A ,"$1,872.00 ","$2,652.00 ", N/A , N/A , N/A ,"$2,964.00 ","$2,371.20 ","$2,340.00 ","$2,028.00 ","$2,652.00 ", N/A ,"$2,028.00 ","$2,028.00 ","$2,184.00 ","$1,900.08 ", N/A , N/A , N/A , N/A , N/A ,"$2,652.00 ", N/A ,"$2,870.40 ","$2,184.00 ","$1,582.46 ","$1,899.14 ","$1,900.08 ","$1,899.14 ","$2,155.92 ","$2,808.00 ","$2,131.58 ", N/A ,"$2,464.80 ", N/A ,"$1,840.80 ","$1,840.80 ", N/A ,"$1,840.80 ","$2,246.40 ","$1,934.40 ","$2,246.40 ","$2,246.40 ","$2,496.00 "
ST NICHOLAS HOSPITAL - ACUTE,27200052,C1730,HC QUADRIPOLAR CATHETER,272,1 ,$810.00 ,$534.60 ,$410.83 ,$810.00 , N/A ,$555.17 ,$555.17 , N/A ,$486.00 ,$688.50 , N/A , N/A , N/A ,$769.50 ,$615.60 ,$607.50 ,$526.50 ,$688.50 , N/A ,$526.50 ,$526.50 ,$567.00 ,$493.29 , N/A , N/A , N/A , N/A , N/A ,$688.50 , N/A ,$745.20 ,$567.00 ,$410.83 ,$493.05 ,$493.29 ,$493.05 ,$559.71 ,$729.00 ,$553.39 , N/A ,$639.90 , N/A ,$477.90 ,$477.90 , N/A ,$477.90 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$648.00 
ST NICHOLAS HOSPITAL - ACUTE,27200056,C1757,HC ANGIOJET CATHETER,272,1 ,"$3,583.00 ","$2,364.78 ","$1,817.30 ","$3,583.00 ", N/A ,"$2,455.79 ","$2,455.79 ", N/A ,"$2,149.80 ","$3,045.55 ", N/A , N/A , N/A ,"$3,403.85 ","$2,723.08 ","$2,687.25 ","$2,328.95 ","$3,045.55 ", N/A ,"$2,328.95 ","$2,328.95 ","$2,508.10 ","$2,182.05 ", N/A , N/A , N/A , N/A , N/A ,"$3,045.55 ", N/A ,"$3,296.36 ","$2,508.10 ","$1,817.30 ","$2,180.97 ","$2,182.05 ","$2,180.97 ","$2,475.85 ","$3,224.70 ","$2,447.91 ", N/A ,"$2,830.57 ", N/A ,"$2,113.97 ","$2,113.97 ", N/A ,"$2,113.97 ","$2,579.76 ","$2,221.46 ","$2,579.76 ","$2,579.76 ","$2,866.40 "
ST NICHOLAS HOSPITAL - ACUTE,27200077,C1764,HC REVEAL LOOP RECORDER,278,1 ,"$11,569.00 ","$7,635.54 ","$5,668.81 ","$11,569.00 ", N/A ,"$6,098.02 ","$6,098.02 ", N/A ,"$6,941.40 ","$9,833.65 ","$8,098.30 ", N/A , N/A ,"$10,990.55 ","$8,792.44 ","$8,676.75 ","$5,784.50 ","$9,833.65 ", N/A ,"$5,784.50 ","$5,784.50 ","$8,098.30 ","$7,045.52 ", N/A , N/A , N/A , N/A , N/A ,"$9,833.65 ", N/A ,"$10,643.48 ","$8,098.30 ","$5,867.80 ","$7,042.05 ","$7,045.52 ","$7,042.05 ","$7,994.18 ","$10,412.10 ","$7,903.94 ", N/A ,"$9,139.51 ", N/A ,"$5,668.81 ","$5,668.81 ", N/A ,"$5,668.81 ","$8,329.68 ","$7,172.78 ","$8,329.68 ","$8,329.68 ","$9,255.20 "
ST NICHOLAS HOSPITAL - ACUTE,27200117,C1769,SVG HC WAVE WIRE,272,1 ,"$1,117.00 ",$737.22 ,$566.54 ,"$1,117.00 ", N/A ,$765.59 ,$765.59 , N/A ,$670.20 ,$949.45 , N/A , N/A , N/A ,"$1,061.15 ",$848.92 ,$837.75 ,$726.05 ,$949.45 , N/A ,$726.05 ,$726.05 ,$781.90 ,$680.25 , N/A , N/A , N/A , N/A , N/A ,$949.45 , N/A ,"$1,027.64 ",$781.90 ,$566.54 ,$679.92 ,$680.25 ,$679.92 ,$771.85 ,"$1,005.30 ",$763.13 , N/A ,$882.43 , N/A ,$659.03 ,$659.03 , N/A ,$659.03 ,$804.24 ,$692.54 ,$804.24 ,$804.24 ,$893.60 
ST NICHOLAS HOSPITAL - ACUTE,27200138,C1773,HC SNARE RETRIEVAL DEVICE,272,1 ,$559.00 ,$368.94 ,$283.52 ,$559.00 , N/A ,$383.14 ,$383.14 , N/A ,$335.40 ,$475.15 , N/A , N/A , N/A ,$531.05 ,$424.84 ,$419.25 ,$363.35 ,$475.15 , N/A ,$363.35 ,$363.35 ,$391.30 ,$340.43 , N/A , N/A , N/A , N/A , N/A ,$475.15 , N/A ,$514.28 ,$391.30 ,$283.52 ,$340.26 ,$340.43 ,$340.26 ,$386.27 ,$503.10 ,$381.91 , N/A ,$441.61 , N/A ,$329.81 ,$329.81 , N/A ,$329.81 ,$402.48 ,$346.58 ,$402.48 ,$402.48 ,$447.20 
ST NICHOLAS HOSPITAL - ACUTE,27200145,C1874,HC STENT EXPANDABLE COVERED,278,1 ,"$4,853.00 ","$3,202.98 ","$2,426.50 ","$4,853.00 ", N/A ,"$2,558.02 ","$2,558.02 ", N/A ,"$2,911.80 ","$4,125.05 ","$3,397.10 ", N/A , N/A ,"$4,610.35 ","$3,688.28 ","$3,639.75 ","$2,426.50 ","$4,125.05 ", N/A ,"$2,426.50 ","$2,426.50 ","$3,397.10 ","$2,955.48 ", N/A , N/A , N/A , N/A , N/A ,"$4,125.05 ", N/A ,"$4,464.76 ","$3,397.10 ","$2,461.44 ","$2,954.02 ","$2,955.48 ","$2,954.02 ","$3,353.42 ","$4,367.70 ","$3,315.57 ", N/A ,"$3,833.87 ", N/A , N/A , N/A , N/A , N/A ,"$3,494.16 ","$3,008.86 ","$3,494.16 ","$3,494.16 ","$3,882.40 "
ST NICHOLAS HOSPITAL - ACUTE,27200152,C1884,HC EMBOLIZATION PROTECTION SYSTEM,272,1 ,"$3,325.00 ","$2,194.50 ","$1,686.44 ","$3,325.00 ", N/A ,"$2,278.96 ","$2,278.96 ", N/A ,"$1,995.00 ","$2,826.25 ","$2,327.50 ", N/A , N/A ,"$3,158.75 ","$2,527.00 ","$2,493.75 ","$2,161.25 ","$2,826.25 ", N/A ,"$2,161.25 ","$2,161.25 ","$2,327.50 ","$2,024.93 ", N/A , N/A , N/A , N/A , N/A ,"$2,826.25 ", N/A ,"$3,059.00 ","$2,327.50 ","$1,686.44 ","$2,023.93 ","$2,024.93 ","$2,023.93 ","$2,297.58 ","$2,992.50 ","$2,271.64 ", N/A ,"$2,626.75 ", N/A ,"$1,961.75 ","$1,961.75 ", N/A ,"$1,961.75 ","$2,394.00 ","$2,061.50 ","$2,394.00 ","$2,394.00 ","$2,660.00 "
ST NICHOLAS HOSPITAL - ACUTE,27200153,C1885,HC TURBO ELITE LASER CATH,272,1 ,"$5,604.00 ","$3,698.64 ","$2,842.35 ","$5,604.00 ", N/A ,"$3,840.98 ","$3,840.98 ", N/A ,"$3,362.40 ","$4,763.40 ", N/A , N/A , N/A ,"$5,323.80 ","$4,259.04 ","$4,203.00 ","$3,642.60 ","$4,763.40 ", N/A ,"$3,642.60 ","$3,642.60 ","$3,922.80 ","$3,412.84 ", N/A , N/A , N/A , N/A , N/A ,"$4,763.40 ", N/A ,"$5,155.68 ","$3,922.80 ","$2,842.35 ","$3,411.15 ","$3,412.84 ","$3,411.15 ","$3,872.36 ","$5,043.60 ","$3,828.65 ", N/A ,"$4,427.16 ", N/A ,"$3,306.36 ","$3,306.36 ", N/A ,"$3,306.36 ","$4,034.88 ","$3,474.48 ","$4,034.88 ","$4,034.88 ","$4,483.20 "
ST NICHOLAS HOSPITAL - ACUTE,27200163,C1892,HC EP PEEL AWAY SHEATH C1892,272,1 ,$147.00 ,$97.02 ,$74.56 ,$147.00 , N/A ,$100.75 ,$100.75 , N/A ,$88.20 ,$124.95 , N/A , N/A , N/A ,$139.65 ,$111.72 ,$110.25 ,$95.55 ,$124.95 , N/A ,$95.55 ,$95.55 ,$102.90 ,$89.52 , N/A , N/A , N/A , N/A , N/A ,$124.95 , N/A ,$135.24 ,$102.90 ,$74.56 ,$89.48 ,$89.52 ,$89.48 ,$101.58 ,$132.30 ,$100.43 , N/A ,$116.13 , N/A ,$86.73 ,$86.73 , N/A ,$86.73 ,$105.84 ,$91.14 ,$105.84 ,$105.84 ,$117.60 
ST NICHOLAS HOSPITAL - ACUTE,27200185,C1733,HC CRYOABLATION CATHETER,272,1 ,"$8,390.00 ","$5,537.40 ","$4,255.41 ","$8,390.00 ", N/A ,"$5,750.51 ","$5,750.51 ", N/A ,"$5,034.00 ","$7,131.50 ", N/A , N/A , N/A ,"$7,970.50 ","$6,376.40 ","$6,292.50 ","$5,453.50 ","$7,131.50 ", N/A ,"$5,453.50 ","$5,453.50 ","$5,873.00 ","$5,109.51 ", N/A , N/A , N/A , N/A , N/A ,"$7,131.50 ", N/A ,"$7,718.80 ","$5,873.00 ","$4,255.41 ","$5,106.99 ","$5,109.51 ","$5,106.99 ","$5,797.49 ","$7,551.00 ","$5,732.05 ", N/A ,"$6,628.10 ", N/A ,"$4,950.10 ","$4,950.10 ", N/A ,"$4,950.10 ","$6,040.80 ","$5,201.80 ","$6,040.80 ","$6,040.80 ","$6,712.00 "
ST NICHOLAS HOSPITAL - ACUTE,27200252,N/A,HC AORTIC EXTENDER,272,1 ,"$4,271.00 ","$2,818.86 ","$2,166.25 ","$4,271.00 ", N/A ,"$2,927.34 ","$2,927.34 ", N/A ,"$2,562.60 ","$3,630.35 ","$2,989.70 ", N/A , N/A ,"$4,057.45 ","$3,245.96 ","$3,203.25 ","$2,776.15 ","$3,630.35 ", N/A ,"$2,776.15 ","$2,776.15 ","$2,989.70 ","$2,601.04 ", N/A , N/A , N/A , N/A , N/A ,"$3,630.35 ", N/A ,"$3,929.32 ","$2,989.70 ","$2,166.25 ","$2,599.76 ","$2,601.04 ","$2,599.76 ","$2,951.26 ","$3,843.90 ","$2,917.95 ", N/A ,"$3,374.09 ", N/A ,"$2,519.89 ","$2,519.89 ", N/A ,"$2,519.89 ","$3,075.12 ","$2,648.02 ","$3,075.12 ","$3,075.12 ","$3,416.80 "
ST NICHOLAS HOSPITAL - ACUTE,27200280,N/A,HC ASAHI CORSAIR MICROCATHETER,272,1 ,"$2,417.00 ","$1,595.22 ","$1,225.90 ","$2,417.00 ", N/A ,"$1,656.61 ","$1,656.61 ", N/A ,"$1,450.20 ","$2,054.45 ","$1,691.90 ", N/A , N/A ,"$2,296.15 ","$1,836.92 ","$1,812.75 ","$1,571.05 ","$2,054.45 ", N/A ,"$1,571.05 ","$1,571.05 ","$1,691.90 ","$1,471.95 ", N/A , N/A , N/A , N/A , N/A ,"$2,054.45 ", N/A ,"$2,223.64 ","$1,691.90 ","$1,225.90 ","$1,471.23 ","$1,471.95 ","$1,471.23 ","$1,670.15 ","$2,175.30 ","$1,651.29 ", N/A ,"$1,909.43 ", N/A ,"$1,426.03 ","$1,426.03 ", N/A ,"$1,426.03 ","$1,740.24 ","$1,498.54 ","$1,740.24 ","$1,740.24 ","$1,933.60 "
ST NICHOLAS HOSPITAL - ACUTE,27200732,N/A,HC CAPSULE,272,1 ,$40.00 ,$26.40 ,$20.29 ,$40.00 , N/A ,$27.42 ,$27.42 , N/A ,$24.00 ,$34.00 ,$28.00 , N/A , N/A ,$38.00 ,$30.40 ,$30.00 ,$26.00 ,$34.00 , N/A ,$26.00 ,$26.00 ,$28.00 ,$24.36 , N/A , N/A , N/A , N/A , N/A ,$34.00 , N/A ,$36.80 ,$28.00 ,$20.29 ,$24.35 ,$24.36 ,$24.35 ,$27.64 ,$36.00 ,$27.33 , N/A ,$31.60 , N/A ,$23.60 ,$23.60 , N/A ,$23.60 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,27200781,C1730,HC CATH DECAPOLAR,272,1 ,"$1,433.00 ",$945.78 ,$726.82 ,"$1,433.00 ", N/A ,$982.18 ,$982.18 , N/A ,$859.80 ,"$1,218.05 ", N/A , N/A , N/A ,"$1,361.35 ","$1,089.08 ","$1,074.75 ",$931.45 ,"$1,218.05 ", N/A ,$931.45 ,$931.45 ,"$1,003.10 ",$872.70 , N/A , N/A , N/A , N/A , N/A ,"$1,218.05 ", N/A ,"$1,318.36 ","$1,003.10 ",$726.82 ,$872.27 ,$872.70 ,$872.27 ,$990.20 ,"$1,289.70 ",$979.03 , N/A ,"$1,132.07 ", N/A ,$845.47 ,$845.47 , N/A ,$845.47 ,"$1,031.76 ",$888.46 ,"$1,031.76 ","$1,031.76 ","$1,146.40 "
ST NICHOLAS HOSPITAL - ACUTE,27200828,N/A,HC CATH FOLEY TEMPERATURE PROBE 16FR,272,1 ,$128.00 ,$84.48 ,$64.92 ,$128.00 , N/A ,$87.73 ,$87.73 , N/A ,$76.80 ,$108.80 ,$89.60 , N/A , N/A ,$121.60 ,$97.28 ,$96.00 ,$83.20 ,$108.80 , N/A ,$83.20 ,$83.20 ,$89.60 ,$77.95 , N/A , N/A , N/A , N/A , N/A ,$108.80 , N/A ,$117.76 ,$89.60 ,$64.92 ,$77.91 ,$77.95 ,$77.91 ,$88.45 ,$115.20 ,$87.45 , N/A ,$101.12 , N/A ,$75.52 ,$75.52 , N/A ,$75.52 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$102.40 
ST NICHOLAS HOSPITAL - ACUTE,27200990,N/A,HC COSCO CAR BED,272,1 ,$105.00 ,$69.30 ,$53.26 ,$105.00 , N/A ,$71.97 ,$71.97 , N/A ,$63.00 ,$89.25 ,$73.50 , N/A , N/A ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 , N/A ,$68.25 ,$68.25 ,$73.50 ,$63.95 , N/A , N/A , N/A , N/A , N/A ,$89.25 , N/A ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 , N/A ,$82.95 , N/A ,$61.95 ,$61.95 , N/A ,$61.95 ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,27201085,N/A,HC DISPOSABLE CLIPS USED  >4 EACH CLIP,272,1 ,$185.00 ,$122.10 ,$93.83 ,$185.00 , N/A ,$126.80 ,$126.80 , N/A ,$111.00 ,$157.25 ,$129.50 , N/A , N/A ,$175.75 ,$140.60 ,$138.75 ,$120.25 ,$157.25 , N/A ,$120.25 ,$120.25 ,$129.50 ,$112.67 , N/A , N/A , N/A , N/A , N/A ,$157.25 , N/A ,$170.20 ,$129.50 ,$93.83 ,$112.61 ,$112.67 ,$112.61 ,$127.84 ,$166.50 ,$126.39 , N/A ,$146.15 , N/A ,$109.15 ,$109.15 , N/A ,$109.15 ,$133.20 ,$114.70 ,$133.20 ,$133.20 ,$148.00 
ST NICHOLAS HOSPITAL - ACUTE,27201086,C1769,HC GUIDEWIRE,272,1 ,$306.00 ,$201.96 ,$155.20 ,$306.00 , N/A ,$209.73 ,$209.73 , N/A ,$183.60 ,$260.10 , N/A , N/A , N/A ,$290.70 ,$232.56 ,$229.50 ,$198.90 ,$260.10 , N/A ,$198.90 ,$198.90 ,$214.20 ,$186.35 , N/A , N/A , N/A , N/A , N/A ,$260.10 , N/A ,$281.52 ,$214.20 ,$155.20 ,$186.26 ,$186.35 ,$186.26 ,$211.45 ,$275.40 ,$209.06 , N/A ,$241.74 , N/A ,$180.54 ,$180.54 , N/A ,$180.54 ,$220.32 ,$189.72 ,$220.32 ,$220.32 ,$244.80 
ST NICHOLAS HOSPITAL - ACUTE,27201164,N/A,HC MINNESOTA 4 LUMEN TUBE,272,1 ,$953.00 ,$628.98 ,$483.36 ,$953.00 , N/A ,$653.19 ,$653.19 , N/A ,$571.80 ,$810.05 ,$667.10 , N/A , N/A ,$905.35 ,$724.28 ,$714.75 ,$619.45 ,$810.05 , N/A ,$619.45 ,$619.45 ,$667.10 ,$580.38 , N/A , N/A , N/A , N/A , N/A ,$810.05 , N/A ,$876.76 ,$667.10 ,$483.36 ,$580.09 ,$580.38 ,$580.09 ,$658.52 ,$857.70 ,$651.09 , N/A ,$752.87 , N/A ,$562.27 ,$562.27 , N/A ,$562.27 ,$686.16 ,$590.86 ,$686.16 ,$686.16 ,$762.40 
ST NICHOLAS HOSPITAL - ACUTE,27201249,N/A,HC EPIDURAL TRAY CONTINUOUS,272,1 ,$122.00 ,$80.52 ,$61.88 ,$122.00 , N/A ,$83.62 ,$83.62 , N/A ,$73.20 ,$103.70 ,$85.40 , N/A , N/A ,$115.90 ,$92.72 ,$91.50 ,$79.30 ,$103.70 , N/A ,$79.30 ,$79.30 ,$85.40 ,$74.30 , N/A , N/A , N/A , N/A , N/A ,$103.70 , N/A ,$112.24 ,$85.40 ,$61.88 ,$74.26 ,$74.30 ,$74.26 ,$84.30 ,$109.80 ,$83.35 , N/A ,$96.38 , N/A ,$71.98 ,$71.98 , N/A ,$71.98 ,$87.84 ,$75.64 ,$87.84 ,$87.84 ,$97.60 
ST NICHOLAS HOSPITAL - ACUTE,27201282,N/A,HC FEEDING TUBE,272,1 ,$61.00 ,$40.26 ,$30.94 ,$61.00 , N/A ,$41.81 ,$41.81 , N/A ,$36.60 ,$51.85 ,$42.70 , N/A , N/A ,$57.95 ,$46.36 ,$45.75 ,$39.65 ,$51.85 , N/A ,$39.65 ,$39.65 ,$42.70 ,$37.15 , N/A , N/A , N/A , N/A , N/A ,$51.85 , N/A ,$56.12 ,$42.70 ,$30.94 ,$37.13 ,$37.15 ,$37.13 ,$42.15 ,$54.90 ,$41.68 , N/A ,$48.19 , N/A ,$35.99 ,$35.99 , N/A ,$35.99 ,$43.92 ,$37.82 ,$43.92 ,$43.92 ,$48.80 
ST NICHOLAS HOSPITAL - ACUTE,27201340,N/A,SVG HC GELFOAM ANGIO AVITENE,272,1 ,$788.00 ,$520.08 ,$399.67 ,$788.00 , N/A ,$540.10 ,$540.10 , N/A ,$472.80 ,$669.80 ,$551.60 , N/A , N/A ,$748.60 ,$598.88 ,$591.00 ,$512.20 ,$669.80 , N/A ,$512.20 ,$512.20 ,$551.60 ,$479.89 , N/A , N/A , N/A , N/A , N/A ,$669.80 , N/A ,$724.96 ,$551.60 ,$399.67 ,$479.66 ,$479.89 ,$479.66 ,$544.51 ,$709.20 ,$538.36 , N/A ,$622.52 , N/A ,$464.92 ,$464.92 , N/A ,$464.92 ,$567.36 ,$488.56 ,$567.36 ,$567.36 ,$630.40 
ST NICHOLAS HOSPITAL - ACUTE,27201423,N/A,HC HYSTEROSALPINGEOGRAM CATH,272,1 ,$160.00 ,$105.60 ,$81.15 ,$160.00 , N/A ,$109.66 ,$109.66 , N/A ,$96.00 ,$136.00 ,$112.00 , N/A , N/A ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 , N/A ,$104.00 ,$104.00 ,$112.00 ,$97.44 , N/A , N/A , N/A , N/A , N/A ,$136.00 , N/A ,$147.20 ,$112.00 ,$81.15 ,$97.39 ,$97.44 ,$97.39 ,$110.56 ,$144.00 ,$109.31 , N/A ,$126.40 , N/A ,$94.40 ,$94.40 , N/A ,$94.40 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,27201424,N/A,HC IABP BALLOON,272,1 ,"$2,612.00 ","$1,723.92 ","$1,324.81 ","$2,612.00 ", N/A ,"$1,790.26 ","$1,790.26 ", N/A ,"$1,567.20 ","$2,220.20 ","$1,828.40 ", N/A , N/A ,"$2,481.40 ","$1,985.12 ","$1,959.00 ","$1,697.80 ","$2,220.20 ", N/A ,"$1,697.80 ","$1,697.80 ","$1,828.40 ","$1,590.71 ", N/A , N/A , N/A , N/A , N/A ,"$2,220.20 ", N/A ,"$2,403.04 ","$1,828.40 ","$1,324.81 ","$1,589.92 ","$1,590.71 ","$1,589.92 ","$1,804.89 ","$2,350.80 ","$1,784.52 ", N/A ,"$2,063.48 ", N/A ,"$1,541.08 ","$1,541.08 ", N/A ,"$1,541.08 ","$1,880.64 ","$1,619.44 ","$1,880.64 ","$1,880.64 ","$2,089.60 "
ST NICHOLAS HOSPITAL - ACUTE,27201450,N/A,HC INTRODUCER KIT,272,1 ,$195.00 ,$128.70 ,$98.90 ,$195.00 , N/A ,$133.65 ,$133.65 , N/A ,$117.00 ,$165.75 ,$136.50 , N/A , N/A ,$185.25 ,$148.20 ,$146.25 ,$126.75 ,$165.75 , N/A ,$126.75 ,$126.75 ,$136.50 ,$118.76 , N/A , N/A , N/A , N/A , N/A ,$165.75 , N/A ,$179.40 ,$136.50 ,$98.90 ,$118.70 ,$118.76 ,$118.70 ,$134.75 ,$175.50 ,$133.22 , N/A ,$154.05 , N/A ,$115.05 ,$115.05 , N/A ,$115.05 ,$140.40 ,$120.90 ,$140.40 ,$140.40 ,$156.00 
ST NICHOLAS HOSPITAL - ACUTE,27201473,N/A,SVG HC JEJUNOSTOMY TUBE,272,1 ,$306.00 ,$201.96 ,$155.20 ,$306.00 , N/A ,$209.73 ,$209.73 , N/A ,$183.60 ,$260.10 ,$214.20 , N/A , N/A ,$290.70 ,$232.56 ,$229.50 ,$198.90 ,$260.10 , N/A ,$198.90 ,$198.90 ,$214.20 ,$186.35 , N/A , N/A , N/A , N/A , N/A ,$260.10 , N/A ,$281.52 ,$214.20 ,$155.20 ,$186.26 ,$186.35 ,$186.26 ,$211.45 ,$275.40 ,$209.06 , N/A ,$241.74 , N/A ,$180.54 ,$180.54 , N/A ,$180.54 ,$220.32 ,$189.72 ,$220.32 ,$220.32 ,$244.80 
ST NICHOLAS HOSPITAL - ACUTE,27201527,N/A,HC KIT NASAL BLIMP(RHINO ROCKET),272,1 ,$91.00 ,$60.06 ,$46.16 ,$91.00 , N/A ,$62.37 ,$62.37 , N/A ,$54.60 ,$77.35 ,$63.70 , N/A , N/A ,$86.45 ,$69.16 ,$68.25 ,$59.15 ,$77.35 , N/A ,$59.15 ,$59.15 ,$63.70 ,$55.42 , N/A , N/A , N/A , N/A , N/A ,$77.35 , N/A ,$83.72 ,$63.70 ,$46.16 ,$55.39 ,$55.42 ,$55.39 ,$62.88 ,$81.90 ,$62.17 , N/A ,$71.89 , N/A ,$53.69 ,$53.69 , N/A ,$53.69 ,$65.52 ,$56.42 ,$65.52 ,$65.52 ,$72.80 
ST NICHOLAS HOSPITAL - ACUTE,27201640,N/A,HC MANUAL HAND BREAST PUMP,272,1 ,$55.00 ,$36.30 ,$27.90 ,$55.00 , N/A ,$37.70 ,$37.70 , N/A ,$33.00 ,$46.75 ,$38.50 , N/A , N/A ,$52.25 ,$41.80 ,$41.25 ,$35.75 ,$46.75 , N/A ,$35.75 ,$35.75 ,$38.50 ,$33.50 , N/A , N/A , N/A , N/A , N/A ,$46.75 , N/A ,$50.60 ,$38.50 ,$27.90 ,$33.48 ,$33.50 ,$33.48 ,$38.01 ,$49.50 ,$37.58 , N/A ,$43.45 , N/A ,$32.45 ,$32.45 , N/A ,$32.45 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$44.00 
ST NICHOLAS HOSPITAL - ACUTE,27201644,N/A,HC DOUBLE BREAST PUMP KT,272,1 ,$111.00 ,$73.26 ,$56.30 ,$111.00 , N/A ,$76.08 ,$76.08 , N/A ,$66.60 ,$94.35 ,$77.70 , N/A , N/A ,$105.45 ,$84.36 ,$83.25 ,$72.15 ,$94.35 , N/A ,$72.15 ,$72.15 ,$77.70 ,$67.60 , N/A , N/A , N/A , N/A , N/A ,$94.35 , N/A ,$102.12 ,$77.70 ,$56.30 ,$67.57 ,$67.60 ,$67.57 ,$76.70 ,$99.90 ,$75.84 , N/A ,$87.69 , N/A ,$65.49 ,$65.49 , N/A ,$65.49 ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$88.80 
ST NICHOLAS HOSPITAL - ACUTE,27201729,N/A,HC NEOPUFF CIRCUIT AND MASK,272,1 ,$64.00 ,$42.24 ,$32.46 ,$64.00 , N/A ,$43.87 ,$43.87 , N/A ,$38.40 ,$54.40 ,$44.80 , N/A , N/A ,$60.80 ,$48.64 ,$48.00 ,$41.60 ,$54.40 , N/A ,$41.60 ,$41.60 ,$44.80 ,$38.98 , N/A , N/A , N/A , N/A , N/A ,$54.40 , N/A ,$58.88 ,$44.80 ,$32.46 ,$38.96 ,$38.98 ,$38.96 ,$44.22 ,$57.60 ,$43.72 , N/A ,$50.56 , N/A ,$37.76 ,$37.76 , N/A ,$37.76 ,$46.08 ,$39.68 ,$46.08 ,$46.08 ,$51.20 
ST NICHOLAS HOSPITAL - ACUTE,27201768,N/A,HC OUTBACK LTD CATHETER,272,1 ,"$4,748.00 ","$3,133.68 ","$2,408.19 ","$4,748.00 ", N/A ,"$3,254.28 ","$3,254.28 ", N/A ,"$2,848.80 ","$4,035.80 ","$3,323.60 ", N/A , N/A ,"$4,510.60 ","$3,608.48 ","$3,561.00 ","$3,086.20 ","$4,035.80 ", N/A ,"$3,086.20 ","$3,086.20 ","$3,323.60 ","$2,891.53 ", N/A , N/A , N/A , N/A , N/A ,"$4,035.80 ", N/A ,"$4,368.16 ","$3,323.60 ","$2,408.19 ","$2,890.11 ","$2,891.53 ","$2,890.11 ","$3,280.87 ","$4,273.20 ","$3,243.83 ", N/A ,"$3,750.92 ", N/A ,"$2,801.32 ","$2,801.32 ", N/A ,"$2,801.32 ","$3,418.56 ","$2,943.76 ","$3,418.56 ","$3,418.56 ","$3,798.40 "
ST NICHOLAS HOSPITAL - ACUTE,27201829,N/A,HC PELVIC BINDER,272,1 ,$639.00 ,$421.74 ,$324.10 ,$639.00 , N/A ,$437.97 ,$437.97 , N/A ,$383.40 ,$543.15 ,$447.30 , N/A , N/A ,$607.05 ,$485.64 ,$479.25 ,$415.35 ,$543.15 , N/A ,$415.35 ,$415.35 ,$447.30 ,$389.15 , N/A , N/A , N/A , N/A , N/A ,$543.15 , N/A ,$587.88 ,$447.30 ,$324.10 ,$388.96 ,$389.15 ,$388.96 ,$441.55 ,$575.10 ,$436.56 , N/A ,$504.81 , N/A ,$377.01 ,$377.01 , N/A ,$377.01 ,$460.08 ,$396.18 ,$460.08 ,$460.08 ,$511.20 
ST NICHOLAS HOSPITAL - ACUTE,27202002,N/A,HC SCD SLEEVE KNEE,272,1 ,$183.00 ,$120.78 ,$92.82 ,$183.00 , N/A ,$125.43 ,$125.43 , N/A ,$109.80 ,$155.55 ,$128.10 , N/A , N/A ,$173.85 ,$139.08 ,$137.25 ,$118.95 ,$155.55 , N/A ,$118.95 ,$118.95 ,$128.10 ,$111.45 , N/A , N/A , N/A , N/A , N/A ,$155.55 , N/A ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$111.39 ,$126.45 ,$164.70 ,$125.03 , N/A ,$144.57 , N/A ,$107.97 ,$107.97 , N/A ,$107.97 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,27202013,N/A,HC SEALANT FLOSEAL MATRIX,272,1 ,$309.00 ,$203.94 ,$156.72 ,$309.00 , N/A ,$211.79 ,$211.79 , N/A ,$185.40 ,$262.65 ,$216.30 , N/A , N/A ,$293.55 ,$234.84 ,$231.75 ,$200.85 ,$262.65 , N/A ,$200.85 ,$200.85 ,$216.30 ,$188.18 , N/A , N/A , N/A , N/A , N/A ,$262.65 , N/A ,$284.28 ,$216.30 ,$156.72 ,$188.09 ,$188.18 ,$188.09 ,$213.52 ,$278.10 ,$211.11 , N/A ,$244.11 , N/A ,$182.31 ,$182.31 , N/A ,$182.31 ,$222.48 ,$191.58 ,$222.48 ,$222.48 ,$247.20 
ST NICHOLAS HOSPITAL - ACUTE,27202140,N/A,HC STENT PANCREATIC PLASTIC,272,1 ,$348.00 ,$229.68 ,$176.51 ,$348.00 , N/A ,$238.52 ,$238.52 , N/A ,$208.80 ,$295.80 ,$243.60 , N/A , N/A ,$330.60 ,$264.48 ,$261.00 ,$226.20 ,$295.80 , N/A ,$226.20 ,$226.20 ,$243.60 ,$211.93 , N/A , N/A , N/A , N/A , N/A ,$295.80 , N/A ,$320.16 ,$243.60 ,$176.51 ,$211.83 ,$211.93 ,$211.83 ,$240.47 ,$313.20 ,$237.75 , N/A ,$274.92 , N/A ,$205.32 ,$205.32 , N/A ,$205.32 ,$250.56 ,$215.76 ,$250.56 ,$250.56 ,$278.40 
ST NICHOLAS HOSPITAL - ACUTE,27202180,N/A,HC SUPPLEMENTAL NURSING SYSTEM,272,1 ,$57.00 ,$37.62 ,$28.91 ,$57.00 , N/A ,$39.07 ,$39.07 , N/A ,$34.20 ,$48.45 ,$39.90 , N/A , N/A ,$54.15 ,$43.32 ,$42.75 ,$37.05 ,$48.45 , N/A ,$37.05 ,$37.05 ,$39.90 ,$34.71 , N/A , N/A , N/A , N/A , N/A ,$48.45 , N/A ,$52.44 ,$39.90 ,$28.91 ,$34.70 ,$34.71 ,$34.70 ,$39.39 ,$51.30 ,$38.94 , N/A ,$45.03 , N/A ,$33.63 ,$33.63 , N/A ,$33.63 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$45.60 
ST NICHOLAS HOSPITAL - ACUTE,27203025,N/A,HC EMBOLIZATION COIL,272,1 ,$318.00 ,$209.88 ,$161.29 ,$318.00 , N/A ,$217.96 ,$217.96 , N/A ,$190.80 ,$270.30 ,$222.60 , N/A , N/A ,$302.10 ,$241.68 ,$238.50 ,$206.70 ,$270.30 , N/A ,$206.70 ,$206.70 ,$222.60 ,$193.66 , N/A , N/A , N/A , N/A , N/A ,$270.30 , N/A ,$292.56 ,$222.60 ,$161.29 ,$193.57 ,$193.66 ,$193.57 ,$219.74 ,$286.20 ,$217.26 , N/A ,$251.22 , N/A ,$187.62 ,$187.62 , N/A ,$187.62 ,$228.96 ,$197.16 ,$228.96 ,$228.96 ,$254.40 
ST NICHOLAS HOSPITAL - ACUTE,27203043,N/A,HC TRANSESOPHAGEAL SUPPLIES,272,1 ,$438.00 ,$289.08 ,$222.15 ,$438.00 , N/A ,$300.21 ,$300.21 , N/A ,$262.80 ,$372.30 ,$306.60 , N/A , N/A ,$416.10 ,$332.88 ,$328.50 ,$284.70 ,$372.30 , N/A ,$284.70 ,$284.70 ,$306.60 ,$266.74 , N/A , N/A , N/A , N/A , N/A ,$372.30 , N/A ,$402.96 ,$306.60 ,$222.15 ,$266.61 ,$266.74 ,$266.61 ,$302.66 ,$394.20 ,$299.24 , N/A ,$346.02 , N/A ,$258.42 ,$258.42 , N/A ,$258.42 ,$315.36 ,$271.56 ,$315.36 ,$315.36 ,$350.40 
ST NICHOLAS HOSPITAL - ACUTE,27203094,N/A,HC SPECIAL NEEDS FEEDER,272,1 ,$38.00 ,$25.08 ,$19.27 ,$38.00 , N/A ,$26.05 ,$26.05 , N/A ,$22.80 ,$32.30 ,$26.60 , N/A , N/A ,$36.10 ,$28.88 ,$28.50 ,$24.70 ,$32.30 , N/A ,$24.70 ,$24.70 ,$26.60 ,$23.14 , N/A , N/A , N/A , N/A , N/A ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$25.96 , N/A ,$30.02 , N/A ,$22.42 ,$22.42 , N/A ,$22.42 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,27203112,C1885,HC TURBO TANDEM LASER CATHETER,272,1 ,"$8,252.00 ","$5,446.32 ","$4,185.41 ","$8,252.00 ", N/A ,"$5,655.92 ","$5,655.92 ", N/A ,"$4,951.20 ","$7,014.20 ", N/A , N/A , N/A ,"$7,839.40 ","$6,271.52 ","$6,189.00 ","$5,363.80 ","$7,014.20 ", N/A ,"$5,363.80 ","$5,363.80 ","$5,776.40 ","$5,025.47 ", N/A , N/A , N/A , N/A , N/A ,"$7,014.20 ", N/A ,"$7,591.84 ","$5,776.40 ","$4,185.41 ","$5,022.99 ","$5,025.47 ","$5,022.99 ","$5,702.13 ","$7,426.80 ","$5,637.77 ", N/A ,"$6,519.08 ", N/A ,"$4,868.68 ","$4,868.68 ", N/A ,"$4,868.68 ","$5,941.44 ","$5,116.24 ","$5,941.44 ","$5,941.44 ","$6,601.60 "
ST NICHOLAS HOSPITAL - ACUTE,27203113,C1766,HC EP STEERABLE NON PEEL AWAY SHEATH C1766,272,1 ,"$2,670.00 ","$1,762.20 ","$1,354.22 ","$2,670.00 ", N/A ,"$1,830.02 ","$1,830.02 ", N/A ,"$1,602.00 ","$2,269.50 ", N/A , N/A , N/A ,"$2,536.50 ","$2,029.20 ","$2,002.50 ","$1,735.50 ","$2,269.50 ", N/A ,"$1,735.50 ","$1,735.50 ","$1,869.00 ","$1,626.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,269.50 ", N/A ,"$2,456.40 ","$1,869.00 ","$1,354.22 ","$1,625.23 ","$1,626.03 ","$1,625.23 ","$1,844.97 ","$2,403.00 ","$1,824.14 ", N/A ,"$2,109.30 ", N/A ,"$1,575.30 ","$1,575.30 ", N/A ,"$1,575.30 ","$1,922.40 ","$1,655.40 ","$1,922.40 ","$1,922.40 ","$2,136.00 "
ST NICHOLAS HOSPITAL - ACUTE,27203115,C1731,HC HALO/LASSO CATHETER,272,1 ,"$2,913.00 ","$1,922.58 ","$1,477.47 ","$2,913.00 ", N/A ,"$1,996.57 ","$1,996.57 ", N/A ,"$1,747.80 ","$2,476.05 ", N/A , N/A , N/A ,"$2,767.35 ","$2,213.88 ","$2,184.75 ","$1,893.45 ","$2,476.05 ", N/A ,"$1,893.45 ","$1,893.45 ","$2,039.10 ","$1,774.02 ", N/A , N/A , N/A , N/A , N/A ,"$2,476.05 ", N/A ,"$2,679.96 ","$2,039.10 ","$1,477.47 ","$1,773.14 ","$1,774.02 ","$1,773.14 ","$2,012.88 ","$2,621.70 ","$1,990.16 ", N/A ,"$2,301.27 ", N/A ,"$1,718.67 ","$1,718.67 ", N/A ,"$1,718.67 ","$2,097.36 ","$1,806.06 ","$2,097.36 ","$2,097.36 ","$2,330.40 "
ST NICHOLAS HOSPITAL - ACUTE,27203116,N/A,HC NAV-X PATCHES,272,1 ,"$2,311.00 ","$1,525.26 ","$1,172.14 ","$2,311.00 ", N/A ,"$1,583.96 ","$1,583.96 ", N/A ,"$1,386.60 ","$1,964.35 ","$1,617.70 ", N/A , N/A ,"$2,195.45 ","$1,756.36 ","$1,733.25 ","$1,502.15 ","$1,964.35 ", N/A ,"$1,502.15 ","$1,502.15 ","$1,617.70 ","$1,407.40 ", N/A , N/A , N/A , N/A , N/A ,"$1,964.35 ", N/A ,"$2,126.12 ","$1,617.70 ","$1,172.14 ","$1,406.71 ","$1,407.40 ","$1,406.71 ","$1,596.90 ","$2,079.90 ","$1,578.88 ", N/A ,"$1,825.69 ", N/A ,"$1,363.49 ","$1,363.49 ", N/A ,"$1,363.49 ","$1,663.92 ","$1,432.82 ","$1,663.92 ","$1,663.92 ","$1,848.80 "
ST NICHOLAS HOSPITAL - ACUTE,27203169,C1769,HC TRUEPATH,272,1 ,"$4,369.00 ","$2,883.54 ","$2,215.96 ","$4,369.00 ", N/A ,"$2,994.51 ","$2,994.51 ", N/A ,"$2,621.40 ","$3,713.65 ", N/A , N/A , N/A ,"$4,150.55 ","$3,320.44 ","$3,276.75 ","$2,839.85 ","$3,713.65 ", N/A ,"$2,839.85 ","$2,839.85 ","$3,058.30 ","$2,660.72 ", N/A , N/A , N/A , N/A , N/A ,"$3,713.65 ", N/A ,"$4,019.48 ","$3,058.30 ","$2,215.96 ","$2,659.41 ","$2,660.72 ","$2,659.41 ","$3,018.98 ","$3,932.10 ","$2,984.90 ", N/A ,"$3,451.51 ", N/A ,"$2,577.71 ","$2,577.71 ", N/A ,"$2,577.71 ","$3,145.68 ","$2,708.78 ","$3,145.68 ","$3,145.68 ","$3,495.20 "
ST NICHOLAS HOSPITAL - ACUTE,27203225,N/A,HC MRI BREAST BIOPSY KIT,272,1 ,"$1,402.00 ",$925.32 ,$711.09 ,"$1,402.00 ", N/A ,$960.93 ,$960.93 , N/A ,$841.20 ,"$1,191.70 ",$981.40 , N/A , N/A ,"$1,331.90 ","$1,065.52 ","$1,051.50 ",$911.30 ,"$1,191.70 ", N/A ,$911.30 ,$911.30 ,$981.40 ,$853.82 , N/A , N/A , N/A , N/A , N/A ,"$1,191.70 ", N/A ,"$1,289.84 ",$981.40 ,$711.09 ,$853.40 ,$853.82 ,$853.40 ,$968.78 ,"$1,261.80 ",$957.85 , N/A ,"$1,107.58 ", N/A ,$827.18 ,$827.18 , N/A ,$827.18 ,"$1,009.44 ",$869.24 ,"$1,009.44 ","$1,009.44 ","$1,121.60 "
ST NICHOLAS HOSPITAL - ACUTE,27203287,N/A,HC MISC SUPPLY CATH LAB TIER 1,272,1 ,$122.00 ,$80.52 ,$61.88 ,$122.00 , N/A ,$83.62 ,$83.62 , N/A ,$73.20 ,$103.70 ,$85.40 , N/A , N/A ,$115.90 ,$92.72 ,$91.50 ,$79.30 ,$103.70 , N/A ,$79.30 ,$79.30 ,$85.40 ,$74.30 , N/A , N/A , N/A , N/A , N/A ,$103.70 , N/A ,$112.24 ,$85.40 ,$61.88 ,$74.26 ,$74.30 ,$74.26 ,$84.30 ,$109.80 ,$83.35 , N/A ,$96.38 , N/A ,$71.98 ,$71.98 , N/A ,$71.98 ,$87.84 ,$75.64 ,$87.84 ,$87.84 ,$97.60 
ST NICHOLAS HOSPITAL - ACUTE,27203288,N/A,HC MISC SUPPLY CATH LAB TIER 2,272,1 ,$244.00 ,$161.04 ,$123.76 ,$244.00 , N/A ,$167.24 ,$167.24 , N/A ,$146.40 ,$207.40 ,$170.80 , N/A , N/A ,$231.80 ,$185.44 ,$183.00 ,$158.60 ,$207.40 , N/A ,$158.60 ,$158.60 ,$170.80 ,$148.60 , N/A , N/A , N/A , N/A , N/A ,$207.40 , N/A ,$224.48 ,$170.80 ,$123.76 ,$148.52 ,$148.60 ,$148.52 ,$168.60 ,$219.60 ,$166.70 , N/A ,$192.76 , N/A ,$143.96 ,$143.96 , N/A ,$143.96 ,$175.68 ,$151.28 ,$175.68 ,$175.68 ,$195.20 
ST NICHOLAS HOSPITAL - ACUTE,27203289,N/A,HC MISC SUPPLY CATH LAB TIER 3,272,1 ,$426.00 ,$281.16 ,$216.07 ,$426.00 , N/A ,$291.98 ,$291.98 , N/A ,$255.60 ,$362.10 ,$298.20 , N/A , N/A ,$404.70 ,$323.76 ,$319.50 ,$276.90 ,$362.10 , N/A ,$276.90 ,$276.90 ,$298.20 ,$259.43 , N/A , N/A , N/A , N/A , N/A ,$362.10 , N/A ,$391.92 ,$298.20 ,$216.07 ,$259.31 ,$259.43 ,$259.31 ,$294.37 ,$383.40 ,$291.04 , N/A ,$336.54 , N/A ,$251.34 ,$251.34 , N/A ,$251.34 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$340.80 
ST NICHOLAS HOSPITAL - ACUTE,27203292,C1732,HC THERMACOOL ABLATION CATH,272,1 ,"$3,721.00 ","$2,455.86 ","$1,887.29 ","$3,721.00 ", N/A ,"$2,550.37 ","$2,550.37 ", N/A ,"$2,232.60 ","$3,162.85 ", N/A , N/A , N/A ,"$3,534.95 ","$2,827.96 ","$2,790.75 ","$2,418.65 ","$3,162.85 ", N/A ,"$2,418.65 ","$2,418.65 ","$2,604.70 ","$2,266.09 ", N/A , N/A , N/A , N/A , N/A ,"$3,162.85 ", N/A ,"$3,423.32 ","$2,604.70 ","$1,887.29 ","$2,264.97 ","$2,266.09 ","$2,264.97 ","$2,571.21 ","$3,348.90 ","$2,542.19 ", N/A ,"$2,939.59 ", N/A ,"$2,195.39 ","$2,195.39 ", N/A ,"$2,195.39 ","$2,679.12 ","$2,307.02 ","$2,679.12 ","$2,679.12 ","$2,976.80 "
ST NICHOLAS HOSPITAL - ACUTE,27203294,C1893,HC EP NON PEEL AWAY SHEATH C1893,272,1 ,"$2,670.00 ","$1,762.20 ","$1,354.22 ","$2,670.00 ", N/A ,"$1,830.02 ","$1,830.02 ", N/A ,"$1,602.00 ","$2,269.50 ", N/A , N/A , N/A ,"$2,536.50 ","$2,029.20 ","$2,002.50 ","$1,735.50 ","$2,269.50 ", N/A ,"$1,735.50 ","$1,735.50 ","$1,869.00 ","$1,626.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,269.50 ", N/A ,"$2,456.40 ","$1,869.00 ","$1,354.22 ","$1,625.23 ","$1,626.03 ","$1,625.23 ","$1,844.97 ","$2,403.00 ","$1,824.14 ", N/A ,"$2,109.30 ", N/A ,"$1,575.30 ","$1,575.30 ", N/A ,"$1,575.30 ","$1,922.40 ","$1,655.40 ","$1,922.40 ","$1,922.40 ","$2,136.00 "
ST NICHOLAS HOSPITAL - ACUTE,27203400,C1725,HC BALLOON TIER 1,272,1 ,$729.00 ,$481.14 ,$369.75 ,$729.00 , N/A ,$499.66 ,$499.66 , N/A ,$437.40 ,$619.65 , N/A , N/A , N/A ,$692.55 ,$554.04 ,$546.75 ,$473.85 ,$619.65 , N/A ,$473.85 ,$473.85 ,$510.30 ,$443.96 , N/A , N/A , N/A , N/A , N/A ,$619.65 , N/A ,$670.68 ,$510.30 ,$369.75 ,$443.74 ,$443.96 ,$443.74 ,$503.74 ,$656.10 ,$498.05 , N/A ,$575.91 , N/A ,$430.11 ,$430.11 , N/A ,$430.11 ,$524.88 ,$451.98 ,$524.88 ,$524.88 ,$583.20 
ST NICHOLAS HOSPITAL - ACUTE,27203401,C1725,HC BALLOON TIER 2,272,1 ,"$1,092.00 ",$720.72 ,$553.86 ,"$1,092.00 ", N/A ,$748.46 ,$748.46 , N/A ,$655.20 ,$928.20 , N/A , N/A , N/A ,"$1,037.40 ",$829.92 ,$819.00 ,$709.80 ,$928.20 , N/A ,$709.80 ,$709.80 ,$764.40 ,$665.03 , N/A , N/A , N/A , N/A , N/A ,$928.20 , N/A ,"$1,004.64 ",$764.40 ,$553.86 ,$664.70 ,$665.03 ,$664.70 ,$754.57 ,$982.80 ,$746.05 , N/A ,$862.68 , N/A ,$644.28 ,$644.28 , N/A ,$644.28 ,$786.24 ,$677.04 ,$786.24 ,$786.24 ,$873.60 
ST NICHOLAS HOSPITAL - ACUTE,27203402,C1725,HC BALLOON TIER 3,272,1 ,"$2,184.00 ","$1,441.44 ","$1,107.72 ","$2,184.00 ", N/A ,"$1,496.91 ","$1,496.91 ", N/A ,"$1,310.40 ","$1,856.40 ", N/A , N/A , N/A ,"$2,074.80 ","$1,659.84 ","$1,638.00 ","$1,419.60 ","$1,856.40 ", N/A ,"$1,419.60 ","$1,419.60 ","$1,528.80 ","$1,330.06 ", N/A , N/A , N/A , N/A , N/A ,"$1,856.40 ", N/A ,"$2,009.28 ","$1,528.80 ","$1,107.72 ","$1,329.40 ","$1,330.06 ","$1,329.40 ","$1,509.14 ","$1,965.60 ","$1,492.11 ", N/A ,"$1,725.36 ", N/A ,"$1,288.56 ","$1,288.56 ", N/A ,"$1,288.56 ","$1,572.48 ","$1,354.08 ","$1,572.48 ","$1,572.48 ","$1,747.20 "
ST NICHOLAS HOSPITAL - ACUTE,27203403,C1769,HC GUIDEWIRE TIER 1,272,1 ,$122.00 ,$80.52 ,$61.88 ,$122.00 , N/A ,$83.62 ,$83.62 , N/A ,$73.20 ,$103.70 , N/A , N/A , N/A ,$115.90 ,$92.72 ,$91.50 ,$79.30 ,$103.70 , N/A ,$79.30 ,$79.30 ,$85.40 ,$74.30 , N/A , N/A , N/A , N/A , N/A ,$103.70 , N/A ,$112.24 ,$85.40 ,$61.88 ,$74.26 ,$74.30 ,$74.26 ,$84.30 ,$109.80 ,$83.35 , N/A ,$96.38 , N/A ,$71.98 ,$71.98 , N/A ,$71.98 ,$87.84 ,$75.64 ,$87.84 ,$87.84 ,$97.60 
ST NICHOLAS HOSPITAL - ACUTE,27203404,C1769,HC GUIDEWIRE TIER 2,272,1 ,$329.00 ,$217.14 ,$166.87 ,$329.00 , N/A ,$225.50 ,$225.50 , N/A ,$197.40 ,$279.65 , N/A , N/A , N/A ,$312.55 ,$250.04 ,$246.75 ,$213.85 ,$279.65 , N/A ,$213.85 ,$213.85 ,$230.30 ,$200.36 , N/A , N/A , N/A , N/A , N/A ,$279.65 , N/A ,$302.68 ,$230.30 ,$166.87 ,$200.26 ,$200.36 ,$200.26 ,$227.34 ,$296.10 ,$224.77 , N/A ,$259.91 , N/A ,$194.11 ,$194.11 , N/A ,$194.11 ,$236.88 ,$203.98 ,$236.88 ,$236.88 ,$263.20 
ST NICHOLAS HOSPITAL - ACUTE,27203405,C1769,HC GUIDEWIRE TIER 3,272,1 ,"$1,117.00 ",$737.22 ,$566.54 ,"$1,117.00 ", N/A ,$765.59 ,$765.59 , N/A ,$670.20 ,$949.45 , N/A , N/A , N/A ,"$1,061.15 ",$848.92 ,$837.75 ,$726.05 ,$949.45 , N/A ,$726.05 ,$726.05 ,$781.90 ,$680.25 , N/A , N/A , N/A , N/A , N/A ,$949.45 , N/A ,"$1,027.64 ",$781.90 ,$566.54 ,$679.92 ,$680.25 ,$679.92 ,$771.85 ,"$1,005.30 ",$763.13 , N/A ,$882.43 , N/A ,$659.03 ,$659.03 , N/A ,$659.03 ,$804.24 ,$692.54 ,$804.24 ,$804.24 ,$893.60 
ST NICHOLAS HOSPITAL - ACUTE,27203406,C1887,HC CATHETER TIER 1,272,1 ,$62.00 ,$40.92 ,$31.45 ,$62.00 , N/A ,$42.49 ,$42.49 , N/A ,$37.20 ,$52.70 , N/A , N/A , N/A ,$58.90 ,$47.12 ,$46.50 ,$40.30 ,$52.70 , N/A ,$40.30 ,$40.30 ,$43.40 ,$37.76 , N/A , N/A , N/A , N/A , N/A ,$52.70 , N/A ,$57.04 ,$43.40 ,$31.45 ,$37.74 ,$37.76 ,$37.74 ,$42.84 ,$55.80 ,$42.36 , N/A ,$48.98 , N/A ,$36.58 ,$36.58 , N/A ,$36.58 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,27203407,C1887,HC CATHETER TIER 2,272,1 ,$244.00 ,$161.04 ,$123.76 ,$244.00 , N/A ,$167.24 ,$167.24 , N/A ,$146.40 ,$207.40 , N/A , N/A , N/A ,$231.80 ,$185.44 ,$183.00 ,$158.60 ,$207.40 , N/A ,$158.60 ,$158.60 ,$170.80 ,$148.60 , N/A , N/A , N/A , N/A , N/A ,$207.40 , N/A ,$224.48 ,$170.80 ,$123.76 ,$148.52 ,$148.60 ,$148.52 ,$168.60 ,$219.60 ,$166.70 , N/A ,$192.76 , N/A ,$143.96 ,$143.96 , N/A ,$143.96 ,$175.68 ,$151.28 ,$175.68 ,$175.68 ,$195.20 
ST NICHOLAS HOSPITAL - ACUTE,27203408,C1887,HC CATHETER TIER 3,272,1 ,$487.00 ,$321.42 ,$247.01 ,$487.00 , N/A ,$333.79 ,$333.79 , N/A ,$292.20 ,$413.95 , N/A , N/A , N/A ,$462.65 ,$370.12 ,$365.25 ,$316.55 ,$413.95 , N/A ,$316.55 ,$316.55 ,$340.90 ,$296.58 , N/A , N/A , N/A , N/A , N/A ,$413.95 , N/A ,$448.04 ,$340.90 ,$247.01 ,$296.44 ,$296.58 ,$296.44 ,$336.52 ,$438.30 ,$332.72 , N/A ,$384.73 , N/A ,$287.33 ,$287.33 , N/A ,$287.33 ,$350.64 ,$301.94 ,$350.64 ,$350.64 ,$389.60 
ST NICHOLAS HOSPITAL - ACUTE,27203409,C1887,HC CATHETER TIER 4,272,1 ,"$1,153.00 ",$760.98 ,$584.80 ,"$1,153.00 ", N/A ,$790.27 ,$790.27 , N/A ,$691.80 ,$980.05 , N/A , N/A , N/A ,"$1,095.35 ",$876.28 ,$864.75 ,$749.45 ,$980.05 , N/A ,$749.45 ,$749.45 ,$807.10 ,$702.18 , N/A , N/A , N/A , N/A , N/A ,$980.05 , N/A ,"$1,060.76 ",$807.10 ,$584.80 ,$701.83 ,$702.18 ,$701.83 ,$796.72 ,"$1,037.70 ",$787.73 , N/A ,$910.87 , N/A ,$680.27 ,$680.27 , N/A ,$680.27 ,$830.16 ,$714.86 ,$830.16 ,$830.16 ,$922.40 
ST NICHOLAS HOSPITAL - ACUTE,27203410,C1894,HC DIAGNOSTIC SHEATH TIER 1,272,1 ,$122.00 ,$80.52 ,$61.88 ,$122.00 , N/A ,$83.62 ,$83.62 , N/A ,$73.20 ,$103.70 , N/A , N/A , N/A ,$115.90 ,$92.72 ,$91.50 ,$79.30 ,$103.70 , N/A ,$79.30 ,$79.30 ,$85.40 ,$74.30 , N/A , N/A , N/A , N/A , N/A ,$103.70 , N/A ,$112.24 ,$85.40 ,$61.88 ,$74.26 ,$74.30 ,$74.26 ,$84.30 ,$109.80 ,$83.35 , N/A ,$96.38 , N/A ,$71.98 ,$71.98 , N/A ,$71.98 ,$87.84 ,$75.64 ,$87.84 ,$87.84 ,$97.60 
ST NICHOLAS HOSPITAL - ACUTE,27203411,C1894,HC DIAGNOSTIC SHEATH TIER 2,272,1 ,$244.00 ,$161.04 ,$123.76 ,$244.00 , N/A ,$167.24 ,$167.24 , N/A ,$146.40 ,$207.40 , N/A , N/A , N/A ,$231.80 ,$185.44 ,$183.00 ,$158.60 ,$207.40 , N/A ,$158.60 ,$158.60 ,$170.80 ,$148.60 , N/A , N/A , N/A , N/A , N/A ,$207.40 , N/A ,$224.48 ,$170.80 ,$123.76 ,$148.52 ,$148.60 ,$148.52 ,$168.60 ,$219.60 ,$166.70 , N/A ,$192.76 , N/A ,$143.96 ,$143.96 , N/A ,$143.96 ,$175.68 ,$151.28 ,$175.68 ,$175.68 ,$195.20 
ST NICHOLAS HOSPITAL - ACUTE,27203412,C1894,HC DIAGNOSTIC SHEATH TIER 3,272,1 ,$729.00 ,$481.14 ,$369.75 ,$729.00 , N/A ,$499.66 ,$499.66 , N/A ,$437.40 ,$619.65 , N/A , N/A , N/A ,$692.55 ,$554.04 ,$546.75 ,$473.85 ,$619.65 , N/A ,$473.85 ,$473.85 ,$510.30 ,$443.96 , N/A , N/A , N/A , N/A , N/A ,$619.65 , N/A ,$670.68 ,$510.30 ,$369.75 ,$443.74 ,$443.96 ,$443.74 ,$503.74 ,$656.10 ,$498.05 , N/A ,$575.91 , N/A ,$430.11 ,$430.11 , N/A ,$430.11 ,$524.88 ,$451.98 ,$524.88 ,$524.88 ,$583.20 
ST NICHOLAS HOSPITAL - ACUTE,27203413,C1894,HC DIAGNOSTIC SHEATH TIER 4,272,1 ,"$1,456.00 ",$960.96 ,$738.48 ,"$1,456.00 ", N/A ,$997.94 ,$997.94 , N/A ,$873.60 ,"$1,237.60 ", N/A , N/A , N/A ,"$1,383.20 ","$1,106.56 ","$1,092.00 ",$946.40 ,"$1,237.60 ", N/A ,$946.40 ,$946.40 ,"$1,019.20 ",$886.70 , N/A , N/A , N/A , N/A , N/A ,"$1,237.60 ", N/A ,"$1,339.52 ","$1,019.20 ",$738.48 ,$886.27 ,$886.70 ,$886.27 ,"$1,006.10 ","$1,310.40 ",$994.74 , N/A ,"$1,150.24 ", N/A ,$859.04 ,$859.04 , N/A ,$859.04 ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ","$1,164.80 "
ST NICHOLAS HOSPITAL - ACUTE,27203414,C1725,HC POLAR CATH KIT,272,1 ,"$3,629.00 ","$2,395.14 ","$1,840.63 ","$3,629.00 ", N/A ,"$2,487.32 ","$2,487.32 ", N/A ,"$2,177.40 ","$3,084.65 ", N/A , N/A , N/A ,"$3,447.55 ","$2,758.04 ","$2,721.75 ","$2,358.85 ","$3,084.65 ", N/A ,"$2,358.85 ","$2,358.85 ","$2,540.30 ","$2,210.06 ", N/A , N/A , N/A , N/A , N/A ,"$3,084.65 ", N/A ,"$3,338.68 ","$2,540.30 ","$1,840.63 ","$2,208.97 ","$2,210.06 ","$2,208.97 ","$2,507.64 ","$3,266.10 ","$2,479.33 ", N/A ,"$2,866.91 ", N/A ,"$2,141.11 ","$2,141.11 ", N/A ,"$2,141.11 ","$2,612.88 ","$2,249.98 ","$2,612.88 ","$2,612.88 ","$2,903.20 "
ST NICHOLAS HOSPITAL - ACUTE,27203415,C1725,HC BALLOON TIER 4,272,1 ,"$3,397.00 ","$2,242.02 ","$1,722.96 ","$3,397.00 ", N/A ,"$2,328.30 ","$2,328.30 ", N/A ,"$2,038.20 ","$2,887.45 ", N/A , N/A , N/A ,"$3,227.15 ","$2,581.72 ","$2,547.75 ","$2,208.05 ","$2,887.45 ", N/A ,"$2,208.05 ","$2,208.05 ","$2,377.90 ","$2,068.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,887.45 ", N/A ,"$3,125.24 ","$2,377.90 ","$1,722.96 ","$2,067.75 ","$2,068.77 ","$2,067.75 ","$2,347.33 ","$3,057.30 ","$2,320.83 ", N/A ,"$2,683.63 ", N/A ,"$2,004.23 ","$2,004.23 ", N/A ,"$2,004.23 ","$2,445.84 ","$2,106.14 ","$2,445.84 ","$2,445.84 ","$2,717.60 "
ST NICHOLAS HOSPITAL - ACUTE,27203503,N/A,HC CANNULA NASAL HEATED HI FLOW,272,1 ,$109.00 ,$71.94 ,$55.28 ,$109.00 , N/A ,$74.71 ,$74.71 , N/A ,$65.40 ,$92.65 ,$76.30 , N/A , N/A ,$103.55 ,$82.84 ,$81.75 ,$70.85 ,$92.65 , N/A ,$70.85 ,$70.85 ,$76.30 ,$66.38 , N/A , N/A , N/A , N/A , N/A ,$92.65 , N/A ,$100.28 ,$76.30 ,$55.28 ,$66.35 ,$66.38 ,$66.35 ,$75.32 ,$98.10 ,$74.47 , N/A ,$86.11 , N/A ,$64.31 ,$64.31 , N/A ,$64.31 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,27205265,N/A,HC SYSTEM DIRECT VISUALIZATION SPYSCOPE,272,1 ,"$7,383.00 ","$4,872.78 ","$3,744.66 ","$7,383.00 ", N/A ,"$5,060.31 ","$5,060.31 ", N/A ,"$4,429.80 ","$6,275.55 ","$5,168.10 ", N/A , N/A ,"$7,013.85 ","$5,611.08 ","$5,537.25 ","$4,798.95 ","$6,275.55 ", N/A ,"$4,798.95 ","$4,798.95 ","$5,168.10 ","$4,496.25 ", N/A , N/A , N/A , N/A , N/A ,"$6,275.55 ", N/A ,"$6,792.36 ","$5,168.10 ","$3,744.66 ","$4,494.03 ","$4,496.25 ","$4,494.03 ","$5,101.65 ","$6,644.70 ","$5,044.07 ", N/A ,"$5,832.57 ", N/A ,"$4,355.97 ","$4,355.97 ", N/A ,"$4,355.97 ","$5,315.76 ","$4,577.46 ","$5,315.76 ","$5,315.76 ","$5,906.40 "
ST NICHOLAS HOSPITAL - ACUTE,27205430,N/A,HC NEO PUFF TUBING,272,1 ,$37.00 ,$24.42 ,$18.77 ,$37.00 , N/A ,$25.36 ,$25.36 , N/A ,$22.20 ,$31.45 ,$25.90 , N/A , N/A ,$35.15 ,$28.12 ,$27.75 ,$24.05 ,$31.45 , N/A ,$24.05 ,$24.05 ,$25.90 ,$22.53 , N/A , N/A , N/A , N/A , N/A ,$31.45 , N/A ,$34.04 ,$25.90 ,$18.77 ,$22.52 ,$22.53 ,$22.52 ,$25.57 ,$33.30 ,$25.28 , N/A ,$29.23 , N/A ,$21.83 ,$21.83 , N/A ,$21.83 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$29.60 
ST NICHOLAS HOSPITAL - ACUTE,27205487,N/A,HC BOTTLE DRAINAGE SAFETY VAC,272,1 ,$41.00 ,$27.06 ,$20.80 ,$41.00 , N/A ,$28.10 ,$28.10 , N/A ,$24.60 ,$34.85 ,$28.70 , N/A , N/A ,$38.95 ,$31.16 ,$30.75 ,$26.65 ,$34.85 , N/A ,$26.65 ,$26.65 ,$28.70 ,$24.97 , N/A , N/A , N/A , N/A , N/A ,$34.85 , N/A ,$37.72 ,$28.70 ,$20.80 ,$24.96 ,$24.97 ,$24.96 ,$28.33 ,$36.90 ,$28.01 , N/A ,$32.39 , N/A ,$24.19 ,$24.19 , N/A ,$24.19 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,ANCHOR SUTURE 12D 2-0 CURVE RAPIDLOC PANACRYL NEEDLE PLA MENISCAL REPAIR SYSTEM,272,1 ,$505.25 ,$333.47 ,$256.26 ,$505.25 , N/A ,$346.30 ,$346.30 , N/A ,$303.15 ,$429.46 ,$353.68 , N/A , N/A ,$479.99 ,$383.99 ,$378.94 ,$328.41 ,$429.46 , N/A ,$328.41 ,$328.41 ,$353.68 ,$307.70 , N/A , N/A , N/A , N/A , N/A ,$429.46 , N/A ,$464.83 ,$353.68 ,$256.26 ,$307.55 ,$307.70 ,$307.55 ,$349.13 ,$454.73 ,$345.19 , N/A ,$399.15 , N/A ,$298.10 ,$298.10 , N/A ,$298.10 ,$363.78 ,$313.26 ,$363.78 ,$363.78 ,$404.20 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,ANCHOR SUTURE 0D 2-0 RAPIDLOC PANACRYL PDS,272,1 ,$505.25 ,$333.47 ,$256.26 ,$505.25 , N/A ,$346.30 ,$346.30 , N/A ,$303.15 ,$429.46 ,$353.68 , N/A , N/A ,$479.99 ,$383.99 ,$378.94 ,$328.41 ,$429.46 , N/A ,$328.41 ,$328.41 ,$353.68 ,$307.70 , N/A , N/A , N/A , N/A , N/A ,$429.46 , N/A ,$464.83 ,$353.68 ,$256.26 ,$307.55 ,$307.70 ,$307.55 ,$349.13 ,$454.73 ,$345.19 , N/A ,$399.15 , N/A ,$298.10 ,$298.10 , N/A ,$298.10 ,$363.78 ,$313.26 ,$363.78 ,$363.78 ,$404.20 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,ANGEL CPRP PROCESS SET,272,1 ,"$1,014.80 ",$669.77 ,$514.71 ,"$1,014.80 ", N/A ,$695.54 ,$695.54 , N/A ,$608.88 ,$862.58 ,$710.36 , N/A , N/A ,$964.06 ,$771.25 ,$761.10 ,$659.62 ,$862.58 , N/A ,$659.62 ,$659.62 ,$710.36 ,$618.01 , N/A , N/A , N/A , N/A , N/A ,$862.58 , N/A ,$933.62 ,$710.36 ,$514.71 ,$617.71 ,$618.01 ,$617.71 ,$701.23 ,$913.32 ,$693.31 , N/A ,$801.69 , N/A ,$598.73 ,$598.73 , N/A ,$598.73 ,$730.66 ,$629.18 ,$730.66 ,$730.66 ,$811.84 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,APPLICATOR BANDAGE WHITE 50YDX5/8IN SURGITUBE 2 TUBULAR SMALL FINGER TOE COTTON ELASTIC NET LATEX FREE,272,1 ,$20.07 ,$13.25 ,$10.18 ,$20.07 , N/A ,$13.76 ,$13.76 , N/A ,$12.04 ,$17.06 ,$14.05 , N/A , N/A ,$19.07 ,$15.25 ,$15.05 ,$13.05 ,$17.06 , N/A ,$13.05 ,$13.05 ,$14.05 ,$12.22 , N/A , N/A , N/A , N/A , N/A ,$17.06 , N/A ,$18.46 ,$14.05 ,$10.18 ,$12.22 ,$12.22 ,$12.22 ,$13.87 ,$18.06 ,$13.71 , N/A ,$15.86 , N/A ,$11.84 ,$11.84 , N/A ,$11.84 ,$14.45 ,$12.44 ,$14.45 ,$14.45 ,$16.06 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,APPROXIMATOR SURGICAL QUICKPASS TENDON SHUTTLE SMALL L16 CM,272,1 ,$191.25 ,$126.23 ,$97.00 ,$191.25 , N/A ,$131.08 ,$131.08 , N/A ,$114.75 ,$162.56 ,$133.88 , N/A , N/A ,$181.69 ,$145.35 ,$143.44 ,$124.31 ,$162.56 , N/A ,$124.31 ,$124.31 ,$133.88 ,$116.47 , N/A , N/A , N/A , N/A , N/A ,$162.56 , N/A ,$175.95 ,$133.88 ,$97.00 ,$116.41 ,$116.47 ,$116.41 ,$132.15 ,$172.13 ,$130.66 , N/A ,$151.09 , N/A ,$112.84 ,$112.84 , N/A ,$112.84 ,$137.70 ,$118.58 ,$137.70 ,$137.70 ,$153.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BLADE BEAVER 6400 MINI ROUND TIP,272,1 ,$3.56 ,$2.35 ,$1.81 ,$3.56 , N/A ,$2.44 ,$2.44 , N/A ,$2.14 ,$3.03 ,$2.49 , N/A , N/A ,$3.38 ,$2.71 ,$2.67 ,$2.31 ,$3.03 , N/A ,$2.31 ,$2.31 ,$2.49 ,$2.17 , N/A , N/A , N/A , N/A , N/A ,$3.03 , N/A ,$3.28 ,$2.49 ,$1.81 ,$2.17 ,$2.17 ,$2.17 ,$2.46 ,$3.20 ,$2.43 , N/A ,$2.81 , N/A ,$2.10 ,$2.10 , N/A ,$2.10 ,$2.56 ,$2.21 ,$2.56 ,$2.56 ,$2.85 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BLADE HIP CAPSULOTOMY W/O HANDLE,272,1 ,$326.25 ,$215.33 ,$165.47 ,$326.25 , N/A ,$223.61 ,$223.61 , N/A ,$195.75 ,$277.31 ,$228.38 , N/A , N/A ,$309.94 ,$247.95 ,$244.69 ,$212.06 ,$277.31 , N/A ,$212.06 ,$212.06 ,$228.38 ,$198.69 , N/A , N/A , N/A , N/A , N/A ,$277.31 , N/A ,$300.15 ,$228.38 ,$165.47 ,$198.59 ,$198.69 ,$198.59 ,$225.44 ,$293.63 ,$222.89 , N/A ,$257.74 , N/A ,$192.49 ,$192.49 , N/A ,$192.49 ,$234.90 ,$202.28 ,$234.90 ,$234.90 ,$261.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BLADE INTRAMEDULLARY NAIL GOLD 95MM 10.35MM TFN-ADVANCED HELICAL FEMORAL PROXIMAL TITANIUM NIOBIUM ALUMINUM CANNULATED FENESTRATED STERILE,272,1 ,"$1,447.71 ",$955.49 ,$734.28 ,"$1,447.71 ", N/A ,$992.26 ,$992.26 , N/A ,$868.63 ,"$1,230.55 ","$1,013.40 ", N/A , N/A ,"$1,375.32 ","$1,100.26 ","$1,085.78 ",$941.01 ,"$1,230.55 ", N/A ,$941.01 ,$941.01 ,"$1,013.40 ",$881.66 , N/A , N/A , N/A , N/A , N/A ,"$1,230.55 ", N/A ,"$1,331.89 ","$1,013.40 ",$734.28 ,$881.22 ,$881.66 ,$881.22 ,"$1,000.37 ","$1,302.94 ",$989.08 , N/A ,"$1,143.69 ", N/A ,$854.15 ,$854.15 , N/A ,$854.15 ,"$1,042.35 ",$897.58 ,"$1,042.35 ","$1,042.35 ","$1,158.17 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BLADE INTRAMEDULLARY NAIL GOLD 100MM 10.35MM TFN-ADVANCED HELICAL FEMUR PROXIMAL TITANIUM NIOBIUM ALUMINUM CANNULATED STERILE,272,1 ,"$1,447.71 ",$955.49 ,$734.28 ,"$1,447.71 ", N/A ,$992.26 ,$992.26 , N/A ,$868.63 ,"$1,230.55 ","$1,013.40 ", N/A , N/A ,"$1,375.32 ","$1,100.26 ","$1,085.78 ",$941.01 ,"$1,230.55 ", N/A ,$941.01 ,$941.01 ,"$1,013.40 ",$881.66 , N/A , N/A , N/A , N/A , N/A ,"$1,230.55 ", N/A ,"$1,331.89 ","$1,013.40 ",$734.28 ,$881.22 ,$881.66 ,$881.22 ,"$1,000.37 ","$1,302.94 ",$989.08 , N/A ,"$1,143.69 ", N/A ,$854.15 ,$854.15 , N/A ,$854.15 ,"$1,042.35 ",$897.58 ,"$1,042.35 ","$1,042.35 ","$1,158.17 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BLADE SHAVER 22CM 2.9MM SKIMMER M4 JH,272,1 ,"$1,143.41 ",$754.65 ,$579.94 ,"$1,143.41 ", N/A ,$783.69 ,$783.69 , N/A ,$686.05 ,$971.90 ,$800.39 , N/A , N/A ,"$1,086.24 ",$868.99 ,$857.56 ,$743.22 ,$971.90 , N/A ,$743.22 ,$743.22 ,$800.39 ,$696.34 , N/A , N/A , N/A , N/A , N/A ,$971.90 , N/A ,"$1,051.94 ",$800.39 ,$579.94 ,$695.99 ,$696.34 ,$695.99 ,$790.10 ,"$1,029.07 ",$781.18 , N/A ,$903.29 , N/A ,$674.61 ,$674.61 , N/A ,$674.61 ,$823.26 ,$708.91 ,$823.26 ,$823.26 ,$914.73 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BLADE SHAVER XOMED STRAIGHTSHOT 13CM 3.4MM QUADCUT M4,272,1 ,$745.25 ,$491.87 ,$377.99 ,$745.25 , N/A ,$510.79 ,$510.79 , N/A ,$447.15 ,$633.46 ,$521.68 , N/A , N/A ,$707.99 ,$566.39 ,$558.94 ,$484.41 ,$633.46 , N/A ,$484.41 ,$484.41 ,$521.68 ,$453.86 , N/A , N/A , N/A , N/A , N/A ,$633.46 , N/A ,$685.63 ,$521.68 ,$377.99 ,$453.63 ,$453.86 ,$453.63 ,$514.97 ,$670.73 ,$509.15 , N/A ,$588.75 , N/A ,$439.70 ,$439.70 , N/A ,$439.70 ,$536.58 ,$462.06 ,$536.58 ,$536.58 ,$596.20 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BLADE SYNTHES 11.0MM TI HELICAL  85MM STERILE,272,1 ,"$1,368.74 ",$903.37 ,$694.22 ,"$1,368.74 ", N/A ,$938.13 ,$938.13 , N/A ,$821.24 ,"$1,163.43 ",$958.12 , N/A , N/A ,"$1,300.30 ","$1,040.24 ","$1,026.56 ",$889.68 ,"$1,163.43 ", N/A ,$889.68 ,$889.68 ,$958.12 ,$833.56 , N/A , N/A , N/A , N/A , N/A ,"$1,163.43 ", N/A ,"$1,259.24 ",$958.12 ,$694.22 ,$833.15 ,$833.56 ,$833.15 ,$945.80 ,"$1,231.87 ",$935.12 , N/A ,"$1,081.30 ", N/A ,$807.56 ,$807.56 , N/A ,$807.56 ,$985.49 ,$848.62 ,$985.49 ,$985.49 ,"$1,094.99 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BUR STRYKER HELIOCOIDAL RASP MED 3.2MM (5120-80-30),272,1 ,$232.13 ,$153.21 ,$117.74 ,$232.13 , N/A ,$159.10 ,$159.10 , N/A ,$139.28 ,$197.31 ,$162.49 , N/A , N/A ,$220.52 ,$176.42 ,$174.10 ,$150.88 ,$197.31 , N/A ,$150.88 ,$150.88 ,$162.49 ,$141.37 , N/A , N/A , N/A , N/A , N/A ,$197.31 , N/A ,$213.56 ,$162.49 ,$117.74 ,$141.30 ,$141.37 ,$141.30 ,$160.40 ,$208.92 ,$158.59 , N/A ,$183.38 , N/A ,$136.96 ,$136.96 , N/A ,$136.96 ,$167.13 ,$143.92 ,$167.13 ,$167.13 ,$185.70 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BURR SURGICAL 5.5MM XL ROUND HEAD DIAMOND POINT,272,1 ,$279.00 ,$184.14 ,$141.51 ,$279.00 , N/A ,$191.23 ,$191.23 , N/A ,$167.40 ,$237.15 ,$195.30 , N/A , N/A ,$265.05 ,$212.04 ,$209.25 ,$181.35 ,$237.15 , N/A ,$181.35 ,$181.35 ,$195.30 ,$169.91 , N/A , N/A , N/A , N/A , N/A ,$237.15 , N/A ,$256.68 ,$195.30 ,$141.51 ,$169.83 ,$169.91 ,$169.83 ,$192.79 ,$251.10 ,$190.61 , N/A ,$220.41 , N/A ,$164.61 ,$164.61 , N/A ,$164.61 ,$200.88 ,$172.98 ,$200.88 ,$200.88 ,$223.20 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,BURR SURGICAL 4MM XL ROUND DIAMOND,272,1 ,$279.00 ,$184.14 ,$141.51 ,$279.00 , N/A ,$191.23 ,$191.23 , N/A ,$167.40 ,$237.15 ,$195.30 , N/A , N/A ,$265.05 ,$212.04 ,$209.25 ,$181.35 ,$237.15 , N/A ,$181.35 ,$181.35 ,$195.30 ,$169.91 , N/A , N/A , N/A , N/A , N/A ,$237.15 , N/A ,$256.68 ,$195.30 ,$141.51 ,$169.83 ,$169.91 ,$169.83 ,$192.79 ,$251.10 ,$190.61 , N/A ,$220.41 , N/A ,$164.61 ,$164.61 , N/A ,$164.61 ,$200.88 ,$172.98 ,$200.88 ,$200.88 ,$223.20 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CANNULA ARTHREX GEMINI 8.25MM X 9CM (AR-6572),272,1 ,$72.00 ,$47.52 ,$36.52 ,$72.00 , N/A ,$49.35 ,$49.35 , N/A ,$43.20 ,$61.20 ,$50.40 , N/A , N/A ,$68.40 ,$54.72 ,$54.00 ,$46.80 ,$61.20 , N/A ,$46.80 ,$46.80 ,$50.40 ,$43.85 , N/A , N/A , N/A , N/A , N/A ,$61.20 , N/A ,$66.24 ,$50.40 ,$36.52 ,$43.83 ,$43.85 ,$43.83 ,$49.75 ,$64.80 ,$49.19 , N/A ,$56.88 , N/A ,$42.48 ,$42.48 , N/A ,$42.48 ,$51.84 ,$44.64 ,$51.84 ,$51.84 ,$57.60 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CATCH ENDO II 15MM,272,1 ,$858.29 ,$566.47 ,$435.32 ,$858.29 , N/A ,$588.27 ,$588.27 , N/A ,$514.97 ,$729.55 ,$600.80 , N/A , N/A ,$815.38 ,$652.30 ,$643.72 ,$557.89 ,$729.55 , N/A ,$557.89 ,$557.89 ,$600.80 ,$522.70 , N/A , N/A , N/A , N/A , N/A ,$729.55 , N/A ,$789.63 ,$600.80 ,$435.32 ,$522.44 ,$522.70 ,$522.44 ,$593.08 ,$772.46 ,$586.38 , N/A ,$678.05 , N/A ,$506.39 ,$506.39 , N/A ,$506.39 ,$617.97 ,$532.14 ,$617.97 ,$617.97 ,$686.63 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CATHETER BICAP INJECTION 7FR ELECTROHEMOSTASIS,272,1 ,$445.05 ,$293.73 ,$225.73 ,$445.05 , N/A ,$305.04 ,$305.04 , N/A ,$267.03 ,$378.29 ,$311.54 , N/A , N/A ,$422.80 ,$338.24 ,$333.79 ,$289.28 ,$378.29 , N/A ,$289.28 ,$289.28 ,$311.54 ,$271.04 , N/A , N/A , N/A , N/A , N/A ,$378.29 , N/A ,$409.45 ,$311.54 ,$225.73 ,$270.90 ,$271.04 ,$270.90 ,$307.53 ,$400.55 ,$304.06 , N/A ,$351.59 , N/A ,$262.58 ,$262.58 , N/A ,$262.58 ,$320.44 ,$275.93 ,$320.44 ,$320.44 ,$356.04 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CATHETER FOLEY 22FR 3 WAY 30CC,272,1 ,$99.24 ,$65.50 ,$50.33 ,$99.24 , N/A ,$68.02 ,$68.02 , N/A ,$59.54 ,$84.35 ,$69.47 , N/A , N/A ,$94.28 ,$75.42 ,$74.43 ,$64.51 ,$84.35 , N/A ,$64.51 ,$64.51 ,$69.47 ,$60.44 , N/A , N/A , N/A , N/A , N/A ,$84.35 , N/A ,$91.30 ,$69.47 ,$50.33 ,$60.41 ,$60.44 ,$60.41 ,$68.57 ,$89.32 ,$67.80 , N/A ,$78.40 , N/A ,$58.55 ,$58.55 , N/A ,$58.55 ,$71.45 ,$61.53 ,$71.45 ,$71.45 ,$79.39 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CATHETER IT SPINE PROX KIT PUMP REV SEG,272,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A ,$589.44 ,$589.44 , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 ,$559.00 ,$731.00 , N/A ,$559.00 ,$559.00 ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A ,$507.40 ,$507.40 , N/A ,$507.40 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CATHETER PLUG,272,1 ,$0.87 ,$0.57 ,$0.44 ,$0.87 , N/A ,$0.60 ,$0.60 , N/A ,$0.52 ,$0.74 ,$0.61 , N/A , N/A ,$0.83 ,$0.66 ,$0.65 ,$0.57 ,$0.74 , N/A ,$0.57 ,$0.57 ,$0.61 ,$0.53 , N/A , N/A , N/A , N/A , N/A ,$0.74 , N/A ,$0.80 ,$0.61 ,$0.44 ,$0.53 ,$0.53 ,$0.53 ,$0.60 ,$0.78 ,$0.59 , N/A ,$0.69 , N/A ,$0.51 ,$0.51 , N/A ,$0.51 ,$0.63 ,$0.54 ,$0.63 ,$0.63 ,$0.70 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CAUTERY LIGASURE HANDPIECE CURVED SMALL JAW,272,1 ,$627.09 ,$413.88 ,$318.06 ,$627.09 , N/A ,$429.81 ,$429.81 , N/A ,$376.25 ,$533.03 ,$438.96 , N/A , N/A ,$595.74 ,$476.59 ,$470.32 ,$407.61 ,$533.03 , N/A ,$407.61 ,$407.61 ,$438.96 ,$381.90 , N/A , N/A , N/A , N/A , N/A ,$533.03 , N/A ,$576.92 ,$438.96 ,$318.06 ,$381.71 ,$381.90 ,$381.71 ,$433.32 ,$564.38 ,$428.43 , N/A ,$495.40 , N/A ,$369.98 ,$369.98 , N/A ,$369.98 ,$451.50 ,$388.80 ,$451.50 ,$451.50 ,$501.67 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CEMENT RESTRICTORS SMITH  AND  NEPHEW 9-15MM,272,1 ,$808.51 ,$533.62 ,$410.08 ,$808.51 , N/A ,$554.15 ,$554.15 , N/A ,$485.11 ,$687.23 ,$565.96 , N/A , N/A ,$768.08 ,$614.47 ,$606.38 ,$525.53 ,$687.23 , N/A ,$525.53 ,$525.53 ,$565.96 ,$492.38 , N/A , N/A , N/A , N/A , N/A ,$687.23 , N/A ,$743.83 ,$565.96 ,$410.08 ,$492.14 ,$492.38 ,$492.14 ,$558.68 ,$727.66 ,$552.37 , N/A ,$638.72 , N/A ,$477.02 ,$477.02 , N/A ,$477.02 ,$582.13 ,$501.28 ,$582.13 ,$582.13 ,$646.81 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CEMENT RESTRICTORS SMITH  AND  NEPHEW 16-21MM,272,1 ,$808.51 ,$533.62 ,$410.08 ,$808.51 , N/A ,$554.15 ,$554.15 , N/A ,$485.11 ,$687.23 ,$565.96 , N/A , N/A ,$768.08 ,$614.47 ,$606.38 ,$525.53 ,$687.23 , N/A ,$525.53 ,$525.53 ,$565.96 ,$492.38 , N/A , N/A , N/A , N/A , N/A ,$687.23 , N/A ,$743.83 ,$565.96 ,$410.08 ,$492.14 ,$492.38 ,$492.14 ,$558.68 ,$727.66 ,$552.37 , N/A ,$638.72 , N/A ,$477.02 ,$477.02 , N/A ,$477.02 ,$582.13 ,$501.28 ,$582.13 ,$582.13 ,$646.81 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES ADJUSTABLE DISTAL RADIUS,272,1 ,"$1,549.80 ","$1,022.87 ",$786.06 ,"$1,549.80 ", N/A ,"$1,062.23 ","$1,062.23 ", N/A ,$929.88 ,"$1,317.33 ","$1,084.86 ", N/A , N/A ,"$1,472.31 ","$1,177.85 ","$1,162.35 ","$1,007.37 ","$1,317.33 ", N/A ,"$1,007.37 ","$1,007.37 ","$1,084.86 ",$943.83 , N/A , N/A , N/A , N/A , N/A ,"$1,317.33 ", N/A ,"$1,425.82 ","$1,084.86 ",$786.06 ,$943.36 ,$943.83 ,$943.36 ,"$1,070.91 ","$1,394.82 ","$1,058.82 ", N/A ,"$1,224.34 ", N/A ,$914.38 ,$914.38 , N/A ,$914.38 ,"$1,115.86 ",$960.88 ,"$1,115.86 ","$1,115.86 ","$1,239.84 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES LARGE COMBINATION,272,1 ,"$1,318.15 ",$869.98 ,$668.57 ,"$1,318.15 ", N/A ,$903.46 ,$903.46 , N/A ,$790.89 ,"$1,120.43 ",$922.71 , N/A , N/A ,"$1,252.24 ","$1,001.79 ",$988.61 ,$856.80 ,"$1,120.43 ", N/A ,$856.80 ,$856.80 ,$922.71 ,$802.75 , N/A , N/A , N/A , N/A , N/A ,"$1,120.43 ", N/A ,"$1,212.70 ",$922.71 ,$668.57 ,$802.36 ,$802.75 ,$802.36 ,$910.84 ,"$1,186.34 ",$900.56 , N/A ,"$1,041.34 ", N/A ,$777.71 ,$777.71 , N/A ,$777.71 ,$949.07 ,$817.25 ,$949.07 ,$949.07 ,"$1,054.52 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES LARGE MULTI-PIN  4 POSITION,272,1 ,"$1,411.43 ",$931.54 ,$715.88 ,"$1,411.43 ", N/A ,$967.39 ,$967.39 , N/A ,$846.86 ,"$1,199.72 ",$988.00 , N/A , N/A ,"$1,340.86 ","$1,072.69 ","$1,058.57 ",$917.43 ,"$1,199.72 ", N/A ,$917.43 ,$917.43 ,$988.00 ,$859.56 , N/A , N/A , N/A , N/A , N/A ,"$1,199.72 ", N/A ,"$1,298.52 ",$988.00 ,$715.88 ,$859.14 ,$859.56 ,$859.14 ,$975.30 ,"$1,270.29 ",$964.29 , N/A ,"$1,115.03 ", N/A ,$832.74 ,$832.74 , N/A ,$832.74 ,"$1,016.23 ",$875.09 ,"$1,016.23 ","$1,016.23 ","$1,129.14 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES LARGE MULTI-PIN  6 POSITION,272,1 ,"$1,506.75 ",$994.46 ,$764.22 ,"$1,506.75 ", N/A ,"$1,032.73 ","$1,032.73 ", N/A ,$904.05 ,"$1,280.74 ","$1,054.73 ", N/A , N/A ,"$1,431.41 ","$1,145.13 ","$1,130.06 ",$979.39 ,"$1,280.74 ", N/A ,$979.39 ,$979.39 ,"$1,054.73 ",$917.61 , N/A , N/A , N/A , N/A , N/A ,"$1,280.74 ", N/A ,"$1,386.21 ","$1,054.73 ",$764.22 ,$917.16 ,$917.61 ,$917.16 ,"$1,041.16 ","$1,356.08 ","$1,029.41 ", N/A ,"$1,190.33 ", N/A ,$888.98 ,$888.98 , N/A ,$888.98 ,"$1,084.86 ",$934.19 ,"$1,084.86 ","$1,084.86 ","$1,205.40 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES LARGE MULTI-PIN ROD ATTACHMENT,272,1 ,$885.80 ,$584.63 ,$449.28 ,$885.80 , N/A ,$607.13 ,$607.13 , N/A ,$531.48 ,$752.93 ,$620.06 , N/A , N/A ,$841.51 ,$673.21 ,$664.35 ,$575.77 ,$752.93 , N/A ,$575.77 ,$575.77 ,$620.06 ,$539.45 , N/A , N/A , N/A , N/A , N/A ,$752.93 , N/A ,$814.94 ,$620.06 ,$449.28 ,$539.19 ,$539.45 ,$539.19 ,$612.09 ,$797.22 ,$605.18 , N/A ,$699.78 , N/A ,$522.62 ,$522.62 , N/A ,$522.62 ,$637.78 ,$549.20 ,$637.78 ,$637.78 ,$708.64 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES LARGE OPEN ADJUSTABLE,272,1 ,"$1,091.63 ",$720.48 ,$553.67 ,"$1,091.63 ", N/A ,$748.20 ,$748.20 , N/A ,$654.98 ,$927.89 ,$764.14 , N/A , N/A ,"$1,037.05 ",$829.64 ,$818.72 ,$709.56 ,$927.89 , N/A ,$709.56 ,$709.56 ,$764.14 ,$664.80 , N/A , N/A , N/A , N/A , N/A ,$927.89 , N/A ,"$1,004.30 ",$764.14 ,$553.67 ,$664.48 ,$664.80 ,$664.48 ,$754.32 ,$982.47 ,$745.80 , N/A ,$862.39 , N/A ,$644.06 ,$644.06 , N/A ,$644.06 ,$785.97 ,$676.81 ,$785.97 ,$785.97 ,$873.30 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES OPEN 4.0/4.0,272,1 ,$657.69 ,$434.08 ,$333.58 ,$657.69 , N/A ,$450.78 ,$450.78 , N/A ,$394.61 ,$559.04 ,$460.38 , N/A , N/A ,$624.81 ,$499.84 ,$493.27 ,$427.50 ,$559.04 , N/A ,$427.50 ,$427.50 ,$460.38 ,$400.53 , N/A , N/A , N/A , N/A , N/A ,$559.04 , N/A ,$605.07 ,$460.38 ,$333.58 ,$400.34 ,$400.53 ,$400.34 ,$454.46 ,$591.92 ,$449.33 , N/A ,$519.58 , N/A ,$388.04 ,$388.04 , N/A ,$388.04 ,$473.54 ,$407.77 ,$473.54 ,$473.54 ,$526.15 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES OPEN 4.0/2.5,272,1 ,$657.69 ,$434.08 ,$333.58 ,$657.69 , N/A ,$450.78 ,$450.78 , N/A ,$394.61 ,$559.04 ,$460.38 , N/A , N/A ,$624.81 ,$499.84 ,$493.27 ,$427.50 ,$559.04 , N/A ,$427.50 ,$427.50 ,$460.38 ,$400.53 , N/A , N/A , N/A , N/A , N/A ,$559.04 , N/A ,$605.07 ,$460.38 ,$333.58 ,$400.34 ,$400.53 ,$400.34 ,$454.46 ,$591.92 ,$449.33 , N/A ,$519.58 , N/A ,$388.04 ,$388.04 , N/A ,$388.04 ,$473.54 ,$407.77 ,$473.54 ,$473.54 ,$526.15 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES TRANSVERSE,272,1 ,"$1,402.00 ",$925.32 ,$711.09 ,"$1,402.00 ", N/A ,$960.93 ,$960.93 , N/A ,$841.20 ,"$1,191.70 ",$981.40 , N/A , N/A ,"$1,331.90 ","$1,065.52 ","$1,051.50 ",$911.30 ,"$1,191.70 ", N/A ,$911.30 ,$911.30 ,$981.40 ,$853.82 , N/A , N/A , N/A , N/A , N/A ,"$1,191.70 ", N/A ,"$1,289.84 ",$981.40 ,$711.09 ,$853.40 ,$853.82 ,$853.40 ,$968.78 ,"$1,261.80 ",$957.85 , N/A ,"$1,107.58 ", N/A ,$827.18 ,$827.18 , N/A ,$827.18 ,"$1,009.44 ",$869.24 ,"$1,009.44 ","$1,009.44 ","$1,121.60 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLAMP SYNTHES TUBE-TO-TUBE,272,1 ,"$1,402.12 ",$925.40 ,$711.16 ,"$1,402.12 ", N/A ,$961.01 ,$961.01 , N/A ,$841.27 ,"$1,191.80 ",$981.48 , N/A , N/A ,"$1,332.01 ","$1,065.61 ","$1,051.59 ",$911.38 ,"$1,191.80 ", N/A ,$911.38 ,$911.38 ,$981.48 ,$853.89 , N/A , N/A , N/A , N/A , N/A ,"$1,191.80 ", N/A ,"$1,289.95 ",$981.48 ,$711.16 ,$853.47 ,$853.89 ,$853.47 ,$968.86 ,"$1,261.91 ",$957.93 , N/A ,"$1,107.67 ", N/A ,$827.25 ,$827.25 , N/A ,$827.25 ,"$1,009.53 ",$869.31 ,"$1,009.53 ","$1,009.53 ","$1,121.70 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CLIP DURACLIP 2.8MM 235CM 16MM,272,1 ,$222.75 ,$147.02 ,$112.98 ,$222.75 , N/A ,$152.67 ,$152.67 , N/A ,$133.65 ,$189.34 ,$155.93 , N/A , N/A ,$211.61 ,$169.29 ,$167.06 ,$144.79 ,$189.34 , N/A ,$144.79 ,$144.79 ,$155.93 ,$135.65 , N/A , N/A , N/A , N/A , N/A ,$189.34 , N/A ,$204.93 ,$155.93 ,$112.98 ,$135.59 ,$135.65 ,$135.59 ,$153.92 ,$200.48 ,$152.18 , N/A ,$175.97 , N/A ,$131.42 ,$131.42 , N/A ,$131.42 ,$160.38 ,$138.11 ,$160.38 ,$160.38 ,$178.20 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CONNECTOR ROD 6.35MM MONARCH SPINE TITANIUM EXTEND SLOT NONSTERILE LATEX FREE,272,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$843.04 ,$843.04 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 ,$799.50 ,"$1,045.50 ", N/A ,$799.50 ,$799.50 ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A ,$725.70 ,$725.70 , N/A ,$725.70 ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CONNECTOR ROD 6.35MM MONARCH MINI SPINE TITANIUM SLOT LEFT OFFSET NONSTERILE LATEX FREE,272,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$843.04 ,$843.04 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 ,$799.50 ,"$1,045.50 ", N/A ,$799.50 ,$799.50 ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A ,$725.70 ,$725.70 , N/A ,$725.70 ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CONNECTOR ROD 6.35MM MONARCH MINI SPINE TITANIUM SLOT RIGHT OFFSET NONSTERILE LATEX FREE,272,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$843.04 ,$843.04 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 ,$799.50 ,"$1,045.50 ", N/A ,$799.50 ,$799.50 ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A ,$725.70 ,$725.70 , N/A ,$725.70 ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,CUP MEDICINE 2OZ PLASTIC GRADUATE STERILE LATEX FREE DISPOSABLE,272,1 ,$60.95 ,$40.23 ,$30.91 ,$60.95 , N/A ,$41.78 ,$41.78 , N/A ,$36.57 ,$51.81 ,$42.67 , N/A , N/A ,$57.90 ,$46.32 ,$45.71 ,$39.62 ,$51.81 , N/A ,$39.62 ,$39.62 ,$42.67 ,$37.12 , N/A , N/A , N/A , N/A , N/A ,$51.81 , N/A ,$56.07 ,$42.67 ,$30.91 ,$37.10 ,$37.12 ,$37.10 ,$42.12 ,$54.86 ,$41.64 , N/A ,$48.15 , N/A ,$35.96 ,$35.96 , N/A ,$35.96 ,$43.88 ,$37.79 ,$43.88 ,$43.88 ,$48.76 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DEVICE NOVASURE,272,1 ,"$2,105.26 ","$1,389.47 ","$1,067.79 ","$2,105.26 ", N/A ,"$1,442.95 ","$1,442.95 ", N/A ,"$1,263.16 ","$1,789.47 ","$1,473.68 ", N/A , N/A ,"$2,000.00 ","$1,600.00 ","$1,578.95 ","$1,368.42 ","$1,789.47 ", N/A ,"$1,368.42 ","$1,368.42 ","$1,473.68 ","$1,282.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,789.47 ", N/A ,"$1,936.84 ","$1,473.68 ","$1,067.79 ","$1,281.47 ","$1,282.10 ","$1,281.47 ","$1,454.73 ","$1,894.73 ","$1,438.31 ", N/A ,"$1,663.16 ", N/A ,"$1,242.10 ","$1,242.10 ", N/A ,"$1,242.10 ","$1,515.79 ","$1,305.26 ","$1,515.79 ","$1,515.79 ","$1,684.21 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DEVICE SYNETURE V-LOC 0 GS-22 6IN ABSORBABLE BLUE CLOSURE,272,1 ,$46.53 ,$30.71 ,$23.60 ,$46.53 , N/A ,$31.89 ,$31.89 , N/A ,$27.92 ,$39.55 ,$32.57 , N/A , N/A ,$44.20 ,$35.36 ,$34.90 ,$30.24 ,$39.55 , N/A ,$30.24 ,$30.24 ,$32.57 ,$28.34 , N/A , N/A , N/A , N/A , N/A ,$39.55 , N/A ,$42.81 ,$32.57 ,$23.60 ,$28.32 ,$28.34 ,$28.32 ,$32.15 ,$41.88 ,$31.79 , N/A ,$36.76 , N/A ,$27.45 ,$27.45 , N/A ,$27.45 ,$33.50 ,$28.85 ,$33.50 ,$33.50 ,$37.22 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DEVICE V-LOC PBT 0 GS-22 23CM NONABSORBABLE BLUE CLOSURE,272,1 ,$52.31 ,$34.52 ,$26.53 ,$52.31 , N/A ,$35.85 ,$35.85 , N/A ,$31.39 ,$44.46 ,$36.62 , N/A , N/A ,$49.69 ,$39.76 ,$39.23 ,$34.00 ,$44.46 , N/A ,$34.00 ,$34.00 ,$36.62 ,$31.86 , N/A , N/A , N/A , N/A , N/A ,$44.46 , N/A ,$48.13 ,$36.62 ,$26.53 ,$31.84 ,$31.86 ,$31.84 ,$36.15 ,$47.08 ,$35.74 , N/A ,$41.32 , N/A ,$30.86 ,$30.86 , N/A ,$30.86 ,$37.66 ,$32.43 ,$37.66 ,$37.66 ,$41.85 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DISSECTOR 7CM 3.5MM SURGICAL,272,1 ,$285.57 ,$188.48 ,$144.84 ,$285.57 , N/A ,$195.73 ,$195.73 , N/A ,$171.34 ,$242.73 ,$199.90 , N/A , N/A ,$271.29 ,$217.03 ,$214.18 ,$185.62 ,$242.73 , N/A ,$185.62 ,$185.62 ,$199.90 ,$173.91 , N/A , N/A , N/A , N/A , N/A ,$242.73 , N/A ,$262.72 ,$199.90 ,$144.84 ,$173.83 ,$173.91 ,$173.83 ,$197.33 ,$257.01 ,$195.10 , N/A ,$225.60 , N/A ,$168.49 ,$168.49 , N/A ,$168.49 ,$205.61 ,$177.05 ,$205.61 ,$205.61 ,$228.46 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DISSECTOR ENDOSCOPIC 2 CUT 4MM COOLCUT CURVE ARTHROSCOPY,272,1 ,$101.25 ,$66.83 ,$51.35 ,$101.25 , N/A ,$69.40 ,$69.40 , N/A ,$60.75 ,$86.06 ,$70.88 , N/A , N/A ,$96.19 ,$76.95 ,$75.94 ,$65.81 ,$86.06 , N/A ,$65.81 ,$65.81 ,$70.88 ,$61.66 , N/A , N/A , N/A , N/A , N/A ,$86.06 , N/A ,$93.15 ,$70.88 ,$51.35 ,$61.63 ,$61.66 ,$61.63 ,$69.96 ,$91.13 ,$69.17 , N/A ,$79.99 , N/A ,$59.74 ,$59.74 , N/A ,$59.74 ,$72.90 ,$62.78 ,$72.90 ,$72.90 ,$81.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DRAIN WOUND 7FR 1/8IN SILICONE END PERFORATE RADIOPAQUE INDICATOR DOT SMOOTH JACKSON-PRATT ROUND STERILE LATEX FREE DISPOSABLE,272,1 ,$19.14 ,$12.63 ,$9.71 ,$19.14 , N/A ,$13.12 ,$13.12 , N/A ,$11.48 ,$16.27 ,$13.40 , N/A , N/A ,$18.18 ,$14.55 ,$14.36 ,$12.44 ,$16.27 , N/A ,$12.44 ,$12.44 ,$13.40 ,$11.66 , N/A , N/A , N/A , N/A , N/A ,$16.27 , N/A ,$17.61 ,$13.40 ,$9.71 ,$11.65 ,$11.66 ,$11.65 ,$13.23 ,$17.23 ,$13.08 , N/A ,$15.12 , N/A ,$11.29 ,$11.29 , N/A ,$11.29 ,$13.78 ,$11.87 ,$13.78 ,$13.78 ,$15.31 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DRESSING HYDROCOLLOID 4X4IN DUODERM CGF MOISTURE RETENTIVE STERILE LATEX FREE ULCER DISPOSABLE,272,1 ,$3.28 ,$2.16 ,$1.66 ,$3.28 , N/A ,$2.25 ,$2.25 , N/A ,$1.97 ,$2.79 ,$2.30 , N/A , N/A ,$3.12 ,$2.49 ,$2.46 ,$2.13 ,$2.79 , N/A ,$2.13 ,$2.13 ,$2.30 ,$2.00 , N/A , N/A , N/A , N/A , N/A ,$2.79 , N/A ,$3.02 ,$2.30 ,$1.66 ,$2.00 ,$2.00 ,$2.00 ,$2.27 ,$2.95 ,$2.24 , N/A ,$2.59 , N/A ,$1.94 ,$1.94 , N/A ,$1.94 ,$2.36 ,$2.03 ,$2.36 ,$2.36 ,$2.62 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DRESSING MEPILEX 10 X 4,272,1 ,$60.36 ,$39.84 ,$30.61 ,$60.36 , N/A ,$41.37 ,$41.37 , N/A ,$36.22 ,$51.31 ,$42.25 , N/A , N/A ,$57.34 ,$45.87 ,$45.27 ,$39.23 ,$51.31 , N/A ,$39.23 ,$39.23 ,$42.25 ,$36.76 , N/A , N/A , N/A , N/A , N/A ,$51.31 , N/A ,$55.53 ,$42.25 ,$30.61 ,$36.74 ,$36.76 ,$36.74 ,$41.71 ,$54.32 ,$41.24 , N/A ,$47.68 , N/A ,$35.61 ,$35.61 , N/A ,$35.61 ,$43.46 ,$37.42 ,$43.46 ,$43.46 ,$48.29 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DRESSING MEPILEX 12 X 4,272,1 ,$68.98 ,$45.53 ,$34.99 ,$68.98 , N/A ,$47.28 ,$47.28 , N/A ,$41.39 ,$58.63 ,$48.29 , N/A , N/A ,$65.53 ,$52.42 ,$51.74 ,$44.84 ,$58.63 , N/A ,$44.84 ,$44.84 ,$48.29 ,$42.01 , N/A , N/A , N/A , N/A , N/A ,$58.63 , N/A ,$63.46 ,$48.29 ,$34.99 ,$41.99 ,$42.01 ,$41.99 ,$47.67 ,$62.08 ,$47.13 , N/A ,$54.49 , N/A ,$40.70 ,$40.70 , N/A ,$40.70 ,$49.67 ,$42.77 ,$49.67 ,$49.67 ,$55.18 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DRESSING MEPILEX FOAM 12X4IN,272,1 ,$14.05 ,$9.27 ,$7.13 ,$14.05 , N/A ,$9.63 ,$9.63 , N/A ,$8.43 ,$11.94 ,$9.84 , N/A , N/A ,$13.35 ,$10.68 ,$10.54 ,$9.13 ,$11.94 , N/A ,$9.13 ,$9.13 ,$9.84 ,$8.56 , N/A , N/A , N/A , N/A , N/A ,$11.94 , N/A ,$12.93 ,$9.84 ,$7.13 ,$8.55 ,$8.56 ,$8.55 ,$9.71 ,$12.65 ,$9.60 , N/A ,$11.10 , N/A ,$8.29 ,$8.29 , N/A ,$8.29 ,$10.12 ,$8.71 ,$10.12 ,$10.12 ,$11.24 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DRESSING V.A.C. ABTHERA OPEN ABDOMEN,272,1 ,$874.28 ,$577.02 ,$443.43 ,$874.28 , N/A ,$599.23 ,$599.23 , N/A ,$524.57 ,$743.14 ,$612.00 , N/A , N/A ,$830.57 ,$664.45 ,$655.71 ,$568.28 ,$743.14 , N/A ,$568.28 ,$568.28 ,$612.00 ,$532.44 , N/A , N/A , N/A , N/A , N/A ,$743.14 , N/A ,$804.34 ,$612.00 ,$443.43 ,$532.17 ,$532.44 ,$532.17 ,$604.13 ,$786.85 ,$597.31 , N/A ,$690.68 , N/A ,$515.83 ,$515.83 , N/A ,$515.83 ,$629.48 ,$542.05 ,$629.48 ,$629.48 ,$699.42 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,DRILL BIT ARTHREX 2.6MM CANNULATED,272,1 ,$393.75 ,$259.88 ,$199.71 ,$393.75 , N/A ,$269.88 ,$269.88 , N/A ,$236.25 ,$334.69 ,$275.63 , N/A , N/A ,$374.06 ,$299.25 ,$295.31 ,$255.94 ,$334.69 , N/A ,$255.94 ,$255.94 ,$275.63 ,$239.79 , N/A , N/A , N/A , N/A , N/A ,$334.69 , N/A ,$362.25 ,$275.63 ,$199.71 ,$239.68 ,$239.79 ,$239.68 ,$272.08 ,$354.38 ,$269.01 , N/A ,$311.06 , N/A ,$232.31 ,$232.31 , N/A ,$232.31 ,$283.50 ,$244.13 ,$283.50 ,$283.50 ,$315.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,ELECTRODE ELECTROSURGICAL INSULATED BLADE 2.75IN 3/32IN EDGE,272,1 ,$6.72 ,$4.44 ,$3.41 ,$6.72 , N/A ,$4.61 ,$4.61 , N/A ,$4.03 ,$5.71 ,$4.70 , N/A , N/A ,$6.38 ,$5.11 ,$5.04 ,$4.37 ,$5.71 , N/A ,$4.37 ,$4.37 ,$4.70 ,$4.09 , N/A , N/A , N/A , N/A , N/A ,$5.71 , N/A ,$6.18 ,$4.70 ,$3.41 ,$4.09 ,$4.09 ,$4.09 ,$4.64 ,$6.05 ,$4.59 , N/A ,$5.31 , N/A ,$3.96 ,$3.96 , N/A ,$3.96 ,$4.84 ,$4.17 ,$4.84 ,$4.84 ,$5.38 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,ELECTRODE ELECTROSURGICAL INSULATED BOVIE TIP 6.5IN,272,1 ,$7.12 ,$4.70 ,$3.61 ,$7.12 , N/A ,$4.88 ,$4.88 , N/A ,$4.27 ,$6.05 ,$4.98 , N/A , N/A ,$6.76 ,$5.41 ,$5.34 ,$4.63 ,$6.05 , N/A ,$4.63 ,$4.63 ,$4.98 ,$4.34 , N/A , N/A , N/A , N/A , N/A ,$6.05 , N/A ,$6.55 ,$4.98 ,$3.61 ,$4.33 ,$4.34 ,$4.33 ,$4.92 ,$6.41 ,$4.86 , N/A ,$5.62 , N/A ,$4.20 ,$4.20 , N/A ,$4.20 ,$5.13 ,$4.41 ,$5.13 ,$5.13 ,$5.70 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,EXTRACTOR STONE 65CM 4.5FR 2CM WIRE NCIRCLE NITINOL STERILE,272,1 ,$407.05 ,$268.65 ,$206.46 ,$407.05 , N/A ,$278.99 ,$278.99 , N/A ,$244.23 ,$345.99 ,$284.94 , N/A , N/A ,$386.70 ,$309.36 ,$305.29 ,$264.58 ,$345.99 , N/A ,$264.58 ,$264.58 ,$284.94 ,$247.89 , N/A , N/A , N/A , N/A , N/A ,$345.99 , N/A ,$374.49 ,$284.94 ,$206.46 ,$247.77 ,$247.89 ,$247.77 ,$281.27 ,$366.35 ,$278.10 , N/A ,$321.57 , N/A ,$240.16 ,$240.16 , N/A ,$240.16 ,$293.08 ,$252.37 ,$293.08 ,$293.08 ,$325.64 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,FIBERTAK W SUTURE TAPE,272,1 ,$763.25 ,$503.75 ,$387.12 ,$763.25 , N/A ,$523.13 ,$523.13 , N/A ,$457.95 ,$648.76 ,$534.28 , N/A , N/A ,$725.09 ,$580.07 ,$572.44 ,$496.11 ,$648.76 , N/A ,$496.11 ,$496.11 ,$534.28 ,$464.82 , N/A , N/A , N/A , N/A , N/A ,$648.76 , N/A ,$702.19 ,$534.28 ,$387.12 ,$464.59 ,$464.82 ,$464.59 ,$527.41 ,$686.93 ,$521.45 , N/A ,$602.97 , N/A ,$450.32 ,$450.32 , N/A ,$450.32 ,$549.54 ,$473.22 ,$549.54 ,$549.54 ,$610.60 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,FLIPCUTTER II SHORT 9.5MM,272,1 ,$698.75 ,$461.18 ,$354.41 ,$698.75 , N/A ,$478.92 ,$478.92 , N/A ,$419.25 ,$593.94 ,$489.13 , N/A , N/A ,$663.81 ,$531.05 ,$524.06 ,$454.19 ,$593.94 , N/A ,$454.19 ,$454.19 ,$489.13 ,$425.54 , N/A , N/A , N/A , N/A , N/A ,$593.94 , N/A ,$642.85 ,$489.13 ,$354.41 ,$425.33 ,$425.54 ,$425.33 ,$482.84 ,$628.88 ,$477.39 , N/A ,$552.01 , N/A ,$412.26 ,$412.26 , N/A ,$412.26 ,$503.10 ,$433.23 ,$503.10 ,$503.10 ,$559.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,FLIPCUTTER II SHORT 8.5MM,272,1 ,$698.75 ,$461.18 ,$354.41 ,$698.75 , N/A ,$478.92 ,$478.92 , N/A ,$419.25 ,$593.94 ,$489.13 , N/A , N/A ,$663.81 ,$531.05 ,$524.06 ,$454.19 ,$593.94 , N/A ,$454.19 ,$454.19 ,$489.13 ,$425.54 , N/A , N/A , N/A , N/A , N/A ,$593.94 , N/A ,$642.85 ,$489.13 ,$354.41 ,$425.33 ,$425.54 ,$425.33 ,$482.84 ,$628.88 ,$477.39 , N/A ,$552.01 , N/A ,$412.26 ,$412.26 , N/A ,$412.26 ,$503.10 ,$433.23 ,$503.10 ,$503.10 ,$559.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,FLIPCUTTER II SHORT 9.0MM,272,1 ,$698.75 ,$461.18 ,$354.41 ,$698.75 , N/A ,$478.92 ,$478.92 , N/A ,$419.25 ,$593.94 ,$489.13 , N/A , N/A ,$663.81 ,$531.05 ,$524.06 ,$454.19 ,$593.94 , N/A ,$454.19 ,$454.19 ,$489.13 ,$425.54 , N/A , N/A , N/A , N/A , N/A ,$593.94 , N/A ,$642.85 ,$489.13 ,$354.41 ,$425.33 ,$425.54 ,$425.33 ,$482.84 ,$628.88 ,$477.39 , N/A ,$552.01 , N/A ,$412.26 ,$412.26 , N/A ,$412.26 ,$503.10 ,$433.23 ,$503.10 ,$503.10 ,$559.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,FORCEP STONE RETRIEVAL NITINOL GRASPIT BOSTON SCI 2.6FR X 120CM,272,1 ,$438.84 ,$289.63 ,$222.58 ,$438.84 , N/A ,$300.78 ,$300.78 , N/A ,$263.30 ,$373.01 ,$307.19 , N/A , N/A ,$416.90 ,$333.52 ,$329.13 ,$285.25 ,$373.01 , N/A ,$285.25 ,$285.25 ,$307.19 ,$267.25 , N/A , N/A , N/A , N/A , N/A ,$373.01 , N/A ,$403.73 ,$307.19 ,$222.58 ,$267.12 ,$267.25 ,$267.12 ,$303.24 ,$394.96 ,$299.82 , N/A ,$346.68 , N/A ,$258.92 ,$258.92 , N/A ,$258.92 ,$315.96 ,$272.08 ,$315.96 ,$315.96 ,$351.07 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,GAS HELIUM 2500 PSI 285CU FT T CYLINDER MEDICAL,272,1 ,"$1,193.10 ",$787.45 ,$605.14 ,"$1,193.10 ", N/A ,$817.75 ,$817.75 , N/A ,$715.86 ,"$1,014.14 ",$835.17 , N/A , N/A ,"$1,133.45 ",$906.76 ,$894.83 ,$775.52 ,"$1,014.14 ", N/A ,$775.52 ,$775.52 ,$835.17 ,$726.60 , N/A , N/A , N/A , N/A , N/A ,"$1,014.14 ", N/A ,"$1,097.65 ",$835.17 ,$605.14 ,$726.24 ,$726.60 ,$726.24 ,$824.43 ,"$1,073.79 ",$815.13 , N/A ,$942.55 , N/A ,$703.93 ,$703.93 , N/A ,$703.93 ,$859.03 ,$739.72 ,$859.03 ,$859.03 ,$954.48 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,GAS INTRAOCULAR CYLINDER ISPAN MULTIDOSE SULFUR HEXAFLUORIDE 20GM,272,1 ,"$1,750.70 ","$1,155.46 ",$887.96 ,"$1,750.70 ", N/A ,"$1,199.93 ","$1,199.93 ", N/A ,"$1,050.42 ","$1,488.10 ","$1,225.49 ", N/A , N/A ,"$1,663.17 ","$1,330.53 ","$1,313.03 ","$1,137.96 ","$1,488.10 ", N/A ,"$1,137.96 ","$1,137.96 ","$1,225.49 ","$1,066.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,488.10 ", N/A ,"$1,610.64 ","$1,225.49 ",$887.96 ,"$1,065.65 ","$1,066.18 ","$1,065.65 ","$1,209.73 ","$1,575.63 ","$1,196.08 ", N/A ,"$1,383.05 ", N/A ,"$1,032.91 ","$1,032.91 ", N/A ,"$1,032.91 ","$1,260.50 ","$1,085.43 ","$1,260.50 ","$1,260.50 ","$1,400.56 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,GAS INTRAOCULAR ISPAN CYLINDER PERFLUOROPROPANE 20GM,272,1 ,"$1,432.95 ",$945.75 ,$726.79 ,"$1,432.95 ", N/A ,$982.14 ,$982.14 , N/A ,$859.77 ,"$1,218.01 ","$1,003.07 ", N/A , N/A ,"$1,361.30 ","$1,089.04 ","$1,074.71 ",$931.42 ,"$1,218.01 ", N/A ,$931.42 ,$931.42 ,"$1,003.07 ",$872.67 , N/A , N/A , N/A , N/A , N/A ,"$1,218.01 ", N/A ,"$1,318.31 ","$1,003.07 ",$726.79 ,$872.24 ,$872.67 ,$872.24 ,$990.17 ,"$1,289.66 ",$978.99 , N/A ,"$1,132.03 ", N/A ,$845.44 ,$845.44 , N/A ,$845.44 ,"$1,031.72 ",$888.43 ,"$1,031.72 ","$1,031.72 ","$1,146.36 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,GUIDE PIN ORTHOPEDIC 230MM 3.2MM THREAD INTRAMEDULLARY HIP SCREW SYSTEM STERILE,272,1 ,$131.47 ,$86.77 ,$66.68 ,$131.47 , N/A ,$90.11 ,$90.11 , N/A ,$78.88 ,$111.75 ,$92.03 , N/A , N/A ,$124.90 ,$99.92 ,$98.60 ,$85.46 ,$111.75 , N/A ,$85.46 ,$85.46 ,$92.03 ,$80.07 , N/A , N/A , N/A , N/A , N/A ,$111.75 , N/A ,$120.95 ,$92.03 ,$66.68 ,$80.03 ,$80.07 ,$80.03 ,$90.85 ,$118.32 ,$89.82 , N/A ,$103.86 , N/A ,$77.57 ,$77.57 , N/A ,$77.57 ,$94.66 ,$81.51 ,$94.66 ,$94.66 ,$105.18 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,GUIDE PIN ORTHOPEDIC 50CM 2.4MM ACL SUTURE EYE PCL REPAIR STERILE DISPOSABLE,272,1 ,$153.00 ,$100.98 ,$77.60 ,$153.00 , N/A ,$104.87 ,$104.87 , N/A ,$91.80 ,$130.05 ,$107.10 , N/A , N/A ,$145.35 ,$116.28 ,$114.75 ,$99.45 ,$130.05 , N/A ,$99.45 ,$99.45 ,$107.10 ,$93.18 , N/A , N/A , N/A , N/A , N/A ,$130.05 , N/A ,$140.76 ,$107.10 ,$77.60 ,$93.13 ,$93.18 ,$93.13 ,$105.72 ,$137.70 ,$104.53 , N/A ,$120.87 , N/A ,$90.27 ,$90.27 , N/A ,$90.27 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$122.40 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,HOOK SPINAL .25MM MCC J TITANIUM 6.35MM ROD,272,1 ,$297.00 ,$196.02 ,$150.64 ,$297.00 , N/A ,$203.56 ,$203.56 , N/A ,$178.20 ,$252.45 ,$207.90 , N/A , N/A ,$282.15 ,$225.72 ,$222.75 ,$193.05 ,$252.45 , N/A ,$193.05 ,$193.05 ,$207.90 ,$180.87 , N/A , N/A , N/A , N/A , N/A ,$252.45 , N/A ,$273.24 ,$207.90 ,$150.64 ,$180.78 ,$180.87 ,$180.78 ,$205.23 ,$267.30 ,$202.91 , N/A ,$234.63 , N/A ,$175.23 ,$175.23 , N/A ,$175.23 ,$213.84 ,$184.14 ,$213.84 ,$213.84 ,$237.60 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,ILLUMINATOR RELIEVA LUMA SINUS (SIS-100B),272,1 ,$922.35 ,$608.75 ,$467.82 ,$922.35 , N/A ,$632.18 ,$632.18 , N/A ,$553.41 ,$784.00 ,$645.65 , N/A , N/A ,$876.23 ,$700.99 ,$691.76 ,$599.53 ,$784.00 , N/A ,$599.53 ,$599.53 ,$645.65 ,$561.71 , N/A , N/A , N/A , N/A , N/A ,$784.00 , N/A ,$848.56 ,$645.65 ,$467.82 ,$561.43 ,$561.71 ,$561.43 ,$637.34 ,$830.12 ,$630.15 , N/A ,$728.66 , N/A ,$544.19 ,$544.19 , N/A ,$544.19 ,$664.09 ,$571.86 ,$664.09 ,$664.09 ,$737.88 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,INTERNAL BRACE KIT KNEE,272,1 ,"$3,245.20 ","$2,141.83 ","$1,645.97 ","$3,245.20 ", N/A ,"$2,224.26 ","$2,224.26 ", N/A ,"$1,947.12 ","$2,758.42 ","$2,271.64 ", N/A , N/A ,"$3,082.94 ","$2,466.35 ","$2,433.90 ","$2,109.38 ","$2,758.42 ", N/A ,"$2,109.38 ","$2,109.38 ","$2,271.64 ","$1,976.33 ", N/A , N/A , N/A , N/A , N/A ,"$2,758.42 ", N/A ,"$2,985.58 ","$2,271.64 ","$1,645.97 ","$1,975.35 ","$1,976.33 ","$1,975.35 ","$2,242.43 ","$2,920.68 ","$2,217.12 ", N/A ,"$2,563.71 ", N/A ,"$1,914.67 ","$1,914.67 ", N/A ,"$1,914.67 ","$2,336.54 ","$2,012.02 ","$2,336.54 ","$2,336.54 ","$2,596.16 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,KIT BONE CEMENT OSTEOBOND COPOLYMER 1 40GM LATEX FREE,272,1 ,$197.51 ,$130.36 ,$100.18 ,$197.51 , N/A ,$135.37 ,$135.37 , N/A ,$118.51 ,$167.88 ,$138.26 , N/A , N/A ,$187.63 ,$150.11 ,$148.13 ,$128.38 ,$167.88 , N/A ,$128.38 ,$128.38 ,$138.26 ,$120.28 , N/A , N/A , N/A , N/A , N/A ,$167.88 , N/A ,$181.71 ,$138.26 ,$100.18 ,$120.22 ,$120.28 ,$120.22 ,$136.48 ,$177.76 ,$134.94 , N/A ,$156.03 , N/A ,$116.53 ,$116.53 , N/A ,$116.53 ,$142.21 ,$122.46 ,$142.21 ,$142.21 ,$158.01 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,LENS IRRIGATION THE MORGAN LENS MEDI-FLOW ATTACH TUBE ADAPTER EYE LATEX FREE OCCULAR TRAUMA,272,1 ,$87.88 ,$58.00 ,$44.57 ,$87.88 , N/A ,$60.23 ,$60.23 , N/A ,$52.73 ,$74.70 ,$61.52 , N/A , N/A ,$83.49 ,$66.79 ,$65.91 ,$57.12 ,$74.70 , N/A ,$57.12 ,$57.12 ,$61.52 ,$53.52 , N/A , N/A , N/A , N/A , N/A ,$74.70 , N/A ,$80.85 ,$61.52 ,$44.57 ,$53.49 ,$53.52 ,$53.49 ,$60.73 ,$79.09 ,$60.04 , N/A ,$69.43 , N/A ,$51.85 ,$51.85 , N/A ,$51.85 ,$63.27 ,$54.49 ,$63.27 ,$63.27 ,$70.30 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,LIGHTGUIDE SURGICAL MICROSCOPE 20GA,272,1 ,$47.25 ,$31.19 ,$23.97 ,$47.25 , N/A ,$32.39 ,$32.39 , N/A ,$28.35 ,$40.16 ,$33.08 , N/A , N/A ,$44.89 ,$35.91 ,$35.44 ,$30.71 ,$40.16 , N/A ,$30.71 ,$30.71 ,$33.08 ,$28.78 , N/A , N/A , N/A , N/A , N/A ,$40.16 , N/A ,$43.47 ,$33.08 ,$23.97 ,$28.76 ,$28.78 ,$28.76 ,$32.65 ,$42.53 ,$32.28 , N/A ,$37.33 , N/A ,$27.88 ,$27.88 , N/A ,$27.88 ,$34.02 ,$29.30 ,$34.02 ,$34.02 ,$37.80 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,GUIDE PIN ORTHOPEDIC 1.1MM NITINOL BIO-INTERFERENCE SCREW,272,1 ,$47.25 ,$31.19 ,$23.97 ,$47.25 , N/A ,$32.39 ,$32.39 , N/A ,$28.35 ,$40.16 ,$33.08 , N/A , N/A ,$44.89 ,$35.91 ,$35.44 ,$30.71 ,$40.16 , N/A ,$30.71 ,$30.71 ,$33.08 ,$28.78 , N/A , N/A , N/A , N/A , N/A ,$40.16 , N/A ,$43.47 ,$33.08 ,$23.97 ,$28.76 ,$28.78 ,$28.76 ,$32.65 ,$42.53 ,$32.28 , N/A ,$37.33 , N/A ,$27.88 ,$27.88 , N/A ,$27.88 ,$34.02 ,$29.30 ,$34.02 ,$34.02 ,$37.80 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,LINE AUTOTRANSFUSION POSTOPERATIVE EXTEND,272,1 ,$32.67 ,$21.56 ,$16.57 ,$32.67 , N/A ,$22.39 ,$22.39 , N/A ,$19.60 ,$27.77 ,$22.87 , N/A , N/A ,$31.04 ,$24.83 ,$24.50 ,$21.24 ,$27.77 , N/A ,$21.24 ,$21.24 ,$22.87 ,$19.90 , N/A , N/A , N/A , N/A , N/A ,$27.77 , N/A ,$30.06 ,$22.87 ,$16.57 ,$19.89 ,$19.90 ,$19.89 ,$22.58 ,$29.40 ,$22.32 , N/A ,$25.81 , N/A ,$19.28 ,$19.28 , N/A ,$19.28 ,$23.52 ,$20.26 ,$23.52 ,$23.52 ,$26.14 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,MANOMETER CVP B-SMART DISPOSABLE PERIPHERAL NERVE BLOCK INJECTION PRESSURE,272,1 ,$22.69 ,$14.98 ,$11.51 ,$22.69 , N/A ,$15.55 ,$15.55 , N/A ,$13.61 ,$19.29 ,$15.88 , N/A , N/A ,$21.56 ,$17.24 ,$17.02 ,$14.75 ,$19.29 , N/A ,$14.75 ,$14.75 ,$15.88 ,$13.82 , N/A , N/A , N/A , N/A , N/A ,$19.29 , N/A ,$20.87 ,$15.88 ,$11.51 ,$13.81 ,$13.82 ,$13.81 ,$15.68 ,$20.42 ,$15.50 , N/A ,$17.93 , N/A ,$13.39 ,$13.39 , N/A ,$13.39 ,$16.34 ,$14.07 ,$16.34 ,$16.34 ,$18.15 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,MARKING PEN BLEPH,272,1 ,$194.13 ,$128.13 ,$98.46 ,$194.13 , N/A ,$133.06 ,$133.06 , N/A ,$116.48 ,$165.01 ,$135.89 , N/A , N/A ,$184.42 ,$147.54 ,$145.60 ,$126.18 ,$165.01 , N/A ,$126.18 ,$126.18 ,$135.89 ,$118.23 , N/A , N/A , N/A , N/A , N/A ,$165.01 , N/A ,$178.60 ,$135.89 ,$98.46 ,$118.17 ,$118.23 ,$118.17 ,$134.14 ,$174.72 ,$132.63 , N/A ,$153.36 , N/A ,$114.54 ,$114.54 , N/A ,$114.54 ,$139.77 ,$120.36 ,$139.77 ,$139.77 ,$155.30 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,NEEDLE BIOPSY MAXCORE 18GA X 25CM,272,1 ,$103.09 ,$68.04 ,$52.29 ,$103.09 , N/A ,$70.66 ,$70.66 , N/A ,$61.85 ,$87.63 ,$72.16 , N/A , N/A ,$97.94 ,$78.35 ,$77.32 ,$67.01 ,$87.63 , N/A ,$67.01 ,$67.01 ,$72.16 ,$62.78 , N/A , N/A , N/A , N/A , N/A ,$87.63 , N/A ,$94.84 ,$72.16 ,$52.29 ,$62.75 ,$62.78 ,$62.75 ,$71.24 ,$92.78 ,$70.43 , N/A ,$81.44 , N/A ,$60.82 ,$60.82 , N/A ,$60.82 ,$74.22 ,$63.92 ,$74.22 ,$74.22 ,$82.47 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,Needle BOTOX 23GA,272,1 ,$174.38 ,$115.09 ,$88.45 ,$174.38 , N/A ,$119.52 ,$119.52 , N/A ,$104.63 ,$148.22 ,$122.07 , N/A , N/A ,$165.66 ,$132.53 ,$130.79 ,$113.35 ,$148.22 , N/A ,$113.35 ,$113.35 ,$122.07 ,$106.20 , N/A , N/A , N/A , N/A , N/A ,$148.22 , N/A ,$160.43 ,$122.07 ,$88.45 ,$106.15 ,$106.20 ,$106.15 ,$120.50 ,$156.94 ,$119.14 , N/A ,$137.76 , N/A ,$102.88 ,$102.88 , N/A ,$102.88 ,$125.55 ,$108.12 ,$125.55 ,$125.55 ,$139.50 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,NEEDLE ENDOSCOPIC MACROPLASTIQUE 3.8FR URETHRAL,272,1 ,$83.25 ,$54.95 ,$42.22 ,$83.25 , N/A ,$57.06 ,$57.06 , N/A ,$49.95 ,$70.76 ,$58.28 , N/A , N/A ,$79.09 ,$63.27 ,$62.44 ,$54.11 ,$70.76 , N/A ,$54.11 ,$54.11 ,$58.28 ,$50.70 , N/A , N/A , N/A , N/A , N/A ,$70.76 , N/A ,$76.59 ,$58.28 ,$42.22 ,$50.67 ,$50.70 ,$50.67 ,$57.53 ,$74.93 ,$56.88 , N/A ,$65.77 , N/A ,$49.12 ,$49.12 , N/A ,$49.12 ,$59.94 ,$51.62 ,$59.94 ,$59.94 ,$66.60 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,Needle RETROBULBAR 23G,272,1 ,$8.92 ,$5.89 ,$4.52 ,$8.92 , N/A ,$6.11 ,$6.11 , N/A ,$5.35 ,$7.58 ,$6.24 , N/A , N/A ,$8.47 ,$6.78 ,$6.69 ,$5.80 ,$7.58 , N/A ,$5.80 ,$5.80 ,$6.24 ,$5.43 , N/A , N/A , N/A , N/A , N/A ,$7.58 , N/A ,$8.21 ,$6.24 ,$4.52 ,$5.43 ,$5.43 ,$5.43 ,$6.16 ,$8.03 ,$6.09 , N/A ,$7.05 , N/A ,$5.26 ,$5.26 , N/A ,$5.26 ,$6.42 ,$5.53 ,$6.42 ,$6.42 ,$7.14 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,Needle SPINOCAN 25GA X 3.5,272,1 ,$2.48 ,$1.64 ,$1.26 ,$2.48 , N/A ,$1.70 ,$1.70 , N/A ,$1.49 ,$2.11 ,$1.74 , N/A , N/A ,$2.36 ,$1.88 ,$1.86 ,$1.61 ,$2.11 , N/A ,$1.61 ,$1.61 ,$1.74 ,$1.51 , N/A , N/A , N/A , N/A , N/A ,$2.11 , N/A ,$2.28 ,$1.74 ,$1.26 ,$1.51 ,$1.51 ,$1.51 ,$1.71 ,$2.23 ,$1.69 , N/A ,$1.96 , N/A ,$1.46 ,$1.46 , N/A ,$1.46 ,$1.79 ,$1.54 ,$1.79 ,$1.79 ,$1.98 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,OBTURATOR 8MM BLUNT,272,1 ,"$1,127.50 ",$744.15 ,$571.87 ,"$1,127.50 ", N/A ,$772.79 ,$772.79 , N/A ,$676.50 ,$958.38 ,$789.25 , N/A , N/A ,"$1,071.13 ",$856.90 ,$845.63 ,$732.88 ,$958.38 , N/A ,$732.88 ,$732.88 ,$789.25 ,$686.65 , N/A , N/A , N/A , N/A , N/A ,$958.38 , N/A ,"$1,037.30 ",$789.25 ,$571.87 ,$686.31 ,$686.65 ,$686.31 ,$779.10 ,"$1,014.75 ",$770.31 , N/A ,$890.73 , N/A ,$665.23 ,$665.23 , N/A ,$665.23 ,$811.80 ,$699.05 ,$811.80 ,$811.80 ,$902.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK ARTHROSCOPY SNS,272,1 ,$86.14 ,$56.85 ,$43.69 ,$86.14 , N/A ,$59.04 ,$59.04 , N/A ,$51.68 ,$73.22 ,$60.30 , N/A , N/A ,$81.83 ,$65.47 ,$64.61 ,$55.99 ,$73.22 , N/A ,$55.99 ,$55.99 ,$60.30 ,$52.46 , N/A , N/A , N/A , N/A , N/A ,$73.22 , N/A ,$79.25 ,$60.30 ,$43.69 ,$52.43 ,$52.46 ,$52.43 ,$59.52 ,$77.53 ,$58.85 , N/A ,$68.05 , N/A ,$50.82 ,$50.82 , N/A ,$50.82 ,$62.02 ,$53.41 ,$62.02 ,$62.02 ,$68.91 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK BASIC SNS,272,1 ,$95.51 ,$63.04 ,$48.44 ,$95.51 , N/A ,$65.46 ,$65.46 , N/A ,$57.31 ,$81.18 ,$66.86 , N/A , N/A ,$90.73 ,$72.59 ,$71.63 ,$62.08 ,$81.18 , N/A ,$62.08 ,$62.08 ,$66.86 ,$58.17 , N/A , N/A , N/A , N/A , N/A ,$81.18 , N/A ,$87.87 ,$66.86 ,$48.44 ,$58.14 ,$58.17 ,$58.14 ,$66.00 ,$85.96 ,$65.25 , N/A ,$75.45 , N/A ,$56.35 ,$56.35 , N/A ,$56.35 ,$68.77 ,$59.22 ,$68.77 ,$68.77 ,$76.41 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK CYSTO SNS,272,1 ,$64.67 ,$42.68 ,$32.80 ,$64.67 , N/A ,$44.32 ,$44.32 , N/A ,$38.80 ,$54.97 ,$45.27 , N/A , N/A ,$61.44 ,$49.15 ,$48.50 ,$42.04 ,$54.97 , N/A ,$42.04 ,$42.04 ,$45.27 ,$39.38 , N/A , N/A , N/A , N/A , N/A ,$54.97 , N/A ,$59.50 ,$45.27 ,$32.80 ,$39.36 ,$39.38 ,$39.36 ,$44.69 ,$58.20 ,$44.18 , N/A ,$51.09 , N/A ,$38.16 ,$38.16 , N/A ,$38.16 ,$46.56 ,$40.10 ,$46.56 ,$46.56 ,$51.74 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK EYE SNS,272,1 ,$40.89 ,$26.99 ,$20.74 ,$40.89 , N/A ,$28.03 ,$28.03 , N/A ,$24.53 ,$34.76 ,$28.62 , N/A , N/A ,$38.85 ,$31.08 ,$30.67 ,$26.58 ,$34.76 , N/A ,$26.58 ,$26.58 ,$28.62 ,$24.90 , N/A , N/A , N/A , N/A , N/A ,$34.76 , N/A ,$37.62 ,$28.62 ,$20.74 ,$24.89 ,$24.90 ,$24.89 ,$28.26 ,$36.80 ,$27.94 , N/A ,$32.30 , N/A ,$24.13 ,$24.13 , N/A ,$24.13 ,$29.44 ,$25.35 ,$29.44 ,$29.44 ,$32.71 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK HAND SNS,272,1 ,$102.23 ,$67.47 ,$51.85 ,$102.23 , N/A ,$70.07 ,$70.07 , N/A ,$61.34 ,$86.90 ,$71.56 , N/A , N/A ,$97.12 ,$77.69 ,$76.67 ,$66.45 ,$86.90 , N/A ,$66.45 ,$66.45 ,$71.56 ,$62.26 , N/A , N/A , N/A , N/A , N/A ,$86.90 , N/A ,$94.05 ,$71.56 ,$51.85 ,$62.23 ,$62.26 ,$62.23 ,$70.64 ,$92.01 ,$69.84 , N/A ,$80.76 , N/A ,$60.32 ,$60.32 , N/A ,$60.32 ,$73.61 ,$63.38 ,$73.61 ,$73.61 ,$81.78 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK HEROLD SNS,272,1 ,$79.03 ,$52.16 ,$40.08 ,$79.03 , N/A ,$54.17 ,$54.17 , N/A ,$47.42 ,$67.18 ,$55.32 , N/A , N/A ,$75.08 ,$60.06 ,$59.27 ,$51.37 ,$67.18 , N/A ,$51.37 ,$51.37 ,$55.32 ,$48.13 , N/A , N/A , N/A , N/A , N/A ,$67.18 , N/A ,$72.71 ,$55.32 ,$40.08 ,$48.11 ,$48.13 ,$48.11 ,$54.61 ,$71.13 ,$53.99 , N/A ,$62.43 , N/A ,$46.63 ,$46.63 , N/A ,$46.63 ,$56.90 ,$49.00 ,$56.90 ,$56.90 ,$63.22 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK LAMINECTOMY SNS,272,1 ,$104.52 ,$68.98 ,$53.01 ,$104.52 , N/A ,$71.64 ,$71.64 , N/A ,$62.71 ,$88.84 ,$73.16 , N/A , N/A ,$99.29 ,$79.44 ,$78.39 ,$67.94 ,$88.84 , N/A ,$67.94 ,$67.94 ,$73.16 ,$63.65 , N/A , N/A , N/A , N/A , N/A ,$88.84 , N/A ,$96.16 ,$73.16 ,$53.01 ,$63.62 ,$63.65 ,$63.62 ,$72.22 ,$94.07 ,$71.41 , N/A ,$82.57 , N/A ,$61.67 ,$61.67 , N/A ,$61.67 ,$75.25 ,$64.80 ,$75.25 ,$75.25 ,$83.62 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK SHOULDER SCOPE SNS,272,1 ,$110.51 ,$72.94 ,$56.05 ,$110.51 , N/A ,$75.74 ,$75.74 , N/A ,$66.31 ,$93.93 ,$77.36 , N/A , N/A ,$104.98 ,$83.99 ,$82.88 ,$71.83 ,$93.93 , N/A ,$71.83 ,$71.83 ,$77.36 ,$67.30 , N/A , N/A , N/A , N/A , N/A ,$93.93 , N/A ,$101.67 ,$77.36 ,$56.05 ,$67.27 ,$67.30 ,$67.27 ,$76.36 ,$99.46 ,$75.50 , N/A ,$87.30 , N/A ,$65.20 ,$65.20 , N/A ,$65.20 ,$79.57 ,$68.52 ,$79.57 ,$79.57 ,$88.41 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK SURGICAL AURORA MAYO UNIVERSAL SPLIT REINFORCE TABLE COVER SUTURE BAG STERILE DISPOSABLE 90X50IN 53X24IN LATEX FREE,272,1 ,$26.54 ,$17.52 ,$13.46 ,$26.54 , N/A ,$18.19 ,$18.19 , N/A ,$15.92 ,$22.56 ,$18.58 , N/A , N/A ,$25.21 ,$20.17 ,$19.91 ,$17.25 ,$22.56 , N/A ,$17.25 ,$17.25 ,$18.58 ,$16.16 , N/A , N/A , N/A , N/A , N/A ,$22.56 , N/A ,$24.42 ,$18.58 ,$13.46 ,$16.15 ,$16.16 ,$16.15 ,$18.34 ,$23.89 ,$18.13 , N/A ,$20.97 , N/A ,$15.66 ,$15.66 , N/A ,$15.66 ,$19.11 ,$16.45 ,$19.11 ,$19.11 ,$21.23 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK SURGICAL ECLIPSE EENT II TABLE COVER SUTURE BAG HEAD TURBAN DRAPE 90X50IN 40X27IN LATEX FREE,272,1 ,$23.98 ,$15.83 ,$12.16 ,$23.98 , N/A ,$16.44 ,$16.44 , N/A ,$14.39 ,$20.38 ,$16.79 , N/A , N/A ,$22.78 ,$18.22 ,$17.99 ,$15.59 ,$20.38 , N/A ,$15.59 ,$15.59 ,$16.79 ,$14.60 , N/A , N/A , N/A , N/A , N/A ,$20.38 , N/A ,$22.06 ,$16.79 ,$12.16 ,$14.60 ,$14.60 ,$14.60 ,$16.57 ,$21.58 ,$16.38 , N/A ,$18.94 , N/A ,$14.15 ,$14.15 , N/A ,$14.15 ,$17.27 ,$14.87 ,$17.27 ,$17.27 ,$19.18 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK TOTAL HIP SNS,272,1 ,$192.90 ,$127.31 ,$97.84 ,$192.90 , N/A ,$132.21 ,$132.21 , N/A ,$115.74 ,$163.97 ,$135.03 , N/A , N/A ,$183.26 ,$146.60 ,$144.68 ,$125.39 ,$163.97 , N/A ,$125.39 ,$125.39 ,$135.03 ,$117.48 , N/A , N/A , N/A , N/A , N/A ,$163.97 , N/A ,$177.47 ,$135.03 ,$97.84 ,$117.42 ,$117.48 ,$117.42 ,$133.29 ,$173.61 ,$131.79 , N/A ,$152.39 , N/A ,$113.81 ,$113.81 , N/A ,$113.81 ,$138.89 ,$119.60 ,$138.89 ,$138.89 ,$154.32 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACK TOTAL KNEE SNS,272,1 ,$156.34 ,$103.18 ,$79.30 ,$156.34 , N/A ,$107.16 ,$107.16 , N/A ,$93.80 ,$132.89 ,$109.44 , N/A , N/A ,$148.52 ,$118.82 ,$117.26 ,$101.62 ,$132.89 , N/A ,$101.62 ,$101.62 ,$109.44 ,$95.21 , N/A , N/A , N/A , N/A , N/A ,$132.89 , N/A ,$143.83 ,$109.44 ,$79.30 ,$95.16 ,$95.21 ,$95.16 ,$108.03 ,$140.71 ,$106.81 , N/A ,$123.51 , N/A ,$92.24 ,$92.24 , N/A ,$92.24 ,$112.56 ,$96.93 ,$112.56 ,$112.56 ,$125.07 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PACKING WOUND 36X4IN GAUZE VAGINAL 4 PLY PREWASH RADIOPAQUE STERILE LATEX FREE DISPOSABLE,272,1 ,$6.31 ,$4.16 ,$3.20 ,$6.31 , N/A ,$4.32 ,$4.32 , N/A ,$3.79 ,$5.36 ,$4.42 , N/A , N/A ,$5.99 ,$4.80 ,$4.73 ,$4.10 ,$5.36 , N/A ,$4.10 ,$4.10 ,$4.42 ,$3.84 , N/A , N/A , N/A , N/A , N/A ,$5.36 , N/A ,$5.81 ,$4.42 ,$3.20 ,$3.84 ,$3.84 ,$3.84 ,$4.36 ,$5.68 ,$4.31 , N/A ,$4.98 , N/A ,$3.72 ,$3.72 , N/A ,$3.72 ,$4.54 ,$3.91 ,$4.54 ,$4.54 ,$5.05 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PAD ULTRASOUND STAND OFF KIT,272,1 ,$56.25 ,$37.13 ,$28.53 ,$56.25 , N/A ,$38.55 ,$38.55 , N/A ,$33.75 ,$47.81 ,$39.38 , N/A , N/A ,$53.44 ,$42.75 ,$42.19 ,$36.56 ,$47.81 , N/A ,$36.56 ,$36.56 ,$39.38 ,$34.26 , N/A , N/A , N/A , N/A , N/A ,$47.81 , N/A ,$51.75 ,$39.38 ,$28.53 ,$34.24 ,$34.26 ,$34.24 ,$38.87 ,$50.63 ,$38.43 , N/A ,$44.44 , N/A ,$33.19 ,$33.19 , N/A ,$33.19 ,$40.50 ,$34.88 ,$40.50 ,$40.50 ,$45.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PORT GELPORT LAPAROSCOPIC SYSTEM 120MM INCISION,272,1 ,"$1,435.00 ",$947.10 ,$727.83 ,"$1,435.00 ", N/A ,$983.55 ,$983.55 , N/A ,$861.00 ,"$1,219.75 ","$1,004.50 ", N/A , N/A ,"$1,363.25 ","$1,090.60 ","$1,076.25 ",$932.75 ,"$1,219.75 ", N/A ,$932.75 ,$932.75 ,"$1,004.50 ",$873.92 , N/A , N/A , N/A , N/A , N/A ,"$1,219.75 ", N/A ,"$1,320.20 ","$1,004.50 ",$727.83 ,$873.48 ,$873.92 ,$873.48 ,$991.59 ,"$1,291.50 ",$980.39 , N/A ,"$1,133.65 ", N/A ,$846.65 ,$846.65 , N/A ,$846.65 ,"$1,033.20 ",$889.70 ,"$1,033.20 ","$1,033.20 ","$1,148.00 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PROBE ELECTROSURGICAL 33CM 5MM MONOPOLAR L TIP,272,1 ,$250.85 ,$165.56 ,$127.23 ,$250.85 , N/A ,$171.93 ,$171.93 , N/A ,$150.51 ,$213.22 ,$175.60 , N/A , N/A ,$238.31 ,$190.65 ,$188.14 ,$163.05 ,$213.22 , N/A ,$163.05 ,$163.05 ,$175.60 ,$152.77 , N/A , N/A , N/A , N/A , N/A ,$213.22 , N/A ,$230.78 ,$175.60 ,$127.23 ,$152.69 ,$152.77 ,$152.69 ,$173.34 ,$225.77 ,$171.38 , N/A ,$198.17 , N/A ,$148.00 ,$148.00 , N/A ,$148.00 ,$180.61 ,$155.53 ,$180.61 ,$180.61 ,$200.68 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,PUSHLOCK 2.9 SHAVEDRILL ARTHREX,272,1 ,$213.75 ,$141.08 ,$108.41 ,$213.75 , N/A ,$146.50 ,$146.50 , N/A ,$128.25 ,$181.69 ,$149.63 , N/A , N/A ,$203.06 ,$162.45 ,$160.31 ,$138.94 ,$181.69 , N/A ,$138.94 ,$138.94 ,$149.63 ,$130.17 , N/A , N/A , N/A , N/A , N/A ,$181.69 , N/A ,$196.65 ,$149.63 ,$108.41 ,$130.11 ,$130.17 ,$130.11 ,$147.70 ,$192.38 ,$146.03 , N/A ,$168.86 , N/A ,$126.11 ,$126.11 , N/A ,$126.11 ,$153.90 ,$132.53 ,$153.90 ,$153.90 ,$171.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,REAMER ARTHREX LOW PROFILE,272,1 ,$438.75 ,$289.58 ,$222.53 ,$438.75 , N/A ,$300.72 ,$300.72 , N/A ,$263.25 ,$372.94 ,$307.13 , N/A , N/A ,$416.81 ,$333.45 ,$329.06 ,$285.19 ,$372.94 , N/A ,$285.19 ,$285.19 ,$307.13 ,$267.20 , N/A , N/A , N/A , N/A , N/A ,$372.94 , N/A ,$403.65 ,$307.13 ,$222.53 ,$267.07 ,$267.20 ,$267.07 ,$303.18 ,$394.88 ,$299.75 , N/A ,$346.61 , N/A ,$258.86 ,$258.86 , N/A ,$258.86 ,$315.90 ,$272.03 ,$315.90 ,$315.90 ,$351.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,RECHARGER NEUROSTIMULATOR RESTORE EXTERNAL PATENT,272,1 ,"$2,850.00 ","$1,881.00 ","$1,445.52 ","$2,850.00 ", N/A ,"$1,953.39 ","$1,953.39 ", N/A ,"$1,710.00 ","$2,422.50 ","$1,995.00 ", N/A , N/A ,"$2,707.50 ","$2,166.00 ","$2,137.50 ","$1,852.50 ","$2,422.50 ", N/A ,"$1,852.50 ","$1,852.50 ","$1,995.00 ","$1,735.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,422.50 ", N/A ,"$2,622.00 ","$1,995.00 ","$1,445.52 ","$1,734.80 ","$1,735.65 ","$1,734.80 ","$1,969.35 ","$2,565.00 ","$1,947.12 ", N/A ,"$2,251.50 ", N/A ,"$1,681.50 ","$1,681.50 ", N/A ,"$1,681.50 ","$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$2,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,RESECTOR ENDOSCOPIC 4 CUT SHAVER CUTTER STRAIGHT FULL RADIUS 7.5CM 3.5MM,272,1 ,$544.49 ,$359.36 ,$276.17 ,$544.49 , N/A ,$373.19 ,$373.19 , N/A ,$326.69 ,$462.82 ,$381.14 , N/A , N/A ,$517.27 ,$413.81 ,$408.37 ,$353.92 ,$462.82 , N/A ,$353.92 ,$353.92 ,$381.14 ,$331.59 , N/A , N/A , N/A , N/A , N/A ,$462.82 , N/A ,$500.93 ,$381.14 ,$276.17 ,$331.43 ,$331.59 ,$331.43 ,$376.24 ,$490.04 ,$372.00 , N/A ,$430.15 , N/A ,$321.25 ,$321.25 , N/A ,$321.25 ,$392.03 ,$337.58 ,$392.03 ,$392.03 ,$435.59 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,RETRACTOR WOUND ALEXIS 11-17CM XL APPLIED MEDICAL,272,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A ,$169.64 ,$169.64 , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 ,$160.88 ,$210.38 , N/A ,$160.88 ,$160.88 ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A ,$146.03 ,$146.03 , N/A ,$146.03 ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SEAL SURESEAL II,272,1 ,$31.50 ,$20.79 ,$15.98 ,$31.50 , N/A ,$21.59 ,$21.59 , N/A ,$18.90 ,$26.78 ,$22.05 , N/A , N/A ,$29.93 ,$23.94 ,$23.63 ,$20.48 ,$26.78 , N/A ,$20.48 ,$20.48 ,$22.05 ,$19.18 , N/A , N/A , N/A , N/A , N/A ,$26.78 , N/A ,$28.98 ,$22.05 ,$15.98 ,$19.17 ,$19.18 ,$19.17 ,$21.77 ,$28.35 ,$21.52 , N/A ,$24.89 , N/A ,$18.59 ,$18.59 , N/A ,$18.59 ,$22.68 ,$19.53 ,$22.68 ,$22.68 ,$25.20 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SET CATHETER CRICOTHYROTOMY UNIVERSAL 9CM MELKER 5MM,272,1 ,$998.89 ,$659.27 ,$506.64 ,$998.89 , N/A ,$684.64 ,$684.64 , N/A ,$599.33 ,$849.06 ,$699.22 , N/A , N/A ,$948.95 ,$759.16 ,$749.17 ,$649.28 ,$849.06 , N/A ,$649.28 ,$649.28 ,$699.22 ,$608.32 , N/A , N/A , N/A , N/A , N/A ,$849.06 , N/A ,$918.98 ,$699.22 ,$506.64 ,$608.02 ,$608.32 ,$608.02 ,$690.23 ,$899.00 ,$682.44 , N/A ,$789.12 , N/A ,$589.35 ,$589.35 , N/A ,$589.35 ,$719.20 ,$619.31 ,$719.20 ,$719.20 ,$799.11 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SET EXTENSION 300 PSI 8IN CLAMP HIGH PRESSURE ROTATE LUER CLAVE PURPLE,272,1 ,$3.27 ,$2.16 ,$1.66 ,$3.27 , N/A ,$2.24 ,$2.24 , N/A ,$1.96 ,$2.78 ,$2.29 , N/A , N/A ,$3.11 ,$2.49 ,$2.45 ,$2.13 ,$2.78 , N/A ,$2.13 ,$2.13 ,$2.29 ,$1.99 , N/A , N/A , N/A , N/A , N/A ,$2.78 , N/A ,$3.01 ,$2.29 ,$1.66 ,$1.99 ,$1.99 ,$1.99 ,$2.26 ,$2.94 ,$2.23 , N/A ,$2.58 , N/A ,$1.93 ,$1.93 , N/A ,$1.93 ,$2.35 ,$2.03 ,$2.35 ,$2.35 ,$2.62 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SET TUBING 10FT INSUFFLATION,272,1 ,$86.94 ,$57.38 ,$44.10 ,$86.94 , N/A ,$59.59 ,$59.59 , N/A ,$52.16 ,$73.90 ,$60.86 , N/A , N/A ,$82.59 ,$66.07 ,$65.21 ,$56.51 ,$73.90 , N/A ,$56.51 ,$56.51 ,$60.86 ,$52.95 , N/A , N/A , N/A , N/A , N/A ,$73.90 , N/A ,$79.98 ,$60.86 ,$44.10 ,$52.92 ,$52.95 ,$52.92 ,$60.08 ,$78.25 ,$59.40 , N/A ,$68.68 , N/A ,$51.29 ,$51.29 , N/A ,$51.29 ,$62.60 ,$53.90 ,$62.60 ,$62.60 ,$69.55 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SET TUBING 10K INFLOW OUTFLOW ARTHROSCOPY STERILE LATEX FREE DISPOSABLE,272,1 ,$79.08 ,$52.19 ,$40.11 ,$79.08 , N/A ,$54.20 ,$54.20 , N/A ,$47.45 ,$67.22 ,$55.36 , N/A , N/A ,$75.13 ,$60.10 ,$59.31 ,$51.40 ,$67.22 , N/A ,$51.40 ,$51.40 ,$55.36 ,$48.16 , N/A , N/A , N/A , N/A , N/A ,$67.22 , N/A ,$72.75 ,$55.36 ,$40.11 ,$48.14 ,$48.16 ,$48.14 ,$54.64 ,$71.17 ,$54.03 , N/A ,$62.47 , N/A ,$46.66 ,$46.66 , N/A ,$46.66 ,$56.94 ,$49.03 ,$56.94 ,$56.94 ,$63.26 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SET TUBING AIRSEAL TRI-LUMEN FILTER,272,1 ,$177.37 ,$117.06 ,$89.96 ,$177.37 , N/A ,$121.57 ,$121.57 , N/A ,$106.42 ,$150.76 ,$124.16 , N/A , N/A ,$168.50 ,$134.80 ,$133.03 ,$115.29 ,$150.76 , N/A ,$115.29 ,$115.29 ,$124.16 ,$108.02 , N/A , N/A , N/A , N/A , N/A ,$150.76 , N/A ,$163.18 ,$124.16 ,$89.96 ,$107.97 ,$108.02 ,$107.97 ,$122.56 ,$159.63 ,$121.18 , N/A ,$140.12 , N/A ,$104.65 ,$104.65 , N/A ,$104.65 ,$127.71 ,$109.97 ,$127.71 ,$127.71 ,$141.90 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SNARE MEDIUM OVAL 240CMX20MM 2.4MM ROTATABLE STAR CATHETER MEDIUM STIFF ENDOSCOPIC POLYPECTOMY 2.8MM DISPOSABLE,272,1 ,$40.37 ,$26.64 ,$20.48 ,$40.37 , N/A ,$27.67 ,$27.67 , N/A ,$24.22 ,$34.31 ,$28.26 , N/A , N/A ,$38.35 ,$30.68 ,$30.28 ,$26.24 ,$34.31 , N/A ,$26.24 ,$26.24 ,$28.26 ,$24.59 , N/A , N/A , N/A , N/A , N/A ,$34.31 , N/A ,$37.14 ,$28.26 ,$20.48 ,$24.57 ,$24.59 ,$24.57 ,$27.90 ,$36.33 ,$27.58 , N/A ,$31.89 , N/A ,$23.82 ,$23.82 , N/A ,$23.82 ,$29.07 ,$25.03 ,$29.07 ,$29.07 ,$32.30 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SPONGE INTERCEED,272,1 ,$682.35 ,$450.35 ,$346.09 ,$682.35 , N/A ,$467.68 ,$467.68 , N/A ,$409.41 ,$580.00 ,$477.65 , N/A , N/A ,$648.23 ,$518.59 ,$511.76 ,$443.53 ,$580.00 , N/A ,$443.53 ,$443.53 ,$477.65 ,$415.55 , N/A , N/A , N/A , N/A , N/A ,$580.00 , N/A ,$627.76 ,$477.65 ,$346.09 ,$415.35 ,$415.55 ,$415.35 ,$471.50 ,$614.12 ,$466.18 , N/A ,$539.06 , N/A ,$402.59 ,$402.59 , N/A ,$402.59 ,$491.29 ,$423.06 ,$491.29 ,$491.29 ,$545.88 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,STAPLER RELOAD 60MMX3.8MM ECHLN ENDPTH SS REG THKTIS,272,1 ,$289.45 ,$191.04 ,$146.81 ,$289.45 , N/A ,$198.39 ,$198.39 , N/A ,$173.67 ,$246.03 ,$202.62 , N/A , N/A ,$274.98 ,$219.98 ,$217.09 ,$188.14 ,$246.03 , N/A ,$188.14 ,$188.14 ,$202.62 ,$176.28 , N/A , N/A , N/A , N/A , N/A ,$246.03 , N/A ,$266.29 ,$202.62 ,$146.81 ,$176.19 ,$176.28 ,$176.19 ,$200.01 ,$260.51 ,$197.75 , N/A ,$228.67 , N/A ,$170.78 ,$170.78 , N/A ,$170.78 ,$208.40 ,$179.46 ,$208.40 ,$208.40 ,$231.56 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,STAYS LONE STAR RETRACTOR SHARP 5MM,272,1 ,$207.41 ,$136.89 ,$105.20 ,$207.41 , N/A ,$142.16 ,$142.16 , N/A ,$124.45 ,$176.30 ,$145.19 , N/A , N/A ,$197.04 ,$157.63 ,$155.56 ,$134.82 ,$176.30 , N/A ,$134.82 ,$134.82 ,$145.19 ,$126.31 , N/A , N/A , N/A , N/A , N/A ,$176.30 , N/A ,$190.82 ,$145.19 ,$105.20 ,$126.25 ,$126.31 ,$126.25 ,$143.32 ,$186.67 ,$141.70 , N/A ,$163.85 , N/A ,$122.37 ,$122.37 , N/A ,$122.37 ,$149.34 ,$128.59 ,$149.34 ,$149.34 ,$165.93 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,STRIP RETINAL 125X4X1.25MM FLAT SILICONE SLEEVE SPONGE STERILE,272,1 ,$29.25 ,$19.31 ,$14.84 ,$29.25 , N/A ,$20.05 ,$20.05 , N/A ,$17.55 ,$24.86 ,$20.48 , N/A , N/A ,$27.79 ,$22.23 ,$21.94 ,$19.01 ,$24.86 , N/A ,$19.01 ,$19.01 ,$20.48 ,$17.81 , N/A , N/A , N/A , N/A , N/A ,$24.86 , N/A ,$26.91 ,$20.48 ,$14.84 ,$17.80 ,$17.81 ,$17.80 ,$20.21 ,$26.33 ,$19.98 , N/A ,$23.11 , N/A ,$17.26 ,$17.26 , N/A ,$17.26 ,$21.06 ,$18.14 ,$21.06 ,$21.06 ,$23.40 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,STRIP SCLERAL 125X3.5X.75MM SILICONE BUCKLE STERILE,272,1 ,$34.20 ,$22.57 ,$17.35 ,$34.20 , N/A ,$23.44 ,$23.44 , N/A ,$20.52 ,$29.07 ,$23.94 , N/A , N/A ,$32.49 ,$25.99 ,$25.65 ,$22.23 ,$29.07 , N/A ,$22.23 ,$22.23 ,$23.94 ,$20.83 , N/A , N/A , N/A , N/A , N/A ,$29.07 , N/A ,$31.46 ,$23.94 ,$17.35 ,$20.82 ,$20.83 ,$20.82 ,$23.63 ,$30.78 ,$23.37 , N/A ,$27.02 , N/A ,$20.18 ,$20.18 , N/A ,$20.18 ,$24.62 ,$21.20 ,$24.62 ,$24.62 ,$27.36 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SUTURE MERSILENE TAPE D9212,272,1 ,$263.72 ,$174.06 ,$133.76 ,$263.72 , N/A ,$180.75 ,$180.75 , N/A ,$158.23 ,$224.16 ,$184.60 , N/A , N/A ,$250.53 ,$200.43 ,$197.79 ,$171.42 ,$224.16 , N/A ,$171.42 ,$171.42 ,$184.60 ,$160.61 , N/A , N/A , N/A , N/A , N/A ,$224.16 , N/A ,$242.62 ,$184.60 ,$133.76 ,$160.53 ,$160.61 ,$160.53 ,$182.23 ,$237.35 ,$180.17 , N/A ,$208.34 , N/A ,$155.59 ,$155.59 , N/A ,$155.59 ,$189.88 ,$163.51 ,$189.88 ,$189.88 ,$210.98 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SUTURE TIGERLOOP TIGERWIRE 2 STRAIGHT 20IN BRAID MULTISTRAND NEEDLE GREEN WHITE 3IN NONABSORBABLE,272,1 ,$112.50 ,$74.25 ,$57.06 ,$112.50 , N/A ,$77.11 ,$77.11 , N/A ,$67.50 ,$95.63 ,$78.75 , N/A , N/A ,$106.88 ,$85.50 ,$84.38 ,$73.13 ,$95.63 , N/A ,$73.13 ,$73.13 ,$78.75 ,$68.51 , N/A , N/A , N/A , N/A , N/A ,$95.63 , N/A ,$103.50 ,$78.75 ,$57.06 ,$68.48 ,$68.51 ,$68.48 ,$77.74 ,$101.25 ,$76.86 , N/A ,$88.88 , N/A ,$66.38 ,$66.38 , N/A ,$66.38 ,$81.00 ,$69.75 ,$81.00 ,$81.00 ,$90.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,FIBERSTICK ARTHREX # 2 (AR-7209),272,1 ,$112.50 ,$74.25 ,$57.06 ,$112.50 , N/A ,$77.11 ,$77.11 , N/A ,$67.50 ,$95.63 ,$78.75 , N/A , N/A ,$106.88 ,$85.50 ,$84.38 ,$73.13 ,$95.63 , N/A ,$73.13 ,$73.13 ,$78.75 ,$68.51 , N/A , N/A , N/A , N/A , N/A ,$95.63 , N/A ,$103.50 ,$78.75 ,$57.06 ,$68.48 ,$68.51 ,$68.48 ,$77.74 ,$101.25 ,$76.86 , N/A ,$88.88 , N/A ,$66.38 ,$66.38 , N/A ,$66.38 ,$81.00 ,$69.75 ,$81.00 ,$81.00 ,$90.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SUTURE FIBERLOOP 2 AR-7234,272,1 ,$112.50 ,$74.25 ,$57.06 ,$112.50 , N/A ,$77.11 ,$77.11 , N/A ,$67.50 ,$95.63 ,$78.75 , N/A , N/A ,$106.88 ,$85.50 ,$84.38 ,$73.13 ,$95.63 , N/A ,$73.13 ,$73.13 ,$78.75 ,$68.51 , N/A , N/A , N/A , N/A , N/A ,$95.63 , N/A ,$103.50 ,$78.75 ,$57.06 ,$68.48 ,$68.51 ,$68.48 ,$77.74 ,$101.25 ,$76.86 , N/A ,$88.88 , N/A ,$66.38 ,$66.38 , N/A ,$66.38 ,$81.00 ,$69.75 ,$81.00 ,$81.00 ,$90.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SWEAT BANDS STRYKER,272,1 ,$3.47 ,$2.29 ,$1.76 ,$3.47 , N/A ,$2.38 ,$2.38 , N/A ,$2.08 ,$2.95 ,$2.43 , N/A , N/A ,$3.30 ,$2.64 ,$2.60 ,$2.26 ,$2.95 , N/A ,$2.26 ,$2.26 ,$2.43 ,$2.11 , N/A , N/A , N/A , N/A , N/A ,$2.95 , N/A ,$3.19 ,$2.43 ,$1.76 ,$2.11 ,$2.11 ,$2.11 ,$2.40 ,$3.12 ,$2.37 , N/A ,$2.74 , N/A ,$2.05 ,$2.05 , N/A ,$2.05 ,$2.50 ,$2.15 ,$2.50 ,$2.50 ,$2.78 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYRINGE PERIFIX 8ML LATEX FREE LOR LUER LOCK DEHP FREE PVC FREE MEDICAL BPA PLASTIC,272,1 ,$3.51 ,$2.32 ,$1.78 ,$3.51 , N/A ,$2.41 ,$2.41 , N/A ,$2.11 ,$2.98 ,$2.46 , N/A , N/A ,$3.33 ,$2.67 ,$2.63 ,$2.28 ,$2.98 , N/A ,$2.28 ,$2.28 ,$2.46 ,$2.14 , N/A , N/A , N/A , N/A , N/A ,$2.98 , N/A ,$3.23 ,$2.46 ,$1.78 ,$2.14 ,$2.14 ,$2.14 ,$2.43 ,$3.16 ,$2.40 , N/A ,$2.77 , N/A ,$2.07 ,$2.07 , N/A ,$2.07 ,$2.53 ,$2.18 ,$2.53 ,$2.53 ,$2.81 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYRINGE PULSATOR 7ML LUER LOCK PMC,272,1 ,$7.90 ,$5.21 ,$4.01 ,$7.90 , N/A ,$5.41 ,$5.41 , N/A ,$4.74 ,$6.72 ,$5.53 , N/A , N/A ,$7.51 ,$6.00 ,$5.93 ,$5.14 ,$6.72 , N/A ,$5.14 ,$5.14 ,$5.53 ,$4.81 , N/A , N/A , N/A , N/A , N/A ,$6.72 , N/A ,$7.27 ,$5.53 ,$4.01 ,$4.81 ,$4.81 ,$4.81 ,$5.46 ,$7.11 ,$5.40 , N/A ,$6.24 , N/A ,$4.66 ,$4.66 , N/A ,$4.66 ,$5.69 ,$4.90 ,$5.69 ,$5.69 ,$6.32 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYSTEM BONE CEMENT TOTAL MIXING KIT BREAK NOZZLE FEMUR LATEX FREE REVOLUTION,272,1 ,$260.60 ,$172.00 ,$132.18 ,$260.60 , N/A ,$178.62 ,$178.62 , N/A ,$156.36 ,$221.51 ,$182.42 , N/A , N/A ,$247.57 ,$198.06 ,$195.45 ,$169.39 ,$221.51 , N/A ,$169.39 ,$169.39 ,$182.42 ,$158.71 , N/A , N/A , N/A , N/A , N/A ,$221.51 , N/A ,$239.75 ,$182.42 ,$132.18 ,$158.63 ,$158.71 ,$158.63 ,$180.07 ,$234.54 ,$178.04 , N/A ,$205.87 , N/A ,$153.75 ,$153.75 , N/A ,$153.75 ,$187.63 ,$161.57 ,$187.63 ,$187.63 ,$208.48 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYSTEM CABLE STANDARD TROCHANTERIC TITANIUM COCR REATTACHMENT DEVICE STERILE,272,1 ,"$3,448.69 ","$2,276.14 ","$1,749.18 ","$3,448.69 ", N/A ,"$2,363.73 ","$2,363.73 ", N/A ,"$2,069.21 ","$2,931.39 ","$2,414.08 ", N/A , N/A ,"$3,276.26 ","$2,621.00 ","$2,586.52 ","$2,241.65 ","$2,931.39 ", N/A ,"$2,241.65 ","$2,241.65 ","$2,414.08 ","$2,100.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,931.39 ", N/A ,"$3,172.79 ","$2,414.08 ","$1,749.18 ","$2,099.22 ","$2,100.25 ","$2,099.22 ","$2,383.04 ","$3,103.82 ","$2,356.15 ", N/A ,"$2,724.47 ", N/A ,"$2,034.73 ","$2,034.73 ", N/A ,"$2,034.73 ","$2,483.06 ","$2,138.19 ","$2,483.06 ","$2,483.06 ","$2,758.95 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYSTEM FIXATION BLACK BLUE WHITE 4.75MM SPEEDBRIDGE SWIVELOCK FIBERTAPE 2 PRELOAD LOOP DISPOSABLE PUNCH,272,1 ,"$3,629.00 ","$2,395.14 ","$1,840.63 ","$3,629.00 ", N/A ,"$2,487.32 ","$2,487.32 ", N/A ,"$2,177.40 ","$3,084.65 ","$2,540.30 ", N/A , N/A ,"$3,447.55 ","$2,758.04 ","$2,721.75 ","$2,358.85 ","$3,084.65 ", N/A ,"$2,358.85 ","$2,358.85 ","$2,540.30 ","$2,210.06 ", N/A , N/A , N/A , N/A , N/A ,"$3,084.65 ", N/A ,"$3,338.68 ","$2,540.30 ","$1,840.63 ","$2,208.97 ","$2,210.06 ","$2,208.97 ","$2,507.64 ","$3,266.10 ","$2,479.33 ", N/A ,"$2,866.91 ", N/A ,"$2,141.11 ","$2,141.11 ", N/A ,"$2,141.11 ","$2,612.88 ","$2,249.98 ","$2,612.88 ","$2,612.88 ","$2,903.20 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYSTEM FIXATION CPR VIPER,272,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,334.82 ","$1,334.82 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ","$1,265.88 ","$1,655.38 ", N/A ,"$1,265.88 ","$1,265.88 ","$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A ,"$1,149.03 ","$1,149.03 ", N/A ,"$1,149.03 ","$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYSTEM FIXATION SPEEDBRIDGE JUMPSTART ACHILLES BIOCOMPOSITE STERILE,272,1 ,"$3,790.50 ","$2,501.73 ","$1,922.54 ","$3,790.50 ", N/A ,"$2,598.01 ","$2,598.01 ", N/A ,"$2,274.30 ","$3,221.93 ","$2,653.35 ", N/A , N/A ,"$3,600.98 ","$2,880.78 ","$2,842.88 ","$2,463.83 ","$3,221.93 ", N/A ,"$2,463.83 ","$2,463.83 ","$2,653.35 ","$2,308.41 ", N/A , N/A , N/A , N/A , N/A ,"$3,221.93 ", N/A ,"$3,487.26 ","$2,653.35 ","$1,922.54 ","$2,307.28 ","$2,308.41 ","$2,307.28 ","$2,619.24 ","$3,411.45 ","$2,589.67 ", N/A ,"$2,994.50 ", N/A ,"$2,236.40 ","$2,236.40 ", N/A ,"$2,236.40 ","$2,729.16 ","$2,350.11 ","$2,729.16 ","$2,729.16 ","$3,032.40 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYSTEM STRAIGHT NEEDLE DELIVERY FAST FIX 360 SMITH  AND  NEPHEW,272,1 ,"$1,010.67 ",$667.04 ,$512.61 ,"$1,010.67 ", N/A ,$692.71 ,$692.71 , N/A ,$606.40 ,$859.07 ,$707.47 , N/A , N/A ,$960.14 ,$768.11 ,$758.00 ,$656.94 ,$859.07 , N/A ,$656.94 ,$656.94 ,$707.47 ,$615.50 , N/A , N/A , N/A , N/A , N/A ,$859.07 , N/A ,$929.82 ,$707.47 ,$512.61 ,$615.19 ,$615.50 ,$615.19 ,$698.37 ,$909.60 ,$690.49 , N/A ,$798.43 , N/A ,$596.30 ,$596.30 , N/A ,$596.30 ,$727.68 ,$626.62 ,$727.68 ,$727.68 ,$808.54 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYSTEM CURVED NEEDLE DELIVERY FAST FIX 360 SMITH  AND  NEPHEW,272,1 ,"$1,010.67 ",$667.04 ,$512.61 ,"$1,010.67 ", N/A ,$692.71 ,$692.71 , N/A ,$606.40 ,$859.07 ,$707.47 , N/A , N/A ,$960.14 ,$768.11 ,$758.00 ,$656.94 ,$859.07 , N/A ,$656.94 ,$656.94 ,$707.47 ,$615.50 , N/A , N/A , N/A , N/A , N/A ,$859.07 , N/A ,$929.82 ,$707.47 ,$512.61 ,$615.19 ,$615.50 ,$615.19 ,$698.37 ,$909.60 ,$690.49 , N/A ,$798.43 , N/A ,$596.30 ,$596.30 , N/A ,$596.30 ,$727.68 ,$626.62 ,$727.68 ,$727.68 ,$808.54 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,SYSTEM URETHRAL SUPPORT BLUE 22CM .15MM OBTRYX II PRECISIONBLUE ADVANTAGE THK.66MM 1182UM MIDURETHRAL TRANSOBTURATOR POLYPROPYLENE SLING HALO NEEDLE DILATOR LEG LOOP FEMALE STRESS URINARY INCONTINENCE STERILE,272,1 ,"$2,010.03 ","$1,326.62 ","$1,019.49 ","$2,010.03 ", N/A ,"$1,377.67 ","$1,377.67 ", N/A ,"$1,206.02 ","$1,708.53 ","$1,407.02 ", N/A , N/A ,"$1,909.53 ","$1,527.62 ","$1,507.52 ","$1,306.52 ","$1,708.53 ", N/A ,"$1,306.52 ","$1,306.52 ","$1,407.02 ","$1,224.11 ", N/A , N/A , N/A , N/A , N/A ,"$1,708.53 ", N/A ,"$1,849.23 ","$1,407.02 ","$1,019.49 ","$1,223.51 ","$1,224.11 ","$1,223.51 ","$1,388.93 ","$1,809.03 ","$1,373.25 ", N/A ,"$1,587.92 ", N/A ,"$1,185.92 ","$1,185.92 ", N/A ,"$1,185.92 ","$1,447.22 ","$1,246.22 ","$1,447.22 ","$1,447.22 ","$1,608.02 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TAMP 10MM 2MM 21MM LOW PROFILE INFLATABLE BALLOON SURGICAL EXPRESS KYPHX,272,1 ,"$1,715.34 ","$1,132.12 ",$870.02 ,"$1,715.34 ", N/A ,"$1,175.69 ","$1,175.69 ", N/A ,"$1,029.20 ","$1,458.04 ","$1,200.74 ", N/A , N/A ,"$1,629.57 ","$1,303.66 ","$1,286.51 ","$1,114.97 ","$1,458.04 ", N/A ,"$1,114.97 ","$1,114.97 ","$1,200.74 ","$1,044.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,458.04 ", N/A ,"$1,578.11 ","$1,200.74 ",$870.02 ,"$1,044.13 ","$1,044.64 ","$1,044.13 ","$1,185.30 ","$1,543.81 ","$1,171.92 ", N/A ,"$1,355.12 ", N/A ,"$1,012.05 ","$1,012.05 ", N/A ,"$1,012.05 ","$1,235.04 ","$1,063.51 ","$1,235.04 ","$1,235.04 ","$1,372.27 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TIGHTROPE ARTHREX ACL RT,272,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A ,$515.76 ,$515.76 , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 ,$489.13 ,$639.63 , N/A ,$489.13 ,$489.13 ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A ,$443.98 ,$443.98 , N/A ,$443.98 ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TIP ELECTROSURGICAL MEGADYNE BALL TIP 5IN,272,1 ,$19.42 ,$12.82 ,$9.85 ,$19.42 , N/A ,$13.31 ,$13.31 , N/A ,$11.65 ,$16.51 ,$13.59 , N/A , N/A ,$18.45 ,$14.76 ,$14.57 ,$12.62 ,$16.51 , N/A ,$12.62 ,$12.62 ,$13.59 ,$11.83 , N/A , N/A , N/A , N/A , N/A ,$16.51 , N/A ,$17.87 ,$13.59 ,$9.85 ,$11.82 ,$11.83 ,$11.82 ,$13.42 ,$17.48 ,$13.27 , N/A ,$15.34 , N/A ,$11.46 ,$11.46 , N/A ,$11.46 ,$13.98 ,$12.04 ,$13.98 ,$13.98 ,$15.54 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TIRE RETINAL 2.5MM GROOVE CONCAVE SILICONE 7MM ASYMMETRICAL STERILE STYLE 276,272,1 ,$218.25 ,$144.05 ,$110.70 ,$218.25 , N/A ,$149.59 ,$149.59 , N/A ,$130.95 ,$185.51 ,$152.78 , N/A , N/A ,$207.34 ,$165.87 ,$163.69 ,$141.86 ,$185.51 , N/A ,$141.86 ,$141.86 ,$152.78 ,$132.91 , N/A , N/A , N/A , N/A , N/A ,$185.51 , N/A ,$200.79 ,$152.78 ,$110.70 ,$132.85 ,$132.91 ,$132.85 ,$150.81 ,$196.43 ,$149.11 , N/A ,$172.42 , N/A ,$128.77 ,$128.77 , N/A ,$128.77 ,$157.14 ,$135.32 ,$157.14 ,$157.14 ,$174.60 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRACH SHILEY CUFFLESS SZ 6,272,1 ,$62.17 ,$41.03 ,$31.53 ,$62.17 , N/A ,$42.61 ,$42.61 , N/A ,$37.30 ,$52.84 ,$43.52 , N/A , N/A ,$59.06 ,$47.25 ,$46.63 ,$40.41 ,$52.84 , N/A ,$40.41 ,$40.41 ,$43.52 ,$37.86 , N/A , N/A , N/A , N/A , N/A ,$52.84 , N/A ,$57.20 ,$43.52 ,$31.53 ,$37.84 ,$37.86 ,$37.84 ,$42.96 ,$55.95 ,$42.47 , N/A ,$49.11 , N/A ,$36.68 ,$36.68 , N/A ,$36.68 ,$44.76 ,$38.55 ,$44.76 ,$44.76 ,$49.74 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRACH SHILEY CUFFLESS SZ 4,272,1 ,$62.17 ,$41.03 ,$31.53 ,$62.17 , N/A ,$42.61 ,$42.61 , N/A ,$37.30 ,$52.84 ,$43.52 , N/A , N/A ,$59.06 ,$47.25 ,$46.63 ,$40.41 ,$52.84 , N/A ,$40.41 ,$40.41 ,$43.52 ,$37.86 , N/A , N/A , N/A , N/A , N/A ,$52.84 , N/A ,$57.20 ,$43.52 ,$31.53 ,$37.84 ,$37.86 ,$37.84 ,$42.96 ,$55.95 ,$42.47 , N/A ,$49.11 , N/A ,$36.68 ,$36.68 , N/A ,$36.68 ,$44.76 ,$38.55 ,$44.76 ,$44.76 ,$49.74 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRACH SHILEY PED SZ 5.0,272,1 ,$46.69 ,$30.82 ,$23.68 ,$46.69 , N/A ,$32.00 ,$32.00 , N/A ,$28.01 ,$39.69 ,$32.68 , N/A , N/A ,$44.36 ,$35.48 ,$35.02 ,$30.35 ,$39.69 , N/A ,$30.35 ,$30.35 ,$32.68 ,$28.43 , N/A , N/A , N/A , N/A , N/A ,$39.69 , N/A ,$42.95 ,$32.68 ,$23.68 ,$28.42 ,$28.43 ,$28.42 ,$32.26 ,$42.02 ,$31.90 , N/A ,$36.89 , N/A ,$27.55 ,$27.55 , N/A ,$27.55 ,$33.62 ,$28.95 ,$33.62 ,$33.62 ,$37.35 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRACH SHILEY PED SZ 3.0,272,1 ,$46.69 ,$30.82 ,$23.68 ,$46.69 , N/A ,$32.00 ,$32.00 , N/A ,$28.01 ,$39.69 ,$32.68 , N/A , N/A ,$44.36 ,$35.48 ,$35.02 ,$30.35 ,$39.69 , N/A ,$30.35 ,$30.35 ,$32.68 ,$28.43 , N/A , N/A , N/A , N/A , N/A ,$39.69 , N/A ,$42.95 ,$32.68 ,$23.68 ,$28.42 ,$28.43 ,$28.42 ,$32.26 ,$42.02 ,$31.90 , N/A ,$36.89 , N/A ,$27.55 ,$27.55 , N/A ,$27.55 ,$33.62 ,$28.95 ,$33.62 ,$33.62 ,$37.35 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRACH SHILEY PED SZ 3.5,272,1 ,$46.69 ,$30.82 ,$23.68 ,$46.69 , N/A ,$32.00 ,$32.00 , N/A ,$28.01 ,$39.69 ,$32.68 , N/A , N/A ,$44.36 ,$35.48 ,$35.02 ,$30.35 ,$39.69 , N/A ,$30.35 ,$30.35 ,$32.68 ,$28.43 , N/A , N/A , N/A , N/A , N/A ,$39.69 , N/A ,$42.95 ,$32.68 ,$23.68 ,$28.42 ,$28.43 ,$28.42 ,$32.26 ,$42.02 ,$31.90 , N/A ,$36.89 , N/A ,$27.55 ,$27.55 , N/A ,$27.55 ,$33.62 ,$28.95 ,$33.62 ,$33.62 ,$37.35 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRACH SHILEY PED SZ 4.0,272,1 ,$46.69 ,$30.82 ,$23.68 ,$46.69 , N/A ,$32.00 ,$32.00 , N/A ,$28.01 ,$39.69 ,$32.68 , N/A , N/A ,$44.36 ,$35.48 ,$35.02 ,$30.35 ,$39.69 , N/A ,$30.35 ,$30.35 ,$32.68 ,$28.43 , N/A , N/A , N/A , N/A , N/A ,$39.69 , N/A ,$42.95 ,$32.68 ,$23.68 ,$28.42 ,$28.43 ,$28.42 ,$32.26 ,$42.02 ,$31.90 , N/A ,$36.89 , N/A ,$27.55 ,$27.55 , N/A ,$27.55 ,$33.62 ,$28.95 ,$33.62 ,$33.62 ,$37.35 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRACH SHILEY PED SZ 4.5,272,1 ,$46.69 ,$30.82 ,$23.68 ,$46.69 , N/A ,$32.00 ,$32.00 , N/A ,$28.01 ,$39.69 ,$32.68 , N/A , N/A ,$44.36 ,$35.48 ,$35.02 ,$30.35 ,$39.69 , N/A ,$30.35 ,$30.35 ,$32.68 ,$28.43 , N/A , N/A , N/A , N/A , N/A ,$39.69 , N/A ,$42.95 ,$32.68 ,$23.68 ,$28.42 ,$28.43 ,$28.42 ,$32.26 ,$42.02 ,$31.90 , N/A ,$36.89 , N/A ,$27.55 ,$27.55 , N/A ,$27.55 ,$33.62 ,$28.95 ,$33.62 ,$33.62 ,$37.35 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRACH SHILEY PED UNCUFFED 3.5MM,272,1 ,$72.27 ,$47.70 ,$36.66 ,$72.27 , N/A ,$49.53 ,$49.53 , N/A ,$43.36 ,$61.43 ,$50.59 , N/A , N/A ,$68.66 ,$54.93 ,$54.20 ,$46.98 ,$61.43 , N/A ,$46.98 ,$46.98 ,$50.59 ,$44.01 , N/A , N/A , N/A , N/A , N/A ,$61.43 , N/A ,$66.49 ,$50.59 ,$36.66 ,$43.99 ,$44.01 ,$43.99 ,$49.94 ,$65.04 ,$49.37 , N/A ,$57.09 , N/A ,$42.64 ,$42.64 , N/A ,$42.64 ,$52.03 ,$44.81 ,$52.03 ,$52.03 ,$57.82 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRAY HUMERAL COMPREHENSIVE STANDARD SHOULDER REVERSE,272,1 ,"$2,375.00 ","$1,567.50 ","$1,204.60 ","$2,375.00 ", N/A ,"$1,627.83 ","$1,627.83 ", N/A ,"$1,425.00 ","$2,018.75 ","$1,662.50 ", N/A , N/A ,"$2,256.25 ","$1,805.00 ","$1,781.25 ","$1,543.75 ","$2,018.75 ", N/A ,"$1,543.75 ","$1,543.75 ","$1,662.50 ","$1,446.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,018.75 ", N/A ,"$2,185.00 ","$1,662.50 ","$1,204.60 ","$1,445.66 ","$1,446.38 ","$1,445.66 ","$1,641.13 ","$2,137.50 ","$1,622.60 ", N/A ,"$1,876.25 ", N/A ,"$1,401.25 ","$1,401.25 ", N/A ,"$1,401.25 ","$1,710.00 ","$1,472.50 ","$1,710.00 ","$1,710.00 ","$1,900.00 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TRAY INTRODUCER EXPRESS KYPHOPAK 15/2,272,1 ,"$4,738.86 ","$3,127.65 ","$2,403.55 ","$4,738.86 ", N/A ,"$3,248.01 ","$3,248.01 ", N/A ,"$2,843.32 ","$4,028.03 ","$3,317.20 ", N/A , N/A ,"$4,501.92 ","$3,601.53 ","$3,554.15 ","$3,080.26 ","$4,028.03 ", N/A ,"$3,080.26 ","$3,080.26 ","$3,317.20 ","$2,885.97 ", N/A , N/A , N/A , N/A , N/A ,"$4,028.03 ", N/A ,"$4,359.75 ","$3,317.20 ","$2,403.55 ","$2,884.54 ","$2,885.97 ","$2,884.54 ","$3,274.55 ","$4,264.97 ","$3,237.59 ", N/A ,"$3,743.70 ", N/A ,"$2,795.93 ","$2,795.93 ", N/A ,"$2,795.93 ","$3,411.98 ","$2,938.09 ","$3,411.98 ","$3,411.98 ","$3,791.09 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TROCHANTERIC REATTACHMENT DEVICE SYNTHES TI W/CABLES/LONG,272,1 ,"$4,707.36 ","$3,106.86 ","$2,387.57 ","$4,707.36 ", N/A ,"$3,226.42 ","$3,226.42 ", N/A ,"$2,824.42 ","$4,001.26 ","$3,295.15 ", N/A , N/A ,"$4,471.99 ","$3,577.59 ","$3,530.52 ","$3,059.78 ","$4,001.26 ", N/A ,"$3,059.78 ","$3,059.78 ","$3,295.15 ","$2,866.78 ", N/A , N/A , N/A , N/A , N/A ,"$4,001.26 ", N/A ,"$4,330.77 ","$3,295.15 ","$2,387.57 ","$2,865.37 ","$2,866.78 ","$2,865.37 ","$3,252.79 ","$4,236.62 ","$3,216.07 ", N/A ,"$3,718.81 ", N/A ,"$2,777.34 ","$2,777.34 ", N/A ,"$2,777.34 ","$3,389.30 ","$2,918.56 ","$3,389.30 ","$3,389.30 ","$3,765.89 "
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TUBE CHEST ARGYLE W/ TROCAR 20FR,272,1 ,$50.54 ,$33.36 ,$25.63 ,$50.54 , N/A ,$34.64 ,$34.64 , N/A ,$30.32 ,$42.96 ,$35.38 , N/A , N/A ,$48.01 ,$38.41 ,$37.91 ,$32.85 ,$42.96 , N/A ,$32.85 ,$32.85 ,$35.38 ,$30.78 , N/A , N/A , N/A , N/A , N/A ,$42.96 , N/A ,$46.50 ,$35.38 ,$25.63 ,$30.76 ,$30.78 ,$30.76 ,$34.92 ,$45.49 ,$34.53 , N/A ,$39.93 , N/A ,$29.82 ,$29.82 , N/A ,$29.82 ,$36.39 ,$31.33 ,$36.39 ,$36.39 ,$40.43 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,TUBE NASOGASTRIC 36IN 10FR 2 LUMEN REMOVABLE 5IN 1 CONNECTOR ARGYLE SALEM SUMP SENTINEL LINE SENTINEL EYE SILICONE STERILE LATEX FREE,272,1 ,$26.89 ,$17.75 ,$13.64 ,$26.89 , N/A ,$18.43 ,$18.43 , N/A ,$16.13 ,$22.86 ,$18.82 , N/A , N/A ,$25.55 ,$20.44 ,$20.17 ,$17.48 ,$22.86 , N/A ,$17.48 ,$17.48 ,$18.82 ,$16.38 , N/A , N/A , N/A , N/A , N/A ,$22.86 , N/A ,$24.74 ,$18.82 ,$13.64 ,$16.37 ,$16.38 ,$16.37 ,$18.58 ,$24.20 ,$18.37 , N/A ,$21.24 , N/A ,$15.87 ,$15.87 , N/A ,$15.87 ,$19.36 ,$16.67 ,$19.36 ,$19.36 ,$21.51 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$43.56 ,$85.88 , N/A ,$58.86 ,$58.86 , N/A ,$51.53 ,$73.00 ,$60.12 , N/A , N/A ,$81.59 ,$65.27 ,$64.41 ,$55.82 ,$73.00 , N/A ,$55.82 ,$55.82 ,$60.12 ,$52.30 , N/A , N/A , N/A , N/A , N/A ,$73.00 , N/A ,$79.01 ,$60.12 ,$43.56 ,$52.28 ,$52.30 ,$52.28 ,$59.34 ,$77.29 ,$58.67 , N/A ,$67.85 , N/A ,$50.67 ,$50.67 , N/A ,$50.67 ,$61.83 ,$53.25 ,$61.83 ,$61.83 ,$68.70 
ST NICHOLAS HOSPITAL - ACUTE,27270000,N/A,VISCERAL RETRACTOR GLASSMAN (BLUE FISH),272,1 ,$55.25 ,$36.47 ,$28.02 ,$55.25 , N/A ,$37.87 ,$37.87 , N/A ,$33.15 ,$46.96 ,$38.68 , N/A , N/A ,$52.49 ,$41.99 ,$41.44 ,$35.91 ,$46.96 , N/A ,$35.91 ,$35.91 ,$38.68 ,$33.65 , N/A , N/A , N/A , N/A , N/A ,$46.96 , N/A ,$50.83 ,$38.68 ,$28.02 ,$33.63 ,$33.65 ,$33.63 ,$38.18 ,$49.73 ,$37.75 , N/A ,$43.65 , N/A ,$32.60 ,$32.60 , N/A ,$32.60 ,$39.78 ,$34.26 ,$39.78 ,$39.78 ,$44.20 
ST NICHOLAS HOSPITAL - ACUTE,27271726,C1726,BALLOON CRE DILATION ESOPHAGEAL 12-15MM 6FR,272,1 ,$387.00 ,$255.42 ,$196.29 ,$387.00 , N/A ,$265.25 ,$265.25 , N/A ,$232.20 ,$328.95 , N/A , N/A , N/A ,$367.65 ,$294.12 ,$290.25 ,$251.55 ,$328.95 , N/A ,$251.55 ,$251.55 ,$270.90 ,$235.68 , N/A , N/A , N/A , N/A , N/A ,$328.95 , N/A ,$356.04 ,$270.90 ,$196.29 ,$235.57 ,$235.68 ,$235.57 ,$267.42 ,$348.30 ,$264.40 , N/A ,$305.73 , N/A ,$228.33 ,$228.33 , N/A ,$228.33 ,$278.64 ,$239.94 ,$278.64 ,$278.64 ,$309.60 
ST NICHOLAS HOSPITAL - ACUTE,27271726,C1726,BALLOON URS + INFLATION DEVICE 30FR X 15CM,272,1 ,$414.72 ,$273.72 ,$210.35 ,$414.72 , N/A ,$284.25 ,$284.25 , N/A ,$248.83 ,$352.51 , N/A , N/A , N/A ,$393.98 ,$315.19 ,$311.04 ,$269.57 ,$352.51 , N/A ,$269.57 ,$269.57 ,$290.30 ,$252.56 , N/A , N/A , N/A , N/A , N/A ,$352.51 , N/A ,$381.54 ,$290.30 ,$210.35 ,$252.44 ,$252.56 ,$252.44 ,$286.57 ,$373.25 ,$283.34 , N/A ,$327.63 , N/A ,$244.68 ,$244.68 , N/A ,$244.68 ,$298.60 ,$257.13 ,$298.60 ,$298.60 ,$331.78 
ST NICHOLAS HOSPITAL - ACUTE,27271726,C1726,DEVICE INFLATION CRE (SYRINGE),272,1 ,$65.70 ,$43.36 ,$33.32 ,$65.70 , N/A ,$45.03 ,$45.03 , N/A ,$39.42 ,$55.85 , N/A , N/A , N/A ,$62.42 ,$49.93 ,$49.28 ,$42.71 ,$55.85 , N/A ,$42.71 ,$42.71 ,$45.99 ,$40.01 , N/A , N/A , N/A , N/A , N/A ,$55.85 , N/A ,$60.44 ,$45.99 ,$33.32 ,$39.99 ,$40.01 ,$39.99 ,$45.40 ,$59.13 ,$44.89 , N/A ,$51.90 , N/A ,$38.76 ,$38.76 , N/A ,$38.76 ,$47.30 ,$40.73 ,$47.30 ,$47.30 ,$52.56 
ST NICHOLAS HOSPITAL - ACUTE,27271727,C1727,BALLOON DISSECTOR LAPAROSCOPIC SPACEMAKER PLUS 3 VALVE RIGID SPRING GRIP LOCK COLLAR BLUNT TIP TROCAR FOAM LATEX DISPOSABLE PREPERITONEAL HERNIA REPAIR OVAL,272,1 ,"$1,225.24 ",$808.66 ,$621.44 ,"$1,225.24 ", N/A ,$839.78 ,$839.78 , N/A ,$735.14 ,"$1,041.45 ", N/A , N/A , N/A ,"$1,163.98 ",$931.18 ,$918.93 ,$796.41 ,"$1,041.45 ", N/A ,$796.41 ,$796.41 ,$857.67 ,$746.17 , N/A , N/A , N/A , N/A , N/A ,"$1,041.45 ", N/A ,"$1,127.22 ",$857.67 ,$621.44 ,$745.80 ,$746.17 ,$745.80 ,$846.64 ,"$1,102.72 ",$837.08 , N/A ,$967.94 , N/A ,$722.89 ,$722.89 , N/A ,$722.89 ,$882.17 ,$759.65 ,$882.17 ,$882.17 ,$980.19 
ST NICHOLAS HOSPITAL - ACUTE,27271729,C1729,CATHETER DRAIN 24FR 20IN ARG SENTL,272,1 ,$29.68 ,$19.59 ,$15.05 ,$29.68 , N/A ,$20.34 ,$20.34 , N/A ,$17.81 ,$25.23 , N/A , N/A , N/A ,$28.20 ,$22.56 ,$22.26 ,$19.29 ,$25.23 , N/A ,$19.29 ,$19.29 ,$20.78 ,$18.08 , N/A , N/A , N/A , N/A , N/A ,$25.23 , N/A ,$27.31 ,$20.78 ,$15.05 ,$18.07 ,$18.08 ,$18.07 ,$20.51 ,$26.71 ,$20.28 , N/A ,$23.45 , N/A ,$17.51 ,$17.51 , N/A ,$17.51 ,$21.37 ,$18.40 ,$21.37 ,$21.37 ,$23.74 
ST NICHOLAS HOSPITAL - ACUTE,27271729,C1729,CATHETER FOLEY BALLOON LATEX 20FR 30CC,272,1 ,$4.54 ,$3.00 ,$2.30 ,$4.54 , N/A ,$3.11 ,$3.11 , N/A ,$2.72 ,$3.86 , N/A , N/A , N/A ,$4.31 ,$3.45 ,$3.41 ,$2.95 ,$3.86 , N/A ,$2.95 ,$2.95 ,$3.18 ,$2.76 , N/A , N/A , N/A , N/A , N/A ,$3.86 , N/A ,$4.18 ,$3.18 ,$2.30 ,$2.76 ,$2.76 ,$2.76 ,$3.14 ,$4.09 ,$3.10 , N/A ,$3.59 , N/A ,$2.68 ,$2.68 , N/A ,$2.68 ,$3.27 ,$2.81 ,$3.27 ,$3.27 ,$3.63 
ST NICHOLAS HOSPITAL - ACUTE,27271729,C1729,CATHETER FOLEY BARD 22FR 30CC SILICONE LATEX FREE,272,1 ,$15.75 ,$10.40 ,$7.99 ,$15.75 , N/A ,$10.80 ,$10.80 , N/A ,$9.45 ,$13.39 , N/A , N/A , N/A ,$14.96 ,$11.97 ,$11.81 ,$10.24 ,$13.39 , N/A ,$10.24 ,$10.24 ,$11.03 ,$9.59 , N/A , N/A , N/A , N/A , N/A ,$13.39 , N/A ,$14.49 ,$11.03 ,$7.99 ,$9.59 ,$9.59 ,$9.59 ,$10.88 ,$14.18 ,$10.76 , N/A ,$12.44 , N/A ,$9.29 ,$9.29 , N/A ,$9.29 ,$11.34 ,$9.77 ,$11.34 ,$11.34 ,$12.60 
ST NICHOLAS HOSPITAL - ACUTE,27271729,C1729,CATHETER URETHRAL LUBRI-SIL 18FR FOLEY 2 WAY BALLOON SILICONE HYDROGEL 30CC STERILE LATEX FREE DISPOSABLE,272,1 ,$8.71 ,$5.75 ,$4.42 ,$8.71 , N/A ,$5.97 ,$5.97 , N/A ,$5.23 ,$7.40 , N/A , N/A , N/A ,$8.27 ,$6.62 ,$6.53 ,$5.66 ,$7.40 , N/A ,$5.66 ,$5.66 ,$6.10 ,$5.30 , N/A , N/A , N/A , N/A , N/A ,$7.40 , N/A ,$8.01 ,$6.10 ,$4.42 ,$5.30 ,$5.30 ,$5.30 ,$6.02 ,$7.84 ,$5.95 , N/A ,$6.88 , N/A ,$5.14 ,$5.14 , N/A ,$5.14 ,$6.27 ,$5.40 ,$6.27 ,$6.27 ,$6.97 
ST NICHOLAS HOSPITAL - ACUTE,27271729,C1729,SET 25CM 14FR 12MM 15CM KAYE NEPHROSTOMY TAMPONADE BALLOON PERCUTANEOUS STERILE DISPOSABLE,272,1 ,$524.19 ,$345.97 ,$265.87 ,$524.19 , N/A ,$359.28 ,$359.28 , N/A ,$314.51 ,$445.56 , N/A , N/A , N/A ,$497.98 ,$398.38 ,$393.14 ,$340.72 ,$445.56 , N/A ,$340.72 ,$340.72 ,$366.93 ,$319.23 , N/A , N/A , N/A , N/A , N/A ,$445.56 , N/A ,$482.25 ,$366.93 ,$265.87 ,$319.07 ,$319.23 ,$319.07 ,$362.22 ,$471.77 ,$358.13 , N/A ,$414.11 , N/A ,$309.27 ,$309.27 , N/A ,$309.27 ,$377.42 ,$325.00 ,$377.42 ,$377.42 ,$419.35 
ST NICHOLAS HOSPITAL - ACUTE,27271758,C1758,CATHETER COUDE 18FR 5CC,272,1 ,$18.74 ,$12.37 ,$9.50 ,$18.74 , N/A ,$12.84 ,$12.84 , N/A ,$11.24 ,$15.93 , N/A , N/A , N/A ,$17.80 ,$14.24 ,$14.06 ,$12.18 ,$15.93 , N/A ,$12.18 ,$12.18 ,$13.12 ,$11.41 , N/A , N/A , N/A , N/A , N/A ,$15.93 , N/A ,$17.24 ,$13.12 ,$9.50 ,$11.41 ,$11.41 ,$11.41 ,$12.95 ,$16.87 ,$12.80 , N/A ,$14.80 , N/A ,$11.06 ,$11.06 , N/A ,$11.06 ,$13.49 ,$11.62 ,$13.49 ,$13.49 ,$14.99 
ST NICHOLAS HOSPITAL - ACUTE,27271758,C1758,CATHETER FOLEY SILICONE 22 FR,272,1 ,$14.89 ,$9.83 ,$7.55 ,$14.89 , N/A ,$10.21 ,$10.21 , N/A ,$8.93 ,$12.66 , N/A , N/A , N/A ,$14.15 ,$11.32 ,$11.17 ,$9.68 ,$12.66 , N/A ,$9.68 ,$9.68 ,$10.42 ,$9.07 , N/A , N/A , N/A , N/A , N/A ,$12.66 , N/A ,$13.70 ,$10.42 ,$7.55 ,$9.06 ,$9.07 ,$9.06 ,$10.29 ,$13.40 ,$10.17 , N/A ,$11.76 , N/A ,$8.79 ,$8.79 , N/A ,$8.79 ,$10.72 ,$9.23 ,$10.72 ,$10.72 ,$11.91 
ST NICHOLAS HOSPITAL - ACUTE,27271769,C1769,GUIDEWIRE ARTHREX KIRSCHNER .062 (157MM/1.6IN) TROCAR TIP,272,1 ,$33.75 ,$22.28 ,$17.12 ,$33.75 , N/A ,$23.13 ,$23.13 , N/A ,$20.25 ,$28.69 , N/A , N/A , N/A ,$32.06 ,$25.65 ,$25.31 ,$21.94 ,$28.69 , N/A ,$21.94 ,$21.94 ,$23.63 ,$20.55 , N/A , N/A , N/A , N/A , N/A ,$28.69 , N/A ,$31.05 ,$23.63 ,$17.12 ,$20.54 ,$20.55 ,$20.54 ,$23.32 ,$30.38 ,$23.06 , N/A ,$26.66 , N/A ,$19.91 ,$19.91 , N/A ,$19.91 ,$24.30 ,$20.93 ,$24.30 ,$24.30 ,$27.00 
ST NICHOLAS HOSPITAL - ACUTE,27271769,C1769,GUIDEWIRE ZIPWIRE STRAIGHT .035 X 150CM,272,1 ,$69.73 ,$46.02 ,$35.37 ,$69.73 , N/A ,$47.79 ,$47.79 , N/A ,$41.84 ,$59.27 , N/A , N/A , N/A ,$66.24 ,$52.99 ,$52.30 ,$45.32 ,$59.27 , N/A ,$45.32 ,$45.32 ,$48.81 ,$42.47 , N/A , N/A , N/A , N/A , N/A ,$59.27 , N/A ,$64.15 ,$48.81 ,$35.37 ,$42.44 ,$42.47 ,$42.44 ,$48.18 ,$62.76 ,$47.64 , N/A ,$55.09 , N/A ,$41.14 ,$41.14 , N/A ,$41.14 ,$50.21 ,$43.23 ,$50.21 ,$50.21 ,$55.78 
ST NICHOLAS HOSPITAL - ACUTE,27271769,C1769,WIRE GUIDE SYNTHES 0.8MM,272,1 ,$31.66 ,$20.90 ,$16.06 ,$31.66 , N/A ,$21.70 ,$21.70 , N/A ,$19.00 ,$26.91 , N/A , N/A , N/A ,$30.08 ,$24.06 ,$23.75 ,$20.58 ,$26.91 , N/A ,$20.58 ,$20.58 ,$22.16 ,$19.28 , N/A , N/A , N/A , N/A , N/A ,$26.91 , N/A ,$29.13 ,$22.16 ,$16.06 ,$19.27 ,$19.28 ,$19.27 ,$21.88 ,$28.49 ,$21.63 , N/A ,$25.01 , N/A ,$18.68 ,$18.68 , N/A ,$18.68 ,$22.80 ,$19.63 ,$22.80 ,$22.80 ,$25.33 
ST NICHOLAS HOSPITAL - ACUTE,27271769,C1769,WIRE KIRSCHNER STRYKER,272,1 ,$90.52 ,$59.74 ,$45.91 ,$90.52 , N/A ,$62.04 ,$62.04 , N/A ,$54.31 ,$76.94 , N/A , N/A , N/A ,$85.99 ,$68.80 ,$67.89 ,$58.84 ,$76.94 , N/A ,$58.84 ,$58.84 ,$63.36 ,$55.13 , N/A , N/A , N/A , N/A , N/A ,$76.94 , N/A ,$83.28 ,$63.36 ,$45.91 ,$55.10 ,$55.13 ,$55.10 ,$62.55 ,$81.47 ,$61.84 , N/A ,$71.51 , N/A ,$53.41 ,$53.41 , N/A ,$53.41 ,$65.17 ,$56.12 ,$65.17 ,$65.17 ,$72.42 
ST NICHOLAS HOSPITAL - ACUTE,27271769,C1769,WIRE KIRSCHNER WRIGHT MEDICAL 2.5 X 230MM,272,1 ,$58.50 ,$38.61 ,$29.67 ,$58.50 , N/A ,$40.10 ,$40.10 , N/A ,$35.10 ,$49.73 , N/A , N/A , N/A ,$55.58 ,$44.46 ,$43.88 ,$38.03 ,$49.73 , N/A ,$38.03 ,$38.03 ,$40.95 ,$35.63 , N/A , N/A , N/A , N/A , N/A ,$49.73 , N/A ,$53.82 ,$40.95 ,$29.67 ,$35.61 ,$35.63 ,$35.61 ,$40.42 ,$52.65 ,$39.97 , N/A ,$46.22 , N/A ,$34.52 ,$34.52 , N/A ,$34.52 ,$42.12 ,$36.27 ,$42.12 ,$42.12 ,$46.80 
ST NICHOLAS HOSPITAL - ACUTE,27271769,C1769,WIRE KIRSCHNER BLUNT TROCAR WRIGHT MEDICAL 0.9 X 150MM,272,1 ,$58.50 ,$38.61 ,$29.67 ,$58.50 , N/A ,$40.10 ,$40.10 , N/A ,$35.10 ,$49.73 , N/A , N/A , N/A ,$55.58 ,$44.46 ,$43.88 ,$38.03 ,$49.73 , N/A ,$38.03 ,$38.03 ,$40.95 ,$35.63 , N/A , N/A , N/A , N/A , N/A ,$49.73 , N/A ,$53.82 ,$40.95 ,$29.67 ,$35.61 ,$35.63 ,$35.61 ,$40.42 ,$52.65 ,$39.97 , N/A ,$46.22 , N/A ,$34.52 ,$34.52 , N/A ,$34.52 ,$42.12 ,$36.27 ,$42.12 ,$42.12 ,$46.80 
ST NICHOLAS HOSPITAL - ACUTE,27271894,C1894,INTRODUCER SUPRAPUBIC 16FR 20- FR 17CM 20CM 1 STEP DILATOR TROCAR STYLET PEEL-AWAY,272,1 ,$232.94 ,$153.74 ,$118.15 ,$232.94 , N/A ,$159.66 ,$159.66 , N/A ,$139.76 ,$198.00 , N/A , N/A , N/A ,$221.29 ,$177.03 ,$174.71 ,$151.41 ,$198.00 , N/A ,$151.41 ,$151.41 ,$163.06 ,$141.86 , N/A , N/A , N/A , N/A , N/A ,$198.00 , N/A ,$214.30 ,$163.06 ,$118.15 ,$141.79 ,$141.86 ,$141.79 ,$160.96 ,$209.65 ,$159.14 , N/A ,$184.02 , N/A ,$137.43 ,$137.43 , N/A ,$137.43 ,$167.72 ,$144.42 ,$167.72 ,$167.72 ,$186.35 
ST NICHOLAS HOSPITAL - ACUTE,27271894,C1894,SHEATH ACCESS 10 12FR URETERAL 35CM,272,1 ,$337.84 ,$222.97 ,$171.35 ,$337.84 , N/A ,$231.56 ,$231.56 , N/A ,$202.70 ,$287.16 , N/A , N/A , N/A ,$320.95 ,$256.76 ,$253.38 ,$219.60 ,$287.16 , N/A ,$219.60 ,$219.60 ,$236.49 ,$205.74 , N/A , N/A , N/A , N/A , N/A ,$287.16 , N/A ,$310.81 ,$236.49 ,$171.35 ,$205.64 ,$205.74 ,$205.64 ,$233.45 ,$304.06 ,$230.81 , N/A ,$266.89 , N/A ,$199.33 ,$199.33 , N/A ,$199.33 ,$243.24 ,$209.46 ,$243.24 ,$243.24 ,$270.27 
ST NICHOLAS HOSPITAL - ACUTE,27271894,C1894,SHEATH ACCESS 10 12FR URETERAL 45CM,272,1 ,$269.10 ,$177.61 ,$136.49 ,$269.10 , N/A ,$184.44 ,$184.44 , N/A ,$161.46 ,$228.74 , N/A , N/A , N/A ,$255.65 ,$204.52 ,$201.83 ,$174.92 ,$228.74 , N/A ,$174.92 ,$174.92 ,$188.37 ,$163.88 , N/A , N/A , N/A , N/A , N/A ,$228.74 , N/A ,$247.57 ,$188.37 ,$136.49 ,$163.80 ,$163.88 ,$163.80 ,$185.95 ,$242.19 ,$183.85 , N/A ,$212.59 , N/A ,$158.77 ,$158.77 , N/A ,$158.77 ,$193.75 ,$166.84 ,$193.75 ,$193.75 ,$215.28 
ST NICHOLAS HOSPITAL - ACUTE,27271894,C1894,SHEATH URETERAL ACCESS 11/13*36CM NAVIGATOR,272,1 ,$235.58 ,$155.48 ,$119.49 ,$235.58 , N/A ,$161.47 ,$161.47 , N/A ,$141.35 ,$200.24 , N/A , N/A , N/A ,$223.80 ,$179.04 ,$176.69 ,$153.13 ,$200.24 , N/A ,$153.13 ,$153.13 ,$164.91 ,$143.47 , N/A , N/A , N/A , N/A , N/A ,$200.24 , N/A ,$216.73 ,$164.91 ,$119.49 ,$143.40 ,$143.47 ,$143.40 ,$162.79 ,$212.02 ,$160.95 , N/A ,$186.11 , N/A ,$138.99 ,$138.99 , N/A ,$138.99 ,$169.62 ,$146.06 ,$169.62 ,$169.62 ,$188.46 
ST NICHOLAS HOSPITAL - ACUTE,27271894,C1894,SHEATH URETERAL ACCESS 12/14*46CM NAVIGATOR,272,1 ,$252.59 ,$166.71 ,$128.11 ,$252.59 , N/A ,$173.13 ,$173.13 , N/A ,$151.55 ,$214.70 , N/A , N/A , N/A ,$239.96 ,$191.97 ,$189.44 ,$164.18 ,$214.70 , N/A ,$164.18 ,$164.18 ,$176.81 ,$153.83 , N/A , N/A , N/A , N/A , N/A ,$214.70 , N/A ,$232.38 ,$176.81 ,$128.11 ,$153.75 ,$153.83 ,$153.75 ,$174.54 ,$227.33 ,$172.57 , N/A ,$199.55 , N/A ,$149.03 ,$149.03 , N/A ,$149.03 ,$181.86 ,$156.61 ,$181.86 ,$181.86 ,$202.07 
ST NICHOLAS HOSPITAL - ACUTE,27271894,C1894,SHEATH URETERAL ACCESS 12/14*36CM NAVIGATOR,272,1 ,$252.59 ,$166.71 ,$128.11 ,$252.59 , N/A ,$173.13 ,$173.13 , N/A ,$151.55 ,$214.70 , N/A , N/A , N/A ,$239.96 ,$191.97 ,$189.44 ,$164.18 ,$214.70 , N/A ,$164.18 ,$164.18 ,$176.81 ,$153.83 , N/A , N/A , N/A , N/A , N/A ,$214.70 , N/A ,$232.38 ,$176.81 ,$128.11 ,$153.75 ,$153.83 ,$153.75 ,$174.54 ,$227.33 ,$172.57 , N/A ,$199.55 , N/A ,$149.03 ,$149.03 , N/A ,$149.03 ,$181.86 ,$156.61 ,$181.86 ,$181.86 ,$202.07 
ST NICHOLAS HOSPITAL - ACUTE,27271894,C1894,SHEATH VNUS INTRODUCER 7FR X 11CM (IS-7F11),272,1 ,$68.63 ,$45.30 ,$34.81 ,$68.63 , N/A ,$47.04 ,$47.04 , N/A ,$41.18 ,$58.34 , N/A , N/A , N/A ,$65.20 ,$52.16 ,$51.47 ,$44.61 ,$58.34 , N/A ,$44.61 ,$44.61 ,$48.04 ,$41.80 , N/A , N/A , N/A , N/A , N/A ,$58.34 , N/A ,$63.14 ,$48.04 ,$34.81 ,$41.78 ,$41.80 ,$41.78 ,$47.42 ,$61.77 ,$46.89 , N/A ,$54.22 , N/A ,$40.49 ,$40.49 , N/A ,$40.49 ,$49.41 ,$42.55 ,$49.41 ,$49.41 ,$54.90 
ST NICHOLAS HOSPITAL - ACUTE,27282056,N/A,HC ENDOSCOPIC TACKING (SUTURE) SYSTEM,272,1 ,"$2,666.00 ","$1,759.56 ","$1,352.20 ","$2,666.00 ", N/A ,"$1,827.28 ","$1,827.28 ", N/A ,"$1,599.60 ","$2,266.10 ","$1,866.20 ", N/A , N/A ,"$2,532.70 ","$2,026.16 ","$1,999.50 ","$1,732.90 ","$2,266.10 ", N/A ,"$1,732.90 ","$1,732.90 ","$1,866.20 ","$1,623.59 ", N/A , N/A , N/A , N/A , N/A ,"$2,266.10 ", N/A ,"$2,452.72 ","$1,866.20 ","$1,352.20 ","$1,622.79 ","$1,623.59 ","$1,622.79 ","$1,842.21 ","$2,399.40 ","$1,821.41 ", N/A ,"$2,106.14 ", N/A ,"$1,572.94 ","$1,572.94 ", N/A ,"$1,572.94 ","$1,919.52 ","$1,652.92 ","$1,919.52 ","$1,919.52 ","$2,132.80 "
ST NICHOLAS HOSPITAL - ACUTE,27400003,L0120,HC CERVICAL COLLAR,274,1 ,$72.00 ,$47.52 ,$36.52 ,$86.99 , N/A , N/A , N/A ,$38.66 ,$43.20 ,$61.20 ,$50.40 , N/A , N/A ,$68.40 ,$54.72 ,$54.00 , N/A ,$61.20 ,$38.66 , N/A , N/A ,$50.40 ,$43.85 , N/A ,$38.66 ,$37.89 ,$72.00 , N/A ,$61.20 ,$86.99 ,$66.24 ,$50.40 ,$36.52 ,$43.83 ,$43.85 ,$43.83 ,$49.75 ,$64.80 ,$49.19 ,$38.27 ,$56.88 , N/A , N/A , N/A ,$37.89 , N/A ,$51.84 ,$44.64 ,$51.84 ,$51.84 ,$57.60 
ST NICHOLAS HOSPITAL - ACUTE,27400004,L0140,HC CERVICAL COLLAR ADJUSTABLE,274,1 ,$208.00 ,$137.28 ,$94.59 ,$217.17 , N/A , N/A , N/A ,$96.52 ,$124.80 ,$176.80 ,$145.60 , N/A , N/A ,$197.60 ,$158.08 ,$156.00 , N/A ,$176.80 ,$96.52 , N/A , N/A ,$145.60 ,$126.67 , N/A ,$96.52 ,$94.59 ,$193.04 , N/A ,$176.80 ,$217.17 ,$191.36 ,$145.60 ,$105.50 ,$126.61 ,$126.67 ,$126.61 ,$143.73 ,$187.20 ,$142.11 ,$95.54 ,$164.32 , N/A , N/A , N/A ,$94.59 , N/A ,$149.76 ,$128.96 ,$149.76 ,$149.76 ,$166.40 
ST NICHOLAS HOSPITAL - ACUTE,27400005,L0150,HC CERVICAL COLLAR-STIFF NECK,274,1 ,$133.00 ,$87.78 ,$67.46 ,$280.80 , N/A , N/A , N/A ,$124.80 ,$79.80 ,$113.05 ,$93.10 , N/A , N/A ,$126.35 ,$101.08 ,$99.75 , N/A ,$113.05 ,$124.80 , N/A , N/A ,$93.10 ,$81.00 , N/A ,$124.80 ,$122.30 ,$133.00 , N/A ,$113.05 ,$280.80 ,$122.36 ,$93.10 ,$67.46 ,$80.96 ,$81.00 ,$80.96 ,$91.90 ,$119.70 ,$90.87 ,$123.53 ,$105.07 , N/A , N/A , N/A ,$122.30 , N/A ,$95.76 ,$82.46 ,$95.76 ,$95.76 ,$106.40 
ST NICHOLAS HOSPITAL - ACUTE,27400006,L0150,HC PHILADELPHA COLLAR,274,1 ,$133.00 ,$87.78 ,$67.46 ,$280.80 , N/A , N/A , N/A ,$124.80 ,$79.80 ,$113.05 ,$93.10 , N/A , N/A ,$126.35 ,$101.08 ,$99.75 , N/A ,$113.05 ,$124.80 , N/A , N/A ,$93.10 ,$81.00 , N/A ,$124.80 ,$122.30 ,$133.00 , N/A ,$113.05 ,$280.80 ,$122.36 ,$93.10 ,$67.46 ,$80.96 ,$81.00 ,$80.96 ,$91.90 ,$119.70 ,$90.87 ,$123.53 ,$105.07 , N/A , N/A , N/A ,$122.30 , N/A ,$95.76 ,$82.46 ,$95.76 ,$95.76 ,$106.40 
ST NICHOLAS HOSPITAL - ACUTE,27400010,L0172,HC CERVICAL COLLAR TWO PIECE,274,1 ,$306.00 ,$201.96 ,$155.20 ,$430.06 , N/A , N/A , N/A ,$191.14 ,$183.60 ,$260.10 ,$214.20 , N/A , N/A ,$290.70 ,$232.56 ,$229.50 , N/A ,$260.10 ,$191.14 , N/A , N/A ,$214.20 ,$186.35 , N/A ,$191.14 ,$187.32 ,$306.00 , N/A ,$260.10 ,$430.06 ,$281.52 ,$214.20 ,$155.20 ,$186.26 ,$186.35 ,$186.26 ,$211.45 ,$275.40 ,$209.06 ,$189.19 ,$241.74 , N/A , N/A , N/A ,$187.32 , N/A ,$220.32 ,$189.72 ,$220.32 ,$220.32 ,$244.80 
ST NICHOLAS HOSPITAL - ACUTE,27400011,L0220,HC RIBBELT,274,1 ,$183.00 ,$120.78 ,$92.82 ,$349.02 , N/A , N/A , N/A ,$155.12 ,$109.80 ,$155.55 ,$128.10 , N/A , N/A ,$173.85 ,$139.08 ,$137.25 , N/A ,$155.55 ,$155.12 , N/A , N/A ,$128.10 ,$111.45 , N/A ,$155.12 ,$152.02 ,$183.00 , N/A ,$155.55 ,$349.02 ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$111.39 ,$126.45 ,$164.70 ,$125.03 ,$153.54 ,$144.57 , N/A , N/A , N/A ,$152.02 , N/A ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,27400019,L1830,HC KNEE IMMOBILIZER,274,1 ,$129.00 ,$85.14 ,$65.43 ,$191.27 , N/A , N/A , N/A ,$85.01 ,$77.40 ,$109.65 ,$90.30 , N/A , N/A ,$122.55 ,$98.04 ,$96.75 , N/A ,$109.65 ,$85.01 , N/A , N/A ,$90.30 ,$78.56 , N/A ,$85.01 ,$83.31 ,$129.00 , N/A ,$109.65 ,$191.27 ,$118.68 ,$90.30 ,$65.43 ,$78.52 ,$78.56 ,$78.52 ,$89.14 ,$116.10 ,$88.13 ,$84.14 ,$101.91 , N/A , N/A , N/A ,$83.31 , N/A ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,27400028,L1830,HC KNEE IMMOBILIZER FIT  AND  ADJ,274,1 ,$203.00 ,$133.98 ,$97.81 ,$224.57 , N/A , N/A , N/A ,$99.81 ,$121.80 ,$172.55 ,$142.10 , N/A , N/A ,$192.85 ,$154.28 ,$152.25 , N/A ,$172.55 ,$99.81 , N/A , N/A ,$142.10 ,$123.63 , N/A ,$99.81 ,$97.81 ,$199.62 , N/A ,$172.55 ,$224.57 ,$186.76 ,$142.10 ,$102.96 ,$123.57 ,$123.63 ,$123.57 ,$140.27 ,$182.70 ,$138.69 ,$98.79 ,$160.37 , N/A , N/A , N/A ,$97.81 , N/A ,$146.16 ,$125.86 ,$146.16 ,$146.16 ,$162.40 
ST NICHOLAS HOSPITAL - ACUTE,27400035,L3650,HC CLAVICLE STRAP/FIT  AND  ADJ,274,1 ,$165.00 ,$108.90 ,$83.69 ,$209.63 , N/A , N/A , N/A ,$93.17 ,$99.00 ,$140.25 ,$115.50 , N/A , N/A ,$156.75 ,$125.40 ,$123.75 , N/A ,$140.25 ,$93.17 , N/A , N/A ,$115.50 ,$100.49 , N/A ,$93.17 ,$91.31 ,$165.00 , N/A ,$140.25 ,$209.63 ,$151.80 ,$115.50 ,$83.69 ,$100.44 ,$100.49 ,$100.44 ,$114.02 ,$148.50 ,$112.73 ,$92.22 ,$130.35 , N/A , N/A , N/A ,$91.31 , N/A ,$118.80 ,$102.30 ,$118.80 ,$118.80 ,$132.00 
ST NICHOLAS HOSPITAL - ACUTE,27400037,L4397,HC SPLINT ANKLE FOOT ORTHOSIS STATIC,274,1 ,$123.00 ,$81.18 ,$62.39 ,$401.76 , N/A , N/A , N/A ,$178.56 ,$73.80 ,$104.55 ,$86.10 , N/A , N/A ,$116.85 ,$93.48 ,$92.25 , N/A ,$104.55 ,$178.56 , N/A , N/A ,$86.10 ,$74.91 , N/A ,$178.56 ,$174.99 ,$123.00 , N/A ,$104.55 ,$401.76 ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$74.87 ,$84.99 ,$110.70 ,$84.03 ,$176.74 ,$97.17 , N/A , N/A , N/A ,$174.99 , N/A ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,27400039,L3670,HC SHOULDER IMMOBILIZER FIT  AND  ADJ,274,1 ,$165.00 ,$108.90 ,$83.69 ,$287.82 , N/A , N/A , N/A ,$127.92 ,$99.00 ,$140.25 ,$115.50 , N/A , N/A ,$156.75 ,$125.40 ,$123.75 , N/A ,$140.25 ,$127.92 , N/A , N/A ,$115.50 ,$100.49 , N/A ,$127.92 ,$125.36 ,$165.00 , N/A ,$140.25 ,$287.82 ,$151.80 ,$115.50 ,$83.69 ,$100.44 ,$100.49 ,$100.44 ,$114.02 ,$148.50 ,$112.73 ,$126.62 ,$130.35 , N/A , N/A , N/A ,$125.36 , N/A ,$118.80 ,$102.30 ,$118.80 ,$118.80 ,$132.00 
ST NICHOLAS HOSPITAL - ACUTE,27400040,L3763,HC SPLINT FOREARM-STATIC,274,1 ,$790.00 ,$521.40 ,$400.69 ,"$1,761.37 ", N/A , N/A , N/A ,$782.83 ,$474.00 ,$671.50 ,$553.00 , N/A , N/A ,$750.50 ,$600.40 ,$592.50 , N/A ,$671.50 ,$782.83 , N/A , N/A ,$553.00 ,$481.11 , N/A ,$782.83 ,$767.17 ,$790.00 , N/A ,$671.50 ,"$1,761.37 ",$726.80 ,$553.00 ,$400.69 ,$480.87 ,$481.11 ,$480.87 ,$545.89 ,$711.00 ,$539.73 ,$774.85 ,$624.10 , N/A , N/A , N/A ,$767.17 , N/A ,$568.80 ,$489.80 ,$568.80 ,$568.80 ,$632.00 
ST NICHOLAS HOSPITAL - ACUTE,27400043,L3807,HC FUNCT POSITION HAND SPLT,274,1 ,$242.00 ,$159.72 ,$122.74 ,$578.65 , N/A , N/A , N/A ,$257.18 ,$145.20 ,$205.70 ,$169.40 , N/A , N/A ,$229.90 ,$183.92 ,$181.50 , N/A ,$205.70 ,$257.18 , N/A , N/A ,$169.40 ,$147.38 , N/A ,$257.18 ,$252.04 ,$242.00 , N/A ,$205.70 ,$578.65 ,$222.64 ,$169.40 ,$122.74 ,$147.31 ,$147.38 ,$147.31 ,$167.22 ,$217.80 ,$165.33 ,$254.55 ,$191.18 , N/A , N/A , N/A ,$252.04 , N/A ,$174.24 ,$150.04 ,$174.24 ,$174.24 ,$193.60 
ST NICHOLAS HOSPITAL - ACUTE,27400044,L3908,HC COCK UP WRIST SPLINT/FIT  AND  ADJ,274,1 ,$163.00 ,$107.58 ,$82.67 ,$211.09 , N/A , N/A , N/A ,$93.82 ,$97.80 ,$138.55 ,$114.10 , N/A , N/A ,$154.85 ,$123.88 ,$122.25 , N/A ,$138.55 ,$93.82 , N/A , N/A ,$114.10 ,$99.27 , N/A ,$93.82 ,$91.94 ,$163.00 , N/A ,$138.55 ,$211.09 ,$149.96 ,$114.10 ,$82.67 ,$99.22 ,$99.27 ,$99.22 ,$112.63 ,$146.70 ,$111.36 ,$92.86 ,$128.77 , N/A , N/A , N/A ,$91.94 , N/A ,$117.36 ,$101.06 ,$117.36 ,$117.36 ,$130.40 
ST NICHOLAS HOSPITAL - ACUTE,27400049,L3913,HC HAND FINGER SPLINT INCL FITTING,274,1 ,$532.00 ,$351.12 ,$269.83 ,$748.17 , N/A , N/A , N/A ,$332.52 ,$319.20 ,$452.20 ,$372.40 , N/A , N/A ,$505.40 ,$404.32 ,$399.00 , N/A ,$452.20 ,$332.52 , N/A , N/A ,$372.40 ,$323.99 , N/A ,$332.52 ,$325.87 ,$532.00 , N/A ,$452.20 ,$748.17 ,$489.44 ,$372.40 ,$269.83 ,$323.83 ,$323.99 ,$323.83 ,$367.61 ,$478.80 ,$363.46 ,$329.13 ,$420.28 , N/A , N/A , N/A ,$325.87 , N/A ,$383.04 ,$329.84 ,$383.04 ,$383.04 ,$425.60 
ST NICHOLAS HOSPITAL - ACUTE,27400051,L3919,HC SPLINT HAND STATIC,274,1 ,$299.00 ,$197.34 ,$151.65 ,$643.32 , N/A , N/A , N/A ,$285.92 ,$179.40 ,$254.15 ,$209.30 , N/A , N/A ,$284.05 ,$227.24 ,$224.25 , N/A ,$254.15 ,$285.92 , N/A , N/A ,$209.30 ,$182.09 , N/A ,$285.92 ,$280.20 ,$299.00 , N/A ,$254.15 ,$643.32 ,$275.08 ,$209.30 ,$151.65 ,$182.00 ,$182.09 ,$182.00 ,$206.61 ,$269.10 ,$204.28 ,$283.00 ,$236.21 , N/A , N/A , N/A ,$280.20 , N/A ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$239.20 
ST NICHOLAS HOSPITAL - ACUTE,27400052,L3921,HC SPLINT HAND DYNAMIC,274,1 ,$406.00 ,$267.96 ,$205.92 ,$786.17 , N/A , N/A , N/A ,$349.41 ,$243.60 ,$345.10 ,$284.20 , N/A , N/A ,$385.70 ,$308.56 ,$304.50 , N/A ,$345.10 ,$349.41 , N/A , N/A ,$284.20 ,$247.25 , N/A ,$349.41 ,$342.42 ,$406.00 , N/A ,$345.10 ,$786.17 ,$373.52 ,$284.20 ,$205.92 ,$247.13 ,$247.25 ,$247.13 ,$280.55 ,$365.40 ,$277.38 ,$345.84 ,$320.74 , N/A , N/A , N/A ,$342.42 , N/A ,$292.32 ,$251.72 ,$292.32 ,$292.32 ,$324.80 
ST NICHOLAS HOSPITAL - ACUTE,27400061,L3931,HC SPLINT DORSAL BLOCKING,274,1 ,$218.00 ,$143.88 ,$110.57 ,$489.80 , N/A , N/A , N/A ,$217.69 ,$130.80 ,$185.30 ,$152.60 , N/A , N/A ,$207.10 ,$165.68 ,$163.50 , N/A ,$185.30 ,$217.69 , N/A , N/A ,$152.60 ,$132.76 , N/A ,$217.69 ,$213.34 ,$218.00 , N/A ,$185.30 ,$489.80 ,$200.56 ,$152.60 ,$110.57 ,$132.70 ,$132.76 ,$132.70 ,$150.64 ,$196.20 ,$148.94 ,$215.47 ,$172.22 , N/A , N/A , N/A ,$213.34 , N/A ,$156.96 ,$135.16 ,$156.96 ,$156.96 ,$174.40 
ST NICHOLAS HOSPITAL - ACUTE,27400063,L4350,HC AIR CAST/FIT  AND  ADJ,274,1 ,$208.00 ,$137.28 ,$105.50 ,$293.33 , N/A , N/A , N/A ,$130.37 ,$124.80 ,$176.80 ,$145.60 , N/A , N/A ,$197.60 ,$158.08 ,$156.00 , N/A ,$176.80 ,$130.37 , N/A , N/A ,$145.60 ,$126.67 , N/A ,$130.37 ,$127.76 ,$208.00 , N/A ,$176.80 ,$293.33 ,$191.36 ,$145.60 ,$105.50 ,$126.61 ,$126.67 ,$126.61 ,$143.73 ,$187.20 ,$142.11 ,$129.04 ,$164.32 , N/A , N/A , N/A ,$127.76 , N/A ,$149.76 ,$128.96 ,$149.76 ,$149.76 ,$166.40 
ST NICHOLAS HOSPITAL - ACUTE,27400064,L4360,HC AIRWALKER SPLINT INCL FITTING,274,1 ,$548.00 ,$361.68 ,$277.95 ,$781.04 , N/A , N/A , N/A ,$347.13 ,$328.80 ,$465.80 ,$383.60 , N/A , N/A ,$520.60 ,$416.48 ,$411.00 , N/A ,$465.80 ,$347.13 , N/A , N/A ,$383.60 ,$333.73 , N/A ,$347.13 ,$340.19 ,$548.00 , N/A ,$465.80 ,$781.04 ,$504.16 ,$383.60 ,$277.95 ,$333.57 ,$333.73 ,$333.57 ,$378.67 ,$493.20 ,$374.39 ,$343.59 ,$432.92 , N/A , N/A , N/A ,$340.19 , N/A ,$394.56 ,$339.76 ,$394.56 ,$394.56 ,$438.40 
ST NICHOLAS HOSPITAL - ACUTE,27400065,L4386,HC ROM WALKER BOOT FIT  AND  ADJ,274,1 ,$340.00 ,$224.40 ,$172.45 ,$480.29 , N/A , N/A , N/A ,$213.46 ,$204.00 ,$289.00 ,$238.00 , N/A , N/A ,$323.00 ,$258.40 ,$255.00 , N/A ,$289.00 ,$213.46 , N/A , N/A ,$238.00 ,$207.06 , N/A ,$213.46 ,$209.19 ,$340.00 , N/A ,$289.00 ,$480.29 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$211.28 ,$268.60 , N/A , N/A , N/A ,$209.19 , N/A ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,27400066,L4398,HC DROP FOOT BRACE (AFO),274,1 ,$170.00 ,$112.20 ,$86.22 ,$235.94 , N/A , N/A , N/A ,$104.86 ,$102.00 ,$144.50 ,$119.00 , N/A , N/A ,$161.50 ,$129.20 ,$127.50 , N/A ,$144.50 ,$104.86 , N/A , N/A ,$119.00 ,$103.53 , N/A ,$104.86 ,$102.76 ,$170.00 , N/A ,$144.50 ,$235.94 ,$156.40 ,$119.00 ,$86.22 ,$103.48 ,$103.53 ,$103.48 ,$117.47 ,$153.00 ,$116.14 ,$103.79 ,$134.30 , N/A , N/A , N/A ,$102.76 , N/A ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,27400069,L8501,HC PASSEY MUIR VALVE,274,1 ,$292.00 ,$192.72 ,$148.10 ,$379.80 , N/A , N/A , N/A ,$168.80 ,$175.20 ,$248.20 ,$204.40 , N/A , N/A ,$277.40 ,$221.92 ,$219.00 , N/A ,$248.20 ,$168.80 , N/A , N/A ,$204.40 ,$177.83 , N/A ,$168.80 ,$165.42 ,$292.00 , N/A ,$248.20 ,$379.80 ,$268.64 ,$204.40 ,$148.10 ,$177.74 ,$177.83 ,$177.74 ,$201.77 ,$262.80 ,$199.49 ,$167.08 ,$230.68 , N/A , N/A , N/A ,$165.42 , N/A ,$210.24 ,$181.04 ,$210.24 ,$210.24 ,$233.60 
ST NICHOLAS HOSPITAL - ACUTE,27400080,L3935,HC THUMB SPLINT FIT AND ADJUST,274,1 ,$244.00 ,$161.04 ,$123.76 ,$524.81 , N/A , N/A , N/A ,$233.25 ,$146.40 ,$207.40 ,$170.80 , N/A , N/A ,$231.80 ,$185.44 ,$183.00 , N/A ,$207.40 ,$233.25 , N/A , N/A ,$170.80 ,$148.60 , N/A ,$233.25 ,$228.58 ,$244.00 , N/A ,$207.40 ,$524.81 ,$224.48 ,$170.80 ,$123.76 ,$148.52 ,$148.60 ,$148.52 ,$168.60 ,$219.60 ,$166.70 ,$230.87 ,$192.76 , N/A , N/A , N/A ,$228.58 , N/A ,$175.68 ,$151.28 ,$175.68 ,$175.68 ,$195.20 
ST NICHOLAS HOSPITAL - ACUTE,27400092,L3927,HC FINGER SPLINT STATIC FIT/ADJUST,274,1 ,$70.00 ,$46.20 ,$35.50 ,$97.25 , N/A , N/A , N/A ,$43.22 ,$42.00 ,$59.50 ,$49.00 , N/A , N/A ,$66.50 ,$53.20 ,$52.50 , N/A ,$59.50 ,$43.22 , N/A , N/A ,$49.00 ,$42.63 , N/A ,$43.22 ,$42.36 ,$70.00 , N/A ,$59.50 ,$97.25 ,$64.40 ,$49.00 ,$35.50 ,$42.61 ,$42.63 ,$42.61 ,$48.37 ,$63.00 ,$47.82 ,$42.78 ,$55.30 , N/A , N/A , N/A ,$42.36 , N/A ,$50.40 ,$43.40 ,$50.40 ,$50.40 ,$56.00 
ST NICHOLAS HOSPITAL - ACUTE,27400109,L3702,HC ORTHOSIS ELBOW W/O JOINTS CUSTOM,274,1 ,$500.00 ,$330.00 ,$253.60 ,$767.48 , N/A , N/A , N/A ,$341.10 ,$300.00 ,$425.00 ,$350.00 , N/A , N/A ,$475.00 ,$380.00 ,$375.00 , N/A ,$425.00 ,$341.10 , N/A , N/A ,$350.00 ,$304.50 , N/A ,$341.10 ,$334.28 ,$500.00 , N/A ,$425.00 ,$767.48 ,$460.00 ,$350.00 ,$253.60 ,$304.35 ,$304.50 ,$304.35 ,$345.50 ,$450.00 ,$341.60 ,$337.62 ,$395.00 , N/A , N/A , N/A ,$334.28 , N/A ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,27400110,L3808,HC ORTHOSIS WHFO RIGID W/O JOINTS,274,1 ,$695.00 ,$458.70 ,$352.50 ,$981.97 , N/A , N/A , N/A ,$436.43 ,$417.00 ,$590.75 ,$486.50 , N/A , N/A ,$660.25 ,$528.20 ,$521.25 , N/A ,$590.75 ,$436.43 , N/A , N/A ,$486.50 ,$423.26 , N/A ,$436.43 ,$427.70 ,$695.00 , N/A ,$590.75 ,$981.97 ,$639.40 ,$486.50 ,$352.50 ,$423.05 ,$423.26 ,$423.05 ,$480.25 ,$625.50 ,$474.82 ,$431.97 ,$549.05 , N/A , N/A , N/A ,$427.70 , N/A ,$500.40 ,$430.90 ,$500.40 ,$500.40 ,$556.00 
ST NICHOLAS HOSPITAL - ACUTE,27400112,L3906,HC ORTHOSIS WHO GAUNTLET MOLDED CUSTOM,274,1 ,$979.00 ,$646.14 ,$496.55 ,"$1,392.59 ", N/A , N/A , N/A ,$618.93 ,$587.40 ,$832.15 ,$685.30 , N/A , N/A ,$930.05 ,$744.04 ,$734.25 , N/A ,$832.15 ,$618.93 , N/A , N/A ,$685.30 ,$596.21 , N/A ,$618.93 ,$606.55 ,$979.00 , N/A ,$832.15 ,"$1,392.59 ",$900.68 ,$685.30 ,$496.55 ,$595.92 ,$596.21 ,$595.92 ,$676.49 ,$881.10 ,$668.85 ,$612.62 ,$773.41 , N/A , N/A , N/A ,$606.55 , N/A ,$704.88 ,$606.98 ,$704.88 ,$704.88 ,$783.20 
ST NICHOLAS HOSPITAL - ACUTE,27400133,L4360,HC BOOT WALKING,274,1 ,$216.00 ,$142.56 ,$109.56 ,$631.64 , N/A , N/A , N/A ,$280.73 ,$129.60 ,$183.60 ,$151.20 , N/A , N/A ,$205.20 ,$164.16 ,$162.00 , N/A ,$183.60 ,$280.73 , N/A , N/A ,$151.20 ,$131.54 , N/A ,$280.73 ,$275.12 ,$216.00 , N/A ,$183.60 ,$631.64 ,$198.72 ,$151.20 ,$109.56 ,$131.48 ,$131.54 ,$131.48 ,$149.26 ,$194.40 ,$147.57 ,$277.87 ,$170.64 , N/A , N/A , N/A ,$275.12 , N/A ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$172.80 
ST NICHOLAS HOSPITAL - ACUTE,27400220,L3806,HC WRIST/HAND/FINGER ORTHOSIS W/JOINT CUSTOM FAB FIT AND ADJUST,274,1 ,$880.00 ,$580.80 ,$446.34 ,"$1,249.33 ", N/A , N/A , N/A ,$555.26 ,$528.00 ,$748.00 ,$616.00 , N/A , N/A ,$836.00 ,$668.80 ,$660.00 , N/A ,$748.00 ,$555.26 , N/A , N/A ,$616.00 ,$535.92 , N/A ,$555.26 ,$544.15 ,$880.00 , N/A ,$748.00 ,"$1,249.33 ",$809.60 ,$616.00 ,$446.34 ,$535.66 ,$535.92 ,$535.66 ,$608.08 ,$792.00 ,$601.22 ,$549.59 ,$695.20 , N/A , N/A , N/A ,$544.15 , N/A ,$633.60 ,$545.60 ,$633.60 ,$633.60 ,$704.00 
ST NICHOLAS HOSPITAL - ACUTE,27400221,L3809,HC WRIST/HAND/FINGER ORTHOSIS W/O JOINT PREFAB,274,1 ,$500.00 ,$330.00 ,$253.60 ,$694.75 , N/A , N/A , N/A ,$308.78 ,$300.00 ,$425.00 ,$350.00 , N/A , N/A ,$475.00 ,$380.00 ,$375.00 , N/A ,$425.00 ,$308.78 , N/A , N/A ,$350.00 ,$304.50 , N/A ,$308.78 ,$302.60 ,$500.00 , N/A ,$425.00 ,$694.75 ,$460.00 ,$350.00 ,$253.60 ,$304.35 ,$304.50 ,$304.35 ,$345.50 ,$450.00 ,$341.60 ,$305.63 ,$395.00 , N/A , N/A , N/A ,$302.60 , N/A ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,27400222,L3933,HC FINGER ORTHOSIS W/O JOINTS CUSTOM FAB FIT AND ADJUST,274,1 ,$424.00 ,$279.84 ,$215.05 ,$591.64 , N/A , N/A , N/A ,$262.95 ,$254.40 ,$360.40 ,$296.80 , N/A , N/A ,$402.80 ,$322.24 ,$318.00 , N/A ,$360.40 ,$262.95 , N/A , N/A ,$296.80 ,$258.22 , N/A ,$262.95 ,$257.69 ,$424.00 , N/A ,$360.40 ,$591.64 ,$390.08 ,$296.80 ,$215.05 ,$258.09 ,$258.22 ,$258.09 ,$292.98 ,$381.60 ,$289.68 ,$260.27 ,$334.96 , N/A , N/A , N/A ,$257.69 , N/A ,$305.28 ,$262.88 ,$305.28 ,$305.28 ,$339.20 
ST NICHOLAS HOSPITAL - ACUTE,27400223,L3807,HC RADIAL NERVE PALSY SPLINT,274,1 ,$242.00 ,$159.72 ,$122.74 ,$578.65 , N/A , N/A , N/A ,$257.18 ,$145.20 ,$205.70 ,$169.40 , N/A , N/A ,$229.90 ,$183.92 ,$181.50 , N/A ,$205.70 ,$257.18 , N/A , N/A ,$169.40 ,$147.38 , N/A ,$257.18 ,$252.04 ,$242.00 , N/A ,$205.70 ,$578.65 ,$222.64 ,$169.40 ,$122.74 ,$147.31 ,$147.38 ,$147.31 ,$167.22 ,$217.80 ,$165.33 ,$254.55 ,$191.18 , N/A , N/A , N/A ,$252.04 , N/A ,$174.24 ,$150.04 ,$174.24 ,$174.24 ,$193.60 
ST NICHOLAS HOSPITAL - ACUTE,27500020,C1898,HC MSB PACEMAKER LEAD,275,1 ,$719.00 ,$474.54 ,$364.68 ,$719.00 , N/A , N/A , N/A , N/A ,$431.40 ,$611.15 ,$503.30 , N/A , N/A ,$683.05 ,$546.44 ,$539.25 , N/A ,$611.15 , N/A , N/A , N/A ,$503.30 ,$437.87 , N/A , N/A , N/A , N/A , N/A ,$611.15 , N/A ,$661.48 ,$503.30 ,$364.68 ,$437.66 ,$437.87 ,$437.66 ,$496.83 ,$647.10 ,$491.22 , N/A ,$568.01 , N/A , N/A , N/A , N/A , N/A ,$517.68 ,$445.78 ,$517.68 ,$517.68 ,$575.20 
ST NICHOLAS HOSPITAL - ACUTE,27500022,C1900,HC MSB LEAD FOR CS,275,1 ,"$3,688.00 ","$2,434.08 ","$1,844.00 ","$3,688.00 ", N/A ,"$1,943.94 ","$1,943.94 ", N/A ,"$2,212.80 ","$3,134.80 ","$2,581.60 ", N/A , N/A ,"$3,503.60 ","$2,802.88 ","$2,766.00 ","$1,844.00 ","$3,134.80 ", N/A ,"$1,844.00 ","$1,844.00 ","$2,581.60 ","$2,245.99 ", N/A , N/A , N/A , N/A , N/A ,"$3,134.80 ", N/A ,"$3,392.96 ","$2,581.60 ","$1,870.55 ","$2,244.89 ","$2,245.99 ","$2,244.89 ","$2,548.41 ","$3,319.20 ","$2,519.64 ", N/A ,"$2,913.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,655.36 ","$2,286.56 ","$2,655.36 ","$2,655.36 ","$2,950.40 "
ST NICHOLAS HOSPITAL - ACUTE,27500023,C1786,HC MSB PACER SINGLE,275,1 ,"$6,333.00 ","$4,179.78 ","$3,103.17 ","$6,333.00 ", N/A ,"$3,338.12 ","$3,338.12 ", N/A ,"$3,799.80 ","$5,383.05 ","$4,433.10 ", N/A , N/A ,"$6,016.35 ","$4,813.08 ","$4,749.75 ","$3,166.50 ","$5,383.05 ", N/A ,"$3,166.50 ","$3,166.50 ","$4,433.10 ","$3,856.80 ", N/A , N/A , N/A , N/A , N/A ,"$5,383.05 ", N/A ,"$5,826.36 ","$4,433.10 ","$3,212.10 ","$3,854.90 ","$3,856.80 ","$3,854.90 ","$4,376.10 ","$5,699.70 ","$4,326.71 ", N/A ,"$5,003.07 ", N/A ,"$3,103.17 ","$3,103.17 ", N/A ,"$3,103.17 ","$4,559.76 ","$3,926.46 ","$4,559.76 ","$4,559.76 ","$5,066.40 "
ST NICHOLAS HOSPITAL - ACUTE,27500024,C1785,HC MSB PACER DUAL,275,1 ,"$8,517.00 ","$5,621.22 ","$4,173.33 ","$8,517.00 ", N/A ,"$4,489.31 ","$4,489.31 ", N/A ,"$5,110.20 ","$7,239.45 ","$5,961.90 ", N/A , N/A ,"$8,091.15 ","$6,472.92 ","$6,387.75 ","$4,258.50 ","$7,239.45 ", N/A ,"$4,258.50 ","$4,258.50 ","$5,961.90 ","$5,186.85 ", N/A , N/A , N/A , N/A , N/A ,"$7,239.45 ", N/A ,"$7,835.64 ","$5,961.90 ","$4,319.82 ","$5,184.30 ","$5,186.85 ","$5,184.30 ","$5,885.25 ","$7,665.30 ","$5,818.81 ", N/A ,"$6,728.43 ", N/A ,"$4,173.33 ","$4,173.33 ", N/A ,"$4,173.33 ","$6,132.24 ","$5,280.54 ","$6,132.24 ","$6,132.24 ","$6,813.60 "
ST NICHOLAS HOSPITAL - ACUTE,27500025,C2621,HC MSB PACER BI-V,275,1 ,"$14,849.00 ","$9,800.34 ","$7,276.01 ","$14,849.00 ", N/A ,"$7,826.91 ","$7,826.91 ", N/A ,"$8,909.40 ","$12,621.65 ","$10,394.30 ", N/A , N/A ,"$14,106.55 ","$11,285.24 ","$11,136.75 ","$7,424.50 ","$12,621.65 ", N/A ,"$7,424.50 ","$7,424.50 ","$10,394.30 ","$9,043.04 ", N/A , N/A , N/A , N/A , N/A ,"$12,621.65 ", N/A ,"$13,661.08 ","$10,394.30 ","$7,531.41 ","$9,038.59 ","$9,043.04 ","$9,038.59 ","$10,260.66 ","$13,364.10 ","$10,144.84 ", N/A ,"$11,730.71 ", N/A ,"$7,276.01 ","$7,276.01 ", N/A ,"$7,276.01 ","$10,691.28 ","$9,206.38 ","$10,691.28 ","$10,691.28 ","$11,879.20 "
ST NICHOLAS HOSPITAL - ACUTE,27500026,C1722,HC MSB ICD SINGLE,275,1 ,"$26,208.00 ","$17,297.28 ","$12,841.92 ","$26,208.00 ", N/A ,"$13,814.24 ","$13,814.24 ", N/A ,"$15,724.80 ","$22,276.80 ","$18,345.60 ", N/A , N/A ,"$24,897.60 ","$19,918.08 ","$19,656.00 ","$13,104.00 ","$22,276.80 ", N/A ,"$13,104.00 ","$13,104.00 ","$18,345.60 ","$15,960.67 ", N/A , N/A , N/A , N/A , N/A ,"$22,276.80 ", N/A ,"$24,111.36 ","$18,345.60 ","$13,292.70 ","$15,952.81 ","$15,960.67 ","$15,952.81 ","$18,109.73 ","$23,587.20 ","$17,905.31 ", N/A ,"$20,704.32 ", N/A ,"$12,841.92 ","$12,841.92 ", N/A ,"$12,841.92 ","$18,869.76 ","$16,248.96 ","$18,869.76 ","$18,869.76 ","$20,966.40 "
ST NICHOLAS HOSPITAL - ACUTE,27500027,C1721,HC MSB ICD DUAL,275,1 ,"$29,489.00 ","$19,462.74 ","$14,449.61 ","$29,489.00 ", N/A ,"$15,543.65 ","$15,543.65 ", N/A ,"$17,693.40 ","$25,065.65 ","$20,642.30 ", N/A , N/A ,"$28,014.55 ","$22,411.64 ","$22,116.75 ","$14,744.50 ","$25,065.65 ", N/A ,"$14,744.50 ","$14,744.50 ","$20,642.30 ","$17,958.80 ", N/A , N/A , N/A , N/A , N/A ,"$25,065.65 ", N/A ,"$27,129.88 ","$20,642.30 ","$14,956.82 ","$17,949.95 ","$17,958.80 ","$17,949.95 ","$20,376.90 ","$26,540.10 ","$20,146.88 ", N/A ,"$23,296.31 ", N/A ,"$14,449.61 ","$14,449.61 ", N/A ,"$14,449.61 ","$21,232.08 ","$18,283.18 ","$21,232.08 ","$21,232.08 ","$23,591.20 "
ST NICHOLAS HOSPITAL - ACUTE,27500028,C1882,HC MSB ICD BI-V,275,1 ,"$42,171.00 ","$27,832.86 ","$20,663.79 ","$42,171.00 ", N/A ,"$22,228.33 ","$22,228.33 ", N/A ,"$25,302.60 ","$35,845.35 ","$29,519.70 ", N/A , N/A ,"$40,062.45 ","$32,049.96 ","$31,628.25 ","$21,085.50 ","$35,845.35 ", N/A ,"$21,085.50 ","$21,085.50 ","$29,519.70 ","$25,682.14 ", N/A , N/A , N/A , N/A , N/A ,"$35,845.35 ", N/A ,"$38,797.32 ","$29,519.70 ","$21,389.13 ","$25,669.49 ","$25,682.14 ","$25,669.49 ","$29,140.16 ","$37,953.90 ","$28,811.23 ", N/A ,"$33,315.09 ", N/A ,"$20,663.79 ","$20,663.79 ", N/A ,"$20,663.79 ","$30,363.12 ","$26,146.02 ","$30,363.12 ","$30,363.12 ","$33,736.80 "
ST NICHOLAS HOSPITAL - ACUTE,27500029,C1777,HC MSB ICD LEAD ENDO SINGLE C1777,275,1 ,"$8,078.00 ","$5,331.48 ","$3,958.22 ","$8,078.00 ", N/A ,"$4,257.91 ","$4,257.91 ", N/A ,"$4,846.80 ","$6,866.30 ","$5,654.60 ", N/A , N/A ,"$7,674.10 ","$6,139.28 ","$6,058.50 ","$4,039.00 ","$6,866.30 ", N/A ,"$4,039.00 ","$4,039.00 ","$5,654.60 ","$4,919.50 ", N/A , N/A , N/A , N/A , N/A ,"$6,866.30 ", N/A ,"$7,431.76 ","$5,654.60 ","$4,097.16 ","$4,917.08 ","$4,919.50 ","$4,917.08 ","$5,581.90 ","$7,270.20 ","$5,518.89 ", N/A ,"$6,381.62 ", N/A ,"$3,958.22 ","$3,958.22 ", N/A ,"$3,958.22 ","$5,816.16 ","$5,008.36 ","$5,816.16 ","$5,816.16 ","$6,462.40 "
ST NICHOLAS HOSPITAL - ACUTE,27500030,C1895,HC MSB ICD LEAD ENDO DUAL,275,1 ,"$8,078.00 ","$5,331.48 ","$3,958.22 ","$8,078.00 ", N/A ,"$4,257.91 ","$4,257.91 ", N/A ,"$4,846.80 ","$6,866.30 ","$5,654.60 ", N/A , N/A ,"$7,674.10 ","$6,139.28 ","$6,058.50 ","$4,039.00 ","$6,866.30 ", N/A ,"$4,039.00 ","$4,039.00 ","$5,654.60 ","$4,919.50 ", N/A , N/A , N/A , N/A , N/A ,"$6,866.30 ", N/A ,"$7,431.76 ","$5,654.60 ","$4,097.16 ","$4,917.08 ","$4,919.50 ","$4,917.08 ","$5,581.90 ","$7,270.20 ","$5,518.89 ", N/A ,"$6,381.62 ", N/A ,"$3,958.22 ","$3,958.22 ", N/A ,"$3,958.22 ","$5,816.16 ","$5,008.36 ","$5,816.16 ","$5,816.16 ","$6,462.40 "
ST NICHOLAS HOSPITAL - ACUTE,27500031,C1896,HC MSB ICD LEAD NON ENDO SGL OR DUAL,275,1 ,"$28,391.00 ","$18,738.06 ","$13,911.59 ","$28,391.00 ", N/A ,"$14,964.90 ","$14,964.90 ", N/A ,"$17,034.60 ","$24,132.35 ","$19,873.70 ", N/A , N/A ,"$26,971.45 ","$21,577.16 ","$21,293.25 ","$14,195.50 ","$24,132.35 ", N/A ,"$14,195.50 ","$14,195.50 ","$19,873.70 ","$17,290.12 ", N/A , N/A , N/A , N/A , N/A ,"$24,132.35 ", N/A ,"$26,119.72 ","$19,873.70 ","$14,399.92 ","$17,281.60 ","$17,290.12 ","$17,281.60 ","$19,618.18 ","$25,551.90 ","$19,396.73 ", N/A ,"$22,428.89 ", N/A ,"$13,911.59 ","$13,911.59 ", N/A ,"$13,911.59 ","$20,441.52 ","$17,602.42 ","$20,441.52 ","$20,441.52 ","$22,712.80 "
ST NICHOLAS HOSPITAL - ACUTE,27500035,C1898,HC MSB MRI PACEMAKER LEAD C1898,275,1 ,"$2,184.00 ","$1,441.44 ","$1,107.72 ","$2,184.00 ", N/A ,"$1,151.19 ","$1,151.19 ", N/A ,"$1,310.40 ","$1,856.40 ","$1,528.80 ", N/A , N/A ,"$2,074.80 ","$1,659.84 ","$1,638.00 ", N/A ,"$1,856.40 ", N/A , N/A , N/A ,"$1,528.80 ","$1,330.06 ", N/A , N/A , N/A , N/A , N/A ,"$1,856.40 ", N/A ,"$2,009.28 ","$1,528.80 ","$1,107.72 ","$1,329.40 ","$1,330.06 ","$1,329.40 ","$1,509.14 ","$1,965.60 ","$1,492.11 ", N/A ,"$1,725.36 ", N/A , N/A , N/A , N/A , N/A ,"$1,572.48 ","$1,354.08 ","$1,572.48 ","$1,572.48 ","$1,747.20 "
ST NICHOLAS HOSPITAL - ACUTE,27500036,C1786,HC MSB MRI PACER SINGLE C1786,275,1 ,"$8,736.00 ","$5,765.76 ","$4,280.64 ","$8,736.00 ", N/A ,"$4,604.75 ","$4,604.75 ", N/A ,"$5,241.60 ","$7,425.60 ","$6,115.20 ", N/A , N/A ,"$8,299.20 ","$6,639.36 ","$6,552.00 ","$4,368.00 ","$7,425.60 ", N/A ,"$4,368.00 ","$4,368.00 ","$6,115.20 ","$5,320.22 ", N/A , N/A , N/A , N/A , N/A ,"$7,425.60 ", N/A ,"$8,037.12 ","$6,115.20 ","$4,430.90 ","$5,317.60 ","$5,320.22 ","$5,317.60 ","$6,036.58 ","$7,862.40 ","$5,968.44 ", N/A ,"$6,901.44 ", N/A ,"$4,280.64 ","$4,280.64 ", N/A ,"$4,280.64 ","$6,289.92 ","$5,416.32 ","$6,289.92 ","$6,289.92 ","$6,988.80 "
ST NICHOLAS HOSPITAL - ACUTE,27500037,C1785,HC MSB MRI PACER DUAL C1785,275,1 ,"$8,736.00 ","$5,765.76 ","$4,280.64 ","$8,736.00 ", N/A ,"$4,604.75 ","$4,604.75 ", N/A ,"$5,241.60 ","$7,425.60 ","$6,115.20 ", N/A , N/A ,"$8,299.20 ","$6,639.36 ","$6,552.00 ","$4,368.00 ","$7,425.60 ", N/A ,"$4,368.00 ","$4,368.00 ","$6,115.20 ","$5,320.22 ", N/A , N/A , N/A , N/A , N/A ,"$7,425.60 ", N/A ,"$8,037.12 ","$6,115.20 ","$4,430.90 ","$5,317.60 ","$5,320.22 ","$5,317.60 ","$6,036.58 ","$7,862.40 ","$5,968.44 ", N/A ,"$6,901.44 ", N/A ,"$4,280.64 ","$4,280.64 ", N/A ,"$4,280.64 ","$6,289.92 ","$5,416.32 ","$6,289.92 ","$6,289.92 ","$6,988.80 "
ST NICHOLAS HOSPITAL - ACUTE,27500038,C1721,HC MSB MRI ICD DUAL,275,1 ,"$33,592.00 ","$22,170.72 ","$16,460.08 ","$33,592.00 ", N/A ,"$17,706.34 ","$17,706.34 ", N/A ,"$20,155.20 ","$28,553.20 ","$23,514.40 ", N/A , N/A ,"$31,912.40 ","$25,529.92 ","$25,194.00 ","$16,796.00 ","$28,553.20 ", N/A ,"$16,796.00 ","$16,796.00 ","$23,514.40 ","$20,457.53 ", N/A , N/A , N/A , N/A , N/A ,"$28,553.20 ", N/A ,"$30,904.64 ","$23,514.40 ","$17,037.86 ","$20,447.45 ","$20,457.53 ","$20,447.45 ","$23,212.07 ","$30,232.80 ","$22,950.05 ", N/A ,"$26,537.68 ", N/A ,"$16,460.08 ","$16,460.08 ", N/A ,"$16,460.08 ","$24,186.24 ","$20,827.04 ","$24,186.24 ","$24,186.24 ","$26,873.60 "
ST NICHOLAS HOSPITAL - ACUTE,27500039,C1722,HC MSB MRI ICD SINGLE,275,1 ,"$31,513.00 ","$20,798.58 ","$15,441.37 ","$31,513.00 ", N/A ,"$16,610.50 ","$16,610.50 ", N/A ,"$18,907.80 ","$26,786.05 ","$22,059.10 ", N/A , N/A ,"$29,937.35 ","$23,949.88 ","$23,634.75 ","$15,756.50 ","$26,786.05 ", N/A ,"$15,756.50 ","$15,756.50 ","$22,059.10 ","$19,191.42 ", N/A , N/A , N/A , N/A , N/A ,"$26,786.05 ", N/A ,"$28,991.96 ","$22,059.10 ","$15,983.39 ","$19,181.96 ","$19,191.42 ","$19,181.96 ","$21,775.48 ","$28,361.70 ","$21,529.68 ", N/A ,"$24,895.27 ", N/A ,"$15,441.37 ","$15,441.37 ", N/A ,"$15,441.37 ","$22,689.36 ","$19,538.06 ","$22,689.36 ","$22,689.36 ","$25,210.40 "
ST NICHOLAS HOSPITAL - ACUTE,27600001,V2785,HC CORNEA PROCESSING,276,1 ,"$6,186.00 ","$4,082.76 ",$88.51 ,"$6,186.00 ",$88.51 ,"$3,260.64 ","$3,260.64 ", N/A ,"$3,711.60 ","$5,258.10 ","$4,330.20 ",$88.51 ,$88.51 ,"$5,876.70 ","$4,701.36 ","$4,639.50 ","$3,093.00 ","$5,258.10 ", N/A ,"$3,093.00 ","$3,093.00 ","$4,330.20 ","$3,767.27 ",$88.51 , N/A , N/A , N/A ,$93.82 ,"$5,258.10 ", N/A ,"$5,691.12 ","$4,330.20 ","$3,137.54 ","$3,765.42 ","$3,767.27 ","$3,765.42 ","$4,274.53 ","$5,567.40 ","$4,226.28 ", N/A ,"$4,886.94 ",$93.82 ,"$3,031.14 ","$3,031.14 ", N/A ,"$3,031.14 ","$4,453.92 ","$3,835.32 ","$4,453.92 ","$4,453.92 ","$4,948.80 "
ST NICHOLAS HOSPITAL - ACUTE,27662787,V2787,IOL ASTIGMATISM (TORIC) CORRECTING UPGRADE,276,1 ,$441.00 ,$291.06 ,$223.68 ,$445.41 , N/A , N/A , N/A , N/A ,$264.60 ,$374.85 ,$308.70 , N/A , N/A ,$418.95 ,$335.16 ,$330.75 , N/A ,$374.85 , N/A , N/A , N/A ,$308.70 ,$268.57 , N/A ,$441.00 , N/A ,$441.00 , N/A ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$268.44 ,$304.73 ,$396.90 ,$301.29 ,$445.41 ,$348.39 , N/A , N/A , N/A , N/A , N/A ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$352.80 
ST NICHOLAS HOSPITAL - ACUTE,27662788,V2788,IOL PRESBYOPIA (PRESBYOPIA/RESTOR) CORRECTING UPGRADE,276,1 ,"$1,100.00 ",$726.00 ,$557.92 ,"$1,100.00 ", N/A ,$579.81 ,$579.81 , N/A ,$660.00 ,$935.00 ,$770.00 , N/A , N/A ,"$1,045.00 ",$836.00 ,$825.00 , N/A ,$935.00 , N/A , N/A , N/A ,$770.00 ,$669.90 , N/A , N/A , N/A , N/A , N/A ,$935.00 , N/A ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$669.57 ,$760.10 ,$990.00 ,$751.52 , N/A ,$869.00 , N/A , N/A , N/A , N/A , N/A ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL TORIC LENS SA6AT6,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL ALCON MN60AC,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL ALCON MTA5UO,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL ALCON RESTOR SN6AD1,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL ALCON SN60AT,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL AMO PRECISION MULTIFOCAL ZKB00,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL AMO PRECISION PCB00,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL BAUSCH  AND  LOMB L122UV,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL BAUSCH  AND  LOMB MX60E ENVISTA,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL BAUSCH  AND  LOMB S122UV,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL BAUSCH LOMB PRECISION MI60L,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL STAAR CC,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL TORIC LENS SA6AT9,276,1 ,$967.50 ,$638.55 ,$490.72 ,$967.50 , N/A , N/A , N/A , N/A ,$580.50 ,$822.38 ,$677.25 , N/A , N/A ,$919.13 ,$735.30 ,$725.63 , N/A ,$822.38 , N/A , N/A , N/A ,$677.25 ,$589.21 , N/A , N/A , N/A , N/A , N/A ,$822.38 , N/A ,$890.10 ,$677.25 ,$490.72 ,$588.92 ,$589.21 ,$588.92 ,$668.54 ,$870.75 ,$661.00 , N/A ,$764.33 , N/A , N/A , N/A , N/A , N/A ,$696.60 ,$599.85 ,$696.60 ,$696.60 ,$774.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL AMO MULTIFOCAL ZLB00,276,1 ,$967.50 ,$638.55 ,$490.72 ,$967.50 , N/A , N/A , N/A , N/A ,$580.50 ,$822.38 ,$677.25 , N/A , N/A ,$919.13 ,$735.30 ,$725.63 , N/A ,$822.38 , N/A , N/A , N/A ,$677.25 ,$589.21 , N/A , N/A , N/A , N/A , N/A ,$822.38 , N/A ,$890.10 ,$677.25 ,$490.72 ,$588.92 ,$589.21 ,$588.92 ,$668.54 ,$870.75 ,$661.00 , N/A ,$764.33 , N/A , N/A , N/A , N/A , N/A ,$696.60 ,$599.85 ,$696.60 ,$696.60 ,$774.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL AMO PRECISION ZCT TORIC,276,1 ,$967.50 ,$638.55 ,$490.72 ,$967.50 , N/A , N/A , N/A , N/A ,$580.50 ,$822.38 ,$677.25 , N/A , N/A ,$919.13 ,$735.30 ,$725.63 , N/A ,$822.38 , N/A , N/A , N/A ,$677.25 ,$589.21 , N/A , N/A , N/A , N/A , N/A ,$822.38 , N/A ,$890.10 ,$677.25 ,$490.72 ,$588.92 ,$589.21 ,$588.92 ,$668.54 ,$870.75 ,$661.00 , N/A ,$764.33 , N/A , N/A , N/A , N/A , N/A ,$696.60 ,$599.85 ,$696.60 ,$696.60 ,$774.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL TORIC LENS SA6AT3,276,1 ,$967.50 ,$638.55 ,$490.72 ,$967.50 , N/A , N/A , N/A , N/A ,$580.50 ,$822.38 ,$677.25 , N/A , N/A ,$919.13 ,$735.30 ,$725.63 , N/A ,$822.38 , N/A , N/A , N/A ,$677.25 ,$589.21 , N/A , N/A , N/A , N/A , N/A ,$822.38 , N/A ,$890.10 ,$677.25 ,$490.72 ,$588.92 ,$589.21 ,$588.92 ,$668.54 ,$870.75 ,$661.00 , N/A ,$764.33 , N/A , N/A , N/A , N/A , N/A ,$696.60 ,$599.85 ,$696.60 ,$696.60 ,$774.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL TORIC LENS SA6AT4,276,1 ,$967.50 ,$638.55 ,$490.72 ,$967.50 , N/A , N/A , N/A , N/A ,$580.50 ,$822.38 ,$677.25 , N/A , N/A ,$919.13 ,$735.30 ,$725.63 , N/A ,$822.38 , N/A , N/A , N/A ,$677.25 ,$589.21 , N/A , N/A , N/A , N/A , N/A ,$822.38 , N/A ,$890.10 ,$677.25 ,$490.72 ,$588.92 ,$589.21 ,$588.92 ,$668.54 ,$870.75 ,$661.00 , N/A ,$764.33 , N/A , N/A , N/A , N/A , N/A ,$696.60 ,$599.85 ,$696.60 ,$696.60 ,$774.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL TORIC LENS SA6AT5,276,1 ,$967.50 ,$638.55 ,$490.72 ,$967.50 , N/A , N/A , N/A , N/A ,$580.50 ,$822.38 ,$677.25 , N/A , N/A ,$919.13 ,$735.30 ,$725.63 , N/A ,$822.38 , N/A , N/A , N/A ,$677.25 ,$589.21 , N/A , N/A , N/A , N/A , N/A ,$822.38 , N/A ,$890.10 ,$677.25 ,$490.72 ,$588.92 ,$589.21 ,$588.92 ,$668.54 ,$870.75 ,$661.00 , N/A ,$764.33 , N/A , N/A , N/A , N/A , N/A ,$696.60 ,$599.85 ,$696.60 ,$696.60 ,$774.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL TORIC LENS SA6AT7,276,1 ,$967.50 ,$638.55 ,$490.72 ,$967.50 , N/A , N/A , N/A , N/A ,$580.50 ,$822.38 ,$677.25 , N/A , N/A ,$919.13 ,$735.30 ,$725.63 , N/A ,$822.38 , N/A , N/A , N/A ,$677.25 ,$589.21 , N/A , N/A , N/A , N/A , N/A ,$822.38 , N/A ,$890.10 ,$677.25 ,$490.72 ,$588.92 ,$589.21 ,$588.92 ,$668.54 ,$870.75 ,$661.00 , N/A ,$764.33 , N/A , N/A , N/A , N/A , N/A ,$696.60 ,$599.85 ,$696.60 ,$696.60 ,$774.00 
ST NICHOLAS HOSPITAL - ACUTE,27671780,C1780,IOL TORIC LENS SA6AT8,276,1 ,$967.50 ,$638.55 ,$490.72 ,$967.50 , N/A , N/A , N/A , N/A ,$580.50 ,$822.38 ,$677.25 , N/A , N/A ,$919.13 ,$735.30 ,$725.63 , N/A ,$822.38 , N/A , N/A , N/A ,$677.25 ,$589.21 , N/A , N/A , N/A , N/A , N/A ,$822.38 , N/A ,$890.10 ,$677.25 ,$490.72 ,$588.92 ,$589.21 ,$588.92 ,$668.54 ,$870.75 ,$661.00 , N/A ,$764.33 , N/A , N/A , N/A , N/A , N/A ,$696.60 ,$599.85 ,$696.60 ,$696.60 ,$774.00 
ST NICHOLAS HOSPITAL - ACUTE,27672632,V2632,IOL PRECISION ZA9003,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27672632,V2632,IOL ALCON MA60AC,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27672632,V2632,IOL ALCON SN60WF,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27672632,V2632,IOL AMO PRECISION ZCB00,276,1 ,$450.00 ,$297.00 ,$228.24 ,$450.00 , N/A , N/A , N/A , N/A ,$270.00 ,$382.50 ,$315.00 , N/A , N/A ,$427.50 ,$342.00 ,$337.50 , N/A ,$382.50 , N/A , N/A , N/A ,$315.00 ,$274.05 , N/A , N/A , N/A , N/A , N/A ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,27800123,C1724,HC DIAMONDBACK BURR  AND  LUBRICANT,278,1 ,"$6,875.00 ","$4,537.50 ","$3,368.75 ","$6,875.00 ", N/A ,"$3,623.81 ","$3,623.81 ", N/A ,"$4,125.00 ","$5,843.75 ", N/A , N/A , N/A ,"$6,531.25 ","$5,225.00 ","$5,156.25 ","$3,437.50 ","$5,843.75 ", N/A ,"$3,437.50 ","$3,437.50 ","$4,812.50 ","$4,186.88 ", N/A , N/A , N/A , N/A , N/A ,"$5,843.75 ", N/A ,"$6,325.00 ","$4,812.50 ","$3,487.00 ","$4,184.81 ","$4,186.88 ","$4,184.81 ","$4,750.63 ","$6,187.50 ","$4,697.00 ", N/A ,"$5,431.25 ", N/A ,"$3,368.75 ","$3,368.75 ", N/A ,"$3,368.75 ","$4,950.00 ","$4,262.50 ","$4,950.00 ","$4,950.00 ","$5,500.00 "
ST NICHOLAS HOSPITAL - ACUTE,27800124,C1724,HC SILVERHAWK DIRECTIONAL ATHERECTOMY DEV,278,1 ,"$7,328.00 ","$4,836.48 ","$3,590.72 ","$7,328.00 ", N/A ,"$3,862.59 ","$3,862.59 ", N/A ,"$4,396.80 ","$6,228.80 ", N/A , N/A , N/A ,"$6,961.60 ","$5,569.28 ","$5,496.00 ","$3,664.00 ","$6,228.80 ", N/A ,"$3,664.00 ","$3,664.00 ","$5,129.60 ","$4,462.75 ", N/A , N/A , N/A , N/A , N/A ,"$6,228.80 ", N/A ,"$6,741.76 ","$5,129.60 ","$3,716.76 ","$4,460.55 ","$4,462.75 ","$4,460.55 ","$5,063.65 ","$6,595.20 ","$5,006.49 ", N/A ,"$5,789.12 ", N/A ,"$3,590.72 ","$3,590.72 ", N/A ,"$3,590.72 ","$5,276.16 ","$4,543.36 ","$5,276.16 ","$5,276.16 ","$5,862.40 "
ST NICHOLAS HOSPITAL - ACUTE,27800133,C1751,HC HICKMAN,278,1 ,$971.00 ,$640.86 ,$492.49 ,$971.00 , N/A , N/A , N/A , N/A ,$582.60 ,$825.35 , N/A , N/A , N/A ,$922.45 ,$737.96 ,$728.25 , N/A ,$825.35 , N/A , N/A , N/A ,$679.70 ,$591.34 , N/A , N/A , N/A , N/A , N/A ,$825.35 , N/A ,$893.32 ,$679.70 ,$492.49 ,$591.05 ,$591.34 ,$591.05 ,$670.96 ,$873.90 ,$663.39 , N/A ,$767.09 , N/A , N/A , N/A , N/A , N/A ,$699.12 ,$602.02 ,$699.12 ,$699.12 ,$776.80 
ST NICHOLAS HOSPITAL - ACUTE,27800160,C1752,HC SHORT TERM DIALYSIS CATH,278,1 ,$971.00 ,$640.86 ,$492.49 ,$971.00 , N/A , N/A , N/A , N/A ,$582.60 ,$825.35 ,$679.70 , N/A , N/A ,$922.45 ,$737.96 ,$728.25 , N/A ,$825.35 , N/A , N/A , N/A ,$679.70 ,$591.34 , N/A , N/A , N/A , N/A , N/A ,$825.35 , N/A ,$893.32 ,$679.70 ,$492.49 ,$591.05 ,$591.34 ,$591.05 ,$670.96 ,$873.90 ,$663.39 , N/A ,$767.09 , N/A , N/A , N/A , N/A , N/A ,$699.12 ,$602.02 ,$699.12 ,$699.12 ,$776.80 
ST NICHOLAS HOSPITAL - ACUTE,27800161,C1753,HC IVUS CATHETER,278,1 ,"$1,931.00 ","$1,274.46 ",$979.40 ,"$1,931.00 ", N/A ,"$1,017.83 ","$1,017.83 ", N/A ,"$1,158.60 ","$1,641.35 ", N/A , N/A , N/A ,"$1,834.45 ","$1,467.56 ","$1,448.25 ", N/A ,"$1,641.35 ", N/A , N/A , N/A ,"$1,351.70 ","$1,175.98 ", N/A , N/A , N/A , N/A , N/A ,"$1,641.35 ", N/A ,"$1,776.52 ","$1,351.70 ",$979.40 ,"$1,175.40 ","$1,175.98 ","$1,175.40 ","$1,334.32 ","$1,737.90 ","$1,319.26 ", N/A ,"$1,525.49 ", N/A , N/A , N/A , N/A , N/A ,"$1,390.32 ","$1,197.22 ","$1,390.32 ","$1,390.32 ","$1,544.80 "
ST NICHOLAS HOSPITAL - ACUTE,27800166,C1760,HC DEVICE VASCULAR CLOSURE,278,1 ,$541.00 ,$357.06 ,$274.40 ,$541.00 , N/A , N/A , N/A , N/A ,$324.60 ,$459.85 ,$378.70 , N/A , N/A ,$513.95 ,$411.16 ,$405.75 , N/A ,$459.85 , N/A , N/A , N/A ,$378.70 ,$329.47 , N/A , N/A , N/A , N/A , N/A ,$459.85 , N/A ,$497.72 ,$378.70 ,$274.40 ,$329.31 ,$329.47 ,$329.31 ,$373.83 ,$486.90 ,$369.61 , N/A ,$427.39 , N/A , N/A , N/A , N/A , N/A ,$389.52 ,$335.42 ,$389.52 ,$389.52 ,$432.80 
ST NICHOLAS HOSPITAL - ACUTE,27800171,N/A,HC VASCULAR PLUG,278,1 ,"$1,645.00 ","$1,085.70 ",$834.34 ,"$1,645.00 ", N/A ,$867.08 ,$867.08 , N/A ,$987.00 ,"$1,398.25 ","$1,151.50 ", N/A , N/A ,"$1,562.75 ","$1,250.20 ","$1,233.75 ", N/A ,"$1,398.25 ", N/A , N/A , N/A ,"$1,151.50 ","$1,001.81 ", N/A , N/A , N/A , N/A , N/A ,"$1,398.25 ", N/A ,"$1,513.40 ","$1,151.50 ",$834.34 ,"$1,001.31 ","$1,001.81 ","$1,001.31 ","$1,136.70 ","$1,480.50 ","$1,123.86 ", N/A ,"$1,299.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,184.40 ","$1,019.90 ","$1,184.40 ","$1,184.40 ","$1,316.00 "
ST NICHOLAS HOSPITAL - ACUTE,27800493,C1788,HC PORT,278,1 ,$971.00 ,$640.86 ,$492.49 ,$971.00 , N/A , N/A , N/A , N/A ,$582.60 ,$825.35 ,$679.70 , N/A , N/A ,$922.45 ,$737.96 ,$728.25 , N/A ,$825.35 , N/A , N/A , N/A ,$679.70 ,$591.34 , N/A , N/A , N/A , N/A , N/A ,$825.35 , N/A ,$893.32 ,$679.70 ,$492.49 ,$591.05 ,$591.34 ,$591.05 ,$670.96 ,$873.90 ,$663.39 , N/A ,$767.09 , N/A , N/A , N/A , N/A , N/A ,$699.12 ,$602.02 ,$699.12 ,$699.12 ,$776.80 
ST NICHOLAS HOSPITAL - ACUTE,27800504,C1817,HC ASD/PFO OCCLUDER,278,1 ,"$13,323.00 ","$8,793.18 ","$6,528.27 ","$13,323.00 ", N/A ,"$7,022.55 ","$7,022.55 ", N/A ,"$7,993.80 ","$11,324.55 ","$9,326.10 ", N/A , N/A ,"$12,656.85 ","$10,125.48 ","$9,992.25 ","$6,661.50 ","$11,324.55 ", N/A ,"$6,661.50 ","$6,661.50 ","$9,326.10 ","$8,113.71 ", N/A , N/A , N/A , N/A , N/A ,"$11,324.55 ", N/A ,"$12,257.16 ","$9,326.10 ","$6,757.43 ","$8,109.71 ","$8,113.71 ","$8,109.71 ","$9,206.19 ","$11,990.70 ","$9,102.27 ", N/A ,"$10,525.17 ", N/A ,"$6,528.27 ","$6,528.27 ", N/A ,"$6,528.27 ","$9,592.56 ","$8,260.26 ","$9,592.56 ","$9,592.56 ","$10,658.40 "
ST NICHOLAS HOSPITAL - ACUTE,27800507,C1874,HC STENT COVERED AND DELIVERY SYSTEM,278,1 ,"$10,254.00 ","$6,767.64 ","$5,024.46 ","$10,254.00 ", N/A ,"$5,404.88 ","$5,404.88 ", N/A ,"$6,152.40 ","$8,715.90 ","$7,177.80 ", N/A , N/A ,"$9,741.30 ","$7,793.04 ","$7,690.50 ","$5,127.00 ","$8,715.90 ", N/A ,"$5,127.00 ","$5,127.00 ","$7,177.80 ","$6,244.69 ", N/A , N/A , N/A , N/A , N/A ,"$8,715.90 ", N/A ,"$9,433.68 ","$7,177.80 ","$5,200.83 ","$6,241.61 ","$6,244.69 ","$6,241.61 ","$7,085.51 ","$9,228.60 ","$7,005.53 ", N/A ,"$8,100.66 ", N/A ,"$5,024.46 ","$5,024.46 ", N/A ,"$5,024.46 ","$7,382.88 ","$6,357.48 ","$7,382.88 ","$7,382.88 ","$8,203.20 "
ST NICHOLAS HOSPITAL - ACUTE,27800515,C1874,HC WALLSTENT COVERED,278,1 ,"$6,066.00 ","$4,003.56 ","$2,972.34 ","$6,066.00 ", N/A ,"$3,197.39 ","$3,197.39 ", N/A ,"$3,639.60 ","$5,156.10 ","$4,246.20 ", N/A , N/A ,"$5,762.70 ","$4,610.16 ","$4,549.50 ","$3,033.00 ","$5,156.10 ", N/A ,"$3,033.00 ","$3,033.00 ","$4,246.20 ","$3,694.19 ", N/A , N/A , N/A , N/A , N/A ,"$5,156.10 ", N/A ,"$5,580.72 ","$4,246.20 ","$3,076.68 ","$3,692.37 ","$3,694.19 ","$3,692.37 ","$4,191.61 ","$5,459.40 ","$4,144.29 ", N/A ,"$4,792.14 ", N/A ,"$2,972.34 ","$2,972.34 ", N/A ,"$2,972.34 ","$4,367.52 ","$3,760.92 ","$4,367.52 ","$4,367.52 ","$4,852.80 "
ST NICHOLAS HOSPITAL - ACUTE,27800522,C1876,HC STENT EXPANDABLE UNCOVERED,278,1 ,"$4,853.00 ","$3,202.98 ","$2,426.50 ","$4,853.00 ", N/A ,"$2,558.02 ","$2,558.02 ", N/A ,"$2,911.80 ","$4,125.05 ","$3,397.10 ", N/A , N/A ,"$4,610.35 ","$3,688.28 ","$3,639.75 ","$2,426.50 ","$4,125.05 ", N/A ,"$2,426.50 ","$2,426.50 ","$3,397.10 ","$2,955.48 ", N/A , N/A , N/A , N/A , N/A ,"$4,125.05 ", N/A ,"$4,464.76 ","$3,397.10 ","$2,461.44 ","$2,954.02 ","$2,955.48 ","$2,954.02 ","$3,353.42 ","$4,367.70 ","$3,315.57 ", N/A ,"$3,833.87 ", N/A , N/A , N/A , N/A , N/A ,"$3,494.16 ","$3,008.86 ","$3,494.16 ","$3,494.16 ","$3,882.40 "
ST NICHOLAS HOSPITAL - ACUTE,27800542,C1876,HC URETERAL STENT,278,1 ,$340.00 ,$224.40 ,$172.45 ,$340.00 , N/A , N/A , N/A , N/A ,$204.00 ,$289.00 ,$238.00 , N/A , N/A ,$323.00 ,$258.40 ,$255.00 , N/A ,$289.00 , N/A , N/A , N/A ,$238.00 ,$207.06 , N/A , N/A , N/A , N/A , N/A ,$289.00 , N/A ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 , N/A ,$268.60 , N/A , N/A , N/A , N/A , N/A ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,27800548,C1877,HC ANGIO STENT Z,278,1 ,"$1,821.00 ","$1,201.86 ",$923.61 ,"$1,821.00 ", N/A ,$959.85 ,$959.85 , N/A ,"$1,092.60 ","$1,547.85 ","$1,274.70 ", N/A , N/A ,"$1,729.95 ","$1,383.96 ","$1,365.75 ", N/A ,"$1,547.85 ", N/A , N/A , N/A ,"$1,274.70 ","$1,108.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,547.85 ", N/A ,"$1,675.32 ","$1,274.70 ",$923.61 ,"$1,108.44 ","$1,108.99 ","$1,108.44 ","$1,258.31 ","$1,638.90 ","$1,244.11 ", N/A ,"$1,438.59 ", N/A , N/A , N/A , N/A , N/A ,"$1,311.12 ","$1,129.02 ","$1,311.12 ","$1,311.12 ","$1,456.80 "
ST NICHOLAS HOSPITAL - ACUTE,27800552,A4648,HC MICROCLIP,278,1 ,$218.00 ,$143.88 ,$110.57 ,$218.00 , N/A , N/A , N/A , N/A ,$130.80 ,$185.30 ,$152.60 , N/A , N/A ,$207.10 ,$165.68 ,$163.50 , N/A ,$185.30 , N/A , N/A , N/A ,$152.60 ,$132.76 , N/A , N/A , N/A , N/A , N/A ,$185.30 , N/A ,$200.56 ,$152.60 ,$110.57 ,$132.70 ,$132.76 ,$132.70 ,$150.64 ,$196.20 ,$148.94 , N/A ,$172.22 , N/A , N/A , N/A , N/A , N/A ,$156.96 ,$135.16 ,$156.96 ,$156.96 ,$174.40 
ST NICHOLAS HOSPITAL - ACUTE,27800553,A4648,HC TISSUE MARKER IMPLANTABLE,278,1 ,$218.00 ,$143.88 ,$110.57 ,$218.00 , N/A , N/A , N/A , N/A ,$130.80 ,$185.30 ,$152.60 , N/A , N/A ,$207.10 ,$165.68 ,$163.50 , N/A ,$185.30 , N/A , N/A , N/A ,$152.60 ,$132.76 , N/A , N/A , N/A , N/A , N/A ,$185.30 , N/A ,$200.56 ,$152.60 ,$110.57 ,$132.70 ,$132.76 ,$132.70 ,$150.64 ,$196.20 ,$148.94 , N/A ,$172.22 , N/A , N/A , N/A , N/A , N/A ,$156.96 ,$135.16 ,$156.96 ,$156.96 ,$174.40 
ST NICHOLAS HOSPITAL - ACUTE,27800557,C1880,HC IVC FILTER,278,1 ,"$5,017.00 ","$3,311.22 ","$2,508.50 ","$5,017.00 ", N/A ,"$2,644.46 ","$2,644.46 ", N/A ,"$3,010.20 ","$4,264.45 ","$3,511.90 ", N/A , N/A ,"$4,766.15 ","$3,812.92 ","$3,762.75 ","$2,508.50 ","$4,264.45 ", N/A ,"$2,508.50 ","$2,508.50 ","$3,511.90 ","$3,055.35 ", N/A , N/A , N/A , N/A , N/A ,"$4,264.45 ", N/A ,"$4,615.64 ","$3,511.90 ","$2,544.62 ","$3,053.85 ","$3,055.35 ","$3,053.85 ","$3,466.75 ","$4,515.30 ","$3,427.61 ", N/A ,"$3,963.43 ", N/A , N/A , N/A , N/A , N/A ,"$3,612.24 ","$3,110.54 ","$3,612.24 ","$3,612.24 ","$4,013.60 "
ST NICHOLAS HOSPITAL - ACUTE,27800581,Q4110,HC SKIN SUBST PRIMATRIX PER SQCM,278,1 ,$91.00 ,$60.06 ,$46.16 ,$91.00 , N/A , N/A , N/A , N/A ,$54.60 ,$77.35 ,$63.70 , N/A , N/A ,$86.45 ,$69.16 ,$68.25 , N/A ,$77.35 , N/A , N/A , N/A ,$63.70 ,$55.42 , N/A , N/A , N/A , N/A , N/A ,$77.35 , N/A ,$83.72 ,$63.70 ,$46.16 ,$55.39 ,$55.42 ,$55.39 ,$62.88 ,$81.90 ,$62.17 , N/A ,$71.89 , N/A , N/A , N/A , N/A , N/A ,$65.52 ,$56.42 ,$65.52 ,$65.52 ,$72.80 
ST NICHOLAS HOSPITAL - ACUTE,27801356,N/A,HC FEMOSTOP CATH LAB,278,1 ,$406.00 ,$267.96 ,$205.92 ,$406.00 , N/A , N/A , N/A , N/A ,$243.60 ,$345.10 ,$284.20 , N/A , N/A ,$385.70 ,$308.56 ,$304.50 , N/A ,$345.10 , N/A , N/A , N/A ,$284.20 ,$247.25 , N/A , N/A , N/A , N/A , N/A ,$345.10 , N/A ,$373.52 ,$284.20 ,$205.92 ,$247.13 ,$247.25 ,$247.13 ,$280.55 ,$365.40 ,$277.38 , N/A ,$320.74 , N/A , N/A , N/A , N/A , N/A ,$292.32 ,$251.72 ,$292.32 ,$292.32 ,$324.80 
ST NICHOLAS HOSPITAL - ACUTE,27801400,Q4121,HC THERASKIN PER SQ CM,278,1 ,$83.00 ,$54.78 ,$42.10 ,$83.00 , N/A , N/A , N/A , N/A ,$49.80 ,$70.55 ,$58.10 , N/A , N/A ,$78.85 ,$63.08 ,$62.25 , N/A ,$70.55 , N/A , N/A , N/A ,$58.10 ,$50.55 , N/A , N/A , N/A , N/A , N/A ,$70.55 , N/A ,$76.36 ,$58.10 ,$42.10 ,$50.52 ,$50.55 ,$50.52 ,$57.35 ,$74.70 ,$56.71 , N/A ,$65.57 , N/A , N/A , N/A , N/A , N/A ,$59.76 ,$51.46 ,$59.76 ,$59.76 ,$66.40 
ST NICHOLAS HOSPITAL - ACUTE,27801410,C1714,HC CROSSER C1714,278,1 ,"$7,086.00 ","$4,676.76 ","$3,472.14 ","$7,086.00 ", N/A ,"$3,735.03 ","$3,735.03 ", N/A ,"$4,251.60 ","$6,023.10 ", N/A , N/A , N/A ,"$6,731.70 ","$5,385.36 ","$5,314.50 ","$3,543.00 ","$6,023.10 ", N/A ,"$3,543.00 ","$3,543.00 ","$4,960.20 ","$4,315.37 ", N/A , N/A , N/A , N/A , N/A ,"$6,023.10 ", N/A ,"$6,519.12 ","$4,960.20 ","$3,594.02 ","$4,313.25 ","$4,315.37 ","$4,313.25 ","$4,896.43 ","$6,377.40 ","$4,841.16 ", N/A ,"$5,597.94 ", N/A ,"$3,472.14 ","$3,472.14 ", N/A ,"$3,472.14 ","$5,101.92 ","$4,393.32 ","$5,101.92 ","$5,101.92 ","$5,668.80 "
ST NICHOLAS HOSPITAL - ACUTE,27801430,C2623,HC CATH TRANSLUMINAL DRUG COATED C2623,278,1 ,"$3,063.00 ","$2,021.58 ","$1,531.50 ","$3,063.00 ", N/A ,"$1,614.51 ","$1,614.51 ", N/A ,"$1,837.80 ","$2,603.55 ", N/A , N/A , N/A ,"$2,909.85 ","$2,327.88 ","$2,297.25 ","$1,531.50 ","$2,603.55 ", N/A ,"$1,531.50 ","$1,531.50 ","$2,144.10 ","$1,865.37 ", N/A , N/A , N/A , N/A , N/A ,"$2,603.55 ", N/A ,"$2,817.96 ","$2,144.10 ","$1,553.55 ","$1,864.45 ","$1,865.37 ","$1,864.45 ","$2,116.53 ","$2,756.70 ","$2,092.64 ", N/A ,"$2,419.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,205.36 ","$1,899.06 ","$2,205.36 ","$2,205.36 ","$2,450.40 "
ST NICHOLAS HOSPITAL - ACUTE,27801450,C1751,HC PICC,278,1 ,$729.00 ,$481.14 ,$369.75 ,$729.00 , N/A , N/A , N/A , N/A ,$437.40 ,$619.65 , N/A , N/A , N/A ,$692.55 ,$554.04 ,$546.75 , N/A ,$619.65 , N/A , N/A , N/A ,$510.30 ,$443.96 , N/A , N/A , N/A , N/A , N/A ,$619.65 , N/A ,$670.68 ,$510.30 ,$369.75 ,$443.74 ,$443.96 ,$443.74 ,$503.74 ,$656.10 ,$498.05 , N/A ,$575.91 , N/A , N/A , N/A , N/A , N/A ,$524.88 ,$451.98 ,$524.88 ,$524.88 ,$583.20 
ST NICHOLAS HOSPITAL - ACUTE,27801451,C1874,HC COVERED STENTS TIER 1,278,1 ,"$8,009.00 ","$5,285.94 ","$3,924.41 ","$8,009.00 ", N/A ,"$4,221.54 ","$4,221.54 ", N/A ,"$4,805.40 ","$6,807.65 ","$5,606.30 ", N/A , N/A ,"$7,608.55 ","$6,086.84 ","$6,006.75 ","$4,004.50 ","$6,807.65 ", N/A ,"$4,004.50 ","$4,004.50 ","$5,606.30 ","$4,877.48 ", N/A , N/A , N/A , N/A , N/A ,"$6,807.65 ", N/A ,"$7,368.28 ","$5,606.30 ","$4,062.16 ","$4,875.08 ","$4,877.48 ","$4,875.08 ","$5,534.22 ","$7,208.10 ","$5,471.75 ", N/A ,"$6,327.11 ", N/A ,"$3,924.41 ","$3,924.41 ", N/A ,"$3,924.41 ","$5,766.48 ","$4,965.58 ","$5,766.48 ","$5,766.48 ","$6,407.20 "
ST NICHOLAS HOSPITAL - ACUTE,27801452,C1874,HC COVERED STENTS TIER 2,278,1 ,"$10,920.00 ","$7,207.20 ","$5,350.80 ","$10,920.00 ", N/A ,"$5,755.93 ","$5,755.93 ", N/A ,"$6,552.00 ","$9,282.00 ","$7,644.00 ", N/A , N/A ,"$10,374.00 ","$8,299.20 ","$8,190.00 ","$5,460.00 ","$9,282.00 ", N/A ,"$5,460.00 ","$5,460.00 ","$7,644.00 ","$6,650.28 ", N/A , N/A , N/A , N/A , N/A ,"$9,282.00 ", N/A ,"$10,046.40 ","$7,644.00 ","$5,538.62 ","$6,647.00 ","$6,650.28 ","$6,647.00 ","$7,545.72 ","$9,828.00 ","$7,460.54 ", N/A ,"$8,626.80 ", N/A ,"$5,350.80 ","$5,350.80 ", N/A ,"$5,350.80 ","$7,862.40 ","$6,770.40 ","$7,862.40 ","$7,862.40 ","$8,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27801453,C1876,HC STENT TIER 1,278,1 ,"$1,826.00 ","$1,205.16 ",$926.15 ,"$1,826.00 ", N/A ,$962.48 ,$962.48 , N/A ,"$1,095.60 ","$1,552.10 ","$1,278.20 ", N/A , N/A ,"$1,734.70 ","$1,387.76 ","$1,369.50 ", N/A ,"$1,552.10 ", N/A , N/A , N/A ,"$1,278.20 ","$1,112.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,552.10 ", N/A ,"$1,679.92 ","$1,278.20 ",$926.15 ,"$1,111.49 ","$1,112.03 ","$1,111.49 ","$1,261.77 ","$1,643.40 ","$1,247.52 ", N/A ,"$1,442.54 ", N/A , N/A , N/A , N/A , N/A ,"$1,314.72 ","$1,132.12 ","$1,314.72 ","$1,314.72 ","$1,460.80 "
ST NICHOLAS HOSPITAL - ACUTE,27801454,C1876,HC STENT TIER 2,278,1 ,"$3,640.00 ","$2,402.40 ","$1,820.00 ","$3,640.00 ", N/A ,"$1,918.64 ","$1,918.64 ", N/A ,"$2,184.00 ","$3,094.00 ","$2,548.00 ", N/A , N/A ,"$3,458.00 ","$2,766.40 ","$2,730.00 ","$1,820.00 ","$3,094.00 ", N/A ,"$1,820.00 ","$1,820.00 ","$2,548.00 ","$2,216.76 ", N/A , N/A , N/A , N/A , N/A ,"$3,094.00 ", N/A ,"$3,348.80 ","$2,548.00 ","$1,846.21 ","$2,215.67 ","$2,216.76 ","$2,215.67 ","$2,515.24 ","$3,276.00 ","$2,486.85 ", N/A ,"$2,875.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,620.80 ","$2,256.80 ","$2,620.80 ","$2,620.80 ","$2,912.00 "
ST NICHOLAS HOSPITAL - ACUTE,27801455,C1876,HC STENT TIER 3,278,1 ,"$4,434.00 ","$2,926.44 ","$2,217.00 ","$4,434.00 ", N/A ,"$2,337.16 ","$2,337.16 ", N/A ,"$2,660.40 ","$3,768.90 ","$3,103.80 ", N/A , N/A ,"$4,212.30 ","$3,369.84 ","$3,325.50 ","$2,217.00 ","$3,768.90 ", N/A ,"$2,217.00 ","$2,217.00 ","$3,103.80 ","$2,700.31 ", N/A , N/A , N/A , N/A , N/A ,"$3,768.90 ", N/A ,"$4,079.28 ","$3,103.80 ","$2,248.92 ","$2,698.98 ","$2,700.31 ","$2,698.98 ","$3,063.89 ","$3,990.60 ","$3,029.31 ", N/A ,"$3,502.86 ", N/A , N/A , N/A , N/A , N/A ,"$3,192.48 ","$2,749.08 ","$3,192.48 ","$3,192.48 ","$3,547.20 "
ST NICHOLAS HOSPITAL - ACUTE,27802177,Q4139,HC INJECT AMINO BIOMATRIX 1CC,278,1 ,$800.00 ,$528.00 ,$405.76 ,$800.00 , N/A , N/A , N/A , N/A ,$480.00 ,$680.00 ,$560.00 , N/A , N/A ,$760.00 ,$608.00 ,$600.00 , N/A ,$680.00 , N/A , N/A , N/A ,$560.00 ,$487.20 , N/A , N/A , N/A , N/A , N/A ,$680.00 , N/A ,$736.00 ,$560.00 ,$405.76 ,$486.96 ,$487.20 ,$486.96 ,$552.80 ,$720.00 ,$546.56 , N/A ,$632.00 , N/A , N/A , N/A , N/A , N/A ,$576.00 ,$496.00 ,$576.00 ,$576.00 ,$640.00 
ST NICHOLAS HOSPITAL - ACUTE,27802184,C1761,HC CATHETER TRANS INTRA LITHOTRIPSY CORONARY,278,1 ,"$14,805.00 ","$9,771.30 ","$3,308.03 ","$14,805.00 ", N/A ,"$7,803.72 ","$7,803.72 ","$3,375.54 ","$8,883.00 ","$12,584.25 ","$10,363.50 ", N/A , N/A ,"$14,064.75 ","$11,251.80 ","$11,103.75 ","$7,402.50 ","$12,584.25 ","$3,375.54 ","$7,402.50 ","$7,402.50 ","$10,363.50 ","$9,016.25 ", N/A ,"$3,375.54 ","$3,308.03 ","$6,751.08 ", N/A ,"$12,584.25 ","$7,594.97 ","$13,620.60 ","$10,363.50 ","$7,509.10 ","$9,011.80 ","$9,016.25 ","$9,011.80 ","$10,230.26 ","$13,324.50 ","$10,114.78 ","$3,341.11 ","$11,695.95 ", N/A ,"$7,254.45 ","$7,254.45 ","$3,308.03 ","$7,254.45 ","$10,659.60 ","$9,179.10 ","$10,659.60 ","$10,659.60 ","$11,844.00 "
ST NICHOLAS HOSPITAL - ACUTE,27864186,Q4186,GRAFT EPIFIX AMNIOTIC MEMBRANE 14MM,278,1 ,$674.03 ,$444.86 ,$341.87 ,$674.03 , N/A , N/A , N/A , N/A ,$404.42 ,$572.93 ,$471.82 , N/A , N/A ,$640.33 ,$512.26 ,$505.52 , N/A ,$572.93 , N/A , N/A , N/A ,$471.82 ,$410.48 , N/A , N/A , N/A , N/A , N/A ,$572.93 , N/A ,$620.11 ,$471.82 ,$341.87 ,$410.28 ,$410.48 ,$410.28 ,$465.75 ,$606.63 ,$460.50 , N/A ,$532.48 , N/A , N/A , N/A , N/A , N/A ,$485.30 ,$417.90 ,$485.30 ,$485.30 ,$539.22 
ST NICHOLAS HOSPITAL - ACUTE,27864186,Q4186,GRAFT EPIFIX CHORION MEMBRANE ALLOGRAFT 10.1SQ CM,278,1 ,"$2,650.50 ","$1,749.33 ","$1,325.25 ","$2,650.50 ", N/A ,"$1,397.08 ","$1,397.08 ", N/A ,"$1,590.30 ","$2,252.93 ","$1,855.35 ", N/A , N/A ,"$2,517.98 ","$2,014.38 ","$1,987.88 ","$1,325.25 ","$2,252.93 ", N/A ,"$1,325.25 ","$1,325.25 ","$1,855.35 ","$1,614.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,252.93 ", N/A ,"$2,438.46 ","$1,855.35 ","$1,344.33 ","$1,613.36 ","$1,614.15 ","$1,613.36 ","$1,831.50 ","$2,385.45 ","$1,810.82 ", N/A ,"$2,093.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.36 ","$1,643.31 ","$1,908.36 ","$1,908.36 ","$2,120.40 "
ST NICHOLAS HOSPITAL - ACUTE,27868606,L8606,IMPLANT MACROPLASTIQUE UROPLASTY,278,1 ,"$1,207.45 ",$796.92 ,$612.42 ,"$1,207.45 ", N/A ,$636.45 ,$636.45 , N/A ,$724.47 ,"$1,026.33 ",$845.22 , N/A , N/A ,"$1,147.08 ",$917.66 ,$905.59 , N/A ,"$1,026.33 ", N/A , N/A , N/A ,$845.22 ,$735.34 , N/A , N/A , N/A , N/A , N/A ,"$1,026.33 ", N/A ,"$1,110.85 ",$845.22 ,$612.42 ,$734.97 ,$735.34 ,$734.97 ,$834.35 ,"$1,086.71 ",$824.93 , N/A ,$953.89 , N/A , N/A , N/A , N/A , N/A ,$869.36 ,$748.62 ,$869.36 ,$869.36 ,$965.96 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ADAPTER HEAD TITANIUM STANDARD TAPER COMPREHENSIVE VERSA-DIAL HUMERUS REVERSE SHOULDER SYSTEM,278,1 ,$337.50 ,$222.75 ,$171.18 ,$337.50 , N/A , N/A , N/A , N/A ,$202.50 ,$286.88 ,$236.25 , N/A , N/A ,$320.63 ,$256.50 ,$253.13 , N/A ,$286.88 , N/A , N/A , N/A ,$236.25 ,$205.54 , N/A , N/A , N/A , N/A , N/A ,$286.88 , N/A ,$310.50 ,$236.25 ,$171.18 ,$205.44 ,$205.54 ,$205.44 ,$233.21 ,$303.75 ,$230.58 , N/A ,$266.63 , N/A , N/A , N/A , N/A , N/A ,$243.00 ,$209.25 ,$243.00 ,$243.00 ,$270.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,AGENT HEMOSTATIC FLOSEAL MATRIX 5 ML,278,1 ,$297.38 ,$196.27 ,$150.83 ,$297.38 , N/A , N/A , N/A , N/A ,$178.43 ,$252.77 ,$208.17 , N/A , N/A ,$282.51 ,$226.01 ,$223.04 , N/A ,$252.77 , N/A , N/A , N/A ,$208.17 ,$181.10 , N/A , N/A , N/A , N/A , N/A ,$252.77 , N/A ,$273.59 ,$208.17 ,$150.83 ,$181.02 ,$181.10 ,$181.02 ,$205.49 ,$267.64 ,$203.17 , N/A ,$234.93 , N/A , N/A , N/A , N/A , N/A ,$214.11 ,$184.38 ,$214.11 ,$214.11 ,$237.90 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ALLOGRAFT THERASKIN 1 X 1IN 6SQ CM MATRIX,278,1 ,"$1,703.55 ","$1,124.34 ",$864.04 ,"$1,703.55 ", N/A ,$897.94 ,$897.94 , N/A ,"$1,022.13 ","$1,448.02 ","$1,192.49 ", N/A , N/A ,"$1,618.37 ","$1,294.70 ","$1,277.66 ", N/A ,"$1,448.02 ", N/A , N/A , N/A ,"$1,192.49 ","$1,037.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,448.02 ", N/A ,"$1,567.27 ","$1,192.49 ",$864.04 ,"$1,036.95 ","$1,037.46 ","$1,036.95 ","$1,177.15 ","$1,533.20 ","$1,163.87 ", N/A ,"$1,345.80 ", N/A , N/A , N/A , N/A , N/A ,"$1,226.56 ","$1,056.20 ","$1,226.56 ","$1,226.56 ","$1,362.84 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ALLOGRAFT THERASKIN 2 X 1IN 13SQ CM CRYOPRESSURE MESH,278,1 ,"$1,898.30 ","$1,252.88 ",$962.82 ,"$1,898.30 ", N/A ,"$1,000.59 ","$1,000.59 ", N/A ,"$1,138.98 ","$1,613.56 ","$1,328.81 ", N/A , N/A ,"$1,803.39 ","$1,442.71 ","$1,423.73 ", N/A ,"$1,613.56 ", N/A , N/A , N/A ,"$1,328.81 ","$1,156.06 ", N/A , N/A , N/A , N/A , N/A ,"$1,613.56 ", N/A ,"$1,746.44 ","$1,328.81 ",$962.82 ,"$1,155.50 ","$1,156.06 ","$1,155.50 ","$1,311.73 ","$1,708.47 ","$1,296.92 ", N/A ,"$1,499.66 ", N/A , N/A , N/A , N/A , N/A ,"$1,366.78 ","$1,176.95 ","$1,366.78 ","$1,366.78 ","$1,518.64 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,AMNIOGRAFT 1.5 X 1.0CM SIZE D,278,1 ,"$1,186.95 ",$783.39 ,$602.02 ,"$1,186.95 ", N/A ,$625.64 ,$625.64 , N/A ,$712.17 ,"$1,008.91 ",$830.87 , N/A , N/A ,"$1,127.60 ",$902.08 ,$890.21 , N/A ,"$1,008.91 ", N/A , N/A , N/A ,$830.87 ,$722.85 , N/A , N/A , N/A , N/A , N/A ,"$1,008.91 ", N/A ,"$1,091.99 ",$830.87 ,$602.02 ,$722.50 ,$722.85 ,$722.50 ,$820.18 ,"$1,068.26 ",$810.92 , N/A ,$937.69 , N/A , N/A , N/A , N/A , N/A ,$854.60 ,$735.91 ,$854.60 ,$854.60 ,$949.56 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ANCHOR SUTURE 2 4.75MM HEALICOIL ULTRABRAID FULL THREAD PRELOAD OPEN ARCHITECTURE REGENESORB STERILE BLUE COBRAID BLUE,278,1 ,$731.00 ,$482.46 ,$370.76 ,$731.00 , N/A , N/A , N/A , N/A ,$438.60 ,$621.35 ,$511.70 , N/A , N/A ,$694.45 ,$555.56 ,$548.25 , N/A ,$621.35 , N/A , N/A , N/A ,$511.70 ,$445.18 , N/A , N/A , N/A , N/A , N/A ,$621.35 , N/A ,$672.52 ,$511.70 ,$370.76 ,$444.96 ,$445.18 ,$444.96 ,$505.12 ,$657.90 ,$499.42 , N/A ,$577.49 , N/A , N/A , N/A , N/A , N/A ,$526.32 ,$453.22 ,$526.32 ,$526.32 ,$584.80 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,AUGMENT ZIMMER TIBIAL SZ 4 08MM FULL WDG 7D,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,BAND RETINAL 125X2.5X.6MM SILICONE CIRCLING,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,BAR SYNTHES CONNECTING 4.0 X  80MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,BAR EXTERNAL FIXATION 60MM 4MM METACARPUS PHALANX,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,BAR SYNTHES CONNECTING 4.0 X 180MM,278,1 ,$89.78 ,$59.25 ,$45.54 ,$89.78 , N/A , N/A , N/A , N/A ,$53.87 ,$76.31 ,$62.85 , N/A , N/A ,$85.29 ,$68.23 ,$67.34 , N/A ,$76.31 , N/A , N/A , N/A ,$62.85 ,$54.68 , N/A , N/A , N/A , N/A , N/A ,$76.31 , N/A ,$82.60 ,$62.85 ,$45.54 ,$54.65 ,$54.68 ,$54.65 ,$62.04 ,$80.80 ,$61.34 , N/A ,$70.93 , N/A , N/A , N/A , N/A , N/A ,$64.64 ,$55.66 ,$64.64 ,$64.64 ,$71.82 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,BARRIER SEPRAFILM 5 X 6,278,1 ,$727.85 ,$480.38 ,$369.17 ,$727.85 , N/A , N/A , N/A , N/A ,$436.71 ,$618.67 ,$509.50 , N/A , N/A ,$691.46 ,$553.17 ,$545.89 , N/A ,$618.67 , N/A , N/A , N/A ,$509.50 ,$443.26 , N/A , N/A , N/A , N/A , N/A ,$618.67 , N/A ,$669.62 ,$509.50 ,$369.17 ,$443.04 ,$443.26 ,$443.04 ,$502.94 ,$655.07 ,$497.27 , N/A ,$575.00 , N/A , N/A , N/A , N/A , N/A ,$524.05 ,$451.27 ,$524.05 ,$524.05 ,$582.28 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,BUTTON CABLE ZIMMER 2.5MM,278,1 ,$354.38 ,$233.89 ,$179.74 ,$354.38 , N/A , N/A , N/A , N/A ,$212.63 ,$301.22 ,$248.07 , N/A , N/A ,$336.66 ,$269.33 ,$265.79 , N/A ,$301.22 , N/A , N/A , N/A ,$248.07 ,$215.82 , N/A , N/A , N/A , N/A , N/A ,$301.22 , N/A ,$326.03 ,$248.07 ,$179.74 ,$215.71 ,$215.82 ,$215.71 ,$244.88 ,$318.94 ,$242.11 , N/A ,$279.96 , N/A , N/A , N/A , N/A , N/A ,$255.15 ,$219.72 ,$255.15 ,$255.15 ,$283.50 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,BUTTON FIXATION 3.5MM T25 HEX CERCLAGE STERILE,278,1 ,$379.13 ,$250.23 ,$192.29 ,$379.13 , N/A , N/A , N/A , N/A ,$227.48 ,$322.26 ,$265.39 , N/A , N/A ,$360.17 ,$288.14 ,$284.35 , N/A ,$322.26 , N/A , N/A , N/A ,$265.39 ,$230.89 , N/A , N/A , N/A , N/A , N/A ,$322.26 , N/A ,$348.80 ,$265.39 ,$192.29 ,$230.78 ,$230.89 ,$230.78 ,$261.98 ,$341.22 ,$259.02 , N/A ,$299.51 , N/A , N/A , N/A , N/A , N/A ,$272.97 ,$235.06 ,$272.97 ,$272.97 ,$303.30 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,CAP SCREW BIOMET,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,COMPONENT FEMORAL 9 STANDARD KNEE RIGHT CRUCIATE RETAIN CEMENT PERSONA COCR,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,COMPONENT FEMORAL 7 STANDARD KNEE RIGHT CRUCIATE RETAIN CEMENT PERSONA COCR,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,COMPONENT PATELLAR 35MM PERSONA VIVACIT-E ALL POLY KNEE STERILE LATEX FREE,278,1 ,"$1,021.25 ",$674.03 ,$517.98 ,"$1,021.25 ", N/A ,$538.30 ,$538.30 , N/A ,$612.75 ,$868.06 ,$714.88 , N/A , N/A ,$970.19 ,$776.15 ,$765.94 , N/A ,$868.06 , N/A , N/A , N/A ,$714.88 ,$621.94 , N/A , N/A , N/A , N/A , N/A ,$868.06 , N/A ,$939.55 ,$714.88 ,$517.98 ,$621.63 ,$621.94 ,$621.63 ,$705.68 ,$919.13 ,$697.72 , N/A ,$806.79 , N/A , N/A , N/A , N/A , N/A ,$735.30 ,$633.18 ,$735.30 ,$735.30 ,$817.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,DEVICE FIXATION TIGHTROPE ACL RIGHT 2 LOAD PASS SUTURE,278,1 ,$795.50 ,$525.03 ,$403.48 ,$795.50 , N/A , N/A , N/A , N/A ,$477.30 ,$676.18 ,$556.85 , N/A , N/A ,$755.73 ,$604.58 ,$596.63 , N/A ,$676.18 , N/A , N/A , N/A ,$556.85 ,$484.46 , N/A , N/A , N/A , N/A , N/A ,$676.18 , N/A ,$731.86 ,$556.85 ,$403.48 ,$484.22 ,$484.46 ,$484.22 ,$549.69 ,$715.95 ,$543.49 , N/A ,$628.45 , N/A , N/A , N/A , N/A , N/A ,$572.76 ,$493.21 ,$572.76 ,$572.76 ,$636.40 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,DURASEAL 5ML,278,1 ,"$1,947.23 ","$1,285.17 ",$987.64 ,"$1,947.23 ", N/A ,"$1,026.38 ","$1,026.38 ", N/A ,"$1,168.34 ","$1,655.15 ","$1,363.06 ", N/A , N/A ,"$1,849.87 ","$1,479.89 ","$1,460.42 ", N/A ,"$1,655.15 ", N/A , N/A , N/A ,"$1,363.06 ","$1,185.86 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.15 ", N/A ,"$1,791.45 ","$1,363.06 ",$987.64 ,"$1,185.28 ","$1,185.86 ","$1,185.28 ","$1,345.54 ","$1,752.51 ","$1,330.35 ", N/A ,"$1,538.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.01 ","$1,207.28 ","$1,402.01 ","$1,402.01 ","$1,557.78 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ENDOBUTTON 4MM X 12MM,278,1 ,$312.17 ,$206.03 ,$158.33 ,$312.17 , N/A , N/A , N/A , N/A ,$187.30 ,$265.34 ,$218.52 , N/A , N/A ,$296.56 ,$237.25 ,$234.13 , N/A ,$265.34 , N/A , N/A , N/A ,$218.52 ,$190.11 , N/A , N/A , N/A , N/A , N/A ,$265.34 , N/A ,$287.20 ,$218.52 ,$158.33 ,$190.02 ,$190.11 ,$190.02 ,$215.71 ,$280.95 ,$213.27 , N/A ,$246.61 , N/A , N/A , N/A , N/A , N/A ,$224.76 ,$193.55 ,$224.76 ,$224.76 ,$249.74 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT BONE CELLULAR BONE MATRIX 1CC,278,1 ,"$1,045.50 ",$690.03 ,$530.28 ,"$1,045.50 ", N/A ,$551.08 ,$551.08 , N/A ,$627.30 ,$888.68 ,$731.85 , N/A , N/A ,$993.23 ,$794.58 ,$784.13 , N/A ,$888.68 , N/A , N/A , N/A ,$731.85 ,$636.71 , N/A , N/A , N/A , N/A , N/A ,$888.68 , N/A ,$961.86 ,$731.85 ,$530.28 ,$636.40 ,$636.71 ,$636.40 ,$722.44 ,$940.95 ,$714.29 , N/A ,$825.95 , N/A , N/A , N/A , N/A , N/A ,$752.76 ,$648.21 ,$752.76 ,$752.76 ,$836.40 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT BONE CORTICAL CANCELLOUS 90ML .5-3MM CRUSHED FROZEN TRADITIONAL ALLOGRAFT,278,1 ,"$1,953.28 ","$1,289.16 ",$990.70 ,"$1,953.28 ", N/A ,"$1,029.57 ","$1,029.57 ", N/A ,"$1,171.97 ","$1,660.29 ","$1,367.30 ", N/A , N/A ,"$1,855.62 ","$1,484.49 ","$1,464.96 ", N/A ,"$1,660.29 ", N/A , N/A , N/A ,"$1,367.30 ","$1,189.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,660.29 ", N/A ,"$1,797.02 ","$1,367.30 ",$990.70 ,"$1,188.96 ","$1,189.55 ","$1,188.96 ","$1,349.72 ","$1,757.95 ","$1,334.48 ", N/A ,"$1,543.09 ", N/A , N/A , N/A , N/A , N/A ,"$1,406.36 ","$1,211.03 ","$1,406.36 ","$1,406.36 ","$1,562.62 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT INFUSE BONE LARGE II,278,1 ,"$10,638.00 ","$7,021.08 ","$5,212.62 ","$10,638.00 ", N/A ,"$5,607.29 ","$5,607.29 ", N/A ,"$6,382.80 ","$9,042.30 ","$7,446.60 ", N/A , N/A ,"$10,106.10 ","$8,084.88 ","$7,978.50 ","$5,319.00 ","$9,042.30 ", N/A ,"$5,319.00 ","$5,319.00 ","$7,446.60 ","$6,478.54 ", N/A , N/A , N/A , N/A , N/A ,"$9,042.30 ", N/A ,"$9,786.96 ","$7,446.60 ","$5,395.59 ","$6,475.35 ","$6,478.54 ","$6,475.35 ","$7,350.86 ","$9,574.20 ","$7,267.88 ", N/A ,"$8,404.02 ", N/A ,"$5,212.62 ","$5,212.62 ", N/A ,"$5,212.62 ","$7,659.36 ","$6,595.56 ","$7,659.36 ","$7,659.36 ","$8,510.40 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE 16MM GRAFIXPL PRIME 2SQ CM AMNIOTIC MEMBRANE ALLOGRAFT DISC LYOPRESERVE,278,1 ,$903.00 ,$595.98 ,$458.00 ,$903.00 , N/A , N/A , N/A , N/A ,$541.80 ,$767.55 ,$632.10 , N/A , N/A ,$857.85 ,$686.28 ,$677.25 , N/A ,$767.55 , N/A , N/A , N/A ,$632.10 ,$549.93 , N/A , N/A , N/A , N/A , N/A ,$767.55 , N/A ,$830.76 ,$632.10 ,$458.00 ,$549.66 ,$549.93 ,$549.66 ,$623.97 ,$812.70 ,$616.93 , N/A ,$713.37 , N/A , N/A , N/A , N/A , N/A ,$650.16 ,$559.86 ,$650.16 ,$650.16 ,$722.40 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT BONE 16MM CORE ALLOGRAFT CM2,278,1 ,$903.00 ,$595.98 ,$458.00 ,$903.00 , N/A , N/A , N/A , N/A ,$541.80 ,$767.55 ,$632.10 , N/A , N/A ,$857.85 ,$686.28 ,$677.25 , N/A ,$767.55 , N/A , N/A , N/A ,$632.10 ,$549.93 , N/A , N/A , N/A , N/A , N/A ,$767.55 , N/A ,$830.76 ,$632.10 ,$458.00 ,$549.66 ,$549.93 ,$549.66 ,$623.97 ,$812.70 ,$616.93 , N/A ,$713.37 , N/A , N/A , N/A , N/A , N/A ,$650.16 ,$559.86 ,$650.16 ,$650.16 ,$722.40 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE 14MM GRAFIX CORE DISK ALLOGRAFT,278,1 ,$903.00 ,$595.98 ,$458.00 ,$903.00 , N/A , N/A , N/A , N/A ,$541.80 ,$767.55 ,$632.10 , N/A , N/A ,$857.85 ,$686.28 ,$677.25 , N/A ,$767.55 , N/A , N/A , N/A ,$632.10 ,$549.93 , N/A , N/A , N/A , N/A , N/A ,$767.55 , N/A ,$830.76 ,$632.10 ,$458.00 ,$549.66 ,$549.93 ,$549.66 ,$623.97 ,$812.70 ,$616.93 , N/A ,$713.37 , N/A , N/A , N/A , N/A , N/A ,$650.16 ,$559.86 ,$650.16 ,$650.16 ,$722.40 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE 14MM GRAFIX PRIME DISK ALLOGRAFT,278,1 ,$903.00 ,$595.98 ,$458.00 ,$903.00 , N/A , N/A , N/A , N/A ,$541.80 ,$767.55 ,$632.10 , N/A , N/A ,$857.85 ,$686.28 ,$677.25 , N/A ,$767.55 , N/A , N/A , N/A ,$632.10 ,$549.93 , N/A , N/A , N/A , N/A , N/A ,$767.55 , N/A ,$830.76 ,$632.10 ,$458.00 ,$549.66 ,$549.93 ,$549.66 ,$623.97 ,$812.70 ,$616.93 , N/A ,$713.37 , N/A , N/A , N/A , N/A , N/A ,$650.16 ,$559.86 ,$650.16 ,$650.16 ,$722.40 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE 2X1.5CM GRAFIXPL PRIME PLACENTAL MEMBRANE ALLOGRAFT,278,1 ,"$1,527.25 ","$1,007.99 ",$774.62 ,"$1,527.25 ", N/A ,$805.01 ,$805.01 , N/A ,$916.35 ,"$1,298.16 ","$1,069.08 ", N/A , N/A ,"$1,450.89 ","$1,160.71 ","$1,145.44 ", N/A ,"$1,298.16 ", N/A , N/A , N/A ,"$1,069.08 ",$930.10 , N/A , N/A , N/A , N/A , N/A ,"$1,298.16 ", N/A ,"$1,405.07 ","$1,069.08 ",$774.62 ,$929.64 ,$930.10 ,$929.64 ,"$1,055.33 ","$1,374.53 ","$1,043.42 ", N/A ,"$1,206.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,099.62 ",$946.90 ,"$1,099.62 ","$1,099.62 ","$1,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE 2X1.5CM GRAFIX CORE 3SQ CM PLACENTAL MEMBRANE ALLOGRAFT,278,1 ,"$1,527.25 ","$1,007.99 ",$774.62 ,"$1,527.25 ", N/A ,$805.01 ,$805.01 , N/A ,$916.35 ,"$1,298.16 ","$1,069.08 ", N/A , N/A ,"$1,450.89 ","$1,160.71 ","$1,145.44 ", N/A ,"$1,298.16 ", N/A , N/A , N/A ,"$1,069.08 ",$930.10 , N/A , N/A , N/A , N/A , N/A ,"$1,298.16 ", N/A ,"$1,405.07 ","$1,069.08 ",$774.62 ,$929.64 ,$930.10 ,$929.64 ,"$1,055.33 ","$1,374.53 ","$1,043.42 ", N/A ,"$1,206.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,099.62 ",$946.90 ,"$1,099.62 ","$1,099.62 ","$1,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE 2X3CM GRAFIX CORE,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE 2X2CM GRAFIX CORE,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE 4X3CM GRAFIX CORE ALLOGRAFT,278,1 ,"$2,384.50 ","$1,573.77 ","$1,209.42 ","$2,384.50 ", N/A ,"$1,256.87 ","$1,256.87 ", N/A ,"$1,430.70 ","$2,026.83 ","$1,669.15 ", N/A , N/A ,"$2,265.28 ","$1,812.22 ","$1,788.38 ", N/A ,"$2,026.83 ", N/A , N/A , N/A ,"$1,669.15 ","$1,452.16 ", N/A , N/A , N/A , N/A , N/A ,"$2,026.83 ", N/A ,"$2,193.74 ","$1,669.15 ","$1,209.42 ","$1,451.45 ","$1,452.16 ","$1,451.45 ","$1,647.69 ","$2,146.05 ","$1,629.09 ", N/A ,"$1,883.76 ", N/A , N/A , N/A , N/A , N/A ,"$1,716.84 ","$1,478.39 ","$1,716.84 ","$1,716.84 ","$1,907.60 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE 3X4CM GRAFIX CORE,278,1 ,"$2,384.50 ","$1,573.77 ","$1,209.42 ","$2,384.50 ", N/A ,"$1,256.87 ","$1,256.87 ", N/A ,"$1,430.70 ","$2,026.83 ","$1,669.15 ", N/A , N/A ,"$2,265.28 ","$1,812.22 ","$1,788.38 ", N/A ,"$2,026.83 ", N/A , N/A , N/A ,"$1,669.15 ","$1,452.16 ", N/A , N/A , N/A , N/A , N/A ,"$2,026.83 ", N/A ,"$2,193.74 ","$1,669.15 ","$1,209.42 ","$1,451.45 ","$1,452.16 ","$1,451.45 ","$1,647.69 ","$2,146.05 ","$1,629.09 ", N/A ,"$1,883.76 ", N/A , N/A , N/A , N/A , N/A ,"$1,716.84 ","$1,478.39 ","$1,716.84 ","$1,716.84 ","$1,907.60 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE EPIFIX 6SQ CM AMNIOTIC MEMBRANE ALLOGRAFT MULTIPLE LAYER CHRONIC ACUTE WOUND HEAL,278,1 ,"$2,270.50 ","$1,498.53 ","$1,151.60 ","$2,270.50 ", N/A ,"$1,196.78 ","$1,196.78 ", N/A ,"$1,362.30 ","$1,929.93 ","$1,589.35 ", N/A , N/A ,"$2,156.98 ","$1,725.58 ","$1,702.88 ", N/A ,"$1,929.93 ", N/A , N/A , N/A ,"$1,589.35 ","$1,382.73 ", N/A , N/A , N/A , N/A , N/A ,"$1,929.93 ", N/A ,"$2,088.86 ","$1,589.35 ","$1,151.60 ","$1,382.05 ","$1,382.73 ","$1,382.05 ","$1,568.92 ","$2,043.45 ","$1,551.21 ", N/A ,"$1,793.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,634.76 ","$1,407.71 ","$1,634.76 ","$1,634.76 ","$1,816.40 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE EPIFIX 8SQ CM AMNIOTIC MEMBRANE ALLOGRAFT MULTIPLE LAYER CHRONIC ACUTE WOUND HEAL,278,1 ,"$2,365.50 ","$1,561.23 ","$1,199.78 ","$2,365.50 ", N/A ,"$1,246.86 ","$1,246.86 ", N/A ,"$1,419.30 ","$2,010.68 ","$1,655.85 ", N/A , N/A ,"$2,247.23 ","$1,797.78 ","$1,774.13 ", N/A ,"$2,010.68 ", N/A , N/A , N/A ,"$1,655.85 ","$1,440.59 ", N/A , N/A , N/A , N/A , N/A ,"$2,010.68 ", N/A ,"$2,176.26 ","$1,655.85 ","$1,199.78 ","$1,439.88 ","$1,440.59 ","$1,439.88 ","$1,634.56 ","$2,128.95 ","$1,616.11 ", N/A ,"$1,868.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,703.16 ","$1,466.61 ","$1,703.16 ","$1,703.16 ","$1,892.40 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,GRAFT SOFT TISSUE EPIFIX PURION 8SQ CM DHACM ALLOGRAFT MULTIPLE LAYER REDUCE INFLAMMATION ACUTE CHRONIC WOUND CARE,278,1 ,"$2,565.02 ","$1,692.91 ","$1,282.51 ","$2,565.02 ", N/A ,"$1,352.02 ","$1,352.02 ", N/A ,"$1,539.01 ","$2,180.27 ","$1,795.51 ", N/A , N/A ,"$2,436.77 ","$1,949.42 ","$1,923.77 ","$1,282.51 ","$2,180.27 ", N/A ,"$1,282.51 ","$1,282.51 ","$1,795.51 ","$1,562.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,180.27 ", N/A ,"$2,359.82 ","$1,795.51 ","$1,300.98 ","$1,561.33 ","$1,562.10 ","$1,561.33 ","$1,772.43 ","$2,308.52 ","$1,752.42 ", N/A ,"$2,026.37 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.81 ","$1,590.31 ","$1,846.81 ","$1,846.81 ","$2,052.02 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,IMPLANT FIXATION MENISCAL ROOT REPAIR,278,1 ,"$2,039.75 ","$1,346.24 ","$1,034.56 ","$2,039.75 ", N/A ,"$1,075.15 ","$1,075.15 ", N/A ,"$1,223.85 ","$1,733.79 ","$1,427.83 ", N/A , N/A ,"$1,937.76 ","$1,550.21 ","$1,529.81 ", N/A ,"$1,733.79 ", N/A , N/A , N/A ,"$1,427.83 ","$1,242.21 ", N/A , N/A , N/A , N/A , N/A ,"$1,733.79 ", N/A ,"$1,876.57 ","$1,427.83 ","$1,034.56 ","$1,241.60 ","$1,242.21 ","$1,241.60 ","$1,409.47 ","$1,835.78 ","$1,393.56 ", N/A ,"$1,611.40 ", N/A , N/A , N/A , N/A , N/A ,"$1,468.62 ","$1,264.65 ","$1,468.62 ","$1,468.62 ","$1,631.80 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,IMPLANT PEEK ZERO-P SYNTHES 8MM,278,1 ,"$3,496.00 ","$2,307.36 ","$1,748.00 ","$3,496.00 ", N/A ,"$1,842.74 ","$1,842.74 ", N/A ,"$2,097.60 ","$2,971.60 ","$2,447.20 ", N/A , N/A ,"$3,321.20 ","$2,656.96 ","$2,622.00 ","$1,748.00 ","$2,971.60 ", N/A ,"$1,748.00 ","$1,748.00 ","$2,447.20 ","$2,129.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,971.60 ", N/A ,"$3,216.32 ","$2,447.20 ","$1,773.17 ","$2,128.02 ","$2,129.06 ","$2,128.02 ","$2,415.74 ","$3,146.40 ","$2,388.47 ", N/A ,"$2,761.84 ", N/A , N/A , N/A , N/A , N/A ,"$2,517.12 ","$2,167.52 ","$2,517.12 ","$2,517.12 ","$2,796.80 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,IMPLANT RETINAL BAND CIRCLING STYLE 240,278,1 ,$25.52 ,$16.84 ,$12.94 ,$25.52 , N/A , N/A , N/A , N/A ,$15.31 ,$21.69 ,$17.86 , N/A , N/A ,$24.24 ,$19.40 ,$19.14 , N/A ,$21.69 , N/A , N/A , N/A ,$17.86 ,$15.54 , N/A , N/A , N/A , N/A , N/A ,$21.69 , N/A ,$23.48 ,$17.86 ,$12.94 ,$15.53 ,$15.54 ,$15.53 ,$17.63 ,$22.97 ,$17.44 , N/A ,$20.16 , N/A , N/A , N/A , N/A , N/A ,$18.37 ,$15.82 ,$18.37 ,$18.37 ,$20.42 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,IMPLANT RETINAL MERIDONAL STYLE 106 (TIRE),278,1 ,$42.66 ,$28.16 ,$21.64 ,$42.66 , N/A , N/A , N/A , N/A ,$25.60 ,$36.26 ,$29.86 , N/A , N/A ,$40.53 ,$32.42 ,$32.00 , N/A ,$36.26 , N/A , N/A , N/A ,$29.86 ,$25.98 , N/A , N/A , N/A , N/A , N/A ,$36.26 , N/A ,$39.25 ,$29.86 ,$21.64 ,$25.97 ,$25.98 ,$25.97 ,$29.48 ,$38.39 ,$29.15 , N/A ,$33.70 , N/A , N/A , N/A , N/A , N/A ,$30.72 ,$26.45 ,$30.72 ,$30.72 ,$34.13 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,IMPLANT RETINAL STRIP SILICONE STYLE  41,278,1 ,$27.81 ,$18.35 ,$14.11 ,$27.81 , N/A , N/A , N/A , N/A ,$16.69 ,$23.64 ,$19.47 , N/A , N/A ,$26.42 ,$21.14 ,$20.86 , N/A ,$23.64 , N/A , N/A , N/A ,$19.47 ,$16.94 , N/A , N/A , N/A , N/A , N/A ,$23.64 , N/A ,$25.59 ,$19.47 ,$14.11 ,$16.93 ,$16.94 ,$16.93 ,$19.22 ,$25.03 ,$19.00 , N/A ,$21.97 , N/A , N/A , N/A , N/A , N/A ,$20.02 ,$17.24 ,$20.02 ,$20.02 ,$22.25 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,IMPLANT RETINAL TIRE SILICONE STYLE 276,278,1 ,$34.79 ,$22.96 ,$17.65 ,$34.79 , N/A , N/A , N/A , N/A ,$20.87 ,$29.57 ,$24.35 , N/A , N/A ,$33.05 ,$26.44 ,$26.09 , N/A ,$29.57 , N/A , N/A , N/A ,$24.35 ,$21.19 , N/A , N/A , N/A , N/A , N/A ,$29.57 , N/A ,$32.01 ,$24.35 ,$17.65 ,$21.18 ,$21.19 ,$21.18 ,$24.04 ,$31.31 ,$23.77 , N/A ,$27.48 , N/A , N/A , N/A , N/A , N/A ,$25.05 ,$21.57 ,$25.05 ,$25.05 ,$27.83 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,IMPLANT RETINAL 287 (TIRE),278,1 ,$34.79 ,$22.96 ,$17.65 ,$34.79 , N/A , N/A , N/A , N/A ,$20.87 ,$29.57 ,$24.35 , N/A , N/A ,$33.05 ,$26.44 ,$26.09 , N/A ,$29.57 , N/A , N/A , N/A ,$24.35 ,$21.19 , N/A , N/A , N/A , N/A , N/A ,$29.57 , N/A ,$32.01 ,$24.35 ,$17.65 ,$21.18 ,$21.19 ,$21.18 ,$24.04 ,$31.31 ,$23.77 , N/A ,$27.48 , N/A , N/A , N/A , N/A , N/A ,$25.05 ,$21.57 ,$25.05 ,$25.05 ,$27.83 
ST NICHOLAS HOSPITAL - ACUTE,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 ",$968.96 ,"$1,910.41 ", N/A ,"$1,006.98 ","$1,006.98 ", N/A ,"$1,146.25 ","$1,623.85 ","$1,337.29 ", N/A , N/A ,"$1,814.89 ","$1,451.91 ","$1,432.81 ", N/A ,"$1,623.85 ", N/A , N/A , N/A ,"$1,337.29 ","$1,163.44 ", N/A , N/A , N/A , N/A , N/A ,"$1,623.85 ", N/A ,"$1,757.58 ","$1,337.29 ",$968.96 ,"$1,162.87 ","$1,163.44 ","$1,162.87 ","$1,320.09 ","$1,719.37 ","$1,305.19 ", N/A ,"$1,509.22 ", N/A , N/A , N/A , N/A , N/A ,"$1,375.50 ","$1,184.45 ","$1,375.50 ","$1,375.50 ","$1,528.33 "
ST NICHOLAS HOSPITAL - ACUTE,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 ","$1,823.23 ","$3,646.46 ", N/A ,"$1,922.05 ","$1,922.05 ", N/A ,"$2,187.88 ","$3,099.49 ","$2,552.52 ", N/A , N/A ,"$3,464.14 ","$2,771.31 ","$2,734.85 ","$1,823.23 ","$3,099.49 ", N/A ,"$1,823.23 ","$1,823.23 ","$2,552.52 ","$2,220.69 ", N/A , N/A , N/A , N/A , N/A ,"$3,099.49 ", N/A ,"$3,354.74 ","$2,552.52 ","$1,849.48 ","$2,219.60 ","$2,220.69 ","$2,219.60 ","$2,519.70 ","$3,281.81 ","$2,491.26 ", N/A ,"$2,880.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,625.45 ","$2,260.81 ","$2,625.45 ","$2,625.45 ","$2,917.17 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,PATELLA ZIMMER NEXGEN ALL-POLY 8 X 29MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SPINAL 55MM 5.5MM EXPEDIUM TITANIUM PREBENT LINE NONSTERILE,278,1 ,$537.50 ,$354.75 ,$272.62 ,$537.50 , N/A , N/A , N/A , N/A ,$322.50 ,$456.88 ,$376.25 , N/A , N/A ,$510.63 ,$408.50 ,$403.13 , N/A ,$456.88 , N/A , N/A , N/A ,$376.25 ,$327.34 , N/A , N/A , N/A , N/A , N/A ,$456.88 , N/A ,$494.50 ,$376.25 ,$272.62 ,$327.18 ,$327.34 ,$327.18 ,$371.41 ,$483.75 ,$367.22 , N/A ,$424.63 , N/A , N/A , N/A , N/A , N/A ,$387.00 ,$333.25 ,$387.00 ,$387.00 ,$430.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD DEPUY SPINE 35MM,278,1 ,$537.50 ,$354.75 ,$272.62 ,$537.50 , N/A , N/A , N/A , N/A ,$322.50 ,$456.88 ,$376.25 , N/A , N/A ,$510.63 ,$408.50 ,$403.13 , N/A ,$456.88 , N/A , N/A , N/A ,$376.25 ,$327.34 , N/A , N/A , N/A , N/A , N/A ,$456.88 , N/A ,$494.50 ,$376.25 ,$272.62 ,$327.18 ,$327.34 ,$327.18 ,$371.41 ,$483.75 ,$367.22 , N/A ,$424.63 , N/A , N/A , N/A , N/A , N/A ,$387.00 ,$333.25 ,$387.00 ,$387.00 ,$430.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SPINAL 45MM 5.5MM EXPEDIUM PREBENT TITANIUM LINE,278,1 ,$537.50 ,$354.75 ,$272.62 ,$537.50 , N/A , N/A , N/A , N/A ,$322.50 ,$456.88 ,$376.25 , N/A , N/A ,$510.63 ,$408.50 ,$403.13 , N/A ,$456.88 , N/A , N/A , N/A ,$376.25 ,$327.34 , N/A , N/A , N/A , N/A , N/A ,$456.88 , N/A ,$494.50 ,$376.25 ,$272.62 ,$327.18 ,$327.34 ,$327.18 ,$371.41 ,$483.75 ,$367.22 , N/A ,$424.63 , N/A , N/A , N/A , N/A , N/A ,$387.00 ,$333.25 ,$387.00 ,$387.00 ,$430.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SPINAL 50MM 5.5MM EXPEDIUM TITANIUM LINE PREBENT NONSTERILE,278,1 ,$537.50 ,$354.75 ,$272.62 ,$537.50 , N/A , N/A , N/A , N/A ,$322.50 ,$456.88 ,$376.25 , N/A , N/A ,$510.63 ,$408.50 ,$403.13 , N/A ,$456.88 , N/A , N/A , N/A ,$376.25 ,$327.34 , N/A , N/A , N/A , N/A , N/A ,$456.88 , N/A ,$494.50 ,$376.25 ,$272.62 ,$327.18 ,$327.34 ,$327.18 ,$371.41 ,$483.75 ,$367.22 , N/A ,$424.63 , N/A , N/A , N/A , N/A , N/A ,$387.00 ,$333.25 ,$387.00 ,$387.00 ,$430.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 200MM,278,1 ,$475.15 ,$313.60 ,$241.00 ,$475.15 , N/A , N/A , N/A , N/A ,$285.09 ,$403.88 ,$332.61 , N/A , N/A ,$451.39 ,$361.11 ,$356.36 , N/A ,$403.88 , N/A , N/A , N/A ,$332.61 ,$289.37 , N/A , N/A , N/A , N/A , N/A ,$403.88 , N/A ,$437.14 ,$332.61 ,$241.00 ,$289.22 ,$289.37 ,$289.22 ,$328.33 ,$427.64 ,$324.62 , N/A ,$375.37 , N/A , N/A , N/A , N/A , N/A ,$342.11 ,$294.59 ,$342.11 ,$342.11 ,$380.12 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 100MM,278,1 ,$475.15 ,$313.60 ,$241.00 ,$475.15 , N/A , N/A , N/A , N/A ,$285.09 ,$403.88 ,$332.61 , N/A , N/A ,$451.39 ,$361.11 ,$356.36 , N/A ,$403.88 , N/A , N/A , N/A ,$332.61 ,$289.37 , N/A , N/A , N/A , N/A , N/A ,$403.88 , N/A ,$437.14 ,$332.61 ,$241.00 ,$289.22 ,$289.37 ,$289.22 ,$328.33 ,$427.64 ,$324.62 , N/A ,$375.37 , N/A , N/A , N/A , N/A , N/A ,$342.11 ,$294.59 ,$342.11 ,$342.11 ,$380.12 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 150MM,278,1 ,$475.15 ,$313.60 ,$241.00 ,$475.15 , N/A , N/A , N/A , N/A ,$285.09 ,$403.88 ,$332.61 , N/A , N/A ,$451.39 ,$361.11 ,$356.36 , N/A ,$403.88 , N/A , N/A , N/A ,$332.61 ,$289.37 , N/A , N/A , N/A , N/A , N/A ,$403.88 , N/A ,$437.14 ,$332.61 ,$241.00 ,$289.22 ,$289.37 ,$289.22 ,$328.33 ,$427.64 ,$324.62 , N/A ,$375.37 , N/A , N/A , N/A , N/A , N/A ,$342.11 ,$294.59 ,$342.11 ,$342.11 ,$380.12 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 300MM,278,1 ,$523.74 ,$345.67 ,$265.64 ,$523.74 , N/A , N/A , N/A , N/A ,$314.24 ,$445.18 ,$366.62 , N/A , N/A ,$497.55 ,$398.04 ,$392.81 , N/A ,$445.18 , N/A , N/A , N/A ,$366.62 ,$318.96 , N/A , N/A , N/A , N/A , N/A ,$445.18 , N/A ,$481.84 ,$366.62 ,$265.64 ,$318.80 ,$318.96 ,$318.80 ,$361.90 ,$471.37 ,$357.82 , N/A ,$413.75 , N/A , N/A , N/A , N/A , N/A ,$377.09 ,$324.72 ,$377.09 ,$377.09 ,$418.99 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 250MM,278,1 ,$523.74 ,$345.67 ,$265.64 ,$523.74 , N/A , N/A , N/A , N/A ,$314.24 ,$445.18 ,$366.62 , N/A , N/A ,$497.55 ,$398.04 ,$392.81 , N/A ,$445.18 , N/A , N/A , N/A ,$366.62 ,$318.96 , N/A , N/A , N/A , N/A , N/A ,$445.18 , N/A ,$481.84 ,$366.62 ,$265.64 ,$318.80 ,$318.96 ,$318.80 ,$361.90 ,$471.37 ,$357.82 , N/A ,$413.75 , N/A , N/A , N/A , N/A , N/A ,$377.09 ,$324.72 ,$377.09 ,$377.09 ,$418.99 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 350MM,278,1 ,$509.55 ,$336.30 ,$258.44 ,$509.55 , N/A , N/A , N/A , N/A ,$305.73 ,$433.12 ,$356.69 , N/A , N/A ,$484.07 ,$387.26 ,$382.16 , N/A ,$433.12 , N/A , N/A , N/A ,$356.69 ,$310.32 , N/A , N/A , N/A , N/A , N/A ,$433.12 , N/A ,$468.79 ,$356.69 ,$258.44 ,$310.16 ,$310.32 ,$310.16 ,$352.10 ,$458.60 ,$348.12 , N/A ,$402.54 , N/A , N/A , N/A , N/A , N/A ,$366.88 ,$315.92 ,$366.88 ,$366.88 ,$407.64 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 400MM,278,1 ,$559.00 ,$368.94 ,$283.52 ,$559.00 , N/A , N/A , N/A , N/A ,$335.40 ,$475.15 ,$391.30 , N/A , N/A ,$531.05 ,$424.84 ,$419.25 , N/A ,$475.15 , N/A , N/A , N/A ,$391.30 ,$340.43 , N/A , N/A , N/A , N/A , N/A ,$475.15 , N/A ,$514.28 ,$391.30 ,$283.52 ,$340.26 ,$340.43 ,$340.26 ,$386.27 ,$503.10 ,$381.91 , N/A ,$441.61 , N/A , N/A , N/A , N/A , N/A ,$402.48 ,$346.58 ,$402.48 ,$402.48 ,$447.20 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 4 X 120MM,278,1 ,$86.63 ,$57.18 ,$43.94 ,$86.63 , N/A , N/A , N/A , N/A ,$51.98 ,$73.64 ,$60.64 , N/A , N/A ,$82.30 ,$65.84 ,$64.97 , N/A ,$73.64 , N/A , N/A , N/A ,$60.64 ,$52.76 , N/A , N/A , N/A , N/A , N/A ,$73.64 , N/A ,$79.70 ,$60.64 ,$43.94 ,$52.73 ,$52.76 ,$52.73 ,$59.86 ,$77.97 ,$59.19 , N/A ,$68.44 , N/A , N/A , N/A , N/A , N/A ,$62.37 ,$53.71 ,$62.37 ,$62.37 ,$69.30 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 4 X  60MM,278,1 ,$86.63 ,$57.18 ,$43.94 ,$86.63 , N/A , N/A , N/A , N/A ,$51.98 ,$73.64 ,$60.64 , N/A , N/A ,$82.30 ,$65.84 ,$64.97 , N/A ,$73.64 , N/A , N/A , N/A ,$60.64 ,$52.76 , N/A , N/A , N/A , N/A , N/A ,$73.64 , N/A ,$79.70 ,$60.64 ,$43.94 ,$52.73 ,$52.76 ,$52.73 ,$59.86 ,$77.97 ,$59.19 , N/A ,$68.44 , N/A , N/A , N/A , N/A , N/A ,$62.37 ,$53.71 ,$62.37 ,$62.37 ,$69.30 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 4 X  80MM,278,1 ,$86.63 ,$57.18 ,$43.94 ,$86.63 , N/A , N/A , N/A , N/A ,$51.98 ,$73.64 ,$60.64 , N/A , N/A ,$82.30 ,$65.84 ,$64.97 , N/A ,$73.64 , N/A , N/A , N/A ,$60.64 ,$52.76 , N/A , N/A , N/A , N/A , N/A ,$73.64 , N/A ,$79.70 ,$60.64 ,$43.94 ,$52.73 ,$52.76 ,$52.73 ,$59.86 ,$77.97 ,$59.19 , N/A ,$68.44 , N/A , N/A , N/A , N/A , N/A ,$62.37 ,$53.71 ,$62.37 ,$62.37 ,$69.30 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 4 X 100MM,278,1 ,$86.63 ,$57.18 ,$43.94 ,$86.63 , N/A , N/A , N/A , N/A ,$51.98 ,$73.64 ,$60.64 , N/A , N/A ,$82.30 ,$65.84 ,$64.97 , N/A ,$73.64 , N/A , N/A , N/A ,$60.64 ,$52.76 , N/A , N/A , N/A , N/A , N/A ,$73.64 , N/A ,$79.70 ,$60.64 ,$43.94 ,$52.73 ,$52.76 ,$52.73 ,$59.86 ,$77.97 ,$59.19 , N/A ,$68.44 , N/A , N/A , N/A , N/A , N/A ,$62.37 ,$53.71 ,$62.37 ,$62.37 ,$69.30 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 4 X 200MM,278,1 ,$119.70 ,$79.00 ,$60.71 ,$119.70 , N/A , N/A , N/A , N/A ,$71.82 ,$101.75 ,$83.79 , N/A , N/A ,$113.72 ,$90.97 ,$89.78 , N/A ,$101.75 , N/A , N/A , N/A ,$83.79 ,$72.90 , N/A , N/A , N/A , N/A , N/A ,$101.75 , N/A ,$110.12 ,$83.79 ,$60.71 ,$72.86 ,$72.90 ,$72.86 ,$82.71 ,$107.73 ,$81.78 , N/A ,$94.56 , N/A , N/A , N/A , N/A , N/A ,$86.18 ,$74.21 ,$86.18 ,$86.18 ,$95.76 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 4 X 140MM,278,1 ,$119.70 ,$79.00 ,$60.71 ,$119.70 , N/A , N/A , N/A , N/A ,$71.82 ,$101.75 ,$83.79 , N/A , N/A ,$113.72 ,$90.97 ,$89.78 , N/A ,$101.75 , N/A , N/A , N/A ,$83.79 ,$72.90 , N/A , N/A , N/A , N/A , N/A ,$101.75 , N/A ,$110.12 ,$83.79 ,$60.71 ,$72.86 ,$72.90 ,$72.86 ,$82.71 ,$107.73 ,$81.78 , N/A ,$94.56 , N/A , N/A , N/A , N/A , N/A ,$86.18 ,$74.21 ,$86.18 ,$86.18 ,$95.76 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 4 X 160MM,278,1 ,$119.70 ,$79.00 ,$60.71 ,$119.70 , N/A , N/A , N/A , N/A ,$71.82 ,$101.75 ,$83.79 , N/A , N/A ,$113.72 ,$90.97 ,$89.78 , N/A ,$101.75 , N/A , N/A , N/A ,$83.79 ,$72.90 , N/A , N/A , N/A , N/A , N/A ,$101.75 , N/A ,$110.12 ,$83.79 ,$60.71 ,$72.86 ,$72.90 ,$72.86 ,$82.71 ,$107.73 ,$81.78 , N/A ,$94.56 , N/A , N/A , N/A , N/A , N/A ,$86.18 ,$74.21 ,$86.18 ,$86.18 ,$95.76 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 4 X 180MM,278,1 ,$119.70 ,$79.00 ,$60.71 ,$119.70 , N/A , N/A , N/A , N/A ,$71.82 ,$101.75 ,$83.79 , N/A , N/A ,$113.72 ,$90.97 ,$89.78 , N/A ,$101.75 , N/A , N/A , N/A ,$83.79 ,$72.90 , N/A , N/A , N/A , N/A , N/A ,$101.75 , N/A ,$110.12 ,$83.79 ,$60.71 ,$72.86 ,$72.90 ,$72.86 ,$82.71 ,$107.73 ,$81.78 , N/A ,$94.56 , N/A , N/A , N/A , N/A , N/A ,$86.18 ,$74.21 ,$86.18 ,$86.18 ,$95.76 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 8.0 X 240MM,278,1 ,$333.00 ,$219.78 ,$168.90 ,$333.00 , N/A , N/A , N/A , N/A ,$199.80 ,$283.05 ,$233.10 , N/A , N/A ,$316.35 ,$253.08 ,$249.75 , N/A ,$283.05 , N/A , N/A , N/A ,$233.10 ,$202.80 , N/A , N/A , N/A , N/A , N/A ,$283.05 , N/A ,$306.36 ,$233.10 ,$168.90 ,$202.70 ,$202.80 ,$202.70 ,$230.10 ,$299.70 ,$227.51 , N/A ,$263.07 , N/A , N/A , N/A , N/A , N/A ,$239.76 ,$206.46 ,$239.76 ,$239.76 ,$266.40 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 8.0 X 200MM,278,1 ,$333.00 ,$219.78 ,$168.90 ,$333.00 , N/A , N/A , N/A , N/A ,$199.80 ,$283.05 ,$233.10 , N/A , N/A ,$316.35 ,$253.08 ,$249.75 , N/A ,$283.05 , N/A , N/A , N/A ,$233.10 ,$202.80 , N/A , N/A , N/A , N/A , N/A ,$283.05 , N/A ,$306.36 ,$233.10 ,$168.90 ,$202.70 ,$202.80 ,$202.70 ,$230.10 ,$299.70 ,$227.51 , N/A ,$263.07 , N/A , N/A , N/A , N/A , N/A ,$239.76 ,$206.46 ,$239.76 ,$239.76 ,$266.40 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SYNTHES CARBON FIBER 8.0 X 220MM,278,1 ,$333.00 ,$219.78 ,$168.90 ,$333.00 , N/A , N/A , N/A , N/A ,$199.80 ,$283.05 ,$233.10 , N/A , N/A ,$316.35 ,$253.08 ,$249.75 , N/A ,$283.05 , N/A , N/A , N/A ,$233.10 ,$202.80 , N/A , N/A , N/A , N/A , N/A ,$283.05 , N/A ,$306.36 ,$233.10 ,$168.90 ,$202.70 ,$202.80 ,$202.70 ,$230.10 ,$299.70 ,$227.51 , N/A ,$263.07 , N/A , N/A , N/A , N/A , N/A ,$239.76 ,$206.46 ,$239.76 ,$239.76 ,$266.40 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SHUNT SUNDT EXTERNAL CAROTID ENDARTERECTOMY 4 X 5 MM,278,1 ,"$1,063.31 ",$701.78 ,$539.31 ,"$1,063.31 ", N/A ,$560.47 ,$560.47 , N/A ,$637.99 ,$903.81 ,$744.32 , N/A , N/A ,"$1,010.14 ",$808.12 ,$797.48 , N/A ,$903.81 , N/A , N/A , N/A ,$744.32 ,$647.56 , N/A , N/A , N/A , N/A , N/A ,$903.81 , N/A ,$978.25 ,$744.32 ,$539.31 ,$647.24 ,$647.56 ,$647.24 ,$734.75 ,$956.98 ,$726.45 , N/A ,$840.01 , N/A , N/A , N/A , N/A , N/A ,$765.58 ,$659.25 ,$765.58 ,$765.58 ,$850.65 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SHUNT SUNDT EXTERNAL CAR END 3 X 4 MM,278,1 ,"$1,063.31 ",$701.78 ,$539.31 ,"$1,063.31 ", N/A ,$560.47 ,$560.47 , N/A ,$637.99 ,$903.81 ,$744.32 , N/A , N/A ,"$1,010.14 ",$808.12 ,$797.48 , N/A ,$903.81 , N/A , N/A , N/A ,$744.32 ,$647.56 , N/A , N/A , N/A , N/A , N/A ,$903.81 , N/A ,$978.25 ,$744.32 ,$539.31 ,$647.24 ,$647.56 ,$647.24 ,$734.75 ,$956.98 ,$726.45 , N/A ,$840.01 , N/A , N/A , N/A , N/A , N/A ,$765.58 ,$659.25 ,$765.58 ,$765.58 ,$850.65 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SHUNT SUNDT EXTERNAL CAR END 3 X 5 MM,278,1 ,"$1,063.31 ",$701.78 ,$539.31 ,"$1,063.31 ", N/A ,$560.47 ,$560.47 , N/A ,$637.99 ,$903.81 ,$744.32 , N/A , N/A ,"$1,010.14 ",$808.12 ,$797.48 , N/A ,$903.81 , N/A , N/A , N/A ,$744.32 ,$647.56 , N/A , N/A , N/A , N/A , N/A ,$903.81 , N/A ,$978.25 ,$744.32 ,$539.31 ,$647.24 ,$647.56 ,$647.24 ,$734.75 ,$956.98 ,$726.45 , N/A ,$840.01 , N/A , N/A , N/A , N/A , N/A ,$765.58 ,$659.25 ,$765.58 ,$765.58 ,$850.65 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SHUNT SUNDT INTERNAL CAROTID ENDARTERECTOMY 3.5 X 5MM,278,1 ,$166.23 ,$109.71 ,$84.31 ,$166.23 , N/A , N/A , N/A , N/A ,$99.74 ,$141.30 ,$116.36 , N/A , N/A ,$157.92 ,$126.33 ,$124.67 , N/A ,$141.30 , N/A , N/A , N/A ,$116.36 ,$101.23 , N/A , N/A , N/A , N/A , N/A ,$141.30 , N/A ,$152.93 ,$116.36 ,$84.31 ,$101.18 ,$101.23 ,$101.18 ,$114.86 ,$149.61 ,$113.57 , N/A ,$131.32 , N/A , N/A , N/A , N/A , N/A ,$119.69 ,$103.06 ,$119.69 ,$119.69 ,$132.98 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SPACER HUMERAL STEM ZIMMER 12MM,278,1 ,$37.97 ,$25.06 ,$19.26 ,$37.97 , N/A , N/A , N/A , N/A ,$22.78 ,$32.27 ,$26.58 , N/A , N/A ,$36.07 ,$28.86 ,$28.48 , N/A ,$32.27 , N/A , N/A , N/A ,$26.58 ,$23.12 , N/A , N/A , N/A , N/A , N/A ,$32.27 , N/A ,$34.93 ,$26.58 ,$19.26 ,$23.11 ,$23.12 ,$23.11 ,$26.24 ,$34.17 ,$25.94 , N/A ,$30.00 , N/A , N/A , N/A , N/A , N/A ,$27.34 ,$23.54 ,$27.34 ,$27.34 ,$30.38 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SPACER SPINAL 14X13X9MM ACIS STANDARD LORDOTIC PEEK RADIOPAQUE AXIAL LUMEN LATERAL WINDOW PYRAMIDAL TEETH STERILE,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SPACER SPINAL 14X13X8MM ACIS STANDARD LORDOTIC PEEK RADIOPAQUE AXIAL LUMEN LATERAL WINDOW PYRAMIDAL TEETH STERILE,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SPACER SPINAL 14X13X8MM ACIS STANDARD PARALLEL PEEK RADIOPAQUE AXIAL LUMEN LATERAL WINDOW PYRAMIDAL TEETH STERILE,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SPACER ZIMMER SHLDR HUM TM REV +9 12D,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,CONNECTOR BIOMET LARGE,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,CONNECTOR BIOMET LATERAL OPEN 25,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,CONNECTOR BIOMET MEDIUM,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,CONNECTOR BIOMET SMALL,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,CONNECTOR BIOMET XSMALL,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,CONNECTOR BIOMET XXSMALL,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,STEM FEMORAL 220MM 15MM CEMENT REVISION VERSYS ZIMALOY 44MM OFFSET HIP CALCAR STERILE,278,1 ,"$7,998.48 ","$5,279.00 ","$3,919.26 ","$7,998.48 ", N/A ,"$4,216.00 ","$4,216.00 ", N/A ,"$4,799.09 ","$6,798.71 ","$5,598.94 ", N/A , N/A ,"$7,598.56 ","$6,078.84 ","$5,998.86 ","$3,999.24 ","$6,798.71 ", N/A ,"$3,999.24 ","$3,999.24 ","$5,598.94 ","$4,871.07 ", N/A , N/A , N/A , N/A , N/A ,"$6,798.71 ", N/A ,"$7,358.60 ","$5,598.94 ","$4,056.83 ","$4,868.67 ","$4,871.07 ","$4,868.67 ","$5,526.95 ","$7,198.63 ","$5,464.56 ", N/A ,"$6,318.80 ", N/A ,"$3,919.26 ","$3,919.26 ", N/A ,"$3,919.26 ","$5,758.91 ","$4,959.06 ","$5,758.91 ","$5,758.91 ","$6,398.78 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,STIMULATOR EBI FUSION SPINAL SPF-XL IIB 2/DM,278,1 ,"$9,000.00 ","$5,940.00 ","$4,410.00 ","$9,000.00 ", N/A ,"$4,743.90 ","$4,743.90 ", N/A ,"$5,400.00 ","$7,650.00 ","$6,300.00 ", N/A , N/A ,"$8,550.00 ","$6,840.00 ","$6,750.00 ","$4,500.00 ","$7,650.00 ", N/A ,"$4,500.00 ","$4,500.00 ","$6,300.00 ","$5,481.00 ", N/A , N/A , N/A , N/A , N/A ,"$7,650.00 ", N/A ,"$8,280.00 ","$6,300.00 ","$4,564.80 ","$5,478.30 ","$5,481.00 ","$5,478.30 ","$6,219.00 ","$8,100.00 ","$6,148.80 ", N/A ,"$7,110.00 ", N/A ,"$4,410.00 ","$4,410.00 ", N/A ,"$4,410.00 ","$6,480.00 ","$5,580.00 ","$6,480.00 ","$6,480.00 ","$7,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SYSTEM LINX REFLUX MANAGEMENT SZ 16,278,1 ,"$9,900.00 ","$6,534.00 ","$4,851.00 ","$9,900.00 ", N/A ,"$5,218.29 ","$5,218.29 ", N/A ,"$5,940.00 ","$8,415.00 ","$6,930.00 ", N/A , N/A ,"$9,405.00 ","$7,524.00 ","$7,425.00 ","$4,950.00 ","$8,415.00 ", N/A ,"$4,950.00 ","$4,950.00 ","$6,930.00 ","$6,029.10 ", N/A , N/A , N/A , N/A , N/A ,"$8,415.00 ", N/A ,"$9,108.00 ","$6,930.00 ","$5,021.28 ","$6,026.13 ","$6,029.10 ","$6,026.13 ","$6,840.90 ","$8,910.00 ","$6,763.68 ", N/A ,"$7,821.00 ", N/A ,"$4,851.00 ","$4,851.00 ", N/A ,"$4,851.00 ","$7,128.00 ","$6,138.00 ","$7,128.00 ","$7,128.00 ","$7,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SYSTEM LINX REFLUX MANAGEMENT SZ 13,278,1 ,"$9,900.00 ","$6,534.00 ","$4,851.00 ","$9,900.00 ", N/A ,"$5,218.29 ","$5,218.29 ", N/A ,"$5,940.00 ","$8,415.00 ","$6,930.00 ", N/A , N/A ,"$9,405.00 ","$7,524.00 ","$7,425.00 ","$4,950.00 ","$8,415.00 ", N/A ,"$4,950.00 ","$4,950.00 ","$6,930.00 ","$6,029.10 ", N/A , N/A , N/A , N/A , N/A ,"$8,415.00 ", N/A ,"$9,108.00 ","$6,930.00 ","$5,021.28 ","$6,026.13 ","$6,029.10 ","$6,026.13 ","$6,840.90 ","$8,910.00 ","$6,763.68 ", N/A ,"$7,821.00 ", N/A ,"$4,851.00 ","$4,851.00 ", N/A ,"$4,851.00 ","$7,128.00 ","$6,138.00 ","$7,128.00 ","$7,128.00 ","$7,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SYSTEM LINX REFLUX MANAGEMENT SZ 14,278,1 ,"$9,900.00 ","$6,534.00 ","$4,851.00 ","$9,900.00 ", N/A ,"$5,218.29 ","$5,218.29 ", N/A ,"$5,940.00 ","$8,415.00 ","$6,930.00 ", N/A , N/A ,"$9,405.00 ","$7,524.00 ","$7,425.00 ","$4,950.00 ","$8,415.00 ", N/A ,"$4,950.00 ","$4,950.00 ","$6,930.00 ","$6,029.10 ", N/A , N/A , N/A , N/A , N/A ,"$8,415.00 ", N/A ,"$9,108.00 ","$6,930.00 ","$5,021.28 ","$6,026.13 ","$6,029.10 ","$6,026.13 ","$6,840.90 ","$8,910.00 ","$6,763.68 ", N/A ,"$7,821.00 ", N/A ,"$4,851.00 ","$4,851.00 ", N/A ,"$4,851.00 ","$7,128.00 ","$6,138.00 ","$7,128.00 ","$7,128.00 ","$7,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SYSTEM LINX REFLUX MANAGEMENT SZ 15,278,1 ,"$9,900.00 ","$6,534.00 ","$4,851.00 ","$9,900.00 ", N/A ,"$5,218.29 ","$5,218.29 ", N/A ,"$5,940.00 ","$8,415.00 ","$6,930.00 ", N/A , N/A ,"$9,405.00 ","$7,524.00 ","$7,425.00 ","$4,950.00 ","$8,415.00 ", N/A ,"$4,950.00 ","$4,950.00 ","$6,930.00 ","$6,029.10 ", N/A , N/A , N/A , N/A , N/A ,"$8,415.00 ", N/A ,"$9,108.00 ","$6,930.00 ","$5,021.28 ","$6,026.13 ","$6,029.10 ","$6,026.13 ","$6,840.90 ","$8,910.00 ","$6,763.68 ", N/A ,"$7,821.00 ", N/A ,"$4,851.00 ","$4,851.00 ", N/A ,"$4,851.00 ","$7,128.00 ","$6,138.00 ","$7,128.00 ","$7,128.00 ","$7,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,SYSTEM SLING SOLYX BLUE SINGLE INCISION,278,1 ,"$2,172.71 ","$1,433.99 ","$1,102.00 ","$2,172.71 ", N/A ,"$1,145.24 ","$1,145.24 ", N/A ,"$1,303.63 ","$1,846.80 ","$1,520.90 ", N/A , N/A ,"$2,064.07 ","$1,651.26 ","$1,629.53 ", N/A ,"$1,846.80 ", N/A , N/A , N/A ,"$1,520.90 ","$1,323.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.80 ", N/A ,"$1,998.89 ","$1,520.90 ","$1,102.00 ","$1,322.53 ","$1,323.18 ","$1,322.53 ","$1,501.34 ","$1,955.44 ","$1,484.40 ", N/A ,"$1,716.44 ", N/A , N/A , N/A , N/A , N/A ,"$1,564.35 ","$1,347.08 ","$1,564.35 ","$1,564.35 ","$1,738.17 "
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,TAPER PLUG ZIMMER NEXGEN,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 100,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 30,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 35,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 40,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 50,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 55,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 60,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 65,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 70,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 75,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 80,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLOY CURVED 90,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD BIOMET TI ALLY WITH HEX 510,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD DEPUY EXPEDIUM TITANIUM 5.5MM X 65MM,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD PRE-CURVED BIOMET 45MM,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SPINAL 45MM 6.35MM MONARCH PREBENT PEDICLE TITANIUM,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SPINAL 65MM 6.35MM MONARCH PREBENT PEDICLE TITANIUM,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SPINAL 75MM 6.35MM MONARCH PREBENT TITANIUM,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,ROD SPINAL 85MM 6.35MM MONARCH PREBENT TITANIUM,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,TISSUE FLOSEAL 10ML,278,1 ,$662.20 ,$437.05 ,$335.87 ,$662.20 , N/A , N/A , N/A , N/A ,$397.32 ,$562.87 ,$463.54 , N/A , N/A ,$629.09 ,$503.27 ,$496.65 , N/A ,$562.87 , N/A , N/A , N/A ,$463.54 ,$403.28 , N/A , N/A , N/A , N/A , N/A ,$562.87 , N/A ,$609.22 ,$463.54 ,$335.87 ,$403.08 ,$403.28 ,$403.08 ,$457.58 ,$595.98 ,$452.42 , N/A ,$523.14 , N/A , N/A , N/A , N/A , N/A ,$476.78 ,$410.56 ,$476.78 ,$476.78 ,$529.76 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,TISSUE FLOSEAL 5ML,278,1 ,$441.46 ,$291.36 ,$223.91 ,$441.46 , N/A , N/A , N/A , N/A ,$264.88 ,$375.24 ,$309.02 , N/A , N/A ,$419.39 ,$335.51 ,$331.10 , N/A ,$375.24 , N/A , N/A , N/A ,$309.02 ,$268.85 , N/A , N/A , N/A , N/A , N/A ,$375.24 , N/A ,$406.14 ,$309.02 ,$223.91 ,$268.72 ,$268.85 ,$268.72 ,$305.05 ,$397.31 ,$301.61 , N/A ,$348.75 , N/A , N/A , N/A , N/A , N/A ,$317.85 ,$273.71 ,$317.85 ,$317.85 ,$353.17 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,TUBE EAR PAPARELLA BLUE 2.2MM 2.6MM 1.14MM,278,1 ,$38.63 ,$25.50 ,$19.59 ,$38.63 , N/A , N/A , N/A , N/A ,$23.18 ,$32.84 ,$27.04 , N/A , N/A ,$36.70 ,$29.36 ,$28.97 , N/A ,$32.84 , N/A , N/A , N/A ,$27.04 ,$23.53 , N/A , N/A , N/A , N/A , N/A ,$32.84 , N/A ,$35.54 ,$27.04 ,$19.59 ,$23.51 ,$23.53 ,$23.51 ,$26.69 ,$34.77 ,$26.39 , N/A ,$30.52 , N/A , N/A , N/A , N/A , N/A ,$27.81 ,$23.95 ,$27.81 ,$27.81 ,$30.90 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,TUBE TRACHEOSTOMY LOW PRESSURE,278,1 ,$123.95 ,$81.81 ,$62.87 ,$123.95 , N/A , N/A , N/A , N/A ,$74.37 ,$105.36 ,$86.77 , N/A , N/A ,$117.75 ,$94.20 ,$92.96 , N/A ,$105.36 , N/A , N/A , N/A ,$86.77 ,$75.49 , N/A , N/A , N/A , N/A , N/A ,$105.36 , N/A ,$114.03 ,$86.77 ,$62.87 ,$75.45 ,$75.49 ,$75.45 ,$85.65 ,$111.56 ,$84.68 , N/A ,$97.92 , N/A , N/A , N/A , N/A , N/A ,$89.24 ,$76.85 ,$89.24 ,$89.24 ,$99.16 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,TUBE TRACHEOSTOMY 6 76MM 10.8MM 6.4MM SHILEY CUFF REUSABLE INNER CANNULA CONNECTOR STERILE LATEX FREE GREEN WHITE,278,1 ,$123.95 ,$81.81 ,$62.87 ,$123.95 , N/A , N/A , N/A , N/A ,$74.37 ,$105.36 ,$86.77 , N/A , N/A ,$117.75 ,$94.20 ,$92.96 , N/A ,$105.36 , N/A , N/A , N/A ,$86.77 ,$75.49 , N/A , N/A , N/A , N/A , N/A ,$105.36 , N/A ,$114.03 ,$86.77 ,$62.87 ,$75.45 ,$75.49 ,$75.45 ,$85.65 ,$111.56 ,$84.68 , N/A ,$97.92 , N/A , N/A , N/A , N/A , N/A ,$89.24 ,$76.85 ,$89.24 ,$89.24 ,$99.16 
ST NICHOLAS HOSPITAL - ACUTE,27870000,N/A,TUBE VENTILATION BLUE 4.8MM 1.32MM T EAR SILICONE SHORT FLANGE MODIFY MYRINGOTOMY STERILE,278,1 ,$90.75 ,$59.90 ,$46.03 ,$90.75 , N/A , N/A , N/A , N/A ,$54.45 ,$77.14 ,$63.53 , N/A , N/A ,$86.21 ,$68.97 ,$68.06 , N/A ,$77.14 , N/A , N/A , N/A ,$63.53 ,$55.27 , N/A , N/A , N/A , N/A , N/A ,$77.14 , N/A ,$83.49 ,$63.53 ,$46.03 ,$55.24 ,$55.27 ,$55.24 ,$62.71 ,$81.68 ,$62.00 , N/A ,$71.69 , N/A , N/A , N/A , N/A , N/A ,$65.34 ,$56.27 ,$65.34 ,$65.34 ,$72.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR MITEK QUICK MICRO W/SUTURE,278,1 ,"$1,090.60 ",$719.80 ,$553.15 ,"$1,090.60 ", N/A ,$574.86 ,$574.86 , N/A ,$654.36 ,$927.01 ,$763.42 , N/A , N/A ,"$1,036.07 ",$828.86 ,$817.95 , N/A ,$927.01 , N/A , N/A , N/A ,$763.42 ,$664.18 , N/A , N/A , N/A , N/A , N/A ,$927.01 , N/A ,"$1,003.35 ",$763.42 ,$553.15 ,$663.85 ,$664.18 ,$663.85 ,$753.60 ,$981.54 ,$745.10 , N/A ,$861.57 , N/A , N/A , N/A , N/A , N/A ,$785.23 ,$676.17 ,$785.23 ,$785.23 ,$872.48 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR MITEK MICRO QUICK PLUS 4/0 ETHIBOND,278,1 ,"$1,090.60 ",$719.80 ,$553.15 ,"$1,090.60 ", N/A ,$574.86 ,$574.86 , N/A ,$654.36 ,$927.01 ,$763.42 , N/A , N/A ,"$1,036.07 ",$828.86 ,$817.95 , N/A ,$927.01 , N/A , N/A , N/A ,$763.42 ,$664.18 , N/A , N/A , N/A , N/A , N/A ,$927.01 , N/A ,"$1,003.35 ",$763.42 ,$553.15 ,$663.85 ,$664.18 ,$663.85 ,$753.60 ,$981.54 ,$745.10 , N/A ,$861.57 , N/A , N/A , N/A , N/A , N/A ,$785.23 ,$676.17 ,$785.23 ,$785.23 ,$872.48 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SOFT JUGGERKNOT 1.45 SHORT RIGID W/ DRILL BIT BIOMET,278,1 ,$773.96 ,$510.81 ,$392.55 ,$773.96 , N/A , N/A , N/A , N/A ,$464.38 ,$657.87 ,$541.77 , N/A , N/A ,$735.26 ,$588.21 ,$580.47 , N/A ,$657.87 , N/A , N/A , N/A ,$541.77 ,$471.34 , N/A , N/A , N/A , N/A , N/A ,$657.87 , N/A ,$712.04 ,$541.77 ,$392.55 ,$471.11 ,$471.34 ,$471.11 ,$534.81 ,$696.56 ,$528.77 , N/A ,$611.43 , N/A , N/A , N/A , N/A , N/A ,$557.25 ,$479.86 ,$557.25 ,$557.25 ,$619.17 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 2 SUPER REVO THREVO-FT HI-FI STERILE LATEX FREE DISPOSABLE,278,1 ,$449.22 ,$296.49 ,$227.84 ,$449.22 , N/A , N/A , N/A , N/A ,$269.53 ,$381.84 ,$314.45 , N/A , N/A ,$426.76 ,$341.41 ,$336.92 , N/A ,$381.84 , N/A , N/A , N/A ,$314.45 ,$273.58 , N/A , N/A , N/A , N/A , N/A ,$381.84 , N/A ,$413.28 ,$314.45 ,$227.84 ,$273.44 ,$273.58 ,$273.44 ,$310.41 ,$404.30 ,$306.91 , N/A ,$354.88 , N/A , N/A , N/A , N/A , N/A ,$323.44 ,$278.52 ,$323.44 ,$323.44 ,$359.38 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 3MM 2 SUTURETAK FIBERWIRE ARTHREX KNOTLESS CRUCIATE LIGAMENT BIOCOMPOSITE 12.7MM STERILE,278,1 ,$913.75 ,$603.08 ,$463.45 ,$913.75 , N/A , N/A , N/A , N/A ,$548.25 ,$776.69 ,$639.63 , N/A , N/A ,$868.06 ,$694.45 ,$685.31 , N/A ,$776.69 , N/A , N/A , N/A ,$639.63 ,$556.47 , N/A , N/A , N/A , N/A , N/A ,$776.69 , N/A ,$840.65 ,$639.63 ,$463.45 ,$556.20 ,$556.47 ,$556.20 ,$631.40 ,$822.38 ,$624.27 , N/A ,$721.86 , N/A , N/A , N/A , N/A , N/A ,$657.90 ,$566.53 ,$657.90 ,$657.90 ,$731.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 5.5MM 2 FULL THREAD HEALICOIL ULTRABRAID SHOULDER PRELOAD COBRAID REGENESORB BLUE,278,1 ,$731.00 ,$482.46 ,$370.76 ,$731.00 , N/A , N/A , N/A , N/A ,$438.60 ,$621.35 ,$511.70 , N/A , N/A ,$694.45 ,$555.56 ,$548.25 , N/A ,$621.35 , N/A , N/A , N/A ,$511.70 ,$445.18 , N/A , N/A , N/A , N/A , N/A ,$621.35 , N/A ,$672.52 ,$511.70 ,$370.76 ,$444.96 ,$445.18 ,$444.96 ,$505.12 ,$657.90 ,$499.42 , N/A ,$577.49 , N/A , N/A , N/A , N/A , N/A ,$526.32 ,$453.22 ,$526.32 ,$526.32 ,$584.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 5MM THREVO PRELOADED DRIVER PRETHREADED SELF DRILLING TITANIUM DISPOSABLE BLACK BLUE WHITE,278,1 ,$445.77 ,$294.21 ,$226.09 ,$445.77 , N/A , N/A , N/A , N/A ,$267.46 ,$378.90 ,$312.04 , N/A , N/A ,$423.48 ,$338.79 ,$334.33 , N/A ,$378.90 , N/A , N/A , N/A ,$312.04 ,$271.47 , N/A , N/A , N/A , N/A , N/A ,$378.90 , N/A ,$410.11 ,$312.04 ,$226.09 ,$271.34 ,$271.47 ,$271.34 ,$308.03 ,$401.19 ,$304.55 , N/A ,$352.16 , N/A , N/A , N/A , N/A , N/A ,$320.95 ,$276.38 ,$320.95 ,$320.95 ,$356.62 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE FIXATION CORKSCREW FT FIBERWIRE 3-0 NANO 2 NEEDLE 1.35MM K WIRE,278,1 ,"$3,825.00 ","$2,524.50 ","$1,912.50 ","$3,825.00 ", N/A ,"$2,016.16 ","$2,016.16 ", N/A ,"$2,295.00 ","$3,251.25 ","$2,677.50 ", N/A , N/A ,"$3,633.75 ","$2,907.00 ","$2,868.75 ","$1,912.50 ","$3,251.25 ", N/A ,"$1,912.50 ","$1,912.50 ","$2,677.50 ","$2,329.43 ", N/A , N/A , N/A , N/A , N/A ,"$3,251.25 ", N/A ,"$3,519.00 ","$2,677.50 ","$1,940.04 ","$2,328.28 ","$2,329.43 ","$2,328.28 ","$2,643.08 ","$3,442.50 ","$2,613.24 ", N/A ,"$3,021.75 ", N/A , N/A , N/A , N/A , N/A ,"$2,754.00 ","$2,371.50 ","$2,754.00 ","$2,754.00 ","$3,060.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE QUICKANCHOR SHOULDER ARTHROSCOPIC SOFT TISSUE,278,1 ,"$1,262.80 ",$833.45 ,$640.49 ,"$1,262.80 ", N/A ,$665.62 ,$665.62 , N/A ,$757.68 ,"$1,073.38 ",$883.96 , N/A , N/A ,"$1,199.66 ",$959.73 ,$947.10 , N/A ,"$1,073.38 ", N/A , N/A , N/A ,$883.96 ,$769.05 , N/A , N/A , N/A , N/A , N/A ,"$1,073.38 ", N/A ,"$1,161.78 ",$883.96 ,$640.49 ,$768.67 ,$769.05 ,$768.67 ,$872.59 ,"$1,136.52 ",$862.75 , N/A ,$997.61 , N/A , N/A , N/A , N/A , N/A ,$909.22 ,$782.94 ,$909.22 ,$909.22 ,"$1,010.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE S AND N 2-0 FIXATION 360D 5MM,278,1 ,"$1,010.67 ",$667.04 ,$512.61 ,"$1,010.67 ", N/A ,$532.72 ,$532.72 , N/A ,$606.40 ,$859.07 ,$707.47 , N/A , N/A ,$960.14 ,$768.11 ,$758.00 , N/A ,$859.07 , N/A , N/A , N/A ,$707.47 ,$615.50 , N/A , N/A , N/A , N/A , N/A ,$859.07 , N/A ,$929.82 ,$707.47 ,$512.61 ,$615.19 ,$615.50 ,$615.19 ,$698.37 ,$909.60 ,$690.49 , N/A ,$798.43 , N/A , N/A , N/A , N/A , N/A ,$727.68 ,$626.62 ,$727.68 ,$727.68 ,$808.54 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ASSEMBLY HUMERAL INTERCHANGEABLE ZIMMER EXTRA SMALL,278,1 ,$366.98 ,$242.21 ,$186.13 ,$366.98 , N/A , N/A , N/A , N/A ,$220.19 ,$311.93 ,$256.89 , N/A , N/A ,$348.63 ,$278.90 ,$275.24 , N/A ,$311.93 , N/A , N/A , N/A ,$256.89 ,$223.49 , N/A , N/A , N/A , N/A , N/A ,$311.93 , N/A ,$337.62 ,$256.89 ,$186.13 ,$223.38 ,$223.49 ,$223.38 ,$253.58 ,$330.28 ,$250.72 , N/A ,$289.91 , N/A , N/A , N/A , N/A , N/A ,$264.23 ,$227.53 ,$264.23 ,$264.23 ,$293.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BASEPLATE ZIMMER GLENOID SHLDR TM REV 15MM,278,1 ,"$2,375.00 ","$1,567.50 ","$1,204.60 ","$2,375.00 ", N/A ,"$1,251.86 ","$1,251.86 ", N/A ,"$1,425.00 ","$2,018.75 ","$1,662.50 ", N/A , N/A ,"$2,256.25 ","$1,805.00 ","$1,781.25 ", N/A ,"$2,018.75 ", N/A , N/A , N/A ,"$1,662.50 ","$1,446.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,018.75 ", N/A ,"$2,185.00 ","$1,662.50 ","$1,204.60 ","$1,445.66 ","$1,446.38 ","$1,445.66 ","$1,641.13 ","$2,137.50 ","$1,622.60 ", N/A ,"$1,876.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,710.00 ","$1,472.50 ","$1,710.00 ","$1,710.00 ","$1,900.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE INTRAMEDULLARY NAIL GOLD 95MM 10.35MM TFN-ADVANCED HELICAL FEMORAL PROXIMAL TITANIUM NIOBIUM ALUMINUM CANNULATED STERILE,278,1 ,"$1,447.71 ",$955.49 ,$734.28 ,"$1,447.71 ", N/A ,$763.09 ,$763.09 , N/A ,$868.63 ,"$1,230.55 ","$1,013.40 ", N/A , N/A ,"$1,375.32 ","$1,100.26 ","$1,085.78 ", N/A ,"$1,230.55 ", N/A , N/A , N/A ,"$1,013.40 ",$881.66 , N/A , N/A , N/A , N/A , N/A ,"$1,230.55 ", N/A ,"$1,331.89 ","$1,013.40 ",$734.28 ,$881.22 ,$881.66 ,$881.22 ,"$1,000.37 ","$1,302.94 ",$989.08 , N/A ,"$1,143.69 ", N/A , N/A , N/A , N/A , N/A ,"$1,042.35 ",$897.58 ,"$1,042.35 ","$1,042.35 ","$1,158.17 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE INTRAMEDULLARY NAIL GOLD 105MM 10.35MM TFN-ADVANCED HELICAL FEMUR PROXIMAL TITANIUM NIOBIUM ALUMINUM CANNULATED STERILE,278,1 ,"$1,447.71 ",$955.49 ,$734.28 ,"$1,447.71 ", N/A ,$763.09 ,$763.09 , N/A ,$868.63 ,"$1,230.55 ","$1,013.40 ", N/A , N/A ,"$1,375.32 ","$1,100.26 ","$1,085.78 ", N/A ,"$1,230.55 ", N/A , N/A , N/A ,"$1,013.40 ",$881.66 , N/A , N/A , N/A , N/A , N/A ,"$1,230.55 ", N/A ,"$1,331.89 ","$1,013.40 ",$734.28 ,$881.22 ,$881.66 ,$881.22 ,"$1,000.37 ","$1,302.94 ",$989.08 , N/A ,"$1,143.69 ", N/A , N/A , N/A , N/A , N/A ,"$1,042.35 ",$897.58 ,"$1,042.35 ","$1,042.35 ","$1,158.17 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE INTRAMEDULLARY NAIL GOLD 110MM 10.35MM TFN-ADVANCED HELICAL FEMORAL PROXIMAL TITANIUM NIOBIUM ALUMINUM CANNULATED STERILE,278,1 ,"$1,447.71 ",$955.49 ,$734.28 ,"$1,447.71 ", N/A ,$763.09 ,$763.09 , N/A ,$868.63 ,"$1,230.55 ","$1,013.40 ", N/A , N/A ,"$1,375.32 ","$1,100.26 ","$1,085.78 ", N/A ,"$1,230.55 ", N/A , N/A , N/A ,"$1,013.40 ",$881.66 , N/A , N/A , N/A , N/A , N/A ,"$1,230.55 ", N/A ,"$1,331.89 ","$1,013.40 ",$734.28 ,$881.22 ,$881.66 ,$881.22 ,"$1,000.37 ","$1,302.94 ",$989.08 , N/A ,"$1,143.69 ", N/A , N/A , N/A , N/A , N/A ,"$1,042.35 ",$897.58 ,"$1,042.35 ","$1,042.35 ","$1,158.17 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES 11.0MM TI HELICAL 120MM,278,1 ,"$1,143.70 ",$754.84 ,$580.08 ,"$1,143.70 ", N/A ,$602.84 ,$602.84 , N/A ,$686.22 ,$972.15 ,$800.59 , N/A , N/A ,"$1,086.52 ",$869.21 ,$857.78 , N/A ,$972.15 , N/A , N/A , N/A ,$800.59 ,$696.51 , N/A , N/A , N/A , N/A , N/A ,$972.15 , N/A ,"$1,052.20 ",$800.59 ,$580.08 ,$696.17 ,$696.51 ,$696.17 ,$790.30 ,"$1,029.33 ",$781.38 , N/A ,$903.52 , N/A , N/A , N/A , N/A , N/A ,$823.46 ,$709.09 ,$823.46 ,$823.46 ,$914.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES 11.0MM TI HELICAL  80MM,278,1 ,"$1,143.70 ",$754.84 ,$580.08 ,"$1,143.70 ", N/A ,$602.84 ,$602.84 , N/A ,$686.22 ,$972.15 ,$800.59 , N/A , N/A ,"$1,086.52 ",$869.21 ,$857.78 , N/A ,$972.15 , N/A , N/A , N/A ,$800.59 ,$696.51 , N/A , N/A , N/A , N/A , N/A ,$972.15 , N/A ,"$1,052.20 ",$800.59 ,$580.08 ,$696.17 ,$696.51 ,$696.17 ,$790.30 ,"$1,029.33 ",$781.38 , N/A ,$903.52 , N/A , N/A , N/A , N/A , N/A ,$823.46 ,$709.09 ,$823.46 ,$823.46 ,$914.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES 11.0MM TI HELICAL  85MM,278,1 ,"$1,143.70 ",$754.84 ,$580.08 ,"$1,143.70 ", N/A ,$602.84 ,$602.84 , N/A ,$686.22 ,$972.15 ,$800.59 , N/A , N/A ,"$1,086.52 ",$869.21 ,$857.78 , N/A ,$972.15 , N/A , N/A , N/A ,$800.59 ,$696.51 , N/A , N/A , N/A , N/A , N/A ,$972.15 , N/A ,"$1,052.20 ",$800.59 ,$580.08 ,$696.17 ,$696.51 ,$696.17 ,$790.30 ,"$1,029.33 ",$781.38 , N/A ,$903.52 , N/A , N/A , N/A , N/A , N/A ,$823.46 ,$709.09 ,$823.46 ,$823.46 ,$914.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES 11.0MM TI HELICAL  90MM,278,1 ,"$1,143.70 ",$754.84 ,$580.08 ,"$1,143.70 ", N/A ,$602.84 ,$602.84 , N/A ,$686.22 ,$972.15 ,$800.59 , N/A , N/A ,"$1,086.52 ",$869.21 ,$857.78 , N/A ,$972.15 , N/A , N/A , N/A ,$800.59 ,$696.51 , N/A , N/A , N/A , N/A , N/A ,$972.15 , N/A ,"$1,052.20 ",$800.59 ,$580.08 ,$696.17 ,$696.51 ,$696.17 ,$790.30 ,"$1,029.33 ",$781.38 , N/A ,$903.52 , N/A , N/A , N/A , N/A , N/A ,$823.46 ,$709.09 ,$823.46 ,$823.46 ,$914.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES 11.0MM TI HELICAL  95MM,278,1 ,"$1,143.70 ",$754.84 ,$580.08 ,"$1,143.70 ", N/A ,$602.84 ,$602.84 , N/A ,$686.22 ,$972.15 ,$800.59 , N/A , N/A ,"$1,086.52 ",$869.21 ,$857.78 , N/A ,$972.15 , N/A , N/A , N/A ,$800.59 ,$696.51 , N/A , N/A , N/A , N/A , N/A ,$972.15 , N/A ,"$1,052.20 ",$800.59 ,$580.08 ,$696.17 ,$696.51 ,$696.17 ,$790.30 ,"$1,029.33 ",$781.38 , N/A ,$903.52 , N/A , N/A , N/A , N/A , N/A ,$823.46 ,$709.09 ,$823.46 ,$823.46 ,$914.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES 11.0MM TI HELICAL 100MM,278,1 ,"$1,143.70 ",$754.84 ,$580.08 ,"$1,143.70 ", N/A ,$602.84 ,$602.84 , N/A ,$686.22 ,$972.15 ,$800.59 , N/A , N/A ,"$1,086.52 ",$869.21 ,$857.78 , N/A ,$972.15 , N/A , N/A , N/A ,$800.59 ,$696.51 , N/A , N/A , N/A , N/A , N/A ,$972.15 , N/A ,"$1,052.20 ",$800.59 ,$580.08 ,$696.17 ,$696.51 ,$696.17 ,$790.30 ,"$1,029.33 ",$781.38 , N/A ,$903.52 , N/A , N/A , N/A , N/A , N/A ,$823.46 ,$709.09 ,$823.46 ,$823.46 ,$914.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES 11.0MM TI HELICAL 105MM,278,1 ,"$1,143.70 ",$754.84 ,$580.08 ,"$1,143.70 ", N/A ,$602.84 ,$602.84 , N/A ,$686.22 ,$972.15 ,$800.59 , N/A , N/A ,"$1,086.52 ",$869.21 ,$857.78 , N/A ,$972.15 , N/A , N/A , N/A ,$800.59 ,$696.51 , N/A , N/A , N/A , N/A , N/A ,$972.15 , N/A ,"$1,052.20 ",$800.59 ,$580.08 ,$696.17 ,$696.51 ,$696.17 ,$790.30 ,"$1,029.33 ",$781.38 , N/A ,$903.52 , N/A , N/A , N/A , N/A , N/A ,$823.46 ,$709.09 ,$823.46 ,$823.46 ,$914.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES 11.0MM TI HELICAL 110MM,278,1 ,"$1,143.70 ",$754.84 ,$580.08 ,"$1,143.70 ", N/A ,$602.84 ,$602.84 , N/A ,$686.22 ,$972.15 ,$800.59 , N/A , N/A ,"$1,086.52 ",$869.21 ,$857.78 , N/A ,$972.15 , N/A , N/A , N/A ,$800.59 ,$696.51 , N/A , N/A , N/A , N/A , N/A ,$972.15 , N/A ,"$1,052.20 ",$800.59 ,$580.08 ,$696.17 ,$696.51 ,$696.17 ,$790.30 ,"$1,029.33 ",$781.38 , N/A ,$903.52 , N/A , N/A , N/A , N/A , N/A ,$823.46 ,$709.09 ,$823.46 ,$823.46 ,$914.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES 11.0MM TI HELICAL 115MM,278,1 ,"$1,143.70 ",$754.84 ,$580.08 ,"$1,143.70 ", N/A ,$602.84 ,$602.84 , N/A ,$686.22 ,$972.15 ,$800.59 , N/A , N/A ,"$1,086.52 ",$869.21 ,$857.78 , N/A ,$972.15 , N/A , N/A , N/A ,$800.59 ,$696.51 , N/A , N/A , N/A , N/A , N/A ,$972.15 , N/A ,"$1,052.20 ",$800.59 ,$580.08 ,$696.17 ,$696.51 ,$696.17 ,$790.30 ,"$1,029.33 ",$781.38 , N/A ,$903.52 , N/A , N/A , N/A , N/A , N/A ,$823.46 ,$709.09 ,$823.46 ,$823.46 ,$914.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL HUMERAL NAIL 38MM,278,1 ,"$1,113.56 ",$734.95 ,$564.80 ,"$1,113.56 ", N/A ,$586.96 ,$586.96 , N/A ,$668.14 ,$946.53 ,$779.49 , N/A , N/A ,"$1,057.88 ",$846.31 ,$835.17 , N/A ,$946.53 , N/A , N/A , N/A ,$779.49 ,$678.16 , N/A , N/A , N/A , N/A , N/A ,$946.53 , N/A ,"$1,024.48 ",$779.49 ,$564.80 ,$677.82 ,$678.16 ,$677.82 ,$769.47 ,"$1,002.20 ",$760.78 , N/A ,$879.71 , N/A , N/A , N/A , N/A , N/A ,$801.76 ,$690.41 ,$801.76 ,$801.76 ,$890.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL HUMERAL NAIL 34MM,278,1 ,"$1,113.56 ",$734.95 ,$564.80 ,"$1,113.56 ", N/A ,$586.96 ,$586.96 , N/A ,$668.14 ,$946.53 ,$779.49 , N/A , N/A ,"$1,057.88 ",$846.31 ,$835.17 , N/A ,$946.53 , N/A , N/A , N/A ,$779.49 ,$678.16 , N/A , N/A , N/A , N/A , N/A ,$946.53 , N/A ,"$1,024.48 ",$779.49 ,$564.80 ,$677.82 ,$678.16 ,$677.82 ,$769.47 ,"$1,002.20 ",$760.78 , N/A ,$879.71 , N/A , N/A , N/A , N/A , N/A ,$801.76 ,$690.41 ,$801.76 ,$801.76 ,$890.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL HUMERAL NAIL 36MM,278,1 ,"$1,113.56 ",$734.95 ,$564.80 ,"$1,113.56 ", N/A ,$586.96 ,$586.96 , N/A ,$668.14 ,$946.53 ,$779.49 , N/A , N/A ,"$1,057.88 ",$846.31 ,$835.17 , N/A ,$946.53 , N/A , N/A , N/A ,$779.49 ,$678.16 , N/A , N/A , N/A , N/A , N/A ,$946.53 , N/A ,"$1,024.48 ",$779.49 ,$564.80 ,$677.82 ,$678.16 ,$677.82 ,$769.47 ,"$1,002.20 ",$760.78 , N/A ,$879.71 , N/A , N/A , N/A , N/A , N/A ,$801.76 ,$690.41 ,$801.76 ,$801.76 ,$890.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 95MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 100MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 45MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 50MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 55MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 60MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 65MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 70MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 75MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 80MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 85MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BLADE SYNTHES TI SPIRAL RETROGRADE 90MM,278,1 ,"$1,048.99 ",$692.33 ,$532.05 ,"$1,048.99 ", N/A ,$552.92 ,$552.92 , N/A ,$629.39 ,$891.64 ,$734.29 , N/A , N/A ,$996.54 ,$797.23 ,$786.74 , N/A ,$891.64 , N/A , N/A , N/A ,$734.29 ,$638.83 , N/A , N/A , N/A , N/A , N/A ,$891.64 , N/A ,$965.07 ,$734.29 ,$532.05 ,$638.52 ,$638.83 ,$638.52 ,$724.85 ,$944.09 ,$716.67 , N/A ,$828.70 , N/A , N/A , N/A , N/A , N/A ,$755.27 ,$650.37 ,$755.27 ,$755.27 ,$839.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BOLT SPINAL 45MM 8.5MM MONARCH PEDICLE TITANIUM NONSTERILE,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BOLT DEPUY PEDICLE 6.25X40,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BOLT DEPUY PEDICLE 6.25X45,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BOLT DEPUY PEDICLE 6.25X50,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BOLT DEPUY PEDICLE 7.0X55,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BOLT SPINAL 40MM 5.5MM MONARCH PEDICLE TITANIUM NONSTERILE,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BOLT SPINAL 40MM 7.75MM MONARCH PEDICLE TITANIUM NONSTERILE,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX QUICKFIX TITANIUM 2MMx13MM,278,1 ,$270.00 ,$178.20 ,$136.94 ,$270.00 , N/A , N/A , N/A , N/A ,$162.00 ,$229.50 ,$189.00 , N/A , N/A ,$256.50 ,$205.20 ,$202.50 , N/A ,$229.50 , N/A , N/A , N/A ,$189.00 ,$164.43 , N/A , N/A , N/A , N/A , N/A ,$229.50 , N/A ,$248.40 ,$189.00 ,$136.94 ,$164.35 ,$164.43 ,$164.35 ,$186.57 ,$243.00 ,$184.46 , N/A ,$213.30 , N/A , N/A , N/A , N/A , N/A ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BUTTON CABLE BLUE 2.5MM FEMUR TITANIUM ALUMINUM VANADIUM POLYAXIAL HEXAGON NCB LOCK PLATE STERILE,278,1 ,$354.38 ,$233.89 ,$179.74 ,$354.38 , N/A , N/A , N/A , N/A ,$212.63 ,$301.22 ,$248.07 , N/A , N/A ,$336.66 ,$269.33 ,$265.79 , N/A ,$301.22 , N/A , N/A , N/A ,$248.07 ,$215.82 , N/A , N/A , N/A , N/A , N/A ,$301.22 , N/A ,$326.03 ,$248.07 ,$179.74 ,$215.71 ,$215.82 ,$215.71 ,$244.88 ,$318.94 ,$242.11 , N/A ,$279.96 , N/A , N/A , N/A , N/A , N/A ,$255.15 ,$219.72 ,$255.15 ,$255.15 ,$283.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CABLE ORTHOPEDIC TITANIUM COCR 1.7MM 750MM CRIMP STERILE CERVICAL CERCLAGE,278,1 ,$970.73 ,$640.68 ,$492.35 ,$970.73 , N/A , N/A , N/A , N/A ,$582.44 ,$825.12 ,$679.51 , N/A , N/A ,$922.19 ,$737.75 ,$728.05 , N/A ,$825.12 , N/A , N/A , N/A ,$679.51 ,$591.17 , N/A , N/A , N/A , N/A , N/A ,$825.12 , N/A ,$893.07 ,$679.51 ,$492.35 ,$590.88 ,$591.17 ,$590.88 ,$670.77 ,$873.66 ,$663.20 , N/A ,$766.88 , N/A , N/A , N/A , N/A , N/A ,$698.93 ,$601.85 ,$698.93 ,$698.93 ,$776.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CABLE SYNTHES 1.0MM TI W/CRIMP 750MM,278,1 ,$984.27 ,$649.62 ,$499.22 ,$984.27 , N/A , N/A , N/A , N/A ,$590.56 ,$836.63 ,$688.99 , N/A , N/A ,$935.06 ,$748.05 ,$738.20 , N/A ,$836.63 , N/A , N/A , N/A ,$688.99 ,$599.42 , N/A , N/A , N/A , N/A , N/A ,$836.63 , N/A ,$905.53 ,$688.99 ,$499.22 ,$599.13 ,$599.42 ,$599.13 ,$680.13 ,$885.84 ,$672.45 , N/A ,$777.57 , N/A , N/A , N/A , N/A , N/A ,$708.67 ,$610.25 ,$708.67 ,$708.67 ,$787.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CABLE SYNTHES 1.7 X 750MM W/ CRIMP,278,1 ,$969.65 ,$639.97 ,$491.81 ,$969.65 , N/A , N/A , N/A , N/A ,$581.79 ,$824.20 ,$678.76 , N/A , N/A ,$921.17 ,$736.93 ,$727.24 , N/A ,$824.20 , N/A , N/A , N/A ,$678.76 ,$590.52 , N/A , N/A , N/A , N/A , N/A ,$824.20 , N/A ,$892.08 ,$678.76 ,$491.81 ,$590.23 ,$590.52 ,$590.23 ,$670.03 ,$872.69 ,$662.46 , N/A ,$766.02 , N/A , N/A , N/A , N/A , N/A ,$698.15 ,$601.18 ,$698.15 ,$698.15 ,$775.72 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CABLE SYNTHES 1.0 X 750MM W/ CRIMP,278,1 ,$969.65 ,$639.97 ,$491.81 ,$969.65 , N/A , N/A , N/A , N/A ,$581.79 ,$824.20 ,$678.76 , N/A , N/A ,$921.17 ,$736.93 ,$727.24 , N/A ,$824.20 , N/A , N/A , N/A ,$678.76 ,$590.52 , N/A , N/A , N/A , N/A , N/A ,$824.20 , N/A ,$892.08 ,$678.76 ,$491.81 ,$590.23 ,$590.52 ,$590.23 ,$670.03 ,$872.69 ,$662.46 , N/A ,$766.02 , N/A , N/A , N/A , N/A , N/A ,$698.15 ,$601.18 ,$698.15 ,$698.15 ,$775.72 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CABLE SYNTHES ZIPFIX  STERNAL PK/5,278,1 ,$905.09 ,$597.36 ,$459.06 ,$905.09 , N/A , N/A , N/A , N/A ,$543.05 ,$769.33 ,$633.56 , N/A , N/A ,$859.84 ,$687.87 ,$678.82 , N/A ,$769.33 , N/A , N/A , N/A ,$633.56 ,$551.20 , N/A , N/A , N/A , N/A , N/A ,$769.33 , N/A ,$832.68 ,$633.56 ,$459.06 ,$550.93 ,$551.20 ,$550.93 ,$625.42 ,$814.58 ,$618.36 , N/A ,$715.02 , N/A , N/A , N/A , N/A , N/A ,$651.66 ,$561.16 ,$651.66 ,$651.66 ,$724.07 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP END SYNTHES TI TIBIAL NAIL T40 STRDRV GRAY/10MM,278,1 ,$458.38 ,$302.53 ,$232.49 ,$458.38 , N/A , N/A , N/A , N/A ,$275.03 ,$389.62 ,$320.87 , N/A , N/A ,$435.46 ,$348.37 ,$343.79 , N/A ,$389.62 , N/A , N/A , N/A ,$320.87 ,$279.15 , N/A , N/A , N/A , N/A , N/A ,$389.62 , N/A ,$421.71 ,$320.87 ,$232.49 ,$279.02 ,$279.15 ,$279.02 ,$316.74 ,$412.54 ,$313.17 , N/A ,$362.12 , N/A , N/A , N/A , N/A , N/A ,$330.03 ,$284.20 ,$330.03 ,$330.03 ,$366.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP PROTECTIVE 8 MM CARBON FIBER ROD NONSTERILE,278,1 ,$4.50 ,$2.97 ,$2.28 ,$4.50 , N/A , N/A , N/A , N/A ,$2.70 ,$3.83 ,$3.15 , N/A , N/A ,$4.28 ,$3.42 ,$3.38 , N/A ,$3.83 , N/A , N/A , N/A ,$3.15 ,$2.74 , N/A , N/A , N/A , N/A , N/A ,$3.83 , N/A ,$4.14 ,$3.15 ,$2.28 ,$2.74 ,$2.74 ,$2.74 ,$3.11 ,$4.05 ,$3.07 , N/A ,$3.56 , N/A , N/A , N/A , N/A , N/A ,$3.24 ,$2.79 ,$3.24 ,$3.24 ,$3.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP SYNTHES PROTECTIVE 4.0MM FIXATION PIN,278,1 ,$12.71 ,$8.39 ,$6.45 ,$12.71 , N/A , N/A , N/A , N/A ,$7.63 ,$10.80 ,$8.90 , N/A , N/A ,$12.07 ,$9.66 ,$9.53 , N/A ,$10.80 , N/A , N/A , N/A ,$8.90 ,$7.74 , N/A , N/A , N/A , N/A , N/A ,$10.80 , N/A ,$11.69 ,$8.90 ,$6.45 ,$7.74 ,$7.74 ,$7.74 ,$8.78 ,$11.44 ,$8.68 , N/A ,$10.04 , N/A , N/A , N/A , N/A , N/A ,$9.15 ,$7.88 ,$9.15 ,$9.15 ,$10.17 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP SYNTHES PROTECTIVE 5.0MM FIXATION PIN,278,1 ,$11.93 ,$7.87 ,$6.05 ,$11.93 , N/A , N/A , N/A , N/A ,$7.16 ,$10.14 ,$8.35 , N/A , N/A ,$11.33 ,$9.07 ,$8.95 , N/A ,$10.14 , N/A , N/A , N/A ,$8.35 ,$7.27 , N/A , N/A , N/A , N/A , N/A ,$10.14 , N/A ,$10.98 ,$8.35 ,$6.05 ,$7.26 ,$7.27 ,$7.26 ,$8.24 ,$10.74 ,$8.15 , N/A ,$9.42 , N/A , N/A , N/A , N/A , N/A ,$8.59 ,$7.40 ,$8.59 ,$8.59 ,$9.54 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP SYNTHES PROTECTIVE 6.0MM FIXATION PIN,278,1 ,$8.44 ,$5.57 ,$4.28 ,$8.44 , N/A , N/A , N/A , N/A ,$5.06 ,$7.17 ,$5.91 , N/A , N/A ,$8.02 ,$6.41 ,$6.33 , N/A ,$7.17 , N/A , N/A , N/A ,$5.91 ,$5.14 , N/A , N/A , N/A , N/A , N/A ,$7.17 , N/A ,$7.76 ,$5.91 ,$4.28 ,$5.14 ,$5.14 ,$5.14 ,$5.83 ,$7.60 ,$5.77 , N/A ,$6.67 , N/A , N/A , N/A , N/A , N/A ,$6.08 ,$5.23 ,$6.08 ,$6.08 ,$6.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP ZIMMER NCB LOCKING 8MM,278,1 ,$296.10 ,$195.43 ,$150.18 ,$296.10 , N/A , N/A , N/A , N/A ,$177.66 ,$251.69 ,$207.27 , N/A , N/A ,$281.30 ,$225.04 ,$222.08 , N/A ,$251.69 , N/A , N/A , N/A ,$207.27 ,$180.32 , N/A , N/A , N/A , N/A , N/A ,$251.69 , N/A ,$272.41 ,$207.27 ,$150.18 ,$180.24 ,$180.32 ,$180.24 ,$204.61 ,$266.49 ,$202.30 , N/A ,$233.92 , N/A , N/A , N/A , N/A , N/A ,$213.19 ,$183.58 ,$213.19 ,$213.19 ,$236.88 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT BONE BIOMET 40GM,278,1 ,$130.50 ,$86.13 ,$66.19 ,$130.50 , N/A , N/A , N/A , N/A ,$78.30 ,$110.93 ,$91.35 , N/A , N/A ,$123.98 ,$99.18 ,$97.88 , N/A ,$110.93 , N/A , N/A , N/A ,$91.35 ,$79.47 , N/A , N/A , N/A , N/A , N/A ,$110.93 , N/A ,$120.06 ,$91.35 ,$66.19 ,$79.44 ,$79.47 ,$79.44 ,$90.18 ,$117.45 ,$89.16 , N/A ,$103.10 , N/A , N/A , N/A , N/A , N/A ,$93.96 ,$80.91 ,$93.96 ,$93.96 ,$104.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT BONE REFOBACIN,278,1 ,$371.25 ,$245.03 ,$188.30 ,$371.25 , N/A , N/A , N/A , N/A ,$222.75 ,$315.56 ,$259.88 , N/A , N/A ,$352.69 ,$282.15 ,$278.44 , N/A ,$315.56 , N/A , N/A , N/A ,$259.88 ,$226.09 , N/A , N/A , N/A , N/A , N/A ,$315.56 , N/A ,$341.55 ,$259.88 ,$188.30 ,$225.98 ,$226.09 ,$225.98 ,$256.53 ,$334.13 ,$253.64 , N/A ,$293.29 , N/A , N/A , N/A , N/A , N/A ,$267.30 ,$230.18 ,$267.30 ,$267.30 ,$297.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT SIMPLEX HV W/GENTAMICIN,278,1 ,$382.05 ,$252.15 ,$193.78 ,$382.05 , N/A , N/A , N/A , N/A ,$229.23 ,$324.74 ,$267.44 , N/A , N/A ,$362.95 ,$290.36 ,$286.54 , N/A ,$324.74 , N/A , N/A , N/A ,$267.44 ,$232.67 , N/A , N/A , N/A , N/A , N/A ,$324.74 , N/A ,$351.49 ,$267.44 ,$193.78 ,$232.55 ,$232.67 ,$232.55 ,$264.00 ,$343.85 ,$261.02 , N/A ,$301.82 , N/A , N/A , N/A , N/A , N/A ,$275.08 ,$236.87 ,$275.08 ,$275.08 ,$305.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT STRYKER SIMPLEX P,278,1 ,$185.40 ,$122.36 ,$94.03 ,$185.40 , N/A , N/A , N/A , N/A ,$111.24 ,$157.59 ,$129.78 , N/A , N/A ,$176.13 ,$140.90 ,$139.05 , N/A ,$157.59 , N/A , N/A , N/A ,$129.78 ,$112.91 , N/A , N/A , N/A , N/A , N/A ,$157.59 , N/A ,$170.57 ,$129.78 ,$94.03 ,$112.85 ,$112.91 ,$112.85 ,$128.11 ,$166.86 ,$126.67 , N/A ,$146.47 , N/A , N/A , N/A , N/A , N/A ,$133.49 ,$114.95 ,$133.49 ,$133.49 ,$148.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT STRYKER SPEED SET,278,1 ,$123.75 ,$81.68 ,$62.77 ,$123.75 , N/A , N/A , N/A , N/A ,$74.25 ,$105.19 ,$86.63 , N/A , N/A ,$117.56 ,$94.05 ,$92.81 , N/A ,$105.19 , N/A , N/A , N/A ,$86.63 ,$75.36 , N/A , N/A , N/A , N/A , N/A ,$105.19 , N/A ,$113.85 ,$86.63 ,$62.77 ,$75.33 ,$75.36 ,$75.33 ,$85.51 ,$111.38 ,$84.55 , N/A ,$97.76 , N/A , N/A , N/A , N/A , N/A ,$89.10 ,$76.73 ,$89.10 ,$89.10 ,$99.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT BONE SIMPLEX SPEED SET 40G STRYKER,278,1 ,$123.75 ,$81.68 ,$62.77 ,$123.75 , N/A , N/A , N/A , N/A ,$74.25 ,$105.19 ,$86.63 , N/A , N/A ,$117.56 ,$94.05 ,$92.81 , N/A ,$105.19 , N/A , N/A , N/A ,$86.63 ,$75.36 , N/A , N/A , N/A , N/A , N/A ,$105.19 , N/A ,$113.85 ,$86.63 ,$62.77 ,$75.33 ,$75.36 ,$75.33 ,$85.51 ,$111.38 ,$84.55 , N/A ,$97.76 , N/A , N/A , N/A , N/A , N/A ,$89.10 ,$76.73 ,$89.10 ,$89.10 ,$99.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT FULL DOSE,278,1 ,$123.75 ,$81.68 ,$62.77 ,$123.75 , N/A , N/A , N/A , N/A ,$74.25 ,$105.19 ,$86.63 , N/A , N/A ,$117.56 ,$94.05 ,$92.81 , N/A ,$105.19 , N/A , N/A , N/A ,$86.63 ,$75.36 , N/A , N/A , N/A , N/A , N/A ,$105.19 , N/A ,$113.85 ,$86.63 ,$62.77 ,$75.33 ,$75.36 ,$75.33 ,$85.51 ,$111.38 ,$84.55 , N/A ,$97.76 , N/A , N/A , N/A , N/A , N/A ,$89.10 ,$76.73 ,$89.10 ,$89.10 ,$99.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT SIMPLEX HV FULL DOSE,278,1 ,$123.75 ,$81.68 ,$62.77 ,$123.75 , N/A , N/A , N/A , N/A ,$74.25 ,$105.19 ,$86.63 , N/A , N/A ,$117.56 ,$94.05 ,$92.81 , N/A ,$105.19 , N/A , N/A , N/A ,$86.63 ,$75.36 , N/A , N/A , N/A , N/A , N/A ,$105.19 , N/A ,$113.85 ,$86.63 ,$62.77 ,$75.33 ,$75.36 ,$75.33 ,$85.51 ,$111.38 ,$84.55 , N/A ,$97.76 , N/A , N/A , N/A , N/A , N/A ,$89.10 ,$76.73 ,$89.10 ,$89.10 ,$99.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT ZIMMER PALACOS  R 40GM GRN,278,1 ,$128.25 ,$84.65 ,$65.05 ,$128.25 , N/A , N/A , N/A , N/A ,$76.95 ,$109.01 ,$89.78 , N/A , N/A ,$121.84 ,$97.47 ,$96.19 , N/A ,$109.01 , N/A , N/A , N/A ,$89.78 ,$78.10 , N/A , N/A , N/A , N/A , N/A ,$109.01 , N/A ,$117.99 ,$89.78 ,$65.05 ,$78.07 ,$78.10 ,$78.07 ,$88.62 ,$115.43 ,$87.62 , N/A ,$101.32 , N/A , N/A , N/A , N/A , N/A ,$92.34 ,$79.52 ,$92.34 ,$92.34 ,$102.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CEMENT ZIMMER PALACOS LV,278,1 ,$204.21 ,$134.78 ,$103.58 ,$204.21 , N/A , N/A , N/A , N/A ,$122.53 ,$173.58 ,$142.95 , N/A , N/A ,$194.00 ,$155.20 ,$153.16 , N/A ,$173.58 , N/A , N/A , N/A ,$142.95 ,$124.36 , N/A , N/A , N/A , N/A , N/A ,$173.58 , N/A ,$187.87 ,$142.95 ,$103.58 ,$124.30 ,$124.36 ,$124.30 ,$141.11 ,$183.79 ,$139.52 , N/A ,$161.33 , N/A , N/A , N/A , N/A , N/A ,$147.03 ,$126.61 ,$147.03 ,$147.03 ,$163.37 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,COMPRESSOR EXTERNAL FIXATION OPEN NONSTERILE,278,1 ,"$1,066.21 ",$703.70 ,$540.78 ,"$1,066.21 ", N/A ,$562.00 ,$562.00 , N/A ,$639.73 ,$906.28 ,$746.35 , N/A , N/A ,"$1,012.90 ",$810.32 ,$799.66 , N/A ,$906.28 , N/A , N/A , N/A ,$746.35 ,$649.32 , N/A , N/A , N/A , N/A , N/A ,$906.28 , N/A ,$980.91 ,$746.35 ,$540.78 ,$649.00 ,$649.32 ,$649.00 ,$736.75 ,$959.59 ,$728.43 , N/A ,$842.31 , N/A , N/A , N/A , N/A , N/A ,$767.67 ,$661.05 ,$767.67 ,$767.67 ,$852.97 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,COUNTERSINK FOR 4.5MM CORTEX SCREW,278,1 ,$447.30 ,$295.22 ,$226.87 ,$447.30 , N/A , N/A , N/A , N/A ,$268.38 ,$380.21 ,$313.11 , N/A , N/A ,$424.94 ,$339.95 ,$335.48 , N/A ,$380.21 , N/A , N/A , N/A ,$313.11 ,$272.41 , N/A , N/A , N/A , N/A , N/A ,$380.21 , N/A ,$411.52 ,$313.11 ,$226.87 ,$272.27 ,$272.41 ,$272.27 ,$309.08 ,$402.57 ,$305.60 , N/A ,$353.37 , N/A , N/A , N/A , N/A , N/A ,$322.06 ,$277.33 ,$322.06 ,$322.06 ,$357.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,COUNTERSINK SYNTHES FOR 2.0MM/2.4MM SCREWS,278,1 ,$228.38 ,$150.73 ,$115.83 ,$228.38 , N/A , N/A , N/A , N/A ,$137.03 ,$194.12 ,$159.87 , N/A , N/A ,$216.96 ,$173.57 ,$171.29 , N/A ,$194.12 , N/A , N/A , N/A ,$159.87 ,$139.08 , N/A , N/A , N/A , N/A , N/A ,$194.12 , N/A ,$210.11 ,$159.87 ,$115.83 ,$139.01 ,$139.08 ,$139.01 ,$157.81 ,$205.54 ,$156.03 , N/A ,$180.42 , N/A , N/A , N/A , N/A , N/A ,$164.43 ,$141.60 ,$164.43 ,$164.43 ,$182.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,COUNTERSINK SYNTHES FOR 1.3MM/1.5MM SCREWS,278,1 ,$228.38 ,$150.73 ,$115.83 ,$228.38 , N/A , N/A , N/A , N/A ,$137.03 ,$194.12 ,$159.87 , N/A , N/A ,$216.96 ,$173.57 ,$171.29 , N/A ,$194.12 , N/A , N/A , N/A ,$159.87 ,$139.08 , N/A , N/A , N/A , N/A , N/A ,$194.12 , N/A ,$210.11 ,$159.87 ,$115.83 ,$139.01 ,$139.08 ,$139.01 ,$157.81 ,$205.54 ,$156.03 , N/A ,$180.42 , N/A , N/A , N/A , N/A , N/A ,$164.43 ,$141.60 ,$164.43 ,$164.43 ,$182.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CROSSLINK DEPUY,278,1 ,"$1,025.00 ",$676.50 ,$519.88 ,"$1,025.00 ", N/A ,$540.28 ,$540.28 , N/A ,$615.00 ,$871.25 ,$717.50 , N/A , N/A ,$973.75 ,$779.00 ,$768.75 , N/A ,$871.25 , N/A , N/A , N/A ,$717.50 ,$624.23 , N/A , N/A , N/A , N/A , N/A ,$871.25 , N/A ,$943.00 ,$717.50 ,$519.88 ,$623.92 ,$624.23 ,$623.92 ,$708.28 ,$922.50 ,$700.28 , N/A ,$809.75 , N/A , N/A , N/A , N/A , N/A ,$738.00 ,$635.50 ,$738.00 ,$738.00 ,$820.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,DEVICE FIXATION ARTHREX BIOCOMPOSITE DISTAL BICEPS REPAIR,278,1 ,"$2,090.00 ","$1,379.40 ","$1,060.05 ","$2,090.00 ", N/A ,"$1,101.64 ","$1,101.64 ", N/A ,"$1,254.00 ","$1,776.50 ","$1,463.00 ", N/A , N/A ,"$1,985.50 ","$1,588.40 ","$1,567.50 ", N/A ,"$1,776.50 ", N/A , N/A , N/A ,"$1,463.00 ","$1,272.81 ", N/A , N/A , N/A , N/A , N/A ,"$1,776.50 ", N/A ,"$1,922.80 ","$1,463.00 ","$1,060.05 ","$1,272.18 ","$1,272.81 ","$1,272.18 ","$1,444.19 ","$1,881.00 ","$1,427.89 ", N/A ,"$1,651.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,504.80 ","$1,295.80 ","$1,504.80 ","$1,504.80 ","$1,672.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,DRILL BIT COUNTERSINK CANNULATED 4.5 MM SCREW,278,1 ,$716.38 ,$472.81 ,$363.35 ,$716.38 , N/A , N/A , N/A , N/A ,$429.83 ,$608.92 ,$501.47 , N/A , N/A ,$680.56 ,$544.45 ,$537.29 , N/A ,$608.92 , N/A , N/A , N/A ,$501.47 ,$436.28 , N/A , N/A , N/A , N/A , N/A ,$608.92 , N/A ,$659.07 ,$501.47 ,$363.35 ,$436.06 ,$436.28 ,$436.06 ,$495.02 ,$644.74 ,$489.43 , N/A ,$565.94 , N/A , N/A , N/A , N/A , N/A ,$515.79 ,$444.16 ,$515.79 ,$515.79 ,$573.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES 12MM TI T40 STARDRIVE  0MM,278,1 ,$393.10 ,$259.45 ,$199.38 ,$393.10 , N/A , N/A , N/A , N/A ,$235.86 ,$334.14 ,$275.17 , N/A , N/A ,$373.45 ,$298.76 ,$294.83 , N/A ,$334.14 , N/A , N/A , N/A ,$275.17 ,$239.40 , N/A , N/A , N/A , N/A , N/A ,$334.14 , N/A ,$361.65 ,$275.17 ,$199.38 ,$239.28 ,$239.40 ,$239.28 ,$271.63 ,$353.79 ,$268.57 , N/A ,$310.55 , N/A , N/A , N/A , N/A , N/A ,$283.03 ,$243.72 ,$283.03 ,$283.03 ,$314.48 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES TI FOR TIBIAL NAILS-EX T40 STARDRIVE GRAY/0MM EXT,278,1 ,$344.93 ,$227.65 ,$174.95 ,$344.93 , N/A , N/A , N/A , N/A ,$206.96 ,$293.19 ,$241.45 , N/A , N/A ,$327.68 ,$262.15 ,$258.70 , N/A ,$293.19 , N/A , N/A , N/A ,$241.45 ,$210.06 , N/A , N/A , N/A , N/A , N/A ,$293.19 , N/A ,$317.34 ,$241.45 ,$174.95 ,$209.96 ,$210.06 ,$209.96 ,$238.35 ,$310.44 ,$235.66 , N/A ,$272.49 , N/A , N/A , N/A , N/A , N/A ,$248.35 ,$213.86 ,$248.35 ,$248.35 ,$275.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP END 0MM T40 EXTEND LOCK STARDRIVE CANNULATED INTRAMEDULLARY NAIL SYSTEM TITANIUM NONSTERILE EXPERT GOLD,278,1 ,$344.93 ,$227.65 ,$174.95 ,$344.93 , N/A , N/A , N/A , N/A ,$206.96 ,$293.19 ,$241.45 , N/A , N/A ,$327.68 ,$262.15 ,$258.70 , N/A ,$293.19 , N/A , N/A , N/A ,$241.45 ,$210.06 , N/A , N/A , N/A , N/A , N/A ,$293.19 , N/A ,$317.34 ,$241.45 ,$174.95 ,$209.96 ,$210.06 ,$209.96 ,$238.35 ,$310.44 ,$235.66 , N/A ,$272.49 , N/A , N/A , N/A , N/A , N/A ,$248.35 ,$213.86 ,$248.35 ,$248.35 ,$275.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP END 0MM T40 TIBIAL EXTENSION CANNULATED STARDRIVE EXPERT TITANIUM NONSTERILE GOLD,278,1 ,$344.93 ,$227.65 ,$174.95 ,$344.93 , N/A , N/A , N/A , N/A ,$206.96 ,$293.19 ,$241.45 , N/A , N/A ,$327.68 ,$262.15 ,$258.70 , N/A ,$293.19 , N/A , N/A , N/A ,$241.45 ,$210.06 , N/A , N/A , N/A , N/A , N/A ,$293.19 , N/A ,$317.34 ,$241.45 ,$174.95 ,$209.96 ,$210.06 ,$209.96 ,$238.35 ,$310.44 ,$235.66 , N/A ,$272.49 , N/A , N/A , N/A , N/A , N/A ,$248.35 ,$213.86 ,$248.35 ,$248.35 ,$275.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES 12MM TI T40 STARDRIVE 10MM,278,1 ,$344.93 ,$227.65 ,$174.95 ,$344.93 , N/A , N/A , N/A , N/A ,$206.96 ,$293.19 ,$241.45 , N/A , N/A ,$327.68 ,$262.15 ,$258.70 , N/A ,$293.19 , N/A , N/A , N/A ,$241.45 ,$210.06 , N/A , N/A , N/A , N/A , N/A ,$293.19 , N/A ,$317.34 ,$241.45 ,$174.95 ,$209.96 ,$210.06 ,$209.96 ,$238.35 ,$310.44 ,$235.66 , N/A ,$272.49 , N/A , N/A , N/A , N/A , N/A ,$248.35 ,$213.86 ,$248.35 ,$248.35 ,$275.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES 12MM TI T40 STARDRIVE 15MM,278,1 ,$344.93 ,$227.65 ,$174.95 ,$344.93 , N/A , N/A , N/A , N/A ,$206.96 ,$293.19 ,$241.45 , N/A , N/A ,$327.68 ,$262.15 ,$258.70 , N/A ,$293.19 , N/A , N/A , N/A ,$241.45 ,$210.06 , N/A , N/A , N/A , N/A , N/A ,$293.19 , N/A ,$317.34 ,$241.45 ,$174.95 ,$209.96 ,$210.06 ,$209.96 ,$238.35 ,$310.44 ,$235.66 , N/A ,$272.49 , N/A , N/A , N/A , N/A , N/A ,$248.35 ,$213.86 ,$248.35 ,$248.35 ,$275.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES 12MM TI T40 STARDRIVE 20MM,278,1 ,$344.93 ,$227.65 ,$174.95 ,$344.93 , N/A , N/A , N/A , N/A ,$206.96 ,$293.19 ,$241.45 , N/A , N/A ,$327.68 ,$262.15 ,$258.70 , N/A ,$293.19 , N/A , N/A , N/A ,$241.45 ,$210.06 , N/A , N/A , N/A , N/A , N/A ,$293.19 , N/A ,$317.34 ,$241.45 ,$174.95 ,$209.96 ,$210.06 ,$209.96 ,$238.35 ,$310.44 ,$235.66 , N/A ,$272.49 , N/A , N/A , N/A , N/A , N/A ,$248.35 ,$213.86 ,$248.35 ,$248.35 ,$275.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES 12MM TI T40 STARDRIVE 5MM,278,1 ,$344.93 ,$227.65 ,$174.95 ,$344.93 , N/A , N/A , N/A , N/A ,$206.96 ,$293.19 ,$241.45 , N/A , N/A ,$327.68 ,$262.15 ,$258.70 , N/A ,$293.19 , N/A , N/A , N/A ,$241.45 ,$210.06 , N/A , N/A , N/A , N/A , N/A ,$293.19 , N/A ,$317.34 ,$241.45 ,$174.95 ,$209.96 ,$210.06 ,$209.96 ,$238.35 ,$310.44 ,$235.66 , N/A ,$272.49 , N/A , N/A , N/A , N/A , N/A ,$248.35 ,$213.86 ,$248.35 ,$248.35 ,$275.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES TI FOR TIBIAL NAILS-EX T40 STARDRIVE GRAY/5MM EXT,278,1 ,$442.58 ,$292.10 ,$224.48 ,$442.58 , N/A , N/A , N/A , N/A ,$265.55 ,$376.19 ,$309.81 , N/A , N/A ,$420.45 ,$336.36 ,$331.94 , N/A ,$376.19 , N/A , N/A , N/A ,$309.81 ,$269.53 , N/A , N/A , N/A , N/A , N/A ,$376.19 , N/A ,$407.17 ,$309.81 ,$224.48 ,$269.40 ,$269.53 ,$269.40 ,$305.82 ,$398.32 ,$302.37 , N/A ,$349.64 , N/A , N/A , N/A , N/A , N/A ,$318.66 ,$274.40 ,$318.66 ,$318.66 ,$354.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES F/TIBIAL NAIL 10MM,278,1 ,$442.58 ,$292.10 ,$224.48 ,$442.58 , N/A , N/A , N/A , N/A ,$265.55 ,$376.19 ,$309.81 , N/A , N/A ,$420.45 ,$336.36 ,$331.94 , N/A ,$376.19 , N/A , N/A , N/A ,$309.81 ,$269.53 , N/A , N/A , N/A , N/A , N/A ,$376.19 , N/A ,$407.17 ,$309.81 ,$224.48 ,$269.40 ,$269.53 ,$269.40 ,$305.82 ,$398.32 ,$302.37 , N/A ,$349.64 , N/A , N/A , N/A , N/A , N/A ,$318.66 ,$274.40 ,$318.66 ,$318.66 ,$354.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES F/TIBIAL NAIL 15MM,278,1 ,$442.58 ,$292.10 ,$224.48 ,$442.58 , N/A , N/A , N/A , N/A ,$265.55 ,$376.19 ,$309.81 , N/A , N/A ,$420.45 ,$336.36 ,$331.94 , N/A ,$376.19 , N/A , N/A , N/A ,$309.81 ,$269.53 , N/A , N/A , N/A , N/A , N/A ,$376.19 , N/A ,$407.17 ,$309.81 ,$224.48 ,$269.40 ,$269.53 ,$269.40 ,$305.82 ,$398.32 ,$302.37 , N/A ,$349.64 , N/A , N/A , N/A , N/A , N/A ,$318.66 ,$274.40 ,$318.66 ,$318.66 ,$354.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES F/TIBIAL NAIL 5MM,278,1 ,$442.58 ,$292.10 ,$224.48 ,$442.58 , N/A , N/A , N/A , N/A ,$265.55 ,$376.19 ,$309.81 , N/A , N/A ,$420.45 ,$336.36 ,$331.94 , N/A ,$376.19 , N/A , N/A , N/A ,$309.81 ,$269.53 , N/A , N/A , N/A , N/A , N/A ,$376.19 , N/A ,$407.17 ,$309.81 ,$224.48 ,$269.40 ,$269.53 ,$269.40 ,$305.82 ,$398.32 ,$302.37 , N/A ,$349.64 , N/A , N/A , N/A , N/A , N/A ,$318.66 ,$274.40 ,$318.66 ,$318.66 ,$354.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES TI FOR TIBIAL NAILS-EX T40 STARDRIVE GRAY/10MM EXT,278,1 ,$442.58 ,$292.10 ,$224.48 ,$442.58 , N/A , N/A , N/A , N/A ,$265.55 ,$376.19 ,$309.81 , N/A , N/A ,$420.45 ,$336.36 ,$331.94 , N/A ,$376.19 , N/A , N/A , N/A ,$309.81 ,$269.53 , N/A , N/A , N/A , N/A , N/A ,$376.19 , N/A ,$407.17 ,$309.81 ,$224.48 ,$269.40 ,$269.53 ,$269.40 ,$305.82 ,$398.32 ,$302.37 , N/A ,$349.64 , N/A , N/A , N/A , N/A , N/A ,$318.66 ,$274.40 ,$318.66 ,$318.66 ,$354.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES TI FOR TIBIAL NAILS-EX T40 STARDRIVE GRAY/15MM EXT,278,1 ,$442.58 ,$292.10 ,$224.48 ,$442.58 , N/A , N/A , N/A , N/A ,$265.55 ,$376.19 ,$309.81 , N/A , N/A ,$420.45 ,$336.36 ,$331.94 , N/A ,$376.19 , N/A , N/A , N/A ,$309.81 ,$269.53 , N/A , N/A , N/A , N/A , N/A ,$376.19 , N/A ,$407.17 ,$309.81 ,$224.48 ,$269.40 ,$269.53 ,$269.40 ,$305.82 ,$398.32 ,$302.37 , N/A ,$349.64 , N/A , N/A , N/A , N/A , N/A ,$318.66 ,$274.40 ,$318.66 ,$318.66 ,$354.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES TI FOR TROCHANTERIC FIXATION NAILS 5MM EXT,278,1 ,$333.90 ,$220.37 ,$169.35 ,$333.90 , N/A , N/A , N/A , N/A ,$200.34 ,$283.82 ,$233.73 , N/A , N/A ,$317.21 ,$253.76 ,$250.43 , N/A ,$283.82 , N/A , N/A , N/A ,$233.73 ,$203.35 , N/A , N/A , N/A , N/A , N/A ,$283.82 , N/A ,$307.19 ,$233.73 ,$169.35 ,$203.24 ,$203.35 ,$203.24 ,$230.72 ,$300.51 ,$228.12 , N/A ,$263.78 , N/A , N/A , N/A , N/A , N/A ,$240.41 ,$207.02 ,$240.41 ,$240.41 ,$267.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES TI FOR TROCHANTERIC FIXATION NAILS 0MM EXT,278,1 ,$333.90 ,$220.37 ,$169.35 ,$333.90 , N/A , N/A , N/A , N/A ,$200.34 ,$283.82 ,$233.73 , N/A , N/A ,$317.21 ,$253.76 ,$250.43 , N/A ,$283.82 , N/A , N/A , N/A ,$233.73 ,$203.35 , N/A , N/A , N/A , N/A , N/A ,$283.82 , N/A ,$307.19 ,$233.73 ,$169.35 ,$203.24 ,$203.35 ,$203.24 ,$230.72 ,$300.51 ,$228.12 , N/A ,$263.78 , N/A , N/A , N/A , N/A , N/A ,$240.41 ,$207.02 ,$240.41 ,$240.41 ,$267.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,END CAP SYNTHES TI FOR TROCHANTERIC FIXATION NAILS 10MM EXT,278,1 ,$333.90 ,$220.37 ,$169.35 ,$333.90 , N/A , N/A , N/A , N/A ,$200.34 ,$283.82 ,$233.73 , N/A , N/A ,$317.21 ,$253.76 ,$250.43 , N/A ,$283.82 , N/A , N/A , N/A ,$233.73 ,$203.35 , N/A , N/A , N/A , N/A , N/A ,$283.82 , N/A ,$307.19 ,$233.73 ,$169.35 ,$203.24 ,$203.35 ,$203.24 ,$230.72 ,$300.51 ,$228.12 , N/A ,$263.78 , N/A , N/A , N/A , N/A , N/A ,$240.41 ,$207.02 ,$240.41 ,$240.41 ,$267.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,FILLER BONE VOID NORIAN DRILLABLE 3ML,278,1 ,"$1,560.05 ","$1,029.63 ",$791.26 ,"$1,560.05 ", N/A ,$822.30 ,$822.30 , N/A ,$936.03 ,"$1,326.04 ","$1,092.04 ", N/A , N/A ,"$1,482.05 ","$1,185.64 ","$1,170.04 ", N/A ,"$1,326.04 ", N/A , N/A , N/A ,"$1,092.04 ",$950.07 , N/A , N/A , N/A , N/A , N/A ,"$1,326.04 ", N/A ,"$1,435.25 ","$1,092.04 ",$791.26 ,$949.60 ,$950.07 ,$949.60 ,"$1,077.99 ","$1,404.05 ","$1,065.83 ", N/A ,"$1,232.44 ", N/A , N/A , N/A , N/A , N/A ,"$1,123.24 ",$967.23 ,"$1,123.24 ","$1,123.24 ","$1,248.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,GRAFT BONE IC CHAMBERS 15CC LIFENET,278,1 ,"$2,280.00 ","$1,504.80 ","$1,156.42 ","$2,280.00 ", N/A ,"$1,201.79 ","$1,201.79 ", N/A ,"$1,368.00 ","$1,938.00 ","$1,596.00 ", N/A , N/A ,"$2,166.00 ","$1,732.80 ","$1,710.00 ", N/A ,"$1,938.00 ", N/A , N/A , N/A ,"$1,596.00 ","$1,388.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,938.00 ", N/A ,"$2,097.60 ","$1,596.00 ","$1,156.42 ","$1,387.84 ","$1,388.52 ","$1,387.84 ","$1,575.48 ","$2,052.00 ","$1,557.70 ", N/A ,"$1,801.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,641.60 ","$1,413.60 ","$1,641.60 ","$1,641.60 ","$1,824.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,GRAFT BONE READIGRAFT CANCELLOUS 1-8 MM 30 ML PRESERVON CHIP,278,1 ,$580.50 ,$383.13 ,$294.43 ,$580.50 , N/A , N/A , N/A , N/A ,$348.30 ,$493.43 ,$406.35 , N/A , N/A ,$551.48 ,$441.18 ,$435.38 , N/A ,$493.43 , N/A , N/A , N/A ,$406.35 ,$353.52 , N/A , N/A , N/A , N/A , N/A ,$493.43 , N/A ,$534.06 ,$406.35 ,$294.43 ,$353.35 ,$353.52 ,$353.35 ,$401.13 ,$522.45 ,$396.60 , N/A ,$458.60 , N/A , N/A , N/A , N/A , N/A ,$417.96 ,$359.91 ,$417.96 ,$417.96 ,$464.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,IMPLANT ANCHOR ARTHREX BIO SWIVELOCK 4.75MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR ARTHREX PUSHLOCK  BIOCOMPOSITE 2.9 X 12.5MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 2.9MM 2.3MM SHORT MEDIUM PUSHLOCK BIOCOMPOSITE 12.5MM STERILE,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 5.5MM BIO-SWIVELOCK C CLOSED EYELET VENT 19.1MM STERILE DISPOSABLE,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE ARTHREX BIO SWIVELOCK 5.5MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,IMPLANT ANCHOR BIO-SWIVELOCK SUTURE 6.25,278,1 ,$881.50 ,$581.79 ,$447.10 ,$881.50 , N/A , N/A , N/A , N/A ,$528.90 ,$749.28 ,$617.05 , N/A , N/A ,$837.43 ,$669.94 ,$661.13 , N/A ,$749.28 , N/A , N/A , N/A ,$617.05 ,$536.83 , N/A , N/A , N/A , N/A , N/A ,$749.28 , N/A ,$810.98 ,$617.05 ,$447.10 ,$536.57 ,$536.83 ,$536.57 ,$609.12 ,$793.35 ,$602.24 , N/A ,$696.39 , N/A , N/A , N/A , N/A , N/A ,$634.68 ,$546.53 ,$634.68 ,$634.68 ,$705.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,IMPLANT ANCHOR SUTURE BIOCORKSCREW 5.5MM,278,1 ,$612.75 ,$404.42 ,$310.79 ,$612.75 , N/A , N/A , N/A , N/A ,$367.65 ,$520.84 ,$428.93 , N/A , N/A ,$582.11 ,$465.69 ,$459.56 , N/A ,$520.84 , N/A , N/A , N/A ,$428.93 ,$373.16 , N/A , N/A , N/A , N/A , N/A ,$520.84 , N/A ,$563.73 ,$428.93 ,$310.79 ,$372.98 ,$373.16 ,$372.98 ,$423.41 ,$551.48 ,$418.63 , N/A ,$484.07 , N/A , N/A , N/A , N/A , N/A ,$441.18 ,$379.91 ,$441.18 ,$441.18 ,$490.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE CORKSCREW ARTHREX 2.2MM,278,1 ,$612.75 ,$404.42 ,$310.79 ,$612.75 , N/A , N/A , N/A , N/A ,$367.65 ,$520.84 ,$428.93 , N/A , N/A ,$582.11 ,$465.69 ,$459.56 , N/A ,$520.84 , N/A , N/A , N/A ,$428.93 ,$373.16 , N/A , N/A , N/A , N/A , N/A ,$520.84 , N/A ,$563.73 ,$428.93 ,$310.79 ,$372.98 ,$373.16 ,$372.98 ,$423.41 ,$551.48 ,$418.63 , N/A ,$484.07 , N/A , N/A , N/A , N/A , N/A ,$441.18 ,$379.91 ,$441.18 ,$441.18 ,$490.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,IMPLANT ANCHOR SUTURE BIOCORKSCREW 5.5MM W/FIBERWIRE,278,1 ,$698.75 ,$461.18 ,$354.41 ,$698.75 , N/A , N/A , N/A , N/A ,$419.25 ,$593.94 ,$489.13 , N/A , N/A ,$663.81 ,$531.05 ,$524.06 , N/A ,$593.94 , N/A , N/A , N/A ,$489.13 ,$425.54 , N/A , N/A , N/A , N/A , N/A ,$593.94 , N/A ,$642.85 ,$489.13 ,$354.41 ,$425.33 ,$425.54 ,$425.33 ,$482.84 ,$628.88 ,$477.39 , N/A ,$552.01 , N/A , N/A , N/A , N/A , N/A ,$503.10 ,$433.23 ,$503.10 ,$503.10 ,$559.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR ARTHREX MINI BIOCOMPOSITE SUTURE TAK,278,1 ,$698.75 ,$461.18 ,$354.41 ,$698.75 , N/A , N/A , N/A , N/A ,$419.25 ,$593.94 ,$489.13 , N/A , N/A ,$663.81 ,$531.05 ,$524.06 , N/A ,$593.94 , N/A , N/A , N/A ,$489.13 ,$425.54 , N/A , N/A , N/A , N/A , N/A ,$593.94 , N/A ,$642.85 ,$489.13 ,$354.41 ,$425.33 ,$425.54 ,$425.33 ,$482.84 ,$628.88 ,$477.39 , N/A ,$552.01 , N/A , N/A , N/A , N/A , N/A ,$503.10 ,$433.23 ,$503.10 ,$503.10 ,$559.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE ARTHREX BIO DIAMOND POINT SUTURETAK 2 FIBERWARE,278,1 ,$698.75 ,$461.18 ,$354.41 ,$698.75 , N/A , N/A , N/A , N/A ,$419.25 ,$593.94 ,$489.13 , N/A , N/A ,$663.81 ,$531.05 ,$524.06 , N/A ,$593.94 , N/A , N/A , N/A ,$489.13 ,$425.54 , N/A , N/A , N/A , N/A , N/A ,$593.94 , N/A ,$642.85 ,$489.13 ,$354.41 ,$425.33 ,$425.54 ,$425.33 ,$482.84 ,$628.88 ,$477.39 , N/A ,$552.01 , N/A , N/A , N/A , N/A , N/A ,$503.10 ,$433.23 ,$503.10 ,$503.10 ,$559.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,IMPLANT ANCHOR SUTURE BIOCORKSCREW 5.5MMBC W/ SUTURE TAPE,278,1 ,$763.25 ,$503.75 ,$387.12 ,$763.25 , N/A , N/A , N/A , N/A ,$457.95 ,$648.76 ,$534.28 , N/A , N/A ,$725.09 ,$580.07 ,$572.44 , N/A ,$648.76 , N/A , N/A , N/A ,$534.28 ,$464.82 , N/A , N/A , N/A , N/A , N/A ,$648.76 , N/A ,$702.19 ,$534.28 ,$387.12 ,$464.59 ,$464.82 ,$464.59 ,$527.41 ,$686.93 ,$521.45 , N/A ,$602.97 , N/A , N/A , N/A , N/A , N/A ,$549.54 ,$473.22 ,$549.54 ,$549.54 ,$610.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,IMPLANT ANCHOR SUTURE BIOCORKSCREW 6.5MM W/FIBERWIRE,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,IMPLANT CABLE ZIMMER CERCLAGE COCR 1.8MM X 635MM,278,1 ,$666.50 ,$439.89 ,$338.05 ,$666.50 , N/A , N/A , N/A , N/A ,$399.90 ,$566.53 ,$466.55 , N/A , N/A ,$633.18 ,$506.54 ,$499.88 , N/A ,$566.53 , N/A , N/A , N/A ,$466.55 ,$405.90 , N/A , N/A , N/A , N/A , N/A ,$566.53 , N/A ,$613.18 ,$466.55 ,$338.05 ,$405.70 ,$405.90 ,$405.70 ,$460.55 ,$599.85 ,$455.35 , N/A ,$526.54 , N/A , N/A , N/A , N/A , N/A ,$479.88 ,$413.23 ,$479.88 ,$479.88 ,$533.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,IMPLANT SYSTEM ARTHREX DISTAL BICEP REPAIR,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,K-WIRE 1.2MM X 100MM,278,1 ,$85.19 ,$56.23 ,$43.21 ,$85.19 , N/A , N/A , N/A , N/A ,$51.11 ,$72.41 ,$59.63 , N/A , N/A ,$80.93 ,$64.74 ,$63.89 , N/A ,$72.41 , N/A , N/A , N/A ,$59.63 ,$51.88 , N/A , N/A , N/A , N/A , N/A ,$72.41 , N/A ,$78.37 ,$59.63 ,$43.21 ,$51.86 ,$51.88 ,$51.86 ,$58.87 ,$76.67 ,$58.20 , N/A ,$67.30 , N/A , N/A , N/A , N/A , N/A ,$61.34 ,$52.82 ,$61.34 ,$61.34 ,$68.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,K-WIRE 2.5MM X 150MM WRIGHT MEDICAL,278,1 ,$58.50 ,$38.61 ,$29.67 ,$58.50 , N/A , N/A , N/A , N/A ,$35.10 ,$49.73 ,$40.95 , N/A , N/A ,$55.58 ,$44.46 ,$43.88 , N/A ,$49.73 , N/A , N/A , N/A ,$40.95 ,$35.63 , N/A , N/A , N/A , N/A , N/A ,$49.73 , N/A ,$53.82 ,$40.95 ,$29.67 ,$35.61 ,$35.63 ,$35.61 ,$40.42 ,$52.65 ,$39.97 , N/A ,$46.22 , N/A , N/A , N/A , N/A , N/A ,$42.12 ,$36.27 ,$42.12 ,$42.12 ,$46.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,KIT INTERNAL BRACE HAND  AND  WRIST LIG AUGMENT REPAIR,278,1 ,"$3,844.80 ","$2,537.57 ","$1,922.40 ","$3,844.80 ", N/A ,"$2,026.59 ","$2,026.59 ", N/A ,"$2,306.88 ","$3,268.08 ","$2,691.36 ", N/A , N/A ,"$3,652.56 ","$2,922.05 ","$2,883.60 ","$1,922.40 ","$3,268.08 ", N/A ,"$1,922.40 ","$1,922.40 ","$2,691.36 ","$2,341.48 ", N/A , N/A , N/A , N/A , N/A ,"$3,268.08 ", N/A ,"$3,537.22 ","$2,691.36 ","$1,950.08 ","$2,340.33 ","$2,341.48 ","$2,340.33 ","$2,656.76 ","$3,460.32 ","$2,626.77 ", N/A ,"$3,037.39 ", N/A , N/A , N/A , N/A , N/A ,"$2,768.26 ","$2,383.78 ","$2,768.26 ","$2,768.26 ","$3,075.84 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL 11MM 380MM TIBIAL INTRAMEDULLARY CANNULATED TITANIUM STERILE GREEN,278,1 ,"$2,231.65 ","$1,472.89 ","$1,131.89 ","$2,231.65 ", N/A ,"$1,176.30 ","$1,176.30 ", N/A ,"$1,338.99 ","$1,896.90 ","$1,562.16 ", N/A , N/A ,"$2,120.07 ","$1,696.05 ","$1,673.74 ", N/A ,"$1,896.90 ", N/A , N/A , N/A ,"$1,562.16 ","$1,359.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,896.90 ", N/A ,"$2,053.12 ","$1,562.16 ","$1,131.89 ","$1,358.41 ","$1,359.07 ","$1,358.41 ","$1,542.07 ","$2,008.49 ","$1,524.66 ", N/A ,"$1,763.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,606.79 ","$1,383.62 ","$1,606.79 ","$1,606.79 ","$1,785.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL 11MM 315MM TIBIAL INTRAMEDULLARY CANNULATED TITANIUM STERILE GREEN,278,1 ,"$2,231.65 ","$1,472.89 ","$1,131.89 ","$2,231.65 ", N/A ,"$1,176.30 ","$1,176.30 ", N/A ,"$1,338.99 ","$1,896.90 ","$1,562.16 ", N/A , N/A ,"$2,120.07 ","$1,696.05 ","$1,673.74 ", N/A ,"$1,896.90 ", N/A , N/A , N/A ,"$1,562.16 ","$1,359.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,896.90 ", N/A ,"$2,053.12 ","$1,562.16 ","$1,131.89 ","$1,358.41 ","$1,359.07 ","$1,358.41 ","$1,542.07 ","$2,008.49 ","$1,524.66 ", N/A ,"$1,763.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,606.79 ","$1,383.62 ","$1,606.79 ","$1,606.79 ","$1,785.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL 11MM 330MM TIBIAL INTRAMEDULLARY CANNULATED TITANIUM STERILE GREEN,278,1 ,"$2,231.65 ","$1,472.89 ","$1,131.89 ","$2,231.65 ", N/A ,"$1,176.30 ","$1,176.30 ", N/A ,"$1,338.99 ","$1,896.90 ","$1,562.16 ", N/A , N/A ,"$2,120.07 ","$1,696.05 ","$1,673.74 ", N/A ,"$1,896.90 ", N/A , N/A , N/A ,"$1,562.16 ","$1,359.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,896.90 ", N/A ,"$2,053.12 ","$1,562.16 ","$1,131.89 ","$1,358.41 ","$1,359.07 ","$1,358.41 ","$1,542.07 ","$2,008.49 ","$1,524.66 ", N/A ,"$1,763.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,606.79 ","$1,383.62 ","$1,606.79 ","$1,606.79 ","$1,785.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/345MM,278,1 ,"$2,784.18 ","$1,837.56 ","$1,392.09 ","$2,784.18 ", N/A ,"$1,467.54 ","$1,467.54 ", N/A ,"$1,670.51 ","$2,366.55 ","$1,948.93 ", N/A , N/A ,"$2,644.97 ","$2,115.98 ","$2,088.14 ","$1,392.09 ","$2,366.55 ", N/A ,"$1,392.09 ","$1,392.09 ","$1,948.93 ","$1,695.57 ", N/A , N/A , N/A , N/A , N/A ,"$2,366.55 ", N/A ,"$2,561.45 ","$1,948.93 ","$1,412.14 ","$1,694.73 ","$1,695.57 ","$1,694.73 ","$1,923.87 ","$2,505.76 ","$1,902.15 ", N/A ,"$2,199.50 ", N/A , N/A , N/A , N/A , N/A ,"$2,004.61 ","$1,726.19 ","$2,004.61 ","$2,004.61 ","$2,227.34 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-160MM,278,1 ,"$3,037.72 ","$2,004.90 ","$1,518.86 ","$3,037.72 ", N/A ,"$1,601.18 ","$1,601.18 ", N/A ,"$1,822.63 ","$2,582.06 ","$2,126.40 ", N/A , N/A ,"$2,885.83 ","$2,308.67 ","$2,278.29 ","$1,518.86 ","$2,582.06 ", N/A ,"$1,518.86 ","$1,518.86 ","$2,126.40 ","$1,849.97 ", N/A , N/A , N/A , N/A , N/A ,"$2,582.06 ", N/A ,"$2,794.70 ","$2,126.40 ","$1,540.73 ","$1,849.06 ","$1,849.97 ","$1,849.06 ","$2,099.06 ","$2,733.95 ","$2,075.37 ", N/A ,"$2,399.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,187.16 ","$1,883.39 ","$2,187.16 ","$2,187.16 ","$2,430.18 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR CURVED 14H 314MM LEFT,278,1 ,"$3,037.72 ","$2,004.90 ","$1,518.86 ","$3,037.72 ", N/A ,"$1,601.18 ","$1,601.18 ", N/A ,"$1,822.63 ","$2,582.06 ","$2,126.40 ", N/A , N/A ,"$2,885.83 ","$2,308.67 ","$2,278.29 ","$1,518.86 ","$2,582.06 ", N/A ,"$1,518.86 ","$1,518.86 ","$2,126.40 ","$1,849.97 ", N/A , N/A , N/A , N/A , N/A ,"$2,582.06 ", N/A ,"$2,794.70 ","$2,126.40 ","$1,540.73 ","$1,849.06 ","$1,849.97 ","$1,849.06 ","$2,099.06 ","$2,733.95 ","$2,075.37 ", N/A ,"$2,399.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,187.16 ","$1,883.39 ","$2,187.16 ","$2,187.16 ","$2,430.18 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-420MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO FEM EX-160MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO FEM EX-200MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO FEM EX-240MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO/ANTE FEM EX-280MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO/ANTE FEM EX-300MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO/ANTE FEM EX-320MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO/ANTE FEM EX-340MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO/ANTE FEM EX-360MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO/ANTE FEM EX-380MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO/ANTE FEM EX-400MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN RETRO/ANTE FEM EX-420MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-160MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-200MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-220MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-240MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-280MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-300MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-320MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-360MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-380MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN RETRO/ANTE FEM EX-420MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO FEM EX-160MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO FEM EX-200MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO FEM EX-240MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO FEM EX-280MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO/ANTE FEM EX-300MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO/ANTE FEM EX-320MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO/ANTE FEM EX-340MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO/ANTE FEM EX-360MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO/ANTE FEM EX-380MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO/ANTE FEM EX-400MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN RETRO/ANTE FEM EX-420MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-200MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-240MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-280MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-300MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-320MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-340MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-360MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-380MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI CANN RETRO/ANTE FEM EX-400MM,278,1 ,"$2,947.28 ","$1,945.20 ","$1,473.64 ","$2,947.28 ", N/A ,"$1,553.51 ","$1,553.51 ", N/A ,"$1,768.37 ","$2,505.19 ","$2,063.10 ", N/A , N/A ,"$2,799.92 ","$2,239.93 ","$2,210.46 ","$1,473.64 ","$2,505.19 ", N/A ,"$1,473.64 ","$1,473.64 ","$2,063.10 ","$1,794.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,505.19 ", N/A ,"$2,711.50 ","$2,063.10 ","$1,494.86 ","$1,794.01 ","$1,794.89 ","$1,794.01 ","$2,036.57 ","$2,652.55 ","$2,013.58 ", N/A ,"$2,328.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,122.04 ","$1,827.31 ","$2,122.04 ","$2,122.04 ","$2,357.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/405MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL 8MM 270MM TIBIAL EXPERT INTRAMEDULLARY ROUND BARREL CANNULATED TITANIUM STERILE DARK BLUE,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/270MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/285MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/300MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/315MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/330MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/360MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/375MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/390MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI CANN TIBIAL -EX/405MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/270MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/285MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/300MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/315MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/330MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/345MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/360MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/375MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/390MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI CANN TIBIAL-EX/405MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN TIBIAL -EX/270MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN TIBIAL -EX/285MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN TIBIAL -EX/300MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN TIBIAL -EX/315MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN TIBIAL -EX/330MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN TIBIAL -EX/345MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN TIBIAL -EX/360MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN TIBIAL -EX/375MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI CANN TIBIAL -EX/390MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 8MM TI CANN TIBIAL -EX/285MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 8MM TI CANN TIBIAL -EX/300MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 8MM TI CANN TIBIAL -EX/315MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 8MM TI CANN TIBIAL -EX/330MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 8MM TI CANN TIBIAL -EX/345MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 8MM TI CANN TIBIAL -EX/360MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 8MM TI CANN TIBIAL -EX/375MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 8MM TI CANN TIBIAL -EX/390MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 8MM TI CANN TIBIAL -EX/405MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/270MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/285MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/300MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/315MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/330MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/345MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/360MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/375MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 9MM TI CANN TIBIAL -EX/390MM,278,1 ,"$2,581.53 ","$1,703.81 ","$1,290.77 ","$2,581.53 ", N/A ,"$1,360.72 ","$1,360.72 ", N/A ,"$1,548.92 ","$2,194.30 ","$1,807.07 ", N/A , N/A ,"$2,452.45 ","$1,961.96 ","$1,936.15 ","$1,290.77 ","$2,194.30 ", N/A ,"$1,290.77 ","$1,290.77 ","$1,807.07 ","$1,572.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.30 ", N/A ,"$2,375.01 ","$1,807.07 ","$1,309.35 ","$1,571.38 ","$1,572.15 ","$1,571.38 ","$1,783.84 ","$2,323.38 ","$1,763.70 ", N/A ,"$2,039.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.70 ","$1,600.55 ","$1,858.70 ","$1,858.70 ","$2,065.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 260MM,278,1 ,"$3,161.60 ","$2,086.66 ","$1,580.80 ","$3,161.60 ", N/A ,"$1,666.48 ","$1,666.48 ", N/A ,"$1,896.96 ","$2,687.36 ","$2,213.12 ", N/A , N/A ,"$3,003.52 ","$2,402.82 ","$2,371.20 ","$1,580.80 ","$2,687.36 ", N/A ,"$1,580.80 ","$1,580.80 ","$2,213.12 ","$1,925.41 ", N/A , N/A , N/A , N/A , N/A ,"$2,687.36 ", N/A ,"$2,908.67 ","$2,213.12 ","$1,603.56 ","$1,924.47 ","$1,925.41 ","$1,924.47 ","$2,184.67 ","$2,845.44 ","$2,160.01 ", N/A ,"$2,497.66 ", N/A , N/A , N/A , N/A , N/A ,"$2,276.35 ","$1,960.19 ","$2,276.35 ","$2,276.35 ","$2,529.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 270MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 150MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 220MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 230MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 240MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 250MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 260MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 270MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 150MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 220MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 230MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 240MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 250MM,278,1 ,"$3,273.13 ","$2,160.27 ","$1,636.57 ","$3,273.13 ", N/A ,"$1,725.27 ","$1,725.27 ", N/A ,"$1,963.88 ","$2,782.16 ","$2,291.19 ", N/A , N/A ,"$3,109.47 ","$2,487.58 ","$2,454.85 ","$1,636.57 ","$2,782.16 ", N/A ,"$1,636.57 ","$1,636.57 ","$2,291.19 ","$1,993.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,782.16 ", N/A ,"$3,011.28 ","$2,291.19 ","$1,660.13 ","$1,992.35 ","$1,993.34 ","$1,992.35 ","$2,261.73 ","$2,945.82 ","$2,236.20 ", N/A ,"$2,585.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,356.65 ","$2,029.34 ","$2,356.65 ","$2,356.65 ","$2,618.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN 11 X 150MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 200MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 210MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 280MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 290MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  7 X 300MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 200MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 210MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 280MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 290MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES HUMERAL TI CANN  9 X 300MM,278,1 ,"$3,371.55 ","$2,225.22 ","$1,685.78 ","$3,371.55 ", N/A ,"$1,777.14 ","$1,777.14 ", N/A ,"$2,022.93 ","$2,865.82 ","$2,360.09 ", N/A , N/A ,"$3,202.97 ","$2,562.38 ","$2,528.66 ","$1,685.78 ","$2,865.82 ", N/A ,"$1,685.78 ","$1,685.78 ","$2,360.09 ","$2,053.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,865.82 ", N/A ,"$3,101.83 ","$2,360.09 ","$1,710.05 ","$2,052.26 ","$2,053.27 ","$2,052.26 ","$2,329.74 ","$3,034.40 ","$2,303.44 ", N/A ,"$2,663.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,427.52 ","$2,090.36 ","$2,427.52 ","$2,427.52 ","$2,697.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 10 X 170MM 130 DEG,278,1 ,"$2,752.82 ","$1,816.86 ","$1,376.41 ","$2,752.82 ", N/A ,"$1,451.01 ","$1,451.01 ", N/A ,"$1,651.69 ","$2,339.90 ","$1,926.97 ", N/A , N/A ,"$2,615.18 ","$2,092.14 ","$2,064.62 ","$1,376.41 ","$2,339.90 ", N/A ,"$1,376.41 ","$1,376.41 ","$1,926.97 ","$1,676.47 ", N/A , N/A , N/A , N/A , N/A ,"$2,339.90 ", N/A ,"$2,532.59 ","$1,926.97 ","$1,396.23 ","$1,675.64 ","$1,676.47 ","$1,675.64 ","$1,902.20 ","$2,477.54 ","$1,880.73 ", N/A ,"$2,174.73 ", N/A , N/A , N/A , N/A , N/A ,"$1,982.03 ","$1,706.75 ","$1,982.03 ","$1,982.03 ","$2,202.26 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 170MM 130 DEG,278,1 ,"$2,956.31 ","$1,951.16 ","$1,478.16 ","$2,956.31 ", N/A ,"$1,558.27 ","$1,558.27 ", N/A ,"$1,773.79 ","$2,512.86 ","$2,069.42 ", N/A , N/A ,"$2,808.49 ","$2,246.80 ","$2,217.23 ","$1,478.16 ","$2,512.86 ", N/A ,"$1,478.16 ","$1,478.16 ","$2,069.42 ","$1,800.39 ", N/A , N/A , N/A , N/A , N/A ,"$2,512.86 ", N/A ,"$2,719.81 ","$2,069.42 ","$1,499.44 ","$1,799.51 ","$1,800.39 ","$1,799.51 ","$2,042.81 ","$2,660.68 ","$2,019.75 ", N/A ,"$2,335.48 ", N/A , N/A , N/A , N/A , N/A ,"$2,128.54 ","$1,832.91 ","$2,128.54 ","$2,128.54 ","$2,365.05 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 170MM 130 DEG,278,1 ,"$2,956.31 ","$1,951.16 ","$1,478.16 ","$2,956.31 ", N/A ,"$1,558.27 ","$1,558.27 ", N/A ,"$1,773.79 ","$2,512.86 ","$2,069.42 ", N/A , N/A ,"$2,808.49 ","$2,246.80 ","$2,217.23 ","$1,478.16 ","$2,512.86 ", N/A ,"$1,478.16 ","$1,478.16 ","$2,069.42 ","$1,800.39 ", N/A , N/A , N/A , N/A , N/A ,"$2,512.86 ", N/A ,"$2,719.81 ","$2,069.42 ","$1,499.44 ","$1,799.51 ","$1,800.39 ","$1,799.51 ","$2,042.81 ","$2,660.68 ","$2,019.75 ", N/A ,"$2,335.48 ", N/A , N/A , N/A , N/A , N/A ,"$2,128.54 ","$1,832.91 ","$2,128.54 ","$2,128.54 ","$2,365.05 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 360MM 130 DEG LT,278,1 ,"$4,055.04 ","$2,676.33 ","$2,027.52 ","$4,055.04 ", N/A ,"$2,137.41 ","$2,137.41 ", N/A ,"$2,433.02 ","$3,446.78 ","$2,838.53 ", N/A , N/A ,"$3,852.29 ","$3,081.83 ","$3,041.28 ","$2,027.52 ","$3,446.78 ", N/A ,"$2,027.52 ","$2,027.52 ","$2,838.53 ","$2,469.52 ", N/A , N/A , N/A , N/A , N/A ,"$3,446.78 ", N/A ,"$3,730.64 ","$2,838.53 ","$2,056.72 ","$2,468.30 ","$2,469.52 ","$2,468.30 ","$2,802.03 ","$3,649.54 ","$2,770.40 ", N/A ,"$3,203.48 ", N/A , N/A , N/A , N/A , N/A ,"$2,919.63 ","$2,514.12 ","$2,919.63 ","$2,919.63 ","$3,244.03 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 440MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 300MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 300MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 320MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 320MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 340MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 340MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 360MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 360MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 380MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 380MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 400MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 400MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 420MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 420MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 440MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 440MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 300MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 300MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 320MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 320MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 340MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 340MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 360MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 380MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 380MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 400MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 400MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 420MM 130 DEG LT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TFNA TI CANN 12 X 420MM 130 DEG RT,278,1 ,"$3,655.08 ","$2,412.35 ","$1,827.54 ","$3,655.08 ", N/A ,"$1,926.59 ","$1,926.59 ", N/A ,"$2,193.05 ","$3,106.82 ","$2,558.56 ", N/A , N/A ,"$3,472.33 ","$2,777.86 ","$2,741.31 ","$1,827.54 ","$3,106.82 ", N/A ,"$1,827.54 ","$1,827.54 ","$2,558.56 ","$2,225.94 ", N/A , N/A , N/A , N/A , N/A ,"$3,106.82 ", N/A ,"$3,362.67 ","$2,558.56 ","$1,853.86 ","$2,224.85 ","$2,225.94 ","$2,224.85 ","$2,525.66 ","$3,289.57 ","$2,497.15 ", N/A ,"$2,887.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.66 ","$2,266.15 ","$2,631.66 ","$2,631.66 ","$2,924.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI ELASTIC 2.0 X 440MM GREEN,278,1 ,$549.33 ,$362.56 ,$278.62 ,$549.33 , N/A , N/A , N/A , N/A ,$329.60 ,$466.93 ,$384.53 , N/A , N/A ,$521.86 ,$417.49 ,$412.00 , N/A ,$466.93 , N/A , N/A , N/A ,$384.53 ,$334.54 , N/A , N/A , N/A , N/A , N/A ,$466.93 , N/A ,$505.38 ,$384.53 ,$278.62 ,$334.38 ,$334.54 ,$334.38 ,$379.59 ,$494.40 ,$375.30 , N/A ,$433.97 , N/A , N/A , N/A , N/A , N/A ,$395.52 ,$340.58 ,$395.52 ,$395.52 ,$439.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI ELASTIC 2.5 X 440MM PINK,278,1 ,$589.96 ,$389.37 ,$299.23 ,$589.96 , N/A , N/A , N/A , N/A ,$353.98 ,$501.47 ,$412.97 , N/A , N/A ,$560.46 ,$448.37 ,$442.47 , N/A ,$501.47 , N/A , N/A , N/A ,$412.97 ,$359.29 , N/A , N/A , N/A , N/A , N/A ,$501.47 , N/A ,$542.76 ,$412.97 ,$299.23 ,$359.11 ,$359.29 ,$359.11 ,$407.66 ,$530.96 ,$403.06 , N/A ,$466.07 , N/A , N/A , N/A , N/A , N/A ,$424.77 ,$365.78 ,$424.77 ,$424.77 ,$471.97 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI ELASTIC 3.0 X 440MM GOLD,278,1 ,$624.58 ,$412.22 ,$316.79 ,$624.58 , N/A , N/A , N/A , N/A ,$374.75 ,$530.89 ,$437.21 , N/A , N/A ,$593.35 ,$474.68 ,$468.44 , N/A ,$530.89 , N/A , N/A , N/A ,$437.21 ,$380.37 , N/A , N/A , N/A , N/A , N/A ,$530.89 , N/A ,$574.61 ,$437.21 ,$316.79 ,$380.18 ,$380.37 ,$380.18 ,$431.58 ,$562.12 ,$426.71 , N/A ,$493.42 , N/A , N/A , N/A , N/A , N/A ,$449.70 ,$387.24 ,$449.70 ,$449.70 ,$499.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI ELASTIC 3.5 X 440MM BLUE,278,1 ,$659.19 ,$435.07 ,$334.34 ,$659.19 , N/A , N/A , N/A , N/A ,$395.51 ,$560.31 ,$461.43 , N/A , N/A ,$626.23 ,$500.98 ,$494.39 , N/A ,$560.31 , N/A , N/A , N/A ,$461.43 ,$401.45 , N/A , N/A , N/A , N/A , N/A ,$560.31 , N/A ,$606.45 ,$461.43 ,$334.34 ,$401.25 ,$401.45 ,$401.25 ,$455.50 ,$593.27 ,$450.36 , N/A ,$520.76 , N/A , N/A , N/A , N/A , N/A ,$474.62 ,$408.70 ,$474.62 ,$474.62 ,$527.35 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI ELASTIC 4.0 X 440MM PURPLE,278,1 ,$707.35 ,$466.85 ,$358.77 ,$707.35 , N/A , N/A , N/A , N/A ,$424.41 ,$601.25 ,$495.15 , N/A , N/A ,$671.98 ,$537.59 ,$530.51 , N/A ,$601.25 , N/A , N/A , N/A ,$495.15 ,$430.78 , N/A , N/A , N/A , N/A , N/A ,$601.25 , N/A ,$650.76 ,$495.15 ,$358.77 ,$430.56 ,$430.78 ,$430.56 ,$488.78 ,$636.62 ,$483.26 , N/A ,$558.81 , N/A , N/A , N/A , N/A , N/A ,$509.29 ,$438.56 ,$509.29 ,$509.29 ,$565.88 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 10MM X 400MM 130 DEG RT,278,1 ,"$3,649.67 ","$2,408.78 ","$1,824.84 ","$3,649.67 ", N/A ,"$1,923.74 ","$1,923.74 ", N/A ,"$2,189.80 ","$3,102.22 ","$2,554.77 ", N/A , N/A ,"$3,467.19 ","$2,773.75 ","$2,737.25 ","$1,824.84 ","$3,102.22 ", N/A ,"$1,824.84 ","$1,824.84 ","$2,554.77 ","$2,222.65 ", N/A , N/A , N/A , N/A , N/A ,"$3,102.22 ", N/A ,"$3,357.70 ","$2,554.77 ","$1,851.11 ","$2,221.55 ","$2,222.65 ","$2,221.55 ","$2,521.92 ","$3,284.70 ","$2,493.45 ", N/A ,"$2,883.24 ", N/A , N/A , N/A , N/A , N/A ,"$2,627.76 ","$2,262.80 ","$2,627.76 ","$2,627.76 ","$2,919.74 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 10MM X 340MM 130 DEG LT,278,1 ,"$3,649.67 ","$2,408.78 ","$1,824.84 ","$3,649.67 ", N/A ,"$1,923.74 ","$1,923.74 ", N/A ,"$2,189.80 ","$3,102.22 ","$2,554.77 ", N/A , N/A ,"$3,467.19 ","$2,773.75 ","$2,737.25 ","$1,824.84 ","$3,102.22 ", N/A ,"$1,824.84 ","$1,824.84 ","$2,554.77 ","$2,222.65 ", N/A , N/A , N/A , N/A , N/A ,"$3,102.22 ", N/A ,"$3,357.70 ","$2,554.77 ","$1,851.11 ","$2,221.55 ","$2,222.65 ","$2,221.55 ","$2,521.92 ","$3,284.70 ","$2,493.45 ", N/A ,"$2,883.24 ", N/A , N/A , N/A , N/A , N/A ,"$2,627.76 ","$2,262.80 ","$2,627.76 ","$2,627.76 ","$2,919.74 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 400MM 130 DEG RT,278,1 ,"$3,427.37 ","$2,262.06 ","$1,713.69 ","$3,427.37 ", N/A ,"$1,806.57 ","$1,806.57 ", N/A ,"$2,056.42 ","$2,913.26 ","$2,399.16 ", N/A , N/A ,"$3,256.00 ","$2,604.80 ","$2,570.53 ","$1,713.69 ","$2,913.26 ", N/A ,"$1,713.69 ","$1,713.69 ","$2,399.16 ","$2,087.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,913.26 ", N/A ,"$3,153.18 ","$2,399.16 ","$1,738.36 ","$2,086.24 ","$2,087.27 ","$2,086.24 ","$2,368.31 ","$3,084.63 ","$2,341.58 ", N/A ,"$2,707.62 ", N/A , N/A , N/A , N/A , N/A ,"$2,467.71 ","$2,124.97 ","$2,467.71 ","$2,467.71 ","$2,741.90 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 360MM 130 DEG LT,278,1 ,"$3,427.37 ","$2,262.06 ","$1,713.69 ","$3,427.37 ", N/A ,"$1,806.57 ","$1,806.57 ", N/A ,"$2,056.42 ","$2,913.26 ","$2,399.16 ", N/A , N/A ,"$3,256.00 ","$2,604.80 ","$2,570.53 ","$1,713.69 ","$2,913.26 ", N/A ,"$1,713.69 ","$1,713.69 ","$2,399.16 ","$2,087.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,913.26 ", N/A ,"$3,153.18 ","$2,399.16 ","$1,738.36 ","$2,086.24 ","$2,087.27 ","$2,086.24 ","$2,368.31 ","$3,084.63 ","$2,341.58 ", N/A ,"$2,707.62 ", N/A , N/A , N/A , N/A , N/A ,"$2,467.71 ","$2,124.97 ","$2,467.71 ","$2,467.71 ","$2,741.90 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 360MM 130 DEG RT,278,1 ,"$3,427.37 ","$2,262.06 ","$1,713.69 ","$3,427.37 ", N/A ,"$1,806.57 ","$1,806.57 ", N/A ,"$2,056.42 ","$2,913.26 ","$2,399.16 ", N/A , N/A ,"$3,256.00 ","$2,604.80 ","$2,570.53 ","$1,713.69 ","$2,913.26 ", N/A ,"$1,713.69 ","$1,713.69 ","$2,399.16 ","$2,087.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,913.26 ", N/A ,"$3,153.18 ","$2,399.16 ","$1,738.36 ","$2,086.24 ","$2,087.27 ","$2,086.24 ","$2,368.31 ","$3,084.63 ","$2,341.58 ", N/A ,"$2,707.62 ", N/A , N/A , N/A , N/A , N/A ,"$2,467.71 ","$2,124.97 ","$2,467.71 ","$2,467.71 ","$2,741.90 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 380MM 130 DEG LT,278,1 ,"$3,427.37 ","$2,262.06 ","$1,713.69 ","$3,427.37 ", N/A ,"$1,806.57 ","$1,806.57 ", N/A ,"$2,056.42 ","$2,913.26 ","$2,399.16 ", N/A , N/A ,"$3,256.00 ","$2,604.80 ","$2,570.53 ","$1,713.69 ","$2,913.26 ", N/A ,"$1,713.69 ","$1,713.69 ","$2,399.16 ","$2,087.27 ", N/A , N/A , N/A , N/A , N/A ,"$2,913.26 ", N/A ,"$3,153.18 ","$2,399.16 ","$1,738.36 ","$2,086.24 ","$2,087.27 ","$2,086.24 ","$2,368.31 ","$3,084.63 ","$2,341.58 ", N/A ,"$2,707.62 ", N/A , N/A , N/A , N/A , N/A ,"$2,467.71 ","$2,124.97 ","$2,467.71 ","$2,467.71 ","$2,741.90 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 12MM X 170MM 130 DEG,278,1 ,"$2,428.50 ","$1,602.81 ","$1,231.74 ","$2,428.50 ", N/A ,"$1,280.06 ","$1,280.06 ", N/A ,"$1,457.10 ","$2,064.23 ","$1,699.95 ", N/A , N/A ,"$2,307.08 ","$1,845.66 ","$1,821.38 ", N/A ,"$2,064.23 ", N/A , N/A , N/A ,"$1,699.95 ","$1,478.96 ", N/A , N/A , N/A , N/A , N/A ,"$2,064.23 ", N/A ,"$2,234.22 ","$1,699.95 ","$1,231.74 ","$1,478.23 ","$1,478.96 ","$1,478.23 ","$1,678.09 ","$2,185.65 ","$1,659.15 ", N/A ,"$1,918.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,748.52 ","$1,505.67 ","$1,748.52 ","$1,748.52 ","$1,942.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 170MM 130 DEG,278,1 ,"$2,428.50 ","$1,602.81 ","$1,231.74 ","$2,428.50 ", N/A ,"$1,280.06 ","$1,280.06 ", N/A ,"$1,457.10 ","$2,064.23 ","$1,699.95 ", N/A , N/A ,"$2,307.08 ","$1,845.66 ","$1,821.38 ", N/A ,"$2,064.23 ", N/A , N/A , N/A ,"$1,699.95 ","$1,478.96 ", N/A , N/A , N/A , N/A , N/A ,"$2,064.23 ", N/A ,"$2,234.22 ","$1,699.95 ","$1,231.74 ","$1,478.23 ","$1,478.96 ","$1,478.23 ","$1,678.09 ","$2,185.65 ","$1,659.15 ", N/A ,"$1,918.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,748.52 ","$1,505.67 ","$1,748.52 ","$1,748.52 ","$1,942.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 12MM X 170MM 135 DEG,278,1 ,"$2,397.99 ","$1,582.67 ","$1,216.26 ","$2,397.99 ", N/A ,"$1,263.98 ","$1,263.98 ", N/A ,"$1,438.79 ","$2,038.29 ","$1,678.59 ", N/A , N/A ,"$2,278.09 ","$1,822.47 ","$1,798.49 ", N/A ,"$2,038.29 ", N/A , N/A , N/A ,"$1,678.59 ","$1,460.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,038.29 ", N/A ,"$2,206.15 ","$1,678.59 ","$1,216.26 ","$1,459.66 ","$1,460.38 ","$1,459.66 ","$1,657.01 ","$2,158.19 ","$1,638.31 ", N/A ,"$1,894.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,726.55 ","$1,486.75 ","$1,726.55 ","$1,726.55 ","$1,918.39 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 10MM X 170MM 125 DEG,278,1 ,"$2,397.99 ","$1,582.67 ","$1,216.26 ","$2,397.99 ", N/A ,"$1,263.98 ","$1,263.98 ", N/A ,"$1,438.79 ","$2,038.29 ","$1,678.59 ", N/A , N/A ,"$2,278.09 ","$1,822.47 ","$1,798.49 ", N/A ,"$2,038.29 ", N/A , N/A , N/A ,"$1,678.59 ","$1,460.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,038.29 ", N/A ,"$2,206.15 ","$1,678.59 ","$1,216.26 ","$1,459.66 ","$1,460.38 ","$1,459.66 ","$1,657.01 ","$2,158.19 ","$1,638.31 ", N/A ,"$1,894.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,726.55 ","$1,486.75 ","$1,726.55 ","$1,726.55 ","$1,918.39 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 10MM X 170MM 135 DEG,278,1 ,"$2,397.99 ","$1,582.67 ","$1,216.26 ","$2,397.99 ", N/A ,"$1,263.98 ","$1,263.98 ", N/A ,"$1,438.79 ","$2,038.29 ","$1,678.59 ", N/A , N/A ,"$2,278.09 ","$1,822.47 ","$1,798.49 ", N/A ,"$2,038.29 ", N/A , N/A , N/A ,"$1,678.59 ","$1,460.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,038.29 ", N/A ,"$2,206.15 ","$1,678.59 ","$1,216.26 ","$1,459.66 ","$1,460.38 ","$1,459.66 ","$1,657.01 ","$2,158.19 ","$1,638.31 ", N/A ,"$1,894.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,726.55 ","$1,486.75 ","$1,726.55 ","$1,726.55 ","$1,918.39 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 170MM 125 DEG,278,1 ,"$2,397.99 ","$1,582.67 ","$1,216.26 ","$2,397.99 ", N/A ,"$1,263.98 ","$1,263.98 ", N/A ,"$1,438.79 ","$2,038.29 ","$1,678.59 ", N/A , N/A ,"$2,278.09 ","$1,822.47 ","$1,798.49 ", N/A ,"$2,038.29 ", N/A , N/A , N/A ,"$1,678.59 ","$1,460.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,038.29 ", N/A ,"$2,206.15 ","$1,678.59 ","$1,216.26 ","$1,459.66 ","$1,460.38 ","$1,459.66 ","$1,657.01 ","$2,158.19 ","$1,638.31 ", N/A ,"$1,894.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,726.55 ","$1,486.75 ","$1,726.55 ","$1,726.55 ","$1,918.39 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 170MM 135 DEG,278,1 ,"$2,397.99 ","$1,582.67 ","$1,216.26 ","$2,397.99 ", N/A ,"$1,263.98 ","$1,263.98 ", N/A ,"$1,438.79 ","$2,038.29 ","$1,678.59 ", N/A , N/A ,"$2,278.09 ","$1,822.47 ","$1,798.49 ", N/A ,"$2,038.29 ", N/A , N/A , N/A ,"$1,678.59 ","$1,460.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,038.29 ", N/A ,"$2,206.15 ","$1,678.59 ","$1,216.26 ","$1,459.66 ","$1,460.38 ","$1,459.66 ","$1,657.01 ","$2,158.19 ","$1,638.31 ", N/A ,"$1,894.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,726.55 ","$1,486.75 ","$1,726.55 ","$1,726.55 ","$1,918.39 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 12MM X 170MM 125 DEG,278,1 ,"$2,397.99 ","$1,582.67 ","$1,216.26 ","$2,397.99 ", N/A ,"$1,263.98 ","$1,263.98 ", N/A ,"$1,438.79 ","$2,038.29 ","$1,678.59 ", N/A , N/A ,"$2,278.09 ","$1,822.47 ","$1,798.49 ", N/A ,"$2,038.29 ", N/A , N/A , N/A ,"$1,678.59 ","$1,460.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,038.29 ", N/A ,"$2,206.15 ","$1,678.59 ","$1,216.26 ","$1,459.66 ","$1,460.38 ","$1,459.66 ","$1,657.01 ","$2,158.19 ","$1,638.31 ", N/A ,"$1,894.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,726.55 ","$1,486.75 ","$1,726.55 ","$1,726.55 ","$1,918.39 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 12MM X 440MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 300MM 130 DEG LT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 300MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 320MM 130 DEG LT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 320MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 340MM 130 DEG LT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 340MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 380MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 400MM 130 DEG LT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 420MM 130 DEG LT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 420MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 440MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 11MM X 460MM 130 DEG LT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 12MM X 320MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 12MM X 340MM 130 DEG LT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 12MM X 340MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 12MM X 360MM 130 DEG LT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES TI FIX 12MM X 400MM 130 DEG RT,278,1 ,"$3,156.09 ","$2,083.02 ","$1,578.05 ","$3,156.09 ", N/A ,"$1,663.58 ","$1,663.58 ", N/A ,"$1,893.65 ","$2,682.68 ","$2,209.26 ", N/A , N/A ,"$2,998.29 ","$2,398.63 ","$2,367.07 ","$1,578.05 ","$2,682.68 ", N/A ,"$1,578.05 ","$1,578.05 ","$2,209.26 ","$1,922.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,682.68 ", N/A ,"$2,903.60 ","$2,209.26 ","$1,600.77 ","$1,921.11 ","$1,922.06 ","$1,921.11 ","$2,180.86 ","$2,840.48 ","$2,156.24 ", N/A ,"$2,493.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,272.38 ","$1,956.78 ","$2,272.38 ","$2,272.38 ","$2,524.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 420MM/RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI RECON FEM -EX/300MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI RECON FEM -EX/300MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI RECON FEM -EX/360MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI RECON FEM -EX/360MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 10MM TI RECON FEM -EX/380MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI RECON FEM -EX/300MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI RECON FEM -EX/300MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 11MM TI RECON FEM -EX/340MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/300MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/300MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/320MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/320MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/340MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/340MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/360MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/360MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/380MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/380MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/400MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/400MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 12MM TI RECON FEM -EX/420MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/320MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/320MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/340MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/360MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/360MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/380MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/400MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/400MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/420MM LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL SYNTHES 13MM TI RECON FEM -EX/420MM RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 10MM  X 320MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 10MM  X 320MM/RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 10MM  X 340MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 10MM  X 340MM/RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 10MM  X 380MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 10MM  X 400MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 10MM  X 400MM/RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 10MM  X 420MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 10MM  X 420MM/RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 320MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 320MM/RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 340MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 360MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 360MM/RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 380MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 380MM/RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 400MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 400MM/RT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 11MM  X 420MM/LT,278,1 ,"$2,859.50 ","$1,887.27 ","$1,429.75 ","$2,859.50 ", N/A ,"$1,507.24 ","$1,507.24 ", N/A ,"$1,715.70 ","$2,430.58 ","$2,001.65 ", N/A , N/A ,"$2,716.53 ","$2,173.22 ","$2,144.63 ","$1,429.75 ","$2,430.58 ", N/A ,"$1,429.75 ","$1,429.75 ","$2,001.65 ","$1,741.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,430.58 ", N/A ,"$2,630.74 ","$2,001.65 ","$1,450.34 ","$1,740.58 ","$1,741.44 ","$1,740.58 ","$1,975.91 ","$2,573.55 ","$1,953.61 ", N/A ,"$2,259.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,058.84 ","$1,772.89 ","$2,058.84 ","$2,058.84 ","$2,287.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NAIL-EX SYNTHES LATERAL ENTRY FEMORAL RECON TI 12MM  X 420MM/LT,278,1 ,"$3,267.54 ","$2,156.58 ","$1,633.77 ","$3,267.54 ", N/A ,"$1,722.32 ","$1,722.32 ", N/A ,"$1,960.52 ","$2,777.41 ","$2,287.28 ", N/A , N/A ,"$3,104.16 ","$2,483.33 ","$2,450.66 ","$1,633.77 ","$2,777.41 ", N/A ,"$1,633.77 ","$1,633.77 ","$2,287.28 ","$1,989.93 ", N/A , N/A , N/A , N/A , N/A ,"$2,777.41 ", N/A ,"$3,006.14 ","$2,287.28 ","$1,657.30 ","$1,988.95 ","$1,989.93 ","$1,988.95 ","$2,257.87 ","$2,940.79 ","$2,232.38 ", N/A ,"$2,581.36 ", N/A , N/A , N/A , N/A , N/A ,"$2,352.63 ","$2,025.87 ","$2,352.63 ","$2,352.63 ","$2,614.03 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NUT SPINAL 3/8IN MCC HEXAGON TITANIUM,278,1 ,$281.25 ,$185.63 ,$142.65 ,$281.25 , N/A , N/A , N/A , N/A ,$168.75 ,$239.06 ,$196.88 , N/A , N/A ,$267.19 ,$213.75 ,$210.94 , N/A ,$239.06 , N/A , N/A , N/A ,$196.88 ,$171.28 , N/A , N/A , N/A , N/A , N/A ,$239.06 , N/A ,$258.75 ,$196.88 ,$142.65 ,$171.20 ,$171.28 ,$171.20 ,$194.34 ,$253.13 ,$192.15 , N/A ,$222.19 , N/A , N/A , N/A , N/A , N/A ,$202.50 ,$174.38 ,$202.50 ,$202.50 ,$225.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,NUT SYNTHES SPRING LOADED,278,1 ,$77.56 ,$51.19 ,$39.34 ,$77.56 , N/A , N/A , N/A , N/A ,$46.54 ,$65.93 ,$54.29 , N/A , N/A ,$73.68 ,$58.95 ,$58.17 , N/A ,$65.93 , N/A , N/A , N/A ,$54.29 ,$47.23 , N/A , N/A , N/A , N/A , N/A ,$65.93 , N/A ,$71.36 ,$54.29 ,$39.34 ,$47.21 ,$47.23 ,$47.21 ,$53.59 ,$69.80 ,$52.99 , N/A ,$61.27 , N/A , N/A , N/A , N/A , N/A ,$55.84 ,$48.09 ,$55.84 ,$55.84 ,$62.05 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN DISTRACTION 16MM CASPAR CERVICAL SELF DRILLING STERILE DISPOSABLE,278,1 ,$169.43 ,$111.82 ,$85.93 ,$169.43 , N/A , N/A , N/A , N/A ,$101.66 ,$144.02 ,$118.60 , N/A , N/A ,$160.96 ,$128.77 ,$127.07 , N/A ,$144.02 , N/A , N/A , N/A ,$118.60 ,$103.18 , N/A , N/A , N/A , N/A , N/A ,$144.02 , N/A ,$155.88 ,$118.60 ,$85.93 ,$103.13 ,$103.18 ,$103.13 ,$117.08 ,$152.49 ,$115.75 , N/A ,$133.85 , N/A , N/A , N/A , N/A , N/A ,$121.99 ,$105.05 ,$121.99 ,$121.99 ,$135.54 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 1.1MM ORTHOLOC 3DI SMALL TEMPORARY DISPOSABLE,278,1 ,$186.75 ,$123.26 ,$94.72 ,$186.75 , N/A , N/A , N/A , N/A ,$112.05 ,$158.74 ,$130.73 , N/A , N/A ,$177.41 ,$141.93 ,$140.06 , N/A ,$158.74 , N/A , N/A , N/A ,$130.73 ,$113.73 , N/A , N/A , N/A , N/A , N/A ,$158.74 , N/A ,$171.81 ,$130.73 ,$94.72 ,$113.67 ,$113.73 ,$113.67 ,$129.04 ,$168.08 ,$127.59 , N/A ,$147.53 , N/A , N/A , N/A , N/A , N/A ,$134.46 ,$115.79 ,$134.46 ,$134.46 ,$149.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 2.4MM STEINMANN,278,1 ,$56.25 ,$37.13 ,$28.53 ,$56.25 , N/A , N/A , N/A , N/A ,$33.75 ,$47.81 ,$39.38 , N/A , N/A ,$53.44 ,$42.75 ,$42.19 , N/A ,$47.81 , N/A , N/A , N/A ,$39.38 ,$34.26 , N/A , N/A , N/A , N/A , N/A ,$47.81 , N/A ,$51.75 ,$39.38 ,$28.53 ,$34.24 ,$34.26 ,$34.24 ,$38.87 ,$50.63 ,$38.43 , N/A ,$44.44 , N/A , N/A , N/A , N/A , N/A ,$40.50 ,$34.88 ,$40.50 ,$40.50 ,$45.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 200MM 5MM STEINMANN STAINLESS STEEL LARGE EXTERNAL FIXATOR NONSTERILE,278,1 ,$173.25 ,$114.35 ,$87.87 ,$173.25 , N/A , N/A , N/A , N/A ,$103.95 ,$147.26 ,$121.28 , N/A , N/A ,$164.59 ,$131.67 ,$129.94 , N/A ,$147.26 , N/A , N/A , N/A ,$121.28 ,$105.51 , N/A , N/A , N/A , N/A , N/A ,$147.26 , N/A ,$159.39 ,$121.28 ,$87.87 ,$105.46 ,$105.51 ,$105.46 ,$119.72 ,$155.93 ,$118.36 , N/A ,$136.87 , N/A , N/A , N/A , N/A , N/A ,$124.74 ,$107.42 ,$124.74 ,$124.74 ,$138.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 300MM 5MM STEINMANN STAINLESS STEEL CENTRAL THREAD MR CONDITIONAL LARGE EXTERNAL FIXATOR NONSTERILE,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 44MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 48MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 52MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 56MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 60MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 32MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 36MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 40MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 14MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 16MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 18MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 22MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 26MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 30MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 42MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 58MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 20MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 22MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 24MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 28MM,278,1 ,$302.40 ,$199.58 ,$153.38 ,$302.40 , N/A , N/A , N/A , N/A ,$181.44 ,$257.04 ,$211.68 , N/A , N/A ,$287.28 ,$229.82 ,$226.80 , N/A ,$257.04 , N/A , N/A , N/A ,$211.68 ,$184.16 , N/A , N/A , N/A , N/A , N/A ,$257.04 , N/A ,$278.21 ,$211.68 ,$153.38 ,$184.07 ,$184.16 ,$184.07 ,$208.96 ,$272.16 ,$206.60 , N/A ,$238.90 , N/A , N/A , N/A , N/A , N/A ,$217.73 ,$187.49 ,$217.73 ,$217.73 ,$241.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 50MM 1.3MM ORTHOSORB KIRSCHNER TAPER STAINLESS STEEL ATTACH DRILL RESORBABLE STERILE,278,1 ,$317.25 ,$209.39 ,$160.91 ,$317.25 , N/A , N/A , N/A , N/A ,$190.35 ,$269.66 ,$222.08 , N/A , N/A ,$301.39 ,$241.11 ,$237.94 , N/A ,$269.66 , N/A , N/A , N/A ,$222.08 ,$193.21 , N/A , N/A , N/A , N/A , N/A ,$269.66 , N/A ,$291.87 ,$222.08 ,$160.91 ,$193.11 ,$193.21 ,$193.11 ,$219.22 ,$285.53 ,$216.75 , N/A ,$250.63 , N/A , N/A , N/A , N/A , N/A ,$228.42 ,$196.70 ,$228.42 ,$228.42 ,$253.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 9IN 3/16IN STEINMANN BRASSELER USA STAINLESS STEEL 1 TROCAR SMOOTH PLAIN NONSTERILE,278,1 ,$9.82 ,$6.48 ,$4.98 ,$9.82 , N/A , N/A , N/A , N/A ,$5.89 ,$8.35 ,$6.87 , N/A , N/A ,$9.33 ,$7.46 ,$7.37 , N/A ,$8.35 , N/A , N/A , N/A ,$6.87 ,$5.98 , N/A , N/A , N/A , N/A , N/A ,$8.35 , N/A ,$9.03 ,$6.87 ,$4.98 ,$5.98 ,$5.98 ,$5.98 ,$6.79 ,$8.84 ,$6.71 , N/A ,$7.76 , N/A , N/A , N/A , N/A , N/A ,$7.07 ,$6.09 ,$7.07 ,$7.07 ,$7.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 9IN 5/64IN STEINMANN BRASSELER USA STAINLESS STEEL 1 TROCAR SMOOTH PLAIN NONSTERILE,278,1 ,$6.21 ,$4.10 ,$3.15 ,$6.21 , N/A , N/A , N/A , N/A ,$3.73 ,$5.28 ,$4.35 , N/A , N/A ,$5.90 ,$4.72 ,$4.66 , N/A ,$5.28 , N/A , N/A , N/A ,$4.35 ,$3.78 , N/A , N/A , N/A , N/A , N/A ,$5.28 , N/A ,$5.71 ,$4.35 ,$3.15 ,$3.78 ,$3.78 ,$3.78 ,$4.29 ,$5.59 ,$4.24 , N/A ,$4.91 , N/A , N/A , N/A , N/A , N/A ,$4.47 ,$3.85 ,$4.47 ,$4.47 ,$4.97 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 9IN 3/32IN STEINMANN BRASSELER USA STAINLESS STEEL 1 TROCAR SMOOTH PLAIN NONSTERILE,278,1 ,$6.21 ,$4.10 ,$3.15 ,$6.21 , N/A , N/A , N/A , N/A ,$3.73 ,$5.28 ,$4.35 , N/A , N/A ,$5.90 ,$4.72 ,$4.66 , N/A ,$5.28 , N/A , N/A , N/A ,$4.35 ,$3.78 , N/A , N/A , N/A , N/A , N/A ,$5.28 , N/A ,$5.71 ,$4.35 ,$3.15 ,$3.78 ,$3.78 ,$3.78 ,$4.29 ,$5.59 ,$4.24 , N/A ,$4.91 , N/A , N/A , N/A , N/A , N/A ,$4.47 ,$3.85 ,$4.47 ,$4.47 ,$4.97 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN SYNTHES 1.8 TI BUTTRESS 18MM,278,1 ,$128.36 ,$84.72 ,$65.10 ,$128.36 , N/A , N/A , N/A , N/A ,$77.02 ,$109.11 ,$89.85 , N/A , N/A ,$121.94 ,$97.55 ,$96.27 , N/A ,$109.11 , N/A , N/A , N/A ,$89.85 ,$78.17 , N/A , N/A , N/A , N/A , N/A ,$109.11 , N/A ,$118.09 ,$89.85 ,$65.10 ,$78.13 ,$78.17 ,$78.13 ,$88.70 ,$115.52 ,$87.70 , N/A ,$101.40 , N/A , N/A , N/A , N/A , N/A ,$92.42 ,$79.58 ,$92.42 ,$92.42 ,$102.69 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN SYNTHES 4.5 CERCLAGE POSITIONING,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN SYNTHES 3.5 CERCLAGE POSITIONING,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN SYNTHES 3.5 THRD CERCLAGE POSITIONING,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 100MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 105MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 110MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 115MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 120MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 125MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 130MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 60MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 65MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 70MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 75MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 80MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 85MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 90MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 TI RECON STARDRIVE 95MM,278,1 ,$384.30 ,$253.64 ,$194.92 ,$384.30 , N/A , N/A , N/A , N/A ,$230.58 ,$326.66 ,$269.01 , N/A , N/A ,$365.09 ,$292.07 ,$288.23 , N/A ,$326.66 , N/A , N/A , N/A ,$269.01 ,$234.04 , N/A , N/A , N/A , N/A , N/A ,$326.66 , N/A ,$353.56 ,$269.01 ,$194.92 ,$233.92 ,$234.04 ,$233.92 ,$265.55 ,$345.87 ,$262.55 , N/A ,$303.60 , N/A , N/A , N/A , N/A , N/A ,$276.70 ,$238.27 ,$276.70 ,$276.70 ,$307.44 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN SYNTHES 4.5 THRD CERCLAGE POSITIONING,278,1 ,$379.13 ,$250.23 ,$192.29 ,$379.13 , N/A , N/A , N/A , N/A ,$227.48 ,$322.26 ,$265.39 , N/A , N/A ,$360.17 ,$288.14 ,$284.35 , N/A ,$322.26 , N/A , N/A , N/A ,$265.39 ,$230.89 , N/A , N/A , N/A , N/A , N/A ,$322.26 , N/A ,$348.80 ,$265.39 ,$192.29 ,$230.78 ,$230.89 ,$230.78 ,$261.98 ,$341.22 ,$259.02 , N/A ,$299.51 , N/A , N/A , N/A , N/A , N/A ,$272.97 ,$235.06 ,$272.97 ,$272.97 ,$303.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE 135D STANDARD BARREL 180MM STAINLESS STEEL 8 HOLE COMPRESSION AMBI CHS BONE 38.1MM HIP STERILE,278,1 ,"$1,574.71 ","$1,039.31 ",$798.69 ,"$1,574.71 ", N/A ,$830.03 ,$830.03 , N/A ,$944.83 ,"$1,338.50 ","$1,102.30 ", N/A , N/A ,"$1,495.97 ","$1,196.78 ","$1,181.03 ", N/A ,"$1,338.50 ", N/A , N/A , N/A ,"$1,102.30 ",$959.00 , N/A , N/A , N/A , N/A , N/A ,"$1,338.50 ", N/A ,"$1,448.73 ","$1,102.30 ",$798.69 ,$958.53 ,$959.00 ,$958.53 ,"$1,088.12 ","$1,417.24 ","$1,075.84 ", N/A ,"$1,244.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,133.79 ",$976.32 ,"$1,133.79 ","$1,133.79 ","$1,259.77 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE 135D STANDARD BARREL 60MM STAINLESS STEEL 2 HOLE COMPRESSION AMBI CHS BONE 38.1MM HIP STERILE,278,1 ,"$1,132.15 ",$747.22 ,$574.23 ,"$1,132.15 ", N/A ,$596.76 ,$596.76 , N/A ,$679.29 ,$962.33 ,$792.51 , N/A , N/A ,"$1,075.54 ",$860.43 ,$849.11 , N/A ,$962.33 , N/A , N/A , N/A ,$792.51 ,$689.48 , N/A , N/A , N/A , N/A , N/A ,$962.33 , N/A ,"$1,041.58 ",$792.51 ,$574.23 ,$689.14 ,$689.48 ,$689.14 ,$782.32 ,"$1,018.94 ",$773.48 , N/A ,$894.40 , N/A , N/A , N/A , N/A , N/A ,$815.15 ,$701.93 ,$815.15 ,$815.15 ,$905.72 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE 130D STANDARD BARREL 60MM STAINLESS STEEL 2 HOLE COMPRESSION AMBI CHS BONE 38.1MM HIP STERILE,278,1 ,"$1,132.15 ",$747.22 ,$574.23 ,"$1,132.15 ", N/A ,$596.76 ,$596.76 , N/A ,$679.29 ,$962.33 ,$792.51 , N/A , N/A ,"$1,075.54 ",$860.43 ,$849.11 , N/A ,$962.33 , N/A , N/A , N/A ,$792.51 ,$689.48 , N/A , N/A , N/A , N/A , N/A ,$962.33 , N/A ,"$1,041.58 ",$792.51 ,$574.23 ,$689.14 ,$689.48 ,$689.14 ,$782.32 ,"$1,018.94 ",$773.48 , N/A ,$894.40 , N/A , N/A , N/A , N/A , N/A ,$815.15 ,$701.93 ,$815.15 ,$815.15 ,$905.72 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE 90D 244MM STAINLESS STEEL 12 HOLE COMPRESSION AMBI CHS BONE 25.4MM HIP SUPRACONDYLAR STERILE,278,1 ,"$1,996.19 ","$1,317.49 ","$1,012.47 ","$1,996.19 ", N/A ,"$1,052.19 ","$1,052.19 ", N/A ,"$1,197.71 ","$1,696.76 ","$1,397.33 ", N/A , N/A ,"$1,896.38 ","$1,517.10 ","$1,497.14 ", N/A ,"$1,696.76 ", N/A , N/A , N/A ,"$1,397.33 ","$1,215.68 ", N/A , N/A , N/A , N/A , N/A ,"$1,696.76 ", N/A ,"$1,836.49 ","$1,397.33 ","$1,012.47 ","$1,215.08 ","$1,215.68 ","$1,215.08 ","$1,379.37 ","$1,796.57 ","$1,363.80 ", N/A ,"$1,576.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.26 ","$1,237.64 ","$1,437.26 ","$1,437.26 ","$1,596.95 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE A STAINLESS STEEL TRP SERIES HALF SLOT VSP BONE SPINE,278,1 ,"$2,289.50 ","$1,511.07 ","$1,161.23 ","$2,289.50 ", N/A ,"$1,206.80 ","$1,206.80 ", N/A ,"$1,373.70 ","$1,946.08 ","$1,602.65 ", N/A , N/A ,"$2,175.03 ","$1,740.02 ","$1,717.13 ", N/A ,"$1,946.08 ", N/A , N/A , N/A ,"$1,602.65 ","$1,394.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,946.08 ", N/A ,"$2,106.34 ","$1,602.65 ","$1,161.23 ","$1,393.62 ","$1,394.31 ","$1,393.62 ","$1,582.04 ","$2,060.55 ","$1,564.19 ", N/A ,"$1,808.71 ", N/A , N/A , N/A , N/A , N/A ,"$1,648.44 ","$1,419.49 ","$1,648.44 ","$1,648.44 ","$1,831.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE ARTHREX LOW PROFILE LAPIDUS,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE CHS SMITH  AND  NEPHEW 150 DEGREE 4 SLOTS 100MM,278,1 ,$659.84 ,$435.49 ,$334.67 ,$659.84 , N/A , N/A , N/A , N/A ,$395.90 ,$560.86 ,$461.89 , N/A , N/A ,$626.85 ,$501.48 ,$494.88 , N/A ,$560.86 , N/A , N/A , N/A ,$461.89 ,$401.84 , N/A , N/A , N/A , N/A , N/A ,$560.86 , N/A ,$607.05 ,$461.89 ,$334.67 ,$401.64 ,$401.84 ,$401.64 ,$455.95 ,$593.86 ,$450.80 , N/A ,$521.27 , N/A , N/A , N/A , N/A , N/A ,$475.08 ,$409.10 ,$475.08 ,$475.08 ,$527.87 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE MEDIUM 25-40MM TITANIUM MULTISPAN D MCC ISOLA BONE SPINE,278,1 ,$757.88 ,$500.20 ,$384.40 ,$757.88 , N/A , N/A , N/A , N/A ,$454.73 ,$644.20 ,$530.52 , N/A , N/A ,$719.99 ,$575.99 ,$568.41 , N/A ,$644.20 , N/A , N/A , N/A ,$530.52 ,$461.55 , N/A , N/A , N/A , N/A , N/A ,$644.20 , N/A ,$697.25 ,$530.52 ,$384.40 ,$461.32 ,$461.55 ,$461.32 ,$523.70 ,$682.09 ,$517.78 , N/A ,$598.73 , N/A , N/A , N/A , N/A , N/A ,$545.67 ,$469.89 ,$545.67 ,$545.67 ,$606.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE MEDIUM 30-50MM TITANIUM MULTISPAN E MCC BONE,278,1 ,$833.66 ,$550.22 ,$422.83 ,$833.66 , N/A , N/A , N/A , N/A ,$500.20 ,$708.61 ,$583.56 , N/A , N/A ,$791.98 ,$633.58 ,$625.25 , N/A ,$708.61 , N/A , N/A , N/A ,$583.56 ,$507.70 , N/A , N/A , N/A , N/A , N/A ,$708.61 , N/A ,$766.97 ,$583.56 ,$422.83 ,$507.45 ,$507.70 ,$507.45 ,$576.06 ,$750.29 ,$569.56 , N/A ,$658.59 , N/A , N/A , N/A , N/A , N/A ,$600.24 ,$516.87 ,$600.24 ,$600.24 ,$666.93 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE RICHARDS AMBI 4 SLOT 135 DEG,278,1 ,"$1,165.06 ",$768.94 ,$590.92 ,"$1,165.06 ", N/A ,$614.10 ,$614.10 , N/A ,$699.04 ,$990.30 ,$815.54 , N/A , N/A ,"$1,106.81 ",$885.45 ,$873.80 , N/A ,$990.30 , N/A , N/A , N/A ,$815.54 ,$709.52 , N/A , N/A , N/A , N/A , N/A ,$990.30 , N/A ,"$1,071.86 ",$815.54 ,$590.92 ,$709.17 ,$709.52 ,$709.17 ,$805.06 ,"$1,048.55 ",$795.97 , N/A ,$920.40 , N/A , N/A , N/A , N/A , N/A ,$838.84 ,$722.34 ,$838.84 ,$838.84 ,$932.05 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE 130D STANDARD BARREL 80MM STAINLESS STEEL 3 HOLE COMPRESSION AMBI CHS BONE 38.1MM HIP STERILE,278,1 ,"$1,165.06 ",$768.94 ,$590.92 ,"$1,165.06 ", N/A ,$614.10 ,$614.10 , N/A ,$699.04 ,$990.30 ,$815.54 , N/A , N/A ,"$1,106.81 ",$885.45 ,$873.80 , N/A ,$990.30 , N/A , N/A , N/A ,$815.54 ,$709.52 , N/A , N/A , N/A , N/A , N/A ,$990.30 , N/A ,"$1,071.86 ",$815.54 ,$590.92 ,$709.17 ,$709.52 ,$709.17 ,$805.06 ,"$1,048.55 ",$795.97 , N/A ,$920.40 , N/A , N/A , N/A , N/A , N/A ,$838.84 ,$722.34 ,$838.84 ,$838.84 ,$932.05 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE 140D STANDARD BARREL 80MM STAINLESS STEEL 3 HOLE COMPRESSION AMBI CHS BONE 38.1MM HIP STERILE,278,1 ,"$1,165.06 ",$768.94 ,$590.92 ,"$1,165.06 ", N/A ,$614.10 ,$614.10 , N/A ,$699.04 ,$990.30 ,$815.54 , N/A , N/A ,"$1,106.81 ",$885.45 ,$873.80 , N/A ,$990.30 , N/A , N/A , N/A ,$815.54 ,$709.52 , N/A , N/A , N/A , N/A , N/A ,$990.30 , N/A ,"$1,071.86 ",$815.54 ,$590.92 ,$709.17 ,$709.52 ,$709.17 ,$805.06 ,"$1,048.55 ",$795.97 , N/A ,$920.40 , N/A , N/A , N/A , N/A , N/A ,$838.84 ,$722.34 ,$838.84 ,$838.84 ,$932.05 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE CHS SMITH  AND  NEPHEW 140 DEGREE 4 SLOTS 100MM,278,1 ,"$1,165.06 ",$768.94 ,$590.92 ,"$1,165.06 ", N/A ,$614.10 ,$614.10 , N/A ,$699.04 ,$990.30 ,$815.54 , N/A , N/A ,"$1,106.81 ",$885.45 ,$873.80 , N/A ,$990.30 , N/A , N/A , N/A ,$815.54 ,$709.52 , N/A , N/A , N/A , N/A , N/A ,$990.30 , N/A ,"$1,071.86 ",$815.54 ,$590.92 ,$709.17 ,$709.52 ,$709.17 ,$805.06 ,"$1,048.55 ",$795.97 , N/A ,$920.40 , N/A , N/A , N/A , N/A , N/A ,$838.84 ,$722.34 ,$838.84 ,$838.84 ,$932.05 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE CHS SMITH  AND  NEPHEW 145 DEGREE 4 SLOTS 100MM,278,1 ,"$1,165.06 ",$768.94 ,$590.92 ,"$1,165.06 ", N/A ,$614.10 ,$614.10 , N/A ,$699.04 ,$990.30 ,$815.54 , N/A , N/A ,"$1,106.81 ",$885.45 ,$873.80 , N/A ,$990.30 , N/A , N/A , N/A ,$815.54 ,$709.52 , N/A , N/A , N/A , N/A , N/A ,$990.30 , N/A ,"$1,071.86 ",$815.54 ,$590.92 ,$709.17 ,$709.52 ,$709.17 ,$805.06 ,"$1,048.55 ",$795.97 , N/A ,$920.40 , N/A , N/A , N/A , N/A , N/A ,$838.84 ,$722.34 ,$838.84 ,$838.84 ,$932.05 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE RICHARDS AMBI 3 SLOT 135 DEG,278,1 ,"$1,165.06 ",$768.94 ,$590.92 ,"$1,165.06 ", N/A ,$614.10 ,$614.10 , N/A ,$699.04 ,$990.30 ,$815.54 , N/A , N/A ,"$1,106.81 ",$885.45 ,$873.80 , N/A ,$990.30 , N/A , N/A , N/A ,$815.54 ,$709.52 , N/A , N/A , N/A , N/A , N/A ,$990.30 , N/A ,"$1,071.86 ",$815.54 ,$590.92 ,$709.17 ,$709.52 ,$709.17 ,$805.06 ,"$1,048.55 ",$795.97 , N/A ,$920.40 , N/A , N/A , N/A , N/A , N/A ,$838.84 ,$722.34 ,$838.84 ,$838.84 ,$932.05 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE RICHARDS AMBI 4 SLOT 130 DEG,278,1 ,"$1,165.06 ",$768.94 ,$590.92 ,"$1,165.06 ", N/A ,$614.10 ,$614.10 , N/A ,$699.04 ,$990.30 ,$815.54 , N/A , N/A ,"$1,106.81 ",$885.45 ,$873.80 , N/A ,$990.30 , N/A , N/A , N/A ,$815.54 ,$709.52 , N/A , N/A , N/A , N/A , N/A ,$990.30 , N/A ,"$1,071.86 ",$815.54 ,$590.92 ,$709.17 ,$709.52 ,$709.17 ,$805.06 ,"$1,048.55 ",$795.97 , N/A ,$920.40 , N/A , N/A , N/A , N/A , N/A ,$838.84 ,$722.34 ,$838.84 ,$838.84 ,$932.05 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE RICHARDS AMBI 5 SLOT 130 DEG,278,1 ,"$1,247.49 ",$823.34 ,$632.73 ,"$1,247.49 ", N/A ,$657.55 ,$657.55 , N/A ,$748.49 ,"$1,060.37 ",$873.24 , N/A , N/A ,"$1,185.12 ",$948.09 ,$935.62 , N/A ,"$1,060.37 ", N/A , N/A , N/A ,$873.24 ,$759.72 , N/A , N/A , N/A , N/A , N/A ,"$1,060.37 ", N/A ,"$1,147.69 ",$873.24 ,$632.73 ,$759.35 ,$759.72 ,$759.35 ,$862.02 ,"$1,122.74 ",$852.29 , N/A ,$985.52 , N/A , N/A , N/A , N/A , N/A ,$898.19 ,$773.44 ,$898.19 ,$898.19 ,$997.99 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE RICHARDS AMBI 5 SLOT 135 DEG,278,1 ,$560.76 ,$370.10 ,$284.42 ,$560.76 , N/A , N/A , N/A , N/A ,$336.46 ,$476.65 ,$392.53 , N/A , N/A ,$532.72 ,$426.18 ,$420.57 , N/A ,$476.65 , N/A , N/A , N/A ,$392.53 ,$341.50 , N/A , N/A , N/A , N/A , N/A ,$476.65 , N/A ,$515.90 ,$392.53 ,$284.42 ,$341.33 ,$341.50 ,$341.33 ,$387.49 ,$504.68 ,$383.11 , N/A ,$443.00 , N/A , N/A , N/A , N/A , N/A ,$403.75 ,$347.67 ,$403.75 ,$403.75 ,$448.61 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE RICHARDS AMBI 5 SLOT 140 DEG,278,1 ,$557.39 ,$367.88 ,$282.71 ,$557.39 , N/A , N/A , N/A , N/A ,$334.43 ,$473.78 ,$390.17 , N/A , N/A ,$529.52 ,$423.62 ,$418.04 , N/A ,$473.78 , N/A , N/A , N/A ,$390.17 ,$339.45 , N/A , N/A , N/A , N/A , N/A ,$473.78 , N/A ,$512.80 ,$390.17 ,$282.71 ,$339.28 ,$339.45 ,$339.28 ,$385.16 ,$501.65 ,$380.81 , N/A ,$440.34 , N/A , N/A , N/A , N/A , N/A ,$401.32 ,$345.58 ,$401.32 ,$401.32 ,$445.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE RICHARDS AMBI 5 SLOT 145 DEG,278,1 ,$705.82 ,$465.84 ,$357.99 ,$705.82 , N/A , N/A , N/A , N/A ,$423.49 ,$599.95 ,$494.07 , N/A , N/A ,$670.53 ,$536.42 ,$529.37 , N/A ,$599.95 , N/A , N/A , N/A ,$494.07 ,$429.84 , N/A , N/A , N/A , N/A , N/A ,$599.95 , N/A ,$649.35 ,$494.07 ,$357.99 ,$429.63 ,$429.84 ,$429.63 ,$487.72 ,$635.24 ,$482.22 , N/A ,$557.60 , N/A , N/A , N/A , N/A , N/A ,$508.19 ,$437.61 ,$508.19 ,$508.19 ,$564.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE RICHARDS AMBI 6 SLOT 135 DEG,278,1 ,"$1,299.58 ",$857.72 ,$659.15 ,"$1,299.58 ", N/A ,$685.01 ,$685.01 , N/A ,$779.75 ,"$1,104.64 ",$909.71 , N/A , N/A ,"$1,234.60 ",$987.68 ,$974.69 , N/A ,"$1,104.64 ", N/A , N/A , N/A ,$909.71 ,$791.44 , N/A , N/A , N/A , N/A , N/A ,"$1,104.64 ", N/A ,"$1,195.61 ",$909.71 ,$659.15 ,$791.05 ,$791.44 ,$791.05 ,$898.01 ,"$1,169.62 ",$887.87 , N/A ,"$1,026.67 ", N/A , N/A , N/A , N/A , N/A ,$935.70 ,$805.74 ,$935.70 ,$935.70 ,"$1,039.66 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE RICHARDS AMBI 6 SLOT 130 DEG,278,1 ,"$1,299.58 ",$857.72 ,$659.15 ,"$1,299.58 ", N/A ,$685.01 ,$685.01 , N/A ,$779.75 ,"$1,104.64 ",$909.71 , N/A , N/A ,"$1,234.60 ",$987.68 ,$974.69 , N/A ,"$1,104.64 ", N/A , N/A , N/A ,$909.71 ,$791.44 , N/A , N/A , N/A , N/A , N/A ,"$1,104.64 ", N/A ,"$1,195.61 ",$909.71 ,$659.15 ,$791.05 ,$791.44 ,$791.05 ,$898.01 ,"$1,169.62 ",$887.87 , N/A ,"$1,026.67 ", N/A , N/A , N/A , N/A , N/A ,$935.70 ,$805.74 ,$935.70 ,$935.70 ,"$1,039.66 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SPINE MONARCH 10MM,278,1 ,"$2,560.25 ","$1,689.77 ","$1,280.13 ","$2,560.25 ", N/A ,"$1,349.51 ","$1,349.51 ", N/A ,"$1,536.15 ","$2,176.21 ","$1,792.18 ", N/A , N/A ,"$2,432.24 ","$1,945.79 ","$1,920.19 ","$1,280.13 ","$2,176.21 ", N/A ,"$1,280.13 ","$1,280.13 ","$1,792.18 ","$1,559.19 ", N/A , N/A , N/A , N/A , N/A ,"$2,176.21 ", N/A ,"$2,355.43 ","$1,792.18 ","$1,298.56 ","$1,558.42 ","$1,559.19 ","$1,558.42 ","$1,769.13 ","$2,304.23 ","$1,749.16 ", N/A ,"$2,022.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,843.38 ","$1,587.36 ","$1,843.38 ","$1,843.38 ","$2,048.20 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SPINE MONARCH 50MM,278,1 ,"$3,519.75 ","$2,323.04 ","$1,759.88 ","$3,519.75 ", N/A ,"$1,855.26 ","$1,855.26 ", N/A ,"$2,111.85 ","$2,991.79 ","$2,463.83 ", N/A , N/A ,"$3,343.76 ","$2,675.01 ","$2,639.81 ","$1,759.88 ","$2,991.79 ", N/A ,"$1,759.88 ","$1,759.88 ","$2,463.83 ","$2,143.53 ", N/A , N/A , N/A , N/A , N/A ,"$2,991.79 ", N/A ,"$3,238.17 ","$2,463.83 ","$1,785.22 ","$2,142.47 ","$2,143.53 ","$2,142.47 ","$2,432.15 ","$3,167.78 ","$2,404.69 ", N/A ,"$2,780.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,534.22 ","$2,182.25 ","$2,534.22 ","$2,534.22 ","$2,815.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI CONDYLAR 7 HOLES/36MM-RIGHT,278,1 ,$577.92 ,$381.43 ,$293.12 ,$577.92 , N/A , N/A , N/A , N/A ,$346.75 ,$491.23 ,$404.54 , N/A , N/A ,$549.02 ,$439.22 ,$433.44 , N/A ,$491.23 , N/A , N/A , N/A ,$404.54 ,$351.95 , N/A , N/A , N/A , N/A , N/A ,$491.23 , N/A ,$531.69 ,$404.54 ,$293.12 ,$351.78 ,$351.95 ,$351.78 ,$399.34 ,$520.13 ,$394.83 , N/A ,$456.56 , N/A , N/A , N/A , N/A , N/A ,$416.10 ,$358.31 ,$416.10 ,$416.10 ,$462.34 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI CONDYLAR 7 HOLES/36MM-LEFT,278,1 ,$577.92 ,$381.43 ,$293.12 ,$577.92 , N/A , N/A , N/A , N/A ,$346.75 ,$491.23 ,$404.54 , N/A , N/A ,$549.02 ,$439.22 ,$433.44 , N/A ,$491.23 , N/A , N/A , N/A ,$404.54 ,$351.95 , N/A , N/A , N/A , N/A , N/A ,$491.23 , N/A ,$531.69 ,$404.54 ,$293.12 ,$351.78 ,$351.95 ,$351.78 ,$399.34 ,$520.13 ,$394.83 , N/A ,$456.56 , N/A , N/A , N/A , N/A , N/A ,$416.10 ,$358.31 ,$416.10 ,$416.10 ,$462.34 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI STRAIGHT  12 HOLES/59MM,278,1 ,$498.16 ,$328.79 ,$252.67 ,$498.16 , N/A , N/A , N/A , N/A ,$298.90 ,$423.44 ,$348.71 , N/A , N/A ,$473.25 ,$378.60 ,$373.62 , N/A ,$423.44 , N/A , N/A , N/A ,$348.71 ,$303.38 , N/A , N/A , N/A , N/A , N/A ,$423.44 , N/A ,$458.31 ,$348.71 ,$252.67 ,$303.23 ,$303.38 ,$303.23 ,$344.23 ,$448.34 ,$340.34 , N/A ,$393.55 , N/A , N/A , N/A , N/A , N/A ,$358.68 ,$308.86 ,$358.68 ,$358.68 ,$398.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI STRAIGHT  6 HOLES/29MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 10MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 11MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 12MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 13MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 14MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 15MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 16MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 17MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 18MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 19MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 20MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 22MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 24MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 26MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 28MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN LONG THREAD 30MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN SHORT THREAD 17MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN SHORT THREAD 18MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN SHORT THREAD 19MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN SHORT THREAD 20MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN SHORT THREAD 22MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN SHORT THREAD 24MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN SHORT THREAD 26MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN SHORT THREAD 28MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4MM CANN SHORT THREAD 30MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.3MM TI STRAIGHT 6 HOLES/23MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 16MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 18MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 22MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 32MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 36MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 52MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 54MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 56MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 58MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 60MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 64MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 68MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 72MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 10MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 16MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 52MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 54MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 56MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 58MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 60MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 64MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 68MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 72MM,278,1 ,$412.65 ,$272.35 ,$209.30 ,$412.65 , N/A , N/A , N/A , N/A ,$247.59 ,$350.75 ,$288.86 , N/A , N/A ,$392.02 ,$313.61 ,$309.49 , N/A ,$350.75 , N/A , N/A , N/A ,$288.86 ,$251.30 , N/A , N/A , N/A , N/A , N/A ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 , N/A , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI STRAIGHT 20 HOLES/100MM,278,1 ,$483.11 ,$318.85 ,$245.03 ,$483.11 , N/A , N/A , N/A , N/A ,$289.87 ,$410.64 ,$338.18 , N/A , N/A ,$458.95 ,$367.16 ,$362.33 , N/A ,$410.64 , N/A , N/A , N/A ,$338.18 ,$294.21 , N/A , N/A , N/A , N/A , N/A ,$410.64 , N/A ,$444.46 ,$338.18 ,$245.03 ,$294.07 ,$294.21 ,$294.07 ,$333.83 ,$434.80 ,$330.06 , N/A ,$381.66 , N/A , N/A , N/A , N/A , N/A ,$347.84 ,$299.53 ,$347.84 ,$347.84 ,$386.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI T  3 HOLES HEAD/ 9 HOLES/50MM,278,1 ,$437.85 ,$288.98 ,$222.08 ,$437.85 , N/A , N/A , N/A , N/A ,$262.71 ,$372.17 ,$306.50 , N/A , N/A ,$415.96 ,$332.77 ,$328.39 , N/A ,$372.17 , N/A , N/A , N/A ,$306.50 ,$266.65 , N/A , N/A , N/A , N/A , N/A ,$372.17 , N/A ,$402.82 ,$306.50 ,$222.08 ,$266.52 ,$266.65 ,$266.52 ,$302.55 ,$394.07 ,$299.14 , N/A ,$345.90 , N/A , N/A , N/A , N/A , N/A ,$315.25 ,$271.47 ,$315.25 ,$315.25 ,$350.28 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI Y 3 X 8 HOLES,278,1 ,$456.02 ,$300.97 ,$231.29 ,$456.02 , N/A , N/A , N/A , N/A ,$273.61 ,$387.62 ,$319.21 , N/A , N/A ,$433.22 ,$346.58 ,$342.02 , N/A ,$387.62 , N/A , N/A , N/A ,$319.21 ,$277.72 , N/A , N/A , N/A , N/A , N/A ,$387.62 , N/A ,$419.54 ,$319.21 ,$231.29 ,$277.58 ,$277.72 ,$277.58 ,$315.11 ,$410.42 ,$311.55 , N/A ,$360.26 , N/A , N/A , N/A , N/A , N/A ,$328.33 ,$282.73 ,$328.33 ,$328.33 ,$364.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.3 TI T 3 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$456.02 ,$300.97 ,$231.29 ,$456.02 , N/A , N/A , N/A , N/A ,$273.61 ,$387.62 ,$319.21 , N/A , N/A ,$433.22 ,$346.58 ,$342.02 , N/A ,$387.62 , N/A , N/A , N/A ,$319.21 ,$277.72 , N/A , N/A , N/A , N/A , N/A ,$387.62 , N/A ,$419.54 ,$319.21 ,$231.29 ,$277.58 ,$277.72 ,$277.58 ,$315.11 ,$410.42 ,$311.55 , N/A ,$360.26 , N/A , N/A , N/A , N/A , N/A ,$328.33 ,$282.73 ,$328.33 ,$328.33 ,$364.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.3 TI Y 3 HOLES HEAD/ 8 HOLES SHAFT/32MM,278,1 ,$456.02 ,$300.97 ,$231.29 ,$456.02 , N/A , N/A , N/A , N/A ,$273.61 ,$387.62 ,$319.21 , N/A , N/A ,$433.22 ,$346.58 ,$342.02 , N/A ,$387.62 , N/A , N/A , N/A ,$319.21 ,$277.72 , N/A , N/A , N/A , N/A , N/A ,$387.62 , N/A ,$419.54 ,$319.21 ,$231.29 ,$277.58 ,$277.72 ,$277.58 ,$315.11 ,$410.42 ,$311.55 , N/A ,$360.26 , N/A , N/A , N/A , N/A , N/A ,$328.33 ,$282.73 ,$328.33 ,$328.33 ,$364.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI T 3 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$456.02 ,$300.97 ,$231.29 ,$456.02 , N/A , N/A , N/A , N/A ,$273.61 ,$387.62 ,$319.21 , N/A , N/A ,$433.22 ,$346.58 ,$342.02 , N/A ,$387.62 , N/A , N/A , N/A ,$319.21 ,$277.72 , N/A , N/A , N/A , N/A , N/A ,$387.62 , N/A ,$419.54 ,$319.21 ,$231.29 ,$277.58 ,$277.72 ,$277.58 ,$315.11 ,$410.42 ,$311.55 , N/A ,$360.26 , N/A , N/A , N/A , N/A , N/A ,$328.33 ,$282.73 ,$328.33 ,$328.33 ,$364.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI T 4 HOLES HEAD/ 9 HOLES/50MM,278,1 ,$456.02 ,$300.97 ,$231.29 ,$456.02 , N/A , N/A , N/A , N/A ,$273.61 ,$387.62 ,$319.21 , N/A , N/A ,$433.22 ,$346.58 ,$342.02 , N/A ,$387.62 , N/A , N/A , N/A ,$319.21 ,$277.72 , N/A , N/A , N/A , N/A , N/A ,$387.62 , N/A ,$419.54 ,$319.21 ,$231.29 ,$277.58 ,$277.72 ,$277.58 ,$315.11 ,$410.42 ,$311.55 , N/A ,$360.26 , N/A , N/A , N/A , N/A , N/A ,$328.33 ,$282.73 ,$328.33 ,$328.33 ,$364.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1/3 TUBULAR LCP W/COLLAR 6 HOLE,278,1 ,$338.47 ,$223.39 ,$171.67 ,$338.47 , N/A , N/A , N/A , N/A ,$203.08 ,$287.70 ,$236.93 , N/A , N/A ,$321.55 ,$257.24 ,$253.85 , N/A ,$287.70 , N/A , N/A , N/A ,$236.93 ,$206.13 , N/A , N/A , N/A , N/A , N/A ,$287.70 , N/A ,$311.39 ,$236.93 ,$171.67 ,$206.03 ,$206.13 ,$206.03 ,$233.88 ,$304.62 ,$231.24 , N/A ,$267.39 , N/A , N/A , N/A , N/A , N/A ,$243.70 ,$209.85 ,$243.70 ,$243.70 ,$270.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 5 HOLE,278,1 ,$338.47 ,$223.39 ,$171.67 ,$338.47 , N/A , N/A , N/A , N/A ,$203.08 ,$287.70 ,$236.93 , N/A , N/A ,$321.55 ,$257.24 ,$253.85 , N/A ,$287.70 , N/A , N/A , N/A ,$236.93 ,$206.13 , N/A , N/A , N/A , N/A , N/A ,$287.70 , N/A ,$311.39 ,$236.93 ,$171.67 ,$206.03 ,$206.13 ,$206.03 ,$233.88 ,$304.62 ,$231.24 , N/A ,$267.39 , N/A , N/A , N/A , N/A , N/A ,$243.70 ,$209.85 ,$243.70 ,$243.70 ,$270.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 150 DEG STD BARREL 4 HOLE/78MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 130 DEG STD BARREL 3H 62MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 130 DEG STD BARREL 4H 78MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 130 DEG STD BARREL 5H 94MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 130 DEG STD BARREL 6H 110MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 135 DEG SHORT BARREL 4 HOLE/78MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 135 DEG STD BARREL 3 HOLE/62MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 135 DEG STD BARREL 4 HOLE/78MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 135 DEG STD BARREL 5 HOLE/94MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 135 DEG STD BARREL 6 HOLE/110MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 140 DEG STD BARREL 3 HOLE/62MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 140 DEG STD BARREL 4 HOLE/78MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 140 DEG STD BARREL 5 HOLE/94MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 140 DEG STD BARREL 6 HOLE/110MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 145 DEG STD BARREL 3 HOLE/62MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 145 DEG STD BARREL 4 HOLE/78MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 145 DEG STD BARREL 5 HOLE/94MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 145 DEG STD BARREL 6 HOLE/110MM,278,1 ,"$1,024.59 ",$676.23 ,$519.67 ,"$1,024.59 ", N/A ,$540.06 ,$540.06 , N/A ,$614.75 ,$870.90 ,$717.21 , N/A , N/A ,$973.36 ,$778.69 ,$768.44 , N/A ,$870.90 , N/A , N/A , N/A ,$717.21 ,$623.98 , N/A , N/A , N/A , N/A , N/A ,$870.90 , N/A ,$942.62 ,$717.21 ,$519.67 ,$623.67 ,$623.98 ,$623.67 ,$707.99 ,$922.13 ,$700.00 , N/A ,$809.43 , N/A , N/A , N/A , N/A , N/A ,$737.70 ,$635.25 ,$737.70 ,$737.70 ,$819.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 LCP 12H/81MM ADAPTION,278,1 ,$832.27 ,$549.30 ,$422.13 ,$832.27 , N/A , N/A , N/A , N/A ,$499.36 ,$707.43 ,$582.59 , N/A , N/A ,$790.66 ,$632.53 ,$624.20 , N/A ,$707.43 , N/A , N/A , N/A ,$582.59 ,$506.85 , N/A , N/A , N/A , N/A , N/A ,$707.43 , N/A ,$765.69 ,$582.59 ,$422.13 ,$506.60 ,$506.85 ,$506.60 ,$575.10 ,$749.04 ,$568.61 , N/A ,$657.49 , N/A , N/A , N/A , N/A , N/A ,$599.23 ,$516.01 ,$599.23 ,$599.23 ,$665.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 LCP 7H/53MM T,278,1 ,$869.89 ,$574.13 ,$441.21 ,$869.89 , N/A , N/A , N/A , N/A ,$521.93 ,$739.41 ,$608.92 , N/A , N/A ,$826.40 ,$661.12 ,$652.42 , N/A ,$739.41 , N/A , N/A , N/A ,$608.92 ,$529.76 , N/A , N/A , N/A , N/A , N/A ,$739.41 , N/A ,$800.30 ,$608.92 ,$441.21 ,$529.50 ,$529.76 ,$529.50 ,$601.09 ,$782.90 ,$594.31 , N/A ,$687.21 , N/A , N/A , N/A , N/A , N/A ,$626.32 ,$539.33 ,$626.32 ,$626.32 ,$695.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 LCP 7H/54MM,278,1 ,"$1,476.62 ",$974.57 ,$748.94 ,"$1,476.62 ", N/A ,$778.33 ,$778.33 , N/A ,$885.97 ,"$1,255.13 ","$1,033.63 ", N/A , N/A ,"$1,402.79 ","$1,122.23 ","$1,107.47 ", N/A ,"$1,255.13 ", N/A , N/A , N/A ,"$1,033.63 ",$899.26 , N/A , N/A , N/A , N/A , N/A ,"$1,255.13 ", N/A ,"$1,358.49 ","$1,033.63 ",$748.94 ,$898.82 ,$899.26 ,$898.82 ,"$1,020.34 ","$1,328.96 ","$1,008.83 ", N/A ,"$1,166.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,063.17 ",$915.50 ,"$1,063.17 ","$1,063.17 ","$1,181.30 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,TAP SYNTHES 7.3 CANNULATED CONICAL LOCKING SCREW,278,1 ,"$1,476.62 ",$974.57 ,$748.94 ,"$1,476.62 ", N/A ,$778.33 ,$778.33 , N/A ,$885.97 ,"$1,255.13 ","$1,033.63 ", N/A , N/A ,"$1,402.79 ","$1,122.23 ","$1,107.47 ", N/A ,"$1,255.13 ", N/A , N/A , N/A ,"$1,033.63 ",$899.26 , N/A , N/A , N/A , N/A , N/A ,"$1,255.13 ", N/A ,"$1,358.49 ","$1,033.63 ",$748.94 ,$898.82 ,$899.26 ,$898.82 ,"$1,020.34 ","$1,328.96 ","$1,008.83 ", N/A ,"$1,166.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,063.17 ",$915.50 ,"$1,063.17 ","$1,063.17 ","$1,181.30 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 LCP 8H/59MM,278,1 ,$492.14 ,$324.81 ,$249.61 ,$492.14 , N/A , N/A , N/A , N/A ,$295.28 ,$418.32 ,$344.50 , N/A , N/A ,$467.53 ,$374.03 ,$369.11 , N/A ,$418.32 , N/A , N/A , N/A ,$344.50 ,$299.71 , N/A , N/A , N/A , N/A , N/A ,$418.32 , N/A ,$452.77 ,$344.50 ,$249.61 ,$299.57 ,$299.71 ,$299.57 ,$340.07 ,$442.93 ,$336.23 , N/A ,$388.79 , N/A , N/A , N/A , N/A , N/A ,$354.34 ,$305.13 ,$354.34 ,$354.34 ,$393.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 LCP 10H/73MM,278,1 ,$492.14 ,$324.81 ,$249.61 ,$492.14 , N/A , N/A , N/A , N/A ,$295.28 ,$418.32 ,$344.50 , N/A , N/A ,$467.53 ,$374.03 ,$369.11 , N/A ,$418.32 , N/A , N/A , N/A ,$344.50 ,$299.71 , N/A , N/A , N/A , N/A , N/A ,$418.32 , N/A ,$452.77 ,$344.50 ,$249.61 ,$299.57 ,$299.71 ,$299.57 ,$340.07 ,$442.93 ,$336.23 , N/A ,$388.79 , N/A , N/A , N/A , N/A , N/A ,$354.34 ,$305.13 ,$354.34 ,$354.34 ,$393.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 LCP 4H/31MM,278,1 ,$492.14 ,$324.81 ,$249.61 ,$492.14 , N/A , N/A , N/A , N/A ,$295.28 ,$418.32 ,$344.50 , N/A , N/A ,$467.53 ,$374.03 ,$369.11 , N/A ,$418.32 , N/A , N/A , N/A ,$344.50 ,$299.71 , N/A , N/A , N/A , N/A , N/A ,$418.32 , N/A ,$452.77 ,$344.50 ,$249.61 ,$299.57 ,$299.71 ,$299.57 ,$340.07 ,$442.93 ,$336.23 , N/A ,$388.79 , N/A , N/A , N/A , N/A , N/A ,$354.34 ,$305.13 ,$354.34 ,$354.34 ,$393.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 LCP 5H/38MM,278,1 ,$492.14 ,$324.81 ,$249.61 ,$492.14 , N/A , N/A , N/A , N/A ,$295.28 ,$418.32 ,$344.50 , N/A , N/A ,$467.53 ,$374.03 ,$369.11 , N/A ,$418.32 , N/A , N/A , N/A ,$344.50 ,$299.71 , N/A , N/A , N/A , N/A , N/A ,$418.32 , N/A ,$452.77 ,$344.50 ,$249.61 ,$299.57 ,$299.71 ,$299.57 ,$340.07 ,$442.93 ,$336.23 , N/A ,$388.79 , N/A , N/A , N/A , N/A , N/A ,$354.34 ,$305.13 ,$354.34 ,$354.34 ,$393.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 LCP 6H/45MM,278,1 ,$492.14 ,$324.81 ,$249.61 ,$492.14 , N/A , N/A , N/A , N/A ,$295.28 ,$418.32 ,$344.50 , N/A , N/A ,$467.53 ,$374.03 ,$369.11 , N/A ,$418.32 , N/A , N/A , N/A ,$344.50 ,$299.71 , N/A , N/A , N/A , N/A , N/A ,$418.32 , N/A ,$452.77 ,$344.50 ,$249.61 ,$299.57 ,$299.71 ,$299.57 ,$340.07 ,$442.93 ,$336.23 , N/A ,$388.79 , N/A , N/A , N/A , N/A , N/A ,$354.34 ,$305.13 ,$354.34 ,$354.34 ,$393.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 LCP 7H/52MM,278,1 ,$492.14 ,$324.81 ,$249.61 ,$492.14 , N/A , N/A , N/A , N/A ,$295.28 ,$418.32 ,$344.50 , N/A , N/A ,$467.53 ,$374.03 ,$369.11 , N/A ,$418.32 , N/A , N/A , N/A ,$344.50 ,$299.71 , N/A , N/A , N/A , N/A , N/A ,$418.32 , N/A ,$452.77 ,$344.50 ,$249.61 ,$299.57 ,$299.71 ,$299.57 ,$340.07 ,$442.93 ,$336.23 , N/A ,$388.79 , N/A , N/A , N/A , N/A , N/A ,$354.34 ,$305.13 ,$354.34 ,$354.34 ,$393.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0 MINI OBLIQUE 2H LT,278,1 ,$115.76 ,$76.40 ,$58.71 ,$115.76 , N/A , N/A , N/A , N/A ,$69.46 ,$98.40 ,$81.03 , N/A , N/A ,$109.97 ,$87.98 ,$86.82 , N/A ,$98.40 , N/A , N/A , N/A ,$81.03 ,$70.50 , N/A , N/A , N/A , N/A , N/A ,$98.40 , N/A ,$106.50 ,$81.03 ,$58.71 ,$70.46 ,$70.50 ,$70.46 ,$79.99 ,$104.18 ,$79.09 , N/A ,$91.45 , N/A , N/A , N/A , N/A , N/A ,$83.35 ,$71.77 ,$83.35 ,$83.35 ,$92.61 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI CONDYLAR 7H/39MM RT,278,1 ,$608.02 ,$401.29 ,$308.39 ,$608.02 , N/A , N/A , N/A , N/A ,$364.81 ,$516.82 ,$425.61 , N/A , N/A ,$577.62 ,$462.10 ,$456.02 , N/A ,$516.82 , N/A , N/A , N/A ,$425.61 ,$370.28 , N/A , N/A , N/A , N/A , N/A ,$516.82 , N/A ,$559.38 ,$425.61 ,$308.39 ,$370.10 ,$370.28 ,$370.10 ,$420.14 ,$547.22 ,$415.40 , N/A ,$480.34 , N/A , N/A , N/A , N/A , N/A ,$437.77 ,$376.97 ,$437.77 ,$437.77 ,$486.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI CONDYLAR 7H/39MM LT,278,1 ,$608.02 ,$401.29 ,$308.39 ,$608.02 , N/A , N/A , N/A , N/A ,$364.81 ,$516.82 ,$425.61 , N/A , N/A ,$577.62 ,$462.10 ,$456.02 , N/A ,$516.82 , N/A , N/A , N/A ,$425.61 ,$370.28 , N/A , N/A , N/A , N/A , N/A ,$516.82 , N/A ,$559.38 ,$425.61 ,$308.39 ,$370.10 ,$370.28 ,$370.10 ,$420.14 ,$547.22 ,$415.40 , N/A ,$480.34 , N/A , N/A , N/A , N/A , N/A ,$437.77 ,$376.97 ,$437.77 ,$437.77 ,$486.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI LC-DCP 6 HOLES/36MM,278,1 ,$559.86 ,$369.51 ,$283.96 ,$559.86 , N/A , N/A , N/A , N/A ,$335.92 ,$475.88 ,$391.90 , N/A , N/A ,$531.87 ,$425.49 ,$419.90 , N/A ,$475.88 , N/A , N/A , N/A ,$391.90 ,$340.95 , N/A , N/A , N/A , N/A , N/A ,$475.88 , N/A ,$515.07 ,$391.90 ,$283.96 ,$340.79 ,$340.95 ,$340.79 ,$386.86 ,$503.87 ,$382.50 , N/A ,$442.29 , N/A , N/A , N/A , N/A , N/A ,$403.10 ,$347.11 ,$403.10 ,$403.10 ,$447.89 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI STRAIGHT 12 HOLES/72MM,278,1 ,$559.86 ,$369.51 ,$283.96 ,$559.86 , N/A , N/A , N/A , N/A ,$335.92 ,$475.88 ,$391.90 , N/A , N/A ,$531.87 ,$425.49 ,$419.90 , N/A ,$475.88 , N/A , N/A , N/A ,$391.90 ,$340.95 , N/A , N/A , N/A , N/A , N/A ,$475.88 , N/A ,$515.07 ,$391.90 ,$283.96 ,$340.79 ,$340.95 ,$340.79 ,$386.86 ,$503.87 ,$382.50 , N/A ,$442.29 , N/A , N/A , N/A , N/A , N/A ,$403.10 ,$347.11 ,$403.10 ,$403.10 ,$447.89 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI LC-DCP 8 HOLES/48MM,278,1 ,$636.62 ,$420.17 ,$322.89 ,$636.62 , N/A , N/A , N/A , N/A ,$381.97 ,$541.13 ,$445.63 , N/A , N/A ,$604.79 ,$483.83 ,$477.47 , N/A ,$541.13 , N/A , N/A , N/A ,$445.63 ,$387.70 , N/A , N/A , N/A , N/A , N/A ,$541.13 , N/A ,$585.69 ,$445.63 ,$322.89 ,$387.51 ,$387.70 ,$387.51 ,$439.90 ,$572.96 ,$434.94 , N/A ,$502.93 , N/A , N/A , N/A , N/A , N/A ,$458.37 ,$394.70 ,$458.37 ,$458.37 ,$509.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI STRAIGHT 20 HOLES/100MM,278,1 ,$505.68 ,$333.75 ,$256.48 ,$505.68 , N/A , N/A , N/A , N/A ,$303.41 ,$429.83 ,$353.98 , N/A , N/A ,$480.40 ,$384.32 ,$379.26 , N/A ,$429.83 , N/A , N/A , N/A ,$353.98 ,$307.96 , N/A , N/A , N/A , N/A , N/A ,$429.83 , N/A ,$465.23 ,$353.98 ,$256.48 ,$307.81 ,$307.96 ,$307.81 ,$349.42 ,$455.11 ,$345.48 , N/A ,$399.49 , N/A , N/A , N/A , N/A , N/A ,$364.09 ,$313.52 ,$364.09 ,$364.09 ,$404.54 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI STRAIGHT 6 HOLES/35MM,278,1 ,$433.44 ,$286.07 ,$219.84 ,$433.44 , N/A , N/A , N/A , N/A ,$260.06 ,$368.42 ,$303.41 , N/A , N/A ,$411.77 ,$329.41 ,$325.08 , N/A ,$368.42 , N/A , N/A , N/A ,$303.41 ,$263.97 , N/A , N/A , N/A , N/A , N/A ,$368.42 , N/A ,$398.76 ,$303.41 ,$219.84 ,$263.83 ,$263.97 ,$263.83 ,$299.51 ,$390.10 ,$296.13 , N/A ,$342.42 , N/A , N/A , N/A , N/A , N/A ,$312.08 ,$268.73 ,$312.08 ,$312.08 ,$346.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI T 2 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$475.58 ,$313.88 ,$241.21 ,$475.58 , N/A , N/A , N/A , N/A ,$285.35 ,$404.24 ,$332.91 , N/A , N/A ,$451.80 ,$361.44 ,$356.69 , N/A ,$404.24 , N/A , N/A , N/A ,$332.91 ,$289.63 , N/A , N/A , N/A , N/A , N/A ,$404.24 , N/A ,$437.53 ,$332.91 ,$241.21 ,$289.49 ,$289.63 ,$289.49 ,$328.63 ,$428.02 ,$324.92 , N/A ,$375.71 , N/A , N/A , N/A , N/A , N/A ,$342.42 ,$294.86 ,$342.42 ,$342.42 ,$380.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI STRAIGHT 6 HOLES/36MM,278,1 ,$475.58 ,$313.88 ,$241.21 ,$475.58 , N/A , N/A , N/A , N/A ,$285.35 ,$404.24 ,$332.91 , N/A , N/A ,$451.80 ,$361.44 ,$356.69 , N/A ,$404.24 , N/A , N/A , N/A ,$332.91 ,$289.63 , N/A , N/A , N/A , N/A , N/A ,$404.24 , N/A ,$437.53 ,$332.91 ,$241.21 ,$289.49 ,$289.63 ,$289.49 ,$328.63 ,$428.02 ,$324.92 , N/A ,$375.71 , N/A , N/A , N/A , N/A , N/A ,$342.42 ,$294.86 ,$342.42 ,$342.42 ,$380.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.3 TI EXTENDED / RIGHT,278,1 ,$475.58 ,$313.88 ,$241.21 ,$475.58 , N/A , N/A , N/A , N/A ,$285.35 ,$404.24 ,$332.91 , N/A , N/A ,$451.80 ,$361.44 ,$356.69 , N/A ,$404.24 , N/A , N/A , N/A ,$332.91 ,$289.63 , N/A , N/A , N/A , N/A , N/A ,$404.24 , N/A ,$437.53 ,$332.91 ,$241.21 ,$289.49 ,$289.63 ,$289.49 ,$328.63 ,$428.02 ,$324.92 , N/A ,$375.71 , N/A , N/A , N/A , N/A , N/A ,$342.42 ,$294.86 ,$342.42 ,$342.42 ,$380.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.3 TI H EXTENDED / LEFT,278,1 ,$475.58 ,$313.88 ,$241.21 ,$475.58 , N/A , N/A , N/A , N/A ,$285.35 ,$404.24 ,$332.91 , N/A , N/A ,$451.80 ,$361.44 ,$356.69 , N/A ,$404.24 , N/A , N/A , N/A ,$332.91 ,$289.63 , N/A , N/A , N/A , N/A , N/A ,$404.24 , N/A ,$437.53 ,$332.91 ,$241.21 ,$289.49 ,$289.63 ,$289.49 ,$328.63 ,$428.02 ,$324.92 , N/A ,$375.71 , N/A , N/A , N/A , N/A , N/A ,$342.42 ,$294.86 ,$342.42 ,$342.42 ,$380.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.3 TI T 4 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$475.58 ,$313.88 ,$241.21 ,$475.58 , N/A , N/A , N/A , N/A ,$285.35 ,$404.24 ,$332.91 , N/A , N/A ,$451.80 ,$361.44 ,$356.69 , N/A ,$404.24 , N/A , N/A , N/A ,$332.91 ,$289.63 , N/A , N/A , N/A , N/A , N/A ,$404.24 , N/A ,$437.53 ,$332.91 ,$241.21 ,$289.49 ,$289.63 ,$289.49 ,$328.63 ,$428.02 ,$324.92 , N/A ,$375.71 , N/A , N/A , N/A , N/A , N/A ,$342.42 ,$294.86 ,$342.42 ,$342.42 ,$380.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI H EXT 8 HOLE LT,278,1 ,$475.58 ,$313.88 ,$241.21 ,$475.58 , N/A , N/A , N/A , N/A ,$285.35 ,$404.24 ,$332.91 , N/A , N/A ,$451.80 ,$361.44 ,$356.69 , N/A ,$404.24 , N/A , N/A , N/A ,$332.91 ,$289.63 , N/A , N/A , N/A , N/A , N/A ,$404.24 , N/A ,$437.53 ,$332.91 ,$241.21 ,$289.49 ,$289.63 ,$289.49 ,$328.63 ,$428.02 ,$324.92 , N/A ,$375.71 , N/A , N/A , N/A , N/A , N/A ,$342.42 ,$294.86 ,$342.42 ,$342.42 ,$380.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI H EXT 8 HOLE RT,278,1 ,$475.58 ,$313.88 ,$241.21 ,$475.58 , N/A , N/A , N/A , N/A ,$285.35 ,$404.24 ,$332.91 , N/A , N/A ,$451.80 ,$361.44 ,$356.69 , N/A ,$404.24 , N/A , N/A , N/A ,$332.91 ,$289.63 , N/A , N/A , N/A , N/A , N/A ,$404.24 , N/A ,$437.53 ,$332.91 ,$241.21 ,$289.49 ,$289.63 ,$289.49 ,$328.63 ,$428.02 ,$324.92 , N/A ,$375.71 , N/A , N/A , N/A , N/A , N/A ,$342.42 ,$294.86 ,$342.42 ,$342.42 ,$380.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 1.5MM TI T 4 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$475.58 ,$313.88 ,$241.21 ,$475.58 , N/A , N/A , N/A , N/A ,$285.35 ,$404.24 ,$332.91 , N/A , N/A ,$451.80 ,$361.44 ,$356.69 , N/A ,$404.24 , N/A , N/A , N/A ,$332.91 ,$289.63 , N/A , N/A , N/A , N/A , N/A ,$404.24 , N/A ,$437.53 ,$332.91 ,$241.21 ,$289.49 ,$289.63 ,$289.49 ,$328.63 ,$428.02 ,$324.92 , N/A ,$375.71 , N/A , N/A , N/A , N/A , N/A ,$342.42 ,$294.86 ,$342.42 ,$342.42 ,$380.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI LC-DCP 4 HOLES/24MM,278,1 ,$475.58 ,$313.88 ,$241.21 ,$475.58 , N/A , N/A , N/A , N/A ,$285.35 ,$404.24 ,$332.91 , N/A , N/A ,$451.80 ,$361.44 ,$356.69 , N/A ,$404.24 , N/A , N/A , N/A ,$332.91 ,$289.63 , N/A , N/A , N/A , N/A , N/A ,$404.24 , N/A ,$437.53 ,$332.91 ,$241.21 ,$289.49 ,$289.63 ,$289.49 ,$328.63 ,$428.02 ,$324.92 , N/A ,$375.71 , N/A , N/A , N/A , N/A , N/A ,$342.42 ,$294.86 ,$342.42 ,$342.42 ,$380.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI T 3 HOLES HEAD/ 9 HOLES/50MM,278,1 ,$430.43 ,$284.08 ,$218.31 ,$430.43 , N/A , N/A , N/A , N/A ,$258.26 ,$365.87 ,$301.30 , N/A , N/A ,$408.91 ,$327.13 ,$322.82 , N/A ,$365.87 , N/A , N/A , N/A ,$301.30 ,$262.13 , N/A , N/A , N/A , N/A , N/A ,$365.87 , N/A ,$396.00 ,$301.30 ,$218.31 ,$262.00 ,$262.13 ,$262.00 ,$297.43 ,$387.39 ,$294.07 , N/A ,$340.04 , N/A , N/A , N/A , N/A , N/A ,$309.91 ,$266.87 ,$309.91 ,$309.91 ,$344.34 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI T 4 HOLES HEAD/ 9 HOLES/50MM,278,1 ,$465.05 ,$306.93 ,$235.87 ,$465.05 , N/A , N/A , N/A , N/A ,$279.03 ,$395.29 ,$325.54 , N/A , N/A ,$441.80 ,$353.44 ,$348.79 , N/A ,$395.29 , N/A , N/A , N/A ,$325.54 ,$283.22 , N/A , N/A , N/A , N/A , N/A ,$395.29 , N/A ,$427.85 ,$325.54 ,$235.87 ,$283.08 ,$283.22 ,$283.08 ,$321.35 ,$418.55 ,$317.72 , N/A ,$367.39 , N/A , N/A , N/A , N/A , N/A ,$334.84 ,$288.33 ,$334.84 ,$334.84 ,$372.04 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI Y 3 HOLES HEAD 8 HOLES SHAFT/48MM,278,1 ,$517.72 ,$341.70 ,$262.59 ,$517.72 , N/A , N/A , N/A , N/A ,$310.63 ,$440.06 ,$362.40 , N/A , N/A ,$491.83 ,$393.47 ,$388.29 , N/A ,$440.06 , N/A , N/A , N/A ,$362.40 ,$315.29 , N/A , N/A , N/A , N/A , N/A ,$440.06 , N/A ,$476.30 ,$362.40 ,$262.59 ,$315.14 ,$315.29 ,$315.14 ,$357.74 ,$465.95 ,$353.71 , N/A ,$409.00 , N/A , N/A , N/A , N/A , N/A ,$372.76 ,$320.99 ,$372.76 ,$372.76 ,$414.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI STRAIGHT 12 HOLES/71MM,278,1 ,$517.72 ,$341.70 ,$262.59 ,$517.72 , N/A , N/A , N/A , N/A ,$310.63 ,$440.06 ,$362.40 , N/A , N/A ,$491.83 ,$393.47 ,$388.29 , N/A ,$440.06 , N/A , N/A , N/A ,$362.40 ,$315.29 , N/A , N/A , N/A , N/A , N/A ,$440.06 , N/A ,$476.30 ,$362.40 ,$262.59 ,$315.14 ,$315.29 ,$315.14 ,$357.74 ,$465.95 ,$353.71 , N/A ,$409.00 , N/A , N/A , N/A , N/A , N/A ,$372.76 ,$320.99 ,$372.76 ,$372.76 ,$414.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.0MM TI T 3 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$517.72 ,$341.70 ,$262.59 ,$517.72 , N/A , N/A , N/A , N/A ,$310.63 ,$440.06 ,$362.40 , N/A , N/A ,$491.83 ,$393.47 ,$388.29 , N/A ,$440.06 , N/A , N/A , N/A ,$362.40 ,$315.29 , N/A , N/A , N/A , N/A , N/A ,$440.06 , N/A ,$476.30 ,$362.40 ,$262.59 ,$315.14 ,$315.29 ,$315.14 ,$357.74 ,$465.95 ,$353.71 , N/A ,$409.00 , N/A , N/A , N/A , N/A , N/A ,$372.76 ,$320.99 ,$372.76 ,$372.76 ,$414.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 135,278,1 ,$517.72 ,$341.70 ,$262.59 ,$517.72 , N/A , N/A , N/A , N/A ,$310.63 ,$440.06 ,$362.40 , N/A , N/A ,$491.83 ,$393.47 ,$388.29 , N/A ,$440.06 , N/A , N/A , N/A ,$362.40 ,$315.29 , N/A , N/A , N/A , N/A , N/A ,$440.06 , N/A ,$476.30 ,$362.40 ,$262.59 ,$315.14 ,$315.29 ,$315.14 ,$357.74 ,$465.95 ,$353.71 , N/A ,$409.00 , N/A , N/A , N/A , N/A , N/A ,$372.76 ,$320.99 ,$372.76 ,$372.76 ,$414.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 140,278,1 ,$517.72 ,$341.70 ,$262.59 ,$517.72 , N/A , N/A , N/A , N/A ,$310.63 ,$440.06 ,$362.40 , N/A , N/A ,$491.83 ,$393.47 ,$388.29 , N/A ,$440.06 , N/A , N/A , N/A ,$362.40 ,$315.29 , N/A , N/A , N/A , N/A , N/A ,$440.06 , N/A ,$476.30 ,$362.40 ,$262.59 ,$315.14 ,$315.29 ,$315.14 ,$357.74 ,$465.95 ,$353.71 , N/A ,$409.00 , N/A , N/A , N/A , N/A , N/A ,$372.76 ,$320.99 ,$372.76 ,$372.76 ,$414.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 145,278,1 ,$517.72 ,$341.70 ,$262.59 ,$517.72 , N/A , N/A , N/A , N/A ,$310.63 ,$440.06 ,$362.40 , N/A , N/A ,$491.83 ,$393.47 ,$388.29 , N/A ,$440.06 , N/A , N/A , N/A ,$362.40 ,$315.29 , N/A , N/A , N/A , N/A , N/A ,$440.06 , N/A ,$476.30 ,$362.40 ,$262.59 ,$315.14 ,$315.29 ,$315.14 ,$357.74 ,$465.95 ,$353.71 , N/A ,$409.00 , N/A , N/A , N/A , N/A , N/A ,$372.76 ,$320.99 ,$372.76 ,$372.76 ,$414.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 150,278,1 ,$517.72 ,$341.70 ,$262.59 ,$517.72 , N/A , N/A , N/A , N/A ,$310.63 ,$440.06 ,$362.40 , N/A , N/A ,$491.83 ,$393.47 ,$388.29 , N/A ,$440.06 , N/A , N/A , N/A ,$362.40 ,$315.29 , N/A , N/A , N/A , N/A , N/A ,$440.06 , N/A ,$476.30 ,$362.40 ,$262.59 ,$315.14 ,$315.29 ,$315.14 ,$357.74 ,$465.95 ,$353.71 , N/A ,$409.00 , N/A , N/A , N/A , N/A , N/A ,$372.76 ,$320.99 ,$372.76 ,$372.76 ,$414.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP 12H/88MM ADAPTION,278,1 ,$916.55 ,$604.92 ,$464.87 ,$916.55 , N/A , N/A , N/A , N/A ,$549.93 ,$779.07 ,$641.59 , N/A , N/A ,$870.72 ,$696.58 ,$687.41 , N/A ,$779.07 , N/A , N/A , N/A ,$641.59 ,$558.18 , N/A , N/A , N/A , N/A , N/A ,$779.07 , N/A ,$843.23 ,$641.59 ,$464.87 ,$557.90 ,$558.18 ,$557.90 ,$633.34 ,$824.90 ,$626.19 , N/A ,$724.07 , N/A , N/A , N/A , N/A , N/A ,$659.92 ,$568.26 ,$659.92 ,$659.92 ,$733.24 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP 12H/97MM ADAPTION,278,1 ,$916.55 ,$604.92 ,$464.87 ,$916.55 , N/A , N/A , N/A , N/A ,$549.93 ,$779.07 ,$641.59 , N/A , N/A ,$870.72 ,$696.58 ,$687.41 , N/A ,$779.07 , N/A , N/A , N/A ,$641.59 ,$558.18 , N/A , N/A , N/A , N/A , N/A ,$779.07 , N/A ,$843.23 ,$641.59 ,$464.87 ,$557.90 ,$558.18 ,$557.90 ,$633.34 ,$824.90 ,$626.19 , N/A ,$724.07 , N/A , N/A , N/A , N/A , N/A ,$659.92 ,$568.26 ,$659.92 ,$659.92 ,$733.24 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP 7H/59MM,278,1 ,"$1,126.48 ",$743.48 ,$571.35 ,"$1,126.48 ", N/A ,$593.77 ,$593.77 , N/A ,$675.89 ,$957.51 ,$788.54 , N/A , N/A ,"$1,070.16 ",$856.12 ,$844.86 , N/A ,$957.51 , N/A , N/A , N/A ,$788.54 ,$686.03 , N/A , N/A , N/A , N/A , N/A ,$957.51 , N/A ,"$1,036.36 ",$788.54 ,$571.35 ,$685.69 ,$686.03 ,$685.69 ,$778.40 ,"$1,013.83 ",$769.61 , N/A ,$889.92 , N/A , N/A , N/A , N/A , N/A ,$811.07 ,$698.42 ,$811.07 ,$811.07 ,$901.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP 8H/68MM,278,1 ,$787.12 ,$519.50 ,$399.23 ,$787.12 , N/A , N/A , N/A , N/A ,$472.27 ,$669.05 ,$550.98 , N/A , N/A ,$747.76 ,$598.21 ,$590.34 , N/A ,$669.05 , N/A , N/A , N/A ,$550.98 ,$479.36 , N/A , N/A , N/A , N/A , N/A ,$669.05 , N/A ,$724.15 ,$550.98 ,$399.23 ,$479.12 ,$479.36 ,$479.12 ,$543.90 ,$708.41 ,$537.76 , N/A ,$621.82 , N/A , N/A , N/A , N/A , N/A ,$566.73 ,$488.01 ,$566.73 ,$566.73 ,$629.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 6 HOLE 116MM,278,1 ,$787.12 ,$519.50 ,$399.23 ,$787.12 , N/A , N/A , N/A , N/A ,$472.27 ,$669.05 ,$550.98 , N/A , N/A ,$747.76 ,$598.21 ,$590.34 , N/A ,$669.05 , N/A , N/A , N/A ,$550.98 ,$479.36 , N/A , N/A , N/A , N/A , N/A ,$669.05 , N/A ,$724.15 ,$550.98 ,$399.23 ,$479.12 ,$479.36 ,$479.12 ,$543.90 ,$708.41 ,$537.76 , N/A ,$621.82 , N/A , N/A , N/A , N/A , N/A ,$566.73 ,$488.01 ,$566.73 ,$566.73 ,$629.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP 10H/84MM,278,1 ,$787.12 ,$519.50 ,$399.23 ,$787.12 , N/A , N/A , N/A , N/A ,$472.27 ,$669.05 ,$550.98 , N/A , N/A ,$747.76 ,$598.21 ,$590.34 , N/A ,$669.05 , N/A , N/A , N/A ,$550.98 ,$479.36 , N/A , N/A , N/A , N/A , N/A ,$669.05 , N/A ,$724.15 ,$550.98 ,$399.23 ,$479.12 ,$479.36 ,$479.12 ,$543.90 ,$708.41 ,$537.76 , N/A ,$621.82 , N/A , N/A , N/A , N/A , N/A ,$566.73 ,$488.01 ,$566.73 ,$566.73 ,$629.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP 4H/36MM,278,1 ,$787.12 ,$519.50 ,$399.23 ,$787.12 , N/A , N/A , N/A , N/A ,$472.27 ,$669.05 ,$550.98 , N/A , N/A ,$747.76 ,$598.21 ,$590.34 , N/A ,$669.05 , N/A , N/A , N/A ,$550.98 ,$479.36 , N/A , N/A , N/A , N/A , N/A ,$669.05 , N/A ,$724.15 ,$550.98 ,$399.23 ,$479.12 ,$479.36 ,$479.12 ,$543.90 ,$708.41 ,$537.76 , N/A ,$621.82 , N/A , N/A , N/A , N/A , N/A ,$566.73 ,$488.01 ,$566.73 ,$566.73 ,$629.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP 5H/44MM,278,1 ,$787.12 ,$519.50 ,$399.23 ,$787.12 , N/A , N/A , N/A , N/A ,$472.27 ,$669.05 ,$550.98 , N/A , N/A ,$747.76 ,$598.21 ,$590.34 , N/A ,$669.05 , N/A , N/A , N/A ,$550.98 ,$479.36 , N/A , N/A , N/A , N/A , N/A ,$669.05 , N/A ,$724.15 ,$550.98 ,$399.23 ,$479.12 ,$479.36 ,$479.12 ,$543.90 ,$708.41 ,$537.76 , N/A ,$621.82 , N/A , N/A , N/A , N/A , N/A ,$566.73 ,$488.01 ,$566.73 ,$566.73 ,$629.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP 6H/52MM,278,1 ,$787.12 ,$519.50 ,$399.23 ,$787.12 , N/A , N/A , N/A , N/A ,$472.27 ,$669.05 ,$550.98 , N/A , N/A ,$747.76 ,$598.21 ,$590.34 , N/A ,$669.05 , N/A , N/A , N/A ,$550.98 ,$479.36 , N/A , N/A , N/A , N/A , N/A ,$669.05 , N/A ,$724.15 ,$550.98 ,$399.23 ,$479.12 ,$479.36 ,$479.12 ,$543.90 ,$708.41 ,$537.76 , N/A ,$621.82 , N/A , N/A , N/A , N/A , N/A ,$566.73 ,$488.01 ,$566.73 ,$566.73 ,$629.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP 7H/60MM,278,1 ,$787.12 ,$519.50 ,$399.23 ,$787.12 , N/A , N/A , N/A , N/A ,$472.27 ,$669.05 ,$550.98 , N/A , N/A ,$747.76 ,$598.21 ,$590.34 , N/A ,$669.05 , N/A , N/A , N/A ,$550.98 ,$479.36 , N/A , N/A , N/A , N/A , N/A ,$669.05 , N/A ,$724.15 ,$550.98 ,$399.23 ,$479.12 ,$479.36 ,$479.12 ,$543.90 ,$708.41 ,$537.76 , N/A ,$621.82 , N/A , N/A , N/A , N/A , N/A ,$566.73 ,$488.01 ,$566.73 ,$566.73 ,$629.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/-90 DEG 3H HEAD/3H SHAFT,278,1 ,$907.52 ,$598.96 ,$460.29 ,$907.52 , N/A , N/A , N/A , N/A ,$544.51 ,$771.39 ,$635.26 , N/A , N/A ,$862.14 ,$689.72 ,$680.64 , N/A ,$771.39 , N/A , N/A , N/A ,$635.26 ,$552.68 , N/A , N/A , N/A , N/A , N/A ,$771.39 , N/A ,$834.92 ,$635.26 ,$460.29 ,$552.41 ,$552.68 ,$552.41 ,$627.10 ,$816.77 ,$620.02 , N/A ,$716.94 , N/A , N/A , N/A , N/A , N/A ,$653.41 ,$562.66 ,$653.41 ,$653.41 ,$726.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/ -90 DEG 2H HEAD/3H SHAFT,278,1 ,$907.52 ,$598.96 ,$460.29 ,$907.52 , N/A , N/A , N/A , N/A ,$544.51 ,$771.39 ,$635.26 , N/A , N/A ,$862.14 ,$689.72 ,$680.64 , N/A ,$771.39 , N/A , N/A , N/A ,$635.26 ,$552.68 , N/A , N/A , N/A , N/A , N/A ,$771.39 , N/A ,$834.92 ,$635.26 ,$460.29 ,$552.41 ,$552.68 ,$552.41 ,$627.10 ,$816.77 ,$620.02 , N/A ,$716.94 , N/A , N/A , N/A , N/A , N/A ,$653.41 ,$562.66 ,$653.41 ,$653.41 ,$726.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/+20 DEG 3H HEAD/3H SHAFT,278,1 ,$907.52 ,$598.96 ,$460.29 ,$907.52 , N/A , N/A , N/A , N/A ,$544.51 ,$771.39 ,$635.26 , N/A , N/A ,$862.14 ,$689.72 ,$680.64 , N/A ,$771.39 , N/A , N/A , N/A ,$635.26 ,$552.68 , N/A , N/A , N/A , N/A , N/A ,$771.39 , N/A ,$834.92 ,$635.26 ,$460.29 ,$552.41 ,$552.68 ,$552.41 ,$627.10 ,$816.77 ,$620.02 , N/A ,$716.94 , N/A , N/A , N/A , N/A , N/A ,$653.41 ,$562.66 ,$653.41 ,$653.41 ,$726.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/+90 DEG 2H HEAD/3H SHAFT,278,1 ,$907.52 ,$598.96 ,$460.29 ,$907.52 , N/A , N/A , N/A , N/A ,$544.51 ,$771.39 ,$635.26 , N/A , N/A ,$862.14 ,$689.72 ,$680.64 , N/A ,$771.39 , N/A , N/A , N/A ,$635.26 ,$552.68 , N/A , N/A , N/A , N/A , N/A ,$771.39 , N/A ,$834.92 ,$635.26 ,$460.29 ,$552.41 ,$552.68 ,$552.41 ,$627.10 ,$816.77 ,$620.02 , N/A ,$716.94 , N/A , N/A , N/A , N/A , N/A ,$653.41 ,$562.66 ,$653.41 ,$653.41 ,$726.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/+90 DEG 3H HEAD/3H SHAFT,278,1 ,$907.52 ,$598.96 ,$460.29 ,$907.52 , N/A , N/A , N/A , N/A ,$544.51 ,$771.39 ,$635.26 , N/A , N/A ,$862.14 ,$689.72 ,$680.64 , N/A ,$771.39 , N/A , N/A , N/A ,$635.26 ,$552.68 , N/A , N/A , N/A , N/A , N/A ,$771.39 , N/A ,$834.92 ,$635.26 ,$460.29 ,$552.41 ,$552.68 ,$552.41 ,$627.10 ,$816.77 ,$620.02 , N/A ,$716.94 , N/A , N/A , N/A , N/A , N/A ,$653.41 ,$562.66 ,$653.41 ,$653.41 ,$726.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/-20 DEG 3H HEAD/3H SHAFT,278,1 ,$907.52 ,$598.96 ,$460.29 ,$907.52 , N/A , N/A , N/A , N/A ,$544.51 ,$771.39 ,$635.26 , N/A , N/A ,$862.14 ,$689.72 ,$680.64 , N/A ,$771.39 , N/A , N/A , N/A ,$635.26 ,$552.68 , N/A , N/A , N/A , N/A , N/A ,$771.39 , N/A ,$834.92 ,$635.26 ,$460.29 ,$552.41 ,$552.68 ,$552.41 ,$627.10 ,$816.77 ,$620.02 , N/A ,$716.94 , N/A , N/A , N/A , N/A , N/A ,$653.41 ,$562.66 ,$653.41 ,$653.41 ,$726.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/-90 DEG 3H HEAD/4H SHAFT,278,1 ,$952.67 ,$628.76 ,$483.19 ,$952.67 , N/A , N/A , N/A , N/A ,$571.60 ,$809.77 ,$666.87 , N/A , N/A ,$905.04 ,$724.03 ,$714.50 , N/A ,$809.77 , N/A , N/A , N/A ,$666.87 ,$580.18 , N/A , N/A , N/A , N/A , N/A ,$809.77 , N/A ,$876.46 ,$666.87 ,$483.19 ,$579.89 ,$580.18 ,$579.89 ,$658.30 ,$857.40 ,$650.86 , N/A ,$752.61 , N/A , N/A , N/A , N/A , N/A ,$685.92 ,$590.66 ,$685.92 ,$685.92 ,$762.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR  8H 125MM,278,1 ,$952.67 ,$628.76 ,$483.19 ,$952.67 , N/A , N/A , N/A , N/A ,$571.60 ,$809.77 ,$666.87 , N/A , N/A ,$905.04 ,$724.03 ,$714.50 , N/A ,$809.77 , N/A , N/A , N/A ,$666.87 ,$580.18 , N/A , N/A , N/A , N/A , N/A ,$809.77 , N/A ,$876.46 ,$666.87 ,$483.19 ,$579.89 ,$580.18 ,$579.89 ,$658.30 ,$857.40 ,$650.86 , N/A ,$752.61 , N/A , N/A , N/A , N/A , N/A ,$685.92 ,$590.66 ,$685.92 ,$685.92 ,$762.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/+20 DEG 3H HEAD/4H SHAFT,278,1 ,$952.67 ,$628.76 ,$483.19 ,$952.67 , N/A , N/A , N/A , N/A ,$571.60 ,$809.77 ,$666.87 , N/A , N/A ,$905.04 ,$724.03 ,$714.50 , N/A ,$809.77 , N/A , N/A , N/A ,$666.87 ,$580.18 , N/A , N/A , N/A , N/A , N/A ,$809.77 , N/A ,$876.46 ,$666.87 ,$483.19 ,$579.89 ,$580.18 ,$579.89 ,$658.30 ,$857.40 ,$650.86 , N/A ,$752.61 , N/A , N/A , N/A , N/A , N/A ,$685.92 ,$590.66 ,$685.92 ,$685.92 ,$762.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/+90 DEG 2H HEAD/ 4H SHAFT,278,1 ,$952.67 ,$628.76 ,$483.19 ,$952.67 , N/A , N/A , N/A , N/A ,$571.60 ,$809.77 ,$666.87 , N/A , N/A ,$905.04 ,$724.03 ,$714.50 , N/A ,$809.77 , N/A , N/A , N/A ,$666.87 ,$580.18 , N/A , N/A , N/A , N/A , N/A ,$809.77 , N/A ,$876.46 ,$666.87 ,$483.19 ,$579.89 ,$580.18 ,$579.89 ,$658.30 ,$857.40 ,$650.86 , N/A ,$752.61 , N/A , N/A , N/A , N/A , N/A ,$685.92 ,$590.66 ,$685.92 ,$685.92 ,$762.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/+90 DEG 3H HEAD/4H SHAFT,278,1 ,$952.67 ,$628.76 ,$483.19 ,$952.67 , N/A , N/A , N/A , N/A ,$571.60 ,$809.77 ,$666.87 , N/A , N/A ,$905.04 ,$724.03 ,$714.50 , N/A ,$809.77 , N/A , N/A , N/A ,$666.87 ,$580.18 , N/A , N/A , N/A , N/A , N/A ,$809.77 , N/A ,$876.46 ,$666.87 ,$483.19 ,$579.89 ,$580.18 ,$579.89 ,$658.30 ,$857.40 ,$650.86 , N/A ,$752.61 , N/A , N/A , N/A , N/A , N/A ,$685.92 ,$590.66 ,$685.92 ,$685.92 ,$762.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/-20 DEG 3H HEAD/ 4H SHAFT,278,1 ,$952.67 ,$628.76 ,$483.19 ,$952.67 , N/A , N/A , N/A , N/A ,$571.60 ,$809.77 ,$666.87 , N/A , N/A ,$905.04 ,$724.03 ,$714.50 , N/A ,$809.77 , N/A , N/A , N/A ,$666.87 ,$580.18 , N/A , N/A , N/A , N/A , N/A ,$809.77 , N/A ,$876.46 ,$666.87 ,$483.19 ,$579.89 ,$580.18 ,$579.89 ,$658.30 ,$857.40 ,$650.86 , N/A ,$752.61 , N/A , N/A , N/A , N/A , N/A ,$685.92 ,$590.66 ,$685.92 ,$685.92 ,$762.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DIST RAD L/-90 DEG 2H HEAD/4H SHAFT,278,1 ,$952.67 ,$628.76 ,$483.19 ,$952.67 , N/A , N/A , N/A , N/A ,$571.60 ,$809.77 ,$666.87 , N/A , N/A ,$905.04 ,$724.03 ,$714.50 , N/A ,$809.77 , N/A , N/A , N/A ,$666.87 ,$580.18 , N/A , N/A , N/A , N/A , N/A ,$809.77 , N/A ,$876.46 ,$666.87 ,$483.19 ,$579.89 ,$580.18 ,$579.89 ,$658.30 ,$857.40 ,$650.86 , N/A ,$752.61 , N/A , N/A , N/A , N/A , N/A ,$685.92 ,$590.66 ,$685.92 ,$685.92 ,$762.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DISTAL RADIUS ST/SHORT,278,1 ,$993.34 ,$655.60 ,$503.82 ,$993.34 , N/A , N/A , N/A , N/A ,$596.00 ,$844.34 ,$695.34 , N/A , N/A ,$943.67 ,$754.94 ,$745.01 , N/A ,$844.34 , N/A , N/A , N/A ,$695.34 ,$604.94 , N/A , N/A , N/A , N/A , N/A ,$844.34 , N/A ,$913.87 ,$695.34 ,$503.82 ,$604.65 ,$604.94 ,$604.65 ,$686.40 ,$894.01 ,$678.65 , N/A ,$784.74 , N/A , N/A , N/A , N/A , N/A ,$715.20 ,$615.87 ,$715.20 ,$715.20 ,$794.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DISTAL RADIUS T 3H HEAD/3H SHAFT,278,1 ,$939.12 ,$619.82 ,$476.32 ,$939.12 , N/A , N/A , N/A , N/A ,$563.47 ,$798.25 ,$657.38 , N/A , N/A ,$892.16 ,$713.73 ,$704.34 , N/A ,$798.25 , N/A , N/A , N/A ,$657.38 ,$571.92 , N/A , N/A , N/A , N/A , N/A ,$798.25 , N/A ,$863.99 ,$657.38 ,$476.32 ,$571.64 ,$571.92 ,$571.64 ,$648.93 ,$845.21 ,$641.61 , N/A ,$741.90 , N/A , N/A , N/A , N/A , N/A ,$676.17 ,$582.25 ,$676.17 ,$676.17 ,$751.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DISTAL RADIUS ST/LONG,278,1 ,$939.12 ,$619.82 ,$476.32 ,$939.12 , N/A , N/A , N/A , N/A ,$563.47 ,$798.25 ,$657.38 , N/A , N/A ,$892.16 ,$713.73 ,$704.34 , N/A ,$798.25 , N/A , N/A , N/A ,$657.38 ,$571.92 , N/A , N/A , N/A , N/A , N/A ,$798.25 , N/A ,$863.99 ,$657.38 ,$476.32 ,$571.64 ,$571.92 ,$571.64 ,$648.93 ,$845.21 ,$641.61 , N/A ,$741.90 , N/A , N/A , N/A , N/A , N/A ,$676.17 ,$582.25 ,$676.17 ,$676.17 ,$751.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP DISTAL RADIUS T 3H HEAD/4H SHAFT,278,1 ,$978.25 ,$645.65 ,$496.17 ,$978.25 , N/A , N/A , N/A , N/A ,$586.95 ,$831.51 ,$684.78 , N/A , N/A ,$929.34 ,$743.47 ,$733.69 , N/A ,$831.51 , N/A , N/A , N/A ,$684.78 ,$595.75 , N/A , N/A , N/A , N/A , N/A ,$831.51 , N/A ,$899.99 ,$684.78 ,$496.17 ,$595.46 ,$595.75 ,$595.46 ,$675.97 ,$880.43 ,$668.34 , N/A ,$772.82 , N/A , N/A , N/A , N/A , N/A ,$704.34 ,$606.52 ,$704.34 ,$704.34 ,$782.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP T 3H HEAD 7H SHAFT,278,1 ,"$1,379.04 ",$910.17 ,$699.45 ,"$1,379.04 ", N/A ,$726.89 ,$726.89 , N/A ,$827.42 ,"$1,172.18 ",$965.33 , N/A , N/A ,"$1,310.09 ","$1,048.07 ","$1,034.28 ", N/A ,"$1,172.18 ", N/A , N/A , N/A ,$965.33 ,$839.84 , N/A , N/A , N/A , N/A , N/A ,"$1,172.18 ", N/A ,"$1,268.72 ",$965.33 ,$699.45 ,$839.42 ,$839.84 ,$839.42 ,$952.92 ,"$1,241.14 ",$942.16 , N/A ,"$1,089.44 ", N/A , N/A , N/A , N/A , N/A ,$992.91 ,$855.00 ,$992.91 ,$992.91 ,"$1,103.23 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP T 2H HEAD 3H SHAFT,278,1 ,"$1,379.04 ",$910.17 ,$699.45 ,"$1,379.04 ", N/A ,$726.89 ,$726.89 , N/A ,$827.42 ,"$1,172.18 ",$965.33 , N/A , N/A ,"$1,310.09 ","$1,048.07 ","$1,034.28 ", N/A ,"$1,172.18 ", N/A , N/A , N/A ,$965.33 ,$839.84 , N/A , N/A , N/A , N/A , N/A ,"$1,172.18 ", N/A ,"$1,268.72 ",$965.33 ,$699.45 ,$839.42 ,$839.84 ,$839.42 ,$952.92 ,"$1,241.14 ",$942.16 , N/A ,"$1,089.44 ", N/A , N/A , N/A , N/A , N/A ,$992.91 ,$855.00 ,$992.91 ,$992.91 ,"$1,103.23 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H 43MM RHT,278,1 ,"$1,568.46 ","$1,035.18 ",$795.52 ,"$1,568.46 ", N/A ,$826.74 ,$826.74 , N/A ,$941.08 ,"$1,333.19 ","$1,097.92 ", N/A , N/A ,"$1,490.04 ","$1,192.03 ","$1,176.35 ", N/A ,"$1,333.19 ", N/A , N/A , N/A ,"$1,097.92 ",$955.19 , N/A , N/A , N/A , N/A , N/A ,"$1,333.19 ", N/A ,"$1,442.98 ","$1,097.92 ",$795.52 ,$954.72 ,$955.19 ,$954.72 ,"$1,083.81 ","$1,411.61 ","$1,071.57 ", N/A ,"$1,239.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,129.29 ",$972.45 ,"$1,129.29 ","$1,129.29 ","$1,254.77 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP DISTAL RADIUS VOLAR EXTRA ARTICULAR 4H RIGHT,278,1 ,"$1,568.46 ","$1,035.18 ",$795.52 ,"$1,568.46 ", N/A ,$826.74 ,$826.74 , N/A ,$941.08 ,"$1,333.19 ","$1,097.92 ", N/A , N/A ,"$1,490.04 ","$1,192.03 ","$1,176.35 ", N/A ,"$1,333.19 ", N/A , N/A , N/A ,"$1,097.92 ",$955.19 , N/A , N/A , N/A , N/A , N/A ,"$1,333.19 ", N/A ,"$1,442.98 ","$1,097.92 ",$795.52 ,$954.72 ,$955.19 ,$954.72 ,"$1,083.81 ","$1,411.61 ","$1,071.57 ", N/A ,"$1,239.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,129.29 ",$972.45 ,"$1,129.29 ","$1,129.29 ","$1,254.77 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR DISTAL RADIUS EXTRA ARTICULAR 4H LEFT,278,1 ,"$1,568.46 ","$1,035.18 ",$795.52 ,"$1,568.46 ", N/A ,$826.74 ,$826.74 , N/A ,$941.08 ,"$1,333.19 ","$1,097.92 ", N/A , N/A ,"$1,490.04 ","$1,192.03 ","$1,176.35 ", N/A ,"$1,333.19 ", N/A , N/A , N/A ,"$1,097.92 ",$955.19 , N/A , N/A , N/A , N/A , N/A ,"$1,333.19 ", N/A ,"$1,442.98 ","$1,097.92 ",$795.52 ,$954.72 ,$955.19 ,$954.72 ,"$1,083.81 ","$1,411.61 ","$1,071.57 ", N/A ,"$1,239.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,129.29 ",$972.45 ,"$1,129.29 ","$1,129.29 ","$1,254.77 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR DISTAL RADIUS EXTRA ARTICULAR LEFT,278,1 ,"$1,568.46 ","$1,035.18 ",$795.52 ,"$1,568.46 ", N/A ,$826.74 ,$826.74 , N/A ,$941.08 ,"$1,333.19 ","$1,097.92 ", N/A , N/A ,"$1,490.04 ","$1,192.03 ","$1,176.35 ", N/A ,"$1,333.19 ", N/A , N/A , N/A ,"$1,097.92 ",$955.19 , N/A , N/A , N/A , N/A , N/A ,"$1,333.19 ", N/A ,"$1,442.98 ","$1,097.92 ",$795.52 ,$954.72 ,$955.19 ,$954.72 ,"$1,083.81 ","$1,411.61 ","$1,071.57 ", N/A ,"$1,239.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,129.29 ",$972.45 ,"$1,129.29 ","$1,129.29 ","$1,254.77 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR DISTAL RADIUS EXTRA ARTICULAR RIGHT,278,1 ,"$1,568.46 ","$1,035.18 ",$795.52 ,"$1,568.46 ", N/A ,$826.74 ,$826.74 , N/A ,$941.08 ,"$1,333.19 ","$1,097.92 ", N/A , N/A ,"$1,490.04 ","$1,192.03 ","$1,176.35 ", N/A ,"$1,333.19 ", N/A , N/A , N/A ,"$1,097.92 ",$955.19 , N/A , N/A , N/A , N/A , N/A ,"$1,333.19 ", N/A ,"$1,442.98 ","$1,097.92 ",$795.52 ,$954.72 ,$955.19 ,$954.72 ,"$1,083.81 ","$1,411.61 ","$1,071.57 ", N/A ,"$1,239.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,129.29 ",$972.45 ,"$1,129.29 ","$1,129.29 ","$1,254.77 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H 43MM LFT,278,1 ,"$1,568.46 ","$1,035.18 ",$795.52 ,"$1,568.46 ", N/A ,$826.74 ,$826.74 , N/A ,$941.08 ,"$1,333.19 ","$1,097.92 ", N/A , N/A ,"$1,490.04 ","$1,192.03 ","$1,176.35 ", N/A ,"$1,333.19 ", N/A , N/A , N/A ,"$1,097.92 ",$955.19 , N/A , N/A , N/A , N/A , N/A ,"$1,333.19 ", N/A ,"$1,442.98 ","$1,097.92 ",$795.52 ,$954.72 ,$955.19 ,$954.72 ,"$1,083.81 ","$1,411.61 ","$1,071.57 ", N/A ,"$1,239.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,129.29 ",$972.45 ,"$1,129.29 ","$1,129.29 ","$1,254.77 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H RGT,278,1 ,"$1,660.30 ","$1,095.80 ",$842.10 ,"$1,660.30 ", N/A ,$875.14 ,$875.14 , N/A ,$996.18 ,"$1,411.26 ","$1,162.21 ", N/A , N/A ,"$1,577.29 ","$1,261.83 ","$1,245.23 ", N/A ,"$1,411.26 ", N/A , N/A , N/A ,"$1,162.21 ","$1,011.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.26 ", N/A ,"$1,527.48 ","$1,162.21 ",$842.10 ,"$1,010.62 ","$1,011.12 ","$1,010.62 ","$1,147.27 ","$1,494.27 ","$1,134.32 ", N/A ,"$1,311.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,195.42 ","$1,029.39 ","$1,195.42 ","$1,195.42 ","$1,328.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP DISTAL RADIUS VOLAR EXTRA ARTICULAR LEFT LONG,278,1 ,"$1,660.30 ","$1,095.80 ",$842.10 ,"$1,660.30 ", N/A ,$875.14 ,$875.14 , N/A ,$996.18 ,"$1,411.26 ","$1,162.21 ", N/A , N/A ,"$1,577.29 ","$1,261.83 ","$1,245.23 ", N/A ,"$1,411.26 ", N/A , N/A , N/A ,"$1,162.21 ","$1,011.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.26 ", N/A ,"$1,527.48 ","$1,162.21 ",$842.10 ,"$1,010.62 ","$1,011.12 ","$1,010.62 ","$1,147.27 ","$1,494.27 ","$1,134.32 ", N/A ,"$1,311.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,195.42 ","$1,029.39 ","$1,195.42 ","$1,195.42 ","$1,328.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 4H LFT,278,1 ,"$1,660.30 ","$1,095.80 ",$842.10 ,"$1,660.30 ", N/A ,$875.14 ,$875.14 , N/A ,$996.18 ,"$1,411.26 ","$1,162.21 ", N/A , N/A ,"$1,577.29 ","$1,261.83 ","$1,245.23 ", N/A ,"$1,411.26 ", N/A , N/A , N/A ,"$1,162.21 ","$1,011.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.26 ", N/A ,"$1,527.48 ","$1,162.21 ",$842.10 ,"$1,010.62 ","$1,011.12 ","$1,010.62 ","$1,147.27 ","$1,494.27 ","$1,134.32 ", N/A ,"$1,311.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,195.42 ","$1,029.39 ","$1,195.42 ","$1,195.42 ","$1,328.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 4H RGT,278,1 ,"$1,660.30 ","$1,095.80 ",$842.10 ,"$1,660.30 ", N/A ,$875.14 ,$875.14 , N/A ,$996.18 ,"$1,411.26 ","$1,162.21 ", N/A , N/A ,"$1,577.29 ","$1,261.83 ","$1,245.23 ", N/A ,"$1,411.26 ", N/A , N/A , N/A ,"$1,162.21 ","$1,011.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.26 ", N/A ,"$1,527.48 ","$1,162.21 ",$842.10 ,"$1,010.62 ","$1,011.12 ","$1,010.62 ","$1,147.27 ","$1,494.27 ","$1,134.32 ", N/A ,"$1,311.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,195.42 ","$1,029.39 ","$1,195.42 ","$1,195.42 ","$1,328.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H 61MM LFT,278,1 ,"$1,660.30 ","$1,095.80 ",$842.10 ,"$1,660.30 ", N/A ,$875.14 ,$875.14 , N/A ,$996.18 ,"$1,411.26 ","$1,162.21 ", N/A , N/A ,"$1,577.29 ","$1,261.83 ","$1,245.23 ", N/A ,"$1,411.26 ", N/A , N/A , N/A ,"$1,162.21 ","$1,011.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.26 ", N/A ,"$1,527.48 ","$1,162.21 ",$842.10 ,"$1,010.62 ","$1,011.12 ","$1,010.62 ","$1,147.27 ","$1,494.27 ","$1,134.32 ", N/A ,"$1,311.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,195.42 ","$1,029.39 ","$1,195.42 ","$1,195.42 ","$1,328.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H 61MM RHT,278,1 ,"$1,660.30 ","$1,095.80 ",$842.10 ,"$1,660.30 ", N/A ,$875.14 ,$875.14 , N/A ,$996.18 ,"$1,411.26 ","$1,162.21 ", N/A , N/A ,"$1,577.29 ","$1,261.83 ","$1,245.23 ", N/A ,"$1,411.26 ", N/A , N/A , N/A ,"$1,162.21 ","$1,011.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.26 ", N/A ,"$1,527.48 ","$1,162.21 ",$842.10 ,"$1,010.62 ","$1,011.12 ","$1,010.62 ","$1,147.27 ","$1,494.27 ","$1,134.32 ", N/A ,"$1,311.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,195.42 ","$1,029.39 ","$1,195.42 ","$1,195.42 ","$1,328.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/2H SHAFT RIGHT,278,1 ,"$1,671.75 ","$1,103.36 ",$847.91 ,"$1,671.75 ", N/A ,$881.18 ,$881.18 , N/A ,"$1,003.05 ","$1,420.99 ","$1,170.23 ", N/A , N/A ,"$1,588.16 ","$1,270.53 ","$1,253.81 ", N/A ,"$1,420.99 ", N/A , N/A , N/A ,"$1,170.23 ","$1,018.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,420.99 ", N/A ,"$1,538.01 ","$1,170.23 ",$847.91 ,"$1,017.59 ","$1,018.10 ","$1,017.59 ","$1,155.18 ","$1,504.58 ","$1,142.14 ", N/A ,"$1,320.68 ", N/A , N/A , N/A , N/A , N/A ,"$1,203.66 ","$1,036.49 ","$1,203.66 ","$1,203.66 ","$1,337.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/4H SHAFT LEFT,278,1 ,"$1,803.49 ","$1,190.30 ",$914.73 ,"$1,803.49 ", N/A ,$950.62 ,$950.62 , N/A ,"$1,082.09 ","$1,532.97 ","$1,262.44 ", N/A , N/A ,"$1,713.32 ","$1,370.65 ","$1,352.62 ", N/A ,"$1,532.97 ", N/A , N/A , N/A ,"$1,262.44 ","$1,098.33 ", N/A , N/A , N/A , N/A , N/A ,"$1,532.97 ", N/A ,"$1,659.21 ","$1,262.44 ",$914.73 ,"$1,097.78 ","$1,098.33 ","$1,097.78 ","$1,246.21 ","$1,623.14 ","$1,232.14 ", N/A ,"$1,424.76 ", N/A , N/A , N/A , N/A , N/A ,"$1,298.51 ","$1,118.16 ","$1,298.51 ","$1,298.51 ","$1,442.79 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 7H HD/2H SHAFT RIGHT,278,1 ,"$1,839.67 ","$1,214.18 ",$933.08 ,"$1,839.67 ", N/A ,$969.69 ,$969.69 , N/A ,"$1,103.80 ","$1,563.72 ","$1,287.77 ", N/A , N/A ,"$1,747.69 ","$1,398.15 ","$1,379.75 ", N/A ,"$1,563.72 ", N/A , N/A , N/A ,"$1,287.77 ","$1,120.36 ", N/A , N/A , N/A , N/A , N/A ,"$1,563.72 ", N/A ,"$1,692.50 ","$1,287.77 ",$933.08 ,"$1,119.81 ","$1,120.36 ","$1,119.81 ","$1,271.21 ","$1,655.70 ","$1,256.86 ", N/A ,"$1,453.34 ", N/A , N/A , N/A , N/A , N/A ,"$1,324.56 ","$1,140.60 ","$1,324.56 ","$1,324.56 ","$1,471.74 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/2H SHAFT LEFT,278,1 ,"$1,839.67 ","$1,214.18 ",$933.08 ,"$1,839.67 ", N/A ,$969.69 ,$969.69 , N/A ,"$1,103.80 ","$1,563.72 ","$1,287.77 ", N/A , N/A ,"$1,747.69 ","$1,398.15 ","$1,379.75 ", N/A ,"$1,563.72 ", N/A , N/A , N/A ,"$1,287.77 ","$1,120.36 ", N/A , N/A , N/A , N/A , N/A ,"$1,563.72 ", N/A ,"$1,692.50 ","$1,287.77 ",$933.08 ,"$1,119.81 ","$1,120.36 ","$1,119.81 ","$1,271.21 ","$1,655.70 ","$1,256.86 ", N/A ,"$1,453.34 ", N/A , N/A , N/A , N/A , N/A ,"$1,324.56 ","$1,140.60 ","$1,324.56 ","$1,324.56 ","$1,471.74 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 7H HD/2H SHAFT LEFT,278,1 ,"$1,839.67 ","$1,214.18 ",$933.08 ,"$1,839.67 ", N/A ,$969.69 ,$969.69 , N/A ,"$1,103.80 ","$1,563.72 ","$1,287.77 ", N/A , N/A ,"$1,747.69 ","$1,398.15 ","$1,379.75 ", N/A ,"$1,563.72 ", N/A , N/A , N/A ,"$1,287.77 ","$1,120.36 ", N/A , N/A , N/A , N/A , N/A ,"$1,563.72 ", N/A ,"$1,692.50 ","$1,287.77 ",$933.08 ,"$1,119.81 ","$1,120.36 ","$1,119.81 ","$1,271.21 ","$1,655.70 ","$1,256.86 ", N/A ,"$1,453.34 ", N/A , N/A , N/A , N/A , N/A ,"$1,324.56 ","$1,140.60 ","$1,324.56 ","$1,324.56 ","$1,471.74 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 7H HD/3H SHAFT LEFT,278,1 ,"$1,738.67 ","$1,147.52 ",$881.85 ,"$1,738.67 ", N/A ,$916.45 ,$916.45 , N/A ,"$1,043.20 ","$1,477.87 ","$1,217.07 ", N/A , N/A ,"$1,651.74 ","$1,321.39 ","$1,304.00 ", N/A ,"$1,477.87 ", N/A , N/A , N/A ,"$1,217.07 ","$1,058.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,477.87 ", N/A ,"$1,599.58 ","$1,217.07 ",$881.85 ,"$1,058.33 ","$1,058.85 ","$1,058.33 ","$1,201.42 ","$1,564.80 ","$1,187.86 ", N/A ,"$1,373.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,251.84 ","$1,077.98 ","$1,251.84 ","$1,251.84 ","$1,390.94 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/3H SHAFT LEFT,278,1 ,"$1,738.67 ","$1,147.52 ",$881.85 ,"$1,738.67 ", N/A ,$916.45 ,$916.45 , N/A ,"$1,043.20 ","$1,477.87 ","$1,217.07 ", N/A , N/A ,"$1,651.74 ","$1,321.39 ","$1,304.00 ", N/A ,"$1,477.87 ", N/A , N/A , N/A ,"$1,217.07 ","$1,058.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,477.87 ", N/A ,"$1,599.58 ","$1,217.07 ",$881.85 ,"$1,058.33 ","$1,058.85 ","$1,058.33 ","$1,201.42 ","$1,564.80 ","$1,187.86 ", N/A ,"$1,373.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,251.84 ","$1,077.98 ","$1,251.84 ","$1,251.84 ","$1,390.94 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/3H SHAFT RIGHT,278,1 ,"$1,738.67 ","$1,147.52 ",$881.85 ,"$1,738.67 ", N/A ,$916.45 ,$916.45 , N/A ,"$1,043.20 ","$1,477.87 ","$1,217.07 ", N/A , N/A ,"$1,651.74 ","$1,321.39 ","$1,304.00 ", N/A ,"$1,477.87 ", N/A , N/A , N/A ,"$1,217.07 ","$1,058.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,477.87 ", N/A ,"$1,599.58 ","$1,217.07 ",$881.85 ,"$1,058.33 ","$1,058.85 ","$1,058.33 ","$1,201.42 ","$1,564.80 ","$1,187.86 ", N/A ,"$1,373.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,251.84 ","$1,077.98 ","$1,251.84 ","$1,251.84 ","$1,390.94 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 7H HD/3H SHAFT RIGHT,278,1 ,"$1,912.86 ","$1,262.49 ",$970.20 ,"$1,912.86 ", N/A ,"$1,008.27 ","$1,008.27 ", N/A ,"$1,147.72 ","$1,625.93 ","$1,339.00 ", N/A , N/A ,"$1,817.22 ","$1,453.77 ","$1,434.65 ", N/A ,"$1,625.93 ", N/A , N/A , N/A ,"$1,339.00 ","$1,164.93 ", N/A , N/A , N/A , N/A , N/A ,"$1,625.93 ", N/A ,"$1,759.83 ","$1,339.00 ",$970.20 ,"$1,164.36 ","$1,164.93 ","$1,164.36 ","$1,321.79 ","$1,721.57 ","$1,306.87 ", N/A ,"$1,511.16 ", N/A , N/A , N/A , N/A , N/A ,"$1,377.26 ","$1,185.97 ","$1,377.26 ","$1,377.26 ","$1,530.29 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 7H HD/4H SHAFT RIGHT,278,1 ,"$1,984.61 ","$1,309.84 ","$1,006.59 ","$1,984.61 ", N/A ,"$1,046.09 ","$1,046.09 ", N/A ,"$1,190.77 ","$1,686.92 ","$1,389.23 ", N/A , N/A ,"$1,885.38 ","$1,508.30 ","$1,488.46 ", N/A ,"$1,686.92 ", N/A , N/A , N/A ,"$1,389.23 ","$1,208.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,686.92 ", N/A ,"$1,825.84 ","$1,389.23 ","$1,006.59 ","$1,208.03 ","$1,208.63 ","$1,208.03 ","$1,371.37 ","$1,786.15 ","$1,355.89 ", N/A ,"$1,567.84 ", N/A , N/A , N/A , N/A , N/A ,"$1,428.92 ","$1,230.46 ","$1,428.92 ","$1,428.92 ","$1,587.69 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/4H SHAFT RIGHT,278,1 ,"$1,984.61 ","$1,309.84 ","$1,006.59 ","$1,984.61 ", N/A ,"$1,046.09 ","$1,046.09 ", N/A ,"$1,190.77 ","$1,686.92 ","$1,389.23 ", N/A , N/A ,"$1,885.38 ","$1,508.30 ","$1,488.46 ", N/A ,"$1,686.92 ", N/A , N/A , N/A ,"$1,389.23 ","$1,208.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,686.92 ", N/A ,"$1,825.84 ","$1,389.23 ","$1,006.59 ","$1,208.03 ","$1,208.63 ","$1,208.03 ","$1,371.37 ","$1,786.15 ","$1,355.89 ", N/A ,"$1,567.84 ", N/A , N/A , N/A , N/A , N/A ,"$1,428.92 ","$1,230.46 ","$1,428.92 ","$1,428.92 ","$1,587.69 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 7H HD/4H SHAFT LEFT,278,1 ,"$1,984.61 ","$1,309.84 ","$1,006.59 ","$1,984.61 ", N/A ,"$1,046.09 ","$1,046.09 ", N/A ,"$1,190.77 ","$1,686.92 ","$1,389.23 ", N/A , N/A ,"$1,885.38 ","$1,508.30 ","$1,488.46 ", N/A ,"$1,686.92 ", N/A , N/A , N/A ,"$1,389.23 ","$1,208.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,686.92 ", N/A ,"$1,825.84 ","$1,389.23 ","$1,006.59 ","$1,208.03 ","$1,208.63 ","$1,208.03 ","$1,371.37 ","$1,786.15 ","$1,355.89 ", N/A ,"$1,567.84 ", N/A , N/A , N/A , N/A , N/A ,"$1,428.92 ","$1,230.46 ","$1,428.92 ","$1,428.92 ","$1,587.69 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 7H HD/5H SHAFT RIGHT,278,1 ,"$1,907.22 ","$1,258.77 ",$967.34 ,"$1,907.22 ", N/A ,"$1,005.30 ","$1,005.30 ", N/A ,"$1,144.33 ","$1,621.14 ","$1,335.05 ", N/A , N/A ,"$1,811.86 ","$1,449.49 ","$1,430.42 ", N/A ,"$1,621.14 ", N/A , N/A , N/A ,"$1,335.05 ","$1,161.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,621.14 ", N/A ,"$1,754.64 ","$1,335.05 ",$967.34 ,"$1,160.92 ","$1,161.50 ","$1,160.92 ","$1,317.89 ","$1,716.50 ","$1,303.01 ", N/A ,"$1,506.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,373.20 ","$1,182.48 ","$1,373.20 ","$1,373.20 ","$1,525.78 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/5H SHAFT LEFT,278,1 ,"$1,907.22 ","$1,258.77 ",$967.34 ,"$1,907.22 ", N/A ,"$1,005.30 ","$1,005.30 ", N/A ,"$1,144.33 ","$1,621.14 ","$1,335.05 ", N/A , N/A ,"$1,811.86 ","$1,449.49 ","$1,430.42 ", N/A ,"$1,621.14 ", N/A , N/A , N/A ,"$1,335.05 ","$1,161.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,621.14 ", N/A ,"$1,754.64 ","$1,335.05 ",$967.34 ,"$1,160.92 ","$1,161.50 ","$1,160.92 ","$1,317.89 ","$1,716.50 ","$1,303.01 ", N/A ,"$1,506.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,373.20 ","$1,182.48 ","$1,373.20 ","$1,373.20 ","$1,525.78 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/5H SHAFT RIGHT,278,1 ,"$1,907.22 ","$1,258.77 ",$967.34 ,"$1,907.22 ", N/A ,"$1,005.30 ","$1,005.30 ", N/A ,"$1,144.33 ","$1,621.14 ","$1,335.05 ", N/A , N/A ,"$1,811.86 ","$1,449.49 ","$1,430.42 ", N/A ,"$1,621.14 ", N/A , N/A , N/A ,"$1,335.05 ","$1,161.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,621.14 ", N/A ,"$1,754.64 ","$1,335.05 ",$967.34 ,"$1,160.92 ","$1,161.50 ","$1,160.92 ","$1,317.89 ","$1,716.50 ","$1,303.01 ", N/A ,"$1,506.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,373.20 ","$1,182.48 ","$1,373.20 ","$1,373.20 ","$1,525.78 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 7H HD/5H SHAFT LEFT,278,1 ,"$1,907.22 ","$1,258.77 ",$967.34 ,"$1,907.22 ", N/A ,"$1,005.30 ","$1,005.30 ", N/A ,"$1,144.33 ","$1,621.14 ","$1,335.05 ", N/A , N/A ,"$1,811.86 ","$1,449.49 ","$1,430.42 ", N/A ,"$1,621.14 ", N/A , N/A , N/A ,"$1,335.05 ","$1,161.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,621.14 ", N/A ,"$1,754.64 ","$1,335.05 ",$967.34 ,"$1,160.92 ","$1,161.50 ","$1,160.92 ","$1,317.89 ","$1,716.50 ","$1,303.01 ", N/A ,"$1,506.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,373.20 ","$1,182.48 ","$1,373.20 ","$1,373.20 ","$1,525.78 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA LOCKING X-PLATE LARGE,278,1 ,"$1,859.76 ","$1,227.44 ",$943.27 ,"$1,859.76 ", N/A ,$980.28 ,$980.28 , N/A ,"$1,115.86 ","$1,580.80 ","$1,301.83 ", N/A , N/A ,"$1,766.77 ","$1,413.42 ","$1,394.82 ", N/A ,"$1,580.80 ", N/A , N/A , N/A ,"$1,301.83 ","$1,132.59 ", N/A , N/A , N/A , N/A , N/A ,"$1,580.80 ", N/A ,"$1,710.98 ","$1,301.83 ",$943.27 ,"$1,132.04 ","$1,132.59 ","$1,132.04 ","$1,285.09 ","$1,673.78 ","$1,270.59 ", N/A ,"$1,469.21 ", N/A , N/A , N/A , N/A , N/A ,"$1,339.03 ","$1,153.05 ","$1,339.03 ","$1,339.03 ","$1,487.81 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA LOCKING X-PLATE SMALL,278,1 ,"$1,809.54 ","$1,194.30 ",$917.80 ,"$1,809.54 ", N/A ,$953.81 ,$953.81 , N/A ,"$1,085.72 ","$1,538.11 ","$1,266.68 ", N/A , N/A ,"$1,719.06 ","$1,375.25 ","$1,357.16 ", N/A ,"$1,538.11 ", N/A , N/A , N/A ,"$1,266.68 ","$1,102.01 ", N/A , N/A , N/A , N/A , N/A ,"$1,538.11 ", N/A ,"$1,664.78 ","$1,266.68 ",$917.80 ,"$1,101.47 ","$1,102.01 ","$1,101.47 ","$1,250.39 ","$1,628.59 ","$1,236.28 ", N/A ,"$1,429.54 ", N/A , N/A , N/A , N/A , N/A ,"$1,302.87 ","$1,121.91 ","$1,302.87 ","$1,302.87 ","$1,447.63 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA STRAIGHT FUSION PLATE/2H,278,1 ,"$1,465.14 ",$966.99 ,$743.12 ,"$1,465.14 ", N/A ,$772.28 ,$772.28 , N/A ,$879.08 ,"$1,245.37 ","$1,025.60 ", N/A , N/A ,"$1,391.88 ","$1,113.51 ","$1,098.86 ", N/A ,"$1,245.37 ", N/A , N/A , N/A ,"$1,025.60 ",$892.27 , N/A , N/A , N/A , N/A , N/A ,"$1,245.37 ", N/A ,"$1,347.93 ","$1,025.60 ",$743.12 ,$891.83 ,$892.27 ,$891.83 ,"$1,012.41 ","$1,318.63 ","$1,000.98 ", N/A ,"$1,157.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,054.90 ",$908.39 ,"$1,054.90 ","$1,054.90 ","$1,172.11 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA STRAIGHT FUSION PLATE/4H,278,1 ,"$1,549.80 ","$1,022.87 ",$786.06 ,"$1,549.80 ", N/A ,$816.90 ,$816.90 , N/A ,$929.88 ,"$1,317.33 ","$1,084.86 ", N/A , N/A ,"$1,472.31 ","$1,177.85 ","$1,162.35 ", N/A ,"$1,317.33 ", N/A , N/A , N/A ,"$1,084.86 ",$943.83 , N/A , N/A , N/A , N/A , N/A ,"$1,317.33 ", N/A ,"$1,425.82 ","$1,084.86 ",$786.06 ,$943.36 ,$943.83 ,$943.36 ,"$1,070.91 ","$1,394.82 ","$1,058.82 ", N/A ,"$1,224.34 ", N/A , N/A , N/A , N/A , N/A ,"$1,115.86 ",$960.88 ,"$1,115.86 ","$1,115.86 ","$1,239.84 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP CLOVERLEAF FUSION LONG,278,1 ,"$1,722.00 ","$1,136.52 ",$873.40 ,"$1,722.00 ", N/A ,$907.67 ,$907.67 , N/A ,"$1,033.20 ","$1,463.70 ","$1,205.40 ", N/A , N/A ,"$1,635.90 ","$1,308.72 ","$1,291.50 ", N/A ,"$1,463.70 ", N/A , N/A , N/A ,"$1,205.40 ","$1,048.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,463.70 ", N/A ,"$1,584.24 ","$1,205.40 ",$873.40 ,"$1,048.18 ","$1,048.70 ","$1,048.18 ","$1,189.90 ","$1,549.80 ","$1,176.47 ", N/A ,"$1,360.38 ", N/A , N/A , N/A , N/A , N/A ,"$1,239.84 ","$1,067.64 ","$1,239.84 ","$1,239.84 ","$1,377.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP T-FUSION 2H LONG,278,1 ,"$1,722.00 ","$1,136.52 ",$873.40 ,"$1,722.00 ", N/A ,$907.67 ,$907.67 , N/A ,"$1,033.20 ","$1,463.70 ","$1,205.40 ", N/A , N/A ,"$1,635.90 ","$1,308.72 ","$1,291.50 ", N/A ,"$1,463.70 ", N/A , N/A , N/A ,"$1,205.40 ","$1,048.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,463.70 ", N/A ,"$1,584.24 ","$1,205.40 ",$873.40 ,"$1,048.18 ","$1,048.70 ","$1,048.18 ","$1,189.90 ","$1,549.80 ","$1,176.47 ", N/A ,"$1,360.38 ", N/A , N/A , N/A , N/A , N/A ,"$1,239.84 ","$1,067.64 ","$1,239.84 ","$1,239.84 ","$1,377.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP TMT FUSION,278,1 ,"$1,722.00 ","$1,136.52 ",$873.40 ,"$1,722.00 ", N/A ,$907.67 ,$907.67 , N/A ,"$1,033.20 ","$1,463.70 ","$1,205.40 ", N/A , N/A ,"$1,635.90 ","$1,308.72 ","$1,291.50 ", N/A ,"$1,463.70 ", N/A , N/A , N/A ,"$1,205.40 ","$1,048.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,463.70 ", N/A ,"$1,584.24 ","$1,205.40 ",$873.40 ,"$1,048.18 ","$1,048.70 ","$1,048.18 ","$1,189.90 ","$1,549.80 ","$1,176.47 ", N/A ,"$1,360.38 ", N/A , N/A , N/A , N/A , N/A ,"$1,239.84 ","$1,067.64 ","$1,239.84 ","$1,239.84 ","$1,377.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP CLOVERLEAF FUSION SHORT,278,1 ,"$1,637.34 ","$1,080.64 ",$830.46 ,"$1,637.34 ", N/A ,$863.04 ,$863.04 , N/A ,$982.40 ,"$1,391.74 ","$1,146.14 ", N/A , N/A ,"$1,555.47 ","$1,244.38 ","$1,228.01 ", N/A ,"$1,391.74 ", N/A , N/A , N/A ,"$1,146.14 ",$997.14 , N/A , N/A , N/A , N/A , N/A ,"$1,391.74 ", N/A ,"$1,506.35 ","$1,146.14 ",$830.46 ,$996.65 ,$997.14 ,$996.65 ,"$1,131.40 ","$1,473.61 ","$1,118.63 ", N/A ,"$1,293.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,178.88 ","$1,015.15 ","$1,178.88 ","$1,178.88 ","$1,309.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP L-FUSION SHORT LEFT,278,1 ,"$1,637.34 ","$1,080.64 ",$830.46 ,"$1,637.34 ", N/A ,$863.04 ,$863.04 , N/A ,$982.40 ,"$1,391.74 ","$1,146.14 ", N/A , N/A ,"$1,555.47 ","$1,244.38 ","$1,228.01 ", N/A ,"$1,391.74 ", N/A , N/A , N/A ,"$1,146.14 ",$997.14 , N/A , N/A , N/A , N/A , N/A ,"$1,391.74 ", N/A ,"$1,506.35 ","$1,146.14 ",$830.46 ,$996.65 ,$997.14 ,$996.65 ,"$1,131.40 ","$1,473.61 ","$1,118.63 ", N/A ,"$1,293.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,178.88 ","$1,015.15 ","$1,178.88 ","$1,178.88 ","$1,309.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP T-FUSION 2H SHORT,278,1 ,"$1,637.34 ","$1,080.64 ",$830.46 ,"$1,637.34 ", N/A ,$863.04 ,$863.04 , N/A ,$982.40 ,"$1,391.74 ","$1,146.14 ", N/A , N/A ,"$1,555.47 ","$1,244.38 ","$1,228.01 ", N/A ,"$1,391.74 ", N/A , N/A , N/A ,"$1,146.14 ",$997.14 , N/A , N/A , N/A , N/A , N/A ,"$1,391.74 ", N/A ,"$1,506.35 ","$1,146.14 ",$830.46 ,$996.65 ,$997.14 ,$996.65 ,"$1,131.40 ","$1,473.61 ","$1,118.63 ", N/A ,"$1,293.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,178.88 ","$1,015.15 ","$1,178.88 ","$1,178.88 ","$1,309.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP CLOVERLEAF FUSION STANDARD,278,1 ,"$1,680.39 ","$1,109.06 ",$852.29 ,"$1,680.39 ", N/A ,$885.73 ,$885.73 , N/A ,"$1,008.23 ","$1,428.33 ","$1,176.27 ", N/A , N/A ,"$1,596.37 ","$1,277.10 ","$1,260.29 ", N/A ,"$1,428.33 ", N/A , N/A , N/A ,"$1,176.27 ","$1,023.36 ", N/A , N/A , N/A , N/A , N/A ,"$1,428.33 ", N/A ,"$1,545.96 ","$1,176.27 ",$852.29 ,"$1,022.85 ","$1,023.36 ","$1,022.85 ","$1,161.15 ","$1,512.35 ","$1,148.04 ", N/A ,"$1,327.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,209.88 ","$1,041.84 ","$1,209.88 ","$1,209.88 ","$1,344.31 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP T-FUSION 2H STANDARD,278,1 ,"$1,680.39 ","$1,109.06 ",$852.29 ,"$1,680.39 ", N/A ,$885.73 ,$885.73 , N/A ,"$1,008.23 ","$1,428.33 ","$1,176.27 ", N/A , N/A ,"$1,596.37 ","$1,277.10 ","$1,260.29 ", N/A ,"$1,428.33 ", N/A , N/A , N/A ,"$1,176.27 ","$1,023.36 ", N/A , N/A , N/A , N/A , N/A ,"$1,428.33 ", N/A ,"$1,545.96 ","$1,176.27 ",$852.29 ,"$1,022.85 ","$1,023.36 ","$1,022.85 ","$1,161.15 ","$1,512.35 ","$1,148.04 ", N/A ,"$1,327.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,209.88 ","$1,041.84 ","$1,209.88 ","$1,209.88 ","$1,344.31 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION LRG 5 DEG RIGHT,278,1 ,"$1,996.33 ","$1,317.58 ","$1,012.54 ","$1,996.33 ", N/A ,"$1,052.27 ","$1,052.27 ", N/A ,"$1,197.80 ","$1,696.88 ","$1,397.43 ", N/A , N/A ,"$1,896.51 ","$1,517.21 ","$1,497.25 ", N/A ,"$1,696.88 ", N/A , N/A , N/A ,"$1,397.43 ","$1,215.77 ", N/A , N/A , N/A , N/A , N/A ,"$1,696.88 ", N/A ,"$1,836.62 ","$1,397.43 ","$1,012.54 ","$1,215.17 ","$1,215.77 ","$1,215.17 ","$1,379.46 ","$1,796.70 ","$1,363.89 ", N/A ,"$1,577.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.36 ","$1,237.72 ","$1,437.36 ","$1,437.36 ","$1,597.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING CUBOID LEFT,278,1 ,"$1,996.33 ","$1,317.58 ","$1,012.54 ","$1,996.33 ", N/A ,"$1,052.27 ","$1,052.27 ", N/A ,"$1,197.80 ","$1,696.88 ","$1,397.43 ", N/A , N/A ,"$1,896.51 ","$1,517.21 ","$1,497.25 ", N/A ,"$1,696.88 ", N/A , N/A , N/A ,"$1,397.43 ","$1,215.77 ", N/A , N/A , N/A , N/A , N/A ,"$1,696.88 ", N/A ,"$1,836.62 ","$1,397.43 ","$1,012.54 ","$1,215.17 ","$1,215.77 ","$1,215.17 ","$1,379.46 ","$1,796.70 ","$1,363.89 ", N/A ,"$1,577.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.36 ","$1,237.72 ","$1,437.36 ","$1,437.36 ","$1,597.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING CUBOID RIGHT,278,1 ,"$1,996.33 ","$1,317.58 ","$1,012.54 ","$1,996.33 ", N/A ,"$1,052.27 ","$1,052.27 ", N/A ,"$1,197.80 ","$1,696.88 ","$1,397.43 ", N/A , N/A ,"$1,896.51 ","$1,517.21 ","$1,497.25 ", N/A ,"$1,696.88 ", N/A , N/A , N/A ,"$1,397.43 ","$1,215.77 ", N/A , N/A , N/A , N/A , N/A ,"$1,696.88 ", N/A ,"$1,836.62 ","$1,397.43 ","$1,012.54 ","$1,215.17 ","$1,215.77 ","$1,215.17 ","$1,379.46 ","$1,796.70 ","$1,363.89 ", N/A ,"$1,577.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.36 ","$1,237.72 ","$1,437.36 ","$1,437.36 ","$1,597.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING NAVICULAR,278,1 ,"$1,996.33 ","$1,317.58 ","$1,012.54 ","$1,996.33 ", N/A ,"$1,052.27 ","$1,052.27 ", N/A ,"$1,197.80 ","$1,696.88 ","$1,397.43 ", N/A , N/A ,"$1,896.51 ","$1,517.21 ","$1,497.25 ", N/A ,"$1,696.88 ", N/A , N/A , N/A ,"$1,397.43 ","$1,215.77 ", N/A , N/A , N/A , N/A , N/A ,"$1,696.88 ", N/A ,"$1,836.62 ","$1,397.43 ","$1,012.54 ","$1,215.17 ","$1,215.77 ","$1,215.17 ","$1,379.46 ","$1,796.70 ","$1,363.89 ", N/A ,"$1,577.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.36 ","$1,237.72 ","$1,437.36 ","$1,437.36 ","$1,597.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION LRG 5 DEG LEFT,278,1 ,"$1,996.33 ","$1,317.58 ","$1,012.54 ","$1,996.33 ", N/A ,"$1,052.27 ","$1,052.27 ", N/A ,"$1,197.80 ","$1,696.88 ","$1,397.43 ", N/A , N/A ,"$1,896.51 ","$1,517.21 ","$1,497.25 ", N/A ,"$1,696.88 ", N/A , N/A , N/A ,"$1,397.43 ","$1,215.77 ", N/A , N/A , N/A , N/A , N/A ,"$1,696.88 ", N/A ,"$1,836.62 ","$1,397.43 ","$1,012.54 ","$1,215.17 ","$1,215.77 ","$1,215.17 ","$1,379.46 ","$1,796.70 ","$1,363.89 ", N/A ,"$1,577.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.36 ","$1,237.72 ","$1,437.36 ","$1,437.36 ","$1,597.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION SM 0 DEG LEFT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION SM 0 DEG RIGHT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION SM 10 DEG LEFT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION SM 10 DEG RIGHT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION SM 5 DEG LEFT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION SM 5 DEG RIGHT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST TMT FUSION LARGE,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST TMT FUSION STANDARD,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION MED 0 DEG LEFT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION MED 0 DEG RIGHT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION MED 10 DEG LEFT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION MED 10 DEG RIGHT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION MED 5 DEG LEFT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP FIRST MTP FUSION MED 5 DEG RIGHT,278,1 ,"$1,894.20 ","$1,250.17 ",$960.74 ,"$1,894.20 ", N/A ,$998.43 ,$998.43 , N/A ,"$1,136.52 ","$1,610.07 ","$1,325.94 ", N/A , N/A ,"$1,799.49 ","$1,439.59 ","$1,420.65 ", N/A ,"$1,610.07 ", N/A , N/A , N/A ,"$1,325.94 ","$1,153.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,610.07 ", N/A ,"$1,742.66 ","$1,325.94 ",$960.74 ,"$1,153.00 ","$1,153.57 ","$1,153.00 ","$1,308.89 ","$1,704.78 ","$1,294.12 ", N/A ,"$1,496.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,363.82 ","$1,174.40 ","$1,363.82 ","$1,363.82 ","$1,515.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP L-FUSION LONG RIGHT,278,1 ,"$1,770.79 ","$1,168.72 ",$898.14 ,"$1,770.79 ", N/A ,$933.38 ,$933.38 , N/A ,"$1,062.47 ","$1,505.17 ","$1,239.55 ", N/A , N/A ,"$1,682.25 ","$1,345.80 ","$1,328.09 ", N/A ,"$1,505.17 ", N/A , N/A , N/A ,"$1,239.55 ","$1,078.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,505.17 ", N/A ,"$1,629.13 ","$1,239.55 ",$898.14 ,"$1,077.88 ","$1,078.41 ","$1,077.88 ","$1,223.62 ","$1,593.71 ","$1,209.80 ", N/A ,"$1,398.92 ", N/A , N/A , N/A , N/A , N/A ,"$1,274.97 ","$1,097.89 ","$1,274.97 ","$1,274.97 ","$1,416.63 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP L-FUSION LONG LEFT,278,1 ,"$1,770.79 ","$1,168.72 ",$898.14 ,"$1,770.79 ", N/A ,$933.38 ,$933.38 , N/A ,"$1,062.47 ","$1,505.17 ","$1,239.55 ", N/A , N/A ,"$1,682.25 ","$1,345.80 ","$1,328.09 ", N/A ,"$1,505.17 ", N/A , N/A , N/A ,"$1,239.55 ","$1,078.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,505.17 ", N/A ,"$1,629.13 ","$1,239.55 ",$898.14 ,"$1,077.88 ","$1,078.41 ","$1,077.88 ","$1,223.62 ","$1,593.71 ","$1,209.80 ", N/A ,"$1,398.92 ", N/A , N/A , N/A , N/A , N/A ,"$1,274.97 ","$1,097.89 ","$1,274.97 ","$1,274.97 ","$1,416.63 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP L-FUSION SHORT RIGHT,278,1 ,"$1,683.26 ","$1,110.95 ",$853.75 ,"$1,683.26 ", N/A ,$887.25 ,$887.25 , N/A ,"$1,009.96 ","$1,430.77 ","$1,178.28 ", N/A , N/A ,"$1,599.10 ","$1,279.28 ","$1,262.45 ", N/A ,"$1,430.77 ", N/A , N/A , N/A ,"$1,178.28 ","$1,025.11 ", N/A , N/A , N/A , N/A , N/A ,"$1,430.77 ", N/A ,"$1,548.60 ","$1,178.28 ",$853.75 ,"$1,024.60 ","$1,025.11 ","$1,024.60 ","$1,163.13 ","$1,514.93 ","$1,150.00 ", N/A ,"$1,329.78 ", N/A , N/A , N/A , N/A , N/A ,"$1,211.95 ","$1,043.62 ","$1,211.95 ","$1,211.95 ","$1,346.61 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP L-FUSION STANDARD RIGHT,278,1 ,"$1,727.74 ","$1,140.31 ",$876.31 ,"$1,727.74 ", N/A ,$910.69 ,$910.69 , N/A ,"$1,036.64 ","$1,468.58 ","$1,209.42 ", N/A , N/A ,"$1,641.35 ","$1,313.08 ","$1,295.81 ", N/A ,"$1,468.58 ", N/A , N/A , N/A ,"$1,209.42 ","$1,052.19 ", N/A , N/A , N/A , N/A , N/A ,"$1,468.58 ", N/A ,"$1,589.52 ","$1,209.42 ",$876.31 ,"$1,051.68 ","$1,052.19 ","$1,051.68 ","$1,193.87 ","$1,554.97 ","$1,180.39 ", N/A ,"$1,364.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,243.97 ","$1,071.20 ","$1,243.97 ","$1,243.97 ","$1,382.19 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP L-FUSION STANDARD LEFT,278,1 ,"$1,727.74 ","$1,140.31 ",$876.31 ,"$1,727.74 ", N/A ,$910.69 ,$910.69 , N/A ,"$1,036.64 ","$1,468.58 ","$1,209.42 ", N/A , N/A ,"$1,641.35 ","$1,313.08 ","$1,295.81 ", N/A ,"$1,468.58 ", N/A , N/A , N/A ,"$1,209.42 ","$1,052.19 ", N/A , N/A , N/A , N/A , N/A ,"$1,468.58 ", N/A ,"$1,589.52 ","$1,209.42 ",$876.31 ,"$1,051.68 ","$1,052.19 ","$1,051.68 ","$1,193.87 ","$1,554.97 ","$1,180.39 ", N/A ,"$1,364.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,243.97 ","$1,071.20 ","$1,243.97 ","$1,243.97 ","$1,382.19 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LCP T-FUSION 3H EXTRA LONG,278,1 ,"$2,186.33 ","$1,442.98 ","$1,108.91 ","$2,186.33 ", N/A ,"$1,152.41 ","$1,152.41 ", N/A ,"$1,311.80 ","$1,858.38 ","$1,530.43 ", N/A , N/A ,"$2,077.01 ","$1,661.61 ","$1,639.75 ", N/A ,"$1,858.38 ", N/A , N/A , N/A ,"$1,530.43 ","$1,331.48 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.38 ", N/A ,"$2,011.42 ","$1,530.43 ","$1,108.91 ","$1,330.82 ","$1,331.48 ","$1,330.82 ","$1,510.75 ","$1,967.70 ","$1,493.70 ", N/A ,"$1,727.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,574.16 ","$1,355.52 ","$1,574.16 ","$1,574.16 ","$1,749.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING MESH 5 X 12H,278,1 ,"$2,811.62 ","$1,855.67 ","$1,405.81 ","$2,811.62 ", N/A ,"$1,482.00 ","$1,482.00 ", N/A ,"$1,686.97 ","$2,389.88 ","$1,968.13 ", N/A , N/A ,"$2,671.04 ","$2,136.83 ","$2,108.72 ","$1,405.81 ","$2,389.88 ", N/A ,"$1,405.81 ","$1,405.81 ","$1,968.13 ","$1,712.28 ", N/A , N/A , N/A , N/A , N/A ,"$2,389.88 ", N/A ,"$2,586.69 ","$1,968.13 ","$1,426.05 ","$1,711.43 ","$1,712.28 ","$1,711.43 ","$1,942.83 ","$2,530.46 ","$1,920.90 ", N/A ,"$2,221.18 ", N/A , N/A , N/A , N/A , N/A ,"$2,024.37 ","$1,743.20 ","$2,024.37 ","$2,024.37 ","$2,249.30 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING OPNG WEDGE 5MM SPACER,278,1 ,"$1,766.49 ","$1,165.88 ",$895.96 ,"$1,766.49 ", N/A ,$931.12 ,$931.12 , N/A ,"$1,059.89 ","$1,501.52 ","$1,236.54 ", N/A , N/A ,"$1,678.17 ","$1,342.53 ","$1,324.87 ", N/A ,"$1,501.52 ", N/A , N/A , N/A ,"$1,236.54 ","$1,075.79 ", N/A , N/A , N/A , N/A , N/A ,"$1,501.52 ", N/A ,"$1,625.17 ","$1,236.54 ",$895.96 ,"$1,075.26 ","$1,075.79 ","$1,075.26 ","$1,220.64 ","$1,589.84 ","$1,206.87 ", N/A ,"$1,395.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,271.87 ","$1,095.22 ","$1,271.87 ","$1,271.87 ","$1,413.19 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING OPNG WEDGE 3MM SPACER,278,1 ,"$1,766.49 ","$1,165.88 ",$895.96 ,"$1,766.49 ", N/A ,$931.12 ,$931.12 , N/A ,"$1,059.89 ","$1,501.52 ","$1,236.54 ", N/A , N/A ,"$1,678.17 ","$1,342.53 ","$1,324.87 ", N/A ,"$1,501.52 ", N/A , N/A , N/A ,"$1,236.54 ","$1,075.79 ", N/A , N/A , N/A , N/A , N/A ,"$1,501.52 ", N/A ,"$1,625.17 ","$1,236.54 ",$895.96 ,"$1,075.26 ","$1,075.79 ","$1,075.26 ","$1,220.64 ","$1,589.84 ","$1,206.87 ", N/A ,"$1,395.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,271.87 ","$1,095.22 ","$1,271.87 ","$1,271.87 ","$1,413.19 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING OPNG WEDGE 4MM SPACER,278,1 ,"$1,766.49 ","$1,165.88 ",$895.96 ,"$1,766.49 ", N/A ,$931.12 ,$931.12 , N/A ,"$1,059.89 ","$1,501.52 ","$1,236.54 ", N/A , N/A ,"$1,678.17 ","$1,342.53 ","$1,324.87 ", N/A ,"$1,501.52 ", N/A , N/A , N/A ,"$1,236.54 ","$1,075.79 ", N/A , N/A , N/A , N/A , N/A ,"$1,501.52 ", N/A ,"$1,625.17 ","$1,236.54 ",$895.96 ,"$1,075.26 ","$1,075.79 ","$1,075.26 ","$1,220.64 ","$1,589.84 ","$1,206.87 ", N/A ,"$1,395.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,271.87 ","$1,095.22 ","$1,271.87 ","$1,271.87 ","$1,413.19 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING OPNG WEDGE NO SPACER,278,1 ,"$1,815.28 ","$1,198.08 ",$920.71 ,"$1,815.28 ", N/A ,$956.83 ,$956.83 , N/A ,"$1,089.17 ","$1,542.99 ","$1,270.70 ", N/A , N/A ,"$1,724.52 ","$1,379.61 ","$1,361.46 ", N/A ,"$1,542.99 ", N/A , N/A , N/A ,"$1,270.70 ","$1,105.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,542.99 ", N/A ,"$1,670.06 ","$1,270.70 ",$920.71 ,"$1,104.96 ","$1,105.51 ","$1,104.96 ","$1,254.36 ","$1,633.75 ","$1,240.20 ", N/A ,"$1,434.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,307.00 ","$1,125.47 ","$1,307.00 ","$1,307.00 ","$1,452.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING OPNG WEDGE 6MM SPACER,278,1 ,"$1,815.28 ","$1,198.08 ",$920.71 ,"$1,815.28 ", N/A ,$956.83 ,$956.83 , N/A ,"$1,089.17 ","$1,542.99 ","$1,270.70 ", N/A , N/A ,"$1,724.52 ","$1,379.61 ","$1,361.46 ", N/A ,"$1,542.99 ", N/A , N/A , N/A ,"$1,270.70 ","$1,105.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,542.99 ", N/A ,"$1,670.06 ","$1,270.70 ",$920.71 ,"$1,104.96 ","$1,105.51 ","$1,104.96 ","$1,254.36 ","$1,633.75 ","$1,240.20 ", N/A ,"$1,434.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,307.00 ","$1,125.47 ","$1,307.00 ","$1,307.00 ","$1,452.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4/2.7 VA-LOCKING OPNG WEDGE 7MM SPACER,278,1 ,"$1,815.28 ","$1,198.08 ",$920.71 ,"$1,815.28 ", N/A ,$956.83 ,$956.83 , N/A ,"$1,089.17 ","$1,542.99 ","$1,270.70 ", N/A , N/A ,"$1,724.52 ","$1,379.61 ","$1,361.46 ", N/A ,"$1,542.99 ", N/A , N/A , N/A ,"$1,270.70 ","$1,105.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,542.99 ", N/A ,"$1,670.06 ","$1,270.70 ",$920.71 ,"$1,104.96 ","$1,105.51 ","$1,104.96 ","$1,254.36 ","$1,633.75 ","$1,240.20 ", N/A ,"$1,434.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,307.00 ","$1,125.47 ","$1,307.00 ","$1,307.00 ","$1,452.22 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM LCP VOLAR COLUMN DISTAL RADIUS MODULE,278,1 ,"$1,424.96 ",$940.47 ,$722.74 ,"$1,424.96 ", N/A ,$751.10 ,$751.10 , N/A ,$854.98 ,"$1,211.22 ",$997.47 , N/A , N/A ,"$1,353.71 ","$1,082.97 ","$1,068.72 ", N/A ,"$1,211.22 ", N/A , N/A , N/A ,$997.47 ,$867.80 , N/A , N/A , N/A , N/A , N/A ,"$1,211.22 ", N/A ,"$1,310.96 ",$997.47 ,$722.74 ,$867.37 ,$867.80 ,$867.37 ,$984.65 ,"$1,282.46 ",$973.53 , N/A ,"$1,125.72 ", N/A , N/A , N/A , N/A , N/A ,"$1,025.97 ",$883.48 ,"$1,025.97 ","$1,025.97 ","$1,139.97 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI CONDYLAR 8 HOLES/57MM - RIGHT,278,1 ,$621.57 ,$410.24 ,$315.26 ,$621.57 , N/A , N/A , N/A , N/A ,$372.94 ,$528.33 ,$435.10 , N/A , N/A ,$590.49 ,$472.39 ,$466.18 , N/A ,$528.33 , N/A , N/A , N/A ,$435.10 ,$378.54 , N/A , N/A , N/A , N/A , N/A ,$528.33 , N/A ,$571.84 ,$435.10 ,$315.26 ,$378.35 ,$378.54 ,$378.35 ,$429.50 ,$559.41 ,$424.66 , N/A ,$491.04 , N/A , N/A , N/A , N/A , N/A ,$447.53 ,$385.37 ,$447.53 ,$447.53 ,$497.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI CONDYLAR 8 HOLES/57MM - LEFT,278,1 ,$621.57 ,$410.24 ,$315.26 ,$621.57 , N/A , N/A , N/A , N/A ,$372.94 ,$528.33 ,$435.10 , N/A , N/A ,$590.49 ,$472.39 ,$466.18 , N/A ,$528.33 , N/A , N/A , N/A ,$435.10 ,$378.54 , N/A , N/A , N/A , N/A , N/A ,$528.33 , N/A ,$571.84 ,$435.10 ,$315.26 ,$378.35 ,$378.54 ,$378.35 ,$429.50 ,$559.41 ,$424.66 , N/A ,$491.04 , N/A , N/A , N/A , N/A , N/A ,$447.53 ,$385.37 ,$447.53 ,$447.53 ,$497.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI LC-DCP 4 HOLES/31MM,278,1 ,$662.20 ,$437.05 ,$335.87 ,$662.20 , N/A , N/A , N/A , N/A ,$397.32 ,$562.87 ,$463.54 , N/A , N/A ,$629.09 ,$503.27 ,$496.65 , N/A ,$562.87 , N/A , N/A , N/A ,$463.54 ,$403.28 , N/A , N/A , N/A , N/A , N/A ,$562.87 , N/A ,$609.22 ,$463.54 ,$335.87 ,$403.08 ,$403.28 ,$403.08 ,$457.58 ,$595.98 ,$452.42 , N/A ,$523.14 , N/A , N/A , N/A , N/A , N/A ,$476.78 ,$410.56 ,$476.78 ,$476.78 ,$529.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI LC-DCP 6 HOLES/47MM,278,1 ,$744.98 ,$491.69 ,$377.85 ,$744.98 , N/A , N/A , N/A , N/A ,$446.99 ,$633.23 ,$521.49 , N/A , N/A ,$707.73 ,$566.18 ,$558.74 , N/A ,$633.23 , N/A , N/A , N/A ,$521.49 ,$453.69 , N/A , N/A , N/A , N/A , N/A ,$633.23 , N/A ,$685.38 ,$521.49 ,$377.85 ,$453.47 ,$453.69 ,$453.47 ,$514.78 ,$670.48 ,$508.97 , N/A ,$588.53 , N/A , N/A , N/A , N/A , N/A ,$536.39 ,$461.89 ,$536.39 ,$536.39 ,$595.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI LC-DCP 8 HOLES/63MM,278,1 ,$803.67 ,$530.42 ,$407.62 ,$803.67 , N/A , N/A , N/A , N/A ,$482.20 ,$683.12 ,$562.57 , N/A , N/A ,$763.49 ,$610.79 ,$602.75 , N/A ,$683.12 , N/A , N/A , N/A ,$562.57 ,$489.44 , N/A , N/A , N/A , N/A , N/A ,$683.12 , N/A ,$739.38 ,$562.57 ,$407.62 ,$489.19 ,$489.44 ,$489.19 ,$555.34 ,$723.30 ,$549.07 , N/A ,$634.90 , N/A , N/A , N/A , N/A , N/A ,$578.64 ,$498.28 ,$578.64 ,$578.64 ,$642.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI T 2 HOLES HEAD/ 8 HOLES SHAFT/54MM,278,1 ,$532.77 ,$351.63 ,$270.22 ,$532.77 , N/A , N/A , N/A , N/A ,$319.66 ,$452.85 ,$372.94 , N/A , N/A ,$506.13 ,$404.91 ,$399.58 , N/A ,$452.85 , N/A , N/A , N/A ,$372.94 ,$324.46 , N/A , N/A , N/A , N/A , N/A ,$452.85 , N/A ,$490.15 ,$372.94 ,$270.22 ,$324.30 ,$324.46 ,$324.30 ,$368.14 ,$479.49 ,$363.99 , N/A ,$420.89 , N/A , N/A , N/A , N/A , N/A ,$383.59 ,$330.32 ,$383.59 ,$383.59 ,$426.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI T 3 HOLES HEAD/ 8 HOLES SHAFT/54MM,278,1 ,$568.89 ,$375.47 ,$288.54 ,$568.89 , N/A , N/A , N/A , N/A ,$341.33 ,$483.56 ,$398.22 , N/A , N/A ,$540.45 ,$432.36 ,$426.67 , N/A ,$483.56 , N/A , N/A , N/A ,$398.22 ,$346.45 , N/A , N/A , N/A , N/A , N/A ,$483.56 , N/A ,$523.38 ,$398.22 ,$288.54 ,$346.28 ,$346.45 ,$346.28 ,$393.10 ,$512.00 ,$388.67 , N/A ,$449.42 , N/A , N/A , N/A , N/A , N/A ,$409.60 ,$352.71 ,$409.60 ,$409.60 ,$455.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.4MM TI Y PLATE,278,1 ,$550.83 ,$363.55 ,$279.38 ,$550.83 , N/A , N/A , N/A , N/A ,$330.50 ,$468.21 ,$385.58 , N/A , N/A ,$523.29 ,$418.63 ,$413.12 , N/A ,$468.21 , N/A , N/A , N/A ,$385.58 ,$335.46 , N/A , N/A , N/A , N/A , N/A ,$468.21 , N/A ,$506.76 ,$385.58 ,$279.38 ,$335.29 ,$335.46 ,$335.29 ,$380.62 ,$495.75 ,$376.33 , N/A ,$435.16 , N/A , N/A , N/A , N/A , N/A ,$396.60 ,$341.51 ,$396.60 ,$396.60 ,$440.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP 7H/66MM,278,1 ,"$1,228.36 ",$810.72 ,$623.02 ,"$1,228.36 ", N/A ,$647.47 ,$647.47 , N/A ,$737.02 ,"$1,044.11 ",$859.85 , N/A , N/A ,"$1,166.94 ",$933.55 ,$921.27 , N/A ,"$1,044.11 ", N/A , N/A , N/A ,$859.85 ,$748.07 , N/A , N/A , N/A , N/A , N/A ,"$1,044.11 ", N/A ,"$1,130.09 ",$859.85 ,$623.02 ,$747.70 ,$748.07 ,$747.70 ,$848.80 ,"$1,105.52 ",$839.22 , N/A ,$970.40 , N/A , N/A , N/A , N/A , N/A ,$884.42 ,$761.58 ,$884.42 ,$884.42 ,$982.69 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP 8H/76MM,278,1 ,$830.76 ,$548.30 ,$421.36 ,$830.76 , N/A , N/A , N/A , N/A ,$498.46 ,$706.15 ,$581.53 , N/A , N/A ,$789.22 ,$631.38 ,$623.07 , N/A ,$706.15 , N/A , N/A , N/A ,$581.53 ,$505.93 , N/A , N/A , N/A , N/A , N/A ,$706.15 , N/A ,$764.30 ,$581.53 ,$421.36 ,$505.68 ,$505.93 ,$505.68 ,$574.06 ,$747.68 ,$567.58 , N/A ,$656.30 , N/A , N/A , N/A , N/A , N/A ,$598.15 ,$515.07 ,$598.15 ,$598.15 ,$664.61 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP 10H/94MM,278,1 ,$830.76 ,$548.30 ,$421.36 ,$830.76 , N/A , N/A , N/A , N/A ,$498.46 ,$706.15 ,$581.53 , N/A , N/A ,$789.22 ,$631.38 ,$623.07 , N/A ,$706.15 , N/A , N/A , N/A ,$581.53 ,$505.93 , N/A , N/A , N/A , N/A , N/A ,$706.15 , N/A ,$764.30 ,$581.53 ,$421.36 ,$505.68 ,$505.93 ,$505.68 ,$574.06 ,$747.68 ,$567.58 , N/A ,$656.30 , N/A , N/A , N/A , N/A , N/A ,$598.15 ,$515.07 ,$598.15 ,$598.15 ,$664.61 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP 4H/40MM,278,1 ,$830.76 ,$548.30 ,$421.36 ,$830.76 , N/A , N/A , N/A , N/A ,$498.46 ,$706.15 ,$581.53 , N/A , N/A ,$789.22 ,$631.38 ,$623.07 , N/A ,$706.15 , N/A , N/A , N/A ,$581.53 ,$505.93 , N/A , N/A , N/A , N/A , N/A ,$706.15 , N/A ,$764.30 ,$581.53 ,$421.36 ,$505.68 ,$505.93 ,$505.68 ,$574.06 ,$747.68 ,$567.58 , N/A ,$656.30 , N/A , N/A , N/A , N/A , N/A ,$598.15 ,$515.07 ,$598.15 ,$598.15 ,$664.61 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP 5H/49MM,278,1 ,$830.76 ,$548.30 ,$421.36 ,$830.76 , N/A , N/A , N/A , N/A ,$498.46 ,$706.15 ,$581.53 , N/A , N/A ,$789.22 ,$631.38 ,$623.07 , N/A ,$706.15 , N/A , N/A , N/A ,$581.53 ,$505.93 , N/A , N/A , N/A , N/A , N/A ,$706.15 , N/A ,$764.30 ,$581.53 ,$421.36 ,$505.68 ,$505.93 ,$505.68 ,$574.06 ,$747.68 ,$567.58 , N/A ,$656.30 , N/A , N/A , N/A , N/A , N/A ,$598.15 ,$515.07 ,$598.15 ,$598.15 ,$664.61 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP 6H/58MM,278,1 ,$830.76 ,$548.30 ,$421.36 ,$830.76 , N/A , N/A , N/A , N/A ,$498.46 ,$706.15 ,$581.53 , N/A , N/A ,$789.22 ,$631.38 ,$623.07 , N/A ,$706.15 , N/A , N/A , N/A ,$581.53 ,$505.93 , N/A , N/A , N/A , N/A , N/A ,$706.15 , N/A ,$764.30 ,$581.53 ,$421.36 ,$505.68 ,$505.93 ,$505.68 ,$574.06 ,$747.68 ,$567.58 , N/A ,$656.30 , N/A , N/A , N/A , N/A , N/A ,$598.15 ,$515.07 ,$598.15 ,$598.15 ,$664.61 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP 7H/67MM,278,1 ,$830.76 ,$548.30 ,$421.36 ,$830.76 , N/A , N/A , N/A , N/A ,$498.46 ,$706.15 ,$581.53 , N/A , N/A ,$789.22 ,$631.38 ,$623.07 , N/A ,$706.15 , N/A , N/A , N/A ,$581.53 ,$505.93 , N/A , N/A , N/A , N/A , N/A ,$706.15 , N/A ,$764.30 ,$581.53 ,$421.36 ,$505.68 ,$505.93 ,$505.68 ,$574.06 ,$747.68 ,$567.58 , N/A ,$656.30 , N/A , N/A , N/A , N/A , N/A ,$598.15 ,$515.07 ,$598.15 ,$598.15 ,$664.61 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP L RIGHT 2H HEAD 3H SHAFT,278,1 ,$788.62 ,$520.49 ,$399.99 ,$788.62 , N/A , N/A , N/A , N/A ,$473.17 ,$670.33 ,$552.03 , N/A , N/A ,$749.19 ,$599.35 ,$591.47 , N/A ,$670.33 , N/A , N/A , N/A ,$552.03 ,$480.27 , N/A , N/A , N/A , N/A , N/A ,$670.33 , N/A ,$725.53 ,$552.03 ,$399.99 ,$480.03 ,$480.27 ,$480.03 ,$544.94 ,$709.76 ,$538.79 , N/A ,$623.01 , N/A , N/A , N/A , N/A , N/A ,$567.81 ,$488.94 ,$567.81 ,$567.81 ,$630.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP L LEFT 2H HEAD 3H SHAFT,278,1 ,$788.62 ,$520.49 ,$399.99 ,$788.62 , N/A , N/A , N/A , N/A ,$473.17 ,$670.33 ,$552.03 , N/A , N/A ,$749.19 ,$599.35 ,$591.47 , N/A ,$670.33 , N/A , N/A , N/A ,$552.03 ,$480.27 , N/A , N/A , N/A , N/A , N/A ,$670.33 , N/A ,$725.53 ,$552.03 ,$399.99 ,$480.03 ,$480.27 ,$480.03 ,$544.94 ,$709.76 ,$538.79 , N/A ,$623.01 , N/A , N/A , N/A , N/A , N/A ,$567.81 ,$488.94 ,$567.81 ,$567.81 ,$630.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP L OBLIQUE LEFT 2H HEAD 3H SHAFT,278,1 ,$788.62 ,$520.49 ,$399.99 ,$788.62 , N/A , N/A , N/A , N/A ,$473.17 ,$670.33 ,$552.03 , N/A , N/A ,$749.19 ,$599.35 ,$591.47 , N/A ,$670.33 , N/A , N/A , N/A ,$552.03 ,$480.27 , N/A , N/A , N/A , N/A , N/A ,$670.33 , N/A ,$725.53 ,$552.03 ,$399.99 ,$480.03 ,$480.27 ,$480.03 ,$544.94 ,$709.76 ,$538.79 , N/A ,$623.01 , N/A , N/A , N/A , N/A , N/A ,$567.81 ,$488.94 ,$567.81 ,$567.81 ,$630.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 LCP L OBLIQUE RIGHT 2H HEAD 3H SHAFT,278,1 ,$788.62 ,$520.49 ,$399.99 ,$788.62 , N/A , N/A , N/A , N/A ,$473.17 ,$670.33 ,$552.03 , N/A , N/A ,$749.19 ,$599.35 ,$591.47 , N/A ,$670.33 , N/A , N/A , N/A ,$552.03 ,$480.27 , N/A , N/A , N/A , N/A , N/A ,$670.33 , N/A ,$725.53 ,$552.03 ,$399.99 ,$480.03 ,$480.27 ,$480.03 ,$544.94 ,$709.76 ,$538.79 , N/A ,$623.01 , N/A , N/A , N/A , N/A , N/A ,$567.81 ,$488.94 ,$567.81 ,$567.81 ,$630.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  3 HOLE 23MM,278,1 ,$163.80 ,$108.11 ,$83.08 ,$163.80 , N/A , N/A , N/A , N/A ,$98.28 ,$139.23 ,$114.66 , N/A , N/A ,$155.61 ,$124.49 ,$122.85 , N/A ,$139.23 , N/A , N/A , N/A ,$114.66 ,$99.75 , N/A , N/A , N/A , N/A , N/A ,$139.23 , N/A ,$150.70 ,$114.66 ,$83.08 ,$99.71 ,$99.75 ,$99.71 ,$113.19 ,$147.42 ,$111.91 , N/A ,$129.40 , N/A , N/A , N/A , N/A , N/A ,$117.94 ,$101.56 ,$117.94 ,$117.94 ,$131.04 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  8 HOLE 63MM,278,1 ,$220.50 ,$145.53 ,$111.84 ,$220.50 , N/A , N/A , N/A , N/A ,$132.30 ,$187.43 ,$154.35 , N/A , N/A ,$209.48 ,$167.58 ,$165.38 , N/A ,$187.43 , N/A , N/A , N/A ,$154.35 ,$134.28 , N/A , N/A , N/A , N/A , N/A ,$187.43 , N/A ,$202.86 ,$154.35 ,$111.84 ,$134.22 ,$134.28 ,$134.22 ,$152.37 ,$198.45 ,$150.65 , N/A ,$174.20 , N/A , N/A , N/A , N/A , N/A ,$158.76 ,$136.71 ,$158.76 ,$158.76 ,$176.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 T  3 HOLE 32MM,278,1 ,$758.52 ,$500.62 ,$384.72 ,$758.52 , N/A , N/A , N/A , N/A ,$455.11 ,$644.74 ,$530.96 , N/A , N/A ,$720.59 ,$576.48 ,$568.89 , N/A ,$644.74 , N/A , N/A , N/A ,$530.96 ,$461.94 , N/A , N/A , N/A , N/A , N/A ,$644.74 , N/A ,$697.84 ,$530.96 ,$384.72 ,$461.71 ,$461.94 ,$461.71 ,$524.14 ,$682.67 ,$518.22 , N/A ,$599.23 , N/A , N/A , N/A , N/A , N/A ,$546.13 ,$470.28 ,$546.13 ,$546.13 ,$606.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 VA-LCP T-PLATE  DIST TIBIA 6 HOLE 90MM,278,1 ,"$1,806.62 ","$1,192.37 ",$916.32 ,"$1,806.62 ", N/A ,$952.27 ,$952.27 , N/A ,"$1,083.97 ","$1,535.63 ","$1,264.63 ", N/A , N/A ,"$1,716.29 ","$1,373.03 ","$1,354.97 ", N/A ,"$1,535.63 ", N/A , N/A , N/A ,"$1,264.63 ","$1,100.23 ", N/A , N/A , N/A , N/A , N/A ,"$1,535.63 ", N/A ,"$1,662.09 ","$1,264.63 ",$916.32 ,"$1,099.69 ","$1,100.23 ","$1,099.69 ","$1,248.37 ","$1,625.96 ","$1,234.28 ", N/A ,"$1,427.23 ", N/A , N/A , N/A , N/A , N/A ,"$1,300.77 ","$1,120.10 ","$1,300.77 ","$1,300.77 ","$1,445.30 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 3H RT 73MM,278,1 ,"$1,170.96 ",$772.83 ,$593.91 ,"$1,170.96 ", N/A ,$617.21 ,$617.21 , N/A ,$702.58 ,$995.32 ,$819.67 , N/A , N/A ,"$1,112.41 ",$889.93 ,$878.22 , N/A ,$995.32 , N/A , N/A , N/A ,$819.67 ,$713.11 , N/A , N/A , N/A , N/A , N/A ,$995.32 , N/A ,"$1,077.28 ",$819.67 ,$593.91 ,$712.76 ,$713.11 ,$712.76 ,$809.13 ,"$1,053.86 ",$800.00 , N/A ,$925.06 , N/A , N/A , N/A , N/A , N/A ,$843.09 ,$726.00 ,$843.09 ,$843.09 ,$936.77 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 3H LT 73MM,278,1 ,"$1,170.96 ",$772.83 ,$593.91 ,"$1,170.96 ", N/A ,$617.21 ,$617.21 , N/A ,$702.58 ,$995.32 ,$819.67 , N/A , N/A ,"$1,112.41 ",$889.93 ,$878.22 , N/A ,$995.32 , N/A , N/A , N/A ,$819.67 ,$713.11 , N/A , N/A , N/A , N/A , N/A ,$995.32 , N/A ,"$1,077.28 ",$819.67 ,$593.91 ,$712.76 ,$713.11 ,$712.76 ,$809.13 ,"$1,053.86 ",$800.00 , N/A ,$925.06 , N/A , N/A , N/A , N/A , N/A ,$843.09 ,$726.00 ,$843.09 ,$843.09 ,$936.77 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 4H RT 86MM,278,1 ,"$1,191.05 ",$786.09 ,$604.10 ,"$1,191.05 ", N/A ,$627.80 ,$627.80 , N/A ,$714.63 ,"$1,012.39 ",$833.74 , N/A , N/A ,"$1,131.50 ",$905.20 ,$893.29 , N/A ,"$1,012.39 ", N/A , N/A , N/A ,$833.74 ,$725.35 , N/A , N/A , N/A , N/A , N/A ,"$1,012.39 ", N/A ,"$1,095.77 ",$833.74 ,$604.10 ,$724.99 ,$725.35 ,$724.99 ,$823.02 ,"$1,071.95 ",$813.73 , N/A ,$940.93 , N/A , N/A , N/A , N/A , N/A ,$857.56 ,$738.45 ,$857.56 ,$857.56 ,$952.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 4H LT 86MM,278,1 ,"$1,191.05 ",$786.09 ,$604.10 ,"$1,191.05 ", N/A ,$627.80 ,$627.80 , N/A ,$714.63 ,"$1,012.39 ",$833.74 , N/A , N/A ,"$1,131.50 ",$905.20 ,$893.29 , N/A ,"$1,012.39 ", N/A , N/A , N/A ,$833.74 ,$725.35 , N/A , N/A , N/A , N/A , N/A ,"$1,012.39 ", N/A ,"$1,095.77 ",$833.74 ,$604.10 ,$724.99 ,$725.35 ,$724.99 ,$823.02 ,"$1,071.95 ",$813.73 , N/A ,$940.93 , N/A , N/A , N/A , N/A , N/A ,$857.56 ,$738.45 ,$857.56 ,$857.56 ,$952.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 5H RT 99MM,278,1 ,"$1,206.84 ",$796.51 ,$612.11 ,"$1,206.84 ", N/A ,$636.13 ,$636.13 , N/A ,$724.10 ,"$1,025.81 ",$844.79 , N/A , N/A ,"$1,146.50 ",$917.20 ,$905.13 , N/A ,"$1,025.81 ", N/A , N/A , N/A ,$844.79 ,$734.97 , N/A , N/A , N/A , N/A , N/A ,"$1,025.81 ", N/A ,"$1,110.29 ",$844.79 ,$612.11 ,$734.60 ,$734.97 ,$734.60 ,$833.93 ,"$1,086.16 ",$824.51 , N/A ,$953.40 , N/A , N/A , N/A , N/A , N/A ,$868.92 ,$748.24 ,$868.92 ,$868.92 ,$965.47 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 5H LT 99MM,278,1 ,"$1,206.84 ",$796.51 ,$612.11 ,"$1,206.84 ", N/A ,$636.13 ,$636.13 , N/A ,$724.10 ,"$1,025.81 ",$844.79 , N/A , N/A ,"$1,146.50 ",$917.20 ,$905.13 , N/A ,"$1,025.81 ", N/A , N/A , N/A ,$844.79 ,$734.97 , N/A , N/A , N/A , N/A , N/A ,"$1,025.81 ", N/A ,"$1,110.29 ",$844.79 ,$612.11 ,$734.60 ,$734.97 ,$734.60 ,$833.93 ,"$1,086.16 ",$824.51 , N/A ,$953.40 , N/A , N/A , N/A , N/A , N/A ,$868.92 ,$748.24 ,$868.92 ,$868.92 ,$965.47 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 7H RT 125MM,278,1 ,"$1,242.71 ",$820.19 ,$630.30 ,"$1,242.71 ", N/A ,$655.03 ,$655.03 , N/A ,$745.63 ,"$1,056.30 ",$869.90 , N/A , N/A ,"$1,180.57 ",$944.46 ,$932.03 , N/A ,"$1,056.30 ", N/A , N/A , N/A ,$869.90 ,$756.81 , N/A , N/A , N/A , N/A , N/A ,"$1,056.30 ", N/A ,"$1,143.29 ",$869.90 ,$630.30 ,$756.44 ,$756.81 ,$756.44 ,$858.71 ,"$1,118.44 ",$849.02 , N/A ,$981.74 , N/A , N/A , N/A , N/A , N/A ,$894.75 ,$770.48 ,$894.75 ,$894.75 ,$994.17 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 7H LT 125MM,278,1 ,"$1,242.71 ",$820.19 ,$630.30 ,"$1,242.71 ", N/A ,$655.03 ,$655.03 , N/A ,$745.63 ,"$1,056.30 ",$869.90 , N/A , N/A ,"$1,180.57 ",$944.46 ,$932.03 , N/A ,"$1,056.30 ", N/A , N/A , N/A ,$869.90 ,$756.81 , N/A , N/A , N/A , N/A , N/A ,"$1,056.30 ", N/A ,"$1,143.29 ",$869.90 ,$630.30 ,$756.44 ,$756.81 ,$756.44 ,$858.71 ,"$1,118.44 ",$849.02 , N/A ,$981.74 , N/A , N/A , N/A , N/A , N/A ,$894.75 ,$770.48 ,$894.75 ,$894.75 ,$994.17 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 9H RT 151MM,278,1 ,"$1,302.98 ",$859.97 ,$660.87 ,"$1,302.98 ", N/A ,$686.80 ,$686.80 , N/A ,$781.79 ,"$1,107.53 ",$912.09 , N/A , N/A ,"$1,237.83 ",$990.26 ,$977.24 , N/A ,"$1,107.53 ", N/A , N/A , N/A ,$912.09 ,$793.51 , N/A , N/A , N/A , N/A , N/A ,"$1,107.53 ", N/A ,"$1,198.74 ",$912.09 ,$660.87 ,$793.12 ,$793.51 ,$793.12 ,$900.36 ,"$1,172.68 ",$890.20 , N/A ,"$1,029.35 ", N/A , N/A , N/A , N/A , N/A ,$938.15 ,$807.85 ,$938.15 ,$938.15 ,"$1,042.38 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 9H LT 151MM,278,1 ,"$1,302.98 ",$859.97 ,$660.87 ,"$1,302.98 ", N/A ,$686.80 ,$686.80 , N/A ,$781.79 ,"$1,107.53 ",$912.09 , N/A , N/A ,"$1,237.83 ",$990.26 ,$977.24 , N/A ,"$1,107.53 ", N/A , N/A , N/A ,$912.09 ,$793.51 , N/A , N/A , N/A , N/A , N/A ,"$1,107.53 ", N/A ,"$1,198.74 ",$912.09 ,$660.87 ,$793.12 ,$793.51 ,$793.12 ,$900.36 ,"$1,172.68 ",$890.20 , N/A ,"$1,029.35 ", N/A , N/A , N/A , N/A , N/A ,$938.15 ,$807.85 ,$938.15 ,$938.15 ,"$1,042.38 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7MM TI CONDYLAR 7 HOLES/57MM-RIGHT,278,1 ,$671.23 ,$443.01 ,$340.45 ,$671.23 , N/A , N/A , N/A , N/A ,$402.74 ,$570.55 ,$469.86 , N/A , N/A ,$637.67 ,$510.13 ,$503.42 , N/A ,$570.55 , N/A , N/A , N/A ,$469.86 ,$408.78 , N/A , N/A , N/A , N/A , N/A ,$570.55 , N/A ,$617.53 ,$469.86 ,$340.45 ,$408.58 ,$408.78 ,$408.58 ,$463.82 ,$604.11 ,$458.58 , N/A ,$530.27 , N/A , N/A , N/A , N/A , N/A ,$483.29 ,$416.16 ,$483.29 ,$483.29 ,$536.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7MM TI CONDYLAR 7 HOLES/57MM-LEFT,278,1 ,$671.23 ,$443.01 ,$340.45 ,$671.23 , N/A , N/A , N/A , N/A ,$402.74 ,$570.55 ,$469.86 , N/A , N/A ,$637.67 ,$510.13 ,$503.42 , N/A ,$570.55 , N/A , N/A , N/A ,$469.86 ,$408.78 , N/A , N/A , N/A , N/A , N/A ,$570.55 , N/A ,$617.53 ,$469.86 ,$340.45 ,$408.58 ,$408.78 ,$408.58 ,$463.82 ,$604.11 ,$458.58 , N/A ,$530.27 , N/A , N/A , N/A , N/A , N/A ,$483.29 ,$416.16 ,$483.29 ,$483.29 ,$536.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7MM TI T 3 HOLES/32MM,278,1 ,$130.73 ,$86.28 ,$66.31 ,$130.73 , N/A , N/A , N/A , N/A ,$78.44 ,$111.12 ,$91.51 , N/A , N/A ,$124.19 ,$99.35 ,$98.05 , N/A ,$111.12 , N/A , N/A , N/A ,$91.51 ,$79.61 , N/A , N/A , N/A , N/A , N/A ,$111.12 , N/A ,$120.27 ,$91.51 ,$66.31 ,$79.58 ,$79.61 ,$79.58 ,$90.33 ,$117.66 ,$89.31 , N/A ,$103.28 , N/A , N/A , N/A , N/A , N/A ,$94.13 ,$81.05 ,$94.13 ,$94.13 ,$104.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7MM TI L 3 HOLES/34MM-OBLIQUE LEFT,278,1 ,$130.73 ,$86.28 ,$66.31 ,$130.73 , N/A , N/A , N/A , N/A ,$78.44 ,$111.12 ,$91.51 , N/A , N/A ,$124.19 ,$99.35 ,$98.05 , N/A ,$111.12 , N/A , N/A , N/A ,$91.51 ,$79.61 , N/A , N/A , N/A , N/A , N/A ,$111.12 , N/A ,$120.27 ,$91.51 ,$66.31 ,$79.58 ,$79.61 ,$79.58 ,$90.33 ,$117.66 ,$89.31 , N/A ,$103.28 , N/A , N/A , N/A , N/A , N/A ,$94.13 ,$81.05 ,$94.13 ,$94.13 ,$104.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7MM TI L 3 HOLES/34MM-OBLIQUE RIGHT,278,1 ,$130.73 ,$86.28 ,$66.31 ,$130.73 , N/A , N/A , N/A , N/A ,$78.44 ,$111.12 ,$91.51 , N/A , N/A ,$124.19 ,$99.35 ,$98.05 , N/A ,$111.12 , N/A , N/A , N/A ,$91.51 ,$79.61 , N/A , N/A , N/A , N/A , N/A ,$111.12 , N/A ,$120.27 ,$91.51 ,$66.31 ,$79.58 ,$79.61 ,$79.58 ,$90.33 ,$117.66 ,$89.31 , N/A ,$103.28 , N/A , N/A , N/A , N/A , N/A ,$94.13 ,$81.05 ,$94.13 ,$94.13 ,$104.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 11 HOLES/RIGHT,278,1 ,"$2,697.24 ","$1,780.18 ","$1,348.62 ","$2,697.24 ", N/A ,"$1,421.72 ","$1,421.72 ", N/A ,"$1,618.34 ","$2,292.65 ","$1,888.07 ", N/A , N/A ,"$2,562.38 ","$2,049.90 ","$2,022.93 ","$1,348.62 ","$2,292.65 ", N/A ,"$1,348.62 ","$1,348.62 ","$1,888.07 ","$1,642.62 ", N/A , N/A , N/A , N/A , N/A ,"$2,292.65 ", N/A ,"$2,481.46 ","$1,888.07 ","$1,368.04 ","$1,641.81 ","$1,642.62 ","$1,641.81 ","$1,863.79 ","$2,427.52 ","$1,842.75 ", N/A ,"$2,130.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,942.01 ","$1,672.29 ","$1,942.01 ","$1,942.01 ","$2,157.79 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 11 HOLES/LEFT,278,1 ,"$2,697.24 ","$1,780.18 ","$1,348.62 ","$2,697.24 ", N/A ,"$1,421.72 ","$1,421.72 ", N/A ,"$1,618.34 ","$2,292.65 ","$1,888.07 ", N/A , N/A ,"$2,562.38 ","$2,049.90 ","$2,022.93 ","$1,348.62 ","$2,292.65 ", N/A ,"$1,348.62 ","$1,348.62 ","$1,888.07 ","$1,642.62 ", N/A , N/A , N/A , N/A , N/A ,"$2,292.65 ", N/A ,"$2,481.46 ","$1,888.07 ","$1,368.04 ","$1,641.81 ","$1,642.62 ","$1,641.81 ","$1,863.79 ","$2,427.52 ","$1,842.75 ", N/A ,"$2,130.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,942.01 ","$1,672.29 ","$1,942.01 ","$1,942.01 ","$2,157.79 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 13 HOLES/RIGHT,278,1 ,"$2,727.83 ","$1,800.37 ","$1,363.92 ","$2,727.83 ", N/A ,"$1,437.84 ","$1,437.84 ", N/A ,"$1,636.70 ","$2,318.66 ","$1,909.48 ", N/A , N/A ,"$2,591.44 ","$2,073.15 ","$2,045.87 ","$1,363.92 ","$2,318.66 ", N/A ,"$1,363.92 ","$1,363.92 ","$1,909.48 ","$1,661.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,318.66 ", N/A ,"$2,509.60 ","$1,909.48 ","$1,383.56 ","$1,660.43 ","$1,661.25 ","$1,660.43 ","$1,884.93 ","$2,455.05 ","$1,863.65 ", N/A ,"$2,154.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,964.04 ","$1,691.25 ","$1,964.04 ","$1,964.04 ","$2,182.26 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 13 HOLES/LEFT,278,1 ,"$2,727.83 ","$1,800.37 ","$1,363.92 ","$2,727.83 ", N/A ,"$1,437.84 ","$1,437.84 ", N/A ,"$1,636.70 ","$2,318.66 ","$1,909.48 ", N/A , N/A ,"$2,591.44 ","$2,073.15 ","$2,045.87 ","$1,363.92 ","$2,318.66 ", N/A ,"$1,363.92 ","$1,363.92 ","$1,909.48 ","$1,661.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,318.66 ", N/A ,"$2,509.60 ","$1,909.48 ","$1,383.56 ","$1,660.43 ","$1,661.25 ","$1,660.43 ","$1,884.93 ","$2,455.05 ","$1,863.65 ", N/A ,"$2,154.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,964.04 ","$1,691.25 ","$1,964.04 ","$1,964.04 ","$2,182.26 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 15 HOLES/RIGHT,278,1 ,"$2,763.74 ","$1,824.07 ","$1,381.87 ","$2,763.74 ", N/A ,"$1,456.77 ","$1,456.77 ", N/A ,"$1,658.24 ","$2,349.18 ","$1,934.62 ", N/A , N/A ,"$2,625.55 ","$2,100.44 ","$2,072.81 ","$1,381.87 ","$2,349.18 ", N/A ,"$1,381.87 ","$1,381.87 ","$1,934.62 ","$1,683.12 ", N/A , N/A , N/A , N/A , N/A ,"$2,349.18 ", N/A ,"$2,542.64 ","$1,934.62 ","$1,401.77 ","$1,682.29 ","$1,683.12 ","$1,682.29 ","$1,909.74 ","$2,487.37 ","$1,888.19 ", N/A ,"$2,183.35 ", N/A , N/A , N/A , N/A , N/A ,"$1,989.89 ","$1,713.52 ","$1,989.89 ","$1,989.89 ","$2,210.99 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 15 HOLES/LEFT,278,1 ,"$2,763.74 ","$1,824.07 ","$1,381.87 ","$2,763.74 ", N/A ,"$1,456.77 ","$1,456.77 ", N/A ,"$1,658.24 ","$2,349.18 ","$1,934.62 ", N/A , N/A ,"$2,625.55 ","$2,100.44 ","$2,072.81 ","$1,381.87 ","$2,349.18 ", N/A ,"$1,381.87 ","$1,381.87 ","$1,934.62 ","$1,683.12 ", N/A , N/A , N/A , N/A , N/A ,"$2,349.18 ", N/A ,"$2,542.64 ","$1,934.62 ","$1,401.77 ","$1,682.29 ","$1,683.12 ","$1,682.29 ","$1,909.74 ","$2,487.37 ","$1,888.19 ", N/A ,"$2,183.35 ", N/A , N/A , N/A , N/A , N/A ,"$1,989.89 ","$1,713.52 ","$1,989.89 ","$1,989.89 ","$2,210.99 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 7 HOLES/RIGHT,278,1 ,"$2,645.37 ","$1,745.94 ","$1,322.69 ","$2,645.37 ", N/A ,"$1,394.37 ","$1,394.37 ", N/A ,"$1,587.22 ","$2,248.56 ","$1,851.76 ", N/A , N/A ,"$2,513.10 ","$2,010.48 ","$1,984.03 ","$1,322.69 ","$2,248.56 ", N/A ,"$1,322.69 ","$1,322.69 ","$1,851.76 ","$1,611.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,248.56 ", N/A ,"$2,433.74 ","$1,851.76 ","$1,341.73 ","$1,610.24 ","$1,611.03 ","$1,610.24 ","$1,827.95 ","$2,380.83 ","$1,807.32 ", N/A ,"$2,089.84 ", N/A , N/A , N/A , N/A , N/A ,"$1,904.67 ","$1,640.13 ","$1,904.67 ","$1,904.67 ","$2,116.30 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 7 HOLES/LEFT,278,1 ,"$2,645.37 ","$1,745.94 ","$1,322.69 ","$2,645.37 ", N/A ,"$1,394.37 ","$1,394.37 ", N/A ,"$1,587.22 ","$2,248.56 ","$1,851.76 ", N/A , N/A ,"$2,513.10 ","$2,010.48 ","$1,984.03 ","$1,322.69 ","$2,248.56 ", N/A ,"$1,322.69 ","$1,322.69 ","$1,851.76 ","$1,611.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,248.56 ", N/A ,"$2,433.74 ","$1,851.76 ","$1,341.73 ","$1,610.24 ","$1,611.03 ","$1,610.24 ","$1,827.95 ","$2,380.83 ","$1,807.32 ", N/A ,"$2,089.84 ", N/A , N/A , N/A , N/A , N/A ,"$1,904.67 ","$1,640.13 ","$1,904.67 ","$1,904.67 ","$2,116.30 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 9 HOLES/RIGHT,278,1 ,"$2,671.97 ","$1,763.50 ","$1,335.99 ","$2,671.97 ", N/A ,"$1,408.40 ","$1,408.40 ", N/A ,"$1,603.18 ","$2,271.17 ","$1,870.38 ", N/A , N/A ,"$2,538.37 ","$2,030.70 ","$2,003.98 ","$1,335.99 ","$2,271.17 ", N/A ,"$1,335.99 ","$1,335.99 ","$1,870.38 ","$1,627.23 ", N/A , N/A , N/A , N/A , N/A ,"$2,271.17 ", N/A ,"$2,458.21 ","$1,870.38 ","$1,355.22 ","$1,626.43 ","$1,627.23 ","$1,626.43 ","$1,846.33 ","$2,404.77 ","$1,825.49 ", N/A ,"$2,110.86 ", N/A , N/A , N/A , N/A , N/A ,"$1,923.82 ","$1,656.62 ","$1,923.82 ","$1,923.82 ","$2,137.58 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 9 HOLES/LEFT,278,1 ,"$2,671.97 ","$1,763.50 ","$1,335.99 ","$2,671.97 ", N/A ,"$1,408.40 ","$1,408.40 ", N/A ,"$1,603.18 ","$2,271.17 ","$1,870.38 ", N/A , N/A ,"$2,538.37 ","$2,030.70 ","$2,003.98 ","$1,335.99 ","$2,271.17 ", N/A ,"$1,335.99 ","$1,335.99 ","$1,870.38 ","$1,627.23 ", N/A , N/A , N/A , N/A , N/A ,"$2,271.17 ", N/A ,"$2,458.21 ","$1,870.38 ","$1,355.22 ","$1,626.43 ","$1,627.23 ","$1,626.43 ","$1,846.33 ","$2,404.77 ","$1,825.49 ", N/A ,"$2,110.86 ", N/A , N/A , N/A , N/A , N/A ,"$1,923.82 ","$1,656.62 ","$1,923.82 ","$1,923.82 ","$2,137.58 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 EX ARTIC DIST HUM  6H RHT,278,1 ,"$2,481.78 ","$1,637.97 ","$1,258.76 ","$2,481.78 ", N/A ,"$1,308.15 ","$1,308.15 ", N/A ,"$1,489.07 ","$2,109.51 ","$1,737.25 ", N/A , N/A ,"$2,357.69 ","$1,886.15 ","$1,861.34 ", N/A ,"$2,109.51 ", N/A , N/A , N/A ,"$1,737.25 ","$1,511.40 ", N/A , N/A , N/A , N/A , N/A ,"$2,109.51 ", N/A ,"$2,283.24 ","$1,737.25 ","$1,258.76 ","$1,510.66 ","$1,511.40 ","$1,510.66 ","$1,714.91 ","$2,233.60 ","$1,695.55 ", N/A ,"$1,960.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,786.88 ","$1,538.70 ","$1,786.88 ","$1,786.88 ","$1,985.42 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 EX ARTIC DIST HUM  6H LEFT,278,1 ,"$2,481.78 ","$1,637.97 ","$1,258.76 ","$2,481.78 ", N/A ,"$1,308.15 ","$1,308.15 ", N/A ,"$1,489.07 ","$2,109.51 ","$1,737.25 ", N/A , N/A ,"$2,357.69 ","$1,886.15 ","$1,861.34 ", N/A ,"$2,109.51 ", N/A , N/A , N/A ,"$1,737.25 ","$1,511.40 ", N/A , N/A , N/A , N/A , N/A ,"$2,109.51 ", N/A ,"$2,283.24 ","$1,737.25 ","$1,258.76 ","$1,510.66 ","$1,511.40 ","$1,510.66 ","$1,714.91 ","$2,233.60 ","$1,695.55 ", N/A ,"$1,960.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,786.88 ","$1,538.70 ","$1,786.88 ","$1,786.88 ","$1,985.42 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 EX ARTIC DIST HUM 8H LEFT,278,1 ,"$2,633.40 ","$1,738.04 ","$1,316.70 ","$2,633.40 ", N/A ,"$1,388.07 ","$1,388.07 ", N/A ,"$1,580.04 ","$2,238.39 ","$1,843.38 ", N/A , N/A ,"$2,501.73 ","$2,001.38 ","$1,975.05 ","$1,316.70 ","$2,238.39 ", N/A ,"$1,316.70 ","$1,316.70 ","$1,843.38 ","$1,603.74 ", N/A , N/A , N/A , N/A , N/A ,"$2,238.39 ", N/A ,"$2,422.73 ","$1,843.38 ","$1,335.66 ","$1,602.95 ","$1,603.74 ","$1,602.95 ","$1,819.68 ","$2,370.06 ","$1,799.14 ", N/A ,"$2,080.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,896.05 ","$1,632.71 ","$1,896.05 ","$1,896.05 ","$2,106.72 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 EX ARTIC DIST HUM  8H RHT,278,1 ,"$2,633.40 ","$1,738.04 ","$1,316.70 ","$2,633.40 ", N/A ,"$1,388.07 ","$1,388.07 ", N/A ,"$1,580.04 ","$2,238.39 ","$1,843.38 ", N/A , N/A ,"$2,501.73 ","$2,001.38 ","$1,975.05 ","$1,316.70 ","$2,238.39 ", N/A ,"$1,316.70 ","$1,316.70 ","$1,843.38 ","$1,603.74 ", N/A , N/A , N/A , N/A , N/A ,"$2,238.39 ", N/A ,"$2,422.73 ","$1,843.38 ","$1,335.66 ","$1,602.95 ","$1,603.74 ","$1,602.95 ","$1,819.68 ","$2,370.06 ","$1,799.14 ", N/A ,"$2,080.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,896.05 ","$1,632.71 ","$1,896.05 ","$1,896.05 ","$2,106.72 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LC-DCP 10 HOLE,278,1 ,$355.95 ,$234.93 ,$180.54 ,$355.95 , N/A , N/A , N/A , N/A ,$213.57 ,$302.56 ,$249.17 , N/A , N/A ,$338.15 ,$270.52 ,$266.96 , N/A ,$302.56 , N/A , N/A , N/A ,$249.17 ,$216.77 , N/A , N/A , N/A , N/A , N/A ,$302.56 , N/A ,$327.47 ,$249.17 ,$180.54 ,$216.67 ,$216.77 ,$216.67 ,$245.96 ,$320.36 ,$243.19 , N/A ,$281.20 , N/A , N/A , N/A , N/A , N/A ,$256.28 ,$220.69 ,$256.28 ,$256.28 ,$284.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LC-DCP 7 HOLE,278,1 ,$318.15 ,$209.98 ,$161.37 ,$318.15 , N/A , N/A , N/A , N/A ,$190.89 ,$270.43 ,$222.71 , N/A , N/A ,$302.24 ,$241.79 ,$238.61 , N/A ,$270.43 , N/A , N/A , N/A ,$222.71 ,$193.75 , N/A , N/A , N/A , N/A , N/A ,$270.43 , N/A ,$292.70 ,$222.71 ,$161.37 ,$193.66 ,$193.75 ,$193.66 ,$219.84 ,$286.34 ,$217.36 , N/A ,$251.34 , N/A , N/A , N/A , N/A , N/A ,$229.07 ,$197.25 ,$229.07 ,$229.07 ,$254.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP SYNTHES HUMERAL NAIL T25 0MM,278,1 ,$318.15 ,$209.98 ,$161.37 ,$318.15 , N/A , N/A , N/A , N/A ,$190.89 ,$270.43 ,$222.71 , N/A , N/A ,$302.24 ,$241.79 ,$238.61 , N/A ,$270.43 , N/A , N/A , N/A ,$222.71 ,$193.75 , N/A , N/A , N/A , N/A , N/A ,$270.43 , N/A ,$292.70 ,$222.71 ,$161.37 ,$193.66 ,$193.75 ,$193.66 ,$219.84 ,$286.34 ,$217.36 , N/A ,$251.34 , N/A , N/A , N/A , N/A , N/A ,$229.07 ,$197.25 ,$229.07 ,$229.07 ,$254.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP SYNTHES HUMERAL NAIL T25 10MM,278,1 ,$318.15 ,$209.98 ,$161.37 ,$318.15 , N/A , N/A , N/A , N/A ,$190.89 ,$270.43 ,$222.71 , N/A , N/A ,$302.24 ,$241.79 ,$238.61 , N/A ,$270.43 , N/A , N/A , N/A ,$222.71 ,$193.75 , N/A , N/A , N/A , N/A , N/A ,$270.43 , N/A ,$292.70 ,$222.71 ,$161.37 ,$193.66 ,$193.75 ,$193.66 ,$219.84 ,$286.34 ,$217.36 , N/A ,$251.34 , N/A , N/A , N/A , N/A , N/A ,$229.07 ,$197.25 ,$229.07 ,$229.07 ,$254.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP SYNTHES HUMERAL NAIL T25 15MM,278,1 ,$318.15 ,$209.98 ,$161.37 ,$318.15 , N/A , N/A , N/A , N/A ,$190.89 ,$270.43 ,$222.71 , N/A , N/A ,$302.24 ,$241.79 ,$238.61 , N/A ,$270.43 , N/A , N/A , N/A ,$222.71 ,$193.75 , N/A , N/A , N/A , N/A , N/A ,$270.43 , N/A ,$292.70 ,$222.71 ,$161.37 ,$193.66 ,$193.75 ,$193.66 ,$219.84 ,$286.34 ,$217.36 , N/A ,$251.34 , N/A , N/A , N/A , N/A , N/A ,$229.07 ,$197.25 ,$229.07 ,$229.07 ,$254.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,CAP SYNTHES HUMERAL NAIL T25 5MM,278,1 ,$318.15 ,$209.98 ,$161.37 ,$318.15 , N/A , N/A , N/A , N/A ,$190.89 ,$270.43 ,$222.71 , N/A , N/A ,$302.24 ,$241.79 ,$238.61 , N/A ,$270.43 , N/A , N/A , N/A ,$222.71 ,$193.75 , N/A , N/A , N/A , N/A , N/A ,$270.43 , N/A ,$292.70 ,$222.71 ,$161.37 ,$193.66 ,$193.75 ,$193.66 ,$219.84 ,$286.34 ,$217.36 , N/A ,$251.34 , N/A , N/A , N/A , N/A , N/A ,$229.07 ,$197.25 ,$229.07 ,$229.07 ,$254.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LC-DCP 8 HOLE,278,1 ,$335.48 ,$221.42 ,$170.16 ,$335.48 , N/A , N/A , N/A , N/A ,$201.29 ,$285.16 ,$234.84 , N/A , N/A ,$318.71 ,$254.96 ,$251.61 , N/A ,$285.16 , N/A , N/A , N/A ,$234.84 ,$204.31 , N/A , N/A , N/A , N/A , N/A ,$285.16 , N/A ,$308.64 ,$234.84 ,$170.16 ,$204.21 ,$204.31 ,$204.21 ,$231.82 ,$301.93 ,$229.20 , N/A ,$265.03 , N/A , N/A , N/A , N/A , N/A ,$241.55 ,$208.00 ,$241.55 ,$241.55 ,$268.38 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LC-DCP 9 HOLE,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 26,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 28,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 30,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 32,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 34,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 36,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 38,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 40,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 42,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 44,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 46,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 48,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 50,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 52,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 54,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 56,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 58,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN CONICAL 15MM THRD X 60,278,1 ,$351.23 ,$231.81 ,$178.14 ,$351.23 , N/A , N/A , N/A , N/A ,$210.74 ,$298.55 ,$245.86 , N/A , N/A ,$333.67 ,$266.93 ,$263.42 , N/A ,$298.55 , N/A , N/A , N/A ,$245.86 ,$213.90 , N/A , N/A , N/A , N/A , N/A ,$298.55 , N/A ,$323.13 ,$245.86 ,$178.14 ,$213.79 ,$213.90 ,$213.79 ,$242.70 ,$316.11 ,$239.96 , N/A ,$277.47 , N/A , N/A , N/A , N/A , N/A ,$252.89 ,$217.76 ,$252.89 ,$252.89 ,$280.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 10H 194MM LEFT,278,1 ,"$2,749.11 ","$1,814.41 ","$1,374.56 ","$2,749.11 ", N/A ,"$1,449.06 ","$1,449.06 ", N/A ,"$1,649.47 ","$2,336.74 ","$1,924.38 ", N/A , N/A ,"$2,611.65 ","$2,089.32 ","$2,061.83 ","$1,374.56 ","$2,336.74 ", N/A ,"$1,374.56 ","$1,374.56 ","$1,924.38 ","$1,674.21 ", N/A , N/A , N/A , N/A , N/A ,"$2,336.74 ", N/A ,"$2,529.18 ","$1,924.38 ","$1,394.35 ","$1,673.38 ","$1,674.21 ","$1,673.38 ","$1,899.64 ","$2,474.20 ","$1,878.19 ", N/A ,"$2,171.80 ", N/A , N/A , N/A , N/A , N/A ,"$1,979.36 ","$1,704.45 ","$1,979.36 ","$1,979.36 ","$2,199.29 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 10H 194MM RIGHT,278,1 ,"$2,648.70 ","$1,748.14 ","$1,324.35 ","$2,648.70 ", N/A ,"$1,396.13 ","$1,396.13 ", N/A ,"$1,589.22 ","$2,251.40 ","$1,854.09 ", N/A , N/A ,"$2,516.27 ","$2,013.01 ","$1,986.53 ","$1,324.35 ","$2,251.40 ", N/A ,"$1,324.35 ","$1,324.35 ","$1,854.09 ","$1,613.06 ", N/A , N/A , N/A , N/A , N/A ,"$2,251.40 ", N/A ,"$2,436.80 ","$1,854.09 ","$1,343.42 ","$1,612.26 ","$1,613.06 ","$1,612.26 ","$1,830.25 ","$2,383.83 ","$1,809.59 ", N/A ,"$2,092.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,907.06 ","$1,642.19 ","$1,907.06 ","$1,907.06 ","$2,118.96 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 12H 220MM LEFT,278,1 ,"$2,778.37 ","$1,833.72 ","$1,389.19 ","$2,778.37 ", N/A ,"$1,464.48 ","$1,464.48 ", N/A ,"$1,667.02 ","$2,361.61 ","$1,944.86 ", N/A , N/A ,"$2,639.45 ","$2,111.56 ","$2,083.78 ","$1,389.19 ","$2,361.61 ", N/A ,"$1,389.19 ","$1,389.19 ","$1,944.86 ","$1,692.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,361.61 ", N/A ,"$2,556.10 ","$1,944.86 ","$1,409.19 ","$1,691.19 ","$1,692.03 ","$1,691.19 ","$1,919.85 ","$2,500.53 ","$1,898.18 ", N/A ,"$2,194.91 ", N/A , N/A , N/A , N/A , N/A ,"$2,000.43 ","$1,722.59 ","$2,000.43 ","$2,000.43 ","$2,222.70 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 12H 220MM RIGHT,278,1 ,"$2,676.63 ","$1,766.58 ","$1,338.32 ","$2,676.63 ", N/A ,"$1,410.85 ","$1,410.85 ", N/A ,"$1,605.98 ","$2,275.14 ","$1,873.64 ", N/A , N/A ,"$2,542.80 ","$2,034.24 ","$2,007.47 ","$1,338.32 ","$2,275.14 ", N/A ,"$1,338.32 ","$1,338.32 ","$1,873.64 ","$1,630.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,275.14 ", N/A ,"$2,462.50 ","$1,873.64 ","$1,357.59 ","$1,629.26 ","$1,630.07 ","$1,629.26 ","$1,849.55 ","$2,408.97 ","$1,828.67 ", N/A ,"$2,114.54 ", N/A , N/A , N/A , N/A , N/A ,"$1,927.17 ","$1,659.51 ","$1,927.17 ","$1,927.17 ","$2,141.30 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 14H 246MM RIGHT,278,1 ,"$2,812.95 ","$1,856.55 ","$1,406.48 ","$2,812.95 ", N/A ,"$1,482.71 ","$1,482.71 ", N/A ,"$1,687.77 ","$2,391.01 ","$1,969.07 ", N/A , N/A ,"$2,672.30 ","$2,137.84 ","$2,109.71 ","$1,406.48 ","$2,391.01 ", N/A ,"$1,406.48 ","$1,406.48 ","$1,969.07 ","$1,713.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,391.01 ", N/A ,"$2,587.91 ","$1,969.07 ","$1,426.73 ","$1,712.24 ","$1,713.09 ","$1,712.24 ","$1,943.75 ","$2,531.66 ","$1,921.81 ", N/A ,"$2,222.23 ", N/A , N/A , N/A , N/A , N/A ,"$2,025.32 ","$1,744.03 ","$2,025.32 ","$2,025.32 ","$2,250.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 14H 246MM LEFT,278,1 ,"$2,812.95 ","$1,856.55 ","$1,406.48 ","$2,812.95 ", N/A ,"$1,482.71 ","$1,482.71 ", N/A ,"$1,687.77 ","$2,391.01 ","$1,969.07 ", N/A , N/A ,"$2,672.30 ","$2,137.84 ","$2,109.71 ","$1,406.48 ","$2,391.01 ", N/A ,"$1,406.48 ","$1,406.48 ","$1,969.07 ","$1,713.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,391.01 ", N/A ,"$2,587.91 ","$1,969.07 ","$1,426.73 ","$1,712.24 ","$1,713.09 ","$1,712.24 ","$1,943.75 ","$2,531.66 ","$1,921.81 ", N/A ,"$2,222.23 ", N/A , N/A , N/A , N/A , N/A ,"$2,025.32 ","$1,744.03 ","$2,025.32 ","$2,025.32 ","$2,250.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 4H 116MM RIGHT,278,1 ,"$2,567.70 ","$1,694.68 ","$1,283.85 ","$2,567.70 ", N/A ,"$1,353.43 ","$1,353.43 ", N/A ,"$1,540.62 ","$2,182.55 ","$1,797.39 ", N/A , N/A ,"$2,439.32 ","$1,951.45 ","$1,925.78 ","$1,283.85 ","$2,182.55 ", N/A ,"$1,283.85 ","$1,283.85 ","$1,797.39 ","$1,563.73 ", N/A , N/A , N/A , N/A , N/A ,"$2,182.55 ", N/A ,"$2,362.28 ","$1,797.39 ","$1,302.34 ","$1,562.96 ","$1,563.73 ","$1,562.96 ","$1,774.28 ","$2,310.93 ","$1,754.25 ", N/A ,"$2,028.48 ", N/A , N/A , N/A , N/A , N/A ,"$1,848.74 ","$1,591.97 ","$1,848.74 ","$1,848.74 ","$2,054.16 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 4H 116MM LEFT,278,1 ,"$2,567.70 ","$1,694.68 ","$1,283.85 ","$2,567.70 ", N/A ,"$1,353.43 ","$1,353.43 ", N/A ,"$1,540.62 ","$2,182.55 ","$1,797.39 ", N/A , N/A ,"$2,439.32 ","$1,951.45 ","$1,925.78 ","$1,283.85 ","$2,182.55 ", N/A ,"$1,283.85 ","$1,283.85 ","$1,797.39 ","$1,563.73 ", N/A , N/A , N/A , N/A , N/A ,"$2,182.55 ", N/A ,"$2,362.28 ","$1,797.39 ","$1,302.34 ","$1,562.96 ","$1,563.73 ","$1,562.96 ","$1,774.28 ","$2,310.93 ","$1,754.25 ", N/A ,"$2,028.48 ", N/A , N/A , N/A , N/A , N/A ,"$1,848.74 ","$1,591.97 ","$1,848.74 ","$1,848.74 ","$2,054.16 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 6H 142MM RIGHT,278,1 ,"$2,593.77 ","$1,711.89 ","$1,296.89 ","$2,593.77 ", N/A ,"$1,367.18 ","$1,367.18 ", N/A ,"$1,556.26 ","$2,204.70 ","$1,815.64 ", N/A , N/A ,"$2,464.08 ","$1,971.27 ","$1,945.33 ","$1,296.89 ","$2,204.70 ", N/A ,"$1,296.89 ","$1,296.89 ","$1,815.64 ","$1,579.61 ", N/A , N/A , N/A , N/A , N/A ,"$2,204.70 ", N/A ,"$2,386.27 ","$1,815.64 ","$1,315.56 ","$1,578.83 ","$1,579.61 ","$1,578.83 ","$1,792.30 ","$2,334.39 ","$1,772.06 ", N/A ,"$2,049.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,867.51 ","$1,608.14 ","$1,867.51 ","$1,867.51 ","$2,075.02 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 6H 142MM LEFT,278,1 ,"$2,593.77 ","$1,711.89 ","$1,296.89 ","$2,593.77 ", N/A ,"$1,367.18 ","$1,367.18 ", N/A ,"$1,556.26 ","$2,204.70 ","$1,815.64 ", N/A , N/A ,"$2,464.08 ","$1,971.27 ","$1,945.33 ","$1,296.89 ","$2,204.70 ", N/A ,"$1,296.89 ","$1,296.89 ","$1,815.64 ","$1,579.61 ", N/A , N/A , N/A , N/A , N/A ,"$2,204.70 ", N/A ,"$2,386.27 ","$1,815.64 ","$1,315.56 ","$1,578.83 ","$1,579.61 ","$1,578.83 ","$1,792.30 ","$2,334.39 ","$1,772.06 ", N/A ,"$2,049.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,867.51 ","$1,608.14 ","$1,867.51 ","$1,867.51 ","$2,075.02 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 8H 168MM RIGHT,278,1 ,"$2,618.90 ","$1,728.47 ","$1,309.45 ","$2,618.90 ", N/A ,"$1,380.42 ","$1,380.42 ", N/A ,"$1,571.34 ","$2,226.07 ","$1,833.23 ", N/A , N/A ,"$2,487.96 ","$1,990.36 ","$1,964.18 ","$1,309.45 ","$2,226.07 ", N/A ,"$1,309.45 ","$1,309.45 ","$1,833.23 ","$1,594.91 ", N/A , N/A , N/A , N/A , N/A ,"$2,226.07 ", N/A ,"$2,409.39 ","$1,833.23 ","$1,328.31 ","$1,594.12 ","$1,594.91 ","$1,594.12 ","$1,809.66 ","$2,357.01 ","$1,789.23 ", N/A ,"$2,068.93 ", N/A , N/A , N/A , N/A , N/A ,"$1,885.61 ","$1,623.72 ","$1,885.61 ","$1,885.61 ","$2,095.12 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP DISTAL TIBIA 8H 168MM LEFT,278,1 ,"$2,618.90 ","$1,728.47 ","$1,309.45 ","$2,618.90 ", N/A ,"$1,380.42 ","$1,380.42 ", N/A ,"$1,571.34 ","$2,226.07 ","$1,833.23 ", N/A , N/A ,"$2,487.96 ","$1,990.36 ","$1,964.18 ","$1,309.45 ","$2,226.07 ", N/A ,"$1,309.45 ","$1,309.45 ","$1,833.23 ","$1,594.91 ", N/A , N/A , N/A , N/A , N/A ,"$2,226.07 ", N/A ,"$2,409.39 ","$1,833.23 ","$1,328.31 ","$1,594.12 ","$1,594.91 ","$1,594.12 ","$1,809.66 ","$2,357.01 ","$1,789.23 ", N/A ,"$2,068.93 ", N/A , N/A , N/A , N/A , N/A ,"$1,885.61 ","$1,623.72 ","$1,885.61 ","$1,885.61 ","$2,095.12 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PERIART PROX HUMERUS 2H/91MM LEFT,278,1 ,"$2,935.44 ","$1,937.39 ","$1,467.72 ","$2,935.44 ", N/A ,"$1,547.27 ","$1,547.27 ", N/A ,"$1,761.26 ","$2,495.12 ","$2,054.81 ", N/A , N/A ,"$2,788.67 ","$2,230.93 ","$2,201.58 ","$1,467.72 ","$2,495.12 ", N/A ,"$1,467.72 ","$1,467.72 ","$2,054.81 ","$1,787.68 ", N/A , N/A , N/A , N/A , N/A ,"$2,495.12 ", N/A ,"$2,700.60 ","$2,054.81 ","$1,488.86 ","$1,786.80 ","$1,787.68 ","$1,786.80 ","$2,028.39 ","$2,641.90 ","$2,005.49 ", N/A ,"$2,319.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,113.52 ","$1,819.97 ","$2,113.52 ","$2,113.52 ","$2,348.35 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PERIART PROX HUMERUS 2H/91MM RIGHT,278,1 ,"$2,703.89 ","$1,784.57 ","$1,351.95 ","$2,703.89 ", N/A ,"$1,425.22 ","$1,425.22 ", N/A ,"$1,622.33 ","$2,298.31 ","$1,892.72 ", N/A , N/A ,"$2,568.70 ","$2,054.96 ","$2,027.92 ","$1,351.95 ","$2,298.31 ", N/A ,"$1,351.95 ","$1,351.95 ","$1,892.72 ","$1,646.67 ", N/A , N/A , N/A , N/A , N/A ,"$2,298.31 ", N/A ,"$2,487.58 ","$1,892.72 ","$1,371.41 ","$1,645.86 ","$1,646.67 ","$1,645.86 ","$1,868.39 ","$2,433.50 ","$1,847.30 ", N/A ,"$2,136.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,946.80 ","$1,676.41 ","$1,946.80 ","$1,946.80 ","$2,163.11 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 5 HOLES/LEFT,278,1 ,"$2,703.89 ","$1,784.57 ","$1,351.95 ","$2,703.89 ", N/A ,"$1,425.22 ","$1,425.22 ", N/A ,"$1,622.33 ","$2,298.31 ","$1,892.72 ", N/A , N/A ,"$2,568.70 ","$2,054.96 ","$2,027.92 ","$1,351.95 ","$2,298.31 ", N/A ,"$1,351.95 ","$1,351.95 ","$1,892.72 ","$1,646.67 ", N/A , N/A , N/A , N/A , N/A ,"$2,298.31 ", N/A ,"$2,487.58 ","$1,892.72 ","$1,371.41 ","$1,645.86 ","$1,646.67 ","$1,645.86 ","$1,868.39 ","$2,433.50 ","$1,847.30 ", N/A ,"$2,136.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,946.80 ","$1,676.41 ","$1,946.80 ","$1,946.80 ","$2,163.11 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 ANTEROLATERAL DISTAL TIBIA PL 5 HOLES/RIGHT,278,1 ,"$2,703.89 ","$1,784.57 ","$1,351.95 ","$2,703.89 ", N/A ,"$1,425.22 ","$1,425.22 ", N/A ,"$1,622.33 ","$2,298.31 ","$1,892.72 ", N/A , N/A ,"$2,568.70 ","$2,054.96 ","$2,027.92 ","$1,351.95 ","$2,298.31 ", N/A ,"$1,351.95 ","$1,351.95 ","$1,892.72 ","$1,646.67 ", N/A , N/A , N/A , N/A , N/A ,"$2,298.31 ", N/A ,"$2,487.58 ","$1,892.72 ","$1,371.41 ","$1,645.86 ","$1,646.67 ","$1,645.86 ","$1,868.39 ","$2,433.50 ","$1,847.30 ", N/A ,"$2,136.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,946.80 ","$1,676.41 ","$1,946.80 ","$1,946.80 ","$2,163.11 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PERIART PROX HUMERUS 3H/109MM RIGHT,278,1 ,"$2,742.46 ","$1,810.02 ","$1,371.23 ","$2,742.46 ", N/A ,"$1,445.55 ","$1,445.55 ", N/A ,"$1,645.48 ","$2,331.09 ","$1,919.72 ", N/A , N/A ,"$2,605.34 ","$2,084.27 ","$2,056.85 ","$1,371.23 ","$2,331.09 ", N/A ,"$1,371.23 ","$1,371.23 ","$1,919.72 ","$1,670.16 ", N/A , N/A , N/A , N/A , N/A ,"$2,331.09 ", N/A ,"$2,523.06 ","$1,919.72 ","$1,390.98 ","$1,669.34 ","$1,670.16 ","$1,669.34 ","$1,895.04 ","$2,468.21 ","$1,873.65 ", N/A ,"$2,166.54 ", N/A , N/A , N/A , N/A , N/A ,"$1,974.57 ","$1,700.33 ","$1,974.57 ","$1,974.57 ","$2,193.97 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PERIART PROX HUMERUS 3H/109MM LEFT,278,1 ,"$2,742.46 ","$1,810.02 ","$1,371.23 ","$2,742.46 ", N/A ,"$1,445.55 ","$1,445.55 ", N/A ,"$1,645.48 ","$2,331.09 ","$1,919.72 ", N/A , N/A ,"$2,605.34 ","$2,084.27 ","$2,056.85 ","$1,371.23 ","$2,331.09 ", N/A ,"$1,371.23 ","$1,371.23 ","$1,919.72 ","$1,670.16 ", N/A , N/A , N/A , N/A , N/A ,"$2,331.09 ", N/A ,"$2,523.06 ","$1,919.72 ","$1,390.98 ","$1,669.34 ","$1,670.16 ","$1,669.34 ","$1,895.04 ","$2,468.21 ","$1,873.65 ", N/A ,"$2,166.54 ", N/A , N/A , N/A , N/A , N/A ,"$1,974.57 ","$1,700.33 ","$1,974.57 ","$1,974.57 ","$2,193.97 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PERIART PROX HUMERUS 4H/127MM RIGHT,278,1 ,"$2,785.02 ","$1,838.11 ","$1,392.51 ","$2,785.02 ", N/A ,"$1,467.98 ","$1,467.98 ", N/A ,"$1,671.01 ","$2,367.27 ","$1,949.51 ", N/A , N/A ,"$2,645.77 ","$2,116.62 ","$2,088.77 ","$1,392.51 ","$2,367.27 ", N/A ,"$1,392.51 ","$1,392.51 ","$1,949.51 ","$1,696.08 ", N/A , N/A , N/A , N/A , N/A ,"$2,367.27 ", N/A ,"$2,562.22 ","$1,949.51 ","$1,412.56 ","$1,695.24 ","$1,696.08 ","$1,695.24 ","$1,924.45 ","$2,506.52 ","$1,902.73 ", N/A ,"$2,200.17 ", N/A , N/A , N/A , N/A , N/A ,"$2,005.21 ","$1,726.71 ","$2,005.21 ","$2,005.21 ","$2,228.02 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PERIART PROX HUMERUS 4H/127MM LEFT,278,1 ,"$2,785.02 ","$1,838.11 ","$1,392.51 ","$2,785.02 ", N/A ,"$1,467.98 ","$1,467.98 ", N/A ,"$1,671.01 ","$2,367.27 ","$1,949.51 ", N/A , N/A ,"$2,645.77 ","$2,116.62 ","$2,088.77 ","$1,392.51 ","$2,367.27 ", N/A ,"$1,392.51 ","$1,392.51 ","$1,949.51 ","$1,696.08 ", N/A , N/A , N/A , N/A , N/A ,"$2,367.27 ", N/A ,"$2,562.22 ","$1,949.51 ","$1,412.56 ","$1,695.24 ","$1,696.08 ","$1,695.24 ","$1,924.45 ","$2,506.52 ","$1,902.73 ", N/A ,"$2,200.17 ", N/A , N/A , N/A , N/A , N/A ,"$2,005.21 ","$1,726.71 ","$2,005.21 ","$2,005.21 ","$2,228.02 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PERIART PROX HUMERUS 5H/145MM RIGHT,278,1 ,"$2,854.18 ","$1,883.76 ","$1,427.09 ","$2,854.18 ", N/A ,"$1,504.44 ","$1,504.44 ", N/A ,"$1,712.51 ","$2,426.05 ","$1,997.93 ", N/A , N/A ,"$2,711.47 ","$2,169.18 ","$2,140.64 ","$1,427.09 ","$2,426.05 ", N/A ,"$1,427.09 ","$1,427.09 ","$1,997.93 ","$1,738.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,426.05 ", N/A ,"$2,625.85 ","$1,997.93 ","$1,447.64 ","$1,737.34 ","$1,738.20 ","$1,737.34 ","$1,972.24 ","$2,568.76 ","$1,949.98 ", N/A ,"$2,254.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,055.01 ","$1,769.59 ","$2,055.01 ","$2,055.01 ","$2,283.34 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PERIART PROX HUMERUS 5H/145MM LEFT,278,1 ,"$2,854.18 ","$1,883.76 ","$1,427.09 ","$2,854.18 ", N/A ,"$1,504.44 ","$1,504.44 ", N/A ,"$1,712.51 ","$2,426.05 ","$1,997.93 ", N/A , N/A ,"$2,711.47 ","$2,169.18 ","$2,140.64 ","$1,427.09 ","$2,426.05 ", N/A ,"$1,427.09 ","$1,427.09 ","$1,997.93 ","$1,738.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,426.05 ", N/A ,"$2,625.85 ","$1,997.93 ","$1,447.64 ","$1,737.34 ","$1,738.20 ","$1,737.34 ","$1,972.24 ","$2,568.76 ","$1,949.98 ", N/A ,"$2,254.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,055.01 ","$1,769.59 ","$2,055.01 ","$2,055.01 ","$2,283.34 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PROX HUMERUS 6H  HEAD 3H SHAFT,278,1 ,"$2,644.97 ","$1,745.68 ","$1,322.49 ","$2,644.97 ", N/A ,"$1,394.16 ","$1,394.16 ", N/A ,"$1,586.98 ","$2,248.22 ","$1,851.48 ", N/A , N/A ,"$2,512.72 ","$2,010.18 ","$1,983.73 ","$1,322.49 ","$2,248.22 ", N/A ,"$1,322.49 ","$1,322.49 ","$1,851.48 ","$1,610.79 ", N/A , N/A , N/A , N/A , N/A ,"$2,248.22 ", N/A ,"$2,433.37 ","$1,851.48 ","$1,341.53 ","$1,609.99 ","$1,610.79 ","$1,609.99 ","$1,827.67 ","$2,380.47 ","$1,807.04 ", N/A ,"$2,089.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,904.38 ","$1,639.88 ","$1,904.38 ","$1,904.38 ","$2,115.98 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PROX HUMERUS 6H HEAD 5H SHAFT,278,1 ,"$2,789.01 ","$1,840.75 ","$1,394.51 ","$2,789.01 ", N/A ,"$1,470.09 ","$1,470.09 ", N/A ,"$1,673.41 ","$2,370.66 ","$1,952.31 ", N/A , N/A ,"$2,649.56 ","$2,119.65 ","$2,091.76 ","$1,394.51 ","$2,370.66 ", N/A ,"$1,394.51 ","$1,394.51 ","$1,952.31 ","$1,698.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,370.66 ", N/A ,"$2,565.89 ","$1,952.31 ","$1,414.59 ","$1,697.67 ","$1,698.51 ","$1,697.67 ","$1,927.21 ","$2,510.11 ","$1,905.45 ", N/A ,"$2,203.32 ", N/A , N/A , N/A , N/A , N/A ,"$2,008.09 ","$1,729.19 ","$2,008.09 ","$2,008.09 ","$2,231.21 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PROXIMAL HUMERUS LONG 10H 232MM,278,1 ,"$3,153.43 ","$2,081.26 ","$1,576.72 ","$3,153.43 ", N/A ,"$1,662.17 ","$1,662.17 ", N/A ,"$1,892.06 ","$2,680.42 ","$2,207.40 ", N/A , N/A ,"$2,995.76 ","$2,396.61 ","$2,365.07 ","$1,576.72 ","$2,680.42 ", N/A ,"$1,576.72 ","$1,576.72 ","$2,207.40 ","$1,920.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,680.42 ", N/A ,"$2,901.16 ","$2,207.40 ","$1,599.42 ","$1,919.49 ","$1,920.44 ","$1,919.49 ","$2,179.02 ","$2,838.09 ","$2,154.42 ", N/A ,"$2,491.21 ", N/A , N/A , N/A , N/A , N/A ,"$2,270.47 ","$1,955.13 ","$2,270.47 ","$2,270.47 ","$2,522.74 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PROXIMAL HUMERUS LONG 12H 268MM,278,1 ,"$3,262.49 ","$2,153.24 ","$1,631.25 ","$3,262.49 ", N/A ,"$1,719.66 ","$1,719.66 ", N/A ,"$1,957.49 ","$2,773.12 ","$2,283.74 ", N/A , N/A ,"$3,099.37 ","$2,479.49 ","$2,446.87 ","$1,631.25 ","$2,773.12 ", N/A ,"$1,631.25 ","$1,631.25 ","$2,283.74 ","$1,986.86 ", N/A , N/A , N/A , N/A , N/A ,"$2,773.12 ", N/A ,"$3,001.49 ","$2,283.74 ","$1,654.73 ","$1,985.88 ","$1,986.86 ","$1,985.88 ","$2,254.38 ","$2,936.24 ","$2,228.93 ", N/A ,"$2,577.37 ", N/A , N/A , N/A , N/A , N/A ,"$2,348.99 ","$2,022.74 ","$2,348.99 ","$2,348.99 ","$2,609.99 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PROXIMAL HUMERUS LONG 5H 142MM,278,1 ,"$2,815.61 ","$1,858.30 ","$1,407.81 ","$2,815.61 ", N/A ,"$1,484.11 ","$1,484.11 ", N/A ,"$1,689.37 ","$2,393.27 ","$1,970.93 ", N/A , N/A ,"$2,674.83 ","$2,139.86 ","$2,111.71 ","$1,407.81 ","$2,393.27 ", N/A ,"$1,407.81 ","$1,407.81 ","$1,970.93 ","$1,714.71 ", N/A , N/A , N/A , N/A , N/A ,"$2,393.27 ", N/A ,"$2,590.36 ","$1,970.93 ","$1,428.08 ","$1,713.86 ","$1,714.71 ","$1,713.86 ","$1,945.59 ","$2,534.05 ","$1,923.62 ", N/A ,"$2,224.33 ", N/A , N/A , N/A , N/A , N/A ,"$2,027.24 ","$1,745.68 ","$2,027.24 ","$2,027.24 ","$2,252.49 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PROXIMAL HUMERUS LONG 6H 160MM,278,1 ,"$2,927.33 ","$1,932.04 ","$1,463.67 ","$2,927.33 ", N/A ,"$1,543.00 ","$1,543.00 ", N/A ,"$1,756.40 ","$2,488.23 ","$2,049.13 ", N/A , N/A ,"$2,780.96 ","$2,224.77 ","$2,195.50 ","$1,463.67 ","$2,488.23 ", N/A ,"$1,463.67 ","$1,463.67 ","$2,049.13 ","$1,782.74 ", N/A , N/A , N/A , N/A , N/A ,"$2,488.23 ", N/A ,"$2,693.14 ","$2,049.13 ","$1,484.74 ","$1,781.87 ","$1,782.74 ","$1,781.87 ","$2,022.79 ","$2,634.60 ","$1,999.95 ", N/A ,"$2,312.59 ", N/A , N/A , N/A , N/A , N/A ,"$2,107.68 ","$1,814.94 ","$2,107.68 ","$2,107.68 ","$2,341.86 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP PROXIMAL HUMERUS LONG 8H 196MM,278,1 ,"$3,040.04 ","$2,006.43 ","$1,520.02 ","$3,040.04 ", N/A ,"$1,602.41 ","$1,602.41 ", N/A ,"$1,824.02 ","$2,584.03 ","$2,128.03 ", N/A , N/A ,"$2,888.04 ","$2,310.43 ","$2,280.03 ","$1,520.02 ","$2,584.03 ", N/A ,"$1,520.02 ","$1,520.02 ","$2,128.03 ","$1,851.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,584.03 ", N/A ,"$2,796.84 ","$2,128.03 ","$1,541.91 ","$1,850.47 ","$1,851.38 ","$1,850.47 ","$2,100.67 ","$2,736.04 ","$2,076.96 ", N/A ,"$2,401.63 ", N/A , N/A , N/A , N/A , N/A ,"$2,188.83 ","$1,884.82 ","$2,188.83 ","$2,188.83 ","$2,432.03 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP RECON  5 HOLE,278,1 ,$824.89 ,$544.43 ,$418.38 ,$824.89 , N/A , N/A , N/A , N/A ,$494.93 ,$701.16 ,$577.42 , N/A , N/A ,$783.65 ,$626.92 ,$618.67 , N/A ,$701.16 , N/A , N/A , N/A ,$577.42 ,$502.36 , N/A , N/A , N/A , N/A , N/A ,$701.16 , N/A ,$758.90 ,$577.42 ,$418.38 ,$502.11 ,$502.36 ,$502.11 ,$570.00 ,$742.40 ,$563.56 , N/A ,$651.66 , N/A , N/A , N/A , N/A , N/A ,$593.92 ,$511.43 ,$593.92 ,$593.92 ,$659.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP RECON  6 HOLE,278,1 ,$953.42 ,$629.26 ,$483.57 ,$953.42 , N/A , N/A , N/A , N/A ,$572.05 ,$810.41 ,$667.39 , N/A , N/A ,$905.75 ,$724.60 ,$715.07 , N/A ,$810.41 , N/A , N/A , N/A ,$667.39 ,$580.63 , N/A , N/A , N/A , N/A , N/A ,$810.41 , N/A ,$877.15 ,$667.39 ,$483.57 ,$580.35 ,$580.63 ,$580.35 ,$658.81 ,$858.08 ,$651.38 , N/A ,$753.20 , N/A , N/A , N/A , N/A , N/A ,$686.46 ,$591.12 ,$686.46 ,$686.46 ,$762.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP RECON  7 HOLE,278,1 ,$999.77 ,$659.85 ,$507.08 ,$999.77 , N/A , N/A , N/A , N/A ,$599.86 ,$849.80 ,$699.84 , N/A , N/A ,$949.78 ,$759.83 ,$749.83 , N/A ,$849.80 , N/A , N/A , N/A ,$699.84 ,$608.86 , N/A , N/A , N/A , N/A , N/A ,$849.80 , N/A ,$919.79 ,$699.84 ,$507.08 ,$608.56 ,$608.86 ,$608.56 ,$690.84 ,$899.79 ,$683.04 , N/A ,$789.82 , N/A , N/A , N/A , N/A , N/A ,$719.83 ,$619.86 ,$719.83 ,$719.83 ,$799.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP RECON  8 HOLE,278,1 ,"$1,044.02 ",$689.05 ,$529.53 ,"$1,044.02 ", N/A ,$550.30 ,$550.30 , N/A ,$626.41 ,$887.42 ,$730.81 , N/A , N/A ,$991.82 ,$793.46 ,$783.02 , N/A ,$887.42 , N/A , N/A , N/A ,$730.81 ,$635.81 , N/A , N/A , N/A , N/A , N/A ,$887.42 , N/A ,$960.50 ,$730.81 ,$529.53 ,$635.50 ,$635.81 ,$635.50 ,$721.42 ,$939.62 ,$713.27 , N/A ,$824.78 , N/A , N/A , N/A , N/A , N/A ,$751.69 ,$647.29 ,$751.69 ,$751.69 ,$835.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP RECON 10 HOLE,278,1 ,"$1,031.62 ",$680.87 ,$523.24 ,"$1,031.62 ", N/A ,$543.77 ,$543.77 , N/A ,$618.97 ,$876.88 ,$722.13 , N/A , N/A ,$980.04 ,$784.03 ,$773.72 , N/A ,$876.88 , N/A , N/A , N/A ,$722.13 ,$628.26 , N/A , N/A , N/A , N/A , N/A ,$876.88 , N/A ,$949.09 ,$722.13 ,$523.24 ,$627.95 ,$628.26 ,$627.95 ,$712.85 ,$928.46 ,$704.80 , N/A ,$814.98 , N/A , N/A , N/A , N/A , N/A ,$742.77 ,$639.60 ,$742.77 ,$742.77 ,$825.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP RECON 12 HOLE,278,1 ,"$1,142.12 ",$753.80 ,$579.28 ,"$1,142.12 ", N/A ,$602.01 ,$602.01 , N/A ,$685.27 ,$970.80 ,$799.48 , N/A , N/A ,"$1,085.01 ",$868.01 ,$856.59 , N/A ,$970.80 , N/A , N/A , N/A ,$799.48 ,$695.55 , N/A , N/A , N/A , N/A , N/A ,$970.80 , N/A ,"$1,050.75 ",$799.48 ,$579.28 ,$695.21 ,$695.55 ,$695.21 ,$789.20 ,"$1,027.91 ",$780.30 , N/A ,$902.27 , N/A , N/A , N/A , N/A , N/A ,$822.33 ,$708.11 ,$822.33 ,$822.33 ,$913.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 3 HOLE SHAFT OBL LT,278,1 ,$677.40 ,$447.08 ,$343.58 ,$677.40 , N/A , N/A , N/A , N/A ,$406.44 ,$575.79 ,$474.18 , N/A , N/A ,$643.53 ,$514.82 ,$508.05 , N/A ,$575.79 , N/A , N/A , N/A ,$474.18 ,$412.54 , N/A , N/A , N/A , N/A , N/A ,$575.79 , N/A ,$623.21 ,$474.18 ,$343.58 ,$412.33 ,$412.54 ,$412.33 ,$468.08 ,$609.66 ,$462.80 , N/A ,$535.15 , N/A , N/A , N/A , N/A , N/A ,$487.73 ,$419.99 ,$487.73 ,$487.73 ,$541.92 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 3 HOLE SHAFT RT ANGLE,278,1 ,$633.61 ,$418.18 ,$321.37 ,$633.61 , N/A , N/A , N/A , N/A ,$380.17 ,$538.57 ,$443.53 , N/A , N/A ,$601.93 ,$481.54 ,$475.21 , N/A ,$538.57 , N/A , N/A , N/A ,$443.53 ,$385.87 , N/A , N/A , N/A , N/A , N/A ,$538.57 , N/A ,$582.92 ,$443.53 ,$321.37 ,$385.68 ,$385.87 ,$385.68 ,$437.82 ,$570.25 ,$432.88 , N/A ,$500.55 , N/A , N/A , N/A , N/A , N/A ,$456.20 ,$392.84 ,$456.20 ,$456.20 ,$506.89 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 3H SHAFT OBL RT,278,1 ,$676.35 ,$446.39 ,$343.04 ,$676.35 , N/A , N/A , N/A , N/A ,$405.81 ,$574.90 ,$473.45 , N/A , N/A ,$642.53 ,$514.03 ,$507.26 , N/A ,$574.90 , N/A , N/A , N/A ,$473.45 ,$411.90 , N/A , N/A , N/A , N/A , N/A ,$574.90 , N/A ,$622.24 ,$473.45 ,$343.04 ,$411.69 ,$411.90 ,$411.69 ,$467.36 ,$608.72 ,$462.08 , N/A ,$534.32 , N/A , N/A , N/A , N/A , N/A ,$486.97 ,$419.34 ,$486.97 ,$486.97 ,$541.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 4 HOLE SHAFT OBL LT,278,1 ,$709.01 ,$467.95 ,$359.61 ,$709.01 , N/A , N/A , N/A , N/A ,$425.41 ,$602.66 ,$496.31 , N/A , N/A ,$673.56 ,$538.85 ,$531.76 , N/A ,$602.66 , N/A , N/A , N/A ,$496.31 ,$431.79 , N/A , N/A , N/A , N/A , N/A ,$602.66 , N/A ,$652.29 ,$496.31 ,$359.61 ,$431.57 ,$431.79 ,$431.57 ,$489.93 ,$638.11 ,$484.40 , N/A ,$560.12 , N/A , N/A , N/A , N/A , N/A ,$510.49 ,$439.59 ,$510.49 ,$510.49 ,$567.21 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 4H SHAFT OBL RT,278,1 ,$706.90 ,$466.55 ,$358.54 ,$706.90 , N/A , N/A , N/A , N/A ,$424.14 ,$600.87 ,$494.83 , N/A , N/A ,$671.56 ,$537.24 ,$530.18 , N/A ,$600.87 , N/A , N/A , N/A ,$494.83 ,$430.50 , N/A , N/A , N/A , N/A , N/A ,$600.87 , N/A ,$650.35 ,$494.83 ,$358.54 ,$430.29 ,$430.50 ,$430.29 ,$488.47 ,$636.21 ,$482.95 , N/A ,$558.45 , N/A , N/A , N/A , N/A , N/A ,$508.97 ,$438.28 ,$508.97 ,$508.97 ,$565.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 5 HOLE SHAFT OBL LT,278,1 ,$740.61 ,$488.80 ,$375.64 ,$740.61 , N/A , N/A , N/A , N/A ,$444.37 ,$629.52 ,$518.43 , N/A , N/A ,$703.58 ,$562.86 ,$555.46 , N/A ,$629.52 , N/A , N/A , N/A ,$518.43 ,$451.03 , N/A , N/A , N/A , N/A , N/A ,$629.52 , N/A ,$681.36 ,$518.43 ,$375.64 ,$450.81 ,$451.03 ,$450.81 ,$511.76 ,$666.55 ,$505.98 , N/A ,$585.08 , N/A , N/A , N/A , N/A , N/A ,$533.24 ,$459.18 ,$533.24 ,$533.24 ,$592.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 5 HOLE SHAFT RT ANGLE,278,1 ,$683.72 ,$451.26 ,$346.78 ,$683.72 , N/A , N/A , N/A , N/A ,$410.23 ,$581.16 ,$478.60 , N/A , N/A ,$649.53 ,$519.63 ,$512.79 , N/A ,$581.16 , N/A , N/A , N/A ,$478.60 ,$416.39 , N/A , N/A , N/A , N/A , N/A ,$581.16 , N/A ,$629.02 ,$478.60 ,$346.78 ,$416.18 ,$416.39 ,$416.18 ,$472.45 ,$615.35 ,$467.12 , N/A ,$540.14 , N/A , N/A , N/A , N/A , N/A ,$492.28 ,$423.91 ,$492.28 ,$492.28 ,$546.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 5H SHAFT OBL RT,278,1 ,$738.50 ,$487.41 ,$374.57 ,$738.50 , N/A , N/A , N/A , N/A ,$443.10 ,$627.73 ,$516.95 , N/A , N/A ,$701.58 ,$561.26 ,$553.88 , N/A ,$627.73 , N/A , N/A , N/A ,$516.95 ,$449.75 , N/A , N/A , N/A , N/A , N/A ,$627.73 , N/A ,$679.42 ,$516.95 ,$374.57 ,$449.53 ,$449.75 ,$449.53 ,$510.30 ,$664.65 ,$504.54 , N/A ,$583.42 , N/A , N/A , N/A , N/A , N/A ,$531.72 ,$457.87 ,$531.72 ,$531.72 ,$590.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 7 HOLE SHAFT OBL LT,278,1 ,$802.77 ,$529.83 ,$407.16 ,$802.77 , N/A , N/A , N/A , N/A ,$481.66 ,$682.35 ,$561.94 , N/A , N/A ,$762.63 ,$610.11 ,$602.08 , N/A ,$682.35 , N/A , N/A , N/A ,$561.94 ,$488.89 , N/A , N/A , N/A , N/A , N/A ,$682.35 , N/A ,$738.55 ,$561.94 ,$407.16 ,$488.65 ,$488.89 ,$488.65 ,$554.71 ,$722.49 ,$548.45 , N/A ,$634.19 , N/A , N/A , N/A , N/A , N/A ,$577.99 ,$497.72 ,$577.99 ,$577.99 ,$642.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 7 HOLE SHAFT RT ANGLE,278,1 ,$998.72 ,$659.16 ,$506.55 ,$998.72 , N/A , N/A , N/A , N/A ,$599.23 ,$848.91 ,$699.10 , N/A , N/A ,$948.78 ,$759.03 ,$749.04 , N/A ,$848.91 , N/A , N/A , N/A ,$699.10 ,$608.22 , N/A , N/A , N/A , N/A , N/A ,$848.91 , N/A ,$918.82 ,$699.10 ,$506.55 ,$607.92 ,$608.22 ,$607.92 ,$690.12 ,$898.85 ,$682.33 , N/A ,$788.99 , N/A , N/A , N/A , N/A , N/A ,$719.08 ,$619.21 ,$719.08 ,$719.08 ,$798.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 3H HEAD 7H SHAFT OBL RT,278,1 ,$801.71 ,$529.13 ,$406.63 ,$801.71 , N/A , N/A , N/A , N/A ,$481.03 ,$681.45 ,$561.20 , N/A , N/A ,$761.62 ,$609.30 ,$601.28 , N/A ,$681.45 , N/A , N/A , N/A ,$561.20 ,$488.24 , N/A , N/A , N/A , N/A , N/A ,$681.45 , N/A ,$737.57 ,$561.20 ,$406.63 ,$488.00 ,$488.24 ,$488.00 ,$553.98 ,$721.54 ,$547.73 , N/A ,$633.35 , N/A , N/A , N/A , N/A , N/A ,$577.23 ,$497.06 ,$577.23 ,$577.23 ,$641.37 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 4H HEAD 4 HOLE SHAFT RT ANGLE,278,1 ,$653.17 ,$431.09 ,$331.29 ,$653.17 , N/A , N/A , N/A , N/A ,$391.90 ,$555.19 ,$457.22 , N/A , N/A ,$620.51 ,$496.41 ,$489.88 , N/A ,$555.19 , N/A , N/A , N/A ,$457.22 ,$397.78 , N/A , N/A , N/A , N/A , N/A ,$555.19 , N/A ,$600.92 ,$457.22 ,$331.29 ,$397.58 ,$397.78 ,$397.58 ,$451.34 ,$587.85 ,$446.25 , N/A ,$516.00 , N/A , N/A , N/A , N/A , N/A ,$470.28 ,$404.97 ,$470.28 ,$470.28 ,$522.54 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP T 4H HEAD 6 HOLE SHAFT RT ANGLE,278,1 ,$838.29 ,$553.27 ,$425.18 ,$838.29 , N/A , N/A , N/A , N/A ,$502.97 ,$712.55 ,$586.80 , N/A , N/A ,$796.38 ,$637.10 ,$628.72 , N/A ,$712.55 , N/A , N/A , N/A ,$586.80 ,$510.52 , N/A , N/A , N/A , N/A , N/A ,$712.55 , N/A ,$771.23 ,$586.80 ,$425.18 ,$510.27 ,$510.52 ,$510.27 ,$579.26 ,$754.46 ,$572.72 , N/A ,$662.25 , N/A , N/A , N/A , N/A , N/A ,$603.57 ,$519.74 ,$603.57 ,$603.57 ,$670.63 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 10 HOLE,278,1 ,$698.47 ,$460.99 ,$354.26 ,$698.47 , N/A , N/A , N/A , N/A ,$419.08 ,$593.70 ,$488.93 , N/A , N/A ,$663.55 ,$530.84 ,$523.85 , N/A ,$593.70 , N/A , N/A , N/A ,$488.93 ,$425.37 , N/A , N/A , N/A , N/A , N/A ,$593.70 , N/A ,$642.59 ,$488.93 ,$354.26 ,$425.16 ,$425.37 ,$425.16 ,$482.64 ,$628.62 ,$477.19 , N/A ,$551.79 , N/A , N/A , N/A , N/A , N/A ,$502.90 ,$433.05 ,$502.90 ,$502.90 ,$558.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 12 HOLE,278,1 ,$771.16 ,$508.97 ,$391.13 ,$771.16 , N/A , N/A , N/A , N/A ,$462.70 ,$655.49 ,$539.81 , N/A , N/A ,$732.60 ,$586.08 ,$578.37 , N/A ,$655.49 , N/A , N/A , N/A ,$539.81 ,$469.64 , N/A , N/A , N/A , N/A , N/A ,$655.49 , N/A ,$709.47 ,$539.81 ,$391.13 ,$469.41 ,$469.64 ,$469.41 ,$532.87 ,$694.04 ,$526.86 , N/A ,$609.22 , N/A , N/A , N/A , N/A , N/A ,$555.24 ,$478.12 ,$555.24 ,$555.24 ,$616.93 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 14 HOLE,278,1 ,"$1,102.94 ",$727.94 ,$559.41 ,"$1,102.94 ", N/A ,$581.36 ,$581.36 , N/A ,$661.76 ,$937.50 ,$772.06 , N/A , N/A ,"$1,047.79 ",$838.23 ,$827.21 , N/A ,$937.50 , N/A , N/A , N/A ,$772.06 ,$671.69 , N/A , N/A , N/A , N/A , N/A ,$937.50 , N/A ,"$1,014.70 ",$772.06 ,$559.41 ,$671.36 ,$671.69 ,$671.36 ,$762.13 ,$992.65 ,$753.53 , N/A ,$871.32 , N/A , N/A , N/A , N/A , N/A ,$794.12 ,$683.82 ,$794.12 ,$794.12 ,$882.35 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 5 HOLE,278,1 ,$561.52 ,$370.60 ,$284.80 ,$561.52 , N/A , N/A , N/A , N/A ,$336.91 ,$477.29 ,$393.06 , N/A , N/A ,$533.44 ,$426.76 ,$421.14 , N/A ,$477.29 , N/A , N/A , N/A ,$393.06 ,$341.97 , N/A , N/A , N/A , N/A , N/A ,$477.29 , N/A ,$516.60 ,$393.06 ,$284.80 ,$341.80 ,$341.97 ,$341.80 ,$388.01 ,$505.37 ,$383.63 , N/A ,$443.60 , N/A , N/A , N/A , N/A , N/A ,$404.29 ,$348.14 ,$404.29 ,$404.29 ,$449.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 6 HOLE,278,1 ,$597.33 ,$394.24 ,$302.97 ,$597.33 , N/A , N/A , N/A , N/A ,$358.40 ,$507.73 ,$418.13 , N/A , N/A ,$567.46 ,$453.97 ,$448.00 , N/A ,$507.73 , N/A , N/A , N/A ,$418.13 ,$363.77 , N/A , N/A , N/A , N/A , N/A ,$507.73 , N/A ,$549.54 ,$418.13 ,$302.97 ,$363.59 ,$363.77 ,$363.59 ,$412.76 ,$537.60 ,$408.10 , N/A ,$471.89 , N/A , N/A , N/A , N/A , N/A ,$430.08 ,$370.34 ,$430.08 ,$430.08 ,$477.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 7 HOLE,278,1 ,$620.51 ,$409.54 ,$314.72 ,$620.51 , N/A , N/A , N/A , N/A ,$372.31 ,$527.43 ,$434.36 , N/A , N/A ,$589.48 ,$471.59 ,$465.38 , N/A ,$527.43 , N/A , N/A , N/A ,$434.36 ,$377.89 , N/A , N/A , N/A , N/A , N/A ,$527.43 , N/A ,$570.87 ,$434.36 ,$314.72 ,$377.70 ,$377.89 ,$377.70 ,$428.77 ,$558.46 ,$423.93 , N/A ,$490.20 , N/A , N/A , N/A , N/A , N/A ,$446.77 ,$384.72 ,$446.77 ,$446.77 ,$496.41 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 8 HOLE,278,1 ,$651.06 ,$429.70 ,$330.22 ,$651.06 , N/A , N/A , N/A , N/A ,$390.64 ,$553.40 ,$455.74 , N/A , N/A ,$618.51 ,$494.81 ,$488.30 , N/A ,$553.40 , N/A , N/A , N/A ,$455.74 ,$396.50 , N/A , N/A , N/A , N/A , N/A ,$553.40 , N/A ,$598.98 ,$455.74 ,$330.22 ,$396.30 ,$396.50 ,$396.30 ,$449.88 ,$585.95 ,$444.80 , N/A ,$514.34 , N/A , N/A , N/A , N/A , N/A ,$468.76 ,$403.66 ,$468.76 ,$468.76 ,$520.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 9 HOLE,278,1 ,$678.45 ,$447.78 ,$344.11 ,$678.45 , N/A , N/A , N/A , N/A ,$407.07 ,$576.68 ,$474.92 , N/A , N/A ,$644.53 ,$515.62 ,$508.84 , N/A ,$576.68 , N/A , N/A , N/A ,$474.92 ,$413.18 , N/A , N/A , N/A , N/A , N/A ,$576.68 , N/A ,$624.17 ,$474.92 ,$344.11 ,$412.97 ,$413.18 ,$412.97 ,$468.81 ,$610.61 ,$463.52 , N/A ,$535.98 , N/A , N/A , N/A , N/A , N/A ,$488.48 ,$420.64 ,$488.48 ,$488.48 ,$542.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MED DIST HUM 3H RGT,278,1 ,"$1,767.92 ","$1,166.83 ",$896.69 ,"$1,767.92 ", N/A ,$931.87 ,$931.87 , N/A ,"$1,060.75 ","$1,502.73 ","$1,237.54 ", N/A , N/A ,"$1,679.52 ","$1,343.62 ","$1,325.94 ", N/A ,"$1,502.73 ", N/A , N/A , N/A ,"$1,237.54 ","$1,076.66 ", N/A , N/A , N/A , N/A , N/A ,"$1,502.73 ", N/A ,"$1,626.49 ","$1,237.54 ",$896.69 ,"$1,076.13 ","$1,076.66 ","$1,076.13 ","$1,221.63 ","$1,591.13 ","$1,207.84 ", N/A ,"$1,396.66 ", N/A , N/A , N/A , N/A , N/A ,"$1,272.90 ","$1,096.11 ","$1,272.90 ","$1,272.90 ","$1,414.34 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MED DIST HUM 3H LFT,278,1 ,"$1,767.92 ","$1,166.83 ",$896.69 ,"$1,767.92 ", N/A ,$931.87 ,$931.87 , N/A ,"$1,060.75 ","$1,502.73 ","$1,237.54 ", N/A , N/A ,"$1,679.52 ","$1,343.62 ","$1,325.94 ", N/A ,"$1,502.73 ", N/A , N/A , N/A ,"$1,237.54 ","$1,076.66 ", N/A , N/A , N/A , N/A , N/A ,"$1,502.73 ", N/A ,"$1,626.49 ","$1,237.54 ",$896.69 ,"$1,076.13 ","$1,076.66 ","$1,076.13 ","$1,221.63 ","$1,591.13 ","$1,207.84 ", N/A ,"$1,396.66 ", N/A , N/A , N/A , N/A , N/A ,"$1,272.90 ","$1,096.11 ","$1,272.90 ","$1,272.90 ","$1,414.34 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MED DIST HUM 5H LFT,278,1 ,"$1,961.65 ","$1,294.69 ",$994.95 ,"$1,961.65 ", N/A ,"$1,033.99 ","$1,033.99 ", N/A ,"$1,176.99 ","$1,667.40 ","$1,373.16 ", N/A , N/A ,"$1,863.57 ","$1,490.85 ","$1,471.24 ", N/A ,"$1,667.40 ", N/A , N/A , N/A ,"$1,373.16 ","$1,194.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,667.40 ", N/A ,"$1,804.72 ","$1,373.16 ",$994.95 ,"$1,194.06 ","$1,194.64 ","$1,194.06 ","$1,355.50 ","$1,765.49 ","$1,340.20 ", N/A ,"$1,549.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,412.39 ","$1,216.22 ","$1,412.39 ","$1,412.39 ","$1,569.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MED DIST HUM 5H RGT,278,1 ,"$1,734.77 ","$1,144.95 ",$879.88 ,"$1,734.77 ", N/A ,$914.40 ,$914.40 , N/A ,"$1,040.86 ","$1,474.55 ","$1,214.34 ", N/A , N/A ,"$1,648.03 ","$1,318.43 ","$1,301.08 ", N/A ,"$1,474.55 ", N/A , N/A , N/A ,"$1,214.34 ","$1,056.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,474.55 ", N/A ,"$1,595.99 ","$1,214.34 ",$879.88 ,"$1,055.95 ","$1,056.47 ","$1,055.95 ","$1,198.73 ","$1,561.29 ","$1,185.19 ", N/A ,"$1,370.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,249.03 ","$1,075.56 ","$1,249.03 ","$1,249.03 ","$1,387.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MED DIST HUM 7H RGT,278,1 ,"$1,998.99 ","$1,319.33 ","$1,013.89 ","$1,998.99 ", N/A ,"$1,053.67 ","$1,053.67 ", N/A ,"$1,199.39 ","$1,699.14 ","$1,399.29 ", N/A , N/A ,"$1,899.04 ","$1,519.23 ","$1,499.24 ", N/A ,"$1,699.14 ", N/A , N/A , N/A ,"$1,399.29 ","$1,217.38 ", N/A , N/A , N/A , N/A , N/A ,"$1,699.14 ", N/A ,"$1,839.07 ","$1,399.29 ","$1,013.89 ","$1,216.79 ","$1,217.38 ","$1,216.79 ","$1,381.30 ","$1,799.09 ","$1,365.71 ", N/A ,"$1,579.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,439.27 ","$1,239.37 ","$1,439.27 ","$1,439.27 ","$1,599.19 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MED DIST HUM 7H LFT,278,1 ,"$1,998.99 ","$1,319.33 ","$1,013.89 ","$1,998.99 ", N/A ,"$1,053.67 ","$1,053.67 ", N/A ,"$1,199.39 ","$1,699.14 ","$1,399.29 ", N/A , N/A ,"$1,899.04 ","$1,519.23 ","$1,499.24 ", N/A ,"$1,699.14 ", N/A , N/A , N/A ,"$1,399.29 ","$1,217.38 ", N/A , N/A , N/A , N/A , N/A ,"$1,699.14 ", N/A ,"$1,839.07 ","$1,399.29 ","$1,013.89 ","$1,216.79 ","$1,217.38 ","$1,216.79 ","$1,381.30 ","$1,799.09 ","$1,365.71 ", N/A ,"$1,579.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,439.27 ","$1,239.37 ","$1,439.27 ","$1,439.27 ","$1,599.19 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIAL RT 12 HOLE,278,1 ,"$1,544.06 ","$1,019.08 ",$783.15 ,"$1,544.06 ", N/A ,$813.87 ,$813.87 , N/A ,$926.44 ,"$1,312.45 ","$1,080.84 ", N/A , N/A ,"$1,466.86 ","$1,173.49 ","$1,158.05 ", N/A ,"$1,312.45 ", N/A , N/A , N/A ,"$1,080.84 ",$940.33 , N/A , N/A , N/A , N/A , N/A ,"$1,312.45 ", N/A ,"$1,420.54 ","$1,080.84 ",$783.15 ,$939.87 ,$940.33 ,$939.87 ,"$1,066.95 ","$1,389.65 ","$1,054.90 ", N/A ,"$1,219.81 ", N/A , N/A , N/A , N/A , N/A ,"$1,111.72 ",$957.32 ,"$1,111.72 ","$1,111.72 ","$1,235.25 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIAL RT 14 HOLE,278,1 ,"$1,723.44 ","$1,137.47 ",$874.13 ,"$1,723.44 ", N/A ,$908.43 ,$908.43 , N/A ,"$1,034.06 ","$1,464.92 ","$1,206.41 ", N/A , N/A ,"$1,637.27 ","$1,309.81 ","$1,292.58 ", N/A ,"$1,464.92 ", N/A , N/A , N/A ,"$1,206.41 ","$1,049.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,464.92 ", N/A ,"$1,585.56 ","$1,206.41 ",$874.13 ,"$1,049.06 ","$1,049.58 ","$1,049.06 ","$1,190.90 ","$1,551.10 ","$1,177.45 ", N/A ,"$1,361.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,240.88 ","$1,068.53 ","$1,240.88 ","$1,240.88 ","$1,378.75 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIAL LT 14 HOLE,278,1 ,"$1,723.44 ","$1,137.47 ",$874.13 ,"$1,723.44 ", N/A ,$908.43 ,$908.43 , N/A ,"$1,034.06 ","$1,464.92 ","$1,206.41 ", N/A , N/A ,"$1,637.27 ","$1,309.81 ","$1,292.58 ", N/A ,"$1,464.92 ", N/A , N/A , N/A ,"$1,206.41 ","$1,049.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,464.92 ", N/A ,"$1,585.56 ","$1,206.41 ",$874.13 ,"$1,049.06 ","$1,049.58 ","$1,049.06 ","$1,190.90 ","$1,551.10 ","$1,177.45 ", N/A ,"$1,361.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,240.88 ","$1,068.53 ","$1,240.88 ","$1,240.88 ","$1,378.75 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIAL RT 16 HOLE,278,1 ,"$1,951.60 ","$1,288.06 ",$989.85 ,"$1,951.60 ", N/A ,"$1,028.69 ","$1,028.69 ", N/A ,"$1,170.96 ","$1,658.86 ","$1,366.12 ", N/A , N/A ,"$1,854.02 ","$1,483.22 ","$1,463.70 ", N/A ,"$1,658.86 ", N/A , N/A , N/A ,"$1,366.12 ","$1,188.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,658.86 ", N/A ,"$1,795.47 ","$1,366.12 ",$989.85 ,"$1,187.94 ","$1,188.52 ","$1,187.94 ","$1,348.56 ","$1,756.44 ","$1,333.33 ", N/A ,"$1,541.76 ", N/A , N/A , N/A , N/A , N/A ,"$1,405.15 ","$1,209.99 ","$1,405.15 ","$1,405.15 ","$1,561.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIAL LT 16 HOLE,278,1 ,"$1,951.60 ","$1,288.06 ",$989.85 ,"$1,951.60 ", N/A ,"$1,028.69 ","$1,028.69 ", N/A ,"$1,170.96 ","$1,658.86 ","$1,366.12 ", N/A , N/A ,"$1,854.02 ","$1,483.22 ","$1,463.70 ", N/A ,"$1,658.86 ", N/A , N/A , N/A ,"$1,366.12 ","$1,188.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,658.86 ", N/A ,"$1,795.47 ","$1,366.12 ",$989.85 ,"$1,187.94 ","$1,188.52 ","$1,187.94 ","$1,348.56 ","$1,756.44 ","$1,333.33 ", N/A ,"$1,541.76 ", N/A , N/A , N/A , N/A , N/A ,"$1,405.15 ","$1,209.99 ","$1,405.15 ","$1,405.15 ","$1,561.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIALRT 10 HOLE,278,1 ,"$1,383.34 ",$913.00 ,$701.63 ,"$1,383.34 ", N/A ,$729.16 ,$729.16 , N/A ,$830.00 ,"$1,175.84 ",$968.34 , N/A , N/A ,"$1,314.17 ","$1,051.34 ","$1,037.51 ", N/A ,"$1,175.84 ", N/A , N/A , N/A ,$968.34 ,$842.45 , N/A , N/A , N/A , N/A , N/A ,"$1,175.84 ", N/A ,"$1,272.67 ",$968.34 ,$701.63 ,$842.04 ,$842.45 ,$842.04 ,$955.89 ,"$1,245.01 ",$945.10 , N/A ,"$1,092.84 ", N/A , N/A , N/A , N/A , N/A ,$996.00 ,$857.67 ,$996.00 ,$996.00 ,"$1,106.67 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIAL LT 10 HOLE,278,1 ,"$1,383.34 ",$913.00 ,$701.63 ,"$1,383.34 ", N/A ,$729.16 ,$729.16 , N/A ,$830.00 ,"$1,175.84 ",$968.34 , N/A , N/A ,"$1,314.17 ","$1,051.34 ","$1,037.51 ", N/A ,"$1,175.84 ", N/A , N/A , N/A ,$968.34 ,$842.45 , N/A , N/A , N/A , N/A , N/A ,"$1,175.84 ", N/A ,"$1,272.67 ",$968.34 ,$701.63 ,$842.04 ,$842.45 ,$842.04 ,$955.89 ,"$1,245.01 ",$945.10 , N/A ,"$1,092.84 ", N/A , N/A , N/A , N/A , N/A ,$996.00 ,$857.67 ,$996.00 ,$996.00 ,"$1,106.67 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIALRT 6 HOLE,278,1 ,"$1,041.81 ",$687.59 ,$528.41 ,"$1,041.81 ", N/A ,$549.14 ,$549.14 , N/A ,$625.09 ,$885.54 ,$729.27 , N/A , N/A ,$989.72 ,$791.78 ,$781.36 , N/A ,$885.54 , N/A , N/A , N/A ,$729.27 ,$634.46 , N/A , N/A , N/A , N/A , N/A ,$885.54 , N/A ,$958.47 ,$729.27 ,$528.41 ,$634.15 ,$634.46 ,$634.15 ,$719.89 ,$937.63 ,$711.76 , N/A ,$823.03 , N/A , N/A , N/A , N/A , N/A ,$750.10 ,$645.92 ,$750.10 ,$750.10 ,$833.45 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIALLT 6 HOLE,278,1 ,"$1,041.81 ",$687.59 ,$528.41 ,"$1,041.81 ", N/A ,$549.14 ,$549.14 , N/A ,$625.09 ,$885.54 ,$729.27 , N/A , N/A ,$989.72 ,$791.78 ,$781.36 , N/A ,$885.54 , N/A , N/A , N/A ,$729.27 ,$634.46 , N/A , N/A , N/A , N/A , N/A ,$885.54 , N/A ,$958.47 ,$729.27 ,$528.41 ,$634.15 ,$634.46 ,$634.15 ,$719.89 ,$937.63 ,$711.76 , N/A ,$823.03 , N/A , N/A , N/A , N/A , N/A ,$750.10 ,$645.92 ,$750.10 ,$750.10 ,$833.45 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIALRT 8 HOLE,278,1 ,"$1,211.14 ",$799.35 ,$614.29 ,"$1,211.14 ", N/A ,$638.39 ,$638.39 , N/A ,$726.68 ,"$1,029.47 ",$847.80 , N/A , N/A ,"$1,150.58 ",$920.47 ,$908.36 , N/A ,"$1,029.47 ", N/A , N/A , N/A ,$847.80 ,$737.58 , N/A , N/A , N/A , N/A , N/A ,"$1,029.47 ", N/A ,"$1,114.25 ",$847.80 ,$614.29 ,$737.22 ,$737.58 ,$737.22 ,$836.90 ,"$1,090.03 ",$827.45 , N/A ,$956.80 , N/A , N/A , N/A , N/A , N/A ,$872.02 ,$750.91 ,$872.02 ,$872.02 ,$968.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MEDIAL DISTAL TIBIALLT 8 HOLE,278,1 ,"$1,211.14 ",$799.35 ,$614.29 ,"$1,211.14 ", N/A ,$638.39 ,$638.39 , N/A ,$726.68 ,"$1,029.47 ",$847.80 , N/A , N/A ,"$1,150.58 ",$920.47 ,$908.36 , N/A ,"$1,029.47 ", N/A , N/A , N/A ,$847.80 ,$737.58 , N/A , N/A , N/A , N/A , N/A ,"$1,029.47 ", N/A ,"$1,114.25 ",$847.80 ,$614.29 ,$737.22 ,$737.58 ,$737.22 ,$836.90 ,"$1,090.03 ",$827.45 , N/A ,$956.80 , N/A , N/A , N/A , N/A , N/A ,$872.02 ,$750.91 ,$872.02 ,$872.02 ,$968.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 OLECRANON 2H RIGHT 86MM,278,1 ,"$1,678.95 ","$1,108.11 ",$851.56 ,"$1,678.95 ", N/A ,$884.97 ,$884.97 , N/A ,"$1,007.37 ","$1,427.11 ","$1,175.27 ", N/A , N/A ,"$1,595.00 ","$1,276.00 ","$1,259.21 ", N/A ,"$1,427.11 ", N/A , N/A , N/A ,"$1,175.27 ","$1,022.48 ", N/A , N/A , N/A , N/A , N/A ,"$1,427.11 ", N/A ,"$1,544.63 ","$1,175.27 ",$851.56 ,"$1,021.98 ","$1,022.48 ","$1,021.98 ","$1,160.15 ","$1,511.06 ","$1,147.06 ", N/A ,"$1,326.37 ", N/A , N/A , N/A , N/A , N/A ,"$1,208.84 ","$1,040.95 ","$1,208.84 ","$1,208.84 ","$1,343.16 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 OLECRANON 2H LEFT 86MM,278,1 ,"$1,678.95 ","$1,108.11 ",$851.56 ,"$1,678.95 ", N/A ,$884.97 ,$884.97 , N/A ,"$1,007.37 ","$1,427.11 ","$1,175.27 ", N/A , N/A ,"$1,595.00 ","$1,276.00 ","$1,259.21 ", N/A ,"$1,427.11 ", N/A , N/A , N/A ,"$1,175.27 ","$1,022.48 ", N/A , N/A , N/A , N/A , N/A ,"$1,427.11 ", N/A ,"$1,544.63 ","$1,175.27 ",$851.56 ,"$1,021.98 ","$1,022.48 ","$1,021.98 ","$1,160.15 ","$1,511.06 ","$1,147.06 ", N/A ,"$1,326.37 ", N/A , N/A , N/A , N/A , N/A ,"$1,208.84 ","$1,040.95 ","$1,208.84 ","$1,208.84 ","$1,343.16 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 OLECRANON 4H RIGHT 112MM,278,1 ,"$1,752.14 ","$1,156.41 ",$888.69 ,"$1,752.14 ", N/A ,$923.55 ,$923.55 , N/A ,"$1,051.28 ","$1,489.32 ","$1,226.50 ", N/A , N/A ,"$1,664.53 ","$1,331.63 ","$1,314.11 ", N/A ,"$1,489.32 ", N/A , N/A , N/A ,"$1,226.50 ","$1,067.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,489.32 ", N/A ,"$1,611.97 ","$1,226.50 ",$888.69 ,"$1,066.53 ","$1,067.05 ","$1,066.53 ","$1,210.73 ","$1,576.93 ","$1,197.06 ", N/A ,"$1,384.19 ", N/A , N/A , N/A , N/A , N/A ,"$1,261.54 ","$1,086.33 ","$1,261.54 ","$1,261.54 ","$1,401.71 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 OLECRANON 4H LEFT 112MM,278,1 ,"$1,752.14 ","$1,156.41 ",$888.69 ,"$1,752.14 ", N/A ,$923.55 ,$923.55 , N/A ,"$1,051.28 ","$1,489.32 ","$1,226.50 ", N/A , N/A ,"$1,664.53 ","$1,331.63 ","$1,314.11 ", N/A ,"$1,489.32 ", N/A , N/A , N/A ,"$1,226.50 ","$1,067.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,489.32 ", N/A ,"$1,611.97 ","$1,226.50 ",$888.69 ,"$1,066.53 ","$1,067.05 ","$1,066.53 ","$1,210.73 ","$1,576.93 ","$1,197.06 ", N/A ,"$1,384.19 ", N/A , N/A , N/A , N/A , N/A ,"$1,261.54 ","$1,086.33 ","$1,261.54 ","$1,261.54 ","$1,401.71 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 OLECRANON 6H RIGHT 138MM,278,1 ,"$1,808.10 ","$1,193.35 ",$917.07 ,"$1,808.10 ", N/A ,$953.05 ,$953.05 , N/A ,"$1,084.86 ","$1,536.89 ","$1,265.67 ", N/A , N/A ,"$1,717.70 ","$1,374.16 ","$1,356.08 ", N/A ,"$1,536.89 ", N/A , N/A , N/A ,"$1,265.67 ","$1,101.13 ", N/A , N/A , N/A , N/A , N/A ,"$1,536.89 ", N/A ,"$1,663.45 ","$1,265.67 ",$917.07 ,"$1,100.59 ","$1,101.13 ","$1,100.59 ","$1,249.40 ","$1,627.29 ","$1,235.29 ", N/A ,"$1,428.40 ", N/A , N/A , N/A , N/A , N/A ,"$1,301.83 ","$1,121.02 ","$1,301.83 ","$1,301.83 ","$1,446.48 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 OLECRANON 8H RIGHT 164MM,278,1 ,"$1,864.07 ","$1,230.29 ",$945.46 ,"$1,864.07 ", N/A ,$982.55 ,$982.55 , N/A ,"$1,118.44 ","$1,584.46 ","$1,304.85 ", N/A , N/A ,"$1,770.87 ","$1,416.69 ","$1,398.05 ", N/A ,"$1,584.46 ", N/A , N/A , N/A ,"$1,304.85 ","$1,135.22 ", N/A , N/A , N/A , N/A , N/A ,"$1,584.46 ", N/A ,"$1,714.94 ","$1,304.85 ",$945.46 ,"$1,134.66 ","$1,135.22 ","$1,134.66 ","$1,288.07 ","$1,677.66 ","$1,273.53 ", N/A ,"$1,472.62 ", N/A , N/A , N/A , N/A , N/A ,"$1,342.13 ","$1,155.72 ","$1,342.13 ","$1,342.13 ","$1,491.26 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 OLECRANON 8H LEFT 164MM,278,1 ,"$1,864.07 ","$1,230.29 ",$945.46 ,"$1,864.07 ", N/A ,$982.55 ,$982.55 , N/A ,"$1,118.44 ","$1,584.46 ","$1,304.85 ", N/A , N/A ,"$1,770.87 ","$1,416.69 ","$1,398.05 ", N/A ,"$1,584.46 ", N/A , N/A , N/A ,"$1,304.85 ","$1,135.22 ", N/A , N/A , N/A , N/A , N/A ,"$1,584.46 ", N/A ,"$1,714.94 ","$1,304.85 ",$945.46 ,"$1,134.66 ","$1,135.22 ","$1,134.66 ","$1,288.07 ","$1,677.66 ","$1,273.53 ", N/A ,"$1,472.62 ", N/A , N/A , N/A , N/A , N/A ,"$1,342.13 ","$1,155.72 ","$1,342.13 ","$1,342.13 ","$1,491.26 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 POST LAT DIST HUM 3H RGT,278,1 ,"$2,027.66 ","$1,338.26 ","$1,028.43 ","$2,027.66 ", N/A ,"$1,068.78 ","$1,068.78 ", N/A ,"$1,216.60 ","$1,723.51 ","$1,419.36 ", N/A , N/A ,"$1,926.28 ","$1,541.02 ","$1,520.75 ", N/A ,"$1,723.51 ", N/A , N/A , N/A ,"$1,419.36 ","$1,234.84 ", N/A , N/A , N/A , N/A , N/A ,"$1,723.51 ", N/A ,"$1,865.45 ","$1,419.36 ","$1,028.43 ","$1,234.24 ","$1,234.84 ","$1,234.24 ","$1,401.11 ","$1,824.89 ","$1,385.30 ", N/A ,"$1,601.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,459.92 ","$1,257.15 ","$1,459.92 ","$1,459.92 ","$1,622.13 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 POST LAT DIST HUM 3H LFT,278,1 ,"$2,027.66 ","$1,338.26 ","$1,028.43 ","$2,027.66 ", N/A ,"$1,068.78 ","$1,068.78 ", N/A ,"$1,216.60 ","$1,723.51 ","$1,419.36 ", N/A , N/A ,"$1,926.28 ","$1,541.02 ","$1,520.75 ", N/A ,"$1,723.51 ", N/A , N/A , N/A ,"$1,419.36 ","$1,234.84 ", N/A , N/A , N/A , N/A , N/A ,"$1,723.51 ", N/A ,"$1,865.45 ","$1,419.36 ","$1,028.43 ","$1,234.24 ","$1,234.84 ","$1,234.24 ","$1,401.11 ","$1,824.89 ","$1,385.30 ", N/A ,"$1,601.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,459.92 ","$1,257.15 ","$1,459.92 ","$1,459.92 ","$1,622.13 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 POST LAT DIST HUM 5H LFT,278,1 ,"$2,049.55 ","$1,352.70 ","$1,039.53 ","$2,049.55 ", N/A ,"$1,080.32 ","$1,080.32 ", N/A ,"$1,229.73 ","$1,742.12 ","$1,434.69 ", N/A , N/A ,"$1,947.07 ","$1,557.66 ","$1,537.16 ", N/A ,"$1,742.12 ", N/A , N/A , N/A ,"$1,434.69 ","$1,248.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,742.12 ", N/A ,"$1,885.59 ","$1,434.69 ","$1,039.53 ","$1,247.56 ","$1,248.18 ","$1,247.56 ","$1,416.24 ","$1,844.60 ","$1,400.25 ", N/A ,"$1,619.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,475.68 ","$1,270.72 ","$1,475.68 ","$1,475.68 ","$1,639.64 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 POST LAT DIST HUM 5H RGT,278,1 ,"$2,049.53 ","$1,352.69 ","$1,039.52 ","$2,049.53 ", N/A ,"$1,080.31 ","$1,080.31 ", N/A ,"$1,229.72 ","$1,742.10 ","$1,434.67 ", N/A , N/A ,"$1,947.05 ","$1,557.64 ","$1,537.15 ", N/A ,"$1,742.10 ", N/A , N/A , N/A ,"$1,434.67 ","$1,248.16 ", N/A , N/A , N/A , N/A , N/A ,"$1,742.10 ", N/A ,"$1,885.57 ","$1,434.67 ","$1,039.52 ","$1,247.55 ","$1,248.16 ","$1,247.55 ","$1,416.23 ","$1,844.58 ","$1,400.24 ", N/A ,"$1,619.13 ", N/A , N/A , N/A , N/A , N/A ,"$1,475.66 ","$1,270.71 ","$1,475.66 ","$1,475.66 ","$1,639.62 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 POST LAT DIST HUM 7H RGT,278,1 ,"$2,221.10 ","$1,465.93 ","$1,126.54 ","$2,221.10 ", N/A ,"$1,170.74 ","$1,170.74 ", N/A ,"$1,332.66 ","$1,887.94 ","$1,554.77 ", N/A , N/A ,"$2,110.05 ","$1,688.04 ","$1,665.83 ", N/A ,"$1,887.94 ", N/A , N/A , N/A ,"$1,554.77 ","$1,352.65 ", N/A , N/A , N/A , N/A , N/A ,"$1,887.94 ", N/A ,"$2,043.41 ","$1,554.77 ","$1,126.54 ","$1,351.98 ","$1,352.65 ","$1,351.98 ","$1,534.78 ","$1,998.99 ","$1,517.46 ", N/A ,"$1,754.67 ", N/A , N/A , N/A , N/A , N/A ,"$1,599.19 ","$1,377.08 ","$1,599.19 ","$1,599.19 ","$1,776.88 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 POST LAT DIST HUM 7H LFT,278,1 ,"$2,221.10 ","$1,465.93 ","$1,126.54 ","$2,221.10 ", N/A ,"$1,170.74 ","$1,170.74 ", N/A ,"$1,332.66 ","$1,887.94 ","$1,554.77 ", N/A , N/A ,"$2,110.05 ","$1,688.04 ","$1,665.83 ", N/A ,"$1,887.94 ", N/A , N/A , N/A ,"$1,554.77 ","$1,352.65 ", N/A , N/A , N/A , N/A , N/A ,"$1,887.94 ", N/A ,"$2,043.41 ","$1,554.77 ","$1,126.54 ","$1,351.98 ","$1,352.65 ","$1,351.98 ","$1,534.78 ","$1,998.99 ","$1,517.46 ", N/A ,"$1,754.67 ", N/A , N/A , N/A , N/A , N/A ,"$1,599.19 ","$1,377.08 ","$1,599.19 ","$1,599.19 ","$1,776.88 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 POST LAT DIST HUM 9H RGT,278,1 ,"$2,158.59 ","$1,424.67 ","$1,094.84 ","$2,158.59 ", N/A ,"$1,137.79 ","$1,137.79 ", N/A ,"$1,295.15 ","$1,834.80 ","$1,511.01 ", N/A , N/A ,"$2,050.66 ","$1,640.53 ","$1,618.94 ", N/A ,"$1,834.80 ", N/A , N/A , N/A ,"$1,511.01 ","$1,314.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,834.80 ", N/A ,"$1,985.90 ","$1,511.01 ","$1,094.84 ","$1,313.93 ","$1,314.58 ","$1,313.93 ","$1,491.59 ","$1,942.73 ","$1,474.75 ", N/A ,"$1,705.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,554.18 ","$1,338.33 ","$1,554.18 ","$1,554.18 ","$1,726.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MED DIST HUM 9H LFT,278,1 ,"$2,158.59 ","$1,424.67 ","$1,094.84 ","$2,158.59 ", N/A ,"$1,137.79 ","$1,137.79 ", N/A ,"$1,295.15 ","$1,834.80 ","$1,511.01 ", N/A , N/A ,"$2,050.66 ","$1,640.53 ","$1,618.94 ", N/A ,"$1,834.80 ", N/A , N/A , N/A ,"$1,511.01 ","$1,314.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,834.80 ", N/A ,"$1,985.90 ","$1,511.01 ","$1,094.84 ","$1,313.93 ","$1,314.58 ","$1,313.93 ","$1,491.59 ","$1,942.73 ","$1,474.75 ", N/A ,"$1,705.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,554.18 ","$1,338.33 ","$1,554.18 ","$1,554.18 ","$1,726.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 MED DIST HUM 9H RGT,278,1 ,"$2,158.59 ","$1,424.67 ","$1,094.84 ","$2,158.59 ", N/A ,"$1,137.79 ","$1,137.79 ", N/A ,"$1,295.15 ","$1,834.80 ","$1,511.01 ", N/A , N/A ,"$2,050.66 ","$1,640.53 ","$1,618.94 ", N/A ,"$1,834.80 ", N/A , N/A , N/A ,"$1,511.01 ","$1,314.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,834.80 ", N/A ,"$1,985.90 ","$1,511.01 ","$1,094.84 ","$1,313.93 ","$1,314.58 ","$1,313.93 ","$1,491.59 ","$1,942.73 ","$1,474.75 ", N/A ,"$1,705.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,554.18 ","$1,338.33 ","$1,554.18 ","$1,554.18 ","$1,726.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 POST LAT DIST HUM 9H LFT,278,1 ,"$2,158.59 ","$1,424.67 ","$1,094.84 ","$2,158.59 ", N/A ,"$1,137.79 ","$1,137.79 ", N/A ,"$1,295.15 ","$1,834.80 ","$1,511.01 ", N/A , N/A ,"$2,050.66 ","$1,640.53 ","$1,618.94 ", N/A ,"$1,834.80 ", N/A , N/A , N/A ,"$1,511.01 ","$1,314.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,834.80 ", N/A ,"$1,985.90 ","$1,511.01 ","$1,094.84 ","$1,313.93 ","$1,314.58 ","$1,313.93 ","$1,491.59 ","$1,942.73 ","$1,474.75 ", N/A ,"$1,705.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,554.18 ","$1,338.33 ","$1,554.18 ","$1,554.18 ","$1,726.87 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST CURVED 18 HOLE,278,1 ,"$1,255.63 ",$828.72 ,$636.86 ,"$1,255.63 ", N/A ,$661.84 ,$661.84 , N/A ,$753.38 ,"$1,067.29 ",$878.94 , N/A , N/A ,"$1,192.85 ",$954.28 ,$941.72 , N/A ,"$1,067.29 ", N/A , N/A , N/A ,$878.94 ,$764.68 , N/A , N/A , N/A , N/A , N/A ,"$1,067.29 ", N/A ,"$1,155.18 ",$878.94 ,$636.86 ,$764.30 ,$764.68 ,$764.30 ,$867.64 ,"$1,130.07 ",$857.85 , N/A ,$991.95 , N/A , N/A , N/A , N/A , N/A ,$904.05 ,$778.49 ,$904.05 ,$904.05 ,"$1,004.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 10H,278,1 ,$896.98 ,$592.01 ,$454.95 ,$896.98 , N/A , N/A , N/A , N/A ,$538.19 ,$762.43 ,$627.89 , N/A , N/A ,$852.13 ,$681.70 ,$672.74 , N/A ,$762.43 , N/A , N/A , N/A ,$627.89 ,$546.26 , N/A , N/A , N/A , N/A , N/A ,$762.43 , N/A ,$825.22 ,$627.89 ,$454.95 ,$545.99 ,$546.26 ,$545.99 ,$619.81 ,$807.28 ,$612.82 , N/A ,$708.61 , N/A , N/A , N/A , N/A , N/A ,$645.83 ,$556.13 ,$645.83 ,$645.83 ,$717.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 11H,278,1 ,$942.13 ,$621.81 ,$477.85 ,$942.13 , N/A , N/A , N/A , N/A ,$565.28 ,$800.81 ,$659.49 , N/A , N/A ,$895.02 ,$716.02 ,$706.60 , N/A ,$800.81 , N/A , N/A , N/A ,$659.49 ,$573.76 , N/A , N/A , N/A , N/A , N/A ,$800.81 , N/A ,$866.76 ,$659.49 ,$477.85 ,$573.47 ,$573.76 ,$573.47 ,$651.01 ,$847.92 ,$643.66 , N/A ,$744.28 , N/A , N/A , N/A , N/A , N/A ,$678.33 ,$584.12 ,$678.33 ,$678.33 ,$753.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 12H,278,1 ,$982.77 ,$648.63 ,$498.46 ,$982.77 , N/A , N/A , N/A , N/A ,$589.66 ,$835.35 ,$687.94 , N/A , N/A ,$933.63 ,$746.91 ,$737.08 , N/A ,$835.35 , N/A , N/A , N/A ,$687.94 ,$598.51 , N/A , N/A , N/A , N/A , N/A ,$835.35 , N/A ,$904.15 ,$687.94 ,$498.46 ,$598.21 ,$598.51 ,$598.21 ,$679.09 ,$884.49 ,$671.43 , N/A ,$776.39 , N/A , N/A , N/A , N/A , N/A ,$707.59 ,$609.32 ,$707.59 ,$707.59 ,$786.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 13H,278,1 ,"$1,027.92 ",$678.43 ,$521.36 ,"$1,027.92 ", N/A ,$541.82 ,$541.82 , N/A ,$616.75 ,$873.73 ,$719.54 , N/A , N/A ,$976.52 ,$781.22 ,$770.94 , N/A ,$873.73 , N/A , N/A , N/A ,$719.54 ,$626.00 , N/A , N/A , N/A , N/A , N/A ,$873.73 , N/A ,$945.69 ,$719.54 ,$521.36 ,$625.69 ,$626.00 ,$625.69 ,$710.29 ,$925.13 ,$702.27 , N/A ,$812.06 , N/A , N/A , N/A , N/A , N/A ,$740.10 ,$637.31 ,$740.10 ,$740.10 ,$822.34 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 14H,278,1 ,"$1,067.05 ",$704.25 ,$541.21 ,"$1,067.05 ", N/A ,$562.44 ,$562.44 , N/A ,$640.23 ,$906.99 ,$746.94 , N/A , N/A ,"$1,013.70 ",$810.96 ,$800.29 , N/A ,$906.99 , N/A , N/A , N/A ,$746.94 ,$649.83 , N/A , N/A , N/A , N/A , N/A ,$906.99 , N/A ,$981.69 ,$746.94 ,$541.21 ,$649.51 ,$649.83 ,$649.51 ,$737.33 ,$960.35 ,$729.01 , N/A ,$842.97 , N/A , N/A , N/A , N/A , N/A ,$768.28 ,$661.57 ,$768.28 ,$768.28 ,$853.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 16H,278,1 ,"$1,102.08 ",$727.37 ,$558.98 ,"$1,102.08 ", N/A ,$580.91 ,$580.91 , N/A ,$661.25 ,$936.77 ,$771.46 , N/A , N/A ,"$1,046.98 ",$837.58 ,$826.56 , N/A ,$936.77 , N/A , N/A , N/A ,$771.46 ,$671.17 , N/A , N/A , N/A , N/A , N/A ,$936.77 , N/A ,"$1,013.91 ",$771.46 ,$558.98 ,$670.84 ,$671.17 ,$670.84 ,$761.54 ,$991.87 ,$752.94 , N/A ,$870.64 , N/A , N/A , N/A , N/A , N/A ,$793.50 ,$683.29 ,$793.50 ,$793.50 ,$881.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 5H,278,1 ,$692.30 ,$456.92 ,$351.13 ,$692.30 , N/A , N/A , N/A , N/A ,$415.38 ,$588.46 ,$484.61 , N/A , N/A ,$657.69 ,$526.15 ,$519.23 , N/A ,$588.46 , N/A , N/A , N/A ,$484.61 ,$421.61 , N/A , N/A , N/A , N/A , N/A ,$588.46 , N/A ,$636.92 ,$484.61 ,$351.13 ,$421.40 ,$421.61 ,$421.40 ,$478.38 ,$623.07 ,$472.98 , N/A ,$546.92 , N/A , N/A , N/A , N/A , N/A ,$498.46 ,$429.23 ,$498.46 ,$498.46 ,$553.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 6H,278,1 ,$794.64 ,$524.46 ,$403.04 ,$794.64 , N/A , N/A , N/A , N/A ,$476.78 ,$675.44 ,$556.25 , N/A , N/A ,$754.91 ,$603.93 ,$595.98 , N/A ,$675.44 , N/A , N/A , N/A ,$556.25 ,$483.94 , N/A , N/A , N/A , N/A , N/A ,$675.44 , N/A ,$731.07 ,$556.25 ,$403.04 ,$483.70 ,$483.94 ,$483.70 ,$549.10 ,$715.18 ,$542.90 , N/A ,$627.77 , N/A , N/A , N/A , N/A , N/A ,$572.14 ,$492.68 ,$572.14 ,$572.14 ,$635.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 7H,278,1 ,$833.77 ,$550.29 ,$422.89 ,$833.77 , N/A , N/A , N/A , N/A ,$500.26 ,$708.70 ,$583.64 , N/A , N/A ,$792.08 ,$633.67 ,$625.33 , N/A ,$708.70 , N/A , N/A , N/A ,$583.64 ,$507.77 , N/A , N/A , N/A , N/A , N/A ,$708.70 , N/A ,$767.07 ,$583.64 ,$422.89 ,$507.52 ,$507.77 ,$507.52 ,$576.14 ,$750.39 ,$569.63 , N/A ,$658.68 , N/A , N/A , N/A , N/A , N/A ,$600.31 ,$516.94 ,$600.31 ,$600.31 ,$667.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 8H,278,1 ,$868.39 ,$573.14 ,$440.45 ,$868.39 , N/A , N/A , N/A , N/A ,$521.03 ,$738.13 ,$607.87 , N/A , N/A ,$824.97 ,$659.98 ,$651.29 , N/A ,$738.13 , N/A , N/A , N/A ,$607.87 ,$528.85 , N/A , N/A , N/A , N/A , N/A ,$738.13 , N/A ,$798.92 ,$607.87 ,$440.45 ,$528.59 ,$528.85 ,$528.59 ,$600.06 ,$781.55 ,$593.28 , N/A ,$686.03 , N/A , N/A , N/A , N/A , N/A ,$625.24 ,$538.40 ,$625.24 ,$625.24 ,$694.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 T 3 HOLES HEAD/ 3 HOLES SHAFT-OBLIQUE ANGLE,278,1 ,$442.47 ,$292.03 ,$224.42 ,$442.47 , N/A , N/A , N/A , N/A ,$265.48 ,$376.10 ,$309.73 , N/A , N/A ,$420.35 ,$336.28 ,$331.85 , N/A ,$376.10 , N/A , N/A , N/A ,$309.73 ,$269.46 , N/A , N/A , N/A , N/A , N/A ,$376.10 , N/A ,$407.07 ,$309.73 ,$224.42 ,$269.33 ,$269.46 ,$269.33 ,$305.75 ,$398.22 ,$302.30 , N/A ,$349.55 , N/A , N/A , N/A , N/A , N/A ,$318.58 ,$274.33 ,$318.58 ,$318.58 ,$353.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 T 3 HOLES HEAD/ 4H SHAFT-OBLIQUE ANGLE,278,1 ,$466.92 ,$308.17 ,$236.82 ,$466.92 , N/A , N/A , N/A , N/A ,$280.15 ,$396.88 ,$326.84 , N/A , N/A ,$443.57 ,$354.86 ,$350.19 , N/A ,$396.88 , N/A , N/A , N/A ,$326.84 ,$284.35 , N/A , N/A , N/A , N/A , N/A ,$396.88 , N/A ,$429.57 ,$326.84 ,$236.82 ,$284.21 ,$284.35 ,$284.21 ,$322.64 ,$420.23 ,$319.00 , N/A ,$368.87 , N/A , N/A , N/A , N/A , N/A ,$336.18 ,$289.49 ,$336.18 ,$336.18 ,$373.54 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 T 3 HOLES HEAD/ 5 HOLES SHAFT-OBLIQUE ANGLE,278,1 ,$481.60 ,$317.86 ,$244.27 ,$481.60 , N/A , N/A , N/A , N/A ,$288.96 ,$409.36 ,$337.12 , N/A , N/A ,$457.52 ,$366.02 ,$361.20 , N/A ,$409.36 , N/A , N/A , N/A ,$337.12 ,$293.29 , N/A , N/A , N/A , N/A , N/A ,$409.36 , N/A ,$443.07 ,$337.12 ,$244.27 ,$293.15 ,$293.29 ,$293.15 ,$332.79 ,$433.44 ,$329.03 , N/A ,$380.46 , N/A , N/A , N/A , N/A , N/A ,$346.75 ,$298.59 ,$346.75 ,$346.75 ,$385.28 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 T 3 HOLES HEAD/ 5 HOLES SHAFT-RIGHT ANGLE,278,1 ,$308.70 ,$203.74 ,$156.57 ,$308.70 , N/A , N/A , N/A , N/A ,$185.22 ,$262.40 ,$216.09 , N/A , N/A ,$293.27 ,$234.61 ,$231.53 , N/A ,$262.40 , N/A , N/A , N/A ,$216.09 ,$188.00 , N/A , N/A , N/A , N/A , N/A ,$262.40 , N/A ,$284.00 ,$216.09 ,$156.57 ,$187.91 ,$188.00 ,$187.91 ,$213.31 ,$277.83 ,$210.90 , N/A ,$243.87 , N/A , N/A , N/A , N/A , N/A ,$222.26 ,$191.39 ,$222.26 ,$222.26 ,$246.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,COUNTERSINK SYNTHES F/1.5MM  AND  2.0MM CORTEX SCREWS,278,1 ,$308.70 ,$203.74 ,$156.57 ,$308.70 , N/A , N/A , N/A , N/A ,$185.22 ,$262.40 ,$216.09 , N/A , N/A ,$293.27 ,$234.61 ,$231.53 , N/A ,$262.40 , N/A , N/A , N/A ,$216.09 ,$188.00 , N/A , N/A , N/A , N/A , N/A ,$262.40 , N/A ,$284.00 ,$216.09 ,$156.57 ,$187.91 ,$188.00 ,$187.91 ,$213.31 ,$277.83 ,$210.90 , N/A ,$243.87 , N/A , N/A , N/A , N/A , N/A ,$222.26 ,$191.39 ,$222.26 ,$222.26 ,$246.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,COUNTERSINK SYNTHES F/3.5MM CORTEX  AND  4.0MM CANCELLOUS BONE SCREWS,278,1 ,$308.70 ,$203.74 ,$156.57 ,$308.70 , N/A , N/A , N/A , N/A ,$185.22 ,$262.40 ,$216.09 , N/A , N/A ,$293.27 ,$234.61 ,$231.53 , N/A ,$262.40 , N/A , N/A , N/A ,$216.09 ,$188.00 , N/A , N/A , N/A , N/A , N/A ,$262.40 , N/A ,$284.00 ,$216.09 ,$156.57 ,$187.91 ,$188.00 ,$187.91 ,$213.31 ,$277.83 ,$210.90 , N/A ,$243.87 , N/A , N/A , N/A , N/A , N/A ,$222.26 ,$191.39 ,$222.26 ,$222.26 ,$246.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,COUNTERSINK SYNTHES FOR 2.7MM CORTEX SCREWS,278,1 ,$308.70 ,$203.74 ,$156.57 ,$308.70 , N/A , N/A , N/A , N/A ,$185.22 ,$262.40 ,$216.09 , N/A , N/A ,$293.27 ,$234.61 ,$231.53 , N/A ,$262.40 , N/A , N/A , N/A ,$216.09 ,$188.00 , N/A , N/A , N/A , N/A , N/A ,$262.40 , N/A ,$284.00 ,$216.09 ,$156.57 ,$187.91 ,$188.00 ,$187.91 ,$213.31 ,$277.83 ,$210.90 , N/A ,$243.87 , N/A , N/A , N/A , N/A , N/A ,$222.26 ,$191.39 ,$222.26 ,$222.26 ,$246.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 T 3H HEAD 3H SHAFT RT ANG,278,1 ,$269.33 ,$177.76 ,$136.60 ,$269.33 , N/A , N/A , N/A , N/A ,$161.60 ,$228.93 ,$188.53 , N/A , N/A ,$255.86 ,$204.69 ,$202.00 , N/A ,$228.93 , N/A , N/A , N/A ,$188.53 ,$164.02 , N/A , N/A , N/A , N/A , N/A ,$228.93 , N/A ,$247.78 ,$188.53 ,$136.60 ,$163.94 ,$164.02 ,$163.94 ,$186.11 ,$242.40 ,$184.01 , N/A ,$212.77 , N/A , N/A , N/A , N/A , N/A ,$193.92 ,$166.98 ,$193.92 ,$193.92 ,$215.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5MM LCP SUPERIOR CLAVICLE PLATE 7H RT,278,1 ,"$1,857.32 ","$1,225.83 ",$942.03 ,"$1,857.32 ", N/A ,$978.99 ,$978.99 , N/A ,"$1,114.39 ","$1,578.72 ","$1,300.12 ", N/A , N/A ,"$1,764.45 ","$1,411.56 ","$1,392.99 ", N/A ,"$1,578.72 ", N/A , N/A , N/A ,"$1,300.12 ","$1,131.11 ", N/A , N/A , N/A , N/A , N/A ,"$1,578.72 ", N/A ,"$1,708.73 ","$1,300.12 ",$942.03 ,"$1,130.55 ","$1,131.11 ","$1,130.55 ","$1,283.41 ","$1,671.59 ","$1,268.92 ", N/A ,"$1,467.28 ", N/A , N/A , N/A , N/A , N/A ,"$1,337.27 ","$1,151.54 ","$1,337.27 ","$1,337.27 ","$1,485.86 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 11H 206MM,278,1 ,"$1,225.49 ",$808.82 ,$621.57 ,"$1,225.49 ", N/A ,$645.96 ,$645.96 , N/A ,$735.29 ,"$1,041.67 ",$857.84 , N/A , N/A ,"$1,164.22 ",$931.37 ,$919.12 , N/A ,"$1,041.67 ", N/A , N/A , N/A ,$857.84 ,$746.32 , N/A , N/A , N/A , N/A , N/A ,"$1,041.67 ", N/A ,"$1,127.45 ",$857.84 ,$621.57 ,$745.96 ,$746.32 ,$745.96 ,$846.81 ,"$1,102.94 ",$837.25 , N/A ,$968.14 , N/A , N/A , N/A , N/A , N/A ,$882.35 ,$759.80 ,$882.35 ,$882.35 ,$980.39 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 6H LT 112MM,278,1 ,"$1,225.49 ",$808.82 ,$621.57 ,"$1,225.49 ", N/A ,$645.96 ,$645.96 , N/A ,$735.29 ,"$1,041.67 ",$857.84 , N/A , N/A ,"$1,164.22 ",$931.37 ,$919.12 , N/A ,"$1,041.67 ", N/A , N/A , N/A ,$857.84 ,$746.32 , N/A , N/A , N/A , N/A , N/A ,"$1,041.67 ", N/A ,"$1,127.45 ",$857.84 ,$621.57 ,$745.96 ,$746.32 ,$745.96 ,$846.81 ,"$1,102.94 ",$837.25 , N/A ,$968.14 , N/A , N/A , N/A , N/A , N/A ,$882.35 ,$759.80 ,$882.35 ,$882.35 ,$980.39 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7/3.5MM LCP LAT DIST/FIB 6H RT 112MM,278,1 ,"$1,225.49 ",$808.82 ,$621.57 ,"$1,225.49 ", N/A ,$645.96 ,$645.96 , N/A ,$735.29 ,"$1,041.67 ",$857.84 , N/A , N/A ,"$1,164.22 ",$931.37 ,$919.12 , N/A ,"$1,041.67 ", N/A , N/A , N/A ,$857.84 ,$746.32 , N/A , N/A , N/A , N/A , N/A ,"$1,041.67 ", N/A ,"$1,127.45 ",$857.84 ,$621.57 ,$745.96 ,$746.32 ,$745.96 ,$846.81 ,"$1,102.94 ",$837.25 , N/A ,$968.14 , N/A , N/A , N/A , N/A , N/A ,$882.35 ,$759.80 ,$882.35 ,$882.35 ,$980.39 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 12H 224MM,278,1 ,"$1,299.82 ",$857.88 ,$659.27 ,"$1,299.82 ", N/A ,$685.14 ,$685.14 , N/A ,$779.89 ,"$1,104.85 ",$909.87 , N/A , N/A ,"$1,234.83 ",$987.86 ,$974.87 , N/A ,"$1,104.85 ", N/A , N/A , N/A ,$909.87 ,$791.59 , N/A , N/A , N/A , N/A , N/A ,"$1,104.85 ", N/A ,"$1,195.83 ",$909.87 ,$659.27 ,$791.20 ,$791.59 ,$791.20 ,$898.18 ,"$1,169.84 ",$888.04 , N/A ,"$1,026.86 ", N/A , N/A , N/A , N/A , N/A ,$935.87 ,$805.89 ,$935.87 ,$935.87 ,"$1,039.86 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 14H 260MM,278,1 ,"$1,446.48 ",$954.68 ,$733.65 ,"$1,446.48 ", N/A ,$762.44 ,$762.44 , N/A ,$867.89 ,"$1,229.51 ","$1,012.54 ", N/A , N/A ,"$1,374.16 ","$1,099.32 ","$1,084.86 ", N/A ,"$1,229.51 ", N/A , N/A , N/A ,"$1,012.54 ",$880.91 , N/A , N/A , N/A , N/A , N/A ,"$1,229.51 ", N/A ,"$1,330.76 ","$1,012.54 ",$733.65 ,$880.47 ,$880.91 ,$880.47 ,$999.52 ,"$1,301.83 ",$988.24 , N/A ,"$1,142.72 ", N/A , N/A , N/A , N/A , N/A ,"$1,041.47 ",$896.82 ,"$1,041.47 ","$1,041.47 ","$1,157.18 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 16H 296MM,278,1 ,"$1,756.87 ","$1,159.53 ",$891.08 ,"$1,756.87 ", N/A ,$926.05 ,$926.05 , N/A ,"$1,054.12 ","$1,493.34 ","$1,229.81 ", N/A , N/A ,"$1,669.03 ","$1,335.22 ","$1,317.65 ", N/A ,"$1,493.34 ", N/A , N/A , N/A ,"$1,229.81 ","$1,069.93 ", N/A , N/A , N/A , N/A , N/A ,"$1,493.34 ", N/A ,"$1,616.32 ","$1,229.81 ",$891.08 ,"$1,069.41 ","$1,069.93 ","$1,069.41 ","$1,214.00 ","$1,581.18 ","$1,200.29 ", N/A ,"$1,387.93 ", N/A , N/A , N/A , N/A , N/A ,"$1,264.95 ","$1,089.26 ","$1,264.95 ","$1,264.95 ","$1,405.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 6H 116MM,278,1 ,$800.66 ,$528.44 ,$406.09 ,$800.66 , N/A , N/A , N/A , N/A ,$480.40 ,$680.56 ,$560.46 , N/A , N/A ,$760.63 ,$608.50 ,$600.50 , N/A ,$680.56 , N/A , N/A , N/A ,$560.46 ,$487.60 , N/A , N/A , N/A , N/A , N/A ,$680.56 , N/A ,$736.61 ,$560.46 ,$406.09 ,$487.36 ,$487.60 ,$487.36 ,$553.26 ,$720.59 ,$547.01 , N/A ,$632.52 , N/A , N/A , N/A , N/A , N/A ,$576.48 ,$496.41 ,$576.48 ,$576.48 ,$640.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 7H 134MM,278,1 ,$849.12 ,$560.42 ,$430.67 ,$849.12 , N/A , N/A , N/A , N/A ,$509.47 ,$721.75 ,$594.38 , N/A , N/A ,$806.66 ,$645.33 ,$636.84 , N/A ,$721.75 , N/A , N/A , N/A ,$594.38 ,$517.11 , N/A , N/A , N/A , N/A , N/A ,$721.75 , N/A ,$781.19 ,$594.38 ,$430.67 ,$516.86 ,$517.11 ,$516.86 ,$586.74 ,$764.21 ,$580.12 , N/A ,$670.80 , N/A , N/A , N/A , N/A , N/A ,$611.37 ,$526.45 ,$611.37 ,$611.37 ,$679.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 8H 152MM,278,1 ,"$1,036.64 ",$684.18 ,$525.78 ,"$1,036.64 ", N/A ,$546.41 ,$546.41 , N/A ,$621.98 ,$881.14 ,$725.65 , N/A , N/A ,$984.81 ,$787.85 ,$777.48 , N/A ,$881.14 , N/A , N/A , N/A ,$725.65 ,$631.31 , N/A , N/A , N/A , N/A , N/A ,$881.14 , N/A ,$953.71 ,$725.65 ,$525.78 ,$631.00 ,$631.31 ,$631.00 ,$716.32 ,$932.98 ,$708.23 , N/A ,$818.95 , N/A , N/A , N/A , N/A , N/A ,$746.38 ,$642.72 ,$746.38 ,$746.38 ,$829.31 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 9H 170MM,278,1 ,"$1,069.79 ",$706.06 ,$542.60 ,"$1,069.79 ", N/A ,$563.89 ,$563.89 , N/A ,$641.87 ,$909.32 ,$748.85 , N/A , N/A ,"$1,016.30 ",$813.04 ,$802.34 , N/A ,$909.32 , N/A , N/A , N/A ,$748.85 ,$651.50 , N/A , N/A , N/A , N/A , N/A ,$909.32 , N/A ,$984.21 ,$748.85 ,$542.60 ,$651.18 ,$651.50 ,$651.18 ,$739.22 ,$962.81 ,$730.88 , N/A ,$845.13 , N/A , N/A , N/A , N/A , N/A ,$770.25 ,$663.27 ,$770.25 ,$770.25 ,$855.83 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR 6H 170MM RIGHT,278,1 ,"$2,581.66 ","$1,703.90 ","$1,290.83 ","$2,581.66 ", N/A ,"$1,360.79 ","$1,360.79 ", N/A ,"$1,549.00 ","$2,194.41 ","$1,807.16 ", N/A , N/A ,"$2,452.58 ","$1,962.06 ","$1,936.25 ","$1,290.83 ","$2,194.41 ", N/A ,"$1,290.83 ","$1,290.83 ","$1,807.16 ","$1,572.23 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.41 ", N/A ,"$2,375.13 ","$1,807.16 ","$1,309.42 ","$1,571.46 ","$1,572.23 ","$1,571.46 ","$1,783.93 ","$2,323.49 ","$1,763.79 ", N/A ,"$2,039.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.80 ","$1,600.63 ","$1,858.80 ","$1,858.80 ","$2,065.33 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR 6H 170MM LEFT,278,1 ,"$2,581.66 ","$1,703.90 ","$1,290.83 ","$2,581.66 ", N/A ,"$1,360.79 ","$1,360.79 ", N/A ,"$1,549.00 ","$2,194.41 ","$1,807.16 ", N/A , N/A ,"$2,452.58 ","$1,962.06 ","$1,936.25 ","$1,290.83 ","$2,194.41 ", N/A ,"$1,290.83 ","$1,290.83 ","$1,807.16 ","$1,572.23 ", N/A , N/A , N/A , N/A , N/A ,"$2,194.41 ", N/A ,"$2,375.13 ","$1,807.16 ","$1,309.42 ","$1,571.46 ","$1,572.23 ","$1,571.46 ","$1,783.93 ","$2,323.49 ","$1,763.79 ", N/A ,"$2,039.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,858.80 ","$1,600.63 ","$1,858.80 ","$1,858.80 ","$2,065.33 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR 8H 206MM RIGHT,278,1 ,"$2,629.14 ","$1,735.23 ","$1,314.57 ","$2,629.14 ", N/A ,"$1,385.82 ","$1,385.82 ", N/A ,"$1,577.48 ","$2,234.77 ","$1,840.40 ", N/A , N/A ,"$2,497.68 ","$1,998.15 ","$1,971.86 ","$1,314.57 ","$2,234.77 ", N/A ,"$1,314.57 ","$1,314.57 ","$1,840.40 ","$1,601.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,234.77 ", N/A ,"$2,418.81 ","$1,840.40 ","$1,333.50 ","$1,600.36 ","$1,601.15 ","$1,600.36 ","$1,816.74 ","$2,366.23 ","$1,796.23 ", N/A ,"$2,077.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,892.98 ","$1,630.07 ","$1,892.98 ","$1,892.98 ","$2,103.31 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR 8H 206MM LEFT,278,1 ,"$2,629.14 ","$1,735.23 ","$1,314.57 ","$2,629.14 ", N/A ,"$1,385.82 ","$1,385.82 ", N/A ,"$1,577.48 ","$2,234.77 ","$1,840.40 ", N/A , N/A ,"$2,497.68 ","$1,998.15 ","$1,971.86 ","$1,314.57 ","$2,234.77 ", N/A ,"$1,314.57 ","$1,314.57 ","$1,840.40 ","$1,601.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,234.77 ", N/A ,"$2,418.81 ","$1,840.40 ","$1,333.50 ","$1,600.36 ","$1,601.15 ","$1,600.36 ","$1,816.74 ","$2,366.23 ","$1,796.23 ", N/A ,"$2,077.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,892.98 ","$1,630.07 ","$1,892.98 ","$1,892.98 ","$2,103.31 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR CURVED 10H 242MM RIGHT,278,1 ,"$2,752.97 ","$1,816.96 ","$1,376.49 ","$2,752.97 ", N/A ,"$1,451.09 ","$1,451.09 ", N/A ,"$1,651.78 ","$2,340.02 ","$1,927.08 ", N/A , N/A ,"$2,615.32 ","$2,092.26 ","$2,064.73 ","$1,376.49 ","$2,340.02 ", N/A ,"$1,376.49 ","$1,376.49 ","$1,927.08 ","$1,676.56 ", N/A , N/A , N/A , N/A , N/A ,"$2,340.02 ", N/A ,"$2,532.73 ","$1,927.08 ","$1,396.31 ","$1,675.73 ","$1,676.56 ","$1,675.73 ","$1,902.30 ","$2,477.67 ","$1,880.83 ", N/A ,"$2,174.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,982.14 ","$1,706.84 ","$1,982.14 ","$1,982.14 ","$2,202.38 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR CURVED 10H 242MM LEFT,278,1 ,"$2,752.97 ","$1,816.96 ","$1,376.49 ","$2,752.97 ", N/A ,"$1,451.09 ","$1,451.09 ", N/A ,"$1,651.78 ","$2,340.02 ","$1,927.08 ", N/A , N/A ,"$2,615.32 ","$2,092.26 ","$2,064.73 ","$1,376.49 ","$2,340.02 ", N/A ,"$1,376.49 ","$1,376.49 ","$1,927.08 ","$1,676.56 ", N/A , N/A , N/A , N/A , N/A ,"$2,340.02 ", N/A ,"$2,532.73 ","$1,927.08 ","$1,396.31 ","$1,675.73 ","$1,676.56 ","$1,675.73 ","$1,902.30 ","$2,477.67 ","$1,880.83 ", N/A ,"$2,174.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,982.14 ","$1,706.84 ","$1,982.14 ","$1,982.14 ","$2,202.38 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR CURVED 12H 278MM RIGHT,278,1 ,"$2,812.55 ","$1,856.28 ","$1,406.28 ","$2,812.55 ", N/A ,"$1,482.50 ","$1,482.50 ", N/A ,"$1,687.53 ","$2,390.67 ","$1,968.79 ", N/A , N/A ,"$2,671.92 ","$2,137.54 ","$2,109.41 ","$1,406.28 ","$2,390.67 ", N/A ,"$1,406.28 ","$1,406.28 ","$1,968.79 ","$1,712.84 ", N/A , N/A , N/A , N/A , N/A ,"$2,390.67 ", N/A ,"$2,587.55 ","$1,968.79 ","$1,426.53 ","$1,712.00 ","$1,712.84 ","$1,712.00 ","$1,943.47 ","$2,531.30 ","$1,921.53 ", N/A ,"$2,221.91 ", N/A , N/A , N/A , N/A , N/A ,"$2,025.04 ","$1,743.78 ","$2,025.04 ","$2,025.04 ","$2,250.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR CURVED 12H 278MM LEFT,278,1 ,"$2,812.55 ","$1,856.28 ","$1,406.28 ","$2,812.55 ", N/A ,"$1,482.50 ","$1,482.50 ", N/A ,"$1,687.53 ","$2,390.67 ","$1,968.79 ", N/A , N/A ,"$2,671.92 ","$2,137.54 ","$2,109.41 ","$1,406.28 ","$2,390.67 ", N/A ,"$1,406.28 ","$1,406.28 ","$1,968.79 ","$1,712.84 ", N/A , N/A , N/A , N/A , N/A ,"$2,390.67 ", N/A ,"$2,587.55 ","$1,968.79 ","$1,426.53 ","$1,712.00 ","$1,712.84 ","$1,712.00 ","$1,943.47 ","$2,531.30 ","$1,921.53 ", N/A ,"$2,221.91 ", N/A , N/A , N/A , N/A , N/A ,"$2,025.04 ","$1,743.78 ","$2,025.04 ","$2,025.04 ","$2,250.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR CURVED 16H 350MM RIGHT,278,1 ,"$3,096.24 ","$2,043.52 ","$1,548.12 ","$3,096.24 ", N/A ,"$1,632.03 ","$1,632.03 ", N/A ,"$1,857.74 ","$2,631.80 ","$2,167.37 ", N/A , N/A ,"$2,941.43 ","$2,353.14 ","$2,322.18 ","$1,548.12 ","$2,631.80 ", N/A ,"$1,548.12 ","$1,548.12 ","$2,167.37 ","$1,885.61 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.80 ", N/A ,"$2,848.54 ","$2,167.37 ","$1,570.41 ","$1,884.68 ","$1,885.61 ","$1,884.68 ","$2,139.50 ","$2,786.62 ","$2,115.35 ", N/A ,"$2,446.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,229.29 ","$1,919.67 ","$2,229.29 ","$2,229.29 ","$2,476.99 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR CURVED 16H 350MM LEFT,278,1 ,"$3,096.24 ","$2,043.52 ","$1,548.12 ","$3,096.24 ", N/A ,"$1,632.03 ","$1,632.03 ", N/A ,"$1,857.74 ","$2,631.80 ","$2,167.37 ", N/A , N/A ,"$2,941.43 ","$2,353.14 ","$2,322.18 ","$1,548.12 ","$2,631.80 ", N/A ,"$1,548.12 ","$1,548.12 ","$2,167.37 ","$1,885.61 ", N/A , N/A , N/A , N/A , N/A ,"$2,631.80 ", N/A ,"$2,848.54 ","$2,167.37 ","$1,570.41 ","$1,884.68 ","$1,885.61 ","$1,884.68 ","$2,139.50 ","$2,786.62 ","$2,115.35 ", N/A ,"$2,446.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,229.29 ","$1,919.67 ","$2,229.29 ","$2,229.29 ","$2,476.99 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR CURVED 18H 386MM RIGHT,278,1 ,"$3,267.81 ","$2,156.75 ","$1,633.91 ","$3,267.81 ", N/A ,"$1,722.46 ","$1,722.46 ", N/A ,"$1,960.69 ","$2,777.64 ","$2,287.47 ", N/A , N/A ,"$3,104.42 ","$2,483.54 ","$2,450.86 ","$1,633.91 ","$2,777.64 ", N/A ,"$1,633.91 ","$1,633.91 ","$2,287.47 ","$1,990.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,777.64 ", N/A ,"$3,006.39 ","$2,287.47 ","$1,657.43 ","$1,989.12 ","$1,990.10 ","$1,989.12 ","$2,258.06 ","$2,941.03 ","$2,232.57 ", N/A ,"$2,581.57 ", N/A , N/A , N/A , N/A , N/A ,"$2,352.82 ","$2,026.04 ","$2,352.82 ","$2,352.82 ","$2,614.25 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP CONDYLAR CURVED 18H 386MM LEFT,278,1 ,"$3,267.81 ","$2,156.75 ","$1,633.91 ","$3,267.81 ", N/A ,"$1,722.46 ","$1,722.46 ", N/A ,"$1,960.69 ","$2,777.64 ","$2,287.47 ", N/A , N/A ,"$3,104.42 ","$2,483.54 ","$2,450.86 ","$1,633.91 ","$2,777.64 ", N/A ,"$1,633.91 ","$1,633.91 ","$2,287.47 ","$1,990.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,777.64 ", N/A ,"$3,006.39 ","$2,287.47 ","$1,657.43 ","$1,989.12 ","$1,990.10 ","$1,989.12 ","$2,258.06 ","$2,941.03 ","$2,232.57 ", N/A ,"$2,581.57 ", N/A , N/A , N/A , N/A , N/A ,"$2,352.82 ","$2,026.04 ","$2,352.82 ","$2,352.82 ","$2,614.25 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM  2H RGT,278,1 ,"$2,473.80 ","$1,632.71 ","$1,254.71 ","$2,473.80 ", N/A ,"$1,303.94 ","$1,303.94 ", N/A ,"$1,484.28 ","$2,102.73 ","$1,731.66 ", N/A , N/A ,"$2,350.11 ","$1,880.09 ","$1,855.35 ", N/A ,"$2,102.73 ", N/A , N/A , N/A ,"$1,731.66 ","$1,506.54 ", N/A , N/A , N/A , N/A , N/A ,"$2,102.73 ", N/A ,"$2,275.90 ","$1,731.66 ","$1,254.71 ","$1,505.80 ","$1,506.54 ","$1,505.80 ","$1,709.40 ","$2,226.42 ","$1,690.10 ", N/A ,"$1,954.30 ", N/A , N/A , N/A , N/A , N/A ,"$1,781.14 ","$1,533.76 ","$1,781.14 ","$1,781.14 ","$1,979.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM  2 HOLE LEFT,278,1 ,"$2,473.80 ","$1,632.71 ","$1,254.71 ","$2,473.80 ", N/A ,"$1,303.94 ","$1,303.94 ", N/A ,"$1,484.28 ","$2,102.73 ","$1,731.66 ", N/A , N/A ,"$2,350.11 ","$1,880.09 ","$1,855.35 ", N/A ,"$2,102.73 ", N/A , N/A , N/A ,"$1,731.66 ","$1,506.54 ", N/A , N/A , N/A , N/A , N/A ,"$2,102.73 ", N/A ,"$2,275.90 ","$1,731.66 ","$1,254.71 ","$1,505.80 ","$1,506.54 ","$1,505.80 ","$1,709.40 ","$2,226.42 ","$1,690.10 ", N/A ,"$1,954.30 ", N/A , N/A , N/A , N/A , N/A ,"$1,781.14 ","$1,533.76 ","$1,781.14 ","$1,781.14 ","$1,979.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM 10H RIGHT,278,1 ,"$2,891.42 ","$1,908.34 ","$1,445.71 ","$2,891.42 ", N/A ,"$1,524.07 ","$1,524.07 ", N/A ,"$1,734.85 ","$2,457.71 ","$2,023.99 ", N/A , N/A ,"$2,746.85 ","$2,197.48 ","$2,168.57 ","$1,445.71 ","$2,457.71 ", N/A ,"$1,445.71 ","$1,445.71 ","$2,023.99 ","$1,760.87 ", N/A , N/A , N/A , N/A , N/A ,"$2,457.71 ", N/A ,"$2,660.11 ","$2,023.99 ","$1,466.53 ","$1,760.01 ","$1,760.87 ","$1,760.01 ","$1,997.97 ","$2,602.28 ","$1,975.42 ", N/A ,"$2,284.22 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.82 ","$1,792.68 ","$2,081.82 ","$2,081.82 ","$2,313.14 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM 10 HOLE LEFT,278,1 ,"$2,891.42 ","$1,908.34 ","$1,445.71 ","$2,891.42 ", N/A ,"$1,524.07 ","$1,524.07 ", N/A ,"$1,734.85 ","$2,457.71 ","$2,023.99 ", N/A , N/A ,"$2,746.85 ","$2,197.48 ","$2,168.57 ","$1,445.71 ","$2,457.71 ", N/A ,"$1,445.71 ","$1,445.71 ","$2,023.99 ","$1,760.87 ", N/A , N/A , N/A , N/A , N/A ,"$2,457.71 ", N/A ,"$2,660.11 ","$2,023.99 ","$1,466.53 ","$1,760.01 ","$1,760.87 ","$1,760.01 ","$1,997.97 ","$2,602.28 ","$1,975.42 ", N/A ,"$2,284.22 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.82 ","$1,792.68 ","$2,081.82 ","$2,081.82 ","$2,313.14 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM 12H RIGHT,278,1 ,"$3,061.66 ","$2,020.70 ","$1,530.83 ","$3,061.66 ", N/A ,"$1,613.80 ","$1,613.80 ", N/A ,"$1,837.00 ","$2,602.41 ","$2,143.16 ", N/A , N/A ,"$2,908.58 ","$2,326.86 ","$2,296.25 ","$1,530.83 ","$2,602.41 ", N/A ,"$1,530.83 ","$1,530.83 ","$2,143.16 ","$1,864.55 ", N/A , N/A , N/A , N/A , N/A ,"$2,602.41 ", N/A ,"$2,816.73 ","$2,143.16 ","$1,552.87 ","$1,863.63 ","$1,864.55 ","$1,863.63 ","$2,115.61 ","$2,755.49 ","$2,091.73 ", N/A ,"$2,418.71 ", N/A , N/A , N/A , N/A , N/A ,"$2,204.40 ","$1,898.23 ","$2,204.40 ","$2,204.40 ","$2,449.33 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM 12 HOLE LEFT,278,1 ,"$3,061.66 ","$2,020.70 ","$1,530.83 ","$3,061.66 ", N/A ,"$1,613.80 ","$1,613.80 ", N/A ,"$1,837.00 ","$2,602.41 ","$2,143.16 ", N/A , N/A ,"$2,908.58 ","$2,326.86 ","$2,296.25 ","$1,530.83 ","$2,602.41 ", N/A ,"$1,530.83 ","$1,530.83 ","$2,143.16 ","$1,864.55 ", N/A , N/A , N/A , N/A , N/A ,"$2,602.41 ", N/A ,"$2,816.73 ","$2,143.16 ","$1,552.87 ","$1,863.63 ","$1,864.55 ","$1,863.63 ","$2,115.61 ","$2,755.49 ","$2,091.73 ", N/A ,"$2,418.71 ", N/A , N/A , N/A , N/A , N/A ,"$2,204.40 ","$1,898.23 ","$2,204.40 ","$2,204.40 ","$2,449.33 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM 14H RIGHT,278,1 ,"$3,307.71 ","$2,183.09 ","$1,653.86 ","$3,307.71 ", N/A ,"$1,743.49 ","$1,743.49 ", N/A ,"$1,984.63 ","$2,811.55 ","$2,315.40 ", N/A , N/A ,"$3,142.32 ","$2,513.86 ","$2,480.78 ","$1,653.86 ","$2,811.55 ", N/A ,"$1,653.86 ","$1,653.86 ","$2,315.40 ","$2,014.40 ", N/A , N/A , N/A , N/A , N/A ,"$2,811.55 ", N/A ,"$3,043.09 ","$2,315.40 ","$1,677.67 ","$2,013.40 ","$2,014.40 ","$2,013.40 ","$2,285.63 ","$2,976.94 ","$2,259.83 ", N/A ,"$2,613.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,381.55 ","$2,050.78 ","$2,381.55 ","$2,381.55 ","$2,646.17 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM 14 HOLE LEFT,278,1 ,"$3,307.71 ","$2,183.09 ","$1,653.86 ","$3,307.71 ", N/A ,"$1,743.49 ","$1,743.49 ", N/A ,"$1,984.63 ","$2,811.55 ","$2,315.40 ", N/A , N/A ,"$3,142.32 ","$2,513.86 ","$2,480.78 ","$1,653.86 ","$2,811.55 ", N/A ,"$1,653.86 ","$1,653.86 ","$2,315.40 ","$2,014.40 ", N/A , N/A , N/A , N/A , N/A ,"$2,811.55 ", N/A ,"$3,043.09 ","$2,315.40 ","$1,677.67 ","$2,013.40 ","$2,014.40 ","$2,013.40 ","$2,285.63 ","$2,976.94 ","$2,259.83 ", N/A ,"$2,613.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,381.55 ","$2,050.78 ","$2,381.55 ","$2,381.55 ","$2,646.17 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM 16H RGT,278,1 ,"$3,407.46 ","$2,248.92 ","$1,703.73 ","$3,407.46 ", N/A ,"$1,796.07 ","$1,796.07 ", N/A ,"$2,044.48 ","$2,896.34 ","$2,385.22 ", N/A , N/A ,"$3,237.09 ","$2,589.67 ","$2,555.60 ","$1,703.73 ","$2,896.34 ", N/A ,"$1,703.73 ","$1,703.73 ","$2,385.22 ","$2,075.14 ", N/A , N/A , N/A , N/A , N/A ,"$2,896.34 ", N/A ,"$3,134.86 ","$2,385.22 ","$1,728.26 ","$2,074.12 ","$2,075.14 ","$2,074.12 ","$2,354.55 ","$3,066.71 ","$2,327.98 ", N/A ,"$2,691.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,453.37 ","$2,112.63 ","$2,453.37 ","$2,453.37 ","$2,725.97 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM 16 HOLE LEFT,278,1 ,"$3,407.46 ","$2,248.92 ","$1,703.73 ","$3,407.46 ", N/A ,"$1,796.07 ","$1,796.07 ", N/A ,"$2,044.48 ","$2,896.34 ","$2,385.22 ", N/A , N/A ,"$3,237.09 ","$2,589.67 ","$2,555.60 ","$1,703.73 ","$2,896.34 ", N/A ,"$1,703.73 ","$1,703.73 ","$2,385.22 ","$2,075.14 ", N/A , N/A , N/A , N/A , N/A ,"$2,896.34 ", N/A ,"$3,134.86 ","$2,385.22 ","$1,728.26 ","$2,074.12 ","$2,075.14 ","$2,074.12 ","$2,354.55 ","$3,066.71 ","$2,327.98 ", N/A ,"$2,691.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,453.37 ","$2,112.63 ","$2,453.37 ","$2,453.37 ","$2,725.97 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB  4H 154MM RIGHT,278,1 ,"$2,658.01 ","$1,754.29 ","$1,329.01 ","$2,658.01 ", N/A ,"$1,401.04 ","$1,401.04 ", N/A ,"$1,594.81 ","$2,259.31 ","$1,860.61 ", N/A , N/A ,"$2,525.11 ","$2,020.09 ","$1,993.51 ","$1,329.01 ","$2,259.31 ", N/A ,"$1,329.01 ","$1,329.01 ","$1,860.61 ","$1,618.73 ", N/A , N/A , N/A , N/A , N/A ,"$2,259.31 ", N/A ,"$2,445.37 ","$1,860.61 ","$1,348.14 ","$1,617.93 ","$1,618.73 ","$1,617.93 ","$1,836.68 ","$2,392.21 ","$1,815.95 ", N/A ,"$2,099.83 ", N/A , N/A , N/A , N/A , N/A ,"$1,913.77 ","$1,647.97 ","$1,913.77 ","$1,913.77 ","$2,126.41 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB  4H 154MM LEFT,278,1 ,"$2,658.01 ","$1,754.29 ","$1,329.01 ","$2,658.01 ", N/A ,"$1,401.04 ","$1,401.04 ", N/A ,"$1,594.81 ","$2,259.31 ","$1,860.61 ", N/A , N/A ,"$2,525.11 ","$2,020.09 ","$1,993.51 ","$1,329.01 ","$2,259.31 ", N/A ,"$1,329.01 ","$1,329.01 ","$1,860.61 ","$1,618.73 ", N/A , N/A , N/A , N/A , N/A ,"$2,259.31 ", N/A ,"$2,445.37 ","$1,860.61 ","$1,348.14 ","$1,617.93 ","$1,618.73 ","$1,617.93 ","$1,836.68 ","$2,392.21 ","$1,815.95 ", N/A ,"$2,099.83 ", N/A , N/A , N/A , N/A , N/A ,"$1,913.77 ","$1,647.97 ","$1,913.77 ","$1,913.77 ","$2,126.41 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB  4H 190MM LEFT,278,1 ,"$2,685.94 ","$1,772.72 ","$1,342.97 ","$2,685.94 ", N/A ,"$1,415.76 ","$1,415.76 ", N/A ,"$1,611.56 ","$2,283.05 ","$1,880.16 ", N/A , N/A ,"$2,551.64 ","$2,041.31 ","$2,014.46 ","$1,342.97 ","$2,283.05 ", N/A ,"$1,342.97 ","$1,342.97 ","$1,880.16 ","$1,635.74 ", N/A , N/A , N/A , N/A , N/A ,"$2,283.05 ", N/A ,"$2,471.06 ","$1,880.16 ","$1,362.31 ","$1,634.93 ","$1,635.74 ","$1,634.93 ","$1,855.98 ","$2,417.35 ","$1,835.03 ", N/A ,"$2,121.89 ", N/A , N/A , N/A , N/A , N/A ,"$1,933.88 ","$1,665.28 ","$1,933.88 ","$1,933.88 ","$2,148.75 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB  4H 190MM RIGHT,278,1 ,"$2,610.79 ","$1,723.12 ","$1,305.40 ","$2,610.79 ", N/A ,"$1,376.15 ","$1,376.15 ", N/A ,"$1,566.47 ","$2,219.17 ","$1,827.55 ", N/A , N/A ,"$2,480.25 ","$1,984.20 ","$1,958.09 ","$1,305.40 ","$2,219.17 ", N/A ,"$1,305.40 ","$1,305.40 ","$1,827.55 ","$1,589.97 ", N/A , N/A , N/A , N/A , N/A ,"$2,219.17 ", N/A ,"$2,401.93 ","$1,827.55 ","$1,324.19 ","$1,589.19 ","$1,589.97 ","$1,589.19 ","$1,804.06 ","$2,349.71 ","$1,783.69 ", N/A ,"$2,062.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,879.77 ","$1,618.69 ","$1,879.77 ","$1,879.77 ","$2,088.63 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB  4H 82MM LEFT,278,1 ,"$2,594.70 ","$1,712.50 ","$1,297.35 ","$2,594.70 ", N/A ,"$1,367.67 ","$1,367.67 ", N/A ,"$1,556.82 ","$2,205.50 ","$1,816.29 ", N/A , N/A ,"$2,464.97 ","$1,971.97 ","$1,946.03 ","$1,297.35 ","$2,205.50 ", N/A ,"$1,297.35 ","$1,297.35 ","$1,816.29 ","$1,580.17 ", N/A , N/A , N/A , N/A , N/A ,"$2,205.50 ", N/A ,"$2,387.12 ","$1,816.29 ","$1,316.03 ","$1,579.39 ","$1,580.17 ","$1,579.39 ","$1,792.94 ","$2,335.23 ","$1,772.70 ", N/A ,"$2,049.81 ", N/A , N/A , N/A , N/A , N/A ,"$1,868.18 ","$1,608.71 ","$1,868.18 ","$1,868.18 ","$2,075.76 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB  4H 82MM RIGHT,278,1 ,"$2,523.01 ","$1,665.19 ","$1,261.51 ","$2,523.01 ", N/A ,"$1,329.88 ","$1,329.88 ", N/A ,"$1,513.81 ","$2,144.56 ","$1,766.11 ", N/A , N/A ,"$2,396.86 ","$1,917.49 ","$1,892.26 ","$1,261.51 ","$2,144.56 ", N/A ,"$1,261.51 ","$1,261.51 ","$1,766.11 ","$1,536.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,144.56 ", N/A ,"$2,321.17 ","$1,766.11 ","$1,279.67 ","$1,535.76 ","$1,536.51 ","$1,535.76 ","$1,743.40 ","$2,270.71 ","$1,723.72 ", N/A ,"$1,993.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,816.57 ","$1,564.27 ","$1,816.57 ","$1,816.57 ","$2,018.41 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM  4 HOLE LEFT,278,1 ,"$2,523.01 ","$1,665.19 ","$1,261.51 ","$2,523.01 ", N/A ,"$1,329.88 ","$1,329.88 ", N/A ,"$1,513.81 ","$2,144.56 ","$1,766.11 ", N/A , N/A ,"$2,396.86 ","$1,917.49 ","$1,892.26 ","$1,261.51 ","$2,144.56 ", N/A ,"$1,261.51 ","$1,261.51 ","$1,766.11 ","$1,536.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,144.56 ", N/A ,"$2,321.17 ","$1,766.11 ","$1,279.67 ","$1,535.76 ","$1,536.51 ","$1,535.76 ","$1,743.40 ","$2,270.71 ","$1,723.72 ", N/A ,"$1,993.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,816.57 ","$1,564.27 ","$1,816.57 ","$1,816.57 ","$2,018.41 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX FEM  4H RIGHT,278,1 ,"$2,523.01 ","$1,665.19 ","$1,261.51 ","$2,523.01 ", N/A ,"$1,329.88 ","$1,329.88 ", N/A ,"$1,513.81 ","$2,144.56 ","$1,766.11 ", N/A , N/A ,"$2,396.86 ","$1,917.49 ","$1,892.26 ","$1,261.51 ","$2,144.56 ", N/A ,"$1,261.51 ","$1,261.51 ","$1,766.11 ","$1,536.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,144.56 ", N/A ,"$2,321.17 ","$1,766.11 ","$1,279.67 ","$1,535.76 ","$1,536.51 ","$1,535.76 ","$1,743.40 ","$2,270.71 ","$1,723.72 ", N/A ,"$1,993.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,816.57 ","$1,564.27 ","$1,816.57 ","$1,816.57 ","$2,018.41 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB  6H 118MM RIGHT,278,1 ,"$2,628.21 ","$1,734.62 ","$1,314.11 ","$2,628.21 ", N/A ,"$1,385.33 ","$1,385.33 ", N/A ,"$1,576.93 ","$2,233.98 ","$1,839.75 ", N/A , N/A ,"$2,496.80 ","$1,997.44 ","$1,971.16 ","$1,314.11 ","$2,233.98 ", N/A ,"$1,314.11 ","$1,314.11 ","$1,839.75 ","$1,600.58 ", N/A , N/A , N/A , N/A , N/A ,"$2,233.98 ", N/A ,"$2,417.95 ","$1,839.75 ","$1,333.03 ","$1,599.79 ","$1,600.58 ","$1,599.79 ","$1,816.09 ","$2,365.39 ","$1,795.59 ", N/A ,"$2,076.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,892.31 ","$1,629.49 ","$1,892.31 ","$1,892.31 ","$2,102.57 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB  6H 118MM LEFT,278,1 ,"$2,628.21 ","$1,734.62 ","$1,314.11 ","$2,628.21 ", N/A ,"$1,385.33 ","$1,385.33 ", N/A ,"$1,576.93 ","$2,233.98 ","$1,839.75 ", N/A , N/A ,"$2,496.80 ","$1,997.44 ","$1,971.16 ","$1,314.11 ","$2,233.98 ", N/A ,"$1,314.11 ","$1,314.11 ","$1,839.75 ","$1,600.58 ", N/A , N/A , N/A , N/A , N/A ,"$2,233.98 ", N/A ,"$2,417.95 ","$1,839.75 ","$1,333.03 ","$1,599.79 ","$1,600.58 ","$1,599.79 ","$1,816.09 ","$2,365.39 ","$1,795.59 ", N/A ,"$2,076.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,892.31 ","$1,629.49 ","$1,892.31 ","$1,892.31 ","$2,102.57 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB 12H 226MM RHT,278,1 ,"$2,641.38 ","$1,743.31 ","$1,320.69 ","$2,641.38 ", N/A ,"$1,392.27 ","$1,392.27 ", N/A ,"$1,584.83 ","$2,245.17 ","$1,848.97 ", N/A , N/A ,"$2,509.31 ","$2,007.45 ","$1,981.04 ","$1,320.69 ","$2,245.17 ", N/A ,"$1,320.69 ","$1,320.69 ","$1,848.97 ","$1,608.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,245.17 ", N/A ,"$2,430.07 ","$1,848.97 ","$1,339.71 ","$1,607.81 ","$1,608.60 ","$1,607.81 ","$1,825.19 ","$2,377.24 ","$1,804.59 ", N/A ,"$2,086.69 ", N/A , N/A , N/A , N/A , N/A ,"$1,901.79 ","$1,637.66 ","$1,901.79 ","$1,901.79 ","$2,113.10 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB 12H 226MM LFT,278,1 ,"$2,641.38 ","$1,743.31 ","$1,320.69 ","$2,641.38 ", N/A ,"$1,392.27 ","$1,392.27 ", N/A ,"$1,584.83 ","$2,245.17 ","$1,848.97 ", N/A , N/A ,"$2,509.31 ","$2,007.45 ","$1,981.04 ","$1,320.69 ","$2,245.17 ", N/A ,"$1,320.69 ","$1,320.69 ","$1,848.97 ","$1,608.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,245.17 ", N/A ,"$2,430.07 ","$1,848.97 ","$1,339.71 ","$1,607.81 ","$1,608.60 ","$1,607.81 ","$1,825.19 ","$2,377.24 ","$1,804.59 ", N/A ,"$2,086.69 ", N/A , N/A , N/A , N/A , N/A ,"$1,901.79 ","$1,637.66 ","$1,901.79 ","$1,901.79 ","$2,113.10 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB 14H 262MM RHT,278,1 ,"$2,669.31 ","$1,761.74 ","$1,334.66 ","$2,669.31 ", N/A ,"$1,406.99 ","$1,406.99 ", N/A ,"$1,601.59 ","$2,268.91 ","$1,868.52 ", N/A , N/A ,"$2,535.84 ","$2,028.68 ","$2,001.98 ","$1,334.66 ","$2,268.91 ", N/A ,"$1,334.66 ","$1,334.66 ","$1,868.52 ","$1,625.61 ", N/A , N/A , N/A , N/A , N/A ,"$2,268.91 ", N/A ,"$2,455.77 ","$1,868.52 ","$1,353.87 ","$1,624.81 ","$1,625.61 ","$1,624.81 ","$1,844.49 ","$2,402.38 ","$1,823.67 ", N/A ,"$2,108.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,921.90 ","$1,654.97 ","$1,921.90 ","$1,921.90 ","$2,135.45 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP PROX TIB 14H 262MM LFT,278,1 ,"$2,669.31 ","$1,761.74 ","$1,334.66 ","$2,669.31 ", N/A ,"$1,406.99 ","$1,406.99 ", N/A ,"$1,601.59 ","$2,268.91 ","$1,868.52 ", N/A , N/A ,"$2,535.84 ","$2,028.68 ","$2,001.98 ","$1,334.66 ","$2,268.91 ", N/A ,"$1,334.66 ","$1,334.66 ","$1,868.52 ","$1,625.61 ", N/A , N/A , N/A , N/A , N/A ,"$2,268.91 ", N/A ,"$2,455.77 ","$1,868.52 ","$1,353.87 ","$1,624.81 ","$1,625.61 ","$1,624.81 ","$1,844.49 ","$2,402.38 ","$1,823.67 ", N/A ,"$2,108.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,921.90 ","$1,654.97 ","$1,921.90 ","$1,921.90 ","$2,135.45 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP T PLATE 6 HOLE 115MM,278,1 ,"$1,264.67 ",$834.68 ,$641.44 ,"$1,264.67 ", N/A ,$666.61 ,$666.61 , N/A ,$758.80 ,"$1,074.97 ",$885.27 , N/A , N/A ,"$1,201.44 ",$961.15 ,$948.50 , N/A ,"$1,074.97 ", N/A , N/A , N/A ,$885.27 ,$770.18 , N/A , N/A , N/A , N/A , N/A ,"$1,074.97 ", N/A ,"$1,163.50 ",$885.27 ,$641.44 ,$769.80 ,$770.18 ,$769.80 ,$873.89 ,"$1,138.20 ",$864.02 , N/A ,$999.09 , N/A , N/A , N/A , N/A , N/A ,$910.56 ,$784.10 ,$910.56 ,$910.56 ,"$1,011.74 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP T PLATE 8 HOLE 147MM,278,1 ,"$1,461.55 ",$964.62 ,$741.30 ,"$1,461.55 ", N/A ,$770.38 ,$770.38 , N/A ,$876.93 ,"$1,242.32 ","$1,023.09 ", N/A , N/A ,"$1,388.47 ","$1,110.78 ","$1,096.16 ", N/A ,"$1,242.32 ", N/A , N/A , N/A ,"$1,023.09 ",$890.08 , N/A , N/A , N/A , N/A , N/A ,"$1,242.32 ", N/A ,"$1,344.63 ","$1,023.09 ",$741.30 ,$889.65 ,$890.08 ,$889.65 ,"$1,009.93 ","$1,315.40 ",$998.53 , N/A ,"$1,154.62 ", N/A , N/A , N/A , N/A , N/A ,"$1,052.32 ",$906.16 ,"$1,052.32 ","$1,052.32 ","$1,169.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBIAL RT 14 HOLE,278,1 ,"$1,878.42 ","$1,239.76 ",$952.73 ,"$1,878.42 ", N/A ,$990.12 ,$990.12 , N/A ,"$1,127.05 ","$1,596.66 ","$1,314.89 ", N/A , N/A ,"$1,784.50 ","$1,427.60 ","$1,408.82 ", N/A ,"$1,596.66 ", N/A , N/A , N/A ,"$1,314.89 ","$1,143.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,596.66 ", N/A ,"$1,728.15 ","$1,314.89 ",$952.73 ,"$1,143.39 ","$1,143.96 ","$1,143.39 ","$1,297.99 ","$1,690.58 ","$1,283.34 ", N/A ,"$1,483.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,352.46 ","$1,164.62 ","$1,352.46 ","$1,352.46 ","$1,502.74 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBIAL LT 14 HOLE,278,1 ,"$1,878.42 ","$1,239.76 ",$952.73 ,"$1,878.42 ", N/A ,$990.12 ,$990.12 , N/A ,"$1,127.05 ","$1,596.66 ","$1,314.89 ", N/A , N/A ,"$1,784.50 ","$1,427.60 ","$1,408.82 ", N/A ,"$1,596.66 ", N/A , N/A , N/A ,"$1,314.89 ","$1,143.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,596.66 ", N/A ,"$1,728.15 ","$1,314.89 ",$952.73 ,"$1,143.39 ","$1,143.96 ","$1,143.39 ","$1,297.99 ","$1,690.58 ","$1,283.34 ", N/A ,"$1,483.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,352.46 ","$1,164.62 ","$1,352.46 ","$1,352.46 ","$1,502.74 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBIAL RT 6 HOLE,278,1 ,"$1,173.83 ",$774.73 ,$595.37 ,"$1,173.83 ", N/A ,$618.73 ,$618.73 , N/A ,$704.30 ,$997.76 ,$821.68 , N/A , N/A ,"$1,115.14 ",$892.11 ,$880.37 , N/A ,$997.76 , N/A , N/A , N/A ,$821.68 ,$714.86 , N/A , N/A , N/A , N/A , N/A ,$997.76 , N/A ,"$1,079.92 ",$821.68 ,$595.37 ,$714.51 ,$714.86 ,$714.51 ,$811.12 ,"$1,056.45 ",$801.96 , N/A ,$927.33 , N/A , N/A , N/A , N/A , N/A ,$845.16 ,$727.77 ,$845.16 ,$845.16 ,$939.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBIAL LT 6 HOLE,278,1 ,"$1,173.83 ",$774.73 ,$595.37 ,"$1,173.83 ", N/A ,$618.73 ,$618.73 , N/A ,$704.30 ,$997.76 ,$821.68 , N/A , N/A ,"$1,115.14 ",$892.11 ,$880.37 , N/A ,$997.76 , N/A , N/A , N/A ,$821.68 ,$714.86 , N/A , N/A , N/A , N/A , N/A ,$997.76 , N/A ,"$1,079.92 ",$821.68 ,$595.37 ,$714.51 ,$714.86 ,$714.51 ,$811.12 ,"$1,056.45 ",$801.96 , N/A ,$927.33 , N/A , N/A , N/A , N/A , N/A ,$845.16 ,$727.77 ,$845.16 ,$845.16 ,$939.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBIALRT 10 HOLE,278,1 ,"$1,508.19 ",$995.41 ,$764.95 ,"$1,508.19 ", N/A ,$794.97 ,$794.97 , N/A ,$904.91 ,"$1,281.96 ","$1,055.73 ", N/A , N/A ,"$1,432.78 ","$1,146.22 ","$1,131.14 ", N/A ,"$1,281.96 ", N/A , N/A , N/A ,"$1,055.73 ",$918.49 , N/A , N/A , N/A , N/A , N/A ,"$1,281.96 ", N/A ,"$1,387.53 ","$1,055.73 ",$764.95 ,$918.04 ,$918.49 ,$918.04 ,"$1,042.16 ","$1,357.37 ","$1,030.40 ", N/A ,"$1,191.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,085.90 ",$935.08 ,"$1,085.90 ","$1,085.90 ","$1,206.55 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBIAL LT 10 HOLE,278,1 ,"$1,508.19 ",$995.41 ,$764.95 ,"$1,508.19 ", N/A ,$794.97 ,$794.97 , N/A ,$904.91 ,"$1,281.96 ","$1,055.73 ", N/A , N/A ,"$1,432.78 ","$1,146.22 ","$1,131.14 ", N/A ,"$1,281.96 ", N/A , N/A , N/A ,"$1,055.73 ",$918.49 , N/A , N/A , N/A , N/A , N/A ,"$1,281.96 ", N/A ,"$1,387.53 ","$1,055.73 ",$764.95 ,$918.04 ,$918.49 ,$918.04 ,"$1,042.16 ","$1,357.37 ","$1,030.40 ", N/A ,"$1,191.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,085.90 ",$935.08 ,"$1,085.90 ","$1,085.90 ","$1,206.55 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBIALRT 8 HOLE,278,1 ,"$1,323.07 ",$873.23 ,$671.06 ,"$1,323.07 ", N/A ,$697.39 ,$697.39 , N/A ,$793.84 ,"$1,124.61 ",$926.15 , N/A , N/A ,"$1,256.92 ","$1,005.53 ",$992.30 , N/A ,"$1,124.61 ", N/A , N/A , N/A ,$926.15 ,$805.75 , N/A , N/A , N/A , N/A , N/A ,"$1,124.61 ", N/A ,"$1,217.22 ",$926.15 ,$671.06 ,$805.35 ,$805.75 ,$805.35 ,$914.24 ,"$1,190.76 ",$903.92 , N/A ,"$1,045.23 ", N/A , N/A , N/A , N/A , N/A ,$952.61 ,$820.30 ,$952.61 ,$952.61 ,"$1,058.46 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBIALLT 8 HOLE,278,1 ,"$1,323.07 ",$873.23 ,$671.06 ,"$1,323.07 ", N/A ,$697.39 ,$697.39 , N/A ,$793.84 ,"$1,124.61 ",$926.15 , N/A , N/A ,"$1,256.92 ","$1,005.53 ",$992.30 , N/A ,"$1,124.61 ", N/A , N/A , N/A ,$926.15 ,$805.75 , N/A , N/A , N/A , N/A , N/A ,"$1,124.61 ", N/A ,"$1,217.22 ",$926.15 ,$671.06 ,$805.35 ,$805.75 ,$805.35 ,$914.24 ,"$1,190.76 ",$903.92 , N/A ,"$1,045.23 ", N/A , N/A , N/A , N/A , N/A ,$952.61 ,$820.30 ,$952.61 ,$952.61 ,"$1,058.46 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBILA LT 12 HOLE,278,1 ,"$1,684.69 ","$1,111.90 ",$854.47 ,"$1,684.69 ", N/A ,$888.00 ,$888.00 , N/A ,"$1,010.81 ","$1,431.99 ","$1,179.28 ", N/A , N/A ,"$1,600.46 ","$1,280.36 ","$1,263.52 ", N/A ,"$1,431.99 ", N/A , N/A , N/A ,"$1,179.28 ","$1,025.98 ", N/A , N/A , N/A , N/A , N/A ,"$1,431.99 ", N/A ,"$1,549.91 ","$1,179.28 ",$854.47 ,"$1,025.47 ","$1,025.98 ","$1,025.47 ","$1,164.12 ","$1,516.22 ","$1,150.98 ", N/A ,"$1,330.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,212.98 ","$1,044.51 ","$1,212.98 ","$1,212.98 ","$1,347.75 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 MEDIAL DISTAL TIBIAL RT 12 HOLE,278,1 ,"$1,684.69 ","$1,111.90 ",$854.47 ,"$1,684.69 ", N/A ,$888.00 ,$888.00 , N/A ,"$1,010.81 ","$1,431.99 ","$1,179.28 ", N/A , N/A ,"$1,600.46 ","$1,280.36 ","$1,263.52 ", N/A ,"$1,431.99 ", N/A , N/A , N/A ,"$1,179.28 ","$1,025.98 ", N/A , N/A , N/A , N/A , N/A ,"$1,431.99 ", N/A ,"$1,549.91 ","$1,179.28 ",$854.47 ,"$1,025.47 ","$1,025.98 ","$1,025.47 ","$1,164.12 ","$1,516.22 ","$1,150.98 ", N/A ,"$1,330.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,212.98 ","$1,044.51 ","$1,212.98 ","$1,212.98 ","$1,347.75 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 10H 188MM,278,1 ,"$1,044.68 ",$689.49 ,$529.86 ,"$1,044.68 ", N/A ,$550.65 ,$550.65 , N/A ,$626.81 ,$887.98 ,$731.28 , N/A , N/A ,$992.45 ,$793.96 ,$783.51 , N/A ,$887.98 , N/A , N/A , N/A ,$731.28 ,$636.21 , N/A , N/A , N/A , N/A , N/A ,$887.98 , N/A ,$961.11 ,$731.28 ,$529.86 ,$635.90 ,$636.21 ,$635.90 ,$721.87 ,$940.21 ,$713.73 , N/A ,$825.30 , N/A , N/A , N/A , N/A , N/A ,$752.17 ,$647.70 ,$752.17 ,$752.17 ,$835.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 11H 206MM,278,1 ,"$1,125.04 ",$742.53 ,$570.62 ,"$1,125.04 ", N/A ,$593.01 ,$593.01 , N/A ,$675.02 ,$956.28 ,$787.53 , N/A , N/A ,"$1,068.79 ",$855.03 ,$843.78 , N/A ,$956.28 , N/A , N/A , N/A ,$787.53 ,$685.15 , N/A , N/A , N/A , N/A , N/A ,$956.28 , N/A ,"$1,035.04 ",$787.53 ,$570.62 ,$684.81 ,$685.15 ,$684.81 ,$777.40 ,"$1,012.54 ",$768.63 , N/A ,$888.78 , N/A , N/A , N/A , N/A , N/A ,$810.03 ,$697.52 ,$810.03 ,$810.03 ,$900.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 12H 224MM,278,1 ,"$1,151.16 ",$759.77 ,$583.87 ,"$1,151.16 ", N/A ,$606.78 ,$606.78 , N/A ,$690.70 ,$978.49 ,$805.81 , N/A , N/A ,"$1,093.60 ",$874.88 ,$863.37 , N/A ,$978.49 , N/A , N/A , N/A ,$805.81 ,$701.06 , N/A , N/A , N/A , N/A , N/A ,$978.49 , N/A ,"$1,059.07 ",$805.81 ,$583.87 ,$700.71 ,$701.06 ,$700.71 ,$795.45 ,"$1,036.04 ",$786.47 , N/A ,$909.42 , N/A , N/A , N/A , N/A , N/A ,$828.84 ,$713.72 ,$828.84 ,$828.84 ,$920.93 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 10H 188MM,278,1 ,"$1,151.16 ",$759.77 ,$583.87 ,"$1,151.16 ", N/A ,$606.78 ,$606.78 , N/A ,$690.70 ,$978.49 ,$805.81 , N/A , N/A ,"$1,093.60 ",$874.88 ,$863.37 , N/A ,$978.49 , N/A , N/A , N/A ,$805.81 ,$701.06 , N/A , N/A , N/A , N/A , N/A ,$978.49 , N/A ,"$1,059.07 ",$805.81 ,$583.87 ,$700.71 ,$701.06 ,$700.71 ,$795.45 ,"$1,036.04 ",$786.47 , N/A ,$909.42 , N/A , N/A , N/A , N/A , N/A ,$828.84 ,$713.72 ,$828.84 ,$828.84 ,$920.93 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 14H 260MM,278,1 ,"$1,290.78 ",$851.91 ,$654.68 ,"$1,290.78 ", N/A ,$680.37 ,$680.37 , N/A ,$774.47 ,"$1,097.16 ",$903.55 , N/A , N/A ,"$1,226.24 ",$980.99 ,$968.09 , N/A ,"$1,097.16 ", N/A , N/A , N/A ,$903.55 ,$786.09 , N/A , N/A , N/A , N/A , N/A ,"$1,097.16 ", N/A ,"$1,187.52 ",$903.55 ,$654.68 ,$785.70 ,$786.09 ,$785.70 ,$891.93 ,"$1,161.70 ",$881.86 , N/A ,"$1,019.72 ", N/A , N/A , N/A , N/A , N/A ,$929.36 ,$800.28 ,$929.36 ,$929.36 ,"$1,032.62 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 16H 296MM,278,1 ,"$1,585.68 ","$1,046.55 ",$804.26 ,"$1,585.68 ", N/A ,$835.81 ,$835.81 , N/A ,$951.41 ,"$1,347.83 ","$1,109.98 ", N/A , N/A ,"$1,506.40 ","$1,205.12 ","$1,189.26 ", N/A ,"$1,347.83 ", N/A , N/A , N/A ,"$1,109.98 ",$965.68 , N/A , N/A , N/A , N/A , N/A ,"$1,347.83 ", N/A ,"$1,458.83 ","$1,109.98 ",$804.26 ,$965.20 ,$965.68 ,$965.20 ,"$1,095.70 ","$1,427.11 ","$1,083.34 ", N/A ,"$1,252.69 ", N/A , N/A , N/A , N/A , N/A ,"$1,141.69 ",$983.12 ,"$1,141.69 ","$1,141.69 ","$1,268.54 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 4 HOLE 80MM,278,1 ,$661.60 ,$436.66 ,$335.56 ,$661.60 , N/A , N/A , N/A , N/A ,$396.96 ,$562.36 ,$463.12 , N/A , N/A ,$628.52 ,$502.82 ,$496.20 , N/A ,$562.36 , N/A , N/A , N/A ,$463.12 ,$402.91 , N/A , N/A , N/A , N/A , N/A ,$562.36 , N/A ,$608.67 ,$463.12 ,$335.56 ,$402.72 ,$402.91 ,$402.72 ,$457.17 ,$595.44 ,$452.01 , N/A ,$522.66 , N/A , N/A , N/A , N/A , N/A ,$476.35 ,$410.19 ,$476.35 ,$476.35 ,$529.28 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 5 HOLE 98MM,278,1 ,$743.47 ,$490.69 ,$377.09 ,$743.47 , N/A , N/A , N/A , N/A ,$446.08 ,$631.95 ,$520.43 , N/A , N/A ,$706.30 ,$565.04 ,$557.60 , N/A ,$631.95 , N/A , N/A , N/A ,$520.43 ,$452.77 , N/A , N/A , N/A , N/A , N/A ,$631.95 , N/A ,$683.99 ,$520.43 ,$377.09 ,$452.55 ,$452.77 ,$452.55 ,$513.74 ,$669.12 ,$507.94 , N/A ,$587.34 , N/A , N/A , N/A , N/A , N/A ,$535.30 ,$460.95 ,$535.30 ,$535.30 ,$594.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 7 HOLE 134MM,278,1 ,$910.53 ,$600.95 ,$461.82 ,$910.53 , N/A , N/A , N/A , N/A ,$546.32 ,$773.95 ,$637.37 , N/A , N/A ,$865.00 ,$692.00 ,$682.90 , N/A ,$773.95 , N/A , N/A , N/A ,$637.37 ,$554.51 , N/A , N/A , N/A , N/A , N/A ,$773.95 , N/A ,$837.69 ,$637.37 ,$461.82 ,$554.24 ,$554.51 ,$554.24 ,$629.18 ,$819.48 ,$622.07 , N/A ,$719.32 , N/A , N/A , N/A , N/A , N/A ,$655.58 ,$564.53 ,$655.58 ,$655.58 ,$728.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 8H 152MM,278,1 ,$917.60 ,$605.62 ,$465.41 ,$917.60 , N/A , N/A , N/A , N/A ,$550.56 ,$779.96 ,$642.32 , N/A , N/A ,$871.72 ,$697.38 ,$688.20 , N/A ,$779.96 , N/A , N/A , N/A ,$642.32 ,$558.82 , N/A , N/A , N/A , N/A , N/A ,$779.96 , N/A ,$844.19 ,$642.32 ,$465.41 ,$558.54 ,$558.82 ,$558.54 ,$634.06 ,$825.84 ,$626.90 , N/A ,$724.90 , N/A , N/A , N/A , N/A , N/A ,$660.67 ,$568.91 ,$660.67 ,$660.67 ,$734.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 9H 170MM,278,1 ,$959.74 ,$633.43 ,$486.78 ,$959.74 , N/A , N/A , N/A , N/A ,$575.84 ,$815.78 ,$671.82 , N/A , N/A ,$911.75 ,$729.40 ,$719.81 , N/A ,$815.78 , N/A , N/A , N/A ,$671.82 ,$584.48 , N/A , N/A , N/A , N/A , N/A ,$815.78 , N/A ,$882.96 ,$671.82 ,$486.78 ,$584.19 ,$584.48 ,$584.19 ,$663.18 ,$863.77 ,$655.69 , N/A ,$758.19 , N/A , N/A , N/A , N/A , N/A ,$691.01 ,$595.04 ,$691.01 ,$691.01 ,$767.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR  3H 45MM,278,1 ,$719.39 ,$474.80 ,$364.87 ,$719.39 , N/A , N/A , N/A , N/A ,$431.63 ,$611.48 ,$503.57 , N/A , N/A ,$683.42 ,$546.74 ,$539.54 , N/A ,$611.48 , N/A , N/A , N/A ,$503.57 ,$438.11 , N/A , N/A , N/A , N/A , N/A ,$611.48 , N/A ,$661.84 ,$503.57 ,$364.87 ,$437.89 ,$438.11 ,$437.89 ,$497.10 ,$647.45 ,$491.49 , N/A ,$568.32 , N/A , N/A , N/A , N/A , N/A ,$517.96 ,$446.02 ,$517.96 ,$517.96 ,$575.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR  4H 61MM,278,1 ,$749.49 ,$494.66 ,$380.14 ,$749.49 , N/A , N/A , N/A , N/A ,$449.69 ,$637.07 ,$524.64 , N/A , N/A ,$712.02 ,$569.61 ,$562.12 , N/A ,$637.07 , N/A , N/A , N/A ,$524.64 ,$456.44 , N/A , N/A , N/A , N/A , N/A ,$637.07 , N/A ,$689.53 ,$524.64 ,$380.14 ,$456.21 ,$456.44 ,$456.21 ,$517.90 ,$674.54 ,$512.05 , N/A ,$592.10 , N/A , N/A , N/A , N/A , N/A ,$539.63 ,$464.68 ,$539.63 ,$539.63 ,$599.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR  5H 77MM,278,1 ,$815.71 ,$538.37 ,$413.73 ,$815.71 , N/A , N/A , N/A , N/A ,$489.43 ,$693.35 ,$571.00 , N/A , N/A ,$774.92 ,$619.94 ,$611.78 , N/A ,$693.35 , N/A , N/A , N/A ,$571.00 ,$496.77 , N/A , N/A , N/A , N/A , N/A ,$693.35 , N/A ,$750.45 ,$571.00 ,$413.73 ,$496.52 ,$496.77 ,$496.52 ,$563.66 ,$734.14 ,$557.29 , N/A ,$644.41 , N/A , N/A , N/A , N/A , N/A ,$587.31 ,$505.74 ,$587.31 ,$587.31 ,$652.57 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR  6H 93MM,278,1 ,$865.38 ,$571.15 ,$438.92 ,$865.38 , N/A , N/A , N/A , N/A ,$519.23 ,$735.57 ,$605.77 , N/A , N/A ,$822.11 ,$657.69 ,$649.04 , N/A ,$735.57 , N/A , N/A , N/A ,$605.77 ,$527.02 , N/A , N/A , N/A , N/A , N/A ,$735.57 , N/A ,$796.15 ,$605.77 ,$438.92 ,$526.76 ,$527.02 ,$526.76 ,$597.98 ,$778.84 ,$591.23 , N/A ,$683.65 , N/A , N/A , N/A , N/A , N/A ,$623.07 ,$536.54 ,$623.07 ,$623.07 ,$692.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR  9H 141MM,278,1 ,"$1,021.90 ",$674.45 ,$518.31 ,"$1,021.90 ", N/A ,$538.64 ,$538.64 , N/A ,$613.14 ,$868.62 ,$715.33 , N/A , N/A ,$970.81 ,$776.64 ,$766.43 , N/A ,$868.62 , N/A , N/A , N/A ,$715.33 ,$622.34 , N/A , N/A , N/A , N/A , N/A ,$868.62 , N/A ,$940.15 ,$715.33 ,$518.31 ,$622.03 ,$622.34 ,$622.03 ,$706.13 ,$919.71 ,$698.16 , N/A ,$807.30 , N/A , N/A , N/A , N/A , N/A ,$735.77 ,$633.58 ,$735.77 ,$735.77 ,$817.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR 10H 157MM,278,1 ,"$1,070.06 ",$706.24 ,$542.73 ,"$1,070.06 ", N/A ,$564.03 ,$564.03 , N/A ,$642.04 ,$909.55 ,$749.04 , N/A , N/A ,"$1,016.56 ",$813.25 ,$802.55 , N/A ,$909.55 , N/A , N/A , N/A ,$749.04 ,$651.67 , N/A , N/A , N/A , N/A , N/A ,$909.55 , N/A ,$984.46 ,$749.04 ,$542.73 ,$651.35 ,$651.67 ,$651.35 ,$739.41 ,$963.05 ,$731.07 , N/A ,$845.35 , N/A , N/A , N/A , N/A , N/A ,$770.44 ,$663.44 ,$770.44 ,$770.44 ,$856.05 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR 11H 173MM,278,1 ,"$1,056.16 ",$697.07 ,$535.68 ,"$1,056.16 ", N/A ,$556.70 ,$556.70 , N/A ,$633.70 ,$897.74 ,$739.31 , N/A , N/A ,"$1,003.35 ",$802.68 ,$792.12 , N/A ,$897.74 , N/A , N/A , N/A ,$739.31 ,$643.20 , N/A , N/A , N/A , N/A , N/A ,$897.74 , N/A ,$971.67 ,$739.31 ,$535.68 ,$642.88 ,$643.20 ,$642.88 ,$729.81 ,$950.54 ,$721.57 , N/A ,$834.37 , N/A , N/A , N/A , N/A , N/A ,$760.44 ,$654.82 ,$760.44 ,$760.44 ,$844.93 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 15H,278,1 ,"$1,056.16 ",$697.07 ,$535.68 ,"$1,056.16 ", N/A ,$556.70 ,$556.70 , N/A ,$633.70 ,$897.74 ,$739.31 , N/A , N/A ,"$1,003.35 ",$802.68 ,$792.12 , N/A ,$897.74 , N/A , N/A , N/A ,$739.31 ,$643.20 , N/A , N/A , N/A , N/A , N/A ,$897.74 , N/A ,$971.67 ,$739.31 ,$535.68 ,$642.88 ,$643.20 ,$642.88 ,$729.81 ,$950.54 ,$721.57 , N/A ,$834.37 , N/A , N/A , N/A , N/A , N/A ,$760.44 ,$654.82 ,$760.44 ,$760.44 ,$844.93 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR 12H 189MM,278,1 ,"$1,104.95 ",$729.27 ,$560.43 ,"$1,104.95 ", N/A ,$582.42 ,$582.42 , N/A ,$662.97 ,$939.21 ,$773.47 , N/A , N/A ,"$1,049.70 ",$839.76 ,$828.71 , N/A ,$939.21 , N/A , N/A , N/A ,$773.47 ,$672.91 , N/A , N/A , N/A , N/A , N/A ,$939.21 , N/A ,"$1,016.55 ",$773.47 ,$560.43 ,$672.58 ,$672.91 ,$672.58 ,$763.52 ,$994.46 ,$754.90 , N/A ,$872.91 , N/A , N/A , N/A , N/A , N/A ,$795.56 ,$685.07 ,$795.56 ,$795.56 ,$883.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 LCP T PLATE 4 HOLE 83MM,278,1 ,"$1,104.95 ",$729.27 ,$560.43 ,"$1,104.95 ", N/A ,$582.42 ,$582.42 , N/A ,$662.97 ,$939.21 ,$773.47 , N/A , N/A ,"$1,049.70 ",$839.76 ,$828.71 , N/A ,$939.21 , N/A , N/A , N/A ,$773.47 ,$672.91 , N/A , N/A , N/A , N/A , N/A ,$939.21 , N/A ,"$1,016.55 ",$773.47 ,$560.43 ,$672.58 ,$672.91 ,$672.58 ,$763.52 ,$994.46 ,$754.90 , N/A ,$872.91 , N/A , N/A , N/A , N/A , N/A ,$795.56 ,$685.07 ,$795.56 ,$795.56 ,$883.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR 13H 205MM,278,1 ,"$1,176.70 ",$776.62 ,$596.82 ,"$1,176.70 ", N/A ,$620.24 ,$620.24 , N/A ,$706.02 ,"$1,000.20 ",$823.69 , N/A , N/A ,"$1,117.87 ",$894.29 ,$882.53 , N/A ,"$1,000.20 ", N/A , N/A , N/A ,$823.69 ,$716.61 , N/A , N/A , N/A , N/A , N/A ,"$1,000.20 ", N/A ,"$1,082.56 ",$823.69 ,$596.82 ,$716.26 ,$716.61 ,$716.26 ,$813.10 ,"$1,059.03 ",$803.92 , N/A ,$929.59 , N/A , N/A , N/A , N/A , N/A ,$847.22 ,$729.55 ,$847.22 ,$847.22 ,$941.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 RECONST STR 14H 221MM,278,1 ,"$1,209.71 ",$798.41 ,$613.56 ,"$1,209.71 ", N/A ,$637.64 ,$637.64 , N/A ,$725.83 ,"$1,028.25 ",$846.80 , N/A , N/A ,"$1,149.22 ",$919.38 ,$907.28 , N/A ,"$1,028.25 ", N/A , N/A , N/A ,$846.80 ,$736.71 , N/A , N/A , N/A , N/A , N/A ,"$1,028.25 ", N/A ,"$1,112.93 ",$846.80 ,$613.56 ,$736.35 ,$736.71 ,$736.35 ,$835.91 ,"$1,088.74 ",$826.47 , N/A ,$955.67 , N/A , N/A , N/A , N/A , N/A ,$870.99 ,$750.02 ,$870.99 ,$870.99 ,$967.77 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 10H 230MM LEFT,278,1 ,"$3,160.08 ","$2,085.65 ","$1,580.04 ","$3,160.08 ", N/A ,"$1,665.68 ","$1,665.68 ", N/A ,"$1,896.05 ","$2,686.07 ","$2,212.06 ", N/A , N/A ,"$3,002.08 ","$2,401.66 ","$2,370.06 ","$1,580.04 ","$2,686.07 ", N/A ,"$1,580.04 ","$1,580.04 ","$2,212.06 ","$1,924.49 ", N/A , N/A , N/A , N/A , N/A ,"$2,686.07 ", N/A ,"$2,907.27 ","$2,212.06 ","$1,602.79 ","$1,923.54 ","$1,924.49 ","$1,923.54 ","$2,183.62 ","$2,844.07 ","$2,158.97 ", N/A ,"$2,496.46 ", N/A , N/A , N/A , N/A , N/A ,"$2,275.26 ","$1,959.25 ","$2,275.26 ","$2,275.26 ","$2,528.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 10H 230MM RIGHT,278,1 ,"$3,308.17 ","$2,183.39 ","$1,654.09 ","$3,308.17 ", N/A ,"$1,743.74 ","$1,743.74 ", N/A ,"$1,984.90 ","$2,811.94 ","$2,315.72 ", N/A , N/A ,"$3,142.76 ","$2,514.21 ","$2,481.13 ","$1,654.09 ","$2,811.94 ", N/A ,"$1,654.09 ","$1,654.09 ","$2,315.72 ","$2,014.68 ", N/A , N/A , N/A , N/A , N/A ,"$2,811.94 ", N/A ,"$3,043.52 ","$2,315.72 ","$1,677.90 ","$2,013.68 ","$2,014.68 ","$2,013.68 ","$2,285.95 ","$2,977.35 ","$2,260.14 ", N/A ,"$2,613.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,381.88 ","$2,051.07 ","$2,381.88 ","$2,381.88 ","$2,646.54 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 12H 266MM RIGHT,278,1 ,"$3,226.58 ","$2,129.54 ","$1,613.29 ","$3,226.58 ", N/A ,"$1,700.73 ","$1,700.73 ", N/A ,"$1,935.95 ","$2,742.59 ","$2,258.61 ", N/A , N/A ,"$3,065.25 ","$2,452.20 ","$2,419.94 ","$1,613.29 ","$2,742.59 ", N/A ,"$1,613.29 ","$1,613.29 ","$2,258.61 ","$1,964.99 ", N/A , N/A , N/A , N/A , N/A ,"$2,742.59 ", N/A ,"$2,968.45 ","$2,258.61 ","$1,636.52 ","$1,964.02 ","$1,964.99 ","$1,964.02 ","$2,229.57 ","$2,903.92 ","$2,204.40 ", N/A ,"$2,549.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,323.14 ","$2,000.48 ","$2,323.14 ","$2,323.14 ","$2,581.26 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 12H 266MM LEFT,278,1 ,"$3,226.58 ","$2,129.54 ","$1,613.29 ","$3,226.58 ", N/A ,"$1,700.73 ","$1,700.73 ", N/A ,"$1,935.95 ","$2,742.59 ","$2,258.61 ", N/A , N/A ,"$3,065.25 ","$2,452.20 ","$2,419.94 ","$1,613.29 ","$2,742.59 ", N/A ,"$1,613.29 ","$1,613.29 ","$2,258.61 ","$1,964.99 ", N/A , N/A , N/A , N/A , N/A ,"$2,742.59 ", N/A ,"$2,968.45 ","$2,258.61 ","$1,636.52 ","$1,964.02 ","$1,964.99 ","$1,964.02 ","$2,229.57 ","$2,903.92 ","$2,204.40 ", N/A ,"$2,549.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,323.14 ","$2,000.48 ","$2,323.14 ","$2,323.14 ","$2,581.26 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 14H 301MM RIGHT,278,1 ,"$3,443.37 ","$2,272.62 ","$1,721.69 ","$3,443.37 ", N/A ,"$1,815.00 ","$1,815.00 ", N/A ,"$2,066.02 ","$2,926.86 ","$2,410.36 ", N/A , N/A ,"$3,271.20 ","$2,616.96 ","$2,582.53 ","$1,721.69 ","$2,926.86 ", N/A ,"$1,721.69 ","$1,721.69 ","$2,410.36 ","$2,097.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,926.86 ", N/A ,"$3,167.90 ","$2,410.36 ","$1,746.48 ","$2,095.98 ","$2,097.01 ","$2,095.98 ","$2,379.37 ","$3,099.03 ","$2,352.51 ", N/A ,"$2,720.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,479.23 ","$2,134.89 ","$2,479.23 ","$2,479.23 ","$2,754.70 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 14H 301MM LEFT,278,1 ,"$3,443.37 ","$2,272.62 ","$1,721.69 ","$3,443.37 ", N/A ,"$1,815.00 ","$1,815.00 ", N/A ,"$2,066.02 ","$2,926.86 ","$2,410.36 ", N/A , N/A ,"$3,271.20 ","$2,616.96 ","$2,582.53 ","$1,721.69 ","$2,926.86 ", N/A ,"$1,721.69 ","$1,721.69 ","$2,410.36 ","$2,097.01 ", N/A , N/A , N/A , N/A , N/A ,"$2,926.86 ", N/A ,"$3,167.90 ","$2,410.36 ","$1,746.48 ","$2,095.98 ","$2,097.01 ","$2,095.98 ","$2,379.37 ","$3,099.03 ","$2,352.51 ", N/A ,"$2,720.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,479.23 ","$2,134.89 ","$2,479.23 ","$2,479.23 ","$2,754.70 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 16H 336MM RIGHT,278,1 ,"$3,509.87 ","$2,316.51 ","$1,754.94 ","$3,509.87 ", N/A ,"$1,850.05 ","$1,850.05 ", N/A ,"$2,105.92 ","$2,983.39 ","$2,456.91 ", N/A , N/A ,"$3,334.38 ","$2,667.50 ","$2,632.40 ","$1,754.94 ","$2,983.39 ", N/A ,"$1,754.94 ","$1,754.94 ","$2,456.91 ","$2,137.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,983.39 ", N/A ,"$3,229.08 ","$2,456.91 ","$1,780.21 ","$2,136.46 ","$2,137.51 ","$2,136.46 ","$2,425.32 ","$3,158.88 ","$2,397.94 ", N/A ,"$2,772.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,527.11 ","$2,176.12 ","$2,527.11 ","$2,527.11 ","$2,807.90 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 16H 336MM LEFT,278,1 ,"$3,509.87 ","$2,316.51 ","$1,754.94 ","$3,509.87 ", N/A ,"$1,850.05 ","$1,850.05 ", N/A ,"$2,105.92 ","$2,983.39 ","$2,456.91 ", N/A , N/A ,"$3,334.38 ","$2,667.50 ","$2,632.40 ","$1,754.94 ","$2,983.39 ", N/A ,"$1,754.94 ","$1,754.94 ","$2,456.91 ","$2,137.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,983.39 ", N/A ,"$3,229.08 ","$2,456.91 ","$1,780.21 ","$2,136.46 ","$2,137.51 ","$2,136.46 ","$2,425.32 ","$3,158.88 ","$2,397.94 ", N/A ,"$2,772.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,527.11 ","$2,176.12 ","$2,527.11 ","$2,527.11 ","$2,807.90 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 18H 370MM RIGHT,278,1 ,"$3,738.63 ","$2,467.50 ","$1,869.32 ","$3,738.63 ", N/A ,"$1,970.63 ","$1,970.63 ", N/A ,"$2,243.18 ","$3,177.84 ","$2,617.04 ", N/A , N/A ,"$3,551.70 ","$2,841.36 ","$2,803.97 ","$1,869.32 ","$3,177.84 ", N/A ,"$1,869.32 ","$1,869.32 ","$2,617.04 ","$2,276.83 ", N/A , N/A , N/A , N/A , N/A ,"$3,177.84 ", N/A ,"$3,439.54 ","$2,617.04 ","$1,896.23 ","$2,275.70 ","$2,276.83 ","$2,275.70 ","$2,583.39 ","$3,364.77 ","$2,554.23 ", N/A ,"$2,953.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,691.81 ","$2,317.95 ","$2,691.81 ","$2,691.81 ","$2,990.90 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 18H 370MM LEFT,278,1 ,"$3,738.63 ","$2,467.50 ","$1,869.32 ","$3,738.63 ", N/A ,"$1,970.63 ","$1,970.63 ", N/A ,"$2,243.18 ","$3,177.84 ","$2,617.04 ", N/A , N/A ,"$3,551.70 ","$2,841.36 ","$2,803.97 ","$1,869.32 ","$3,177.84 ", N/A ,"$1,869.32 ","$1,869.32 ","$2,617.04 ","$2,276.83 ", N/A , N/A , N/A , N/A , N/A ,"$3,177.84 ", N/A ,"$3,439.54 ","$2,617.04 ","$1,896.23 ","$2,275.70 ","$2,276.83 ","$2,275.70 ","$2,583.39 ","$3,364.77 ","$2,554.23 ", N/A ,"$2,953.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,691.81 ","$2,317.95 ","$2,691.81 ","$2,691.81 ","$2,990.90 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 6H 159MM RIGHT,278,1 ,"$2,961.91 ","$1,954.86 ","$1,480.96 ","$2,961.91 ", N/A ,"$1,561.22 ","$1,561.22 ", N/A ,"$1,777.15 ","$2,517.62 ","$2,073.34 ", N/A , N/A ,"$2,813.81 ","$2,251.05 ","$2,221.43 ","$1,480.96 ","$2,517.62 ", N/A ,"$1,480.96 ","$1,480.96 ","$2,073.34 ","$1,803.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,517.62 ", N/A ,"$2,724.96 ","$2,073.34 ","$1,502.28 ","$1,802.91 ","$1,803.80 ","$1,802.91 ","$2,046.68 ","$2,665.72 ","$2,023.58 ", N/A ,"$2,339.91 ", N/A , N/A , N/A , N/A , N/A ,"$2,132.58 ","$1,836.38 ","$2,132.58 ","$2,132.58 ","$2,369.53 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 6H 159MM LEFT,278,1 ,"$2,961.91 ","$1,954.86 ","$1,480.96 ","$2,961.91 ", N/A ,"$1,561.22 ","$1,561.22 ", N/A ,"$1,777.15 ","$2,517.62 ","$2,073.34 ", N/A , N/A ,"$2,813.81 ","$2,251.05 ","$2,221.43 ","$1,480.96 ","$2,517.62 ", N/A ,"$1,480.96 ","$1,480.96 ","$2,073.34 ","$1,803.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,517.62 ", N/A ,"$2,724.96 ","$2,073.34 ","$1,502.28 ","$1,802.91 ","$1,803.80 ","$1,802.91 ","$2,046.68 ","$2,665.72 ","$2,023.58 ", N/A ,"$2,339.91 ", N/A , N/A , N/A , N/A , N/A ,"$2,132.58 ","$1,836.38 ","$2,132.58 ","$2,132.58 ","$2,369.53 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 8H 195MM RIGHT,278,1 ,"$3,019.10 ","$1,992.61 ","$1,509.55 ","$3,019.10 ", N/A ,"$1,591.37 ","$1,591.37 ", N/A ,"$1,811.46 ","$2,566.24 ","$2,113.37 ", N/A , N/A ,"$2,868.15 ","$2,294.52 ","$2,264.33 ","$1,509.55 ","$2,566.24 ", N/A ,"$1,509.55 ","$1,509.55 ","$2,113.37 ","$1,838.63 ", N/A , N/A , N/A , N/A , N/A ,"$2,566.24 ", N/A ,"$2,777.57 ","$2,113.37 ","$1,531.29 ","$1,837.73 ","$1,838.63 ","$1,837.73 ","$2,086.20 ","$2,717.19 ","$2,062.65 ", N/A ,"$2,385.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,173.75 ","$1,871.84 ","$2,173.75 ","$2,173.75 ","$2,415.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 4.5 VA-LCP CURVED CONDYLAR 8H 195MM LEFT,278,1 ,"$3,019.10 ","$1,992.61 ","$1,509.55 ","$3,019.10 ", N/A ,"$1,591.37 ","$1,591.37 ", N/A ,"$1,811.46 ","$2,566.24 ","$2,113.37 ", N/A , N/A ,"$2,868.15 ","$2,294.52 ","$2,264.33 ","$1,509.55 ","$2,566.24 ", N/A ,"$1,509.55 ","$1,509.55 ","$2,113.37 ","$1,838.63 ", N/A , N/A , N/A , N/A , N/A ,"$2,566.24 ", N/A ,"$2,777.57 ","$2,113.37 ","$1,531.29 ","$1,837.73 ","$1,838.63 ","$1,837.73 ","$2,086.20 ","$2,717.19 ","$2,062.65 ", N/A ,"$2,385.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,173.75 ","$1,871.84 ","$2,173.75 ","$2,173.75 ","$2,415.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES BIFURCATED 115' 35MM,278,1 ,$592.97 ,$391.36 ,$300.75 ,$592.97 , N/A , N/A , N/A , N/A ,$355.78 ,$504.02 ,$415.08 , N/A , N/A ,$563.32 ,$450.66 ,$444.73 , N/A ,$504.02 , N/A , N/A , N/A ,$415.08 ,$361.12 , N/A , N/A , N/A , N/A , N/A ,$504.02 , N/A ,$545.53 ,$415.08 ,$300.75 ,$360.94 ,$361.12 ,$360.94 ,$409.74 ,$533.67 ,$405.12 , N/A ,$468.45 , N/A , N/A , N/A , N/A , N/A ,$426.94 ,$367.64 ,$426.94 ,$426.94 ,$474.38 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES BIFURCATED 115' 30MM,278,1 ,$592.97 ,$391.36 ,$300.75 ,$592.97 , N/A , N/A , N/A , N/A ,$355.78 ,$504.02 ,$415.08 , N/A , N/A ,$563.32 ,$450.66 ,$444.73 , N/A ,$504.02 , N/A , N/A , N/A ,$415.08 ,$361.12 , N/A , N/A , N/A , N/A , N/A ,$504.02 , N/A ,$545.53 ,$415.08 ,$300.75 ,$360.94 ,$361.12 ,$360.94 ,$409.74 ,$533.67 ,$405.12 , N/A ,$468.45 , N/A , N/A , N/A , N/A , N/A ,$426.94 ,$367.64 ,$426.94 ,$426.94 ,$474.38 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES CLOVERLEAF THIN BLADE 3 HOLES/88MM,278,1 ,$609.53 ,$402.29 ,$309.15 ,$609.53 , N/A , N/A , N/A , N/A ,$365.72 ,$518.10 ,$426.67 , N/A , N/A ,$579.05 ,$463.24 ,$457.15 , N/A ,$518.10 , N/A , N/A , N/A ,$426.67 ,$371.20 , N/A , N/A , N/A , N/A , N/A ,$518.10 , N/A ,$560.77 ,$426.67 ,$309.15 ,$371.02 ,$371.20 ,$371.02 ,$421.19 ,$548.58 ,$416.43 , N/A ,$481.53 , N/A , N/A , N/A , N/A , N/A ,$438.86 ,$377.91 ,$438.86 ,$438.86 ,$487.62 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES CLOVERLEAF THIN BLADE 4 HOLES/104MM,278,1 ,$651.67 ,$430.10 ,$330.53 ,$651.67 , N/A , N/A , N/A , N/A ,$391.00 ,$553.92 ,$456.17 , N/A , N/A ,$619.09 ,$495.27 ,$488.75 , N/A ,$553.92 , N/A , N/A , N/A ,$456.17 ,$396.87 , N/A , N/A , N/A , N/A , N/A ,$553.92 , N/A ,$599.54 ,$456.17 ,$330.53 ,$396.67 ,$396.87 ,$396.67 ,$450.30 ,$586.50 ,$445.22 , N/A ,$514.82 , N/A , N/A , N/A , N/A , N/A ,$469.20 ,$404.04 ,$469.20 ,$469.20 ,$521.34 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES INFANT OSTEOTOMY 90' 42MM,278,1 ,$980.89 ,$647.39 ,$497.51 ,$980.89 , N/A , N/A , N/A , N/A ,$588.53 ,$833.76 ,$686.62 , N/A , N/A ,$931.85 ,$745.48 ,$735.67 , N/A ,$833.76 , N/A , N/A , N/A ,$686.62 ,$597.36 , N/A , N/A , N/A , N/A , N/A ,$833.76 , N/A ,$902.42 ,$686.62 ,$497.51 ,$597.07 ,$597.36 ,$597.07 ,$677.80 ,$882.80 ,$670.14 , N/A ,$774.90 , N/A , N/A , N/A , N/A , N/A ,$706.24 ,$608.15 ,$706.24 ,$706.24 ,$784.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LATERAL DISTAL FIBULA RIGHT 7H,278,1 ,"$2,097.89 ","$1,384.61 ","$1,064.05 ","$2,097.89 ", N/A ,"$1,105.80 ","$1,105.80 ", N/A ,"$1,258.73 ","$1,783.21 ","$1,468.52 ", N/A , N/A ,"$1,993.00 ","$1,594.40 ","$1,573.42 ", N/A ,"$1,783.21 ", N/A , N/A , N/A ,"$1,468.52 ","$1,277.62 ", N/A , N/A , N/A , N/A , N/A ,"$1,783.21 ", N/A ,"$1,930.06 ","$1,468.52 ","$1,064.05 ","$1,276.99 ","$1,277.62 ","$1,276.99 ","$1,449.64 ","$1,888.10 ","$1,433.28 ", N/A ,"$1,657.33 ", N/A , N/A , N/A , N/A , N/A ,"$1,510.48 ","$1,300.69 ","$1,510.48 ","$1,510.48 ","$1,678.31 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/3H SHAFT RIGHT,278,1 ,"$1,602.90 ","$1,057.91 ",$812.99 ,"$1,602.90 ", N/A ,$844.89 ,$844.89 , N/A ,$961.74 ,"$1,362.47 ","$1,122.03 ", N/A , N/A ,"$1,522.76 ","$1,218.20 ","$1,202.18 ", N/A ,"$1,362.47 ", N/A , N/A , N/A ,"$1,122.03 ",$976.17 , N/A , N/A , N/A , N/A , N/A ,"$1,362.47 ", N/A ,"$1,474.67 ","$1,122.03 ",$812.99 ,$975.69 ,$976.17 ,$975.69 ,"$1,107.60 ","$1,442.61 ","$1,095.10 ", N/A ,"$1,266.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,154.09 ",$993.80 ,"$1,154.09 ","$1,154.09 ","$1,282.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/3H SHAFT LEFT,278,1 ,"$1,602.90 ","$1,057.91 ",$812.99 ,"$1,602.90 ", N/A ,$844.89 ,$844.89 , N/A ,$961.74 ,"$1,362.47 ","$1,122.03 ", N/A , N/A ,"$1,522.76 ","$1,218.20 ","$1,202.18 ", N/A ,"$1,362.47 ", N/A , N/A , N/A ,"$1,122.03 ",$976.17 , N/A , N/A , N/A , N/A , N/A ,"$1,362.47 ", N/A ,"$1,474.67 ","$1,122.03 ",$812.99 ,$975.69 ,$976.17 ,$975.69 ,"$1,107.60 ","$1,442.61 ","$1,095.10 ", N/A ,"$1,266.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,154.09 ",$993.80 ,"$1,154.09 ","$1,154.09 ","$1,282.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/3H SHAFT RIGHT,278,1 ,"$1,602.90 ","$1,057.91 ",$812.99 ,"$1,602.90 ", N/A ,$844.89 ,$844.89 , N/A ,$961.74 ,"$1,362.47 ","$1,122.03 ", N/A , N/A ,"$1,522.76 ","$1,218.20 ","$1,202.18 ", N/A ,"$1,362.47 ", N/A , N/A , N/A ,"$1,122.03 ",$976.17 , N/A , N/A , N/A , N/A , N/A ,"$1,362.47 ", N/A ,"$1,474.67 ","$1,122.03 ",$812.99 ,$975.69 ,$976.17 ,$975.69 ,"$1,107.60 ","$1,442.61 ","$1,095.10 ", N/A ,"$1,266.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,154.09 ",$993.80 ,"$1,154.09 ","$1,154.09 ","$1,282.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/3H SHAFT LEFT,278,1 ,"$1,602.90 ","$1,057.91 ",$812.99 ,"$1,602.90 ", N/A ,$844.89 ,$844.89 , N/A ,$961.74 ,"$1,362.47 ","$1,122.03 ", N/A , N/A ,"$1,522.76 ","$1,218.20 ","$1,202.18 ", N/A ,"$1,362.47 ", N/A , N/A , N/A ,"$1,122.03 ",$976.17 , N/A , N/A , N/A , N/A , N/A ,"$1,362.47 ", N/A ,"$1,474.67 ","$1,122.03 ",$812.99 ,$975.69 ,$976.17 ,$975.69 ,"$1,107.60 ","$1,442.61 ","$1,095.10 ", N/A ,"$1,266.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,154.09 ",$993.80 ,"$1,154.09 ","$1,154.09 ","$1,282.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/4H SHAFT LEFT,278,1 ,"$1,653.12 ","$1,091.06 ",$838.46 ,"$1,653.12 ", N/A ,$871.36 ,$871.36 , N/A ,$991.87 ,"$1,405.15 ","$1,157.18 ", N/A , N/A ,"$1,570.46 ","$1,256.37 ","$1,239.84 ", N/A ,"$1,405.15 ", N/A , N/A , N/A ,"$1,157.18 ","$1,006.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,405.15 ", N/A ,"$1,520.87 ","$1,157.18 ",$838.46 ,"$1,006.25 ","$1,006.75 ","$1,006.25 ","$1,142.31 ","$1,487.81 ","$1,129.41 ", N/A ,"$1,305.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,190.25 ","$1,024.93 ","$1,190.25 ","$1,190.25 ","$1,322.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/4H SHAFT LEFT,278,1 ,"$1,653.12 ","$1,091.06 ",$838.46 ,"$1,653.12 ", N/A ,$871.36 ,$871.36 , N/A ,$991.87 ,"$1,405.15 ","$1,157.18 ", N/A , N/A ,"$1,570.46 ","$1,256.37 ","$1,239.84 ", N/A ,"$1,405.15 ", N/A , N/A , N/A ,"$1,157.18 ","$1,006.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,405.15 ", N/A ,"$1,520.87 ","$1,157.18 ",$838.46 ,"$1,006.25 ","$1,006.75 ","$1,006.25 ","$1,142.31 ","$1,487.81 ","$1,129.41 ", N/A ,"$1,305.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,190.25 ","$1,024.93 ","$1,190.25 ","$1,190.25 ","$1,322.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/4H SHAFT RIGHT,278,1 ,"$1,653.12 ","$1,091.06 ",$838.46 ,"$1,653.12 ", N/A ,$871.36 ,$871.36 , N/A ,$991.87 ,"$1,405.15 ","$1,157.18 ", N/A , N/A ,"$1,570.46 ","$1,256.37 ","$1,239.84 ", N/A ,"$1,405.15 ", N/A , N/A , N/A ,"$1,157.18 ","$1,006.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,405.15 ", N/A ,"$1,520.87 ","$1,157.18 ",$838.46 ,"$1,006.25 ","$1,006.75 ","$1,006.25 ","$1,142.31 ","$1,487.81 ","$1,129.41 ", N/A ,"$1,305.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,190.25 ","$1,024.93 ","$1,190.25 ","$1,190.25 ","$1,322.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/4H SHAFT  RIGHT,278,1 ,"$1,653.12 ","$1,091.06 ",$838.46 ,"$1,653.12 ", N/A ,$871.36 ,$871.36 , N/A ,$991.87 ,"$1,405.15 ","$1,157.18 ", N/A , N/A ,"$1,570.46 ","$1,256.37 ","$1,239.84 ", N/A ,"$1,405.15 ", N/A , N/A , N/A ,"$1,157.18 ","$1,006.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,405.15 ", N/A ,"$1,520.87 ","$1,157.18 ",$838.46 ,"$1,006.25 ","$1,006.75 ","$1,006.25 ","$1,142.31 ","$1,487.81 ","$1,129.41 ", N/A ,"$1,305.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,190.25 ","$1,024.93 ","$1,190.25 ","$1,190.25 ","$1,322.50 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/5H SHAFT RIGHT,278,1 ,"$1,701.91 ","$1,123.26 ",$863.21 ,"$1,701.91 ", N/A ,$897.08 ,$897.08 , N/A ,"$1,021.15 ","$1,446.62 ","$1,191.34 ", N/A , N/A ,"$1,616.81 ","$1,293.45 ","$1,276.43 ", N/A ,"$1,446.62 ", N/A , N/A , N/A ,"$1,191.34 ","$1,036.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,446.62 ", N/A ,"$1,565.76 ","$1,191.34 ",$863.21 ,"$1,035.95 ","$1,036.46 ","$1,035.95 ","$1,176.02 ","$1,531.72 ","$1,162.74 ", N/A ,"$1,344.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,225.38 ","$1,055.18 ","$1,225.38 ","$1,225.38 ","$1,361.53 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/5H SHAFT LEFT,278,1 ,"$1,701.91 ","$1,123.26 ",$863.21 ,"$1,701.91 ", N/A ,$897.08 ,$897.08 , N/A ,"$1,021.15 ","$1,446.62 ","$1,191.34 ", N/A , N/A ,"$1,616.81 ","$1,293.45 ","$1,276.43 ", N/A ,"$1,446.62 ", N/A , N/A , N/A ,"$1,191.34 ","$1,036.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,446.62 ", N/A ,"$1,565.76 ","$1,191.34 ",$863.21 ,"$1,035.95 ","$1,036.46 ","$1,035.95 ","$1,176.02 ","$1,531.72 ","$1,162.74 ", N/A ,"$1,344.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,225.38 ","$1,055.18 ","$1,225.38 ","$1,225.38 ","$1,361.53 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/5H SHAFT RIGHT,278,1 ,"$1,701.91 ","$1,123.26 ",$863.21 ,"$1,701.91 ", N/A ,$897.08 ,$897.08 , N/A ,"$1,021.15 ","$1,446.62 ","$1,191.34 ", N/A , N/A ,"$1,616.81 ","$1,293.45 ","$1,276.43 ", N/A ,"$1,446.62 ", N/A , N/A , N/A ,"$1,191.34 ","$1,036.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,446.62 ", N/A ,"$1,565.76 ","$1,191.34 ",$863.21 ,"$1,035.95 ","$1,036.46 ","$1,035.95 ","$1,176.02 ","$1,531.72 ","$1,162.74 ", N/A ,"$1,344.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,225.38 ","$1,055.18 ","$1,225.38 ","$1,225.38 ","$1,361.53 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/5H SHAFT LEFT,278,1 ,"$1,701.91 ","$1,123.26 ",$863.21 ,"$1,701.91 ", N/A ,$897.08 ,$897.08 , N/A ,"$1,021.15 ","$1,446.62 ","$1,191.34 ", N/A , N/A ,"$1,616.81 ","$1,293.45 ","$1,276.43 ", N/A ,"$1,446.62 ", N/A , N/A , N/A ,"$1,191.34 ","$1,036.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,446.62 ", N/A ,"$1,565.76 ","$1,191.34 ",$863.21 ,"$1,035.95 ","$1,036.46 ","$1,035.95 ","$1,176.02 ","$1,531.72 ","$1,162.74 ", N/A ,"$1,344.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,225.38 ","$1,055.18 ","$1,225.38 ","$1,225.38 ","$1,361.53 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES MINI 5 HOLE 2.0MM,278,1 ,$569.94 ,$376.16 ,$289.07 ,$569.94 , N/A , N/A , N/A , N/A ,$341.96 ,$484.45 ,$398.96 , N/A , N/A ,$541.44 ,$433.15 ,$427.46 , N/A ,$484.45 , N/A , N/A , N/A ,$398.96 ,$347.09 , N/A , N/A , N/A , N/A , N/A ,$484.45 , N/A ,$524.34 ,$398.96 ,$289.07 ,$346.92 ,$347.09 ,$346.92 ,$393.83 ,$512.95 ,$389.38 , N/A ,$450.25 , N/A , N/A , N/A , N/A , N/A ,$410.36 ,$353.36 ,$410.36 ,$410.36 ,$455.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR  WITH COLLAR 2 HOLES/25MM,278,1 ,$117.34 ,$77.44 ,$59.51 ,$117.34 , N/A , N/A , N/A , N/A ,$70.40 ,$99.74 ,$82.14 , N/A , N/A ,$111.47 ,$89.18 ,$88.01 , N/A ,$99.74 , N/A , N/A , N/A ,$82.14 ,$71.46 , N/A , N/A , N/A , N/A , N/A ,$99.74 , N/A ,$107.95 ,$82.14 ,$59.51 ,$71.42 ,$71.46 ,$71.42 ,$81.08 ,$105.61 ,$80.17 , N/A ,$92.70 , N/A , N/A , N/A , N/A , N/A ,$84.48 ,$72.75 ,$84.48 ,$84.48 ,$93.87 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR  WITH COLLAR 3 HOLES/37MM,278,1 ,$120.49 ,$79.52 ,$61.11 ,$120.49 , N/A , N/A , N/A , N/A ,$72.29 ,$102.42 ,$84.34 , N/A , N/A ,$114.47 ,$91.57 ,$90.37 , N/A ,$102.42 , N/A , N/A , N/A ,$84.34 ,$73.38 , N/A , N/A , N/A , N/A , N/A ,$102.42 , N/A ,$110.85 ,$84.34 ,$61.11 ,$73.34 ,$73.38 ,$73.34 ,$83.26 ,$108.44 ,$82.32 , N/A ,$95.19 , N/A , N/A , N/A , N/A , N/A ,$86.75 ,$74.70 ,$86.75 ,$86.75 ,$96.39 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR  WITH COLLAR 5 HOLES/61MM,278,1 ,$138.60 ,$91.48 ,$70.30 ,$138.60 , N/A , N/A , N/A , N/A ,$83.16 ,$117.81 ,$97.02 , N/A , N/A ,$131.67 ,$105.34 ,$103.95 , N/A ,$117.81 , N/A , N/A , N/A ,$97.02 ,$84.41 , N/A , N/A , N/A , N/A , N/A ,$117.81 , N/A ,$127.51 ,$97.02 ,$70.30 ,$84.37 ,$84.41 ,$84.37 ,$95.77 ,$124.74 ,$94.69 , N/A ,$109.49 , N/A , N/A , N/A , N/A , N/A ,$99.79 ,$85.93 ,$99.79 ,$99.79 ,$110.88 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR  WITH COLLAR 4 HOLES/49MM,278,1 ,$138.60 ,$91.48 ,$70.30 ,$138.60 , N/A , N/A , N/A , N/A ,$83.16 ,$117.81 ,$97.02 , N/A , N/A ,$131.67 ,$105.34 ,$103.95 , N/A ,$117.81 , N/A , N/A , N/A ,$97.02 ,$84.41 , N/A , N/A , N/A , N/A , N/A ,$117.81 , N/A ,$127.51 ,$97.02 ,$70.30 ,$84.37 ,$84.41 ,$84.37 ,$95.77 ,$124.74 ,$94.69 , N/A ,$109.49 , N/A , N/A , N/A , N/A , N/A ,$99.79 ,$85.93 ,$99.79 ,$99.79 ,$110.88 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR  WITH COLLAR 7 HOLES/85MM,278,1 ,$144.11 ,$95.11 ,$73.09 ,$144.11 , N/A , N/A , N/A , N/A ,$86.47 ,$122.49 ,$100.88 , N/A , N/A ,$136.90 ,$109.52 ,$108.08 , N/A ,$122.49 , N/A , N/A , N/A ,$100.88 ,$87.76 , N/A , N/A , N/A , N/A , N/A ,$122.49 , N/A ,$132.58 ,$100.88 ,$73.09 ,$87.72 ,$87.76 ,$87.72 ,$99.58 ,$129.70 ,$98.46 , N/A ,$113.85 , N/A , N/A , N/A , N/A , N/A ,$103.76 ,$89.35 ,$103.76 ,$103.76 ,$115.29 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR  WITH COLLAR 6 HOLES/73MM,278,1 ,$144.11 ,$95.11 ,$73.09 ,$144.11 , N/A , N/A , N/A , N/A ,$86.47 ,$122.49 ,$100.88 , N/A , N/A ,$136.90 ,$109.52 ,$108.08 , N/A ,$122.49 , N/A , N/A , N/A ,$100.88 ,$87.76 , N/A , N/A , N/A , N/A , N/A ,$122.49 , N/A ,$132.58 ,$100.88 ,$73.09 ,$87.72 ,$87.76 ,$87.72 ,$99.58 ,$129.70 ,$98.46 , N/A ,$113.85 , N/A , N/A , N/A , N/A , N/A ,$103.76 ,$89.35 ,$103.76 ,$103.76 ,$115.29 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR  WITH COLLAR 8 HOLES/97MM,278,1 ,$149.63 ,$98.76 ,$75.89 ,$149.63 , N/A , N/A , N/A , N/A ,$89.78 ,$127.19 ,$104.74 , N/A , N/A ,$142.15 ,$113.72 ,$112.22 , N/A ,$127.19 , N/A , N/A , N/A ,$104.74 ,$91.12 , N/A , N/A , N/A , N/A , N/A ,$127.19 , N/A ,$137.66 ,$104.74 ,$75.89 ,$91.08 ,$91.12 ,$91.08 ,$103.39 ,$134.67 ,$102.23 , N/A ,$118.21 , N/A , N/A , N/A , N/A , N/A ,$107.73 ,$92.77 ,$107.73 ,$107.73 ,$119.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 12 HOLE,278,1 ,$375.95 ,$248.13 ,$190.68 ,$375.95 , N/A , N/A , N/A , N/A ,$225.57 ,$319.56 ,$263.17 , N/A , N/A ,$357.15 ,$285.72 ,$281.96 , N/A ,$319.56 , N/A , N/A , N/A ,$263.17 ,$228.95 , N/A , N/A , N/A , N/A , N/A ,$319.56 , N/A ,$345.87 ,$263.17 ,$190.68 ,$228.84 ,$228.95 ,$228.84 ,$259.78 ,$338.36 ,$256.85 , N/A ,$297.00 , N/A , N/A , N/A , N/A , N/A ,$270.68 ,$233.09 ,$270.68 ,$270.68 ,$300.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 7 HOLE,278,1 ,$343.98 ,$227.03 ,$174.47 ,$343.98 , N/A , N/A , N/A , N/A ,$206.39 ,$292.38 ,$240.79 , N/A , N/A ,$326.78 ,$261.42 ,$257.99 , N/A ,$292.38 , N/A , N/A , N/A ,$240.79 ,$209.48 , N/A , N/A , N/A , N/A , N/A ,$292.38 , N/A ,$316.46 ,$240.79 ,$174.47 ,$209.38 ,$209.48 ,$209.38 ,$237.69 ,$309.58 ,$235.01 , N/A ,$271.74 , N/A , N/A , N/A , N/A , N/A ,$247.67 ,$213.27 ,$247.67 ,$247.67 ,$275.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 8 HOLE,278,1 ,$364.93 ,$240.85 ,$185.09 ,$364.93 , N/A , N/A , N/A , N/A ,$218.96 ,$310.19 ,$255.45 , N/A , N/A ,$346.68 ,$277.35 ,$273.70 , N/A ,$310.19 , N/A , N/A , N/A ,$255.45 ,$222.24 , N/A , N/A , N/A , N/A , N/A ,$310.19 , N/A ,$335.74 ,$255.45 ,$185.09 ,$222.13 ,$222.24 ,$222.13 ,$252.17 ,$328.44 ,$249.32 , N/A ,$288.29 , N/A , N/A , N/A , N/A , N/A ,$262.75 ,$226.26 ,$262.75 ,$262.75 ,$291.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 10 HOLE,278,1 ,$364.93 ,$240.85 ,$185.09 ,$364.93 , N/A , N/A , N/A , N/A ,$218.96 ,$310.19 ,$255.45 , N/A , N/A ,$346.68 ,$277.35 ,$273.70 , N/A ,$310.19 , N/A , N/A , N/A ,$255.45 ,$222.24 , N/A , N/A , N/A , N/A , N/A ,$310.19 , N/A ,$335.74 ,$255.45 ,$185.09 ,$222.13 ,$222.24 ,$222.13 ,$252.17 ,$328.44 ,$249.32 , N/A ,$288.29 , N/A , N/A , N/A , N/A , N/A ,$262.75 ,$226.26 ,$262.75 ,$262.75 ,$291.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES OSTEOTOMY INFANT 90 DEG 25MM/12MM,278,1 ,$887.95 ,$586.05 ,$450.37 ,$887.95 , N/A , N/A , N/A , N/A ,$532.77 ,$754.76 ,$621.57 , N/A , N/A ,$843.55 ,$674.84 ,$665.96 , N/A ,$754.76 , N/A , N/A , N/A ,$621.57 ,$540.76 , N/A , N/A , N/A , N/A , N/A ,$754.76 , N/A ,$816.91 ,$621.57 ,$450.37 ,$540.50 ,$540.76 ,$540.50 ,$613.57 ,$799.16 ,$606.65 , N/A ,$701.48 , N/A , N/A , N/A , N/A , N/A ,$639.32 ,$550.53 ,$639.32 ,$639.32 ,$710.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES INFANT OSTEOTMY 90' 25MM,278,1 ,$887.95 ,$586.05 ,$450.37 ,$887.95 , N/A , N/A , N/A , N/A ,$532.77 ,$754.76 ,$621.57 , N/A , N/A ,$843.55 ,$674.84 ,$665.96 , N/A ,$754.76 , N/A , N/A , N/A ,$621.57 ,$540.76 , N/A , N/A , N/A , N/A , N/A ,$754.76 , N/A ,$816.91 ,$621.57 ,$450.37 ,$540.50 ,$540.76 ,$540.50 ,$613.57 ,$799.16 ,$606.65 , N/A ,$701.48 , N/A , N/A , N/A , N/A , N/A ,$639.32 ,$550.53 ,$639.32 ,$639.32 ,$710.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES INFANT OSTEOTOMY 90' 32MM,278,1 ,$887.95 ,$586.05 ,$450.37 ,$887.95 , N/A , N/A , N/A , N/A ,$532.77 ,$754.76 ,$621.57 , N/A , N/A ,$843.55 ,$674.84 ,$665.96 , N/A ,$754.76 , N/A , N/A , N/A ,$621.57 ,$540.76 , N/A , N/A , N/A , N/A , N/A ,$754.76 , N/A ,$816.91 ,$621.57 ,$450.37 ,$540.50 ,$540.76 ,$540.50 ,$613.57 ,$799.16 ,$606.65 , N/A ,$701.48 , N/A , N/A , N/A , N/A , N/A ,$639.32 ,$550.53 ,$639.32 ,$639.32 ,$710.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES PROXIMAL FEMUR 4.5MM LCP 6H/RIGHT,278,1 ,"$2,572.22 ","$1,697.67 ","$1,286.11 ","$2,572.22 ", N/A ,"$1,355.82 ","$1,355.82 ", N/A ,"$1,543.33 ","$2,186.39 ","$1,800.55 ", N/A , N/A ,"$2,443.61 ","$1,954.89 ","$1,929.17 ","$1,286.11 ","$2,186.39 ", N/A ,"$1,286.11 ","$1,286.11 ","$1,800.55 ","$1,566.48 ", N/A , N/A , N/A , N/A , N/A ,"$2,186.39 ", N/A ,"$2,366.44 ","$1,800.55 ","$1,304.63 ","$1,565.71 ","$1,566.48 ","$1,565.71 ","$1,777.40 ","$2,315.00 ","$1,757.34 ", N/A ,"$2,032.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,852.00 ","$1,594.78 ","$1,852.00 ","$1,852.00 ","$2,057.78 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES PROXIMAL FEMUR 4.5MM LCP 6H/LEFT,278,1 ,"$2,572.22 ","$1,697.67 ","$1,286.11 ","$2,572.22 ", N/A ,"$1,355.82 ","$1,355.82 ", N/A ,"$1,543.33 ","$2,186.39 ","$1,800.55 ", N/A , N/A ,"$2,443.61 ","$1,954.89 ","$1,929.17 ","$1,286.11 ","$2,186.39 ", N/A ,"$1,286.11 ","$1,286.11 ","$1,800.55 ","$1,566.48 ", N/A , N/A , N/A , N/A , N/A ,"$2,186.39 ", N/A ,"$2,366.44 ","$1,800.55 ","$1,304.63 ","$1,565.71 ","$1,566.48 ","$1,565.71 ","$1,777.40 ","$2,315.00 ","$1,757.34 ", N/A ,"$2,032.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,852.00 ","$1,594.78 ","$1,852.00 ","$1,852.00 ","$2,057.78 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES PROXIMAL FEMUR 4.5MM LCP 8H/RIGHT,278,1 ,"$2,698.57 ","$1,781.06 ","$1,349.29 ","$2,698.57 ", N/A ,"$1,422.42 ","$1,422.42 ", N/A ,"$1,619.14 ","$2,293.78 ","$1,889.00 ", N/A , N/A ,"$2,563.64 ","$2,050.91 ","$2,023.93 ","$1,349.29 ","$2,293.78 ", N/A ,"$1,349.29 ","$1,349.29 ","$1,889.00 ","$1,643.43 ", N/A , N/A , N/A , N/A , N/A ,"$2,293.78 ", N/A ,"$2,482.68 ","$1,889.00 ","$1,368.71 ","$1,642.62 ","$1,643.43 ","$1,642.62 ","$1,864.71 ","$2,428.71 ","$1,843.66 ", N/A ,"$2,131.87 ", N/A , N/A , N/A , N/A , N/A ,"$1,942.97 ","$1,673.11 ","$1,942.97 ","$1,942.97 ","$2,158.86 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES PROXIMAL FEMUR 4.5MM LCP 8H/LEFT,278,1 ,"$2,698.57 ","$1,781.06 ","$1,349.29 ","$2,698.57 ", N/A ,"$1,422.42 ","$1,422.42 ", N/A ,"$1,619.14 ","$2,293.78 ","$1,889.00 ", N/A , N/A ,"$2,563.64 ","$2,050.91 ","$2,023.93 ","$1,349.29 ","$2,293.78 ", N/A ,"$1,349.29 ","$1,349.29 ","$1,889.00 ","$1,643.43 ", N/A , N/A , N/A , N/A , N/A ,"$2,293.78 ", N/A ,"$2,482.68 ","$1,889.00 ","$1,368.71 ","$1,642.62 ","$1,643.43 ","$1,642.62 ","$1,864.71 ","$2,428.71 ","$1,843.66 ", N/A ,"$2,131.87 ", N/A , N/A , N/A , N/A , N/A ,"$1,942.97 ","$1,673.11 ","$1,942.97 ","$1,942.97 ","$2,158.86 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TI QUARTER-TUBULAR  WITH COLLAR 5 HOLES/39MM,278,1 ,$185.85 ,$122.66 ,$94.26 ,$185.85 , N/A , N/A , N/A , N/A ,$111.51 ,$157.97 ,$130.10 , N/A , N/A ,$176.56 ,$141.25 ,$139.39 , N/A ,$157.97 , N/A , N/A , N/A ,$130.10 ,$113.18 , N/A , N/A , N/A , N/A , N/A ,$157.97 , N/A ,$170.98 ,$130.10 ,$94.26 ,$113.13 ,$113.18 ,$113.13 ,$128.42 ,$167.27 ,$126.97 , N/A ,$146.82 , N/A , N/A , N/A , N/A , N/A ,$133.81 ,$115.23 ,$133.81 ,$133.81 ,$148.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  5 HOLE 39MM,278,1 ,$185.85 ,$122.66 ,$94.26 ,$185.85 , N/A , N/A , N/A , N/A ,$111.51 ,$157.97 ,$130.10 , N/A , N/A ,$176.56 ,$141.25 ,$139.39 , N/A ,$157.97 , N/A , N/A , N/A ,$130.10 ,$113.18 , N/A , N/A , N/A , N/A , N/A ,$157.97 , N/A ,$170.98 ,$130.10 ,$94.26 ,$113.13 ,$113.18 ,$113.13 ,$128.42 ,$167.27 ,$126.97 , N/A ,$146.82 , N/A , N/A , N/A , N/A , N/A ,$133.81 ,$115.23 ,$133.81 ,$133.81 ,$148.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TI QUARTER-TUBULAR  WITH COLLAR 6 HOLES/47MM,278,1 ,$201.60 ,$133.06 ,$102.25 ,$201.60 , N/A , N/A , N/A , N/A ,$120.96 ,$171.36 ,$141.12 , N/A , N/A ,$191.52 ,$153.22 ,$151.20 , N/A ,$171.36 , N/A , N/A , N/A ,$141.12 ,$122.77 , N/A , N/A , N/A , N/A , N/A ,$171.36 , N/A ,$185.47 ,$141.12 ,$102.25 ,$122.71 ,$122.77 ,$122.71 ,$139.31 ,$181.44 ,$137.73 , N/A ,$159.26 , N/A , N/A , N/A , N/A , N/A ,$145.15 ,$124.99 ,$145.15 ,$145.15 ,$161.28 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  6 HOLE 47MM,278,1 ,$201.60 ,$133.06 ,$102.25 ,$201.60 , N/A , N/A , N/A , N/A ,$120.96 ,$171.36 ,$141.12 , N/A , N/A ,$191.52 ,$153.22 ,$151.20 , N/A ,$171.36 , N/A , N/A , N/A ,$141.12 ,$122.77 , N/A , N/A , N/A , N/A , N/A ,$171.36 , N/A ,$185.47 ,$141.12 ,$102.25 ,$122.71 ,$122.77 ,$122.71 ,$139.31 ,$181.44 ,$137.73 , N/A ,$159.26 , N/A , N/A , N/A , N/A , N/A ,$145.15 ,$124.99 ,$145.15 ,$145.15 ,$161.28 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TI QUARTER-TUBULAR WITH COLLAR 4 HOLES/31MM,278,1 ,$174.83 ,$115.39 ,$88.67 ,$174.83 , N/A , N/A , N/A , N/A ,$104.90 ,$148.61 ,$122.38 , N/A , N/A ,$166.09 ,$132.87 ,$131.12 , N/A ,$148.61 , N/A , N/A , N/A ,$122.38 ,$106.47 , N/A , N/A , N/A , N/A , N/A ,$148.61 , N/A ,$160.84 ,$122.38 ,$88.67 ,$106.42 ,$106.47 ,$106.42 ,$120.81 ,$157.35 ,$119.44 , N/A ,$138.12 , N/A , N/A , N/A , N/A , N/A ,$125.88 ,$108.39 ,$125.88 ,$125.88 ,$139.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  4 HOLE 31MM,278,1 ,$174.83 ,$115.39 ,$88.67 ,$174.83 , N/A , N/A , N/A , N/A ,$104.90 ,$148.61 ,$122.38 , N/A , N/A ,$166.09 ,$132.87 ,$131.12 , N/A ,$148.61 , N/A , N/A , N/A ,$122.38 ,$106.47 , N/A , N/A , N/A , N/A , N/A ,$148.61 , N/A ,$160.84 ,$122.38 ,$88.67 ,$106.42 ,$106.47 ,$106.42 ,$120.81 ,$157.35 ,$119.44 , N/A ,$138.12 , N/A , N/A , N/A , N/A , N/A ,$125.88 ,$108.39 ,$125.88 ,$125.88 ,$139.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TI WRIST FUSION 9 HOLES/STRAIGHT,278,1 ,"$1,923.18 ","$1,269.30 ",$975.44 ,"$1,923.18 ", N/A ,"$1,013.71 ","$1,013.71 ", N/A ,"$1,153.91 ","$1,634.70 ","$1,346.23 ", N/A , N/A ,"$1,827.02 ","$1,461.62 ","$1,442.39 ", N/A ,"$1,634.70 ", N/A , N/A , N/A ,"$1,346.23 ","$1,171.22 ", N/A , N/A , N/A , N/A , N/A ,"$1,634.70 ", N/A ,"$1,769.33 ","$1,346.23 ",$975.44 ,"$1,170.64 ","$1,171.22 ","$1,170.64 ","$1,328.92 ","$1,730.86 ","$1,313.92 ", N/A ,"$1,519.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,384.69 ","$1,192.37 ","$1,384.69 ","$1,384.69 ","$1,538.54 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TI WRIST FUSION 8 HOLES/SHORT BEND,278,1 ,"$1,923.18 ","$1,269.30 ",$975.44 ,"$1,923.18 ", N/A ,"$1,013.71 ","$1,013.71 ", N/A ,"$1,153.91 ","$1,634.70 ","$1,346.23 ", N/A , N/A ,"$1,827.02 ","$1,461.62 ","$1,442.39 ", N/A ,"$1,634.70 ", N/A , N/A , N/A ,"$1,346.23 ","$1,171.22 ", N/A , N/A , N/A , N/A , N/A ,"$1,634.70 ", N/A ,"$1,769.33 ","$1,346.23 ",$975.44 ,"$1,170.64 ","$1,171.22 ","$1,170.64 ","$1,328.92 ","$1,730.86 ","$1,313.92 ", N/A ,"$1,519.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,384.69 ","$1,192.37 ","$1,384.69 ","$1,384.69 ","$1,538.54 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TI WRIST FUSION 8 HOLES/STANDARD,278,1 ,"$1,923.18 ","$1,269.30 ",$975.44 ,"$1,923.18 ", N/A ,"$1,013.71 ","$1,013.71 ", N/A ,"$1,153.91 ","$1,634.70 ","$1,346.23 ", N/A , N/A ,"$1,827.02 ","$1,461.62 ","$1,442.39 ", N/A ,"$1,634.70 ", N/A , N/A , N/A ,"$1,346.23 ","$1,171.22 ", N/A , N/A , N/A , N/A , N/A ,"$1,634.70 ", N/A ,"$1,769.33 ","$1,346.23 ",$975.44 ,"$1,170.64 ","$1,171.22 ","$1,170.64 ","$1,328.92 ","$1,730.86 ","$1,313.92 ", N/A ,"$1,519.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,384.69 ","$1,192.37 ","$1,384.69 ","$1,384.69 ","$1,538.54 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TODDLER OSTEOTOMY 90' 38/8MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ADULT OSTEOTOMY  90D 40MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ADULT OSTEOTOMY  90D 50MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ADULT OSTEOTOMY 90D 40MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ADULT OSTEOTOMY 90D 50MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ADULT OSTEOTOMY 90D 60MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES CHILD OSTEOTOMY 100D 35MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES CHILD OSTEOTOMY 100D 45MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES CHILD OSTEOTOMY 80D 35MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES CHILD OSTEOTOMY 80D 45MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES CHILD OSTEOTOMY 90D 35MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES CHILD OSTEOTOMY 90D 45MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TODDLER OSTEOTOMY 90' 26/4MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TODDLER OSTEOTOMY 90' 26/8MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TODDLER OSTEOTOMY 90' 32/4MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TODDLER OSTEOTOMY 90' 32/8MM,278,1 ,"$1,033.94 ",$682.40 ,$524.41 ,"$1,033.94 ", N/A ,$544.99 ,$544.99 , N/A ,$620.36 ,$878.85 ,$723.76 , N/A , N/A ,$982.24 ,$785.79 ,$775.46 , N/A ,$878.85 , N/A , N/A , N/A ,$723.76 ,$629.67 , N/A , N/A , N/A , N/A , N/A ,$878.85 , N/A ,$951.22 ,$723.76 ,$524.41 ,$629.36 ,$629.67 ,$629.36 ,$714.45 ,$930.55 ,$706.39 , N/A ,$816.81 , N/A , N/A , N/A , N/A , N/A ,$744.44 ,$641.04 ,$744.44 ,$744.44 ,$827.15 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TROCHANTER STABILIZATION 148MM,278,1 ,"$1,096.34 ",$723.58 ,$556.06 ,"$1,096.34 ", N/A ,$577.88 ,$577.88 , N/A ,$657.80 ,$931.89 ,$767.44 , N/A , N/A ,"$1,041.52 ",$833.22 ,$822.26 , N/A ,$931.89 , N/A , N/A , N/A ,$767.44 ,$667.67 , N/A , N/A , N/A , N/A , N/A ,$931.89 , N/A ,"$1,008.63 ",$767.44 ,$556.06 ,$667.34 ,$667.67 ,$667.34 ,$757.57 ,$986.71 ,$749.02 , N/A ,$866.11 , N/A , N/A , N/A , N/A , N/A ,$789.36 ,$679.73 ,$789.36 ,$789.36 ,$877.07 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES TROCHANTER STABILIZATION 138MM,278,1 ,"$1,096.34 ",$723.58 ,$556.06 ,"$1,096.34 ", N/A ,$577.88 ,$577.88 , N/A ,$657.80 ,$931.89 ,$767.44 , N/A , N/A ,"$1,041.52 ",$833.22 ,$822.26 , N/A ,$931.89 , N/A , N/A , N/A ,$767.44 ,$667.67 , N/A , N/A , N/A , N/A , N/A ,$931.89 , N/A ,"$1,008.63 ",$767.44 ,$556.06 ,$667.34 ,$667.67 ,$667.34 ,$757.57 ,$986.71 ,$749.02 , N/A ,$866.11 , N/A , N/A , N/A , N/A , N/A ,$789.36 ,$679.73 ,$789.36 ,$789.36 ,$877.07 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES VECTRA ONE LEVEL 16MM,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE EAGLE DEPUY 16MM,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE EAGLE DEPUY 18MM,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES VECTRA ONE LEVEL 36MM,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE EAGLE DEPUY 32MM,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES VECTRA ONE LEVEL 34MM,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE TIBIAL FIXED BEARING ZIMMER SIZE 6,278,1 ,"$2,679.00 ","$1,768.14 ","$1,339.50 ","$2,679.00 ", N/A ,"$1,412.10 ","$1,412.10 ", N/A ,"$1,607.40 ","$2,277.15 ","$1,875.30 ", N/A , N/A ,"$2,545.05 ","$2,036.04 ","$2,009.25 ","$1,339.50 ","$2,277.15 ", N/A ,"$1,339.50 ","$1,339.50 ","$1,875.30 ","$1,631.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,277.15 ", N/A ,"$2,464.68 ","$1,875.30 ","$1,358.79 ","$1,630.71 ","$1,631.51 ","$1,630.71 ","$1,851.19 ","$2,411.10 ","$1,830.29 ", N/A ,"$2,116.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,928.88 ","$1,660.98 ","$1,928.88 ","$1,928.88 ","$2,143.20 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BASEPLATE TIBIAL STEMMED ZIMMER SIZE 5,278,1 ,"$2,679.00 ","$1,768.14 ","$1,339.50 ","$2,679.00 ", N/A ,"$1,412.10 ","$1,412.10 ", N/A ,"$1,607.40 ","$2,277.15 ","$1,875.30 ", N/A , N/A ,"$2,545.05 ","$2,036.04 ","$2,009.25 ","$1,339.50 ","$2,277.15 ", N/A ,"$1,339.50 ","$1,339.50 ","$1,875.30 ","$1,631.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,277.15 ", N/A ,"$2,464.68 ","$1,875.30 ","$1,358.79 ","$1,630.71 ","$1,631.51 ","$1,630.71 ","$1,851.19 ","$2,411.10 ","$1,830.29 ", N/A ,"$2,116.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,928.88 ","$1,660.98 ","$1,928.88 ","$1,928.88 ","$2,143.20 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE TIBIAL FIXED BEARING ZIMMER SIZE 4,278,1 ,"$2,679.00 ","$1,768.14 ","$1,339.50 ","$2,679.00 ", N/A ,"$1,412.10 ","$1,412.10 ", N/A ,"$1,607.40 ","$2,277.15 ","$1,875.30 ", N/A , N/A ,"$2,545.05 ","$2,036.04 ","$2,009.25 ","$1,339.50 ","$2,277.15 ", N/A ,"$1,339.50 ","$1,339.50 ","$1,875.30 ","$1,631.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,277.15 ", N/A ,"$2,464.68 ","$1,875.30 ","$1,358.79 ","$1,630.71 ","$1,631.51 ","$1,630.71 ","$1,851.19 ","$2,411.10 ","$1,830.29 ", N/A ,"$2,116.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,928.88 ","$1,660.98 ","$1,928.88 ","$1,928.88 ","$2,143.20 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE TIBIAL NEXGEN 3 WEDGE KNEE CEMENT PRECOAT MODULAR STEM,278,1 ,"$3,823.20 ","$2,523.31 ","$1,911.60 ","$3,823.20 ", N/A ,"$2,015.21 ","$2,015.21 ", N/A ,"$2,293.92 ","$3,249.72 ","$2,676.24 ", N/A , N/A ,"$3,632.04 ","$2,905.63 ","$2,867.40 ","$1,911.60 ","$3,249.72 ", N/A ,"$1,911.60 ","$1,911.60 ","$2,676.24 ","$2,328.33 ", N/A , N/A , N/A , N/A , N/A ,"$3,249.72 ", N/A ,"$3,517.34 ","$2,676.24 ","$1,939.13 ","$2,327.18 ","$2,328.33 ","$2,327.18 ","$2,641.83 ","$3,440.88 ","$2,612.01 ", N/A ,"$3,020.33 ", N/A , N/A , N/A , N/A , N/A ,"$2,752.70 ","$2,370.38 ","$2,752.70 ","$2,752.70 ","$3,058.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE TITANIUM 3 HALF SLOT MONARCH BONE SPINE,278,1 ,"$3,025.75 ","$1,997.00 ","$1,512.88 ","$3,025.75 ", N/A ,"$1,594.87 ","$1,594.87 ", N/A ,"$1,815.45 ","$2,571.89 ","$2,118.03 ", N/A , N/A ,"$2,874.46 ","$2,299.57 ","$2,269.31 ","$1,512.88 ","$2,571.89 ", N/A ,"$1,512.88 ","$1,512.88 ","$2,118.03 ","$1,842.68 ", N/A , N/A , N/A , N/A , N/A ,"$2,571.89 ", N/A ,"$2,783.69 ","$2,118.03 ","$1,534.66 ","$1,841.77 ","$1,842.68 ","$1,841.77 ","$2,090.79 ","$2,723.18 ","$2,067.19 ", N/A ,"$2,390.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,178.54 ","$1,875.97 ","$2,178.54 ","$2,178.54 ","$2,420.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SHORT TITANIUM 1 SLOT MONARCH BONE SPINE NONSTERILE,278,1 ,"$3,025.75 ","$1,997.00 ","$1,512.88 ","$3,025.75 ", N/A ,"$1,594.87 ","$1,594.87 ", N/A ,"$1,815.45 ","$2,571.89 ","$2,118.03 ", N/A , N/A ,"$2,874.46 ","$2,299.57 ","$2,269.31 ","$1,512.88 ","$2,571.89 ", N/A ,"$1,512.88 ","$1,512.88 ","$2,118.03 ","$1,842.68 ", N/A , N/A , N/A , N/A , N/A ,"$2,571.89 ", N/A ,"$2,783.69 ","$2,118.03 ","$1,534.66 ","$1,841.77 ","$1,842.68 ","$1,841.77 ","$2,090.79 ","$2,723.18 ","$2,067.19 ", N/A ,"$2,390.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,178.54 ","$1,875.97 ","$2,178.54 ","$2,178.54 ","$2,420.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE TITANIUM 2 HALF SLOT MONARCH BONE SPINE,278,1 ,"$3,025.75 ","$1,997.00 ","$1,512.88 ","$3,025.75 ", N/A ,"$1,594.87 ","$1,594.87 ", N/A ,"$1,815.45 ","$2,571.89 ","$2,118.03 ", N/A , N/A ,"$2,874.46 ","$2,299.57 ","$2,269.31 ","$1,512.88 ","$2,571.89 ", N/A ,"$1,512.88 ","$1,512.88 ","$2,118.03 ","$1,842.68 ", N/A , N/A , N/A , N/A , N/A ,"$2,571.89 ", N/A ,"$2,783.69 ","$2,118.03 ","$1,534.66 ","$1,841.77 ","$1,842.68 ","$1,841.77 ","$2,090.79 ","$2,723.18 ","$2,067.19 ", N/A ,"$2,390.34 ", N/A , N/A , N/A , N/A , N/A ,"$2,178.54 ","$1,875.97 ","$2,178.54 ","$2,178.54 ","$2,420.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PUTTY DBX BONE 1ML,278,1 ,$324.52 ,$214.18 ,$164.60 ,$324.52 , N/A , N/A , N/A , N/A ,$194.71 ,$275.84 ,$227.16 , N/A , N/A ,$308.29 ,$246.64 ,$243.39 , N/A ,$275.84 , N/A , N/A , N/A ,$227.16 ,$197.63 , N/A , N/A , N/A , N/A , N/A ,$275.84 , N/A ,$298.56 ,$227.16 ,$164.60 ,$197.54 ,$197.63 ,$197.54 ,$224.24 ,$292.07 ,$221.71 , N/A ,$256.37 , N/A , N/A , N/A , N/A , N/A ,$233.65 ,$201.20 ,$233.65 ,$233.65 ,$259.62 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PUTTY DBX BONE 5ML,278,1 ,"$1,169.71 ",$772.01 ,$593.28 ,"$1,169.71 ", N/A ,$616.55 ,$616.55 , N/A ,$701.83 ,$994.25 ,$818.80 , N/A , N/A ,"$1,111.22 ",$888.98 ,$877.28 , N/A ,$994.25 , N/A , N/A , N/A ,$818.80 ,$712.35 , N/A , N/A , N/A , N/A , N/A ,$994.25 , N/A ,"$1,076.13 ",$818.80 ,$593.28 ,$712.00 ,$712.35 ,$712.00 ,$808.27 ,"$1,052.74 ",$799.15 , N/A ,$924.07 , N/A , N/A , N/A , N/A , N/A ,$842.19 ,$725.22 ,$842.19 ,$842.19 ,$935.77 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,RING SYNTHES 3/4 115MM,278,1 ,$889.46 ,$587.04 ,$451.13 ,$889.46 , N/A , N/A , N/A , N/A ,$533.68 ,$756.04 ,$622.62 , N/A , N/A ,$844.99 ,$675.99 ,$667.10 , N/A ,$756.04 , N/A , N/A , N/A ,$622.62 ,$541.68 , N/A , N/A , N/A , N/A , N/A ,$756.04 , N/A ,$818.30 ,$622.62 ,$451.13 ,$541.41 ,$541.68 ,$541.41 ,$614.62 ,$800.51 ,$607.68 , N/A ,$702.67 , N/A , N/A , N/A , N/A , N/A ,$640.41 ,$551.47 ,$640.41 ,$640.41 ,$711.57 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 9H,278,1 ,$889.46 ,$587.04 ,$451.13 ,$889.46 , N/A , N/A , N/A , N/A ,$533.68 ,$756.04 ,$622.62 , N/A , N/A ,$844.99 ,$675.99 ,$667.10 , N/A ,$756.04 , N/A , N/A , N/A ,$622.62 ,$541.68 , N/A , N/A , N/A , N/A , N/A ,$756.04 , N/A ,$818.30 ,$622.62 ,$451.13 ,$541.41 ,$541.68 ,$541.41 ,$614.62 ,$800.51 ,$607.68 , N/A ,$702.67 , N/A , N/A , N/A , N/A , N/A ,$640.41 ,$551.47 ,$640.41 ,$640.41 ,$711.57 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,RING SYNTHES 3/4 140MM,278,1 ,$972.23 ,$641.67 ,$493.12 ,$972.23 , N/A , N/A , N/A , N/A ,$583.34 ,$826.40 ,$680.56 , N/A , N/A ,$923.62 ,$738.89 ,$729.17 , N/A ,$826.40 , N/A , N/A , N/A ,$680.56 ,$592.09 , N/A , N/A , N/A , N/A , N/A ,$826.40 , N/A ,$894.45 ,$680.56 ,$493.12 ,$591.80 ,$592.09 ,$591.80 ,$671.81 ,$875.01 ,$664.23 , N/A ,$768.06 , N/A , N/A , N/A , N/A , N/A ,$700.01 ,$602.78 ,$700.01 ,$700.01 ,$777.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,RING SYNTHES 3/4 165MM,278,1 ,"$1,020.39 ",$673.46 ,$517.54 ,"$1,020.39 ", N/A ,$537.85 ,$537.85 , N/A ,$612.23 ,$867.33 ,$714.27 , N/A , N/A ,$969.37 ,$775.50 ,$765.29 , N/A ,$867.33 , N/A , N/A , N/A ,$714.27 ,$621.42 , N/A , N/A , N/A , N/A , N/A ,$867.33 , N/A ,$938.76 ,$714.27 ,$517.54 ,$621.11 ,$621.42 ,$621.11 ,$705.09 ,$918.35 ,$697.13 , N/A ,$806.11 , N/A , N/A , N/A , N/A , N/A ,$734.68 ,$632.64 ,$734.68 ,$734.68 ,$816.31 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,RING SYNTHES 3/4 205MM,278,1 ,"$1,152.31 ",$760.52 ,$584.45 ,"$1,152.31 ", N/A ,$607.38 ,$607.38 , N/A ,$691.39 ,$979.46 ,$806.62 , N/A , N/A ,"$1,094.69 ",$875.76 ,$864.23 , N/A ,$979.46 , N/A , N/A , N/A ,$806.62 ,$701.76 , N/A , N/A , N/A , N/A , N/A ,$979.46 , N/A ,"$1,060.13 ",$806.62 ,$584.45 ,$701.41 ,$701.76 ,$701.41 ,$796.25 ,"$1,037.08 ",$787.26 , N/A ,$910.32 , N/A , N/A , N/A , N/A , N/A ,$829.66 ,$714.43 ,$829.66 ,$829.66 ,$921.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 RECONST STRAIGHT 18H,278,1 ,"$1,152.31 ",$760.52 ,$584.45 ,"$1,152.31 ", N/A ,$607.38 ,$607.38 , N/A ,$691.39 ,$979.46 ,$806.62 , N/A , N/A ,"$1,094.69 ",$875.76 ,$864.23 , N/A ,$979.46 , N/A , N/A , N/A ,$806.62 ,$701.76 , N/A , N/A , N/A , N/A , N/A ,$979.46 , N/A ,"$1,060.13 ",$806.62 ,$584.45 ,$701.41 ,$701.76 ,$701.41 ,$796.25 ,"$1,037.08 ",$787.26 , N/A ,$910.32 , N/A , N/A , N/A , N/A , N/A ,$829.66 ,$714.43 ,$829.66 ,$829.66 ,$921.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ROD SYNTHES 11.0 CARBON FIBER CAP,278,1 ,$6.82 ,$4.50 ,$3.46 ,$6.82 , N/A , N/A , N/A , N/A ,$4.09 ,$5.80 ,$4.77 , N/A , N/A ,$6.48 ,$5.18 ,$5.12 , N/A ,$5.80 , N/A , N/A , N/A ,$4.77 ,$4.15 , N/A , N/A , N/A , N/A , N/A ,$5.80 , N/A ,$6.27 ,$4.77 ,$3.46 ,$4.15 ,$4.15 ,$4.15 ,$4.71 ,$6.14 ,$4.66 , N/A ,$5.39 , N/A , N/A , N/A , N/A , N/A ,$4.91 ,$4.23 ,$4.91 ,$4.91 ,$5.46 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX BIO-INTERFERENCE 9 X 23MM,278,1 ,$319.50 ,$210.87 ,$162.05 ,$319.50 , N/A , N/A , N/A , N/A ,$191.70 ,$271.58 ,$223.65 , N/A , N/A ,$303.53 ,$242.82 ,$239.63 , N/A ,$271.58 , N/A , N/A , N/A ,$223.65 ,$194.58 , N/A , N/A , N/A , N/A , N/A ,$271.58 , N/A ,$293.94 ,$223.65 ,$162.05 ,$194.48 ,$194.58 ,$194.48 ,$220.77 ,$287.55 ,$218.28 , N/A ,$252.41 , N/A , N/A , N/A , N/A , N/A ,$230.04 ,$198.09 ,$230.04 ,$230.04 ,$255.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 1.5MM 5MM DRILL-FREE TITANIUM MICRO MANDIBLE SELF RETAINING CROSS DRIVE GOLD,278,1 ,$103.50 ,$68.31 ,$52.50 ,$103.50 , N/A , N/A , N/A , N/A ,$62.10 ,$87.98 ,$72.45 , N/A , N/A ,$98.33 ,$78.66 ,$77.63 , N/A ,$87.98 , N/A , N/A , N/A ,$72.45 ,$63.03 , N/A , N/A , N/A , N/A , N/A ,$87.98 , N/A ,$95.22 ,$72.45 ,$52.50 ,$63.00 ,$63.03 ,$63.00 ,$71.52 ,$93.15 ,$70.71 , N/A ,$81.77 , N/A , N/A , N/A , N/A , N/A ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 1.5MM 4MM DRILL-FREE TITANIUM MICRO MANDIBLE SELF RETAIN CROSS DRIVE GOLD,278,1 ,$103.50 ,$68.31 ,$52.50 ,$103.50 , N/A , N/A , N/A , N/A ,$62.10 ,$87.98 ,$72.45 , N/A , N/A ,$98.33 ,$78.66 ,$77.63 , N/A ,$87.98 , N/A , N/A , N/A ,$72.45 ,$63.03 , N/A , N/A , N/A , N/A , N/A ,$87.98 , N/A ,$95.22 ,$72.45 ,$52.50 ,$63.00 ,$63.03 ,$63.00 ,$71.52 ,$93.15 ,$70.71 , N/A ,$81.77 , N/A , N/A , N/A , N/A , N/A ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 2.4MM 18MM LOW PROFILE SCREWS TITANIUM SELF TAP LOCK VARIABLE ANGLE SOLID ACCEPTS .034IN GUIDEWIRE COMPREHENSIVE FOOT SYSTEM,278,1 ,$315.00 ,$207.90 ,$159.77 ,$315.00 , N/A , N/A , N/A , N/A ,$189.00 ,$267.75 ,$220.50 , N/A , N/A ,$299.25 ,$239.40 ,$236.25 , N/A ,$267.75 , N/A , N/A , N/A ,$220.50 ,$191.84 , N/A , N/A , N/A , N/A , N/A ,$267.75 , N/A ,$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$191.74 ,$217.67 ,$283.50 ,$215.21 , N/A ,$248.85 , N/A , N/A , N/A , N/A , N/A ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$252.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 2.4MM 16MM LOW PROFILE SCREW TITANIUM SELF TAP LOCK VARIABLE ANGLE SOLID ACCEPTS .034IN GUIDEWIRE COMPREHENSIVE FOOT SYSTEM,278,1 ,$315.00 ,$207.90 ,$159.77 ,$315.00 , N/A , N/A , N/A , N/A ,$189.00 ,$267.75 ,$220.50 , N/A , N/A ,$299.25 ,$239.40 ,$236.25 , N/A ,$267.75 , N/A , N/A , N/A ,$220.50 ,$191.84 , N/A , N/A , N/A , N/A , N/A ,$267.75 , N/A ,$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$191.74 ,$217.67 ,$283.50 ,$215.21 , N/A ,$248.85 , N/A , N/A , N/A , N/A , N/A ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$252.00 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$233.06 ,$459.50 , N/A , N/A , N/A , N/A ,$275.70 ,$390.58 ,$321.65 , N/A , N/A ,$436.53 ,$349.22 ,$344.63 , N/A ,$390.58 , N/A , N/A , N/A ,$321.65 ,$279.84 , N/A , N/A , N/A , N/A , N/A ,$390.58 , N/A ,$422.74 ,$321.65 ,$233.06 ,$279.70 ,$279.84 ,$279.70 ,$317.51 ,$413.55 ,$313.93 , N/A ,$363.01 , N/A , N/A , N/A , N/A , N/A ,$330.84 ,$284.89 ,$330.84 ,$330.84 ,$367.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 36MM,278,1 ,$459.50 ,$303.27 ,$233.06 ,$459.50 , N/A , N/A , N/A , N/A ,$275.70 ,$390.58 ,$321.65 , N/A , N/A ,$436.53 ,$349.22 ,$344.63 , N/A ,$390.58 , N/A , N/A , N/A ,$321.65 ,$279.84 , N/A , N/A , N/A , N/A , N/A ,$390.58 , N/A ,$422.74 ,$321.65 ,$233.06 ,$279.70 ,$279.84 ,$279.70 ,$317.51 ,$413.55 ,$313.93 , N/A ,$363.01 , N/A , N/A , N/A , N/A , N/A ,$330.84 ,$284.89 ,$330.84 ,$330.84 ,$367.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 46MM,278,1 ,$459.50 ,$303.27 ,$233.06 ,$459.50 , N/A , N/A , N/A , N/A ,$275.70 ,$390.58 ,$321.65 , N/A , N/A ,$436.53 ,$349.22 ,$344.63 , N/A ,$390.58 , N/A , N/A , N/A ,$321.65 ,$279.84 , N/A , N/A , N/A , N/A , N/A ,$390.58 , N/A ,$422.74 ,$321.65 ,$233.06 ,$279.70 ,$279.84 ,$279.70 ,$317.51 ,$413.55 ,$313.93 , N/A ,$363.01 , N/A , N/A , N/A , N/A , N/A ,$330.84 ,$284.89 ,$330.84 ,$330.84 ,$367.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 40MM GROSSE-KEMPF TIBIA CORTICAL TRANSVERSE INTRAMEDULLARY NAIL,278,1 ,$267.12 ,$176.30 ,$135.48 ,$267.12 , N/A , N/A , N/A , N/A ,$160.27 ,$227.05 ,$186.98 , N/A , N/A ,$253.76 ,$203.01 ,$200.34 , N/A ,$227.05 , N/A , N/A , N/A ,$186.98 ,$162.68 , N/A , N/A , N/A , N/A , N/A ,$227.05 , N/A ,$245.75 ,$186.98 ,$135.48 ,$162.60 ,$162.68 ,$162.60 ,$184.58 ,$240.41 ,$182.50 , N/A ,$211.02 , N/A , N/A , N/A , N/A , N/A ,$192.33 ,$165.61 ,$192.33 ,$192.33 ,$213.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 90MM OPTILINK T25 SELF TAP VARIABLE ANGLE STARDRIVE LOCK,278,1 ,$432.19 ,$285.25 ,$219.21 ,$432.19 , N/A , N/A , N/A , N/A ,$259.31 ,$367.36 ,$302.53 , N/A , N/A ,$410.58 ,$328.46 ,$324.14 , N/A ,$367.36 , N/A , N/A , N/A ,$302.53 ,$263.20 , N/A , N/A , N/A , N/A , N/A ,$367.36 , N/A ,$397.61 ,$302.53 ,$219.21 ,$263.07 ,$263.20 ,$263.07 ,$298.64 ,$388.97 ,$295.27 , N/A ,$341.43 , N/A , N/A , N/A , N/A , N/A ,$311.18 ,$267.96 ,$311.18 ,$311.18 ,$345.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 34MM STAINLESS STEEL T25 SELF TAP VARIABLE ANGLE STARDRIVE LOCK GOLDEN,278,1 ,$432.19 ,$285.25 ,$219.21 ,$432.19 , N/A , N/A , N/A , N/A ,$259.31 ,$367.36 ,$302.53 , N/A , N/A ,$410.58 ,$328.46 ,$324.14 , N/A ,$367.36 , N/A , N/A , N/A ,$302.53 ,$263.20 , N/A , N/A , N/A , N/A , N/A ,$367.36 , N/A ,$397.61 ,$302.53 ,$219.21 ,$263.07 ,$263.20 ,$263.07 ,$298.64 ,$388.97 ,$295.27 , N/A ,$341.43 , N/A , N/A , N/A , N/A , N/A ,$311.18 ,$267.96 ,$311.18 ,$311.18 ,$345.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 36MM STAINLESS STEEL T25 SELF TAP VARIABLE ANGLE STARDRIVE LOCK GOLDEN,278,1 ,$432.19 ,$285.25 ,$219.21 ,$432.19 , N/A , N/A , N/A , N/A ,$259.31 ,$367.36 ,$302.53 , N/A , N/A ,$410.58 ,$328.46 ,$324.14 , N/A ,$367.36 , N/A , N/A , N/A ,$302.53 ,$263.20 , N/A , N/A , N/A , N/A , N/A ,$367.36 , N/A ,$397.61 ,$302.53 ,$219.21 ,$263.07 ,$263.20 ,$263.07 ,$298.64 ,$388.97 ,$295.27 , N/A ,$341.43 , N/A , N/A , N/A , N/A , N/A ,$311.18 ,$267.96 ,$311.18 ,$311.18 ,$345.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 40MM STAINLESS STEEL T25 SELF TAP VARIABLE ANGLE STARDRIVE LOCK GOLDEN,278,1 ,$432.19 ,$285.25 ,$219.21 ,$432.19 , N/A , N/A , N/A , N/A ,$259.31 ,$367.36 ,$302.53 , N/A , N/A ,$410.58 ,$328.46 ,$324.14 , N/A ,$367.36 , N/A , N/A , N/A ,$302.53 ,$263.20 , N/A , N/A , N/A , N/A , N/A ,$367.36 , N/A ,$397.61 ,$302.53 ,$219.21 ,$263.07 ,$263.20 ,$263.07 ,$298.64 ,$388.97 ,$295.27 , N/A ,$341.43 , N/A , N/A , N/A , N/A , N/A ,$311.18 ,$267.96 ,$311.18 ,$311.18 ,$345.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 42MM STAINLESS STEEL T25 SELF TAP VARIABLE ANGLE STARDRIVE LOCK GOLDEN,278,1 ,$432.19 ,$285.25 ,$219.21 ,$432.19 , N/A , N/A , N/A , N/A ,$259.31 ,$367.36 ,$302.53 , N/A , N/A ,$410.58 ,$328.46 ,$324.14 , N/A ,$367.36 , N/A , N/A , N/A ,$302.53 ,$263.20 , N/A , N/A , N/A , N/A , N/A ,$367.36 , N/A ,$397.61 ,$302.53 ,$219.21 ,$263.07 ,$263.20 ,$263.07 ,$298.64 ,$388.97 ,$295.27 , N/A ,$341.43 , N/A , N/A , N/A , N/A , N/A ,$311.18 ,$267.96 ,$311.18 ,$311.18 ,$345.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 44MM OPTILINK T25 SELF TAP VARIABLE ANGLE STARDRIVE LOCK,278,1 ,$432.19 ,$285.25 ,$219.21 ,$432.19 , N/A , N/A , N/A , N/A ,$259.31 ,$367.36 ,$302.53 , N/A , N/A ,$410.58 ,$328.46 ,$324.14 , N/A ,$367.36 , N/A , N/A , N/A ,$302.53 ,$263.20 , N/A , N/A , N/A , N/A , N/A ,$367.36 , N/A ,$397.61 ,$302.53 ,$219.21 ,$263.07 ,$263.20 ,$263.07 ,$298.64 ,$388.97 ,$295.27 , N/A ,$341.43 , N/A , N/A , N/A , N/A , N/A ,$311.18 ,$267.96 ,$311.18 ,$311.18 ,$345.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 46MM OPTILINK T25 SELF TAP VARIABLE ANGLE STARDRIVE LOCK,278,1 ,$432.19 ,$285.25 ,$219.21 ,$432.19 , N/A , N/A , N/A , N/A ,$259.31 ,$367.36 ,$302.53 , N/A , N/A ,$410.58 ,$328.46 ,$324.14 , N/A ,$367.36 , N/A , N/A , N/A ,$302.53 ,$263.20 , N/A , N/A , N/A , N/A , N/A ,$367.36 , N/A ,$397.61 ,$302.53 ,$219.21 ,$263.07 ,$263.20 ,$263.07 ,$298.64 ,$388.97 ,$295.27 , N/A ,$341.43 , N/A , N/A , N/A , N/A , N/A ,$311.18 ,$267.96 ,$311.18 ,$311.18 ,$345.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 70MM OPTILINK SELF TAP VARIABLE ANGLE STARDRIVE,278,1 ,$432.19 ,$285.25 ,$219.21 ,$432.19 , N/A , N/A , N/A , N/A ,$259.31 ,$367.36 ,$302.53 , N/A , N/A ,$410.58 ,$328.46 ,$324.14 , N/A ,$367.36 , N/A , N/A , N/A ,$302.53 ,$263.20 , N/A , N/A , N/A , N/A , N/A ,$367.36 , N/A ,$397.61 ,$302.53 ,$219.21 ,$263.07 ,$263.20 ,$263.07 ,$298.64 ,$388.97 ,$295.27 , N/A ,$341.43 , N/A , N/A , N/A , N/A , N/A ,$311.18 ,$267.96 ,$311.18 ,$311.18 ,$345.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 5MM 85MM OPTILINK T25 SELF TAP VARIABLE ANGLE STARDRIVE LOCK,278,1 ,$432.19 ,$285.25 ,$219.21 ,$432.19 , N/A , N/A , N/A , N/A ,$259.31 ,$367.36 ,$302.53 , N/A , N/A ,$410.58 ,$328.46 ,$324.14 , N/A ,$367.36 , N/A , N/A , N/A ,$302.53 ,$263.20 , N/A , N/A , N/A , N/A , N/A ,$367.36 , N/A ,$397.61 ,$302.53 ,$219.21 ,$263.07 ,$263.20 ,$263.07 ,$298.64 ,$388.97 ,$295.27 , N/A ,$341.43 , N/A , N/A , N/A , N/A , N/A ,$311.18 ,$267.96 ,$311.18 ,$311.18 ,$345.75 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 6.5MM 35MM TITANIUM ACL PCL CANCELLOUS DEPTH MARK STEP DRILL GROOVE LOW PROFILE STERILE,278,1 ,$200.25 ,$132.17 ,$101.57 ,$200.25 , N/A , N/A , N/A , N/A ,$120.15 ,$170.21 ,$140.18 , N/A , N/A ,$190.24 ,$152.19 ,$150.19 , N/A ,$170.21 , N/A , N/A , N/A ,$140.18 ,$121.95 , N/A , N/A , N/A , N/A , N/A ,$170.21 , N/A ,$184.23 ,$140.18 ,$101.57 ,$121.89 ,$121.95 ,$121.89 ,$138.37 ,$180.23 ,$136.81 , N/A ,$158.20 , N/A , N/A , N/A , N/A , N/A ,$144.18 ,$124.16 ,$144.18 ,$144.18 ,$160.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX  LOW PROFILE 6.5 X 30MM CANCELLOUS (AR-1356),278,1 ,$200.25 ,$132.17 ,$101.57 ,$200.25 , N/A , N/A , N/A , N/A ,$120.15 ,$170.21 ,$140.18 , N/A , N/A ,$190.24 ,$152.19 ,$150.19 , N/A ,$170.21 , N/A , N/A , N/A ,$140.18 ,$121.95 , N/A , N/A , N/A , N/A , N/A ,$170.21 , N/A ,$184.23 ,$140.18 ,$101.57 ,$121.89 ,$121.95 ,$121.89 ,$138.37 ,$180.23 ,$136.81 , N/A ,$158.20 , N/A , N/A , N/A , N/A , N/A ,$144.18 ,$124.16 ,$144.18 ,$144.18 ,$160.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW CANCELLOUS SMITH  AND  NEPHEW 6.5 X 25,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 22MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 24MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 26MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 28MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 30MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 32MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 34MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 36MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 38MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 40MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 42MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 44MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 46MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 48MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 50MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 52MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 54MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 56MM,278,1 ,$299.25 ,$197.51 ,$151.78 ,$299.25 , N/A , N/A , N/A , N/A ,$179.55 ,$254.36 ,$209.48 , N/A , N/A ,$284.29 ,$227.43 ,$224.44 , N/A ,$254.36 , N/A , N/A , N/A ,$209.48 ,$182.24 , N/A , N/A , N/A , N/A , N/A ,$254.36 , N/A ,$275.31 ,$209.48 ,$151.78 ,$182.15 ,$182.24 ,$182.15 ,$206.78 ,$269.33 ,$204.45 , N/A ,$236.41 , N/A , N/A , N/A , N/A , N/A ,$215.46 ,$185.54 ,$215.46 ,$215.46 ,$239.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW CANNULATED ARTHREX 2.5 X 13MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 2 FULL THREAD BIO-CORKSCREW FIBERWIRE POLY L LACTIC ACID 14.7MM STERILE DISPOSABLE,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX MICRO COMPRESSION 2.5MMx24MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX MINI COMPRESSION 3.5MMx22MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX MINI COMPRESSION 3.5MMx24MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX MINI COMPRESSION 3.5MMx26MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX MINI COMPRESSION 3.5MMx28MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX MINI COMPRESSION 3.5MMx30MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX MINI COMPRESSION 3.5MMx32MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX MINI COMPRESSION 3.5MMx34MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 9MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX MINI COMPRESSION 18MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX MINI COMPRESSION 20MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 3.5MM 12MM COMPRESSION FT TITANIUM MINI FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 3.5MM 14MM COMPRESSION FT TITANIUM MINI FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 3.5MM 16MM COMPRESSION FT TITANIUM MINI FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 16MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 18MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 20MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 22MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 24MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 26MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 28MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 30MM TITANIUM STANDARD FULL THREAD CANNULATED COMPRESSION VARIABLE STEP PITCH,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 32MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 34MM TITANIUM STANDARD FULL THREAD FOOT HAND ANKLE ELBOW WRIST CANNULATED COMPRESSION VARIABLE STEP PITCH,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 36MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 38MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 40MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 42MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 44MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 46MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 48MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 4MM 50MM COMPRESSION FT TITANIUM STANDARD FULL THREAD COMPRESSION SELF TAP CANNULATED HEX,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 10MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 11MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 12MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 14MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 16MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 18MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 20MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 22MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 24MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 26MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 28MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 2.5MM TI CANN SELF TAP FULL TH 8MM,278,1 ,$634.25 ,$418.61 ,$321.69 ,$634.25 , N/A , N/A , N/A , N/A ,$380.55 ,$539.11 ,$443.98 , N/A , N/A ,$602.54 ,$482.03 ,$475.69 , N/A ,$539.11 , N/A , N/A , N/A ,$443.98 ,$386.26 , N/A , N/A , N/A , N/A , N/A ,$539.11 , N/A ,$583.51 ,$443.98 ,$321.69 ,$386.07 ,$386.26 ,$386.07 ,$438.27 ,$570.83 ,$433.32 , N/A ,$501.06 , N/A , N/A , N/A , N/A , N/A ,$456.66 ,$393.24 ,$456.66 ,$456.66 ,$507.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW COVER CONICAL,278,1 ,$374.63 ,$247.26 ,$190.01 ,$374.63 , N/A , N/A , N/A , N/A ,$224.78 ,$318.44 ,$262.24 , N/A , N/A ,$355.90 ,$284.72 ,$280.97 , N/A ,$318.44 , N/A , N/A , N/A ,$262.24 ,$228.15 , N/A , N/A , N/A , N/A , N/A ,$318.44 , N/A ,$344.66 ,$262.24 ,$190.01 ,$228.04 ,$228.15 ,$228.04 ,$258.87 ,$337.17 ,$255.95 , N/A ,$295.96 , N/A , N/A , N/A , N/A , N/A ,$269.73 ,$232.27 ,$269.73 ,$269.73 ,$299.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY EXPEDIUM POLYAXIAL 7 X 55MM,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY EXPEDIUM POLYAXIAL 5 X 45MM,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY EXPEDIUM POLYAXIAL 6 X 30MM,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY EXPEDIUM POLYAXIAL 6 X 40MM,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY EXPEDIUM POLYAXIAL 6 X 45MM,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY EXPEDIUM POLYAXIAL 6 X 50MM,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY EXPEDIUM POLYAXIAL 7 X 40MM,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY EXPEDIUM POLYAXIAL 7 X 45MM,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY EXPEDIUM POLYAXIAL 7 X 50MM,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY PINNACLE CANCELLOUS 6.5 X 40MM,278,1 ,$284.63 ,$187.86 ,$144.36 ,$284.63 , N/A , N/A , N/A , N/A ,$170.78 ,$241.94 ,$199.24 , N/A , N/A ,$270.40 ,$216.32 ,$213.47 , N/A ,$241.94 , N/A , N/A , N/A ,$199.24 ,$173.34 , N/A , N/A , N/A , N/A , N/A ,$241.94 , N/A ,$261.86 ,$199.24 ,$144.36 ,$173.25 ,$173.34 ,$173.25 ,$196.68 ,$256.17 ,$194.46 , N/A ,$224.86 , N/A , N/A , N/A , N/A , N/A ,$204.93 ,$176.47 ,$204.93 ,$204.93 ,$227.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY SET EXPEDIUM SINGLE INNER,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 SCHANZ 200,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER 6.5 SELF TAP 25MM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER BONE 15MM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER BONE 20MM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER BONE 30MM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER BONE 35MM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER BONE 40MM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER BONE 50MM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WASHER ARTHREX SPIKED 18MM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WASHER SPINAL MONARCH TITANIUM POLYAXIAL,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW EXTERNAL FIXATION 80MM 4MM SCHANZ STAINLESS STEEL SPADE POINT LARGE EXTERNAL FIXATOR NONSTERILE,278,1 ,$181.13 ,$119.55 ,$91.87 ,$181.13 , N/A , N/A , N/A , N/A ,$108.68 ,$153.96 ,$126.79 , N/A , N/A ,$172.07 ,$137.66 ,$135.85 , N/A ,$153.96 , N/A , N/A , N/A ,$126.79 ,$110.31 , N/A , N/A , N/A , N/A , N/A ,$153.96 , N/A ,$166.64 ,$126.79 ,$91.87 ,$110.25 ,$110.31 ,$110.25 ,$125.16 ,$163.02 ,$123.75 , N/A ,$143.09 , N/A , N/A , N/A , N/A , N/A ,$130.41 ,$112.30 ,$130.41 ,$130.41 ,$144.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW EXTERNAL FIXATION 80MM 4MM 3MM SCHANZ STAINLESS STEEL TROCAR POINT MR CONDITIONAL 20MM LARGE EXTERNAL FIXATOR NONSTERILE,278,1 ,$181.13 ,$119.55 ,$91.87 ,$181.13 , N/A , N/A , N/A , N/A ,$108.68 ,$153.96 ,$126.79 , N/A , N/A ,$172.07 ,$137.66 ,$135.85 , N/A ,$153.96 , N/A , N/A , N/A ,$126.79 ,$110.31 , N/A , N/A , N/A , N/A , N/A ,$153.96 , N/A ,$166.64 ,$126.79 ,$91.87 ,$110.25 ,$110.31 ,$110.25 ,$125.16 ,$163.02 ,$123.75 , N/A ,$143.09 , N/A , N/A , N/A , N/A , N/A ,$130.41 ,$112.30 ,$130.41 ,$130.41 ,$144.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW FIXED LOCKING BIOMET 4.75 X 30MM,278,1 ,$157.50 ,$103.95 ,$79.88 ,$157.50 , N/A , N/A , N/A , N/A ,$94.50 ,$133.88 ,$110.25 , N/A , N/A ,$149.63 ,$119.70 ,$118.13 , N/A ,$133.88 , N/A , N/A , N/A ,$110.25 ,$95.92 , N/A , N/A , N/A , N/A , N/A ,$133.88 , N/A ,$144.90 ,$110.25 ,$79.88 ,$95.87 ,$95.92 ,$95.87 ,$108.83 ,$141.75 ,$107.60 , N/A ,$124.43 , N/A , N/A , N/A , N/A , N/A ,$113.40 ,$97.65 ,$113.40 ,$113.40 ,$126.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER 4.75 TI HEX HEAD REVERSE SHOULDER 15MM,278,1 ,$157.50 ,$103.95 ,$79.88 ,$157.50 , N/A , N/A , N/A , N/A ,$94.50 ,$133.88 ,$110.25 , N/A , N/A ,$149.63 ,$119.70 ,$118.13 , N/A ,$133.88 , N/A , N/A , N/A ,$110.25 ,$95.92 , N/A , N/A , N/A , N/A , N/A ,$133.88 , N/A ,$144.90 ,$110.25 ,$79.88 ,$95.87 ,$95.92 ,$95.87 ,$108.83 ,$141.75 ,$107.60 , N/A ,$124.43 , N/A , N/A , N/A , N/A , N/A ,$113.40 ,$97.65 ,$113.40 ,$113.40 ,$126.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER 4.75 TI HEX REVERSE SHOULDER 25MM,278,1 ,$157.50 ,$103.95 ,$79.88 ,$157.50 , N/A , N/A , N/A , N/A ,$94.50 ,$133.88 ,$110.25 , N/A , N/A ,$149.63 ,$119.70 ,$118.13 , N/A ,$133.88 , N/A , N/A , N/A ,$110.25 ,$95.92 , N/A , N/A , N/A , N/A , N/A ,$133.88 , N/A ,$144.90 ,$110.25 ,$79.88 ,$95.87 ,$95.92 ,$95.87 ,$108.83 ,$141.75 ,$107.60 , N/A ,$124.43 , N/A , N/A , N/A , N/A , N/A ,$113.40 ,$97.65 ,$113.40 ,$113.40 ,$126.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW HEADLESS MIS ZIMMER 48MM,278,1 ,$180.00 ,$118.80 ,$91.30 ,$180.00 , N/A , N/A , N/A , N/A ,$108.00 ,$153.00 ,$126.00 , N/A , N/A ,$171.00 ,$136.80 ,$135.00 , N/A ,$153.00 , N/A , N/A , N/A ,$126.00 ,$109.62 , N/A , N/A , N/A , N/A , N/A ,$153.00 , N/A ,$165.60 ,$126.00 ,$91.30 ,$109.57 ,$109.62 ,$109.57 ,$124.38 ,$162.00 ,$122.98 , N/A ,$142.20 , N/A , N/A , N/A , N/A , N/A ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW HEADED ZIMMER 48MM,278,1 ,$180.00 ,$118.80 ,$91.30 ,$180.00 , N/A , N/A , N/A , N/A ,$108.00 ,$153.00 ,$126.00 , N/A , N/A ,$171.00 ,$136.80 ,$135.00 , N/A ,$153.00 , N/A , N/A , N/A ,$126.00 ,$109.62 , N/A , N/A , N/A , N/A , N/A ,$153.00 , N/A ,$165.60 ,$126.00 ,$91.30 ,$109.57 ,$109.62 ,$109.57 ,$124.38 ,$162.00 ,$122.98 , N/A ,$142.20 , N/A , N/A , N/A , N/A , N/A ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW HEADLESS WRIGHT MEDICAL 3.0 X 40MM,278,1 ,$554.70 ,$366.10 ,$281.34 ,$554.70 , N/A , N/A , N/A , N/A ,$332.82 ,$471.50 ,$388.29 , N/A , N/A ,$526.97 ,$421.57 ,$416.03 , N/A ,$471.50 , N/A , N/A , N/A ,$388.29 ,$337.81 , N/A , N/A , N/A , N/A , N/A ,$471.50 , N/A ,$510.32 ,$388.29 ,$281.34 ,$337.65 ,$337.81 ,$337.65 ,$383.30 ,$499.23 ,$378.97 , N/A ,$438.21 , N/A , N/A , N/A , N/A , N/A ,$399.38 ,$343.91 ,$399.38 ,$399.38 ,$443.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW HEADLESS WRIGHT MEDICAL 3.0 X 36MM,278,1 ,$554.70 ,$366.10 ,$281.34 ,$554.70 , N/A , N/A , N/A , N/A ,$332.82 ,$471.50 ,$388.29 , N/A , N/A ,$526.97 ,$421.57 ,$416.03 , N/A ,$471.50 , N/A , N/A , N/A ,$388.29 ,$337.81 , N/A , N/A , N/A , N/A , N/A ,$471.50 , N/A ,$510.32 ,$388.29 ,$281.34 ,$337.65 ,$337.81 ,$337.65 ,$383.30 ,$499.23 ,$378.97 , N/A ,$438.21 , N/A , N/A , N/A , N/A , N/A ,$399.38 ,$343.91 ,$399.38 ,$399.38 ,$443.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INTERFERENCE BIOCOMPOSITE 10MM 4MM DISPOSABLE DRIVER PACK TENODESIS SCREW,278,1 ,$870.75 ,$574.70 ,$441.64 ,$870.75 , N/A , N/A , N/A , N/A ,$522.45 ,$740.14 ,$609.53 , N/A , N/A ,$827.21 ,$661.77 ,$653.06 , N/A ,$740.14 , N/A , N/A , N/A ,$609.53 ,$530.29 , N/A , N/A , N/A , N/A , N/A ,$740.14 , N/A ,$801.09 ,$609.53 ,$441.64 ,$530.03 ,$530.29 ,$530.03 ,$601.69 ,$783.68 ,$594.90 , N/A ,$687.89 , N/A , N/A , N/A , N/A , N/A ,$626.94 ,$539.87 ,$626.94 ,$626.94 ,$696.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INTERFERENCE BIOCOMPOSITE 28MM 9MM DELTA TAPER SHOULDER STERILE,278,1 ,$505.25 ,$333.47 ,$256.26 ,$505.25 , N/A , N/A , N/A , N/A ,$303.15 ,$429.46 ,$353.68 , N/A , N/A ,$479.99 ,$383.99 ,$378.94 , N/A ,$429.46 , N/A , N/A , N/A ,$353.68 ,$307.70 , N/A , N/A , N/A , N/A , N/A ,$429.46 , N/A ,$464.83 ,$353.68 ,$256.26 ,$307.55 ,$307.70 ,$307.55 ,$349.13 ,$454.73 ,$345.19 , N/A ,$399.15 , N/A , N/A , N/A , N/A , N/A ,$363.78 ,$313.26 ,$363.78 ,$363.78 ,$404.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 27D 2-0 RAPIDLOC PANACRYL MENISCUS NEEDLE PDS PLA STERILE DISPOSABLE,278,1 ,$505.25 ,$333.47 ,$256.26 ,$505.25 , N/A , N/A , N/A , N/A ,$303.15 ,$429.46 ,$353.68 , N/A , N/A ,$479.99 ,$383.99 ,$378.94 , N/A ,$429.46 , N/A , N/A , N/A ,$353.68 ,$307.70 , N/A , N/A , N/A , N/A , N/A ,$429.46 , N/A ,$464.83 ,$353.68 ,$256.26 ,$307.55 ,$307.70 ,$307.55 ,$349.13 ,$454.73 ,$345.19 , N/A ,$399.15 , N/A , N/A , N/A , N/A , N/A ,$363.78 ,$313.26 ,$363.78 ,$363.78 ,$404.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX BIOCOMPOSITE BIOTENODESIS TAPER TIP 6 X 23,278,1 ,$505.25 ,$333.47 ,$256.26 ,$505.25 , N/A , N/A , N/A , N/A ,$303.15 ,$429.46 ,$353.68 , N/A , N/A ,$479.99 ,$383.99 ,$378.94 , N/A ,$429.46 , N/A , N/A , N/A ,$353.68 ,$307.70 , N/A , N/A , N/A , N/A , N/A ,$429.46 , N/A ,$464.83 ,$353.68 ,$256.26 ,$307.55 ,$307.70 ,$307.55 ,$349.13 ,$454.73 ,$345.19 , N/A ,$399.15 , N/A , N/A , N/A , N/A , N/A ,$363.78 ,$313.26 ,$363.78 ,$363.78 ,$404.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIO COMPOSITE 8MM X 23MM,278,1 ,$505.25 ,$333.47 ,$256.26 ,$505.25 , N/A , N/A , N/A , N/A ,$303.15 ,$429.46 ,$353.68 , N/A , N/A ,$479.99 ,$383.99 ,$378.94 , N/A ,$429.46 , N/A , N/A , N/A ,$353.68 ,$307.70 , N/A , N/A , N/A , N/A , N/A ,$429.46 , N/A ,$464.83 ,$353.68 ,$256.26 ,$307.55 ,$307.70 ,$307.55 ,$349.13 ,$454.73 ,$345.19 , N/A ,$399.15 , N/A , N/A , N/A , N/A , N/A ,$363.78 ,$313.26 ,$363.78 ,$363.78 ,$404.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIO-COMPRESSION ARTHREX 10X35MM,278,1 ,$505.25 ,$333.47 ,$256.26 ,$505.25 , N/A , N/A , N/A , N/A ,$303.15 ,$429.46 ,$353.68 , N/A , N/A ,$479.99 ,$383.99 ,$378.94 , N/A ,$429.46 , N/A , N/A , N/A ,$353.68 ,$307.70 , N/A , N/A , N/A , N/A , N/A ,$429.46 , N/A ,$464.83 ,$353.68 ,$256.26 ,$307.55 ,$307.70 ,$307.55 ,$349.13 ,$454.73 ,$345.19 , N/A ,$399.15 , N/A , N/A , N/A , N/A , N/A ,$363.78 ,$313.26 ,$363.78 ,$363.78 ,$404.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INTERFERENCE BIOCOMPOSITE 28MM 8MM DELTA TAPER SHOULDER STERILE,278,1 ,$505.25 ,$333.47 ,$256.26 ,$505.25 , N/A , N/A , N/A , N/A ,$303.15 ,$429.46 ,$353.68 , N/A , N/A ,$479.99 ,$383.99 ,$378.94 , N/A ,$429.46 , N/A , N/A , N/A ,$353.68 ,$307.70 , N/A , N/A , N/A , N/A , N/A ,$429.46 , N/A ,$464.83 ,$353.68 ,$256.26 ,$307.55 ,$307.70 ,$307.55 ,$349.13 ,$454.73 ,$345.19 , N/A ,$399.15 , N/A , N/A , N/A , N/A , N/A ,$363.78 ,$313.26 ,$363.78 ,$363.78 ,$404.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SYSTEM FIXATION 37CM CAPSURE STRAIGHT PEEK STAINLESS STEEL 15 FASTENER PERMANENT HANDLE LARGE PORE MESH HERNIA REPAIR STERILE DISPOSABLE,278,1 ,$505.25 ,$333.47 ,$256.26 ,$505.25 , N/A , N/A , N/A , N/A ,$303.15 ,$429.46 ,$353.68 , N/A , N/A ,$479.99 ,$383.99 ,$378.94 , N/A ,$429.46 , N/A , N/A , N/A ,$353.68 ,$307.70 , N/A , N/A , N/A , N/A , N/A ,$429.46 , N/A ,$464.83 ,$353.68 ,$256.26 ,$307.55 ,$307.70 ,$307.55 ,$349.13 ,$454.73 ,$345.19 , N/A ,$399.15 , N/A , N/A , N/A , N/A , N/A ,$363.78 ,$313.26 ,$363.78 ,$363.78 ,$404.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INTERFERENCE POLY L LACTIC ACID 35MM 8.5-10MM DELTA TAPER ACL CANNULATED STERILE,278,1 ,$436.50 ,$288.09 ,$221.39 ,$436.50 , N/A , N/A , N/A , N/A ,$261.90 ,$371.03 ,$305.55 , N/A , N/A ,$414.68 ,$331.74 ,$327.38 , N/A ,$371.03 , N/A , N/A , N/A ,$305.55 ,$265.83 , N/A , N/A , N/A , N/A , N/A ,$371.03 , N/A ,$401.58 ,$305.55 ,$221.39 ,$265.70 ,$265.83 ,$265.70 ,$301.62 ,$392.85 ,$298.22 , N/A ,$344.84 , N/A , N/A , N/A , N/A , N/A ,$314.28 ,$270.63 ,$314.28 ,$314.28 ,$349.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIO-INTERFERENCE ARTHREX ROUND DELTA TAPERED 10 X 28MM,278,1 ,$436.50 ,$288.09 ,$221.39 ,$436.50 , N/A , N/A , N/A , N/A ,$261.90 ,$371.03 ,$305.55 , N/A , N/A ,$414.68 ,$331.74 ,$327.38 , N/A ,$371.03 , N/A , N/A , N/A ,$305.55 ,$265.83 , N/A , N/A , N/A , N/A , N/A ,$371.03 , N/A ,$401.58 ,$305.55 ,$221.39 ,$265.70 ,$265.83 ,$265.70 ,$301.62 ,$392.85 ,$298.22 , N/A ,$344.84 , N/A , N/A , N/A , N/A , N/A ,$314.28 ,$270.63 ,$314.28 ,$314.28 ,$349.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INTERFERENCE POLY L LACTIC ACID 28MM 6.5MM 8MM DELTA TAPER ACL BIO-INTERFERENCE STERILE,278,1 ,$436.50 ,$288.09 ,$221.39 ,$436.50 , N/A , N/A , N/A , N/A ,$261.90 ,$371.03 ,$305.55 , N/A , N/A ,$414.68 ,$331.74 ,$327.38 , N/A ,$371.03 , N/A , N/A , N/A ,$305.55 ,$265.83 , N/A , N/A , N/A , N/A , N/A ,$371.03 , N/A ,$401.58 ,$305.55 ,$221.39 ,$265.70 ,$265.83 ,$265.70 ,$301.62 ,$392.85 ,$298.22 , N/A ,$344.84 , N/A , N/A , N/A , N/A , N/A ,$314.28 ,$270.63 ,$314.28 ,$314.28 ,$349.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INTERFERENCE POLY L LACTIC ACID 28MM 7.5MM 9MM DELTA TAPER ACL BIO-INTERFERENCE STERILE,278,1 ,$436.50 ,$288.09 ,$221.39 ,$436.50 , N/A , N/A , N/A , N/A ,$261.90 ,$371.03 ,$305.55 , N/A , N/A ,$414.68 ,$331.74 ,$327.38 , N/A ,$371.03 , N/A , N/A , N/A ,$305.55 ,$265.83 , N/A , N/A , N/A , N/A , N/A ,$371.03 , N/A ,$401.58 ,$305.55 ,$221.39 ,$265.70 ,$265.83 ,$265.70 ,$301.62 ,$392.85 ,$298.22 , N/A ,$344.84 , N/A , N/A , N/A , N/A , N/A ,$314.28 ,$270.63 ,$314.28 ,$314.28 ,$349.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INTERFERENCE POLY L LACTIC ACID 35MM 7.5-9MM DELTA TAPER ACL CANNULATED STERILE,278,1 ,$436.50 ,$288.09 ,$221.39 ,$436.50 , N/A , N/A , N/A , N/A ,$261.90 ,$371.03 ,$305.55 , N/A , N/A ,$414.68 ,$331.74 ,$327.38 , N/A ,$371.03 , N/A , N/A , N/A ,$305.55 ,$265.83 , N/A , N/A , N/A , N/A , N/A ,$371.03 , N/A ,$401.58 ,$305.55 ,$221.39 ,$265.70 ,$265.83 ,$265.70 ,$301.62 ,$392.85 ,$298.22 , N/A ,$344.84 , N/A , N/A , N/A , N/A , N/A ,$314.28 ,$270.63 ,$314.28 ,$314.28 ,$349.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INTFR BIOCMPS 23MM 7MM TENODESIS STER,278,1 ,$741.75 ,$489.56 ,$376.22 ,$741.75 , N/A , N/A , N/A , N/A ,$445.05 ,$630.49 ,$519.23 , N/A , N/A ,$704.66 ,$563.73 ,$556.31 , N/A ,$630.49 , N/A , N/A , N/A ,$519.23 ,$451.73 , N/A , N/A , N/A , N/A , N/A ,$630.49 , N/A ,$682.41 ,$519.23 ,$376.22 ,$451.50 ,$451.73 ,$451.50 ,$512.55 ,$667.58 ,$506.76 , N/A ,$585.98 , N/A , N/A , N/A , N/A , N/A ,$534.06 ,$459.89 ,$534.06 ,$534.06 ,$593.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX INTFR BIOCMPS 23MM 8MM ACL TENODESIS STER,278,1 ,$741.75 ,$489.56 ,$376.22 ,$741.75 , N/A , N/A , N/A , N/A ,$445.05 ,$630.49 ,$519.23 , N/A , N/A ,$704.66 ,$563.73 ,$556.31 , N/A ,$630.49 , N/A , N/A , N/A ,$519.23 ,$451.73 , N/A , N/A , N/A , N/A , N/A ,$630.49 , N/A ,$682.41 ,$519.23 ,$376.22 ,$451.50 ,$451.73 ,$451.50 ,$512.55 ,$667.58 ,$506.76 , N/A ,$585.98 , N/A , N/A , N/A , N/A , N/A ,$534.06 ,$459.89 ,$534.06 ,$534.06 ,$593.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INVERSE/REVERSE ZIMMER 4.5 X 42MM,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX LOW PROFILE T15 HEXALOBE 3.5MMx26MM,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX TI LOW PROFILE 3.5 X 20,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX TI LOW PROFILE 3.5 X 28,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE COMPREHENSIVE TITANIUM 3.5 MM L20 MM OD4.75 MM LO,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE COMPREHENSIVE TITANIUM 3.5 MM L25 MM OD4.75 MM VA,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE COMPREHENSIVE TITANIUM 3.5 MM L25 MM OD6.5 MM CEN,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INVERSE/REVERSE ZIMMER 4.5 X 33MM,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER 6.5MM TI REVERSE SHOULDER 30MM,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 115MM,278,1 ,"$1,159.01 ",$764.95 ,$587.85 ,"$1,159.01 ", N/A ,$610.91 ,$610.91 , N/A ,$695.41 ,$985.16 ,$811.31 , N/A , N/A ,"$1,101.06 ",$880.85 ,$869.26 , N/A ,$985.16 , N/A , N/A , N/A ,$811.31 ,$705.84 , N/A , N/A , N/A , N/A , N/A ,$985.16 , N/A ,"$1,066.29 ",$811.31 ,$587.85 ,$705.49 ,$705.84 ,$705.49 ,$800.88 ,"$1,043.11 ",$791.84 , N/A ,$915.62 , N/A , N/A , N/A , N/A , N/A ,$834.49 ,$718.59 ,$834.49 ,$834.49 ,$927.21 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 95MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 100MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 105MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 110MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 120MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 70MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 75MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 80MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 85MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LAG CHS SMITH  AND  NEPHEW 90MM,278,1 ,$798.14 ,$526.77 ,$404.82 ,$798.14 , N/A , N/A , N/A , N/A ,$478.88 ,$678.42 ,$558.70 , N/A , N/A ,$758.23 ,$606.59 ,$598.61 , N/A ,$678.42 , N/A , N/A , N/A ,$558.70 ,$486.07 , N/A , N/A , N/A , N/A , N/A ,$678.42 , N/A ,$734.29 ,$558.70 ,$404.82 ,$485.83 ,$486.07 ,$485.83 ,$551.51 ,$718.33 ,$545.29 , N/A ,$630.53 , N/A , N/A , N/A , N/A , N/A ,$574.66 ,$494.85 ,$574.66 ,$574.66 ,$638.51 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LOCKING 3.5MM X 24MM WRIGHT MEDICAL,278,1 ,$445.05 ,$293.73 ,$225.73 ,$445.05 , N/A , N/A , N/A , N/A ,$267.03 ,$378.29 ,$311.54 , N/A , N/A ,$422.80 ,$338.24 ,$333.79 , N/A ,$378.29 , N/A , N/A , N/A ,$311.54 ,$271.04 , N/A , N/A , N/A , N/A , N/A ,$378.29 , N/A ,$409.45 ,$311.54 ,$225.73 ,$270.90 ,$271.04 ,$270.90 ,$307.53 ,$400.55 ,$304.06 , N/A ,$351.59 , N/A , N/A , N/A , N/A , N/A ,$320.44 ,$275.93 ,$320.44 ,$320.44 ,$356.04 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LOCKING 3.5MM X 16MM WRIGHT MEDICAL,278,1 ,$445.05 ,$293.73 ,$225.73 ,$445.05 , N/A , N/A , N/A , N/A ,$267.03 ,$378.29 ,$311.54 , N/A , N/A ,$422.80 ,$338.24 ,$333.79 , N/A ,$378.29 , N/A , N/A , N/A ,$311.54 ,$271.04 , N/A , N/A , N/A , N/A , N/A ,$378.29 , N/A ,$409.45 ,$311.54 ,$225.73 ,$270.90 ,$271.04 ,$270.90 ,$307.53 ,$400.55 ,$304.06 , N/A ,$351.59 , N/A , N/A , N/A , N/A , N/A ,$320.44 ,$275.93 ,$320.44 ,$320.44 ,$356.04 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LOCKING ARTHREX 3.5 X 24MM,278,1 ,$191.25 ,$126.23 ,$97.00 ,$191.25 , N/A , N/A , N/A , N/A ,$114.75 ,$162.56 ,$133.88 , N/A , N/A ,$181.69 ,$145.35 ,$143.44 , N/A ,$162.56 , N/A , N/A , N/A ,$133.88 ,$116.47 , N/A , N/A , N/A , N/A , N/A ,$162.56 , N/A ,$175.95 ,$133.88 ,$97.00 ,$116.41 ,$116.47 ,$116.41 ,$132.15 ,$172.13 ,$130.66 , N/A ,$151.09 , N/A , N/A , N/A , N/A , N/A ,$137.70 ,$118.58 ,$137.70 ,$137.70 ,$153.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX LOW PROFILE HEXALOBE LOCK 3.5MMx16MM,278,1 ,$191.25 ,$126.23 ,$97.00 ,$191.25 , N/A , N/A , N/A , N/A ,$114.75 ,$162.56 ,$133.88 , N/A , N/A ,$181.69 ,$145.35 ,$143.44 , N/A ,$162.56 , N/A , N/A , N/A ,$133.88 ,$116.47 , N/A , N/A , N/A , N/A , N/A ,$162.56 , N/A ,$175.95 ,$133.88 ,$97.00 ,$116.41 ,$116.47 ,$116.41 ,$132.15 ,$172.13 ,$130.66 , N/A ,$151.09 , N/A , N/A , N/A , N/A , N/A ,$137.70 ,$118.58 ,$137.70 ,$137.70 ,$153.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX LOW PROFILE HEXALOBE LOCK 3.5MMx18MM,278,1 ,$191.25 ,$126.23 ,$97.00 ,$191.25 , N/A , N/A , N/A , N/A ,$114.75 ,$162.56 ,$133.88 , N/A , N/A ,$181.69 ,$145.35 ,$143.44 , N/A ,$162.56 , N/A , N/A , N/A ,$133.88 ,$116.47 , N/A , N/A , N/A , N/A , N/A ,$162.56 , N/A ,$175.95 ,$133.88 ,$97.00 ,$116.41 ,$116.47 ,$116.41 ,$132.15 ,$172.13 ,$130.66 , N/A ,$151.09 , N/A , N/A , N/A , N/A , N/A ,$137.70 ,$118.58 ,$137.70 ,$137.70 ,$153.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX LOW PROFILE HEXALOBE LOCK 3.5MMx20MM,278,1 ,$191.25 ,$126.23 ,$97.00 ,$191.25 , N/A , N/A , N/A , N/A ,$114.75 ,$162.56 ,$133.88 , N/A , N/A ,$181.69 ,$145.35 ,$143.44 , N/A ,$162.56 , N/A , N/A , N/A ,$133.88 ,$116.47 , N/A , N/A , N/A , N/A , N/A ,$162.56 , N/A ,$175.95 ,$133.88 ,$97.00 ,$116.41 ,$116.47 ,$116.41 ,$132.15 ,$172.13 ,$130.66 , N/A ,$151.09 , N/A , N/A , N/A , N/A , N/A ,$137.70 ,$118.58 ,$137.70 ,$137.70 ,$153.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LOCKING TITANIUM SYNTHES 3.0 X 14MM,278,1 ,$258.75 ,$170.78 ,$131.24 ,$258.75 , N/A , N/A , N/A , N/A ,$155.25 ,$219.94 ,$181.13 , N/A , N/A ,$245.81 ,$196.65 ,$194.06 , N/A ,$219.94 , N/A , N/A , N/A ,$181.13 ,$157.58 , N/A , N/A , N/A , N/A , N/A ,$219.94 , N/A ,$238.05 ,$181.13 ,$131.24 ,$157.50 ,$157.58 ,$157.50 ,$178.80 ,$232.88 ,$176.78 , N/A ,$204.41 , N/A , N/A , N/A , N/A , N/A ,$186.30 ,$160.43 ,$186.30 ,$186.30 ,$207.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW INTERFERENCE CANNULATED ARTHREX 8 X 20MM,278,1 ,$258.75 ,$170.78 ,$131.24 ,$258.75 , N/A , N/A , N/A , N/A ,$155.25 ,$219.94 ,$181.13 , N/A , N/A ,$245.81 ,$196.65 ,$194.06 , N/A ,$219.94 , N/A , N/A , N/A ,$181.13 ,$157.58 , N/A , N/A , N/A , N/A , N/A ,$219.94 , N/A ,$238.05 ,$181.13 ,$131.24 ,$157.50 ,$157.58 ,$157.50 ,$178.80 ,$232.88 ,$176.78 , N/A ,$204.41 , N/A , N/A , N/A , N/A , N/A ,$186.30 ,$160.43 ,$186.30 ,$186.30 ,$207.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LOCKING TITANIUM SYNTHES 3 X 14MM,278,1 ,$258.75 ,$170.78 ,$131.24 ,$258.75 , N/A , N/A , N/A , N/A ,$155.25 ,$219.94 ,$181.13 , N/A , N/A ,$245.81 ,$196.65 ,$194.06 , N/A ,$219.94 , N/A , N/A , N/A ,$181.13 ,$157.58 , N/A , N/A , N/A , N/A , N/A ,$219.94 , N/A ,$238.05 ,$181.13 ,$131.24 ,$157.50 ,$157.58 ,$157.50 ,$178.80 ,$232.88 ,$176.78 , N/A ,$204.41 , N/A , N/A , N/A , N/A , N/A ,$186.30 ,$160.43 ,$186.30 ,$186.30 ,$207.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LOCKING TITANIUM SYNTHES 3.0 X 12MM,278,1 ,$258.75 ,$170.78 ,$131.24 ,$258.75 , N/A , N/A , N/A , N/A ,$155.25 ,$219.94 ,$181.13 , N/A , N/A ,$245.81 ,$196.65 ,$194.06 , N/A ,$219.94 , N/A , N/A , N/A ,$181.13 ,$157.58 , N/A , N/A , N/A , N/A , N/A ,$219.94 , N/A ,$238.05 ,$181.13 ,$131.24 ,$157.50 ,$157.58 ,$157.50 ,$178.80 ,$232.88 ,$176.78 , N/A ,$204.41 , N/A , N/A , N/A , N/A , N/A ,$186.30 ,$160.43 ,$186.30 ,$186.30 ,$207.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW MUC WRIGHT MEDICAL 3.0MM X 34MM,278,1 ,$546.10 ,$360.43 ,$276.98 ,$546.10 , N/A , N/A , N/A , N/A ,$327.66 ,$464.19 ,$382.27 , N/A , N/A ,$518.80 ,$415.04 ,$409.58 , N/A ,$464.19 , N/A , N/A , N/A ,$382.27 ,$332.57 , N/A , N/A , N/A , N/A , N/A ,$464.19 , N/A ,$502.41 ,$382.27 ,$276.98 ,$332.41 ,$332.57 ,$332.41 ,$377.36 ,$491.49 ,$373.10 , N/A ,$431.42 , N/A , N/A , N/A , N/A , N/A ,$393.19 ,$338.58 ,$393.19 ,$393.19 ,$436.88 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW MUC WRIGHT MEDICAL 3.0MM X 28MM,278,1 ,$546.10 ,$360.43 ,$276.98 ,$546.10 , N/A , N/A , N/A , N/A ,$327.66 ,$464.19 ,$382.27 , N/A , N/A ,$518.80 ,$415.04 ,$409.58 , N/A ,$464.19 , N/A , N/A , N/A ,$382.27 ,$332.57 , N/A , N/A , N/A , N/A , N/A ,$464.19 , N/A ,$502.41 ,$382.27 ,$276.98 ,$332.41 ,$332.57 ,$332.41 ,$377.36 ,$491.49 ,$373.10 , N/A ,$431.42 , N/A , N/A , N/A , N/A , N/A ,$393.19 ,$338.58 ,$393.19 ,$393.19 ,$436.88 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW MUC WRIGHT MEDICAL 4.3 X 34MM,278,1 ,$655.75 ,$432.80 ,$332.60 ,$655.75 , N/A , N/A , N/A , N/A ,$393.45 ,$557.39 ,$459.03 , N/A , N/A ,$622.96 ,$498.37 ,$491.81 , N/A ,$557.39 , N/A , N/A , N/A ,$459.03 ,$399.35 , N/A , N/A , N/A , N/A , N/A ,$557.39 , N/A ,$603.29 ,$459.03 ,$332.60 ,$399.16 ,$399.35 ,$399.16 ,$453.12 ,$590.18 ,$448.01 , N/A ,$518.04 , N/A , N/A , N/A , N/A , N/A ,$472.14 ,$406.57 ,$472.14 ,$472.14 ,$524.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW MUC WRIGHT MEDICAL 4.3 X 30MM,278,1 ,$655.75 ,$432.80 ,$332.60 ,$655.75 , N/A , N/A , N/A , N/A ,$393.45 ,$557.39 ,$459.03 , N/A , N/A ,$622.96 ,$498.37 ,$491.81 , N/A ,$557.39 , N/A , N/A , N/A ,$459.03 ,$399.35 , N/A , N/A , N/A , N/A , N/A ,$557.39 , N/A ,$603.29 ,$459.03 ,$332.60 ,$399.16 ,$399.35 ,$399.16 ,$453.12 ,$590.18 ,$448.01 , N/A ,$518.04 , N/A , N/A , N/A , N/A , N/A ,$472.14 ,$406.57 ,$472.14 ,$472.14 ,$524.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW NON-LOCKING STRYKER 3.0 X 20MM,278,1 ,$389.97 ,$257.38 ,$197.79 ,$389.97 , N/A , N/A , N/A , N/A ,$233.98 ,$331.47 ,$272.98 , N/A , N/A ,$370.47 ,$296.38 ,$292.48 , N/A ,$331.47 , N/A , N/A , N/A ,$272.98 ,$237.49 , N/A , N/A , N/A , N/A , N/A ,$331.47 , N/A ,$358.77 ,$272.98 ,$197.79 ,$237.37 ,$237.49 ,$237.37 ,$269.47 ,$350.97 ,$266.43 , N/A ,$308.08 , N/A , N/A , N/A , N/A , N/A ,$280.78 ,$241.78 ,$280.78 ,$280.78 ,$311.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW NON-LOCKING STRYKER 3.0 X 16MM,278,1 ,$389.97 ,$257.38 ,$197.79 ,$389.97 , N/A , N/A , N/A , N/A ,$233.98 ,$331.47 ,$272.98 , N/A , N/A ,$370.47 ,$296.38 ,$292.48 , N/A ,$331.47 , N/A , N/A , N/A ,$272.98 ,$237.49 , N/A , N/A , N/A , N/A , N/A ,$331.47 , N/A ,$358.77 ,$272.98 ,$197.79 ,$237.37 ,$237.49 ,$237.37 ,$269.47 ,$350.97 ,$266.43 , N/A ,$308.08 , N/A , N/A , N/A , N/A , N/A ,$280.78 ,$241.78 ,$280.78 ,$280.78 ,$311.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED  2.4MM TI CANN HPS 20MM,278,1 ,$591.25 ,$390.23 ,$299.88 ,$591.25 , N/A , N/A , N/A , N/A ,$354.75 ,$502.56 ,$413.88 , N/A , N/A ,$561.69 ,$449.35 ,$443.44 , N/A ,$502.56 , N/A , N/A , N/A ,$413.88 ,$360.07 , N/A , N/A , N/A , N/A , N/A ,$502.56 , N/A ,$543.95 ,$413.88 ,$299.88 ,$359.89 ,$360.07 ,$359.89 ,$408.55 ,$532.13 ,$403.94 , N/A ,$467.09 , N/A , N/A , N/A , N/A , N/A ,$425.70 ,$366.58 ,$425.70 ,$425.70 ,$473.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 2MM 42MM OSTEOMED TITANIUM CANCELLOUS CANNULATED NONSTERILE,278,1 ,$591.25 ,$390.23 ,$299.88 ,$591.25 , N/A , N/A , N/A , N/A ,$354.75 ,$502.56 ,$413.88 , N/A , N/A ,$561.69 ,$449.35 ,$443.44 , N/A ,$502.56 , N/A , N/A , N/A ,$413.88 ,$360.07 , N/A , N/A , N/A , N/A , N/A ,$502.56 , N/A ,$543.95 ,$413.88 ,$299.88 ,$359.89 ,$360.07 ,$359.89 ,$408.55 ,$532.13 ,$403.94 , N/A ,$467.09 , N/A , N/A , N/A , N/A , N/A ,$425.70 ,$366.58 ,$425.70 ,$425.70 ,$473.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 14MM,278,1 ,$348.75 ,$230.18 ,$176.89 ,$348.75 , N/A , N/A , N/A , N/A ,$209.25 ,$296.44 ,$244.13 , N/A , N/A ,$331.31 ,$265.05 ,$261.56 , N/A ,$296.44 , N/A , N/A , N/A ,$244.13 ,$212.39 , N/A , N/A , N/A , N/A , N/A ,$296.44 , N/A ,$320.85 ,$244.13 ,$176.89 ,$212.28 ,$212.39 ,$212.28 ,$240.99 ,$313.88 ,$238.27 , N/A ,$275.51 , N/A , N/A , N/A , N/A , N/A ,$251.10 ,$216.23 ,$251.10 ,$251.10 ,$279.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 16MM,278,1 ,$382.50 ,$252.45 ,$194.00 ,$382.50 , N/A , N/A , N/A , N/A ,$229.50 ,$325.13 ,$267.75 , N/A , N/A ,$363.38 ,$290.70 ,$286.88 , N/A ,$325.13 , N/A , N/A , N/A ,$267.75 ,$232.94 , N/A , N/A , N/A , N/A , N/A ,$325.13 , N/A ,$351.90 ,$267.75 ,$194.00 ,$232.83 ,$232.94 ,$232.83 ,$264.31 ,$344.25 ,$261.32 , N/A ,$302.18 , N/A , N/A , N/A , N/A , N/A ,$275.40 ,$237.15 ,$275.40 ,$275.40 ,$306.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 10MM,278,1 ,$382.50 ,$252.45 ,$194.00 ,$382.50 , N/A , N/A , N/A , N/A ,$229.50 ,$325.13 ,$267.75 , N/A , N/A ,$363.38 ,$290.70 ,$286.88 , N/A ,$325.13 , N/A , N/A , N/A ,$267.75 ,$232.94 , N/A , N/A , N/A , N/A , N/A ,$325.13 , N/A ,$351.90 ,$267.75 ,$194.00 ,$232.83 ,$232.94 ,$232.83 ,$264.31 ,$344.25 ,$261.32 , N/A ,$302.18 , N/A , N/A , N/A , N/A , N/A ,$275.40 ,$237.15 ,$275.40 ,$275.40 ,$306.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 12MM,278,1 ,$382.50 ,$252.45 ,$194.00 ,$382.50 , N/A , N/A , N/A , N/A ,$229.50 ,$325.13 ,$267.75 , N/A , N/A ,$363.38 ,$290.70 ,$286.88 , N/A ,$325.13 , N/A , N/A , N/A ,$267.75 ,$232.94 , N/A , N/A , N/A , N/A , N/A ,$325.13 , N/A ,$351.90 ,$267.75 ,$194.00 ,$232.83 ,$232.94 ,$232.83 ,$264.31 ,$344.25 ,$261.32 , N/A ,$302.18 , N/A , N/A , N/A , N/A , N/A ,$275.40 ,$237.15 ,$275.40 ,$275.40 ,$306.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 SCHANZ 20MM THREAD/ 80MM,278,1 ,$382.50 ,$252.45 ,$194.00 ,$382.50 , N/A , N/A , N/A , N/A ,$229.50 ,$325.13 ,$267.75 , N/A , N/A ,$363.38 ,$290.70 ,$286.88 , N/A ,$325.13 , N/A , N/A , N/A ,$267.75 ,$232.94 , N/A , N/A , N/A , N/A , N/A ,$325.13 , N/A ,$351.90 ,$267.75 ,$194.00 ,$232.83 ,$232.94 ,$232.83 ,$264.31 ,$344.25 ,$261.32 , N/A ,$302.18 , N/A , N/A , N/A , N/A , N/A ,$275.40 ,$237.15 ,$275.40 ,$275.40 ,$306.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 SCHANZ SELF DRILL 3MM,278,1 ,$382.50 ,$252.45 ,$194.00 ,$382.50 , N/A , N/A , N/A , N/A ,$229.50 ,$325.13 ,$267.75 , N/A , N/A ,$363.38 ,$290.70 ,$286.88 , N/A ,$325.13 , N/A , N/A , N/A ,$267.75 ,$232.94 , N/A , N/A , N/A , N/A , N/A ,$325.13 , N/A ,$351.90 ,$267.75 ,$194.00 ,$232.83 ,$232.94 ,$232.83 ,$264.31 ,$344.25 ,$261.32 , N/A ,$302.18 , N/A , N/A , N/A , N/A , N/A ,$275.40 ,$237.15 ,$275.40 ,$275.40 ,$306.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 18MM,278,1 ,$337.50 ,$222.75 ,$171.18 ,$337.50 , N/A , N/A , N/A , N/A ,$202.50 ,$286.88 ,$236.25 , N/A , N/A ,$320.63 ,$256.50 ,$253.13 , N/A ,$286.88 , N/A , N/A , N/A ,$236.25 ,$205.54 , N/A , N/A , N/A , N/A , N/A ,$286.88 , N/A ,$310.50 ,$236.25 ,$171.18 ,$205.44 ,$205.54 ,$205.44 ,$233.21 ,$303.75 ,$230.58 , N/A ,$266.63 , N/A , N/A , N/A , N/A , N/A ,$243.00 ,$209.25 ,$243.00 ,$243.00 ,$270.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 3.0 QUICKFIX TI CANN PT 28MM,278,1 ,$337.50 ,$222.75 ,$171.18 ,$337.50 , N/A , N/A , N/A , N/A ,$202.50 ,$286.88 ,$236.25 , N/A , N/A ,$320.63 ,$256.50 ,$253.13 , N/A ,$286.88 , N/A , N/A , N/A ,$236.25 ,$205.54 , N/A , N/A , N/A , N/A , N/A ,$286.88 , N/A ,$310.50 ,$236.25 ,$171.18 ,$205.44 ,$205.54 ,$205.44 ,$233.21 ,$303.75 ,$230.58 , N/A ,$266.63 , N/A , N/A , N/A , N/A , N/A ,$243.00 ,$209.25 ,$243.00 ,$243.00 ,$270.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 2.5MM 25MM PERSONA KNEE FEMALE HEX,278,1 ,$337.50 ,$222.75 ,$171.18 ,$337.50 , N/A , N/A , N/A , N/A ,$202.50 ,$286.88 ,$236.25 , N/A , N/A ,$320.63 ,$256.50 ,$253.13 , N/A ,$286.88 , N/A , N/A , N/A ,$236.25 ,$205.54 , N/A , N/A , N/A , N/A , N/A ,$286.88 , N/A ,$310.50 ,$236.25 ,$171.18 ,$205.44 ,$205.54 ,$205.44 ,$233.21 ,$303.75 ,$230.58 , N/A ,$266.63 , N/A , N/A , N/A , N/A , N/A ,$243.00 ,$209.25 ,$243.00 ,$243.00 ,$270.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX 100MM,278,1 ,$337.50 ,$222.75 ,$171.18 ,$337.50 , N/A , N/A , N/A , N/A ,$202.50 ,$286.88 ,$236.25 , N/A , N/A ,$320.63 ,$256.50 ,$253.13 , N/A ,$286.88 , N/A , N/A , N/A ,$236.25 ,$205.54 , N/A , N/A , N/A , N/A , N/A ,$286.88 , N/A ,$310.50 ,$236.25 ,$171.18 ,$205.44 ,$205.54 ,$205.44 ,$233.21 ,$303.75 ,$230.58 , N/A ,$266.63 , N/A , N/A , N/A , N/A , N/A ,$243.00 ,$209.25 ,$243.00 ,$243.00 ,$270.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 26MM,278,1 ,$328.50 ,$216.81 ,$166.62 ,$328.50 , N/A , N/A , N/A , N/A ,$197.10 ,$279.23 ,$229.95 , N/A , N/A ,$312.08 ,$249.66 ,$246.38 , N/A ,$279.23 , N/A , N/A , N/A ,$229.95 ,$200.06 , N/A , N/A , N/A , N/A , N/A ,$279.23 , N/A ,$302.22 ,$229.95 ,$166.62 ,$199.96 ,$200.06 ,$199.96 ,$226.99 ,$295.65 ,$224.43 , N/A ,$259.52 , N/A , N/A , N/A , N/A , N/A ,$236.52 ,$203.67 ,$236.52 ,$236.52 ,$262.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 20MM,278,1 ,$328.50 ,$216.81 ,$166.62 ,$328.50 , N/A , N/A , N/A , N/A ,$197.10 ,$279.23 ,$229.95 , N/A , N/A ,$312.08 ,$249.66 ,$246.38 , N/A ,$279.23 , N/A , N/A , N/A ,$229.95 ,$200.06 , N/A , N/A , N/A , N/A , N/A ,$279.23 , N/A ,$302.22 ,$229.95 ,$166.62 ,$199.96 ,$200.06 ,$199.96 ,$226.99 ,$295.65 ,$224.43 , N/A ,$259.52 , N/A , N/A , N/A , N/A , N/A ,$236.52 ,$203.67 ,$236.52 ,$236.52 ,$262.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 28MM,278,1 ,$272.25 ,$179.69 ,$138.09 ,$272.25 , N/A , N/A , N/A , N/A ,$163.35 ,$231.41 ,$190.58 , N/A , N/A ,$258.64 ,$206.91 ,$204.19 , N/A ,$231.41 , N/A , N/A , N/A ,$190.58 ,$165.80 , N/A , N/A , N/A , N/A , N/A ,$231.41 , N/A ,$250.47 ,$190.58 ,$138.09 ,$165.72 ,$165.80 ,$165.72 ,$188.12 ,$245.03 ,$186.00 , N/A ,$215.08 , N/A , N/A , N/A , N/A , N/A ,$196.02 ,$168.80 ,$196.02 ,$196.02 ,$217.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 30MM,278,1 ,$360.00 ,$237.60 ,$182.59 ,$360.00 , N/A , N/A , N/A , N/A ,$216.00 ,$306.00 ,$252.00 , N/A , N/A ,$342.00 ,$273.60 ,$270.00 , N/A ,$306.00 , N/A , N/A , N/A ,$252.00 ,$219.24 , N/A , N/A , N/A , N/A , N/A ,$306.00 , N/A ,$331.20 ,$252.00 ,$182.59 ,$219.13 ,$219.24 ,$219.13 ,$248.76 ,$324.00 ,$245.95 , N/A ,$284.40 , N/A , N/A , N/A , N/A , N/A ,$259.20 ,$223.20 ,$259.20 ,$259.20 ,$288.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 22MM,278,1 ,$360.00 ,$237.60 ,$182.59 ,$360.00 , N/A , N/A , N/A , N/A ,$216.00 ,$306.00 ,$252.00 , N/A , N/A ,$342.00 ,$273.60 ,$270.00 , N/A ,$306.00 , N/A , N/A , N/A ,$252.00 ,$219.24 , N/A , N/A , N/A , N/A , N/A ,$306.00 , N/A ,$331.20 ,$252.00 ,$182.59 ,$219.13 ,$219.24 ,$219.13 ,$248.76 ,$324.00 ,$245.95 , N/A ,$284.40 , N/A , N/A , N/A , N/A , N/A ,$259.20 ,$223.20 ,$259.20 ,$259.20 ,$288.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 3.0MM X 24MM,278,1 ,$360.00 ,$237.60 ,$182.59 ,$360.00 , N/A , N/A , N/A , N/A ,$216.00 ,$306.00 ,$252.00 , N/A , N/A ,$342.00 ,$273.60 ,$270.00 , N/A ,$306.00 , N/A , N/A , N/A ,$252.00 ,$219.24 , N/A , N/A , N/A , N/A , N/A ,$306.00 , N/A ,$331.20 ,$252.00 ,$182.59 ,$219.13 ,$219.24 ,$219.13 ,$248.76 ,$324.00 ,$245.95 , N/A ,$284.40 , N/A , N/A , N/A , N/A , N/A ,$259.20 ,$223.20 ,$259.20 ,$259.20 ,$288.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 52MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 4.0MM X 34MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED 4.0MM X 44MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 12MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 14MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 16MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 18MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 20MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 22MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 24MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 26MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 28MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 30MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 32MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 40MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW OSTEOMED CAN LAG 4.0 X 48MM,278,1 ,$308.25 ,$203.45 ,$156.34 ,$308.25 , N/A , N/A , N/A , N/A ,$184.95 ,$262.01 ,$215.78 , N/A , N/A ,$292.84 ,$234.27 ,$231.19 , N/A ,$262.01 , N/A , N/A , N/A ,$215.78 ,$187.72 , N/A , N/A , N/A , N/A , N/A ,$262.01 , N/A ,$283.59 ,$215.78 ,$156.34 ,$187.63 ,$187.72 ,$187.63 ,$213.00 ,$277.43 ,$210.60 , N/A ,$243.52 , N/A , N/A , N/A , N/A , N/A ,$221.94 ,$191.12 ,$221.94 ,$221.94 ,$246.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW POLY BIOMET 6.5 X 45MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 5.5 MULTIAXIAL 30,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 5.5 MULTIAXIAL 35,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 5.5 MULTIAXIAL 40,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 5.5 MULTIAXIAL 45,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 5.5 MULTIAXIAL 50,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 5.5 MULTIAXIAL 55,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 6.5 MULTIAXIAL 55,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 6.5 X 30MM BLUE,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 6.5 X 50MM BLUE,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 7.5 MULTIAXIAL 30,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 7.5 MULTIAXIAL 35,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 7.5 MULTIAXIAL 40,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 7.5 MULTIAXIAL 45,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 7.5 MULTIAXIAL 50,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BIOMET 7.5 MULTIAXIAL 55,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE MONARCH TITANIUM LEFT OFFSET MINI SPINE WASHER,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE MONARCH TITANIUM RIGHT OFFSET MINI SPINE WASHER,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE MONARCH TITANIUM STRAIGHT SPINE WASHER,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW POLY BIOMET 6.5 X 35MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE CONTOURED ARTHREX,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW QUICKFIX ARTHREX  3MM X 13MM,278,1 ,$516.00 ,$340.56 ,$261.72 ,$516.00 , N/A , N/A , N/A , N/A ,$309.60 ,$438.60 ,$361.20 , N/A , N/A ,$490.20 ,$392.16 ,$387.00 , N/A ,$438.60 , N/A , N/A , N/A ,$361.20 ,$314.24 , N/A , N/A , N/A , N/A , N/A ,$438.60 , N/A ,$474.72 ,$361.20 ,$261.72 ,$314.09 ,$314.24 ,$314.09 ,$356.56 ,$464.40 ,$352.53 , N/A ,$407.64 , N/A , N/A , N/A , N/A , N/A ,$371.52 ,$319.92 ,$371.52 ,$371.52 ,$412.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 0D 2-0 RAPIDLOC PANACRYL MENISCAL,278,1 ,$516.00 ,$340.56 ,$261.72 ,$516.00 , N/A , N/A , N/A , N/A ,$309.60 ,$438.60 ,$361.20 , N/A , N/A ,$490.20 ,$392.16 ,$387.00 , N/A ,$438.60 , N/A , N/A , N/A ,$361.20 ,$314.24 , N/A , N/A , N/A , N/A , N/A ,$438.60 , N/A ,$474.72 ,$361.20 ,$261.72 ,$314.09 ,$314.24 ,$314.09 ,$356.56 ,$464.40 ,$352.53 , N/A ,$407.64 , N/A , N/A , N/A , N/A , N/A ,$371.52 ,$319.92 ,$371.52 ,$371.52 ,$412.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 12D 2-0 CURVE RAPIDLOC PANACRYL MENISCAL ABSORBABLE BRAID FLEXIBLE FIXATION PDS PLA LATEX FREE ARTHROSCOPIC,278,1 ,$516.00 ,$340.56 ,$261.72 ,$516.00 , N/A , N/A , N/A , N/A ,$309.60 ,$438.60 ,$361.20 , N/A , N/A ,$490.20 ,$392.16 ,$387.00 , N/A ,$438.60 , N/A , N/A , N/A ,$361.20 ,$314.24 , N/A , N/A , N/A , N/A , N/A ,$438.60 , N/A ,$474.72 ,$361.20 ,$261.72 ,$314.09 ,$314.24 ,$314.09 ,$356.56 ,$464.40 ,$352.53 , N/A ,$407.64 , N/A , N/A , N/A , N/A , N/A ,$371.52 ,$319.92 ,$371.52 ,$371.52 ,$412.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE 27D 2-0 CURVED PANACRYL RAPIDLOC MENISCAL ABSORBABLE BRAID FLEXIBLE FIXATION PDS PLA STERILE ARTHROSCOPIC,278,1 ,$516.00 ,$340.56 ,$261.72 ,$516.00 , N/A , N/A , N/A , N/A ,$309.60 ,$438.60 ,$361.20 , N/A , N/A ,$490.20 ,$392.16 ,$387.00 , N/A ,$438.60 , N/A , N/A , N/A ,$361.20 ,$314.24 , N/A , N/A , N/A , N/A , N/A ,$438.60 , N/A ,$474.72 ,$361.20 ,$261.72 ,$314.09 ,$314.24 ,$314.09 ,$356.56 ,$464.40 ,$352.53 , N/A ,$407.64 , N/A , N/A , N/A , N/A , N/A ,$371.52 ,$319.92 ,$371.52 ,$371.52 ,$412.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX QUICKFIX TITANIUM 2MMx12MM,278,1 ,$516.00 ,$340.56 ,$261.72 ,$516.00 , N/A , N/A , N/A , N/A ,$309.60 ,$438.60 ,$361.20 , N/A , N/A ,$490.20 ,$392.16 ,$387.00 , N/A ,$438.60 , N/A , N/A , N/A ,$361.20 ,$314.24 , N/A , N/A , N/A , N/A , N/A ,$438.60 , N/A ,$474.72 ,$361.20 ,$261.72 ,$314.09 ,$314.24 ,$314.09 ,$356.56 ,$464.40 ,$352.53 , N/A ,$407.64 , N/A , N/A , N/A , N/A , N/A ,$371.52 ,$319.92 ,$371.52 ,$371.52 ,$412.80 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS 28.5MM COMPRESSION,278,1 ,$146.75 ,$96.86 ,$74.43 ,$146.75 , N/A , N/A , N/A , N/A ,$88.05 ,$124.74 ,$102.73 , N/A , N/A ,$139.41 ,$111.53 ,$110.06 , N/A ,$124.74 , N/A , N/A , N/A ,$102.73 ,$89.37 , N/A , N/A , N/A , N/A , N/A ,$124.74 , N/A ,$135.01 ,$102.73 ,$74.43 ,$89.33 ,$89.37 ,$89.33 ,$101.40 ,$132.08 ,$100.26 , N/A ,$115.93 , N/A , N/A , N/A , N/A , N/A ,$105.66 ,$90.99 ,$105.66 ,$105.66 ,$117.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS 19MM COMPRESSION,278,1 ,$146.75 ,$96.86 ,$74.43 ,$146.75 , N/A , N/A , N/A , N/A ,$88.05 ,$124.74 ,$102.73 , N/A , N/A ,$139.41 ,$111.53 ,$110.06 , N/A ,$124.74 , N/A , N/A , N/A ,$102.73 ,$89.37 , N/A , N/A , N/A , N/A , N/A ,$124.74 , N/A ,$135.01 ,$102.73 ,$74.43 ,$89.33 ,$89.37 ,$89.33 ,$101.40 ,$132.08 ,$100.26 , N/A ,$115.93 , N/A , N/A , N/A , N/A , N/A ,$105.66 ,$90.99 ,$105.66 ,$105.66 ,$117.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 54MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 30MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 32MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 34MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 36MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 38MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 40MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 42MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 44MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 46MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 48MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 50MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 52MM,278,1 ,$62.28 ,$41.10 ,$31.59 ,$62.28 , N/A , N/A , N/A , N/A ,$37.37 ,$52.94 ,$43.60 , N/A , N/A ,$59.17 ,$47.33 ,$46.71 , N/A ,$52.94 , N/A , N/A , N/A ,$43.60 ,$37.93 , N/A , N/A , N/A , N/A , N/A ,$52.94 , N/A ,$57.30 ,$43.60 ,$31.59 ,$37.91 ,$37.93 ,$37.91 ,$43.04 ,$56.05 ,$42.55 , N/A ,$49.20 , N/A , N/A , N/A , N/A , N/A ,$44.84 ,$38.61 ,$44.84 ,$44.84 ,$49.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 56MM,278,1 ,$53.96 ,$35.61 ,$27.37 ,$53.96 , N/A , N/A , N/A , N/A ,$32.38 ,$45.87 ,$37.77 , N/A , N/A ,$51.26 ,$41.01 ,$40.47 , N/A ,$45.87 , N/A , N/A , N/A ,$37.77 ,$32.86 , N/A , N/A , N/A , N/A , N/A ,$45.87 , N/A ,$49.64 ,$37.77 ,$27.37 ,$32.85 ,$32.86 ,$32.85 ,$37.29 ,$48.56 ,$36.87 , N/A ,$42.63 , N/A , N/A , N/A , N/A , N/A ,$38.85 ,$33.46 ,$38.85 ,$38.85 ,$43.17 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS AMBI HEXHEAD 26MM,278,1 ,$53.96 ,$35.61 ,$27.37 ,$53.96 , N/A , N/A , N/A , N/A ,$32.38 ,$45.87 ,$37.77 , N/A , N/A ,$51.26 ,$41.01 ,$40.47 , N/A ,$45.87 , N/A , N/A , N/A ,$37.77 ,$32.86 , N/A , N/A , N/A , N/A , N/A ,$45.87 , N/A ,$49.64 ,$37.77 ,$27.37 ,$32.85 ,$32.86 ,$32.85 ,$37.29 ,$48.56 ,$36.87 , N/A ,$42.63 , N/A , N/A , N/A , N/A , N/A ,$38.85 ,$33.46 ,$38.85 ,$38.85 ,$43.17 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS LAG 60MM,278,1 ,$435.60 ,$287.50 ,$220.94 ,$435.60 , N/A , N/A , N/A , N/A ,$261.36 ,$370.26 ,$304.92 , N/A , N/A ,$413.82 ,$331.06 ,$326.70 , N/A ,$370.26 , N/A , N/A , N/A ,$304.92 ,$265.28 , N/A , N/A , N/A , N/A , N/A ,$370.26 , N/A ,$400.75 ,$304.92 ,$220.94 ,$265.15 ,$265.28 ,$265.15 ,$301.00 ,$392.04 ,$297.60 , N/A ,$344.12 , N/A , N/A , N/A , N/A , N/A ,$313.63 ,$270.07 ,$313.63 ,$313.63 ,$348.48 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS SUPER LAG 110MM,278,1 ,$661.53 ,$436.61 ,$335.53 ,$661.53 , N/A , N/A , N/A , N/A ,$396.92 ,$562.30 ,$463.07 , N/A , N/A ,$628.45 ,$502.76 ,$496.15 , N/A ,$562.30 , N/A , N/A , N/A ,$463.07 ,$402.87 , N/A , N/A , N/A , N/A , N/A ,$562.30 , N/A ,$608.61 ,$463.07 ,$335.53 ,$402.67 ,$402.87 ,$402.67 ,$457.12 ,$595.38 ,$451.96 , N/A ,$522.61 , N/A , N/A , N/A , N/A , N/A ,$476.30 ,$410.15 ,$476.30 ,$476.30 ,$529.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS SUPER LAG 90MM,278,1 ,$850.95 ,$561.63 ,$431.60 ,$850.95 , N/A , N/A , N/A , N/A ,$510.57 ,$723.31 ,$595.67 , N/A , N/A ,$808.40 ,$646.72 ,$638.21 , N/A ,$723.31 , N/A , N/A , N/A ,$595.67 ,$518.23 , N/A , N/A , N/A , N/A , N/A ,$723.31 , N/A ,$782.87 ,$595.67 ,$431.60 ,$517.97 ,$518.23 ,$517.97 ,$588.01 ,$765.86 ,$581.37 , N/A ,$672.25 , N/A , N/A , N/A , N/A , N/A ,$612.68 ,$527.59 ,$612.68 ,$612.68 ,$680.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS SUPER LAG 100MM,278,1 ,$850.95 ,$561.63 ,$431.60 ,$850.95 , N/A , N/A , N/A , N/A ,$510.57 ,$723.31 ,$595.67 , N/A , N/A ,$808.40 ,$646.72 ,$638.21 , N/A ,$723.31 , N/A , N/A , N/A ,$595.67 ,$518.23 , N/A , N/A , N/A , N/A , N/A ,$723.31 , N/A ,$782.87 ,$595.67 ,$431.60 ,$517.97 ,$518.23 ,$517.97 ,$588.01 ,$765.86 ,$581.37 , N/A ,$672.25 , N/A , N/A , N/A , N/A , N/A ,$612.68 ,$527.59 ,$612.68 ,$612.68 ,$680.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS SUPER LAG 70MM,278,1 ,$850.95 ,$561.63 ,$431.60 ,$850.95 , N/A , N/A , N/A , N/A ,$510.57 ,$723.31 ,$595.67 , N/A , N/A ,$808.40 ,$646.72 ,$638.21 , N/A ,$723.31 , N/A , N/A , N/A ,$595.67 ,$518.23 , N/A , N/A , N/A , N/A , N/A ,$723.31 , N/A ,$782.87 ,$595.67 ,$431.60 ,$517.97 ,$518.23 ,$517.97 ,$588.01 ,$765.86 ,$581.37 , N/A ,$672.25 , N/A , N/A , N/A , N/A , N/A ,$612.68 ,$527.59 ,$612.68 ,$612.68 ,$680.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS SUPER LAG 75MM,278,1 ,$850.95 ,$561.63 ,$431.60 ,$850.95 , N/A , N/A , N/A , N/A ,$510.57 ,$723.31 ,$595.67 , N/A , N/A ,$808.40 ,$646.72 ,$638.21 , N/A ,$723.31 , N/A , N/A , N/A ,$595.67 ,$518.23 , N/A , N/A , N/A , N/A , N/A ,$723.31 , N/A ,$782.87 ,$595.67 ,$431.60 ,$517.97 ,$518.23 ,$517.97 ,$588.01 ,$765.86 ,$581.37 , N/A ,$672.25 , N/A , N/A , N/A , N/A , N/A ,$612.68 ,$527.59 ,$612.68 ,$612.68 ,$680.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW RICHARDS SUPER LAG 85MM,278,1 ,$850.95 ,$561.63 ,$431.60 ,$850.95 , N/A , N/A , N/A , N/A ,$510.57 ,$723.31 ,$595.67 , N/A , N/A ,$808.40 ,$646.72 ,$638.21 , N/A ,$723.31 , N/A , N/A , N/A ,$595.67 ,$518.23 , N/A , N/A , N/A , N/A , N/A ,$723.31 , N/A ,$782.87 ,$595.67 ,$431.60 ,$517.97 ,$518.23 ,$517.97 ,$588.01 ,$765.86 ,$581.37 , N/A ,$672.25 , N/A , N/A , N/A , N/A , N/A ,$612.68 ,$527.59 ,$612.68 ,$612.68 ,$680.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SCHANZ SYNTHES 5 X 200MM,278,1 ,$398.48 ,$263.00 ,$202.11 ,$398.48 , N/A , N/A , N/A , N/A ,$239.09 ,$338.71 ,$278.94 , N/A , N/A ,$378.56 ,$302.84 ,$298.86 , N/A ,$338.71 , N/A , N/A , N/A ,$278.94 ,$242.67 , N/A , N/A , N/A , N/A , N/A ,$338.71 , N/A ,$366.60 ,$278.94 ,$202.11 ,$242.55 ,$242.67 ,$242.55 ,$275.35 ,$358.63 ,$272.24 , N/A ,$314.80 , N/A , N/A , N/A , N/A , N/A ,$286.91 ,$247.06 ,$286.91 ,$286.91 ,$318.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SET TITANIUM SPINE HEXAGONAL LOBE MCC TIMX,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW DEPUY INNER SET,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER PERSONA MG 48MM,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 2.5MM SHOULDER TRABECULAR METAL REVERSE SYSTEM STERILE,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PIN FIXATION 9IN 3.2MM STEINMANN,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SET TITANIUM SPINE ISOLA,278,1 ,$202.50 ,$133.65 ,$102.71 ,$202.50 , N/A , N/A , N/A , N/A ,$121.50 ,$172.13 ,$141.75 , N/A , N/A ,$192.38 ,$153.90 ,$151.88 , N/A ,$172.13 , N/A , N/A , N/A ,$141.75 ,$123.32 , N/A , N/A , N/A , N/A , N/A ,$172.13 , N/A ,$186.30 ,$141.75 ,$102.71 ,$123.26 ,$123.32 ,$123.26 ,$139.93 ,$182.25 ,$138.35 , N/A ,$159.98 , N/A , N/A , N/A , N/A , N/A ,$145.80 ,$125.55 ,$145.80 ,$145.80 ,$162.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SMITH  AND  NEPHEW LOCKING 3MM X 14MM,278,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A , N/A , N/A , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 , N/A ,$210.38 , N/A , N/A , N/A ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A , N/A , N/A , N/A , N/A ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX LOW PROFILE 3MMx16MM,278,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A , N/A , N/A , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 , N/A ,$210.38 , N/A , N/A , N/A ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A , N/A , N/A , N/A , N/A ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,BONE SCREW ARTHREX LOW PROFILE STARDRIVE 3MMx18MM,278,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A , N/A , N/A , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 , N/A ,$210.38 , N/A , N/A , N/A ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A , N/A , N/A , N/A , N/A ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ARTHREX 3MM X12MM,278,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A , N/A , N/A , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 , N/A ,$210.38 , N/A , N/A , N/A ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A , N/A , N/A , N/A , N/A ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW BONE 3MM 22MM TITANIUM T10 FULL THREAD SELF TAP LOCK COMPREHENSIVE FOOT SYSTEM,278,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A , N/A , N/A , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 , N/A ,$210.38 , N/A , N/A , N/A ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A , N/A , N/A , N/A , N/A ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LOCKING ARTHREX 3 X 16MM,278,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A , N/A , N/A , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 , N/A ,$210.38 , N/A , N/A , N/A ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A , N/A , N/A , N/A , N/A ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW LOCKING ARTHREX 3 X 18MM,278,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A , N/A , N/A , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 , N/A ,$210.38 , N/A , N/A , N/A ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A , N/A , N/A , N/A , N/A ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW NON-LOCKING 2.4 X 12MM ARTHREX,278,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A , N/A , N/A , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 , N/A ,$210.38 , N/A , N/A , N/A ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A , N/A , N/A , N/A , N/A ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW QUICKFIX ARTHREX MAGENTA 2MM X 11MM,278,1 ,$247.50 ,$163.35 ,$125.53 ,$247.50 , N/A , N/A , N/A , N/A ,$148.50 ,$210.38 ,$173.25 , N/A , N/A ,$235.13 ,$188.10 ,$185.63 , N/A ,$210.38 , N/A , N/A , N/A ,$173.25 ,$150.73 , N/A , N/A , N/A , N/A , N/A ,$210.38 , N/A ,$227.70 ,$173.25 ,$125.53 ,$150.65 ,$150.73 ,$150.65 ,$171.02 ,$222.75 ,$169.09 , N/A ,$195.53 , N/A , N/A , N/A , N/A , N/A ,$178.20 ,$153.45 ,$178.20 ,$178.20 ,$198.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW STRYKER 6.5CANCELLOUS BONE 35MM,278,1 ,$112.50 ,$74.25 ,$57.06 ,$112.50 , N/A , N/A , N/A , N/A ,$67.50 ,$95.63 ,$78.75 , N/A , N/A ,$106.88 ,$85.50 ,$84.38 , N/A ,$95.63 , N/A , N/A , N/A ,$78.75 ,$68.51 , N/A , N/A , N/A , N/A , N/A ,$95.63 , N/A ,$103.50 ,$78.75 ,$57.06 ,$68.48 ,$68.51 ,$68.48 ,$77.74 ,$101.25 ,$76.86 , N/A ,$88.88 , N/A , N/A , N/A , N/A , N/A ,$81.00 ,$69.75 ,$81.00 ,$81.00 ,$90.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,HOLDER PLATE ARTHREX BB TAK,278,1 ,$112.50 ,$74.25 ,$57.06 ,$112.50 , N/A , N/A , N/A , N/A ,$67.50 ,$95.63 ,$78.75 , N/A , N/A ,$106.88 ,$85.50 ,$84.38 , N/A ,$95.63 , N/A , N/A , N/A ,$78.75 ,$68.51 , N/A , N/A , N/A , N/A , N/A ,$95.63 , N/A ,$103.50 ,$78.75 ,$57.06 ,$68.48 ,$68.51 ,$68.48 ,$77.74 ,$101.25 ,$76.86 , N/A ,$88.88 , N/A , N/A , N/A , N/A , N/A ,$81.00 ,$69.75 ,$81.00 ,$81.00 ,$90.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW STRYKER 6.5 CANCELLOUS BONE 30MM,278,1 ,$112.50 ,$74.25 ,$57.06 ,$112.50 , N/A , N/A , N/A , N/A ,$67.50 ,$95.63 ,$78.75 , N/A , N/A ,$106.88 ,$85.50 ,$84.38 , N/A ,$95.63 , N/A , N/A , N/A ,$78.75 ,$68.51 , N/A , N/A , N/A , N/A , N/A ,$95.63 , N/A ,$103.50 ,$78.75 ,$57.06 ,$68.48 ,$68.51 ,$68.48 ,$77.74 ,$101.25 ,$76.86 , N/A ,$88.88 , N/A , N/A , N/A , N/A , N/A ,$81.00 ,$69.75 ,$81.00 ,$81.00 ,$90.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW STRYKER 6.5 CANCELLOUS BONE 40MM,278,1 ,$112.50 ,$74.25 ,$57.06 ,$112.50 , N/A , N/A , N/A , N/A ,$67.50 ,$95.63 ,$78.75 , N/A , N/A ,$106.88 ,$85.50 ,$84.38 , N/A ,$95.63 , N/A , N/A , N/A ,$78.75 ,$68.51 , N/A , N/A , N/A , N/A , N/A ,$95.63 , N/A ,$103.50 ,$78.75 ,$57.06 ,$68.48 ,$68.51 ,$68.48 ,$77.74 ,$101.25 ,$76.86 , N/A ,$88.88 , N/A , N/A , N/A , N/A , N/A ,$81.00 ,$69.75 ,$81.00 ,$81.00 ,$90.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 14MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP  6MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP  7MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP  8MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP  9MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 10MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 11MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 12MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 13MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR  WITH COLLAR 10 HOLES/121MM,278,1 ,$153.56 ,$101.35 ,$77.89 ,$153.56 , N/A , N/A , N/A , N/A ,$92.14 ,$130.53 ,$107.49 , N/A , N/A ,$145.88 ,$116.71 ,$115.17 , N/A ,$130.53 , N/A , N/A , N/A ,$107.49 ,$93.52 , N/A , N/A , N/A , N/A , N/A ,$130.53 , N/A ,$141.28 ,$107.49 ,$77.89 ,$93.47 ,$93.52 ,$93.47 ,$106.11 ,$138.20 ,$104.91 , N/A ,$121.31 , N/A , N/A , N/A , N/A , N/A ,$110.56 ,$95.21 ,$110.56 ,$110.56 ,$122.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 18MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP  6MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP  7MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP  8MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP  9MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 10MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 11MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 12MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 13MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 14MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 16MM,278,1 ,$160.65 ,$106.03 ,$81.48 ,$160.65 , N/A , N/A , N/A , N/A ,$96.39 ,$136.55 ,$112.46 , N/A , N/A ,$152.62 ,$122.09 ,$120.49 , N/A ,$136.55 , N/A , N/A , N/A ,$112.46 ,$97.84 , N/A , N/A , N/A , N/A , N/A ,$136.55 , N/A ,$147.80 ,$112.46 ,$81.48 ,$97.79 ,$97.84 ,$97.79 ,$111.01 ,$144.59 ,$109.76 , N/A ,$126.91 , N/A , N/A , N/A , N/A , N/A ,$115.67 ,$99.60 ,$115.67 ,$115.67 ,$128.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX 20MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX  6MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX  7MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX  8MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX  9MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX 10MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX 11MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX 12MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX 14MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX 16MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX  6MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX  7MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX  8MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX  9MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX 10MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX 11MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX 12MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX 14MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX 16MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX 18MM,278,1 ,$61.02 ,$40.27 ,$30.95 ,$61.02 , N/A , N/A , N/A , N/A ,$36.61 ,$51.87 ,$42.71 , N/A , N/A ,$57.97 ,$46.38 ,$45.77 , N/A ,$51.87 , N/A , N/A , N/A ,$42.71 ,$37.16 , N/A , N/A , N/A , N/A , N/A ,$51.87 , N/A ,$56.14 ,$42.71 ,$30.95 ,$37.14 ,$37.16 ,$37.14 ,$42.16 ,$54.92 ,$41.69 , N/A ,$48.21 , N/A , N/A , N/A , N/A , N/A ,$43.93 ,$37.83 ,$43.93 ,$43.93 ,$48.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF DRILL 6MM,278,1 ,$184.50 ,$121.77 ,$93.58 ,$184.50 , N/A , N/A , N/A , N/A ,$110.70 ,$156.83 ,$129.15 , N/A , N/A ,$175.28 ,$140.22 ,$138.38 , N/A ,$156.83 , N/A , N/A , N/A ,$129.15 ,$112.36 , N/A , N/A , N/A , N/A , N/A ,$156.83 , N/A ,$169.74 ,$129.15 ,$93.58 ,$112.31 ,$112.36 ,$112.31 ,$127.49 ,$166.05 ,$126.05 , N/A ,$145.76 , N/A , N/A , N/A , N/A , N/A ,$132.84 ,$114.39 ,$132.84 ,$132.84 ,$147.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF DRILL 8MM,278,1 ,$147.60 ,$97.42 ,$74.86 ,$147.60 , N/A , N/A , N/A , N/A ,$88.56 ,$125.46 ,$103.32 , N/A , N/A ,$140.22 ,$112.18 ,$110.70 , N/A ,$125.46 , N/A , N/A , N/A ,$103.32 ,$89.89 , N/A , N/A , N/A , N/A , N/A ,$125.46 , N/A ,$135.79 ,$103.32 ,$74.86 ,$89.84 ,$89.89 ,$89.84 ,$101.99 ,$132.84 ,$100.84 , N/A ,$116.60 , N/A , N/A , N/A , N/A , N/A ,$106.27 ,$91.51 ,$106.27 ,$106.27 ,$118.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF DRILL 4MM,278,1 ,$147.60 ,$97.42 ,$74.86 ,$147.60 , N/A , N/A , N/A , N/A ,$88.56 ,$125.46 ,$103.32 , N/A , N/A ,$140.22 ,$112.18 ,$110.70 , N/A ,$125.46 , N/A , N/A , N/A ,$103.32 ,$89.89 , N/A , N/A , N/A , N/A , N/A ,$125.46 , N/A ,$135.79 ,$103.32 ,$74.86 ,$89.84 ,$89.89 ,$89.84 ,$101.99 ,$132.84 ,$100.84 , N/A ,$116.60 , N/A , N/A , N/A , N/A , N/A ,$106.27 ,$91.51 ,$106.27 ,$106.27 ,$118.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF DRILL 5MM,278,1 ,$147.60 ,$97.42 ,$74.86 ,$147.60 , N/A , N/A , N/A , N/A ,$88.56 ,$125.46 ,$103.32 , N/A , N/A ,$140.22 ,$112.18 ,$110.70 , N/A ,$125.46 , N/A , N/A , N/A ,$103.32 ,$89.89 , N/A , N/A , N/A , N/A , N/A ,$125.46 , N/A ,$135.79 ,$103.32 ,$74.86 ,$89.84 ,$89.89 ,$89.84 ,$101.99 ,$132.84 ,$100.84 , N/A ,$116.60 , N/A , N/A , N/A , N/A , N/A ,$106.27 ,$91.51 ,$106.27 ,$106.27 ,$118.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 24MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP  6MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP  7MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP  8MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP  9MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 10MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 11MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 12MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 13MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 14MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 16MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 18MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 20MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 22MM,278,1 ,$73.24 ,$48.34 ,$37.15 ,$73.24 , N/A , N/A , N/A , N/A ,$43.94 ,$62.25 ,$51.27 , N/A , N/A ,$69.58 ,$55.66 ,$54.93 , N/A ,$62.25 , N/A , N/A , N/A ,$51.27 ,$44.60 , N/A , N/A , N/A , N/A , N/A ,$62.25 , N/A ,$67.38 ,$51.27 ,$37.15 ,$44.58 ,$44.60 ,$44.58 ,$50.61 ,$65.92 ,$50.04 , N/A ,$57.86 , N/A , N/A , N/A , N/A , N/A ,$52.73 ,$45.41 ,$52.73 ,$52.73 ,$58.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS/DCS LAG 36MM ONE STEP,278,1 ,$92.14 ,$60.81 ,$46.73 ,$92.14 , N/A , N/A , N/A , N/A ,$55.28 ,$78.32 ,$64.50 , N/A , N/A ,$87.53 ,$70.03 ,$69.11 , N/A ,$78.32 , N/A , N/A , N/A ,$64.50 ,$56.11 , N/A , N/A , N/A , N/A , N/A ,$78.32 , N/A ,$84.77 ,$64.50 ,$46.73 ,$56.09 ,$56.11 ,$56.09 ,$63.67 ,$82.93 ,$62.95 , N/A ,$72.79 , N/A , N/A , N/A , N/A , N/A ,$66.34 ,$57.13 ,$66.34 ,$66.34 ,$73.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD 115MM,278,1 ,$92.14 ,$60.81 ,$46.73 ,$92.14 , N/A , N/A , N/A , N/A ,$55.28 ,$78.32 ,$64.50 , N/A , N/A ,$87.53 ,$70.03 ,$69.11 , N/A ,$78.32 , N/A , N/A , N/A ,$64.50 ,$56.11 , N/A , N/A , N/A , N/A , N/A ,$78.32 , N/A ,$84.77 ,$64.50 ,$46.73 ,$56.09 ,$56.11 ,$56.09 ,$63.67 ,$82.93 ,$62.95 , N/A ,$72.79 , N/A , N/A , N/A , N/A , N/A ,$66.34 ,$57.13 ,$66.34 ,$66.34 ,$73.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD 120MM,278,1 ,$92.14 ,$60.81 ,$46.73 ,$92.14 , N/A , N/A , N/A , N/A ,$55.28 ,$78.32 ,$64.50 , N/A , N/A ,$87.53 ,$70.03 ,$69.11 , N/A ,$78.32 , N/A , N/A , N/A ,$64.50 ,$56.11 , N/A , N/A , N/A , N/A , N/A ,$78.32 , N/A ,$84.77 ,$64.50 ,$46.73 ,$56.09 ,$56.11 ,$56.09 ,$63.67 ,$82.93 ,$62.95 , N/A ,$72.79 , N/A , N/A , N/A , N/A , N/A ,$66.34 ,$57.13 ,$66.34 ,$66.34 ,$73.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD 125MM,278,1 ,$92.14 ,$60.81 ,$46.73 ,$92.14 , N/A , N/A , N/A , N/A ,$55.28 ,$78.32 ,$64.50 , N/A , N/A ,$87.53 ,$70.03 ,$69.11 , N/A ,$78.32 , N/A , N/A , N/A ,$64.50 ,$56.11 , N/A , N/A , N/A , N/A , N/A ,$78.32 , N/A ,$84.77 ,$64.50 ,$46.73 ,$56.09 ,$56.11 ,$56.09 ,$63.67 ,$82.93 ,$62.95 , N/A ,$72.79 , N/A , N/A , N/A , N/A , N/A ,$66.34 ,$57.13 ,$66.34 ,$66.34 ,$73.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD 130MM,278,1 ,$92.14 ,$60.81 ,$46.73 ,$92.14 , N/A , N/A , N/A , N/A ,$55.28 ,$78.32 ,$64.50 , N/A , N/A ,$87.53 ,$70.03 ,$69.11 , N/A ,$78.32 , N/A , N/A , N/A ,$64.50 ,$56.11 , N/A , N/A , N/A , N/A , N/A ,$78.32 , N/A ,$84.77 ,$64.50 ,$46.73 ,$56.09 ,$56.11 ,$56.09 ,$63.67 ,$82.93 ,$62.95 , N/A ,$72.79 , N/A , N/A , N/A , N/A , N/A ,$66.34 ,$57.13 ,$66.34 ,$66.34 ,$73.71 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7MM ONE-STEP LAG THREAD/125MM,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG  65MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG  70MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG  75MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG  80MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG  85MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG  90MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG  95MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG 100MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG 105MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG 130MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7 DHS LAG 135MM ONE STEP,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7MM ONE-STEP LAG 140MM,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7MM ONE-STEP LAG 145MM,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7MM ONE-STEP LAG THREAD/110MM,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7MM ONE-STEP LAG THREAD/115MM,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 12.7MM ONE-STEP LAG THREAD/120MM,278,1 ,$686.28 ,$452.94 ,$348.08 ,$686.28 , N/A , N/A , N/A , N/A ,$411.77 ,$583.34 ,$480.40 , N/A , N/A ,$651.97 ,$521.57 ,$514.71 , N/A ,$583.34 , N/A , N/A , N/A ,$480.40 ,$417.94 , N/A , N/A , N/A , N/A , N/A ,$583.34 , N/A ,$631.38 ,$480.40 ,$348.08 ,$417.74 ,$417.94 ,$417.74 ,$474.22 ,$617.65 ,$468.87 , N/A ,$542.16 , N/A , N/A , N/A , N/A , N/A ,$494.12 ,$425.49 ,$494.12 ,$494.12 ,$549.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 40MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP 18MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP 20MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP 22MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP 24MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 22MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 24MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 26MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 28MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 30MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 32MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 34MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 36MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 38MM,278,1 ,$68.11 ,$44.95 ,$34.55 ,$68.11 , N/A , N/A , N/A , N/A ,$40.87 ,$57.89 ,$47.68 , N/A , N/A ,$64.70 ,$51.76 ,$51.08 , N/A ,$57.89 , N/A , N/A , N/A ,$47.68 ,$41.48 , N/A , N/A , N/A , N/A , N/A ,$57.89 , N/A ,$62.66 ,$47.68 ,$34.55 ,$41.46 ,$41.48 ,$41.46 ,$47.06 ,$61.30 ,$46.53 , N/A ,$53.81 , N/A , N/A , N/A , N/A , N/A ,$49.04 ,$42.23 ,$49.04 ,$49.04 ,$54.49 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 11MM,278,1 ,$94.82 ,$62.58 ,$48.09 ,$94.82 , N/A , N/A , N/A , N/A ,$56.89 ,$80.60 ,$66.37 , N/A , N/A ,$90.08 ,$72.06 ,$71.12 , N/A ,$80.60 , N/A , N/A , N/A ,$66.37 ,$57.75 , N/A , N/A , N/A , N/A , N/A ,$80.60 , N/A ,$87.23 ,$66.37 ,$48.09 ,$57.72 ,$57.75 ,$57.72 ,$65.52 ,$85.34 ,$64.78 , N/A ,$74.91 , N/A , N/A , N/A , N/A , N/A ,$68.27 ,$58.79 ,$68.27 ,$68.27 ,$75.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX STARDRIVE  8MM,278,1 ,$94.82 ,$62.58 ,$48.09 ,$94.82 , N/A , N/A , N/A , N/A ,$56.89 ,$80.60 ,$66.37 , N/A , N/A ,$90.08 ,$72.06 ,$71.12 , N/A ,$80.60 , N/A , N/A , N/A ,$66.37 ,$57.75 , N/A , N/A , N/A , N/A , N/A ,$80.60 , N/A ,$87.23 ,$66.37 ,$48.09 ,$57.72 ,$57.75 ,$57.72 ,$65.52 ,$85.34 ,$64.78 , N/A ,$74.91 , N/A , N/A , N/A , N/A , N/A ,$68.27 ,$58.79 ,$68.27 ,$68.27 ,$75.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX STARDRIVE  9MM,278,1 ,$94.82 ,$62.58 ,$48.09 ,$94.82 , N/A , N/A , N/A , N/A ,$56.89 ,$80.60 ,$66.37 , N/A , N/A ,$90.08 ,$72.06 ,$71.12 , N/A ,$80.60 , N/A , N/A , N/A ,$66.37 ,$57.75 , N/A , N/A , N/A , N/A , N/A ,$80.60 , N/A ,$87.23 ,$66.37 ,$48.09 ,$57.72 ,$57.75 ,$57.72 ,$65.52 ,$85.34 ,$64.78 , N/A ,$74.91 , N/A , N/A , N/A , N/A , N/A ,$68.27 ,$58.79 ,$68.27 ,$68.27 ,$75.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 1.5 CORTEX STARDRIVE 10MM,278,1 ,$94.82 ,$62.58 ,$48.09 ,$94.82 , N/A , N/A , N/A , N/A ,$56.89 ,$80.60 ,$66.37 , N/A , N/A ,$90.08 ,$72.06 ,$71.12 , N/A ,$80.60 , N/A , N/A , N/A ,$66.37 ,$57.75 , N/A , N/A , N/A , N/A , N/A ,$80.60 , N/A ,$87.23 ,$66.37 ,$48.09 ,$57.72 ,$57.75 ,$57.72 ,$65.52 ,$85.34 ,$64.78 , N/A ,$74.91 , N/A , N/A , N/A , N/A , N/A ,$68.27 ,$58.79 ,$68.27 ,$68.27 ,$75.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE  8MM,278,1 ,$94.82 ,$62.58 ,$48.09 ,$94.82 , N/A , N/A , N/A , N/A ,$56.89 ,$80.60 ,$66.37 , N/A , N/A ,$90.08 ,$72.06 ,$71.12 , N/A ,$80.60 , N/A , N/A , N/A ,$66.37 ,$57.75 , N/A , N/A , N/A , N/A , N/A ,$80.60 , N/A ,$87.23 ,$66.37 ,$48.09 ,$57.72 ,$57.75 ,$57.72 ,$65.52 ,$85.34 ,$64.78 , N/A ,$74.91 , N/A , N/A , N/A , N/A , N/A ,$68.27 ,$58.79 ,$68.27 ,$68.27 ,$75.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 10MM,278,1 ,$94.82 ,$62.58 ,$48.09 ,$94.82 , N/A , N/A , N/A , N/A ,$56.89 ,$80.60 ,$66.37 , N/A , N/A ,$90.08 ,$72.06 ,$71.12 , N/A ,$80.60 , N/A , N/A , N/A ,$66.37 ,$57.75 , N/A , N/A , N/A , N/A , N/A ,$80.60 , N/A ,$87.23 ,$66.37 ,$48.09 ,$57.72 ,$57.75 ,$57.72 ,$65.52 ,$85.34 ,$64.78 , N/A ,$74.91 , N/A , N/A , N/A , N/A , N/A ,$68.27 ,$58.79 ,$68.27 ,$68.27 ,$75.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 40MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE  6MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE  7MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE  9MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 12MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 13MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 14MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 16MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 18MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 20MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 22MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 24MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 26MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 28MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 30MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 32MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 34MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 36MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTEX STARDRIVE 38MM,278,1 ,$74.41 ,$49.11 ,$37.74 ,$74.41 , N/A , N/A , N/A , N/A ,$44.65 ,$63.25 ,$52.09 , N/A , N/A ,$70.69 ,$56.55 ,$55.81 , N/A ,$63.25 , N/A , N/A , N/A ,$52.09 ,$45.32 , N/A , N/A , N/A , N/A , N/A ,$63.25 , N/A ,$68.46 ,$52.09 ,$37.74 ,$45.29 ,$45.32 ,$45.29 ,$51.42 ,$66.97 ,$50.84 , N/A ,$58.78 , N/A , N/A , N/A , N/A , N/A ,$53.58 ,$46.13 ,$53.58 ,$53.58 ,$59.53 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 12MM,278,1 ,$63.25 ,$41.75 ,$32.08 ,$63.25 , N/A , N/A , N/A , N/A ,$37.95 ,$53.76 ,$44.28 , N/A , N/A ,$60.09 ,$48.07 ,$47.44 , N/A ,$53.76 , N/A , N/A , N/A ,$44.28 ,$38.52 , N/A , N/A , N/A , N/A , N/A ,$53.76 , N/A ,$58.19 ,$44.28 ,$32.08 ,$38.50 ,$38.52 ,$38.50 ,$43.71 ,$56.93 ,$43.21 , N/A ,$49.97 , N/A , N/A , N/A , N/A , N/A ,$45.54 ,$39.22 ,$45.54 ,$45.54 ,$50.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL  8MM,278,1 ,$63.25 ,$41.75 ,$32.08 ,$63.25 , N/A , N/A , N/A , N/A ,$37.95 ,$53.76 ,$44.28 , N/A , N/A ,$60.09 ,$48.07 ,$47.44 , N/A ,$53.76 , N/A , N/A , N/A ,$44.28 ,$38.52 , N/A , N/A , N/A , N/A , N/A ,$53.76 , N/A ,$58.19 ,$44.28 ,$32.08 ,$38.50 ,$38.52 ,$38.50 ,$43.71 ,$56.93 ,$43.21 , N/A ,$49.97 , N/A , N/A , N/A , N/A , N/A ,$45.54 ,$39.22 ,$45.54 ,$45.54 ,$50.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 10MM,278,1 ,$63.25 ,$41.75 ,$32.08 ,$63.25 , N/A , N/A , N/A , N/A ,$37.95 ,$53.76 ,$44.28 , N/A , N/A ,$60.09 ,$48.07 ,$47.44 , N/A ,$53.76 , N/A , N/A , N/A ,$44.28 ,$38.52 , N/A , N/A , N/A , N/A , N/A ,$53.76 , N/A ,$58.19 ,$44.28 ,$32.08 ,$38.50 ,$38.52 ,$38.50 ,$43.71 ,$56.93 ,$43.21 , N/A ,$49.97 , N/A , N/A , N/A , N/A , N/A ,$45.54 ,$39.22 ,$45.54 ,$45.54 ,$50.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 30MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL  6MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 14MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 32MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 16MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 18MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 20MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 22MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 24MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 26MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 CORTICAL 28MM,278,1 ,$60.23 ,$39.75 ,$30.55 ,$60.23 , N/A , N/A , N/A , N/A ,$36.14 ,$51.20 ,$42.16 , N/A , N/A ,$57.22 ,$45.77 ,$45.17 , N/A ,$51.20 , N/A , N/A , N/A ,$42.16 ,$36.68 , N/A , N/A , N/A , N/A , N/A ,$51.20 , N/A ,$55.41 ,$42.16 ,$30.55 ,$36.66 ,$36.68 ,$36.66 ,$41.62 ,$54.21 ,$41.15 , N/A ,$47.58 , N/A , N/A , N/A , N/A , N/A ,$43.37 ,$37.34 ,$43.37 ,$43.37 ,$48.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 9MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 10MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 11MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 12MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 13MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 14MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 16MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 18MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 20MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 22MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 24MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 26MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 28MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 30MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 6MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 7MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 LOCKING SELF TAP STARDRIVE RECESS 8MM,278,1 ,$240.98 ,$159.05 ,$122.23 ,$240.98 , N/A , N/A , N/A , N/A ,$144.59 ,$204.83 ,$168.69 , N/A , N/A ,$228.93 ,$183.14 ,$180.74 , N/A ,$204.83 , N/A , N/A , N/A ,$168.69 ,$146.76 , N/A , N/A , N/A , N/A , N/A ,$204.83 , N/A ,$221.70 ,$168.69 ,$122.23 ,$146.68 ,$146.76 ,$146.68 ,$166.52 ,$216.88 ,$164.64 , N/A ,$190.37 , N/A , N/A , N/A , N/A , N/A ,$173.51 ,$149.41 ,$173.51 ,$173.51 ,$192.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0MM TI CORTEX  8MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP  6MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP  7MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP  8MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP  9MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 10MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 11MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 12MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 13MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 14MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 16MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 18MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 20MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 22MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 24MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 26MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 28MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 30MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 32MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0MM TI CORTEX  10MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0MM TI CORTEX  12MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0MM TI CORTEX  14MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0MM TI CORTEX  16MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0MM TI CORTEX  20MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0MM TI CORTEX  22MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0MM TI CORTEX  24MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.0MM TI CORTEX  6MM,278,1 ,$72.83 ,$48.07 ,$36.94 ,$72.83 , N/A , N/A , N/A , N/A ,$43.70 ,$61.91 ,$50.98 , N/A , N/A ,$69.19 ,$55.35 ,$54.62 , N/A ,$61.91 , N/A , N/A , N/A ,$50.98 ,$44.35 , N/A , N/A , N/A , N/A , N/A ,$61.91 , N/A ,$67.00 ,$50.98 ,$36.94 ,$44.33 ,$44.35 ,$44.33 ,$50.33 ,$65.55 ,$49.76 , N/A ,$57.54 , N/A , N/A , N/A , N/A , N/A ,$52.44 ,$45.15 ,$52.44 ,$52.44 ,$58.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 16MM,278,1 ,$112.46 ,$74.22 ,$57.04 ,$112.46 , N/A , N/A , N/A , N/A ,$67.48 ,$95.59 ,$78.72 , N/A , N/A ,$106.84 ,$85.47 ,$84.35 , N/A ,$95.59 , N/A , N/A , N/A ,$78.72 ,$68.49 , N/A , N/A , N/A , N/A , N/A ,$95.59 , N/A ,$103.46 ,$78.72 ,$57.04 ,$68.45 ,$68.49 ,$68.45 ,$77.71 ,$101.21 ,$76.83 , N/A ,$88.84 , N/A , N/A , N/A , N/A , N/A ,$80.97 ,$69.73 ,$80.97 ,$80.97 ,$89.97 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 14MM,278,1 ,$112.46 ,$74.22 ,$57.04 ,$112.46 , N/A , N/A , N/A , N/A ,$67.48 ,$95.59 ,$78.72 , N/A , N/A ,$106.84 ,$85.47 ,$84.35 , N/A ,$95.59 , N/A , N/A , N/A ,$78.72 ,$68.49 , N/A , N/A , N/A , N/A , N/A ,$95.59 , N/A ,$103.46 ,$78.72 ,$57.04 ,$68.45 ,$68.49 ,$68.45 ,$77.71 ,$101.21 ,$76.83 , N/A ,$88.84 , N/A , N/A , N/A , N/A , N/A ,$80.97 ,$69.73 ,$80.97 ,$80.97 ,$89.97 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 9MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 10MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 11MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 12MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 13MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 18MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 20MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 22MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 24MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 26MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 28MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 30MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 32MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 34MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 36MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 38MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 40MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 6MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 7MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 CORTICAL SELF TAP 8MM,278,1 ,$118.13 ,$77.97 ,$59.92 ,$118.13 , N/A , N/A , N/A , N/A ,$70.88 ,$100.41 ,$82.69 , N/A , N/A ,$112.22 ,$89.78 ,$88.60 , N/A ,$100.41 , N/A , N/A , N/A ,$82.69 ,$71.94 , N/A , N/A , N/A , N/A , N/A ,$100.41 , N/A ,$108.68 ,$82.69 ,$59.92 ,$71.91 ,$71.94 ,$71.91 ,$81.63 ,$106.32 ,$80.71 , N/A ,$93.32 , N/A , N/A , N/A , N/A , N/A ,$85.05 ,$73.24 ,$85.05 ,$85.05 ,$94.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 13MM,278,1 ,$245.70 ,$162.16 ,$124.62 ,$245.70 , N/A , N/A , N/A , N/A ,$147.42 ,$208.85 ,$171.99 , N/A , N/A ,$233.42 ,$186.73 ,$184.28 , N/A ,$208.85 , N/A , N/A , N/A ,$171.99 ,$149.63 , N/A , N/A , N/A , N/A , N/A ,$208.85 , N/A ,$226.04 ,$171.99 ,$124.62 ,$149.56 ,$149.63 ,$149.56 ,$169.78 ,$221.13 ,$167.86 , N/A ,$194.10 , N/A , N/A , N/A , N/A , N/A ,$176.90 ,$152.33 ,$176.90 ,$176.90 ,$196.56 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE  7MM,278,1 ,$245.70 ,$162.16 ,$124.62 ,$245.70 , N/A , N/A , N/A , N/A ,$147.42 ,$208.85 ,$171.99 , N/A , N/A ,$233.42 ,$186.73 ,$184.28 , N/A ,$208.85 , N/A , N/A , N/A ,$171.99 ,$149.63 , N/A , N/A , N/A , N/A , N/A ,$208.85 , N/A ,$226.04 ,$171.99 ,$124.62 ,$149.56 ,$149.63 ,$149.56 ,$169.78 ,$221.13 ,$167.86 , N/A ,$194.10 , N/A , N/A , N/A , N/A , N/A ,$176.90 ,$152.33 ,$176.90 ,$176.90 ,$196.56 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE  8MM,278,1 ,$245.70 ,$162.16 ,$124.62 ,$245.70 , N/A , N/A , N/A , N/A ,$147.42 ,$208.85 ,$171.99 , N/A , N/A ,$233.42 ,$186.73 ,$184.28 , N/A ,$208.85 , N/A , N/A , N/A ,$171.99 ,$149.63 , N/A , N/A , N/A , N/A , N/A ,$208.85 , N/A ,$226.04 ,$171.99 ,$124.62 ,$149.56 ,$149.63 ,$149.56 ,$169.78 ,$221.13 ,$167.86 , N/A ,$194.10 , N/A , N/A , N/A , N/A , N/A ,$176.90 ,$152.33 ,$176.90 ,$176.90 ,$196.56 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE  9MM,278,1 ,$245.70 ,$162.16 ,$124.62 ,$245.70 , N/A , N/A , N/A , N/A ,$147.42 ,$208.85 ,$171.99 , N/A , N/A ,$233.42 ,$186.73 ,$184.28 , N/A ,$208.85 , N/A , N/A , N/A ,$171.99 ,$149.63 , N/A , N/A , N/A , N/A , N/A ,$208.85 , N/A ,$226.04 ,$171.99 ,$124.62 ,$149.56 ,$149.63 ,$149.56 ,$169.78 ,$221.13 ,$167.86 , N/A ,$194.10 , N/A , N/A , N/A , N/A , N/A ,$176.90 ,$152.33 ,$176.90 ,$176.90 ,$196.56 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 10MM,278,1 ,$245.70 ,$162.16 ,$124.62 ,$245.70 , N/A , N/A , N/A , N/A ,$147.42 ,$208.85 ,$171.99 , N/A , N/A ,$233.42 ,$186.73 ,$184.28 , N/A ,$208.85 , N/A , N/A , N/A ,$171.99 ,$149.63 , N/A , N/A , N/A , N/A , N/A ,$208.85 , N/A ,$226.04 ,$171.99 ,$124.62 ,$149.56 ,$149.63 ,$149.56 ,$169.78 ,$221.13 ,$167.86 , N/A ,$194.10 , N/A , N/A , N/A , N/A , N/A ,$176.90 ,$152.33 ,$176.90 ,$176.90 ,$196.56 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 11MM,278,1 ,$245.70 ,$162.16 ,$124.62 ,$245.70 , N/A , N/A , N/A , N/A ,$147.42 ,$208.85 ,$171.99 , N/A , N/A ,$233.42 ,$186.73 ,$184.28 , N/A ,$208.85 , N/A , N/A , N/A ,$171.99 ,$149.63 , N/A , N/A , N/A , N/A , N/A ,$208.85 , N/A ,$226.04 ,$171.99 ,$124.62 ,$149.56 ,$149.63 ,$149.56 ,$169.78 ,$221.13 ,$167.86 , N/A ,$194.10 , N/A , N/A , N/A , N/A , N/A ,$176.90 ,$152.33 ,$176.90 ,$176.90 ,$196.56 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 24MM,278,1 ,$283.43 ,$187.06 ,$143.76 ,$283.43 , N/A , N/A , N/A , N/A ,$170.06 ,$240.92 ,$198.40 , N/A , N/A ,$269.26 ,$215.41 ,$212.57 , N/A ,$240.92 , N/A , N/A , N/A ,$198.40 ,$172.61 , N/A , N/A , N/A , N/A , N/A ,$240.92 , N/A ,$260.76 ,$198.40 ,$143.76 ,$172.52 ,$172.61 ,$172.52 ,$195.85 ,$255.09 ,$193.64 , N/A ,$223.91 , N/A , N/A , N/A , N/A , N/A ,$204.07 ,$175.73 ,$204.07 ,$204.07 ,$226.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 16MM,278,1 ,$283.43 ,$187.06 ,$143.76 ,$283.43 , N/A , N/A , N/A , N/A ,$170.06 ,$240.92 ,$198.40 , N/A , N/A ,$269.26 ,$215.41 ,$212.57 , N/A ,$240.92 , N/A , N/A , N/A ,$198.40 ,$172.61 , N/A , N/A , N/A , N/A , N/A ,$240.92 , N/A ,$260.76 ,$198.40 ,$143.76 ,$172.52 ,$172.61 ,$172.52 ,$195.85 ,$255.09 ,$193.64 , N/A ,$223.91 , N/A , N/A , N/A , N/A , N/A ,$204.07 ,$175.73 ,$204.07 ,$204.07 ,$226.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 18MM,278,1 ,$283.43 ,$187.06 ,$143.76 ,$283.43 , N/A , N/A , N/A , N/A ,$170.06 ,$240.92 ,$198.40 , N/A , N/A ,$269.26 ,$215.41 ,$212.57 , N/A ,$240.92 , N/A , N/A , N/A ,$198.40 ,$172.61 , N/A , N/A , N/A , N/A , N/A ,$240.92 , N/A ,$260.76 ,$198.40 ,$143.76 ,$172.52 ,$172.61 ,$172.52 ,$195.85 ,$255.09 ,$193.64 , N/A ,$223.91 , N/A , N/A , N/A , N/A , N/A ,$204.07 ,$175.73 ,$204.07 ,$204.07 ,$226.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 20MM,278,1 ,$283.43 ,$187.06 ,$143.76 ,$283.43 , N/A , N/A , N/A , N/A ,$170.06 ,$240.92 ,$198.40 , N/A , N/A ,$269.26 ,$215.41 ,$212.57 , N/A ,$240.92 , N/A , N/A , N/A ,$198.40 ,$172.61 , N/A , N/A , N/A , N/A , N/A ,$240.92 , N/A ,$260.76 ,$198.40 ,$143.76 ,$172.52 ,$172.61 ,$172.52 ,$195.85 ,$255.09 ,$193.64 , N/A ,$223.91 , N/A , N/A , N/A , N/A , N/A ,$204.07 ,$175.73 ,$204.07 ,$204.07 ,$226.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 22MM,278,1 ,$283.43 ,$187.06 ,$143.76 ,$283.43 , N/A , N/A , N/A , N/A ,$170.06 ,$240.92 ,$198.40 , N/A , N/A ,$269.26 ,$215.41 ,$212.57 , N/A ,$240.92 , N/A , N/A , N/A ,$198.40 ,$172.61 , N/A , N/A , N/A , N/A , N/A ,$240.92 , N/A ,$260.76 ,$198.40 ,$143.76 ,$172.52 ,$172.61 ,$172.52 ,$195.85 ,$255.09 ,$193.64 , N/A ,$223.91 , N/A , N/A , N/A , N/A , N/A ,$204.07 ,$175.73 ,$204.07 ,$204.07 ,$226.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 8MM,278,1 ,$285.08 ,$188.15 ,$144.59 ,$285.08 , N/A , N/A , N/A , N/A ,$171.05 ,$242.32 ,$199.56 , N/A , N/A ,$270.83 ,$216.66 ,$213.81 , N/A ,$242.32 , N/A , N/A , N/A ,$199.56 ,$173.61 , N/A , N/A , N/A , N/A , N/A ,$242.32 , N/A ,$262.27 ,$199.56 ,$144.59 ,$173.53 ,$173.61 ,$173.53 ,$196.99 ,$256.57 ,$194.77 , N/A ,$225.21 , N/A , N/A , N/A , N/A , N/A ,$205.26 ,$176.75 ,$205.26 ,$205.26 ,$228.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 12MM,278,1 ,$285.08 ,$188.15 ,$144.59 ,$285.08 , N/A , N/A , N/A , N/A ,$171.05 ,$242.32 ,$199.56 , N/A , N/A ,$270.83 ,$216.66 ,$213.81 , N/A ,$242.32 , N/A , N/A , N/A ,$199.56 ,$173.61 , N/A , N/A , N/A , N/A , N/A ,$242.32 , N/A ,$262.27 ,$199.56 ,$144.59 ,$173.53 ,$173.61 ,$173.53 ,$196.99 ,$256.57 ,$194.77 , N/A ,$225.21 , N/A , N/A , N/A , N/A , N/A ,$205.26 ,$176.75 ,$205.26 ,$205.26 ,$228.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 14MM,278,1 ,$285.08 ,$188.15 ,$144.59 ,$285.08 , N/A , N/A , N/A , N/A ,$171.05 ,$242.32 ,$199.56 , N/A , N/A ,$270.83 ,$216.66 ,$213.81 , N/A ,$242.32 , N/A , N/A , N/A ,$199.56 ,$173.61 , N/A , N/A , N/A , N/A , N/A ,$242.32 , N/A ,$262.27 ,$199.56 ,$144.59 ,$173.53 ,$173.61 ,$173.53 ,$196.99 ,$256.57 ,$194.77 , N/A ,$225.21 , N/A , N/A , N/A , N/A , N/A ,$205.26 ,$176.75 ,$205.26 ,$205.26 ,$228.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 26MM,278,1 ,$285.08 ,$188.15 ,$144.59 ,$285.08 , N/A , N/A , N/A , N/A ,$171.05 ,$242.32 ,$199.56 , N/A , N/A ,$270.83 ,$216.66 ,$213.81 , N/A ,$242.32 , N/A , N/A , N/A ,$199.56 ,$173.61 , N/A , N/A , N/A , N/A , N/A ,$242.32 , N/A ,$262.27 ,$199.56 ,$144.59 ,$173.53 ,$173.61 ,$173.53 ,$196.99 ,$256.57 ,$194.77 , N/A ,$225.21 , N/A , N/A , N/A , N/A , N/A ,$205.26 ,$176.75 ,$205.26 ,$205.26 ,$228.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 28MM,278,1 ,$285.08 ,$188.15 ,$144.59 ,$285.08 , N/A , N/A , N/A , N/A ,$171.05 ,$242.32 ,$199.56 , N/A , N/A ,$270.83 ,$216.66 ,$213.81 , N/A ,$242.32 , N/A , N/A , N/A ,$199.56 ,$173.61 , N/A , N/A , N/A , N/A , N/A ,$242.32 , N/A ,$262.27 ,$199.56 ,$144.59 ,$173.53 ,$173.61 ,$173.53 ,$196.99 ,$256.57 ,$194.77 , N/A ,$225.21 , N/A , N/A , N/A , N/A , N/A ,$205.26 ,$176.75 ,$205.26 ,$205.26 ,$228.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 30MM,278,1 ,$285.08 ,$188.15 ,$144.59 ,$285.08 , N/A , N/A , N/A , N/A ,$171.05 ,$242.32 ,$199.56 , N/A , N/A ,$270.83 ,$216.66 ,$213.81 , N/A ,$242.32 , N/A , N/A , N/A ,$199.56 ,$173.61 , N/A , N/A , N/A , N/A , N/A ,$242.32 , N/A ,$262.27 ,$199.56 ,$144.59 ,$173.53 ,$173.61 ,$173.53 ,$196.99 ,$256.57 ,$194.77 , N/A ,$225.21 , N/A , N/A , N/A , N/A , N/A ,$205.26 ,$176.75 ,$205.26 ,$205.26 ,$228.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE  6MM,278,1 ,$285.08 ,$188.15 ,$144.59 ,$285.08 , N/A , N/A , N/A , N/A ,$171.05 ,$242.32 ,$199.56 , N/A , N/A ,$270.83 ,$216.66 ,$213.81 , N/A ,$242.32 , N/A , N/A , N/A ,$199.56 ,$173.61 , N/A , N/A , N/A , N/A , N/A ,$242.32 , N/A ,$262.27 ,$199.56 ,$144.59 ,$173.53 ,$173.61 ,$173.53 ,$196.99 ,$256.57 ,$194.77 , N/A ,$225.21 , N/A , N/A , N/A , N/A , N/A ,$205.26 ,$176.75 ,$205.26 ,$205.26 ,$228.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 32MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP  6MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP  7MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP  8MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP  9MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 10MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 11MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 12MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 13MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 14MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 16MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 18MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 20MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 22MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 24MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 26MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 28MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 30MM,278,1 ,$168.53 ,$111.23 ,$85.48 ,$168.53 , N/A , N/A , N/A , N/A ,$101.12 ,$143.25 ,$117.97 , N/A , N/A ,$160.10 ,$128.08 ,$126.40 , N/A ,$143.25 , N/A , N/A , N/A ,$117.97 ,$102.63 , N/A , N/A , N/A , N/A , N/A ,$143.25 , N/A ,$155.05 ,$117.97 ,$85.48 ,$102.58 ,$102.63 ,$102.58 ,$116.45 ,$151.68 ,$115.14 , N/A ,$133.14 , N/A , N/A , N/A , N/A , N/A ,$121.34 ,$104.49 ,$121.34 ,$121.34 ,$134.82 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTEX FULL TH 16MM,278,1 ,$63.97 ,$42.22 ,$32.45 ,$63.97 , N/A , N/A , N/A , N/A ,$38.38 ,$54.37 ,$44.78 , N/A , N/A ,$60.77 ,$48.62 ,$47.98 , N/A ,$54.37 , N/A , N/A , N/A ,$44.78 ,$38.96 , N/A , N/A , N/A , N/A , N/A ,$54.37 , N/A ,$58.85 ,$44.78 ,$32.45 ,$38.94 ,$38.96 ,$38.94 ,$44.20 ,$57.57 ,$43.70 , N/A ,$50.54 , N/A , N/A , N/A , N/A , N/A ,$46.06 ,$39.66 ,$46.06 ,$46.06 ,$51.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTEX FULL TH 10MM,278,1 ,$63.97 ,$42.22 ,$32.45 ,$63.97 , N/A , N/A , N/A , N/A ,$38.38 ,$54.37 ,$44.78 , N/A , N/A ,$60.77 ,$48.62 ,$47.98 , N/A ,$54.37 , N/A , N/A , N/A ,$44.78 ,$38.96 , N/A , N/A , N/A , N/A , N/A ,$54.37 , N/A ,$58.85 ,$44.78 ,$32.45 ,$38.94 ,$38.96 ,$38.94 ,$44.20 ,$57.57 ,$43.70 , N/A ,$50.54 , N/A , N/A , N/A , N/A , N/A ,$46.06 ,$39.66 ,$46.06 ,$46.06 ,$51.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTEX FULL TH 12MM,278,1 ,$63.97 ,$42.22 ,$32.45 ,$63.97 , N/A , N/A , N/A , N/A ,$38.38 ,$54.37 ,$44.78 , N/A , N/A ,$60.77 ,$48.62 ,$47.98 , N/A ,$54.37 , N/A , N/A , N/A ,$44.78 ,$38.96 , N/A , N/A , N/A , N/A , N/A ,$54.37 , N/A ,$58.85 ,$44.78 ,$32.45 ,$38.94 ,$38.96 ,$38.94 ,$44.20 ,$57.57 ,$43.70 , N/A ,$50.54 , N/A , N/A , N/A , N/A , N/A ,$46.06 ,$39.66 ,$46.06 ,$46.06 ,$51.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 18MM,278,1 ,$77.18 ,$50.94 ,$39.15 ,$77.18 , N/A , N/A , N/A , N/A ,$46.31 ,$65.60 ,$54.03 , N/A , N/A ,$73.32 ,$58.66 ,$57.89 , N/A ,$65.60 , N/A , N/A , N/A ,$54.03 ,$47.00 , N/A , N/A , N/A , N/A , N/A ,$65.60 , N/A ,$71.01 ,$54.03 ,$39.15 ,$46.98 ,$47.00 ,$46.98 ,$53.33 ,$69.46 ,$52.73 , N/A ,$60.97 , N/A , N/A , N/A , N/A , N/A ,$55.57 ,$47.85 ,$55.57 ,$55.57 ,$61.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 12MM,278,1 ,$77.18 ,$50.94 ,$39.15 ,$77.18 , N/A , N/A , N/A , N/A ,$46.31 ,$65.60 ,$54.03 , N/A , N/A ,$73.32 ,$58.66 ,$57.89 , N/A ,$65.60 , N/A , N/A , N/A ,$54.03 ,$47.00 , N/A , N/A , N/A , N/A , N/A ,$65.60 , N/A ,$71.01 ,$54.03 ,$39.15 ,$46.98 ,$47.00 ,$46.98 ,$53.33 ,$69.46 ,$52.73 , N/A ,$60.97 , N/A , N/A , N/A , N/A , N/A ,$55.57 ,$47.85 ,$55.57 ,$55.57 ,$61.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 14MM,278,1 ,$77.18 ,$50.94 ,$39.15 ,$77.18 , N/A , N/A , N/A , N/A ,$46.31 ,$65.60 ,$54.03 , N/A , N/A ,$73.32 ,$58.66 ,$57.89 , N/A ,$65.60 , N/A , N/A , N/A ,$54.03 ,$47.00 , N/A , N/A , N/A , N/A , N/A ,$65.60 , N/A ,$71.01 ,$54.03 ,$39.15 ,$46.98 ,$47.00 ,$46.98 ,$53.33 ,$69.46 ,$52.73 , N/A ,$60.97 , N/A , N/A , N/A , N/A , N/A ,$55.57 ,$47.85 ,$55.57 ,$55.57 ,$61.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 16MM,278,1 ,$77.18 ,$50.94 ,$39.15 ,$77.18 , N/A , N/A , N/A , N/A ,$46.31 ,$65.60 ,$54.03 , N/A , N/A ,$73.32 ,$58.66 ,$57.89 , N/A ,$65.60 , N/A , N/A , N/A ,$54.03 ,$47.00 , N/A , N/A , N/A , N/A , N/A ,$65.60 , N/A ,$71.01 ,$54.03 ,$39.15 ,$46.98 ,$47.00 ,$46.98 ,$53.33 ,$69.46 ,$52.73 , N/A ,$60.97 , N/A , N/A , N/A , N/A , N/A ,$55.57 ,$47.85 ,$55.57 ,$55.57 ,$61.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 46MM,278,1 ,$74.59 ,$49.23 ,$37.83 ,$74.59 , N/A , N/A , N/A , N/A ,$44.75 ,$63.40 ,$52.21 , N/A , N/A ,$70.86 ,$56.69 ,$55.94 , N/A ,$63.40 , N/A , N/A , N/A ,$52.21 ,$45.43 , N/A , N/A , N/A , N/A , N/A ,$63.40 , N/A ,$68.62 ,$52.21 ,$37.83 ,$45.40 ,$45.43 ,$45.40 ,$51.54 ,$67.13 ,$50.96 , N/A ,$58.93 , N/A , N/A , N/A , N/A , N/A ,$53.70 ,$46.25 ,$53.70 ,$53.70 ,$59.67 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 60MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 10MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 20MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 22MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 24MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 26MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 28MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 30MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 32MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 34MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 36MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 38MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 40MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 42MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 44MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 48MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 50MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 55MM,278,1 ,$80.33 ,$53.02 ,$40.74 ,$80.33 , N/A , N/A , N/A , N/A ,$48.20 ,$68.28 ,$56.23 , N/A , N/A ,$76.31 ,$61.05 ,$60.25 , N/A ,$68.28 , N/A , N/A , N/A ,$56.23 ,$48.92 , N/A , N/A , N/A , N/A , N/A ,$68.28 , N/A ,$73.90 ,$56.23 ,$40.74 ,$48.90 ,$48.92 ,$48.90 ,$55.51 ,$72.30 ,$54.88 , N/A ,$63.46 , N/A , N/A , N/A , N/A , N/A ,$57.84 ,$49.80 ,$57.84 ,$57.84 ,$64.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 22,278,1 ,$76.77 ,$50.67 ,$38.94 ,$76.77 , N/A , N/A , N/A , N/A ,$46.06 ,$65.25 ,$53.74 , N/A , N/A ,$72.93 ,$58.35 ,$57.58 , N/A ,$65.25 , N/A , N/A , N/A ,$53.74 ,$46.75 , N/A , N/A , N/A , N/A , N/A ,$65.25 , N/A ,$70.63 ,$53.74 ,$38.94 ,$46.73 ,$46.75 ,$46.73 ,$53.05 ,$69.09 ,$52.45 , N/A ,$60.65 , N/A , N/A , N/A , N/A , N/A ,$55.27 ,$47.60 ,$55.27 ,$55.27 ,$61.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 10,278,1 ,$76.77 ,$50.67 ,$38.94 ,$76.77 , N/A , N/A , N/A , N/A ,$46.06 ,$65.25 ,$53.74 , N/A , N/A ,$72.93 ,$58.35 ,$57.58 , N/A ,$65.25 , N/A , N/A , N/A ,$53.74 ,$46.75 , N/A , N/A , N/A , N/A , N/A ,$65.25 , N/A ,$70.63 ,$53.74 ,$38.94 ,$46.73 ,$46.75 ,$46.73 ,$53.05 ,$69.09 ,$52.45 , N/A ,$60.65 , N/A , N/A , N/A , N/A , N/A ,$55.27 ,$47.60 ,$55.27 ,$55.27 ,$61.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 12,278,1 ,$76.77 ,$50.67 ,$38.94 ,$76.77 , N/A , N/A , N/A , N/A ,$46.06 ,$65.25 ,$53.74 , N/A , N/A ,$72.93 ,$58.35 ,$57.58 , N/A ,$65.25 , N/A , N/A , N/A ,$53.74 ,$46.75 , N/A , N/A , N/A , N/A , N/A ,$65.25 , N/A ,$70.63 ,$53.74 ,$38.94 ,$46.73 ,$46.75 ,$46.73 ,$53.05 ,$69.09 ,$52.45 , N/A ,$60.65 , N/A , N/A , N/A , N/A , N/A ,$55.27 ,$47.60 ,$55.27 ,$55.27 ,$61.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 14,278,1 ,$76.77 ,$50.67 ,$38.94 ,$76.77 , N/A , N/A , N/A , N/A ,$46.06 ,$65.25 ,$53.74 , N/A , N/A ,$72.93 ,$58.35 ,$57.58 , N/A ,$65.25 , N/A , N/A , N/A ,$53.74 ,$46.75 , N/A , N/A , N/A , N/A , N/A ,$65.25 , N/A ,$70.63 ,$53.74 ,$38.94 ,$46.73 ,$46.75 ,$46.73 ,$53.05 ,$69.09 ,$52.45 , N/A ,$60.65 , N/A , N/A , N/A , N/A , N/A ,$55.27 ,$47.60 ,$55.27 ,$55.27 ,$61.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 16,278,1 ,$76.77 ,$50.67 ,$38.94 ,$76.77 , N/A , N/A , N/A , N/A ,$46.06 ,$65.25 ,$53.74 , N/A , N/A ,$72.93 ,$58.35 ,$57.58 , N/A ,$65.25 , N/A , N/A , N/A ,$53.74 ,$46.75 , N/A , N/A , N/A , N/A , N/A ,$65.25 , N/A ,$70.63 ,$53.74 ,$38.94 ,$46.73 ,$46.75 ,$46.73 ,$53.05 ,$69.09 ,$52.45 , N/A ,$60.65 , N/A , N/A , N/A , N/A , N/A ,$55.27 ,$47.60 ,$55.27 ,$55.27 ,$61.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 18,278,1 ,$76.77 ,$50.67 ,$38.94 ,$76.77 , N/A , N/A , N/A , N/A ,$46.06 ,$65.25 ,$53.74 , N/A , N/A ,$72.93 ,$58.35 ,$57.58 , N/A ,$65.25 , N/A , N/A , N/A ,$53.74 ,$46.75 , N/A , N/A , N/A , N/A , N/A ,$65.25 , N/A ,$70.63 ,$53.74 ,$38.94 ,$46.73 ,$46.75 ,$46.73 ,$53.05 ,$69.09 ,$52.45 , N/A ,$60.65 , N/A , N/A , N/A , N/A , N/A ,$55.27 ,$47.60 ,$55.27 ,$55.27 ,$61.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 20,278,1 ,$76.77 ,$50.67 ,$38.94 ,$76.77 , N/A , N/A , N/A , N/A ,$46.06 ,$65.25 ,$53.74 , N/A , N/A ,$72.93 ,$58.35 ,$57.58 , N/A ,$65.25 , N/A , N/A , N/A ,$53.74 ,$46.75 , N/A , N/A , N/A , N/A , N/A ,$65.25 , N/A ,$70.63 ,$53.74 ,$38.94 ,$46.73 ,$46.75 ,$46.73 ,$53.05 ,$69.09 ,$52.45 , N/A ,$60.65 , N/A , N/A , N/A , N/A , N/A ,$55.27 ,$47.60 ,$55.27 ,$55.27 ,$61.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 36MM,278,1 ,$237.04 ,$156.45 ,$120.23 ,$237.04 , N/A , N/A , N/A , N/A ,$142.22 ,$201.48 ,$165.93 , N/A , N/A ,$225.19 ,$180.15 ,$177.78 , N/A ,$201.48 , N/A , N/A , N/A ,$165.93 ,$144.36 , N/A , N/A , N/A , N/A , N/A ,$201.48 , N/A ,$218.08 ,$165.93 ,$120.23 ,$144.29 ,$144.36 ,$144.29 ,$163.79 ,$213.34 ,$161.95 , N/A ,$187.26 , N/A , N/A , N/A , N/A , N/A ,$170.67 ,$146.96 ,$170.67 ,$170.67 ,$189.63 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 14MM,278,1 ,$237.04 ,$156.45 ,$120.23 ,$237.04 , N/A , N/A , N/A , N/A ,$142.22 ,$201.48 ,$165.93 , N/A , N/A ,$225.19 ,$180.15 ,$177.78 , N/A ,$201.48 , N/A , N/A , N/A ,$165.93 ,$144.36 , N/A , N/A , N/A , N/A , N/A ,$201.48 , N/A ,$218.08 ,$165.93 ,$120.23 ,$144.29 ,$144.36 ,$144.29 ,$163.79 ,$213.34 ,$161.95 , N/A ,$187.26 , N/A , N/A , N/A , N/A , N/A ,$170.67 ,$146.96 ,$170.67 ,$170.67 ,$189.63 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 16MM,278,1 ,$237.04 ,$156.45 ,$120.23 ,$237.04 , N/A , N/A , N/A , N/A ,$142.22 ,$201.48 ,$165.93 , N/A , N/A ,$225.19 ,$180.15 ,$177.78 , N/A ,$201.48 , N/A , N/A , N/A ,$165.93 ,$144.36 , N/A , N/A , N/A , N/A , N/A ,$201.48 , N/A ,$218.08 ,$165.93 ,$120.23 ,$144.29 ,$144.36 ,$144.29 ,$163.79 ,$213.34 ,$161.95 , N/A ,$187.26 , N/A , N/A , N/A , N/A , N/A ,$170.67 ,$146.96 ,$170.67 ,$170.67 ,$189.63 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 20MM,278,1 ,$237.04 ,$156.45 ,$120.23 ,$237.04 , N/A , N/A , N/A , N/A ,$142.22 ,$201.48 ,$165.93 , N/A , N/A ,$225.19 ,$180.15 ,$177.78 , N/A ,$201.48 , N/A , N/A , N/A ,$165.93 ,$144.36 , N/A , N/A , N/A , N/A , N/A ,$201.48 , N/A ,$218.08 ,$165.93 ,$120.23 ,$144.29 ,$144.36 ,$144.29 ,$163.79 ,$213.34 ,$161.95 , N/A ,$187.26 , N/A , N/A , N/A , N/A , N/A ,$170.67 ,$146.96 ,$170.67 ,$170.67 ,$189.63 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 60MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE  8MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 10MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 12MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 18MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 22MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 24MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 26MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 28MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 30MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 32MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 34MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 38MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 40MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 42MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 44MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 46MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 48MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 50MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 LOCKING STARDRIVE 55MM,278,1 ,$248.85 ,$164.24 ,$126.22 ,$248.85 , N/A , N/A , N/A , N/A ,$149.31 ,$211.52 ,$174.20 , N/A , N/A ,$236.41 ,$189.13 ,$186.64 , N/A ,$211.52 , N/A , N/A , N/A ,$174.20 ,$151.55 , N/A , N/A , N/A , N/A , N/A ,$211.52 , N/A ,$228.94 ,$174.20 ,$126.22 ,$151.48 ,$151.55 ,$151.48 ,$171.96 ,$223.97 ,$170.01 , N/A ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$179.17 ,$154.29 ,$179.17 ,$179.17 ,$199.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  6MM,278,1 ,$63.38 ,$41.83 ,$32.15 ,$63.38 , N/A , N/A , N/A , N/A ,$38.03 ,$53.87 ,$44.37 , N/A , N/A ,$60.21 ,$48.17 ,$47.54 , N/A ,$53.87 , N/A , N/A , N/A ,$44.37 ,$38.60 , N/A , N/A , N/A , N/A , N/A ,$53.87 , N/A ,$58.31 ,$44.37 ,$32.15 ,$38.58 ,$38.60 ,$38.58 ,$43.80 ,$57.04 ,$43.30 , N/A ,$50.07 , N/A , N/A , N/A , N/A , N/A ,$45.63 ,$39.30 ,$45.63 ,$45.63 ,$50.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  8MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 TI CORTEX 12MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 24,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 26,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 28,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 30,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 32,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 34,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 36,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 38,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 40,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 45,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 50,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 55,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  10MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  12MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  14MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  16MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  18MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  20MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  22MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 TI CORTEX  24MM,278,1 ,$68.90 ,$45.47 ,$34.95 ,$68.90 , N/A , N/A , N/A , N/A ,$41.34 ,$58.57 ,$48.23 , N/A , N/A ,$65.46 ,$52.36 ,$51.68 , N/A ,$58.57 , N/A , N/A , N/A ,$48.23 ,$41.96 , N/A , N/A , N/A , N/A , N/A ,$58.57 , N/A ,$63.39 ,$48.23 ,$34.95 ,$41.94 ,$41.96 ,$41.94 ,$47.61 ,$62.01 ,$47.07 , N/A ,$54.43 , N/A , N/A , N/A , N/A , N/A ,$49.61 ,$42.72 ,$49.61 ,$49.61 ,$55.12 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 12MM,278,1 ,$277.88 ,$183.40 ,$140.94 ,$277.88 , N/A , N/A , N/A , N/A ,$166.73 ,$236.20 ,$194.52 , N/A , N/A ,$263.99 ,$211.19 ,$208.41 , N/A ,$236.20 , N/A , N/A , N/A ,$194.52 ,$169.23 , N/A , N/A , N/A , N/A , N/A ,$236.20 , N/A ,$255.65 ,$194.52 ,$140.94 ,$169.15 ,$169.23 ,$169.15 ,$192.02 ,$250.09 ,$189.85 , N/A ,$219.53 , N/A , N/A , N/A , N/A , N/A ,$200.07 ,$172.29 ,$200.07 ,$200.07 ,$222.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 10MM,278,1 ,$277.88 ,$183.40 ,$140.94 ,$277.88 , N/A , N/A , N/A , N/A ,$166.73 ,$236.20 ,$194.52 , N/A , N/A ,$263.99 ,$211.19 ,$208.41 , N/A ,$236.20 , N/A , N/A , N/A ,$194.52 ,$169.23 , N/A , N/A , N/A , N/A , N/A ,$236.20 , N/A ,$255.65 ,$194.52 ,$140.94 ,$169.15 ,$169.23 ,$169.15 ,$192.02 ,$250.09 ,$189.85 , N/A ,$219.53 , N/A , N/A , N/A , N/A , N/A ,$200.07 ,$172.29 ,$200.07 ,$200.07 ,$222.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 20MM,278,1 ,$296.06 ,$195.40 ,$150.16 ,$296.06 , N/A , N/A , N/A , N/A ,$177.64 ,$251.65 ,$207.24 , N/A , N/A ,$281.26 ,$225.01 ,$222.05 , N/A ,$251.65 , N/A , N/A , N/A ,$207.24 ,$180.30 , N/A , N/A , N/A , N/A , N/A ,$251.65 , N/A ,$272.38 ,$207.24 ,$150.16 ,$180.21 ,$180.30 ,$180.21 ,$204.58 ,$266.45 ,$202.27 , N/A ,$233.89 , N/A , N/A , N/A , N/A , N/A ,$213.16 ,$183.56 ,$213.16 ,$213.16 ,$236.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 14MM,278,1 ,$296.06 ,$195.40 ,$150.16 ,$296.06 , N/A , N/A , N/A , N/A ,$177.64 ,$251.65 ,$207.24 , N/A , N/A ,$281.26 ,$225.01 ,$222.05 , N/A ,$251.65 , N/A , N/A , N/A ,$207.24 ,$180.30 , N/A , N/A , N/A , N/A , N/A ,$251.65 , N/A ,$272.38 ,$207.24 ,$150.16 ,$180.21 ,$180.30 ,$180.21 ,$204.58 ,$266.45 ,$202.27 , N/A ,$233.89 , N/A , N/A , N/A , N/A , N/A ,$213.16 ,$183.56 ,$213.16 ,$213.16 ,$236.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 16MM,278,1 ,$296.06 ,$195.40 ,$150.16 ,$296.06 , N/A , N/A , N/A , N/A ,$177.64 ,$251.65 ,$207.24 , N/A , N/A ,$281.26 ,$225.01 ,$222.05 , N/A ,$251.65 , N/A , N/A , N/A ,$207.24 ,$180.30 , N/A , N/A , N/A , N/A , N/A ,$251.65 , N/A ,$272.38 ,$207.24 ,$150.16 ,$180.21 ,$180.30 ,$180.21 ,$204.58 ,$266.45 ,$202.27 , N/A ,$233.89 , N/A , N/A , N/A , N/A , N/A ,$213.16 ,$183.56 ,$213.16 ,$213.16 ,$236.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 2.7 VA LOCKING S/TAP T8 18MM,278,1 ,$296.06 ,$195.40 ,$150.16 ,$296.06 , N/A , N/A , N/A , N/A ,$177.64 ,$251.65 ,$207.24 , N/A , N/A ,$281.26 ,$225.01 ,$222.05 , N/A ,$251.65 , N/A , N/A , N/A ,$207.24 ,$180.30 , N/A , N/A , N/A , N/A , N/A ,$251.65 , N/A ,$272.38 ,$207.24 ,$150.16 ,$180.21 ,$180.30 ,$180.21 ,$204.58 ,$266.45 ,$202.27 , N/A ,$233.89 , N/A , N/A , N/A , N/A , N/A ,$213.16 ,$183.56 ,$213.16 ,$213.16 ,$236.85 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 50MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 10MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 12MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 14MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 16MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 18MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 20MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 22MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 24MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 26MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 28MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 30MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 32MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 34MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 36MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 38MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 40MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 42MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 44MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 46MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CANN PART THREADED 48MM,278,1 ,$396.90 ,$261.95 ,$201.31 ,$396.90 , N/A , N/A , N/A , N/A ,$238.14 ,$337.37 ,$277.83 , N/A , N/A ,$377.06 ,$301.64 ,$297.68 , N/A ,$337.37 , N/A , N/A , N/A ,$277.83 ,$241.71 , N/A , N/A , N/A , N/A , N/A ,$337.37 , N/A ,$365.15 ,$277.83 ,$201.31 ,$241.59 ,$241.71 ,$241.59 ,$274.26 ,$357.21 ,$271.16 , N/A ,$313.55 , N/A , N/A , N/A , N/A , N/A ,$285.77 ,$246.08 ,$285.77 ,$285.77 ,$317.52 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 60MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 10MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 12MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 14MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 16MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 18MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 20MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 22MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 24MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 26MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 28MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 30MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 32MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 34MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 36MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 38MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 40MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 45MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 50MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 55MM,278,1 ,$42.53 ,$28.07 ,$21.57 ,$42.53 , N/A , N/A , N/A , N/A ,$25.52 ,$36.15 ,$29.77 , N/A , N/A ,$40.40 ,$32.32 ,$31.90 , N/A ,$36.15 , N/A , N/A , N/A ,$29.77 ,$25.90 , N/A , N/A , N/A , N/A , N/A ,$36.15 , N/A ,$39.13 ,$29.77 ,$21.57 ,$25.89 ,$25.90 ,$25.89 ,$29.39 ,$38.28 ,$29.06 , N/A ,$33.60 , N/A , N/A , N/A , N/A , N/A ,$30.62 ,$26.37 ,$30.62 ,$30.62 ,$34.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 95MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 42MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 44MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 46MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 48MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 65MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 70MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 75MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 80MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 85MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 90MM,278,1 ,$44.48 ,$29.36 ,$22.56 ,$44.48 , N/A , N/A , N/A , N/A ,$26.69 ,$37.81 ,$31.14 , N/A , N/A ,$42.26 ,$33.80 ,$33.36 , N/A ,$37.81 , N/A , N/A , N/A ,$31.14 ,$27.09 , N/A , N/A , N/A , N/A , N/A ,$37.81 , N/A ,$40.92 ,$31.14 ,$22.56 ,$27.08 ,$27.09 ,$27.08 ,$30.74 ,$40.03 ,$30.39 , N/A ,$35.14 , N/A , N/A , N/A , N/A , N/A ,$32.03 ,$27.58 ,$32.03 ,$32.03 ,$35.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  48MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  52MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  54MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  56MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  58MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  60MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  35MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  42MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  44MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  46MM,278,1 ,$263.03 ,$173.60 ,$133.41 ,$263.03 , N/A , N/A , N/A , N/A ,$157.82 ,$223.58 ,$184.12 , N/A , N/A ,$249.88 ,$199.90 ,$197.27 , N/A ,$223.58 , N/A , N/A , N/A ,$184.12 ,$160.19 , N/A , N/A , N/A , N/A , N/A ,$223.58 , N/A ,$241.99 ,$184.12 ,$133.41 ,$160.11 ,$160.19 ,$160.11 ,$181.75 ,$236.73 ,$179.70 , N/A ,$207.79 , N/A , N/A , N/A , N/A , N/A ,$189.38 ,$163.08 ,$189.38 ,$189.38 ,$210.42 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  50MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  55MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  10MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  12MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  14MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  16MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  18MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  20MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  22MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  24MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  26MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  28MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  30MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  32MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  34MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  36MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  38MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  40MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  45MM,278,1 ,$252.47 ,$166.63 ,$128.05 ,$252.47 , N/A , N/A , N/A , N/A ,$151.48 ,$214.60 ,$176.73 , N/A , N/A ,$239.85 ,$191.88 ,$189.35 , N/A ,$214.60 , N/A , N/A , N/A ,$176.73 ,$153.75 , N/A , N/A , N/A , N/A , N/A ,$214.60 , N/A ,$232.27 ,$176.73 ,$128.05 ,$153.68 ,$153.75 ,$153.68 ,$174.46 ,$227.22 ,$172.49 , N/A ,$199.45 , N/A , N/A , N/A , N/A , N/A ,$181.78 ,$156.53 ,$181.78 ,$181.78 ,$201.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 TI CORTEX 28MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 16MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 18MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 20MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 22MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 24MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 26MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 28MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 30MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 32MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 34MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 36MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 SHAFT 38MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 TI CORTEX 14MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 TI CORTEX 16MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 TI CORTEX 18MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 TI CORTEX 20MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 TI CORTEX 22MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 TI CORTEX 24MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.5 TI CORTEX 26MM,278,1 ,$31.88 ,$21.04 ,$16.17 ,$31.88 , N/A , N/A , N/A , N/A ,$19.13 ,$27.10 ,$22.32 , N/A , N/A ,$30.29 ,$24.23 ,$23.91 , N/A ,$27.10 , N/A , N/A , N/A ,$22.32 ,$19.41 , N/A , N/A , N/A , N/A , N/A ,$27.10 , N/A ,$29.33 ,$22.32 ,$16.17 ,$19.41 ,$19.41 ,$19.41 ,$22.03 ,$28.69 ,$21.78 , N/A ,$25.19 , N/A , N/A , N/A , N/A , N/A ,$22.95 ,$19.77 ,$22.95 ,$22.95 ,$25.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 60MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 26MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 28MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 30MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 32MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 34MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 36MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 38MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 40MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 42MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 44MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 46MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 48MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 50MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 52MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 54MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 56MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.7 CANN LOCKING 58MM,278,1 ,$401.63 ,$265.08 ,$203.71 ,$401.63 , N/A , N/A , N/A , N/A ,$240.98 ,$341.39 ,$281.14 , N/A , N/A ,$381.55 ,$305.24 ,$301.22 , N/A ,$341.39 , N/A , N/A , N/A ,$281.14 ,$244.59 , N/A , N/A , N/A , N/A , N/A ,$341.39 , N/A ,$369.50 ,$281.14 ,$203.71 ,$244.47 ,$244.59 ,$244.47 ,$277.53 ,$361.47 ,$274.39 , N/A ,$317.29 , N/A , N/A , N/A , N/A , N/A ,$289.17 ,$249.01 ,$289.17 ,$289.17 ,$321.30 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 60,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 10,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 12,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 14,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 16,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 18,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 20,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 22,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 24,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 26,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 28,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 30,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 35,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 40,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 45,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 50,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 55,278,1 ,$34.97 ,$23.08 ,$17.74 ,$34.97 , N/A , N/A , N/A , N/A ,$20.98 ,$29.72 ,$24.48 , N/A , N/A ,$33.22 ,$26.58 ,$26.23 , N/A ,$29.72 , N/A , N/A , N/A ,$24.48 ,$21.30 , N/A , N/A , N/A , N/A , N/A ,$29.72 , N/A ,$32.17 ,$24.48 ,$17.74 ,$21.29 ,$21.30 ,$21.29 ,$24.16 ,$31.47 ,$23.89 , N/A ,$27.63 , N/A , N/A , N/A , N/A , N/A ,$25.18 ,$21.68 ,$25.18 ,$25.18 ,$27.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  60,278,1 ,$34.65 ,$22.87 ,$17.57 ,$34.65 , N/A , N/A , N/A , N/A ,$20.79 ,$29.45 ,$24.26 , N/A , N/A ,$32.92 ,$26.33 ,$25.99 , N/A ,$29.45 , N/A , N/A , N/A ,$24.26 ,$21.10 , N/A , N/A , N/A , N/A , N/A ,$29.45 , N/A ,$31.88 ,$24.26 ,$17.57 ,$21.09 ,$21.10 ,$21.09 ,$23.94 ,$31.19 ,$23.67 , N/A ,$27.37 , N/A , N/A , N/A , N/A , N/A ,$24.95 ,$21.48 ,$24.95 ,$24.95 ,$27.72 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  55,278,1 ,$34.65 ,$22.87 ,$17.57 ,$34.65 , N/A , N/A , N/A , N/A ,$20.79 ,$29.45 ,$24.26 , N/A , N/A ,$32.92 ,$26.33 ,$25.99 , N/A ,$29.45 , N/A , N/A , N/A ,$24.26 ,$21.10 , N/A , N/A , N/A , N/A , N/A ,$29.45 , N/A ,$31.88 ,$24.26 ,$17.57 ,$21.09 ,$21.10 ,$21.09 ,$23.94 ,$31.19 ,$23.67 , N/A ,$27.37 , N/A , N/A , N/A , N/A , N/A ,$24.95 ,$21.48 ,$24.95 ,$24.95 ,$27.72 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT 50,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  10,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  12,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  14,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  16,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  18,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  20,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  22,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  24,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  26,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  28,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  30,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  35,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  40,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  45,278,1 ,$32.63 ,$21.54 ,$16.55 ,$32.63 , N/A , N/A , N/A , N/A ,$19.58 ,$27.74 ,$22.84 , N/A , N/A ,$31.00 ,$24.80 ,$24.47 , N/A ,$27.74 , N/A , N/A , N/A ,$22.84 ,$19.87 , N/A , N/A , N/A , N/A , N/A ,$27.74 , N/A ,$30.02 ,$22.84 ,$16.55 ,$19.86 ,$19.87 ,$19.86 ,$22.55 ,$29.37 ,$22.29 , N/A ,$25.78 , N/A , N/A , N/A , N/A , N/A ,$23.49 ,$20.23 ,$23.49 ,$23.49 ,$26.10 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 50MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 20MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 24MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 26MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 28MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 30MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 34MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 38MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 40MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 42MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 44MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 46MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 48MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN LONG THREAD 50MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 12MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 14MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 18MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 20MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 22MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 24MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 26MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 28MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 30MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 32MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 34MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 36MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 38MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 40MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 42MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 44MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 46MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 48MM,278,1 ,$402.44 ,$265.61 ,$204.12 ,$402.44 , N/A , N/A , N/A , N/A ,$241.46 ,$342.07 ,$281.71 , N/A , N/A ,$382.32 ,$305.85 ,$301.83 , N/A ,$342.07 , N/A , N/A , N/A ,$281.71 ,$245.09 , N/A , N/A , N/A , N/A , N/A ,$342.07 , N/A ,$370.24 ,$281.71 ,$204.12 ,$244.97 ,$245.09 ,$244.97 ,$278.09 ,$362.20 ,$274.95 , N/A ,$317.93 , N/A , N/A , N/A , N/A , N/A ,$289.76 ,$249.51 ,$289.76 ,$289.76 ,$321.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 54MM,278,1 ,$280.80 ,$185.33 ,$142.42 ,$280.80 , N/A , N/A , N/A , N/A ,$168.48 ,$238.68 ,$196.56 , N/A , N/A ,$266.76 ,$213.41 ,$210.60 , N/A ,$238.68 , N/A , N/A , N/A ,$196.56 ,$171.01 , N/A , N/A , N/A , N/A , N/A ,$238.68 , N/A ,$258.34 ,$196.56 ,$142.42 ,$170.92 ,$171.01 ,$170.92 ,$194.03 ,$252.72 ,$191.84 , N/A ,$221.83 , N/A , N/A , N/A , N/A , N/A ,$202.18 ,$174.10 ,$202.18 ,$202.18 ,$224.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKIING 62MM,278,1 ,$280.80 ,$185.33 ,$142.42 ,$280.80 , N/A , N/A , N/A , N/A ,$168.48 ,$238.68 ,$196.56 , N/A , N/A ,$266.76 ,$213.41 ,$210.60 , N/A ,$238.68 , N/A , N/A , N/A ,$196.56 ,$171.01 , N/A , N/A , N/A , N/A , N/A ,$238.68 , N/A ,$258.34 ,$196.56 ,$142.42 ,$170.92 ,$171.01 ,$170.92 ,$194.03 ,$252.72 ,$191.84 , N/A ,$221.83 , N/A , N/A , N/A , N/A , N/A ,$202.18 ,$174.10 ,$202.18 ,$202.18 ,$224.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 34MM,278,1 ,$280.80 ,$185.33 ,$142.42 ,$280.80 , N/A , N/A , N/A , N/A ,$168.48 ,$238.68 ,$196.56 , N/A , N/A ,$266.76 ,$213.41 ,$210.60 , N/A ,$238.68 , N/A , N/A , N/A ,$196.56 ,$171.01 , N/A , N/A , N/A , N/A , N/A ,$238.68 , N/A ,$258.34 ,$196.56 ,$142.42 ,$170.92 ,$171.01 ,$170.92 ,$194.03 ,$252.72 ,$191.84 , N/A ,$221.83 , N/A , N/A , N/A , N/A , N/A ,$202.18 ,$174.10 ,$202.18 ,$202.18 ,$224.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 38MM,278,1 ,$280.80 ,$185.33 ,$142.42 ,$280.80 , N/A , N/A , N/A , N/A ,$168.48 ,$238.68 ,$196.56 , N/A , N/A ,$266.76 ,$213.41 ,$210.60 , N/A ,$238.68 , N/A , N/A , N/A ,$196.56 ,$171.01 , N/A , N/A , N/A , N/A , N/A ,$238.68 , N/A ,$258.34 ,$196.56 ,$142.42 ,$170.92 ,$171.01 ,$170.92 ,$194.03 ,$252.72 ,$191.84 , N/A ,$221.83 , N/A , N/A , N/A , N/A , N/A ,$202.18 ,$174.10 ,$202.18 ,$202.18 ,$224.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 46MM,278,1 ,$280.80 ,$185.33 ,$142.42 ,$280.80 , N/A , N/A , N/A , N/A ,$168.48 ,$238.68 ,$196.56 , N/A , N/A ,$266.76 ,$213.41 ,$210.60 , N/A ,$238.68 , N/A , N/A , N/A ,$196.56 ,$171.01 , N/A , N/A , N/A , N/A , N/A ,$238.68 , N/A ,$258.34 ,$196.56 ,$142.42 ,$170.92 ,$171.01 ,$170.92 ,$194.03 ,$252.72 ,$191.84 , N/A ,$221.83 , N/A , N/A , N/A , N/A , N/A ,$202.18 ,$174.10 ,$202.18 ,$202.18 ,$224.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING 50MM,278,1 ,$280.80 ,$185.33 ,$142.42 ,$280.80 , N/A , N/A , N/A , N/A ,$168.48 ,$238.68 ,$196.56 , N/A , N/A ,$266.76 ,$213.41 ,$210.60 , N/A ,$238.68 , N/A , N/A , N/A ,$196.56 ,$171.01 , N/A , N/A , N/A , N/A , N/A ,$238.68 , N/A ,$258.34 ,$196.56 ,$142.42 ,$170.92 ,$171.01 ,$170.92 ,$194.03 ,$252.72 ,$191.84 , N/A ,$221.83 , N/A , N/A , N/A , N/A , N/A ,$202.18 ,$174.10 ,$202.18 ,$202.18 ,$224.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 62MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 42MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 46MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 50MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 54MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 58MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 30MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 34MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 38MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 14MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 16MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 18MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 LOCKING SELF TAP STARDRIVE 26MM,278,1 ,$286.65 ,$189.19 ,$145.39 ,$286.65 , N/A , N/A , N/A , N/A ,$171.99 ,$243.65 ,$200.66 , N/A , N/A ,$272.32 ,$217.85 ,$214.99 , N/A ,$243.65 , N/A , N/A , N/A ,$200.66 ,$174.57 , N/A , N/A , N/A , N/A , N/A ,$243.65 , N/A ,$263.72 ,$200.66 ,$145.39 ,$174.48 ,$174.57 ,$174.48 ,$198.08 ,$257.99 ,$195.84 , N/A ,$226.45 , N/A , N/A , N/A , N/A , N/A ,$206.39 ,$177.72 ,$206.39 ,$206.39 ,$229.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 SCHANZ 20MM THREAD/ 30MM,278,1 ,$393.75 ,$259.88 ,$199.71 ,$393.75 , N/A , N/A , N/A , N/A ,$236.25 ,$334.69 ,$275.63 , N/A , N/A ,$374.06 ,$299.25 ,$295.31 , N/A ,$334.69 , N/A , N/A , N/A ,$275.63 ,$239.79 , N/A , N/A , N/A , N/A , N/A ,$334.69 , N/A ,$362.25 ,$275.63 ,$199.71 ,$239.68 ,$239.79 ,$239.68 ,$272.08 ,$354.38 ,$269.01 , N/A ,$311.06 , N/A , N/A , N/A , N/A , N/A ,$283.50 ,$244.13 ,$283.50 ,$283.50 ,$315.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 SCHANZ SELF DRILLING 20MM X 80,278,1 ,$352.80 ,$232.85 ,$178.94 ,$352.80 , N/A , N/A , N/A , N/A ,$211.68 ,$299.88 ,$246.96 , N/A , N/A ,$335.16 ,$268.13 ,$264.60 , N/A ,$299.88 , N/A , N/A , N/A ,$246.96 ,$214.86 , N/A , N/A , N/A , N/A , N/A ,$299.88 , N/A ,$324.58 ,$246.96 ,$178.94 ,$214.75 ,$214.86 ,$214.75 ,$243.78 ,$317.52 ,$241.03 , N/A ,$278.71 , N/A , N/A , N/A , N/A , N/A ,$254.02 ,$218.74 ,$254.02 ,$254.02 ,$282.24 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 72MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 20MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 22MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 24MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 26MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 28MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 30MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 32MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 34MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 36MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 38MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 40MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 42MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 44MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 46MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 48MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 50MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 52MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 54MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 56MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 60MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 64MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 68MM,278,1 ,$422.10 ,$278.59 ,$214.09 ,$422.10 , N/A , N/A , N/A , N/A ,$253.26 ,$358.79 ,$295.47 , N/A , N/A ,$401.00 ,$320.80 ,$316.58 , N/A ,$358.79 , N/A , N/A , N/A ,$295.47 ,$257.06 , N/A , N/A , N/A , N/A , N/A ,$358.79 , N/A ,$388.33 ,$295.47 ,$214.09 ,$256.93 ,$257.06 ,$256.93 ,$291.67 ,$379.89 ,$288.38 , N/A ,$333.46 , N/A , N/A , N/A , N/A , N/A ,$303.91 ,$261.70 ,$303.91 ,$303.91 ,$337.68 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 80MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 20MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 22MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 24MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 26MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 28MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 30MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 32MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 34MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 36MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 38MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 40MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 42MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 44MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 46MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 48MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 50MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 52MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 54MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 56MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 60MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 64MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 68MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN F/THRD 72MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CANN P/THRD 76MM,278,1 ,$434.70 ,$286.90 ,$220.48 ,$434.70 , N/A , N/A , N/A , N/A ,$260.82 ,$369.50 ,$304.29 , N/A , N/A ,$412.97 ,$330.37 ,$326.03 , N/A ,$369.50 , N/A , N/A , N/A ,$304.29 ,$264.73 , N/A , N/A , N/A , N/A , N/A ,$369.50 , N/A ,$399.92 ,$304.29 ,$220.48 ,$264.60 ,$264.73 ,$264.60 ,$300.38 ,$391.23 ,$296.99 , N/A ,$343.41 , N/A , N/A , N/A , N/A , N/A ,$312.98 ,$269.51 ,$312.98 ,$312.98 ,$347.76 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX 72,278,1 ,$34.25 ,$22.61 ,$17.37 ,$34.25 , N/A , N/A , N/A , N/A ,$20.55 ,$29.11 ,$23.98 , N/A , N/A ,$32.54 ,$26.03 ,$25.69 , N/A ,$29.11 , N/A , N/A , N/A ,$23.98 ,$20.86 , N/A , N/A , N/A , N/A , N/A ,$29.11 , N/A ,$31.51 ,$23.98 ,$17.37 ,$20.85 ,$20.86 ,$20.85 ,$23.67 ,$30.83 ,$23.40 , N/A ,$27.06 , N/A , N/A , N/A , N/A , N/A ,$24.66 ,$21.24 ,$24.66 ,$24.66 ,$27.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX 95,278,1 ,$57.49 ,$37.94 ,$29.16 ,$57.49 , N/A , N/A , N/A , N/A ,$34.49 ,$48.87 ,$40.24 , N/A , N/A ,$54.62 ,$43.69 ,$43.12 , N/A ,$48.87 , N/A , N/A , N/A ,$40.24 ,$35.01 , N/A , N/A , N/A , N/A , N/A ,$48.87 , N/A ,$52.89 ,$40.24 ,$29.16 ,$34.99 ,$35.01 ,$34.99 ,$39.73 ,$51.74 ,$39.28 , N/A ,$45.42 , N/A , N/A , N/A , N/A , N/A ,$41.39 ,$35.64 ,$41.39 ,$41.39 ,$45.99 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX 105,278,1 ,$57.49 ,$37.94 ,$29.16 ,$57.49 , N/A , N/A , N/A , N/A ,$34.49 ,$48.87 ,$40.24 , N/A , N/A ,$54.62 ,$43.69 ,$43.12 , N/A ,$48.87 , N/A , N/A , N/A ,$40.24 ,$35.01 , N/A , N/A , N/A , N/A , N/A ,$48.87 , N/A ,$52.89 ,$40.24 ,$29.16 ,$34.99 ,$35.01 ,$34.99 ,$39.73 ,$51.74 ,$39.28 , N/A ,$45.42 , N/A , N/A , N/A , N/A , N/A ,$41.39 ,$35.64 ,$41.39 ,$41.39 ,$45.99 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX 110,278,1 ,$57.49 ,$37.94 ,$29.16 ,$57.49 , N/A , N/A , N/A , N/A ,$34.49 ,$48.87 ,$40.24 , N/A , N/A ,$54.62 ,$43.69 ,$43.12 , N/A ,$48.87 , N/A , N/A , N/A ,$40.24 ,$35.01 , N/A , N/A , N/A , N/A , N/A ,$48.87 , N/A ,$52.89 ,$40.24 ,$29.16 ,$34.99 ,$35.01 ,$34.99 ,$39.73 ,$51.74 ,$39.28 , N/A ,$45.42 , N/A , N/A , N/A , N/A , N/A ,$41.39 ,$35.64 ,$41.39 ,$41.39 ,$45.99 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX 90,278,1 ,$57.49 ,$37.94 ,$29.16 ,$57.49 , N/A , N/A , N/A , N/A ,$34.49 ,$48.87 ,$40.24 , N/A , N/A ,$54.62 ,$43.69 ,$43.12 , N/A ,$48.87 , N/A , N/A , N/A ,$40.24 ,$35.01 , N/A , N/A , N/A , N/A , N/A ,$48.87 , N/A ,$52.89 ,$40.24 ,$29.16 ,$34.99 ,$35.01 ,$34.99 ,$39.73 ,$51.74 ,$39.28 , N/A ,$45.42 , N/A , N/A , N/A , N/A , N/A ,$41.39 ,$35.64 ,$41.39 ,$41.39 ,$45.99 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 40MM,278,1 ,$35.82 ,$23.64 ,$18.17 ,$35.82 , N/A , N/A , N/A , N/A ,$21.49 ,$30.45 ,$25.07 , N/A , N/A ,$34.03 ,$27.22 ,$26.87 , N/A ,$30.45 , N/A , N/A , N/A ,$25.07 ,$21.81 , N/A , N/A , N/A , N/A , N/A ,$30.45 , N/A ,$32.95 ,$25.07 ,$18.17 ,$21.80 ,$21.81 ,$21.80 ,$24.75 ,$32.24 ,$24.47 , N/A ,$28.30 , N/A , N/A , N/A , N/A , N/A ,$25.79 ,$22.21 ,$25.79 ,$25.79 ,$28.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 28MM,278,1 ,$35.82 ,$23.64 ,$18.17 ,$35.82 , N/A , N/A , N/A , N/A ,$21.49 ,$30.45 ,$25.07 , N/A , N/A ,$34.03 ,$27.22 ,$26.87 , N/A ,$30.45 , N/A , N/A , N/A ,$25.07 ,$21.81 , N/A , N/A , N/A , N/A , N/A ,$30.45 , N/A ,$32.95 ,$25.07 ,$18.17 ,$21.80 ,$21.81 ,$21.80 ,$24.75 ,$32.24 ,$24.47 , N/A ,$28.30 , N/A , N/A , N/A , N/A , N/A ,$25.79 ,$22.21 ,$25.79 ,$25.79 ,$28.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 30MM,278,1 ,$35.82 ,$23.64 ,$18.17 ,$35.82 , N/A , N/A , N/A , N/A ,$21.49 ,$30.45 ,$25.07 , N/A , N/A ,$34.03 ,$27.22 ,$26.87 , N/A ,$30.45 , N/A , N/A , N/A ,$25.07 ,$21.81 , N/A , N/A , N/A , N/A , N/A ,$30.45 , N/A ,$32.95 ,$25.07 ,$18.17 ,$21.80 ,$21.81 ,$21.80 ,$24.75 ,$32.24 ,$24.47 , N/A ,$28.30 , N/A , N/A , N/A , N/A , N/A ,$25.79 ,$22.21 ,$25.79 ,$25.79 ,$28.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 32MM,278,1 ,$35.82 ,$23.64 ,$18.17 ,$35.82 , N/A , N/A , N/A , N/A ,$21.49 ,$30.45 ,$25.07 , N/A , N/A ,$34.03 ,$27.22 ,$26.87 , N/A ,$30.45 , N/A , N/A , N/A ,$25.07 ,$21.81 , N/A , N/A , N/A , N/A , N/A ,$30.45 , N/A ,$32.95 ,$25.07 ,$18.17 ,$21.80 ,$21.81 ,$21.80 ,$24.75 ,$32.24 ,$24.47 , N/A ,$28.30 , N/A , N/A , N/A , N/A , N/A ,$25.79 ,$22.21 ,$25.79 ,$25.79 ,$28.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 34MM,278,1 ,$35.82 ,$23.64 ,$18.17 ,$35.82 , N/A , N/A , N/A , N/A ,$21.49 ,$30.45 ,$25.07 , N/A , N/A ,$34.03 ,$27.22 ,$26.87 , N/A ,$30.45 , N/A , N/A , N/A ,$25.07 ,$21.81 , N/A , N/A , N/A , N/A , N/A ,$30.45 , N/A ,$32.95 ,$25.07 ,$18.17 ,$21.80 ,$21.81 ,$21.80 ,$24.75 ,$32.24 ,$24.47 , N/A ,$28.30 , N/A , N/A , N/A , N/A , N/A ,$25.79 ,$22.21 ,$25.79 ,$25.79 ,$28.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 36MM,278,1 ,$35.82 ,$23.64 ,$18.17 ,$35.82 , N/A , N/A , N/A , N/A ,$21.49 ,$30.45 ,$25.07 , N/A , N/A ,$34.03 ,$27.22 ,$26.87 , N/A ,$30.45 , N/A , N/A , N/A ,$25.07 ,$21.81 , N/A , N/A , N/A , N/A , N/A ,$30.45 , N/A ,$32.95 ,$25.07 ,$18.17 ,$21.80 ,$21.81 ,$21.80 ,$24.75 ,$32.24 ,$24.47 , N/A ,$28.30 , N/A , N/A , N/A , N/A , N/A ,$25.79 ,$22.21 ,$25.79 ,$25.79 ,$28.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 38MM,278,1 ,$35.82 ,$23.64 ,$18.17 ,$35.82 , N/A , N/A , N/A , N/A ,$21.49 ,$30.45 ,$25.07 , N/A , N/A ,$34.03 ,$27.22 ,$26.87 , N/A ,$30.45 , N/A , N/A , N/A ,$25.07 ,$21.81 , N/A , N/A , N/A , N/A , N/A ,$30.45 , N/A ,$32.95 ,$25.07 ,$18.17 ,$21.80 ,$21.81 ,$21.80 ,$24.75 ,$32.24 ,$24.47 , N/A ,$28.30 , N/A , N/A , N/A , N/A , N/A ,$25.79 ,$22.21 ,$25.79 ,$25.79 ,$28.66 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 50MM,278,1 ,$39.76 ,$26.24 ,$20.17 ,$39.76 , N/A , N/A , N/A , N/A ,$23.86 ,$33.80 ,$27.83 , N/A , N/A ,$37.77 ,$30.22 ,$29.82 , N/A ,$33.80 , N/A , N/A , N/A ,$27.83 ,$24.21 , N/A , N/A , N/A , N/A , N/A ,$33.80 , N/A ,$36.58 ,$27.83 ,$20.17 ,$24.20 ,$24.21 ,$24.20 ,$27.47 ,$35.78 ,$27.16 , N/A ,$31.41 , N/A , N/A , N/A , N/A , N/A ,$28.63 ,$24.65 ,$28.63 ,$28.63 ,$31.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 42MM,278,1 ,$39.76 ,$26.24 ,$20.17 ,$39.76 , N/A , N/A , N/A , N/A ,$23.86 ,$33.80 ,$27.83 , N/A , N/A ,$37.77 ,$30.22 ,$29.82 , N/A ,$33.80 , N/A , N/A , N/A ,$27.83 ,$24.21 , N/A , N/A , N/A , N/A , N/A ,$33.80 , N/A ,$36.58 ,$27.83 ,$20.17 ,$24.20 ,$24.21 ,$24.20 ,$27.47 ,$35.78 ,$27.16 , N/A ,$31.41 , N/A , N/A , N/A , N/A , N/A ,$28.63 ,$24.65 ,$28.63 ,$28.63 ,$31.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 44MM,278,1 ,$39.76 ,$26.24 ,$20.17 ,$39.76 , N/A , N/A , N/A , N/A ,$23.86 ,$33.80 ,$27.83 , N/A , N/A ,$37.77 ,$30.22 ,$29.82 , N/A ,$33.80 , N/A , N/A , N/A ,$27.83 ,$24.21 , N/A , N/A , N/A , N/A , N/A ,$33.80 , N/A ,$36.58 ,$27.83 ,$20.17 ,$24.20 ,$24.21 ,$24.20 ,$27.47 ,$35.78 ,$27.16 , N/A ,$31.41 , N/A , N/A , N/A , N/A , N/A ,$28.63 ,$24.65 ,$28.63 ,$28.63 ,$31.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 46MM,278,1 ,$39.76 ,$26.24 ,$20.17 ,$39.76 , N/A , N/A , N/A , N/A ,$23.86 ,$33.80 ,$27.83 , N/A , N/A ,$37.77 ,$30.22 ,$29.82 , N/A ,$33.80 , N/A , N/A , N/A ,$27.83 ,$24.21 , N/A , N/A , N/A , N/A , N/A ,$33.80 , N/A ,$36.58 ,$27.83 ,$20.17 ,$24.20 ,$24.21 ,$24.20 ,$27.47 ,$35.78 ,$27.16 , N/A ,$31.41 , N/A , N/A , N/A , N/A , N/A ,$28.63 ,$24.65 ,$28.63 ,$28.63 ,$31.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX PART TH 48MM,278,1 ,$39.76 ,$26.24 ,$20.17 ,$39.76 , N/A , N/A , N/A , N/A ,$23.86 ,$33.80 ,$27.83 , N/A , N/A ,$37.77 ,$30.22 ,$29.82 , N/A ,$33.80 , N/A , N/A , N/A ,$27.83 ,$24.21 , N/A , N/A , N/A , N/A , N/A ,$33.80 , N/A ,$36.58 ,$27.83 ,$20.17 ,$24.20 ,$24.21 ,$24.20 ,$27.47 ,$35.78 ,$27.16 , N/A ,$31.41 , N/A , N/A , N/A , N/A , N/A ,$28.63 ,$24.65 ,$28.63 ,$28.63 ,$31.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 66MM,278,1 ,$44.89 ,$29.63 ,$22.77 ,$44.89 , N/A , N/A , N/A , N/A ,$26.93 ,$38.16 ,$31.42 , N/A , N/A ,$42.65 ,$34.12 ,$33.67 , N/A ,$38.16 , N/A , N/A , N/A ,$31.42 ,$27.34 , N/A , N/A , N/A , N/A , N/A ,$38.16 , N/A ,$41.30 ,$31.42 ,$22.77 ,$27.32 ,$27.34 ,$27.32 ,$31.02 ,$40.40 ,$30.67 , N/A ,$35.46 , N/A , N/A , N/A , N/A , N/A ,$32.32 ,$27.83 ,$32.32 ,$32.32 ,$35.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 14MM,278,1 ,$44.89 ,$29.63 ,$22.77 ,$44.89 , N/A , N/A , N/A , N/A ,$26.93 ,$38.16 ,$31.42 , N/A , N/A ,$42.65 ,$34.12 ,$33.67 , N/A ,$38.16 , N/A , N/A , N/A ,$31.42 ,$27.34 , N/A , N/A , N/A , N/A , N/A ,$38.16 , N/A ,$41.30 ,$31.42 ,$22.77 ,$27.32 ,$27.34 ,$27.32 ,$31.02 ,$40.40 ,$30.67 , N/A ,$35.46 , N/A , N/A , N/A , N/A , N/A ,$32.32 ,$27.83 ,$32.32 ,$32.32 ,$35.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 22MM,278,1 ,$44.89 ,$29.63 ,$22.77 ,$44.89 , N/A , N/A , N/A , N/A ,$26.93 ,$38.16 ,$31.42 , N/A , N/A ,$42.65 ,$34.12 ,$33.67 , N/A ,$38.16 , N/A , N/A , N/A ,$31.42 ,$27.34 , N/A , N/A , N/A , N/A , N/A ,$38.16 , N/A ,$41.30 ,$31.42 ,$22.77 ,$27.32 ,$27.34 ,$27.32 ,$31.02 ,$40.40 ,$30.67 , N/A ,$35.46 , N/A , N/A , N/A , N/A , N/A ,$32.32 ,$27.83 ,$32.32 ,$32.32 ,$35.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 56MM,278,1 ,$44.89 ,$29.63 ,$22.77 ,$44.89 , N/A , N/A , N/A , N/A ,$26.93 ,$38.16 ,$31.42 , N/A , N/A ,$42.65 ,$34.12 ,$33.67 , N/A ,$38.16 , N/A , N/A , N/A ,$31.42 ,$27.34 , N/A , N/A , N/A , N/A , N/A ,$38.16 , N/A ,$41.30 ,$31.42 ,$22.77 ,$27.32 ,$27.34 ,$27.32 ,$31.02 ,$40.40 ,$30.67 , N/A ,$35.46 , N/A , N/A , N/A , N/A , N/A ,$32.32 ,$27.83 ,$32.32 ,$32.32 ,$35.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 58MM,278,1 ,$44.89 ,$29.63 ,$22.77 ,$44.89 , N/A , N/A , N/A , N/A ,$26.93 ,$38.16 ,$31.42 , N/A , N/A ,$42.65 ,$34.12 ,$33.67 , N/A ,$38.16 , N/A , N/A , N/A ,$31.42 ,$27.34 , N/A , N/A , N/A , N/A , N/A ,$38.16 , N/A ,$41.30 ,$31.42 ,$22.77 ,$27.32 ,$27.34 ,$27.32 ,$31.02 ,$40.40 ,$30.67 , N/A ,$35.46 , N/A , N/A , N/A , N/A , N/A ,$32.32 ,$27.83 ,$32.32 ,$32.32 ,$35.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 64MM,278,1 ,$44.89 ,$29.63 ,$22.77 ,$44.89 , N/A , N/A , N/A , N/A ,$26.93 ,$38.16 ,$31.42 , N/A , N/A ,$42.65 ,$34.12 ,$33.67 , N/A ,$38.16 , N/A , N/A , N/A ,$31.42 ,$27.34 , N/A , N/A , N/A , N/A , N/A ,$38.16 , N/A ,$41.30 ,$31.42 ,$22.77 ,$27.32 ,$27.34 ,$27.32 ,$31.02 ,$40.40 ,$30.67 , N/A ,$35.46 , N/A , N/A , N/A , N/A , N/A ,$32.32 ,$27.83 ,$32.32 ,$32.32 ,$35.91 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 70MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 16MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 18MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 20MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 24MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 26MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 28MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 30MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 32MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 34MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 36MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 38MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 40MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 42MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 44MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 46MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 48MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 50MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 52MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 54MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 60MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 62MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 68MM,278,1 ,$43.79 ,$28.90 ,$22.21 ,$43.79 , N/A , N/A , N/A , N/A ,$26.27 ,$37.22 ,$30.65 , N/A , N/A ,$41.60 ,$33.28 ,$32.84 , N/A ,$37.22 , N/A , N/A , N/A ,$30.65 ,$26.67 , N/A , N/A , N/A , N/A , N/A ,$37.22 , N/A ,$40.29 ,$30.65 ,$22.21 ,$26.66 ,$26.67 ,$26.66 ,$30.26 ,$39.41 ,$29.92 , N/A ,$34.59 , N/A , N/A , N/A , N/A , N/A ,$31.53 ,$27.15 ,$31.53 ,$31.53 ,$35.03 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 70MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 25MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 30MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 35MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 40MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 45MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 50MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 55MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 60MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 MALLEOLAR 65MM,278,1 ,$66.94 ,$44.18 ,$33.95 ,$66.94 , N/A , N/A , N/A , N/A ,$40.16 ,$56.90 ,$46.86 , N/A , N/A ,$63.59 ,$50.87 ,$50.21 , N/A ,$56.90 , N/A , N/A , N/A ,$46.86 ,$40.77 , N/A , N/A , N/A , N/A , N/A ,$56.90 , N/A ,$61.58 ,$46.86 ,$33.95 ,$40.75 ,$40.77 ,$40.75 ,$46.26 ,$60.25 ,$45.73 , N/A ,$52.88 , N/A , N/A , N/A , N/A , N/A ,$48.20 ,$41.50 ,$48.20 ,$48.20 ,$53.55 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 70MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 14MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 16MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 18MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 20MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 22MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 24MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 26MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 28MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 30MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 32MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 34MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 36MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 38MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 40MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 42MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 44MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 46MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 48MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 50MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 55MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 60MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 65MM,278,1 ,$292.16 ,$192.83 ,$148.18 ,$292.16 , N/A , N/A , N/A , N/A ,$175.30 ,$248.34 ,$204.51 , N/A , N/A ,$277.55 ,$222.04 ,$219.12 , N/A ,$248.34 , N/A , N/A , N/A ,$204.51 ,$177.93 , N/A , N/A , N/A , N/A , N/A ,$248.34 , N/A ,$268.79 ,$204.51 ,$148.18 ,$177.84 ,$177.93 ,$177.84 ,$201.88 ,$262.94 ,$199.60 , N/A ,$230.81 , N/A , N/A , N/A , N/A , N/A ,$210.36 ,$181.14 ,$210.36 ,$210.36 ,$233.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 90MM,278,1 ,$307.13 ,$202.71 ,$155.78 ,$307.13 , N/A , N/A , N/A , N/A ,$184.28 ,$261.06 ,$214.99 , N/A , N/A ,$291.77 ,$233.42 ,$230.35 , N/A ,$261.06 , N/A , N/A , N/A ,$214.99 ,$187.04 , N/A , N/A , N/A , N/A , N/A ,$261.06 , N/A ,$282.56 ,$214.99 ,$155.78 ,$186.95 ,$187.04 ,$186.95 ,$212.23 ,$276.42 ,$209.83 , N/A ,$242.63 , N/A , N/A , N/A , N/A , N/A ,$221.13 ,$190.42 ,$221.13 ,$221.13 ,$245.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 75MM,278,1 ,$307.13 ,$202.71 ,$155.78 ,$307.13 , N/A , N/A , N/A , N/A ,$184.28 ,$261.06 ,$214.99 , N/A , N/A ,$291.77 ,$233.42 ,$230.35 , N/A ,$261.06 , N/A , N/A , N/A ,$214.99 ,$187.04 , N/A , N/A , N/A , N/A , N/A ,$261.06 , N/A ,$282.56 ,$214.99 ,$155.78 ,$186.95 ,$187.04 ,$186.95 ,$212.23 ,$276.42 ,$209.83 , N/A ,$242.63 , N/A , N/A , N/A , N/A , N/A ,$221.13 ,$190.42 ,$221.13 ,$221.13 ,$245.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 80MM,278,1 ,$307.13 ,$202.71 ,$155.78 ,$307.13 , N/A , N/A , N/A , N/A ,$184.28 ,$261.06 ,$214.99 , N/A , N/A ,$291.77 ,$233.42 ,$230.35 , N/A ,$261.06 , N/A , N/A , N/A ,$214.99 ,$187.04 , N/A , N/A , N/A , N/A , N/A ,$261.06 , N/A ,$282.56 ,$214.99 ,$155.78 ,$186.95 ,$187.04 ,$186.95 ,$212.23 ,$276.42 ,$209.83 , N/A ,$242.63 , N/A , N/A , N/A , N/A , N/A ,$221.13 ,$190.42 ,$221.13 ,$221.13 ,$245.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 85MM,278,1 ,$307.13 ,$202.71 ,$155.78 ,$307.13 , N/A , N/A , N/A , N/A ,$184.28 ,$261.06 ,$214.99 , N/A , N/A ,$291.77 ,$233.42 ,$230.35 , N/A ,$261.06 , N/A , N/A , N/A ,$214.99 ,$187.04 , N/A , N/A , N/A , N/A , N/A ,$261.06 , N/A ,$282.56 ,$214.99 ,$155.78 ,$186.95 ,$187.04 ,$186.95 ,$212.23 ,$276.42 ,$209.83 , N/A ,$242.63 , N/A , N/A , N/A , N/A , N/A ,$221.13 ,$190.42 ,$221.13 ,$221.13 ,$245.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 3.5 LC-DCP 6 HOLE,278,1 ,$307.13 ,$202.71 ,$155.78 ,$307.13 , N/A , N/A , N/A , N/A ,$184.28 ,$261.06 ,$214.99 , N/A , N/A ,$291.77 ,$233.42 ,$230.35 , N/A ,$261.06 , N/A , N/A , N/A ,$214.99 ,$187.04 , N/A , N/A , N/A , N/A , N/A ,$261.06 , N/A ,$282.56 ,$214.99 ,$155.78 ,$186.95 ,$187.04 ,$186.95 ,$212.23 ,$276.42 ,$209.83 , N/A ,$242.63 , N/A , N/A , N/A , N/A , N/A ,$221.13 ,$190.42 ,$221.13 ,$221.13 ,$245.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 NUT 12MM 4MM,278,1 ,$340.20 ,$224.53 ,$172.55 ,$340.20 , N/A , N/A , N/A , N/A ,$204.12 ,$289.17 ,$238.14 , N/A , N/A ,$323.19 ,$258.55 ,$255.15 , N/A ,$289.17 , N/A , N/A , N/A ,$238.14 ,$207.18 , N/A , N/A , N/A , N/A , N/A ,$289.17 , N/A ,$312.98 ,$238.14 ,$172.55 ,$207.08 ,$207.18 ,$207.08 ,$235.08 ,$306.18 ,$232.42 , N/A ,$268.76 , N/A , N/A , N/A , N/A , N/A ,$244.94 ,$210.92 ,$244.94 ,$244.94 ,$272.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 SCHANZ 150MM,278,1 ,$194.63 ,$128.46 ,$98.72 ,$194.63 , N/A , N/A , N/A , N/A ,$116.78 ,$165.44 ,$136.24 , N/A , N/A ,$184.90 ,$147.92 ,$145.97 , N/A ,$165.44 , N/A , N/A , N/A ,$136.24 ,$118.53 , N/A , N/A , N/A , N/A , N/A ,$165.44 , N/A ,$179.06 ,$136.24 ,$98.72 ,$118.47 ,$118.53 ,$118.47 ,$134.49 ,$175.17 ,$132.97 , N/A ,$153.76 , N/A , N/A , N/A , N/A , N/A ,$140.13 ,$120.67 ,$140.13 ,$140.13 ,$155.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 SCHANZ 170MM,278,1 ,$231.53 ,$152.81 ,$117.43 ,$231.53 , N/A , N/A , N/A , N/A ,$138.92 ,$196.80 ,$162.07 , N/A , N/A ,$219.95 ,$175.96 ,$173.65 , N/A ,$196.80 , N/A , N/A , N/A ,$162.07 ,$141.00 , N/A , N/A , N/A , N/A , N/A ,$196.80 , N/A ,$213.01 ,$162.07 ,$117.43 ,$140.93 ,$141.00 ,$140.93 ,$159.99 ,$208.38 ,$158.18 , N/A ,$182.91 , N/A , N/A , N/A , N/A , N/A ,$166.70 ,$143.55 ,$166.70 ,$166.70 ,$185.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 60MM,278,1 ,$381.42 ,$251.74 ,$193.46 ,$381.42 , N/A , N/A , N/A , N/A ,$228.85 ,$324.21 ,$266.99 , N/A , N/A ,$362.35 ,$289.88 ,$286.07 , N/A ,$324.21 , N/A , N/A , N/A ,$266.99 ,$232.28 , N/A , N/A , N/A , N/A , N/A ,$324.21 , N/A ,$350.91 ,$266.99 ,$193.46 ,$232.17 ,$232.28 ,$232.17 ,$263.56 ,$343.28 ,$260.59 , N/A ,$301.32 , N/A , N/A , N/A , N/A , N/A ,$274.62 ,$236.48 ,$274.62 ,$274.62 ,$305.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 42MM,278,1 ,$381.42 ,$251.74 ,$193.46 ,$381.42 , N/A , N/A , N/A , N/A ,$228.85 ,$324.21 ,$266.99 , N/A , N/A ,$362.35 ,$289.88 ,$286.07 , N/A ,$324.21 , N/A , N/A , N/A ,$266.99 ,$232.28 , N/A , N/A , N/A , N/A , N/A ,$324.21 , N/A ,$350.91 ,$266.99 ,$193.46 ,$232.17 ,$232.28 ,$232.17 ,$263.56 ,$343.28 ,$260.59 , N/A ,$301.32 , N/A , N/A , N/A , N/A , N/A ,$274.62 ,$236.48 ,$274.62 ,$274.62 ,$305.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 48MM,278,1 ,$381.42 ,$251.74 ,$193.46 ,$381.42 , N/A , N/A , N/A , N/A ,$228.85 ,$324.21 ,$266.99 , N/A , N/A ,$362.35 ,$289.88 ,$286.07 , N/A ,$324.21 , N/A , N/A , N/A ,$266.99 ,$232.28 , N/A , N/A , N/A , N/A , N/A ,$324.21 , N/A ,$350.91 ,$266.99 ,$193.46 ,$232.17 ,$232.28 ,$232.17 ,$263.56 ,$343.28 ,$260.59 , N/A ,$301.32 , N/A , N/A , N/A , N/A , N/A ,$274.62 ,$236.48 ,$274.62 ,$274.62 ,$305.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 56MM,278,1 ,$381.42 ,$251.74 ,$193.46 ,$381.42 , N/A , N/A , N/A , N/A ,$228.85 ,$324.21 ,$266.99 , N/A , N/A ,$362.35 ,$289.88 ,$286.07 , N/A ,$324.21 , N/A , N/A , N/A ,$266.99 ,$232.28 , N/A , N/A , N/A , N/A , N/A ,$324.21 , N/A ,$350.91 ,$266.99 ,$193.46 ,$232.17 ,$232.28 ,$232.17 ,$263.56 ,$343.28 ,$260.59 , N/A ,$301.32 , N/A , N/A , N/A , N/A , N/A ,$274.62 ,$236.48 ,$274.62 ,$274.62 ,$305.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 95MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 26MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 28MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 30MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 32MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 34MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 36MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 38MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 40MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 42MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 44MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 46MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 48MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 50MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 52MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 54MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 56MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 58MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 60MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 62MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 64MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 66MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 68MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 70MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 72MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 74MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 76MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 78MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING 80MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 100MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 26MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 28MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 30MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 32MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 34MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 36MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 38MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 40MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 44MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 46MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 50MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 52MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 54MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 58MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 64MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 68MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 72MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 76MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 80MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 85MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 90MM,278,1 ,$378.00 ,$249.48 ,$191.72 ,$378.00 , N/A , N/A , N/A , N/A ,$226.80 ,$321.30 ,$264.60 , N/A , N/A ,$359.10 ,$287.28 ,$283.50 , N/A ,$321.30 , N/A , N/A , N/A ,$264.60 ,$230.20 , N/A , N/A , N/A , N/A , N/A ,$321.30 , N/A ,$347.76 ,$264.60 ,$191.72 ,$230.09 ,$230.20 ,$230.09 ,$261.20 ,$340.20 ,$258.25 , N/A ,$298.62 , N/A , N/A , N/A , N/A , N/A ,$272.16 ,$234.36 ,$272.16 ,$272.16 ,$302.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 50MM,278,1 ,$372.06 ,$245.56 ,$188.71 ,$372.06 , N/A , N/A , N/A , N/A ,$223.24 ,$316.25 ,$260.44 , N/A , N/A ,$353.46 ,$282.77 ,$279.05 , N/A ,$316.25 , N/A , N/A , N/A ,$260.44 ,$226.58 , N/A , N/A , N/A , N/A , N/A ,$316.25 , N/A ,$342.30 ,$260.44 ,$188.71 ,$226.47 ,$226.58 ,$226.47 ,$257.09 ,$334.85 ,$254.19 , N/A ,$293.93 , N/A , N/A , N/A , N/A , N/A ,$267.88 ,$230.68 ,$267.88 ,$267.88 ,$297.65 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 26MM,278,1 ,$372.06 ,$245.56 ,$188.71 ,$372.06 , N/A , N/A , N/A , N/A ,$223.24 ,$316.25 ,$260.44 , N/A , N/A ,$353.46 ,$282.77 ,$279.05 , N/A ,$316.25 , N/A , N/A , N/A ,$260.44 ,$226.58 , N/A , N/A , N/A , N/A , N/A ,$316.25 , N/A ,$342.30 ,$260.44 ,$188.71 ,$226.47 ,$226.58 ,$226.47 ,$257.09 ,$334.85 ,$254.19 , N/A ,$293.93 , N/A , N/A , N/A , N/A , N/A ,$267.88 ,$230.68 ,$267.88 ,$267.88 ,$297.65 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 30MM,278,1 ,$372.06 ,$245.56 ,$188.71 ,$372.06 , N/A , N/A , N/A , N/A ,$223.24 ,$316.25 ,$260.44 , N/A , N/A ,$353.46 ,$282.77 ,$279.05 , N/A ,$316.25 , N/A , N/A , N/A ,$260.44 ,$226.58 , N/A , N/A , N/A , N/A , N/A ,$316.25 , N/A ,$342.30 ,$260.44 ,$188.71 ,$226.47 ,$226.58 ,$226.47 ,$257.09 ,$334.85 ,$254.19 , N/A ,$293.93 , N/A , N/A , N/A , N/A , N/A ,$267.88 ,$230.68 ,$267.88 ,$267.88 ,$297.65 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 32MM,278,1 ,$372.06 ,$245.56 ,$188.71 ,$372.06 , N/A , N/A , N/A , N/A ,$223.24 ,$316.25 ,$260.44 , N/A , N/A ,$353.46 ,$282.77 ,$279.05 , N/A ,$316.25 , N/A , N/A , N/A ,$260.44 ,$226.58 , N/A , N/A , N/A , N/A , N/A ,$316.25 , N/A ,$342.30 ,$260.44 ,$188.71 ,$226.47 ,$226.58 ,$226.47 ,$257.09 ,$334.85 ,$254.19 , N/A ,$293.93 , N/A , N/A , N/A , N/A , N/A ,$267.88 ,$230.68 ,$267.88 ,$267.88 ,$297.65 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 34MM,278,1 ,$372.06 ,$245.56 ,$188.71 ,$372.06 , N/A , N/A , N/A , N/A ,$223.24 ,$316.25 ,$260.44 , N/A , N/A ,$353.46 ,$282.77 ,$279.05 , N/A ,$316.25 , N/A , N/A , N/A ,$260.44 ,$226.58 , N/A , N/A , N/A , N/A , N/A ,$316.25 , N/A ,$342.30 ,$260.44 ,$188.71 ,$226.47 ,$226.58 ,$226.47 ,$257.09 ,$334.85 ,$254.19 , N/A ,$293.93 , N/A , N/A , N/A , N/A , N/A ,$267.88 ,$230.68 ,$267.88 ,$267.88 ,$297.65 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 38MM,278,1 ,$372.06 ,$245.56 ,$188.71 ,$372.06 , N/A , N/A , N/A , N/A ,$223.24 ,$316.25 ,$260.44 , N/A , N/A ,$353.46 ,$282.77 ,$279.05 , N/A ,$316.25 , N/A , N/A , N/A ,$260.44 ,$226.58 , N/A , N/A , N/A , N/A , N/A ,$316.25 , N/A ,$342.30 ,$260.44 ,$188.71 ,$226.47 ,$226.58 ,$226.47 ,$257.09 ,$334.85 ,$254.19 , N/A ,$293.93 , N/A , N/A , N/A , N/A , N/A ,$267.88 ,$230.68 ,$267.88 ,$267.88 ,$297.65 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 40MM,278,1 ,$372.06 ,$245.56 ,$188.71 ,$372.06 , N/A , N/A , N/A , N/A ,$223.24 ,$316.25 ,$260.44 , N/A , N/A ,$353.46 ,$282.77 ,$279.05 , N/A ,$316.25 , N/A , N/A , N/A ,$260.44 ,$226.58 , N/A , N/A , N/A , N/A , N/A ,$316.25 , N/A ,$342.30 ,$260.44 ,$188.71 ,$226.47 ,$226.58 ,$226.47 ,$257.09 ,$334.85 ,$254.19 , N/A ,$293.93 , N/A , N/A , N/A , N/A , N/A ,$267.88 ,$230.68 ,$267.88 ,$267.88 ,$297.65 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 44MM,278,1 ,$372.06 ,$245.56 ,$188.71 ,$372.06 , N/A , N/A , N/A , N/A ,$223.24 ,$316.25 ,$260.44 , N/A , N/A ,$353.46 ,$282.77 ,$279.05 , N/A ,$316.25 , N/A , N/A , N/A ,$260.44 ,$226.58 , N/A , N/A , N/A , N/A , N/A ,$316.25 , N/A ,$342.30 ,$260.44 ,$188.71 ,$226.47 ,$226.58 ,$226.47 ,$257.09 ,$334.85 ,$254.19 , N/A ,$293.93 , N/A , N/A , N/A , N/A , N/A ,$267.88 ,$230.68 ,$267.88 ,$267.88 ,$297.65 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 95MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 18MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 20MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 22MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 24MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 28MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 30MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 32MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 34MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 36MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 38MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 40MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 42MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 44MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 46MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 48MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 50MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 52MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 54MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 56MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 58MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 60MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 62MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 64MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 66MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 68MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 70MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 72MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 74MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 76MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 78MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.0 TI LOCKING W/T25 STAR 80MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 100MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 26MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 28MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 36MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 42MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 46MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 48MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 52MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 54MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 56MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 58MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 60MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 62MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 64MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 66MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 68MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 70MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 72MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 74MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 76MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 78MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 80MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 85MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING STARDRIVE 90MM,278,1 ,$368.55 ,$243.24 ,$186.93 ,$368.55 , N/A , N/A , N/A , N/A ,$221.13 ,$313.27 ,$257.99 , N/A , N/A ,$350.12 ,$280.10 ,$276.41 , N/A ,$313.27 , N/A , N/A , N/A ,$257.99 ,$224.45 , N/A , N/A , N/A , N/A , N/A ,$313.27 , N/A ,$339.07 ,$257.99 ,$186.93 ,$224.34 ,$224.45 ,$224.34 ,$254.67 ,$331.70 ,$251.79 , N/A ,$291.15 , N/A , N/A , N/A , N/A , N/A ,$265.36 ,$228.50 ,$265.36 ,$265.36 ,$294.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 90MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 20MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 25MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 30MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 35MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 40MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 45MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 50MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 55MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 60MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 65MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 70MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 75MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 80MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING CANN 85MM,278,1 ,$496.65 ,$327.79 ,$251.90 ,$496.65 , N/A , N/A , N/A , N/A ,$297.99 ,$422.15 ,$347.66 , N/A , N/A ,$471.82 ,$377.45 ,$372.49 , N/A ,$422.15 , N/A , N/A , N/A ,$347.66 ,$302.46 , N/A , N/A , N/A , N/A , N/A ,$422.15 , N/A ,$456.92 ,$347.66 ,$251.90 ,$302.31 ,$302.46 ,$302.31 ,$343.19 ,$446.99 ,$339.31 , N/A ,$392.35 , N/A , N/A , N/A , N/A , N/A ,$357.59 ,$307.92 ,$357.59 ,$357.59 ,$397.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 12MM,278,1 ,$516.45 ,$340.86 ,$261.94 ,$516.45 , N/A , N/A , N/A , N/A ,$309.87 ,$438.98 ,$361.52 , N/A , N/A ,$490.63 ,$392.50 ,$387.34 , N/A ,$438.98 , N/A , N/A , N/A ,$361.52 ,$314.52 , N/A , N/A , N/A , N/A , N/A ,$438.98 , N/A ,$475.13 ,$361.52 ,$261.94 ,$314.36 ,$314.52 ,$314.36 ,$356.87 ,$464.81 ,$352.84 , N/A ,$408.00 , N/A , N/A , N/A , N/A , N/A ,$371.84 ,$320.20 ,$371.84 ,$371.84 ,$413.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 18MM,278,1 ,$513.21 ,$338.72 ,$260.30 ,$513.21 , N/A , N/A , N/A , N/A ,$307.93 ,$436.23 ,$359.25 , N/A , N/A ,$487.55 ,$390.04 ,$384.91 , N/A ,$436.23 , N/A , N/A , N/A ,$359.25 ,$312.54 , N/A , N/A , N/A , N/A , N/A ,$436.23 , N/A ,$472.15 ,$359.25 ,$260.30 ,$312.39 ,$312.54 ,$312.39 ,$354.63 ,$461.89 ,$350.63 , N/A ,$405.44 , N/A , N/A , N/A , N/A , N/A ,$369.51 ,$318.19 ,$369.51 ,$369.51 ,$410.57 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 14MM,278,1 ,$513.21 ,$338.72 ,$260.30 ,$513.21 , N/A , N/A , N/A , N/A ,$307.93 ,$436.23 ,$359.25 , N/A , N/A ,$487.55 ,$390.04 ,$384.91 , N/A ,$436.23 , N/A , N/A , N/A ,$359.25 ,$312.54 , N/A , N/A , N/A , N/A , N/A ,$436.23 , N/A ,$472.15 ,$359.25 ,$260.30 ,$312.39 ,$312.54 ,$312.39 ,$354.63 ,$461.89 ,$350.63 , N/A ,$405.44 , N/A , N/A , N/A , N/A , N/A ,$369.51 ,$318.19 ,$369.51 ,$369.51 ,$410.57 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 16MM,278,1 ,$513.21 ,$338.72 ,$260.30 ,$513.21 , N/A , N/A , N/A , N/A ,$307.93 ,$436.23 ,$359.25 , N/A , N/A ,$487.55 ,$390.04 ,$384.91 , N/A ,$436.23 , N/A , N/A , N/A ,$359.25 ,$312.54 , N/A , N/A , N/A , N/A , N/A ,$436.23 , N/A ,$472.15 ,$359.25 ,$260.30 ,$312.39 ,$312.54 ,$312.39 ,$354.63 ,$461.89 ,$350.63 , N/A ,$405.44 , N/A , N/A , N/A , N/A , N/A ,$369.51 ,$318.19 ,$369.51 ,$369.51 ,$410.57 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 90MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 10MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 20MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 22MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 24MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 30MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 32MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 34MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 36MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 38MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 40MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 42MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 46MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 48MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 50MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 55MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 65MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 VA LOCKING SELF TAP 75MM,278,1 ,$382.73 ,$252.60 ,$194.12 ,$382.73 , N/A , N/A , N/A , N/A ,$229.64 ,$325.32 ,$267.91 , N/A , N/A ,$363.59 ,$290.87 ,$287.05 , N/A ,$325.32 , N/A , N/A , N/A ,$267.91 ,$233.08 , N/A , N/A , N/A , N/A , N/A ,$325.32 , N/A ,$352.11 ,$267.91 ,$194.12 ,$232.97 ,$233.08 ,$232.97 ,$264.47 ,$344.46 ,$261.48 , N/A ,$302.36 , N/A , N/A , N/A , N/A , N/A ,$275.57 ,$237.29 ,$275.57 ,$275.57 ,$306.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 65MM,278,1 ,$365.40 ,$241.16 ,$185.33 ,$365.40 , N/A , N/A , N/A , N/A ,$219.24 ,$310.59 ,$255.78 , N/A , N/A ,$347.13 ,$277.70 ,$274.05 , N/A ,$310.59 , N/A , N/A , N/A ,$255.78 ,$222.53 , N/A , N/A , N/A , N/A , N/A ,$310.59 , N/A ,$336.17 ,$255.78 ,$185.33 ,$222.42 ,$222.53 ,$222.42 ,$252.49 ,$328.86 ,$249.64 , N/A ,$288.67 , N/A , N/A , N/A , N/A , N/A ,$263.09 ,$226.55 ,$263.09 ,$263.09 ,$292.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 45MM,278,1 ,$365.40 ,$241.16 ,$185.33 ,$365.40 , N/A , N/A , N/A , N/A ,$219.24 ,$310.59 ,$255.78 , N/A , N/A ,$347.13 ,$277.70 ,$274.05 , N/A ,$310.59 , N/A , N/A , N/A ,$255.78 ,$222.53 , N/A , N/A , N/A , N/A , N/A ,$310.59 , N/A ,$336.17 ,$255.78 ,$185.33 ,$222.42 ,$222.53 ,$222.42 ,$252.49 ,$328.86 ,$249.64 , N/A ,$288.67 , N/A , N/A , N/A , N/A , N/A ,$263.09 ,$226.55 ,$263.09 ,$263.09 ,$292.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 50MM,278,1 ,$365.40 ,$241.16 ,$185.33 ,$365.40 , N/A , N/A , N/A , N/A ,$219.24 ,$310.59 ,$255.78 , N/A , N/A ,$347.13 ,$277.70 ,$274.05 , N/A ,$310.59 , N/A , N/A , N/A ,$255.78 ,$222.53 , N/A , N/A , N/A , N/A , N/A ,$310.59 , N/A ,$336.17 ,$255.78 ,$185.33 ,$222.42 ,$222.53 ,$222.42 ,$252.49 ,$328.86 ,$249.64 , N/A ,$288.67 , N/A , N/A , N/A , N/A , N/A ,$263.09 ,$226.55 ,$263.09 ,$263.09 ,$292.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 55MM,278,1 ,$365.40 ,$241.16 ,$185.33 ,$365.40 , N/A , N/A , N/A , N/A ,$219.24 ,$310.59 ,$255.78 , N/A , N/A ,$347.13 ,$277.70 ,$274.05 , N/A ,$310.59 , N/A , N/A , N/A ,$255.78 ,$222.53 , N/A , N/A , N/A , N/A , N/A ,$310.59 , N/A ,$336.17 ,$255.78 ,$185.33 ,$222.42 ,$222.53 ,$222.42 ,$252.49 ,$328.86 ,$249.64 , N/A ,$288.67 , N/A , N/A , N/A , N/A , N/A ,$263.09 ,$226.55 ,$263.09 ,$263.09 ,$292.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 95MM,278,1 ,$346.19 ,$228.49 ,$175.59 ,$346.19 , N/A , N/A , N/A , N/A ,$207.71 ,$294.26 ,$242.33 , N/A , N/A ,$328.88 ,$263.10 ,$259.64 , N/A ,$294.26 , N/A , N/A , N/A ,$242.33 ,$210.83 , N/A , N/A , N/A , N/A , N/A ,$294.26 , N/A ,$318.49 ,$242.33 ,$175.59 ,$210.73 ,$210.83 ,$210.73 ,$239.22 ,$311.57 ,$236.52 , N/A ,$273.49 , N/A , N/A , N/A , N/A , N/A ,$249.26 ,$214.64 ,$249.26 ,$249.26 ,$276.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 40MM,278,1 ,$346.19 ,$228.49 ,$175.59 ,$346.19 , N/A , N/A , N/A , N/A ,$207.71 ,$294.26 ,$242.33 , N/A , N/A ,$328.88 ,$263.10 ,$259.64 , N/A ,$294.26 , N/A , N/A , N/A ,$242.33 ,$210.83 , N/A , N/A , N/A , N/A , N/A ,$294.26 , N/A ,$318.49 ,$242.33 ,$175.59 ,$210.73 ,$210.83 ,$210.73 ,$239.22 ,$311.57 ,$236.52 , N/A ,$273.49 , N/A , N/A , N/A , N/A , N/A ,$249.26 ,$214.64 ,$249.26 ,$249.26 ,$276.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 60MM,278,1 ,$346.19 ,$228.49 ,$175.59 ,$346.19 , N/A , N/A , N/A , N/A ,$207.71 ,$294.26 ,$242.33 , N/A , N/A ,$328.88 ,$263.10 ,$259.64 , N/A ,$294.26 , N/A , N/A , N/A ,$242.33 ,$210.83 , N/A , N/A , N/A , N/A , N/A ,$294.26 , N/A ,$318.49 ,$242.33 ,$175.59 ,$210.73 ,$210.83 ,$210.73 ,$239.22 ,$311.57 ,$236.52 , N/A ,$273.49 , N/A , N/A , N/A , N/A , N/A ,$249.26 ,$214.64 ,$249.26 ,$249.26 ,$276.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 70MM,278,1 ,$346.19 ,$228.49 ,$175.59 ,$346.19 , N/A , N/A , N/A , N/A ,$207.71 ,$294.26 ,$242.33 , N/A , N/A ,$328.88 ,$263.10 ,$259.64 , N/A ,$294.26 , N/A , N/A , N/A ,$242.33 ,$210.83 , N/A , N/A , N/A , N/A , N/A ,$294.26 , N/A ,$318.49 ,$242.33 ,$175.59 ,$210.73 ,$210.83 ,$210.73 ,$239.22 ,$311.57 ,$236.52 , N/A ,$273.49 , N/A , N/A , N/A , N/A , N/A ,$249.26 ,$214.64 ,$249.26 ,$249.26 ,$276.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 75MM,278,1 ,$346.19 ,$228.49 ,$175.59 ,$346.19 , N/A , N/A , N/A , N/A ,$207.71 ,$294.26 ,$242.33 , N/A , N/A ,$328.88 ,$263.10 ,$259.64 , N/A ,$294.26 , N/A , N/A , N/A ,$242.33 ,$210.83 , N/A , N/A , N/A , N/A , N/A ,$294.26 , N/A ,$318.49 ,$242.33 ,$175.59 ,$210.73 ,$210.83 ,$210.73 ,$239.22 ,$311.57 ,$236.52 , N/A ,$273.49 , N/A , N/A , N/A , N/A , N/A ,$249.26 ,$214.64 ,$249.26 ,$249.26 ,$276.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 80MM,278,1 ,$346.19 ,$228.49 ,$175.59 ,$346.19 , N/A , N/A , N/A , N/A ,$207.71 ,$294.26 ,$242.33 , N/A , N/A ,$328.88 ,$263.10 ,$259.64 , N/A ,$294.26 , N/A , N/A , N/A ,$242.33 ,$210.83 , N/A , N/A , N/A , N/A , N/A ,$294.26 , N/A ,$318.49 ,$242.33 ,$175.59 ,$210.73 ,$210.83 ,$210.73 ,$239.22 ,$311.57 ,$236.52 , N/A ,$273.49 , N/A , N/A , N/A , N/A , N/A ,$249.26 ,$214.64 ,$249.26 ,$249.26 ,$276.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 85MM,278,1 ,$346.19 ,$228.49 ,$175.59 ,$346.19 , N/A , N/A , N/A , N/A ,$207.71 ,$294.26 ,$242.33 , N/A , N/A ,$328.88 ,$263.10 ,$259.64 , N/A ,$294.26 , N/A , N/A , N/A ,$242.33 ,$210.83 , N/A , N/A , N/A , N/A , N/A ,$294.26 , N/A ,$318.49 ,$242.33 ,$175.59 ,$210.73 ,$210.83 ,$210.73 ,$239.22 ,$311.57 ,$236.52 , N/A ,$273.49 , N/A , N/A , N/A , N/A , N/A ,$249.26 ,$214.64 ,$249.26 ,$249.26 ,$276.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED CONICAL 90MM,278,1 ,$346.19 ,$228.49 ,$175.59 ,$346.19 , N/A , N/A , N/A , N/A ,$207.71 ,$294.26 ,$242.33 , N/A , N/A ,$328.88 ,$263.10 ,$259.64 , N/A ,$294.26 , N/A , N/A , N/A ,$242.33 ,$210.83 , N/A , N/A , N/A , N/A , N/A ,$294.26 , N/A ,$318.49 ,$242.33 ,$175.59 ,$210.73 ,$210.83 ,$210.73 ,$239.22 ,$311.57 ,$236.52 , N/A ,$273.49 , N/A , N/A , N/A , N/A , N/A ,$249.26 ,$214.64 ,$249.26 ,$249.26 ,$276.95 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 145MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 100MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 105MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 110MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 115MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 120MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 125MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 130MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 135MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 140MM,278,1 ,$425.25 ,$280.67 ,$215.69 ,$425.25 , N/A , N/A , N/A , N/A ,$255.15 ,$361.46 ,$297.68 , N/A , N/A ,$403.99 ,$323.19 ,$318.94 , N/A ,$361.46 , N/A , N/A , N/A ,$297.68 ,$258.98 , N/A , N/A , N/A , N/A , N/A ,$361.46 , N/A ,$391.23 ,$297.68 ,$215.69 ,$258.85 ,$258.98 ,$258.85 ,$293.85 ,$382.73 ,$290.53 , N/A ,$335.95 , N/A , N/A , N/A , N/A , N/A ,$306.18 ,$263.66 ,$306.18 ,$306.18 ,$340.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 95MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 25MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 30MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 35MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 40MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 45MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 50MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 55MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 60MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 65MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 70MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 75MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 80MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 85MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM CANNULATED LOCKING 90MM,278,1 ,$391.39 ,$258.32 ,$198.51 ,$391.39 , N/A , N/A , N/A , N/A ,$234.83 ,$332.68 ,$273.97 , N/A , N/A ,$371.82 ,$297.46 ,$293.54 , N/A ,$332.68 , N/A , N/A , N/A ,$273.97 ,$238.36 , N/A , N/A , N/A , N/A , N/A ,$332.68 , N/A ,$360.08 ,$273.97 ,$198.51 ,$238.24 ,$238.36 ,$238.24 ,$270.45 ,$352.25 ,$267.40 , N/A ,$309.20 , N/A , N/A , N/A , N/A , N/A ,$281.80 ,$242.66 ,$281.80 ,$281.80 ,$313.11 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG T25 STARDRIVE 35MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 40MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 45MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 50MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 55MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 60MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 65MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 70MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 75MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 80MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 85MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG  T25 STARDRIVE 90MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0MM TI DUAL CORE LCKNG T25 STARDRIVE 30MM,278,1 ,$418.95 ,$276.51 ,$212.49 ,$418.95 , N/A , N/A , N/A , N/A ,$251.37 ,$356.11 ,$293.27 , N/A , N/A ,$398.00 ,$318.40 ,$314.21 , N/A ,$356.11 , N/A , N/A , N/A ,$293.27 ,$255.14 , N/A , N/A , N/A , N/A , N/A ,$356.11 , N/A ,$385.43 ,$293.27 ,$212.49 ,$255.01 ,$255.14 ,$255.01 ,$289.49 ,$377.06 ,$286.23 , N/A ,$330.97 , N/A , N/A , N/A , N/A , N/A ,$301.64 ,$259.75 ,$301.64 ,$301.64 ,$335.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0SCHANZ SELF DRILL 200MM,278,1 ,$439.88 ,$290.32 ,$223.11 ,$439.88 , N/A , N/A , N/A , N/A ,$263.93 ,$373.90 ,$307.92 , N/A , N/A ,$417.89 ,$334.31 ,$329.91 , N/A ,$373.90 , N/A , N/A , N/A ,$307.92 ,$267.89 , N/A , N/A , N/A , N/A , N/A ,$373.90 , N/A ,$404.69 ,$307.92 ,$223.11 ,$267.76 ,$267.89 ,$267.76 ,$303.96 ,$395.89 ,$300.53 , N/A ,$347.51 , N/A , N/A , N/A , N/A , N/A ,$316.71 ,$272.73 ,$316.71 ,$316.71 ,$351.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 SCHANZ SELF DRILL150,278,1 ,$439.88 ,$290.32 ,$223.11 ,$439.88 , N/A , N/A , N/A , N/A ,$263.93 ,$373.90 ,$307.92 , N/A , N/A ,$417.89 ,$334.31 ,$329.91 , N/A ,$373.90 , N/A , N/A , N/A ,$307.92 ,$267.89 , N/A , N/A , N/A , N/A , N/A ,$373.90 , N/A ,$404.69 ,$307.92 ,$223.11 ,$267.76 ,$267.89 ,$267.76 ,$303.96 ,$395.89 ,$300.53 , N/A ,$347.51 , N/A , N/A , N/A , N/A , N/A ,$316.71 ,$272.73 ,$316.71 ,$316.71 ,$351.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 5.0 SCHANZ TI SELF-DRILLING 60MM THRD/175MM,278,1 ,$439.88 ,$290.32 ,$223.11 ,$439.88 , N/A , N/A , N/A , N/A ,$263.93 ,$373.90 ,$307.92 , N/A , N/A ,$417.89 ,$334.31 ,$329.91 , N/A ,$373.90 , N/A , N/A , N/A ,$307.92 ,$267.89 , N/A , N/A , N/A , N/A , N/A ,$373.90 , N/A ,$404.69 ,$307.92 ,$223.11 ,$267.76 ,$267.89 ,$267.76 ,$303.96 ,$395.89 ,$300.53 , N/A ,$347.51 , N/A , N/A , N/A , N/A , N/A ,$316.71 ,$272.73 ,$316.71 ,$316.71 ,$351.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 95MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 14MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 15MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 16MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 17MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 18MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 19MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 20MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 21MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 22MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 23MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 24MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 25MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 26MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 27MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 28MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 29MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 30MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 32MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 34MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 36MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 38MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN LNG THRD 40MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD  8MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD  9MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 10MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 11MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 12MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 13MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 14MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 15MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 16MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 17MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 18MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 19MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 20MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 21MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 22MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 23MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 24MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 25MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 26MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 27MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 28MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 29MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 30MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 32MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 34MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 36MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 38MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 3.0 CANN SHRT THRD 40MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 100MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 30MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 35MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 40MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 45MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 50MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 55MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 60MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 65MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 70MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 75MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 80MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 85MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.0MM TI LOCKING 90MM,278,1 ,$417.38 ,$275.47 ,$211.70 ,$417.38 , N/A , N/A , N/A , N/A ,$250.43 ,$354.77 ,$292.17 , N/A , N/A ,$396.51 ,$317.21 ,$313.04 , N/A ,$354.77 , N/A , N/A , N/A ,$292.17 ,$254.18 , N/A , N/A , N/A , N/A , N/A ,$354.77 , N/A ,$383.99 ,$292.17 ,$211.70 ,$254.06 ,$254.18 ,$254.06 ,$288.41 ,$375.64 ,$285.15 , N/A ,$329.73 , N/A , N/A , N/A , N/A , N/A ,$300.51 ,$258.78 ,$300.51 ,$300.51 ,$333.90 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  90MM,278,1 ,$70.74 ,$46.69 ,$35.88 ,$70.74 , N/A , N/A , N/A , N/A ,$42.44 ,$60.13 ,$49.52 , N/A , N/A ,$67.20 ,$53.76 ,$53.06 , N/A ,$60.13 , N/A , N/A , N/A ,$49.52 ,$43.08 , N/A , N/A , N/A , N/A , N/A ,$60.13 , N/A ,$65.08 ,$49.52 ,$35.88 ,$43.06 ,$43.08 ,$43.06 ,$48.88 ,$63.67 ,$48.33 , N/A ,$55.88 , N/A , N/A , N/A , N/A , N/A ,$50.93 ,$43.86 ,$50.93 ,$50.93 ,$56.59 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  40MM,278,1 ,$65.23 ,$43.05 ,$33.08 ,$65.23 , N/A , N/A , N/A , N/A ,$39.14 ,$55.45 ,$45.66 , N/A , N/A ,$61.97 ,$49.57 ,$48.92 , N/A ,$55.45 , N/A , N/A , N/A ,$45.66 ,$39.73 , N/A , N/A , N/A , N/A , N/A ,$55.45 , N/A ,$60.01 ,$45.66 ,$33.08 ,$39.71 ,$39.73 ,$39.71 ,$45.07 ,$58.71 ,$44.57 , N/A ,$51.53 , N/A , N/A , N/A , N/A , N/A ,$46.97 ,$40.44 ,$46.97 ,$46.97 ,$52.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 50MM,278,1 ,$65.23 ,$43.05 ,$33.08 ,$65.23 , N/A , N/A , N/A , N/A ,$39.14 ,$55.45 ,$45.66 , N/A , N/A ,$61.97 ,$49.57 ,$48.92 , N/A ,$55.45 , N/A , N/A , N/A ,$45.66 ,$39.73 , N/A , N/A , N/A , N/A , N/A ,$55.45 , N/A ,$60.01 ,$45.66 ,$33.08 ,$39.71 ,$39.73 ,$39.71 ,$45.07 ,$58.71 ,$44.57 , N/A ,$51.53 , N/A , N/A , N/A , N/A , N/A ,$46.97 ,$40.44 ,$46.97 ,$46.97 ,$52.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  45MM,278,1 ,$65.23 ,$43.05 ,$33.08 ,$65.23 , N/A , N/A , N/A , N/A ,$39.14 ,$55.45 ,$45.66 , N/A , N/A ,$61.97 ,$49.57 ,$48.92 , N/A ,$55.45 , N/A , N/A , N/A ,$45.66 ,$39.73 , N/A , N/A , N/A , N/A , N/A ,$55.45 , N/A ,$60.01 ,$45.66 ,$33.08 ,$39.71 ,$39.73 ,$39.71 ,$45.07 ,$58.71 ,$44.57 , N/A ,$51.53 , N/A , N/A , N/A , N/A , N/A ,$46.97 ,$40.44 ,$46.97 ,$46.97 ,$52.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  50MM,278,1 ,$65.23 ,$43.05 ,$33.08 ,$65.23 , N/A , N/A , N/A , N/A ,$39.14 ,$55.45 ,$45.66 , N/A , N/A ,$61.97 ,$49.57 ,$48.92 , N/A ,$55.45 , N/A , N/A , N/A ,$45.66 ,$39.73 , N/A , N/A , N/A , N/A , N/A ,$55.45 , N/A ,$60.01 ,$45.66 ,$33.08 ,$39.71 ,$39.73 ,$39.71 ,$45.07 ,$58.71 ,$44.57 , N/A ,$51.53 , N/A , N/A , N/A , N/A , N/A ,$46.97 ,$40.44 ,$46.97 ,$46.97 ,$52.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  70MM,278,1 ,$65.23 ,$43.05 ,$33.08 ,$65.23 , N/A , N/A , N/A , N/A ,$39.14 ,$55.45 ,$45.66 , N/A , N/A ,$61.97 ,$49.57 ,$48.92 , N/A ,$55.45 , N/A , N/A , N/A ,$45.66 ,$39.73 , N/A , N/A , N/A , N/A , N/A ,$55.45 , N/A ,$60.01 ,$45.66 ,$33.08 ,$39.71 ,$39.73 ,$39.71 ,$45.07 ,$58.71 ,$44.57 , N/A ,$51.53 , N/A , N/A , N/A , N/A , N/A ,$46.97 ,$40.44 ,$46.97 ,$46.97 ,$52.18 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  80MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 30MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 35MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 40MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 45MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 55MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 60MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 65MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 70MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 75MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 80MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  55MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  60MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  65MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  75MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  80MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  25MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  30MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  35MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  45MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  50MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  55MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  60MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  65MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  70MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  75MM,278,1 ,$68.51 ,$45.22 ,$34.75 ,$68.51 , N/A , N/A , N/A , N/A ,$41.11 ,$58.23 ,$47.96 , N/A , N/A ,$65.08 ,$52.07 ,$51.38 , N/A ,$58.23 , N/A , N/A , N/A ,$47.96 ,$41.72 , N/A , N/A , N/A , N/A , N/A ,$58.23 , N/A ,$63.03 ,$47.96 ,$34.75 ,$41.70 ,$41.72 ,$41.70 ,$47.34 ,$61.66 ,$46.81 , N/A ,$54.12 , N/A , N/A , N/A , N/A , N/A ,$49.33 ,$42.48 ,$49.33 ,$49.33 ,$54.81 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD 110MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 76MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 80MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 100MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 105MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 110MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 85MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 90MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 95MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  85MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  95MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT 100MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT 105MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT 110MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  85MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  90MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  95MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD 100MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD 105MM,278,1 ,$74.03 ,$48.86 ,$37.55 ,$74.03 , N/A , N/A , N/A , N/A ,$44.42 ,$62.93 ,$51.82 , N/A , N/A ,$70.33 ,$56.26 ,$55.52 , N/A ,$62.93 , N/A , N/A , N/A ,$51.82 ,$45.08 , N/A , N/A , N/A , N/A , N/A ,$62.93 , N/A ,$68.11 ,$51.82 ,$37.55 ,$45.06 ,$45.08 ,$45.06 ,$51.15 ,$66.63 ,$50.58 , N/A ,$58.48 , N/A , N/A , N/A , N/A , N/A ,$53.30 ,$45.90 ,$53.30 ,$53.30 ,$59.22 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 180,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  30,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  35,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  40,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  45,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  50,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  55,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  60,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  65,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  70,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  75,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  80,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  85,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  90,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  95,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 100,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 105,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 110,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 115,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 120,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 125,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 130,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 135,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 140,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 145,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 150,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  45,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  50,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  55,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  60,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  65,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  70,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  75,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  80,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  85,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  90,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  95,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 100,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 105,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 110,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 115,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 120,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 125,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 130,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 135,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 140,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 145,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 150,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 160,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 170,278,1 ,$520.73 ,$343.68 ,$264.11 ,$520.73 , N/A , N/A , N/A , N/A ,$312.44 ,$442.62 ,$364.51 , N/A , N/A ,$494.69 ,$395.75 ,$390.55 , N/A ,$442.62 , N/A , N/A , N/A ,$364.51 ,$317.12 , N/A , N/A , N/A , N/A , N/A ,$442.62 , N/A ,$479.07 ,$364.51 ,$264.11 ,$316.97 ,$317.12 ,$316.97 ,$359.82 ,$468.66 ,$355.76 , N/A ,$411.38 , N/A , N/A , N/A , N/A , N/A ,$374.93 ,$322.85 ,$374.93 ,$374.93 ,$416.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN PART TH 80MM,278,1 ,$484.93 ,$320.05 ,$245.96 ,$484.93 , N/A , N/A , N/A , N/A ,$290.96 ,$412.19 ,$339.45 , N/A , N/A ,$460.68 ,$368.55 ,$363.70 , N/A ,$412.19 , N/A , N/A , N/A ,$339.45 ,$295.32 , N/A , N/A , N/A , N/A , N/A ,$412.19 , N/A ,$446.14 ,$339.45 ,$245.96 ,$295.18 ,$295.32 ,$295.18 ,$335.09 ,$436.44 ,$331.30 , N/A ,$383.09 , N/A , N/A , N/A , N/A , N/A ,$349.15 ,$300.66 ,$349.15 ,$349.15 ,$387.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 95,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  30,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  35,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  40,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  45,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  50,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  55,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  60,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  65,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  70,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  75,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  80,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  85,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  90,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT  95,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT 100,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT 105,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT 110,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT 115,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT 120,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT 125,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 16MM PT 130,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 100,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 105,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 110,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 115,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 120,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 125,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 130,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 50,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 55,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 60,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 65,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 70,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 75,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 80,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 85,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3 CANN SELF TAP 32MM THRD 90,278,1 ,$503.83 ,$332.53 ,$255.54 ,$503.83 , N/A , N/A , N/A , N/A ,$302.30 ,$428.26 ,$352.68 , N/A , N/A ,$478.64 ,$382.91 ,$377.87 , N/A ,$428.26 , N/A , N/A , N/A ,$352.68 ,$306.83 , N/A , N/A , N/A , N/A , N/A ,$428.26 , N/A ,$463.52 ,$352.68 ,$255.54 ,$306.68 ,$306.83 ,$306.68 ,$348.15 ,$453.45 ,$344.22 , N/A ,$398.03 , N/A , N/A , N/A , N/A , N/A ,$362.76 ,$312.37 ,$362.76 ,$362.76 ,$403.06 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 70MM,278,1 ,$496.20 ,$327.49 ,$251.67 ,$496.20 , N/A , N/A , N/A , N/A ,$297.72 ,$421.77 ,$347.34 , N/A , N/A ,$471.39 ,$377.11 ,$372.15 , N/A ,$421.77 , N/A , N/A , N/A ,$347.34 ,$302.19 , N/A , N/A , N/A , N/A , N/A ,$421.77 , N/A ,$456.50 ,$347.34 ,$251.67 ,$302.04 ,$302.19 ,$302.04 ,$342.87 ,$446.58 ,$339.00 , N/A ,$392.00 , N/A , N/A , N/A , N/A , N/A ,$357.26 ,$307.64 ,$357.26 ,$357.26 ,$396.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 55MM,278,1 ,$496.20 ,$327.49 ,$251.67 ,$496.20 , N/A , N/A , N/A , N/A ,$297.72 ,$421.77 ,$347.34 , N/A , N/A ,$471.39 ,$377.11 ,$372.15 , N/A ,$421.77 , N/A , N/A , N/A ,$347.34 ,$302.19 , N/A , N/A , N/A , N/A , N/A ,$421.77 , N/A ,$456.50 ,$347.34 ,$251.67 ,$302.04 ,$302.19 ,$302.04 ,$342.87 ,$446.58 ,$339.00 , N/A ,$392.00 , N/A , N/A , N/A , N/A , N/A ,$357.26 ,$307.64 ,$357.26 ,$357.26 ,$396.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 60MM,278,1 ,$496.20 ,$327.49 ,$251.67 ,$496.20 , N/A , N/A , N/A , N/A ,$297.72 ,$421.77 ,$347.34 , N/A , N/A ,$471.39 ,$377.11 ,$372.15 , N/A ,$421.77 , N/A , N/A , N/A ,$347.34 ,$302.19 , N/A , N/A , N/A , N/A , N/A ,$421.77 , N/A ,$456.50 ,$347.34 ,$251.67 ,$302.04 ,$302.19 ,$302.04 ,$342.87 ,$446.58 ,$339.00 , N/A ,$392.00 , N/A , N/A , N/A , N/A , N/A ,$357.26 ,$307.64 ,$357.26 ,$357.26 ,$396.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 70MM,278,1 ,$496.20 ,$327.49 ,$251.67 ,$496.20 , N/A , N/A , N/A , N/A ,$297.72 ,$421.77 ,$347.34 , N/A , N/A ,$471.39 ,$377.11 ,$372.15 , N/A ,$421.77 , N/A , N/A , N/A ,$347.34 ,$302.19 , N/A , N/A , N/A , N/A , N/A ,$421.77 , N/A ,$456.50 ,$347.34 ,$251.67 ,$302.04 ,$302.19 ,$302.04 ,$342.87 ,$446.58 ,$339.00 , N/A ,$392.00 , N/A , N/A , N/A , N/A , N/A ,$357.26 ,$307.64 ,$357.26 ,$357.26 ,$396.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 75MM,278,1 ,$496.20 ,$327.49 ,$251.67 ,$496.20 , N/A , N/A , N/A , N/A ,$297.72 ,$421.77 ,$347.34 , N/A , N/A ,$471.39 ,$377.11 ,$372.15 , N/A ,$421.77 , N/A , N/A , N/A ,$347.34 ,$302.19 , N/A , N/A , N/A , N/A , N/A ,$421.77 , N/A ,$456.50 ,$347.34 ,$251.67 ,$302.04 ,$302.19 ,$302.04 ,$342.87 ,$446.58 ,$339.00 , N/A ,$392.00 , N/A , N/A , N/A , N/A , N/A ,$357.26 ,$307.64 ,$357.26 ,$357.26 ,$396.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 80MM,278,1 ,$496.20 ,$327.49 ,$251.67 ,$496.20 , N/A , N/A , N/A , N/A ,$297.72 ,$421.77 ,$347.34 , N/A , N/A ,$471.39 ,$377.11 ,$372.15 , N/A ,$421.77 , N/A , N/A , N/A ,$347.34 ,$302.19 , N/A , N/A , N/A , N/A , N/A ,$421.77 , N/A ,$456.50 ,$347.34 ,$251.67 ,$302.04 ,$302.19 ,$302.04 ,$342.87 ,$446.58 ,$339.00 , N/A ,$392.00 , N/A , N/A , N/A , N/A , N/A ,$357.26 ,$307.64 ,$357.26 ,$357.26 ,$396.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 85MM,278,1 ,$496.20 ,$327.49 ,$251.67 ,$496.20 , N/A , N/A , N/A , N/A ,$297.72 ,$421.77 ,$347.34 , N/A , N/A ,$471.39 ,$377.11 ,$372.15 , N/A ,$421.77 , N/A , N/A , N/A ,$347.34 ,$302.19 , N/A , N/A , N/A , N/A , N/A ,$421.77 , N/A ,$456.50 ,$347.34 ,$251.67 ,$302.04 ,$302.19 ,$302.04 ,$342.87 ,$446.58 ,$339.00 , N/A ,$392.00 , N/A , N/A , N/A , N/A , N/A ,$357.26 ,$307.64 ,$357.26 ,$357.26 ,$396.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 90MM,278,1 ,$496.20 ,$327.49 ,$251.67 ,$496.20 , N/A , N/A , N/A , N/A ,$297.72 ,$421.77 ,$347.34 , N/A , N/A ,$471.39 ,$377.11 ,$372.15 , N/A ,$421.77 , N/A , N/A , N/A ,$347.34 ,$302.19 , N/A , N/A , N/A , N/A , N/A ,$421.77 , N/A ,$456.50 ,$347.34 ,$251.67 ,$302.04 ,$302.19 ,$302.04 ,$342.87 ,$446.58 ,$339.00 , N/A ,$392.00 , N/A , N/A , N/A , N/A , N/A ,$357.26 ,$307.64 ,$357.26 ,$357.26 ,$396.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 95MM,278,1 ,$496.20 ,$327.49 ,$251.67 ,$496.20 , N/A , N/A , N/A , N/A ,$297.72 ,$421.77 ,$347.34 , N/A , N/A ,$471.39 ,$377.11 ,$372.15 , N/A ,$421.77 , N/A , N/A , N/A ,$347.34 ,$302.19 , N/A , N/A , N/A , N/A , N/A ,$421.77 , N/A ,$456.50 ,$347.34 ,$251.67 ,$302.04 ,$302.19 ,$302.04 ,$342.87 ,$446.58 ,$339.00 , N/A ,$392.00 , N/A , N/A , N/A , N/A , N/A ,$357.26 ,$307.64 ,$357.26 ,$357.26 ,$396.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 95MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 50MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL 65MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 50MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 55MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 60MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 65MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 75MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 80MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 85MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED CONICAL PART TH 90MM,278,1 ,$522.24 ,$344.68 ,$264.88 ,$522.24 , N/A , N/A , N/A , N/A ,$313.34 ,$443.90 ,$365.57 , N/A , N/A ,$496.13 ,$396.90 ,$391.68 , N/A ,$443.90 , N/A , N/A , N/A ,$365.57 ,$318.04 , N/A , N/A , N/A , N/A , N/A ,$443.90 , N/A ,$480.46 ,$365.57 ,$264.88 ,$317.89 ,$318.04 ,$317.89 ,$360.87 ,$470.02 ,$356.79 , N/A ,$412.57 , N/A , N/A , N/A , N/A , N/A ,$376.01 ,$323.79 ,$376.01 ,$376.01 ,$417.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 145MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 100MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 105MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 110MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 115MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 120MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 125MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 130MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 135MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 140MM,278,1 ,$598.99 ,$395.33 ,$303.81 ,$598.99 , N/A , N/A , N/A , N/A ,$359.39 ,$509.14 ,$419.29 , N/A , N/A ,$569.04 ,$455.23 ,$449.24 , N/A ,$509.14 , N/A , N/A , N/A ,$419.29 ,$364.78 , N/A , N/A , N/A , N/A , N/A ,$509.14 , N/A ,$551.07 ,$419.29 ,$303.81 ,$364.61 ,$364.78 ,$364.61 ,$413.90 ,$539.09 ,$409.23 , N/A ,$473.20 , N/A , N/A , N/A , N/A , N/A ,$431.27 ,$371.37 ,$431.27 ,$431.27 ,$479.19 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 40MM,278,1 ,$585.45 ,$386.40 ,$296.94 ,$585.45 , N/A , N/A , N/A , N/A ,$351.27 ,$497.63 ,$409.82 , N/A , N/A ,$556.18 ,$444.94 ,$439.09 , N/A ,$497.63 , N/A , N/A , N/A ,$409.82 ,$356.54 , N/A , N/A , N/A , N/A , N/A ,$497.63 , N/A ,$538.61 ,$409.82 ,$296.94 ,$356.36 ,$356.54 ,$356.36 ,$404.55 ,$526.91 ,$399.98 , N/A ,$462.51 , N/A , N/A , N/A , N/A , N/A ,$421.52 ,$362.98 ,$421.52 ,$421.52 ,$468.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 45MM,278,1 ,$585.45 ,$386.40 ,$296.94 ,$585.45 , N/A , N/A , N/A , N/A ,$351.27 ,$497.63 ,$409.82 , N/A , N/A ,$556.18 ,$444.94 ,$439.09 , N/A ,$497.63 , N/A , N/A , N/A ,$409.82 ,$356.54 , N/A , N/A , N/A , N/A , N/A ,$497.63 , N/A ,$538.61 ,$409.82 ,$296.94 ,$356.36 ,$356.54 ,$356.36 ,$404.55 ,$526.91 ,$399.98 , N/A ,$462.51 , N/A , N/A , N/A , N/A , N/A ,$421.52 ,$362.98 ,$421.52 ,$421.52 ,$468.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 55MM,278,1 ,$585.45 ,$386.40 ,$296.94 ,$585.45 , N/A , N/A , N/A , N/A ,$351.27 ,$497.63 ,$409.82 , N/A , N/A ,$556.18 ,$444.94 ,$439.09 , N/A ,$497.63 , N/A , N/A , N/A ,$409.82 ,$356.54 , N/A , N/A , N/A , N/A , N/A ,$497.63 , N/A ,$538.61 ,$409.82 ,$296.94 ,$356.36 ,$356.54 ,$356.36 ,$404.55 ,$526.91 ,$399.98 , N/A ,$462.51 , N/A , N/A , N/A , N/A , N/A ,$421.52 ,$362.98 ,$421.52 ,$421.52 ,$468.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 95MM,278,1 ,$585.45 ,$386.40 ,$296.94 ,$585.45 , N/A , N/A , N/A , N/A ,$351.27 ,$497.63 ,$409.82 , N/A , N/A ,$556.18 ,$444.94 ,$439.09 , N/A ,$497.63 , N/A , N/A , N/A ,$409.82 ,$356.54 , N/A , N/A , N/A , N/A , N/A ,$497.63 , N/A ,$538.61 ,$409.82 ,$296.94 ,$356.36 ,$356.54 ,$356.36 ,$404.55 ,$526.91 ,$399.98 , N/A ,$462.51 , N/A , N/A , N/A , N/A , N/A ,$421.52 ,$362.98 ,$421.52 ,$421.52 ,$468.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 20MM,278,1 ,$585.45 ,$386.40 ,$296.94 ,$585.45 , N/A , N/A , N/A , N/A ,$351.27 ,$497.63 ,$409.82 , N/A , N/A ,$556.18 ,$444.94 ,$439.09 , N/A ,$497.63 , N/A , N/A , N/A ,$409.82 ,$356.54 , N/A , N/A , N/A , N/A , N/A ,$497.63 , N/A ,$538.61 ,$409.82 ,$296.94 ,$356.36 ,$356.54 ,$356.36 ,$404.55 ,$526.91 ,$399.98 , N/A ,$462.51 , N/A , N/A , N/A , N/A , N/A ,$421.52 ,$362.98 ,$421.52 ,$421.52 ,$468.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 25MM,278,1 ,$585.45 ,$386.40 ,$296.94 ,$585.45 , N/A , N/A , N/A , N/A ,$351.27 ,$497.63 ,$409.82 , N/A , N/A ,$556.18 ,$444.94 ,$439.09 , N/A ,$497.63 , N/A , N/A , N/A ,$409.82 ,$356.54 , N/A , N/A , N/A , N/A , N/A ,$497.63 , N/A ,$538.61 ,$409.82 ,$296.94 ,$356.36 ,$356.54 ,$356.36 ,$404.55 ,$526.91 ,$399.98 , N/A ,$462.51 , N/A , N/A , N/A , N/A , N/A ,$421.52 ,$362.98 ,$421.52 ,$421.52 ,$468.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 30MM,278,1 ,$585.45 ,$386.40 ,$296.94 ,$585.45 , N/A , N/A , N/A , N/A ,$351.27 ,$497.63 ,$409.82 , N/A , N/A ,$556.18 ,$444.94 ,$439.09 , N/A ,$497.63 , N/A , N/A , N/A ,$409.82 ,$356.54 , N/A , N/A , N/A , N/A , N/A ,$497.63 , N/A ,$538.61 ,$409.82 ,$296.94 ,$356.36 ,$356.54 ,$356.36 ,$404.55 ,$526.91 ,$399.98 , N/A ,$462.51 , N/A , N/A , N/A , N/A , N/A ,$421.52 ,$362.98 ,$421.52 ,$421.52 ,$468.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 35MM,278,1 ,$585.45 ,$386.40 ,$296.94 ,$585.45 , N/A , N/A , N/A , N/A ,$351.27 ,$497.63 ,$409.82 , N/A , N/A ,$556.18 ,$444.94 ,$439.09 , N/A ,$497.63 , N/A , N/A , N/A ,$409.82 ,$356.54 , N/A , N/A , N/A , N/A , N/A ,$497.63 , N/A ,$538.61 ,$409.82 ,$296.94 ,$356.36 ,$356.54 ,$356.36 ,$404.55 ,$526.91 ,$399.98 , N/A ,$462.51 , N/A , N/A , N/A , N/A , N/A ,$421.52 ,$362.98 ,$421.52 ,$421.52 ,$468.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 90MM,278,1 ,$556.25 ,$367.13 ,$282.13 ,$556.25 , N/A , N/A , N/A , N/A ,$333.75 ,$472.81 ,$389.38 , N/A , N/A ,$528.44 ,$422.75 ,$417.19 , N/A ,$472.81 , N/A , N/A , N/A ,$389.38 ,$338.76 , N/A , N/A , N/A , N/A , N/A ,$472.81 , N/A ,$511.75 ,$389.38 ,$282.13 ,$338.59 ,$338.76 ,$338.59 ,$384.37 ,$500.63 ,$380.03 , N/A ,$439.44 , N/A , N/A , N/A , N/A , N/A ,$400.50 ,$344.88 ,$400.50 ,$400.50 ,$445.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 50MM,278,1 ,$556.25 ,$367.13 ,$282.13 ,$556.25 , N/A , N/A , N/A , N/A ,$333.75 ,$472.81 ,$389.38 , N/A , N/A ,$528.44 ,$422.75 ,$417.19 , N/A ,$472.81 , N/A , N/A , N/A ,$389.38 ,$338.76 , N/A , N/A , N/A , N/A , N/A ,$472.81 , N/A ,$511.75 ,$389.38 ,$282.13 ,$338.59 ,$338.76 ,$338.59 ,$384.37 ,$500.63 ,$380.03 , N/A ,$439.44 , N/A , N/A , N/A , N/A , N/A ,$400.50 ,$344.88 ,$400.50 ,$400.50 ,$445.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 60MM,278,1 ,$556.25 ,$367.13 ,$282.13 ,$556.25 , N/A , N/A , N/A , N/A ,$333.75 ,$472.81 ,$389.38 , N/A , N/A ,$528.44 ,$422.75 ,$417.19 , N/A ,$472.81 , N/A , N/A , N/A ,$389.38 ,$338.76 , N/A , N/A , N/A , N/A , N/A ,$472.81 , N/A ,$511.75 ,$389.38 ,$282.13 ,$338.59 ,$338.76 ,$338.59 ,$384.37 ,$500.63 ,$380.03 , N/A ,$439.44 , N/A , N/A , N/A , N/A , N/A ,$400.50 ,$344.88 ,$400.50 ,$400.50 ,$445.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 65MM,278,1 ,$556.25 ,$367.13 ,$282.13 ,$556.25 , N/A , N/A , N/A , N/A ,$333.75 ,$472.81 ,$389.38 , N/A , N/A ,$528.44 ,$422.75 ,$417.19 , N/A ,$472.81 , N/A , N/A , N/A ,$389.38 ,$338.76 , N/A , N/A , N/A , N/A , N/A ,$472.81 , N/A ,$511.75 ,$389.38 ,$282.13 ,$338.59 ,$338.76 ,$338.59 ,$384.37 ,$500.63 ,$380.03 , N/A ,$439.44 , N/A , N/A , N/A , N/A , N/A ,$400.50 ,$344.88 ,$400.50 ,$400.50 ,$445.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 70MM,278,1 ,$556.25 ,$367.13 ,$282.13 ,$556.25 , N/A , N/A , N/A , N/A ,$333.75 ,$472.81 ,$389.38 , N/A , N/A ,$528.44 ,$422.75 ,$417.19 , N/A ,$472.81 , N/A , N/A , N/A ,$389.38 ,$338.76 , N/A , N/A , N/A , N/A , N/A ,$472.81 , N/A ,$511.75 ,$389.38 ,$282.13 ,$338.59 ,$338.76 ,$338.59 ,$384.37 ,$500.63 ,$380.03 , N/A ,$439.44 , N/A , N/A , N/A , N/A , N/A ,$400.50 ,$344.88 ,$400.50 ,$400.50 ,$445.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 75MM,278,1 ,$556.25 ,$367.13 ,$282.13 ,$556.25 , N/A , N/A , N/A , N/A ,$333.75 ,$472.81 ,$389.38 , N/A , N/A ,$528.44 ,$422.75 ,$417.19 , N/A ,$472.81 , N/A , N/A , N/A ,$389.38 ,$338.76 , N/A , N/A , N/A , N/A , N/A ,$472.81 , N/A ,$511.75 ,$389.38 ,$282.13 ,$338.59 ,$338.76 ,$338.59 ,$384.37 ,$500.63 ,$380.03 , N/A ,$439.44 , N/A , N/A , N/A , N/A , N/A ,$400.50 ,$344.88 ,$400.50 ,$400.50 ,$445.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 80MM,278,1 ,$556.25 ,$367.13 ,$282.13 ,$556.25 , N/A , N/A , N/A , N/A ,$333.75 ,$472.81 ,$389.38 , N/A , N/A ,$528.44 ,$422.75 ,$417.19 , N/A ,$472.81 , N/A , N/A , N/A ,$389.38 ,$338.76 , N/A , N/A , N/A , N/A , N/A ,$472.81 , N/A ,$511.75 ,$389.38 ,$282.13 ,$338.59 ,$338.76 ,$338.59 ,$384.37 ,$500.63 ,$380.03 , N/A ,$439.44 , N/A , N/A , N/A , N/A , N/A ,$400.50 ,$344.88 ,$400.50 ,$400.50 ,$445.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES 7.3MM CANNULATED LOCKING 85MM,278,1 ,$556.25 ,$367.13 ,$282.13 ,$556.25 , N/A , N/A , N/A , N/A ,$333.75 ,$472.81 ,$389.38 , N/A , N/A ,$528.44 ,$422.75 ,$417.19 , N/A ,$472.81 , N/A , N/A , N/A ,$389.38 ,$338.76 , N/A , N/A , N/A , N/A , N/A ,$472.81 , N/A ,$511.75 ,$389.38 ,$282.13 ,$338.59 ,$338.76 ,$338.59 ,$384.37 ,$500.63 ,$380.03 , N/A ,$439.44 , N/A , N/A , N/A , N/A , N/A ,$400.50 ,$344.88 ,$400.50 ,$400.50 ,$445.00 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW SYNTHES CANNULATED COUNTERSINK 3.5/4.0,278,1 ,$689.29 ,$454.93 ,$349.61 ,$689.29 , N/A , N/A , N/A , N/A ,$413.57 ,$585.90 ,$482.50 , N/A , N/A ,$654.83 ,$523.86 ,$516.97 , N/A ,$585.90 , N/A , N/A , N/A ,$482.50 ,$419.78 , N/A , N/A , N/A , N/A , N/A ,$585.90 , N/A ,$634.15 ,$482.50 ,$349.61 ,$419.57 ,$419.78 ,$419.57 ,$476.30 ,$620.36 ,$470.92 , N/A ,$544.54 , N/A , N/A , N/A , N/A , N/A ,$496.29 ,$427.36 ,$496.29 ,$496.29 ,$551.43 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER 5.0 CORTICAL SELF TAPPING 60MM,278,1 ,$319.73 ,$211.02 ,$162.17 ,$319.73 , N/A , N/A , N/A , N/A ,$191.84 ,$271.77 ,$223.81 , N/A , N/A ,$303.74 ,$242.99 ,$239.80 , N/A ,$271.77 , N/A , N/A , N/A ,$223.81 ,$194.72 , N/A , N/A , N/A , N/A , N/A ,$271.77 , N/A ,$294.15 ,$223.81 ,$162.17 ,$194.62 ,$194.72 ,$194.62 ,$220.93 ,$287.76 ,$218.44 , N/A ,$252.59 , N/A , N/A , N/A , N/A , N/A ,$230.21 ,$198.23 ,$230.21 ,$230.21 ,$255.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER 5.0 CORTICAL SELF TAPPING 40MM,278,1 ,$319.73 ,$211.02 ,$162.17 ,$319.73 , N/A , N/A , N/A , N/A ,$191.84 ,$271.77 ,$223.81 , N/A , N/A ,$303.74 ,$242.99 ,$239.80 , N/A ,$271.77 , N/A , N/A , N/A ,$223.81 ,$194.72 , N/A , N/A , N/A , N/A , N/A ,$271.77 , N/A ,$294.15 ,$223.81 ,$162.17 ,$194.62 ,$194.72 ,$194.62 ,$220.93 ,$287.76 ,$218.44 , N/A ,$252.59 , N/A , N/A , N/A , N/A , N/A ,$230.21 ,$198.23 ,$230.21 ,$230.21 ,$255.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER 5.0 CORTICAL SELF TAPPING 46MM,278,1 ,$319.73 ,$211.02 ,$162.17 ,$319.73 , N/A , N/A , N/A , N/A ,$191.84 ,$271.77 ,$223.81 , N/A , N/A ,$303.74 ,$242.99 ,$239.80 , N/A ,$271.77 , N/A , N/A , N/A ,$223.81 ,$194.72 , N/A , N/A , N/A , N/A , N/A ,$271.77 , N/A ,$294.15 ,$223.81 ,$162.17 ,$194.62 ,$194.72 ,$194.62 ,$220.93 ,$287.76 ,$218.44 , N/A ,$252.59 , N/A , N/A , N/A , N/A , N/A ,$230.21 ,$198.23 ,$230.21 ,$230.21 ,$255.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER 5.0 CORTICAL SELF TAPPING 55MM,278,1 ,$319.73 ,$211.02 ,$162.17 ,$319.73 , N/A , N/A , N/A , N/A ,$191.84 ,$271.77 ,$223.81 , N/A , N/A ,$303.74 ,$242.99 ,$239.80 , N/A ,$271.77 , N/A , N/A , N/A ,$223.81 ,$194.72 , N/A , N/A , N/A , N/A , N/A ,$271.77 , N/A ,$294.15 ,$223.81 ,$162.17 ,$194.62 ,$194.72 ,$194.62 ,$220.93 ,$287.76 ,$218.44 , N/A ,$252.59 , N/A , N/A , N/A , N/A , N/A ,$230.21 ,$198.23 ,$230.21 ,$230.21 ,$255.78 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SCREW ZIMMER BONE 60MM,278,1 ,$276.75 ,$182.66 ,$140.37 ,$276.75 , N/A , N/A , N/A , N/A ,$166.05 ,$235.24 ,$193.73 , N/A , N/A ,$262.91 ,$210.33 ,$207.56 , N/A ,$235.24 , N/A , N/A , N/A ,$193.73 ,$168.54 , N/A , N/A , N/A , N/A , N/A ,$235.24 , N/A ,$254.61 ,$193.73 ,$140.37 ,$168.46 ,$168.54 ,$168.46 ,$191.23 ,$249.08 ,$189.08 , N/A ,$218.63 , N/A , N/A , N/A , N/A , N/A ,$199.26 ,$171.59 ,$199.26 ,$199.26 ,$221.40 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE ARTHREX SPIKE LIGAMENT,278,1 ,$177.75 ,$117.32 ,$90.15 ,$177.75 , N/A , N/A , N/A , N/A ,$106.65 ,$151.09 ,$124.43 , N/A , N/A ,$168.86 ,$135.09 ,$133.31 , N/A ,$151.09 , N/A , N/A , N/A ,$124.43 ,$108.25 , N/A , N/A , N/A , N/A , N/A ,$151.09 , N/A ,$163.53 ,$124.43 ,$90.15 ,$108.20 ,$108.25 ,$108.20 ,$122.83 ,$159.98 ,$121.44 , N/A ,$140.42 , N/A , N/A , N/A , N/A , N/A ,$127.98 ,$110.21 ,$127.98 ,$127.98 ,$142.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS 14MM,278,1 ,$293.04 ,$193.41 ,$148.63 ,$293.04 , N/A , N/A , N/A , N/A ,$175.82 ,$249.08 ,$205.13 , N/A , N/A ,$278.39 ,$222.71 ,$219.78 , N/A ,$249.08 , N/A , N/A , N/A ,$205.13 ,$178.46 , N/A , N/A , N/A , N/A , N/A ,$249.08 , N/A ,$269.60 ,$205.13 ,$148.63 ,$178.37 ,$178.46 ,$178.37 ,$202.49 ,$263.74 ,$200.20 , N/A ,$231.50 , N/A , N/A , N/A , N/A , N/A ,$210.99 ,$181.68 ,$210.99 ,$210.99 ,$234.43 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS 5MM,278,1 ,$437.05 ,$288.45 ,$221.67 ,$437.05 , N/A , N/A , N/A , N/A ,$262.23 ,$371.49 ,$305.94 , N/A , N/A ,$415.20 ,$332.16 ,$327.79 , N/A ,$371.49 , N/A , N/A , N/A ,$305.94 ,$266.16 , N/A , N/A , N/A , N/A , N/A ,$371.49 , N/A ,$402.09 ,$305.94 ,$221.67 ,$266.03 ,$266.16 ,$266.03 ,$302.00 ,$393.35 ,$298.59 , N/A ,$345.27 , N/A , N/A , N/A , N/A , N/A ,$314.68 ,$270.97 ,$314.68 ,$314.68 ,$349.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS 10MM,278,1 ,$437.05 ,$288.45 ,$221.67 ,$437.05 , N/A , N/A , N/A , N/A ,$262.23 ,$371.49 ,$305.94 , N/A , N/A ,$415.20 ,$332.16 ,$327.79 , N/A ,$371.49 , N/A , N/A , N/A ,$305.94 ,$266.16 , N/A , N/A , N/A , N/A , N/A ,$371.49 , N/A ,$402.09 ,$305.94 ,$221.67 ,$266.03 ,$266.16 ,$266.03 ,$302.00 ,$393.35 ,$298.59 , N/A ,$345.27 , N/A , N/A , N/A , N/A , N/A ,$314.68 ,$270.97 ,$314.68 ,$314.68 ,$349.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS FIXATION SHORT LG,278,1 ,$178.09 ,$117.54 ,$90.33 ,$178.09 , N/A , N/A , N/A , N/A ,$106.85 ,$151.38 ,$124.66 , N/A , N/A ,$169.19 ,$135.35 ,$133.57 , N/A ,$151.38 , N/A , N/A , N/A ,$124.66 ,$108.46 , N/A , N/A , N/A , N/A , N/A ,$151.38 , N/A ,$163.84 ,$124.66 ,$90.33 ,$108.40 ,$108.46 ,$108.40 ,$123.06 ,$160.28 ,$121.67 , N/A ,$140.69 , N/A , N/A , N/A , N/A , N/A ,$128.22 ,$110.42 ,$128.22 ,$128.22 ,$142.47 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS FIXATION SHORT X-SM,278,1 ,$183.49 ,$121.10 ,$93.07 ,$183.49 , N/A , N/A , N/A , N/A ,$110.09 ,$155.97 ,$128.44 , N/A , N/A ,$174.32 ,$139.45 ,$137.62 , N/A ,$155.97 , N/A , N/A , N/A ,$128.44 ,$111.75 , N/A , N/A , N/A , N/A , N/A ,$155.97 , N/A ,$168.81 ,$128.44 ,$93.07 ,$111.69 ,$111.75 ,$111.69 ,$126.79 ,$165.14 ,$125.36 , N/A ,$144.96 , N/A , N/A , N/A , N/A , N/A ,$132.11 ,$113.76 ,$132.11 ,$132.11 ,$146.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS FIXATION SHORT MED,278,1 ,$183.49 ,$121.10 ,$93.07 ,$183.49 , N/A , N/A , N/A , N/A ,$110.09 ,$155.97 ,$128.44 , N/A , N/A ,$174.32 ,$139.45 ,$137.62 , N/A ,$155.97 , N/A , N/A , N/A ,$128.44 ,$111.75 , N/A , N/A , N/A , N/A , N/A ,$155.97 , N/A ,$168.81 ,$128.44 ,$93.07 ,$111.69 ,$111.75 ,$111.69 ,$126.79 ,$165.14 ,$125.36 , N/A ,$144.96 , N/A , N/A , N/A , N/A , N/A ,$132.11 ,$113.76 ,$132.11 ,$132.11 ,$146.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS FIXATION SHORT SM,278,1 ,$183.49 ,$121.10 ,$93.07 ,$183.49 , N/A , N/A , N/A , N/A ,$110.09 ,$155.97 ,$128.44 , N/A , N/A ,$174.32 ,$139.45 ,$137.62 , N/A ,$155.97 , N/A , N/A , N/A ,$128.44 ,$111.75 , N/A , N/A , N/A , N/A , N/A ,$155.97 , N/A ,$168.81 ,$128.44 ,$93.07 ,$111.69 ,$111.75 ,$111.69 ,$126.79 ,$165.14 ,$125.36 , N/A ,$144.96 , N/A , N/A , N/A , N/A , N/A ,$132.11 ,$113.76 ,$132.11 ,$132.11 ,$146.79 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS FIXATION SPIKED MED,278,1 ,$290.86 ,$191.97 ,$147.52 ,$290.86 , N/A , N/A , N/A , N/A ,$174.52 ,$247.23 ,$203.60 , N/A , N/A ,$276.32 ,$221.05 ,$218.15 , N/A ,$247.23 , N/A , N/A , N/A ,$203.60 ,$177.13 , N/A , N/A , N/A , N/A , N/A ,$247.23 , N/A ,$267.59 ,$203.60 ,$147.52 ,$177.05 ,$177.13 ,$177.05 ,$200.98 ,$261.77 ,$198.72 , N/A ,$229.78 , N/A , N/A , N/A , N/A , N/A ,$209.42 ,$180.33 ,$209.42 ,$209.42 ,$232.69 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS FIXATION SPIKED LG,278,1 ,$290.86 ,$191.97 ,$147.52 ,$290.86 , N/A , N/A , N/A , N/A ,$174.52 ,$247.23 ,$203.60 , N/A , N/A ,$276.32 ,$221.05 ,$218.15 , N/A ,$247.23 , N/A , N/A , N/A ,$203.60 ,$177.13 , N/A , N/A , N/A , N/A , N/A ,$247.23 , N/A ,$267.59 ,$203.60 ,$147.52 ,$177.05 ,$177.13 ,$177.05 ,$200.98 ,$261.77 ,$198.72 , N/A ,$229.78 , N/A , N/A , N/A , N/A , N/A ,$209.42 ,$180.33 ,$209.42 ,$209.42 ,$232.69 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE RICHARDS FIXATION SPIKED SM,278,1 ,$583.73 ,$385.26 ,$296.07 ,$583.73 , N/A , N/A , N/A , N/A ,$350.24 ,$496.17 ,$408.61 , N/A , N/A ,$554.54 ,$443.63 ,$437.80 , N/A ,$496.17 , N/A , N/A , N/A ,$408.61 ,$355.49 , N/A , N/A , N/A , N/A , N/A ,$496.17 , N/A ,$537.03 ,$408.61 ,$296.07 ,$355.32 ,$355.49 ,$355.32 ,$403.36 ,$525.36 ,$398.80 , N/A ,$461.15 , N/A , N/A , N/A , N/A , N/A ,$420.29 ,$361.91 ,$420.29 ,$420.29 ,$466.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,STAPLE FIXATION X-SMALL W/SPIKES,278,1 ,$583.73 ,$385.26 ,$296.07 ,$583.73 , N/A , N/A , N/A , N/A ,$350.24 ,$496.17 ,$408.61 , N/A , N/A ,$554.54 ,$443.63 ,$437.80 , N/A ,$496.17 , N/A , N/A , N/A ,$408.61 ,$355.49 , N/A , N/A , N/A , N/A , N/A ,$496.17 , N/A ,$537.03 ,$408.61 ,$296.07 ,$355.32 ,$355.49 ,$355.32 ,$403.36 ,$525.36 ,$398.80 , N/A ,$461.15 , N/A , N/A , N/A , N/A , N/A ,$420.29 ,$361.91 ,$420.29 ,$420.29 ,$466.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SYSTEM ARTHREX BIOCOMPOSITE MPFL/ACL TIGHTROPE,278,1 ,"$3,205.30 ","$2,115.50 ","$1,602.65 ","$3,205.30 ", N/A ,"$1,689.51 ","$1,689.51 ", N/A ,"$1,923.18 ","$2,724.51 ","$2,243.71 ", N/A , N/A ,"$3,045.04 ","$2,436.03 ","$2,403.98 ","$1,602.65 ","$2,724.51 ", N/A ,"$1,602.65 ","$1,602.65 ","$2,243.71 ","$1,952.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,724.51 ", N/A ,"$2,948.88 ","$2,243.71 ","$1,625.73 ","$1,951.07 ","$1,952.03 ","$1,951.07 ","$2,214.86 ","$2,884.77 ","$2,189.86 ", N/A ,"$2,532.19 ", N/A , N/A , N/A , N/A , N/A ,"$2,307.82 ","$1,987.29 ","$2,307.82 ","$2,307.82 ","$2,564.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SYSTEM FIXATION 19.1MM 4.75MM SWIVELOCK BIOCOMPOSITE SECONDARY,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SYSTEM FIXATION TIGHTROPE XP STAINLESS STEEL SYNDESMOSIS REPAIR,278,1 ,"$2,840.50 ","$1,874.73 ","$1,420.25 ","$2,840.50 ", N/A ,"$1,497.23 ","$1,497.23 ", N/A ,"$1,704.30 ","$2,414.43 ","$1,988.35 ", N/A , N/A ,"$2,698.48 ","$2,158.78 ","$2,130.38 ","$1,420.25 ","$2,414.43 ", N/A ,"$1,420.25 ","$1,420.25 ","$1,988.35 ","$1,729.86 ", N/A , N/A , N/A , N/A , N/A ,"$2,414.43 ", N/A ,"$2,613.26 ","$1,988.35 ","$1,440.70 ","$1,729.01 ","$1,729.86 ","$1,729.01 ","$1,962.79 ","$2,556.45 ","$1,940.63 ", N/A ,"$2,244.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,045.16 ","$1,761.11 ","$2,045.16 ","$2,045.16 ","$2,272.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SYSTEM IMPLANT ACHILLES SPEEDBRIDGE ARTHREX,278,1 ,"$3,306.00 ","$2,181.96 ","$1,653.00 ","$3,306.00 ", N/A ,"$1,742.59 ","$1,742.59 ", N/A ,"$1,983.60 ","$2,810.10 ","$2,314.20 ", N/A , N/A ,"$3,140.70 ","$2,512.56 ","$2,479.50 ","$1,653.00 ","$2,810.10 ", N/A ,"$1,653.00 ","$1,653.00 ","$2,314.20 ","$2,013.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,810.10 ", N/A ,"$3,041.52 ","$2,314.20 ","$1,676.80 ","$2,012.36 ","$2,013.35 ","$2,012.36 ","$2,284.45 ","$2,975.40 ","$2,258.66 ", N/A ,"$2,611.74 ", N/A , N/A , N/A , N/A , N/A ,"$2,380.32 ","$2,049.72 ","$2,380.32 ","$2,380.32 ","$2,644.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,ANCHOR SUTURE SPEEDBRIDGE ARTHREX 4.75 X 19.1MM,278,1 ,"$3,306.00 ","$2,181.96 ","$1,653.00 ","$3,306.00 ", N/A ,"$1,742.59 ","$1,742.59 ", N/A ,"$1,983.60 ","$2,810.10 ","$2,314.20 ", N/A , N/A ,"$3,140.70 ","$2,512.56 ","$2,479.50 ","$1,653.00 ","$2,810.10 ", N/A ,"$1,653.00 ","$1,653.00 ","$2,314.20 ","$2,013.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,810.10 ", N/A ,"$3,041.52 ","$2,314.20 ","$1,676.80 ","$2,012.36 ","$2,013.35 ","$2,012.36 ","$2,284.45 ","$2,975.40 ","$2,258.66 ", N/A ,"$2,611.74 ", N/A , N/A , N/A , N/A , N/A ,"$2,380.32 ","$2,049.72 ","$2,380.32 ","$2,380.32 ","$2,644.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,SYSTEM IMPLANT ARTHREX INTERNALBRACE PEEK FOREFOOT,278,1 ,"$2,650.50 ","$1,749.33 ","$1,325.25 ","$2,650.50 ", N/A ,"$1,397.08 ","$1,397.08 ", N/A ,"$1,590.30 ","$2,252.93 ","$1,855.35 ", N/A , N/A ,"$2,517.98 ","$2,014.38 ","$1,987.88 ","$1,325.25 ","$2,252.93 ", N/A ,"$1,325.25 ","$1,325.25 ","$1,855.35 ","$1,614.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,252.93 ", N/A ,"$2,438.46 ","$1,855.35 ","$1,344.33 ","$1,613.36 ","$1,614.15 ","$1,613.36 ","$1,831.50 ","$2,385.45 ","$1,810.82 ", N/A ,"$2,093.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.36 ","$1,643.31 ","$1,908.36 ","$1,908.36 ","$2,120.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,TAP SYNTHES 3.5 CANNULATED SCREW,278,1 ,$886.45 ,$585.06 ,$449.61 ,$886.45 , N/A , N/A , N/A , N/A ,$531.87 ,$753.48 ,$620.52 , N/A , N/A ,$842.13 ,$673.70 ,$664.84 , N/A ,$753.48 , N/A , N/A , N/A ,$620.52 ,$539.85 , N/A , N/A , N/A , N/A , N/A ,$753.48 , N/A ,$815.53 ,$620.52 ,$449.61 ,$539.58 ,$539.85 ,$539.58 ,$612.54 ,$797.81 ,$605.62 , N/A ,$700.30 , N/A , N/A , N/A , N/A , N/A ,$638.24 ,$549.60 ,$638.24 ,$638.24 ,$709.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,DRILL BIT COUNTERSINK CANNULATED 6.5/7.3 MM SCREW,278,1 ,$886.45 ,$585.06 ,$449.61 ,$886.45 , N/A , N/A , N/A , N/A ,$531.87 ,$753.48 ,$620.52 , N/A , N/A ,$842.13 ,$673.70 ,$664.84 , N/A ,$753.48 , N/A , N/A , N/A ,$620.52 ,$539.85 , N/A , N/A , N/A , N/A , N/A ,$753.48 , N/A ,$815.53 ,$620.52 ,$449.61 ,$539.58 ,$539.85 ,$539.58 ,$612.54 ,$797.81 ,$605.62 , N/A ,$700.30 , N/A , N/A , N/A , N/A , N/A ,$638.24 ,$549.60 ,$638.24 ,$638.24 ,$709.16 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,TEMPLATE SYNTHES BENDING 12 HOLE FOR 3.5 LC - DCP  AND  DCP PLATES,278,1 ,$94.50 ,$62.37 ,$47.93 ,$94.50 , N/A , N/A , N/A , N/A ,$56.70 ,$80.33 ,$66.15 , N/A , N/A ,$89.78 ,$71.82 ,$70.88 , N/A ,$80.33 , N/A , N/A , N/A ,$66.15 ,$57.55 , N/A , N/A , N/A , N/A , N/A ,$80.33 , N/A ,$86.94 ,$66.15 ,$47.93 ,$57.52 ,$57.55 ,$57.52 ,$65.30 ,$85.05 ,$64.56 , N/A ,$74.66 , N/A , N/A , N/A , N/A , N/A ,$68.04 ,$58.59 ,$68.04 ,$68.04 ,$75.60 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,TEMPLATE SYNTHES CURVED RECONSTRUCTION 22 HOLE,278,1 ,$200.03 ,$132.02 ,$101.46 ,$200.03 , N/A , N/A , N/A , N/A ,$120.02 ,$170.03 ,$140.02 , N/A , N/A ,$190.03 ,$152.02 ,$150.02 , N/A ,$170.03 , N/A , N/A , N/A ,$140.02 ,$121.82 , N/A , N/A , N/A , N/A , N/A ,$170.03 , N/A ,$184.03 ,$140.02 ,$101.46 ,$121.76 ,$121.82 ,$121.76 ,$138.22 ,$180.03 ,$136.66 , N/A ,$158.02 , N/A , N/A , N/A , N/A , N/A ,$144.02 ,$124.02 ,$144.02 ,$144.02 ,$160.02 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,TIGHTROPE ABS ACL ARTHREX,278,1 ,$414.00 ,$273.24 ,$209.98 ,$414.00 , N/A , N/A , N/A , N/A ,$248.40 ,$351.90 ,$289.80 , N/A , N/A ,$393.30 ,$314.64 ,$310.50 , N/A ,$351.90 , N/A , N/A , N/A ,$289.80 ,$252.13 , N/A , N/A , N/A , N/A , N/A ,$351.90 , N/A ,$380.88 ,$289.80 ,$209.98 ,$252.00 ,$252.13 ,$252.00 ,$286.07 ,$372.60 ,$282.84 , N/A ,$327.06 , N/A , N/A , N/A , N/A , N/A ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$331.20 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,TIGHTROPE BUTTON ACL ARTHREX,278,1 ,$657.90 ,$434.21 ,$333.69 ,$657.90 , N/A , N/A , N/A , N/A ,$394.74 ,$559.22 ,$460.53 , N/A , N/A ,$625.01 ,$500.00 ,$493.43 , N/A ,$559.22 , N/A , N/A , N/A ,$460.53 ,$400.66 , N/A , N/A , N/A , N/A , N/A ,$559.22 , N/A ,$605.27 ,$460.53 ,$333.69 ,$400.46 ,$400.66 ,$400.46 ,$454.61 ,$592.11 ,$449.48 , N/A ,$519.74 , N/A , N/A , N/A , N/A , N/A ,$473.69 ,$407.90 ,$473.69 ,$473.69 ,$526.32 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WASHER 9MM ORTHOPEDIC ACROMIOCLAVICULAR DEVICE STERILE LATEX FREE,278,1 ,"$1,435.00 ",$947.10 ,$727.83 ,"$1,435.00 ", N/A ,$756.39 ,$756.39 , N/A ,$861.00 ,"$1,219.75 ","$1,004.50 ", N/A , N/A ,"$1,363.25 ","$1,090.60 ","$1,076.25 ", N/A ,"$1,219.75 ", N/A , N/A , N/A ,"$1,004.50 ",$873.92 , N/A , N/A , N/A , N/A , N/A ,"$1,219.75 ", N/A ,"$1,320.20 ","$1,004.50 ",$727.83 ,$873.48 ,$873.92 ,$873.48 ,$991.59 ,"$1,291.50 ",$980.39 , N/A ,"$1,133.65 ", N/A , N/A , N/A , N/A , N/A ,"$1,033.20 ",$889.70 ,"$1,033.20 ","$1,033.20 ","$1,148.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WASHER SYNTHES 10.0MM,278,1 ,$55.91 ,$36.90 ,$28.36 ,$55.91 , N/A , N/A , N/A , N/A ,$33.55 ,$47.52 ,$39.14 , N/A , N/A ,$53.11 ,$42.49 ,$41.93 , N/A ,$47.52 , N/A , N/A , N/A ,$39.14 ,$34.05 , N/A , N/A , N/A , N/A , N/A ,$47.52 , N/A ,$51.44 ,$39.14 ,$28.36 ,$34.03 ,$34.05 ,$34.03 ,$38.63 ,$50.32 ,$38.20 , N/A ,$44.17 , N/A , N/A , N/A , N/A , N/A ,$40.26 ,$34.66 ,$40.26 ,$40.26 ,$44.73 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WASHER SYNTHES 13.0MM,278,1 ,$56.23 ,$37.11 ,$28.52 ,$56.23 , N/A , N/A , N/A , N/A ,$33.74 ,$47.80 ,$39.36 , N/A , N/A ,$53.42 ,$42.73 ,$42.17 , N/A ,$47.80 , N/A , N/A , N/A ,$39.36 ,$34.24 , N/A , N/A , N/A , N/A , N/A ,$47.80 , N/A ,$51.73 ,$39.36 ,$28.52 ,$34.23 ,$34.24 ,$34.23 ,$38.85 ,$50.61 ,$38.42 , N/A ,$44.42 , N/A , N/A , N/A , N/A , N/A ,$40.49 ,$34.86 ,$40.49 ,$40.49 ,$44.98 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WASHER SYNTHES 3.0 THREADED CANN,278,1 ,$289.80 ,$191.27 ,$146.99 ,$289.80 , N/A , N/A , N/A , N/A ,$173.88 ,$246.33 ,$202.86 , N/A , N/A ,$275.31 ,$220.25 ,$217.35 , N/A ,$246.33 , N/A , N/A , N/A ,$202.86 ,$176.49 , N/A , N/A , N/A , N/A , N/A ,$246.33 , N/A ,$266.62 ,$202.86 ,$146.99 ,$176.40 ,$176.49 ,$176.40 ,$200.25 ,$260.82 ,$197.99 , N/A ,$228.94 , N/A , N/A , N/A , N/A , N/A ,$208.66 ,$179.68 ,$208.66 ,$208.66 ,$231.84 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WASHER SYNTHES 6.5MM,278,1 ,$62.60 ,$41.32 ,$31.75 ,$62.60 , N/A , N/A , N/A , N/A ,$37.56 ,$53.21 ,$43.82 , N/A , N/A ,$59.47 ,$47.58 ,$46.95 , N/A ,$53.21 , N/A , N/A , N/A ,$43.82 ,$38.12 , N/A , N/A , N/A , N/A , N/A ,$53.21 , N/A ,$57.59 ,$43.82 ,$31.75 ,$38.10 ,$38.12 ,$38.10 ,$43.26 ,$56.34 ,$42.77 , N/A ,$49.45 , N/A , N/A , N/A , N/A , N/A ,$45.07 ,$38.81 ,$45.07 ,$45.07 ,$50.08 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WASHER SYNTHES 7.0MM,278,1 ,$50.72 ,$33.48 ,$25.73 ,$50.72 , N/A , N/A , N/A , N/A ,$30.43 ,$43.11 ,$35.50 , N/A , N/A ,$48.18 ,$38.55 ,$38.04 , N/A ,$43.11 , N/A , N/A , N/A ,$35.50 ,$30.89 , N/A , N/A , N/A , N/A , N/A ,$43.11 , N/A ,$46.66 ,$35.50 ,$25.73 ,$30.87 ,$30.89 ,$30.87 ,$35.05 ,$45.65 ,$34.65 , N/A ,$40.07 , N/A , N/A , N/A , N/A , N/A ,$36.52 ,$31.45 ,$36.52 ,$36.52 ,$40.58 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE KIRSCHNER .028,278,1 ,$18.70 ,$12.34 ,$9.48 ,$18.70 , N/A , N/A , N/A , N/A ,$11.22 ,$15.90 ,$13.09 , N/A , N/A ,$17.77 ,$14.21 ,$14.03 , N/A ,$15.90 , N/A , N/A , N/A ,$13.09 ,$11.39 , N/A , N/A , N/A , N/A , N/A ,$15.90 , N/A ,$17.20 ,$13.09 ,$9.48 ,$11.38 ,$11.39 ,$11.38 ,$12.92 ,$16.83 ,$12.78 , N/A ,$14.77 , N/A , N/A , N/A , N/A , N/A ,$13.46 ,$11.59 ,$13.46 ,$13.46 ,$14.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE KIRSCHNER .045 X 9 DOUBLE ENDED TROCAR POINT,278,1 ,$5.45 ,$3.60 ,$2.76 ,$5.45 , N/A , N/A , N/A , N/A ,$3.27 ,$4.63 ,$3.82 , N/A , N/A ,$5.18 ,$4.14 ,$4.09 , N/A ,$4.63 , N/A , N/A , N/A ,$3.82 ,$3.32 , N/A , N/A , N/A , N/A , N/A ,$4.63 , N/A ,$5.01 ,$3.82 ,$2.76 ,$3.32 ,$3.32 ,$3.32 ,$3.77 ,$4.91 ,$3.72 , N/A ,$4.31 , N/A , N/A , N/A , N/A , N/A ,$3.92 ,$3.38 ,$3.92 ,$3.92 ,$4.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE KIRSCHNER .035 X 9 TROCAR POINT,278,1 ,$5.45 ,$3.60 ,$2.76 ,$5.45 , N/A , N/A , N/A , N/A ,$3.27 ,$4.63 ,$3.82 , N/A , N/A ,$5.18 ,$4.14 ,$4.09 , N/A ,$4.63 , N/A , N/A , N/A ,$3.82 ,$3.32 , N/A , N/A , N/A , N/A , N/A ,$4.63 , N/A ,$5.01 ,$3.82 ,$2.76 ,$3.32 ,$3.32 ,$3.32 ,$3.77 ,$4.91 ,$3.72 , N/A ,$4.31 , N/A , N/A , N/A , N/A , N/A ,$3.92 ,$3.38 ,$3.92 ,$3.92 ,$4.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE KIRSCHNER .062 X 9 TROCAR SMOOTH PLAIN,278,1 ,$32.67 ,$21.56 ,$16.57 ,$32.67 , N/A , N/A , N/A , N/A ,$19.60 ,$27.77 ,$22.87 , N/A , N/A ,$31.04 ,$24.83 ,$24.50 , N/A ,$27.77 , N/A , N/A , N/A ,$22.87 ,$19.90 , N/A , N/A , N/A , N/A , N/A ,$27.77 , N/A ,$30.06 ,$22.87 ,$16.57 ,$19.89 ,$19.90 ,$19.89 ,$22.58 ,$29.40 ,$22.32 , N/A ,$25.81 , N/A , N/A , N/A , N/A , N/A ,$23.52 ,$20.26 ,$23.52 ,$23.52 ,$26.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SPOOL 20 GA,278,1 ,$61.43 ,$40.54 ,$31.16 ,$61.43 , N/A , N/A , N/A , N/A ,$36.86 ,$52.22 ,$43.00 , N/A , N/A ,$58.36 ,$46.69 ,$46.07 , N/A ,$52.22 , N/A , N/A , N/A ,$43.00 ,$37.41 , N/A , N/A , N/A , N/A , N/A ,$52.22 , N/A ,$56.52 ,$43.00 ,$31.16 ,$37.39 ,$37.41 ,$37.39 ,$42.45 ,$55.29 ,$41.97 , N/A ,$48.53 , N/A , N/A , N/A , N/A , N/A ,$44.23 ,$38.09 ,$44.23 ,$44.23 ,$49.14 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SPOOL 25 GA,278,1 ,$241.56 ,$159.43 ,$122.52 ,$241.56 , N/A , N/A , N/A , N/A ,$144.94 ,$205.33 ,$169.09 , N/A , N/A ,$229.48 ,$183.59 ,$181.17 , N/A ,$205.33 , N/A , N/A , N/A ,$169.09 ,$147.11 , N/A , N/A , N/A , N/A , N/A ,$205.33 , N/A ,$222.24 ,$169.09 ,$122.52 ,$147.04 ,$147.11 ,$147.04 ,$166.92 ,$217.40 ,$165.03 , N/A ,$190.83 , N/A , N/A , N/A , N/A , N/A ,$173.92 ,$149.77 ,$173.92 ,$173.92 ,$193.25 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SPOOL 22 GA,278,1 ,$241.56 ,$159.43 ,$122.52 ,$241.56 , N/A , N/A , N/A , N/A ,$144.94 ,$205.33 ,$169.09 , N/A , N/A ,$229.48 ,$183.59 ,$181.17 , N/A ,$205.33 , N/A , N/A , N/A ,$169.09 ,$147.11 , N/A , N/A , N/A , N/A , N/A ,$205.33 , N/A ,$222.24 ,$169.09 ,$122.52 ,$147.04 ,$147.11 ,$147.04 ,$166.92 ,$217.40 ,$165.03 , N/A ,$190.83 , N/A , N/A , N/A , N/A , N/A ,$173.92 ,$149.77 ,$173.92 ,$173.92 ,$193.25 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SPOOL 26GA,278,1 ,$131.67 ,$86.90 ,$66.78 ,$131.67 , N/A , N/A , N/A , N/A ,$79.00 ,$111.92 ,$92.17 , N/A , N/A ,$125.09 ,$100.07 ,$98.75 , N/A ,$111.92 , N/A , N/A , N/A ,$92.17 ,$80.19 , N/A , N/A , N/A , N/A , N/A ,$111.92 , N/A ,$121.14 ,$92.17 ,$66.78 ,$80.15 ,$80.19 ,$80.15 ,$90.98 ,$118.50 ,$89.96 , N/A ,$104.02 , N/A , N/A , N/A , N/A , N/A ,$94.80 ,$81.64 ,$94.80 ,$94.80 ,$105.34 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SPOOL 18 GA,278,1 ,$131.67 ,$86.90 ,$66.78 ,$131.67 , N/A , N/A , N/A , N/A ,$79.00 ,$111.92 ,$92.17 , N/A , N/A ,$125.09 ,$100.07 ,$98.75 , N/A ,$111.92 , N/A , N/A , N/A ,$92.17 ,$80.19 , N/A , N/A , N/A , N/A , N/A ,$111.92 , N/A ,$121.14 ,$92.17 ,$66.78 ,$80.15 ,$80.19 ,$80.15 ,$90.98 ,$118.50 ,$89.96 , N/A ,$104.02 , N/A , N/A , N/A , N/A , N/A ,$94.80 ,$81.64 ,$94.80 ,$94.80 ,$105.34 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SPOOL 24GA,278,1 ,$131.67 ,$86.90 ,$66.78 ,$131.67 , N/A , N/A , N/A , N/A ,$79.00 ,$111.92 ,$92.17 , N/A , N/A ,$125.09 ,$100.07 ,$98.75 , N/A ,$111.92 , N/A , N/A , N/A ,$92.17 ,$80.19 , N/A , N/A , N/A , N/A , N/A ,$111.92 , N/A ,$121.14 ,$92.17 ,$66.78 ,$80.15 ,$80.19 ,$80.15 ,$90.98 ,$118.50 ,$89.96 , N/A ,$104.02 , N/A , N/A , N/A , N/A , N/A ,$94.80 ,$81.64 ,$94.80 ,$94.80 ,$105.34 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 0.6 KIRSCHNER,278,1 ,$16.07 ,$10.61 ,$8.15 ,$16.07 , N/A , N/A , N/A , N/A ,$9.64 ,$13.66 ,$11.25 , N/A , N/A ,$15.27 ,$12.21 ,$12.05 , N/A ,$13.66 , N/A , N/A , N/A ,$11.25 ,$9.79 , N/A , N/A , N/A , N/A , N/A ,$13.66 , N/A ,$14.78 ,$11.25 ,$8.15 ,$9.78 ,$9.79 ,$9.78 ,$11.10 ,$14.46 ,$10.98 , N/A ,$12.70 , N/A , N/A , N/A , N/A , N/A ,$11.57 ,$9.96 ,$11.57 ,$11.57 ,$12.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 0.60MM CERCLAGE 175MM,278,1 ,$17.01 ,$11.23 ,$8.63 ,$17.01 , N/A , N/A , N/A , N/A ,$10.21 ,$14.46 ,$11.91 , N/A , N/A ,$16.16 ,$12.93 ,$12.76 , N/A ,$14.46 , N/A , N/A , N/A ,$11.91 ,$10.36 , N/A , N/A , N/A , N/A , N/A ,$14.46 , N/A ,$15.65 ,$11.91 ,$8.63 ,$10.35 ,$10.36 ,$10.35 ,$11.75 ,$15.31 ,$11.62 , N/A ,$13.44 , N/A , N/A , N/A , N/A , N/A ,$12.25 ,$10.55 ,$12.25 ,$12.25 ,$13.61 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 0.8 KIRSCHNER  W/TROCAR POINT 70MM,278,1 ,$15.88 ,$10.48 ,$8.05 ,$15.88 , N/A , N/A , N/A , N/A ,$9.53 ,$13.50 ,$11.12 , N/A , N/A ,$15.09 ,$12.07 ,$11.91 , N/A ,$13.50 , N/A , N/A , N/A ,$11.12 ,$9.67 , N/A , N/A , N/A , N/A , N/A ,$13.50 , N/A ,$14.61 ,$11.12 ,$8.05 ,$9.67 ,$9.67 ,$9.67 ,$10.97 ,$14.29 ,$10.85 , N/A ,$12.55 , N/A , N/A , N/A , N/A , N/A ,$11.43 ,$9.85 ,$11.43 ,$11.43 ,$12.70 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 0.80MM CERCLAGE 200MM,278,1 ,$19.37 ,$12.78 ,$9.82 ,$19.37 , N/A , N/A , N/A , N/A ,$11.62 ,$16.46 ,$13.56 , N/A , N/A ,$18.40 ,$14.72 ,$14.53 , N/A ,$16.46 , N/A , N/A , N/A ,$13.56 ,$11.80 , N/A , N/A , N/A , N/A , N/A ,$16.46 , N/A ,$17.82 ,$13.56 ,$9.82 ,$11.79 ,$11.80 ,$11.79 ,$13.38 ,$17.43 ,$13.23 , N/A ,$15.30 , N/A , N/A , N/A , N/A , N/A ,$13.95 ,$12.01 ,$13.95 ,$13.95 ,$15.50 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6 COMPRESSION 20MM X 150MM,278,1 ,$96.08 ,$63.41 ,$48.73 ,$96.08 , N/A , N/A , N/A , N/A ,$57.65 ,$81.67 ,$67.26 , N/A , N/A ,$91.28 ,$73.02 ,$72.06 , N/A ,$81.67 , N/A , N/A , N/A ,$67.26 ,$58.51 , N/A , N/A , N/A , N/A , N/A ,$81.67 , N/A ,$88.39 ,$67.26 ,$48.73 ,$58.48 ,$58.51 ,$58.48 ,$66.39 ,$86.47 ,$65.64 , N/A ,$75.90 , N/A , N/A , N/A , N/A , N/A ,$69.18 ,$59.57 ,$69.18 ,$69.18 ,$76.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6 COMPRESSION 15MM X 150MM,278,1 ,$96.08 ,$63.41 ,$48.73 ,$96.08 , N/A , N/A , N/A , N/A ,$57.65 ,$81.67 ,$67.26 , N/A , N/A ,$91.28 ,$73.02 ,$72.06 , N/A ,$81.67 , N/A , N/A , N/A ,$67.26 ,$58.51 , N/A , N/A , N/A , N/A , N/A ,$81.67 , N/A ,$88.39 ,$67.26 ,$48.73 ,$58.48 ,$58.51 ,$58.48 ,$66.39 ,$86.47 ,$65.64 , N/A ,$75.90 , N/A , N/A , N/A , N/A , N/A ,$69.18 ,$59.57 ,$69.18 ,$69.18 ,$76.86 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6 COMPRESSION 30MM X 150MM,278,1 ,$106.20 ,$70.09 ,$53.86 ,$106.20 , N/A , N/A , N/A , N/A ,$63.72 ,$90.27 ,$74.34 , N/A , N/A ,$100.89 ,$80.71 ,$79.65 , N/A ,$90.27 , N/A , N/A , N/A ,$74.34 ,$64.68 , N/A , N/A , N/A , N/A , N/A ,$90.27 , N/A ,$97.70 ,$74.34 ,$53.86 ,$64.64 ,$64.68 ,$64.64 ,$73.38 ,$95.58 ,$72.56 , N/A ,$83.90 , N/A , N/A , N/A , N/A , N/A ,$76.46 ,$65.84 ,$76.46 ,$76.46 ,$84.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6 COMPRESSION 10MM X 150MM,278,1 ,$106.20 ,$70.09 ,$53.86 ,$106.20 , N/A , N/A , N/A , N/A ,$63.72 ,$90.27 ,$74.34 , N/A , N/A ,$100.89 ,$80.71 ,$79.65 , N/A ,$90.27 , N/A , N/A , N/A ,$74.34 ,$64.68 , N/A , N/A , N/A , N/A , N/A ,$90.27 , N/A ,$97.70 ,$74.34 ,$53.86 ,$64.64 ,$64.68 ,$64.64 ,$73.38 ,$95.58 ,$72.56 , N/A ,$83.90 , N/A , N/A , N/A , N/A , N/A ,$76.46 ,$65.84 ,$76.46 ,$76.46 ,$84.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6 COMPRESSION 25MM X 150MM,278,1 ,$106.20 ,$70.09 ,$53.86 ,$106.20 , N/A , N/A , N/A , N/A ,$63.72 ,$90.27 ,$74.34 , N/A , N/A ,$100.89 ,$80.71 ,$79.65 , N/A ,$90.27 , N/A , N/A , N/A ,$74.34 ,$64.68 , N/A , N/A , N/A , N/A , N/A ,$90.27 , N/A ,$97.70 ,$74.34 ,$53.86 ,$64.64 ,$64.68 ,$64.64 ,$73.38 ,$95.58 ,$72.56 , N/A ,$83.90 , N/A , N/A , N/A , N/A , N/A ,$76.46 ,$65.84 ,$76.46 ,$76.46 ,$84.96 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6 COMPRESSION 40MM X 150MM,278,1 ,$99.23 ,$65.49 ,$50.33 ,$99.23 , N/A , N/A , N/A , N/A ,$59.54 ,$84.35 ,$69.46 , N/A , N/A ,$94.27 ,$75.41 ,$74.42 , N/A ,$84.35 , N/A , N/A , N/A ,$69.46 ,$60.43 , N/A , N/A , N/A , N/A , N/A ,$84.35 , N/A ,$91.29 ,$69.46 ,$50.33 ,$60.40 ,$60.43 ,$60.40 ,$68.57 ,$89.31 ,$67.79 , N/A ,$78.39 , N/A , N/A , N/A , N/A , N/A ,$71.45 ,$61.52 ,$71.45 ,$71.45 ,$79.38 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6 COMPRESSION 35MM X 150MM,278,1 ,$99.23 ,$65.49 ,$50.33 ,$99.23 , N/A , N/A , N/A , N/A ,$59.54 ,$84.35 ,$69.46 , N/A , N/A ,$94.27 ,$75.41 ,$74.42 , N/A ,$84.35 , N/A , N/A , N/A ,$69.46 ,$60.43 , N/A , N/A , N/A , N/A , N/A ,$84.35 , N/A ,$91.29 ,$69.46 ,$50.33 ,$60.40 ,$60.43 ,$60.40 ,$68.57 ,$89.31 ,$67.79 , N/A ,$78.39 , N/A , N/A , N/A , N/A , N/A ,$71.45 ,$61.52 ,$71.45 ,$71.45 ,$79.38 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6 KIRSCHNER W/5MM THREAD TROCAR 150MM,278,1 ,$34.07 ,$22.49 ,$17.28 ,$34.07 , N/A , N/A , N/A , N/A ,$20.44 ,$28.96 ,$23.85 , N/A , N/A ,$32.37 ,$25.89 ,$25.55 , N/A ,$28.96 , N/A , N/A , N/A ,$23.85 ,$20.75 , N/A , N/A , N/A , N/A , N/A ,$28.96 , N/A ,$31.34 ,$23.85 ,$17.28 ,$20.74 ,$20.75 ,$20.74 ,$23.54 ,$30.66 ,$23.28 , N/A ,$26.92 , N/A , N/A , N/A , N/A , N/A ,$24.53 ,$21.12 ,$24.53 ,$24.53 ,$27.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE FIXATION 1.6MM 150MM 15MM KIRSCHNER STAINLESS STEEL TROCAR POINT THREAD NONSTERILE,278,1 ,$34.07 ,$22.49 ,$17.28 ,$34.07 , N/A , N/A , N/A , N/A ,$20.44 ,$28.96 ,$23.85 , N/A , N/A ,$32.37 ,$25.89 ,$25.55 , N/A ,$28.96 , N/A , N/A , N/A ,$23.85 ,$20.75 , N/A , N/A , N/A , N/A , N/A ,$28.96 , N/A ,$31.34 ,$23.85 ,$17.28 ,$20.74 ,$20.75 ,$20.74 ,$23.54 ,$30.66 ,$23.28 , N/A ,$26.92 , N/A , N/A , N/A , N/A , N/A ,$24.53 ,$21.12 ,$24.53 ,$24.53 ,$27.26 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6 KIRSCHNER W/TROCAR 150MM,278,1 ,$21.61 ,$14.26 ,$10.96 ,$21.61 , N/A , N/A , N/A , N/A ,$12.97 ,$18.37 ,$15.13 , N/A , N/A ,$20.53 ,$16.42 ,$16.21 , N/A ,$18.37 , N/A , N/A , N/A ,$15.13 ,$13.16 , N/A , N/A , N/A , N/A , N/A ,$18.37 , N/A ,$19.88 ,$15.13 ,$10.96 ,$13.15 ,$13.16 ,$13.15 ,$14.93 ,$19.45 ,$14.76 , N/A ,$17.07 , N/A , N/A , N/A , N/A , N/A ,$15.56 ,$13.40 ,$15.56 ,$15.56 ,$17.29 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE FIXATION 2MM 150MM KIRSCHNER STAINLESS STEEL 2 END TROCAR POINT NONSTERILE,278,1 ,$21.61 ,$14.26 ,$10.96 ,$21.61 , N/A , N/A , N/A , N/A ,$12.97 ,$18.37 ,$15.13 , N/A , N/A ,$20.53 ,$16.42 ,$16.21 , N/A ,$18.37 , N/A , N/A , N/A ,$15.13 ,$13.16 , N/A , N/A , N/A , N/A , N/A ,$18.37 , N/A ,$19.88 ,$15.13 ,$10.96 ,$13.15 ,$13.16 ,$13.15 ,$14.93 ,$19.45 ,$14.76 , N/A ,$17.07 , N/A , N/A , N/A , N/A , N/A ,$15.56 ,$13.40 ,$15.56 ,$15.56 ,$17.29 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE KIRSCHNER 1.25MM 150MM 2 END TROCAR POINT,278,1 ,$21.61 ,$14.26 ,$10.96 ,$21.61 , N/A , N/A , N/A , N/A ,$12.97 ,$18.37 ,$15.13 , N/A , N/A ,$20.53 ,$16.42 ,$16.21 , N/A ,$18.37 , N/A , N/A , N/A ,$15.13 ,$13.16 , N/A , N/A , N/A , N/A , N/A ,$18.37 , N/A ,$19.88 ,$15.13 ,$10.96 ,$13.15 ,$13.16 ,$13.15 ,$14.93 ,$19.45 ,$14.76 , N/A ,$17.07 , N/A , N/A , N/A , N/A , N/A ,$15.56 ,$13.40 ,$15.56 ,$15.56 ,$17.29 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.6MM KIRSCHNER 150MM W/TROCAR POINT,278,1 ,$18.59 ,$12.27 ,$9.43 ,$18.59 , N/A , N/A , N/A , N/A ,$11.15 ,$15.80 ,$13.01 , N/A , N/A ,$17.66 ,$14.13 ,$13.94 , N/A ,$15.80 , N/A , N/A , N/A ,$13.01 ,$11.32 , N/A , N/A , N/A , N/A , N/A ,$15.80 , N/A ,$17.10 ,$13.01 ,$9.43 ,$11.32 ,$11.32 ,$11.32 ,$12.85 ,$16.73 ,$12.70 , N/A ,$14.69 , N/A , N/A , N/A , N/A , N/A ,$13.38 ,$11.53 ,$13.38 ,$13.38 ,$14.87 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 2.0 GUIDE 240MM,278,1 ,$71.26 ,$47.03 ,$36.14 ,$71.26 , N/A , N/A , N/A , N/A ,$42.76 ,$60.57 ,$49.88 , N/A , N/A ,$67.70 ,$54.16 ,$53.45 , N/A ,$60.57 , N/A , N/A , N/A ,$49.88 ,$43.40 , N/A , N/A , N/A , N/A , N/A ,$60.57 , N/A ,$65.56 ,$49.88 ,$36.14 ,$43.38 ,$43.40 ,$43.38 ,$49.24 ,$64.13 ,$48.68 , N/A ,$56.30 , N/A , N/A , N/A , N/A , N/A ,$51.31 ,$44.18 ,$51.31 ,$51.31 ,$57.01 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 2.0 KIRSCHNER,278,1 ,$18.30 ,$12.08 ,$9.28 ,$18.30 , N/A , N/A , N/A , N/A ,$10.98 ,$15.56 ,$12.81 , N/A , N/A ,$17.39 ,$13.91 ,$13.73 , N/A ,$15.56 , N/A , N/A , N/A ,$12.81 ,$11.14 , N/A , N/A , N/A , N/A , N/A ,$15.56 , N/A ,$16.84 ,$12.81 ,$9.28 ,$11.14 ,$11.14 ,$11.14 ,$12.65 ,$16.47 ,$12.50 , N/A ,$14.46 , N/A , N/A , N/A , N/A , N/A ,$13.18 ,$11.35 ,$13.18 ,$13.18 ,$14.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.0MM KIRSCHNER  W/TROCAR POINT 150MM,278,1 ,$18.30 ,$12.08 ,$9.28 ,$18.30 , N/A , N/A , N/A , N/A ,$10.98 ,$15.56 ,$12.81 , N/A , N/A ,$17.39 ,$13.91 ,$13.73 , N/A ,$15.56 , N/A , N/A , N/A ,$12.81 ,$11.14 , N/A , N/A , N/A , N/A , N/A ,$15.56 , N/A ,$16.84 ,$12.81 ,$9.28 ,$11.14 ,$11.14 ,$11.14 ,$12.65 ,$16.47 ,$12.50 , N/A ,$14.46 , N/A , N/A , N/A , N/A , N/A ,$13.18 ,$11.35 ,$13.18 ,$13.18 ,$14.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 1.25MM KIRSCHNER  W/TROCAR POINT 150MM,278,1 ,$18.30 ,$12.08 ,$9.28 ,$18.30 , N/A , N/A , N/A , N/A ,$10.98 ,$15.56 ,$12.81 , N/A , N/A ,$17.39 ,$13.91 ,$13.73 , N/A ,$15.56 , N/A , N/A , N/A ,$12.81 ,$11.14 , N/A , N/A , N/A , N/A , N/A ,$15.56 , N/A ,$16.84 ,$12.81 ,$9.28 ,$11.14 ,$11.14 ,$11.14 ,$12.65 ,$16.47 ,$12.50 , N/A ,$14.46 , N/A , N/A , N/A , N/A , N/A ,$13.18 ,$11.35 ,$13.18 ,$13.18 ,$14.64 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 2.0 SPADE POINT REDUCTION,278,1 ,$501.17 ,$330.77 ,$254.19 ,$501.17 , N/A , N/A , N/A , N/A ,$300.70 ,$425.99 ,$350.82 , N/A , N/A ,$476.11 ,$380.89 ,$375.88 , N/A ,$425.99 , N/A , N/A , N/A ,$350.82 ,$305.21 , N/A , N/A , N/A , N/A , N/A ,$425.99 , N/A ,$461.08 ,$350.82 ,$254.19 ,$305.06 ,$305.21 ,$305.06 ,$346.31 ,$451.05 ,$342.40 , N/A ,$395.92 , N/A , N/A , N/A , N/A , N/A ,$360.84 ,$310.73 ,$360.84 ,$360.84 ,$400.94 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 2.0 TITANIUM,278,1 ,$214.20 ,$141.37 ,$108.64 ,$214.20 , N/A , N/A , N/A , N/A ,$128.52 ,$182.07 ,$149.94 , N/A , N/A ,$203.49 ,$162.79 ,$160.65 , N/A ,$182.07 , N/A , N/A , N/A ,$149.94 ,$130.45 , N/A , N/A , N/A , N/A , N/A ,$182.07 , N/A ,$197.06 ,$149.94 ,$108.64 ,$130.38 ,$130.45 ,$130.38 ,$148.01 ,$192.78 ,$146.34 , N/A ,$169.22 , N/A , N/A , N/A , N/A , N/A ,$154.22 ,$132.80 ,$154.22 ,$154.22 ,$171.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  7 HOLE 55MM,278,1 ,$214.20 ,$141.37 ,$108.64 ,$214.20 , N/A , N/A , N/A , N/A ,$128.52 ,$182.07 ,$149.94 , N/A , N/A ,$203.49 ,$162.79 ,$160.65 , N/A ,$182.07 , N/A , N/A , N/A ,$149.94 ,$130.45 , N/A , N/A , N/A , N/A , N/A ,$182.07 , N/A ,$197.06 ,$149.94 ,$108.64 ,$130.38 ,$130.45 ,$130.38 ,$148.01 ,$192.78 ,$146.34 , N/A ,$169.22 , N/A , N/A , N/A , N/A , N/A ,$154.22 ,$132.80 ,$154.22 ,$154.22 ,$171.36 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES 2.5MM KIRSHCNER THREADED,278,1 ,$38.43 ,$25.36 ,$19.49 ,$38.43 , N/A , N/A , N/A , N/A ,$23.06 ,$32.67 ,$26.90 , N/A , N/A ,$36.51 ,$29.21 ,$28.82 , N/A ,$32.67 , N/A , N/A , N/A ,$26.90 ,$23.40 , N/A , N/A , N/A , N/A , N/A ,$32.67 , N/A ,$35.36 ,$26.90 ,$19.49 ,$23.39 ,$23.40 ,$23.39 ,$26.56 ,$34.59 ,$26.26 , N/A ,$30.36 , N/A , N/A , N/A , N/A , N/A ,$27.67 ,$23.83 ,$27.67 ,$27.67 ,$30.74 
ST NICHOLAS HOSPITAL - ACUTE,27871713,C1713,WIRE SYNTHES GUIDE 2.8 THREADED 450/300MM,278,1 ,$165.38 ,$109.15 ,$83.88 ,$165.38 , N/A , N/A , N/A , N/A ,$99.23 ,$140.57 ,$115.77 , N/A , N/A ,$157.11 ,$125.69 ,$124.04 , N/A ,$140.57 , N/A , N/A , N/A ,$115.77 ,$100.72 , N/A , N/A , N/A , N/A , N/A ,$140.57 , N/A ,$152.15 ,$115.77 ,$83.88 ,$100.67 ,$100.72 ,$100.67 ,$114.28 ,$148.84 ,$112.99 , N/A ,$130.65 , N/A , N/A , N/A , N/A , N/A ,$119.07 ,$102.54 ,$119.07 ,$119.07 ,$132.30 
ST NICHOLAS HOSPITAL - ACUTE,27871726,C1726,DEVICE BALLOON DILATATION XPRESS LOPROFILE 20MM 7MM,278,1 ,"$2,770.24 ","$1,828.36 ","$1,385.12 ","$2,770.24 ", N/A ,"$1,460.19 ","$1,460.19 ", N/A ,"$1,662.14 ","$2,354.70 ", N/A , N/A , N/A ,"$2,631.73 ","$2,105.38 ","$2,077.68 ","$1,385.12 ","$2,354.70 ", N/A ,"$1,385.12 ","$1,385.12 ","$1,939.17 ","$1,687.08 ", N/A , N/A , N/A , N/A , N/A ,"$2,354.70 ", N/A ,"$2,548.62 ","$1,939.17 ","$1,405.07 ","$1,686.25 ","$1,687.08 ","$1,686.25 ","$1,914.24 ","$2,493.22 ","$1,892.63 ", N/A ,"$2,188.49 ", N/A , N/A , N/A , N/A , N/A ,"$1,994.57 ","$1,717.55 ","$1,994.57 ","$1,994.57 ","$2,216.19 "
ST NICHOLAS HOSPITAL - ACUTE,27871729,C1729,CATHETER NEPHROSTOMY 27.6CM 10FR FADER TIP .038IN PERCUFLEX SOFT LOCK LOOP FLEXIBLE STIFF CANNULA GUIDEWIRE LATEX FREE,278,1 ,$191.93 ,$126.67 ,$97.35 ,$191.93 , N/A , N/A , N/A , N/A ,$115.16 ,$163.14 , N/A , N/A , N/A ,$182.33 ,$145.87 ,$143.95 , N/A ,$163.14 , N/A , N/A , N/A ,$134.35 ,$116.89 , N/A , N/A , N/A , N/A , N/A ,$163.14 , N/A ,$176.58 ,$134.35 ,$97.35 ,$116.83 ,$116.89 ,$116.83 ,$132.62 ,$172.74 ,$131.13 , N/A ,$151.62 , N/A , N/A , N/A , N/A , N/A ,$138.19 ,$119.00 ,$138.19 ,$138.19 ,$153.54 
ST NICHOLAS HOSPITAL - ACUTE,27871729,C1729,CATHETER PIGTAIL 14FR X 25CM,278,1 ,$137.70 ,$90.88 ,$69.84 ,$137.70 , N/A , N/A , N/A , N/A ,$82.62 ,$117.05 , N/A , N/A , N/A ,$130.82 ,$104.65 ,$103.28 , N/A ,$117.05 , N/A , N/A , N/A ,$96.39 ,$83.86 , N/A , N/A , N/A , N/A , N/A ,$117.05 , N/A ,$126.68 ,$96.39 ,$69.84 ,$83.82 ,$83.86 ,$83.82 ,$95.15 ,$123.93 ,$94.08 , N/A ,$108.78 , N/A , N/A , N/A , N/A , N/A ,$99.14 ,$85.37 ,$99.14 ,$99.14 ,$110.16 
ST NICHOLAS HOSPITAL - ACUTE,27871751,C1751,KIT INTRODUCER 15CM 8FR GROSHONG PERCUTANEOUS PTFE PEEL APART LATEX FREE,278,1 ,$434.30 ,$286.64 ,$220.28 ,$434.30 , N/A , N/A , N/A , N/A ,$260.58 ,$369.16 , N/A , N/A , N/A ,$412.59 ,$330.07 ,$325.73 , N/A ,$369.16 , N/A , N/A , N/A ,$304.01 ,$264.49 , N/A , N/A , N/A , N/A , N/A ,$369.16 , N/A ,$399.56 ,$304.01 ,$220.28 ,$264.36 ,$264.49 ,$264.36 ,$300.10 ,$390.87 ,$296.71 , N/A ,$343.10 , N/A , N/A , N/A , N/A , N/A ,$312.70 ,$269.27 ,$312.70 ,$312.70 ,$347.44 
ST NICHOLAS HOSPITAL - ACUTE,27871762,C1762,ALLOGRAFT VERTIGRAFT PLIF VG2 9X9,278,1 ,"$2,850.00 ","$1,881.00 ","$1,425.00 ","$2,850.00 ", N/A ,"$1,502.24 ","$1,502.24 ", N/A ,"$1,710.00 ","$2,422.50 ","$1,995.00 ", N/A , N/A ,"$2,707.50 ","$2,166.00 ","$2,137.50 ","$1,425.00 ","$2,422.50 ", N/A ,"$1,425.00 ","$1,425.00 ","$1,995.00 ","$1,735.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,422.50 ", N/A ,"$2,622.00 ","$1,995.00 ","$1,445.52 ","$1,734.80 ","$1,735.65 ","$1,734.80 ","$1,969.35 ","$2,565.00 ","$1,947.12 ", N/A ,"$2,251.50 ", N/A , N/A , N/A , N/A , N/A ,"$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$2,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871762,C1762,ALLOGRAFT VERTIGRAFT PLIF VG2 11X11,278,1 ,"$2,850.00 ","$1,881.00 ","$1,425.00 ","$2,850.00 ", N/A ,"$1,502.24 ","$1,502.24 ", N/A ,"$1,710.00 ","$2,422.50 ","$1,995.00 ", N/A , N/A ,"$2,707.50 ","$2,166.00 ","$2,137.50 ","$1,425.00 ","$2,422.50 ", N/A ,"$1,425.00 ","$1,425.00 ","$1,995.00 ","$1,735.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,422.50 ", N/A ,"$2,622.00 ","$1,995.00 ","$1,445.52 ","$1,734.80 ","$1,735.65 ","$1,734.80 ","$1,969.35 ","$2,565.00 ","$1,947.12 ", N/A ,"$2,251.50 ", N/A , N/A , N/A , N/A , N/A ,"$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$2,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871762,C1762,ALLOMAX BARD 8 X 16CM,278,1 ,"$4,795.20 ","$3,164.83 ","$2,397.60 ","$4,795.20 ", N/A ,"$2,527.55 ","$2,527.55 ", N/A ,"$2,877.12 ","$4,075.92 ","$3,356.64 ", N/A , N/A ,"$4,555.44 ","$3,644.35 ","$3,596.40 ","$2,397.60 ","$4,075.92 ", N/A ,"$2,397.60 ","$2,397.60 ","$3,356.64 ","$2,920.28 ", N/A , N/A , N/A , N/A , N/A ,"$4,075.92 ", N/A ,"$4,411.58 ","$3,356.64 ","$2,432.13 ","$2,918.84 ","$2,920.28 ","$2,918.84 ","$3,313.48 ","$4,315.68 ","$3,276.08 ", N/A ,"$3,788.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,452.54 ","$2,973.02 ","$3,452.54 ","$3,452.54 ","$3,836.16 "
ST NICHOLAS HOSPITAL - ACUTE,27871762,C1762,GRAFT BONE MATRIGRAFT TRICORTICAL ILIAC L22 MM X H45 MM ALLO,278,1 ,"$2,188.80 ","$1,444.61 ","$1,110.16 ","$2,188.80 ", N/A ,"$1,153.72 ","$1,153.72 ", N/A ,"$1,313.28 ","$1,860.48 ","$1,532.16 ", N/A , N/A ,"$2,079.36 ","$1,663.49 ","$1,641.60 ", N/A ,"$1,860.48 ", N/A , N/A , N/A ,"$1,532.16 ","$1,332.98 ", N/A , N/A , N/A , N/A , N/A ,"$1,860.48 ", N/A ,"$2,013.70 ","$1,532.16 ","$1,110.16 ","$1,332.32 ","$1,332.98 ","$1,332.32 ","$1,512.46 ","$1,969.92 ","$1,495.39 ", N/A ,"$1,729.15 ", N/A , N/A , N/A , N/A , N/A ,"$1,575.94 ","$1,357.06 ","$1,575.94 ","$1,575.94 ","$1,751.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871762,C1762,TISSUE ALLOMAX MATRIX 6CM X 16CM,278,1 ,"$4,492.80 ","$2,965.25 ","$2,246.40 ","$4,492.80 ", N/A ,"$2,368.15 ","$2,368.15 ", N/A ,"$2,695.68 ","$3,818.88 ","$3,144.96 ", N/A , N/A ,"$4,268.16 ","$3,414.53 ","$3,369.60 ","$2,246.40 ","$3,818.88 ", N/A ,"$2,246.40 ","$2,246.40 ","$3,144.96 ","$2,736.12 ", N/A , N/A , N/A , N/A , N/A ,"$3,818.88 ", N/A ,"$4,133.38 ","$3,144.96 ","$2,278.75 ","$2,734.77 ","$2,736.12 ","$2,734.77 ","$3,104.52 ","$4,043.52 ","$3,069.48 ", N/A ,"$3,549.31 ", N/A , N/A , N/A , N/A , N/A ,"$3,234.82 ","$2,785.54 ","$3,234.82 ","$3,234.82 ","$3,594.24 "
ST NICHOLAS HOSPITAL - ACUTE,27871763,C1763,FIBER LASER SLIMLINE 200UM HOLMIUM REUSABLE,278,1 ,"$1,922.67 ","$1,268.96 ",$975.18 ,"$1,922.67 ", N/A ,"$1,013.44 ","$1,013.44 ", N/A ,"$1,153.60 ","$1,634.27 ","$1,345.87 ", N/A , N/A ,"$1,826.54 ","$1,461.23 ","$1,442.00 ", N/A ,"$1,634.27 ", N/A , N/A , N/A ,"$1,345.87 ","$1,170.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,634.27 ", N/A ,"$1,768.86 ","$1,345.87 ",$975.18 ,"$1,170.33 ","$1,170.91 ","$1,170.33 ","$1,328.57 ","$1,730.40 ","$1,313.57 ", N/A ,"$1,518.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,384.32 ","$1,192.06 ","$1,384.32 ","$1,384.32 ","$1,538.14 "
ST NICHOLAS HOSPITAL - ACUTE,27871763,C1763,GRAFT DURAGEN MATRIX 1 X 1,278,1 ,$663.15 ,$437.68 ,$336.35 ,$663.15 , N/A , N/A , N/A , N/A ,$397.89 ,$563.68 ,$464.21 , N/A , N/A ,$629.99 ,$503.99 ,$497.36 , N/A ,$563.68 , N/A , N/A , N/A ,$464.21 ,$403.86 , N/A , N/A , N/A , N/A , N/A ,$563.68 , N/A ,$610.10 ,$464.21 ,$336.35 ,$403.66 ,$403.86 ,$403.66 ,$458.24 ,$596.84 ,$453.06 , N/A ,$523.89 , N/A , N/A , N/A , N/A , N/A ,$477.47 ,$411.15 ,$477.47 ,$477.47 ,$530.52 
ST NICHOLAS HOSPITAL - ACUTE,27871763,C1763,GRAFT SOFT TISSUE 12X8CM XENFORM PELVIC FLOOR FETAL BOVINE DERMAL MATRIX PATCH RECONSTRUCTION STERILE,278,1 ,"$3,176.80 ","$2,096.69 ","$1,588.40 ","$3,176.80 ", N/A ,"$1,674.49 ","$1,674.49 ", N/A ,"$1,906.08 ","$2,700.28 ","$2,223.76 ", N/A , N/A ,"$3,017.96 ","$2,414.37 ","$2,382.60 ","$1,588.40 ","$2,700.28 ", N/A ,"$1,588.40 ","$1,588.40 ","$2,223.76 ","$1,934.67 ", N/A , N/A , N/A , N/A , N/A ,"$2,700.28 ", N/A ,"$2,922.66 ","$2,223.76 ","$1,611.27 ","$1,933.72 ","$1,934.67 ","$1,933.72 ","$2,195.17 ","$2,859.12 ","$2,170.39 ", N/A ,"$2,509.67 ", N/A , N/A , N/A , N/A , N/A ,"$2,287.30 ","$1,969.62 ","$2,287.30 ","$2,287.30 ","$2,541.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871763,C1763,MATRIX TISSUE XENOFORM,278,1 ,"$2,671.02 ","$1,762.87 ","$1,335.51 ","$2,671.02 ", N/A ,"$1,407.89 ","$1,407.89 ", N/A ,"$1,602.61 ","$2,270.37 ","$1,869.71 ", N/A , N/A ,"$2,537.47 ","$2,029.98 ","$2,003.27 ","$1,335.51 ","$2,270.37 ", N/A ,"$1,335.51 ","$1,335.51 ","$1,869.71 ","$1,626.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,270.37 ", N/A ,"$2,457.34 ","$1,869.71 ","$1,354.74 ","$1,625.85 ","$1,626.65 ","$1,625.85 ","$1,845.67 ","$2,403.92 ","$1,824.84 ", N/A ,"$2,110.11 ", N/A , N/A , N/A , N/A , N/A ,"$1,923.13 ","$1,656.03 ","$1,923.13 ","$1,923.13 ","$2,136.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871763,C1763,MESH TRANSVAGINAL UPHOLD LITE CAPIO SLIM,278,1 ,"$4,077.00 ","$2,690.82 ","$2,038.50 ","$4,077.00 ", N/A ,"$2,148.99 ","$2,148.99 ", N/A ,"$2,446.20 ","$3,465.45 ","$2,853.90 ", N/A , N/A ,"$3,873.15 ","$3,098.52 ","$3,057.75 ","$2,038.50 ","$3,465.45 ", N/A ,"$2,038.50 ","$2,038.50 ","$2,853.90 ","$2,482.89 ", N/A , N/A , N/A , N/A , N/A ,"$3,465.45 ", N/A ,"$3,750.84 ","$2,853.90 ","$2,067.85 ","$2,481.67 ","$2,482.89 ","$2,481.67 ","$2,817.21 ","$3,669.30 ","$2,785.41 ", N/A ,"$3,220.83 ", N/A , N/A , N/A , N/A , N/A ,"$2,935.44 ","$2,527.74 ","$2,935.44 ","$2,935.44 ","$3,261.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871763,C1763,TISSUE DURAGEN MATRIX 1 X 3,278,1 ,"$1,026.37 ",$677.40 ,$520.57 ,"$1,026.37 ", N/A ,$541.00 ,$541.00 , N/A ,$615.82 ,$872.41 ,$718.46 , N/A , N/A ,$975.05 ,$780.04 ,$769.78 , N/A ,$872.41 , N/A , N/A , N/A ,$718.46 ,$625.06 , N/A , N/A , N/A , N/A , N/A ,$872.41 , N/A ,$944.26 ,$718.46 ,$520.57 ,$624.75 ,$625.06 ,$624.75 ,$709.22 ,$923.73 ,$701.22 , N/A ,$810.83 , N/A , N/A , N/A , N/A , N/A ,$738.99 ,$636.35 ,$738.99 ,$738.99 ,$821.10 
ST NICHOLAS HOSPITAL - ACUTE,27871767,C1767,NEUROSTIMULATOR IMPLANTABLE PRIMEADVANCED SURESCAN MRI,278,1 ,"$22,500.00 ","$14,850.00 ","$11,025.00 ","$22,500.00 ", N/A ,"$11,859.75 ","$11,859.75 ", N/A ,"$13,500.00 ","$19,125.00 ","$15,750.00 ", N/A , N/A ,"$21,375.00 ","$17,100.00 ","$16,875.00 ","$11,250.00 ","$19,125.00 ", N/A ,"$11,250.00 ","$11,250.00 ","$15,750.00 ","$13,702.50 ", N/A , N/A , N/A , N/A , N/A ,"$19,125.00 ", N/A ,"$20,700.00 ","$15,750.00 ","$11,412.00 ","$13,695.75 ","$13,702.50 ","$13,695.75 ","$15,547.50 ","$20,250.00 ","$15,372.00 ", N/A ,"$17,775.00 ", N/A ,"$11,025.00 ","$11,025.00 ", N/A ,"$11,025.00 ","$16,200.00 ","$13,950.00 ","$16,200.00 ","$16,200.00 ","$18,000.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871767,C1767,NEUROSTIMULATOR MEDTRONIC,278,1 ,"$21,024.00 ","$13,875.84 ","$10,301.76 ","$21,024.00 ", N/A ,"$11,081.75 ","$11,081.75 ", N/A ,"$12,614.40 ","$17,870.40 ","$14,716.80 ", N/A , N/A ,"$19,972.80 ","$15,978.24 ","$15,768.00 ","$10,512.00 ","$17,870.40 ", N/A ,"$10,512.00 ","$10,512.00 ","$14,716.80 ","$12,803.62 ", N/A , N/A , N/A , N/A , N/A ,"$17,870.40 ", N/A ,"$19,342.08 ","$14,716.80 ","$10,663.37 ","$12,797.31 ","$12,803.62 ","$12,797.31 ","$14,527.58 ","$18,921.60 ","$14,363.60 ", N/A ,"$16,608.96 ", N/A ,"$10,301.76 ","$10,301.76 ", N/A ,"$10,301.76 ","$15,137.28 ","$13,034.88 ","$15,137.28 ","$15,137.28 ","$16,819.20 "
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT CARDIOVASCULAR 60CM 8MM ABDOMEN AORTA PERIPHERAL KNIT NONSEAL TEXTILE IMPREGNATE MICROVEL 2 VELOUR POLYESTER STRAIGHT,278,1 ,"$1,178.75 ",$777.98 ,$597.86 ,"$1,178.75 ", N/A ,$621.32 ,$621.32 , N/A ,$707.25 ,"$1,001.94 ",$825.13 , N/A , N/A ,"$1,119.81 ",$895.85 ,$884.06 , N/A ,"$1,001.94 ", N/A , N/A , N/A ,$825.13 ,$717.86 , N/A , N/A , N/A , N/A , N/A ,"$1,001.94 ", N/A ,"$1,084.45 ",$825.13 ,$597.86 ,$717.51 ,$717.86 ,$717.51 ,$814.52 ,"$1,060.88 ",$805.32 , N/A ,$931.21 , N/A , N/A , N/A , N/A , N/A ,$848.70 ,$730.83 ,$848.70 ,$848.70 ,$943.00 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT GORE-TEX STANDARD WALL TAPERED 4-7 X 40,278,1 ,"$1,044.90 ",$689.63 ,$529.97 ,"$1,044.90 ", N/A ,$550.77 ,$550.77 , N/A ,$626.94 ,$888.17 ,$731.43 , N/A , N/A ,$992.66 ,$794.12 ,$783.68 , N/A ,$888.17 , N/A , N/A , N/A ,$731.43 ,$636.34 , N/A , N/A , N/A , N/A , N/A ,$888.17 , N/A ,$961.31 ,$731.43 ,$529.97 ,$636.03 ,$636.34 ,$636.03 ,$722.03 ,$940.41 ,$713.88 , N/A ,$825.47 , N/A , N/A , N/A , N/A , N/A ,$752.33 ,$647.84 ,$752.33 ,$752.33 ,$835.92 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT HEMASHIELD  GOLD 16 X 18 BIFURCATED MEADOX,278,1 ,"$1,135.93 ",$749.71 ,$576.14 ,"$1,135.93 ", N/A ,$598.75 ,$598.75 , N/A ,$681.56 ,$965.54 ,$795.15 , N/A , N/A ,"$1,079.13 ",$863.31 ,$851.95 , N/A ,$965.54 , N/A , N/A , N/A ,$795.15 ,$691.78 , N/A , N/A , N/A , N/A , N/A ,$965.54 , N/A ,"$1,045.06 ",$795.15 ,$576.14 ,$691.44 ,$691.78 ,$691.44 ,$784.93 ,"$1,022.34 ",$776.07 , N/A ,$897.38 , N/A , N/A , N/A , N/A , N/A ,$817.87 ,$704.28 ,$817.87 ,$817.87 ,$908.74 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT HEMASHIELD GOLD 18 X 9  BIFURCATED MEADOX,278,1 ,"$1,101.85 ",$727.22 ,$558.86 ,"$1,101.85 ", N/A ,$580.79 ,$580.79 , N/A ,$661.11 ,$936.57 ,$771.30 , N/A , N/A ,"$1,046.76 ",$837.41 ,$826.39 , N/A ,$936.57 , N/A , N/A , N/A ,$771.30 ,$671.03 , N/A , N/A , N/A , N/A , N/A ,$936.57 , N/A ,"$1,013.70 ",$771.30 ,$558.86 ,$670.70 ,$671.03 ,$670.70 ,$761.38 ,$991.67 ,$752.78 , N/A ,$870.46 , N/A , N/A , N/A , N/A , N/A ,$793.33 ,$683.15 ,$793.33 ,$793.33 ,$881.48 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT HEMASHIELD GOLD 18MM X 15CM,278,1 ,$609.03 ,$401.96 ,$308.90 ,$609.03 , N/A , N/A , N/A , N/A ,$365.42 ,$517.68 ,$426.32 , N/A , N/A ,$578.58 ,$462.86 ,$456.77 , N/A ,$517.68 , N/A , N/A , N/A ,$426.32 ,$370.90 , N/A , N/A , N/A , N/A , N/A ,$517.68 , N/A ,$560.31 ,$426.32 ,$308.90 ,$370.72 ,$370.90 ,$370.72 ,$420.84 ,$548.13 ,$416.09 , N/A ,$481.13 , N/A , N/A , N/A , N/A , N/A ,$438.50 ,$377.60 ,$438.50 ,$438.50 ,$487.22 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT HEMASHIELD WOVEN 14MM BIFURCATED,278,1 ,"$1,122.48 ",$740.84 ,$569.32 ,"$1,122.48 ", N/A ,$591.66 ,$591.66 , N/A ,$673.49 ,$954.11 ,$785.74 , N/A , N/A ,"$1,066.36 ",$853.08 ,$841.86 , N/A ,$954.11 , N/A , N/A , N/A ,$785.74 ,$683.59 , N/A , N/A , N/A , N/A , N/A ,$954.11 , N/A ,"$1,032.68 ",$785.74 ,$569.32 ,$683.25 ,$683.59 ,$683.25 ,$775.63 ,"$1,010.23 ",$766.88 , N/A ,$886.76 , N/A , N/A , N/A , N/A , N/A ,$808.19 ,$695.94 ,$808.19 ,$808.19 ,$897.98 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT MICROVEL 18 X 9MM,278,1 ,"$1,026.39 ",$677.42 ,$520.59 ,"$1,026.39 ", N/A ,$541.01 ,$541.01 , N/A ,$615.83 ,$872.43 ,$718.47 , N/A , N/A ,$975.07 ,$780.06 ,$769.79 , N/A ,$872.43 , N/A , N/A , N/A ,$718.47 ,$625.07 , N/A , N/A , N/A , N/A , N/A ,$872.43 , N/A ,$944.28 ,$718.47 ,$520.59 ,$624.76 ,$625.07 ,$624.76 ,$709.24 ,$923.75 ,$701.23 , N/A ,$810.85 , N/A , N/A , N/A , N/A , N/A ,$739.00 ,$636.36 ,$739.00 ,$739.00 ,$821.11 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT MICROVEL 22 X 11MM,278,1 ,"$1,058.15 ",$698.38 ,$536.69 ,"$1,058.15 ", N/A ,$557.75 ,$557.75 , N/A ,$634.89 ,$899.43 ,$740.71 , N/A , N/A ,"$1,005.24 ",$804.19 ,$793.61 , N/A ,$899.43 , N/A , N/A , N/A ,$740.71 ,$644.41 , N/A , N/A , N/A , N/A , N/A ,$899.43 , N/A ,$973.50 ,$740.71 ,$536.69 ,$644.10 ,$644.41 ,$644.10 ,$731.18 ,$952.34 ,$722.93 , N/A ,$835.94 , N/A , N/A , N/A , N/A , N/A ,$761.87 ,$656.05 ,$761.87 ,$761.87 ,$846.52 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT MICROVEL 14 X 7MM,278,1 ,"$1,058.15 ",$698.38 ,$536.69 ,"$1,058.15 ", N/A ,$557.75 ,$557.75 , N/A ,$634.89 ,$899.43 ,$740.71 , N/A , N/A ,"$1,005.24 ",$804.19 ,$793.61 , N/A ,$899.43 , N/A , N/A , N/A ,$740.71 ,$644.41 , N/A , N/A , N/A , N/A , N/A ,$899.43 , N/A ,$973.50 ,$740.71 ,$536.69 ,$644.10 ,$644.41 ,$644.10 ,$731.18 ,$952.34 ,$722.93 , N/A ,$835.94 , N/A , N/A , N/A , N/A , N/A ,$761.87 ,$656.05 ,$761.87 ,$761.87 ,$846.52 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT MICROVEL 16 X 8MM,278,1 ,"$1,058.15 ",$698.38 ,$536.69 ,"$1,058.15 ", N/A ,$557.75 ,$557.75 , N/A ,$634.89 ,$899.43 ,$740.71 , N/A , N/A ,"$1,005.24 ",$804.19 ,$793.61 , N/A ,$899.43 , N/A , N/A , N/A ,$740.71 ,$644.41 , N/A , N/A , N/A , N/A , N/A ,$899.43 , N/A ,$973.50 ,$740.71 ,$536.69 ,$644.10 ,$644.41 ,$644.10 ,$731.18 ,$952.34 ,$722.93 , N/A ,$835.94 , N/A , N/A , N/A , N/A , N/A ,$761.87 ,$656.05 ,$761.87 ,$761.87 ,$846.52 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT MICROVEL 20 X10MM,278,1 ,"$1,058.15 ",$698.38 ,$536.69 ,"$1,058.15 ", N/A ,$557.75 ,$557.75 , N/A ,$634.89 ,$899.43 ,$740.71 , N/A , N/A ,"$1,005.24 ",$804.19 ,$793.61 , N/A ,$899.43 , N/A , N/A , N/A ,$740.71 ,$644.41 , N/A , N/A , N/A , N/A , N/A ,$899.43 , N/A ,$973.50 ,$740.71 ,$536.69 ,$644.10 ,$644.41 ,$644.10 ,$731.18 ,$952.34 ,$722.93 , N/A ,$835.94 , N/A , N/A , N/A , N/A , N/A ,$761.87 ,$656.05 ,$761.87 ,$761.87 ,$846.52 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT PTFE 4 7MM X 45CM STEP,278,1 ,$980.40 ,$647.06 ,$497.26 ,$980.40 , N/A , N/A , N/A , N/A ,$588.24 ,$833.34 ,$686.28 , N/A , N/A ,$931.38 ,$745.10 ,$735.30 , N/A ,$833.34 , N/A , N/A , N/A ,$686.28 ,$597.06 , N/A , N/A , N/A , N/A , N/A ,$833.34 , N/A ,$901.97 ,$686.28 ,$497.26 ,$596.77 ,$597.06 ,$596.77 ,$677.46 ,$882.36 ,$669.81 , N/A ,$774.52 , N/A , N/A , N/A , N/A , N/A ,$705.89 ,$607.85 ,$705.89 ,$705.89 ,$784.32 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT PTFE 6 X 80 THIN WALL  SM BEADED FLEX,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT PTFE 8 X 80 SM BEADED FLEX,278,1 ,"$1,713.80 ","$1,131.11 ",$869.24 ,"$1,713.80 ", N/A ,$903.34 ,$903.34 , N/A ,"$1,028.28 ","$1,456.73 ","$1,199.66 ", N/A , N/A ,"$1,628.11 ","$1,302.49 ","$1,285.35 ", N/A ,"$1,456.73 ", N/A , N/A , N/A ,"$1,199.66 ","$1,043.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,456.73 ", N/A ,"$1,576.70 ","$1,199.66 ",$869.24 ,"$1,043.19 ","$1,043.70 ","$1,043.19 ","$1,184.24 ","$1,542.42 ","$1,170.87 ", N/A ,"$1,353.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,233.94 ","$1,062.56 ","$1,233.94 ","$1,233.94 ","$1,371.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT VASCULAR 10CM 6MM IMPRA STRAIGHT THINWALL ARTERIOVENOUS CARBOFLO EPTFE,278,1 ,$283.50 ,$187.11 ,$143.79 ,$283.50 , N/A , N/A , N/A , N/A ,$170.10 ,$240.98 ,$198.45 , N/A , N/A ,$269.33 ,$215.46 ,$212.63 , N/A ,$240.98 , N/A , N/A , N/A ,$198.45 ,$172.65 , N/A , N/A , N/A , N/A , N/A ,$240.98 , N/A ,$260.82 ,$198.45 ,$143.79 ,$172.57 ,$172.65 ,$172.57 ,$195.90 ,$255.15 ,$193.69 , N/A ,$223.97 , N/A , N/A , N/A , N/A , N/A ,$204.12 ,$175.77 ,$204.12 ,$204.12 ,$226.80 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT VASCULAR 10CM 8MM IMPRA STRAIGHT ARTERIOVENOUS CARBOFLO EPTFE,278,1 ,$254.25 ,$167.81 ,$128.96 ,$254.25 , N/A , N/A , N/A , N/A ,$152.55 ,$216.11 ,$177.98 , N/A , N/A ,$241.54 ,$193.23 ,$190.69 , N/A ,$216.11 , N/A , N/A , N/A ,$177.98 ,$154.84 , N/A , N/A , N/A , N/A , N/A ,$216.11 , N/A ,$233.91 ,$177.98 ,$128.96 ,$154.76 ,$154.84 ,$154.76 ,$175.69 ,$228.83 ,$173.70 , N/A ,$200.86 , N/A , N/A , N/A , N/A , N/A ,$183.06 ,$157.64 ,$183.06 ,$183.06 ,$203.40 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT VASCULAR 40CM 16MM 8MM STANDARD WALL 2 BRANCH PERIPHERAL GORE-TEX STRETCH STERILE,278,1 ,"$1,834.75 ","$1,210.94 ",$930.59 ,"$1,834.75 ", N/A ,$967.10 ,$967.10 , N/A ,"$1,100.85 ","$1,559.54 ","$1,284.33 ", N/A , N/A ,"$1,743.01 ","$1,394.41 ","$1,376.06 ", N/A ,"$1,559.54 ", N/A , N/A , N/A ,"$1,284.33 ","$1,117.36 ", N/A , N/A , N/A , N/A , N/A ,"$1,559.54 ", N/A ,"$1,687.97 ","$1,284.33 ",$930.59 ,"$1,116.81 ","$1,117.36 ","$1,116.81 ","$1,267.81 ","$1,651.28 ","$1,253.50 ", N/A ,"$1,449.45 ", N/A , N/A , N/A , N/A , N/A ,"$1,321.02 ","$1,137.55 ","$1,321.02 ","$1,321.02 ","$1,467.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT VASCULAR 40CM 6MM IMPRA THIN WALL STRAIGHT PERIPHERAL CARBOFLO PTFE,278,1 ,$903.00 ,$595.98 ,$458.00 ,$903.00 , N/A , N/A , N/A , N/A ,$541.80 ,$767.55 ,$632.10 , N/A , N/A ,$857.85 ,$686.28 ,$677.25 , N/A ,$767.55 , N/A , N/A , N/A ,$632.10 ,$549.93 , N/A , N/A , N/A , N/A , N/A ,$767.55 , N/A ,$830.76 ,$632.10 ,$458.00 ,$549.66 ,$549.93 ,$549.66 ,$623.97 ,$812.70 ,$616.93 , N/A ,$713.37 , N/A , N/A , N/A , N/A , N/A ,$650.16 ,$559.86 ,$650.16 ,$650.16 ,$722.40 
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT VASCULAR 50CM 6MM IMPRA THIN WALL SMALL BEAD PERIPHERAL CARBOFLO PTFE FLEX,278,1 ,"$1,309.95 ",$864.57 ,$664.41 ,"$1,309.95 ", N/A ,$690.47 ,$690.47 , N/A ,$785.97 ,"$1,113.46 ",$916.97 , N/A , N/A ,"$1,244.45 ",$995.56 ,$982.46 , N/A ,"$1,113.46 ", N/A , N/A , N/A ,$916.97 ,$797.76 , N/A , N/A , N/A , N/A , N/A ,"$1,113.46 ", N/A ,"$1,205.15 ",$916.97 ,$664.41 ,$797.37 ,$797.76 ,$797.37 ,$905.18 ,"$1,178.96 ",$894.96 , N/A ,"$1,034.86 ", N/A , N/A , N/A , N/A , N/A ,$943.16 ,$812.17 ,$943.16 ,$943.16 ,"$1,047.96 "
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT VASCULAR 80CM 6MM IMPRA THIN WALL SMALL BEAD PERIPHERAL CARBOFLO PTFE FLEX,278,1 ,"$1,496.50 ",$987.69 ,$759.02 ,"$1,496.50 ", N/A ,$788.81 ,$788.81 , N/A ,$897.90 ,"$1,272.03 ","$1,047.55 ", N/A , N/A ,"$1,421.68 ","$1,137.34 ","$1,122.38 ", N/A ,"$1,272.03 ", N/A , N/A , N/A ,"$1,047.55 ",$911.37 , N/A , N/A , N/A , N/A , N/A ,"$1,272.03 ", N/A ,"$1,376.78 ","$1,047.55 ",$759.02 ,$910.92 ,$911.37 ,$910.92 ,"$1,034.08 ","$1,346.85 ","$1,022.41 ", N/A ,"$1,182.24 ", N/A , N/A , N/A , N/A , N/A ,"$1,077.48 ",$927.83 ,"$1,077.48 ","$1,077.48 ","$1,197.20 "
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT PTFE 6 X 80 THIN WALL STRAIGHT,278,1 ,"$1,496.50 ",$987.69 ,$759.02 ,"$1,496.50 ", N/A ,$788.81 ,$788.81 , N/A ,$897.90 ,"$1,272.03 ","$1,047.55 ", N/A , N/A ,"$1,421.68 ","$1,137.34 ","$1,122.38 ", N/A ,"$1,272.03 ", N/A , N/A , N/A ,"$1,047.55 ",$911.37 , N/A , N/A , N/A , N/A , N/A ,"$1,272.03 ", N/A ,"$1,376.78 ","$1,047.55 ",$759.02 ,$910.92 ,$911.37 ,$910.92 ,"$1,034.08 ","$1,346.85 ","$1,022.41 ", N/A ,"$1,182.24 ", N/A , N/A , N/A , N/A , N/A ,"$1,077.48 ",$927.83 ,"$1,077.48 ","$1,077.48 ","$1,197.20 "
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,GRAFT PTFE 8 X 80 THIN WALL STRAIGHT,278,1 ,"$1,496.50 ",$987.69 ,$759.02 ,"$1,496.50 ", N/A ,$788.81 ,$788.81 , N/A ,$897.90 ,"$1,272.03 ","$1,047.55 ", N/A , N/A ,"$1,421.68 ","$1,137.34 ","$1,122.38 ", N/A ,"$1,272.03 ", N/A , N/A , N/A ,"$1,047.55 ",$911.37 , N/A , N/A , N/A , N/A , N/A ,"$1,272.03 ", N/A ,"$1,376.78 ","$1,047.55 ",$759.02 ,$910.92 ,$911.37 ,$910.92 ,"$1,034.08 ","$1,346.85 ","$1,022.41 ", N/A ,"$1,182.24 ", N/A , N/A , N/A , N/A , N/A ,"$1,077.48 ",$927.83 ,"$1,077.48 ","$1,077.48 ","$1,197.20 "
ST NICHOLAS HOSPITAL - ACUTE,27871768,C1768,PATCH HEMASHIELD CARDIOVASCULAR FABRIC 1 X 3,278,1 ,$190.19 ,$125.53 ,$96.46 ,$190.19 , N/A , N/A , N/A , N/A ,$114.11 ,$161.66 ,$133.13 , N/A , N/A ,$180.68 ,$144.54 ,$142.64 , N/A ,$161.66 , N/A , N/A , N/A ,$133.13 ,$115.83 , N/A , N/A , N/A , N/A , N/A ,$161.66 , N/A ,$174.97 ,$133.13 ,$96.46 ,$115.77 ,$115.83 ,$115.77 ,$131.42 ,$171.17 ,$129.94 , N/A ,$150.25 , N/A , N/A , N/A , N/A , N/A ,$136.94 ,$117.92 ,$136.94 ,$136.94 ,$152.15 
ST NICHOLAS HOSPITAL - ACUTE,27871769,C1769,WIRE GUIDE SYNTHES 1.1 NON-THREADED 150MM,278,1 ,$58.50 ,$38.61 ,$29.67 ,$58.50 , N/A , N/A , N/A , N/A ,$35.10 ,$49.73 , N/A , N/A , N/A ,$55.58 ,$44.46 ,$43.88 , N/A ,$49.73 , N/A , N/A , N/A ,$40.95 ,$35.63 , N/A , N/A , N/A , N/A , N/A ,$49.73 , N/A ,$53.82 ,$40.95 ,$29.67 ,$35.61 ,$35.63 ,$35.61 ,$40.42 ,$52.65 ,$39.97 , N/A ,$46.22 , N/A , N/A , N/A , N/A , N/A ,$42.12 ,$36.27 ,$42.12 ,$42.12 ,$46.80 
ST NICHOLAS HOSPITAL - ACUTE,27871771,C1771,KIT ACCESSORY ADVANCE SUBURETHRAL SLING POLYPROPYLENE MALE,278,1 ,"$10,483.45 ","$6,919.08 ","$5,136.89 ","$10,483.45 ", N/A ,"$5,525.83 ","$5,525.83 ", N/A ,"$6,290.07 ","$8,910.93 ","$7,338.42 ", N/A , N/A ,"$9,959.28 ","$7,967.42 ","$7,862.59 ","$5,241.73 ","$8,910.93 ", N/A ,"$5,241.73 ","$5,241.73 ","$7,338.42 ","$6,384.42 ", N/A , N/A , N/A , N/A , N/A ,"$8,910.93 ", N/A ,"$9,644.77 ","$7,338.42 ","$5,317.21 ","$6,381.28 ","$6,384.42 ","$6,381.28 ","$7,244.06 ","$9,435.11 ","$7,162.29 ", N/A ,"$8,281.93 ", N/A ,"$5,136.89 ","$5,136.89 ", N/A ,"$5,136.89 ","$7,548.08 ","$6,499.74 ","$7,548.08 ","$7,548.08 ","$8,386.76 "
ST NICHOLAS HOSPITAL - ACUTE,27871771,C1771,SLING LYNX MIDURETHRAL,278,1 ,"$1,839.01 ","$1,213.75 ",$932.75 ,"$1,839.01 ", N/A ,$969.34 ,$969.34 , N/A ,"$1,103.41 ","$1,563.16 ","$1,287.31 ", N/A , N/A ,"$1,747.06 ","$1,397.65 ","$1,379.26 ", N/A ,"$1,563.16 ", N/A , N/A , N/A ,"$1,287.31 ","$1,119.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,563.16 ", N/A ,"$1,691.89 ","$1,287.31 ",$932.75 ,"$1,119.41 ","$1,119.96 ","$1,119.41 ","$1,270.76 ","$1,655.11 ","$1,256.41 ", N/A ,"$1,452.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,324.09 ","$1,140.19 ","$1,324.09 ","$1,324.09 ","$1,471.21 "
ST NICHOLAS HOSPITAL - ACUTE,27871771,C1771,SLING OBTRYX HALO,278,1 ,"$1,908.99 ","$1,259.93 ",$968.24 ,"$1,908.99 ", N/A ,"$1,006.23 ","$1,006.23 ", N/A ,"$1,145.39 ","$1,622.64 ","$1,336.29 ", N/A , N/A ,"$1,813.54 ","$1,450.83 ","$1,431.74 ", N/A ,"$1,622.64 ", N/A , N/A , N/A ,"$1,336.29 ","$1,162.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,622.64 ", N/A ,"$1,756.27 ","$1,336.29 ",$968.24 ,"$1,162.00 ","$1,162.57 ","$1,162.00 ","$1,319.11 ","$1,718.09 ","$1,304.22 ", N/A ,"$1,508.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,374.47 ","$1,183.57 ","$1,374.47 ","$1,374.47 ","$1,527.19 "
ST NICHOLAS HOSPITAL - ACUTE,27871771,C1771,SLING PUBOVAGINAL MONARC STERILE LATEX FREE,278,1 ,"$1,631.80 ","$1,076.99 ",$827.65 ,"$1,631.80 ", N/A ,$860.12 ,$860.12 , N/A ,$979.08 ,"$1,387.03 ","$1,142.26 ", N/A , N/A ,"$1,550.21 ","$1,240.17 ","$1,223.85 ", N/A ,"$1,387.03 ", N/A , N/A , N/A ,"$1,142.26 ",$993.77 , N/A , N/A , N/A , N/A , N/A ,"$1,387.03 ", N/A ,"$1,501.26 ","$1,142.26 ",$827.65 ,$993.28 ,$993.77 ,$993.28 ,"$1,127.57 ","$1,468.62 ","$1,114.85 ", N/A ,"$1,289.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,174.90 ","$1,011.72 ","$1,174.90 ","$1,174.90 ","$1,305.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871771,C1771,SLING TO HOOK AND HALO,278,1 ,"$1,932.13 ","$1,275.21 ",$979.98 ,"$1,932.13 ", N/A ,"$1,018.43 ","$1,018.43 ", N/A ,"$1,159.28 ","$1,642.31 ","$1,352.49 ", N/A , N/A ,"$1,835.52 ","$1,468.42 ","$1,449.10 ", N/A ,"$1,642.31 ", N/A , N/A , N/A ,"$1,352.49 ","$1,176.67 ", N/A , N/A , N/A , N/A , N/A ,"$1,642.31 ", N/A ,"$1,777.56 ","$1,352.49 ",$979.98 ,"$1,176.09 ","$1,176.67 ","$1,176.09 ","$1,335.10 ","$1,738.92 ","$1,320.03 ", N/A ,"$1,526.38 ", N/A , N/A , N/A , N/A , N/A ,"$1,391.13 ","$1,197.92 ","$1,391.13 ","$1,391.13 ","$1,545.70 "
ST NICHOLAS HOSPITAL - ACUTE,27871771,C1771,SYSTEM URETHRAL SUPPORT 9CM SOLYX ADVANTAGE MIDURETHRAL POLYPROPYLENE 1 INCISION SLING 1 DELIVERY DEVICE 1 MESH,278,1 ,"$2,172.71 ","$1,433.99 ","$1,102.00 ","$2,172.71 ", N/A ,"$1,145.24 ","$1,145.24 ", N/A ,"$1,303.63 ","$1,846.80 ","$1,520.90 ", N/A , N/A ,"$2,064.07 ","$1,651.26 ","$1,629.53 ", N/A ,"$1,846.80 ", N/A , N/A , N/A ,"$1,520.90 ","$1,323.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.80 ", N/A ,"$1,998.89 ","$1,520.90 ","$1,102.00 ","$1,322.53 ","$1,323.18 ","$1,322.53 ","$1,501.34 ","$1,955.44 ","$1,484.40 ", N/A ,"$1,716.44 ", N/A , N/A , N/A , N/A , N/A ,"$1,564.35 ","$1,347.08 ","$1,564.35 ","$1,564.35 ","$1,738.17 "
ST NICHOLAS HOSPITAL - ACUTE,27871772,C1772,PUMP ON Q I FLOW FEMORAL PAIN (CB005),278,1 ,$393.75 ,$259.88 ,$199.71 ,$393.75 , N/A , N/A , N/A , N/A ,$236.25 ,$334.69 ,$275.63 , N/A , N/A ,$374.06 ,$299.25 ,$295.31 , N/A ,$334.69 , N/A , N/A , N/A ,$275.63 ,$239.79 , N/A , N/A , N/A , N/A , N/A ,$334.69 , N/A ,$362.25 ,$275.63 ,$199.71 ,$239.68 ,$239.79 ,$239.68 ,$272.08 ,$354.38 ,$269.01 , N/A ,$311.06 , N/A , N/A , N/A , N/A , N/A ,$283.50 ,$244.13 ,$283.50 ,$283.50 ,$315.00 
ST NICHOLAS HOSPITAL - ACUTE,27871772,C1772,PUMP PROGRAMMABLE PAIN MEDTRONIC,278,1 ,"$19,555.20 ","$12,906.43 ","$9,582.05 ","$19,555.20 ", N/A ,"$10,307.55 ","$10,307.55 ", N/A ,"$11,733.12 ","$16,621.92 ","$13,688.64 ", N/A , N/A ,"$18,577.44 ","$14,861.95 ","$14,666.40 ","$9,777.60 ","$16,621.92 ", N/A ,"$9,777.60 ","$9,777.60 ","$13,688.64 ","$11,909.12 ", N/A , N/A , N/A , N/A , N/A ,"$16,621.92 ", N/A ,"$17,990.78 ","$13,688.64 ","$9,918.40 ","$11,903.25 ","$11,909.12 ","$11,903.25 ","$13,512.64 ","$17,599.68 ","$13,360.11 ", N/A ,"$15,448.61 ", N/A ,"$9,582.05 ","$9,582.05 ", N/A ,"$9,582.05 ","$14,079.74 ","$12,124.22 ","$14,079.74 ","$14,079.74 ","$15,644.16 "
ST NICHOLAS HOSPITAL - ACUTE,27871772,C1772,PUMP PAIN SYNCHROMED II PROGRAMMABLE MEDTRONIC,278,1 ,"$19,555.20 ","$12,906.43 ","$9,582.05 ","$19,555.20 ", N/A ,"$10,307.55 ","$10,307.55 ", N/A ,"$11,733.12 ","$16,621.92 ","$13,688.64 ", N/A , N/A ,"$18,577.44 ","$14,861.95 ","$14,666.40 ","$9,777.60 ","$16,621.92 ", N/A ,"$9,777.60 ","$9,777.60 ","$13,688.64 ","$11,909.12 ", N/A , N/A , N/A , N/A , N/A ,"$16,621.92 ", N/A ,"$17,990.78 ","$13,688.64 ","$9,918.40 ","$11,903.25 ","$11,909.12 ","$11,903.25 ","$13,512.64 ","$17,599.68 ","$13,360.11 ", N/A ,"$15,448.61 ", N/A ,"$9,582.05 ","$9,582.05 ", N/A ,"$9,582.05 ","$14,079.74 ","$12,124.22 ","$14,079.74 ","$14,079.74 ","$15,644.16 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ASSEMBLY HUMERUS ZIMMER,278,1 ,"$6,120.00 ","$4,039.20 ","$2,998.80 ","$6,120.00 ", N/A ,"$3,225.85 ","$3,225.85 ", N/A ,"$3,672.00 ","$5,202.00 ","$4,284.00 ", N/A , N/A ,"$5,814.00 ","$4,651.20 ","$4,590.00 ","$3,060.00 ","$5,202.00 ", N/A ,"$3,060.00 ","$3,060.00 ","$4,284.00 ","$3,727.08 ", N/A , N/A , N/A , N/A , N/A ,"$5,202.00 ", N/A ,"$5,630.40 ","$4,284.00 ","$3,104.06 ","$3,725.24 ","$3,727.08 ","$3,725.24 ","$4,228.92 ","$5,508.00 ","$4,181.18 ", N/A ,"$4,834.80 ", N/A ,"$2,998.80 ","$2,998.80 ", N/A ,"$2,998.80 ","$4,406.40 ","$3,794.40 ","$4,406.40 ","$4,406.40 ","$4,896.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 6 05MM HALF BLK,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER DISTAL SZ C 10MM,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER DISTAL SZ D 5MM,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER DISTAL SZ E 10MM,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER DISTAL SZ E 5MM,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER DISTAL SZ F 10MM,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER DISTAL SZ F 5MM,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER DISTAL SZ G 5MM,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER POSTERIOR SZ E 5MM,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER POSTERIOR SZ F 10MM,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 3 05MM HALF BLK,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 3 10MM HALF BLK,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 4 05MM HALF BLK,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 5 10MM HALF BLK,278,1 ,"$1,955.70 ","$1,290.76 ",$991.93 ,"$1,955.70 ", N/A ,"$1,030.85 ","$1,030.85 ", N/A ,"$1,173.42 ","$1,662.35 ","$1,368.99 ", N/A , N/A ,"$1,857.92 ","$1,486.33 ","$1,466.78 ", N/A ,"$1,662.35 ", N/A , N/A , N/A ,"$1,368.99 ","$1,191.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,662.35 ", N/A ,"$1,799.24 ","$1,368.99 ",$991.93 ,"$1,190.43 ","$1,191.02 ","$1,190.43 ","$1,351.39 ","$1,760.13 ","$1,336.13 ", N/A ,"$1,545.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,408.10 ","$1,212.53 ","$1,408.10 ","$1,408.10 ","$1,564.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 8-9 05MM HALF BLK,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER POSTERIOR SZ C 5MM,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER POSTERIOR SZ D 5MM,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT BLOCK ZIMMER POSTERIOR SZ F 5MM,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 4 10MM HALF BLK,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 5 05MM HALF BLK,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 6 10MM HALF BLK,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 7 05MM HALF BLK,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 7 10MM HALF BLK,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,AUGMENT ZIMMER TIBIAL SZ 8 10MM HALF BLK,278,1 ,"$2,029.50 ","$1,339.47 ","$1,029.36 ","$2,029.50 ", N/A ,"$1,069.75 ","$1,069.75 ", N/A ,"$1,217.70 ","$1,725.08 ","$1,420.65 ", N/A , N/A ,"$1,928.03 ","$1,542.42 ","$1,522.13 ", N/A ,"$1,725.08 ", N/A , N/A , N/A ,"$1,420.65 ","$1,235.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,725.08 ", N/A ,"$1,867.14 ","$1,420.65 ","$1,029.36 ","$1,235.36 ","$1,235.97 ","$1,235.36 ","$1,402.38 ","$1,826.55 ","$1,386.55 ", N/A ,"$1,603.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,461.24 ","$1,258.29 ","$1,461.24 ","$1,461.24 ","$1,623.60 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CEMENT ZIMMER PALACOS LV 40 GM,278,1 ,$128.25 ,$84.65 ,$65.05 ,$128.25 , N/A , N/A , N/A , N/A ,$76.95 ,$109.01 ,$89.78 , N/A , N/A ,$121.84 ,$97.47 ,$96.19 , N/A ,$109.01 , N/A , N/A , N/A ,$89.78 ,$78.10 , N/A , N/A , N/A , N/A , N/A ,$109.01 , N/A ,$117.99 ,$89.78 ,$65.05 ,$78.07 ,$78.10 ,$78.07 ,$88.62 ,$115.43 ,$87.62 , N/A ,$101.32 , N/A , N/A , N/A , N/A , N/A ,$92.34 ,$79.52 ,$92.34 ,$92.34 ,$102.60 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CENTRALIZER ZIMMER VERSYS DISTAL 09MM,278,1 ,$236.25 ,$155.93 ,$119.83 ,$236.25 , N/A , N/A , N/A , N/A ,$141.75 ,$200.81 ,$165.38 , N/A , N/A ,$224.44 ,$179.55 ,$177.19 , N/A ,$200.81 , N/A , N/A , N/A ,$165.38 ,$143.88 , N/A , N/A , N/A , N/A , N/A ,$200.81 , N/A ,$217.35 ,$165.38 ,$119.83 ,$143.81 ,$143.88 ,$143.81 ,$163.25 ,$212.63 ,$161.41 , N/A ,$186.64 , N/A , N/A , N/A , N/A , N/A ,$170.10 ,$146.48 ,$170.10 ,$170.10 ,$189.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CENTRALIZER ZIMMER VERSYS DISTAL 17MM,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CENTRALIZER ZIMMER VERSYS DISTAL 10MM,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CENTRALIZER ZIMMER VERSYS DISTAL 11MM,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CENTRALIZER ZIMMER VERSYS DISTAL 12MM,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CENTRALIZER ZIMMER VERSYS DISTAL 13MM,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CENTRALIZER ZIMMER VERSYS DISTAL 14MM,278,1 ,$168.75 ,$111.38 ,$85.59 ,$168.75 , N/A , N/A , N/A , N/A ,$101.25 ,$143.44 ,$118.13 , N/A , N/A ,$160.31 ,$128.25 ,$126.56 , N/A ,$143.44 , N/A , N/A , N/A ,$118.13 ,$102.77 , N/A , N/A , N/A , N/A , N/A ,$143.44 , N/A ,$155.25 ,$118.13 ,$85.59 ,$102.72 ,$102.77 ,$102.72 ,$116.61 ,$151.88 ,$115.29 , N/A ,$133.31 , N/A , N/A , N/A , N/A , N/A ,$121.50 ,$104.63 ,$121.50 ,$121.50 ,$135.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMP RVS CNTRL 6.5,278,1 ,$135.00 ,$89.10 ,$68.47 ,$135.00 , N/A , N/A , N/A , N/A ,$81.00 ,$114.75 ,$94.50 , N/A , N/A ,$128.25 ,$102.60 ,$101.25 , N/A ,$114.75 , N/A , N/A , N/A ,$94.50 ,$82.22 , N/A , N/A , N/A , N/A , N/A ,$114.75 , N/A ,$124.20 ,$94.50 ,$68.47 ,$82.17 ,$82.22 ,$82.17 ,$93.29 ,$121.50 ,$92.23 , N/A ,$106.65 , N/A , N/A , N/A , N/A , N/A ,$97.20 ,$83.70 ,$97.20 ,$97.20 ,$108.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 9 71X49MM LEFT POSTERIOR STABILIZE PRIMARY WAFFLE POST LFIT SCORPIO COCR STERILE 1 AXIS KNEE SYSTEM,278,1 ,"$3,040.00 ","$2,006.40 ","$1,520.00 ","$3,040.00 ", N/A ,"$1,602.38 ","$1,602.38 ", N/A ,"$1,824.00 ","$2,584.00 ","$2,128.00 ", N/A , N/A ,"$2,888.00 ","$2,310.40 ","$2,280.00 ","$1,520.00 ","$2,584.00 ", N/A ,"$1,520.00 ","$1,520.00 ","$2,128.00 ","$1,851.36 ", N/A , N/A , N/A , N/A , N/A ,"$2,584.00 ", N/A ,"$2,796.80 ","$2,128.00 ","$1,541.89 ","$1,850.45 ","$1,851.36 ","$1,850.45 ","$2,100.64 ","$2,736.00 ","$2,076.93 ", N/A ,"$2,401.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,188.80 ","$1,884.80 ","$2,188.80 ","$2,188.80 ","$2,432.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 11 76X53MM RIGHT POSTERIOR STABILIZE PRIMARY WAFFLE POST LFIT SCORPIO COCR STERILE 1 AXIS KNEE SYSTEM,278,1 ,"$3,040.00 ","$2,006.40 ","$1,520.00 ","$3,040.00 ", N/A ,"$1,602.38 ","$1,602.38 ", N/A ,"$1,824.00 ","$2,584.00 ","$2,128.00 ", N/A , N/A ,"$2,888.00 ","$2,310.40 ","$2,280.00 ","$1,520.00 ","$2,584.00 ", N/A ,"$1,520.00 ","$1,520.00 ","$2,128.00 ","$1,851.36 ", N/A , N/A , N/A , N/A , N/A ,"$2,584.00 ", N/A ,"$2,796.80 ","$2,128.00 ","$1,541.89 ","$1,850.45 ","$1,851.36 ","$1,850.45 ","$2,100.64 ","$2,736.00 ","$2,076.93 ", N/A ,"$2,401.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,188.80 ","$1,884.80 ","$2,188.80 ","$2,188.80 ","$2,432.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 7 66X44MM LEFT POSTERIOR STABILIZE PRIMARY WAFFLE POST LFIT SCORPIO COCR STERILE 1 AXIS KNEE SYSTEM,278,1 ,"$3,040.00 ","$2,006.40 ","$1,520.00 ","$3,040.00 ", N/A ,"$1,602.38 ","$1,602.38 ", N/A ,"$1,824.00 ","$2,584.00 ","$2,128.00 ", N/A , N/A ,"$2,888.00 ","$2,310.40 ","$2,280.00 ","$1,520.00 ","$2,584.00 ", N/A ,"$1,520.00 ","$1,520.00 ","$2,128.00 ","$1,851.36 ", N/A , N/A , N/A , N/A , N/A ,"$2,584.00 ", N/A ,"$2,796.80 ","$2,128.00 ","$1,541.89 ","$1,850.45 ","$1,851.36 ","$1,850.45 ","$2,100.64 ","$2,736.00 ","$2,076.93 ", N/A ,"$2,401.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,188.80 ","$1,884.80 ","$2,188.80 ","$2,188.80 ","$2,432.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 7 66X44MM RIGHT POSTERIOR STABILIZE PRIMARY WAFFLE POST LFIT SCORPIO COCR STERILE 1 AXIS KNEE SYSTEM,278,1 ,"$3,040.00 ","$2,006.40 ","$1,520.00 ","$3,040.00 ", N/A ,"$1,602.38 ","$1,602.38 ", N/A ,"$1,824.00 ","$2,584.00 ","$2,128.00 ", N/A , N/A ,"$2,888.00 ","$2,310.40 ","$2,280.00 ","$1,520.00 ","$2,584.00 ", N/A ,"$1,520.00 ","$1,520.00 ","$2,128.00 ","$1,851.36 ", N/A , N/A , N/A , N/A , N/A ,"$2,584.00 ", N/A ,"$2,796.80 ","$2,128.00 ","$1,541.89 ","$1,850.45 ","$1,851.36 ","$1,850.45 ","$2,100.64 ","$2,736.00 ","$2,076.93 ", N/A ,"$2,401.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,188.80 ","$1,884.80 ","$2,188.80 ","$2,188.80 ","$2,432.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 7 LEFT CRUCIATE RETAIN CEMENT PRIMARY WAFFLE SCORPIO COCR 1 AXIS KNEE SYSTEM,278,1 ,"$3,040.00 ","$2,006.40 ","$1,520.00 ","$3,040.00 ", N/A ,"$1,602.38 ","$1,602.38 ", N/A ,"$1,824.00 ","$2,584.00 ","$2,128.00 ", N/A , N/A ,"$2,888.00 ","$2,310.40 ","$2,280.00 ","$1,520.00 ","$2,584.00 ", N/A ,"$1,520.00 ","$1,520.00 ","$2,128.00 ","$1,851.36 ", N/A , N/A , N/A , N/A , N/A ,"$2,584.00 ", N/A ,"$2,796.80 ","$2,128.00 ","$1,541.89 ","$1,850.45 ","$1,851.36 ","$1,850.45 ","$2,100.64 ","$2,736.00 ","$2,076.93 ", N/A ,"$2,401.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,188.80 ","$1,884.80 ","$2,188.80 ","$2,188.80 ","$2,432.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE C RIGHT,278,1 ,"$2,945.00 ","$1,943.70 ","$1,472.50 ","$2,945.00 ", N/A ,"$1,552.31 ","$1,552.31 ", N/A ,"$1,767.00 ","$2,503.25 ","$2,061.50 ", N/A , N/A ,"$2,797.75 ","$2,238.20 ","$2,208.75 ","$1,472.50 ","$2,503.25 ", N/A ,"$1,472.50 ","$1,472.50 ","$2,061.50 ","$1,793.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,503.25 ", N/A ,"$2,709.40 ","$2,061.50 ","$1,493.70 ","$1,792.62 ","$1,793.51 ","$1,792.62 ","$2,035.00 ","$2,650.50 ","$2,012.02 ", N/A ,"$2,326.55 ", N/A , N/A , N/A , N/A , N/A ,"$2,120.40 ","$1,825.90 ","$2,120.40 ","$2,120.40 ","$2,356.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE A-LEFT,278,1 ,"$2,945.00 ","$1,943.70 ","$1,472.50 ","$2,945.00 ", N/A ,"$1,552.31 ","$1,552.31 ", N/A ,"$1,767.00 ","$2,503.25 ","$2,061.50 ", N/A , N/A ,"$2,797.75 ","$2,238.20 ","$2,208.75 ","$1,472.50 ","$2,503.25 ", N/A ,"$1,472.50 ","$1,472.50 ","$2,061.50 ","$1,793.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,503.25 ", N/A ,"$2,709.40 ","$2,061.50 ","$1,493.70 ","$1,792.62 ","$1,793.51 ","$1,792.62 ","$2,035.00 ","$2,650.50 ","$2,012.02 ", N/A ,"$2,326.55 ", N/A , N/A , N/A , N/A , N/A ,"$2,120.40 ","$1,825.90 ","$2,120.40 ","$2,120.40 ","$2,356.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE A-RIGHT,278,1 ,"$2,945.00 ","$1,943.70 ","$1,472.50 ","$2,945.00 ", N/A ,"$1,552.31 ","$1,552.31 ", N/A ,"$1,767.00 ","$2,503.25 ","$2,061.50 ", N/A , N/A ,"$2,797.75 ","$2,238.20 ","$2,208.75 ","$1,472.50 ","$2,503.25 ", N/A ,"$1,472.50 ","$1,472.50 ","$2,061.50 ","$1,793.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,503.25 ", N/A ,"$2,709.40 ","$2,061.50 ","$1,493.70 ","$1,792.62 ","$1,793.51 ","$1,792.62 ","$2,035.00 ","$2,650.50 ","$2,012.02 ", N/A ,"$2,326.55 ", N/A , N/A , N/A , N/A , N/A ,"$2,120.40 ","$1,825.90 ","$2,120.40 ","$2,120.40 ","$2,356.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE B LEFT,278,1 ,"$2,945.00 ","$1,943.70 ","$1,472.50 ","$2,945.00 ", N/A ,"$1,552.31 ","$1,552.31 ", N/A ,"$1,767.00 ","$2,503.25 ","$2,061.50 ", N/A , N/A ,"$2,797.75 ","$2,238.20 ","$2,208.75 ","$1,472.50 ","$2,503.25 ", N/A ,"$1,472.50 ","$1,472.50 ","$2,061.50 ","$1,793.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,503.25 ", N/A ,"$2,709.40 ","$2,061.50 ","$1,493.70 ","$1,792.62 ","$1,793.51 ","$1,792.62 ","$2,035.00 ","$2,650.50 ","$2,012.02 ", N/A ,"$2,326.55 ", N/A , N/A , N/A , N/A , N/A ,"$2,120.40 ","$1,825.90 ","$2,120.40 ","$2,120.40 ","$2,356.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE B-RIGHT,278,1 ,"$2,945.00 ","$1,943.70 ","$1,472.50 ","$2,945.00 ", N/A ,"$1,552.31 ","$1,552.31 ", N/A ,"$1,767.00 ","$2,503.25 ","$2,061.50 ", N/A , N/A ,"$2,797.75 ","$2,238.20 ","$2,208.75 ","$1,472.50 ","$2,503.25 ", N/A ,"$1,472.50 ","$1,472.50 ","$2,061.50 ","$1,793.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,503.25 ", N/A ,"$2,709.40 ","$2,061.50 ","$1,493.70 ","$1,792.62 ","$1,793.51 ","$1,792.62 ","$2,035.00 ","$2,650.50 ","$2,012.02 ", N/A ,"$2,326.55 ", N/A , N/A , N/A , N/A , N/A ,"$2,120.40 ","$1,825.90 ","$2,120.40 ","$2,120.40 ","$2,356.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE H RIGHT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE C LEFT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE D LEFT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE D RIGHT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE E LEFT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE E RIGHT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE F LEFT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE F RIGHT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE G LEFT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE G RIGHT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR PRECOAT SIZE H LEFT,278,1 ,"$2,802.50 ","$1,849.65 ","$1,401.25 ","$2,802.50 ", N/A ,"$1,477.20 ","$1,477.20 ", N/A ,"$1,681.50 ","$2,382.13 ","$1,961.75 ", N/A , N/A ,"$2,662.38 ","$2,129.90 ","$2,101.88 ","$1,401.25 ","$2,382.13 ", N/A ,"$1,401.25 ","$1,401.25 ","$1,961.75 ","$1,706.72 ", N/A , N/A , N/A , N/A , N/A ,"$2,382.13 ", N/A ,"$2,578.30 ","$1,961.75 ","$1,421.43 ","$1,705.88 ","$1,706.72 ","$1,705.88 ","$1,936.53 ","$2,522.25 ","$1,914.67 ", N/A ,"$2,213.98 ", N/A , N/A , N/A , N/A , N/A ,"$2,017.80 ","$1,737.55 ","$2,017.80 ","$2,017.80 ","$2,242.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER SIZE F RIGHT,278,1 ,"$10,991.70 ","$7,254.52 ","$5,385.93 ","$10,991.70 ", N/A ,"$5,793.73 ","$5,793.73 ", N/A ,"$6,595.02 ","$9,342.95 ","$7,694.19 ", N/A , N/A ,"$10,442.12 ","$8,353.69 ","$8,243.78 ","$5,495.85 ","$9,342.95 ", N/A ,"$5,495.85 ","$5,495.85 ","$7,694.19 ","$6,693.95 ", N/A , N/A , N/A , N/A , N/A ,"$9,342.95 ", N/A ,"$10,112.36 ","$7,694.19 ","$5,574.99 ","$6,690.65 ","$6,693.95 ","$6,690.65 ","$7,595.26 ","$9,892.53 ","$7,509.53 ", N/A ,"$8,683.44 ", N/A ,"$5,385.93 ","$5,385.93 ", N/A ,"$5,385.93 ","$7,914.02 ","$6,814.85 ","$7,914.02 ","$7,914.02 ","$8,793.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER SIZE D LEFT,278,1 ,"$10,991.70 ","$7,254.52 ","$5,385.93 ","$10,991.70 ", N/A ,"$5,793.73 ","$5,793.73 ", N/A ,"$6,595.02 ","$9,342.95 ","$7,694.19 ", N/A , N/A ,"$10,442.12 ","$8,353.69 ","$8,243.78 ","$5,495.85 ","$9,342.95 ", N/A ,"$5,495.85 ","$5,495.85 ","$7,694.19 ","$6,693.95 ", N/A , N/A , N/A , N/A , N/A ,"$9,342.95 ", N/A ,"$10,112.36 ","$7,694.19 ","$5,574.99 ","$6,690.65 ","$6,693.95 ","$6,690.65 ","$7,595.26 ","$9,892.53 ","$7,509.53 ", N/A ,"$8,683.44 ", N/A ,"$5,385.93 ","$5,385.93 ", N/A ,"$5,385.93 ","$7,914.02 ","$6,814.85 ","$7,914.02 ","$7,914.02 ","$8,793.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER SIZE D RIGHT,278,1 ,"$10,991.70 ","$7,254.52 ","$5,385.93 ","$10,991.70 ", N/A ,"$5,793.73 ","$5,793.73 ", N/A ,"$6,595.02 ","$9,342.95 ","$7,694.19 ", N/A , N/A ,"$10,442.12 ","$8,353.69 ","$8,243.78 ","$5,495.85 ","$9,342.95 ", N/A ,"$5,495.85 ","$5,495.85 ","$7,694.19 ","$6,693.95 ", N/A , N/A , N/A , N/A , N/A ,"$9,342.95 ", N/A ,"$10,112.36 ","$7,694.19 ","$5,574.99 ","$6,690.65 ","$6,693.95 ","$6,690.65 ","$7,595.26 ","$9,892.53 ","$7,509.53 ", N/A ,"$8,683.44 ", N/A ,"$5,385.93 ","$5,385.93 ", N/A ,"$5,385.93 ","$7,914.02 ","$6,814.85 ","$7,914.02 ","$7,914.02 ","$8,793.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER SIZE E LEFT,278,1 ,"$10,991.70 ","$7,254.52 ","$5,385.93 ","$10,991.70 ", N/A ,"$5,793.73 ","$5,793.73 ", N/A ,"$6,595.02 ","$9,342.95 ","$7,694.19 ", N/A , N/A ,"$10,442.12 ","$8,353.69 ","$8,243.78 ","$5,495.85 ","$9,342.95 ", N/A ,"$5,495.85 ","$5,495.85 ","$7,694.19 ","$6,693.95 ", N/A , N/A , N/A , N/A , N/A ,"$9,342.95 ", N/A ,"$10,112.36 ","$7,694.19 ","$5,574.99 ","$6,690.65 ","$6,693.95 ","$6,690.65 ","$7,595.26 ","$9,892.53 ","$7,509.53 ", N/A ,"$8,683.44 ", N/A ,"$5,385.93 ","$5,385.93 ", N/A ,"$5,385.93 ","$7,914.02 ","$6,814.85 ","$7,914.02 ","$7,914.02 ","$8,793.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER SIZE E RIGHT,278,1 ,"$10,991.70 ","$7,254.52 ","$5,385.93 ","$10,991.70 ", N/A ,"$5,793.73 ","$5,793.73 ", N/A ,"$6,595.02 ","$9,342.95 ","$7,694.19 ", N/A , N/A ,"$10,442.12 ","$8,353.69 ","$8,243.78 ","$5,495.85 ","$9,342.95 ", N/A ,"$5,495.85 ","$5,495.85 ","$7,694.19 ","$6,693.95 ", N/A , N/A , N/A , N/A , N/A ,"$9,342.95 ", N/A ,"$10,112.36 ","$7,694.19 ","$5,574.99 ","$6,690.65 ","$6,693.95 ","$6,690.65 ","$7,595.26 ","$9,892.53 ","$7,509.53 ", N/A ,"$8,683.44 ", N/A ,"$5,385.93 ","$5,385.93 ", N/A ,"$5,385.93 ","$7,914.02 ","$6,814.85 ","$7,914.02 ","$7,914.02 ","$8,793.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER SIZE F LEFT,278,1 ,"$10,991.70 ","$7,254.52 ","$5,385.93 ","$10,991.70 ", N/A ,"$5,793.73 ","$5,793.73 ", N/A ,"$6,595.02 ","$9,342.95 ","$7,694.19 ", N/A , N/A ,"$10,442.12 ","$8,353.69 ","$8,243.78 ","$5,495.85 ","$9,342.95 ", N/A ,"$5,495.85 ","$5,495.85 ","$7,694.19 ","$6,693.95 ", N/A , N/A , N/A , N/A , N/A ,"$9,342.95 ", N/A ,"$10,112.36 ","$7,694.19 ","$5,574.99 ","$6,690.65 ","$6,693.95 ","$6,690.65 ","$7,595.26 ","$9,892.53 ","$7,509.53 ", N/A ,"$8,683.44 ", N/A ,"$5,385.93 ","$5,385.93 ", N/A ,"$5,385.93 ","$7,914.02 ","$6,814.85 ","$7,914.02 ","$7,914.02 ","$8,793.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT GLENOID 52MM PEG BIGLIANI/FLATOW SHOULDER STERILE STAINLESS STEEL UHMWPE,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/5-6 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/5-6 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/5-6 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/7-10 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/7-10 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/7-10 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 1-2 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 3-4 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 3-4 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 3-4 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 3-4 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 3-4 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 5-6 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 5-6 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 5-6 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 5-6 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX CD 5-6 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 3-4 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 3-4 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 3-4 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 3-4 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 3-4 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 5-6 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 5-6 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 5-6 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 5-6 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 5-6 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 7-10 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 7-10 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 7-10 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 7-10 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR FLEX C-H/3-4 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR FLEX C-H/5-6 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR FLEX C-H/5-6 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR FLEX C-H/7-10 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX A-B/1-2 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX A-B/1-2 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX A-B/1-2 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX A-B/1-2 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX A-B/1-2 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/1-2 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/1-2 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/1-2 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/3-4 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/3-4 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/3-4 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/3-4 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/5-6 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX EF 7-10 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 5-6 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 5-6 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 5-6 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 5-6 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 5-6 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 7-10 10MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 7-10 12MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 7-10 14MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 7-10 17MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LPS FLEX GH 7-10 20MM,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,BEARING HUMERAL 36MM COMPREHENSIVE STANDARD SHOULDER PROLONG REVERSE,278,1 ,"$1,742.50 ","$1,150.05 ",$883.80 ,"$1,742.50 ", N/A ,$918.47 ,$918.47 , N/A ,"$1,045.50 ","$1,481.13 ","$1,219.75 ", N/A , N/A ,"$1,655.38 ","$1,324.30 ","$1,306.88 ", N/A ,"$1,481.13 ", N/A , N/A , N/A ,"$1,219.75 ","$1,061.18 ", N/A , N/A , N/A , N/A , N/A ,"$1,481.13 ", N/A ,"$1,603.10 ","$1,219.75 ",$883.80 ,"$1,060.66 ","$1,061.18 ","$1,060.66 ","$1,204.07 ","$1,568.25 ","$1,190.48 ", N/A ,"$1,376.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,254.60 ","$1,080.35 ","$1,254.60 ","$1,254.60 ","$1,394.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT PTLR 38MM PERSONA ALPLY KN LF,278,1 ,"$1,021.25 ",$674.03 ,$517.98 ,"$1,021.25 ", N/A ,$538.30 ,$538.30 , N/A ,$612.75 ,$868.06 ,$714.88 , N/A , N/A ,$970.19 ,$776.15 ,$765.94 , N/A ,$868.06 , N/A , N/A , N/A ,$714.88 ,$621.94 , N/A , N/A , N/A , N/A , N/A ,$868.06 , N/A ,$939.55 ,$714.88 ,$517.98 ,$621.63 ,$621.94 ,$621.63 ,$705.68 ,$919.13 ,$697.72 , N/A ,$806.79 , N/A , N/A , N/A , N/A , N/A ,$735.30 ,$633.18 ,$735.30 ,$735.30 ,$817.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT PATELLAR 29MM PERSONA VIVACIT-E ALL POLY KNEE STERILE LATEX FREE,278,1 ,"$1,021.25 ",$674.03 ,$517.98 ,"$1,021.25 ", N/A ,$538.30 ,$538.30 , N/A ,$612.75 ,$868.06 ,$714.88 , N/A , N/A ,$970.19 ,$776.15 ,$765.94 , N/A ,$868.06 , N/A , N/A , N/A ,$714.88 ,$621.94 , N/A , N/A , N/A , N/A , N/A ,$868.06 , N/A ,$939.55 ,$714.88 ,$517.98 ,$621.63 ,$621.94 ,$621.63 ,$705.68 ,$919.13 ,$697.72 , N/A ,$806.79 , N/A , N/A , N/A , N/A , N/A ,$735.30 ,$633.18 ,$735.30 ,$735.30 ,$817.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT PATELLAR 32MM PERSONA VIVACIT-E ALL POLY KNEE STERILE LATEX FREE,278,1 ,"$1,021.25 ",$674.03 ,$517.98 ,"$1,021.25 ", N/A ,$538.30 ,$538.30 , N/A ,$612.75 ,$868.06 ,$714.88 , N/A , N/A ,$970.19 ,$776.15 ,$765.94 , N/A ,$868.06 , N/A , N/A , N/A ,$714.88 ,$621.94 , N/A , N/A , N/A , N/A , N/A ,$868.06 , N/A ,$939.55 ,$714.88 ,$517.98 ,$621.63 ,$621.94 ,$621.63 ,$705.68 ,$919.13 ,$697.72 , N/A ,$806.79 , N/A , N/A , N/A , N/A , N/A ,$735.30 ,$633.18 ,$735.30 ,$735.30 ,$817.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT TIBIAL PERSONA D KNEE LEFT NONPOROUS REVISION FIXATION STERILE LATEX FREE,278,1 ,"$4,131.00 ","$2,726.46 ","$2,065.50 ","$4,131.00 ", N/A ,"$2,177.45 ","$2,177.45 ", N/A ,"$2,478.60 ","$3,511.35 ","$2,891.70 ", N/A , N/A ,"$3,924.45 ","$3,139.56 ","$3,098.25 ","$2,065.50 ","$3,511.35 ", N/A ,"$2,065.50 ","$2,065.50 ","$2,891.70 ","$2,515.78 ", N/A , N/A , N/A , N/A , N/A ,"$3,511.35 ", N/A ,"$3,800.52 ","$2,891.70 ","$2,095.24 ","$2,514.54 ","$2,515.78 ","$2,514.54 ","$2,854.52 ","$3,717.90 ","$2,822.30 ", N/A ,"$3,263.49 ", N/A , N/A , N/A , N/A , N/A ,"$2,974.32 ","$2,561.22 ","$2,974.32 ","$2,974.32 ","$3,304.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT ULNAR NEXEL SIZE 5 ZIMMER,278,1 ,"$3,823.20 ","$2,523.31 ","$1,911.60 ","$3,823.20 ", N/A ,"$2,015.21 ","$2,015.21 ", N/A ,"$2,293.92 ","$3,249.72 ","$2,676.24 ", N/A , N/A ,"$3,632.04 ","$2,905.63 ","$2,867.40 ","$1,911.60 ","$3,249.72 ", N/A ,"$1,911.60 ","$1,911.60 ","$2,676.24 ","$2,328.33 ", N/A , N/A , N/A , N/A , N/A ,"$3,249.72 ", N/A ,"$3,517.34 ","$2,676.24 ","$1,939.13 ","$2,327.18 ","$2,328.33 ","$2,327.18 ","$2,641.83 ","$3,440.88 ","$2,612.01 ", N/A ,"$3,020.33 ", N/A , N/A , N/A , N/A , N/A ,"$2,752.70 ","$2,370.38 ","$2,752.70 ","$2,752.70 ","$3,058.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CUP ZIMMER ACETABULAR 56MM MODULAR CH,278,1 ,"$2,565.00 ","$1,692.90 ","$1,282.50 ","$2,565.00 ", N/A ,"$1,352.01 ","$1,352.01 ", N/A ,"$1,539.00 ","$2,180.25 ","$1,795.50 ", N/A , N/A ,"$2,436.75 ","$1,949.40 ","$1,923.75 ","$1,282.50 ","$2,180.25 ", N/A ,"$1,282.50 ","$1,282.50 ","$1,795.50 ","$1,562.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,180.25 ", N/A ,"$2,359.80 ","$1,795.50 ","$1,300.97 ","$1,561.32 ","$1,562.09 ","$1,561.32 ","$1,772.42 ","$2,308.50 ","$1,752.41 ", N/A ,"$2,026.35 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.80 ","$1,590.30 ","$1,846.80 ","$1,846.80 ","$2,052.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CUP ZIMMER ACETABULAR 54MM MODULAR CH,278,1 ,"$2,565.00 ","$1,692.90 ","$1,282.50 ","$2,565.00 ", N/A ,"$1,352.01 ","$1,352.01 ", N/A ,"$1,539.00 ","$2,180.25 ","$1,795.50 ", N/A , N/A ,"$2,436.75 ","$1,949.40 ","$1,923.75 ","$1,282.50 ","$2,180.25 ", N/A ,"$1,282.50 ","$1,282.50 ","$1,795.50 ","$1,562.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,180.25 ", N/A ,"$2,359.80 ","$1,795.50 ","$1,300.97 ","$1,561.32 ","$1,562.09 ","$1,561.32 ","$1,772.42 ","$2,308.50 ","$1,752.41 ", N/A ,"$2,026.35 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.80 ","$1,590.30 ","$1,846.80 ","$1,846.80 ","$2,052.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM CH 60MM MM,278,1 ,"$2,565.00 ","$1,692.90 ","$1,282.50 ","$2,565.00 ", N/A ,"$1,352.01 ","$1,352.01 ", N/A ,"$1,539.00 ","$2,180.25 ","$1,795.50 ", N/A , N/A ,"$2,436.75 ","$1,949.40 ","$1,923.75 ","$1,282.50 ","$2,180.25 ", N/A ,"$1,282.50 ","$1,282.50 ","$1,795.50 ","$1,562.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,180.25 ", N/A ,"$2,359.80 ","$1,795.50 ","$1,300.97 ","$1,561.32 ","$1,562.09 ","$1,561.32 ","$1,772.42 ","$2,308.50 ","$1,752.41 ", N/A ,"$2,026.35 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.80 ","$1,590.30 ","$1,846.80 ","$1,846.80 ","$2,052.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM CH 50MM HH,278,1 ,"$2,565.00 ","$1,692.90 ","$1,282.50 ","$2,565.00 ", N/A ,"$1,352.01 ","$1,352.01 ", N/A ,"$1,539.00 ","$2,180.25 ","$1,795.50 ", N/A , N/A ,"$2,436.75 ","$1,949.40 ","$1,923.75 ","$1,282.50 ","$2,180.25 ", N/A ,"$1,282.50 ","$1,282.50 ","$1,795.50 ","$1,562.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,180.25 ", N/A ,"$2,359.80 ","$1,795.50 ","$1,300.97 ","$1,561.32 ","$1,562.09 ","$1,561.32 ","$1,772.42 ","$2,308.50 ","$1,752.41 ", N/A ,"$2,026.35 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.80 ","$1,590.30 ","$1,846.80 ","$1,846.80 ","$2,052.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM CH 52MM II,278,1 ,"$2,565.00 ","$1,692.90 ","$1,282.50 ","$2,565.00 ", N/A ,"$1,352.01 ","$1,352.01 ", N/A ,"$1,539.00 ","$2,180.25 ","$1,795.50 ", N/A , N/A ,"$2,436.75 ","$1,949.40 ","$1,923.75 ","$1,282.50 ","$2,180.25 ", N/A ,"$1,282.50 ","$1,282.50 ","$1,795.50 ","$1,562.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,180.25 ", N/A ,"$2,359.80 ","$1,795.50 ","$1,300.97 ","$1,561.32 ","$1,562.09 ","$1,561.32 ","$1,772.42 ","$2,308.50 ","$1,752.41 ", N/A ,"$2,026.35 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.80 ","$1,590.30 ","$1,846.80 ","$1,846.80 ","$2,052.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM CH 56MM KK,278,1 ,"$2,565.00 ","$1,692.90 ","$1,282.50 ","$2,565.00 ", N/A ,"$1,352.01 ","$1,352.01 ", N/A ,"$1,539.00 ","$2,180.25 ","$1,795.50 ", N/A , N/A ,"$2,436.75 ","$1,949.40 ","$1,923.75 ","$1,282.50 ","$2,180.25 ", N/A ,"$1,282.50 ","$1,282.50 ","$1,795.50 ","$1,562.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,180.25 ", N/A ,"$2,359.80 ","$1,795.50 ","$1,300.97 ","$1,561.32 ","$1,562.09 ","$1,561.32 ","$1,772.42 ","$2,308.50 ","$1,752.41 ", N/A ,"$2,026.35 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.80 ","$1,590.30 ","$1,846.80 ","$1,846.80 ","$2,052.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM CH 58MM LL,278,1 ,"$2,565.00 ","$1,692.90 ","$1,282.50 ","$2,565.00 ", N/A ,"$1,352.01 ","$1,352.01 ", N/A ,"$1,539.00 ","$2,180.25 ","$1,795.50 ", N/A , N/A ,"$2,436.75 ","$1,949.40 ","$1,923.75 ","$1,282.50 ","$2,180.25 ", N/A ,"$1,282.50 ","$1,282.50 ","$1,795.50 ","$1,562.09 ", N/A , N/A , N/A , N/A , N/A ,"$2,180.25 ", N/A ,"$2,359.80 ","$1,795.50 ","$1,300.97 ","$1,561.32 ","$1,562.09 ","$1,561.32 ","$1,772.42 ","$2,308.50 ","$1,752.41 ", N/A ,"$2,026.35 ", N/A , N/A , N/A , N/A , N/A ,"$1,846.80 ","$1,590.30 ","$1,846.80 ","$1,846.80 ","$2,052.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE H LEFT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE A LEFT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE A RIGHT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE B LEFT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE B RIGHT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE C LEFT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE C RIGHT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE D LEFT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE D RIGHT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE E LEFT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE E RIGHT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE F LEFT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE F RIGHT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE G LEFT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE G RIGHT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE C LEFT,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE C LEFT MINUS,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE C RIGHT MINUS,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE D LEFT MINUS,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 11X130MM LM BODY STD NECK,278,1 ,"$3,690.00 ","$2,435.40 ","$1,845.00 ","$3,690.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$2,214.00 ","$3,136.50 ","$2,583.00 ", N/A , N/A ,"$3,505.50 ","$2,804.40 ","$2,767.50 ","$1,845.00 ","$3,136.50 ", N/A ,"$1,845.00 ","$1,845.00 ","$2,583.00 ","$2,247.21 ", N/A , N/A , N/A , N/A , N/A ,"$3,136.50 ", N/A ,"$3,394.80 ","$2,583.00 ","$1,871.57 ","$2,246.10 ","$2,247.21 ","$2,246.10 ","$2,549.79 ","$3,321.00 ","$2,521.01 ", N/A ,"$2,915.10 ", N/A , N/A , N/A , N/A , N/A ,"$2,656.80 ","$2,287.80 ","$2,656.80 ","$2,656.80 ","$2,952.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER LCCK SZ C LEFT,278,1 ,"$10,929.60 ","$7,213.54 ","$5,355.50 ","$10,929.60 ", N/A ,"$5,760.99 ","$5,760.99 ", N/A ,"$6,557.76 ","$9,290.16 ","$7,650.72 ", N/A , N/A ,"$10,383.12 ","$8,306.50 ","$8,197.20 ","$5,464.80 ","$9,290.16 ", N/A ,"$5,464.80 ","$5,464.80 ","$7,650.72 ","$6,656.13 ", N/A , N/A , N/A , N/A , N/A ,"$9,290.16 ", N/A ,"$10,055.23 ","$7,650.72 ","$5,543.49 ","$6,652.85 ","$6,656.13 ","$6,652.85 ","$7,552.35 ","$9,836.64 ","$7,467.10 ", N/A ,"$8,634.38 ", N/A ,"$5,355.50 ","$5,355.50 ", N/A ,"$5,355.50 ","$7,869.31 ","$6,776.35 ","$7,869.31 ","$7,869.31 ","$8,743.68 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER SIZE C RIGHT,278,1 ,"$10,929.60 ","$7,213.54 ","$5,355.50 ","$10,929.60 ", N/A ,"$5,760.99 ","$5,760.99 ", N/A ,"$6,557.76 ","$9,290.16 ","$7,650.72 ", N/A , N/A ,"$10,383.12 ","$8,306.50 ","$8,197.20 ","$5,464.80 ","$9,290.16 ", N/A ,"$5,464.80 ","$5,464.80 ","$7,650.72 ","$6,656.13 ", N/A , N/A , N/A , N/A , N/A ,"$9,290.16 ", N/A ,"$10,055.23 ","$7,650.72 ","$5,543.49 ","$6,652.85 ","$6,656.13 ","$6,652.85 ","$7,552.35 ","$9,836.64 ","$7,467.10 ", N/A ,"$8,634.38 ", N/A ,"$5,355.50 ","$5,355.50 ", N/A ,"$5,355.50 ","$7,869.31 ","$6,776.35 ","$7,869.31 ","$7,869.31 ","$8,743.68 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER SIZE G LEFT,278,1 ,"$10,929.60 ","$7,213.54 ","$5,355.50 ","$10,929.60 ", N/A ,"$5,760.99 ","$5,760.99 ", N/A ,"$6,557.76 ","$9,290.16 ","$7,650.72 ", N/A , N/A ,"$10,383.12 ","$8,306.50 ","$8,197.20 ","$5,464.80 ","$9,290.16 ", N/A ,"$5,464.80 ","$5,464.80 ","$7,650.72 ","$6,656.13 ", N/A , N/A , N/A , N/A , N/A ,"$9,290.16 ", N/A ,"$10,055.23 ","$7,650.72 ","$5,543.49 ","$6,652.85 ","$6,656.13 ","$6,652.85 ","$7,552.35 ","$9,836.64 ","$7,467.10 ", N/A ,"$8,634.38 ", N/A ,"$5,355.50 ","$5,355.50 ", N/A ,"$5,355.50 ","$7,869.31 ","$6,776.35 ","$7,869.31 ","$7,869.31 ","$8,743.68 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER SIZE G RIGHT,278,1 ,"$10,929.60 ","$7,213.54 ","$5,355.50 ","$10,929.60 ", N/A ,"$5,760.99 ","$5,760.99 ", N/A ,"$6,557.76 ","$9,290.16 ","$7,650.72 ", N/A , N/A ,"$10,383.12 ","$8,306.50 ","$8,197.20 ","$5,464.80 ","$9,290.16 ", N/A ,"$5,464.80 ","$5,464.80 ","$7,650.72 ","$6,656.13 ", N/A , N/A , N/A , N/A , N/A ,"$9,290.16 ", N/A ,"$10,055.23 ","$7,650.72 ","$5,543.49 ","$6,652.85 ","$6,656.13 ","$6,652.85 ","$7,552.35 ","$9,836.64 ","$7,467.10 ", N/A ,"$8,634.38 ", N/A ,"$5,355.50 ","$5,355.50 ", N/A ,"$5,355.50 ","$7,869.31 ","$6,776.35 ","$7,869.31 ","$7,869.31 ","$8,743.68 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA PS STANDARD SIZE 9 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE E LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE E LEFT MINUS,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE E RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE E RIGHT MINUS,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE F LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE F LEFT MINUS,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE F RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE F RIGHT MINUS,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE G LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE G LEFT MINUS,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE G RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE G RIGHT MINUS,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR NEXGEN LPS-FLEX PRECOAT SIZE H RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR NARROW SIZE 10 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR NARROW SIZE 5 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR NARROW SIZE 6 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR NARROW SIZE 6 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR NARROW SIZE 7 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR NARROW SIZE 7 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR NARROW SIZE 8 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR NARROW SIZE 8 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 10 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 10 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 11 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 11 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 12 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 12 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 5 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 6 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 6 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 7 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 8 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 8 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA CR STANDARD SIZE 9 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA PS STANDARD SIZE 10 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA PS STANDARD SIZE 11 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA PS STANDARD SIZE 11 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA PS STANDARD SIZE 12 RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA PS STANDARD SIZE 6 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA PS STANDARD SIZE 7 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA PS STANDARD SIZE 8 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMUR ZIMMER PERSONA PS STANDARD SIZE 9 LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 10 STANDARD KNEE LEFT POSTERIOR STABILIZE CEMENT PERSONA COCR STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 11 STANDARD KNEE LEFT CRUCIATE RETAIN CEMENT PERSONA COCR,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 12 STANDARD KNEE LEFT CRUCIATE RETAIN CEMENT PERSONA COCR,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 5 NARROW KNEE LEFT CRUCIATE RETAIN CEMENT PERSONA COCR,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 6 STANDARD KNEE RIGHT POSTERIOR STABILIZE CEMENT PERSONA COCR STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 7 STANDARD KNEE RIGHT POSTERIOR STABILIZE CEMENT PERSONA COCR STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL 8 STANDARD KNEE RIGHT POSTERIOR STABILIZE CEMENT PERSONA COCR STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL C 60X53.5MM KNEE RIGHT CEMENT PRECOAT NEXGEN CR-FLEX ZIMALOY STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL D- 64X55.7MM KNEE LEFT CEMENT PRECOAT NEXGEN CR-FLEX ZIMALOY STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL D- 64X55.7MM KNEE RIGHT CEMENT PRECOAT NEXGEN CR-FLEX ZIMALOY STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL E- 68X59.4MM KNEE LEFT CEMENT PRECOAT NEXGEN CR-FLEX ZIMALOY STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL E- 68X59.4MM KNEE RIGHT CEMENT PRECOAT NEXGEN CR-FLEX ZIMALOY STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL F- 72X63.6MM KNEE LEFT CEMENT PRECOAT NEXGEN CR-FLEX ZIMALOY STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL F- 72X63.6MM KNEE RIGHT CEMENT PRECOAT NEXGEN CR-FLEX ZIMALOY STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL G- 76.5X68.5MM KNEE LEFT CEMENT PRECOAT NEXGEN CR-FLEX ZIMALOY STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL G- 76.5X68.5MM KNEE RIGHT CEMENT PRECOAT NEXGEN CR-FLEX ZIMALOY STERILE,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX  SIZE D LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX  SIZE D RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX  SIZE E LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX  SIZE E RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX  SIZE F LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX  SIZE F RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX  SIZE G LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX  SIZE G RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE C RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE D LEFT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE D RIGHT,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT FEMORAL ZIMMER CR-FLEX SIZE D RIGHT MINUS,278,1 ,"$3,600.00 ","$2,376.00 ","$1,800.00 ","$3,600.00 ", N/A ,"$1,897.56 ","$1,897.56 ", N/A ,"$2,160.00 ","$3,060.00 ","$2,520.00 ", N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,800.00 ","$3,060.00 ", N/A ,"$1,800.00 ","$1,800.00 ","$2,520.00 ","$2,192.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,060.00 ", N/A ,"$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,459.52 ", N/A ,"$2,844.00 ", N/A , N/A , N/A , N/A , N/A ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL BHR SMITH  AND  NEPHEW 50MM,278,1 ,"$9,088.20 ","$5,998.21 ","$4,453.22 ","$9,088.20 ", N/A ,"$4,790.39 ","$4,790.39 ", N/A ,"$5,452.92 ","$7,724.97 ","$6,361.74 ", N/A , N/A ,"$8,633.79 ","$6,907.03 ","$6,816.15 ","$4,544.10 ","$7,724.97 ", N/A ,"$4,544.10 ","$4,544.10 ","$6,361.74 ","$5,534.71 ", N/A , N/A , N/A , N/A , N/A ,"$7,724.97 ", N/A ,"$8,361.14 ","$6,361.74 ","$4,609.54 ","$5,531.99 ","$5,534.71 ","$5,531.99 ","$6,279.95 ","$8,179.38 ","$6,209.06 ", N/A ,"$7,179.68 ", N/A ,"$4,453.22 ","$4,453.22 ", N/A ,"$4,453.22 ","$6,543.50 ","$5,634.68 ","$6,543.50 ","$6,543.50 ","$7,270.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL C-TAPER STRYKER 36MM,278,1 ,$957.83 ,$632.17 ,$485.81 ,$957.83 , N/A , N/A , N/A , N/A ,$574.70 ,$814.16 ,$670.48 , N/A , N/A ,$909.94 ,$727.95 ,$718.37 , N/A ,$814.16 , N/A , N/A , N/A ,$670.48 ,$583.32 , N/A , N/A , N/A , N/A , N/A ,$814.16 , N/A ,$881.20 ,$670.48 ,$485.81 ,$583.03 ,$583.32 ,$583.03 ,$661.86 ,$862.05 ,$654.39 , N/A ,$756.69 , N/A , N/A , N/A , N/A , N/A ,$689.64 ,$593.85 ,$689.64 ,$689.64 ,$766.26 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER UNIPOLAR ADAPTER +7MM,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR ADAPTER +10.5MM,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR ADAPTER +14MM,278,1 ,$430.00 ,$283.80 ,$218.10 ,$430.00 , N/A , N/A , N/A , N/A ,$258.00 ,$365.50 ,$301.00 , N/A , N/A ,$408.50 ,$326.80 ,$322.50 , N/A ,$365.50 , N/A , N/A , N/A ,$301.00 ,$261.87 , N/A , N/A , N/A , N/A , N/A ,$365.50 , N/A ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 , N/A ,$339.70 , N/A , N/A , N/A , N/A , N/A ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD ZIMMER FEMORAL HIP BIOLOX DELTA OPTION G7 28MM,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 32MM +0,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 32MM +7,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 32MM -3.5,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 32MM 3.5,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 36MM +0,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 36MM +3.5,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 36MM +7,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 36MM -3.5,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 40MM +0,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 40MM +3.5,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 40MM +7,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER BIOLOX DELTA 40MM -3.5,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL BIOLOX OPTION ZIMMER,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 40MM -3.5,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR 3-4 11MM KNEE POSTERIOR STABILIZE HIGH FLEXION XLPE LEGION,278,1 ,"$1,523.15 ","$1,005.28 ",$772.54 ,"$1,523.15 ", N/A ,$802.85 ,$802.85 , N/A ,$913.89 ,"$1,294.68 ","$1,066.21 ", N/A , N/A ,"$1,446.99 ","$1,157.59 ","$1,142.36 ", N/A ,"$1,294.68 ", N/A , N/A , N/A ,"$1,066.21 ",$927.60 , N/A , N/A , N/A , N/A , N/A ,"$1,294.68 ", N/A ,"$1,401.30 ","$1,066.21 ",$772.54 ,$927.14 ,$927.60 ,$927.14 ,"$1,052.50 ","$1,370.84 ","$1,040.62 ", N/A ,"$1,203.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,096.67 ",$944.35 ,"$1,096.67 ","$1,096.67 ","$1,218.52 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR 3-4 C-H STANDARD 66X42X17MM KNEE PROLONG NEXGEN CR-FLEX STERILE YELLOW,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/7-10 10MM,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/7-10 12MM,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD MODULAR BIOMET,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR FLEX C-H/1-2 20MM,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR FLEX C-H/3-4 20MM,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR FLEX C-H/7-10 17MM,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/1-2 10MM,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/3-4 12MM,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER CR-FLEX C-H/5-6 10MM,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPLETE KNEE SOLUTION SIZE BLUE CH 10MM HEIGHT,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 74X46X17MM NEXGEN CR-FLEX 5-6 C-H STANDARD KNEE UHMWPE PROLONG STERILE,278,1 ,"$1,537.50 ","$1,014.75 ",$779.82 ,"$1,537.50 ", N/A ,$810.42 ,$810.42 , N/A ,$922.50 ,"$1,306.88 ","$1,076.25 ", N/A , N/A ,"$1,460.63 ","$1,168.50 ","$1,153.13 ", N/A ,"$1,306.88 ", N/A , N/A , N/A ,"$1,076.25 ",$936.34 , N/A , N/A , N/A , N/A , N/A ,"$1,306.88 ", N/A ,"$1,414.50 ","$1,076.25 ",$779.82 ,$935.88 ,$936.34 ,$935.88 ,"$1,062.41 ","$1,383.75 ","$1,050.42 ", N/A ,"$1,214.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,107.00 ",$953.25 ,"$1,107.00 ","$1,107.00 ","$1,230.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 5-6 E-F 12MM,278,1 ,"$3,831.30 ","$2,528.66 ","$1,915.65 ","$3,831.30 ", N/A ,"$2,019.48 ","$2,019.48 ", N/A ,"$2,298.78 ","$3,256.61 ","$2,681.91 ", N/A , N/A ,"$3,639.74 ","$2,911.79 ","$2,873.48 ","$1,915.65 ","$3,256.61 ", N/A ,"$1,915.65 ","$1,915.65 ","$2,681.91 ","$2,333.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,256.61 ", N/A ,"$3,524.80 ","$2,681.91 ","$1,943.24 ","$2,332.11 ","$2,333.26 ","$2,332.11 ","$2,647.43 ","$3,448.17 ","$2,617.54 ", N/A ,"$3,026.73 ", N/A , N/A , N/A , N/A , N/A ,"$2,758.54 ","$2,375.41 ","$2,758.54 ","$2,758.54 ","$3,065.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 3-4 C-D 10MM,278,1 ,"$3,831.30 ","$2,528.66 ","$1,915.65 ","$3,831.30 ", N/A ,"$2,019.48 ","$2,019.48 ", N/A ,"$2,298.78 ","$3,256.61 ","$2,681.91 ", N/A , N/A ,"$3,639.74 ","$2,911.79 ","$2,873.48 ","$1,915.65 ","$3,256.61 ", N/A ,"$1,915.65 ","$1,915.65 ","$2,681.91 ","$2,333.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,256.61 ", N/A ,"$3,524.80 ","$2,681.91 ","$1,943.24 ","$2,332.11 ","$2,333.26 ","$2,332.11 ","$2,647.43 ","$3,448.17 ","$2,617.54 ", N/A ,"$3,026.73 ", N/A , N/A , N/A , N/A , N/A ,"$2,758.54 ","$2,375.41 ","$2,758.54 ","$2,758.54 ","$3,065.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 3-4 C-D 14MM,278,1 ,"$3,831.30 ","$2,528.66 ","$1,915.65 ","$3,831.30 ", N/A ,"$2,019.48 ","$2,019.48 ", N/A ,"$2,298.78 ","$3,256.61 ","$2,681.91 ", N/A , N/A ,"$3,639.74 ","$2,911.79 ","$2,873.48 ","$1,915.65 ","$3,256.61 ", N/A ,"$1,915.65 ","$1,915.65 ","$2,681.91 ","$2,333.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,256.61 ", N/A ,"$3,524.80 ","$2,681.91 ","$1,943.24 ","$2,332.11 ","$2,333.26 ","$2,332.11 ","$2,647.43 ","$3,448.17 ","$2,617.54 ", N/A ,"$3,026.73 ", N/A , N/A , N/A , N/A , N/A ,"$2,758.54 ","$2,375.41 ","$2,758.54 ","$2,758.54 ","$3,065.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 3-4 C-D 17MM,278,1 ,"$3,831.30 ","$2,528.66 ","$1,915.65 ","$3,831.30 ", N/A ,"$2,019.48 ","$2,019.48 ", N/A ,"$2,298.78 ","$3,256.61 ","$2,681.91 ", N/A , N/A ,"$3,639.74 ","$2,911.79 ","$2,873.48 ","$1,915.65 ","$3,256.61 ", N/A ,"$1,915.65 ","$1,915.65 ","$2,681.91 ","$2,333.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,256.61 ", N/A ,"$3,524.80 ","$2,681.91 ","$1,943.24 ","$2,332.11 ","$2,333.26 ","$2,332.11 ","$2,647.43 ","$3,448.17 ","$2,617.54 ", N/A ,"$3,026.73 ", N/A , N/A , N/A , N/A , N/A ,"$2,758.54 ","$2,375.41 ","$2,758.54 ","$2,758.54 ","$3,065.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 3-4 C-D 23MM,278,1 ,"$3,831.30 ","$2,528.66 ","$1,915.65 ","$3,831.30 ", N/A ,"$2,019.48 ","$2,019.48 ", N/A ,"$2,298.78 ","$3,256.61 ","$2,681.91 ", N/A , N/A ,"$3,639.74 ","$2,911.79 ","$2,873.48 ","$1,915.65 ","$3,256.61 ", N/A ,"$1,915.65 ","$1,915.65 ","$2,681.91 ","$2,333.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,256.61 ", N/A ,"$3,524.80 ","$2,681.91 ","$1,943.24 ","$2,332.11 ","$2,333.26 ","$2,332.11 ","$2,647.43 ","$3,448.17 ","$2,617.54 ", N/A ,"$3,026.73 ", N/A , N/A , N/A , N/A , N/A ,"$2,758.54 ","$2,375.41 ","$2,758.54 ","$2,758.54 ","$3,065.04 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER SIZE 7-10 G/H 14MM,278,1 ,"$3,798.00 ","$2,506.68 ","$1,899.00 ","$3,798.00 ", N/A ,"$2,001.93 ","$2,001.93 ", N/A ,"$2,278.80 ","$3,228.30 ","$2,658.60 ", N/A , N/A ,"$3,608.10 ","$2,886.48 ","$2,848.50 ","$1,899.00 ","$3,228.30 ", N/A ,"$1,899.00 ","$1,899.00 ","$2,658.60 ","$2,312.98 ", N/A , N/A , N/A , N/A , N/A ,"$3,228.30 ", N/A ,"$3,494.16 ","$2,658.60 ","$1,926.35 ","$2,311.84 ","$2,312.98 ","$2,311.84 ","$2,624.42 ","$3,418.20 ","$2,594.79 ", N/A ,"$3,000.42 ", N/A , N/A , N/A , N/A , N/A ,"$2,734.56 ","$2,354.76 ","$2,734.56 ","$2,734.56 ","$3,038.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER SIZE 7-10 G/H 17MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LCCK STR BLUE E/F SZ 7-10 17MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LCCK STR BLUE E/F SZ 7-10 20MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LCCK STR BLUE E/F SZ 7-10 23MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LCCK STR GREEN C/D SZ 5-6 17MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LCCK STR GREEN C/D SZ 5-6 20MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER LCCK STR GREEN C/D SZ 5-6 23MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 3-4 C-D 12MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 3-4 C-D 20MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 5-6 E-F 14MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 5-6 E-F 17MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 5-6 E-F 20MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 5-6 E-F 23MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER KNEE REV 7-10 G-H 12MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER NEXGEN LCCK GREEN  E/F SZ 5-6 10MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER SIZE 7-10 G 20MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR ZIMMER SIZE 7-10 G 23MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER NEXGEN LCCK BLUE G SZ 7-10 10MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER NEXGEN LCCK STR BLUE E/F SZ 7-10 10MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER NEXGEN LCCK STR BLUE E/F SZ 7-10 12MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER NEXGEN LCCK STR BLUE E/F SZ 7-10 14MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER NEXGEN LCCK STR GREEN  C/D SZ 5-6 10MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER NEXGEN LCCK STR GREEN  C/D SZ 5-6 12MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER NEXGEN LCCK STR GREEN  C/D SZ 5-6 14MM,278,1 ,"$3,801.60 ","$2,509.06 ","$1,900.80 ","$3,801.60 ", N/A ,"$2,003.82 ","$2,003.82 ", N/A ,"$2,280.96 ","$3,231.36 ","$2,661.12 ", N/A , N/A ,"$3,611.52 ","$2,889.22 ","$2,851.20 ","$1,900.80 ","$3,231.36 ", N/A ,"$1,900.80 ","$1,900.80 ","$2,661.12 ","$2,315.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,231.36 ", N/A ,"$3,497.47 ","$2,661.12 ","$1,928.17 ","$2,314.03 ","$2,315.17 ","$2,314.03 ","$2,626.91 ","$3,421.44 ","$2,597.25 ", N/A ,"$3,003.26 ", N/A , N/A , N/A , N/A , N/A ,"$2,737.15 ","$2,356.99 ","$2,737.15 ","$2,737.15 ","$3,041.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT TIBIAL 9 10MM KNEE X3 POSTERIOR STABILIZE SCORPIO-FLEX STERILE LATEX FREE,278,1 ,"$2,042.50 ","$1,348.05 ","$1,035.96 ","$2,042.50 ", N/A ,"$1,076.60 ","$1,076.60 ", N/A ,"$1,225.50 ","$1,736.13 ","$1,429.75 ", N/A , N/A ,"$1,940.38 ","$1,552.30 ","$1,531.88 ", N/A ,"$1,736.13 ", N/A , N/A , N/A ,"$1,429.75 ","$1,243.88 ", N/A , N/A , N/A , N/A , N/A ,"$1,736.13 ", N/A ,"$1,879.10 ","$1,429.75 ","$1,035.96 ","$1,243.27 ","$1,243.88 ","$1,243.27 ","$1,411.37 ","$1,838.25 ","$1,395.44 ", N/A ,"$1,613.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,470.60 ","$1,266.35 ","$1,470.60 ","$1,470.60 ","$1,634.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT TIBIAL 7 12MM KNEE X3 POSTERIOR STABILIZE SCORPIO-FLEX STERILE LATEX FREE,278,1 ,"$2,042.50 ","$1,348.05 ","$1,035.96 ","$2,042.50 ", N/A ,"$1,076.60 ","$1,076.60 ", N/A ,"$1,225.50 ","$1,736.13 ","$1,429.75 ", N/A , N/A ,"$1,940.38 ","$1,552.30 ","$1,531.88 ", N/A ,"$1,736.13 ", N/A , N/A , N/A ,"$1,429.75 ","$1,243.88 ", N/A , N/A , N/A , N/A , N/A ,"$1,736.13 ", N/A ,"$1,879.10 ","$1,429.75 ","$1,035.96 ","$1,243.27 ","$1,243.88 ","$1,243.27 ","$1,411.37 ","$1,838.25 ","$1,395.44 ", N/A ,"$1,613.58 ", N/A , N/A , N/A , N/A , N/A ,"$1,470.60 ","$1,266.35 ","$1,470.60 ","$1,470.60 ","$1,634.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER BIOMET G7 DUAL MOBILITY 42MM E,278,1 ,"$3,355.40 ","$2,214.56 ","$1,677.70 ","$3,355.40 ", N/A ,"$1,768.63 ","$1,768.63 ", N/A ,"$2,013.24 ","$2,852.09 ","$2,348.78 ", N/A , N/A ,"$3,187.63 ","$2,550.10 ","$2,516.55 ","$1,677.70 ","$2,852.09 ", N/A ,"$1,677.70 ","$1,677.70 ","$2,348.78 ","$2,043.44 ", N/A , N/A , N/A , N/A , N/A ,"$2,852.09 ", N/A ,"$3,086.97 ","$2,348.78 ","$1,701.86 ","$2,042.43 ","$2,043.44 ","$2,042.43 ","$2,318.58 ","$3,019.86 ","$2,292.41 ", N/A ,"$2,650.77 ", N/A , N/A , N/A , N/A , N/A ,"$2,415.89 ","$2,080.35 ","$2,415.89 ","$2,415.89 ","$2,684.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR  7.3 ELEV 20D 32 X 58MM,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR TRILOGY 10D 6.4MM 56MM 32MM UHMWPE HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM LATEX FREE,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR TRILOGY 20D 6.3MM 50MM 32MM UHMWPE HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM LATEX FREE,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR TRILOGY 20D 6.4MM 56MM 32MM UHMWPE HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM LATEX FREE,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR  6.3 ELEV 10D 32 X 50/52/54MM,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR  7.3 ELEV 10D 32 X 58MM,278,1 ,"$1,230.00 ",$811.80 ,$623.86 ,"$1,230.00 ", N/A ,$648.33 ,$648.33 , N/A ,$738.00 ,"$1,045.50 ",$861.00 , N/A , N/A ,"$1,168.50 ",$934.80 ,$922.50 , N/A ,"$1,045.50 ", N/A , N/A , N/A ,$861.00 ,$749.07 , N/A , N/A , N/A , N/A , N/A ,"$1,045.50 ", N/A ,"$1,131.60 ",$861.00 ,$623.86 ,$748.70 ,$749.07 ,$748.70 ,$849.93 ,"$1,107.00 ",$840.34 , N/A ,$971.70 , N/A , N/A , N/A , N/A , N/A ,$885.60 ,$762.60 ,$885.60 ,$885.60 ,$984.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR HIP 22 ID 42/43MM,278,1 ,$445.50 ,$294.03 ,$225.96 ,$445.50 , N/A , N/A , N/A , N/A ,$267.30 ,$378.68 ,$311.85 , N/A , N/A ,$423.23 ,$338.58 ,$334.13 , N/A ,$378.68 , N/A , N/A , N/A ,$311.85 ,$271.31 , N/A , N/A , N/A , N/A , N/A ,$378.68 , N/A ,$409.86 ,$311.85 ,$225.96 ,$271.18 ,$271.31 ,$271.18 ,$307.84 ,$400.95 ,$304.37 , N/A ,$351.95 , N/A , N/A , N/A , N/A , N/A ,$320.76 ,$276.21 ,$320.76 ,$320.76 ,$356.40 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 70 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER 64MM 36MM NEUTRAL,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER 64MM 40MM NEUTRAL,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 50MM 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 56MM 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 58MM 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 58MM 40MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 60MM 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 60MM 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 60MM 40MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 62MM 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 66MM 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 66MM 40MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 68MM 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 68MM 40MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 70MM 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER TRIL STD 70MM 40MM MODULAR CUP LONGEVITY NEUTRAL 70X40,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR GG ELEV 32 X 48MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR HH ELEV 32 X 50MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR II ELEV 36 X 52MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR JJ ELEV 36 X 54MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR KK ELEV 36 X 56MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR LL ELEV 36 X 58MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER ACETABULAR MM ELEV 36 X 60MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT GG 32 X 48MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT HH 32 X 50MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT II 32 X 52MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT II 36 X 52MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT JJ 32 X 54MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT JJ 36 X 54MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT KK 32 X 56MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT KK 36 X 56MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT KK 40 X 56MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT LL 32 X 58MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT LL 36 X 58MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT LL 40 X 58MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT MM 32 X 60MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT MM 36 X 60MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT MM 40 X 60MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT NN 32 X 62MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT NN 36 X 62MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT NN 40 X 62MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT OO 32 X 64MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT OO 36 X 64MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CONTIN LONGEVITY NEUT OO 40 X 64MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 48 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 50 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 56 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 58 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 58 X 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 60 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 60 X 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 62 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 62 X 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 64 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 64 X 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 66 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 66 X 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 68 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 68 X 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 10 D ELEV 70 X 36MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 46 X 28MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 48 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 50 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 56 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 58 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 60 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 62 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 64 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 66 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER CUP LONGEVITY 20 D ELEV 68 X 32MM,278,1 ,"$1,640.00 ","$1,082.40 ",$831.81 ,"$1,640.00 ", N/A ,$864.44 ,$864.44 , N/A ,$984.00 ,"$1,394.00 ","$1,148.00 ", N/A , N/A ,"$1,558.00 ","$1,246.40 ","$1,230.00 ", N/A ,"$1,394.00 ", N/A , N/A , N/A ,"$1,148.00 ",$998.76 , N/A , N/A , N/A , N/A , N/A ,"$1,394.00 ", N/A ,"$1,508.80 ","$1,148.00 ",$831.81 ,$998.27 ,$998.76 ,$998.27 ,"$1,133.24 ","$1,476.00 ","$1,120.45 ", N/A ,"$1,295.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,180.80 ","$1,016.80 ","$1,180.80 ","$1,180.80 ","$1,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER SHOULDER HUMRUS 36MM 12D 65D +6MM,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,IMPLANT HUMERAL BEARING BIOMET,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ACETABULAR ZIMMER SHOULDER HUM +3 STD 7D 36MM,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER SHLDR HUM +0 OFST STD 7D 36MM,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER SHLDR HUM TM REV +0 12D 36MM,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,BEARING HUMERAL 36MM COMPREHENSIVE +3MM SHOULDER PROLONG REVERSE,278,1 ,"$1,332.50 ",$879.45 ,$675.84 ,"$1,332.50 ", N/A ,$702.36 ,$702.36 , N/A ,$799.50 ,"$1,132.63 ",$932.75 , N/A , N/A ,"$1,265.88 ","$1,012.70 ",$999.38 , N/A ,"$1,132.63 ", N/A , N/A , N/A ,$932.75 ,$811.49 , N/A , N/A , N/A , N/A , N/A ,"$1,132.63 ", N/A ,"$1,225.90 ",$932.75 ,$675.84 ,$811.09 ,$811.49 ,$811.09 ,$920.76 ,"$1,199.25 ",$910.36 , N/A ,"$1,052.68 ", N/A , N/A , N/A , N/A , N/A ,$959.40 ,$826.15 ,$959.40 ,$959.40 ,"$1,066.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER VIVACIT-E ELEV MM 36 X 60,278,1 ,"$2,280.00 ","$1,504.80 ","$1,156.42 ","$2,280.00 ", N/A ,"$1,201.79 ","$1,201.79 ", N/A ,"$1,368.00 ","$1,938.00 ","$1,596.00 ", N/A , N/A ,"$2,166.00 ","$1,732.80 ","$1,710.00 ", N/A ,"$1,938.00 ", N/A , N/A , N/A ,"$1,596.00 ","$1,388.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,938.00 ", N/A ,"$2,097.60 ","$1,596.00 ","$1,156.42 ","$1,387.84 ","$1,388.52 ","$1,387.84 ","$1,575.48 ","$2,052.00 ","$1,557.70 ", N/A ,"$1,801.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,641.60 ","$1,413.60 ","$1,641.60 ","$1,641.60 ","$1,824.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER VIVACIT-E ELEV GG 32 X 48,278,1 ,"$2,280.00 ","$1,504.80 ","$1,156.42 ","$2,280.00 ", N/A ,"$1,201.79 ","$1,201.79 ", N/A ,"$1,368.00 ","$1,938.00 ","$1,596.00 ", N/A , N/A ,"$2,166.00 ","$1,732.80 ","$1,710.00 ", N/A ,"$1,938.00 ", N/A , N/A , N/A ,"$1,596.00 ","$1,388.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,938.00 ", N/A ,"$2,097.60 ","$1,596.00 ","$1,156.42 ","$1,387.84 ","$1,388.52 ","$1,387.84 ","$1,575.48 ","$2,052.00 ","$1,557.70 ", N/A ,"$1,801.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,641.60 ","$1,413.60 ","$1,641.60 ","$1,641.60 ","$1,824.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER VIVACIT-E ELEV HH 32 X 50,278,1 ,"$2,280.00 ","$1,504.80 ","$1,156.42 ","$2,280.00 ", N/A ,"$1,201.79 ","$1,201.79 ", N/A ,"$1,368.00 ","$1,938.00 ","$1,596.00 ", N/A , N/A ,"$2,166.00 ","$1,732.80 ","$1,710.00 ", N/A ,"$1,938.00 ", N/A , N/A , N/A ,"$1,596.00 ","$1,388.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,938.00 ", N/A ,"$2,097.60 ","$1,596.00 ","$1,156.42 ","$1,387.84 ","$1,388.52 ","$1,387.84 ","$1,575.48 ","$2,052.00 ","$1,557.70 ", N/A ,"$1,801.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,641.60 ","$1,413.60 ","$1,641.60 ","$1,641.60 ","$1,824.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER VIVACIT-E ELEV II 36 X 52,278,1 ,"$2,280.00 ","$1,504.80 ","$1,156.42 ","$2,280.00 ", N/A ,"$1,201.79 ","$1,201.79 ", N/A ,"$1,368.00 ","$1,938.00 ","$1,596.00 ", N/A , N/A ,"$2,166.00 ","$1,732.80 ","$1,710.00 ", N/A ,"$1,938.00 ", N/A , N/A , N/A ,"$1,596.00 ","$1,388.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,938.00 ", N/A ,"$2,097.60 ","$1,596.00 ","$1,156.42 ","$1,387.84 ","$1,388.52 ","$1,387.84 ","$1,575.48 ","$2,052.00 ","$1,557.70 ", N/A ,"$1,801.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,641.60 ","$1,413.60 ","$1,641.60 ","$1,641.60 ","$1,824.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER VIVACIT-E ELEV JJ 36 X 54,278,1 ,"$2,280.00 ","$1,504.80 ","$1,156.42 ","$2,280.00 ", N/A ,"$1,201.79 ","$1,201.79 ", N/A ,"$1,368.00 ","$1,938.00 ","$1,596.00 ", N/A , N/A ,"$2,166.00 ","$1,732.80 ","$1,710.00 ", N/A ,"$1,938.00 ", N/A , N/A , N/A ,"$1,596.00 ","$1,388.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,938.00 ", N/A ,"$2,097.60 ","$1,596.00 ","$1,156.42 ","$1,387.84 ","$1,388.52 ","$1,387.84 ","$1,575.48 ","$2,052.00 ","$1,557.70 ", N/A ,"$1,801.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,641.60 ","$1,413.60 ","$1,641.60 ","$1,641.60 ","$1,824.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER VIVACIT-E ELEV KK 36 X 56,278,1 ,"$2,280.00 ","$1,504.80 ","$1,156.42 ","$2,280.00 ", N/A ,"$1,201.79 ","$1,201.79 ", N/A ,"$1,368.00 ","$1,938.00 ","$1,596.00 ", N/A , N/A ,"$2,166.00 ","$1,732.80 ","$1,710.00 ", N/A ,"$1,938.00 ", N/A , N/A , N/A ,"$1,596.00 ","$1,388.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,938.00 ", N/A ,"$2,097.60 ","$1,596.00 ","$1,156.42 ","$1,387.84 ","$1,388.52 ","$1,387.84 ","$1,575.48 ","$2,052.00 ","$1,557.70 ", N/A ,"$1,801.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,641.60 ","$1,413.60 ","$1,641.60 ","$1,641.60 ","$1,824.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER VIVACIT-E ELEV LL 36 X 58,278,1 ,"$2,280.00 ","$1,504.80 ","$1,156.42 ","$2,280.00 ", N/A ,"$1,201.79 ","$1,201.79 ", N/A ,"$1,368.00 ","$1,938.00 ","$1,596.00 ", N/A , N/A ,"$2,166.00 ","$1,732.80 ","$1,710.00 ", N/A ,"$1,938.00 ", N/A , N/A , N/A ,"$1,596.00 ","$1,388.52 ", N/A , N/A , N/A , N/A , N/A ,"$1,938.00 ", N/A ,"$2,097.60 ","$1,596.00 ","$1,156.42 ","$1,387.84 ","$1,388.52 ","$1,387.84 ","$1,575.48 ","$2,052.00 ","$1,557.70 ", N/A ,"$1,801.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,641.60 ","$1,413.60 ","$1,641.60 ","$1,641.60 ","$1,824.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,NAIL 10MM 315MM TIBIAL INTRAMEDULLARY CANNULATED TITANIUM STERILE GREEN,278,1 ,"$2,231.65 ","$1,472.89 ","$1,131.89 ","$2,231.65 ", N/A ,"$1,176.30 ","$1,176.30 ", N/A ,"$1,338.99 ","$1,896.90 ","$1,562.16 ", N/A , N/A ,"$2,120.07 ","$1,696.05 ","$1,673.74 ", N/A ,"$1,896.90 ", N/A , N/A , N/A ,"$1,562.16 ","$1,359.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,896.90 ", N/A ,"$2,053.12 ","$1,562.16 ","$1,131.89 ","$1,358.41 ","$1,359.07 ","$1,358.41 ","$1,542.07 ","$2,008.49 ","$1,524.66 ", N/A ,"$1,763.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,606.79 ","$1,383.62 ","$1,606.79 ","$1,606.79 ","$1,785.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,NAIL 10MM 300MM TIBIAL INTRAMEDULLARY CANNULATED TITANIUM STERILE GREEN,278,1 ,"$2,231.65 ","$1,472.89 ","$1,131.89 ","$2,231.65 ", N/A ,"$1,176.30 ","$1,176.30 ", N/A ,"$1,338.99 ","$1,896.90 ","$1,562.16 ", N/A , N/A ,"$2,120.07 ","$1,696.05 ","$1,673.74 ", N/A ,"$1,896.90 ", N/A , N/A , N/A ,"$1,562.16 ","$1,359.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,896.90 ", N/A ,"$2,053.12 ","$1,562.16 ","$1,131.89 ","$1,358.41 ","$1,359.07 ","$1,358.41 ","$1,542.07 ","$2,008.49 ","$1,524.66 ", N/A ,"$1,763.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,606.79 ","$1,383.62 ","$1,606.79 ","$1,606.79 ","$1,785.32 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA PRIMARY ZIMMER TRAB METAL SIZE 35MM,278,1 ,"$4,455.00 ","$2,940.30 ","$2,227.50 ","$4,455.00 ", N/A ,"$2,348.23 ","$2,348.23 ", N/A ,"$2,673.00 ","$3,786.75 ","$3,118.50 ", N/A , N/A ,"$4,232.25 ","$3,385.80 ","$3,341.25 ","$2,227.50 ","$3,786.75 ", N/A ,"$2,227.50 ","$2,227.50 ","$3,118.50 ","$2,713.10 ", N/A , N/A , N/A , N/A , N/A ,"$3,786.75 ", N/A ,"$4,098.60 ","$3,118.50 ","$2,259.58 ","$2,711.76 ","$2,713.10 ","$2,711.76 ","$3,078.41 ","$4,009.50 ","$3,043.66 ", N/A ,"$3,519.45 ", N/A , N/A , N/A , N/A , N/A ,"$3,207.60 ","$2,762.10 ","$3,207.60 ","$3,207.60 ","$3,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPONENT ZIMMER FEMUR CR-FLEX SZ F LEFT,278,1 ,"$4,455.00 ","$2,940.30 ","$2,227.50 ","$4,455.00 ", N/A ,"$2,348.23 ","$2,348.23 ", N/A ,"$2,673.00 ","$3,786.75 ","$3,118.50 ", N/A , N/A ,"$4,232.25 ","$3,385.80 ","$3,341.25 ","$2,227.50 ","$3,786.75 ", N/A ,"$2,227.50 ","$2,227.50 ","$3,118.50 ","$2,713.10 ", N/A , N/A , N/A , N/A , N/A ,"$3,786.75 ", N/A ,"$4,098.60 ","$3,118.50 ","$2,259.58 ","$2,711.76 ","$2,713.10 ","$2,711.76 ","$3,078.41 ","$4,009.50 ","$3,043.66 ", N/A ,"$3,519.45 ", N/A , N/A , N/A , N/A , N/A ,"$3,207.60 ","$2,762.10 ","$3,207.60 ","$3,207.60 ","$3,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,CUP ACETABULAR BHR SMITH  AND  NEPHEW 58MM,278,1 ,"$4,455.00 ","$2,940.30 ","$2,227.50 ","$4,455.00 ", N/A ,"$2,348.23 ","$2,348.23 ", N/A ,"$2,673.00 ","$3,786.75 ","$3,118.50 ", N/A , N/A ,"$4,232.25 ","$3,385.80 ","$3,341.25 ","$2,227.50 ","$3,786.75 ", N/A ,"$2,227.50 ","$2,227.50 ","$3,118.50 ","$2,713.10 ", N/A , N/A , N/A , N/A , N/A ,"$3,786.75 ", N/A ,"$4,098.60 ","$3,118.50 ","$2,259.58 ","$2,711.76 ","$2,713.10 ","$2,711.76 ","$3,078.41 ","$4,009.50 ","$3,043.66 ", N/A ,"$3,519.45 ", N/A , N/A , N/A , N/A , N/A ,"$3,207.60 ","$2,762.10 ","$3,207.60 ","$3,207.60 ","$3,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA PRIMARY ZIMMER TRAB METAL SIZE 38MM,278,1 ,"$1,281.25 ",$845.63 ,$649.85 ,"$1,281.25 ", N/A ,$675.35 ,$675.35 , N/A ,$768.75 ,"$1,089.06 ",$896.88 , N/A , N/A ,"$1,217.19 ",$973.75 ,$960.94 , N/A ,"$1,089.06 ", N/A , N/A , N/A ,$896.88 ,$780.28 , N/A , N/A , N/A , N/A , N/A ,"$1,089.06 ", N/A ,"$1,178.75 ",$896.88 ,$649.85 ,$779.90 ,$780.28 ,$779.90 ,$885.34 ,"$1,153.13 ",$875.35 , N/A ,"$1,012.19 ", N/A , N/A , N/A , N/A , N/A ,$922.50 ,$794.38 ,$922.50 ,$922.50 ,"$1,025.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA PRIMARY ZIMMER TRAB METAL SIZE 32MM,278,1 ,"$1,281.25 ",$845.63 ,$649.85 ,"$1,281.25 ", N/A ,$675.35 ,$675.35 , N/A ,$768.75 ,"$1,089.06 ",$896.88 , N/A , N/A ,"$1,217.19 ",$973.75 ,$960.94 , N/A ,"$1,089.06 ", N/A , N/A , N/A ,$896.88 ,$780.28 , N/A , N/A , N/A , N/A , N/A ,"$1,089.06 ", N/A ,"$1,178.75 ",$896.88 ,$649.85 ,$779.90 ,$780.28 ,$779.90 ,$885.34 ,"$1,153.13 ",$875.35 , N/A ,"$1,012.19 ", N/A , N/A , N/A , N/A , N/A ,$922.50 ,$794.38 ,$922.50 ,$922.50 ,"$1,025.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN PROLONG 26MM,278,1 ,"$1,025.00 ",$676.50 ,$519.88 ,"$1,025.00 ", N/A ,$540.28 ,$540.28 , N/A ,$615.00 ,$871.25 ,$717.50 , N/A , N/A ,$973.75 ,$779.00 ,$768.75 , N/A ,$871.25 , N/A , N/A , N/A ,$717.50 ,$624.23 , N/A , N/A , N/A , N/A , N/A ,$871.25 , N/A ,$943.00 ,$717.50 ,$519.88 ,$623.92 ,$624.23 ,$623.92 ,$708.28 ,$922.50 ,$700.28 , N/A ,$809.75 , N/A , N/A , N/A , N/A , N/A ,$738.00 ,$635.50 ,$738.00 ,$738.00 ,$820.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN PROLONG 41MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR 57/58MM X 28MM ID,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR 60/62MM X 28MM ID,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR 64/66MM X 28MM ID,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR 68/70MM X 28MM ID,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR 72MM X 28MM ID,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR HIP 28 ID 44/45/45MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR HIP 28 ID 47/48/49MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR HIP 28 ID 53/54/55MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER ZIMMER BIPOLAR HIP 28 OD 50/51/52MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN ALL-POLY 10 X 41MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN ALL-POLY 8.5 X 32MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN ALL-POLY 9 X 35MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN ALL-POLY 9.5 X 38MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN PROLONG 29MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN PROLONG 32MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN PROLONG 35MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PATELLA ZIMMER NEXGEN PROLONG 38MM,278,1 ,$645.00 ,$425.70 ,$327.14 ,$645.00 , N/A , N/A , N/A , N/A ,$387.00 ,$548.25 ,$451.50 , N/A , N/A ,$612.75 ,$490.20 ,$483.75 , N/A ,$548.25 , N/A , N/A , N/A ,$451.50 ,$392.81 , N/A , N/A , N/A , N/A , N/A ,$548.25 , N/A ,$593.40 ,$451.50 ,$327.14 ,$392.61 ,$392.81 ,$392.61 ,$445.70 ,$580.50 ,$440.66 , N/A ,$509.55 , N/A , N/A , N/A , N/A , N/A ,$464.40 ,$399.90 ,$464.40 ,$464.40 ,$516.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE TIBIAL FIXED BEARING ZIMMER SIZE 8,278,1 ,"$2,679.00 ","$1,768.14 ","$1,339.50 ","$2,679.00 ", N/A ,"$1,412.10 ","$1,412.10 ", N/A ,"$1,607.40 ","$2,277.15 ","$1,875.30 ", N/A , N/A ,"$2,545.05 ","$2,036.04 ","$2,009.25 ","$1,339.50 ","$2,277.15 ", N/A ,"$1,339.50 ","$1,339.50 ","$1,875.30 ","$1,631.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,277.15 ", N/A ,"$2,464.68 ","$1,875.30 ","$1,358.79 ","$1,630.71 ","$1,631.51 ","$1,630.71 ","$1,851.19 ","$2,411.10 ","$1,830.29 ", N/A ,"$2,116.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,928.88 ","$1,660.98 ","$1,928.88 ","$1,928.88 ","$2,143.20 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 10,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 28MM +1.5,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 28MM +5,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 28MM +8.5,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 32MM +1,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 32MM +5,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 32MM +9,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 36MM +1.5,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 36MM +12,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 36MM +5,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL DELTA 36MM +8.5,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD HUMERAL ZIMMER 24MM X 52MM,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD HUMERAL ZIMMER OFFSETMOD 17MM X 46MM,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD HUMERAL ZIMMER OFFSETMOD 18MM X 40MM,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD HUMERAL ZIMMER OFFSETMOD 19MM X 52MM,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,LINER DEPUY ACETABULAR ALTRX +4 10D 36 X 60,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,BEARING HUMERAL 36MM COMPREHENSIVE STANDARD SHOULDER VIVACIT-E REVERSE,278,1 ,"$1,947.50 ","$1,285.35 ",$987.77 ,"$1,947.50 ", N/A ,"$1,026.53 ","$1,026.53 ", N/A ,"$1,168.50 ","$1,655.38 ","$1,363.25 ", N/A , N/A ,"$1,850.13 ","$1,480.10 ","$1,460.63 ", N/A ,"$1,655.38 ", N/A , N/A , N/A ,"$1,363.25 ","$1,186.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,655.38 ", N/A ,"$1,791.70 ","$1,363.25 ",$987.77 ,"$1,185.44 ","$1,186.03 ","$1,185.44 ","$1,345.72 ","$1,752.75 ","$1,330.53 ", N/A ,"$1,538.53 ", N/A , N/A , N/A , N/A , N/A ,"$1,402.20 ","$1,207.45 ","$1,402.20 ","$1,402.20 ","$1,558.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 9,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,GLENOSPHERE COMPREHENSIVE BIOMET,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 1,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 2,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 3,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 4,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 5,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 6,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 7,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PLATE ZIMMER TIBIAL STEMMED SIZE 8,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,BASEPLATE TIBIAL PERSONA 5D D KNEE RIGHT CEMENT STEM TIVANIUM,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,BASEPLATE TIBIAL PERSONA 5D G KNEE RIGHT CEMENT STEM TIVANIUM,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,BASEPLATE TIBIAL ZIMMER  PERSONA 5D C LEFT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SPHERE ZIMMER GLENOID SHLDR TM REV 36MM,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE C LEFT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE C RIGHT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE D LEFT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE E LEFT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE E RIGHT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE F LEFT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE F RIGHT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE G LEFT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE H LEFT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TIBIA STEMMED BASE ZIMMER PERSONA SIZE H RIGHT,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM FEMORAL PRIMARY CEMENT LOW DEMAND NATURAL-HIP COCR 3 HIP,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM HIP ZIMMER VERSYS PF LD/FX 13 X 130MM,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM HIP ZIMMER VERSYS PF LD/FX 14 X 135MM,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM HIP ZIMMER VERSYS PF LD/FX 15 X 140MM,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HIP VERSYS CEMENTED LD/FX 18 X 155,278,1 ,"$1,900.00 ","$1,254.00 ",$963.68 ,"$1,900.00 ", N/A ,"$1,001.49 ","$1,001.49 ", N/A ,"$1,140.00 ","$1,615.00 ","$1,330.00 ", N/A , N/A ,"$1,805.00 ","$1,444.00 ","$1,425.00 ", N/A ,"$1,615.00 ", N/A , N/A , N/A ,"$1,330.00 ","$1,157.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.00 ", N/A ,"$1,748.00 ","$1,330.00 ",$963.68 ,"$1,156.53 ","$1,157.10 ","$1,156.53 ","$1,312.90 ","$1,710.00 ","$1,298.08 ", N/A ,"$1,501.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PSN MC VE ASF R 14MM 6-7/EF,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTC 10-11 EF 12MM KN LT VIVACIT-E,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTC 10MM KN VIVACIT-E PERSONA STRL,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTC 12 11MM KN CRCTE RTN VIVACIT-E PERSONA STRL LF,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTC 6-7 C-D 10MM KN RT VIVACIT-E PERSONA STRL,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTC 6-7 C-D 11MM KN RT VIVACIT-E PERSONA STRL,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTC 6-7 EF 12MM KN RT VIVACIT-E PERSONA MDL CNGRT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTC 6-9 EF 10MM KN LT POST STAB VIVACIT-E PERSONA,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTC 8-9 C-D 11MM KN RT VIVACIT-E PERSONA STRL,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTC PERSONA VIVACIT-E 6-7 C-D H13 MM KNEE LEFT STERI,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR 10MM PERSONA 10-12 GH KNEE LEFT VIVACIT-E,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR 8-11 E-F 10MM KN RT VIVACIT-E PERSONA STRL,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR 8-11 G-H 10MM KN LT VIVACIT-E PERSONA,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT ARTICULAR 8-11 G-H 12MM KN LT VIVACIT-E PERSONA,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT TIB 10MM PERSONA VIVACIT-E STRL,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,PSN MC VE ASF L 11MM 8-11 GH,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E CD/10MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E CD/10MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E CD/11MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E CD/11MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E CD/12MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E CD/12MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E CD/14MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E CD/14MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E EF/10MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E EF/10MM RGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E EF/11MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E EF/11MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E EF/12MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E EF/12MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E EF/13MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E EF/13MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E GH/10MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E GH/10MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E GH/11MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E GH/11MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E GH/12MM LEFT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E GH/12MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER PERSONA VIVACIT-E GH/13MM RIGHT,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 10MM PERSONA 6-9 C-D KNEE RIGHT VIVACIT-E POSTERIOR STABILIZE CONSTRAIN STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 10MM PERSONA 6-9 E-F KNEE RIGHT TIBIA VIVACIT-E POSTERIOR STABILIZE FIX BEARING STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 10MM PERSONA 7-12 G-H KNEE LEFT VIVACIT-E ULTRACONGRUENT STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 10MM PERSONA MEDIAL CONGRUENT 6-7 E-F KNEE RIGHT TIBIA VIVACIT-E FIX BEARING STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 11MM PERSONA 3-7 C-D KNEE LEFT VIVACIT-E ULTRACONGRUENT STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 11MM PERSONA 7-12 G-H KNEE LEFT VIVACIT-E ULTRACONGRUENT STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 11MM PERSONA MEDIAL CONGRUENT 8-11 G-H KNEE LEFT VIVACIT-E CRUCIATE RETAIN STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 12MM PERSONA 3-7 C-D KNEE RIGHT TIBIA VIVACIT-E ULTRACONGRUENT FIX BEARING STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 12MM PERSONA 6-9 E-F KNEE RIGHT TIBIA VIVACIT-E POSTERIOR STABILIZE FIX BEARING STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 13MM PERSONA 10-12 G-H KNEE LEFT VIVACIT-E POSTERIOR STABILIZE STERILE LATEX FREE,278,1 ,"$1,995.00 ","$1,316.70 ","$1,011.86 ","$1,995.00 ", N/A ,"$1,051.56 ","$1,051.56 ", N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A , N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ","$1,214.96 ", N/A , N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,362.98 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SCREW BIOMET CORTICAL 2.7 X 12MM,278,1 ,"$1,691.25 ","$1,116.23 ",$857.80 ,"$1,691.25 ", N/A ,$891.46 ,$891.46 , N/A ,"$1,014.75 ","$1,437.56 ","$1,183.88 ", N/A , N/A ,"$1,606.69 ","$1,285.35 ","$1,268.44 ", N/A ,"$1,437.56 ", N/A , N/A , N/A ,"$1,183.88 ","$1,029.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.56 ", N/A ,"$1,555.95 ","$1,183.88 ",$857.80 ,"$1,029.46 ","$1,029.97 ","$1,029.46 ","$1,168.65 ","$1,522.13 ","$1,155.46 ", N/A ,"$1,336.09 ", N/A , N/A , N/A , N/A , N/A ,"$1,217.70 ","$1,048.58 ","$1,217.70 ","$1,217.70 ","$1,353.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SCREW FEMORAL HEAD 12 14 TAPER 32MM DIAMETER 0MM NECK LENGTH,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 43MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 44MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 49MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 50MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 51MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 52MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 53MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 54MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 55MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 57MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 60MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,FEMORAL HEAD ZIMMER UNIPOLAR 63MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD DEPUY FEMORAL ARTICULEZE 36MM +1.5,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER 06 DEG +14 28MM LONG,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER 06 DEG 32MM SHORT,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER UNIPOLAR 38MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER UNIPOLAR 40MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER UNIPOLAR 42MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER UNIPOLAR 45MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER UNIPOLAR 46MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER UNIPOLAR 47MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER UNIPOLAR 48MM,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 22MM +0,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 28MM +0,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 28MM +3.5,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 28MM +7,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 28MM -3.5,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 32MM +0,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 32MM +10.5,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 32MM +3.5,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 32MM +7,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 32MM -3.5,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 36MM +0,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 36MM +10.5,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 36MM +3.5,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 36MM +7,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,HEAD FEMORAL ZIMMER VERSYS 12/14 36MM -3.5,278,1 ,$860.00 ,$567.60 ,$436.19 ,$860.00 , N/A , N/A , N/A , N/A ,$516.00 ,$731.00 ,$602.00 , N/A , N/A ,$817.00 ,$653.60 ,$645.00 , N/A ,$731.00 , N/A , N/A , N/A ,$602.00 ,$523.74 , N/A , N/A , N/A , N/A , N/A ,$731.00 , N/A ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 , N/A ,$679.40 , N/A , N/A , N/A , N/A , N/A ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ACETABULAR STRYKER 2600 TRIDENT PSL 58MM,278,1 ,"$1,726.10 ","$1,139.23 ",$875.48 ,"$1,726.10 ", N/A ,$909.83 ,$909.83 , N/A ,"$1,035.66 ","$1,467.19 ","$1,208.27 ", N/A , N/A ,"$1,639.80 ","$1,311.84 ","$1,294.58 ", N/A ,"$1,467.19 ", N/A , N/A , N/A ,"$1,208.27 ","$1,051.19 ", N/A , N/A , N/A , N/A , N/A ,"$1,467.19 ", N/A ,"$1,588.01 ","$1,208.27 ",$875.48 ,"$1,050.68 ","$1,051.19 ","$1,050.68 ","$1,192.74 ","$1,553.49 ","$1,179.27 ", N/A ,"$1,363.62 ", N/A , N/A , N/A , N/A , N/A ,"$1,242.79 ","$1,070.18 ","$1,242.79 ","$1,242.79 ","$1,380.88 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ACETABULAR STRYKER 2600 TRIDENT PSL 54MM,278,1 ,"$1,726.10 ","$1,139.23 ",$875.48 ,"$1,726.10 ", N/A ,$909.83 ,$909.83 , N/A ,"$1,035.66 ","$1,467.19 ","$1,208.27 ", N/A , N/A ,"$1,639.80 ","$1,311.84 ","$1,294.58 ", N/A ,"$1,467.19 ", N/A , N/A , N/A ,"$1,208.27 ","$1,051.19 ", N/A , N/A , N/A , N/A , N/A ,"$1,467.19 ", N/A ,"$1,588.01 ","$1,208.27 ",$875.48 ,"$1,050.68 ","$1,051.19 ","$1,050.68 ","$1,192.74 ","$1,553.49 ","$1,179.27 ", N/A ,"$1,363.62 ", N/A , N/A , N/A , N/A , N/A ,"$1,242.79 ","$1,070.18 ","$1,242.79 ","$1,242.79 ","$1,380.88 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 64MM CH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT STRYKER TRIDENT 36MM 10 DEGREE F,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,INSERT STRYKER TRIDENT 36MM 10 DEGREE G,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 48MM CH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 50MM CH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 52MM CH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 54MM CH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 56MM CH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 56MM MH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 58MM CH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 58MM MH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 60MM CH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 62MM CH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 62MM MH,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 70MM MH,278,1 ,"$3,420.00 ","$2,257.20 ","$1,710.00 ","$3,420.00 ", N/A ,"$1,802.68 ","$1,802.68 ", N/A ,"$2,052.00 ","$2,907.00 ","$2,394.00 ", N/A , N/A ,"$3,249.00 ","$2,599.20 ","$2,565.00 ","$1,710.00 ","$2,907.00 ", N/A ,"$1,710.00 ","$1,710.00 ","$2,394.00 ","$2,082.78 ", N/A , N/A , N/A , N/A , N/A ,"$2,907.00 ", N/A ,"$3,146.40 ","$2,394.00 ","$1,734.62 ","$2,081.75 ","$2,082.78 ","$2,081.75 ","$2,363.22 ","$3,078.00 ","$2,336.54 ", N/A ,"$2,701.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,462.40 ","$2,120.40 ","$2,462.40 ","$2,462.40 ","$2,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 48MM MH,278,1 ,"$3,420.00 ","$2,257.20 ","$1,710.00 ","$3,420.00 ", N/A ,"$1,802.68 ","$1,802.68 ", N/A ,"$2,052.00 ","$2,907.00 ","$2,394.00 ", N/A , N/A ,"$3,249.00 ","$2,599.20 ","$2,565.00 ","$1,710.00 ","$2,907.00 ", N/A ,"$1,710.00 ","$1,710.00 ","$2,394.00 ","$2,082.78 ", N/A , N/A , N/A , N/A , N/A ,"$2,907.00 ", N/A ,"$3,146.40 ","$2,394.00 ","$1,734.62 ","$2,081.75 ","$2,082.78 ","$2,081.75 ","$2,363.22 ","$3,078.00 ","$2,336.54 ", N/A ,"$2,701.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,462.40 ","$2,120.40 ","$2,462.40 ","$2,462.40 ","$2,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 50MM MH,278,1 ,"$3,420.00 ","$2,257.20 ","$1,710.00 ","$3,420.00 ", N/A ,"$1,802.68 ","$1,802.68 ", N/A ,"$2,052.00 ","$2,907.00 ","$2,394.00 ", N/A , N/A ,"$3,249.00 ","$2,599.20 ","$2,565.00 ","$1,710.00 ","$2,907.00 ", N/A ,"$1,710.00 ","$1,710.00 ","$2,394.00 ","$2,082.78 ", N/A , N/A , N/A , N/A , N/A ,"$2,907.00 ", N/A ,"$3,146.40 ","$2,394.00 ","$1,734.62 ","$2,081.75 ","$2,082.78 ","$2,081.75 ","$2,363.22 ","$3,078.00 ","$2,336.54 ", N/A ,"$2,701.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,462.40 ","$2,120.40 ","$2,462.40 ","$2,462.40 ","$2,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 52MM MH,278,1 ,"$3,420.00 ","$2,257.20 ","$1,710.00 ","$3,420.00 ", N/A ,"$1,802.68 ","$1,802.68 ", N/A ,"$2,052.00 ","$2,907.00 ","$2,394.00 ", N/A , N/A ,"$3,249.00 ","$2,599.20 ","$2,565.00 ","$1,710.00 ","$2,907.00 ", N/A ,"$1,710.00 ","$1,710.00 ","$2,394.00 ","$2,082.78 ", N/A , N/A , N/A , N/A , N/A ,"$2,907.00 ", N/A ,"$3,146.40 ","$2,394.00 ","$1,734.62 ","$2,081.75 ","$2,082.78 ","$2,081.75 ","$2,363.22 ","$3,078.00 ","$2,336.54 ", N/A ,"$2,701.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,462.40 ","$2,120.40 ","$2,462.40 ","$2,462.40 ","$2,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 54MM MH,278,1 ,"$3,420.00 ","$2,257.20 ","$1,710.00 ","$3,420.00 ", N/A ,"$1,802.68 ","$1,802.68 ", N/A ,"$2,052.00 ","$2,907.00 ","$2,394.00 ", N/A , N/A ,"$3,249.00 ","$2,599.20 ","$2,565.00 ","$1,710.00 ","$2,907.00 ", N/A ,"$1,710.00 ","$1,710.00 ","$2,394.00 ","$2,082.78 ", N/A , N/A , N/A , N/A , N/A ,"$2,907.00 ", N/A ,"$3,146.40 ","$2,394.00 ","$1,734.62 ","$2,081.75 ","$2,082.78 ","$2,081.75 ","$2,363.22 ","$3,078.00 ","$2,336.54 ", N/A ,"$2,701.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,462.40 ","$2,120.40 ","$2,462.40 ","$2,462.40 ","$2,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 60MM MH,278,1 ,"$3,420.00 ","$2,257.20 ","$1,710.00 ","$3,420.00 ", N/A ,"$1,802.68 ","$1,802.68 ", N/A ,"$2,052.00 ","$2,907.00 ","$2,394.00 ", N/A , N/A ,"$3,249.00 ","$2,599.20 ","$2,565.00 ","$1,710.00 ","$2,907.00 ", N/A ,"$1,710.00 ","$1,710.00 ","$2,394.00 ","$2,082.78 ", N/A , N/A , N/A , N/A , N/A ,"$2,907.00 ", N/A ,"$3,146.40 ","$2,394.00 ","$1,734.62 ","$2,081.75 ","$2,082.78 ","$2,081.75 ","$2,363.22 ","$3,078.00 ","$2,336.54 ", N/A ,"$2,701.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,462.40 ","$2,120.40 ","$2,462.40 ","$2,462.40 ","$2,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 66MM CH,278,1 ,"$3,420.00 ","$2,257.20 ","$1,710.00 ","$3,420.00 ", N/A ,"$1,802.68 ","$1,802.68 ", N/A ,"$2,052.00 ","$2,907.00 ","$2,394.00 ", N/A , N/A ,"$3,249.00 ","$2,599.20 ","$2,565.00 ","$1,710.00 ","$2,907.00 ", N/A ,"$1,710.00 ","$1,710.00 ","$2,394.00 ","$2,082.78 ", N/A , N/A , N/A , N/A , N/A ,"$2,907.00 ", N/A ,"$3,146.40 ","$2,394.00 ","$1,734.62 ","$2,081.75 ","$2,082.78 ","$2,081.75 ","$2,363.22 ","$3,078.00 ","$2,336.54 ", N/A ,"$2,701.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,462.40 ","$2,120.40 ","$2,462.40 ","$2,462.40 ","$2,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 68MM CH,278,1 ,"$3,420.00 ","$2,257.20 ","$1,710.00 ","$3,420.00 ", N/A ,"$1,802.68 ","$1,802.68 ", N/A ,"$2,052.00 ","$2,907.00 ","$2,394.00 ", N/A , N/A ,"$3,249.00 ","$2,599.20 ","$2,565.00 ","$1,710.00 ","$2,907.00 ", N/A ,"$1,710.00 ","$1,710.00 ","$2,394.00 ","$2,082.78 ", N/A , N/A , N/A , N/A , N/A ,"$2,907.00 ", N/A ,"$3,146.40 ","$2,394.00 ","$1,734.62 ","$2,081.75 ","$2,082.78 ","$2,081.75 ","$2,363.22 ","$3,078.00 ","$2,336.54 ", N/A ,"$2,701.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,462.40 ","$2,120.40 ","$2,462.40 ","$2,462.40 ","$2,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER ACETABULAR TRILOGY 70MM CH,278,1 ,"$3,420.00 ","$2,257.20 ","$1,710.00 ","$3,420.00 ", N/A ,"$1,802.68 ","$1,802.68 ", N/A ,"$2,052.00 ","$2,907.00 ","$2,394.00 ", N/A , N/A ,"$3,249.00 ","$2,599.20 ","$2,565.00 ","$1,710.00 ","$2,907.00 ", N/A ,"$1,710.00 ","$1,710.00 ","$2,394.00 ","$2,082.78 ", N/A , N/A , N/A , N/A , N/A ,"$2,907.00 ", N/A ,"$3,146.40 ","$2,394.00 ","$1,734.62 ","$2,081.75 ","$2,082.78 ","$2,081.75 ","$2,363.22 ","$3,078.00 ","$2,336.54 ", N/A ,"$2,701.80 ", N/A , N/A , N/A , N/A , N/A ,"$2,462.40 ","$2,120.40 ","$2,462.40 ","$2,462.40 ","$2,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 43MM OD,278,1 ,$638.55 ,$421.44 ,$323.87 ,$638.55 , N/A , N/A , N/A , N/A ,$383.13 ,$542.77 ,$446.99 , N/A , N/A ,$606.62 ,$485.30 ,$478.91 , N/A ,$542.77 , N/A , N/A , N/A ,$446.99 ,$388.88 , N/A , N/A , N/A , N/A , N/A ,$542.77 , N/A ,$587.47 ,$446.99 ,$323.87 ,$388.69 ,$388.88 ,$388.69 ,$441.24 ,$574.70 ,$436.26 , N/A ,$504.45 , N/A , N/A , N/A , N/A , N/A ,$459.76 ,$395.90 ,$459.76 ,$459.76 ,$510.84 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 55MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 44MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 45MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 46MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 47MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 48MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 49MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 50MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 51MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 52MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 53MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 54MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 57MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 58MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 60MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 62MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 64MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 66MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 70MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER BIPOLAR 72MM OD,278,1 ,$752.50 ,$496.65 ,$381.67 ,$752.50 , N/A , N/A , N/A , N/A ,$451.50 ,$639.63 ,$526.75 , N/A , N/A ,$714.88 ,$571.90 ,$564.38 , N/A ,$639.63 , N/A , N/A , N/A ,$526.75 ,$458.27 , N/A , N/A , N/A , N/A , N/A ,$639.63 , N/A ,$692.30 ,$526.75 ,$381.67 ,$458.05 ,$458.27 ,$458.05 ,$519.98 ,$677.25 ,$514.11 , N/A ,$594.48 , N/A , N/A , N/A , N/A , N/A ,$541.80 ,$466.55 ,$541.80 ,$541.80 ,$602.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM CH 54MM JJ,278,1 ,"$2,660.00 ","$1,755.60 ","$1,330.00 ","$2,660.00 ", N/A ,"$1,402.09 ","$1,402.09 ", N/A ,"$1,596.00 ","$2,261.00 ","$1,862.00 ", N/A , N/A ,"$2,527.00 ","$2,021.60 ","$1,995.00 ","$1,330.00 ","$2,261.00 ", N/A ,"$1,330.00 ","$1,330.00 ","$1,862.00 ","$1,619.94 ", N/A , N/A , N/A , N/A , N/A ,"$2,261.00 ", N/A ,"$2,447.20 ","$1,862.00 ","$1,349.15 ","$1,619.14 ","$1,619.94 ","$1,619.14 ","$1,838.06 ","$2,394.00 ","$1,817.31 ", N/A ,"$2,101.40 ", N/A , N/A , N/A , N/A , N/A ,"$1,915.20 ","$1,649.20 ","$1,915.20 ","$1,915.20 ","$2,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM CH 64MM OO,278,1 ,"$2,850.00 ","$1,881.00 ","$1,425.00 ","$2,850.00 ", N/A ,"$1,502.24 ","$1,502.24 ", N/A ,"$1,710.00 ","$2,422.50 ","$1,995.00 ", N/A , N/A ,"$2,707.50 ","$2,166.00 ","$2,137.50 ","$1,425.00 ","$2,422.50 ", N/A ,"$1,425.00 ","$1,425.00 ","$1,995.00 ","$1,735.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,422.50 ", N/A ,"$2,622.00 ","$1,995.00 ","$1,445.52 ","$1,734.80 ","$1,735.65 ","$1,734.80 ","$1,969.35 ","$2,565.00 ","$1,947.12 ", N/A ,"$2,251.50 ", N/A , N/A , N/A , N/A , N/A ,"$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$2,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,BASEPLATE GLENOID COMPREHENSIVE 25 MM MINI TAPER ADAPTER REV,278,1 ,"$2,850.00 ","$1,881.00 ","$1,425.00 ","$2,850.00 ", N/A ,"$1,502.24 ","$1,502.24 ", N/A ,"$1,710.00 ","$2,422.50 ","$1,995.00 ", N/A , N/A ,"$2,707.50 ","$2,166.00 ","$2,137.50 ","$1,425.00 ","$2,422.50 ", N/A ,"$1,425.00 ","$1,425.00 ","$1,995.00 ","$1,735.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,422.50 ", N/A ,"$2,622.00 ","$1,995.00 ","$1,445.52 ","$1,734.80 ","$1,735.65 ","$1,734.80 ","$1,969.35 ","$2,565.00 ","$1,947.12 ", N/A ,"$2,251.50 ", N/A , N/A , N/A , N/A , N/A ,"$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$2,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM CH 62MM NN,278,1 ,"$2,850.00 ","$1,881.00 ","$1,425.00 ","$2,850.00 ", N/A ,"$1,502.24 ","$1,502.24 ", N/A ,"$1,710.00 ","$2,422.50 ","$1,995.00 ", N/A , N/A ,"$2,707.50 ","$2,166.00 ","$2,137.50 ","$1,425.00 ","$2,422.50 ", N/A ,"$1,425.00 ","$1,425.00 ","$1,995.00 ","$1,735.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,422.50 ", N/A ,"$2,622.00 ","$1,995.00 ","$1,445.52 ","$1,734.80 ","$1,735.65 ","$1,734.80 ","$1,969.35 ","$2,565.00 ","$1,947.12 ", N/A ,"$2,251.50 ", N/A , N/A , N/A , N/A , N/A ,"$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$2,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM CH 48MM GG,278,1 ,"$2,850.00 ","$1,881.00 ","$1,425.00 ","$2,850.00 ", N/A ,"$1,502.24 ","$1,502.24 ", N/A ,"$1,710.00 ","$2,422.50 ","$1,995.00 ", N/A , N/A ,"$2,707.50 ","$2,166.00 ","$2,137.50 ","$1,425.00 ","$2,422.50 ", N/A ,"$1,425.00 ","$1,425.00 ","$1,995.00 ","$1,735.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,422.50 ", N/A ,"$2,622.00 ","$1,995.00 ","$1,445.52 ","$1,734.80 ","$1,735.65 ","$1,734.80 ","$1,969.35 ","$2,565.00 ","$1,947.12 ", N/A ,"$2,251.50 ", N/A , N/A , N/A , N/A , N/A ,"$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$2,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM MH 64MM OO,278,1 ,"$4,698.00 ","$3,100.68 ","$2,349.00 ","$4,698.00 ", N/A ,"$2,476.32 ","$2,476.32 ", N/A ,"$2,818.80 ","$3,993.30 ","$3,288.60 ", N/A , N/A ,"$4,463.10 ","$3,570.48 ","$3,523.50 ","$2,349.00 ","$3,993.30 ", N/A ,"$2,349.00 ","$2,349.00 ","$3,288.60 ","$2,861.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,993.30 ", N/A ,"$4,322.16 ","$3,288.60 ","$2,382.83 ","$2,859.67 ","$2,861.08 ","$2,859.67 ","$3,246.32 ","$4,228.20 ","$3,209.67 ", N/A ,"$3,711.42 ", N/A , N/A , N/A , N/A , N/A ,"$3,382.56 ","$2,912.76 ","$3,382.56 ","$3,382.56 ","$3,758.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM MH 48MM GG,278,1 ,"$4,698.00 ","$3,100.68 ","$2,349.00 ","$4,698.00 ", N/A ,"$2,476.32 ","$2,476.32 ", N/A ,"$2,818.80 ","$3,993.30 ","$3,288.60 ", N/A , N/A ,"$4,463.10 ","$3,570.48 ","$3,523.50 ","$2,349.00 ","$3,993.30 ", N/A ,"$2,349.00 ","$2,349.00 ","$3,288.60 ","$2,861.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,993.30 ", N/A ,"$4,322.16 ","$3,288.60 ","$2,382.83 ","$2,859.67 ","$2,861.08 ","$2,859.67 ","$3,246.32 ","$4,228.20 ","$3,209.67 ", N/A ,"$3,711.42 ", N/A , N/A , N/A , N/A , N/A ,"$3,382.56 ","$2,912.76 ","$3,382.56 ","$3,382.56 ","$3,758.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM MH 50MM HH,278,1 ,"$4,698.00 ","$3,100.68 ","$2,349.00 ","$4,698.00 ", N/A ,"$2,476.32 ","$2,476.32 ", N/A ,"$2,818.80 ","$3,993.30 ","$3,288.60 ", N/A , N/A ,"$4,463.10 ","$3,570.48 ","$3,523.50 ","$2,349.00 ","$3,993.30 ", N/A ,"$2,349.00 ","$2,349.00 ","$3,288.60 ","$2,861.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,993.30 ", N/A ,"$4,322.16 ","$3,288.60 ","$2,382.83 ","$2,859.67 ","$2,861.08 ","$2,859.67 ","$3,246.32 ","$4,228.20 ","$3,209.67 ", N/A ,"$3,711.42 ", N/A , N/A , N/A , N/A , N/A ,"$3,382.56 ","$2,912.76 ","$3,382.56 ","$3,382.56 ","$3,758.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM MH 52MM II,278,1 ,"$4,698.00 ","$3,100.68 ","$2,349.00 ","$4,698.00 ", N/A ,"$2,476.32 ","$2,476.32 ", N/A ,"$2,818.80 ","$3,993.30 ","$3,288.60 ", N/A , N/A ,"$4,463.10 ","$3,570.48 ","$3,523.50 ","$2,349.00 ","$3,993.30 ", N/A ,"$2,349.00 ","$2,349.00 ","$3,288.60 ","$2,861.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,993.30 ", N/A ,"$4,322.16 ","$3,288.60 ","$2,382.83 ","$2,859.67 ","$2,861.08 ","$2,859.67 ","$3,246.32 ","$4,228.20 ","$3,209.67 ", N/A ,"$3,711.42 ", N/A , N/A , N/A , N/A , N/A ,"$3,382.56 ","$2,912.76 ","$3,382.56 ","$3,382.56 ","$3,758.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM MH 54MM JJ,278,1 ,"$4,698.00 ","$3,100.68 ","$2,349.00 ","$4,698.00 ", N/A ,"$2,476.32 ","$2,476.32 ", N/A ,"$2,818.80 ","$3,993.30 ","$3,288.60 ", N/A , N/A ,"$4,463.10 ","$3,570.48 ","$3,523.50 ","$2,349.00 ","$3,993.30 ", N/A ,"$2,349.00 ","$2,349.00 ","$3,288.60 ","$2,861.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,993.30 ", N/A ,"$4,322.16 ","$3,288.60 ","$2,382.83 ","$2,859.67 ","$2,861.08 ","$2,859.67 ","$3,246.32 ","$4,228.20 ","$3,209.67 ", N/A ,"$3,711.42 ", N/A , N/A , N/A , N/A , N/A ,"$3,382.56 ","$2,912.76 ","$3,382.56 ","$3,382.56 ","$3,758.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM MH 56MM KK,278,1 ,"$4,698.00 ","$3,100.68 ","$2,349.00 ","$4,698.00 ", N/A ,"$2,476.32 ","$2,476.32 ", N/A ,"$2,818.80 ","$3,993.30 ","$3,288.60 ", N/A , N/A ,"$4,463.10 ","$3,570.48 ","$3,523.50 ","$2,349.00 ","$3,993.30 ", N/A ,"$2,349.00 ","$2,349.00 ","$3,288.60 ","$2,861.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,993.30 ", N/A ,"$4,322.16 ","$3,288.60 ","$2,382.83 ","$2,859.67 ","$2,861.08 ","$2,859.67 ","$3,246.32 ","$4,228.20 ","$3,209.67 ", N/A ,"$3,711.42 ", N/A , N/A , N/A , N/A , N/A ,"$3,382.56 ","$2,912.76 ","$3,382.56 ","$3,382.56 ","$3,758.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM MH 58MM LL,278,1 ,"$4,698.00 ","$3,100.68 ","$2,349.00 ","$4,698.00 ", N/A ,"$2,476.32 ","$2,476.32 ", N/A ,"$2,818.80 ","$3,993.30 ","$3,288.60 ", N/A , N/A ,"$4,463.10 ","$3,570.48 ","$3,523.50 ","$2,349.00 ","$3,993.30 ", N/A ,"$2,349.00 ","$2,349.00 ","$3,288.60 ","$2,861.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,993.30 ", N/A ,"$4,322.16 ","$3,288.60 ","$2,382.83 ","$2,859.67 ","$2,861.08 ","$2,859.67 ","$3,246.32 ","$4,228.20 ","$3,209.67 ", N/A ,"$3,711.42 ", N/A , N/A , N/A , N/A , N/A ,"$3,382.56 ","$2,912.76 ","$3,382.56 ","$3,382.56 ","$3,758.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM MH 60MM MM,278,1 ,"$4,698.00 ","$3,100.68 ","$2,349.00 ","$4,698.00 ", N/A ,"$2,476.32 ","$2,476.32 ", N/A ,"$2,818.80 ","$3,993.30 ","$3,288.60 ", N/A , N/A ,"$4,463.10 ","$3,570.48 ","$3,523.50 ","$2,349.00 ","$3,993.30 ", N/A ,"$2,349.00 ","$2,349.00 ","$3,288.60 ","$2,861.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,993.30 ", N/A ,"$4,322.16 ","$3,288.60 ","$2,382.83 ","$2,859.67 ","$2,861.08 ","$2,859.67 ","$3,246.32 ","$4,228.20 ","$3,209.67 ", N/A ,"$3,711.42 ", N/A , N/A , N/A , N/A , N/A ,"$3,382.56 ","$2,912.76 ","$3,382.56 ","$3,382.56 ","$3,758.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SHELL ZIMMER CONTINUUM TM MH 62MM NN,278,1 ,"$4,698.00 ","$3,100.68 ","$2,349.00 ","$4,698.00 ", N/A ,"$2,476.32 ","$2,476.32 ", N/A ,"$2,818.80 ","$3,993.30 ","$3,288.60 ", N/A , N/A ,"$4,463.10 ","$3,570.48 ","$3,523.50 ","$2,349.00 ","$3,993.30 ", N/A ,"$2,349.00 ","$2,349.00 ","$3,288.60 ","$2,861.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,993.30 ", N/A ,"$4,322.16 ","$3,288.60 ","$2,382.83 ","$2,859.67 ","$2,861.08 ","$2,859.67 ","$3,246.32 ","$4,228.20 ","$3,209.67 ", N/A ,"$3,711.42 ", N/A , N/A , N/A , N/A , N/A ,"$3,382.56 ","$2,912.76 ","$3,382.56 ","$3,382.56 ","$3,758.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEINMANN PIN SYNTHES WITH CENTRAL THREAD 5.0MM X 200MM,278,1 ,$292.50 ,$193.05 ,$148.36 ,$292.50 , N/A , N/A , N/A , N/A ,$175.50 ,$248.63 ,$204.75 , N/A , N/A ,$277.88 ,$222.30 ,$219.38 , N/A ,$248.63 , N/A , N/A , N/A ,$204.75 ,$178.13 , N/A , N/A , N/A , N/A , N/A ,$248.63 , N/A ,$269.10 ,$204.75 ,$148.36 ,$178.04 ,$178.13 ,$178.04 ,$202.12 ,$263.25 ,$199.84 , N/A ,$231.08 , N/A , N/A , N/A , N/A , N/A ,$210.60 ,$181.35 ,$210.60 ,$210.60 ,$234.00 
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM EXTENSION ZIMMER PERSONA FLUTED 10 X 130MM,278,1 ,"$3,021.00 ","$1,993.86 ","$1,510.50 ","$3,021.00 ", N/A ,"$1,592.37 ","$1,592.37 ", N/A ,"$1,812.60 ","$2,567.85 ","$2,114.70 ", N/A , N/A ,"$2,869.95 ","$2,295.96 ","$2,265.75 ","$1,510.50 ","$2,567.85 ", N/A ,"$1,510.50 ","$1,510.50 ","$2,114.70 ","$1,839.79 ", N/A , N/A , N/A , N/A , N/A ,"$2,567.85 ", N/A ,"$2,779.32 ","$2,114.70 ","$1,532.25 ","$1,838.88 ","$1,839.79 ","$1,838.88 ","$2,087.51 ","$2,718.90 ","$2,063.95 ", N/A ,"$2,386.59 ", N/A , N/A , N/A , N/A , N/A ,"$2,175.12 ","$1,873.02 ","$2,175.12 ","$2,175.12 ","$2,416.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM FEM 130MM 13MM CMNT CPT S,278,1 ,"$3,135.00 ","$2,069.10 ","$1,567.50 ","$3,135.00 ", N/A ,"$1,652.46 ","$1,652.46 ", N/A ,"$1,881.00 ","$2,664.75 ","$2,194.50 ", N/A , N/A ,"$2,978.25 ","$2,382.60 ","$2,351.25 ","$1,567.50 ","$2,664.75 ", N/A ,"$1,567.50 ","$1,567.50 ","$2,194.50 ","$1,909.22 ", N/A , N/A , N/A , N/A , N/A ,"$2,664.75 ", N/A ,"$2,884.20 ","$2,194.50 ","$1,590.07 ","$1,908.27 ","$1,909.22 ","$1,908.27 ","$2,166.29 ","$2,821.50 ","$2,141.83 ", N/A ,"$2,476.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,257.20 ","$1,943.70 ","$2,257.20 ","$2,257.20 ","$2,508.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM HIP OSTEONICS STRYKER 127 DEGREE SIZE 9,278,1 ,"$3,610.00 ","$2,382.60 ","$1,805.00 ","$3,610.00 ", N/A ,"$1,902.83 ","$1,902.83 ", N/A ,"$2,166.00 ","$3,068.50 ","$2,527.00 ", N/A , N/A ,"$3,429.50 ","$2,743.60 ","$2,707.50 ","$1,805.00 ","$3,068.50 ", N/A ,"$1,805.00 ","$1,805.00 ","$2,527.00 ","$2,198.49 ", N/A , N/A , N/A , N/A , N/A ,"$3,068.50 ", N/A ,"$3,321.20 ","$2,527.00 ","$1,830.99 ","$2,197.41 ","$2,198.49 ","$2,197.41 ","$2,494.51 ","$3,249.00 ","$2,466.35 ", N/A ,"$2,851.90 ", N/A , N/A , N/A , N/A , N/A ,"$2,599.20 ","$2,238.20 ","$2,599.20 ","$2,599.20 ","$2,888.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM HIP OSTEONICS STRYKER 127 DEGREE SIZE 8,278,1 ,"$3,610.00 ","$2,382.60 ","$1,805.00 ","$3,610.00 ", N/A ,"$1,902.83 ","$1,902.83 ", N/A ,"$2,166.00 ","$3,068.50 ","$2,527.00 ", N/A , N/A ,"$3,429.50 ","$2,743.60 ","$2,707.50 ","$1,805.00 ","$3,068.50 ", N/A ,"$1,805.00 ","$1,805.00 ","$2,527.00 ","$2,198.49 ", N/A , N/A , N/A , N/A , N/A ,"$3,068.50 ", N/A ,"$3,321.20 ","$2,527.00 ","$1,830.99 ","$2,197.41 ","$2,198.49 ","$2,197.41 ","$2,494.51 ","$3,249.00 ","$2,466.35 ", N/A ,"$2,851.90 ", N/A , N/A , N/A , N/A , N/A ,"$2,599.20 ","$2,238.20 ","$2,599.20 ","$2,599.20 ","$2,888.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM HUMERAL MINI BIOMET 13MM X 83MM,278,1 ,"$5,760.00 ","$3,801.60 ","$2,822.40 ","$5,760.00 ", N/A ,"$3,036.10 ","$3,036.10 ", N/A ,"$3,456.00 ","$4,896.00 ","$4,032.00 ", N/A , N/A ,"$5,472.00 ","$4,377.60 ","$4,320.00 ","$2,880.00 ","$4,896.00 ", N/A ,"$2,880.00 ","$2,880.00 ","$4,032.00 ","$3,507.84 ", N/A , N/A , N/A , N/A , N/A ,"$4,896.00 ", N/A ,"$5,299.20 ","$4,032.00 ","$2,921.47 ","$3,506.11 ","$3,507.84 ","$3,506.11 ","$3,980.16 ","$5,184.00 ","$3,935.23 ", N/A ,"$4,550.40 ", N/A ,"$2,822.40 ","$2,822.40 ", N/A ,"$2,822.40 ","$4,147.20 ","$3,571.20 ","$4,147.20 ","$4,147.20 ","$4,608.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 17X150MM,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 0 STD,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 2 STD,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 3 EXT,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 3 STD,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 4 STD,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 4EXT,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 5 EXT,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 5 STD,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE I EXT,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 11X120MM,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 12X125MM,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 13X130MM,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 13X130MM X-OFF,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 14X135MM,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 14X135MM X-OFF,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 15X140MM,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 15X140MM X-OFF,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 16X145MM,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMORAL VERSYS HERITAGE 16X145MM X-OFF,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMUR EXT OFFSET 17 X 145MM,278,1 ,"$2,650.50 ","$1,749.33 ","$1,325.25 ","$2,650.50 ", N/A ,"$1,397.08 ","$1,397.08 ", N/A ,"$1,590.30 ","$2,252.93 ","$1,855.35 ", N/A , N/A ,"$2,517.98 ","$2,014.38 ","$1,987.88 ","$1,325.25 ","$2,252.93 ", N/A ,"$1,325.25 ","$1,325.25 ","$1,855.35 ","$1,614.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,252.93 ", N/A ,"$2,438.46 ","$1,855.35 ","$1,344.33 ","$1,613.36 ","$1,614.15 ","$1,613.36 ","$1,831.50 ","$2,385.45 ","$1,810.82 ", N/A ,"$2,093.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.36 ","$1,643.31 ","$1,908.36 ","$1,908.36 ","$2,120.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMUR EXT OFFSET 11 X 145MM,278,1 ,"$2,650.50 ","$1,749.33 ","$1,325.25 ","$2,650.50 ", N/A ,"$1,397.08 ","$1,397.08 ", N/A ,"$1,590.30 ","$2,252.93 ","$1,855.35 ", N/A , N/A ,"$2,517.98 ","$2,014.38 ","$1,987.88 ","$1,325.25 ","$2,252.93 ", N/A ,"$1,325.25 ","$1,325.25 ","$1,855.35 ","$1,614.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,252.93 ", N/A ,"$2,438.46 ","$1,855.35 ","$1,344.33 ","$1,613.36 ","$1,614.15 ","$1,613.36 ","$1,831.50 ","$2,385.45 ","$1,810.82 ", N/A ,"$2,093.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.36 ","$1,643.31 ","$1,908.36 ","$1,908.36 ","$2,120.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMUR EXT OFFSET 12 X 145MM,278,1 ,"$2,650.50 ","$1,749.33 ","$1,325.25 ","$2,650.50 ", N/A ,"$1,397.08 ","$1,397.08 ", N/A ,"$1,590.30 ","$2,252.93 ","$1,855.35 ", N/A , N/A ,"$2,517.98 ","$2,014.38 ","$1,987.88 ","$1,325.25 ","$2,252.93 ", N/A ,"$1,325.25 ","$1,325.25 ","$1,855.35 ","$1,614.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,252.93 ", N/A ,"$2,438.46 ","$1,855.35 ","$1,344.33 ","$1,613.36 ","$1,614.15 ","$1,613.36 ","$1,831.50 ","$2,385.45 ","$1,810.82 ", N/A ,"$2,093.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.36 ","$1,643.31 ","$1,908.36 ","$1,908.36 ","$2,120.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMUR EXT OFFSET 13 X 145MM,278,1 ,"$2,650.50 ","$1,749.33 ","$1,325.25 ","$2,650.50 ", N/A ,"$1,397.08 ","$1,397.08 ", N/A ,"$1,590.30 ","$2,252.93 ","$1,855.35 ", N/A , N/A ,"$2,517.98 ","$2,014.38 ","$1,987.88 ","$1,325.25 ","$2,252.93 ", N/A ,"$1,325.25 ","$1,325.25 ","$1,855.35 ","$1,614.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,252.93 ", N/A ,"$2,438.46 ","$1,855.35 ","$1,344.33 ","$1,613.36 ","$1,614.15 ","$1,613.36 ","$1,831.50 ","$2,385.45 ","$1,810.82 ", N/A ,"$2,093.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.36 ","$1,643.31 ","$1,908.36 ","$1,908.36 ","$2,120.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMUR EXT OFFSET 14 X 145MM,278,1 ,"$2,650.50 ","$1,749.33 ","$1,325.25 ","$2,650.50 ", N/A ,"$1,397.08 ","$1,397.08 ", N/A ,"$1,590.30 ","$2,252.93 ","$1,855.35 ", N/A , N/A ,"$2,517.98 ","$2,014.38 ","$1,987.88 ","$1,325.25 ","$2,252.93 ", N/A ,"$1,325.25 ","$1,325.25 ","$1,855.35 ","$1,614.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,252.93 ", N/A ,"$2,438.46 ","$1,855.35 ","$1,344.33 ","$1,613.36 ","$1,614.15 ","$1,613.36 ","$1,831.50 ","$2,385.45 ","$1,810.82 ", N/A ,"$2,093.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.36 ","$1,643.31 ","$1,908.36 ","$1,908.36 ","$2,120.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMUR EXT OFFSET 15 X 145MM,278,1 ,"$2,650.50 ","$1,749.33 ","$1,325.25 ","$2,650.50 ", N/A ,"$1,397.08 ","$1,397.08 ", N/A ,"$1,590.30 ","$2,252.93 ","$1,855.35 ", N/A , N/A ,"$2,517.98 ","$2,014.38 ","$1,987.88 ","$1,325.25 ","$2,252.93 ", N/A ,"$1,325.25 ","$1,325.25 ","$1,855.35 ","$1,614.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,252.93 ", N/A ,"$2,438.46 ","$1,855.35 ","$1,344.33 ","$1,613.36 ","$1,614.15 ","$1,613.36 ","$1,831.50 ","$2,385.45 ","$1,810.82 ", N/A ,"$2,093.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.36 ","$1,643.31 ","$1,908.36 ","$1,908.36 ","$2,120.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMUR EXT OFFSET 16 X 145MM,278,1 ,"$2,650.50 ","$1,749.33 ","$1,325.25 ","$2,650.50 ", N/A ,"$1,397.08 ","$1,397.08 ", N/A ,"$1,590.30 ","$2,252.93 ","$1,855.35 ", N/A , N/A ,"$2,517.98 ","$2,014.38 ","$1,987.88 ","$1,325.25 ","$2,252.93 ", N/A ,"$1,325.25 ","$1,325.25 ","$1,855.35 ","$1,614.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,252.93 ", N/A ,"$2,438.46 ","$1,855.35 ","$1,344.33 ","$1,613.36 ","$1,614.15 ","$1,613.36 ","$1,831.50 ","$2,385.45 ","$1,810.82 ", N/A ,"$2,093.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.36 ","$1,643.31 ","$1,908.36 ","$1,908.36 ","$2,120.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEMUR EXT OFFSET 18 X 145MM,278,1 ,"$2,781.60 ","$1,835.86 ","$1,390.80 ","$2,781.60 ", N/A ,"$1,466.18 ","$1,466.18 ", N/A ,"$1,668.96 ","$2,364.36 ","$1,947.12 ", N/A , N/A ,"$2,642.52 ","$2,114.02 ","$2,086.20 ","$1,390.80 ","$2,364.36 ", N/A ,"$1,390.80 ","$1,390.80 ","$1,947.12 ","$1,693.99 ", N/A , N/A , N/A , N/A , N/A ,"$2,364.36 ", N/A ,"$2,559.07 ","$1,947.12 ","$1,410.83 ","$1,693.16 ","$1,693.99 ","$1,693.16 ","$1,922.09 ","$2,503.44 ","$1,900.39 ", N/A ,"$2,197.46 ", N/A , N/A , N/A , N/A , N/A ,"$2,002.75 ","$1,724.59 ","$2,002.75 ","$2,002.75 ","$2,225.28 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HUMERAL 14MM 130MM 48D SHOULDER,278,1 ,"$4,860.00 ","$3,207.60 ","$2,430.00 ","$4,860.00 ", N/A ,"$2,561.71 ","$2,561.71 ", N/A ,"$2,916.00 ","$4,131.00 ","$3,402.00 ", N/A , N/A ,"$4,617.00 ","$3,693.60 ","$3,645.00 ","$2,430.00 ","$4,131.00 ", N/A ,"$2,430.00 ","$2,430.00 ","$3,402.00 ","$2,959.74 ", N/A , N/A , N/A , N/A , N/A ,"$4,131.00 ", N/A ,"$4,471.20 ","$3,402.00 ","$2,464.99 ","$2,958.28 ","$2,959.74 ","$2,958.28 ","$3,358.26 ","$4,374.00 ","$3,320.35 ", N/A ,"$3,839.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,499.20 ","$3,013.20 ","$3,499.20 ","$3,499.20 ","$3,888.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM 9MM,278,1 ,"$4,860.00 ","$3,207.60 ","$2,430.00 ","$4,860.00 ", N/A ,"$2,561.71 ","$2,561.71 ", N/A ,"$2,916.00 ","$4,131.00 ","$3,402.00 ", N/A , N/A ,"$4,617.00 ","$3,693.60 ","$3,645.00 ","$2,430.00 ","$4,131.00 ", N/A ,"$2,430.00 ","$2,430.00 ","$3,402.00 ","$2,959.74 ", N/A , N/A , N/A , N/A , N/A ,"$4,131.00 ", N/A ,"$4,471.20 ","$3,402.00 ","$2,464.99 ","$2,958.28 ","$2,959.74 ","$2,958.28 ","$3,358.26 ","$4,374.00 ","$3,320.35 ", N/A ,"$3,839.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,499.20 ","$3,013.20 ","$3,499.20 ","$3,499.20 ","$3,888.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM MINI BIOMET 11MM X 83MM,278,1 ,"$4,860.00 ","$3,207.60 ","$2,430.00 ","$4,860.00 ", N/A ,"$2,561.71 ","$2,561.71 ", N/A ,"$2,916.00 ","$4,131.00 ","$3,402.00 ", N/A , N/A ,"$4,617.00 ","$3,693.60 ","$3,645.00 ","$2,430.00 ","$4,131.00 ", N/A ,"$2,430.00 ","$2,430.00 ","$3,402.00 ","$2,959.74 ", N/A , N/A , N/A , N/A , N/A ,"$4,131.00 ", N/A ,"$4,471.20 ","$3,402.00 ","$2,464.99 ","$2,958.28 ","$2,959.74 ","$2,958.28 ","$3,358.26 ","$4,374.00 ","$3,320.35 ", N/A ,"$3,839.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,499.20 ","$3,013.20 ","$3,499.20 ","$3,499.20 ","$3,888.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HUMERAL 10MM 130MM 48D SHOULDER,278,1 ,"$4,860.00 ","$3,207.60 ","$2,430.00 ","$4,860.00 ", N/A ,"$2,561.71 ","$2,561.71 ", N/A ,"$2,916.00 ","$4,131.00 ","$3,402.00 ", N/A , N/A ,"$4,617.00 ","$3,693.60 ","$3,645.00 ","$2,430.00 ","$4,131.00 ", N/A ,"$2,430.00 ","$2,430.00 ","$3,402.00 ","$2,959.74 ", N/A , N/A , N/A , N/A , N/A ,"$4,131.00 ", N/A ,"$4,471.20 ","$3,402.00 ","$2,464.99 ","$2,958.28 ","$2,959.74 ","$2,958.28 ","$3,358.26 ","$4,374.00 ","$3,320.35 ", N/A ,"$3,839.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,499.20 ","$3,013.20 ","$3,499.20 ","$3,499.20 ","$3,888.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HUMERAL 12MM 130MM 48D SHOULDER,278,1 ,"$4,860.00 ","$3,207.60 ","$2,430.00 ","$4,860.00 ", N/A ,"$2,561.71 ","$2,561.71 ", N/A ,"$2,916.00 ","$4,131.00 ","$3,402.00 ", N/A , N/A ,"$4,617.00 ","$3,693.60 ","$3,645.00 ","$2,430.00 ","$4,131.00 ", N/A ,"$2,430.00 ","$2,430.00 ","$3,402.00 ","$2,959.74 ", N/A , N/A , N/A , N/A , N/A ,"$4,131.00 ", N/A ,"$4,471.20 ","$3,402.00 ","$2,464.99 ","$2,958.28 ","$2,959.74 ","$2,958.28 ","$3,358.26 ","$4,374.00 ","$3,320.35 ", N/A ,"$3,839.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,499.20 ","$3,013.20 ","$3,499.20 ","$3,499.20 ","$3,888.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HUMERAL TM REV 14 X 130MM,278,1 ,"$9,000.00 ","$5,940.00 ","$4,410.00 ","$9,000.00 ", N/A ,"$4,743.90 ","$4,743.90 ", N/A ,"$5,400.00 ","$7,650.00 ","$6,300.00 ", N/A , N/A ,"$8,550.00 ","$6,840.00 ","$6,750.00 ","$4,500.00 ","$7,650.00 ", N/A ,"$4,500.00 ","$4,500.00 ","$6,300.00 ","$5,481.00 ", N/A , N/A , N/A , N/A , N/A ,"$7,650.00 ", N/A ,"$8,280.00 ","$6,300.00 ","$4,564.80 ","$5,478.30 ","$5,481.00 ","$5,478.30 ","$6,219.00 ","$8,100.00 ","$6,148.80 ", N/A ,"$7,110.00 ", N/A ,"$4,410.00 ","$4,410.00 ", N/A ,"$4,410.00 ","$6,480.00 ","$5,580.00 ","$6,480.00 ","$6,480.00 ","$7,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HUMERAL TM REV 10 X 130MM,278,1 ,"$9,000.00 ","$5,940.00 ","$4,410.00 ","$9,000.00 ", N/A ,"$4,743.90 ","$4,743.90 ", N/A ,"$5,400.00 ","$7,650.00 ","$6,300.00 ", N/A , N/A ,"$8,550.00 ","$6,840.00 ","$6,750.00 ","$4,500.00 ","$7,650.00 ", N/A ,"$4,500.00 ","$4,500.00 ","$6,300.00 ","$5,481.00 ", N/A , N/A , N/A , N/A , N/A ,"$7,650.00 ", N/A ,"$8,280.00 ","$6,300.00 ","$4,564.80 ","$5,478.30 ","$5,481.00 ","$5,478.30 ","$6,219.00 ","$8,100.00 ","$6,148.80 ", N/A ,"$7,110.00 ", N/A ,"$4,410.00 ","$4,410.00 ", N/A ,"$4,410.00 ","$6,480.00 ","$5,580.00 ","$6,480.00 ","$6,480.00 ","$7,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HUMERAL TM REV 12 X 130MM,278,1 ,"$9,000.00 ","$5,940.00 ","$4,410.00 ","$9,000.00 ", N/A ,"$4,743.90 ","$4,743.90 ", N/A ,"$5,400.00 ","$7,650.00 ","$6,300.00 ", N/A , N/A ,"$8,550.00 ","$6,840.00 ","$6,750.00 ","$4,500.00 ","$7,650.00 ", N/A ,"$4,500.00 ","$4,500.00 ","$6,300.00 ","$5,481.00 ", N/A , N/A , N/A , N/A , N/A ,"$7,650.00 ", N/A ,"$8,280.00 ","$6,300.00 ","$4,564.80 ","$5,478.30 ","$5,481.00 ","$5,478.30 ","$6,219.00 ","$8,100.00 ","$6,148.80 ", N/A ,"$7,110.00 ", N/A ,"$4,410.00 ","$4,410.00 ", N/A ,"$4,410.00 ","$6,480.00 ","$5,580.00 ","$6,480.00 ","$6,480.00 ","$7,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 12 X 145MM STR,278,1 ,"$2,131.80 ","$1,406.99 ","$1,081.25 ","$2,131.80 ", N/A ,"$1,123.67 ","$1,123.67 ", N/A ,"$1,279.08 ","$1,812.03 ","$1,492.26 ", N/A , N/A ,"$2,025.21 ","$1,620.17 ","$1,598.85 ", N/A ,"$1,812.03 ", N/A , N/A , N/A ,"$1,492.26 ","$1,298.27 ", N/A , N/A , N/A , N/A , N/A ,"$1,812.03 ", N/A ,"$1,961.26 ","$1,492.26 ","$1,081.25 ","$1,297.63 ","$1,298.27 ","$1,297.63 ","$1,473.07 ","$1,918.62 ","$1,456.45 ", N/A ,"$1,684.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,534.90 ","$1,321.72 ","$1,534.90 ","$1,534.90 ","$1,705.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 11 X 145MM STR,278,1 ,"$2,131.80 ","$1,406.99 ","$1,081.25 ","$2,131.80 ", N/A ,"$1,123.67 ","$1,123.67 ", N/A ,"$1,279.08 ","$1,812.03 ","$1,492.26 ", N/A , N/A ,"$2,025.21 ","$1,620.17 ","$1,598.85 ", N/A ,"$1,812.03 ", N/A , N/A , N/A ,"$1,492.26 ","$1,298.27 ", N/A , N/A , N/A , N/A , N/A ,"$1,812.03 ", N/A ,"$1,961.26 ","$1,492.26 ","$1,081.25 ","$1,297.63 ","$1,298.27 ","$1,297.63 ","$1,473.07 ","$1,918.62 ","$1,456.45 ", N/A ,"$1,684.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,534.90 ","$1,321.72 ","$1,534.90 ","$1,534.90 ","$1,705.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 14 X 120MM FLUTED,278,1 ,"$2,038.73 ","$1,345.56 ","$1,034.04 ","$2,038.73 ", N/A ,"$1,074.61 ","$1,074.61 ", N/A ,"$1,223.24 ","$1,732.92 ","$1,427.11 ", N/A , N/A ,"$1,936.79 ","$1,549.43 ","$1,529.05 ", N/A ,"$1,732.92 ", N/A , N/A , N/A ,"$1,427.11 ","$1,241.59 ", N/A , N/A , N/A , N/A , N/A ,"$1,732.92 ", N/A ,"$1,875.63 ","$1,427.11 ","$1,034.04 ","$1,240.98 ","$1,241.59 ","$1,240.98 ","$1,408.76 ","$1,834.86 ","$1,392.86 ", N/A ,"$1,610.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,467.89 ","$1,264.01 ","$1,467.89 ","$1,467.89 ","$1,630.98 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 12 X 120MM FLUTED,278,1 ,"$2,038.73 ","$1,345.56 ","$1,034.04 ","$2,038.73 ", N/A ,"$1,074.61 ","$1,074.61 ", N/A ,"$1,223.24 ","$1,732.92 ","$1,427.11 ", N/A , N/A ,"$1,936.79 ","$1,549.43 ","$1,529.05 ", N/A ,"$1,732.92 ", N/A , N/A , N/A ,"$1,427.11 ","$1,241.59 ", N/A , N/A , N/A , N/A , N/A ,"$1,732.92 ", N/A ,"$1,875.63 ","$1,427.11 ","$1,034.04 ","$1,240.98 ","$1,241.59 ","$1,240.98 ","$1,408.76 ","$1,834.86 ","$1,392.86 ", N/A ,"$1,610.60 ", N/A , N/A , N/A , N/A , N/A ,"$1,467.89 ","$1,264.01 ","$1,467.89 ","$1,467.89 ","$1,630.98 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 18 X 145MM STR,278,1 ,"$2,034.90 ","$1,343.03 ","$1,032.10 ","$2,034.90 ", N/A ,"$1,072.60 ","$1,072.60 ", N/A ,"$1,220.94 ","$1,729.67 ","$1,424.43 ", N/A , N/A ,"$1,933.16 ","$1,546.52 ","$1,526.18 ", N/A ,"$1,729.67 ", N/A , N/A , N/A ,"$1,424.43 ","$1,239.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,729.67 ", N/A ,"$1,872.11 ","$1,424.43 ","$1,032.10 ","$1,238.64 ","$1,239.25 ","$1,238.64 ","$1,406.12 ","$1,831.41 ","$1,390.24 ", N/A ,"$1,607.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,465.13 ","$1,261.64 ","$1,465.13 ","$1,465.13 ","$1,627.92 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 10 X 145MM STR,278,1 ,"$2,034.90 ","$1,343.03 ","$1,032.10 ","$2,034.90 ", N/A ,"$1,072.60 ","$1,072.60 ", N/A ,"$1,220.94 ","$1,729.67 ","$1,424.43 ", N/A , N/A ,"$1,933.16 ","$1,546.52 ","$1,526.18 ", N/A ,"$1,729.67 ", N/A , N/A , N/A ,"$1,424.43 ","$1,239.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,729.67 ", N/A ,"$1,872.11 ","$1,424.43 ","$1,032.10 ","$1,238.64 ","$1,239.25 ","$1,238.64 ","$1,406.12 ","$1,831.41 ","$1,390.24 ", N/A ,"$1,607.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,465.13 ","$1,261.64 ","$1,465.13 ","$1,465.13 ","$1,627.92 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 13 X 145MM STR,278,1 ,"$2,034.90 ","$1,343.03 ","$1,032.10 ","$2,034.90 ", N/A ,"$1,072.60 ","$1,072.60 ", N/A ,"$1,220.94 ","$1,729.67 ","$1,424.43 ", N/A , N/A ,"$1,933.16 ","$1,546.52 ","$1,526.18 ", N/A ,"$1,729.67 ", N/A , N/A , N/A ,"$1,424.43 ","$1,239.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,729.67 ", N/A ,"$1,872.11 ","$1,424.43 ","$1,032.10 ","$1,238.64 ","$1,239.25 ","$1,238.64 ","$1,406.12 ","$1,831.41 ","$1,390.24 ", N/A ,"$1,607.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,465.13 ","$1,261.64 ","$1,465.13 ","$1,465.13 ","$1,627.92 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 14 X 145MM STR,278,1 ,"$2,034.90 ","$1,343.03 ","$1,032.10 ","$2,034.90 ", N/A ,"$1,072.60 ","$1,072.60 ", N/A ,"$1,220.94 ","$1,729.67 ","$1,424.43 ", N/A , N/A ,"$1,933.16 ","$1,546.52 ","$1,526.18 ", N/A ,"$1,729.67 ", N/A , N/A , N/A ,"$1,424.43 ","$1,239.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,729.67 ", N/A ,"$1,872.11 ","$1,424.43 ","$1,032.10 ","$1,238.64 ","$1,239.25 ","$1,238.64 ","$1,406.12 ","$1,831.41 ","$1,390.24 ", N/A ,"$1,607.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,465.13 ","$1,261.64 ","$1,465.13 ","$1,465.13 ","$1,627.92 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 15 X 145MM STR,278,1 ,"$2,034.90 ","$1,343.03 ","$1,032.10 ","$2,034.90 ", N/A ,"$1,072.60 ","$1,072.60 ", N/A ,"$1,220.94 ","$1,729.67 ","$1,424.43 ", N/A , N/A ,"$1,933.16 ","$1,546.52 ","$1,526.18 ", N/A ,"$1,729.67 ", N/A , N/A , N/A ,"$1,424.43 ","$1,239.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,729.67 ", N/A ,"$1,872.11 ","$1,424.43 ","$1,032.10 ","$1,238.64 ","$1,239.25 ","$1,238.64 ","$1,406.12 ","$1,831.41 ","$1,390.24 ", N/A ,"$1,607.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,465.13 ","$1,261.64 ","$1,465.13 ","$1,465.13 ","$1,627.92 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 15 X 75MM STR,278,1 ,"$2,034.90 ","$1,343.03 ","$1,032.10 ","$2,034.90 ", N/A ,"$1,072.60 ","$1,072.60 ", N/A ,"$1,220.94 ","$1,729.67 ","$1,424.43 ", N/A , N/A ,"$1,933.16 ","$1,546.52 ","$1,526.18 ", N/A ,"$1,729.67 ", N/A , N/A , N/A ,"$1,424.43 ","$1,239.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,729.67 ", N/A ,"$1,872.11 ","$1,424.43 ","$1,032.10 ","$1,238.64 ","$1,239.25 ","$1,238.64 ","$1,406.12 ","$1,831.41 ","$1,390.24 ", N/A ,"$1,607.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,465.13 ","$1,261.64 ","$1,465.13 ","$1,465.13 ","$1,627.92 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 16 X 145MM,278,1 ,"$2,034.90 ","$1,343.03 ","$1,032.10 ","$2,034.90 ", N/A ,"$1,072.60 ","$1,072.60 ", N/A ,"$1,220.94 ","$1,729.67 ","$1,424.43 ", N/A , N/A ,"$1,933.16 ","$1,546.52 ","$1,526.18 ", N/A ,"$1,729.67 ", N/A , N/A , N/A ,"$1,424.43 ","$1,239.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,729.67 ", N/A ,"$1,872.11 ","$1,424.43 ","$1,032.10 ","$1,238.64 ","$1,239.25 ","$1,238.64 ","$1,406.12 ","$1,831.41 ","$1,390.24 ", N/A ,"$1,607.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,465.13 ","$1,261.64 ","$1,465.13 ","$1,465.13 ","$1,627.92 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TIBIAL EXT 17 X 145MM STR,278,1 ,"$2,034.90 ","$1,343.03 ","$1,032.10 ","$2,034.90 ", N/A ,"$1,072.60 ","$1,072.60 ", N/A ,"$1,220.94 ","$1,729.67 ","$1,424.43 ", N/A , N/A ,"$1,933.16 ","$1,546.52 ","$1,526.18 ", N/A ,"$1,729.67 ", N/A , N/A , N/A ,"$1,424.43 ","$1,239.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,729.67 ", N/A ,"$1,872.11 ","$1,424.43 ","$1,032.10 ","$1,238.64 ","$1,239.25 ","$1,238.64 ","$1,406.12 ","$1,831.41 ","$1,390.24 ", N/A ,"$1,607.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,465.13 ","$1,261.64 ","$1,465.13 ","$1,465.13 ","$1,627.92 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 18MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY EXTENDED 11MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY EXTENDED 12MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY EXTENDED 13MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY EXTENDED 14MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY EXTENDED 15MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY EXTENDED 16MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY EXTENDED 17MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY EXTENDED 18MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 09MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 10MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 11MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 12MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 13MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 14MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 15MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 16MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER TM PRIMARY STANDARD 17MM,278,1 ,"$5,310.00 ","$3,504.60 ","$2,655.00 ","$5,310.00 ", N/A ,"$2,798.90 ","$2,798.90 ", N/A ,"$3,186.00 ","$4,513.50 ","$3,717.00 ", N/A , N/A ,"$5,044.50 ","$4,035.60 ","$3,982.50 ","$2,655.00 ","$4,513.50 ", N/A ,"$2,655.00 ","$2,655.00 ","$3,717.00 ","$3,233.79 ", N/A , N/A , N/A , N/A , N/A ,"$4,513.50 ", N/A ,"$4,885.20 ","$3,717.00 ","$2,693.23 ","$3,232.20 ","$3,233.79 ","$3,232.20 ","$3,669.21 ","$4,779.00 ","$3,627.79 ", N/A ,"$4,194.90 ", N/A , N/A , N/A , N/A , N/A ,"$3,823.20 ","$3,292.20 ","$3,823.20 ","$3,823.20 ","$4,248.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 17 X 150 45MM STD V-LIGN,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 0 EXT,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 1 STD,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER CPT 12/14 COCR SIZE 2 EXT,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 11 X 120 36MM STD,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 12 X 125 39MM STD,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 12 X 125 42MM STD,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 13 X 130 39MM STD,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 13 X 130 44M EXT,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 14 X 135 42MM STD,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 14 X 135 47MM EXT V-LIGN,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 15 X 140 42MM STD V-LIGN,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 15 X 140 47MM EXT V-LIGN,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 16 X 145 45MM STD,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS ADV CEM 16 X 145 50MM EXT,278,1 ,"$3,087.50 ","$2,037.75 ","$1,543.75 ","$3,087.50 ", N/A ,"$1,627.42 ","$1,627.42 ", N/A ,"$1,852.50 ","$2,624.38 ","$2,161.25 ", N/A , N/A ,"$2,933.13 ","$2,346.50 ","$2,315.63 ","$1,543.75 ","$2,624.38 ", N/A ,"$1,543.75 ","$1,543.75 ","$2,161.25 ","$1,880.29 ", N/A , N/A , N/A , N/A , N/A ,"$2,624.38 ", N/A ,"$2,840.50 ","$2,161.25 ","$1,565.98 ","$1,879.36 ","$1,880.29 ","$1,879.36 ","$2,133.46 ","$2,778.75 ","$2,109.38 ", N/A ,"$2,439.13 ", N/A , N/A , N/A , N/A , N/A ,"$2,223.00 ","$1,914.25 ","$2,223.00 ","$2,223.00 ","$2,470.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 18X160MM STD BODY EXT NECK,278,1 ,"$4,500.00 ","$2,970.00 ","$2,250.00 ","$4,500.00 ", N/A ,"$2,371.95 ","$2,371.95 ", N/A ,"$2,700.00 ","$3,825.00 ","$3,150.00 ", N/A , N/A ,"$4,275.00 ","$3,420.00 ","$3,375.00 ","$2,250.00 ","$3,825.00 ", N/A ,"$2,250.00 ","$2,250.00 ","$3,150.00 ","$2,740.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,825.00 ", N/A ,"$4,140.00 ","$3,150.00 ","$2,282.40 ","$2,739.15 ","$2,740.50 ","$2,739.15 ","$3,109.50 ","$4,050.00 ","$3,074.40 ", N/A ,"$3,555.00 ", N/A , N/A , N/A , N/A , N/A ,"$3,240.00 ","$2,790.00 ","$3,240.00 ","$3,240.00 ","$3,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,COMPLETE KNEE SOLUTION CRUCIATE RETAINING CRFLEX FEMORAL,278,1 ,"$4,500.00 ","$2,970.00 ","$2,250.00 ","$4,500.00 ", N/A ,"$2,371.95 ","$2,371.95 ", N/A ,"$2,700.00 ","$3,825.00 ","$3,150.00 ", N/A , N/A ,"$4,275.00 ","$3,420.00 ","$3,375.00 ","$2,250.00 ","$3,825.00 ", N/A ,"$2,250.00 ","$2,250.00 ","$3,150.00 ","$2,740.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,825.00 ", N/A ,"$4,140.00 ","$3,150.00 ","$2,282.40 ","$2,739.15 ","$2,740.50 ","$2,739.15 ","$3,109.50 ","$4,050.00 ","$3,074.40 ", N/A ,"$3,555.00 ", N/A , N/A , N/A , N/A , N/A ,"$3,240.00 ","$2,790.00 ","$3,240.00 ","$3,240.00 ","$3,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 11X130MM LM BODY EXT NECK,278,1 ,"$4,500.00 ","$2,970.00 ","$2,250.00 ","$4,500.00 ", N/A ,"$2,371.95 ","$2,371.95 ", N/A ,"$2,700.00 ","$3,825.00 ","$3,150.00 ", N/A , N/A ,"$4,275.00 ","$3,420.00 ","$3,375.00 ","$2,250.00 ","$3,825.00 ", N/A ,"$2,250.00 ","$2,250.00 ","$3,150.00 ","$2,740.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,825.00 ", N/A ,"$4,140.00 ","$3,150.00 ","$2,282.40 ","$2,739.15 ","$2,740.50 ","$2,739.15 ","$3,109.50 ","$4,050.00 ","$3,074.40 ", N/A ,"$3,555.00 ", N/A , N/A , N/A , N/A , N/A ,"$3,240.00 ","$2,790.00 ","$3,240.00 ","$3,240.00 ","$3,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 17X160MM LM BODY STD NECK,278,1 ,"$4,500.00 ","$2,970.00 ","$2,250.00 ","$4,500.00 ", N/A ,"$2,371.95 ","$2,371.95 ", N/A ,"$2,700.00 ","$3,825.00 ","$3,150.00 ", N/A , N/A ,"$4,275.00 ","$3,420.00 ","$3,375.00 ","$2,250.00 ","$3,825.00 ", N/A ,"$2,250.00 ","$2,250.00 ","$3,150.00 ","$2,740.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,825.00 ", N/A ,"$4,140.00 ","$3,150.00 ","$2,282.40 ","$2,739.15 ","$2,740.50 ","$2,739.15 ","$3,109.50 ","$4,050.00 ","$3,074.40 ", N/A ,"$3,555.00 ", N/A , N/A , N/A , N/A , N/A ,"$3,240.00 ","$2,790.00 ","$3,240.00 ","$3,240.00 ","$3,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 18X160MM LM BODY EXT NECK CEMENTLESS,278,1 ,"$4,500.00 ","$2,970.00 ","$2,250.00 ","$4,500.00 ", N/A ,"$2,371.95 ","$2,371.95 ", N/A ,"$2,700.00 ","$3,825.00 ","$3,150.00 ", N/A , N/A ,"$4,275.00 ","$3,420.00 ","$3,375.00 ","$2,250.00 ","$3,825.00 ", N/A ,"$2,250.00 ","$2,250.00 ","$3,150.00 ","$2,740.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,825.00 ", N/A ,"$4,140.00 ","$3,150.00 ","$2,282.40 ","$2,739.15 ","$2,740.50 ","$2,739.15 ","$3,109.50 ","$4,050.00 ","$3,074.40 ", N/A ,"$3,555.00 ", N/A , N/A , N/A , N/A , N/A ,"$3,240.00 ","$2,790.00 ","$3,240.00 ","$3,240.00 ","$3,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR LM 16 X 160MM,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM FEMORAL 129MM 15MM PRIMARY M/L TAPER TIVANIUM POROUS 12/14 46MM STANDARD OFFSET HIP STERILE,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM FEMORAL 132MM 16.25MM PRIMARY M/L TAPER TIVANIUM POROUS 12/14 52MM EXTEND OFFSET HIP STERILE,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM FEMORAL ZIMMER 130MM 11MM 41MM EXTEND OFFSET STRAIGHT HIP,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM EXT M/L TAPER 10,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM EXT M/L TAPER 11,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM EXT M/L TAPER 12.5,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM EXT M/L TAPER 13.5,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM EXT M/L TAPER 15,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM EXT M/L TAPER 17.5,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM EXT M/L TAPER 9,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM STD M/L TAPER 10,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM STD M/L TAPER 11,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM STD M/L TAPER 12.5,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM STD M/L TAPER 13.5,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM STD M/L TAPER 16.25,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM STD M/L TAPER 5,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM STD M/L TAPER 7.5,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER FEM STD M/L TAPER 9,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 11X130MM STD BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 12X140MM LM BODY EXT NECK CEMENTLESS,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 12X140MM LM BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 12X140MM STD BODY EXT NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 12X140MM STD BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 13X140MM LM BODY EXT NECK CEMENTLESS,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 13X140MM LM BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 13X140MM STD BODY EXT NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 13X140MM STD BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 14X140MM LM BODY EXT NECK CEMENTLESS,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 14X140MM STD BODY EXT NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 14X140MM STD BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 15X160MM LM BODY EXT NECK CEMENTLESS,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 15X160MM STD BODY EXT NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 15X160MM STD BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 16X160MM LM BODY EXT NECK CEMENTLESS,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 16X160MM STD BODY EXT NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 16X160MM STD BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 17X160MM LM BODY EXT NECK CEMENTLESS,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 17X160MM STD BODY EXT NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 17X160MM STD BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 18X160MM LM BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR 18X160MM STD BODY STD NECK,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR LM 14 X 140MM STD BODY,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS FM MC CLR LM 15 X 160MM STD BODY,278,1 ,"$4,140.00 ","$2,732.40 ","$2,070.00 ","$4,140.00 ", N/A ,"$2,182.19 ","$2,182.19 ", N/A ,"$2,484.00 ","$3,519.00 ","$2,898.00 ", N/A , N/A ,"$3,933.00 ","$3,146.40 ","$3,105.00 ","$2,070.00 ","$3,519.00 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,898.00 ","$2,521.26 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.00 ", N/A ,"$3,808.80 ","$2,898.00 ","$2,099.81 ","$2,520.02 ","$2,521.26 ","$2,520.02 ","$2,860.74 ","$3,726.00 ","$2,828.45 ", N/A ,"$3,270.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,980.80 ","$2,566.80 ","$2,980.80 ","$2,980.80 ","$3,312.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICLUAR 14MM 3-7 C-D LEFT KNEE,N/A,1 ,"$1,995.00 ", N/A ,"$1,362.98 ","$1,795.50 ", N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,"$1,795.50 ","$1,362.98 ", 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 NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 66X42X23MM NEXGEN 3-4 C-H STANDARD KNEE UHMWPE CRUCIATE RETAIN ANTERIOR CONSTRAIN MACHINE MOLD STERILE,278,1 ,"$1,435.00 ",$947.10 ,$727.83 ,"$1,435.00 ", N/A ,$756.39 ,$756.39 , N/A ,$861.00 ,"$1,219.75 ","$1,004.50 ", N/A , N/A ,"$1,363.25 ","$1,090.60 ","$1,076.25 ", N/A ,"$1,219.75 ", N/A , N/A , N/A ,"$1,004.50 ",$873.92 , N/A , N/A , N/A , N/A , N/A ,"$1,219.75 ", N/A ,"$1,320.20 ","$1,004.50 ",$727.83 ,$873.48 ,$873.92 ,$873.48 ,$991.59 ,"$1,291.50 ",$980.39 , N/A ,"$1,133.65 ", N/A , N/A , N/A , N/A , N/A ,"$1,033.20 ",$889.70 ,"$1,033.20 ","$1,033.20 ","$1,148.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 3-4/YELLOW 17MM,278,1 ,"$1,435.00 ",$947.10 ,$727.83 ,"$1,435.00 ", N/A ,$756.39 ,$756.39 , N/A ,$861.00 ,"$1,219.75 ","$1,004.50 ", N/A , N/A ,"$1,363.25 ","$1,090.60 ","$1,076.25 ", N/A ,"$1,219.75 ", N/A , N/A , N/A ,"$1,004.50 ",$873.92 , N/A , N/A , N/A , N/A , N/A ,"$1,219.75 ", N/A ,"$1,320.20 ","$1,004.50 ",$727.83 ,$873.48 ,$873.92 ,$873.48 ,$991.59 ,"$1,291.50 ",$980.39 , N/A ,"$1,133.65 ", N/A , N/A , N/A , N/A , N/A ,"$1,033.20 ",$889.70 ,"$1,033.20 ","$1,033.20 ","$1,148.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 5-6/GREEN 10MM,278,1 ,"$1,435.00 ",$947.10 ,$727.83 ,"$1,435.00 ", N/A ,$756.39 ,$756.39 , N/A ,$861.00 ,"$1,219.75 ","$1,004.50 ", N/A , N/A ,"$1,363.25 ","$1,090.60 ","$1,076.25 ", N/A ,"$1,219.75 ", N/A , N/A , N/A ,"$1,004.50 ",$873.92 , N/A , N/A , N/A , N/A , N/A ,"$1,219.75 ", N/A ,"$1,320.20 ","$1,004.50 ",$727.83 ,$873.48 ,$873.92 ,$873.48 ,$991.59 ,"$1,291.50 ",$980.39 , N/A ,"$1,133.65 ", N/A , N/A , N/A , N/A , N/A ,"$1,033.20 ",$889.70 ,"$1,033.20 ","$1,033.20 ","$1,148.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 7-10/BLUE 12MM,278,1 ,"$1,435.00 ",$947.10 ,$727.83 ,"$1,435.00 ", N/A ,$756.39 ,$756.39 , N/A ,$861.00 ,"$1,219.75 ","$1,004.50 ", N/A , N/A ,"$1,363.25 ","$1,090.60 ","$1,076.25 ", N/A ,"$1,219.75 ", N/A , N/A , N/A ,"$1,004.50 ",$873.92 , N/A , N/A , N/A , N/A , N/A ,"$1,219.75 ", N/A ,"$1,320.20 ","$1,004.50 ",$727.83 ,$873.48 ,$873.92 ,$873.48 ,$991.59 ,"$1,291.50 ",$980.39 , N/A ,"$1,133.65 ", N/A , N/A , N/A , N/A , N/A ,"$1,033.20 ",$889.70 ,"$1,033.20 ","$1,033.20 ","$1,148.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 74X46X14MM NEXGEN CR-FLEX 5-6 C-H STANDARD KNEE UHMWPE NET MOLD STERILE,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 3-4/YELLOW 10MM,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 3-4/YELLOW 12MM,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 3-4/YELLOW 14MM,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 5-6/GREEN 12MM,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 5-6/GREEN 14MM,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 5-6/GREEN 17MM,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 7-10/BLUE 10MM,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 7-10/BLUE 14MM,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,ARTICULAR SURFACE ZIMMER AC 7-10/BLUE 17MM,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 66X42X10MM NEXGEN CR-FLEX 3-4 C-H STANDARD KNEE UHMWPE NET MOLD STERILE,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,SURFACE ARTICULAR 74X46X12MM NEXGEN CR-FLEX 5-6 C-H STANDARD KNEE UHMWPE NET MOLD STERILE,278,1 ,"$1,486.25 ",$980.93 ,$753.83 ,"$1,486.25 ", N/A ,$783.40 ,$783.40 , N/A ,$891.75 ,"$1,263.31 ","$1,040.38 ", N/A , N/A ,"$1,411.94 ","$1,129.55 ","$1,114.69 ", N/A ,"$1,263.31 ", N/A , N/A , N/A ,"$1,040.38 ",$905.13 , N/A , N/A , N/A , N/A , N/A ,"$1,263.31 ", N/A ,"$1,367.35 ","$1,040.38 ",$753.83 ,$904.68 ,$905.13 ,$904.68 ,"$1,027.00 ","$1,337.63 ","$1,015.41 ", N/A ,"$1,174.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,070.10 ",$921.48 ,"$1,070.10 ","$1,070.10 ","$1,189.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TRAY HUMERAL COMPREHENSIVE REVERSE SHOULDER BIOMET,278,1 ,"$2,375.00 ","$1,567.50 ","$1,204.60 ","$2,375.00 ", N/A ,"$1,251.86 ","$1,251.86 ", N/A ,"$1,425.00 ","$2,018.75 ","$1,662.50 ", N/A , N/A ,"$2,256.25 ","$1,805.00 ","$1,781.25 ", N/A ,"$2,018.75 ", N/A , N/A , N/A ,"$1,662.50 ","$1,446.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,018.75 ", N/A ,"$2,185.00 ","$1,662.50 ","$1,204.60 ","$1,445.66 ","$1,446.38 ","$1,445.66 ","$1,641.13 ","$2,137.50 ","$1,622.60 ", N/A ,"$1,876.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,710.00 ","$1,472.50 ","$1,710.00 ","$1,710.00 ","$1,900.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HIP VERSYS CEMENTED LD/FX 11 X 120,278,1 ,"$2,375.00 ","$1,567.50 ","$1,204.60 ","$2,375.00 ", N/A ,"$1,251.86 ","$1,251.86 ", N/A ,"$1,425.00 ","$2,018.75 ","$1,662.50 ", N/A , N/A ,"$2,256.25 ","$1,805.00 ","$1,781.25 ", N/A ,"$2,018.75 ", N/A , N/A , N/A ,"$1,662.50 ","$1,446.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,018.75 ", N/A ,"$2,185.00 ","$1,662.50 ","$1,204.60 ","$1,445.66 ","$1,446.38 ","$1,445.66 ","$1,641.13 ","$2,137.50 ","$1,622.60 ", N/A ,"$1,876.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,710.00 ","$1,472.50 ","$1,710.00 ","$1,710.00 ","$1,900.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HIP VERSYS CEMENTED LD/FX 12 X 125,278,1 ,"$2,375.00 ","$1,567.50 ","$1,204.60 ","$2,375.00 ", N/A ,"$1,251.86 ","$1,251.86 ", N/A ,"$1,425.00 ","$2,018.75 ","$1,662.50 ", N/A , N/A ,"$2,256.25 ","$1,805.00 ","$1,781.25 ", N/A ,"$2,018.75 ", N/A , N/A , N/A ,"$1,662.50 ","$1,446.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,018.75 ", N/A ,"$2,185.00 ","$1,662.50 ","$1,204.60 ","$1,445.66 ","$1,446.38 ","$1,445.66 ","$1,641.13 ","$2,137.50 ","$1,622.60 ", N/A ,"$1,876.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,710.00 ","$1,472.50 ","$1,710.00 ","$1,710.00 ","$1,900.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HIP VERSYS CEMENTED LD/FX 14 X 135,278,1 ,"$2,375.00 ","$1,567.50 ","$1,204.60 ","$2,375.00 ", N/A ,"$1,251.86 ","$1,251.86 ", N/A ,"$1,425.00 ","$2,018.75 ","$1,662.50 ", N/A , N/A ,"$2,256.25 ","$1,805.00 ","$1,781.25 ", N/A ,"$2,018.75 ", N/A , N/A , N/A ,"$1,662.50 ","$1,446.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,018.75 ", N/A ,"$2,185.00 ","$1,662.50 ","$1,204.60 ","$1,445.66 ","$1,446.38 ","$1,445.66 ","$1,641.13 ","$2,137.50 ","$1,622.60 ", N/A ,"$1,876.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,710.00 ","$1,472.50 ","$1,710.00 ","$1,710.00 ","$1,900.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER HIP VERSYS CEMENTED LD/FX 16 X 145,278,1 ,"$2,375.00 ","$1,567.50 ","$1,204.60 ","$2,375.00 ", N/A ,"$1,251.86 ","$1,251.86 ", N/A ,"$1,425.00 ","$2,018.75 ","$1,662.50 ", N/A , N/A ,"$2,256.25 ","$1,805.00 ","$1,781.25 ", N/A ,"$2,018.75 ", N/A , N/A , N/A ,"$1,662.50 ","$1,446.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,018.75 ", N/A ,"$2,185.00 ","$1,662.50 ","$1,204.60 ","$1,445.66 ","$1,446.38 ","$1,445.66 ","$1,641.13 ","$2,137.50 ","$1,622.60 ", N/A ,"$1,876.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,710.00 ","$1,472.50 ","$1,710.00 ","$1,710.00 ","$1,900.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,STEM ZIMMER VERSYS PRESS FIT LD/FX SZ 11X120MM,278,1 ,"$2,375.00 ","$1,567.50 ","$1,204.60 ","$2,375.00 ", N/A ,"$1,251.86 ","$1,251.86 ", N/A ,"$1,425.00 ","$2,018.75 ","$1,662.50 ", N/A , N/A ,"$2,256.25 ","$1,805.00 ","$1,781.25 ", N/A ,"$2,018.75 ", N/A , N/A , N/A ,"$1,662.50 ","$1,446.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,018.75 ", N/A ,"$2,185.00 ","$1,662.50 ","$1,204.60 ","$1,445.66 ","$1,446.38 ","$1,445.66 ","$1,641.13 ","$2,137.50 ","$1,622.60 ", N/A ,"$1,876.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,710.00 ","$1,472.50 ","$1,710.00 ","$1,710.00 ","$1,900.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TRAY TIBIAL SCORPIO 9 STANDARD KNEE PRIMARY POSTERIOR STABILIZE CRUCIATE RETAIN WAFFLE SERIES 7000,278,1 ,"$1,979.80 ","$1,306.67 ","$1,004.15 ","$1,979.80 ", N/A ,"$1,043.55 ","$1,043.55 ", N/A ,"$1,187.88 ","$1,682.83 ","$1,385.86 ", N/A , N/A ,"$1,880.81 ","$1,504.65 ","$1,484.85 ", N/A ,"$1,682.83 ", N/A , N/A , N/A ,"$1,385.86 ","$1,205.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.83 ", N/A ,"$1,821.42 ","$1,385.86 ","$1,004.15 ","$1,205.10 ","$1,205.70 ","$1,205.10 ","$1,368.04 ","$1,781.82 ","$1,352.60 ", N/A ,"$1,564.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,425.46 ","$1,227.48 ","$1,425.46 ","$1,425.46 ","$1,583.84 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TRAY TIBIAL SCORPIO 11 STANDARD KNEE PRIMARY POSTERIOR STABILIZE CRUCIATE RETAIN WAFFLE SERIES 7000,278,1 ,"$1,979.80 ","$1,306.67 ","$1,004.15 ","$1,979.80 ", N/A ,"$1,043.55 ","$1,043.55 ", N/A ,"$1,187.88 ","$1,682.83 ","$1,385.86 ", N/A , N/A ,"$1,880.81 ","$1,504.65 ","$1,484.85 ", N/A ,"$1,682.83 ", N/A , N/A , N/A ,"$1,385.86 ","$1,205.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.83 ", N/A ,"$1,821.42 ","$1,385.86 ","$1,004.15 ","$1,205.10 ","$1,205.70 ","$1,205.10 ","$1,368.04 ","$1,781.82 ","$1,352.60 ", N/A ,"$1,564.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,425.46 ","$1,227.48 ","$1,425.46 ","$1,425.46 ","$1,583.84 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TRAY TIBIAL SCORPIO 5 STANDARD KNEE PRIMARY POSTERIOR STABILIZE CRUCIATE RETAIN WAFFLE SERIES 7000,278,1 ,"$1,979.80 ","$1,306.67 ","$1,004.15 ","$1,979.80 ", N/A ,"$1,043.55 ","$1,043.55 ", N/A ,"$1,187.88 ","$1,682.83 ","$1,385.86 ", N/A , N/A ,"$1,880.81 ","$1,504.65 ","$1,484.85 ", N/A ,"$1,682.83 ", N/A , N/A , N/A ,"$1,385.86 ","$1,205.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.83 ", N/A ,"$1,821.42 ","$1,385.86 ","$1,004.15 ","$1,205.10 ","$1,205.70 ","$1,205.10 ","$1,368.04 ","$1,781.82 ","$1,352.60 ", N/A ,"$1,564.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,425.46 ","$1,227.48 ","$1,425.46 ","$1,425.46 ","$1,583.84 "
ST NICHOLAS HOSPITAL - ACUTE,27871776,C1776,TRAY TIBIAL SCORPIO 7 STANDARD KNEE PRIMARY POSTERIOR STABILIZE CRUCIATE RETAIN WAFFLE SERIES 7000,278,1 ,"$1,979.80 ","$1,306.67 ","$1,004.15 ","$1,979.80 ", N/A ,"$1,043.55 ","$1,043.55 ", N/A ,"$1,187.88 ","$1,682.83 ","$1,385.86 ", N/A , N/A ,"$1,880.81 ","$1,504.65 ","$1,484.85 ", N/A ,"$1,682.83 ", N/A , N/A , N/A ,"$1,385.86 ","$1,205.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.83 ", N/A ,"$1,821.42 ","$1,385.86 ","$1,004.15 ","$1,205.10 ","$1,205.70 ","$1,205.10 ","$1,368.04 ","$1,781.82 ","$1,352.60 ", N/A ,"$1,564.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,425.46 ","$1,227.48 ","$1,425.46 ","$1,425.46 ","$1,583.84 "
ST NICHOLAS HOSPITAL - ACUTE,27871778,C1778,KIT SPINAL LEAD  MEDTRONIC,278,1 ,"$3,230.00 ","$2,131.80 ","$1,615.00 ","$3,230.00 ", N/A ,"$1,702.53 ","$1,702.53 ", N/A ,"$1,938.00 ","$2,745.50 ","$2,261.00 ", N/A , N/A ,"$3,068.50 ","$2,454.80 ","$2,422.50 ","$1,615.00 ","$2,745.50 ", N/A ,"$1,615.00 ","$1,615.00 ","$2,261.00 ","$1,967.07 ", N/A , N/A , N/A , N/A , N/A ,"$2,745.50 ", N/A ,"$2,971.60 ","$2,261.00 ","$1,638.26 ","$1,966.10 ","$1,967.07 ","$1,966.10 ","$2,231.93 ","$2,907.00 ","$2,206.74 ", N/A ,"$2,551.70 ", N/A , N/A , N/A , N/A , N/A ,"$2,325.60 ","$2,002.60 ","$2,325.60 ","$2,325.60 ","$2,584.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871778,C1778,LEAD NEUROSTIMULATOR 28CM INTERSTIM QUADRIPOLAR WITHOUT MRI CAPABILITY,278,1 ,"$5,688.00 ","$3,754.08 ","$2,844.00 ","$5,688.00 ", N/A ,"$2,998.14 ","$2,998.14 ", N/A ,"$3,412.80 ","$4,834.80 ","$3,981.60 ", N/A , N/A ,"$5,403.60 ","$4,322.88 ","$4,266.00 ","$2,844.00 ","$4,834.80 ", N/A ,"$2,844.00 ","$2,844.00 ","$3,981.60 ","$3,463.99 ", N/A , N/A , N/A , N/A , N/A ,"$4,834.80 ", N/A ,"$5,232.96 ","$3,981.60 ","$2,884.95 ","$3,462.29 ","$3,463.99 ","$3,462.29 ","$3,930.41 ","$5,119.20 ","$3,886.04 ", N/A ,"$4,493.52 ", N/A , N/A , N/A , N/A , N/A ,"$4,095.36 ","$3,526.56 ","$4,095.36 ","$4,095.36 ","$4,550.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH 3DMAX LEFT MID LARGE 16X10CM INGUINAL,278,1 ,$478.38 ,$315.73 ,$242.63 ,$478.38 , N/A , N/A , N/A , N/A ,$287.03 ,$406.62 ,$334.87 , N/A , N/A ,$454.46 ,$363.57 ,$358.79 , N/A ,$406.62 , N/A , N/A , N/A ,$334.87 ,$291.33 , N/A , N/A , N/A , N/A , N/A ,$406.62 , N/A ,$440.11 ,$334.87 ,$242.63 ,$291.19 ,$291.33 ,$291.19 ,$330.56 ,$430.54 ,$326.83 , N/A ,$377.92 , N/A , N/A , N/A , N/A , N/A ,$344.43 ,$296.60 ,$344.43 ,$344.43 ,$382.70 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH 3DMAX RIGHT MID MEDIUM 8CMX13CM INGUINAL,278,1 ,$449.35 ,$296.57 ,$227.91 ,$449.35 , N/A , N/A , N/A , N/A ,$269.61 ,$381.95 ,$314.55 , N/A , N/A ,$426.88 ,$341.51 ,$337.01 , N/A ,$381.95 , N/A , N/A , N/A ,$314.55 ,$273.65 , N/A , N/A , N/A , N/A , N/A ,$381.95 , N/A ,$413.40 ,$314.55 ,$227.91 ,$273.52 ,$273.65 ,$273.52 ,$310.50 ,$404.42 ,$307.00 , N/A ,$354.99 , N/A , N/A , N/A , N/A , N/A ,$323.53 ,$278.60 ,$323.53 ,$323.53 ,$359.48 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH 3DMAX LEFT MID MEDIUM 8CMX13CM INGUINAL,278,1 ,$449.35 ,$296.57 ,$227.91 ,$449.35 , N/A , N/A , N/A , N/A ,$269.61 ,$381.95 ,$314.55 , N/A , N/A ,$426.88 ,$341.51 ,$337.01 , N/A ,$381.95 , N/A , N/A , N/A ,$314.55 ,$273.65 , N/A , N/A , N/A , N/A , N/A ,$381.95 , N/A ,$413.40 ,$314.55 ,$227.91 ,$273.52 ,$273.65 ,$273.52 ,$310.50 ,$404.42 ,$307.00 , N/A ,$354.99 , N/A , N/A , N/A , N/A , N/A ,$323.53 ,$278.60 ,$323.53 ,$323.53 ,$359.48 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD 3D MAX INGUINAL 5 X 3 RIGHT,278,1 ,$348.98 ,$230.33 ,$177.00 ,$348.98 , N/A , N/A , N/A , N/A ,$209.39 ,$296.63 ,$244.29 , N/A , N/A ,$331.53 ,$265.22 ,$261.74 , N/A ,$296.63 , N/A , N/A , N/A ,$244.29 ,$212.53 , N/A , N/A , N/A , N/A , N/A ,$296.63 , N/A ,$321.06 ,$244.29 ,$177.00 ,$212.42 ,$212.53 ,$212.42 ,$241.15 ,$314.08 ,$238.42 , N/A ,$275.69 , N/A , N/A , N/A , N/A , N/A ,$251.27 ,$216.37 ,$251.27 ,$251.27 ,$279.18 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD 3D MAX INGUINAL 5 X 3 LEFT,278,1 ,$348.98 ,$230.33 ,$177.00 ,$348.98 , N/A , N/A , N/A , N/A ,$209.39 ,$296.63 ,$244.29 , N/A , N/A ,$331.53 ,$265.22 ,$261.74 , N/A ,$296.63 , N/A , N/A , N/A ,$244.29 ,$212.53 , N/A , N/A , N/A , N/A , N/A ,$296.63 , N/A ,$321.06 ,$244.29 ,$177.00 ,$212.42 ,$212.53 ,$212.42 ,$241.15 ,$314.08 ,$238.42 , N/A ,$275.69 , N/A , N/A , N/A , N/A , N/A ,$251.27 ,$216.37 ,$251.27 ,$251.27 ,$279.18 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD 3D MAX INGUINAL 6 X 4 RIGHT,278,1 ,$371.25 ,$245.03 ,$188.30 ,$371.25 , N/A , N/A , N/A , N/A ,$222.75 ,$315.56 ,$259.88 , N/A , N/A ,$352.69 ,$282.15 ,$278.44 , N/A ,$315.56 , N/A , N/A , N/A ,$259.88 ,$226.09 , N/A , N/A , N/A , N/A , N/A ,$315.56 , N/A ,$341.55 ,$259.88 ,$188.30 ,$225.98 ,$226.09 ,$225.98 ,$256.53 ,$334.13 ,$253.64 , N/A ,$293.29 , N/A , N/A , N/A , N/A , N/A ,$267.30 ,$230.18 ,$267.30 ,$267.30 ,$297.00 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD 3D MAX INGUINAL 6 X 4 LEFT,278,1 ,$371.25 ,$245.03 ,$188.30 ,$371.25 , N/A , N/A , N/A , N/A ,$222.75 ,$315.56 ,$259.88 , N/A , N/A ,$352.69 ,$282.15 ,$278.44 , N/A ,$315.56 , N/A , N/A , N/A ,$259.88 ,$226.09 , N/A , N/A , N/A , N/A , N/A ,$315.56 , N/A ,$341.55 ,$259.88 ,$188.30 ,$225.98 ,$226.09 ,$225.98 ,$256.53 ,$334.13 ,$253.64 , N/A ,$293.29 , N/A , N/A , N/A , N/A , N/A ,$267.30 ,$230.18 ,$267.30 ,$267.30 ,$297.00 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD 3D MAX LARGE RIGHT 4.1 X 6.2 0117321,278,1 ,$455.59 ,$300.69 ,$231.08 ,$455.59 , N/A , N/A , N/A , N/A ,$273.35 ,$387.25 ,$318.91 , N/A , N/A ,$432.81 ,$346.25 ,$341.69 , N/A ,$387.25 , N/A , N/A , N/A ,$318.91 ,$277.45 , N/A , N/A , N/A , N/A , N/A ,$387.25 , N/A ,$419.14 ,$318.91 ,$231.08 ,$277.32 ,$277.45 ,$277.32 ,$314.81 ,$410.03 ,$311.26 , N/A ,$359.92 , N/A , N/A , N/A , N/A , N/A ,$328.02 ,$282.47 ,$328.02 ,$328.02 ,$364.47 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD 3D MAX LARGE LEFT 4.1 X 6.2 0117311,278,1 ,$455.59 ,$300.69 ,$231.08 ,$455.59 , N/A , N/A , N/A , N/A ,$273.35 ,$387.25 ,$318.91 , N/A , N/A ,$432.81 ,$346.25 ,$341.69 , N/A ,$387.25 , N/A , N/A , N/A ,$318.91 ,$277.45 , N/A , N/A , N/A , N/A , N/A ,$387.25 , N/A ,$419.14 ,$318.91 ,$231.08 ,$277.32 ,$277.45 ,$277.32 ,$314.81 ,$410.03 ,$311.26 , N/A ,$359.92 , N/A , N/A , N/A , N/A , N/A ,$328.02 ,$282.47 ,$328.02 ,$328.02 ,$364.47 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD MARLEX 3 X 6 0112680,278,1 ,$82.80 ,$54.65 ,$42.00 ,$82.80 , N/A , N/A , N/A , N/A ,$49.68 ,$70.38 ,$57.96 , N/A , N/A ,$78.66 ,$62.93 ,$62.10 , N/A ,$70.38 , N/A , N/A , N/A ,$57.96 ,$50.43 , N/A , N/A , N/A , N/A , N/A ,$70.38 , N/A ,$76.18 ,$57.96 ,$42.00 ,$50.40 ,$50.43 ,$50.40 ,$57.21 ,$74.52 ,$56.57 , N/A ,$65.41 , N/A , N/A , N/A , N/A , N/A ,$59.62 ,$51.34 ,$59.62 ,$59.62 ,$66.24 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD PLUG XLARGE 0112780,278,1 ,$384.75 ,$253.94 ,$195.15 ,$384.75 , N/A , N/A , N/A , N/A ,$230.85 ,$327.04 ,$269.33 , N/A , N/A ,$365.51 ,$292.41 ,$288.56 , N/A ,$327.04 , N/A , N/A , N/A ,$269.33 ,$234.31 , N/A , N/A , N/A , N/A , N/A ,$327.04 , N/A ,$353.97 ,$269.33 ,$195.15 ,$234.20 ,$234.31 ,$234.20 ,$265.86 ,$346.28 ,$262.86 , N/A ,$303.95 , N/A , N/A , N/A , N/A , N/A ,$277.02 ,$238.55 ,$277.02 ,$277.02 ,$307.80 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD SOFT 3 X 6 0117009,278,1 ,$95.85 ,$63.26 ,$48.62 ,$95.85 , N/A , N/A , N/A , N/A ,$57.51 ,$81.47 ,$67.10 , N/A , N/A ,$91.06 ,$72.85 ,$71.89 , N/A ,$81.47 , N/A , N/A , N/A ,$67.10 ,$58.37 , N/A , N/A , N/A , N/A , N/A ,$81.47 , N/A ,$88.18 ,$67.10 ,$48.62 ,$58.34 ,$58.37 ,$58.34 ,$66.23 ,$86.27 ,$65.48 , N/A ,$75.72 , N/A , N/A , N/A , N/A , N/A ,$69.01 ,$59.43 ,$69.01 ,$69.01 ,$76.68 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH BARD SOFT 6 X 6   0117011,278,1 ,$135.45 ,$89.40 ,$68.70 ,$135.45 , N/A , N/A , N/A , N/A ,$81.27 ,$115.13 ,$94.82 , N/A , N/A ,$128.68 ,$102.94 ,$101.59 , N/A ,$115.13 , N/A , N/A , N/A ,$94.82 ,$82.49 , N/A , N/A , N/A , N/A , N/A ,$115.13 , N/A ,$124.61 ,$94.82 ,$68.70 ,$82.45 ,$82.49 ,$82.45 ,$93.60 ,$121.91 ,$92.54 , N/A ,$107.01 , N/A , N/A , N/A , N/A , N/A ,$97.52 ,$83.98 ,$97.52 ,$97.52 ,$108.36 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH CMPSX L/PPOLYPRO,278,1 ,$773.57 ,$510.56 ,$392.35 ,$773.57 , N/A , N/A , N/A , N/A ,$464.14 ,$657.53 ,$541.50 , N/A , N/A ,$734.89 ,$587.91 ,$580.18 , N/A ,$657.53 , N/A , N/A , N/A ,$541.50 ,$471.10 , N/A , N/A , N/A , N/A , N/A ,$657.53 , N/A ,$711.68 ,$541.50 ,$392.35 ,$470.87 ,$471.10 ,$470.87 ,$534.54 ,$696.21 ,$528.50 , N/A ,$611.12 , N/A , N/A , N/A , N/A , N/A ,$556.97 ,$479.61 ,$556.97 ,$556.97 ,$618.86 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH COMPOSIX 8X10 '0123810,278,1 ,"$2,208.94 ","$1,457.90 ","$1,120.37 ","$2,208.94 ", N/A ,"$1,164.33 ","$1,164.33 ", N/A ,"$1,325.36 ","$1,877.60 ","$1,546.26 ", N/A , N/A ,"$2,098.49 ","$1,678.79 ","$1,656.71 ", N/A ,"$1,877.60 ", N/A , N/A , N/A ,"$1,546.26 ","$1,345.24 ", N/A , N/A , N/A , N/A , N/A ,"$1,877.60 ", N/A ,"$2,032.22 ","$1,546.26 ","$1,120.37 ","$1,344.58 ","$1,345.24 ","$1,344.58 ","$1,526.38 ","$1,988.05 ","$1,509.15 ", N/A ,"$1,745.06 ", N/A , N/A , N/A , N/A , N/A ,"$1,590.44 ","$1,369.54 ","$1,590.44 ","$1,590.44 ","$1,767.15 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH COMPOSIX LP ELLIPSE 6.2 X 8.2,278,1 ,"$1,558.41 ","$1,028.55 ",$790.43 ,"$1,558.41 ", N/A ,$821.44 ,$821.44 , N/A ,$935.05 ,"$1,324.65 ","$1,090.89 ", N/A , N/A ,"$1,480.49 ","$1,184.39 ","$1,168.81 ", N/A ,"$1,324.65 ", N/A , N/A , N/A ,"$1,090.89 ",$949.07 , N/A , N/A , N/A , N/A , N/A ,"$1,324.65 ", N/A ,"$1,433.74 ","$1,090.89 ",$790.43 ,$948.60 ,$949.07 ,$948.60 ,"$1,076.86 ","$1,402.57 ","$1,064.71 ", N/A ,"$1,231.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,122.06 ",$966.21 ,"$1,122.06 ","$1,122.06 ","$1,246.73 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH KUGEL HERNIA MEDIUM OVAL 0010105,278,1 ,$535.35 ,$353.33 ,$271.53 ,$535.35 , N/A , N/A , N/A , N/A ,$321.21 ,$455.05 ,$374.75 , N/A , N/A ,$508.58 ,$406.87 ,$401.51 , N/A ,$455.05 , N/A , N/A , N/A ,$374.75 ,$326.03 , N/A , N/A , N/A , N/A , N/A ,$455.05 , N/A ,$492.52 ,$374.75 ,$271.53 ,$325.87 ,$326.03 ,$325.87 ,$369.93 ,$481.82 ,$365.75 , N/A ,$422.93 , N/A , N/A , N/A , N/A , N/A ,$385.45 ,$331.92 ,$385.45 ,$385.45 ,$428.28 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH PARASTOMAL PATCH 6.1 X 8.1,278,1 ,"$2,063.40 ","$1,361.84 ","$1,046.56 ","$2,063.40 ", N/A ,"$1,087.62 ","$1,087.62 ", N/A ,"$1,238.04 ","$1,753.89 ","$1,444.38 ", N/A , N/A ,"$1,960.23 ","$1,568.18 ","$1,547.55 ", N/A ,"$1,753.89 ", N/A , N/A , N/A ,"$1,444.38 ","$1,256.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,753.89 ", N/A ,"$1,898.33 ","$1,444.38 ","$1,046.56 ","$1,255.99 ","$1,256.61 ","$1,255.99 ","$1,425.81 ","$1,857.06 ","$1,409.71 ", N/A ,"$1,630.09 ", N/A , N/A , N/A , N/A , N/A ,"$1,485.65 ","$1,279.31 ","$1,485.65 ","$1,485.65 ","$1,650.72 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH PARIETENE COVIDIEN 5IN X 7.5 CM,278,1 ,$375.01 ,$247.51 ,$190.21 ,$375.01 , N/A , N/A , N/A , N/A ,$225.01 ,$318.76 ,$262.51 , N/A , N/A ,$356.26 ,$285.01 ,$281.26 , N/A ,$318.76 , N/A , N/A , N/A ,$262.51 ,$228.38 , N/A , N/A , N/A , N/A , N/A ,$318.76 , N/A ,$345.01 ,$262.51 ,$190.21 ,$228.27 ,$228.38 ,$228.27 ,$259.13 ,$337.51 ,$256.21 , N/A ,$296.26 , N/A , N/A , N/A , N/A , N/A ,$270.01 ,$232.51 ,$270.01 ,$270.01 ,$300.01 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH PARIETEX,278,1 ,$168.22 ,$111.03 ,$85.32 ,$168.22 , N/A , N/A , N/A , N/A ,$100.93 ,$142.99 ,$117.75 , N/A , N/A ,$159.81 ,$127.85 ,$126.17 , N/A ,$142.99 , N/A , N/A , N/A ,$117.75 ,$102.45 , N/A , N/A , N/A , N/A , N/A ,$142.99 , N/A ,$154.76 ,$117.75 ,$85.32 ,$102.40 ,$102.45 ,$102.40 ,$116.24 ,$151.40 ,$114.93 , N/A ,$132.89 , N/A , N/A , N/A , N/A , N/A ,$121.12 ,$104.30 ,$121.12 ,$121.12 ,$134.58 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH PARIETEX PROGRIP RECTANGLE 15CM X 9CM,278,1 ,$691.48 ,$456.38 ,$350.72 ,$691.48 , N/A , N/A , N/A , N/A ,$414.89 ,$587.76 ,$484.04 , N/A , N/A ,$656.91 ,$525.52 ,$518.61 , N/A ,$587.76 , N/A , N/A , N/A ,$484.04 ,$421.11 , N/A , N/A , N/A , N/A , N/A ,$587.76 , N/A ,$636.16 ,$484.04 ,$350.72 ,$420.90 ,$421.11 ,$420.90 ,$477.81 ,$622.33 ,$472.42 , N/A ,$546.27 , N/A , N/A , N/A , N/A , N/A ,$497.87 ,$428.72 ,$497.87 ,$497.87 ,$553.18 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH POLYPROYLENE,278,1 ,"$1,558.00 ","$1,028.28 ",$790.22 ,"$1,558.00 ", N/A ,$821.22 ,$821.22 , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A , N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ",$948.82 , N/A , N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,064.43 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH PROGRIP ANATOMICAL 10X15CM LEFT,278,1 ,$862.37 ,$569.16 ,$437.39 ,$862.37 , N/A , N/A , N/A , N/A ,$517.42 ,$733.01 ,$603.66 , N/A , N/A ,$819.25 ,$655.40 ,$646.78 , N/A ,$733.01 , N/A , N/A , N/A ,$603.66 ,$525.18 , N/A , N/A , N/A , N/A , N/A ,$733.01 , N/A ,$793.38 ,$603.66 ,$437.39 ,$524.92 ,$525.18 ,$524.92 ,$595.90 ,$776.13 ,$589.17 , N/A ,$681.27 , N/A , N/A , N/A , N/A , N/A ,$620.91 ,$534.67 ,$620.91 ,$620.91 ,$689.90 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH PROGRIP ANATOMICAL 10X15CM RIGHT,278,1 ,"$1,155.65 ",$762.73 ,$586.15 ,"$1,155.65 ", N/A ,$609.14 ,$609.14 , N/A ,$693.39 ,$982.30 ,$808.96 , N/A , N/A ,"$1,097.87 ",$878.29 ,$866.74 , N/A ,$982.30 , N/A , N/A , N/A ,$808.96 ,$703.79 , N/A , N/A , N/A , N/A , N/A ,$982.30 , N/A ,"$1,063.20 ",$808.96 ,$586.15 ,$703.44 ,$703.79 ,$703.44 ,$798.55 ,"$1,040.09 ",$789.54 , N/A ,$912.96 , N/A , N/A , N/A , N/A , N/A ,$832.07 ,$716.50 ,$832.07 ,$832.07 ,$924.52 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH PROGRIP SELF FIXATING 15CM X 10CM LAP,278,1 ,"$1,027.89 ",$678.41 ,$521.35 ,"$1,027.89 ", N/A ,$541.80 ,$541.80 , N/A ,$616.73 ,$873.71 ,$719.52 , N/A , N/A ,$976.50 ,$781.20 ,$770.92 , N/A ,$873.71 , N/A , N/A , N/A ,$719.52 ,$625.99 , N/A , N/A , N/A , N/A , N/A ,$873.71 , N/A ,$945.66 ,$719.52 ,$521.35 ,$625.68 ,$625.99 ,$625.68 ,$710.27 ,$925.10 ,$702.25 , N/A ,$812.03 , N/A , N/A , N/A , N/A , N/A ,$740.08 ,$637.29 ,$740.08 ,$740.08 ,$822.31 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH SURGICAL COMPOSIX 4.5IN LOW PROFILE LIGHTWEIGHT PATCH POLYPROPYLENE EPTFE CIRCLE LAPROSCOPIC VENTRAL HERNIA REPAIR,278,1 ,"$1,163.58 ",$767.96 ,$590.17 ,"$1,163.58 ", N/A ,$613.32 ,$613.32 , N/A ,$698.15 ,$989.04 ,$814.51 , N/A , N/A ,"$1,105.40 ",$884.32 ,$872.69 , N/A ,$989.04 , N/A , N/A , N/A ,$814.51 ,$708.62 , N/A , N/A , N/A , N/A , N/A ,$989.04 , N/A ,"$1,070.49 ",$814.51 ,$590.17 ,$708.27 ,$708.62 ,$708.27 ,$804.03 ,"$1,047.22 ",$794.96 , N/A ,$919.23 , N/A , N/A , N/A , N/A , N/A ,$837.78 ,$721.42 ,$837.78 ,$837.78 ,$930.86 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH SURGICAL VENTRALIGHT ST SEPRA 4.5IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE POLYPROPYLENE HYDROGEL CIRCLE LATEX FREE VENTRAL HERNIA REPAIR,278,1 ,$881.50 ,$581.79 ,$447.10 ,$881.50 , N/A , N/A , N/A , N/A ,$528.90 ,$749.28 ,$617.05 , N/A , N/A ,$837.43 ,$669.94 ,$661.13 , N/A ,$749.28 , N/A , N/A , N/A ,$617.05 ,$536.83 , N/A , N/A , N/A , N/A , N/A ,$749.28 , N/A ,$810.98 ,$617.05 ,$447.10 ,$536.57 ,$536.83 ,$536.57 ,$609.12 ,$793.35 ,$602.24 , N/A ,$696.39 , N/A , N/A , N/A , N/A , N/A ,$634.68 ,$546.53 ,$634.68 ,$634.68 ,$705.20 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH SURGICAL VENTRALIGHT ST SEPRA 6IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE POLYPROPYLENE HYDROGEL CIRCLE LATEX FREE VENTRAL HERNIA REPAIR,278,1 ,"$1,127.50 ",$744.15 ,$571.87 ,"$1,127.50 ", N/A ,$594.31 ,$594.31 , N/A ,$676.50 ,$958.38 ,$789.25 , N/A , N/A ,"$1,071.13 ",$856.90 ,$845.63 , N/A ,$958.38 , N/A , N/A , N/A ,$789.25 ,$686.65 , N/A , N/A , N/A , N/A , N/A ,$958.38 , N/A ,"$1,037.30 ",$789.25 ,$571.87 ,$686.31 ,$686.65 ,$686.31 ,$779.10 ,"$1,014.75 ",$770.31 , N/A ,$890.73 , N/A , N/A , N/A , N/A , N/A ,$811.80 ,$699.05 ,$811.80 ,$811.80 ,$902.00 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH SURGIPRO 6 X 6,278,1 ,$171.88 ,$113.44 ,$87.18 ,$171.88 , N/A , N/A , N/A , N/A ,$103.13 ,$146.10 ,$120.32 , N/A , N/A ,$163.29 ,$130.63 ,$128.91 , N/A ,$146.10 , N/A , N/A , N/A ,$120.32 ,$104.67 , N/A , N/A , N/A , N/A , N/A ,$146.10 , N/A ,$158.13 ,$120.32 ,$87.18 ,$104.62 ,$104.67 ,$104.62 ,$118.77 ,$154.69 ,$117.43 , N/A ,$135.79 , N/A , N/A , N/A , N/A , N/A ,$123.75 ,$106.57 ,$123.75 ,$123.75 ,$137.50 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH SURGIPRO USS 3IN X 5 IN,278,1 ,$134.17 ,$88.55 ,$68.05 ,$134.17 , N/A , N/A , N/A , N/A ,$80.50 ,$114.04 ,$93.92 , N/A , N/A ,$127.46 ,$101.97 ,$100.63 , N/A ,$114.04 , N/A , N/A , N/A ,$93.92 ,$81.71 , N/A , N/A , N/A , N/A , N/A ,$114.04 , N/A ,$123.44 ,$93.92 ,$68.05 ,$81.67 ,$81.71 ,$81.67 ,$92.71 ,$120.75 ,$91.66 , N/A ,$105.99 , N/A , N/A , N/A , N/A , N/A ,$96.60 ,$83.19 ,$96.60 ,$96.60 ,$107.34 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH UPSLON Y,278,1 ,"$1,988.52 ","$1,312.42 ","$1,008.58 ","$1,988.52 ", N/A ,"$1,048.15 ","$1,048.15 ", N/A ,"$1,193.11 ","$1,690.24 ","$1,391.96 ", N/A , N/A ,"$1,889.09 ","$1,511.28 ","$1,491.39 ", N/A ,"$1,690.24 ", N/A , N/A , N/A ,"$1,391.96 ","$1,211.01 ", N/A , N/A , N/A , N/A , N/A ,"$1,690.24 ", N/A ,"$1,829.44 ","$1,391.96 ","$1,008.58 ","$1,210.41 ","$1,211.01 ","$1,210.41 ","$1,374.07 ","$1,789.67 ","$1,358.56 ", N/A ,"$1,570.93 ", N/A , N/A , N/A , N/A , N/A ,"$1,431.73 ","$1,232.88 ","$1,431.73 ","$1,431.73 ","$1,590.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALEX LARGE 0010303,278,1 ,"$1,229.18 ",$811.26 ,$623.44 ,"$1,229.18 ", N/A ,$647.90 ,$647.90 , N/A ,$737.51 ,"$1,044.80 ",$860.43 , N/A , N/A ,"$1,167.72 ",$934.18 ,$921.89 , N/A ,"$1,044.80 ", N/A , N/A , N/A ,$860.43 ,$748.57 , N/A , N/A , N/A , N/A , N/A ,"$1,044.80 ", N/A ,"$1,130.85 ",$860.43 ,$623.44 ,$748.20 ,$748.57 ,$748.20 ,$849.36 ,"$1,106.26 ",$839.78 , N/A ,$971.05 , N/A , N/A , N/A , N/A , N/A ,$885.01 ,$762.09 ,$885.01 ,$885.01 ,$983.34 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALEX MEDIUM 0010302,278,1 ,"$1,013.73 ",$669.06 ,$514.16 ,"$1,013.73 ", N/A ,$534.34 ,$534.34 , N/A ,$608.24 ,$861.67 ,$709.61 , N/A , N/A ,$963.04 ,$770.43 ,$760.30 , N/A ,$861.67 , N/A , N/A , N/A ,$709.61 ,$617.36 , N/A , N/A , N/A , N/A , N/A ,$861.67 , N/A ,$932.63 ,$709.61 ,$514.16 ,$617.06 ,$617.36 ,$617.06 ,$700.49 ,$912.36 ,$692.58 , N/A ,$800.85 , N/A , N/A , N/A , N/A , N/A ,$729.89 ,$628.51 ,$729.89 ,$729.89 ,$810.98 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALEX SMALL 0010301,278,1 ,$848.39 ,$559.94 ,$430.30 ,$848.39 , N/A , N/A , N/A , N/A ,$509.03 ,$721.13 ,$593.87 , N/A , N/A ,$805.97 ,$644.78 ,$636.29 , N/A ,$721.13 , N/A , N/A , N/A ,$593.87 ,$516.67 , N/A , N/A , N/A , N/A , N/A ,$721.13 , N/A ,$780.52 ,$593.87 ,$430.30 ,$516.42 ,$516.67 ,$516.42 ,$586.24 ,$763.55 ,$579.62 , N/A ,$670.23 , N/A , N/A , N/A , N/A , N/A ,$610.84 ,$526.00 ,$610.84 ,$610.84 ,$678.71 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALIGHT 4 X 6 5954460,278,1 ,"$1,089.78 ",$719.25 ,$552.74 ,"$1,089.78 ", N/A ,$574.42 ,$574.42 , N/A ,$653.87 ,$926.31 ,$762.85 , N/A , N/A ,"$1,035.29 ",$828.23 ,$817.34 , N/A ,$926.31 , N/A , N/A , N/A ,$762.85 ,$663.68 , N/A , N/A , N/A , N/A , N/A ,$926.31 , N/A ,"$1,002.60 ",$762.85 ,$552.74 ,$663.35 ,$663.68 ,$663.35 ,$753.04 ,$980.80 ,$744.54 , N/A ,$860.93 , N/A , N/A , N/A , N/A , N/A ,$784.64 ,$675.66 ,$784.64 ,$784.64 ,$871.82 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALIGHT ST ECHO 2 11CM CIRCLE,278,1 ,"$1,199.25 ",$791.51 ,$608.26 ,"$1,199.25 ", N/A ,$632.12 ,$632.12 , N/A ,$719.55 ,"$1,019.36 ",$839.48 , N/A , N/A ,"$1,139.29 ",$911.43 ,$899.44 , N/A ,"$1,019.36 ", N/A , N/A , N/A ,$839.48 ,$730.34 , N/A , N/A , N/A , N/A , N/A ,"$1,019.36 ", N/A ,"$1,103.31 ",$839.48 ,$608.26 ,$729.98 ,$730.34 ,$729.98 ,$828.68 ,"$1,079.33 ",$819.33 , N/A ,$947.41 , N/A , N/A , N/A , N/A , N/A ,$863.46 ,$743.54 ,$863.46 ,$863.46 ,$959.40 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALIGHT ST ECHO 2 20X15CM ELLIPSE,278,1 ,"$2,071.00 ","$1,366.86 ","$1,050.41 ","$2,071.00 ", N/A ,"$1,091.62 ","$1,091.62 ", N/A ,"$1,242.60 ","$1,760.35 ","$1,449.70 ", N/A , N/A ,"$1,967.45 ","$1,573.96 ","$1,553.25 ", N/A ,"$1,760.35 ", N/A , N/A , N/A ,"$1,449.70 ","$1,261.24 ", N/A , N/A , N/A , N/A , N/A ,"$1,760.35 ", N/A ,"$1,905.32 ","$1,449.70 ","$1,050.41 ","$1,260.62 ","$1,261.24 ","$1,260.62 ","$1,431.06 ","$1,863.90 ","$1,414.91 ", N/A ,"$1,636.09 ", N/A , N/A , N/A , N/A , N/A ,"$1,491.12 ","$1,284.02 ","$1,491.12 ","$1,491.12 ","$1,656.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALIGHT ST ECHO CIRCLE 4.5,278,1 ,"$1,148.00 ",$757.68 ,$582.27 ,"$1,148.00 ", N/A ,$605.11 ,$605.11 , N/A ,$688.80 ,$975.80 ,$803.60 , N/A , N/A ,"$1,090.60 ",$872.48 ,$861.00 , N/A ,$975.80 , N/A , N/A , N/A ,$803.60 ,$699.13 , N/A , N/A , N/A , N/A , N/A ,$975.80 , N/A ,"$1,056.16 ",$803.60 ,$582.27 ,$698.79 ,$699.13 ,$698.79 ,$793.27 ,"$1,033.20 ",$784.31 , N/A ,$906.92 , N/A , N/A , N/A , N/A , N/A ,$826.56 ,$711.76 ,$826.56 ,$826.56 ,$918.40 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALIGHT ST OVAL,278,1 ,"$2,435.80 ","$1,607.63 ","$1,235.44 ","$2,435.80 ", N/A ,"$1,283.91 ","$1,283.91 ", N/A ,"$1,461.48 ","$2,070.43 ","$1,705.06 ", N/A , N/A ,"$2,314.01 ","$1,851.21 ","$1,826.85 ", N/A ,"$2,070.43 ", N/A , N/A , N/A ,"$1,705.06 ","$1,483.40 ", N/A , N/A , N/A , N/A , N/A ,"$2,070.43 ", N/A ,"$2,240.94 ","$1,705.06 ","$1,235.44 ","$1,482.67 ","$1,483.40 ","$1,482.67 ","$1,683.14 ","$2,192.22 ","$1,664.14 ", N/A ,"$1,924.28 ", N/A , N/A , N/A , N/A , N/A ,"$1,753.78 ","$1,510.20 ","$1,753.78 ","$1,753.78 ","$1,948.64 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALIGHT ST W/ECHO POSITIONING 6 X 8 5955680,278,1 ,"$2,023.50 ","$1,335.51 ","$1,026.32 ","$2,023.50 ", N/A ,"$1,066.59 ","$1,066.59 ", N/A ,"$1,214.10 ","$1,719.98 ","$1,416.45 ", N/A , N/A ,"$1,922.33 ","$1,537.86 ","$1,517.63 ", N/A ,"$1,719.98 ", N/A , N/A , N/A ,"$1,416.45 ","$1,232.31 ", N/A , N/A , N/A , N/A , N/A ,"$1,719.98 ", N/A ,"$1,861.62 ","$1,416.45 ","$1,026.32 ","$1,231.70 ","$1,232.31 ","$1,231.70 ","$1,398.24 ","$1,821.15 ","$1,382.46 ", N/A ,"$1,598.57 ", N/A , N/A , N/A , N/A , N/A ,"$1,456.92 ","$1,254.57 ","$1,456.92 ","$1,456.92 ","$1,618.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRALIGHT ST W/ECHO POSITIONING 7 X 9 5955790,278,1 ,"$3,053.55 ","$2,015.34 ","$1,526.78 ","$3,053.55 ", N/A ,"$1,609.53 ","$1,609.53 ", N/A ,"$1,832.13 ","$2,595.52 ","$2,137.49 ", N/A , N/A ,"$2,900.87 ","$2,320.70 ","$2,290.16 ","$1,526.78 ","$2,595.52 ", N/A ,"$1,526.78 ","$1,526.78 ","$2,137.49 ","$1,859.61 ", N/A , N/A , N/A , N/A , N/A ,"$2,595.52 ", N/A ,"$2,809.27 ","$2,137.49 ","$1,548.76 ","$1,858.70 ","$1,859.61 ","$1,858.70 ","$2,110.00 ","$2,748.20 ","$2,086.19 ", N/A ,"$2,412.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,198.56 ","$1,893.20 ","$2,198.56 ","$2,198.56 ","$2,442.84 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,MESH VENTRIO MED OVAL 4.3 X 5.5 0010215,278,1 ,"$1,648.20 ","$1,087.81 ",$835.97 ,"$1,648.20 ", N/A ,$868.77 ,$868.77 , N/A ,$988.92 ,"$1,400.97 ","$1,153.74 ", N/A , N/A ,"$1,565.79 ","$1,252.63 ","$1,236.15 ", N/A ,"$1,400.97 ", N/A , N/A , N/A ,"$1,153.74 ","$1,003.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,400.97 ", N/A ,"$1,516.34 ","$1,153.74 ",$835.97 ,"$1,003.26 ","$1,003.75 ","$1,003.26 ","$1,138.91 ","$1,483.38 ","$1,126.05 ", N/A ,"$1,302.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,186.70 ","$1,021.88 ","$1,186.70 ","$1,186.70 ","$1,318.56 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,PATCH HERNIA KUGEL COMPOSIX CIRCLE 4.5   LARGE,278,1 ,"$1,265.67 ",$835.34 ,$641.95 ,"$1,265.67 ", N/A ,$667.13 ,$667.13 , N/A ,$759.40 ,"$1,075.82 ",$885.97 , N/A , N/A ,"$1,202.39 ",$961.91 ,$949.25 , N/A ,"$1,075.82 ", N/A , N/A , N/A ,$885.97 ,$770.79 , N/A , N/A , N/A , N/A , N/A ,"$1,075.82 ", N/A ,"$1,164.42 ",$885.97 ,$641.95 ,$770.41 ,$770.79 ,$770.41 ,$874.58 ,"$1,139.10 ",$864.71 , N/A ,$999.88 , N/A , N/A , N/A , N/A , N/A ,$911.28 ,$784.72 ,$911.28 ,$911.28 ,"$1,012.54 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,PATCH HERNIA KUGEL COMPOSIX CIRCLE 8 X 8CM SMALL,278,1 ,$919.13 ,$606.63 ,$466.18 ,$919.13 , N/A , N/A , N/A , N/A ,$551.48 ,$781.26 ,$643.39 , N/A , N/A ,$873.17 ,$698.54 ,$689.35 , N/A ,$781.26 , N/A , N/A , N/A ,$643.39 ,$559.75 , N/A , N/A , N/A , N/A , N/A ,$781.26 , N/A ,$845.60 ,$643.39 ,$466.18 ,$559.47 ,$559.75 ,$559.47 ,$635.12 ,$827.22 ,$627.95 , N/A ,$726.11 , N/A , N/A , N/A , N/A , N/A ,$661.77 ,$569.86 ,$661.77 ,$661.77 ,$735.30 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,PATCH HERNIA KUGEL COMPOSIX OVAL 19.6 X 24.6CM,278,1 ,"$2,587.23 ","$1,707.57 ","$1,293.62 ","$2,587.23 ", N/A ,"$1,363.73 ","$1,363.73 ", N/A ,"$1,552.34 ","$2,199.15 ","$1,811.06 ", N/A , N/A ,"$2,457.87 ","$1,966.29 ","$1,940.42 ","$1,293.62 ","$2,199.15 ", N/A ,"$1,293.62 ","$1,293.62 ","$1,811.06 ","$1,575.62 ", N/A , N/A , N/A , N/A , N/A ,"$2,199.15 ", N/A ,"$2,380.25 ","$1,811.06 ","$1,312.24 ","$1,574.85 ","$1,575.62 ","$1,574.85 ","$1,787.78 ","$2,328.51 ","$1,767.60 ", N/A ,"$2,043.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,862.81 ","$1,604.08 ","$1,862.81 ","$1,862.81 ","$2,069.78 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,PATCH SURGICAL 10.7X8.7IN PERMANENT BARRIER COMPOSIX KUGEL EPTFE XL OVAL HERNIA REPAIR,278,1 ,"$3,146.19 ","$2,076.49 ","$1,573.10 ","$3,146.19 ", N/A ,"$1,658.36 ","$1,658.36 ", N/A ,"$1,887.71 ","$2,674.26 ","$2,202.33 ", N/A , N/A ,"$2,988.88 ","$2,391.10 ","$2,359.64 ","$1,573.10 ","$2,674.26 ", N/A ,"$1,573.10 ","$1,573.10 ","$2,202.33 ","$1,916.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,674.26 ", N/A ,"$2,894.49 ","$2,202.33 ","$1,595.75 ","$1,915.09 ","$1,916.03 ","$1,915.09 ","$2,174.02 ","$2,831.57 ","$2,149.48 ", N/A ,"$2,485.49 ", N/A , N/A , N/A , N/A , N/A ,"$2,265.26 ","$1,950.64 ","$2,265.26 ","$2,265.26 ","$2,516.95 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,PATCH SURGICAL 4.7X3.1IN VENTRAL 2 LAYER MONOFILAMENT SELF EXPAND SEAL EDGE WELD POINT VENTRIO SORBAFLEX POLYPROPYLENE EPTFE SMALL OVAL STERILE HERNIA REPAIR,278,1 ,"$1,117.05 ",$737.25 ,$566.57 ,"$1,117.05 ", N/A ,$588.80 ,$588.80 , N/A ,$670.23 ,$949.49 ,$781.94 , N/A , N/A ,"$1,061.20 ",$848.96 ,$837.79 , N/A ,$949.49 , N/A , N/A , N/A ,$781.94 ,$680.28 , N/A , N/A , N/A , N/A , N/A ,$949.49 , N/A ,"$1,027.69 ",$781.94 ,$566.57 ,$679.95 ,$680.28 ,$679.95 ,$771.88 ,"$1,005.35 ",$763.17 , N/A ,$882.47 , N/A , N/A , N/A , N/A , N/A ,$804.28 ,$692.57 ,$804.28 ,$804.28 ,$893.64 
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,PATCH SURGICAL 7X5.4IN VENTRAL 2 LAYER MONOFILAMENT SELF EXPAND SEAL EDGE WELD POINT VENTRIO SORBAFLEX POLYPROPYLENE EPTFE LARGE OVAL STERILE HERNIA REPAIR,278,1 ,"$1,934.77 ","$1,276.95 ",$981.32 ,"$1,934.77 ", N/A ,"$1,019.82 ","$1,019.82 ", N/A ,"$1,160.86 ","$1,644.55 ","$1,354.34 ", N/A , N/A ,"$1,838.03 ","$1,470.43 ","$1,451.08 ", N/A ,"$1,644.55 ", N/A , N/A , N/A ,"$1,354.34 ","$1,178.27 ", N/A , N/A , N/A , N/A , N/A ,"$1,644.55 ", N/A ,"$1,779.99 ","$1,354.34 ",$981.32 ,"$1,177.69 ","$1,178.27 ","$1,177.69 ","$1,336.93 ","$1,741.29 ","$1,321.83 ", N/A ,"$1,528.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,393.03 ","$1,199.56 ","$1,393.03 ","$1,393.03 ","$1,547.82 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,SYSTEM URETHRAL SUPPORT BLUE ADVANTAGE FIT TRANSVAGINAL POLYPROPYLENE DILATOR PUSHER DELIVERY DEVICE HANDLE CURVE NEEDLE TIP,278,1 ,"$1,912.57 ","$1,262.30 ",$970.06 ,"$1,912.57 ", N/A ,"$1,008.12 ","$1,008.12 ", N/A ,"$1,147.54 ","$1,625.68 ","$1,338.80 ", N/A , N/A ,"$1,816.94 ","$1,453.55 ","$1,434.43 ", N/A ,"$1,625.68 ", N/A , N/A , N/A ,"$1,338.80 ","$1,164.76 ", N/A , N/A , N/A , N/A , N/A ,"$1,625.68 ", N/A ,"$1,759.56 ","$1,338.80 ",$970.06 ,"$1,164.18 ","$1,164.76 ","$1,164.18 ","$1,321.59 ","$1,721.31 ","$1,306.67 ", N/A ,"$1,510.93 ", N/A , N/A , N/A , N/A , N/A ,"$1,377.05 ","$1,185.79 ","$1,377.05 ","$1,377.05 ","$1,530.06 "
ST NICHOLAS HOSPITAL - ACUTE,27871781,C1781,TISSUE HUMAN DERMAL COLLAGEN 16 X 20CM,278,1 ,"$13,996.80 ","$9,237.89 ","$6,858.43 ","$13,996.80 ", N/A ,"$7,377.71 ","$7,377.71 ", N/A ,"$8,398.08 ","$11,897.28 ","$9,797.76 ", N/A , N/A ,"$13,296.96 ","$10,637.57 ","$10,497.60 ","$6,998.40 ","$11,897.28 ", N/A ,"$6,998.40 ","$6,998.40 ","$9,797.76 ","$8,524.05 ", N/A , N/A , N/A , N/A , N/A ,"$11,897.28 ", N/A ,"$12,877.06 ","$9,797.76 ","$7,099.18 ","$8,519.85 ","$8,524.05 ","$8,519.85 ","$9,671.79 ","$12,597.12 ","$9,562.61 ", N/A ,"$11,057.47 ", N/A ,"$6,858.43 ","$6,858.43 ", N/A ,"$6,858.43 ","$10,077.70 ","$8,678.02 ","$10,077.70 ","$10,077.70 ","$11,197.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871783,C1783,"HC OCULAR IMPLANT, AQUEOUS DRAINAGE ASSIST DEVICE",278,1 ,"$3,941.00 ","$2,601.06 ","$1,970.50 ","$3,941.00 ", N/A ,"$2,077.30 ","$2,077.30 ", N/A ,"$2,364.60 ","$3,349.85 ","$2,758.70 ", N/A , N/A ,"$3,743.95 ","$2,995.16 ","$2,955.75 ","$1,970.50 ","$3,349.85 ", N/A ,"$1,970.50 ","$1,970.50 ","$2,758.70 ","$2,400.07 ", N/A , N/A , N/A , N/A , N/A ,"$3,349.85 ", N/A ,"$3,625.72 ","$2,758.70 ","$1,998.88 ","$2,398.89 ","$2,400.07 ","$2,398.89 ","$2,723.23 ","$3,546.90 ","$2,692.49 ", N/A ,"$3,113.39 ", N/A , N/A , N/A , N/A , N/A ,"$2,837.52 ","$2,443.42 ","$2,837.52 ","$2,837.52 ","$3,152.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871787,C1787,PROGRAMMER MEDTRONIC,278,1 ,"$2,261.00 ","$1,492.26 ","$1,146.78 ","$2,261.00 ", N/A ,"$1,191.77 ","$1,191.77 ", N/A ,"$1,356.60 ","$1,921.85 ","$1,582.70 ", N/A , N/A ,"$2,147.95 ","$1,718.36 ","$1,695.75 ", N/A ,"$1,921.85 ", N/A , N/A , N/A ,"$1,582.70 ","$1,376.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,921.85 ", N/A ,"$2,080.12 ","$1,582.70 ","$1,146.78 ","$1,376.27 ","$1,376.95 ","$1,376.27 ","$1,562.35 ","$2,034.90 ","$1,544.72 ", N/A ,"$1,786.19 ", N/A , N/A , N/A , N/A , N/A ,"$1,627.92 ","$1,401.82 ","$1,627.92 ","$1,627.92 ","$1,808.80 "
ST NICHOLAS HOSPITAL - ACUTE,27871788,C1788,PORT BARD POWERPORT WITH 8FR. CATHETER,278,1 ,$554.70 ,$366.10 ,$281.34 ,$554.70 , N/A , N/A , N/A , N/A ,$332.82 ,$471.50 ,$388.29 , N/A , N/A ,$526.97 ,$421.57 ,$416.03 , N/A ,$471.50 , N/A , N/A , N/A ,$388.29 ,$337.81 , N/A , N/A , N/A , N/A , N/A ,$471.50 , N/A ,$510.32 ,$388.29 ,$281.34 ,$337.65 ,$337.81 ,$337.65 ,$383.30 ,$499.23 ,$378.97 , N/A ,$438.21 , N/A , N/A , N/A , N/A , N/A ,$399.38 ,$343.91 ,$399.38 ,$399.38 ,$443.76 
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST 640CC P5.6CM TEARDROP MEDIUM HEIGHT MODERATE PROFILE STYLE CPG 312 MEMORYSHAPE COHESIVE III MEMORYGEL SILTEX 16X15CM STERILE,278,1 ,"$1,960.80 ","$1,294.13 ",$994.52 ,"$1,960.80 ", N/A ,"$1,033.54 ","$1,033.54 ", N/A ,"$1,176.48 ","$1,666.68 ","$1,372.56 ", N/A , N/A ,"$1,862.76 ","$1,490.21 ","$1,470.60 ", N/A ,"$1,666.68 ", N/A , N/A , N/A ,"$1,372.56 ","$1,194.13 ", N/A , N/A , N/A , N/A , N/A ,"$1,666.68 ", N/A ,"$1,803.94 ","$1,372.56 ",$994.52 ,"$1,193.54 ","$1,194.13 ","$1,193.54 ","$1,354.91 ","$1,764.72 ","$1,339.62 ", N/A ,"$1,549.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.78 ","$1,215.70 ","$1,411.78 ","$1,411.78 ","$1,568.64 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST 315CC P4.4CM MODERATE PROFILE MEDIUM HEIGHT TEARDROP STYLE CPG 312 MEMORYGEL COHESIVE III MEMORYSHAPE SILTEX 12.5X11.8CM STERILE,278,1 ,"$1,960.80 ","$1,294.13 ",$994.52 ,"$1,960.80 ", N/A ,"$1,033.54 ","$1,033.54 ", N/A ,"$1,176.48 ","$1,666.68 ","$1,372.56 ", N/A , N/A ,"$1,862.76 ","$1,490.21 ","$1,470.60 ", N/A ,"$1,666.68 ", N/A , N/A , N/A ,"$1,372.56 ","$1,194.13 ", N/A , N/A , N/A , N/A , N/A ,"$1,666.68 ", N/A ,"$1,803.94 ","$1,372.56 ",$994.52 ,"$1,193.54 ","$1,194.13 ","$1,193.54 ","$1,354.91 ","$1,764.72 ","$1,339.62 ", N/A ,"$1,549.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.78 ","$1,215.70 ","$1,411.78 ","$1,411.78 ","$1,568.64 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST 355CC P4.6CM TEARDROP MEDIUM HEIGHT MODERATE PROFILE STYLE CPG 312 MEMORYSHAPE COHESIVE III MEMORYGEL SILTEX 13X12.2CM STERILE,278,1 ,"$1,960.80 ","$1,294.13 ",$994.52 ,"$1,960.80 ", N/A ,"$1,033.54 ","$1,033.54 ", N/A ,"$1,176.48 ","$1,666.68 ","$1,372.56 ", N/A , N/A ,"$1,862.76 ","$1,490.21 ","$1,470.60 ", N/A ,"$1,666.68 ", N/A , N/A , N/A ,"$1,372.56 ","$1,194.13 ", N/A , N/A , N/A , N/A , N/A ,"$1,666.68 ", N/A ,"$1,803.94 ","$1,372.56 ",$994.52 ,"$1,193.54 ","$1,194.13 ","$1,193.54 ","$1,354.91 ","$1,764.72 ","$1,339.62 ", N/A ,"$1,549.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.78 ","$1,215.70 ","$1,411.78 ","$1,411.78 ","$1,568.64 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST 395CC P4.7CM TEARDROP MEDIUM HEIGHT MODERATE PROFILE STYLE CPG 312 MEMORYSHAPE COHESIVE III MEMORYGEL SILTEX 13.5X12.7CM STERILE,278,1 ,"$1,960.80 ","$1,294.13 ",$994.52 ,"$1,960.80 ", N/A ,"$1,033.54 ","$1,033.54 ", N/A ,"$1,176.48 ","$1,666.68 ","$1,372.56 ", N/A , N/A ,"$1,862.76 ","$1,490.21 ","$1,470.60 ", N/A ,"$1,666.68 ", N/A , N/A , N/A ,"$1,372.56 ","$1,194.13 ", N/A , N/A , N/A , N/A , N/A ,"$1,666.68 ", N/A ,"$1,803.94 ","$1,372.56 ",$994.52 ,"$1,193.54 ","$1,194.13 ","$1,193.54 ","$1,354.91 ","$1,764.72 ","$1,339.62 ", N/A ,"$1,549.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.78 ","$1,215.70 ","$1,411.78 ","$1,411.78 ","$1,568.64 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST 440CC P4.9CM TEARDROP MEDIUM HEIGHT MODERATE PROFILE STYLE CPG 312 MEMORYSHAPE COHESIVE III MEMORYGEL SILTEX 14X13.2CM STERILE,278,1 ,"$1,960.80 ","$1,294.13 ",$994.52 ,"$1,960.80 ", N/A ,"$1,033.54 ","$1,033.54 ", N/A ,"$1,176.48 ","$1,666.68 ","$1,372.56 ", N/A , N/A ,"$1,862.76 ","$1,490.21 ","$1,470.60 ", N/A ,"$1,666.68 ", N/A , N/A , N/A ,"$1,372.56 ","$1,194.13 ", N/A , N/A , N/A , N/A , N/A ,"$1,666.68 ", N/A ,"$1,803.94 ","$1,372.56 ",$994.52 ,"$1,193.54 ","$1,194.13 ","$1,193.54 ","$1,354.91 ","$1,764.72 ","$1,339.62 ", N/A ,"$1,549.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.78 ","$1,215.70 ","$1,411.78 ","$1,411.78 ","$1,568.64 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST 480CC P5CM MEDIUM HEIGHT MODERATE PROFILE COHESIVE III CPG 321 SILTEX 14.5X13.6CM STERILE,278,1 ,"$1,960.80 ","$1,294.13 ",$994.52 ,"$1,960.80 ", N/A ,"$1,033.54 ","$1,033.54 ", N/A ,"$1,176.48 ","$1,666.68 ","$1,372.56 ", N/A , N/A ,"$1,862.76 ","$1,490.21 ","$1,470.60 ", N/A ,"$1,666.68 ", N/A , N/A , N/A ,"$1,372.56 ","$1,194.13 ", N/A , N/A , N/A , N/A , N/A ,"$1,666.68 ", N/A ,"$1,803.94 ","$1,372.56 ",$994.52 ,"$1,193.54 ","$1,194.13 ","$1,193.54 ","$1,354.91 ","$1,764.72 ","$1,339.62 ", N/A ,"$1,549.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.78 ","$1,215.70 ","$1,411.78 ","$1,411.78 ","$1,568.64 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST 530CC P5.2CM TEARDROP MEDIUM HEIGHT MODERATE PROFILE STYLE CPG 312 MEMORYSHAPE COHESIVE III MEMORYGEL SILTEX 15X14.1CM STERILE,278,1 ,"$1,960.80 ","$1,294.13 ",$994.52 ,"$1,960.80 ", N/A ,"$1,033.54 ","$1,033.54 ", N/A ,"$1,176.48 ","$1,666.68 ","$1,372.56 ", N/A , N/A ,"$1,862.76 ","$1,490.21 ","$1,470.60 ", N/A ,"$1,666.68 ", N/A , N/A , N/A ,"$1,372.56 ","$1,194.13 ", N/A , N/A , N/A , N/A , N/A ,"$1,666.68 ", N/A ,"$1,803.94 ","$1,372.56 ",$994.52 ,"$1,193.54 ","$1,194.13 ","$1,193.54 ","$1,354.91 ","$1,764.72 ","$1,339.62 ", N/A ,"$1,549.03 ", N/A , N/A , N/A , N/A , N/A ,"$1,411.78 ","$1,215.70 ","$1,411.78 ","$1,411.78 ","$1,568.64 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST MENTOR ROUND SILTEX SALINE 650ML,278,1 ,"$1,996.70 ","$1,317.82 ","$1,012.73 ","$1,996.70 ", N/A ,"$1,052.46 ","$1,052.46 ", N/A ,"$1,198.02 ","$1,697.20 ","$1,397.69 ", N/A , N/A ,"$1,896.87 ","$1,517.49 ","$1,497.53 ", N/A ,"$1,697.20 ", N/A , N/A , N/A ,"$1,397.69 ","$1,215.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,697.20 ", N/A ,"$1,836.96 ","$1,397.69 ","$1,012.73 ","$1,215.39 ","$1,215.99 ","$1,215.39 ","$1,379.72 ","$1,797.03 ","$1,364.15 ", N/A ,"$1,577.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.62 ","$1,237.95 ","$1,437.62 ","$1,437.62 ","$1,597.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,EXPANDER MAMMARY/BREAST MENTOR CONTOUR 275CC,278,1 ,"$1,996.70 ","$1,317.82 ","$1,012.73 ","$1,996.70 ", N/A ,"$1,052.46 ","$1,052.46 ", N/A ,"$1,198.02 ","$1,697.20 ","$1,397.69 ", N/A , N/A ,"$1,896.87 ","$1,517.49 ","$1,497.53 ", N/A ,"$1,697.20 ", N/A , N/A , N/A ,"$1,397.69 ","$1,215.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,697.20 ", N/A ,"$1,836.96 ","$1,397.69 ","$1,012.73 ","$1,215.39 ","$1,215.99 ","$1,215.39 ","$1,379.72 ","$1,797.03 ","$1,364.15 ", N/A ,"$1,577.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.62 ","$1,237.95 ","$1,437.62 ","$1,437.62 ","$1,597.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,EXPANDER TISSUE 15.7X11.2CM 650CC STYLE 6100 INJECTION DOME SELF SEAL MAGNETIC DETECTION DEVICE STERILE CPX2 CENTERSCOPE SILTEX P7.9CM LOW HEIGHT,278,1 ,"$1,996.70 ","$1,317.82 ","$1,012.73 ","$1,996.70 ", N/A ,"$1,052.46 ","$1,052.46 ", N/A ,"$1,198.02 ","$1,697.20 ","$1,397.69 ", N/A , N/A ,"$1,896.87 ","$1,517.49 ","$1,497.53 ", N/A ,"$1,697.20 ", N/A , N/A , N/A ,"$1,397.69 ","$1,215.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,697.20 ", N/A ,"$1,836.96 ","$1,397.69 ","$1,012.73 ","$1,215.39 ","$1,215.99 ","$1,215.39 ","$1,379.72 ","$1,797.03 ","$1,364.15 ", N/A ,"$1,577.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.62 ","$1,237.95 ","$1,437.62 ","$1,437.62 ","$1,597.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,EXPANDER TISSUE 15X10.9CM 550CC STYLE 6100 INJECTION DOME SELF SEAL MAGNETIC DETECTION DEVICE STERILE CPX2 CENTERSCOPE CONTOUR PROFILE SILTEX P7.4CM LOW HEIGHT,278,1 ,"$1,996.70 ","$1,317.82 ","$1,012.73 ","$1,996.70 ", N/A ,"$1,052.46 ","$1,052.46 ", N/A ,"$1,198.02 ","$1,697.20 ","$1,397.69 ", N/A , N/A ,"$1,896.87 ","$1,517.49 ","$1,497.53 ", N/A ,"$1,697.20 ", N/A , N/A , N/A ,"$1,397.69 ","$1,215.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,697.20 ", N/A ,"$1,836.96 ","$1,397.69 ","$1,012.73 ","$1,215.39 ","$1,215.99 ","$1,215.39 ","$1,379.72 ","$1,797.03 ","$1,364.15 ", N/A ,"$1,577.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.62 ","$1,237.95 ","$1,437.62 ","$1,437.62 ","$1,597.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,EXPANDER TISSUE BREAST 550ML STYLE 6200 MED,278,1 ,"$1,996.70 ","$1,317.82 ","$1,012.73 ","$1,996.70 ", N/A ,"$1,052.46 ","$1,052.46 ", N/A ,"$1,198.02 ","$1,697.20 ","$1,397.69 ", N/A , N/A ,"$1,896.87 ","$1,517.49 ","$1,497.53 ", N/A ,"$1,697.20 ", N/A , N/A , N/A ,"$1,397.69 ","$1,215.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,697.20 ", N/A ,"$1,836.96 ","$1,397.69 ","$1,012.73 ","$1,215.39 ","$1,215.99 ","$1,215.39 ","$1,379.72 ","$1,797.03 ","$1,364.15 ", N/A ,"$1,577.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.62 ","$1,237.95 ","$1,437.62 ","$1,437.62 ","$1,597.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST MENTOR ROUND SILTEX SALINE 350ML,278,1 ,"$1,996.70 ","$1,317.82 ","$1,012.73 ","$1,996.70 ", N/A ,"$1,052.46 ","$1,052.46 ", N/A ,"$1,198.02 ","$1,697.20 ","$1,397.69 ", N/A , N/A ,"$1,896.87 ","$1,517.49 ","$1,497.53 ", N/A ,"$1,697.20 ", N/A , N/A , N/A ,"$1,397.69 ","$1,215.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,697.20 ", N/A ,"$1,836.96 ","$1,397.69 ","$1,012.73 ","$1,215.39 ","$1,215.99 ","$1,215.39 ","$1,379.72 ","$1,797.03 ","$1,364.15 ", N/A ,"$1,577.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.62 ","$1,237.95 ","$1,437.62 ","$1,437.62 ","$1,597.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST MENTOR ROUND SILTEX SALINE 450ML,278,1 ,"$1,996.70 ","$1,317.82 ","$1,012.73 ","$1,996.70 ", N/A ,"$1,052.46 ","$1,052.46 ", N/A ,"$1,198.02 ","$1,697.20 ","$1,397.69 ", N/A , N/A ,"$1,896.87 ","$1,517.49 ","$1,497.53 ", N/A ,"$1,697.20 ", N/A , N/A , N/A ,"$1,397.69 ","$1,215.99 ", N/A , N/A , N/A , N/A , N/A ,"$1,697.20 ", N/A ,"$1,836.96 ","$1,397.69 ","$1,012.73 ","$1,215.39 ","$1,215.99 ","$1,215.39 ","$1,379.72 ","$1,797.03 ","$1,364.15 ", N/A ,"$1,577.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,437.62 ","$1,237.95 ","$1,437.62 ","$1,437.62 ","$1,597.36 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST MENTOR SMOOTH ROUND MODERATE,278,1 ,"$1,845.00 ","$1,217.70 ",$935.78 ,"$1,845.00 ", N/A ,$972.50 ,$972.50 , N/A ,"$1,107.00 ","$1,568.25 ","$1,291.50 ", N/A , N/A ,"$1,752.75 ","$1,402.20 ","$1,383.75 ", N/A ,"$1,568.25 ", N/A , N/A , N/A ,"$1,291.50 ","$1,123.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,568.25 ", N/A ,"$1,697.40 ","$1,291.50 ",$935.78 ,"$1,123.05 ","$1,123.61 ","$1,123.05 ","$1,274.90 ","$1,660.50 ","$1,260.50 ", N/A ,"$1,457.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,328.40 ","$1,143.90 ","$1,328.40 ","$1,328.40 ","$1,476.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT MAMMARY MENTOR SMOOTH ROUND GEL FILL 450ML,278,1 ,"$1,375.55 ",$907.86 ,$697.68 ,"$1,375.55 ", N/A ,$725.05 ,$725.05 , N/A ,$825.33 ,"$1,169.22 ",$962.89 , N/A , N/A ,"$1,306.77 ","$1,045.42 ","$1,031.66 ", N/A ,"$1,169.22 ", N/A , N/A , N/A ,$962.89 ,$837.71 , N/A , N/A , N/A , N/A , N/A ,"$1,169.22 ", N/A ,"$1,265.51 ",$962.89 ,$697.68 ,$837.30 ,$837.71 ,$837.30 ,$950.51 ,"$1,238.00 ",$939.78 , N/A ,"$1,086.68 ", N/A , N/A , N/A , N/A , N/A ,$990.40 ,$852.84 ,$990.40 ,$990.40 ,"$1,100.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST MENTOR,278,1 ,"$1,375.55 ",$907.86 ,$697.68 ,"$1,375.55 ", N/A ,$725.05 ,$725.05 , N/A ,$825.33 ,"$1,169.22 ",$962.89 , N/A , N/A ,"$1,306.77 ","$1,045.42 ","$1,031.66 ", N/A ,"$1,169.22 ", N/A , N/A , N/A ,$962.89 ,$837.71 , N/A , N/A , N/A , N/A , N/A ,"$1,169.22 ", N/A ,"$1,265.51 ",$962.89 ,$697.68 ,$837.30 ,$837.71 ,$837.30 ,$950.51 ,"$1,238.00 ",$939.78 , N/A ,"$1,086.68 ", N/A , N/A , N/A , N/A , N/A ,$990.40 ,$852.84 ,$990.40 ,$990.40 ,"$1,100.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST MENTOR ROUND MODERATE PLUS GEL,278,1 ,"$1,375.55 ",$907.86 ,$697.68 ,"$1,375.55 ", N/A ,$725.05 ,$725.05 , N/A ,$825.33 ,"$1,169.22 ",$962.89 , N/A , N/A ,"$1,306.77 ","$1,045.42 ","$1,031.66 ", N/A ,"$1,169.22 ", N/A , N/A , N/A ,$962.89 ,$837.71 , N/A , N/A , N/A , N/A , N/A ,"$1,169.22 ", N/A ,"$1,265.51 ",$962.89 ,$697.68 ,$837.30 ,$837.71 ,$837.30 ,$950.51 ,"$1,238.00 ",$939.78 , N/A ,"$1,086.68 ", N/A , N/A , N/A , N/A , N/A ,$990.40 ,$852.84 ,$990.40 ,$990.40 ,"$1,100.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST MENTOR SILICONE GEL,278,1 ,"$1,375.55 ",$907.86 ,$697.68 ,"$1,375.55 ", N/A ,$725.05 ,$725.05 , N/A ,$825.33 ,"$1,169.22 ",$962.89 , N/A , N/A ,"$1,306.77 ","$1,045.42 ","$1,031.66 ", N/A ,"$1,169.22 ", N/A , N/A , N/A ,$962.89 ,$837.71 , N/A , N/A , N/A , N/A , N/A ,"$1,169.22 ", N/A ,"$1,265.51 ",$962.89 ,$697.68 ,$837.30 ,$837.71 ,$837.30 ,$950.51 ,"$1,238.00 ",$939.78 , N/A ,"$1,086.68 ", N/A , N/A , N/A , N/A , N/A ,$990.40 ,$852.84 ,$990.40 ,$990.40 ,"$1,100.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST MENTOR SMOOTH MPP GEL,278,1 ,"$1,375.55 ",$907.86 ,$697.68 ,"$1,375.55 ", N/A ,$725.05 ,$725.05 , N/A ,$825.33 ,"$1,169.22 ",$962.89 , N/A , N/A ,"$1,306.77 ","$1,045.42 ","$1,031.66 ", N/A ,"$1,169.22 ", N/A , N/A , N/A ,$962.89 ,$837.71 , N/A , N/A , N/A , N/A , N/A ,"$1,169.22 ", N/A ,"$1,265.51 ",$962.89 ,$697.68 ,$837.30 ,$837.71 ,$837.30 ,$950.51 ,"$1,238.00 ",$939.78 , N/A ,"$1,086.68 ", N/A , N/A , N/A , N/A , N/A ,$990.40 ,$852.84 ,$990.40 ,$990.40 ,"$1,100.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT BREAST MENTOR SMOOTH ROUND MODERATE GEL FILL 375ML,278,1 ,"$1,375.55 ",$907.86 ,$697.68 ,"$1,375.55 ", N/A ,$725.05 ,$725.05 , N/A ,$825.33 ,"$1,169.22 ",$962.89 , N/A , N/A ,"$1,306.77 ","$1,045.42 ","$1,031.66 ", N/A ,"$1,169.22 ", N/A , N/A , N/A ,$962.89 ,$837.71 , N/A , N/A , N/A , N/A , N/A ,"$1,169.22 ", N/A ,"$1,265.51 ",$962.89 ,$697.68 ,$837.30 ,$837.71 ,$837.30 ,$950.51 ,"$1,238.00 ",$939.78 , N/A ,"$1,086.68 ", N/A , N/A , N/A , N/A , N/A ,$990.40 ,$852.84 ,$990.40 ,$990.40 ,"$1,100.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871789,C1789,IMPLANT MAMMARY MENTOR 600CC,278,1 ,"$1,375.55 ",$907.86 ,$697.68 ,"$1,375.55 ", N/A ,$725.05 ,$725.05 , N/A ,$825.33 ,"$1,169.22 ",$962.89 , N/A , N/A ,"$1,306.77 ","$1,045.42 ","$1,031.66 ", N/A ,"$1,169.22 ", N/A , N/A , N/A ,$962.89 ,$837.71 , N/A , N/A , N/A , N/A , N/A ,"$1,169.22 ", N/A ,"$1,265.51 ",$962.89 ,$697.68 ,$837.30 ,$837.71 ,$837.30 ,$950.51 ,"$1,238.00 ",$939.78 , N/A ,"$1,086.68 ", N/A , N/A , N/A , N/A , N/A ,$990.40 ,$852.84 ,$990.40 ,$990.40 ,"$1,100.44 "
ST NICHOLAS HOSPITAL - ACUTE,27871815,C1815,BALLOON AMS PRESSURE REGULATING 61-70CM,278,1 ,"$5,609.52 ","$3,702.28 ","$2,804.76 ","$5,609.52 ", N/A ,"$2,956.78 ","$2,956.78 ", N/A ,"$3,365.71 ","$4,768.09 ","$3,926.66 ", N/A , N/A ,"$5,329.04 ","$4,263.24 ","$4,207.14 ","$2,804.76 ","$4,768.09 ", N/A ,"$2,804.76 ","$2,804.76 ","$3,926.66 ","$3,416.20 ", N/A , N/A , N/A , N/A , N/A ,"$4,768.09 ", N/A ,"$5,160.76 ","$3,926.66 ","$2,845.15 ","$3,414.51 ","$3,416.20 ","$3,414.51 ","$3,876.18 ","$5,048.57 ","$3,832.42 ", N/A ,"$4,431.52 ", N/A , N/A , N/A , N/A , N/A ,"$4,038.85 ","$3,477.90 ","$4,038.85 ","$4,038.85 ","$4,487.62 "
ST NICHOLAS HOSPITAL - ACUTE,27871820,C1820,STIMULATOR SPINAL RESTORE MEDTRONIC,278,1 ,"$26,460.00 ","$17,463.60 ","$12,965.40 ","$26,460.00 ", N/A ,"$13,947.07 ","$13,947.07 ", N/A ,"$15,876.00 ","$22,491.00 ","$18,522.00 ", N/A , N/A ,"$25,137.00 ","$20,109.60 ","$19,845.00 ","$13,230.00 ","$22,491.00 ", N/A ,"$13,230.00 ","$13,230.00 ","$18,522.00 ","$16,114.14 ", N/A , N/A , N/A , N/A , N/A ,"$22,491.00 ", N/A ,"$24,343.20 ","$18,522.00 ","$13,420.51 ","$16,106.20 ","$16,114.14 ","$16,106.20 ","$18,283.86 ","$23,814.00 ","$18,077.47 ", N/A ,"$20,903.40 ", N/A ,"$12,965.40 ","$12,965.40 ", N/A ,"$12,965.40 ","$19,051.20 ","$16,405.20 ","$19,051.20 ","$19,051.20 ","$21,168.00 "
ST NICHOLAS HOSPITAL - ACUTE,27871897,C1897,LEAD NEUROSTIMULATOR 60CM 1.3MM OCTAD 9MM SPACE STANDARD SPINAL CORD 8 CONDUCTOR CONNECTOR TRIAL KIT 3MM,278,1 ,"$1,025.00 ",$676.50 ,$519.88 ,"$1,025.00 ", N/A ,$540.28 ,$540.28 , N/A ,$615.00 ,$871.25 ,$717.50 , N/A , N/A ,$973.75 ,$779.00 ,$768.75 , N/A ,$871.25 , N/A , N/A , N/A ,$717.50 ,$624.23 , N/A , N/A , N/A , N/A , N/A ,$871.25 , N/A ,$943.00 ,$717.50 ,$519.88 ,$623.92 ,$624.23 ,$623.92 ,$708.28 ,$922.50 ,$700.28 , N/A ,$809.75 , N/A , N/A , N/A , N/A , N/A ,$738.00 ,$635.50 ,$738.00 ,$738.00 ,$820.00 
ST NICHOLAS HOSPITAL - ACUTE,27872615,C2615,PARTICLES ARISTA HEMOSTATIC 3GM  (SM0002-USA),278,1 ,$451.93 ,$298.27 ,$229.22 ,$451.93 , N/A , N/A , N/A , N/A ,$271.16 ,$384.14 ,$316.35 , N/A , N/A ,$429.33 ,$343.47 ,$338.95 , N/A ,$384.14 , N/A , N/A , N/A ,$316.35 ,$275.23 , N/A , N/A , N/A , N/A , N/A ,$384.14 , N/A ,$415.78 ,$316.35 ,$229.22 ,$275.09 ,$275.23 ,$275.09 ,$312.28 ,$406.74 ,$308.76 , N/A ,$357.02 , N/A , N/A , N/A , N/A , N/A ,$325.39 ,$280.20 ,$325.39 ,$325.39 ,$361.54 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,SET STENT 21-32CM 4.7FR URETER C-FLEX CATHETER RADIOPAQUE MULTILENGTH TETHER GUIDEWIRE STERILE DISPOSABLE,278,1 ,$6.41 ,$4.23 ,$3.25 ,$6.41 , N/A , N/A , N/A , N/A ,$3.85 ,$5.45 ,$4.49 , N/A , N/A ,$6.09 ,$4.87 ,$4.81 , N/A ,$5.45 , N/A , N/A , N/A ,$4.49 ,$3.90 , N/A , N/A , N/A , N/A , N/A ,$5.45 , N/A ,$5.90 ,$4.49 ,$3.25 ,$3.90 ,$3.90 ,$3.90 ,$4.43 ,$5.77 ,$4.38 , N/A ,$5.06 , N/A , N/A , N/A , N/A , N/A ,$4.62 ,$3.97 ,$4.62 ,$4.62 ,$5.13 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 6FR X 28CM,278,1 ,$220.10 ,$145.27 ,$111.63 ,$220.10 , N/A , N/A , N/A , N/A ,$132.06 ,$187.09 ,$154.07 , N/A , N/A ,$209.10 ,$167.28 ,$165.08 , N/A ,$187.09 , N/A , N/A , N/A ,$154.07 ,$134.04 , N/A , N/A , N/A , N/A , N/A ,$187.09 , N/A ,$202.49 ,$154.07 ,$111.63 ,$133.97 ,$134.04 ,$133.97 ,$152.09 ,$198.09 ,$150.37 , N/A ,$173.88 , N/A , N/A , N/A , N/A , N/A ,$158.47 ,$136.46 ,$158.47 ,$158.47 ,$176.08 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 6FR X 22CM,278,1 ,$220.10 ,$145.27 ,$111.63 ,$220.10 , N/A , N/A , N/A , N/A ,$132.06 ,$187.09 ,$154.07 , N/A , N/A ,$209.10 ,$167.28 ,$165.08 , N/A ,$187.09 , N/A , N/A , N/A ,$154.07 ,$134.04 , N/A , N/A , N/A , N/A , N/A ,$187.09 , N/A ,$202.49 ,$154.07 ,$111.63 ,$133.97 ,$134.04 ,$133.97 ,$152.09 ,$198.09 ,$150.37 , N/A ,$173.88 , N/A , N/A , N/A , N/A , N/A ,$158.47 ,$136.46 ,$158.47 ,$158.47 ,$176.08 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 6FR X 24CM,278,1 ,$220.10 ,$145.27 ,$111.63 ,$220.10 , N/A , N/A , N/A , N/A ,$132.06 ,$187.09 ,$154.07 , N/A , N/A ,$209.10 ,$167.28 ,$165.08 , N/A ,$187.09 , N/A , N/A , N/A ,$154.07 ,$134.04 , N/A , N/A , N/A , N/A , N/A ,$187.09 , N/A ,$202.49 ,$154.07 ,$111.63 ,$133.97 ,$134.04 ,$133.97 ,$152.09 ,$198.09 ,$150.37 , N/A ,$173.88 , N/A , N/A , N/A , N/A , N/A ,$158.47 ,$136.46 ,$158.47 ,$158.47 ,$176.08 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 6FR X 26CM,278,1 ,$220.10 ,$145.27 ,$111.63 ,$220.10 , N/A , N/A , N/A , N/A ,$132.06 ,$187.09 ,$154.07 , N/A , N/A ,$209.10 ,$167.28 ,$165.08 , N/A ,$187.09 , N/A , N/A , N/A ,$154.07 ,$134.04 , N/A , N/A , N/A , N/A , N/A ,$187.09 , N/A ,$202.49 ,$154.07 ,$111.63 ,$133.97 ,$134.04 ,$133.97 ,$152.09 ,$198.09 ,$150.37 , N/A ,$173.88 , N/A , N/A , N/A , N/A , N/A ,$158.47 ,$136.46 ,$158.47 ,$158.47 ,$176.08 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 7FR X 24CM,278,1 ,$196.43 ,$129.64 ,$99.63 ,$196.43 , N/A , N/A , N/A , N/A ,$117.86 ,$166.97 ,$137.50 , N/A , N/A ,$186.61 ,$149.29 ,$147.32 , N/A ,$166.97 , N/A , N/A , N/A ,$137.50 ,$119.63 , N/A , N/A , N/A , N/A , N/A ,$166.97 , N/A ,$180.72 ,$137.50 ,$99.63 ,$119.57 ,$119.63 ,$119.57 ,$135.73 ,$176.79 ,$134.20 , N/A ,$155.18 , N/A , N/A , N/A , N/A , N/A ,$141.43 ,$121.79 ,$141.43 ,$141.43 ,$157.14 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 6FR X 20CM,278,1 ,$196.43 ,$129.64 ,$99.63 ,$196.43 , N/A , N/A , N/A , N/A ,$117.86 ,$166.97 ,$137.50 , N/A , N/A ,$186.61 ,$149.29 ,$147.32 , N/A ,$166.97 , N/A , N/A , N/A ,$137.50 ,$119.63 , N/A , N/A , N/A , N/A , N/A ,$166.97 , N/A ,$180.72 ,$137.50 ,$99.63 ,$119.57 ,$119.63 ,$119.57 ,$135.73 ,$176.79 ,$134.20 , N/A ,$155.18 , N/A , N/A , N/A , N/A , N/A ,$141.43 ,$121.79 ,$141.43 ,$141.43 ,$157.14 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 7FR X 22CM,278,1 ,$196.43 ,$129.64 ,$99.63 ,$196.43 , N/A , N/A , N/A , N/A ,$117.86 ,$166.97 ,$137.50 , N/A , N/A ,$186.61 ,$149.29 ,$147.32 , N/A ,$166.97 , N/A , N/A , N/A ,$137.50 ,$119.63 , N/A , N/A , N/A , N/A , N/A ,$166.97 , N/A ,$180.72 ,$137.50 ,$99.63 ,$119.57 ,$119.63 ,$119.57 ,$135.73 ,$176.79 ,$134.20 , N/A ,$155.18 , N/A , N/A , N/A , N/A , N/A ,$141.43 ,$121.79 ,$141.43 ,$141.43 ,$157.14 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT FILFORM DOUBLE PIGTAIL COOK 6FR X 22CM,278,1 ,$384.68 ,$253.89 ,$195.11 ,$384.68 , N/A , N/A , N/A , N/A ,$230.81 ,$326.98 ,$269.28 , N/A , N/A ,$365.45 ,$292.36 ,$288.51 , N/A ,$326.98 , N/A , N/A , N/A ,$269.28 ,$234.27 , N/A , N/A , N/A , N/A , N/A ,$326.98 , N/A ,$353.91 ,$269.28 ,$195.11 ,$234.15 ,$234.27 ,$234.15 ,$265.81 ,$346.21 ,$262.81 , N/A ,$303.90 , N/A , N/A , N/A , N/A , N/A ,$276.97 ,$238.50 ,$276.97 ,$276.97 ,$307.74 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT PERCUFLEX 6FR X 80CM,278,1 ,$410.06 ,$270.64 ,$207.98 ,$410.06 , N/A , N/A , N/A , N/A ,$246.04 ,$348.55 ,$287.04 , N/A , N/A ,$389.56 ,$311.65 ,$307.55 , N/A ,$348.55 , N/A , N/A , N/A ,$287.04 ,$249.73 , N/A , N/A , N/A , N/A , N/A ,$348.55 , N/A ,$377.26 ,$287.04 ,$207.98 ,$249.60 ,$249.73 ,$249.60 ,$283.35 ,$369.05 ,$280.15 , N/A ,$323.95 , N/A , N/A , N/A , N/A , N/A ,$295.24 ,$254.24 ,$295.24 ,$295.24 ,$328.05 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 4.6FR 24CM STANDARD,278,1 ,$405.00 ,$267.30 ,$205.42 ,$405.00 , N/A , N/A , N/A , N/A ,$243.00 ,$344.25 ,$283.50 , N/A , N/A ,$384.75 ,$307.80 ,$303.75 , N/A ,$344.25 , N/A , N/A , N/A ,$283.50 ,$246.65 , N/A , N/A , N/A , N/A , N/A ,$344.25 , N/A ,$372.60 ,$283.50 ,$205.42 ,$246.52 ,$246.65 ,$246.52 ,$279.86 ,$364.50 ,$276.70 , N/A ,$319.95 , N/A , N/A , N/A , N/A , N/A ,$291.60 ,$251.10 ,$291.60 ,$291.60 ,$324.00 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 6FR 22CM 2 DUROMETER,278,1 ,$322.81 ,$213.05 ,$163.73 ,$322.81 , N/A , N/A , N/A , N/A ,$193.69 ,$274.39 ,$225.97 , N/A , N/A ,$306.67 ,$245.34 ,$242.11 , N/A ,$274.39 , N/A , N/A , N/A ,$225.97 ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$274.39 , N/A ,$296.99 ,$225.97 ,$163.73 ,$196.49 ,$196.59 ,$196.49 ,$223.06 ,$290.53 ,$220.54 , N/A ,$255.02 , N/A , N/A , N/A , N/A , N/A ,$232.42 ,$200.14 ,$232.42 ,$232.42 ,$258.25 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT POLARIS LOOP URETERAL 6FR X 24CM,278,1 ,$322.81 ,$213.05 ,$163.73 ,$322.81 , N/A , N/A , N/A , N/A ,$193.69 ,$274.39 ,$225.97 , N/A , N/A ,$306.67 ,$245.34 ,$242.11 , N/A ,$274.39 , N/A , N/A , N/A ,$225.97 ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$274.39 , N/A ,$296.99 ,$225.97 ,$163.73 ,$196.49 ,$196.59 ,$196.49 ,$223.06 ,$290.53 ,$220.54 , N/A ,$255.02 , N/A , N/A , N/A , N/A , N/A ,$232.42 ,$200.14 ,$232.42 ,$232.42 ,$258.25 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 6FR 20CM 2 DUROMETER,278,1 ,$322.81 ,$213.05 ,$163.73 ,$322.81 , N/A , N/A , N/A , N/A ,$193.69 ,$274.39 ,$225.97 , N/A , N/A ,$306.67 ,$245.34 ,$242.11 , N/A ,$274.39 , N/A , N/A , N/A ,$225.97 ,$196.59 , N/A , N/A , N/A , N/A , N/A ,$274.39 , N/A ,$296.99 ,$225.97 ,$163.73 ,$196.49 ,$196.59 ,$196.49 ,$223.06 ,$290.53 ,$220.54 , N/A ,$255.02 , N/A , N/A , N/A , N/A , N/A ,$232.42 ,$200.14 ,$232.42 ,$232.42 ,$258.25 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 8.5FR 20CM 150CM KIDNEY CURL TAPER RADIOPAQUE 2 DUROMETER OPEN TIP MULTI-FLEX TECOFLEX NYLON HYDROPHILIC STERILE,278,1 ,$195.48 ,$129.02 ,$99.15 ,$195.48 , N/A , N/A , N/A , N/A ,$117.29 ,$166.16 ,$136.84 , N/A , N/A ,$185.71 ,$148.56 ,$146.61 , N/A ,$166.16 , N/A , N/A , N/A ,$136.84 ,$119.05 , N/A , N/A , N/A , N/A , N/A ,$166.16 , N/A ,$179.84 ,$136.84 ,$99.15 ,$118.99 ,$119.05 ,$118.99 ,$135.08 ,$175.93 ,$133.55 , N/A ,$154.43 , N/A , N/A , N/A , N/A , N/A ,$140.75 ,$121.20 ,$140.75 ,$140.75 ,$156.38 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 8FR 24CM FLUORO MARKER GRADUAL TAPER TIP ATRAUMATIC INSERTION PUSHER INLAY OPTIMA PHREECOAT POLYMER STERILE LATEX FREE DISPOSABLE LIME GREEN,278,1 ,$218.25 ,$144.05 ,$110.70 ,$218.25 , N/A , N/A , N/A , N/A ,$130.95 ,$185.51 ,$152.78 , N/A , N/A ,$207.34 ,$165.87 ,$163.69 , N/A ,$185.51 , N/A , N/A , N/A ,$152.78 ,$132.91 , N/A , N/A , N/A , N/A , N/A ,$185.51 , N/A ,$200.79 ,$152.78 ,$110.70 ,$132.85 ,$132.91 ,$132.85 ,$150.81 ,$196.43 ,$149.11 , N/A ,$172.42 , N/A , N/A , N/A , N/A , N/A ,$157.14 ,$135.32 ,$157.14 ,$157.14 ,$174.60 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 7FR X 20CM,278,1 ,$218.25 ,$144.05 ,$110.70 ,$218.25 , N/A , N/A , N/A , N/A ,$130.95 ,$185.51 ,$152.78 , N/A , N/A ,$207.34 ,$165.87 ,$163.69 , N/A ,$185.51 , N/A , N/A , N/A ,$152.78 ,$132.91 , N/A , N/A , N/A , N/A , N/A ,$185.51 , N/A ,$200.79 ,$152.78 ,$110.70 ,$132.85 ,$132.91 ,$132.85 ,$150.81 ,$196.43 ,$149.11 , N/A ,$172.42 , N/A , N/A , N/A , N/A , N/A ,$157.14 ,$135.32 ,$157.14 ,$157.14 ,$174.60 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 7FR X 26CM,278,1 ,$218.25 ,$144.05 ,$110.70 ,$218.25 , N/A , N/A , N/A , N/A ,$130.95 ,$185.51 ,$152.78 , N/A , N/A ,$207.34 ,$165.87 ,$163.69 , N/A ,$185.51 , N/A , N/A , N/A ,$152.78 ,$132.91 , N/A , N/A , N/A , N/A , N/A ,$185.51 , N/A ,$200.79 ,$152.78 ,$110.70 ,$132.85 ,$132.91 ,$132.85 ,$150.81 ,$196.43 ,$149.11 , N/A ,$172.42 , N/A , N/A , N/A , N/A , N/A ,$157.14 ,$135.32 ,$157.14 ,$157.14 ,$174.60 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT BARD OPTIMA 7FR X 28CM,278,1 ,$218.25 ,$144.05 ,$110.70 ,$218.25 , N/A , N/A , N/A , N/A ,$130.95 ,$185.51 ,$152.78 , N/A , N/A ,$207.34 ,$165.87 ,$163.69 , N/A ,$185.51 , N/A , N/A , N/A ,$152.78 ,$132.91 , N/A , N/A , N/A , N/A , N/A ,$185.51 , N/A ,$200.79 ,$152.78 ,$110.70 ,$132.85 ,$132.91 ,$132.85 ,$150.81 ,$196.43 ,$149.11 , N/A ,$172.42 , N/A , N/A , N/A , N/A , N/A ,$157.14 ,$135.32 ,$157.14 ,$157.14 ,$174.60 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT PERCUFLEX 4.8FR X 14CM,278,1 ,$218.25 ,$144.05 ,$110.70 ,$218.25 , N/A , N/A , N/A , N/A ,$130.95 ,$185.51 ,$152.78 , N/A , N/A ,$207.34 ,$165.87 ,$163.69 , N/A ,$185.51 , N/A , N/A , N/A ,$152.78 ,$132.91 , N/A , N/A , N/A , N/A , N/A ,$185.51 , N/A ,$200.79 ,$152.78 ,$110.70 ,$132.85 ,$132.91 ,$132.85 ,$150.81 ,$196.43 ,$149.11 , N/A ,$172.42 , N/A , N/A , N/A , N/A , N/A ,$157.14 ,$135.32 ,$157.14 ,$157.14 ,$174.60 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 8FR 24CM LARGE REGULAR PIGTAIL CURVE DUROMETER DRAINAGE HOLE CATHETER FLEXIBLE STIFF CANNULA NEPHROURETERAL PERCUFLEX GLIDEX,278,1 ,$275.40 ,$181.76 ,$139.68 ,$275.40 , N/A , N/A , N/A , N/A ,$165.24 ,$234.09 ,$192.78 , N/A , N/A ,$261.63 ,$209.30 ,$206.55 , N/A ,$234.09 , N/A , N/A , N/A ,$192.78 ,$167.72 , N/A , N/A , N/A , N/A , N/A ,$234.09 , N/A ,$253.37 ,$192.78 ,$139.68 ,$167.64 ,$167.72 ,$167.64 ,$190.30 ,$247.86 ,$188.15 , N/A ,$217.57 , N/A , N/A , N/A , N/A , N/A ,$198.29 ,$170.75 ,$198.29 ,$198.29 ,$220.32 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 10FR 22CM PIGTAIL CURVE TAPER RADIOPAQUE DRAINAGE FLEXIBLE STIFF CANNULA NEPHROURETERAL GLIDEX PERCUFLEX STERILE,278,1 ,$275.40 ,$181.76 ,$139.68 ,$275.40 , N/A , N/A , N/A , N/A ,$165.24 ,$234.09 ,$192.78 , N/A , N/A ,$261.63 ,$209.30 ,$206.55 , N/A ,$234.09 , N/A , N/A , N/A ,$192.78 ,$167.72 , N/A , N/A , N/A , N/A , N/A ,$234.09 , N/A ,$253.37 ,$192.78 ,$139.68 ,$167.64 ,$167.72 ,$167.64 ,$190.30 ,$247.86 ,$188.15 , N/A ,$217.57 , N/A , N/A , N/A , N/A , N/A ,$198.29 ,$170.75 ,$198.29 ,$198.29 ,$220.32 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 10FR 24CM LARGE REGULAR PIGTAIL CURVE DUROMETER DRAINAGE HOLE CATHETER FLEXIBLE STIFFEN CANNULA NEPHROURETERAL PERCUFLEX GLIDEX,278,1 ,$275.40 ,$181.76 ,$139.68 ,$275.40 , N/A , N/A , N/A , N/A ,$165.24 ,$234.09 ,$192.78 , N/A , N/A ,$261.63 ,$209.30 ,$206.55 , N/A ,$234.09 , N/A , N/A , N/A ,$192.78 ,$167.72 , N/A , N/A , N/A , N/A , N/A ,$234.09 , N/A ,$253.37 ,$192.78 ,$139.68 ,$167.64 ,$167.72 ,$167.64 ,$190.30 ,$247.86 ,$188.15 , N/A ,$217.57 , N/A , N/A , N/A , N/A , N/A ,$198.29 ,$170.75 ,$198.29 ,$198.29 ,$220.32 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 10FR 26CM LARGE REGULAR PIGTAIL CURVE FLEXIBLE STIFF CANNULA DUROMETER DRAINAGE HOLE CATHETER NEPHROURETERAL PERCUFLEX GLIDEX,278,1 ,$275.40 ,$181.76 ,$139.68 ,$275.40 , N/A , N/A , N/A , N/A ,$165.24 ,$234.09 ,$192.78 , N/A , N/A ,$261.63 ,$209.30 ,$206.55 , N/A ,$234.09 , N/A , N/A , N/A ,$192.78 ,$167.72 , N/A , N/A , N/A , N/A , N/A ,$234.09 , N/A ,$253.37 ,$192.78 ,$139.68 ,$167.64 ,$167.72 ,$167.64 ,$190.30 ,$247.86 ,$188.15 , N/A ,$217.57 , N/A , N/A , N/A , N/A , N/A ,$198.29 ,$170.75 ,$198.29 ,$198.29 ,$220.32 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 10FR 28CM LARGE REGULAR PIGTAIL CURVE FLEXIBLE STIFF CANNULA DUROMETER DRAINAGE HOLE CATHETER NEPHROURETERAL PERCUFLEX GLIDEX,278,1 ,$275.40 ,$181.76 ,$139.68 ,$275.40 , N/A , N/A , N/A , N/A ,$165.24 ,$234.09 ,$192.78 , N/A , N/A ,$261.63 ,$209.30 ,$206.55 , N/A ,$234.09 , N/A , N/A , N/A ,$192.78 ,$167.72 , N/A , N/A , N/A , N/A , N/A ,$234.09 , N/A ,$253.37 ,$192.78 ,$139.68 ,$167.64 ,$167.72 ,$167.64 ,$190.30 ,$247.86 ,$188.15 , N/A ,$217.57 , N/A , N/A , N/A , N/A , N/A ,$198.29 ,$170.75 ,$198.29 ,$198.29 ,$220.32 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 7FR X 22CM,278,1 ,$237.89 ,$157.01 ,$120.66 ,$237.89 , N/A , N/A , N/A , N/A ,$142.73 ,$202.21 ,$166.52 , N/A , N/A ,$226.00 ,$180.80 ,$178.42 , N/A ,$202.21 , N/A , N/A , N/A ,$166.52 ,$144.88 , N/A , N/A , N/A , N/A , N/A ,$202.21 , N/A ,$218.86 ,$166.52 ,$120.66 ,$144.80 ,$144.88 ,$144.80 ,$164.38 ,$214.10 ,$162.53 , N/A ,$187.93 , N/A , N/A , N/A , N/A , N/A ,$171.28 ,$147.49 ,$171.28 ,$171.28 ,$190.31 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 6FR X 20CM,278,1 ,$237.89 ,$157.01 ,$120.66 ,$237.89 , N/A , N/A , N/A , N/A ,$142.73 ,$202.21 ,$166.52 , N/A , N/A ,$226.00 ,$180.80 ,$178.42 , N/A ,$202.21 , N/A , N/A , N/A ,$166.52 ,$144.88 , N/A , N/A , N/A , N/A , N/A ,$202.21 , N/A ,$218.86 ,$166.52 ,$120.66 ,$144.80 ,$144.88 ,$144.80 ,$164.38 ,$214.10 ,$162.53 , N/A ,$187.93 , N/A , N/A , N/A , N/A , N/A ,$171.28 ,$147.49 ,$171.28 ,$171.28 ,$190.31 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 7FR X 20CM,278,1 ,$237.89 ,$157.01 ,$120.66 ,$237.89 , N/A , N/A , N/A , N/A ,$142.73 ,$202.21 ,$166.52 , N/A , N/A ,$226.00 ,$180.80 ,$178.42 , N/A ,$202.21 , N/A , N/A , N/A ,$166.52 ,$144.88 , N/A , N/A , N/A , N/A , N/A ,$202.21 , N/A ,$218.86 ,$166.52 ,$120.66 ,$144.80 ,$144.88 ,$144.80 ,$164.38 ,$214.10 ,$162.53 , N/A ,$187.93 , N/A , N/A , N/A , N/A , N/A ,$171.28 ,$147.49 ,$171.28 ,$171.28 ,$190.31 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 7FR X 28CM,278,1 ,$231.95 ,$153.09 ,$117.65 ,$231.95 , N/A , N/A , N/A , N/A ,$139.17 ,$197.16 ,$162.37 , N/A , N/A ,$220.35 ,$176.28 ,$173.96 , N/A ,$197.16 , N/A , N/A , N/A ,$162.37 ,$141.26 , N/A , N/A , N/A , N/A , N/A ,$197.16 , N/A ,$213.39 ,$162.37 ,$117.65 ,$141.19 ,$141.26 ,$141.19 ,$160.28 ,$208.76 ,$158.47 , N/A ,$183.24 , N/A , N/A , N/A , N/A , N/A ,$167.00 ,$143.81 ,$167.00 ,$167.00 ,$185.56 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 6FR X 22CM,278,1 ,$231.95 ,$153.09 ,$117.65 ,$231.95 , N/A , N/A , N/A , N/A ,$139.17 ,$197.16 ,$162.37 , N/A , N/A ,$220.35 ,$176.28 ,$173.96 , N/A ,$197.16 , N/A , N/A , N/A ,$162.37 ,$141.26 , N/A , N/A , N/A , N/A , N/A ,$197.16 , N/A ,$213.39 ,$162.37 ,$117.65 ,$141.19 ,$141.26 ,$141.19 ,$160.28 ,$208.76 ,$158.47 , N/A ,$183.24 , N/A , N/A , N/A , N/A , N/A ,$167.00 ,$143.81 ,$167.00 ,$167.00 ,$185.56 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 6FR X 24CM,278,1 ,$231.95 ,$153.09 ,$117.65 ,$231.95 , N/A , N/A , N/A , N/A ,$139.17 ,$197.16 ,$162.37 , N/A , N/A ,$220.35 ,$176.28 ,$173.96 , N/A ,$197.16 , N/A , N/A , N/A ,$162.37 ,$141.26 , N/A , N/A , N/A , N/A , N/A ,$197.16 , N/A ,$213.39 ,$162.37 ,$117.65 ,$141.19 ,$141.26 ,$141.19 ,$160.28 ,$208.76 ,$158.47 , N/A ,$183.24 , N/A , N/A , N/A , N/A , N/A ,$167.00 ,$143.81 ,$167.00 ,$167.00 ,$185.56 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 6FR X 26CM,278,1 ,$231.95 ,$153.09 ,$117.65 ,$231.95 , N/A , N/A , N/A , N/A ,$139.17 ,$197.16 ,$162.37 , N/A , N/A ,$220.35 ,$176.28 ,$173.96 , N/A ,$197.16 , N/A , N/A , N/A ,$162.37 ,$141.26 , N/A , N/A , N/A , N/A , N/A ,$197.16 , N/A ,$213.39 ,$162.37 ,$117.65 ,$141.19 ,$141.26 ,$141.19 ,$160.28 ,$208.76 ,$158.47 , N/A ,$183.24 , N/A , N/A , N/A , N/A , N/A ,$167.00 ,$143.81 ,$167.00 ,$167.00 ,$185.56 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 6FR X 28CM,278,1 ,$231.95 ,$153.09 ,$117.65 ,$231.95 , N/A , N/A , N/A , N/A ,$139.17 ,$197.16 ,$162.37 , N/A , N/A ,$220.35 ,$176.28 ,$173.96 , N/A ,$197.16 , N/A , N/A , N/A ,$162.37 ,$141.26 , N/A , N/A , N/A , N/A , N/A ,$197.16 , N/A ,$213.39 ,$162.37 ,$117.65 ,$141.19 ,$141.26 ,$141.19 ,$160.28 ,$208.76 ,$158.47 , N/A ,$183.24 , N/A , N/A , N/A , N/A , N/A ,$167.00 ,$143.81 ,$167.00 ,$167.00 ,$185.56 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 7FR X 24CM,278,1 ,$231.95 ,$153.09 ,$117.65 ,$231.95 , N/A , N/A , N/A , N/A ,$139.17 ,$197.16 ,$162.37 , N/A , N/A ,$220.35 ,$176.28 ,$173.96 , N/A ,$197.16 , N/A , N/A , N/A ,$162.37 ,$141.26 , N/A , N/A , N/A , N/A , N/A ,$197.16 , N/A ,$213.39 ,$162.37 ,$117.65 ,$141.19 ,$141.26 ,$141.19 ,$160.28 ,$208.76 ,$158.47 , N/A ,$183.24 , N/A , N/A , N/A , N/A , N/A ,$167.00 ,$143.81 ,$167.00 ,$167.00 ,$185.56 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL BOSTON SCI CONTOUR 7FR X 26CM,278,1 ,$231.95 ,$153.09 ,$117.65 ,$231.95 , N/A , N/A , N/A , N/A ,$139.17 ,$197.16 ,$162.37 , N/A , N/A ,$220.35 ,$176.28 ,$173.96 , N/A ,$197.16 , N/A , N/A , N/A ,$162.37 ,$141.26 , N/A , N/A , N/A , N/A , N/A ,$197.16 , N/A ,$213.39 ,$162.37 ,$117.65 ,$141.19 ,$141.26 ,$141.19 ,$160.28 ,$208.76 ,$158.47 , N/A ,$183.24 , N/A , N/A , N/A , N/A , N/A ,$167.00 ,$143.81 ,$167.00 ,$167.00 ,$185.56 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL SOF-CURL 4.5FR X24CM,278,1 ,$146.88 ,$96.94 ,$74.50 ,$146.88 , N/A , N/A , N/A , N/A ,$88.13 ,$124.85 ,$102.82 , N/A , N/A ,$139.54 ,$111.63 ,$110.16 , N/A ,$124.85 , N/A , N/A , N/A ,$102.82 ,$89.45 , N/A , N/A , N/A , N/A , N/A ,$124.85 , N/A ,$135.13 ,$102.82 ,$74.50 ,$89.41 ,$89.45 ,$89.41 ,$101.49 ,$132.19 ,$100.35 , N/A ,$116.04 , N/A , N/A , N/A , N/A , N/A ,$105.75 ,$91.07 ,$105.75 ,$105.75 ,$117.50 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL SOF-CURL 4.5FR X 26CM,278,1 ,$146.88 ,$96.94 ,$74.50 ,$146.88 , N/A , N/A , N/A , N/A ,$88.13 ,$124.85 ,$102.82 , N/A , N/A ,$139.54 ,$111.63 ,$110.16 , N/A ,$124.85 , N/A , N/A , N/A ,$102.82 ,$89.45 , N/A , N/A , N/A , N/A , N/A ,$124.85 , N/A ,$135.13 ,$102.82 ,$74.50 ,$89.41 ,$89.45 ,$89.41 ,$101.49 ,$132.19 ,$100.35 , N/A ,$116.04 , N/A , N/A , N/A , N/A , N/A ,$105.75 ,$91.07 ,$105.75 ,$105.75 ,$117.50 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL SOF-CURL 7FR X 26CM,278,1 ,$152.75 ,$100.82 ,$77.47 ,$152.75 , N/A , N/A , N/A , N/A ,$91.65 ,$129.84 ,$106.93 , N/A , N/A ,$145.11 ,$116.09 ,$114.56 , N/A ,$129.84 , N/A , N/A , N/A ,$106.93 ,$93.02 , N/A , N/A , N/A , N/A , N/A ,$129.84 , N/A ,$140.53 ,$106.93 ,$77.47 ,$92.98 ,$93.02 ,$92.98 ,$105.55 ,$137.48 ,$104.36 , N/A ,$120.67 , N/A , N/A , N/A , N/A , N/A ,$109.98 ,$94.71 ,$109.98 ,$109.98 ,$122.20 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 4.5FR 20CM,278,1 ,$152.75 ,$100.82 ,$77.47 ,$152.75 , N/A , N/A , N/A , N/A ,$91.65 ,$129.84 ,$106.93 , N/A , N/A ,$145.11 ,$116.09 ,$114.56 , N/A ,$129.84 , N/A , N/A , N/A ,$106.93 ,$93.02 , N/A , N/A , N/A , N/A , N/A ,$129.84 , N/A ,$140.53 ,$106.93 ,$77.47 ,$92.98 ,$93.02 ,$92.98 ,$105.55 ,$137.48 ,$104.36 , N/A ,$120.67 , N/A , N/A , N/A , N/A , N/A ,$109.98 ,$94.71 ,$109.98 ,$109.98 ,$122.20 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 4.5FR 22CM TEMPORARY INDWELL CATHETER STERILE LATEX FREE,278,1 ,$152.75 ,$100.82 ,$77.47 ,$152.75 , N/A , N/A , N/A , N/A ,$91.65 ,$129.84 ,$106.93 , N/A , N/A ,$145.11 ,$116.09 ,$114.56 , N/A ,$129.84 , N/A , N/A , N/A ,$106.93 ,$93.02 , N/A , N/A , N/A , N/A , N/A ,$129.84 , N/A ,$140.53 ,$106.93 ,$77.47 ,$92.98 ,$93.02 ,$92.98 ,$105.55 ,$137.48 ,$104.36 , N/A ,$120.67 , N/A , N/A , N/A , N/A , N/A ,$109.98 ,$94.71 ,$109.98 ,$109.98 ,$122.20 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 4.5FR 28CM TEMPORARY INDWELL CATHETER STERILE LATEX FREE,278,1 ,$152.75 ,$100.82 ,$77.47 ,$152.75 , N/A , N/A , N/A , N/A ,$91.65 ,$129.84 ,$106.93 , N/A , N/A ,$145.11 ,$116.09 ,$114.56 , N/A ,$129.84 , N/A , N/A , N/A ,$106.93 ,$93.02 , N/A , N/A , N/A , N/A , N/A ,$129.84 , N/A ,$140.53 ,$106.93 ,$77.47 ,$92.98 ,$93.02 ,$92.98 ,$105.55 ,$137.48 ,$104.36 , N/A ,$120.67 , N/A , N/A , N/A , N/A , N/A ,$109.98 ,$94.71 ,$109.98 ,$109.98 ,$122.20 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 7FR 22CM TEMPORARY INDWELL CATHETER SOF-CURL STERILE LATEX FREE,278,1 ,$152.75 ,$100.82 ,$77.47 ,$152.75 , N/A , N/A , N/A , N/A ,$91.65 ,$129.84 ,$106.93 , N/A , N/A ,$145.11 ,$116.09 ,$114.56 , N/A ,$129.84 , N/A , N/A , N/A ,$106.93 ,$93.02 , N/A , N/A , N/A , N/A , N/A ,$129.84 , N/A ,$140.53 ,$106.93 ,$77.47 ,$92.98 ,$93.02 ,$92.98 ,$105.55 ,$137.48 ,$104.36 , N/A ,$120.67 , N/A , N/A , N/A , N/A , N/A ,$109.98 ,$94.71 ,$109.98 ,$109.98 ,$122.20 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL SOF-CURL 6FR X 24CM,278,1 ,$152.75 ,$100.82 ,$77.47 ,$152.75 , N/A , N/A , N/A , N/A ,$91.65 ,$129.84 ,$106.93 , N/A , N/A ,$145.11 ,$116.09 ,$114.56 , N/A ,$129.84 , N/A , N/A , N/A ,$106.93 ,$93.02 , N/A , N/A , N/A , N/A , N/A ,$129.84 , N/A ,$140.53 ,$106.93 ,$77.47 ,$92.98 ,$93.02 ,$92.98 ,$105.55 ,$137.48 ,$104.36 , N/A ,$120.67 , N/A , N/A , N/A , N/A , N/A ,$109.98 ,$94.71 ,$109.98 ,$109.98 ,$122.20 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL SOF-CURL 6FR X 26CM,278,1 ,$152.75 ,$100.82 ,$77.47 ,$152.75 , N/A , N/A , N/A , N/A ,$91.65 ,$129.84 ,$106.93 , N/A , N/A ,$145.11 ,$116.09 ,$114.56 , N/A ,$129.84 , N/A , N/A , N/A ,$106.93 ,$93.02 , N/A , N/A , N/A , N/A , N/A ,$129.84 , N/A ,$140.53 ,$106.93 ,$77.47 ,$92.98 ,$93.02 ,$92.98 ,$105.55 ,$137.48 ,$104.36 , N/A ,$120.67 , N/A , N/A , N/A , N/A , N/A ,$109.98 ,$94.71 ,$109.98 ,$109.98 ,$122.20 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL SOF-CURL 7FR X 24CM,278,1 ,$152.75 ,$100.82 ,$77.47 ,$152.75 , N/A , N/A , N/A , N/A ,$91.65 ,$129.84 ,$106.93 , N/A , N/A ,$145.11 ,$116.09 ,$114.56 , N/A ,$129.84 , N/A , N/A , N/A ,$106.93 ,$93.02 , N/A , N/A , N/A , N/A , N/A ,$129.84 , N/A ,$140.53 ,$106.93 ,$77.47 ,$92.98 ,$93.02 ,$92.98 ,$105.55 ,$137.48 ,$104.36 , N/A ,$120.67 , N/A , N/A , N/A , N/A , N/A ,$109.98 ,$94.71 ,$109.98 ,$109.98 ,$122.20 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL SOF-CURL 7FR X 28CM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL SOF-CURL 6FR X 22CM,278,1 ,$225.00 ,$148.50 ,$114.12 ,$225.00 , N/A , N/A , N/A , N/A ,$135.00 ,$191.25 ,$157.50 , N/A , N/A ,$213.75 ,$171.00 ,$168.75 , N/A ,$191.25 , N/A , N/A , N/A ,$157.50 ,$137.03 , N/A , N/A , N/A , N/A , N/A ,$191.25 , N/A ,$207.00 ,$157.50 ,$114.12 ,$136.96 ,$137.03 ,$136.96 ,$155.48 ,$202.50 ,$153.72 , N/A ,$177.75 , N/A , N/A , N/A , N/A , N/A ,$162.00 ,$139.50 ,$162.00 ,$162.00 ,$180.00 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,SYSTEM STENT NEPHROURETERAL BOSTON SCIENTIFIC 8FR X 26CM,278,1 ,$201.96 ,$133.29 ,$102.43 ,$201.96 , N/A , N/A , N/A , N/A ,$121.18 ,$171.67 ,$141.37 , N/A , N/A ,$191.86 ,$153.49 ,$151.47 , N/A ,$171.67 , N/A , N/A , N/A ,$141.37 ,$122.99 , N/A , N/A , N/A , N/A , N/A ,$171.67 , N/A ,$185.80 ,$141.37 ,$102.43 ,$122.93 ,$122.99 ,$122.93 ,$139.55 ,$181.76 ,$137.98 , N/A ,$159.55 , N/A , N/A , N/A , N/A , N/A ,$145.41 ,$125.22 ,$145.41 ,$145.41 ,$161.57 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT NEPHROURETERAL 22CM 10FR PIGTAIL CURVE PERCUFLEX METAL STIFFEN CANNULA NONCOATED INTERNAL EXTERNAL DRAINAGE,278,1 ,$201.96 ,$133.29 ,$102.43 ,$201.96 , N/A , N/A , N/A , N/A ,$121.18 ,$171.67 ,$141.37 , N/A , N/A ,$191.86 ,$153.49 ,$151.47 , N/A ,$171.67 , N/A , N/A , N/A ,$141.37 ,$122.99 , N/A , N/A , N/A , N/A , N/A ,$171.67 , N/A ,$185.80 ,$141.37 ,$102.43 ,$122.93 ,$122.99 ,$122.93 ,$139.55 ,$181.76 ,$137.98 , N/A ,$159.55 , N/A , N/A , N/A , N/A , N/A ,$145.41 ,$125.22 ,$145.41 ,$145.41 ,$161.57 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT NEPHROURETERAL 26CM 10FR TEMPTIP HYDROPHILIC STIFF CANNULA INTERNAL EXTERNAL DRAINAGE,278,1 ,$201.96 ,$133.29 ,$102.43 ,$201.96 , N/A , N/A , N/A , N/A ,$121.18 ,$171.67 ,$141.37 , N/A , N/A ,$191.86 ,$153.49 ,$151.47 , N/A ,$171.67 , N/A , N/A , N/A ,$141.37 ,$122.99 , N/A , N/A , N/A , N/A , N/A ,$171.67 , N/A ,$185.80 ,$141.37 ,$102.43 ,$122.93 ,$122.99 ,$122.93 ,$139.55 ,$181.76 ,$137.98 , N/A ,$159.55 , N/A , N/A , N/A , N/A , N/A ,$145.41 ,$125.22 ,$145.41 ,$145.41 ,$161.57 
ST NICHOLAS HOSPITAL - ACUTE,27872617,C2617,STENT URETERAL 8FR 22CM PIGTAIL STIFF,278,1 ,$201.96 ,$133.29 ,$102.43 ,$201.96 , N/A , N/A , N/A , N/A ,$121.18 ,$171.67 ,$141.37 , N/A , N/A ,$191.86 ,$153.49 ,$151.47 , N/A ,$171.67 , N/A , N/A , N/A ,$141.37 ,$122.99 , N/A , N/A , N/A , N/A , N/A ,$171.67 , N/A ,$185.80 ,$141.37 ,$102.43 ,$122.93 ,$122.99 ,$122.93 ,$139.55 ,$181.76 ,$137.98 , N/A ,$159.55 , N/A , N/A , N/A , N/A , N/A ,$145.41 ,$125.22 ,$145.41 ,$145.41 ,$161.57 
ST NICHOLAS HOSPITAL - ACUTE,27872625,C2625,STENT PROPEL 23MM,278,1 ,"$1,629.75 ","$1,075.64 ",$826.61 ,"$1,629.75 ", N/A ,$859.04 ,$859.04 , N/A ,$977.85 ,"$1,385.29 ","$1,140.83 ", N/A , N/A ,"$1,548.26 ","$1,238.61 ","$1,222.31 ", N/A ,"$1,385.29 ", N/A , N/A , N/A ,"$1,140.83 ",$992.52 , N/A , N/A , N/A , N/A , N/A ,"$1,385.29 ", N/A ,"$1,499.37 ","$1,140.83 ",$826.61 ,$992.03 ,$992.52 ,$992.03 ,"$1,126.16 ","$1,466.78 ","$1,113.45 ", N/A ,"$1,287.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,173.42 ","$1,010.45 ","$1,173.42 ","$1,173.42 ","$1,303.80 "
ST NICHOLAS HOSPITAL - ACUTE,27872625,C2625,STENT PROPEL MINI 16MM,278,1 ,"$2,270.50 ","$1,498.53 ","$1,151.60 ","$2,270.50 ", N/A ,"$1,196.78 ","$1,196.78 ", N/A ,"$1,362.30 ","$1,929.93 ","$1,589.35 ", N/A , N/A ,"$2,156.98 ","$1,725.58 ","$1,702.88 ", N/A ,"$1,929.93 ", N/A , N/A , N/A ,"$1,589.35 ","$1,382.73 ", N/A , N/A , N/A , N/A , N/A ,"$1,929.93 ", N/A ,"$2,088.86 ","$1,589.35 ","$1,151.60 ","$1,382.05 ","$1,382.73 ","$1,382.05 ","$1,568.92 ","$2,043.45 ","$1,551.21 ", N/A ,"$1,793.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,634.76 ","$1,407.71 ","$1,634.76 ","$1,634.76 ","$1,816.40 "
ST NICHOLAS HOSPITAL - ACUTE,27872625,C2625,STENT URETERAL METALLIC W/ DELIVERY SYSTEM,278,1 ,"$2,261.00 ","$1,492.26 ","$1,146.78 ","$2,261.00 ", N/A ,"$1,191.77 ","$1,191.77 ", N/A ,"$1,356.60 ","$1,921.85 ","$1,582.70 ", N/A , N/A ,"$2,147.95 ","$1,718.36 ","$1,695.75 ", N/A ,"$1,921.85 ", N/A , N/A , N/A ,"$1,582.70 ","$1,376.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,921.85 ", N/A ,"$2,080.12 ","$1,582.70 ","$1,146.78 ","$1,376.27 ","$1,376.95 ","$1,376.27 ","$1,562.35 ","$2,034.90 ","$1,544.72 ", N/A ,"$1,786.19 ", N/A , N/A , N/A , N/A , N/A ,"$1,627.92 ","$1,401.82 ","$1,627.92 ","$1,627.92 ","$1,808.80 "
ST NICHOLAS HOSPITAL - ACUTE,27874104,Q4104,DRESSING BIOLOGICAL 2X2IN INTEGRA BOVINE COLLAGEN GLYCOSAMINOGLYCAN POLYSILOXANE MESH STERILE LATEX FREE DISPOSABLE,636,1 ,"$6,303.35 ","$4,160.21 ",$69.06 ,"$6,303.35 ", N/A ,$107.17 ,$71.45 , N/A ,"$3,782.01 ","$5,357.85 ","$4,412.35 ", N/A , N/A ,"$5,988.18 ","$4,790.55 ","$4,727.51 ",$80.58 ,"$5,357.85 ", N/A ,$80.58 ,$80.58 ,"$4,412.35 ","$3,838.74 ", N/A , N/A , N/A , N/A , N/A ,"$5,357.85 ", N/A ,"$5,799.08 ","$4,412.35 ",$69.06 ,$69.06 ,"$3,838.74 ",$69.06 ,"$4,355.61 ","$5,673.02 ","$4,306.45 ", N/A ,"$4,979.65 ", N/A , N/A , N/A , N/A , N/A ,"$4,538.41 ","$3,908.08 ","$4,538.41 ","$4,538.41 ","$5,042.68 "
ST NICHOLAS HOSPITAL - ACUTE,27874104,Q4104,DRESSING MATRIX WOUND INTEGRA 2IN X 2IN,636,1 ,"$4,458.83 ","$2,942.83 ",$69.06 ,"$4,458.83 ", N/A ,$107.17 ,$71.45 , N/A ,"$2,675.30 ","$3,790.01 ","$3,121.18 ", N/A , N/A ,"$4,235.89 ","$3,388.71 ","$3,344.12 ",$80.58 ,"$3,790.01 ", N/A ,$80.58 ,$80.58 ,"$3,121.18 ","$2,715.43 ", N/A , N/A , N/A , N/A , N/A ,"$3,790.01 ", N/A ,"$4,102.12 ","$3,121.18 ",$69.06 ,$69.06 ,"$2,715.43 ",$69.06 ,"$3,081.05 ","$4,012.95 ","$3,046.27 ", N/A ,"$3,522.48 ", N/A , N/A , N/A , N/A , N/A ,"$3,210.36 ","$2,764.47 ","$3,210.36 ","$3,210.36 ","$3,567.06 "
ST NICHOLAS HOSPITAL - ACUTE,27874104,Q4104,DRESSING WOUND BOVINE COLLAGEN GLYCOSAMINOGLYCAN POLYSILOXANE 3ML STERILE LATEX FREE DISPOSABLE,636,1 ,"$7,769.03 ","$5,127.56 ",$69.06 ,"$7,769.03 ", N/A ,$107.17 ,$71.45 , N/A ,"$4,661.42 ","$6,603.68 ","$5,438.32 ", N/A , N/A ,"$7,380.58 ","$5,904.46 ","$5,826.77 ",$80.58 ,"$6,603.68 ", N/A ,$80.58 ,$80.58 ,"$5,438.32 ","$4,731.34 ", N/A , N/A , N/A , N/A , N/A ,"$6,603.68 ", N/A ,"$7,147.51 ","$5,438.32 ",$69.06 ,$69.06 ,"$4,731.34 ",$69.06 ,"$5,368.40 ","$6,992.13 ","$5,307.80 ", N/A ,"$6,137.53 ", N/A , N/A , N/A , N/A , N/A ,"$5,593.70 ","$4,816.80 ","$5,593.70 ","$5,593.70 ","$6,215.22 "
ST NICHOLAS HOSPITAL - ACUTE,27874112,Q4112,TISSUE CYMETRA 2CC  (603020) CHARGE PER CC,278,1 ,$623.50 ,$411.51 ,$316.24 ,$623.50 , N/A , N/A , N/A , N/A ,$374.10 ,$529.98 ,$436.45 , N/A , N/A ,$592.33 ,$473.86 ,$467.63 , N/A ,$529.98 , N/A , N/A , N/A ,$436.45 ,$379.71 , N/A , N/A , N/A , N/A , N/A ,$529.98 , N/A ,$573.62 ,$436.45 ,$316.24 ,$379.52 ,$379.71 ,$379.52 ,$430.84 ,$561.15 ,$425.98 , N/A ,$492.57 , N/A , N/A , N/A , N/A , N/A ,$448.92 ,$386.57 ,$448.92 ,$448.92 ,$498.80 
ST NICHOLAS HOSPITAL - ACUTE,27878690,L8690,IMPLANT BAHA BI 300 4MM,278,1 ,"$2,770.20 ","$1,828.33 ","$1,385.10 ","$2,770.20 ", N/A ,"$1,460.17 ","$1,460.17 ", N/A ,"$1,662.12 ","$2,354.67 ","$1,939.14 ", N/A , N/A ,"$2,631.69 ","$2,105.35 ","$2,077.65 ","$1,385.10 ","$2,354.67 ", N/A ,"$1,385.10 ","$1,385.10 ","$1,939.14 ","$1,687.05 ", N/A , N/A , N/A , N/A , N/A ,"$2,354.67 ", N/A ,"$2,548.58 ","$1,939.14 ","$1,405.05 ","$1,686.22 ","$1,687.05 ","$1,686.22 ","$1,914.21 ","$2,493.18 ","$1,892.60 ", N/A ,"$2,188.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,994.54 ","$1,717.52 ","$1,994.54 ","$1,994.54 ","$2,216.16 "
ST NICHOLAS HOSPITAL - ACUTE,27878690,L8690,IMPLANT BAHA BI 300 3MM,278,1 ,"$2,770.20 ","$1,828.33 ","$1,385.10 ","$2,770.20 ", N/A ,"$1,460.17 ","$1,460.17 ", N/A ,"$1,662.12 ","$2,354.67 ","$1,939.14 ", N/A , N/A ,"$2,631.69 ","$2,105.35 ","$2,077.65 ","$1,385.10 ","$2,354.67 ", N/A ,"$1,385.10 ","$1,385.10 ","$1,939.14 ","$1,687.05 ", N/A , N/A , N/A , N/A , N/A ,"$2,354.67 ", N/A ,"$2,548.58 ","$1,939.14 ","$1,405.05 ","$1,686.22 ","$1,687.05 ","$1,686.22 ","$1,914.21 ","$2,493.18 ","$1,892.60 ", N/A ,"$2,188.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,994.54 ","$1,717.52 ","$1,994.54 ","$1,994.54 ","$2,216.16 "
ST NICHOLAS HOSPITAL - ACUTE,27878699,L8699,UROLIFT,278,1 ,"$1,896.25 ","$1,251.53 ",$961.78 ,"$1,896.25 ", N/A ,$999.51 ,$999.51 , N/A ,"$1,137.75 ","$1,611.81 ","$1,327.38 ", N/A , N/A ,"$1,801.44 ","$1,441.15 ","$1,422.19 ", N/A ,"$1,611.81 ", N/A , N/A , N/A ,"$1,327.38 ","$1,154.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,611.81 ", N/A ,"$1,744.55 ","$1,327.38 ",$961.78 ,"$1,154.25 ","$1,154.82 ","$1,154.25 ","$1,310.31 ","$1,706.63 ","$1,295.52 ", N/A ,"$1,498.04 ", N/A , N/A , N/A , N/A , N/A ,"$1,365.30 ","$1,175.68 ","$1,365.30 ","$1,365.30 ","$1,517.00 "
ST NICHOLAS HOSPITAL - ACUTE,27879359,C9359,GRAFT BONE TRIBIO TCP BIOACTIVE GLASS HA 7.5MM BIORESORBABLE BACKFILL PLUG 40MM 8MM,278,1 ,"$1,428.85 ",$943.04 ,$724.71 ,"$1,428.85 ", N/A ,$753.15 ,$753.15 , N/A ,$857.31 ,"$1,214.52 ","$1,000.20 ", N/A , N/A ,"$1,357.41 ","$1,085.93 ","$1,071.64 ", N/A ,"$1,214.52 ", N/A , N/A , N/A ,"$1,000.20 ",$870.17 , N/A , N/A , N/A , N/A , N/A ,"$1,214.52 ", N/A ,"$1,314.54 ","$1,000.20 ",$724.71 ,$869.74 ,$870.17 ,$869.74 ,$987.34 ,"$1,285.97 ",$976.19 , N/A ,"$1,128.79 ", N/A , N/A , N/A , N/A , N/A ,"$1,028.77 ",$885.89 ,"$1,028.77 ","$1,028.77 ","$1,143.08 "
ST NICHOLAS HOSPITAL - ACUTE,30000002,N/A,HC CHEMISTRY PANEL-VET,300,1 ,$20.70 ,$13.66 ,$10.14 ,$20.70 , N/A ,$14.19 ,$14.19 , N/A ,$12.42 ,$17.60 ,$14.49 , N/A , N/A ,$19.67 ,$15.73 ,$15.53 , N/A ,$17.60 , N/A , N/A , N/A ,$14.49 ,$12.61 , N/A , N/A , N/A , N/A , N/A ,$17.60 , N/A ,$19.04 ,$14.49 ,$10.50 ,$12.60 ,$12.61 ,$12.60 ,$14.30 ,$18.63 ,$14.14 , N/A ,$16.35 , N/A ,$10.14 ,$10.14 , N/A ,$10.14 ,$14.90 ,$12.83 ,$14.90 ,$14.90 ,$16.56 
ST NICHOLAS HOSPITAL - ACUTE,30000005,36415,HC BLOOD COLLECTION FOR EVIDENCE,300,1 ,$46.50 ,$30.69 ,$3.60 ,$46.50 , N/A ,$9.00 ,$9.00 ,$8.57 ,$27.90 ,$39.53 , N/A , N/A , N/A ,$44.18 ,$35.34 ,$34.88 ,$14.57 ,$39.53 ,$8.57 ,$14.57 ,$14.57 ,$32.55 ,$28.32 , N/A ,$8.57 ,$8.40 ,$17.14 , N/A ,$39.53 ,$19.28 ,$42.78 ,$32.55 ,$10.99 ,$10.99 ,$28.32 ,$10.99 ,$32.13 ,$41.85 ,$31.77 ,$8.49 ,$36.74 , N/A ,$3.60 ,$3.60 ,$8.40 ,$3.60 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$37.20 
ST NICHOLAS HOSPITAL - ACUTE,30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$30.00 ,$19.80 ,$0.08 ,$30.00 ,$0.08 ,$9.00 ,$9.00 , N/A ,$18.00 ,$25.50 , N/A ,$0.08 ,$0.08 ,$28.50 ,$22.80 ,$22.50 ,$13.69 ,$25.50 , N/A ,$13.69 ,$13.69 ,$21.00 ,$18.27 ,$0.08 , N/A , N/A , N/A ,$0.08 ,$25.50 , N/A ,$27.60 ,$21.00 ,$15.22 ,$18.26 ,$18.27 ,$18.26 ,$20.73 ,$27.00 ,$20.50 , N/A ,$23.70 ,$0.08 ,$3.47 ,$3.47 , N/A ,$3.47 ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$24.00 
ST NICHOLAS HOSPITAL - ACUTE,30000010,36415,HC VENIPUNCTURE,300,1 ,$46.50 ,$30.69 ,$3.60 ,$46.50 , N/A ,$9.00 ,$9.00 ,$8.57 ,$27.90 ,$39.53 , N/A , N/A , N/A ,$44.18 ,$35.34 ,$34.88 ,$14.57 ,$39.53 ,$8.57 ,$14.57 ,$14.57 ,$32.55 ,$28.32 , N/A ,$8.57 ,$8.40 ,$17.14 , N/A ,$39.53 ,$19.28 ,$42.78 ,$32.55 ,$10.99 ,$10.99 ,$28.32 ,$10.99 ,$32.13 ,$41.85 ,$31.77 ,$8.49 ,$36.74 , N/A ,$3.60 ,$3.60 ,$8.40 ,$3.60 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$37.20 
ST NICHOLAS HOSPITAL - ACUTE,30000011,36415,HC CATHETER COLLECTION,300,1 ,$46.50 ,$30.69 ,$3.60 ,$46.50 , N/A ,$9.00 ,$9.00 ,$8.57 ,$27.90 ,$39.53 , N/A , N/A , N/A ,$44.18 ,$35.34 ,$34.88 ,$14.57 ,$39.53 ,$8.57 ,$14.57 ,$14.57 ,$32.55 ,$28.32 , N/A ,$8.57 ,$8.40 ,$17.14 , N/A ,$39.53 ,$19.28 ,$42.78 ,$32.55 ,$10.99 ,$10.99 ,$28.32 ,$10.99 ,$32.13 ,$41.85 ,$31.77 ,$8.49 ,$36.74 , N/A ,$3.60 ,$3.60 ,$8.40 ,$3.60 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$37.20 
ST NICHOLAS HOSPITAL - ACUTE,30000012,36415,HC COURTESY DRAW FEE,300,1 ,$46.50 ,$30.69 ,$3.60 ,$46.50 , N/A ,$9.00 ,$9.00 ,$8.57 ,$27.90 ,$39.53 , N/A , N/A , N/A ,$44.18 ,$35.34 ,$34.88 ,$14.57 ,$39.53 ,$8.57 ,$14.57 ,$14.57 ,$32.55 ,$28.32 , N/A ,$8.57 ,$8.40 ,$17.14 , N/A ,$39.53 ,$19.28 ,$42.78 ,$32.55 ,$10.99 ,$10.99 ,$28.32 ,$10.99 ,$32.13 ,$41.85 ,$31.77 ,$8.49 ,$36.74 , N/A ,$3.60 ,$3.60 ,$8.40 ,$3.60 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$37.20 
ST NICHOLAS HOSPITAL - ACUTE,30000014,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$136.85 ,$90.32 ,$2.32 ,$254.98 ,$2.32 ,$93.80 ,$93.80 ,$113.32 ,$82.11 ,$116.32 , N/A ,$2.32 ,$2.32 ,$130.01 ,$104.01 ,$102.64 ,$43.42 ,$116.32 ,$113.32 ,$43.42 ,$43.42 ,$95.80 ,$83.34 ,$2.32 ,$113.32 ,$111.05 ,$136.85 ,$2.46 ,$116.32 ,$254.98 ,$125.90 ,$95.80 ,$69.41 ,$83.30 ,$83.34 ,$83.30 ,$94.56 ,$123.17 ,$93.50 ,$112.16 ,$108.11 ,$2.46 , N/A , N/A ,$111.05 , N/A ,$98.53 ,$84.85 ,$98.53 ,$98.53 ,$109.48 
ST NICHOLAS HOSPITAL - ACUTE,30000015,36600,HC ARTERIAL PUNCTURE,300,1 ,$74.75 ,$49.34 ,$2.32 ,$254.98 ,$2.32 ,$51.23 ,$51.23 ,$113.32 ,$44.85 ,$63.54 ,$52.33 ,$2.32 ,$2.32 ,$71.01 ,$56.81 ,$56.06 ,$24.28 ,$63.54 ,$113.32 ,$24.28 ,$24.28 ,$52.33 ,$45.52 ,$2.32 ,$113.32 ,$111.05 ,$74.75 ,$2.46 ,$63.54 ,$254.98 ,$68.77 ,$52.33 ,$37.91 ,$45.50 ,$45.52 ,$45.50 ,$51.65 ,$67.28 ,$51.07 ,$112.16 ,$59.05 ,$2.46 , N/A , N/A ,$111.05 , N/A ,$53.82 ,$46.35 ,$53.82 ,$53.82 ,$59.80 
ST NICHOLAS HOSPITAL - ACUTE,30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$148.35 ,$97.91 ,$2.32 ,$254.98 ,$2.32 ,$101.68 ,$101.68 ,$113.32 ,$89.01 ,$126.10 , N/A ,$2.32 ,$2.32 ,$140.93 ,$112.75 ,$111.26 ,$47.24 ,$126.10 ,$113.32 ,$47.24 ,$47.24 ,$103.85 ,$90.35 ,$2.32 ,$113.32 ,$111.05 ,$148.35 ,$2.46 ,$126.10 ,$254.98 ,$136.48 ,$103.85 ,$75.24 ,$90.30 ,$90.35 ,$90.30 ,$102.51 ,$133.52 ,$101.35 ,$112.16 ,$117.20 ,$2.46 , N/A , N/A ,$111.05 , N/A ,$106.81 ,$91.98 ,$106.81 ,$106.81 ,$118.68 
ST NICHOLAS HOSPITAL - ACUTE,30000101,89051,HC CELL CT BODY FLUID W/DIFF,300,1 ,$74.75 ,$49.34 ,$5.49 ,$74.75 ,$5.79 ,$19.60 ,$19.60 ,$5.60 ,$44.85 ,$63.54 ,$52.33 ,$5.79 ,$5.79 ,$71.01 ,$56.81 ,$56.06 ,$9.52 ,$63.54 ,$5.60 ,$9.52 ,$9.52 ,$52.33 ,$45.52 ,$5.79 ,$5.60 ,$5.49 ,$11.20 ,$6.14 ,$63.54 ,$12.60 ,$68.77 ,$52.33 ,$27.51 ,$27.51 ,$45.52 ,$27.51 ,$51.65 ,$67.28 ,$51.07 ,$5.55 ,$59.05 ,$6.14 ,$6.72 ,$6.72 ,$5.49 ,$6.72 ,$53.82 ,$46.35 ,$53.82 ,$53.82 ,$59.80 
ST NICHOLAS HOSPITAL - ACUTE,30000102,89051,HC CELL CT BODY FLUID W/DIFF (SYN),300,1 ,$113.85 ,$75.14 ,$5.49 ,$113.85 ,$5.79 ,$19.60 ,$19.60 ,$5.60 ,$68.31 ,$96.77 ,$79.70 ,$5.79 ,$5.79 ,$108.16 ,$86.53 ,$85.39 ,$9.52 ,$96.77 ,$5.60 ,$9.52 ,$9.52 ,$79.70 ,$69.33 ,$5.79 ,$5.60 ,$5.49 ,$11.20 ,$6.14 ,$96.77 ,$12.60 ,$104.74 ,$79.70 ,$27.51 ,$27.51 ,$69.33 ,$27.51 ,$78.67 ,$102.47 ,$77.78 ,$5.55 ,$89.94 ,$6.14 ,$6.72 ,$6.72 ,$5.49 ,$6.72 ,$81.97 ,$70.59 ,$81.97 ,$81.97 ,$91.08 
ST NICHOLAS HOSPITAL - ACUTE,30000104,89055,HC LEUKO ASSESS STOOL QN/SEMI,300,1 ,$47.15 ,$31.12 ,$4.18 ,$47.15 ,$4.41 ,$14.95 ,$14.95 ,$4.27 ,$28.29 ,$40.08 ,$33.01 ,$4.41 ,$4.41 ,$44.79 ,$35.83 ,$35.36 ,$7.26 ,$40.08 ,$4.27 ,$7.26 ,$7.26 ,$33.01 ,$28.71 ,$4.41 ,$4.27 ,$4.18 ,$8.54 ,$4.67 ,$40.08 ,$9.61 ,$43.38 ,$33.01 ,$21.32 ,$21.32 ,$28.71 ,$21.32 ,$32.58 ,$42.44 ,$32.21 ,$4.22 ,$37.25 ,$4.67 ,$5.12 ,$5.12 ,$4.18 ,$5.12 ,$33.95 ,$29.23 ,$33.95 ,$33.95 ,$37.72 
ST NICHOLAS HOSPITAL - ACUTE,30000105,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$60.95 ,$40.23 ,$7.18 ,$60.95 ,$7.57 ,$25.66 ,$25.66 ,$7.33 ,$36.57 ,$51.81 ,$42.67 ,$7.57 ,$7.57 ,$57.90 ,$46.32 ,$45.71 ,$12.46 ,$51.81 ,$7.33 ,$12.46 ,$12.46 ,$42.67 ,$37.12 ,$7.57 ,$7.33 ,$7.18 ,$14.66 ,$8.02 ,$51.81 ,$16.49 ,$56.07 ,$42.67 ,$35.76 ,$35.76 ,$37.12 ,$35.76 ,$42.12 ,$54.86 ,$41.64 ,$7.25 ,$48.15 ,$8.02 ,$8.80 ,$8.80 ,$7.18 ,$8.80 ,$43.88 ,$37.79 ,$43.88 ,$43.88 ,$48.76 
ST NICHOLAS HOSPITAL - ACUTE,30000106,89125,HC FAT STAIN,300,1 ,$44.85 ,$29.60 ,$5.76 ,$44.85 ,$6.08 ,$20.58 ,$20.58 ,$5.88 ,$26.91 ,$38.12 ,$31.40 ,$6.08 ,$6.08 ,$42.61 ,$34.09 ,$33.64 ,$10.00 ,$38.12 ,$5.88 ,$10.00 ,$10.00 ,$31.40 ,$27.31 ,$6.08 ,$5.88 ,$5.76 ,$11.76 ,$6.44 ,$38.12 ,$13.23 ,$41.26 ,$31.40 ,$21.58 ,$21.58 ,$27.31 ,$21.58 ,$30.99 ,$40.37 ,$30.64 ,$5.82 ,$35.43 ,$6.44 ,$7.06 ,$7.06 ,$5.76 ,$7.06 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30000107,89190,HC SMEAR NASAL EOSINOPHILS,300,1 ,$47.15 ,$31.12 ,$5.67 ,$47.15 ,$5.98 ,$20.27 ,$20.27 ,$5.79 ,$28.29 ,$40.08 ,$33.01 ,$5.98 ,$5.98 ,$44.79 ,$35.83 ,$35.36 ,$9.84 ,$40.08 ,$5.79 ,$9.84 ,$9.84 ,$33.01 ,$28.71 ,$5.98 ,$5.79 ,$5.67 ,$11.58 ,$6.34 ,$40.08 ,$13.03 ,$43.38 ,$33.01 ,$23.74 ,$23.74 ,$28.71 ,$23.74 ,$32.58 ,$42.44 ,$32.21 ,$5.73 ,$37.25 ,$6.34 ,$6.95 ,$6.95 ,$5.67 ,$6.95 ,$33.95 ,$29.23 ,$33.95 ,$33.95 ,$37.72 
ST NICHOLAS HOSPITAL - ACUTE,30000108,89220,HC SPUTUM COLLECTION,300,1 ,$111.55 ,$73.62 ,$2.61 ,$345.32 ,$2.61 ,$61.19 ,$61.19 ,$153.48 ,$66.93 ,$94.82 ,$78.09 ,$2.61 ,$2.61 ,$105.97 ,$84.78 ,$83.66 ,$29.19 ,$94.82 ,$153.48 ,$29.19 ,$29.19 ,$78.09 ,$67.93 ,$2.61 ,$153.48 ,$150.41 ,$111.55 ,$2.77 ,$94.82 ,$345.32 ,$102.63 ,$78.09 ,$56.58 ,$67.90 ,$67.93 ,$67.90 ,$77.08 ,$100.40 ,$76.21 ,$151.91 ,$88.12 ,$2.77 ,$111.55 ,$111.55 ,$150.41 ,$111.55 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,30000109,89230,HC SWEAT COLLECTION,300,1 ,$223.10 ,$147.25 ,$1.19 ,$223.10 ,$1.19 ,$7.20 ,$7.20 ,$48.94 ,$133.86 ,$189.64 ,$156.17 ,$1.19 ,$1.19 ,$211.95 ,$169.56 ,$167.33 ,$4.01 ,$189.64 ,$48.94 ,$4.01 ,$4.01 ,$156.17 ,$135.87 ,$1.19 ,$48.94 ,$47.96 ,$97.88 ,$1.26 ,$189.64 ,$110.11 ,$205.25 ,$156.17 ,$113.16 ,$135.80 ,$135.87 ,$135.80 ,$154.16 ,$200.79 ,$152.42 ,$48.44 ,$176.25 ,$1.26 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$160.63 ,$138.32 ,$160.63 ,$160.63 ,$178.48 
ST NICHOLAS HOSPITAL - ACUTE,30000111,89310,HC SPERM COUNT,300,1 ,$328.90 ,$217.07 ,$8.44 ,$328.90 ,$8.90 ,$30.14 ,$30.14 ,$8.61 ,$197.34 ,$279.57 ,$230.23 ,$8.90 ,$8.90 ,$312.46 ,$249.96 ,$246.68 ,$14.64 ,$279.57 ,$8.61 ,$14.64 ,$14.64 ,$230.23 ,$200.30 ,$8.90 ,$8.61 ,$8.44 ,$17.22 ,$9.43 ,$279.57 ,$19.37 ,$302.59 ,$230.23 ,$43.01 ,$43.01 ,$200.30 ,$43.01 ,$227.27 ,$296.01 ,$224.70 ,$8.53 ,$259.83 ,$9.43 ,$10.33 ,$10.33 ,$8.44 ,$10.33 ,$236.81 ,$203.92 ,$236.81 ,$236.81 ,$263.12 
ST NICHOLAS HOSPITAL - ACUTE,30000113,89320,HC SEMEN ANALYSIS,300,1 ,$69.00 ,$45.54 ,$12.06 ,$69.00 ,$12.72 ,$43.09 ,$43.09 ,$12.31 ,$41.40 ,$58.65 ,$48.30 ,$12.72 ,$12.72 ,$65.55 ,$52.44 ,$51.75 ,$20.93 ,$58.65 ,$12.31 ,$20.93 ,$20.93 ,$48.30 ,$42.02 ,$12.72 ,$12.31 ,$12.06 ,$24.62 ,$13.48 ,$58.65 ,$27.70 ,$63.48 ,$48.30 ,$60.23 ,$60.23 ,$42.02 ,$60.23 ,$47.68 ,$62.10 ,$47.14 ,$12.18 ,$54.51 ,$13.48 ,$14.77 ,$14.77 ,$12.06 ,$14.77 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30000114,89325,HC SPERM ANTIBODIES,300,1 ,$79.35 ,$52.37 ,$0.15 ,$79.35 ,$0.15 ,$37.35 ,$37.35 ,$10.67 ,$47.61 ,$67.45 ,$55.55 ,$0.15 ,$0.15 ,$75.38 ,$60.31 ,$59.51 ,$18.14 ,$67.45 ,$10.67 ,$18.14 ,$18.14 ,$55.55 ,$48.32 ,$0.15 ,$10.67 ,$10.46 ,$21.34 ,$0.16 ,$67.45 ,$24.01 ,$73.00 ,$55.55 ,$53.34 ,$53.34 ,$48.32 ,$53.34 ,$54.83 ,$71.42 ,$54.21 ,$10.56 ,$62.69 ,$0.16 ,$12.80 ,$12.80 ,$10.46 ,$12.80 ,$57.13 ,$49.20 ,$57.13 ,$57.13 ,$63.48 
ST NICHOLAS HOSPITAL - ACUTE,30000115,99001,HC SPECIMEN HAND/CONVEY OTHER,300,1 ,$29.90 ,$19.73 ,$3.92 ,$29.90 ,$3.92 ,$20.49 ,$20.49 , N/A ,$17.94 ,$25.42 ,$20.93 ,$3.92 ,$3.92 ,$28.41 ,$22.72 ,$22.43 ,$10.20 ,$25.42 , N/A ,$10.20 ,$10.20 ,$20.93 ,$18.21 ,$3.92 , N/A , N/A , N/A ,$4.16 ,$25.42 , N/A ,$27.51 ,$20.93 ,$15.17 ,$18.20 ,$18.21 ,$18.20 ,$20.66 ,$26.91 ,$20.43 , N/A ,$23.62 ,$4.16 ,$7.37 ,$7.37 , N/A ,$7.37 ,$21.53 ,$18.54 ,$21.53 ,$21.53 ,$23.92 
ST NICHOLAS HOSPITAL - ACUTE,30000116,99080,HC EMPL DRUG SCREEN COL,300,1 ,$23.00 ,$15.18 ,$11.67 ,$23.00 , N/A ,$15.76 ,$15.76 , N/A ,$13.80 ,$19.55 ,$16.10 , N/A , N/A ,$21.85 ,$17.48 ,$17.25 , N/A ,$19.55 , N/A , N/A , N/A ,$16.10 ,$14.01 , N/A , N/A , N/A , N/A , N/A ,$19.55 , N/A ,$21.16 ,$16.10 ,$11.67 ,$14.00 ,$14.01 ,$14.00 ,$15.89 ,$20.70 ,$15.71 , N/A ,$18.17 , N/A , N/A , N/A , N/A , N/A ,$16.56 ,$14.26 ,$16.56 ,$16.56 ,$18.40 
ST NICHOLAS HOSPITAL - ACUTE,30000117,99080,HC LAB PROCESS FEE,300,1 ,$22.00 ,$14.52 ,$11.16 ,$22.00 , N/A ,$15.08 ,$15.08 , N/A ,$13.20 ,$18.70 ,$15.40 , N/A , N/A ,$20.90 ,$16.72 ,$16.50 , N/A ,$18.70 , N/A , N/A , N/A ,$15.40 ,$13.40 , N/A , N/A , N/A , N/A , N/A ,$18.70 , N/A ,$20.24 ,$15.40 ,$11.16 ,$13.39 ,$13.40 ,$13.39 ,$15.20 ,$19.80 ,$15.03 , N/A ,$17.38 , N/A , N/A , N/A , N/A , N/A ,$15.84 ,$13.64 ,$15.84 ,$15.84 ,$17.60 
ST NICHOLAS HOSPITAL - ACUTE,30000120,80306,HC DRUG SCREEN URINE,300,1 ,$300.00 ,$198.00 ,$16.80 ,$300.00 ,$17.71 ,$59.99 ,$59.99 ,$17.14 ,$180.00 ,$255.00 ,$210.00 ,$17.71 ,$17.71 ,$285.00 ,$228.00 ,$225.00 ,$29.14 ,$255.00 ,$17.14 ,$29.14 ,$29.14 ,$210.00 ,$182.70 ,$17.71 ,$17.14 ,$16.80 ,$34.28 ,$18.77 ,$255.00 ,$38.57 ,$276.00 ,$210.00 ,$73.09 ,$73.09 ,$182.70 ,$73.09 ,$207.30 ,$270.00 ,$204.96 ,$16.96 ,$237.00 ,$18.77 ,$20.57 ,$20.57 ,$16.80 ,$20.57 ,$216.00 ,$186.00 ,$216.00 ,$216.00 ,$240.00 
ST NICHOLAS HOSPITAL - ACUTE,30000121,80306,HC DRUG SCREEN SGL CLASS PRESUMPTIVE INSTRMNT,300,1 ,$300.00 ,$198.00 ,$16.80 ,$300.00 ,$17.71 ,$59.99 ,$59.99 ,$17.14 ,$180.00 ,$255.00 ,$210.00 ,$17.71 ,$17.71 ,$285.00 ,$228.00 ,$225.00 ,$29.14 ,$255.00 ,$17.14 ,$29.14 ,$29.14 ,$210.00 ,$182.70 ,$17.71 ,$17.14 ,$16.80 ,$34.28 ,$18.77 ,$255.00 ,$38.57 ,$276.00 ,$210.00 ,$73.09 ,$73.09 ,$182.70 ,$73.09 ,$207.30 ,$270.00 ,$204.96 ,$16.96 ,$237.00 ,$18.77 ,$20.57 ,$20.57 ,$16.80 ,$20.57 ,$216.00 ,$186.00 ,$216.00 ,$216.00 ,$240.00 
ST NICHOLAS HOSPITAL - ACUTE,30000122,80306,HC DRUG SCREEN (FLUNITRAZEPAM),300,1 ,$330.00 ,$217.80 ,$16.80 ,$330.00 ,$17.71 ,$59.99 ,$59.99 ,$17.14 ,$198.00 ,$280.50 ,$231.00 ,$17.71 ,$17.71 ,$313.50 ,$250.80 ,$247.50 ,$29.14 ,$280.50 ,$17.14 ,$29.14 ,$29.14 ,$231.00 ,$200.97 ,$17.71 ,$17.14 ,$16.80 ,$34.28 ,$18.77 ,$280.50 ,$38.57 ,$303.60 ,$231.00 ,$73.09 ,$73.09 ,$200.97 ,$73.09 ,$228.03 ,$297.00 ,$225.46 ,$16.96 ,$260.70 ,$18.77 ,$20.57 ,$20.57 ,$16.80 ,$20.57 ,$237.60 ,$204.60 ,$237.60 ,$237.60 ,$264.00 
ST NICHOLAS HOSPITAL - ACUTE,30000123,80306,HC DRUG SCREEN (HYDROXYBUTYRIC),300,1 ,$183.00 ,$120.78 ,$16.80 ,$183.00 ,$17.71 ,$59.99 ,$59.99 ,$17.14 ,$109.80 ,$155.55 ,$128.10 ,$17.71 ,$17.71 ,$173.85 ,$139.08 ,$137.25 ,$29.14 ,$155.55 ,$17.14 ,$29.14 ,$29.14 ,$128.10 ,$111.45 ,$17.71 ,$17.14 ,$16.80 ,$34.28 ,$18.77 ,$155.55 ,$38.57 ,$168.36 ,$128.10 ,$73.09 ,$73.09 ,$111.45 ,$73.09 ,$126.45 ,$164.70 ,$125.03 ,$16.96 ,$144.57 ,$18.77 ,$20.57 ,$20.57 ,$16.80 ,$20.57 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,30000124,80307,HC DRUG SCREEN MECONIUM,300,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000125,G0432,HC HIV I-II SCREEN,300,1 ,$103.50 ,$68.31 ,$0.24 ,$103.50 ,$0.24 ,$68.50 ,$68.50 ,$19.57 ,$62.10 ,$87.98 ,$72.45 ,$0.24 ,$0.24 ,$98.33 ,$78.66 ,$77.63 ,$33.27 ,$87.98 ,$19.57 ,$33.27 ,$33.27 ,$72.45 ,$63.03 ,$0.24 ,$19.57 ,$19.18 ,$39.14 ,$0.25 ,$87.98 ,$44.03 ,$95.22 ,$72.45 ,$68.51 ,$68.51 ,$63.03 ,$68.51 ,$71.52 ,$93.15 ,$70.71 ,$19.37 ,$81.77 ,$0.25 ,$23.48 ,$23.48 ,$19.18 ,$23.48 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30000126,J2790,HC RH IMMUNE GLOBULIN,300,1 ,$129.00 ,$85.14 ,$1.81 ,$129.00 ,$1.81 ,$88.42 ,$88.42 , N/A ,$77.40 ,$109.65 ,$90.30 ,$1.81 ,$1.81 ,$122.55 ,$98.04 ,$96.75 ,$129.00 ,$109.65 , N/A ,$129.00 ,$129.00 ,$90.30 ,$78.56 ,$1.81 , N/A , N/A , N/A ,$1.92 ,$109.65 , N/A ,$118.68 ,$90.30 ,$65.43 ,$78.52 ,$78.56 ,$78.52 ,$89.14 ,$116.10 ,$88.13 , N/A ,$101.91 ,$1.92 , N/A , N/A , N/A , N/A ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,30000200,80307,HC MECONIUM SCREEN MAYO,300,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000205,84311,HC PM SCREEN OXIDANT,300,1 ,$118.45 ,$78.18 ,$7.94 ,$118.45 ,$8.37 ,$28.35 ,$28.35 ,$8.10 ,$71.07 ,$100.68 ,$82.92 ,$8.37 ,$8.37 ,$112.53 ,$90.02 ,$88.84 ,$13.77 ,$100.68 ,$8.10 ,$13.77 ,$13.77 ,$82.92 ,$72.14 ,$8.37 ,$8.10 ,$7.94 ,$16.20 ,$8.87 ,$100.68 ,$18.23 ,$108.97 ,$82.92 ,$34.95 ,$34.95 ,$72.14 ,$34.95 ,$81.85 ,$106.61 ,$80.93 ,$8.02 ,$93.58 ,$8.87 ,$9.72 ,$9.72 ,$7.94 ,$9.72 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,30000206,80307,HC DRUG SCREEN PANEL 9,300,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000207,80307,HC DRUG SCREEN PANEL 20,300,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000209,G0480,HC M-PHENIDATE MET QN URINE DEFINITIVE,300,1 ,$200.00 ,$132.00 ,$63.95 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$114.43 ,$120.00 ,$170.00 ,$140.00 ,$63.95 ,$63.95 ,$190.00 ,$152.00 ,$150.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$194.53 ,$140.00 ,$121.80 ,$63.95 ,$114.43 ,$112.14 ,$200.00 ,$67.79 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$180.00 ,$136.64 ,$113.26 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30000210,G0480,HC FENTANYL QN URINE DEFINITIVE,300,1 ,$200.00 ,$132.00 ,$63.95 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$114.43 ,$120.00 ,$170.00 ,$140.00 ,$63.95 ,$63.95 ,$190.00 ,$152.00 ,$150.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$194.53 ,$140.00 ,$121.80 ,$63.95 ,$114.43 ,$112.14 ,$200.00 ,$67.79 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$180.00 ,$136.64 ,$113.26 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30000211,80306,HC BUPRENORPHINE SCR/QN URINE,300,1 ,$200.00 ,$132.00 ,$16.80 ,$200.00 ,$17.71 ,$59.99 ,$59.99 ,$17.14 ,$120.00 ,$170.00 ,$140.00 ,$17.71 ,$17.71 ,$190.00 ,$152.00 ,$150.00 ,$29.14 ,$170.00 ,$17.14 ,$29.14 ,$29.14 ,$140.00 ,$121.80 ,$17.71 ,$17.14 ,$16.80 ,$34.28 ,$18.77 ,$170.00 ,$38.57 ,$184.00 ,$140.00 ,$73.09 ,$73.09 ,$121.80 ,$73.09 ,$138.20 ,$180.00 ,$136.64 ,$16.96 ,$158.00 ,$18.77 ,$20.57 ,$20.57 ,$16.80 ,$20.57 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30000212,G0480,HC BUPRENORPHINE QN URINE,300,1 ,$200.00 ,$132.00 ,$63.95 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$114.43 ,$120.00 ,$170.00 ,$140.00 ,$63.95 ,$63.95 ,$190.00 ,$152.00 ,$150.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$194.53 ,$140.00 ,$121.80 ,$63.95 ,$114.43 ,$112.14 ,$200.00 ,$67.79 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$180.00 ,$136.64 ,$113.26 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30000227,89321,HC SEMEN PRESENCE/MOTILITY,300,1 ,$297.85 ,$196.58 ,$11.81 ,$297.85 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$178.71 ,$253.17 ,$208.50 ,$12.45 ,$12.45 ,$282.96 ,$226.37 ,$223.39 ,$20.49 ,$253.17 ,$12.05 ,$20.49 ,$20.49 ,$208.50 ,$181.39 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$253.17 ,$27.11 ,$274.02 ,$208.50 ,$60.23 ,$60.23 ,$181.39 ,$60.23 ,$205.81 ,$268.07 ,$203.49 ,$11.93 ,$235.30 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$214.45 ,$184.67 ,$214.45 ,$214.45 ,$238.28 
ST NICHOLAS HOSPITAL - ACUTE,30000229,89322,HC SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA,300,1 ,$445.05 ,$293.73 ,$15.19 ,$445.05 ,$16.02 ,$54.25 ,$54.25 ,$15.50 ,$267.03 ,$378.29 ,$311.54 ,$16.02 ,$16.02 ,$422.80 ,$338.24 ,$333.79 ,$26.35 ,$378.29 ,$15.50 ,$26.35 ,$26.35 ,$311.54 ,$271.04 ,$16.02 ,$15.50 ,$15.19 ,$31.00 ,$16.98 ,$378.29 ,$34.88 ,$409.45 ,$311.54 ,$77.45 ,$77.45 ,$271.04 ,$77.45 ,$307.53 ,$400.55 ,$304.06 ,$15.35 ,$351.59 ,$16.98 ,$18.60 ,$18.60 ,$15.19 ,$18.60 ,$320.44 ,$275.93 ,$320.44 ,$320.44 ,$356.04 
ST NICHOLAS HOSPITAL - ACUTE,30000236,80307,HC DRUG SCREEN PANEL 4,301,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000237,80307,HC DRUG SCREEN PANEL 6,301,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000463,76120,HC CINERADIOGRAPHY 76120,320,1 ,$418.24 ,$276.04 ,$1.93 ,$418.24 ,$1.93 ,$402.22 ,$323.32 ,$104.31 ,$250.94 ,$355.50 ,$292.77 ,$1.93 ,$1.93 ,$397.33 ,$317.86 ,$313.68 ,$194.26 ,$355.50 ,$104.31 ,$194.26 ,$194.26 ,$292.77 ,$254.71 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$355.50 ,$234.71 ,$384.78 ,$292.77 ,$418.24 ,$418.24 ,$254.71 ,$418.24 ,$289.00 ,$376.42 ,$285.74 ,$103.24 ,$330.41 ,$2.05 ,$418.24 ,$418.24 ,$102.22 ,$418.24 ,$301.13 ,$259.31 ,$301.13 ,$301.13 ,$334.59 
ST NICHOLAS HOSPITAL - ACUTE,30002038,81288,HC MLH1 GENE ANALYSIS,300,1 ,$595.70 ,$393.16 ,$164.96 ,$595.70 ,$164.96 ,$595.70 ,$595.70 ,$192.32 ,$357.42 ,$506.35 ,$416.99 ,$164.96 ,$164.96 ,$565.92 ,$452.73 ,$446.78 ,$326.94 ,$506.35 ,$192.32 ,$326.94 ,$326.94 ,$416.99 ,$362.78 ,$164.96 ,$192.32 ,$188.47 ,$384.64 ,$174.86 ,$506.35 ,$432.72 ,$548.04 ,$416.99 ,$584.84 ,$584.84 ,$362.78 ,$584.84 ,$411.63 ,$536.13 ,$406.98 ,$190.36 ,$470.60 ,$174.86 ,$230.78 ,$230.78 ,$188.47 ,$230.78 ,$428.90 ,$369.33 ,$428.90 ,$428.90 ,$476.56 
ST NICHOLAS HOSPITAL - ACUTE,30002044,0346U,HC BETA AMYLOID AB40/AB42 LC-MS/MS RATIO PLASMA,300,1 ,$412.50 ,$272.25 ,$209.22 ,$412.50 , N/A ,$282.73 ,$282.73 , N/A ,$247.50 ,$350.63 ,$288.75 , N/A , N/A ,$391.88 ,$313.50 ,$309.38 , N/A ,$350.63 , N/A , N/A , N/A ,$288.75 ,$251.21 , N/A , N/A , N/A , N/A , N/A ,$350.63 , N/A ,$379.50 ,$288.75 ,$209.22 ,$251.09 ,$251.21 ,$251.09 ,$285.04 ,$371.25 ,$281.82 , N/A ,$325.88 , N/A , N/A , N/A , N/A , N/A ,$297.00 ,$255.75 ,$297.00 ,$297.00 ,$330.00 
ST NICHOLAS HOSPITAL - ACUTE,30100062,80307,HC AMPHET/METHAMPHET CONFIRM MEC,301,1 ,$120.00 ,$79.20 ,$60.90 ,$139.82 ,$63.40 ,$120.00 ,$120.00 ,$62.14 ,$72.00 ,$102.00 ,$84.00 ,$63.40 ,$63.40 ,$114.00 ,$91.20 ,$90.00 ,$105.64 ,$102.00 ,$62.14 ,$105.64 ,$105.64 ,$84.00 ,$73.08 ,$63.40 ,$62.14 ,$60.90 ,$120.00 ,$67.20 ,$102.00 ,$139.82 ,$110.40 ,$84.00 ,$120.00 ,$120.00 ,$73.08 ,$120.00 ,$82.92 ,$108.00 ,$81.98 ,$61.50 ,$94.80 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30100063,80307,HC COCAINE  AND  MET CONFIRM MEC,301,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30100064,80307,HC OPIATE CONFIRM MEC,301,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30100065,80307,HC PCP CONFIRM MEC,301,1 ,$120.00 ,$79.20 ,$60.90 ,$139.82 ,$63.40 ,$120.00 ,$120.00 ,$62.14 ,$72.00 ,$102.00 ,$84.00 ,$63.40 ,$63.40 ,$114.00 ,$91.20 ,$90.00 ,$105.64 ,$102.00 ,$62.14 ,$105.64 ,$105.64 ,$84.00 ,$73.08 ,$63.40 ,$62.14 ,$60.90 ,$120.00 ,$67.20 ,$102.00 ,$139.82 ,$110.40 ,$84.00 ,$120.00 ,$120.00 ,$73.08 ,$120.00 ,$82.92 ,$108.00 ,$81.98 ,$61.50 ,$94.80 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30100066,80307,HC THC CONFIRM MEC,301,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30100099,80048,HC SURGICAL VET PANEL,301,1 ,$10.35 ,$6.83 ,$6.21 ,$19.04 ,$8.74 ,$10.35 ,$10.35 ,$8.46 ,$6.21 ,$8.80 ,$7.25 ,$8.74 ,$8.74 ,$9.83 ,$7.87 ,$7.76 ,$10.35 ,$8.80 ,$8.46 ,$10.35 ,$10.35 ,$7.25 ,$6.30 ,$8.74 ,$8.46 ,$8.29 ,$10.35 ,$9.26 ,$8.80 ,$19.04 ,$9.52 ,$7.25 ,$10.35 ,$10.35 ,$6.30 ,$10.35 ,$7.15 ,$9.32 ,$7.07 ,$8.37 ,$8.18 ,$9.26 ,$10.15 ,$10.15 ,$8.29 ,$10.15 ,$7.45 ,$6.42 ,$7.45 ,$7.45 ,$8.28 
ST NICHOLAS HOSPITAL - ACUTE,30100101,80048,HC BASIC METABOLIC PANEL,301,1 ,$111.55 ,$73.62 ,$8.29 ,$111.55 ,$8.74 ,$29.61 ,$29.61 ,$8.46 ,$66.93 ,$94.82 ,$78.09 ,$8.74 ,$8.74 ,$105.97 ,$84.78 ,$83.66 ,$14.38 ,$94.82 ,$8.46 ,$14.38 ,$14.38 ,$78.09 ,$67.93 ,$8.74 ,$8.46 ,$8.29 ,$16.92 ,$9.26 ,$94.82 ,$19.04 ,$102.63 ,$78.09 ,$42.28 ,$42.28 ,$67.93 ,$42.28 ,$77.08 ,$100.40 ,$76.21 ,$8.37 ,$88.12 ,$9.26 ,$10.15 ,$10.15 ,$8.29 ,$10.15 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,30100103,80051,HC ELECTROLYTE PANEL,301,1 ,$63.25 ,$41.75 ,$6.87 ,$63.25 ,$7.24 ,$24.54 ,$24.54 ,$7.01 ,$37.95 ,$53.76 ,$44.28 ,$7.24 ,$7.24 ,$60.09 ,$48.07 ,$47.44 ,$11.92 ,$53.76 ,$7.01 ,$11.92 ,$11.92 ,$44.28 ,$38.52 ,$7.24 ,$7.01 ,$6.87 ,$14.02 ,$7.67 ,$53.76 ,$15.77 ,$58.19 ,$44.28 ,$35.06 ,$35.06 ,$38.52 ,$35.06 ,$43.71 ,$56.93 ,$43.21 ,$6.94 ,$49.97 ,$7.67 ,$8.41 ,$8.41 ,$6.87 ,$8.41 ,$45.54 ,$39.22 ,$45.54 ,$45.54 ,$50.60 
ST NICHOLAS HOSPITAL - ACUTE,30100104,80053,HC COMPREHENSIVE METABOL PANEL,301,1 ,$154.10 ,$101.71 ,$10.35 ,$154.10 ,$10.91 ,$36.96 ,$36.96 ,$10.56 ,$92.46 ,$130.99 ,$107.87 ,$10.91 ,$10.91 ,$146.40 ,$117.12 ,$115.58 ,$17.95 ,$130.99 ,$10.56 ,$17.95 ,$17.95 ,$107.87 ,$93.85 ,$10.91 ,$10.56 ,$10.35 ,$21.12 ,$11.56 ,$130.99 ,$23.76 ,$141.77 ,$107.87 ,$52.79 ,$52.79 ,$93.85 ,$52.79 ,$106.48 ,$138.69 ,$105.28 ,$10.46 ,$121.74 ,$11.56 ,$12.67 ,$12.67 ,$10.35 ,$12.67 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100105,80053,HC COMPREHENSIVE METABOL PANEL VET,301,1 ,$17.25 ,$11.39 ,$10.35 ,$23.76 ,$10.91 ,$17.25 ,$17.25 ,$10.56 ,$10.35 ,$14.66 ,$12.08 ,$10.91 ,$10.91 ,$16.39 ,$13.11 ,$12.94 ,$17.25 ,$14.66 ,$10.56 ,$17.25 ,$17.25 ,$12.08 ,$10.51 ,$10.91 ,$10.56 ,$10.35 ,$17.25 ,$11.56 ,$14.66 ,$23.76 ,$15.87 ,$12.08 ,$17.25 ,$17.25 ,$10.51 ,$17.25 ,$11.92 ,$15.53 ,$11.79 ,$10.46 ,$13.63 ,$11.56 ,$12.67 ,$12.67 ,$10.35 ,$12.67 ,$12.42 ,$10.70 ,$12.42 ,$12.42 ,$13.80 
ST NICHOLAS HOSPITAL - ACUTE,30100106,80055,HC PRENATAL PANEL,301,1 ,$334.65 ,$220.87 ,$18.84 ,$334.65 ,$18.84 ,$167.34 ,$167.34 ,$47.81 ,$200.79 ,$284.45 ,$234.26 ,$18.84 ,$18.84 ,$317.92 ,$254.33 ,$250.99 ,$81.28 ,$284.45 ,$47.81 ,$81.28 ,$81.28 ,$234.26 ,$203.80 ,$18.84 ,$47.81 ,$46.85 ,$95.62 ,$19.97 ,$284.45 ,$107.57 ,$307.88 ,$234.26 ,$238.57 ,$238.57 ,$203.80 ,$238.57 ,$231.24 ,$301.19 ,$228.63 ,$47.32 ,$264.37 ,$19.97 ,$57.37 ,$57.37 ,$46.85 ,$57.37 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30100107,80061,HC LIPID PANEL,301,1 ,$116.15 ,$76.66 ,$13.12 ,$116.15 ,$13.84 ,$46.87 ,$46.87 ,$13.39 ,$69.69 ,$98.73 ,$81.31 ,$13.84 ,$13.84 ,$110.34 ,$88.27 ,$87.11 ,$22.76 ,$98.73 ,$13.39 ,$22.76 ,$22.76 ,$81.31 ,$70.74 ,$13.84 ,$13.39 ,$13.12 ,$26.78 ,$14.67 ,$98.73 ,$30.13 ,$106.86 ,$81.31 ,$66.93 ,$66.93 ,$70.74 ,$66.93 ,$80.26 ,$104.54 ,$79.35 ,$13.25 ,$91.76 ,$14.67 ,$16.07 ,$16.07 ,$13.12 ,$16.07 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100108,80069,HC RENAL PANEL,301,1 ,$128.80 ,$85.01 ,$8.51 ,$128.80 ,$8.97 ,$30.38 ,$30.38 ,$8.68 ,$77.28 ,$109.48 ,$90.16 ,$8.97 ,$8.97 ,$122.36 ,$97.89 ,$96.60 ,$14.76 ,$109.48 ,$8.68 ,$14.76 ,$14.76 ,$90.16 ,$78.44 ,$8.97 ,$8.68 ,$8.51 ,$17.36 ,$9.51 ,$109.48 ,$19.53 ,$118.50 ,$90.16 ,$43.41 ,$43.41 ,$78.44 ,$43.41 ,$89.00 ,$115.92 ,$88.00 ,$8.59 ,$101.75 ,$9.51 ,$10.42 ,$10.42 ,$8.51 ,$10.42 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100109,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$411.70 ,$271.72 ,$46.68 ,$411.70 ,$49.22 ,$166.71 ,$166.71 ,$47.63 ,$247.02 ,$349.95 ,$288.19 ,$49.22 ,$49.22 ,$391.12 ,$312.89 ,$308.78 ,$80.97 ,$349.95 ,$47.63 ,$80.97 ,$80.97 ,$288.19 ,$250.73 ,$49.22 ,$47.63 ,$46.68 ,$95.26 ,$52.17 ,$349.95 ,$107.17 ,$378.76 ,$288.19 ,$238.09 ,$238.09 ,$250.73 ,$238.09 ,$284.48 ,$370.53 ,$281.27 ,$47.15 ,$325.24 ,$52.17 ,$57.16 ,$57.16 ,$46.68 ,$57.16 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,30100110,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$89.70 ,$59.20 ,$8.01 ,$89.70 ,$8.44 ,$28.60 ,$28.60 ,$8.17 ,$53.82 ,$76.25 ,$62.79 ,$8.44 ,$8.44 ,$85.22 ,$68.17 ,$67.28 ,$13.89 ,$76.25 ,$8.17 ,$13.89 ,$13.89 ,$62.79 ,$54.63 ,$8.44 ,$8.17 ,$8.01 ,$16.34 ,$8.95 ,$76.25 ,$18.38 ,$82.52 ,$62.79 ,$40.81 ,$40.81 ,$54.63 ,$40.81 ,$61.98 ,$80.73 ,$61.28 ,$8.08 ,$70.86 ,$8.95 ,$9.80 ,$9.80 ,$8.01 ,$9.80 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100111,80150,HC AMIKACIN,301,1 ,$136.85 ,$90.32 ,$14.78 ,$136.85 ,$15.58 ,$52.78 ,$52.78 ,$15.08 ,$82.11 ,$116.32 ,$95.80 ,$15.58 ,$15.58 ,$130.01 ,$104.01 ,$102.64 ,$25.64 ,$116.32 ,$15.08 ,$25.64 ,$25.64 ,$95.80 ,$83.34 ,$15.58 ,$15.08 ,$14.78 ,$30.16 ,$16.51 ,$116.32 ,$33.93 ,$125.90 ,$95.80 ,$75.32 ,$75.32 ,$83.34 ,$75.32 ,$94.56 ,$123.17 ,$93.50 ,$14.93 ,$108.11 ,$16.51 ,$18.10 ,$18.10 ,$14.78 ,$18.10 ,$98.53 ,$84.85 ,$98.53 ,$98.53 ,$109.48 
ST NICHOLAS HOSPITAL - ACUTE,30100112,80335,HC AMITRIPTYLINE,301,1 ,$90.00 ,$59.40 ,$0.38 ,$90.00 ,$0.38 ,$79.87 ,$79.87 , N/A ,$54.00 ,$76.50 ,$63.00 ,$0.38 ,$0.38 ,$85.50 ,$68.40 ,$67.50 ,$38.86 ,$76.50 , N/A ,$38.86 ,$38.86 ,$63.00 ,$54.81 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$76.50 , N/A ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$61.49 , N/A ,$71.10 ,$0.40 , N/A , N/A , N/A , N/A ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100113,80346,HC LORAZEPAM,301,1 ,$106.00 ,$69.96 ,$0.38 ,$106.00 ,$0.38 ,$79.87 ,$79.87 , N/A ,$63.60 ,$90.10 ,$74.20 ,$0.38 ,$0.38 ,$100.70 ,$80.56 ,$79.50 ,$38.86 ,$90.10 , N/A ,$38.86 ,$38.86 ,$74.20 ,$64.55 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$64.52 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 ,$0.40 , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,30100114,80346,HC CLONOPIN,301,1 ,$38.00 ,$25.08 ,$0.38 ,$38.00 ,$0.38 ,$38.00 ,$38.00 , N/A ,$22.80 ,$32.30 ,$26.60 ,$0.38 ,$0.38 ,$36.10 ,$28.88 ,$28.50 ,$38.00 ,$32.30 , N/A ,$38.00 ,$38.00 ,$26.60 ,$23.14 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$25.96 , N/A ,$30.02 ,$0.40 , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100115,80346,HC BENZODIAZEPINE GC/MS,301,1 ,$38.00 ,$25.08 ,$0.38 ,$38.00 ,$0.38 ,$38.00 ,$38.00 , N/A ,$22.80 ,$32.30 ,$26.60 ,$0.38 ,$0.38 ,$36.10 ,$28.88 ,$28.50 ,$38.00 ,$32.30 , N/A ,$38.00 ,$38.00 ,$26.60 ,$23.14 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$25.96 , N/A ,$30.02 ,$0.40 , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100116,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$124.20 ,$81.97 ,$14.28 ,$124.20 ,$15.06 ,$51.00 ,$51.00 ,$14.57 ,$74.52 ,$105.57 ,$86.94 ,$15.06 ,$15.06 ,$117.99 ,$94.39 ,$93.15 ,$24.77 ,$105.57 ,$14.57 ,$24.77 ,$24.77 ,$86.94 ,$75.64 ,$15.06 ,$14.57 ,$14.28 ,$29.14 ,$15.96 ,$105.57 ,$32.78 ,$114.26 ,$86.94 ,$72.79 ,$72.79 ,$75.64 ,$72.79 ,$85.82 ,$111.78 ,$84.85 ,$14.43 ,$98.12 ,$15.96 ,$17.48 ,$17.48 ,$14.28 ,$17.48 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,30100117,80157,HC CARBAMAZEPINE FREE,301,1 ,$142.60 ,$94.12 ,$12.98 ,$142.60 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$85.56 ,$121.21 ,$99.82 ,$13.69 ,$13.69 ,$135.47 ,$108.38 ,$106.95 ,$22.53 ,$121.21 ,$13.25 ,$22.53 ,$22.53 ,$99.82 ,$86.84 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$121.21 ,$29.81 ,$131.19 ,$99.82 ,$66.27 ,$66.27 ,$86.84 ,$66.27 ,$98.54 ,$128.34 ,$97.42 ,$13.11 ,$112.65 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$102.67 ,$88.41 ,$102.67 ,$102.67 ,$114.08 
ST NICHOLAS HOSPITAL - ACUTE,30100118,80158,HC CYCLOSPORINE,301,1 ,$90.00 ,$59.40 ,$17.69 ,$90.00 ,$18.65 ,$63.18 ,$63.18 ,$18.05 ,$54.00 ,$76.50 ,$63.00 ,$18.65 ,$18.65 ,$85.50 ,$68.40 ,$67.50 ,$30.69 ,$76.50 ,$18.05 ,$30.69 ,$30.69 ,$63.00 ,$54.81 ,$18.65 ,$18.05 ,$17.69 ,$36.10 ,$19.77 ,$76.50 ,$40.61 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$81.00 ,$61.49 ,$17.87 ,$71.10 ,$19.77 ,$21.66 ,$21.66 ,$17.69 ,$21.66 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100119,80335,HC DESIPRAMINE,301,1 ,$42.00 ,$27.72 ,$0.38 ,$42.00 ,$0.38 ,$42.00 ,$42.00 , N/A ,$25.20 ,$35.70 ,$29.40 ,$0.38 ,$0.38 ,$39.90 ,$31.92 ,$31.50 ,$38.86 ,$35.70 , N/A ,$38.86 ,$38.86 ,$29.40 ,$25.58 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$35.70 , N/A ,$38.64 ,$29.40 ,$21.30 ,$25.57 ,$25.58 ,$25.57 ,$29.02 ,$37.80 ,$28.69 , N/A ,$33.18 ,$0.40 , N/A , N/A , N/A , N/A ,$30.24 ,$26.04 ,$30.24 ,$30.24 ,$33.60 
ST NICHOLAS HOSPITAL - ACUTE,30100120,80162,HC DIGOXIN LEVELS,301,1 ,$163.30 ,$107.78 ,$13.01 ,$163.30 ,$13.72 ,$46.48 ,$46.48 ,$13.28 ,$97.98 ,$138.81 ,$114.31 ,$13.72 ,$13.72 ,$155.14 ,$124.11 ,$122.48 ,$22.58 ,$138.81 ,$13.28 ,$22.58 ,$22.58 ,$114.31 ,$99.45 ,$13.72 ,$13.28 ,$13.01 ,$26.56 ,$14.54 ,$138.81 ,$29.88 ,$150.24 ,$114.31 ,$66.38 ,$66.38 ,$99.45 ,$66.38 ,$112.84 ,$146.97 ,$111.57 ,$13.14 ,$129.01 ,$14.54 ,$15.94 ,$15.94 ,$13.01 ,$15.94 ,$117.58 ,$101.25 ,$117.58 ,$117.58 ,$130.64 
ST NICHOLAS HOSPITAL - ACUTE,30100121,80164,HC VALPROIC ACID,301,1 ,$111.55 ,$73.62 ,$13.27 ,$111.55 ,$13.99 ,$47.39 ,$47.39 ,$13.54 ,$66.93 ,$94.82 ,$78.09 ,$13.99 ,$13.99 ,$105.97 ,$84.78 ,$83.66 ,$23.02 ,$94.82 ,$13.54 ,$23.02 ,$23.02 ,$78.09 ,$67.93 ,$13.99 ,$13.54 ,$13.27 ,$27.08 ,$14.83 ,$94.82 ,$30.47 ,$102.63 ,$78.09 ,$67.74 ,$67.74 ,$67.93 ,$67.74 ,$77.08 ,$100.40 ,$76.21 ,$13.41 ,$88.12 ,$14.83 ,$16.25 ,$16.25 ,$13.27 ,$16.25 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,30100122,80335,HC DOXEPIN,301,1 ,$62.00 ,$40.92 ,$0.38 ,$62.00 ,$0.38 ,$62.00 ,$62.00 , N/A ,$37.20 ,$52.70 ,$43.40 ,$0.38 ,$0.38 ,$58.90 ,$47.12 ,$46.50 ,$38.86 ,$52.70 , N/A ,$38.86 ,$38.86 ,$43.40 ,$37.76 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$52.70 , N/A ,$57.04 ,$43.40 ,$31.45 ,$37.74 ,$37.76 ,$37.74 ,$42.84 ,$55.80 ,$42.36 , N/A ,$48.98 ,$0.40 , N/A , N/A , N/A , N/A ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,30100123,80168,HC ZARONTIN,301,1 ,$136.85 ,$90.32 ,$16.01 ,$136.85 ,$16.88 ,$57.19 ,$57.19 ,$16.34 ,$82.11 ,$116.32 ,$95.80 ,$16.88 ,$16.88 ,$130.01 ,$104.01 ,$102.64 ,$27.78 ,$116.32 ,$16.34 ,$27.78 ,$27.78 ,$95.80 ,$83.34 ,$16.88 ,$16.34 ,$16.01 ,$32.68 ,$17.89 ,$116.32 ,$36.77 ,$125.90 ,$95.80 ,$81.70 ,$81.70 ,$83.34 ,$81.70 ,$94.56 ,$123.17 ,$93.50 ,$16.17 ,$108.11 ,$17.89 ,$19.61 ,$19.61 ,$16.01 ,$19.61 ,$98.53 ,$84.85 ,$98.53 ,$98.53 ,$109.48 
ST NICHOLAS HOSPITAL - ACUTE,30100124,80170,HC GENTAMICIN,301,1 ,$198.95 ,$131.31 ,$16.05 ,$198.95 ,$16.93 ,$57.33 ,$57.33 ,$16.38 ,$119.37 ,$169.11 ,$139.27 ,$16.93 ,$16.93 ,$189.00 ,$151.20 ,$149.21 ,$27.85 ,$169.11 ,$16.38 ,$27.85 ,$27.85 ,$139.27 ,$121.16 ,$16.93 ,$16.38 ,$16.05 ,$32.76 ,$17.95 ,$169.11 ,$36.86 ,$183.03 ,$139.27 ,$81.92 ,$81.92 ,$121.16 ,$81.92 ,$137.47 ,$179.06 ,$135.92 ,$16.21 ,$157.17 ,$17.95 ,$19.66 ,$19.66 ,$16.05 ,$19.66 ,$143.24 ,$123.35 ,$143.24 ,$143.24 ,$159.16 
ST NICHOLAS HOSPITAL - ACUTE,30100125,80335,HC IMIPRAMINE,301,1 ,$65.00 ,$42.90 ,$0.38 ,$65.00 ,$0.38 ,$65.00 ,$65.00 , N/A ,$39.00 ,$55.25 ,$45.50 ,$0.38 ,$0.38 ,$61.75 ,$49.40 ,$48.75 ,$38.86 ,$55.25 , N/A ,$38.86 ,$38.86 ,$45.50 ,$39.59 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$55.25 , N/A ,$59.80 ,$45.50 ,$32.97 ,$39.57 ,$39.59 ,$39.57 ,$44.92 ,$58.50 ,$44.41 , N/A ,$51.35 ,$0.40 , N/A , N/A , N/A , N/A ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$52.00 
ST NICHOLAS HOSPITAL - ACUTE,30100126,80176,HC LIDOCAINE,301,1 ,$223.10 ,$147.25 ,$14.40 ,$223.10 ,$15.18 ,$51.42 ,$51.42 ,$14.69 ,$133.86 ,$189.64 ,$156.17 ,$15.18 ,$15.18 ,$211.95 ,$169.56 ,$167.33 ,$24.97 ,$189.64 ,$14.69 ,$24.97 ,$24.97 ,$156.17 ,$135.87 ,$15.18 ,$14.69 ,$14.40 ,$29.38 ,$16.09 ,$189.64 ,$33.05 ,$205.25 ,$156.17 ,$73.42 ,$73.42 ,$135.87 ,$73.42 ,$154.16 ,$200.79 ,$152.42 ,$14.54 ,$176.25 ,$16.09 ,$17.63 ,$17.63 ,$14.40 ,$17.63 ,$160.63 ,$138.32 ,$160.63 ,$160.63 ,$178.48 
ST NICHOLAS HOSPITAL - ACUTE,30100127,80178,HC LITHIUM,301,1 ,$56.35 ,$37.19 ,$6.48 ,$56.35 ,$6.83 ,$23.14 ,$23.14 ,$6.61 ,$33.81 ,$47.90 ,$39.45 ,$6.83 ,$6.83 ,$53.53 ,$42.83 ,$42.26 ,$11.24 ,$47.90 ,$6.61 ,$11.24 ,$11.24 ,$39.45 ,$34.32 ,$6.83 ,$6.61 ,$6.48 ,$13.22 ,$7.24 ,$47.90 ,$14.87 ,$51.84 ,$39.45 ,$33.04 ,$33.04 ,$34.32 ,$33.04 ,$38.94 ,$50.72 ,$38.50 ,$6.55 ,$44.52 ,$7.24 ,$7.93 ,$7.93 ,$6.48 ,$7.93 ,$40.57 ,$34.94 ,$40.57 ,$40.57 ,$45.08 
ST NICHOLAS HOSPITAL - ACUTE,30100128,80335,HC NORTRIPTYLINE,301,1 ,$85.00 ,$56.10 ,$0.38 ,$85.00 ,$0.38 ,$79.87 ,$79.87 , N/A ,$51.00 ,$72.25 ,$59.50 ,$0.38 ,$0.38 ,$80.75 ,$64.60 ,$63.75 ,$38.86 ,$72.25 , N/A ,$38.86 ,$38.86 ,$59.50 ,$51.77 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$72.25 , N/A ,$78.20 ,$59.50 ,$43.11 ,$51.74 ,$51.77 ,$51.74 ,$58.74 ,$76.50 ,$58.07 , N/A ,$67.15 ,$0.40 , N/A , N/A , N/A , N/A ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$68.00 
ST NICHOLAS HOSPITAL - ACUTE,30100129,80184,HC PHENOBARBITAL,301,1 ,$111.55 ,$73.62 ,$14.99 ,$111.55 ,$15.81 ,$53.55 ,$53.55 ,$15.30 ,$66.93 ,$94.82 ,$78.09 ,$15.81 ,$15.81 ,$105.97 ,$84.78 ,$83.66 ,$26.01 ,$94.82 ,$15.30 ,$26.01 ,$26.01 ,$78.09 ,$67.93 ,$15.81 ,$15.30 ,$14.99 ,$30.60 ,$16.76 ,$94.82 ,$34.43 ,$102.63 ,$78.09 ,$57.22 ,$57.22 ,$67.93 ,$57.22 ,$77.08 ,$100.40 ,$76.21 ,$15.14 ,$88.12 ,$16.76 ,$18.36 ,$18.36 ,$14.99 ,$18.36 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,30100130,80185,HC PHENYTOIN TOTAL,301,1 ,$111.55 ,$73.62 ,$12.98 ,$111.55 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$66.93 ,$94.82 ,$78.09 ,$13.69 ,$13.69 ,$105.97 ,$84.78 ,$83.66 ,$22.53 ,$94.82 ,$13.25 ,$22.53 ,$22.53 ,$78.09 ,$67.93 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$94.82 ,$29.81 ,$102.63 ,$78.09 ,$66.27 ,$66.27 ,$67.93 ,$66.27 ,$77.08 ,$100.40 ,$76.21 ,$13.11 ,$88.12 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,30100131,80186,HC PHENYTOIN FREE,301,1 ,$87.40 ,$57.68 ,$13.48 ,$87.40 ,$14.22 ,$48.16 ,$48.16 ,$13.76 ,$52.44 ,$74.29 ,$61.18 ,$14.22 ,$14.22 ,$83.03 ,$66.42 ,$65.55 ,$23.39 ,$74.29 ,$13.76 ,$23.39 ,$23.39 ,$61.18 ,$53.23 ,$14.22 ,$13.76 ,$13.48 ,$27.52 ,$15.07 ,$74.29 ,$30.96 ,$80.41 ,$61.18 ,$58.65 ,$58.65 ,$53.23 ,$58.65 ,$60.39 ,$78.66 ,$59.71 ,$13.62 ,$69.05 ,$15.07 ,$16.51 ,$16.51 ,$13.48 ,$16.51 ,$62.93 ,$54.19 ,$62.93 ,$62.93 ,$69.92 
ST NICHOLAS HOSPITAL - ACUTE,30100132,80188,HC PRIMIDONE,301,1 ,$111.55 ,$73.62 ,$16.26 ,$111.55 ,$17.14 ,$58.07 ,$58.07 ,$16.59 ,$66.93 ,$94.82 ,$78.09 ,$17.14 ,$17.14 ,$105.97 ,$84.78 ,$83.66 ,$28.20 ,$94.82 ,$16.59 ,$28.20 ,$28.20 ,$78.09 ,$67.93 ,$17.14 ,$16.59 ,$16.26 ,$33.18 ,$18.17 ,$94.82 ,$37.33 ,$102.63 ,$78.09 ,$82.94 ,$82.94 ,$67.93 ,$82.94 ,$77.08 ,$100.40 ,$76.21 ,$16.42 ,$88.12 ,$18.17 ,$19.91 ,$19.91 ,$16.26 ,$19.91 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,30100133,80192,HC PROCAINEAMIDE,301,1 ,$132.25 ,$87.29 ,$16.41 ,$132.25 ,$17.31 ,$58.63 ,$58.63 ,$16.75 ,$79.35 ,$112.41 ,$92.58 ,$17.31 ,$17.31 ,$125.64 ,$100.51 ,$99.19 ,$28.48 ,$112.41 ,$16.75 ,$28.48 ,$28.48 ,$92.58 ,$80.54 ,$17.31 ,$16.75 ,$16.41 ,$33.50 ,$18.35 ,$112.41 ,$37.69 ,$121.67 ,$92.58 ,$83.71 ,$83.71 ,$80.54 ,$83.71 ,$91.38 ,$119.03 ,$90.35 ,$16.58 ,$104.48 ,$18.35 ,$20.10 ,$20.10 ,$16.41 ,$20.10 ,$95.22 ,$82.00 ,$95.22 ,$95.22 ,$105.80 
ST NICHOLAS HOSPITAL - ACUTE,30100134,80194,HC QUINIDINE,301,1 ,$126.50 ,$83.49 ,$14.31 ,$126.50 ,$15.09 ,$51.10 ,$51.10 ,$14.60 ,$75.90 ,$107.53 ,$88.55 ,$15.09 ,$15.09 ,$120.18 ,$96.14 ,$94.88 ,$24.82 ,$107.53 ,$14.60 ,$24.82 ,$24.82 ,$88.55 ,$77.04 ,$15.09 ,$14.60 ,$14.31 ,$29.20 ,$16.00 ,$107.53 ,$32.85 ,$116.38 ,$88.55 ,$72.98 ,$72.98 ,$77.04 ,$72.98 ,$87.41 ,$113.85 ,$86.42 ,$14.45 ,$99.94 ,$16.00 ,$17.52 ,$17.52 ,$14.31 ,$17.52 ,$91.08 ,$78.43 ,$91.08 ,$91.08 ,$101.20 
ST NICHOLAS HOSPITAL - ACUTE,30100135,80195,HC RAPAMYCIN (SIROLIMUS),301,1 ,$98.90 ,$65.27 ,$13.46 ,$98.90 ,$14.19 ,$48.06 ,$48.06 ,$13.73 ,$59.34 ,$84.07 ,$69.23 ,$14.19 ,$14.19 ,$93.96 ,$75.16 ,$74.18 ,$23.34 ,$84.07 ,$13.73 ,$23.34 ,$23.34 ,$69.23 ,$60.23 ,$14.19 ,$13.73 ,$13.46 ,$27.46 ,$15.04 ,$84.07 ,$30.89 ,$90.99 ,$69.23 ,$68.62 ,$68.62 ,$60.23 ,$68.62 ,$68.34 ,$89.01 ,$67.57 ,$13.59 ,$78.13 ,$15.04 ,$16.48 ,$16.48 ,$13.46 ,$16.48 ,$71.21 ,$61.32 ,$71.21 ,$71.21 ,$79.12 
ST NICHOLAS HOSPITAL - ACUTE,30100136,G0480,HC SALICYLATE,301,1 ,$180.00 ,$118.80 ,$63.95 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$114.43 ,$108.00 ,$153.00 ,$126.00 ,$63.95 ,$63.95 ,$171.00 ,$136.80 ,$135.00 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$180.00 ,$126.00 ,$109.62 ,$63.95 ,$114.43 ,$112.14 ,$180.00 ,$67.79 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$162.00 ,$122.98 ,$113.26 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30100137,80197,HC TACROLIMUS,301,1 ,$111.55 ,$73.62 ,$13.46 ,$111.55 ,$14.19 ,$48.06 ,$48.06 ,$13.73 ,$66.93 ,$94.82 ,$78.09 ,$14.19 ,$14.19 ,$105.97 ,$84.78 ,$83.66 ,$23.34 ,$94.82 ,$13.73 ,$23.34 ,$23.34 ,$78.09 ,$67.93 ,$14.19 ,$13.73 ,$13.46 ,$27.46 ,$15.04 ,$94.82 ,$30.89 ,$102.63 ,$78.09 ,$68.62 ,$68.62 ,$67.93 ,$68.62 ,$77.08 ,$100.40 ,$76.21 ,$13.59 ,$88.12 ,$15.04 ,$16.48 ,$16.48 ,$13.46 ,$16.48 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,30100138,80198,HC THEOPHYLLINE,301,1 ,$98.90 ,$65.27 ,$13.86 ,$98.90 ,$14.61 ,$49.49 ,$49.49 ,$14.14 ,$59.34 ,$84.07 ,$69.23 ,$14.61 ,$14.61 ,$93.96 ,$75.16 ,$74.18 ,$24.04 ,$84.07 ,$14.14 ,$24.04 ,$24.04 ,$69.23 ,$60.23 ,$14.61 ,$14.14 ,$13.86 ,$28.28 ,$15.49 ,$84.07 ,$31.82 ,$90.99 ,$69.23 ,$70.71 ,$70.71 ,$60.23 ,$70.71 ,$68.34 ,$89.01 ,$67.57 ,$13.99 ,$78.13 ,$15.49 ,$16.97 ,$16.97 ,$13.86 ,$16.97 ,$71.21 ,$61.32 ,$71.21 ,$71.21 ,$79.12 
ST NICHOLAS HOSPITAL - ACUTE,30100139,80200,HC TOBRAMYCIN,301,1 ,$111.55 ,$73.62 ,$15.81 ,$111.55 ,$16.67 ,$56.46 ,$56.46 ,$16.13 ,$66.93 ,$94.82 ,$78.09 ,$16.67 ,$16.67 ,$105.97 ,$84.78 ,$83.66 ,$27.42 ,$94.82 ,$16.13 ,$27.42 ,$27.42 ,$78.09 ,$67.93 ,$16.67 ,$16.13 ,$15.81 ,$32.26 ,$17.67 ,$94.82 ,$36.29 ,$102.63 ,$78.09 ,$80.56 ,$80.56 ,$67.93 ,$80.56 ,$77.08 ,$100.40 ,$76.21 ,$15.96 ,$88.12 ,$17.67 ,$19.36 ,$19.36 ,$15.81 ,$19.36 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,30100140,80201,HC TOPIRAMATE,301,1 ,$111.55 ,$73.62 ,$11.68 ,$111.55 ,$12.32 ,$41.72 ,$41.72 ,$11.92 ,$66.93 ,$94.82 ,$78.09 ,$12.32 ,$12.32 ,$105.97 ,$84.78 ,$83.66 ,$20.26 ,$94.82 ,$11.92 ,$20.26 ,$20.26 ,$78.09 ,$67.93 ,$12.32 ,$11.92 ,$11.68 ,$23.84 ,$13.06 ,$94.82 ,$26.82 ,$102.63 ,$78.09 ,$59.61 ,$59.61 ,$67.93 ,$59.61 ,$77.08 ,$100.40 ,$76.21 ,$11.80 ,$88.12 ,$13.06 ,$14.30 ,$14.30 ,$11.68 ,$14.30 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,30100141,80202,HC VANCOMYCIN,301,1 ,$136.85 ,$90.32 ,$13.27 ,$136.85 ,$13.99 ,$47.39 ,$47.39 ,$13.54 ,$82.11 ,$116.32 ,$95.80 ,$13.99 ,$13.99 ,$130.01 ,$104.01 ,$102.64 ,$23.02 ,$116.32 ,$13.54 ,$23.02 ,$23.02 ,$95.80 ,$83.34 ,$13.99 ,$13.54 ,$13.27 ,$27.08 ,$14.83 ,$116.32 ,$30.47 ,$125.90 ,$95.80 ,$67.74 ,$67.74 ,$83.34 ,$67.74 ,$94.56 ,$123.17 ,$93.50 ,$13.41 ,$108.11 ,$14.83 ,$16.25 ,$16.25 ,$13.27 ,$16.25 ,$98.53 ,$84.85 ,$98.53 ,$98.53 ,$109.48 
ST NICHOLAS HOSPITAL - ACUTE,30100142,80299,HC WARFARIN,301,1 ,$179.40 ,$118.40 ,$18.27 ,$179.40 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$107.64 ,$152.49 ,$125.58 ,$19.26 ,$19.26 ,$170.43 ,$136.34 ,$134.55 ,$31.69 ,$152.49 ,$18.64 ,$31.69 ,$31.69 ,$125.58 ,$109.25 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$152.49 ,$41.94 ,$165.05 ,$125.58 ,$68.43 ,$68.43 ,$109.25 ,$68.43 ,$123.97 ,$161.46 ,$122.57 ,$18.45 ,$141.73 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$129.17 ,$111.23 ,$129.17 ,$129.17 ,$143.52 
ST NICHOLAS HOSPITAL - ACUTE,30100143,80299,HC FELBAMATE,301,1 ,$186.30 ,$122.96 ,$18.27 ,$186.30 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$111.78 ,$158.36 ,$130.41 ,$19.26 ,$19.26 ,$176.99 ,$141.59 ,$139.73 ,$31.69 ,$158.36 ,$18.64 ,$31.69 ,$31.69 ,$130.41 ,$113.46 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$158.36 ,$41.94 ,$171.40 ,$130.41 ,$68.43 ,$68.43 ,$113.46 ,$68.43 ,$128.73 ,$167.67 ,$127.28 ,$18.45 ,$147.18 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,30100144,80299,HC IBUPROFEN,301,1 ,$141.45 ,$93.36 ,$18.27 ,$141.45 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$84.87 ,$120.23 ,$99.02 ,$19.26 ,$19.26 ,$134.38 ,$107.50 ,$106.09 ,$31.69 ,$120.23 ,$18.64 ,$31.69 ,$31.69 ,$99.02 ,$86.14 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$120.23 ,$41.94 ,$130.13 ,$99.02 ,$68.43 ,$68.43 ,$86.14 ,$68.43 ,$97.74 ,$127.31 ,$96.64 ,$18.45 ,$111.75 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100145,80187,HC FLECAINAIDE,301,1 ,$50.00 ,$33.00 ,$21.69 ,$61.00 ,$21.69 ,$50.00 ,$50.00 ,$27.11 ,$30.00 ,$42.50 ,$35.00 ,$21.69 ,$21.69 ,$47.50 ,$38.00 ,$37.50 ,$46.09 ,$42.50 ,$27.11 ,$46.09 ,$46.09 ,$35.00 ,$30.45 ,$21.69 ,$27.11 ,$26.57 ,$50.00 ,$22.99 ,$42.50 ,$61.00 ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$30.44 ,$34.55 ,$45.00 ,$34.16 ,$26.83 ,$39.50 ,$22.99 ,$32.53 ,$32.53 ,$26.57 ,$32.53 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30100146,80171,HC GABAPENTIN PLASMA,301,1 ,$110.00 ,$72.60 ,$14.48 ,$110.00 ,$14.48 ,$75.85 ,$75.85 ,$21.67 ,$66.00 ,$93.50 ,$77.00 ,$14.48 ,$14.48 ,$104.50 ,$83.60 ,$82.50 ,$36.84 ,$93.50 ,$21.67 ,$36.84 ,$36.84 ,$77.00 ,$66.99 ,$14.48 ,$21.67 ,$21.24 ,$43.34 ,$15.35 ,$93.50 ,$48.76 ,$101.20 ,$77.00 ,$66.27 ,$66.27 ,$66.99 ,$66.27 ,$76.01 ,$99.00 ,$75.15 ,$21.45 ,$86.90 ,$15.35 ,$26.00 ,$26.00 ,$21.24 ,$26.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,30100147,80175,HC LAMOTRIGINE,301,1 ,$90.00 ,$59.40 ,$12.98 ,$90.00 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$54.00 ,$76.50 ,$63.00 ,$13.69 ,$13.69 ,$85.50 ,$68.40 ,$67.50 ,$22.53 ,$76.50 ,$13.25 ,$22.53 ,$22.53 ,$63.00 ,$54.81 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$76.50 ,$29.81 ,$82.80 ,$63.00 ,$66.27 ,$66.27 ,$54.81 ,$66.27 ,$62.19 ,$81.00 ,$61.49 ,$13.11 ,$71.10 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100148,80183,HC TRILEPTAL,301,1 ,$100.00 ,$66.00 ,$12.98 ,$100.00 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$60.00 ,$85.00 ,$70.00 ,$13.69 ,$13.69 ,$95.00 ,$76.00 ,$75.00 ,$22.53 ,$85.00 ,$13.25 ,$22.53 ,$22.53 ,$70.00 ,$60.90 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$85.00 ,$29.81 ,$92.00 ,$70.00 ,$66.27 ,$66.27 ,$60.90 ,$66.27 ,$69.10 ,$90.00 ,$68.32 ,$13.11 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100149,80177,HC KEPPRA,301,1 ,$110.00 ,$72.60 ,$12.98 ,$110.00 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$66.00 ,$93.50 ,$77.00 ,$13.69 ,$13.69 ,$104.50 ,$83.60 ,$82.50 ,$22.53 ,$93.50 ,$13.25 ,$22.53 ,$22.53 ,$77.00 ,$66.99 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$93.50 ,$29.81 ,$101.20 ,$77.00 ,$66.27 ,$66.27 ,$66.99 ,$66.27 ,$76.01 ,$99.00 ,$75.15 ,$13.11 ,$86.90 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,30100150,80203,HC ZONISAMIDE,301,1 ,$100.00 ,$66.00 ,$12.98 ,$100.00 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$60.00 ,$85.00 ,$70.00 ,$13.69 ,$13.69 ,$95.00 ,$76.00 ,$75.00 ,$22.53 ,$85.00 ,$13.25 ,$22.53 ,$22.53 ,$70.00 ,$60.90 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$85.00 ,$29.81 ,$92.00 ,$70.00 ,$66.27 ,$66.27 ,$60.90 ,$66.27 ,$69.10 ,$90.00 ,$68.32 ,$13.11 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100151,80199,HC TIAGABINE,301,1 ,$120.00 ,$79.20 ,$19.70 ,$120.00 ,$19.70 ,$94.89 ,$94.89 ,$27.11 ,$72.00 ,$102.00 ,$84.00 ,$19.70 ,$19.70 ,$114.00 ,$91.20 ,$90.00 ,$46.09 ,$102.00 ,$27.11 ,$46.09 ,$46.09 ,$84.00 ,$73.08 ,$19.70 ,$27.11 ,$26.57 ,$54.22 ,$20.88 ,$102.00 ,$61.00 ,$110.40 ,$84.00 ,$90.23 ,$90.23 ,$73.08 ,$90.23 ,$82.92 ,$108.00 ,$81.98 ,$26.83 ,$94.80 ,$20.88 ,$32.53 ,$32.53 ,$26.57 ,$32.53 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30100152,80299,HC TRAZODONE,301,1 ,$186.30 ,$122.96 ,$18.27 ,$186.30 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$111.78 ,$158.36 ,$130.41 ,$19.26 ,$19.26 ,$176.99 ,$141.59 ,$139.73 ,$31.69 ,$158.36 ,$18.64 ,$31.69 ,$31.69 ,$130.41 ,$113.46 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$158.36 ,$41.94 ,$171.40 ,$130.41 ,$68.43 ,$68.43 ,$113.46 ,$68.43 ,$128.73 ,$167.67 ,$127.28 ,$18.45 ,$147.18 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,30100153,80299,HC RITALIN,301,1 ,$104.65 ,$69.07 ,$18.27 ,$104.65 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$62.79 ,$88.95 ,$73.26 ,$19.26 ,$19.26 ,$99.42 ,$79.53 ,$78.49 ,$31.69 ,$88.95 ,$18.64 ,$31.69 ,$31.69 ,$73.26 ,$63.73 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$88.95 ,$41.94 ,$96.28 ,$73.26 ,$68.43 ,$68.43 ,$63.73 ,$68.43 ,$72.31 ,$94.19 ,$71.50 ,$18.45 ,$82.67 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$75.35 ,$64.88 ,$75.35 ,$75.35 ,$83.72 
ST NICHOLAS HOSPITAL - ACUTE,30100154,80299,HC AMIODARONE,301,1 ,$186.30 ,$122.96 ,$18.27 ,$186.30 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$111.78 ,$158.36 ,$130.41 ,$19.26 ,$19.26 ,$176.99 ,$141.59 ,$139.73 ,$31.69 ,$158.36 ,$18.64 ,$31.69 ,$31.69 ,$130.41 ,$113.46 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$158.36 ,$41.94 ,$171.40 ,$130.41 ,$68.43 ,$68.43 ,$113.46 ,$68.43 ,$128.73 ,$167.67 ,$127.28 ,$18.45 ,$147.18 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,30100155,81099,HC INBORN ERR METABOLISM,301,1 ,$760.15 ,$501.70 ,$0.09 ,$760.15 ,$0.09 ,$521.01 ,$521.01 , N/A ,$456.09 ,$646.13 ,$532.11 ,$0.09 ,$0.09 ,$722.14 ,$577.71 ,$570.11 , N/A ,$646.13 , N/A , N/A , N/A ,$532.11 ,$462.93 ,$0.09 , N/A , N/A , N/A ,$0.10 ,$646.13 ,$456.09 ,$699.34 ,$532.11 ,$385.55 ,$462.70 ,$462.93 ,$462.70 ,$525.26 ,$684.14 ,$519.33 , N/A ,$600.52 ,$0.10 , N/A , N/A , N/A , N/A ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,30100156,G0480,HC ACETAMINOPHEN,301,1 ,$200.00 ,$132.00 ,$63.95 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$114.43 ,$120.00 ,$170.00 ,$140.00 ,$63.95 ,$63.95 ,$190.00 ,$152.00 ,$150.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$194.53 ,$140.00 ,$121.80 ,$63.95 ,$114.43 ,$112.14 ,$200.00 ,$67.79 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$180.00 ,$136.64 ,$113.26 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30100157,82009,HC ACETONE SERUM,301,1 ,$55.20 ,$36.43 ,$4.43 ,$55.20 ,$4.67 ,$15.82 ,$15.82 ,$4.52 ,$33.12 ,$46.92 ,$38.64 ,$4.67 ,$4.67 ,$52.44 ,$41.95 ,$41.40 ,$7.68 ,$46.92 ,$4.52 ,$7.68 ,$7.68 ,$38.64 ,$33.62 ,$4.67 ,$4.52 ,$4.43 ,$9.04 ,$4.95 ,$46.92 ,$10.17 ,$50.78 ,$38.64 ,$22.57 ,$22.57 ,$33.62 ,$22.57 ,$38.14 ,$49.68 ,$37.71 ,$4.48 ,$43.61 ,$4.95 ,$5.42 ,$5.42 ,$4.43 ,$5.42 ,$39.74 ,$34.22 ,$39.74 ,$39.74 ,$44.16 
ST NICHOLAS HOSPITAL - ACUTE,30100158,82010,HC ACETONE KETONES SERUM QN,301,1 ,$63.25 ,$41.75 ,$8.01 ,$63.25 ,$8.44 ,$28.60 ,$28.60 ,$8.17 ,$37.95 ,$53.76 ,$44.28 ,$8.44 ,$8.44 ,$60.09 ,$48.07 ,$47.44 ,$13.89 ,$53.76 ,$8.17 ,$13.89 ,$13.89 ,$44.28 ,$38.52 ,$8.44 ,$8.17 ,$8.01 ,$16.34 ,$8.95 ,$53.76 ,$18.38 ,$58.19 ,$44.28 ,$40.85 ,$40.85 ,$38.52 ,$40.85 ,$43.71 ,$56.93 ,$43.21 ,$8.08 ,$49.97 ,$8.95 ,$9.80 ,$9.80 ,$8.01 ,$9.80 ,$45.54 ,$39.22 ,$45.54 ,$45.54 ,$50.60 
ST NICHOLAS HOSPITAL - ACUTE,30100159,82017,HC ACYLCARNITINES QN EA SPEC,301,1 ,$554.30 ,$365.84 ,$16.53 ,$554.30 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$332.58 ,$471.16 ,$388.01 ,$17.43 ,$17.43 ,$526.59 ,$421.27 ,$415.73 ,$28.68 ,$471.16 ,$16.87 ,$28.68 ,$28.68 ,$388.01 ,$337.57 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$471.16 ,$37.96 ,$509.96 ,$388.01 ,$72.02 ,$72.02 ,$337.57 ,$72.02 ,$383.02 ,$498.87 ,$378.70 ,$16.70 ,$437.90 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$399.10 ,$343.67 ,$399.10 ,$399.10 ,$443.44 
ST NICHOLAS HOSPITAL - ACUTE,30100160,82017,HC FATTY ACID OXIDATION SCREEN,301,1 ,$19.55 ,$12.90 ,$11.73 ,$37.96 ,$17.43 ,$19.55 ,$19.55 ,$16.87 ,$11.73 ,$16.62 ,$13.69 ,$17.43 ,$17.43 ,$18.57 ,$14.86 ,$14.66 ,$19.55 ,$16.62 ,$16.87 ,$19.55 ,$19.55 ,$13.69 ,$11.91 ,$17.43 ,$16.87 ,$16.53 ,$19.55 ,$18.48 ,$16.62 ,$37.96 ,$17.99 ,$13.69 ,$19.55 ,$19.55 ,$11.91 ,$19.55 ,$13.51 ,$17.60 ,$13.36 ,$16.70 ,$15.44 ,$18.48 ,$19.55 ,$19.55 ,$16.53 ,$19.55 ,$14.08 ,$12.12 ,$14.08 ,$14.08 ,$15.64 
ST NICHOLAS HOSPITAL - ACUTE,30100161,82017,HC ORGANIC ACIDEMIA SCREEN,301,1 ,$19.55 ,$12.90 ,$11.73 ,$37.96 ,$17.43 ,$19.55 ,$19.55 ,$16.87 ,$11.73 ,$16.62 ,$13.69 ,$17.43 ,$17.43 ,$18.57 ,$14.86 ,$14.66 ,$19.55 ,$16.62 ,$16.87 ,$19.55 ,$19.55 ,$13.69 ,$11.91 ,$17.43 ,$16.87 ,$16.53 ,$19.55 ,$18.48 ,$16.62 ,$37.96 ,$17.99 ,$13.69 ,$19.55 ,$19.55 ,$11.91 ,$19.55 ,$13.51 ,$17.60 ,$13.36 ,$16.70 ,$15.44 ,$18.48 ,$19.55 ,$19.55 ,$16.53 ,$19.55 ,$14.08 ,$12.12 ,$14.08 ,$14.08 ,$15.64 
ST NICHOLAS HOSPITAL - ACUTE,30100162,82017,HC ACYLCARNITINES QN PLASMA MAYO,301,1 ,$497.95 ,$328.65 ,$16.53 ,$497.95 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$298.77 ,$423.26 ,$348.57 ,$17.43 ,$17.43 ,$473.05 ,$378.44 ,$373.46 ,$28.68 ,$423.26 ,$16.87 ,$28.68 ,$28.68 ,$348.57 ,$303.25 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$423.26 ,$37.96 ,$458.11 ,$348.57 ,$72.02 ,$72.02 ,$303.25 ,$72.02 ,$344.08 ,$448.16 ,$340.20 ,$16.70 ,$393.38 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$358.52 ,$308.73 ,$358.52 ,$358.52 ,$398.36 
ST NICHOLAS HOSPITAL - ACUTE,30100163,82024,HC ACTH,301,1 ,$334.65 ,$220.87 ,$37.85 ,$334.65 ,$39.91 ,$135.17 ,$135.17 ,$38.62 ,$200.79 ,$284.45 ,$234.26 ,$39.91 ,$39.91 ,$317.92 ,$254.33 ,$250.99 ,$65.65 ,$284.45 ,$38.62 ,$65.65 ,$65.65 ,$234.26 ,$203.80 ,$39.91 ,$38.62 ,$37.85 ,$77.24 ,$42.30 ,$284.45 ,$86.90 ,$307.88 ,$234.26 ,$193.07 ,$193.07 ,$203.80 ,$193.07 ,$231.24 ,$301.19 ,$228.63 ,$38.23 ,$264.37 ,$42.30 ,$46.34 ,$46.34 ,$37.85 ,$46.34 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30100164,82040,HC ALBUMIN,301,1 ,$43.70 ,$28.84 ,$4.85 ,$43.70 ,$5.11 ,$17.33 ,$17.33 ,$4.95 ,$26.22 ,$37.15 ,$30.59 ,$5.11 ,$5.11 ,$41.52 ,$33.21 ,$32.78 ,$8.42 ,$37.15 ,$4.95 ,$8.42 ,$8.42 ,$30.59 ,$26.61 ,$5.11 ,$4.95 ,$4.85 ,$9.90 ,$5.42 ,$37.15 ,$11.14 ,$40.20 ,$30.59 ,$24.73 ,$24.73 ,$26.61 ,$24.73 ,$30.20 ,$39.33 ,$29.86 ,$4.90 ,$34.52 ,$5.42 ,$5.94 ,$5.94 ,$4.85 ,$5.94 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30100165,82040,HC ALBUMIN SERUM,301,1 ,$43.70 ,$28.84 ,$4.85 ,$43.70 ,$5.11 ,$17.33 ,$17.33 ,$4.95 ,$26.22 ,$37.15 ,$30.59 ,$5.11 ,$5.11 ,$41.52 ,$33.21 ,$32.78 ,$8.42 ,$37.15 ,$4.95 ,$8.42 ,$8.42 ,$30.59 ,$26.61 ,$5.11 ,$4.95 ,$4.85 ,$9.90 ,$5.42 ,$37.15 ,$11.14 ,$40.20 ,$30.59 ,$24.73 ,$24.73 ,$26.61 ,$24.73 ,$30.20 ,$39.33 ,$29.86 ,$4.90 ,$34.52 ,$5.42 ,$5.94 ,$5.94 ,$4.85 ,$5.94 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30100166,82042,HC ALBUMIN BODY FLUID,301,1 ,$77.05 ,$50.85 ,$7.27 ,$77.05 ,$7.27 ,$27.23 ,$27.23 ,$7.78 ,$46.23 ,$65.49 ,$53.94 ,$7.27 ,$7.27 ,$73.20 ,$58.56 ,$57.79 ,$13.23 ,$65.49 ,$7.78 ,$13.23 ,$13.23 ,$53.94 ,$46.92 ,$7.27 ,$7.78 ,$7.62 ,$15.56 ,$7.71 ,$65.49 ,$17.51 ,$70.89 ,$53.94 ,$25.86 ,$25.86 ,$46.92 ,$25.86 ,$53.24 ,$69.35 ,$52.64 ,$7.70 ,$60.87 ,$7.71 ,$9.34 ,$9.34 ,$7.62 ,$9.34 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100167,82042,HC ALBUMIN CSF,301,1 ,$77.05 ,$50.85 ,$7.27 ,$77.05 ,$7.27 ,$27.23 ,$27.23 ,$7.78 ,$46.23 ,$65.49 ,$53.94 ,$7.27 ,$7.27 ,$73.20 ,$58.56 ,$57.79 ,$13.23 ,$65.49 ,$7.78 ,$13.23 ,$13.23 ,$53.94 ,$46.92 ,$7.27 ,$7.78 ,$7.62 ,$15.56 ,$7.71 ,$65.49 ,$17.51 ,$70.89 ,$53.94 ,$25.86 ,$25.86 ,$46.92 ,$25.86 ,$53.24 ,$69.35 ,$52.64 ,$7.70 ,$60.87 ,$7.71 ,$9.34 ,$9.34 ,$7.62 ,$9.34 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$62.10 ,$40.99 ,$5.66 ,$62.10 ,$5.97 ,$20.23 ,$20.23 ,$5.78 ,$37.26 ,$52.79 ,$43.47 ,$5.97 ,$5.97 ,$59.00 ,$47.20 ,$46.58 ,$9.83 ,$52.79 ,$5.78 ,$9.83 ,$9.83 ,$43.47 ,$37.82 ,$5.97 ,$5.78 ,$5.66 ,$11.56 ,$6.33 ,$52.79 ,$13.01 ,$57.13 ,$43.47 ,$28.91 ,$28.91 ,$37.82 ,$28.91 ,$42.91 ,$55.89 ,$42.43 ,$5.72 ,$49.06 ,$6.33 ,$6.94 ,$6.94 ,$5.66 ,$6.94 ,$44.71 ,$38.50 ,$44.71 ,$44.71 ,$49.68 
ST NICHOLAS HOSPITAL - ACUTE,30100169,G0480,HC ALCOHOL (ETOH),301,1 ,$180.00 ,$118.80 ,$63.95 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$114.43 ,$108.00 ,$153.00 ,$126.00 ,$63.95 ,$63.95 ,$171.00 ,$136.80 ,$135.00 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$180.00 ,$126.00 ,$109.62 ,$63.95 ,$114.43 ,$112.14 ,$180.00 ,$67.79 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$162.00 ,$122.98 ,$113.26 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30100170,82085,HC ALDOLASE,301,1 ,$77.05 ,$50.85 ,$9.52 ,$77.05 ,$10.03 ,$33.99 ,$33.99 ,$9.71 ,$46.23 ,$65.49 ,$53.94 ,$10.03 ,$10.03 ,$73.20 ,$58.56 ,$57.79 ,$16.51 ,$65.49 ,$9.71 ,$16.51 ,$16.51 ,$53.94 ,$46.92 ,$10.03 ,$9.71 ,$9.52 ,$19.42 ,$10.63 ,$65.49 ,$21.85 ,$70.89 ,$53.94 ,$48.50 ,$48.50 ,$46.92 ,$48.50 ,$53.24 ,$69.35 ,$52.64 ,$9.61 ,$60.87 ,$10.63 ,$11.65 ,$11.65 ,$9.52 ,$11.65 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100171,82088,HC ALDOSTERONE,301,1 ,$361.10 ,$238.33 ,$39.93 ,$361.10 ,$42.11 ,$142.63 ,$142.63 ,$40.75 ,$216.66 ,$306.94 ,$252.77 ,$42.11 ,$42.11 ,$343.05 ,$274.44 ,$270.83 ,$69.28 ,$306.94 ,$40.75 ,$69.28 ,$69.28 ,$252.77 ,$219.91 ,$42.11 ,$40.75 ,$39.93 ,$81.50 ,$44.64 ,$306.94 ,$91.69 ,$332.21 ,$252.77 ,$203.69 ,$203.69 ,$219.91 ,$203.69 ,$249.52 ,$324.99 ,$246.70 ,$40.34 ,$285.27 ,$44.64 ,$48.90 ,$48.90 ,$39.93 ,$48.90 ,$259.99 ,$223.88 ,$259.99 ,$259.99 ,$288.88 
ST NICHOLAS HOSPITAL - ACUTE,30100172,82103,HC ALPHA-1 ANTITRYPSIN TOTAL,301,1 ,$116.15 ,$76.66 ,$13.17 ,$116.15 ,$13.89 ,$47.04 ,$47.04 ,$13.44 ,$69.69 ,$98.73 ,$81.31 ,$13.89 ,$13.89 ,$110.34 ,$88.27 ,$87.11 ,$22.85 ,$98.73 ,$13.44 ,$22.85 ,$22.85 ,$81.31 ,$70.74 ,$13.89 ,$13.44 ,$13.17 ,$26.88 ,$14.72 ,$98.73 ,$30.24 ,$106.86 ,$81.31 ,$67.15 ,$67.15 ,$70.74 ,$67.15 ,$80.26 ,$104.54 ,$79.35 ,$13.30 ,$91.76 ,$14.72 ,$16.13 ,$16.13 ,$13.17 ,$16.13 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100173,82103,HC A-1 ANTITRYPSIN TOTAL,301,1 ,$116.15 ,$76.66 ,$13.17 ,$116.15 ,$13.89 ,$47.04 ,$47.04 ,$13.44 ,$69.69 ,$98.73 ,$81.31 ,$13.89 ,$13.89 ,$110.34 ,$88.27 ,$87.11 ,$22.85 ,$98.73 ,$13.44 ,$22.85 ,$22.85 ,$81.31 ,$70.74 ,$13.89 ,$13.44 ,$13.17 ,$26.88 ,$14.72 ,$98.73 ,$30.24 ,$106.86 ,$81.31 ,$67.15 ,$67.15 ,$70.74 ,$67.15 ,$80.26 ,$104.54 ,$79.35 ,$13.30 ,$91.76 ,$14.72 ,$16.13 ,$16.13 ,$13.17 ,$16.13 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100174,82104,HC ANTITRYPSIN PHENO,301,1 ,$170.20 ,$112.33 ,$14.17 ,$170.20 ,$14.94 ,$50.61 ,$50.61 ,$14.46 ,$102.12 ,$144.67 ,$119.14 ,$14.94 ,$14.94 ,$161.69 ,$129.35 ,$127.65 ,$24.58 ,$144.67 ,$14.46 ,$24.58 ,$24.58 ,$119.14 ,$103.65 ,$14.94 ,$14.46 ,$14.17 ,$28.92 ,$15.84 ,$144.67 ,$32.54 ,$156.58 ,$119.14 ,$72.28 ,$72.28 ,$103.65 ,$72.28 ,$117.61 ,$153.18 ,$116.28 ,$14.31 ,$134.46 ,$15.84 ,$17.35 ,$17.35 ,$14.17 ,$17.35 ,$122.54 ,$105.52 ,$122.54 ,$122.54 ,$136.16 
ST NICHOLAS HOSPITAL - ACUTE,30100175,82105,HC ALPHA FETOPROTEIN SERUM,301,1 ,$141.45 ,$93.36 ,$16.43 ,$141.45 ,$17.33 ,$58.70 ,$58.70 ,$16.77 ,$84.87 ,$120.23 ,$99.02 ,$17.33 ,$17.33 ,$134.38 ,$107.50 ,$106.09 ,$28.51 ,$120.23 ,$16.77 ,$28.51 ,$28.51 ,$99.02 ,$86.14 ,$17.33 ,$16.77 ,$16.43 ,$33.54 ,$18.37 ,$120.23 ,$37.73 ,$130.13 ,$99.02 ,$83.86 ,$83.86 ,$86.14 ,$83.86 ,$97.74 ,$127.31 ,$96.64 ,$16.60 ,$111.75 ,$18.37 ,$20.12 ,$20.12 ,$16.43 ,$20.12 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100177,82105,HC QUAD AFP,301,1 ,$141.45 ,$93.36 ,$16.43 ,$141.45 ,$17.33 ,$58.70 ,$58.70 ,$16.77 ,$84.87 ,$120.23 ,$99.02 ,$17.33 ,$17.33 ,$134.38 ,$107.50 ,$106.09 ,$28.51 ,$120.23 ,$16.77 ,$28.51 ,$28.51 ,$99.02 ,$86.14 ,$17.33 ,$16.77 ,$16.43 ,$33.54 ,$18.37 ,$120.23 ,$37.73 ,$130.13 ,$99.02 ,$83.86 ,$83.86 ,$86.14 ,$83.86 ,$97.74 ,$127.31 ,$96.64 ,$16.60 ,$111.75 ,$18.37 ,$20.12 ,$20.12 ,$16.43 ,$20.12 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100178,82105,HC AFP MATERNAL,301,1 ,$141.45 ,$93.36 ,$16.43 ,$141.45 ,$17.33 ,$58.70 ,$58.70 ,$16.77 ,$84.87 ,$120.23 ,$99.02 ,$17.33 ,$17.33 ,$134.38 ,$107.50 ,$106.09 ,$28.51 ,$120.23 ,$16.77 ,$28.51 ,$28.51 ,$99.02 ,$86.14 ,$17.33 ,$16.77 ,$16.43 ,$33.54 ,$18.37 ,$120.23 ,$37.73 ,$130.13 ,$99.02 ,$83.86 ,$83.86 ,$86.14 ,$83.86 ,$97.74 ,$127.31 ,$96.64 ,$16.60 ,$111.75 ,$18.37 ,$20.12 ,$20.12 ,$16.43 ,$20.12 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100179,82108,HC ALUMINUM,301,1 ,$180.55 ,$119.16 ,$24.97 ,$180.55 ,$26.33 ,$89.18 ,$89.18 ,$25.48 ,$108.33 ,$153.47 ,$126.39 ,$26.33 ,$26.33 ,$171.52 ,$137.22 ,$135.41 ,$43.32 ,$153.47 ,$25.48 ,$43.32 ,$43.32 ,$126.39 ,$109.96 ,$26.33 ,$25.48 ,$24.97 ,$50.96 ,$27.91 ,$153.47 ,$57.33 ,$166.11 ,$126.39 ,$127.34 ,$127.34 ,$109.96 ,$127.34 ,$124.76 ,$162.50 ,$123.35 ,$25.22 ,$142.63 ,$27.91 ,$30.58 ,$30.58 ,$24.97 ,$30.58 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30100180,82131,HC AMINO ACID QN SINGLE,301,1 ,$195.50 ,$129.03 ,$21.01 ,$195.50 ,$21.01 ,$80.43 ,$80.43 ,$22.98 ,$117.30 ,$166.18 ,$136.85 ,$21.01 ,$21.01 ,$185.73 ,$148.58 ,$146.63 ,$39.07 ,$166.18 ,$22.98 ,$39.07 ,$39.07 ,$136.85 ,$119.06 ,$21.01 ,$22.98 ,$22.52 ,$45.96 ,$22.27 ,$166.18 ,$51.71 ,$179.86 ,$136.85 ,$84.30 ,$84.30 ,$119.06 ,$84.30 ,$135.09 ,$175.95 ,$133.57 ,$22.75 ,$154.45 ,$22.27 ,$27.58 ,$27.58 ,$22.52 ,$27.58 ,$140.76 ,$121.21 ,$140.76 ,$140.76 ,$156.40 
ST NICHOLAS HOSPITAL - ACUTE,30100181,82131,HC CYSTINE,301,1 ,$195.50 ,$129.03 ,$21.01 ,$195.50 ,$21.01 ,$80.43 ,$80.43 ,$22.98 ,$117.30 ,$166.18 ,$136.85 ,$21.01 ,$21.01 ,$185.73 ,$148.58 ,$146.63 ,$39.07 ,$166.18 ,$22.98 ,$39.07 ,$39.07 ,$136.85 ,$119.06 ,$21.01 ,$22.98 ,$22.52 ,$45.96 ,$22.27 ,$166.18 ,$51.71 ,$179.86 ,$136.85 ,$84.30 ,$84.30 ,$119.06 ,$84.30 ,$135.09 ,$175.95 ,$133.57 ,$22.75 ,$154.45 ,$22.27 ,$27.58 ,$27.58 ,$22.52 ,$27.58 ,$140.76 ,$121.21 ,$140.76 ,$140.76 ,$156.40 
ST NICHOLAS HOSPITAL - ACUTE,30100182,82139,HC AMINO ACID 6+ QN PLASMA,301,1 ,"$1,288.00 ",$850.08 ,$16.53 ,"$1,288.00 ",$17.43 ,$59.05 ,$59.05 ,$16.87 ,$772.80 ,"$1,094.80 ",$901.60 ,$17.43 ,$17.43 ,"$1,223.60 ",$978.88 ,$966.00 ,$28.68 ,"$1,094.80 ",$16.87 ,$28.68 ,$28.68 ,$901.60 ,$784.39 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,"$1,094.80 ",$37.96 ,"$1,184.96 ",$901.60 ,$72.02 ,$72.02 ,$784.39 ,$72.02 ,$890.01 ,"$1,159.20 ",$879.96 ,$16.70 ,"$1,017.52 ",$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$927.36 ,$798.56 ,$927.36 ,$927.36 ,"$1,030.40 "
ST NICHOLAS HOSPITAL - ACUTE,30100183,82139,HC AMINO ACID 6+ QN URINE,301,1 ,$554.30 ,$365.84 ,$16.53 ,$554.30 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$332.58 ,$471.16 ,$388.01 ,$17.43 ,$17.43 ,$526.59 ,$421.27 ,$415.73 ,$28.68 ,$471.16 ,$16.87 ,$28.68 ,$28.68 ,$388.01 ,$337.57 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$471.16 ,$37.96 ,$509.96 ,$388.01 ,$72.02 ,$72.02 ,$337.57 ,$72.02 ,$383.02 ,$498.87 ,$378.70 ,$16.70 ,$437.90 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$399.10 ,$343.67 ,$399.10 ,$399.10 ,$443.44 
ST NICHOLAS HOSPITAL - ACUTE,30100184,82139,HC AMINO ACID 6+ QN SERUM,301,1 ,$807.30 ,$532.82 ,$16.53 ,$807.30 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$484.38 ,$686.21 ,$565.11 ,$17.43 ,$17.43 ,$766.94 ,$613.55 ,$605.48 ,$28.68 ,$686.21 ,$16.87 ,$28.68 ,$28.68 ,$565.11 ,$491.65 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$686.21 ,$37.96 ,$742.72 ,$565.11 ,$72.02 ,$72.02 ,$491.65 ,$72.02 ,$557.84 ,$726.57 ,$551.55 ,$16.70 ,$637.77 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$581.26 ,$500.53 ,$581.26 ,$581.26 ,$645.84 
ST NICHOLAS HOSPITAL - ACUTE,30100185,82139,HC AMINO ACID 6+ URINE,301,1 ,$859.05 ,$566.97 ,$16.53 ,$859.05 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$515.43 ,$730.19 ,$601.34 ,$17.43 ,$17.43 ,$816.10 ,$652.88 ,$644.29 ,$28.68 ,$730.19 ,$16.87 ,$28.68 ,$28.68 ,$601.34 ,$523.16 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$730.19 ,$37.96 ,$790.33 ,$601.34 ,$72.02 ,$72.02 ,$523.16 ,$72.02 ,$593.60 ,$773.15 ,$586.90 ,$16.70 ,$678.65 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$618.52 ,$532.61 ,$618.52 ,$618.52 ,$687.24 
ST NICHOLAS HOSPITAL - ACUTE,30100186,82140,HC AMMONIA,301,1 ,$128.80 ,$85.01 ,$14.28 ,$128.80 ,$15.06 ,$51.00 ,$51.00 ,$14.57 ,$77.28 ,$109.48 ,$90.16 ,$15.06 ,$15.06 ,$122.36 ,$97.89 ,$96.60 ,$24.77 ,$109.48 ,$14.57 ,$24.77 ,$24.77 ,$90.16 ,$78.44 ,$15.06 ,$14.57 ,$14.28 ,$29.14 ,$15.96 ,$109.48 ,$32.78 ,$118.50 ,$90.16 ,$72.83 ,$72.83 ,$78.44 ,$72.83 ,$89.00 ,$115.92 ,$88.00 ,$14.43 ,$101.75 ,$15.96 ,$17.48 ,$17.48 ,$14.28 ,$17.48 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100187,80324,HC AMPHETAMINE,301,1 ,$46.00 ,$30.36 ,$0.38 ,$46.00 ,$0.38 ,$46.00 ,$46.00 , N/A ,$27.60 ,$39.10 ,$32.20 ,$0.38 ,$0.38 ,$43.70 ,$34.96 ,$34.50 ,$38.86 ,$39.10 , N/A ,$38.86 ,$38.86 ,$32.20 ,$28.01 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$39.10 , N/A ,$42.32 ,$32.20 ,$23.33 ,$28.00 ,$28.01 ,$28.00 ,$31.79 ,$41.40 ,$31.43 , N/A ,$36.34 ,$0.40 , N/A , N/A , N/A , N/A ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30100188,82150,HC AMYLASE,301,1 ,$77.05 ,$50.85 ,$6.35 ,$77.05 ,$6.70 ,$22.68 ,$22.68 ,$6.48 ,$46.23 ,$65.49 ,$53.94 ,$6.70 ,$6.70 ,$73.20 ,$58.56 ,$57.79 ,$11.02 ,$65.49 ,$6.48 ,$11.02 ,$11.02 ,$53.94 ,$46.92 ,$6.70 ,$6.48 ,$6.35 ,$12.96 ,$7.10 ,$65.49 ,$14.58 ,$70.89 ,$53.94 ,$32.39 ,$32.39 ,$46.92 ,$32.39 ,$53.24 ,$69.35 ,$52.64 ,$6.41 ,$60.87 ,$7.10 ,$7.78 ,$7.78 ,$6.35 ,$7.78 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100189,82157,HC ANDROSTENEDIONE,301,1 ,$257.60 ,$170.02 ,$28.69 ,$257.60 ,$30.26 ,$102.48 ,$102.48 ,$29.28 ,$154.56 ,$218.96 ,$180.32 ,$30.26 ,$30.26 ,$244.72 ,$195.78 ,$193.20 ,$49.78 ,$218.96 ,$29.28 ,$49.78 ,$49.78 ,$180.32 ,$156.88 ,$30.26 ,$29.28 ,$28.69 ,$58.56 ,$32.08 ,$218.96 ,$65.88 ,$236.99 ,$180.32 ,$146.32 ,$146.32 ,$156.88 ,$146.32 ,$178.00 ,$231.84 ,$175.99 ,$28.98 ,$203.50 ,$32.08 ,$35.14 ,$35.14 ,$28.69 ,$35.14 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30100190,82164,"HC ACE, CSF",301,1 ,$128.80 ,$85.01 ,$14.31 ,$128.80 ,$15.09 ,$51.10 ,$51.10 ,$14.60 ,$77.28 ,$109.48 ,$90.16 ,$15.09 ,$15.09 ,$122.36 ,$97.89 ,$96.60 ,$24.82 ,$109.48 ,$14.60 ,$24.82 ,$24.82 ,$90.16 ,$78.44 ,$15.09 ,$14.60 ,$14.31 ,$29.20 ,$16.00 ,$109.48 ,$32.85 ,$118.50 ,$90.16 ,$72.98 ,$72.98 ,$78.44 ,$72.98 ,$89.00 ,$115.92 ,$88.00 ,$14.45 ,$101.75 ,$16.00 ,$17.52 ,$17.52 ,$14.31 ,$17.52 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100191,82164,HC ANGIOTENSIN 1 ENZYME (ACE),301,1 ,$128.80 ,$85.01 ,$14.31 ,$128.80 ,$15.09 ,$51.10 ,$51.10 ,$14.60 ,$77.28 ,$109.48 ,$90.16 ,$15.09 ,$15.09 ,$122.36 ,$97.89 ,$96.60 ,$24.82 ,$109.48 ,$14.60 ,$24.82 ,$24.82 ,$90.16 ,$78.44 ,$15.09 ,$14.60 ,$14.31 ,$29.20 ,$16.00 ,$109.48 ,$32.85 ,$118.50 ,$90.16 ,$72.98 ,$72.98 ,$78.44 ,$72.98 ,$89.00 ,$115.92 ,$88.00 ,$14.45 ,$101.75 ,$16.00 ,$17.52 ,$17.52 ,$14.31 ,$17.52 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100192,82172,HC APOLIPOPROTEIN SERUM,301,1 ,$116.15 ,$76.66 ,$20.67 ,$116.15 ,$21.79 ,$73.82 ,$73.82 ,$21.09 ,$69.69 ,$98.73 ,$81.31 ,$21.79 ,$21.79 ,$110.34 ,$88.27 ,$87.11 ,$35.85 ,$98.73 ,$21.09 ,$35.85 ,$35.85 ,$81.31 ,$70.74 ,$21.79 ,$21.09 ,$20.67 ,$42.18 ,$23.10 ,$98.73 ,$47.45 ,$106.86 ,$81.31 ,$77.45 ,$77.45 ,$70.74 ,$77.45 ,$80.26 ,$104.54 ,$79.35 ,$20.87 ,$91.76 ,$23.10 ,$25.31 ,$25.31 ,$20.67 ,$25.31 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100193,82175,HC ARSENIC,301,1 ,$60.95 ,$40.23 ,$18.59 ,$60.95 ,$19.60 ,$60.95 ,$60.95 ,$18.97 ,$36.57 ,$51.81 ,$42.67 ,$19.60 ,$19.60 ,$57.90 ,$46.32 ,$45.71 ,$32.25 ,$51.81 ,$18.97 ,$32.25 ,$32.25 ,$42.67 ,$37.12 ,$19.60 ,$18.97 ,$18.59 ,$37.94 ,$20.78 ,$51.81 ,$42.68 ,$56.07 ,$42.67 ,$60.95 ,$60.95 ,$37.12 ,$60.95 ,$42.12 ,$54.86 ,$41.64 ,$18.78 ,$48.15 ,$20.78 ,$22.76 ,$22.76 ,$18.59 ,$22.76 ,$43.88 ,$37.79 ,$43.88 ,$43.88 ,$48.76 
ST NICHOLAS HOSPITAL - ACUTE,30100194,82175,HC ARSENIC BLOOD,301,1 ,$103.50 ,$68.31 ,$18.59 ,$103.50 ,$19.60 ,$66.40 ,$66.40 ,$18.97 ,$62.10 ,$87.98 ,$72.45 ,$19.60 ,$19.60 ,$98.33 ,$78.66 ,$77.63 ,$32.25 ,$87.98 ,$18.97 ,$32.25 ,$32.25 ,$72.45 ,$63.03 ,$19.60 ,$18.97 ,$18.59 ,$37.94 ,$20.78 ,$87.98 ,$42.68 ,$95.22 ,$72.45 ,$94.85 ,$94.85 ,$63.03 ,$94.85 ,$71.52 ,$93.15 ,$70.71 ,$18.78 ,$81.77 ,$20.78 ,$22.76 ,$22.76 ,$18.59 ,$22.76 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100195,82175,HC ARSENIC URINE,301,1 ,$103.50 ,$68.31 ,$18.59 ,$103.50 ,$19.60 ,$66.40 ,$66.40 ,$18.97 ,$62.10 ,$87.98 ,$72.45 ,$19.60 ,$19.60 ,$98.33 ,$78.66 ,$77.63 ,$32.25 ,$87.98 ,$18.97 ,$32.25 ,$32.25 ,$72.45 ,$63.03 ,$19.60 ,$18.97 ,$18.59 ,$37.94 ,$20.78 ,$87.98 ,$42.68 ,$95.22 ,$72.45 ,$94.85 ,$94.85 ,$63.03 ,$94.85 ,$71.52 ,$93.15 ,$70.71 ,$18.78 ,$81.77 ,$20.78 ,$22.76 ,$22.76 ,$18.59 ,$22.76 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100196,82175,HC ARESNIC 24 HR URINE,301,1 ,$103.50 ,$68.31 ,$18.59 ,$103.50 ,$19.60 ,$66.40 ,$66.40 ,$18.97 ,$62.10 ,$87.98 ,$72.45 ,$19.60 ,$19.60 ,$98.33 ,$78.66 ,$77.63 ,$32.25 ,$87.98 ,$18.97 ,$32.25 ,$32.25 ,$72.45 ,$63.03 ,$19.60 ,$18.97 ,$18.59 ,$37.94 ,$20.78 ,$87.98 ,$42.68 ,$95.22 ,$72.45 ,$94.85 ,$94.85 ,$63.03 ,$94.85 ,$71.52 ,$93.15 ,$70.71 ,$18.78 ,$81.77 ,$20.78 ,$22.76 ,$22.76 ,$18.59 ,$22.76 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100197,82180,HC VITAMIN C (ASCORBIC ACID),301,1 ,$89.70 ,$59.20 ,$9.69 ,$89.70 ,$10.22 ,$34.62 ,$34.62 ,$9.89 ,$53.82 ,$76.25 ,$62.79 ,$10.22 ,$10.22 ,$85.22 ,$68.17 ,$67.28 ,$16.81 ,$76.25 ,$9.89 ,$16.81 ,$16.81 ,$62.79 ,$54.63 ,$10.22 ,$9.89 ,$9.69 ,$19.78 ,$10.83 ,$76.25 ,$22.25 ,$82.52 ,$62.79 ,$49.38 ,$49.38 ,$54.63 ,$49.38 ,$61.98 ,$80.73 ,$61.28 ,$9.79 ,$70.86 ,$10.83 ,$11.87 ,$11.87 ,$9.69 ,$11.87 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100199,80345,HC BARBITURATE,301,1 ,$38.00 ,$25.08 ,$0.38 ,$38.00 ,$0.38 ,$38.00 ,$38.00 , N/A ,$22.80 ,$32.30 ,$26.60 ,$0.38 ,$0.38 ,$36.10 ,$28.88 ,$28.50 ,$38.00 ,$32.30 , N/A ,$38.00 ,$38.00 ,$26.60 ,$23.14 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$25.96 , N/A ,$30.02 ,$0.40 , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100200,G0480,HC PENTOBARB,301,1 ,$139.00 ,$91.74 ,$63.95 ,$257.47 ,$63.95 ,$139.00 ,$139.00 ,$114.43 ,$83.40 ,$118.15 ,$97.30 ,$63.95 ,$63.95 ,$132.05 ,$105.64 ,$104.25 ,$139.00 ,$118.15 ,$114.43 ,$139.00 ,$139.00 ,$97.30 ,$84.65 ,$63.95 ,$114.43 ,$112.14 ,$139.00 ,$67.79 ,$118.15 ,$257.47 ,$127.88 ,$97.30 ,$139.00 ,$139.00 ,$84.65 ,$139.00 ,$96.05 ,$125.10 ,$94.96 ,$113.26 ,$109.81 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$100.08 ,$86.18 ,$100.08 ,$100.08 ,$111.20 
ST NICHOLAS HOSPITAL - ACUTE,30100201,82232,HC BETA 2 MICROGLOBULIN,301,1 ,$141.45 ,$93.36 ,$15.86 ,$141.45 ,$16.72 ,$56.63 ,$56.63 ,$16.18 ,$84.87 ,$120.23 ,$99.02 ,$16.72 ,$16.72 ,$134.38 ,$107.50 ,$106.09 ,$27.51 ,$120.23 ,$16.18 ,$27.51 ,$27.51 ,$99.02 ,$86.14 ,$16.72 ,$16.18 ,$15.86 ,$32.36 ,$17.72 ,$120.23 ,$36.41 ,$130.13 ,$99.02 ,$80.85 ,$80.85 ,$86.14 ,$80.85 ,$97.74 ,$127.31 ,$96.64 ,$16.01 ,$111.75 ,$17.72 ,$19.42 ,$19.42 ,$15.86 ,$19.42 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$43.70 ,$28.84 ,$4.24 ,$43.70 ,$4.24 ,$17.57 ,$17.57 ,$5.02 ,$26.22 ,$37.15 ,$30.59 ,$4.24 ,$4.24 ,$41.52 ,$33.21 ,$32.78 ,$8.53 ,$37.15 ,$5.02 ,$8.53 ,$8.53 ,$30.59 ,$26.61 ,$4.24 ,$5.02 ,$4.92 ,$10.04 ,$4.49 ,$37.15 ,$11.30 ,$40.20 ,$30.59 ,$25.06 ,$25.06 ,$26.61 ,$25.06 ,$30.20 ,$39.33 ,$29.86 ,$4.97 ,$34.52 ,$4.49 ,$6.02 ,$6.02 ,$4.92 ,$6.02 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$43.70 ,$28.84 ,$4.70 ,$43.70 ,$4.70 ,$17.57 ,$17.57 ,$5.02 ,$26.22 ,$37.15 ,$30.59 ,$4.70 ,$4.70 ,$41.52 ,$33.21 ,$32.78 ,$8.53 ,$37.15 ,$5.02 ,$8.53 ,$8.53 ,$30.59 ,$26.61 ,$4.70 ,$5.02 ,$4.92 ,$10.04 ,$4.98 ,$37.15 ,$11.30 ,$40.20 ,$30.59 ,$25.06 ,$25.06 ,$26.61 ,$25.06 ,$30.20 ,$39.33 ,$29.86 ,$4.97 ,$34.52 ,$4.98 ,$6.02 ,$6.02 ,$4.92 ,$6.02 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30100205,82270,HC OCCULT BLOOD FECAL SCRN,301,1 ,$29.90 ,$19.73 ,$3.66 ,$29.90 ,$3.66 ,$15.33 ,$15.33 ,$4.38 ,$17.94 ,$25.42 ,$20.93 ,$3.66 ,$3.66 ,$28.41 ,$22.72 ,$22.43 ,$7.45 ,$25.42 ,$4.38 ,$7.45 ,$7.45 ,$20.93 ,$18.21 ,$3.66 ,$4.38 ,$4.29 ,$8.76 ,$3.88 ,$25.42 ,$9.86 ,$27.51 ,$20.93 ,$16.27 ,$16.27 ,$18.21 ,$16.27 ,$20.66 ,$26.91 ,$20.43 ,$4.33 ,$23.62 ,$3.88 ,$5.26 ,$5.26 ,$4.29 ,$5.26 ,$21.53 ,$18.54 ,$21.53 ,$21.53 ,$23.92 
ST NICHOLAS HOSPITAL - ACUTE,30100206,82271,HC OCCULT BLOOD GASTRIC,301,1 ,$29.90 ,$19.73 ,$4.26 ,$29.90 ,$4.26 ,$18.62 ,$18.62 ,$5.32 ,$17.94 ,$25.42 ,$20.93 ,$4.26 ,$4.26 ,$28.41 ,$22.72 ,$22.43 ,$9.04 ,$25.42 ,$5.32 ,$9.04 ,$9.04 ,$20.93 ,$18.21 ,$4.26 ,$5.32 ,$5.21 ,$10.64 ,$4.52 ,$25.42 ,$11.97 ,$27.51 ,$20.93 ,$16.27 ,$16.27 ,$18.21 ,$16.27 ,$20.66 ,$26.91 ,$20.43 ,$5.26 ,$23.62 ,$4.52 ,$6.38 ,$6.38 ,$5.21 ,$6.38 ,$21.53 ,$18.54 ,$21.53 ,$21.53 ,$23.92 
ST NICHOLAS HOSPITAL - ACUTE,30100207,82272,HC OCCULT BLOOD FECAL DIAG,301,1 ,$28.75 ,$18.98 ,$4.15 ,$28.75 ,$4.26 ,$14.81 ,$14.81 ,$4.23 ,$17.25 ,$24.44 ,$20.13 ,$4.26 ,$4.26 ,$27.31 ,$21.85 ,$21.56 ,$7.19 ,$24.44 ,$4.23 ,$7.19 ,$7.19 ,$20.13 ,$17.51 ,$4.26 ,$4.23 ,$4.15 ,$8.46 ,$4.52 ,$24.44 ,$9.52 ,$26.45 ,$20.13 ,$16.27 ,$16.27 ,$17.51 ,$16.27 ,$19.87 ,$25.88 ,$19.64 ,$4.18 ,$22.71 ,$4.52 ,$5.08 ,$5.08 ,$4.15 ,$5.08 ,$20.70 ,$17.83 ,$20.70 ,$20.70 ,$23.00 
ST NICHOLAS HOSPITAL - ACUTE,30100208,82274,HC OCCULT BLOOD FECAL HGB,301,1 ,$141.45 ,$93.36 ,$15.60 ,$141.45 ,$16.45 ,$55.72 ,$55.72 ,$15.92 ,$84.87 ,$120.23 ,$99.02 ,$16.45 ,$16.45 ,$134.38 ,$107.50 ,$106.09 ,$27.06 ,$120.23 ,$15.92 ,$27.06 ,$27.06 ,$99.02 ,$86.14 ,$16.45 ,$15.92 ,$15.60 ,$31.84 ,$17.44 ,$120.23 ,$35.82 ,$130.13 ,$99.02 ,$79.50 ,$79.50 ,$86.14 ,$79.50 ,$97.74 ,$127.31 ,$96.64 ,$15.76 ,$111.75 ,$17.44 ,$19.10 ,$19.10 ,$15.60 ,$19.10 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100209,82300,HC CADMIUM,301,1 ,$103.50 ,$68.31 ,$23.17 ,$103.50 ,$24.43 ,$82.74 ,$82.74 ,$23.64 ,$62.10 ,$87.98 ,$72.45 ,$24.43 ,$24.43 ,$98.33 ,$78.66 ,$77.63 ,$40.19 ,$87.98 ,$23.64 ,$40.19 ,$40.19 ,$72.45 ,$63.03 ,$24.43 ,$23.64 ,$23.17 ,$47.28 ,$25.90 ,$87.98 ,$53.19 ,$95.22 ,$72.45 ,$103.50 ,$103.50 ,$63.03 ,$103.50 ,$71.52 ,$93.15 ,$70.71 ,$23.40 ,$81.77 ,$25.90 ,$28.37 ,$28.37 ,$23.17 ,$28.37 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100210,82300,HC CADMIUM URINE,301,1 ,$103.50 ,$68.31 ,$23.17 ,$103.50 ,$24.43 ,$82.74 ,$82.74 ,$23.64 ,$62.10 ,$87.98 ,$72.45 ,$24.43 ,$24.43 ,$98.33 ,$78.66 ,$77.63 ,$40.19 ,$87.98 ,$23.64 ,$40.19 ,$40.19 ,$72.45 ,$63.03 ,$24.43 ,$23.64 ,$23.17 ,$47.28 ,$25.90 ,$87.98 ,$53.19 ,$95.22 ,$72.45 ,$103.50 ,$103.50 ,$63.03 ,$103.50 ,$71.52 ,$93.15 ,$70.71 ,$23.40 ,$81.77 ,$25.90 ,$28.37 ,$28.37 ,$23.17 ,$28.37 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100211,82300,HC CADMIUM 24 HR URINE,301,1 ,$103.50 ,$68.31 ,$23.17 ,$103.50 ,$24.43 ,$82.74 ,$82.74 ,$23.64 ,$62.10 ,$87.98 ,$72.45 ,$24.43 ,$24.43 ,$98.33 ,$78.66 ,$77.63 ,$40.19 ,$87.98 ,$23.64 ,$40.19 ,$40.19 ,$72.45 ,$63.03 ,$24.43 ,$23.64 ,$23.17 ,$47.28 ,$25.90 ,$87.98 ,$53.19 ,$95.22 ,$72.45 ,$103.50 ,$103.50 ,$63.03 ,$103.50 ,$71.52 ,$93.15 ,$70.71 ,$23.40 ,$81.77 ,$25.90 ,$28.37 ,$28.37 ,$23.17 ,$28.37 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100212,82306,HC VITAMIN D 25 OH,301,1 ,$257.60 ,$170.02 ,$29.01 ,$257.60 ,$30.59 ,$103.60 ,$103.60 ,$29.60 ,$154.56 ,$218.96 ,$180.32 ,$30.59 ,$30.59 ,$244.72 ,$195.78 ,$193.20 ,$50.32 ,$218.96 ,$29.60 ,$50.32 ,$50.32 ,$180.32 ,$156.88 ,$30.59 ,$29.60 ,$29.01 ,$59.20 ,$32.43 ,$218.96 ,$66.60 ,$236.99 ,$180.32 ,$148.01 ,$148.01 ,$156.88 ,$148.01 ,$178.00 ,$231.84 ,$175.99 ,$29.30 ,$203.50 ,$32.43 ,$35.52 ,$35.52 ,$29.01 ,$35.52 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30100213,82308,HC CALCITONIN,301,1 ,$180.55 ,$119.16 ,$26.25 ,$180.55 ,$27.68 ,$93.77 ,$93.77 ,$26.79 ,$108.33 ,$153.47 ,$126.39 ,$27.68 ,$27.68 ,$171.52 ,$137.22 ,$135.41 ,$45.54 ,$153.47 ,$26.79 ,$45.54 ,$45.54 ,$126.39 ,$109.96 ,$27.68 ,$26.79 ,$26.25 ,$53.58 ,$29.34 ,$153.47 ,$60.28 ,$166.11 ,$126.39 ,$133.86 ,$133.86 ,$109.96 ,$133.86 ,$124.76 ,$162.50 ,$123.35 ,$26.52 ,$142.63 ,$29.34 ,$32.15 ,$32.15 ,$26.25 ,$32.15 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30100214,82310,HC CALCIUM,301,1 ,$43.70 ,$28.84 ,$5.06 ,$43.70 ,$5.33 ,$18.06 ,$18.06 ,$5.16 ,$26.22 ,$37.15 ,$30.59 ,$5.33 ,$5.33 ,$41.52 ,$33.21 ,$32.78 ,$8.77 ,$37.15 ,$5.16 ,$8.77 ,$8.77 ,$30.59 ,$26.61 ,$5.33 ,$5.16 ,$5.06 ,$10.32 ,$5.65 ,$37.15 ,$11.61 ,$40.20 ,$30.59 ,$25.79 ,$25.79 ,$26.61 ,$25.79 ,$30.20 ,$39.33 ,$29.86 ,$5.11 ,$34.52 ,$5.65 ,$6.19 ,$6.19 ,$5.06 ,$6.19 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30100215,82330,HC CALCIUM IONIZED,301,1 ,$116.15 ,$76.66 ,$13.41 ,$116.15 ,$14.14 ,$47.88 ,$47.88 ,$13.68 ,$69.69 ,$98.73 ,$81.31 ,$14.14 ,$14.14 ,$110.34 ,$88.27 ,$87.11 ,$23.26 ,$98.73 ,$13.68 ,$23.26 ,$23.26 ,$81.31 ,$70.74 ,$14.14 ,$13.68 ,$13.41 ,$27.36 ,$14.99 ,$98.73 ,$30.78 ,$106.86 ,$81.31 ,$68.32 ,$68.32 ,$70.74 ,$68.32 ,$80.26 ,$104.54 ,$79.35 ,$13.54 ,$91.76 ,$14.99 ,$16.42 ,$16.42 ,$13.41 ,$16.42 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100216,82340,HC CALCIUM URINE QN TIMED,301,1 ,$52.90 ,$34.91 ,$5.91 ,$52.90 ,$6.23 ,$21.11 ,$21.11 ,$6.03 ,$31.74 ,$44.97 ,$37.03 ,$6.23 ,$6.23 ,$50.26 ,$40.20 ,$39.68 ,$10.25 ,$44.97 ,$6.03 ,$10.25 ,$10.25 ,$37.03 ,$32.22 ,$6.23 ,$6.03 ,$5.91 ,$12.06 ,$6.60 ,$44.97 ,$13.57 ,$48.67 ,$37.03 ,$30.15 ,$30.15 ,$32.22 ,$30.15 ,$36.55 ,$47.61 ,$36.14 ,$5.97 ,$41.79 ,$6.60 ,$7.24 ,$7.24 ,$5.91 ,$7.24 ,$38.09 ,$32.80 ,$38.09 ,$38.09 ,$42.32 
ST NICHOLAS HOSPITAL - ACUTE,30100217,82360,HC CALCULUS ANALYSIS QN,301,1 ,$116.15 ,$76.66 ,$12.61 ,$116.15 ,$13.30 ,$45.05 ,$45.05 ,$12.87 ,$69.69 ,$98.73 ,$81.31 ,$13.30 ,$13.30 ,$110.34 ,$88.27 ,$87.11 ,$21.88 ,$98.73 ,$12.87 ,$21.88 ,$21.88 ,$81.31 ,$70.74 ,$13.30 ,$12.87 ,$12.61 ,$25.74 ,$14.10 ,$98.73 ,$28.96 ,$106.86 ,$81.31 ,$64.33 ,$64.33 ,$70.74 ,$64.33 ,$80.26 ,$104.54 ,$79.35 ,$12.74 ,$91.76 ,$14.10 ,$15.44 ,$15.44 ,$12.61 ,$15.44 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100218,82365,HC CALCULUS ANLYS (SA) INFRARED,301,1 ,$135.70 ,$89.56 ,$12.64 ,$135.70 ,$13.33 ,$45.15 ,$45.15 ,$12.90 ,$81.42 ,$115.35 ,$94.99 ,$13.33 ,$13.33 ,$128.92 ,$103.13 ,$101.78 ,$21.93 ,$115.35 ,$12.90 ,$21.93 ,$21.93 ,$94.99 ,$82.64 ,$13.33 ,$12.90 ,$12.64 ,$25.80 ,$14.13 ,$115.35 ,$29.03 ,$124.84 ,$94.99 ,$64.44 ,$64.44 ,$82.64 ,$64.44 ,$93.77 ,$122.13 ,$92.71 ,$12.77 ,$107.20 ,$14.13 ,$15.48 ,$15.48 ,$12.64 ,$15.48 ,$97.70 ,$84.13 ,$97.70 ,$97.70 ,$108.56 
ST NICHOLAS HOSPITAL - ACUTE,30100221,82373,HC CARBOHY DEFICIENT TRANSFER,301,1 ,$594.55 ,$392.40 ,$10.38 ,$594.55 ,$10.38 ,$63.21 ,$63.21 ,$18.06 ,$356.73 ,$505.37 ,$416.19 ,$10.38 ,$10.38 ,$564.82 ,$451.86 ,$445.91 ,$30.70 ,$505.37 ,$18.06 ,$30.70 ,$30.70 ,$416.19 ,$362.08 ,$10.38 ,$18.06 ,$17.70 ,$36.12 ,$11.00 ,$505.37 ,$40.64 ,$546.99 ,$416.19 ,$90.23 ,$90.23 ,$362.08 ,$90.23 ,$410.83 ,$535.10 ,$406.20 ,$17.88 ,$469.69 ,$11.00 ,$21.67 ,$21.67 ,$17.70 ,$21.67 ,$428.08 ,$368.62 ,$428.08 ,$428.08 ,$475.64 
ST NICHOLAS HOSPITAL - ACUTE,30100222,82374,HC BICARBONATE,301,1 ,$116.15 ,$76.66 ,$4.78 ,$116.15 ,$5.04 ,$17.08 ,$17.08 ,$4.88 ,$69.69 ,$98.73 ,$81.31 ,$5.04 ,$5.04 ,$110.34 ,$88.27 ,$87.11 ,$8.30 ,$98.73 ,$4.88 ,$8.30 ,$8.30 ,$81.31 ,$70.74 ,$5.04 ,$4.88 ,$4.78 ,$9.76 ,$5.34 ,$98.73 ,$10.98 ,$106.86 ,$81.31 ,$24.44 ,$24.44 ,$70.74 ,$24.44 ,$80.26 ,$104.54 ,$79.35 ,$4.83 ,$91.76 ,$5.34 ,$5.86 ,$5.86 ,$4.78 ,$5.86 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100223,82374,HC CO2,301,1 ,$49.45 ,$32.64 ,$4.78 ,$49.45 ,$5.04 ,$17.08 ,$17.08 ,$4.88 ,$29.67 ,$42.03 ,$34.62 ,$5.04 ,$5.04 ,$46.98 ,$37.58 ,$37.09 ,$8.30 ,$42.03 ,$4.88 ,$8.30 ,$8.30 ,$34.62 ,$30.12 ,$5.04 ,$4.88 ,$4.78 ,$9.76 ,$5.34 ,$42.03 ,$10.98 ,$45.49 ,$34.62 ,$24.44 ,$24.44 ,$30.12 ,$24.44 ,$34.17 ,$44.51 ,$33.78 ,$4.83 ,$39.07 ,$5.34 ,$5.86 ,$5.86 ,$4.78 ,$5.86 ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,30100224,82375,HC CARBON MONOXIDE,301,1 ,$193.20 ,$127.51 ,$12.07 ,$193.20 ,$12.73 ,$43.12 ,$43.12 ,$12.32 ,$115.92 ,$164.22 ,$135.24 ,$12.73 ,$12.73 ,$183.54 ,$146.83 ,$144.90 ,$20.94 ,$164.22 ,$12.32 ,$20.94 ,$20.94 ,$135.24 ,$117.66 ,$12.73 ,$12.32 ,$12.07 ,$24.64 ,$13.49 ,$164.22 ,$27.72 ,$177.74 ,$135.24 ,$61.58 ,$61.58 ,$117.66 ,$61.58 ,$133.50 ,$173.88 ,$131.99 ,$12.19 ,$152.63 ,$13.49 ,$14.78 ,$14.78 ,$12.07 ,$14.78 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30100225,82375,HC CARBOXYHEMOGLOBIN,301,1 ,$193.20 ,$127.51 ,$12.07 ,$193.20 ,$12.73 ,$43.12 ,$43.12 ,$12.32 ,$115.92 ,$164.22 ,$135.24 ,$12.73 ,$12.73 ,$183.54 ,$146.83 ,$144.90 ,$20.94 ,$164.22 ,$12.32 ,$20.94 ,$20.94 ,$135.24 ,$117.66 ,$12.73 ,$12.32 ,$12.07 ,$24.64 ,$13.49 ,$164.22 ,$27.72 ,$177.74 ,$135.24 ,$61.58 ,$61.58 ,$117.66 ,$61.58 ,$133.50 ,$173.88 ,$131.99 ,$12.19 ,$152.63 ,$13.49 ,$14.78 ,$14.78 ,$12.07 ,$14.78 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30100226,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$167.90 ,$110.81 ,$18.58 ,$167.90 ,$19.59 ,$66.36 ,$66.36 ,$18.96 ,$100.74 ,$142.72 ,$117.53 ,$19.59 ,$19.59 ,$159.51 ,$127.60 ,$125.93 ,$32.23 ,$142.72 ,$18.96 ,$32.23 ,$32.23 ,$117.53 ,$102.25 ,$19.59 ,$18.96 ,$18.58 ,$37.92 ,$20.77 ,$142.72 ,$42.66 ,$154.47 ,$117.53 ,$94.81 ,$94.81 ,$102.25 ,$94.81 ,$116.02 ,$151.11 ,$114.71 ,$18.77 ,$132.64 ,$20.77 ,$22.75 ,$22.75 ,$18.58 ,$22.75 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100227,82378,HC CEA BODY FLUID,301,1 ,$270.25 ,$178.37 ,$18.58 ,$270.25 ,$19.59 ,$66.36 ,$66.36 ,$18.96 ,$162.15 ,$229.71 ,$189.18 ,$19.59 ,$19.59 ,$256.74 ,$205.39 ,$202.69 ,$32.23 ,$229.71 ,$18.96 ,$32.23 ,$32.23 ,$189.18 ,$164.58 ,$19.59 ,$18.96 ,$18.58 ,$37.92 ,$20.77 ,$229.71 ,$42.66 ,$248.63 ,$189.18 ,$94.81 ,$94.81 ,$164.58 ,$94.81 ,$186.74 ,$243.23 ,$184.63 ,$18.77 ,$213.50 ,$20.77 ,$22.75 ,$22.75 ,$18.58 ,$22.75 ,$194.58 ,$167.56 ,$194.58 ,$194.58 ,$216.20 
ST NICHOLAS HOSPITAL - ACUTE,30100228,82379,HC CARNITINE URINE,301,1 ,$646.30 ,$426.56 ,$16.53 ,$646.30 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$387.78 ,$549.36 ,$452.41 ,$17.43 ,$17.43 ,$613.99 ,$491.19 ,$484.73 ,$28.68 ,$549.36 ,$16.87 ,$28.68 ,$28.68 ,$452.41 ,$393.60 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$549.36 ,$37.96 ,$594.60 ,$452.41 ,$72.02 ,$72.02 ,$393.60 ,$72.02 ,$446.59 ,$581.67 ,$441.55 ,$16.70 ,$510.58 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$465.34 ,$400.71 ,$465.34 ,$465.34 ,$517.04 
ST NICHOLAS HOSPITAL - ACUTE,30100229,82379,HC CARNITINE SERUM,301,1 ,$596.85 ,$393.92 ,$16.53 ,$596.85 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$358.11 ,$507.32 ,$417.80 ,$17.43 ,$17.43 ,$567.01 ,$453.61 ,$447.64 ,$28.68 ,$507.32 ,$16.87 ,$28.68 ,$28.68 ,$417.80 ,$363.48 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$507.32 ,$37.96 ,$549.10 ,$417.80 ,$72.02 ,$72.02 ,$363.48 ,$72.02 ,$412.42 ,$537.17 ,$407.77 ,$16.70 ,$471.51 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$429.73 ,$370.05 ,$429.73 ,$429.73 ,$477.48 
ST NICHOLAS HOSPITAL - ACUTE,30100230,82379,HC CARNITINE,301,1 ,$489.90 ,$323.33 ,$16.53 ,$489.90 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$293.94 ,$416.42 ,$342.93 ,$17.43 ,$17.43 ,$465.41 ,$372.32 ,$367.43 ,$28.68 ,$416.42 ,$16.87 ,$28.68 ,$28.68 ,$342.93 ,$298.35 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$416.42 ,$37.96 ,$450.71 ,$342.93 ,$72.02 ,$72.02 ,$298.35 ,$72.02 ,$338.52 ,$440.91 ,$334.70 ,$16.70 ,$387.02 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$352.73 ,$303.74 ,$352.73 ,$352.73 ,$391.92 
ST NICHOLAS HOSPITAL - ACUTE,30100231,82380,HC CAROTENE,301,1 ,$65.55 ,$43.26 ,$9.04 ,$65.55 ,$9.53 ,$32.27 ,$32.27 ,$9.22 ,$39.33 ,$55.72 ,$45.89 ,$9.53 ,$9.53 ,$62.27 ,$49.82 ,$49.16 ,$15.67 ,$55.72 ,$9.22 ,$15.67 ,$15.67 ,$45.89 ,$39.92 ,$9.53 ,$9.22 ,$9.04 ,$18.44 ,$10.10 ,$55.72 ,$20.75 ,$60.31 ,$45.89 ,$46.09 ,$46.09 ,$39.92 ,$46.09 ,$45.30 ,$59.00 ,$44.78 ,$9.12 ,$51.78 ,$10.10 ,$11.06 ,$11.06 ,$9.04 ,$11.06 ,$47.20 ,$40.64 ,$47.20 ,$47.20 ,$52.44 
ST NICHOLAS HOSPITAL - ACUTE,30100232,82384,HC CATECHOLAMINE FRACTION,301,1 ,$218.50 ,$144.21 ,$24.74 ,$218.50 ,$26.09 ,$88.38 ,$88.38 ,$25.25 ,$131.10 ,$185.73 ,$152.95 ,$26.09 ,$26.09 ,$207.58 ,$166.06 ,$163.88 ,$42.93 ,$185.73 ,$25.25 ,$42.93 ,$42.93 ,$152.95 ,$133.07 ,$26.09 ,$25.25 ,$24.74 ,$50.50 ,$27.66 ,$185.73 ,$56.81 ,$201.02 ,$152.95 ,$126.21 ,$126.21 ,$133.07 ,$126.21 ,$150.98 ,$196.65 ,$149.28 ,$24.99 ,$172.62 ,$27.66 ,$30.30 ,$30.30 ,$24.74 ,$30.30 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100233,82384,HC CATECHOLAMINE RNDM URINE,301,1 ,$218.50 ,$144.21 ,$24.74 ,$218.50 ,$26.09 ,$88.38 ,$88.38 ,$25.25 ,$131.10 ,$185.73 ,$152.95 ,$26.09 ,$26.09 ,$207.58 ,$166.06 ,$163.88 ,$42.93 ,$185.73 ,$25.25 ,$42.93 ,$42.93 ,$152.95 ,$133.07 ,$26.09 ,$25.25 ,$24.74 ,$50.50 ,$27.66 ,$185.73 ,$56.81 ,$201.02 ,$152.95 ,$126.21 ,$126.21 ,$133.07 ,$126.21 ,$150.98 ,$196.65 ,$149.28 ,$24.99 ,$172.62 ,$27.66 ,$30.30 ,$30.30 ,$24.74 ,$30.30 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100234,82384,HC CATECHOLAMINE PLASMA,301,1 ,$96.60 ,$63.76 ,$24.74 ,$96.60 ,$26.09 ,$88.38 ,$88.38 ,$25.25 ,$57.96 ,$82.11 ,$67.62 ,$26.09 ,$26.09 ,$91.77 ,$73.42 ,$72.45 ,$42.93 ,$82.11 ,$25.25 ,$42.93 ,$42.93 ,$67.62 ,$58.83 ,$26.09 ,$25.25 ,$24.74 ,$50.50 ,$27.66 ,$82.11 ,$56.81 ,$88.87 ,$67.62 ,$96.60 ,$96.60 ,$58.83 ,$96.60 ,$66.75 ,$86.94 ,$66.00 ,$24.99 ,$76.31 ,$27.66 ,$30.30 ,$30.30 ,$24.74 ,$30.30 ,$69.55 ,$59.89 ,$69.55 ,$69.55 ,$77.28 
ST NICHOLAS HOSPITAL - ACUTE,30100235,82390,HC CERULOPLASMIN,301,1 ,$89.70 ,$59.20 ,$10.53 ,$89.70 ,$11.10 ,$37.59 ,$37.59 ,$10.74 ,$53.82 ,$76.25 ,$62.79 ,$11.10 ,$11.10 ,$85.22 ,$68.17 ,$67.28 ,$18.26 ,$76.25 ,$10.74 ,$18.26 ,$18.26 ,$62.79 ,$54.63 ,$11.10 ,$10.74 ,$10.53 ,$21.48 ,$11.77 ,$76.25 ,$24.17 ,$82.52 ,$62.79 ,$53.67 ,$53.67 ,$54.63 ,$53.67 ,$61.98 ,$80.73 ,$61.28 ,$10.63 ,$70.86 ,$11.77 ,$12.89 ,$12.89 ,$10.53 ,$12.89 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100236,82397,HC CHEMILUMINESCENT ASSAY,301,1 ,$128.80 ,$85.01 ,$13.84 ,$128.80 ,$14.59 ,$49.42 ,$49.42 ,$14.12 ,$77.28 ,$109.48 ,$90.16 ,$14.59 ,$14.59 ,$122.36 ,$97.89 ,$96.60 ,$24.00 ,$109.48 ,$14.12 ,$24.00 ,$24.00 ,$90.16 ,$78.44 ,$14.59 ,$14.12 ,$13.84 ,$28.24 ,$15.47 ,$109.48 ,$31.77 ,$118.50 ,$90.16 ,$70.60 ,$70.60 ,$78.44 ,$70.60 ,$89.00 ,$115.92 ,$88.00 ,$13.97 ,$101.75 ,$15.47 ,$16.94 ,$16.94 ,$13.84 ,$16.94 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100237,82435,HC CHLORIDE,301,1 ,$77.05 ,$50.85 ,$4.51 ,$77.05 ,$4.75 ,$16.10 ,$16.10 ,$4.60 ,$46.23 ,$65.49 ,$53.94 ,$4.75 ,$4.75 ,$73.20 ,$58.56 ,$57.79 ,$7.82 ,$65.49 ,$4.60 ,$7.82 ,$7.82 ,$53.94 ,$46.92 ,$4.75 ,$4.60 ,$4.51 ,$9.20 ,$5.04 ,$65.49 ,$10.35 ,$70.89 ,$53.94 ,$22.97 ,$22.97 ,$46.92 ,$22.97 ,$53.24 ,$69.35 ,$52.64 ,$4.56 ,$60.87 ,$5.04 ,$5.52 ,$5.52 ,$4.51 ,$5.52 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100238,82436,HC CHLORIDE URINE,301,1 ,$55.20 ,$36.43 ,$5.63 ,$55.20 ,$5.94 ,$20.13 ,$20.13 ,$5.75 ,$33.12 ,$46.92 ,$38.64 ,$5.94 ,$5.94 ,$52.44 ,$41.95 ,$41.40 ,$9.78 ,$46.92 ,$5.75 ,$9.78 ,$9.78 ,$38.64 ,$33.62 ,$5.94 ,$5.75 ,$5.63 ,$11.50 ,$6.30 ,$46.92 ,$12.94 ,$50.78 ,$38.64 ,$25.13 ,$25.13 ,$33.62 ,$25.13 ,$38.14 ,$49.68 ,$37.71 ,$5.69 ,$43.61 ,$6.30 ,$6.90 ,$6.90 ,$5.63 ,$6.90 ,$39.74 ,$34.22 ,$39.74 ,$39.74 ,$44.16 
ST NICHOLAS HOSPITAL - ACUTE,30100240,82438,HC CHLORIDE OTHER SOURCE,301,1 ,$87.40 ,$57.68 ,$4.90 ,$87.40 ,$5.17 ,$17.50 ,$17.50 ,$5.00 ,$52.44 ,$74.29 ,$61.18 ,$5.17 ,$5.17 ,$83.03 ,$66.42 ,$65.55 ,$8.50 ,$74.29 ,$5.00 ,$8.50 ,$8.50 ,$61.18 ,$53.23 ,$5.17 ,$5.00 ,$4.90 ,$10.00 ,$5.48 ,$74.29 ,$11.25 ,$80.41 ,$61.18 ,$24.44 ,$24.44 ,$53.23 ,$24.44 ,$60.39 ,$78.66 ,$59.71 ,$4.95 ,$69.05 ,$5.48 ,$6.00 ,$6.00 ,$4.90 ,$6.00 ,$62.93 ,$54.19 ,$62.93 ,$62.93 ,$69.92 
ST NICHOLAS HOSPITAL - ACUTE,30100241,82465,HC CHOLESTEROL,301,1 ,$64.40 ,$42.50 ,$4.26 ,$64.40 ,$4.49 ,$15.23 ,$15.23 ,$4.35 ,$38.64 ,$54.74 ,$45.08 ,$4.49 ,$4.49 ,$61.18 ,$48.94 ,$48.30 ,$7.40 ,$54.74 ,$4.35 ,$7.40 ,$7.40 ,$45.08 ,$39.22 ,$4.49 ,$4.35 ,$4.26 ,$8.70 ,$4.76 ,$54.74 ,$9.79 ,$59.25 ,$45.08 ,$21.72 ,$21.72 ,$39.22 ,$21.72 ,$44.50 ,$57.96 ,$44.00 ,$4.30 ,$50.88 ,$4.76 ,$5.22 ,$5.22 ,$4.26 ,$5.22 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30100242,82542,HC CHROMATO QN SGL COLUMN,301,1 ,$180.55 ,$119.16 ,$23.61 ,$180.55 ,$24.89 ,$84.32 ,$84.32 ,$24.09 ,$108.33 ,$153.47 ,$126.39 ,$24.89 ,$24.89 ,$171.52 ,$137.22 ,$135.41 ,$40.95 ,$153.47 ,$24.09 ,$40.95 ,$40.95 ,$126.39 ,$109.96 ,$24.89 ,$24.09 ,$23.61 ,$48.18 ,$26.38 ,$153.47 ,$54.20 ,$166.11 ,$126.39 ,$90.23 ,$90.23 ,$109.96 ,$90.23 ,$124.76 ,$162.50 ,$123.35 ,$23.84 ,$142.63 ,$26.38 ,$28.91 ,$28.91 ,$23.61 ,$28.91 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30100243,80299,HC CHROMATO QN MLT COLUMN,301,1 ,$210.45 ,$138.90 ,$18.27 ,$210.45 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$126.27 ,$178.88 ,$147.32 ,$19.26 ,$19.26 ,$199.93 ,$159.94 ,$157.84 ,$31.69 ,$178.88 ,$18.64 ,$31.69 ,$31.69 ,$147.32 ,$128.16 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$178.88 ,$41.94 ,$193.61 ,$147.32 ,$68.43 ,$68.43 ,$128.16 ,$68.43 ,$145.42 ,$189.41 ,$143.78 ,$18.45 ,$166.26 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$151.52 ,$130.48 ,$151.52 ,$151.52 ,$168.36 
ST NICHOLAS HOSPITAL - ACUTE,30100244,82495,HC CHROMIUM (MAYO) SERUM,301,1 ,$308.20 ,$203.41 ,$10.23 ,$308.20 ,$10.23 ,$70.98 ,$70.98 ,$20.28 ,$184.92 ,$261.97 ,$215.74 ,$10.23 ,$10.23 ,$292.79 ,$234.23 ,$231.15 ,$34.48 ,$261.97 ,$20.28 ,$34.48 ,$34.48 ,$215.74 ,$187.69 ,$10.23 ,$20.28 ,$19.87 ,$40.56 ,$10.84 ,$261.97 ,$45.63 ,$283.54 ,$215.74 ,$36.34 ,$36.34 ,$187.69 ,$36.34 ,$212.97 ,$277.38 ,$210.56 ,$20.07 ,$243.48 ,$10.84 ,$24.34 ,$24.34 ,$19.87 ,$24.34 ,$221.90 ,$191.08 ,$221.90 ,$221.90 ,$246.56 
ST NICHOLAS HOSPITAL - ACUTE,30100245,82495,HC CHROMIUM SERUM,301,1 ,$141.45 ,$93.36 ,$10.23 ,$141.45 ,$10.23 ,$70.98 ,$70.98 ,$20.28 ,$84.87 ,$120.23 ,$99.02 ,$10.23 ,$10.23 ,$134.38 ,$107.50 ,$106.09 ,$34.48 ,$120.23 ,$20.28 ,$34.48 ,$34.48 ,$99.02 ,$86.14 ,$10.23 ,$20.28 ,$19.87 ,$40.56 ,$10.84 ,$120.23 ,$45.63 ,$130.13 ,$99.02 ,$36.34 ,$36.34 ,$86.14 ,$36.34 ,$97.74 ,$127.31 ,$96.64 ,$20.07 ,$111.75 ,$10.84 ,$24.34 ,$24.34 ,$19.87 ,$24.34 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100246,82507,HC CITRATE,301,1 ,$232.30 ,$153.32 ,$27.24 ,$232.30 ,$28.73 ,$97.30 ,$97.30 ,$27.80 ,$139.38 ,$197.46 ,$162.61 ,$28.73 ,$28.73 ,$220.69 ,$176.55 ,$174.23 ,$47.26 ,$197.46 ,$27.80 ,$47.26 ,$47.26 ,$162.61 ,$141.47 ,$28.73 ,$27.80 ,$27.24 ,$55.60 ,$30.45 ,$197.46 ,$62.55 ,$213.72 ,$162.61 ,$138.96 ,$138.96 ,$141.47 ,$138.96 ,$160.52 ,$209.07 ,$158.71 ,$27.52 ,$183.52 ,$30.45 ,$33.36 ,$33.36 ,$27.24 ,$33.36 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30100247,80343,HC COCAINE QN,301,1 ,$36.00 ,$23.76 ,$0.38 ,$36.00 ,$0.38 ,$24.67 ,$24.67 , N/A ,$21.60 ,$30.60 ,$25.20 ,$0.38 ,$0.38 ,$34.20 ,$27.36 ,$27.00 ,$36.00 ,$30.60 , N/A ,$36.00 ,$36.00 ,$25.20 ,$21.92 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$30.60 , N/A ,$33.12 ,$25.20 ,$18.26 ,$21.91 ,$21.92 ,$21.91 ,$24.88 ,$32.40 ,$24.60 , N/A ,$28.44 ,$0.40 , N/A , N/A , N/A , N/A ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,30100248,82525,HC COPPER (MAYO) SERUM,301,1 ,$175.95 ,$116.13 ,$12.16 ,$175.95 ,$12.82 ,$43.44 ,$43.44 ,$12.41 ,$105.57 ,$149.56 ,$123.17 ,$12.82 ,$12.82 ,$167.15 ,$133.72 ,$131.96 ,$21.10 ,$149.56 ,$12.41 ,$21.10 ,$21.10 ,$123.17 ,$107.15 ,$12.82 ,$12.41 ,$12.16 ,$24.82 ,$13.59 ,$149.56 ,$27.92 ,$161.87 ,$123.17 ,$51.33 ,$51.33 ,$107.15 ,$51.33 ,$121.58 ,$158.36 ,$120.21 ,$12.28 ,$139.00 ,$13.59 ,$14.89 ,$14.89 ,$12.16 ,$14.89 ,$126.68 ,$109.09 ,$126.68 ,$126.68 ,$140.76 
ST NICHOLAS HOSPITAL - ACUTE,30100249,82525,HC COPPER URINE,301,1 ,$79.35 ,$52.37 ,$12.16 ,$79.35 ,$12.82 ,$43.44 ,$43.44 ,$12.41 ,$47.61 ,$67.45 ,$55.55 ,$12.82 ,$12.82 ,$75.38 ,$60.31 ,$59.51 ,$21.10 ,$67.45 ,$12.41 ,$21.10 ,$21.10 ,$55.55 ,$48.32 ,$12.82 ,$12.41 ,$12.16 ,$24.82 ,$13.59 ,$67.45 ,$27.92 ,$73.00 ,$55.55 ,$51.33 ,$51.33 ,$48.32 ,$51.33 ,$54.83 ,$71.42 ,$54.21 ,$12.28 ,$62.69 ,$13.59 ,$14.89 ,$14.89 ,$12.16 ,$14.89 ,$57.13 ,$49.20 ,$57.13 ,$57.13 ,$63.48 
ST NICHOLAS HOSPITAL - ACUTE,30100250,82525,HC COPPER SERUM QCOP,301,1 ,$103.50 ,$68.31 ,$12.16 ,$103.50 ,$12.82 ,$43.44 ,$43.44 ,$12.41 ,$62.10 ,$87.98 ,$72.45 ,$12.82 ,$12.82 ,$98.33 ,$78.66 ,$77.63 ,$21.10 ,$87.98 ,$12.41 ,$21.10 ,$21.10 ,$72.45 ,$63.03 ,$12.82 ,$12.41 ,$12.16 ,$24.82 ,$13.59 ,$87.98 ,$27.92 ,$95.22 ,$72.45 ,$51.33 ,$51.33 ,$63.03 ,$51.33 ,$71.52 ,$93.15 ,$70.71 ,$12.28 ,$81.77 ,$13.59 ,$14.89 ,$14.89 ,$12.16 ,$14.89 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100251,82525,HC COPPER PLASMA,301,1 ,$138.00 ,$91.08 ,$12.16 ,$138.00 ,$12.82 ,$43.44 ,$43.44 ,$12.41 ,$82.80 ,$117.30 ,$96.60 ,$12.82 ,$12.82 ,$131.10 ,$104.88 ,$103.50 ,$21.10 ,$117.30 ,$12.41 ,$21.10 ,$21.10 ,$96.60 ,$84.04 ,$12.82 ,$12.41 ,$12.16 ,$24.82 ,$13.59 ,$117.30 ,$27.92 ,$126.96 ,$96.60 ,$51.33 ,$51.33 ,$84.04 ,$51.33 ,$95.36 ,$124.20 ,$94.28 ,$12.28 ,$109.02 ,$13.59 ,$14.89 ,$14.89 ,$12.16 ,$14.89 ,$99.36 ,$85.56 ,$99.36 ,$99.36 ,$110.40 
ST NICHOLAS HOSPITAL - ACUTE,30100252,82525,HC COPPER,301,1 ,$77.05 ,$50.85 ,$12.16 ,$77.05 ,$12.82 ,$43.44 ,$43.44 ,$12.41 ,$46.23 ,$65.49 ,$53.94 ,$12.82 ,$12.82 ,$73.20 ,$58.56 ,$57.79 ,$21.10 ,$65.49 ,$12.41 ,$21.10 ,$21.10 ,$53.94 ,$46.92 ,$12.82 ,$12.41 ,$12.16 ,$24.82 ,$13.59 ,$65.49 ,$27.92 ,$70.89 ,$53.94 ,$51.33 ,$51.33 ,$46.92 ,$51.33 ,$53.24 ,$69.35 ,$52.64 ,$12.28 ,$60.87 ,$13.59 ,$14.89 ,$14.89 ,$12.16 ,$14.89 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100253,82530,HC CORTISOL FREE,301,1 ,$141.45 ,$93.36 ,$16.38 ,$141.45 ,$17.27 ,$58.49 ,$58.49 ,$16.71 ,$84.87 ,$120.23 ,$99.02 ,$17.27 ,$17.27 ,$134.38 ,$107.50 ,$106.09 ,$28.41 ,$120.23 ,$16.71 ,$28.41 ,$28.41 ,$99.02 ,$86.14 ,$17.27 ,$16.71 ,$16.38 ,$33.42 ,$18.31 ,$120.23 ,$37.60 ,$130.13 ,$99.02 ,$83.53 ,$83.53 ,$86.14 ,$83.53 ,$97.74 ,$127.31 ,$96.64 ,$16.54 ,$111.75 ,$18.31 ,$20.05 ,$20.05 ,$16.38 ,$20.05 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100254,82533,HC CORTISOL TOTAL,301,1 ,$141.45 ,$93.36 ,$15.97 ,$141.45 ,$16.84 ,$57.05 ,$57.05 ,$16.30 ,$84.87 ,$120.23 ,$99.02 ,$16.84 ,$16.84 ,$134.38 ,$107.50 ,$106.09 ,$27.71 ,$120.23 ,$16.30 ,$27.71 ,$27.71 ,$99.02 ,$86.14 ,$16.84 ,$16.30 ,$15.97 ,$32.60 ,$17.85 ,$120.23 ,$36.68 ,$130.13 ,$99.02 ,$81.48 ,$81.48 ,$86.14 ,$81.48 ,$97.74 ,$127.31 ,$96.64 ,$16.13 ,$111.75 ,$17.85 ,$19.56 ,$19.56 ,$15.97 ,$19.56 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100255,G0480,HC RISPERIDONE,301,1 ,$128.00 ,$84.48 ,$63.95 ,$257.47 ,$63.95 ,$128.00 ,$128.00 ,$114.43 ,$76.80 ,$108.80 ,$89.60 ,$63.95 ,$63.95 ,$121.60 ,$97.28 ,$96.00 ,$128.00 ,$108.80 ,$114.43 ,$128.00 ,$128.00 ,$89.60 ,$77.95 ,$63.95 ,$114.43 ,$112.14 ,$128.00 ,$67.79 ,$108.80 ,$257.47 ,$117.76 ,$89.60 ,$128.00 ,$128.00 ,$77.95 ,$128.00 ,$88.45 ,$115.20 ,$87.45 ,$113.26 ,$101.12 ,$67.79 ,$128.00 ,$128.00 ,$112.14 ,$128.00 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$102.40 
ST NICHOLAS HOSPITAL - ACUTE,30100256,G0480,HC THC CONFIRMATION,301,1 ,$100.00 ,$66.00 ,$60.00 ,$225.00 ,$63.95 ,$100.00 ,$100.00 ,$100.00 ,$60.00 ,$85.00 ,$70.00 ,$63.95 ,$63.95 ,$95.00 ,$76.00 ,$75.00 ,$100.00 ,$85.00 ,$100.00 ,$100.00 ,$100.00 ,$70.00 ,$60.90 ,$63.95 ,$100.00 ,$98.00 ,$100.00 ,$67.79 ,$85.00 ,$225.00 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$98.98 ,$79.00 ,$67.79 ,$100.00 ,$100.00 ,$98.00 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100257,82542,HC ACYLGYLCINES QD,301,1 ,$861.35 ,$568.49 ,$23.61 ,$861.35 ,$24.89 ,$84.32 ,$84.32 ,$24.09 ,$516.81 ,$732.15 ,$602.95 ,$24.89 ,$24.89 ,$818.28 ,$654.63 ,$646.01 ,$40.95 ,$732.15 ,$24.09 ,$40.95 ,$40.95 ,$602.95 ,$524.56 ,$24.89 ,$24.09 ,$23.61 ,$48.18 ,$26.38 ,$732.15 ,$54.20 ,$792.44 ,$602.95 ,$90.23 ,$90.23 ,$524.56 ,$90.23 ,$595.19 ,$775.22 ,$588.47 ,$23.84 ,$680.47 ,$26.38 ,$28.91 ,$28.91 ,$23.61 ,$28.91 ,$620.17 ,$534.04 ,$620.17 ,$620.17 ,$689.08 
ST NICHOLAS HOSPITAL - ACUTE,30100258,82542,HC ACYLGYLCINES (MAYO) URINE,301,1 ,$737.15 ,$486.52 ,$23.61 ,$737.15 ,$24.89 ,$84.32 ,$84.32 ,$24.09 ,$442.29 ,$626.58 ,$516.01 ,$24.89 ,$24.89 ,$700.29 ,$560.23 ,$552.86 ,$40.95 ,$626.58 ,$24.09 ,$40.95 ,$40.95 ,$516.01 ,$448.92 ,$24.89 ,$24.09 ,$23.61 ,$48.18 ,$26.38 ,$626.58 ,$54.20 ,$678.18 ,$516.01 ,$90.23 ,$90.23 ,$448.92 ,$90.23 ,$509.37 ,$663.44 ,$503.62 ,$23.84 ,$582.35 ,$26.38 ,$28.91 ,$28.91 ,$23.61 ,$28.91 ,$530.75 ,$457.03 ,$530.75 ,$530.75 ,$589.72 
ST NICHOLAS HOSPITAL - ACUTE,30100259,82550,HC CREATINE KINASE (CPK) TOTAL,301,1 ,$59.80 ,$39.47 ,$6.38 ,$59.80 ,$6.73 ,$22.79 ,$22.79 ,$6.51 ,$35.88 ,$50.83 ,$41.86 ,$6.73 ,$6.73 ,$56.81 ,$45.45 ,$44.85 ,$11.07 ,$50.83 ,$6.51 ,$11.07 ,$11.07 ,$41.86 ,$36.42 ,$6.73 ,$6.51 ,$6.38 ,$13.02 ,$7.13 ,$50.83 ,$14.65 ,$55.02 ,$41.86 ,$32.53 ,$32.53 ,$36.42 ,$32.53 ,$41.32 ,$53.82 ,$40.86 ,$6.45 ,$47.24 ,$7.13 ,$7.81 ,$7.81 ,$6.38 ,$7.81 ,$43.06 ,$37.08 ,$43.06 ,$43.06 ,$47.84 
ST NICHOLAS HOSPITAL - ACUTE,30100260,82552,HC CREATINE KINASE (CPK) ISO,301,1 ,$105.80 ,$69.83 ,$13.12 ,$105.80 ,$13.84 ,$46.87 ,$46.87 ,$13.39 ,$63.48 ,$89.93 ,$74.06 ,$13.84 ,$13.84 ,$100.51 ,$80.41 ,$79.35 ,$22.76 ,$89.93 ,$13.39 ,$22.76 ,$22.76 ,$74.06 ,$64.43 ,$13.84 ,$13.39 ,$13.12 ,$26.78 ,$14.67 ,$89.93 ,$30.13 ,$97.34 ,$74.06 ,$66.97 ,$66.97 ,$64.43 ,$66.97 ,$73.11 ,$95.22 ,$72.28 ,$13.25 ,$83.58 ,$14.67 ,$16.07 ,$16.07 ,$13.12 ,$16.07 ,$76.18 ,$65.60 ,$76.18 ,$76.18 ,$84.64 
ST NICHOLAS HOSPITAL - ACUTE,30100261,82553,HC CREATINE KINASE MB FRAC,301,1 ,$77.05 ,$50.85 ,$8.66 ,$77.05 ,$8.66 ,$40.43 ,$40.43 ,$11.55 ,$46.23 ,$65.49 ,$53.94 ,$8.66 ,$8.66 ,$73.20 ,$58.56 ,$57.79 ,$19.64 ,$65.49 ,$11.55 ,$19.64 ,$19.64 ,$53.94 ,$46.92 ,$8.66 ,$11.55 ,$11.32 ,$23.10 ,$9.18 ,$65.49 ,$25.99 ,$70.89 ,$53.94 ,$30.77 ,$30.77 ,$46.92 ,$30.77 ,$53.24 ,$69.35 ,$52.64 ,$11.44 ,$60.87 ,$9.18 ,$13.86 ,$13.86 ,$11.32 ,$13.86 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100262,82565,HC CREATININE,301,1 ,$44.85 ,$29.60 ,$5.02 ,$44.85 ,$5.29 ,$17.92 ,$17.92 ,$5.12 ,$26.91 ,$38.12 ,$31.40 ,$5.29 ,$5.29 ,$42.61 ,$34.09 ,$33.64 ,$8.70 ,$38.12 ,$5.12 ,$8.70 ,$8.70 ,$31.40 ,$27.31 ,$5.29 ,$5.12 ,$5.02 ,$10.24 ,$5.61 ,$38.12 ,$11.52 ,$41.26 ,$31.40 ,$25.61 ,$25.61 ,$27.31 ,$25.61 ,$30.99 ,$40.37 ,$30.64 ,$5.07 ,$35.43 ,$5.61 ,$6.14 ,$6.14 ,$5.02 ,$6.14 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30100263,82570,HC CREATININE BODY FLUID,301,1 ,$44.85 ,$29.60 ,$5.08 ,$44.85 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$26.91 ,$38.12 ,$31.40 ,$5.35 ,$5.35 ,$42.61 ,$34.09 ,$33.64 ,$8.81 ,$38.12 ,$5.18 ,$8.81 ,$8.81 ,$31.40 ,$27.31 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$38.12 ,$11.66 ,$41.26 ,$31.40 ,$25.86 ,$25.86 ,$27.31 ,$25.86 ,$30.99 ,$40.37 ,$30.64 ,$5.13 ,$35.43 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$44.85 ,$29.60 ,$5.08 ,$44.85 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$26.91 ,$38.12 ,$31.40 ,$5.35 ,$5.35 ,$42.61 ,$34.09 ,$33.64 ,$8.81 ,$38.12 ,$5.18 ,$8.81 ,$8.81 ,$31.40 ,$27.31 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$38.12 ,$11.66 ,$41.26 ,$31.40 ,$25.86 ,$25.86 ,$27.31 ,$25.86 ,$30.99 ,$40.37 ,$30.64 ,$5.13 ,$35.43 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30100265,82570,HC CREATININE STONE,301,1 ,$44.85 ,$29.60 ,$5.08 ,$44.85 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$26.91 ,$38.12 ,$31.40 ,$5.35 ,$5.35 ,$42.61 ,$34.09 ,$33.64 ,$8.81 ,$38.12 ,$5.18 ,$8.81 ,$8.81 ,$31.40 ,$27.31 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$38.12 ,$11.66 ,$41.26 ,$31.40 ,$25.86 ,$25.86 ,$27.31 ,$25.86 ,$30.99 ,$40.37 ,$30.64 ,$5.13 ,$35.43 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30100266,82575,HC CREATININE CLEARANCE,301,1 ,$103.50 ,$68.31 ,$9.27 ,$103.50 ,$9.78 ,$33.11 ,$33.11 ,$9.46 ,$62.10 ,$87.98 ,$72.45 ,$9.78 ,$9.78 ,$98.33 ,$78.66 ,$77.63 ,$16.08 ,$87.98 ,$9.46 ,$16.08 ,$16.08 ,$72.45 ,$63.03 ,$9.78 ,$9.46 ,$9.27 ,$18.92 ,$10.37 ,$87.98 ,$21.29 ,$95.22 ,$72.45 ,$47.22 ,$47.22 ,$63.03 ,$47.22 ,$71.52 ,$93.15 ,$70.71 ,$9.36 ,$81.77 ,$10.37 ,$11.35 ,$11.35 ,$9.27 ,$11.35 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100267,82585,HC CRYOFIBRINOGEN,301,1 ,$59.80 ,$39.47 ,$9.02 ,$59.80 ,$9.02 ,$49.49 ,$49.49 ,$14.14 ,$35.88 ,$50.83 ,$41.86 ,$9.02 ,$9.02 ,$56.81 ,$45.45 ,$44.85 ,$24.04 ,$50.83 ,$14.14 ,$24.04 ,$24.04 ,$41.86 ,$36.42 ,$9.02 ,$14.14 ,$13.86 ,$28.28 ,$9.56 ,$50.83 ,$31.82 ,$55.02 ,$41.86 ,$32.06 ,$32.06 ,$36.42 ,$32.06 ,$41.32 ,$53.82 ,$40.86 ,$13.99 ,$47.24 ,$9.56 ,$16.97 ,$16.97 ,$13.86 ,$16.97 ,$43.06 ,$37.08 ,$43.06 ,$43.06 ,$47.84 
ST NICHOLAS HOSPITAL - ACUTE,30100268,82595,HC CRYOGLOBULIN,301,1 ,$193.20 ,$127.51 ,$6.34 ,$193.20 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$115.92 ,$164.22 ,$135.24 ,$6.69 ,$6.69 ,$183.54 ,$146.83 ,$144.90 ,$11.00 ,$164.22 ,$6.47 ,$11.00 ,$11.00 ,$135.24 ,$117.66 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$164.22 ,$14.56 ,$177.74 ,$135.24 ,$32.35 ,$32.35 ,$117.66 ,$32.35 ,$133.50 ,$173.88 ,$131.99 ,$6.40 ,$152.63 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30100269,82607,HC VITAMIN B12,301,1 ,$128.80 ,$85.01 ,$14.78 ,$128.80 ,$15.58 ,$52.78 ,$52.78 ,$15.08 ,$77.28 ,$109.48 ,$90.16 ,$15.58 ,$15.58 ,$122.36 ,$97.89 ,$96.60 ,$25.64 ,$109.48 ,$15.08 ,$25.64 ,$25.64 ,$90.16 ,$78.44 ,$15.58 ,$15.08 ,$14.78 ,$30.16 ,$16.51 ,$109.48 ,$33.93 ,$118.50 ,$90.16 ,$75.32 ,$75.32 ,$78.44 ,$75.32 ,$89.00 ,$115.92 ,$88.00 ,$14.93 ,$101.75 ,$16.51 ,$18.10 ,$18.10 ,$14.78 ,$18.10 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100270,82626,HC DHEA,301,1 ,$218.50 ,$144.21 ,$24.76 ,$218.50 ,$26.11 ,$88.45 ,$88.45 ,$25.27 ,$131.10 ,$185.73 ,$152.95 ,$26.11 ,$26.11 ,$207.58 ,$166.06 ,$163.88 ,$42.96 ,$185.73 ,$25.27 ,$42.96 ,$42.96 ,$152.95 ,$133.07 ,$26.11 ,$25.27 ,$24.76 ,$50.54 ,$27.68 ,$185.73 ,$56.86 ,$201.02 ,$152.95 ,$126.32 ,$126.32 ,$133.07 ,$126.32 ,$150.98 ,$196.65 ,$149.28 ,$25.01 ,$172.62 ,$27.68 ,$30.32 ,$30.32 ,$24.76 ,$30.32 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100271,82627,HC DHEA SULFATE,301,1 ,$193.20 ,$127.51 ,$21.79 ,$193.20 ,$22.97 ,$77.81 ,$77.81 ,$22.23 ,$115.92 ,$164.22 ,$135.24 ,$22.97 ,$22.97 ,$183.54 ,$146.83 ,$144.90 ,$37.79 ,$164.22 ,$22.23 ,$37.79 ,$37.79 ,$135.24 ,$117.66 ,$22.97 ,$22.23 ,$21.79 ,$44.46 ,$24.35 ,$164.22 ,$50.02 ,$177.74 ,$135.24 ,$111.11 ,$111.11 ,$117.66 ,$111.11 ,$133.50 ,$173.88 ,$131.99 ,$22.00 ,$152.63 ,$24.35 ,$26.68 ,$26.68 ,$21.79 ,$26.68 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30100272,82652,HC VITAMIN D (1 25 DIHYDROXY),301,1 ,$334.65 ,$220.87 ,$37.73 ,$334.65 ,$39.78 ,$134.75 ,$134.75 ,$38.50 ,$200.79 ,$284.45 ,$234.26 ,$39.78 ,$39.78 ,$317.92 ,$254.33 ,$250.99 ,$65.45 ,$284.45 ,$38.50 ,$65.45 ,$65.45 ,$234.26 ,$203.80 ,$39.78 ,$38.50 ,$37.73 ,$77.00 ,$42.17 ,$284.45 ,$86.63 ,$307.88 ,$234.26 ,$192.44 ,$192.44 ,$203.80 ,$192.44 ,$231.24 ,$301.19 ,$228.63 ,$38.11 ,$264.37 ,$42.17 ,$46.20 ,$46.20 ,$37.73 ,$46.20 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30100273,82657,HC ENZYME ACT NONRAD SUBS,301,1 ,$296.70 ,$195.82 ,$21.73 ,$296.70 ,$22.91 ,$77.60 ,$77.60 ,$22.17 ,$178.02 ,$252.20 ,$207.69 ,$22.91 ,$22.91 ,$281.87 ,$225.49 ,$222.53 ,$37.69 ,$252.20 ,$22.17 ,$37.69 ,$37.69 ,$207.69 ,$180.69 ,$22.91 ,$22.17 ,$21.73 ,$44.34 ,$24.28 ,$252.20 ,$49.88 ,$272.96 ,$207.69 ,$90.23 ,$90.23 ,$180.69 ,$90.23 ,$205.02 ,$267.03 ,$202.71 ,$21.94 ,$234.39 ,$24.28 ,$26.60 ,$26.60 ,$21.73 ,$26.60 ,$213.62 ,$183.95 ,$213.62 ,$213.62 ,$237.36 
ST NICHOLAS HOSPITAL - ACUTE,30100274,82664,HC ELECTROPHORETIC TEST,301,1 ,$257.60 ,$170.02 ,$48.31 ,$257.60 ,$48.31 ,$215.25 ,$215.25 ,$61.50 ,$154.56 ,$218.96 ,$180.32 ,$48.31 ,$48.31 ,$244.72 ,$195.78 ,$193.20 ,$104.55 ,$218.96 ,$61.50 ,$104.55 ,$104.55 ,$180.32 ,$156.88 ,$48.31 ,$61.50 ,$60.27 ,$123.00 ,$51.21 ,$218.96 ,$138.38 ,$236.99 ,$180.32 ,$171.71 ,$171.71 ,$156.88 ,$171.71 ,$178.00 ,$231.84 ,$175.99 ,$60.88 ,$203.50 ,$51.21 ,$73.80 ,$73.80 ,$60.27 ,$73.80 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30100275,82668,HC ERYTHROPOIETIN,301,1 ,$116.15 ,$76.66 ,$18.41 ,$116.15 ,$19.42 ,$65.77 ,$65.77 ,$18.79 ,$69.69 ,$98.73 ,$81.31 ,$19.42 ,$19.42 ,$110.34 ,$88.27 ,$87.11 ,$31.94 ,$98.73 ,$18.79 ,$31.94 ,$31.94 ,$81.31 ,$70.74 ,$19.42 ,$18.79 ,$18.41 ,$37.58 ,$20.59 ,$98.73 ,$42.28 ,$106.86 ,$81.31 ,$93.97 ,$93.97 ,$70.74 ,$93.97 ,$80.26 ,$104.54 ,$79.35 ,$18.60 ,$91.76 ,$20.59 ,$22.55 ,$22.55 ,$18.41 ,$22.55 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100276,82670,HC ESTRADIOL,301,1 ,$244.95 ,$161.67 ,$27.38 ,$244.95 ,$28.87 ,$97.79 ,$97.79 ,$27.94 ,$146.97 ,$208.21 ,$171.47 ,$28.87 ,$28.87 ,$232.70 ,$186.16 ,$183.71 ,$47.50 ,$208.21 ,$27.94 ,$47.50 ,$47.50 ,$171.47 ,$149.17 ,$28.87 ,$27.94 ,$27.38 ,$55.88 ,$30.60 ,$208.21 ,$62.87 ,$225.35 ,$171.47 ,$139.65 ,$139.65 ,$149.17 ,$139.65 ,$169.26 ,$220.46 ,$167.35 ,$27.66 ,$193.51 ,$30.60 ,$33.53 ,$33.53 ,$27.38 ,$33.53 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30100277,82670,HC ESTRADIOL SERUM,301,1 ,$244.95 ,$161.67 ,$27.38 ,$244.95 ,$28.87 ,$97.79 ,$97.79 ,$27.94 ,$146.97 ,$208.21 ,$171.47 ,$28.87 ,$28.87 ,$232.70 ,$186.16 ,$183.71 ,$47.50 ,$208.21 ,$27.94 ,$47.50 ,$47.50 ,$171.47 ,$149.17 ,$28.87 ,$27.94 ,$27.38 ,$55.88 ,$30.60 ,$208.21 ,$62.87 ,$225.35 ,$171.47 ,$139.65 ,$139.65 ,$149.17 ,$139.65 ,$169.26 ,$220.46 ,$167.35 ,$27.66 ,$193.51 ,$30.60 ,$33.53 ,$33.53 ,$27.38 ,$33.53 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30100278,82672,HC ESTROGEN TOTAL,301,1 ,$193.20 ,$127.51 ,$21.27 ,$193.20 ,$22.42 ,$75.95 ,$75.95 ,$21.70 ,$115.92 ,$164.22 ,$135.24 ,$22.42 ,$22.42 ,$183.54 ,$146.83 ,$144.90 ,$36.89 ,$164.22 ,$21.70 ,$36.89 ,$36.89 ,$135.24 ,$117.66 ,$22.42 ,$21.70 ,$21.27 ,$43.40 ,$23.77 ,$164.22 ,$48.83 ,$177.74 ,$135.24 ,$108.44 ,$108.44 ,$117.66 ,$108.44 ,$133.50 ,$173.88 ,$131.99 ,$21.48 ,$152.63 ,$23.77 ,$26.04 ,$26.04 ,$21.27 ,$26.04 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30100279,82672,HC ESTROGEN 24HR URINE,301,1 ,$215.05 ,$141.93 ,$21.27 ,$215.05 ,$22.42 ,$75.95 ,$75.95 ,$21.70 ,$129.03 ,$182.79 ,$150.54 ,$22.42 ,$22.42 ,$204.30 ,$163.44 ,$161.29 ,$36.89 ,$182.79 ,$21.70 ,$36.89 ,$36.89 ,$150.54 ,$130.97 ,$22.42 ,$21.70 ,$21.27 ,$43.40 ,$23.77 ,$182.79 ,$48.83 ,$197.85 ,$150.54 ,$108.44 ,$108.44 ,$130.97 ,$108.44 ,$148.60 ,$193.55 ,$146.92 ,$21.48 ,$169.89 ,$23.77 ,$26.04 ,$26.04 ,$21.27 ,$26.04 ,$154.84 ,$133.33 ,$154.84 ,$154.84 ,$172.04 
ST NICHOLAS HOSPITAL - ACUTE,30100280,82677,HC ESTRIOL,301,1 ,$232.30 ,$153.32 ,$23.70 ,$232.30 ,$24.99 ,$84.63 ,$84.63 ,$24.18 ,$139.38 ,$197.46 ,$162.61 ,$24.99 ,$24.99 ,$220.69 ,$176.55 ,$174.23 ,$41.11 ,$197.46 ,$24.18 ,$41.11 ,$41.11 ,$162.61 ,$141.47 ,$24.99 ,$24.18 ,$23.70 ,$48.36 ,$26.49 ,$197.46 ,$54.41 ,$213.72 ,$162.61 ,$120.86 ,$120.86 ,$141.47 ,$120.86 ,$160.52 ,$209.07 ,$158.71 ,$23.93 ,$183.52 ,$26.49 ,$29.02 ,$29.02 ,$23.70 ,$29.02 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30100281,82677,HC ESTRIOL QUAD,301,1 ,$129.95 ,$85.77 ,$23.70 ,$129.95 ,$24.99 ,$84.63 ,$84.63 ,$24.18 ,$77.97 ,$110.46 ,$90.97 ,$24.99 ,$24.99 ,$123.45 ,$98.76 ,$97.46 ,$41.11 ,$110.46 ,$24.18 ,$41.11 ,$41.11 ,$90.97 ,$79.14 ,$24.99 ,$24.18 ,$23.70 ,$48.36 ,$26.49 ,$110.46 ,$54.41 ,$119.55 ,$90.97 ,$120.86 ,$120.86 ,$79.14 ,$120.86 ,$89.80 ,$116.96 ,$88.78 ,$23.93 ,$102.66 ,$26.49 ,$29.02 ,$29.02 ,$23.70 ,$29.02 ,$93.56 ,$80.57 ,$93.56 ,$93.56 ,$103.96 
ST NICHOLAS HOSPITAL - ACUTE,30100283,82677,HC ESTRIOL URINE,301,1 ,$270.25 ,$178.37 ,$23.70 ,$270.25 ,$24.99 ,$84.63 ,$84.63 ,$24.18 ,$162.15 ,$229.71 ,$189.18 ,$24.99 ,$24.99 ,$256.74 ,$205.39 ,$202.69 ,$41.11 ,$229.71 ,$24.18 ,$41.11 ,$41.11 ,$189.18 ,$164.58 ,$24.99 ,$24.18 ,$23.70 ,$48.36 ,$26.49 ,$229.71 ,$54.41 ,$248.63 ,$189.18 ,$120.86 ,$120.86 ,$164.58 ,$120.86 ,$186.74 ,$243.23 ,$184.63 ,$23.93 ,$213.50 ,$26.49 ,$29.02 ,$29.02 ,$23.70 ,$29.02 ,$194.58 ,$167.56 ,$194.58 ,$194.58 ,$216.20 
ST NICHOLAS HOSPITAL - ACUTE,30100284,82677,HC ESTRIOL ASSAY,301,1 ,$163.30 ,$107.78 ,$23.70 ,$163.30 ,$24.99 ,$84.63 ,$84.63 ,$24.18 ,$97.98 ,$138.81 ,$114.31 ,$24.99 ,$24.99 ,$155.14 ,$124.11 ,$122.48 ,$41.11 ,$138.81 ,$24.18 ,$41.11 ,$41.11 ,$114.31 ,$99.45 ,$24.99 ,$24.18 ,$23.70 ,$48.36 ,$26.49 ,$138.81 ,$54.41 ,$150.24 ,$114.31 ,$120.86 ,$120.86 ,$99.45 ,$120.86 ,$112.84 ,$146.97 ,$111.57 ,$23.93 ,$129.01 ,$26.49 ,$29.02 ,$29.02 ,$23.70 ,$29.02 ,$117.58 ,$101.25 ,$117.58 ,$117.58 ,$130.64 
ST NICHOLAS HOSPITAL - ACUTE,30100285,82679,HC ESTRONE,301,1 ,$210.45 ,$138.90 ,$24.45 ,$210.45 ,$25.78 ,$87.33 ,$87.33 ,$24.95 ,$126.27 ,$178.88 ,$147.32 ,$25.78 ,$25.78 ,$199.93 ,$159.94 ,$157.84 ,$42.42 ,$178.88 ,$24.95 ,$42.42 ,$42.42 ,$147.32 ,$128.16 ,$25.78 ,$24.95 ,$24.45 ,$49.90 ,$27.33 ,$178.88 ,$56.14 ,$193.61 ,$147.32 ,$124.74 ,$124.74 ,$128.16 ,$124.74 ,$145.42 ,$189.41 ,$143.78 ,$24.70 ,$166.26 ,$27.33 ,$29.94 ,$29.94 ,$24.45 ,$29.94 ,$151.52 ,$130.48 ,$151.52 ,$151.52 ,$168.36 
ST NICHOLAS HOSPITAL - ACUTE,30100286,82693,HC ETHYLENE GLYCOL,301,1 ,$460.00 ,$303.60 ,$7.95 ,$460.00 ,$7.95 ,$52.15 ,$52.15 ,$14.90 ,$276.00 ,$391.00 ,$322.00 ,$7.95 ,$7.95 ,$437.00 ,$349.60 ,$345.00 ,$25.33 ,$391.00 ,$14.90 ,$25.33 ,$25.33 ,$322.00 ,$280.14 ,$7.95 ,$14.90 ,$14.60 ,$29.80 ,$8.43 ,$391.00 ,$33.53 ,$423.20 ,$322.00 ,$28.25 ,$28.25 ,$280.14 ,$28.25 ,$317.86 ,$414.00 ,$314.27 ,$14.75 ,$363.40 ,$8.43 ,$17.88 ,$17.88 ,$14.60 ,$17.88 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,30100287,82710,HC FECAL FAT QN,301,1 ,$322.00 ,$212.52 ,$16.46 ,$322.00 ,$17.36 ,$58.80 ,$58.80 ,$16.80 ,$193.20 ,$273.70 ,$225.40 ,$17.36 ,$17.36 ,$305.90 ,$244.72 ,$241.50 ,$28.56 ,$273.70 ,$16.80 ,$28.56 ,$28.56 ,$225.40 ,$196.10 ,$17.36 ,$16.80 ,$16.46 ,$33.60 ,$18.40 ,$273.70 ,$37.80 ,$296.24 ,$225.40 ,$84.00 ,$84.00 ,$196.10 ,$84.00 ,$222.50 ,$289.80 ,$219.99 ,$16.63 ,$254.38 ,$18.40 ,$20.16 ,$20.16 ,$16.46 ,$20.16 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,30100288,82725,HC FATTY ACIDS NONESTERIFIED,301,1 ,$180.55 ,$119.16 ,$18.39 ,$180.55 ,$18.72 ,$65.70 ,$65.70 ,$18.77 ,$108.33 ,$153.47 ,$126.39 ,$18.72 ,$18.72 ,$171.52 ,$137.22 ,$135.41 ,$31.91 ,$153.47 ,$18.77 ,$31.91 ,$31.91 ,$126.39 ,$109.96 ,$18.72 ,$18.77 ,$18.39 ,$37.54 ,$19.84 ,$153.47 ,$42.23 ,$166.11 ,$126.39 ,$66.53 ,$66.53 ,$109.96 ,$66.53 ,$124.76 ,$162.50 ,$123.35 ,$18.58 ,$142.63 ,$19.84 ,$22.52 ,$22.52 ,$18.39 ,$22.52 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30100289,82726,HC VLFC FATTY ACIDS,301,1 ,$322.00 ,$212.52 ,$19.35 ,$322.00 ,$20.41 ,$69.13 ,$69.13 ,$19.75 ,$193.20 ,$273.70 ,$225.40 ,$20.41 ,$20.41 ,$305.90 ,$244.72 ,$241.50 ,$33.58 ,$273.70 ,$19.75 ,$33.58 ,$33.58 ,$225.40 ,$196.10 ,$20.41 ,$19.75 ,$19.35 ,$39.50 ,$21.63 ,$273.70 ,$44.44 ,$296.24 ,$225.40 ,$90.23 ,$90.23 ,$196.10 ,$90.23 ,$222.50 ,$289.80 ,$219.99 ,$19.55 ,$254.38 ,$21.63 ,$23.70 ,$23.70 ,$19.35 ,$23.70 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,30100290,82728,HC FERRITIN,301,1 ,$116.15 ,$76.66 ,$13.36 ,$116.15 ,$14.08 ,$47.71 ,$47.71 ,$13.63 ,$69.69 ,$98.73 ,$81.31 ,$14.08 ,$14.08 ,$110.34 ,$88.27 ,$87.11 ,$23.17 ,$98.73 ,$13.63 ,$23.17 ,$23.17 ,$81.31 ,$70.74 ,$14.08 ,$13.63 ,$13.36 ,$27.26 ,$14.92 ,$98.73 ,$30.67 ,$106.86 ,$81.31 ,$68.10 ,$68.10 ,$70.74 ,$68.10 ,$80.26 ,$104.54 ,$79.35 ,$13.49 ,$91.76 ,$14.92 ,$16.36 ,$16.36 ,$13.36 ,$16.36 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100291,82731,HC FETAL FIBRONECTIN,301,1 ,$566.95 ,$374.19 ,$63.12 ,$566.95 ,$66.55 ,$225.44 ,$225.44 ,$64.41 ,$340.17 ,$481.91 ,$396.87 ,$66.55 ,$66.55 ,$538.60 ,$430.88 ,$425.21 ,$109.50 ,$481.91 ,$64.41 ,$109.50 ,$109.50 ,$396.87 ,$345.27 ,$66.55 ,$64.41 ,$63.12 ,$128.82 ,$70.54 ,$481.91 ,$144.92 ,$521.59 ,$396.87 ,$321.95 ,$321.95 ,$345.27 ,$321.95 ,$391.76 ,$510.26 ,$387.34 ,$63.75 ,$447.89 ,$70.54 ,$77.29 ,$77.29 ,$63.12 ,$77.29 ,$408.20 ,$351.51 ,$408.20 ,$408.20 ,$453.56 
ST NICHOLAS HOSPITAL - ACUTE,30100292,82746,HC FOLIC ACID SERUM,301,1 ,$128.80 ,$85.01 ,$14.41 ,$128.80 ,$15.19 ,$51.45 ,$51.45 ,$14.70 ,$77.28 ,$109.48 ,$90.16 ,$15.19 ,$15.19 ,$122.36 ,$97.89 ,$96.60 ,$24.99 ,$109.48 ,$14.70 ,$24.99 ,$24.99 ,$90.16 ,$78.44 ,$15.19 ,$14.70 ,$14.41 ,$29.40 ,$16.10 ,$109.48 ,$33.08 ,$118.50 ,$90.16 ,$73.49 ,$73.49 ,$78.44 ,$73.49 ,$89.00 ,$115.92 ,$88.00 ,$14.55 ,$101.75 ,$16.10 ,$17.64 ,$17.64 ,$14.41 ,$17.64 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100293,82747,HC FOLIC ACID RBC,301,1 ,$103.50 ,$68.31 ,$16.37 ,$103.50 ,$16.37 ,$61.78 ,$61.78 ,$17.65 ,$62.10 ,$87.98 ,$72.45 ,$16.37 ,$16.37 ,$98.33 ,$78.66 ,$77.63 ,$30.01 ,$87.98 ,$17.65 ,$30.01 ,$30.01 ,$72.45 ,$63.03 ,$16.37 ,$17.65 ,$17.30 ,$35.30 ,$17.35 ,$87.98 ,$39.71 ,$95.22 ,$72.45 ,$58.18 ,$58.18 ,$63.03 ,$58.18 ,$71.52 ,$93.15 ,$70.71 ,$17.47 ,$81.77 ,$17.35 ,$21.18 ,$21.18 ,$17.30 ,$21.18 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100295,82784,HC GAMMAGLOBULIN,301,1 ,$77.05 ,$50.85 ,$9.11 ,$77.05 ,$9.61 ,$32.55 ,$32.55 ,$9.30 ,$46.23 ,$65.49 ,$53.94 ,$9.61 ,$9.61 ,$73.20 ,$58.56 ,$57.79 ,$15.81 ,$65.49 ,$9.30 ,$15.81 ,$15.81 ,$53.94 ,$46.92 ,$9.61 ,$9.30 ,$9.11 ,$18.60 ,$10.19 ,$65.49 ,$20.93 ,$70.89 ,$53.94 ,$46.45 ,$46.45 ,$46.92 ,$46.45 ,$53.24 ,$69.35 ,$52.64 ,$9.20 ,$60.87 ,$10.19 ,$11.16 ,$11.16 ,$9.11 ,$11.16 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100296,82784,HC IGA (TISSUE TRNSGLT),301,1 ,$41.40 ,$27.32 ,$9.11 ,$41.40 ,$9.61 ,$32.55 ,$32.55 ,$9.30 ,$24.84 ,$35.19 ,$28.98 ,$9.61 ,$9.61 ,$39.33 ,$31.46 ,$31.05 ,$15.81 ,$35.19 ,$9.30 ,$15.81 ,$15.81 ,$28.98 ,$25.21 ,$9.61 ,$9.30 ,$9.11 ,$18.60 ,$10.19 ,$35.19 ,$20.93 ,$38.09 ,$28.98 ,$41.40 ,$41.40 ,$25.21 ,$41.40 ,$28.61 ,$37.26 ,$28.28 ,$9.20 ,$32.71 ,$10.19 ,$11.16 ,$11.16 ,$9.11 ,$11.16 ,$29.81 ,$25.67 ,$29.81 ,$29.81 ,$33.12 
ST NICHOLAS HOSPITAL - ACUTE,30100297,82784,HC IGA (CELIAC SCRN),301,1 ,$77.05 ,$50.85 ,$9.11 ,$77.05 ,$9.61 ,$32.55 ,$32.55 ,$9.30 ,$46.23 ,$65.49 ,$53.94 ,$9.61 ,$9.61 ,$73.20 ,$58.56 ,$57.79 ,$15.81 ,$65.49 ,$9.30 ,$15.81 ,$15.81 ,$53.94 ,$46.92 ,$9.61 ,$9.30 ,$9.11 ,$18.60 ,$10.19 ,$65.49 ,$20.93 ,$70.89 ,$53.94 ,$46.45 ,$46.45 ,$46.92 ,$46.45 ,$53.24 ,$69.35 ,$52.64 ,$9.20 ,$60.87 ,$10.19 ,$11.16 ,$11.16 ,$9.11 ,$11.16 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100298,82784,HC GAMMAGLOBULIN TOTAL,301,1 ,$77.05 ,$50.85 ,$9.11 ,$77.05 ,$9.61 ,$32.55 ,$32.55 ,$9.30 ,$46.23 ,$65.49 ,$53.94 ,$9.61 ,$9.61 ,$73.20 ,$58.56 ,$57.79 ,$15.81 ,$65.49 ,$9.30 ,$15.81 ,$15.81 ,$53.94 ,$46.92 ,$9.61 ,$9.30 ,$9.11 ,$18.60 ,$10.19 ,$65.49 ,$20.93 ,$70.89 ,$53.94 ,$46.45 ,$46.45 ,$46.92 ,$46.45 ,$53.24 ,$69.35 ,$52.64 ,$9.20 ,$60.87 ,$10.19 ,$11.16 ,$11.16 ,$9.11 ,$11.16 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100299,82784,HC CP IGA,301,1 ,$77.05 ,$50.85 ,$9.11 ,$77.05 ,$9.61 ,$32.55 ,$32.55 ,$9.30 ,$46.23 ,$65.49 ,$53.94 ,$9.61 ,$9.61 ,$73.20 ,$58.56 ,$57.79 ,$15.81 ,$65.49 ,$9.30 ,$15.81 ,$15.81 ,$53.94 ,$46.92 ,$9.61 ,$9.30 ,$9.11 ,$18.60 ,$10.19 ,$65.49 ,$20.93 ,$70.89 ,$53.94 ,$46.45 ,$46.45 ,$46.92 ,$46.45 ,$53.24 ,$69.35 ,$52.64 ,$9.20 ,$60.87 ,$10.19 ,$11.16 ,$11.16 ,$9.11 ,$11.16 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100300,82784,HC IGD SERUM,301,1 ,$81.65 ,$53.89 ,$9.11 ,$81.65 ,$9.61 ,$32.55 ,$32.55 ,$9.30 ,$48.99 ,$69.40 ,$57.16 ,$9.61 ,$9.61 ,$77.57 ,$62.05 ,$61.24 ,$15.81 ,$69.40 ,$9.30 ,$15.81 ,$15.81 ,$57.16 ,$49.72 ,$9.61 ,$9.30 ,$9.11 ,$18.60 ,$10.19 ,$69.40 ,$20.93 ,$75.12 ,$57.16 ,$46.45 ,$46.45 ,$49.72 ,$46.45 ,$56.42 ,$73.49 ,$55.78 ,$9.20 ,$64.50 ,$10.19 ,$11.16 ,$11.16 ,$9.11 ,$11.16 ,$58.79 ,$50.62 ,$58.79 ,$58.79 ,$65.32 
ST NICHOLAS HOSPITAL - ACUTE,30100301,82784,HC GAMMAGLOBULIN CSF/SERUM,301,1 ,$81.65 ,$53.89 ,$9.11 ,$81.65 ,$9.61 ,$32.55 ,$32.55 ,$9.30 ,$48.99 ,$69.40 ,$57.16 ,$9.61 ,$9.61 ,$77.57 ,$62.05 ,$61.24 ,$15.81 ,$69.40 ,$9.30 ,$15.81 ,$15.81 ,$57.16 ,$49.72 ,$9.61 ,$9.30 ,$9.11 ,$18.60 ,$10.19 ,$69.40 ,$20.93 ,$75.12 ,$57.16 ,$46.45 ,$46.45 ,$49.72 ,$46.45 ,$56.42 ,$73.49 ,$55.78 ,$9.20 ,$64.50 ,$10.19 ,$11.16 ,$11.16 ,$9.11 ,$11.16 ,$58.79 ,$50.62 ,$58.79 ,$58.79 ,$65.32 
ST NICHOLAS HOSPITAL - ACUTE,30100302,82785,HC GAMMAGLOBULIN IGE,301,1 ,$141.45 ,$93.36 ,$16.13 ,$141.45 ,$17.01 ,$57.61 ,$57.61 ,$16.46 ,$84.87 ,$120.23 ,$99.02 ,$17.01 ,$17.01 ,$134.38 ,$107.50 ,$106.09 ,$27.98 ,$120.23 ,$16.46 ,$27.98 ,$27.98 ,$99.02 ,$86.14 ,$17.01 ,$16.46 ,$16.13 ,$32.92 ,$18.03 ,$120.23 ,$37.04 ,$130.13 ,$99.02 ,$82.32 ,$82.32 ,$86.14 ,$82.32 ,$97.74 ,$127.31 ,$96.64 ,$16.29 ,$111.75 ,$18.03 ,$19.75 ,$19.75 ,$16.13 ,$19.75 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100303,82787,HC IGG SUBCLASS1-3,301,1 ,$47.15 ,$31.12 ,$5.90 ,$47.15 ,$5.90 ,$28.07 ,$28.07 ,$8.02 ,$28.29 ,$40.08 ,$33.01 ,$5.90 ,$5.90 ,$44.79 ,$35.83 ,$35.36 ,$13.63 ,$40.08 ,$8.02 ,$13.63 ,$13.63 ,$33.01 ,$28.71 ,$5.90 ,$8.02 ,$7.86 ,$16.04 ,$6.25 ,$40.08 ,$18.05 ,$43.38 ,$33.01 ,$20.96 ,$20.96 ,$28.71 ,$20.96 ,$32.58 ,$42.44 ,$32.21 ,$7.94 ,$37.25 ,$6.25 ,$9.62 ,$9.62 ,$7.86 ,$9.62 ,$33.95 ,$29.23 ,$33.95 ,$33.95 ,$37.72 
ST NICHOLAS HOSPITAL - ACUTE,30100304,82787,HC IGG SUBCLASS 4,301,1 ,$47.15 ,$31.12 ,$5.90 ,$47.15 ,$5.90 ,$28.07 ,$28.07 ,$8.02 ,$28.29 ,$40.08 ,$33.01 ,$5.90 ,$5.90 ,$44.79 ,$35.83 ,$35.36 ,$13.63 ,$40.08 ,$8.02 ,$13.63 ,$13.63 ,$33.01 ,$28.71 ,$5.90 ,$8.02 ,$7.86 ,$16.04 ,$6.25 ,$40.08 ,$18.05 ,$43.38 ,$33.01 ,$20.96 ,$20.96 ,$28.71 ,$20.96 ,$32.58 ,$42.44 ,$32.21 ,$7.94 ,$37.25 ,$6.25 ,$9.62 ,$9.62 ,$7.86 ,$9.62 ,$33.95 ,$29.23 ,$33.95 ,$33.95 ,$37.72 
ST NICHOLAS HOSPITAL - ACUTE,30100305,82800,HC BLOOD GAS PH,301,1 ,$96.60 ,$63.76 ,$10.78 ,$96.60 ,$11.37 ,$38.50 ,$38.50 ,$11.00 ,$57.96 ,$82.11 ,$67.62 ,$11.37 ,$11.37 ,$91.77 ,$73.42 ,$72.45 ,$18.70 ,$82.11 ,$11.00 ,$18.70 ,$18.70 ,$67.62 ,$58.83 ,$11.37 ,$11.00 ,$10.78 ,$22.00 ,$12.05 ,$82.11 ,$24.75 ,$88.87 ,$67.62 ,$42.28 ,$42.28 ,$58.83 ,$42.28 ,$66.75 ,$86.94 ,$66.00 ,$10.89 ,$76.31 ,$12.05 ,$13.20 ,$13.20 ,$10.78 ,$13.20 ,$69.55 ,$59.89 ,$69.55 ,$69.55 ,$77.28 
ST NICHOLAS HOSPITAL - ACUTE,30100306,82803,HC BLOOD GAS PH PO2  AND /OR PCO2,301,1 ,$167.90 ,$110.81 ,$25.55 ,$167.90 ,$26.94 ,$91.25 ,$91.25 ,$26.07 ,$100.74 ,$142.72 ,$117.53 ,$26.94 ,$26.94 ,$159.51 ,$127.60 ,$125.93 ,$44.32 ,$142.72 ,$26.07 ,$44.32 ,$44.32 ,$117.53 ,$102.25 ,$26.94 ,$26.07 ,$25.55 ,$52.14 ,$28.56 ,$142.72 ,$58.66 ,$154.47 ,$117.53 ,$96.72 ,$96.72 ,$102.25 ,$96.72 ,$116.02 ,$151.11 ,$114.71 ,$25.80 ,$132.64 ,$28.56 ,$31.28 ,$31.28 ,$25.55 ,$31.28 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100307,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$244.95 ,$161.67 ,$39.91 ,$244.95 ,$39.91 ,$244.95 ,$244.95 ,$78.77 ,$146.97 ,$208.21 ,$171.47 ,$39.91 ,$39.91 ,$232.70 ,$186.16 ,$183.71 ,$133.91 ,$208.21 ,$78.77 ,$133.91 ,$133.91 ,$171.47 ,$149.17 ,$39.91 ,$78.77 ,$77.19 ,$157.54 ,$42.30 ,$208.21 ,$177.23 ,$225.35 ,$171.47 ,$141.81 ,$141.81 ,$149.17 ,$141.81 ,$169.26 ,$220.46 ,$167.35 ,$77.97 ,$193.51 ,$42.30 ,$94.52 ,$94.52 ,$77.19 ,$94.52 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30100308,82810,HC BLOOD GAS O2 SAT ONLY,301,1 ,$173.65 ,$114.61 ,$9.57 ,$173.65 ,$10.10 ,$34.20 ,$34.20 ,$9.77 ,$104.19 ,$147.60 ,$121.56 ,$10.10 ,$10.10 ,$164.97 ,$131.97 ,$130.24 ,$16.61 ,$147.60 ,$9.77 ,$16.61 ,$16.61 ,$121.56 ,$105.75 ,$10.10 ,$9.77 ,$9.57 ,$19.54 ,$10.71 ,$147.60 ,$21.98 ,$159.76 ,$121.56 ,$43.63 ,$43.63 ,$105.75 ,$43.63 ,$119.99 ,$156.29 ,$118.64 ,$9.67 ,$137.18 ,$10.71 ,$11.72 ,$11.72 ,$9.57 ,$11.72 ,$125.03 ,$107.66 ,$125.03 ,$125.03 ,$138.92 
ST NICHOLAS HOSPITAL - ACUTE,30100309,82941,HC GASTRIN,301,1 ,$116.15 ,$76.66 ,$17.28 ,$116.15 ,$18.22 ,$61.71 ,$61.71 ,$17.63 ,$69.69 ,$98.73 ,$81.31 ,$18.22 ,$18.22 ,$110.34 ,$88.27 ,$87.11 ,$29.97 ,$98.73 ,$17.63 ,$29.97 ,$29.97 ,$81.31 ,$70.74 ,$18.22 ,$17.63 ,$17.28 ,$35.26 ,$19.31 ,$98.73 ,$39.67 ,$106.86 ,$81.31 ,$88.14 ,$88.14 ,$70.74 ,$88.14 ,$80.26 ,$104.54 ,$79.35 ,$17.45 ,$91.76 ,$19.31 ,$21.16 ,$21.16 ,$17.28 ,$21.16 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100310,82943,HC GLUCAGON PLASMA,301,1 ,$71.30 ,$47.06 ,$13.88 ,$71.30 ,$13.88 ,$50.02 ,$50.02 ,$14.29 ,$42.78 ,$60.61 ,$49.91 ,$13.88 ,$13.88 ,$67.74 ,$54.19 ,$53.48 ,$24.29 ,$60.61 ,$14.29 ,$24.29 ,$24.29 ,$49.91 ,$43.42 ,$13.88 ,$14.29 ,$14.00 ,$28.58 ,$14.71 ,$60.61 ,$32.15 ,$65.60 ,$49.91 ,$49.31 ,$49.31 ,$43.42 ,$49.31 ,$49.27 ,$64.17 ,$48.71 ,$14.14 ,$56.33 ,$14.71 ,$17.15 ,$17.15 ,$14.00 ,$17.15 ,$51.34 ,$44.21 ,$51.34 ,$51.34 ,$57.04 
ST NICHOLAS HOSPITAL - ACUTE,30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$62.10 ,$40.99 ,$3.85 ,$62.10 ,$4.06 ,$13.76 ,$13.76 ,$3.93 ,$37.26 ,$52.79 ,$43.47 ,$4.06 ,$4.06 ,$59.00 ,$47.20 ,$46.58 ,$6.68 ,$52.79 ,$3.93 ,$6.68 ,$6.68 ,$43.47 ,$37.82 ,$4.06 ,$3.93 ,$3.85 ,$7.86 ,$4.30 ,$52.79 ,$8.84 ,$57.13 ,$43.47 ,$19.64 ,$19.64 ,$37.82 ,$19.64 ,$42.91 ,$55.89 ,$42.43 ,$3.89 ,$49.06 ,$4.30 ,$4.72 ,$4.72 ,$3.85 ,$4.72 ,$44.71 ,$38.50 ,$44.71 ,$44.71 ,$49.68 
ST NICHOLAS HOSPITAL - ACUTE,30100312,82947,HC GLUCOSE,301,1 ,$34.50 ,$22.77 ,$3.85 ,$34.50 ,$4.06 ,$13.76 ,$13.76 ,$3.93 ,$20.70 ,$29.33 ,$24.15 ,$4.06 ,$4.06 ,$32.78 ,$26.22 ,$25.88 ,$6.68 ,$29.33 ,$3.93 ,$6.68 ,$6.68 ,$24.15 ,$21.01 ,$4.06 ,$3.93 ,$3.85 ,$7.86 ,$4.30 ,$29.33 ,$8.84 ,$31.74 ,$24.15 ,$19.64 ,$19.64 ,$21.01 ,$19.64 ,$23.84 ,$31.05 ,$23.57 ,$3.89 ,$27.26 ,$4.30 ,$4.72 ,$4.72 ,$3.85 ,$4.72 ,$24.84 ,$21.39 ,$24.84 ,$24.84 ,$27.60 
ST NICHOLAS HOSPITAL - ACUTE,30100313,82950,HC GLUCOSE SCREEN,301,1 ,$103.50 ,$68.31 ,$4.65 ,$103.50 ,$4.91 ,$16.63 ,$16.63 ,$4.75 ,$62.10 ,$87.98 ,$72.45 ,$4.91 ,$4.91 ,$98.33 ,$78.66 ,$77.63 ,$8.08 ,$87.98 ,$4.75 ,$8.08 ,$8.08 ,$72.45 ,$63.03 ,$4.91 ,$4.75 ,$4.65 ,$9.50 ,$5.20 ,$87.98 ,$10.69 ,$95.22 ,$72.45 ,$23.74 ,$23.74 ,$63.03 ,$23.74 ,$71.52 ,$93.15 ,$70.71 ,$4.70 ,$81.77 ,$5.20 ,$5.70 ,$5.70 ,$4.65 ,$5.70 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$128.80 ,$85.01 ,$12.61 ,$128.80 ,$13.30 ,$45.05 ,$45.05 ,$12.87 ,$77.28 ,$109.48 ,$90.16 ,$13.30 ,$13.30 ,$122.36 ,$97.89 ,$96.60 ,$21.88 ,$109.48 ,$12.87 ,$21.88 ,$21.88 ,$90.16 ,$78.44 ,$13.30 ,$12.87 ,$12.61 ,$25.74 ,$14.10 ,$109.48 ,$28.96 ,$118.50 ,$90.16 ,$64.33 ,$64.33 ,$78.44 ,$64.33 ,$89.00 ,$115.92 ,$88.00 ,$12.74 ,$101.75 ,$14.10 ,$15.44 ,$15.44 ,$12.61 ,$15.44 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$35.65 ,$23.53 ,$3.84 ,$35.65 ,$4.05 ,$13.72 ,$13.72 ,$3.92 ,$21.39 ,$30.30 ,$24.96 ,$4.05 ,$4.05 ,$33.87 ,$27.09 ,$26.74 ,$6.66 ,$30.30 ,$3.92 ,$6.66 ,$6.66 ,$24.96 ,$21.71 ,$4.05 ,$3.92 ,$3.84 ,$7.84 ,$4.29 ,$30.30 ,$8.82 ,$32.80 ,$24.96 ,$19.60 ,$19.60 ,$21.71 ,$19.60 ,$24.63 ,$32.09 ,$24.36 ,$3.88 ,$28.16 ,$4.29 ,$4.70 ,$4.70 ,$3.84 ,$4.70 ,$25.67 ,$22.10 ,$25.67 ,$25.67 ,$28.52 
ST NICHOLAS HOSPITAL - ACUTE,30100316,82955,HC G6PD ENZYME QN,301,1 ,$495.65 ,$327.13 ,$9.51 ,$495.65 ,$10.02 ,$33.95 ,$33.95 ,$9.70 ,$297.39 ,$421.30 ,$346.96 ,$10.02 ,$10.02 ,$470.87 ,$376.69 ,$371.74 ,$16.49 ,$421.30 ,$9.70 ,$16.49 ,$16.49 ,$346.96 ,$301.85 ,$10.02 ,$9.70 ,$9.51 ,$19.40 ,$10.62 ,$421.30 ,$21.83 ,$456.00 ,$346.96 ,$48.43 ,$48.43 ,$301.85 ,$48.43 ,$342.49 ,$446.09 ,$338.63 ,$9.60 ,$391.56 ,$10.62 ,$11.64 ,$11.64 ,$9.51 ,$11.64 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,30100317,82955,HC GLUCOSE 6 PHOS DEHYDROGN,301,1 ,$89.70 ,$59.20 ,$9.51 ,$89.70 ,$10.02 ,$33.95 ,$33.95 ,$9.70 ,$53.82 ,$76.25 ,$62.79 ,$10.02 ,$10.02 ,$85.22 ,$68.17 ,$67.28 ,$16.49 ,$76.25 ,$9.70 ,$16.49 ,$16.49 ,$62.79 ,$54.63 ,$10.02 ,$9.70 ,$9.51 ,$19.40 ,$10.62 ,$76.25 ,$21.83 ,$82.52 ,$62.79 ,$48.43 ,$48.43 ,$54.63 ,$48.43 ,$61.98 ,$80.73 ,$61.28 ,$9.60 ,$70.86 ,$10.62 ,$11.64 ,$11.64 ,$9.51 ,$11.64 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100318,82962,HC GLUCOSE BY DEVICE,301,1 ,$21.85 ,$14.42 ,$3.21 ,$21.85 ,$3.30 ,$11.48 ,$11.48 ,$3.28 ,$13.11 ,$18.57 ,$15.30 ,$3.30 ,$3.30 ,$20.76 ,$16.61 ,$16.39 ,$5.58 ,$18.57 ,$3.28 ,$5.58 ,$5.58 ,$15.30 ,$13.31 ,$3.30 ,$3.28 ,$3.21 ,$6.56 ,$3.50 ,$18.57 ,$7.38 ,$20.10 ,$15.30 ,$11.72 ,$11.72 ,$13.31 ,$11.72 ,$15.10 ,$19.67 ,$14.93 ,$3.24 ,$17.26 ,$3.50 ,$3.94 ,$3.94 ,$3.21 ,$3.94 ,$15.73 ,$13.55 ,$15.73 ,$15.73 ,$17.48 
ST NICHOLAS HOSPITAL - ACUTE,30100319,82977,HC GGT/GGTP,301,1 ,$63.25 ,$41.75 ,$7.06 ,$63.25 ,$7.44 ,$25.20 ,$25.20 ,$7.20 ,$37.95 ,$53.76 ,$44.28 ,$7.44 ,$7.44 ,$60.09 ,$48.07 ,$47.44 ,$12.24 ,$53.76 ,$7.20 ,$12.24 ,$12.24 ,$44.28 ,$38.52 ,$7.44 ,$7.20 ,$7.06 ,$14.40 ,$7.89 ,$53.76 ,$16.20 ,$58.19 ,$44.28 ,$35.98 ,$35.98 ,$38.52 ,$35.98 ,$43.71 ,$56.93 ,$43.21 ,$7.12 ,$49.97 ,$7.89 ,$8.64 ,$8.64 ,$7.06 ,$8.64 ,$45.54 ,$39.22 ,$45.54 ,$45.54 ,$50.60 
ST NICHOLAS HOSPITAL - ACUTE,30100320,82978,HC GLUTATHIONE,301,1 ,$299.00 ,$197.34 ,$15.14 ,$299.00 ,$15.96 ,$54.08 ,$54.08 ,$15.45 ,$179.40 ,$254.15 ,$209.30 ,$15.96 ,$15.96 ,$284.05 ,$227.24 ,$224.25 ,$26.27 ,$254.15 ,$15.45 ,$26.27 ,$26.27 ,$209.30 ,$182.09 ,$15.96 ,$15.45 ,$15.14 ,$30.90 ,$16.92 ,$254.15 ,$34.76 ,$275.08 ,$209.30 ,$71.26 ,$71.26 ,$182.09 ,$71.26 ,$206.61 ,$269.10 ,$204.28 ,$15.29 ,$236.21 ,$16.92 ,$18.54 ,$18.54 ,$15.14 ,$18.54 ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$239.20 
ST NICHOLAS HOSPITAL - ACUTE,30100321,82985,HC FRUCTOSAMINE,301,1 ,$103.50 ,$68.31 ,$16.42 ,$103.50 ,$16.62 ,$58.66 ,$58.66 ,$16.76 ,$62.10 ,$87.98 ,$72.45 ,$16.62 ,$16.62 ,$98.33 ,$78.66 ,$77.63 ,$28.49 ,$87.98 ,$16.76 ,$28.49 ,$28.49 ,$72.45 ,$63.03 ,$16.62 ,$16.76 ,$16.42 ,$33.52 ,$17.62 ,$87.98 ,$37.71 ,$95.22 ,$72.45 ,$59.06 ,$59.06 ,$63.03 ,$59.06 ,$71.52 ,$93.15 ,$70.71 ,$16.59 ,$81.77 ,$17.62 ,$20.11 ,$20.11 ,$16.42 ,$20.11 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100323,83001,HC FSH,301,1 ,$167.90 ,$110.81 ,$18.21 ,$167.90 ,$19.20 ,$65.03 ,$65.03 ,$18.58 ,$100.74 ,$142.72 ,$117.53 ,$19.20 ,$19.20 ,$159.51 ,$127.60 ,$125.93 ,$31.59 ,$142.72 ,$18.58 ,$31.59 ,$31.59 ,$117.53 ,$102.25 ,$19.20 ,$18.58 ,$18.21 ,$37.16 ,$20.35 ,$142.72 ,$41.81 ,$154.47 ,$117.53 ,$92.87 ,$92.87 ,$102.25 ,$92.87 ,$116.02 ,$151.11 ,$114.71 ,$18.39 ,$132.64 ,$20.35 ,$22.30 ,$22.30 ,$18.21 ,$22.30 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100325,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$167.90 ,$110.81 ,$18.15 ,$167.90 ,$19.14 ,$64.82 ,$64.82 ,$18.52 ,$100.74 ,$142.72 ,$117.53 ,$19.14 ,$19.14 ,$159.51 ,$127.60 ,$125.93 ,$31.48 ,$142.72 ,$18.52 ,$31.48 ,$31.48 ,$117.53 ,$102.25 ,$19.14 ,$18.52 ,$18.15 ,$37.04 ,$20.29 ,$142.72 ,$41.67 ,$154.47 ,$117.53 ,$92.54 ,$92.54 ,$102.25 ,$92.54 ,$116.02 ,$151.11 ,$114.71 ,$18.34 ,$132.64 ,$20.29 ,$22.22 ,$22.22 ,$18.15 ,$22.22 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100326,83003,HC GROWTH HORMONE,301,1 ,$116.15 ,$76.66 ,$16.34 ,$116.15 ,$17.23 ,$58.35 ,$58.35 ,$16.67 ,$69.69 ,$98.73 ,$81.31 ,$17.23 ,$17.23 ,$110.34 ,$88.27 ,$87.11 ,$28.34 ,$98.73 ,$16.67 ,$28.34 ,$28.34 ,$81.31 ,$70.74 ,$17.23 ,$16.67 ,$16.34 ,$33.34 ,$18.26 ,$98.73 ,$37.51 ,$106.86 ,$81.31 ,$83.38 ,$83.38 ,$70.74 ,$83.38 ,$80.26 ,$104.54 ,$79.35 ,$16.50 ,$91.76 ,$18.26 ,$20.00 ,$20.00 ,$16.34 ,$20.00 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100327,83010,HC HAPTOGLOBIN,301,1 ,$116.15 ,$76.66 ,$12.33 ,$116.15 ,$13.00 ,$44.03 ,$44.03 ,$12.58 ,$69.69 ,$98.73 ,$81.31 ,$13.00 ,$13.00 ,$110.34 ,$88.27 ,$87.11 ,$21.39 ,$98.73 ,$12.58 ,$21.39 ,$21.39 ,$81.31 ,$70.74 ,$13.00 ,$12.58 ,$12.33 ,$25.16 ,$13.78 ,$98.73 ,$28.31 ,$106.86 ,$81.31 ,$62.87 ,$62.87 ,$70.74 ,$62.87 ,$80.26 ,$104.54 ,$79.35 ,$12.46 ,$91.76 ,$13.78 ,$15.10 ,$15.10 ,$12.33 ,$15.10 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100328,83018,HC HEAVY METAL EACH,301,1 ,$141.45 ,$93.36 ,$21.52 ,$141.45 ,$22.69 ,$76.86 ,$76.86 ,$21.96 ,$84.87 ,$120.23 ,$99.02 ,$22.69 ,$22.69 ,$134.38 ,$107.50 ,$106.09 ,$37.33 ,$120.23 ,$21.96 ,$37.33 ,$37.33 ,$99.02 ,$86.14 ,$22.69 ,$21.96 ,$21.52 ,$43.92 ,$24.05 ,$120.23 ,$49.41 ,$130.13 ,$99.02 ,$109.76 ,$109.76 ,$86.14 ,$109.76 ,$97.74 ,$127.31 ,$96.64 ,$21.74 ,$111.75 ,$24.05 ,$26.35 ,$26.35 ,$21.52 ,$26.35 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100329,83018,HC HEAVY METAL 24HR EACH,301,1 ,$141.45 ,$93.36 ,$21.52 ,$141.45 ,$22.69 ,$76.86 ,$76.86 ,$21.96 ,$84.87 ,$120.23 ,$99.02 ,$22.69 ,$22.69 ,$134.38 ,$107.50 ,$106.09 ,$37.33 ,$120.23 ,$21.96 ,$37.33 ,$37.33 ,$99.02 ,$86.14 ,$22.69 ,$21.96 ,$21.52 ,$43.92 ,$24.05 ,$120.23 ,$49.41 ,$130.13 ,$99.02 ,$109.76 ,$109.76 ,$86.14 ,$109.76 ,$97.74 ,$127.31 ,$96.64 ,$21.74 ,$111.75 ,$24.05 ,$26.35 ,$26.35 ,$21.52 ,$26.35 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100330,83020,HC HGB ELECTROPHORESIS,301,1 ,$147.20 ,$97.15 ,$6.41 ,$147.20 ,$6.41 ,$45.05 ,$45.05 ,$12.87 ,$88.32 ,$125.12 ,$103.04 ,$6.41 ,$6.41 ,$139.84 ,$111.87 ,$110.40 ,$21.88 ,$125.12 ,$12.87 ,$21.88 ,$21.88 ,$103.04 ,$89.64 ,$6.41 ,$12.87 ,$12.61 ,$25.74 ,$6.79 ,$125.12 ,$28.96 ,$135.42 ,$103.04 ,$22.79 ,$22.79 ,$89.64 ,$22.79 ,$101.72 ,$132.48 ,$100.57 ,$12.74 ,$116.29 ,$6.79 ,$15.44 ,$15.44 ,$12.61 ,$15.44 ,$105.98 ,$91.26 ,$105.98 ,$105.98 ,$117.76 
ST NICHOLAS HOSPITAL - ACUTE,30100331,83020,HC HGB ELECTROPHORESIS (MAYO),301,1 ,$113.85 ,$75.14 ,$6.41 ,$113.85 ,$6.41 ,$45.05 ,$45.05 ,$12.87 ,$68.31 ,$96.77 ,$79.70 ,$6.41 ,$6.41 ,$108.16 ,$86.53 ,$85.39 ,$21.88 ,$96.77 ,$12.87 ,$21.88 ,$21.88 ,$79.70 ,$69.33 ,$6.41 ,$12.87 ,$12.61 ,$25.74 ,$6.79 ,$96.77 ,$28.96 ,$104.74 ,$79.70 ,$22.79 ,$22.79 ,$69.33 ,$22.79 ,$78.67 ,$102.47 ,$77.78 ,$12.74 ,$89.94 ,$6.79 ,$15.44 ,$15.44 ,$12.61 ,$15.44 ,$81.97 ,$70.59 ,$81.97 ,$81.97 ,$91.08 
ST NICHOLAS HOSPITAL - ACUTE,30100332,83020,HC HGB ELECTORPHORESIS (QHBCV),301,1 ,$150.65 ,$99.43 ,$6.41 ,$150.65 ,$6.41 ,$45.05 ,$45.05 ,$12.87 ,$90.39 ,$128.05 ,$105.46 ,$6.41 ,$6.41 ,$143.12 ,$114.49 ,$112.99 ,$21.88 ,$128.05 ,$12.87 ,$21.88 ,$21.88 ,$105.46 ,$91.75 ,$6.41 ,$12.87 ,$12.61 ,$25.74 ,$6.79 ,$128.05 ,$28.96 ,$138.60 ,$105.46 ,$22.79 ,$22.79 ,$91.75 ,$22.79 ,$104.10 ,$135.59 ,$102.92 ,$12.74 ,$119.01 ,$6.79 ,$15.44 ,$15.44 ,$12.61 ,$15.44 ,$108.47 ,$93.40 ,$108.47 ,$108.47 ,$120.52 
ST NICHOLAS HOSPITAL - ACUTE,30100334,83021,HC HEMOGLOBIN FRACT QN,301,1 ,$218.50 ,$144.21 ,$17.70 ,$218.50 ,$18.66 ,$63.21 ,$63.21 ,$18.06 ,$131.10 ,$185.73 ,$152.95 ,$18.66 ,$18.66 ,$207.58 ,$166.06 ,$163.88 ,$30.70 ,$185.73 ,$18.06 ,$30.70 ,$30.70 ,$152.95 ,$133.07 ,$18.66 ,$18.06 ,$17.70 ,$36.12 ,$19.78 ,$185.73 ,$40.64 ,$201.02 ,$152.95 ,$90.23 ,$90.23 ,$133.07 ,$90.23 ,$150.98 ,$196.65 ,$149.28 ,$17.88 ,$172.62 ,$19.78 ,$21.67 ,$21.67 ,$17.70 ,$21.67 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100335,83021,HC HEMOGLOBIN FRACT QN HPLC,301,1 ,$218.50 ,$144.21 ,$17.70 ,$218.50 ,$18.66 ,$63.21 ,$63.21 ,$18.06 ,$131.10 ,$185.73 ,$152.95 ,$18.66 ,$18.66 ,$207.58 ,$166.06 ,$163.88 ,$30.70 ,$185.73 ,$18.06 ,$30.70 ,$30.70 ,$152.95 ,$133.07 ,$18.66 ,$18.06 ,$17.70 ,$36.12 ,$19.78 ,$185.73 ,$40.64 ,$201.02 ,$152.95 ,$90.23 ,$90.23 ,$133.07 ,$90.23 ,$150.98 ,$196.65 ,$149.28 ,$17.88 ,$172.62 ,$19.78 ,$21.67 ,$21.67 ,$17.70 ,$21.67 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100336,83021,HC HEMOGLOBIN VARIANTS,301,1 ,$218.50 ,$144.21 ,$17.70 ,$218.50 ,$18.66 ,$63.21 ,$63.21 ,$18.06 ,$131.10 ,$185.73 ,$152.95 ,$18.66 ,$18.66 ,$207.58 ,$166.06 ,$163.88 ,$30.70 ,$185.73 ,$18.06 ,$30.70 ,$30.70 ,$152.95 ,$133.07 ,$18.66 ,$18.06 ,$17.70 ,$36.12 ,$19.78 ,$185.73 ,$40.64 ,$201.02 ,$152.95 ,$90.23 ,$90.23 ,$133.07 ,$90.23 ,$150.98 ,$196.65 ,$149.28 ,$17.88 ,$172.62 ,$19.78 ,$21.67 ,$21.67 ,$17.70 ,$21.67 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100337,83036,HC GLYCOSYLATED HGB,301,1 ,$89.70 ,$59.20 ,$9.52 ,$89.70 ,$10.03 ,$33.99 ,$33.99 ,$9.71 ,$53.82 ,$76.25 ,$62.79 ,$10.03 ,$10.03 ,$85.22 ,$68.17 ,$67.28 ,$16.51 ,$76.25 ,$9.71 ,$16.51 ,$16.51 ,$62.79 ,$54.63 ,$10.03 ,$9.71 ,$9.52 ,$19.42 ,$10.63 ,$76.25 ,$21.85 ,$82.52 ,$62.79 ,$48.50 ,$48.50 ,$54.63 ,$48.50 ,$61.98 ,$80.73 ,$61.28 ,$9.61 ,$70.86 ,$10.63 ,$11.65 ,$11.65 ,$9.52 ,$11.65 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100338,83050,HC METHEMOGLOBIN,301,1 ,$77.05 ,$50.85 ,$4.12 ,$77.05 ,$4.12 ,$28.70 ,$28.70 ,$8.20 ,$46.23 ,$65.49 ,$53.94 ,$4.12 ,$4.12 ,$73.20 ,$58.56 ,$57.79 ,$13.94 ,$65.49 ,$8.20 ,$13.94 ,$13.94 ,$53.94 ,$46.92 ,$4.12 ,$8.20 ,$8.04 ,$16.40 ,$4.37 ,$65.49 ,$18.45 ,$70.89 ,$53.94 ,$14.65 ,$14.65 ,$46.92 ,$14.65 ,$53.24 ,$69.35 ,$52.64 ,$8.11 ,$60.87 ,$4.37 ,$9.84 ,$9.84 ,$8.04 ,$9.84 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100339,83051,HC HEMOGLOBIN PLASMA,301,1 ,$28.75 ,$18.98 ,$4.90 ,$28.75 ,$4.90 ,$25.59 ,$25.59 ,$7.31 ,$17.25 ,$24.44 ,$20.13 ,$4.90 ,$4.90 ,$27.31 ,$21.85 ,$21.56 ,$12.43 ,$24.44 ,$7.31 ,$12.43 ,$12.43 ,$20.13 ,$17.51 ,$4.90 ,$7.31 ,$7.16 ,$14.62 ,$5.19 ,$24.44 ,$16.45 ,$26.45 ,$20.13 ,$17.40 ,$17.40 ,$17.51 ,$17.40 ,$19.87 ,$25.88 ,$19.64 ,$7.23 ,$22.71 ,$5.19 ,$8.77 ,$8.77 ,$7.16 ,$8.77 ,$20.70 ,$17.83 ,$20.70 ,$20.70 ,$23.00 
ST NICHOLAS HOSPITAL - ACUTE,30100341,83051,HC HEMOGLOBIN PLASMA,301,1 ,$28.75 ,$18.98 ,$4.90 ,$28.75 ,$4.90 ,$25.59 ,$25.59 ,$7.31 ,$17.25 ,$24.44 ,$20.13 ,$4.90 ,$4.90 ,$27.31 ,$21.85 ,$21.56 ,$12.43 ,$24.44 ,$7.31 ,$12.43 ,$12.43 ,$20.13 ,$17.51 ,$4.90 ,$7.31 ,$7.16 ,$14.62 ,$5.19 ,$24.44 ,$16.45 ,$26.45 ,$20.13 ,$17.40 ,$17.40 ,$17.51 ,$17.40 ,$19.87 ,$25.88 ,$19.64 ,$7.23 ,$22.71 ,$5.19 ,$8.77 ,$8.77 ,$7.16 ,$8.77 ,$20.70 ,$17.83 ,$20.70 ,$20.70 ,$23.00 
ST NICHOLAS HOSPITAL - ACUTE,30100342,83051,HC HEMOGLOBIN (MAYO),301,1 ,$116.15 ,$76.66 ,$4.90 ,$116.15 ,$4.90 ,$25.59 ,$25.59 ,$7.31 ,$69.69 ,$98.73 ,$81.31 ,$4.90 ,$4.90 ,$110.34 ,$88.27 ,$87.11 ,$12.43 ,$98.73 ,$7.31 ,$12.43 ,$12.43 ,$81.31 ,$70.74 ,$4.90 ,$7.31 ,$7.16 ,$14.62 ,$5.19 ,$98.73 ,$16.45 ,$106.86 ,$81.31 ,$17.40 ,$17.40 ,$70.74 ,$17.40 ,$80.26 ,$104.54 ,$79.35 ,$7.23 ,$91.76 ,$5.19 ,$8.77 ,$8.77 ,$7.16 ,$8.77 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100343,83068,HC HEMOGLOBIN UNSTABLE,301,1 ,$139.15 ,$91.84 ,$9.28 ,$139.15 ,$9.79 ,$33.15 ,$33.15 ,$9.47 ,$83.49 ,$118.28 ,$97.41 ,$9.79 ,$9.79 ,$132.19 ,$105.75 ,$104.36 ,$16.10 ,$118.28 ,$9.47 ,$16.10 ,$16.10 ,$97.41 ,$84.74 ,$9.79 ,$9.47 ,$9.28 ,$18.94 ,$10.38 ,$118.28 ,$21.31 ,$128.02 ,$97.41 ,$42.28 ,$42.28 ,$84.74 ,$42.28 ,$96.15 ,$125.24 ,$95.07 ,$9.37 ,$109.93 ,$10.38 ,$11.36 ,$11.36 ,$9.28 ,$11.36 ,$100.19 ,$86.27 ,$100.19 ,$100.19 ,$111.32 
ST NICHOLAS HOSPITAL - ACUTE,30100344,83070,HC HEMOSIDERIN,301,1 ,$64.40 ,$42.50 ,$4.65 ,$64.40 ,$4.91 ,$16.63 ,$16.63 ,$4.75 ,$38.64 ,$54.74 ,$45.08 ,$4.91 ,$4.91 ,$61.18 ,$48.94 ,$48.30 ,$8.08 ,$54.74 ,$4.75 ,$8.08 ,$8.08 ,$45.08 ,$39.22 ,$4.91 ,$4.75 ,$4.65 ,$9.50 ,$5.20 ,$54.74 ,$10.69 ,$59.25 ,$45.08 ,$23.74 ,$23.74 ,$39.22 ,$23.74 ,$44.50 ,$57.96 ,$44.00 ,$4.70 ,$50.88 ,$5.20 ,$5.70 ,$5.70 ,$4.65 ,$5.70 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30100345,83088,HC HISTAMINE,301,1 ,$244.95 ,$161.67 ,$28.94 ,$244.95 ,$30.51 ,$103.36 ,$103.36 ,$29.53 ,$146.97 ,$208.21 ,$171.47 ,$30.51 ,$30.51 ,$232.70 ,$186.16 ,$183.71 ,$50.20 ,$208.21 ,$29.53 ,$50.20 ,$50.20 ,$171.47 ,$149.17 ,$30.51 ,$29.53 ,$28.94 ,$59.06 ,$32.34 ,$208.21 ,$66.44 ,$225.35 ,$171.47 ,$147.60 ,$147.60 ,$149.17 ,$147.60 ,$169.26 ,$220.46 ,$167.35 ,$29.23 ,$193.51 ,$32.34 ,$35.44 ,$35.44 ,$28.94 ,$35.44 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30100346,83090,HC HOMOCYSTEINE,301,1 ,$154.10 ,$101.71 ,$17.56 ,$154.10 ,$18.52 ,$62.72 ,$62.72 ,$17.92 ,$92.46 ,$130.99 ,$107.87 ,$18.52 ,$18.52 ,$146.40 ,$117.12 ,$115.58 ,$30.46 ,$130.99 ,$17.92 ,$30.46 ,$30.46 ,$107.87 ,$93.85 ,$18.52 ,$17.92 ,$17.56 ,$35.84 ,$19.63 ,$130.99 ,$40.32 ,$141.77 ,$107.87 ,$84.30 ,$84.30 ,$93.85 ,$84.30 ,$106.48 ,$138.69 ,$105.28 ,$17.74 ,$121.74 ,$19.63 ,$21.50 ,$21.50 ,$17.56 ,$21.50 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100347,83150,HC HOMOVANILLIC ACID (HVA24),301,1 ,$128.80 ,$85.01 ,$19.62 ,$128.80 ,$19.62 ,$78.44 ,$78.44 ,$22.41 ,$77.28 ,$109.48 ,$90.16 ,$19.62 ,$19.62 ,$122.36 ,$97.89 ,$96.60 ,$38.10 ,$109.48 ,$22.41 ,$38.10 ,$38.10 ,$90.16 ,$78.44 ,$19.62 ,$22.41 ,$21.96 ,$44.82 ,$20.80 ,$109.48 ,$50.42 ,$118.50 ,$90.16 ,$69.75 ,$69.75 ,$78.44 ,$69.75 ,$89.00 ,$115.92 ,$88.00 ,$22.18 ,$101.75 ,$20.80 ,$26.89 ,$26.89 ,$21.96 ,$26.89 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100348,83150,HC HOMOVANILLIC ACID,301,1 ,$128.80 ,$85.01 ,$19.62 ,$128.80 ,$19.62 ,$78.44 ,$78.44 ,$22.41 ,$77.28 ,$109.48 ,$90.16 ,$19.62 ,$19.62 ,$122.36 ,$97.89 ,$96.60 ,$38.10 ,$109.48 ,$22.41 ,$38.10 ,$38.10 ,$90.16 ,$78.44 ,$19.62 ,$22.41 ,$21.96 ,$44.82 ,$20.80 ,$109.48 ,$50.42 ,$118.50 ,$90.16 ,$69.75 ,$69.75 ,$78.44 ,$69.75 ,$89.00 ,$115.92 ,$88.00 ,$22.18 ,$101.75 ,$20.80 ,$26.89 ,$26.89 ,$21.96 ,$26.89 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100349,83491,HC CORTICOSTEROIDS 17D,301,1 ,$143.75 ,$94.88 ,$17.54 ,$143.75 ,$18.50 ,$62.65 ,$62.65 ,$17.90 ,$86.25 ,$122.19 ,$100.63 ,$18.50 ,$18.50 ,$136.56 ,$109.25 ,$107.81 ,$30.43 ,$122.19 ,$17.90 ,$30.43 ,$30.43 ,$100.63 ,$87.54 ,$18.50 ,$17.90 ,$17.54 ,$35.80 ,$19.61 ,$122.19 ,$40.28 ,$132.25 ,$100.63 ,$87.56 ,$87.56 ,$87.54 ,$87.56 ,$99.33 ,$129.38 ,$98.21 ,$17.72 ,$113.56 ,$19.61 ,$21.48 ,$21.48 ,$17.54 ,$21.48 ,$103.50 ,$89.13 ,$103.50 ,$103.50 ,$115.00 
ST NICHOLAS HOSPITAL - ACUTE,30100350,83497,HC HYDROXYINDOLACET 5 (HIAA),301,1 ,$116.15 ,$76.66 ,$12.64 ,$116.15 ,$13.33 ,$45.15 ,$45.15 ,$12.90 ,$69.69 ,$98.73 ,$81.31 ,$13.33 ,$13.33 ,$110.34 ,$88.27 ,$87.11 ,$21.93 ,$98.73 ,$12.90 ,$21.93 ,$21.93 ,$81.31 ,$70.74 ,$13.33 ,$12.90 ,$12.64 ,$25.80 ,$14.13 ,$98.73 ,$29.03 ,$106.86 ,$81.31 ,$64.44 ,$64.44 ,$70.74 ,$64.44 ,$80.26 ,$104.54 ,$79.35 ,$12.77 ,$91.76 ,$14.13 ,$15.48 ,$15.48 ,$12.64 ,$15.48 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100351,83497,HC HYDROXYINDOLACET 5 URINE,301,1 ,$54.05 ,$35.67 ,$12.64 ,$54.05 ,$13.33 ,$45.15 ,$45.15 ,$12.90 ,$32.43 ,$45.94 ,$37.84 ,$13.33 ,$13.33 ,$51.35 ,$41.08 ,$40.54 ,$21.93 ,$45.94 ,$12.90 ,$21.93 ,$21.93 ,$37.84 ,$32.92 ,$13.33 ,$12.90 ,$12.64 ,$25.80 ,$14.13 ,$45.94 ,$29.03 ,$49.73 ,$37.84 ,$54.05 ,$54.05 ,$32.92 ,$54.05 ,$37.35 ,$48.65 ,$36.93 ,$12.77 ,$42.70 ,$14.13 ,$15.48 ,$15.48 ,$12.64 ,$15.48 ,$38.92 ,$33.51 ,$38.92 ,$38.92 ,$43.24 
ST NICHOLAS HOSPITAL - ACUTE,30100352,83498,HC HYDROXYPROGESTERONE 17D,301,1 ,$244.95 ,$161.67 ,$26.63 ,$244.95 ,$28.07 ,$95.10 ,$95.10 ,$27.17 ,$146.97 ,$208.21 ,$171.47 ,$28.07 ,$28.07 ,$232.70 ,$186.16 ,$183.71 ,$46.19 ,$208.21 ,$27.17 ,$46.19 ,$46.19 ,$171.47 ,$149.17 ,$28.07 ,$27.17 ,$26.63 ,$54.34 ,$29.75 ,$208.21 ,$61.13 ,$225.35 ,$171.47 ,$135.81 ,$135.81 ,$149.17 ,$135.81 ,$169.26 ,$220.46 ,$167.35 ,$26.89 ,$193.51 ,$29.75 ,$32.60 ,$32.60 ,$26.63 ,$32.60 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30100354,83505,HC HYDROXYPROLIN,301,1 ,$207.00 ,$136.62 ,$23.81 ,$207.00 ,$25.11 ,$85.05 ,$85.05 ,$24.30 ,$124.20 ,$175.95 ,$144.90 ,$25.11 ,$25.11 ,$196.65 ,$157.32 ,$155.25 ,$41.31 ,$175.95 ,$24.30 ,$41.31 ,$41.31 ,$144.90 ,$126.06 ,$25.11 ,$24.30 ,$23.81 ,$48.60 ,$26.62 ,$175.95 ,$54.68 ,$190.44 ,$144.90 ,$121.52 ,$121.52 ,$126.06 ,$121.52 ,$143.04 ,$186.30 ,$141.42 ,$24.05 ,$163.53 ,$26.62 ,$29.16 ,$29.16 ,$23.81 ,$29.16 ,$149.04 ,$128.34 ,$149.04 ,$149.04 ,$165.60 
ST NICHOLAS HOSPITAL - ACUTE,30100355,83516,HC IMMUNO QL/SQ MLT,301,1 ,$103.50 ,$68.31 ,$11.30 ,$103.50 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$62.10 ,$87.98 ,$72.45 ,$11.91 ,$11.91 ,$98.33 ,$78.66 ,$77.63 ,$19.60 ,$87.98 ,$11.53 ,$19.60 ,$19.60 ,$72.45 ,$63.03 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$87.98 ,$25.94 ,$95.22 ,$72.45 ,$57.66 ,$57.66 ,$63.03 ,$57.66 ,$71.52 ,$93.15 ,$70.71 ,$11.42 ,$81.77 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100356,83516,HC ANTICARDIOPLIPIN SCREEN,301,1 ,$127.65 ,$84.25 ,$11.30 ,$127.65 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$76.59 ,$108.50 ,$89.36 ,$11.91 ,$11.91 ,$121.27 ,$97.01 ,$95.74 ,$19.60 ,$108.50 ,$11.53 ,$19.60 ,$19.60 ,$89.36 ,$77.74 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$108.50 ,$25.94 ,$117.44 ,$89.36 ,$57.66 ,$57.66 ,$77.74 ,$57.66 ,$88.21 ,$114.89 ,$87.21 ,$11.42 ,$100.84 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$91.91 ,$79.14 ,$91.91 ,$91.91 ,$102.12 
ST NICHOLAS HOSPITAL - ACUTE,30100357,83516,HC HISTONE ANTIBODY,301,1 ,$116.15 ,$76.66 ,$11.30 ,$116.15 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$69.69 ,$98.73 ,$81.31 ,$11.91 ,$11.91 ,$110.34 ,$88.27 ,$87.11 ,$19.60 ,$98.73 ,$11.53 ,$19.60 ,$19.60 ,$81.31 ,$70.74 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$98.73 ,$25.94 ,$106.86 ,$81.31 ,$57.66 ,$57.66 ,$70.74 ,$57.66 ,$80.26 ,$104.54 ,$79.35 ,$11.42 ,$91.76 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100358,83516,HC ACTIN AB,301,1 ,$92.00 ,$60.72 ,$11.30 ,$92.00 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$55.20 ,$78.20 ,$64.40 ,$11.91 ,$11.91 ,$87.40 ,$69.92 ,$69.00 ,$19.60 ,$78.20 ,$11.53 ,$19.60 ,$19.60 ,$64.40 ,$56.03 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$78.20 ,$25.94 ,$84.64 ,$64.40 ,$57.66 ,$57.66 ,$56.03 ,$57.66 ,$63.57 ,$82.80 ,$62.85 ,$11.42 ,$72.68 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,30100359,83516,HC IMMUNO QL/SQ MLT (2),301,1 ,$95.45 ,$63.00 ,$11.30 ,$95.45 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$57.27 ,$81.13 ,$66.82 ,$11.91 ,$11.91 ,$90.68 ,$72.54 ,$71.59 ,$19.60 ,$81.13 ,$11.53 ,$19.60 ,$19.60 ,$66.82 ,$58.13 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$81.13 ,$25.94 ,$87.81 ,$66.82 ,$57.66 ,$57.66 ,$58.13 ,$57.66 ,$65.96 ,$85.91 ,$65.21 ,$11.42 ,$75.41 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$68.72 ,$59.18 ,$68.72 ,$68.72 ,$76.36 
ST NICHOLAS HOSPITAL - ACUTE,30100360,83516,HC SMOOTH MUSCLE AB,301,1 ,$103.50 ,$68.31 ,$11.30 ,$103.50 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$62.10 ,$87.98 ,$72.45 ,$11.91 ,$11.91 ,$98.33 ,$78.66 ,$77.63 ,$19.60 ,$87.98 ,$11.53 ,$19.60 ,$19.60 ,$72.45 ,$63.03 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$87.98 ,$25.94 ,$95.22 ,$72.45 ,$57.66 ,$57.66 ,$63.03 ,$57.66 ,$71.52 ,$93.15 ,$70.71 ,$11.42 ,$81.77 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100361,83516,HC IMMUNO QL/SQ MLT (3),301,1 ,$116.15 ,$76.66 ,$11.30 ,$116.15 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$69.69 ,$98.73 ,$81.31 ,$11.91 ,$11.91 ,$110.34 ,$88.27 ,$87.11 ,$19.60 ,$98.73 ,$11.53 ,$19.60 ,$19.60 ,$81.31 ,$70.74 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$98.73 ,$25.94 ,$106.86 ,$81.31 ,$57.66 ,$57.66 ,$70.74 ,$57.66 ,$80.26 ,$104.54 ,$79.35 ,$11.42 ,$91.76 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100363,83519,HC ACETYLCHOLINE RECEPTR AB,301,1 ,$116.15 ,$76.66 ,$18.03 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$69.69 ,$98.73 ,$81.31 ,$19.00 ,$19.00 ,$110.34 ,$88.27 ,$87.11 ,$31.28 ,$98.73 ,$18.40 ,$31.28 ,$31.28 ,$81.31 ,$70.74 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$98.73 ,$41.40 ,$106.86 ,$81.31 ,$67.52 ,$67.52 ,$70.74 ,$67.52 ,$80.26 ,$104.54 ,$79.35 ,$18.21 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100364,83519,HC ADI LEMS AUTO AB,301,1 ,$555.45 ,$366.60 ,$18.03 ,$555.45 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$333.27 ,$472.13 ,$388.82 ,$19.00 ,$19.00 ,$527.68 ,$422.14 ,$416.59 ,$31.28 ,$472.13 ,$18.40 ,$31.28 ,$31.28 ,$388.82 ,$338.27 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$472.13 ,$41.40 ,$511.01 ,$388.82 ,$67.52 ,$67.52 ,$338.27 ,$67.52 ,$383.82 ,$499.91 ,$379.48 ,$18.21 ,$438.81 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$399.92 ,$344.38 ,$399.92 ,$399.92 ,$444.36 
ST NICHOLAS HOSPITAL - ACUTE,30100365,83519,HC GAD 65 AB,301,1 ,$118.45 ,$78.18 ,$18.03 ,$118.45 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$71.07 ,$100.68 ,$82.92 ,$19.00 ,$19.00 ,$112.53 ,$90.02 ,$88.84 ,$31.28 ,$100.68 ,$18.40 ,$31.28 ,$31.28 ,$82.92 ,$72.14 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$100.68 ,$41.40 ,$108.97 ,$82.92 ,$67.52 ,$67.52 ,$72.14 ,$67.52 ,$81.85 ,$106.61 ,$80.93 ,$18.21 ,$93.58 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,30100366,86341,HC ISLET CELL AUTO AB,301,1 ,$296.70 ,$195.82 ,$19.88 ,$296.70 ,$19.88 ,$82.50 ,$82.50 ,$23.57 ,$178.02 ,$252.20 ,$207.69 ,$19.88 ,$19.88 ,$281.87 ,$225.49 ,$222.53 ,$40.07 ,$252.20 ,$23.57 ,$40.07 ,$40.07 ,$207.69 ,$180.69 ,$19.88 ,$23.57 ,$23.10 ,$47.14 ,$21.07 ,$252.20 ,$53.03 ,$272.96 ,$207.69 ,$70.67 ,$70.67 ,$180.69 ,$70.67 ,$205.02 ,$267.03 ,$202.71 ,$23.33 ,$234.39 ,$21.07 ,$28.28 ,$28.28 ,$23.10 ,$28.28 ,$213.62 ,$183.95 ,$213.62 ,$213.62 ,$237.36 
ST NICHOLAS HOSPITAL - ACUTE,30100367,83519,HC PTH RELATED PROTEIN,301,1 ,$116.15 ,$76.66 ,$18.03 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$69.69 ,$98.73 ,$81.31 ,$19.00 ,$19.00 ,$110.34 ,$88.27 ,$87.11 ,$31.28 ,$98.73 ,$18.40 ,$31.28 ,$31.28 ,$81.31 ,$70.74 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$98.73 ,$41.40 ,$106.86 ,$81.31 ,$67.52 ,$67.52 ,$70.74 ,$67.52 ,$80.26 ,$104.54 ,$79.35 ,$18.21 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100368,83519,HC NEOPTERIN,301,1 ,$116.15 ,$76.66 ,$18.03 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$69.69 ,$98.73 ,$81.31 ,$19.00 ,$19.00 ,$110.34 ,$88.27 ,$87.11 ,$31.28 ,$98.73 ,$18.40 ,$31.28 ,$31.28 ,$81.31 ,$70.74 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$98.73 ,$41.40 ,$106.86 ,$81.31 ,$67.52 ,$67.52 ,$70.74 ,$67.52 ,$80.26 ,$104.54 ,$79.35 ,$18.21 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100369,83519,HC IGF BINDING PROTEIN,301,1 ,$116.15 ,$76.66 ,$18.03 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$69.69 ,$98.73 ,$81.31 ,$19.00 ,$19.00 ,$110.34 ,$88.27 ,$87.11 ,$31.28 ,$98.73 ,$18.40 ,$31.28 ,$31.28 ,$81.31 ,$70.74 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$98.73 ,$41.40 ,$106.86 ,$81.31 ,$67.52 ,$67.52 ,$70.74 ,$67.52 ,$80.26 ,$104.54 ,$79.35 ,$18.21 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100370,83519,HC ACHR BINDING AB,301,1 ,$194.35 ,$128.27 ,$18.03 ,$194.35 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$116.61 ,$165.20 ,$136.05 ,$19.00 ,$19.00 ,$184.63 ,$147.71 ,$145.76 ,$31.28 ,$165.20 ,$18.40 ,$31.28 ,$31.28 ,$136.05 ,$118.36 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$165.20 ,$41.40 ,$178.80 ,$136.05 ,$67.52 ,$67.52 ,$118.36 ,$67.52 ,$134.30 ,$174.92 ,$132.78 ,$18.21 ,$153.54 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$139.93 ,$120.50 ,$139.93 ,$139.93 ,$155.48 
ST NICHOLAS HOSPITAL - ACUTE,30100371,83519,HC MUSK ANTIBODY,301,1 ,$644.00 ,$425.04 ,$18.03 ,$644.00 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$386.40 ,$547.40 ,$450.80 ,$19.00 ,$19.00 ,$611.80 ,$489.44 ,$483.00 ,$31.28 ,$547.40 ,$18.40 ,$31.28 ,$31.28 ,$450.80 ,$392.20 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$547.40 ,$41.40 ,$592.48 ,$450.80 ,$67.52 ,$67.52 ,$392.20 ,$67.52 ,$445.00 ,$579.60 ,$439.98 ,$18.21 ,$508.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,30100372,83519,HC ACEYTLCHOLINE RECPT AB (BK),301,1 ,$116.15 ,$76.66 ,$18.03 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$69.69 ,$98.73 ,$81.31 ,$19.00 ,$19.00 ,$110.34 ,$88.27 ,$87.11 ,$31.28 ,$98.73 ,$18.40 ,$31.28 ,$31.28 ,$81.31 ,$70.74 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$98.73 ,$41.40 ,$106.86 ,$81.31 ,$67.52 ,$67.52 ,$70.74 ,$67.52 ,$80.26 ,$104.54 ,$79.35 ,$18.21 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100373,83519,HC ACEYTLCHOLINE RECPT AB (MD),301,1 ,$116.15 ,$76.66 ,$18.03 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$69.69 ,$98.73 ,$81.31 ,$19.00 ,$19.00 ,$110.34 ,$88.27 ,$87.11 ,$31.28 ,$98.73 ,$18.40 ,$31.28 ,$31.28 ,$81.31 ,$70.74 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$98.73 ,$41.40 ,$106.86 ,$81.31 ,$67.52 ,$67.52 ,$70.74 ,$67.52 ,$80.26 ,$104.54 ,$79.35 ,$18.21 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100374,83519,HC IGF BINDING PROTEIN 3,301,1 ,$276.00 ,$182.16 ,$18.03 ,$276.00 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$165.60 ,$234.60 ,$193.20 ,$19.00 ,$19.00 ,$262.20 ,$209.76 ,$207.00 ,$31.28 ,$234.60 ,$18.40 ,$31.28 ,$31.28 ,$193.20 ,$168.08 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$234.60 ,$41.40 ,$253.92 ,$193.20 ,$67.52 ,$67.52 ,$168.08 ,$67.52 ,$190.72 ,$248.40 ,$188.56 ,$18.21 ,$218.04 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$198.72 ,$171.12 ,$198.72 ,$198.72 ,$220.80 
ST NICHOLAS HOSPITAL - ACUTE,30100375,80155,HC CAFFEINE,301,1 ,$180.00 ,$118.80 ,$15.44 ,$180.00 ,$15.44 ,$135.00 ,$135.00 ,$38.57 ,$108.00 ,$153.00 ,$126.00 ,$15.44 ,$15.44 ,$171.00 ,$136.80 ,$135.00 ,$65.57 ,$153.00 ,$38.57 ,$65.57 ,$65.57 ,$126.00 ,$109.62 ,$15.44 ,$38.57 ,$37.80 ,$77.14 ,$16.37 ,$153.00 ,$86.78 ,$165.60 ,$126.00 ,$70.71 ,$70.71 ,$109.62 ,$70.71 ,$124.38 ,$162.00 ,$122.98 ,$38.18 ,$142.20 ,$16.37 ,$46.28 ,$46.28 ,$37.80 ,$46.28 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30100376,83520,HC METHOTREXATE,301,1 ,$386.40 ,$255.02 ,$16.92 ,$386.40 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$231.84 ,$328.44 ,$270.48 ,$17.85 ,$17.85 ,$367.08 ,$293.66 ,$289.80 ,$29.36 ,$328.44 ,$17.27 ,$29.36 ,$29.36 ,$270.48 ,$235.32 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$328.44 ,$38.86 ,$355.49 ,$270.48 ,$64.70 ,$64.70 ,$235.32 ,$64.70 ,$267.00 ,$347.76 ,$263.99 ,$17.09 ,$305.26 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$278.21 ,$239.57 ,$278.21 ,$278.21 ,$309.12 
ST NICHOLAS HOSPITAL - ACUTE,30100377,83520,HC GLOMERULAR BS MEM IGG,301,1 ,$162.15 ,$107.02 ,$16.92 ,$162.15 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$97.29 ,$137.83 ,$113.51 ,$17.85 ,$17.85 ,$154.04 ,$123.23 ,$121.61 ,$29.36 ,$137.83 ,$17.27 ,$29.36 ,$29.36 ,$113.51 ,$98.75 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$137.83 ,$38.86 ,$149.18 ,$113.51 ,$64.70 ,$64.70 ,$98.75 ,$64.70 ,$112.05 ,$145.94 ,$110.78 ,$17.09 ,$128.10 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,30100378,83520,HC C1 ESTERASE IHHIB FUNCTN,301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.85 ,$17.85 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$64.70 ,$64.70 ,$70.74 ,$64.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100379,83520,HC IMMUNOASSAY QN PROTEIN,301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.85 ,$17.85 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$64.70 ,$64.70 ,$70.74 ,$64.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100380,83520,HC GASTRIC PARIETAL AB,301,1 ,$113.85 ,$75.14 ,$16.92 ,$113.85 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$68.31 ,$96.77 ,$79.70 ,$17.85 ,$17.85 ,$108.16 ,$86.53 ,$85.39 ,$29.36 ,$96.77 ,$17.27 ,$29.36 ,$29.36 ,$79.70 ,$69.33 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$96.77 ,$38.86 ,$104.74 ,$79.70 ,$64.70 ,$64.70 ,$69.33 ,$64.70 ,$78.67 ,$102.47 ,$77.78 ,$17.09 ,$89.94 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$81.97 ,$70.59 ,$81.97 ,$81.97 ,$91.08 
ST NICHOLAS HOSPITAL - ACUTE,30100381,83520,HC C3 A,301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.85 ,$17.85 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$64.70 ,$64.70 ,$70.74 ,$64.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100382,83520,HC ANTI GBM,301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.85 ,$17.85 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$64.70 ,$64.70 ,$70.74 ,$64.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100383,83520,HC CITRULLINE PEPTIDE ANTIBODY,301,1 ,$184.00 ,$121.44 ,$16.92 ,$184.00 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$110.40 ,$156.40 ,$128.80 ,$17.85 ,$17.85 ,$174.80 ,$139.84 ,$138.00 ,$29.36 ,$156.40 ,$17.27 ,$29.36 ,$29.36 ,$128.80 ,$112.06 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$156.40 ,$38.86 ,$169.28 ,$128.80 ,$64.70 ,$64.70 ,$112.06 ,$64.70 ,$127.14 ,$165.60 ,$125.71 ,$17.09 ,$145.36 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,30100384,83520,HC IMMUNOASSAY QN OTHER,301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.85 ,$17.85 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$64.70 ,$64.70 ,$70.74 ,$64.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100385,83520,HC CD ANTI GLIADIN,301,1 ,$113.85 ,$75.14 ,$16.92 ,$113.85 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$68.31 ,$96.77 ,$79.70 ,$17.85 ,$17.85 ,$108.16 ,$86.53 ,$85.39 ,$29.36 ,$96.77 ,$17.27 ,$29.36 ,$29.36 ,$79.70 ,$69.33 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$96.77 ,$38.86 ,$104.74 ,$79.70 ,$64.70 ,$64.70 ,$69.33 ,$64.70 ,$78.67 ,$102.47 ,$77.78 ,$17.09 ,$89.94 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$81.97 ,$70.59 ,$81.97 ,$81.97 ,$91.08 
ST NICHOLAS HOSPITAL - ACUTE,30100386,83520,HC FIBROSPECT TIMP 1,301,1 ,$113.85 ,$75.14 ,$16.92 ,$113.85 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$68.31 ,$96.77 ,$79.70 ,$17.85 ,$17.85 ,$108.16 ,$86.53 ,$85.39 ,$29.36 ,$96.77 ,$17.27 ,$29.36 ,$29.36 ,$79.70 ,$69.33 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$96.77 ,$38.86 ,$104.74 ,$79.70 ,$64.70 ,$64.70 ,$69.33 ,$64.70 ,$78.67 ,$102.47 ,$77.78 ,$17.09 ,$89.94 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$81.97 ,$70.59 ,$81.97 ,$81.97 ,$91.08 
ST NICHOLAS HOSPITAL - ACUTE,30100388,83520,HC CD ANTI HU TGG IGA,301,1 ,$113.85 ,$75.14 ,$16.92 ,$113.85 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$68.31 ,$96.77 ,$79.70 ,$17.85 ,$17.85 ,$108.16 ,$86.53 ,$85.39 ,$29.36 ,$96.77 ,$17.27 ,$29.36 ,$29.36 ,$79.70 ,$69.33 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$96.77 ,$38.86 ,$104.74 ,$79.70 ,$64.70 ,$64.70 ,$69.33 ,$64.70 ,$78.67 ,$102.47 ,$77.78 ,$17.09 ,$89.94 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$81.97 ,$70.59 ,$81.97 ,$81.97 ,$91.08 
ST NICHOLAS HOSPITAL - ACUTE,30100389,83520,HC TRYPTASE,301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.85 ,$17.85 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$64.70 ,$64.70 ,$70.74 ,$64.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100390,82397,HC INHIBIN B,301,1 ,$257.60 ,$170.02 ,$13.84 ,$257.60 ,$14.59 ,$49.42 ,$49.42 ,$14.12 ,$154.56 ,$218.96 ,$180.32 ,$14.59 ,$14.59 ,$244.72 ,$195.78 ,$193.20 ,$24.00 ,$218.96 ,$14.12 ,$24.00 ,$24.00 ,$180.32 ,$156.88 ,$14.59 ,$14.12 ,$13.84 ,$28.24 ,$15.47 ,$218.96 ,$31.77 ,$236.99 ,$180.32 ,$70.60 ,$70.60 ,$156.88 ,$70.60 ,$178.00 ,$231.84 ,$175.99 ,$13.97 ,$203.50 ,$15.47 ,$16.94 ,$16.94 ,$13.84 ,$16.94 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30100392,83525,HC INSULIN TOTAL,301,1 ,$89.70 ,$59.20 ,$11.20 ,$89.70 ,$11.81 ,$40.01 ,$40.01 ,$11.43 ,$53.82 ,$76.25 ,$62.79 ,$11.81 ,$11.81 ,$85.22 ,$68.17 ,$67.28 ,$19.43 ,$76.25 ,$11.43 ,$19.43 ,$19.43 ,$62.79 ,$54.63 ,$11.81 ,$11.43 ,$11.20 ,$22.86 ,$12.52 ,$76.25 ,$25.72 ,$82.52 ,$62.79 ,$57.11 ,$57.11 ,$54.63 ,$57.11 ,$61.98 ,$80.73 ,$61.28 ,$11.31 ,$70.86 ,$12.52 ,$13.72 ,$13.72 ,$11.20 ,$13.72 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100393,83540,HC IRON TOTAL,301,1 ,$56.35 ,$37.19 ,$6.34 ,$56.35 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$33.81 ,$47.90 ,$39.45 ,$6.69 ,$6.69 ,$53.53 ,$42.83 ,$42.26 ,$11.00 ,$47.90 ,$6.47 ,$11.00 ,$11.00 ,$39.45 ,$34.32 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$47.90 ,$14.56 ,$51.84 ,$39.45 ,$32.35 ,$32.35 ,$34.32 ,$32.35 ,$38.94 ,$50.72 ,$38.50 ,$6.40 ,$44.52 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$40.57 ,$34.94 ,$40.57 ,$40.57 ,$45.08 
ST NICHOLAS HOSPITAL - ACUTE,30100394,83550,HC IRON BINDING CAPACITY,301,1 ,$77.05 ,$50.85 ,$8.57 ,$77.05 ,$9.03 ,$30.59 ,$30.59 ,$8.74 ,$46.23 ,$65.49 ,$53.94 ,$9.03 ,$9.03 ,$73.20 ,$58.56 ,$57.79 ,$14.86 ,$65.49 ,$8.74 ,$14.86 ,$14.86 ,$53.94 ,$46.92 ,$9.03 ,$8.74 ,$8.57 ,$17.48 ,$9.57 ,$65.49 ,$19.67 ,$70.89 ,$53.94 ,$43.71 ,$43.71 ,$46.92 ,$43.71 ,$53.24 ,$69.35 ,$52.64 ,$8.65 ,$60.87 ,$9.57 ,$10.49 ,$10.49 ,$8.57 ,$10.49 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100395,83586,HC KETOSTEROIDS (17-KS),301,1 ,$105.80 ,$69.83 ,$12.54 ,$105.80 ,$13.23 ,$44.80 ,$44.80 ,$12.80 ,$63.48 ,$89.93 ,$74.06 ,$13.23 ,$13.23 ,$100.51 ,$80.41 ,$79.35 ,$21.76 ,$89.93 ,$12.80 ,$21.76 ,$21.76 ,$74.06 ,$64.43 ,$13.23 ,$12.80 ,$12.54 ,$25.60 ,$14.02 ,$89.93 ,$28.80 ,$97.34 ,$74.06 ,$64.00 ,$64.00 ,$64.43 ,$64.00 ,$73.11 ,$95.22 ,$72.28 ,$12.67 ,$83.58 ,$14.02 ,$15.36 ,$15.36 ,$12.54 ,$15.36 ,$76.18 ,$65.60 ,$76.18 ,$76.18 ,$84.64 
ST NICHOLAS HOSPITAL - ACUTE,30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$103.50 ,$68.31 ,$11.34 ,$103.50 ,$11.96 ,$40.50 ,$40.50 ,$11.57 ,$62.10 ,$87.98 ,$72.45 ,$11.96 ,$11.96 ,$98.33 ,$78.66 ,$77.63 ,$19.67 ,$87.98 ,$11.57 ,$19.67 ,$19.67 ,$72.45 ,$63.03 ,$11.96 ,$11.57 ,$11.34 ,$23.14 ,$12.68 ,$87.98 ,$26.03 ,$95.22 ,$72.45 ,$53.38 ,$53.38 ,$63.03 ,$53.38 ,$71.52 ,$93.15 ,$70.71 ,$11.46 ,$81.77 ,$12.68 ,$13.88 ,$13.88 ,$11.34 ,$13.88 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$56.35 ,$37.19 ,$5.92 ,$56.35 ,$6.24 ,$21.14 ,$21.14 ,$6.04 ,$33.81 ,$47.90 ,$39.45 ,$6.24 ,$6.24 ,$53.53 ,$42.83 ,$42.26 ,$10.27 ,$47.90 ,$6.04 ,$10.27 ,$10.27 ,$39.45 ,$34.32 ,$6.24 ,$6.04 ,$5.92 ,$12.08 ,$6.61 ,$47.90 ,$13.59 ,$51.84 ,$39.45 ,$30.15 ,$30.15 ,$34.32 ,$30.15 ,$38.94 ,$50.72 ,$38.50 ,$5.98 ,$44.52 ,$6.61 ,$7.25 ,$7.25 ,$5.92 ,$7.25 ,$40.57 ,$34.94 ,$40.57 ,$40.57 ,$45.08 
ST NICHOLAS HOSPITAL - ACUTE,30100399,83625,HC LDH ISOENZYMES,301,1 ,$89.70 ,$59.20 ,$12.53 ,$89.70 ,$13.22 ,$44.77 ,$44.77 ,$12.79 ,$53.82 ,$76.25 ,$62.79 ,$13.22 ,$13.22 ,$85.22 ,$68.17 ,$67.28 ,$21.74 ,$76.25 ,$12.79 ,$21.74 ,$21.74 ,$62.79 ,$54.63 ,$13.22 ,$12.79 ,$12.53 ,$25.58 ,$14.01 ,$76.25 ,$28.78 ,$82.52 ,$62.79 ,$63.96 ,$63.96 ,$54.63 ,$63.96 ,$61.98 ,$80.73 ,$61.28 ,$12.66 ,$70.86 ,$14.01 ,$15.35 ,$15.35 ,$12.53 ,$15.35 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100401,83655,HC LEAD,301,1 ,$103.50 ,$68.31 ,$11.87 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$12.11 ,$62.10 ,$87.98 ,$72.45 ,$12.51 ,$12.51 ,$98.33 ,$78.66 ,$77.63 ,$20.59 ,$87.98 ,$12.11 ,$20.59 ,$20.59 ,$72.45 ,$63.03 ,$12.51 ,$12.11 ,$11.87 ,$24.22 ,$13.26 ,$87.98 ,$27.25 ,$95.22 ,$72.45 ,$60.52 ,$60.52 ,$63.03 ,$60.52 ,$71.52 ,$93.15 ,$70.71 ,$11.99 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$11.87 ,$14.53 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100403,83655,HC LEAD BLOOD PT DEMO,301,1 ,$103.50 ,$68.31 ,$11.87 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$12.11 ,$62.10 ,$87.98 ,$72.45 ,$12.51 ,$12.51 ,$98.33 ,$78.66 ,$77.63 ,$20.59 ,$87.98 ,$12.11 ,$20.59 ,$20.59 ,$72.45 ,$63.03 ,$12.51 ,$12.11 ,$11.87 ,$24.22 ,$13.26 ,$87.98 ,$27.25 ,$95.22 ,$72.45 ,$60.52 ,$60.52 ,$63.03 ,$60.52 ,$71.52 ,$93.15 ,$70.71 ,$11.99 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$11.87 ,$14.53 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100404,83655,HC LEAD URINE,301,1 ,$103.50 ,$68.31 ,$11.87 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$12.11 ,$62.10 ,$87.98 ,$72.45 ,$12.51 ,$12.51 ,$98.33 ,$78.66 ,$77.63 ,$20.59 ,$87.98 ,$12.11 ,$20.59 ,$20.59 ,$72.45 ,$63.03 ,$12.51 ,$12.11 ,$11.87 ,$24.22 ,$13.26 ,$87.98 ,$27.25 ,$95.22 ,$72.45 ,$60.52 ,$60.52 ,$63.03 ,$60.52 ,$71.52 ,$93.15 ,$70.71 ,$11.99 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$11.87 ,$14.53 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100405,83655,HC LEAD URINE UPB,301,1 ,$103.50 ,$68.31 ,$11.87 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$12.11 ,$62.10 ,$87.98 ,$72.45 ,$12.51 ,$12.51 ,$98.33 ,$78.66 ,$77.63 ,$20.59 ,$87.98 ,$12.11 ,$20.59 ,$20.59 ,$72.45 ,$63.03 ,$12.51 ,$12.11 ,$11.87 ,$24.22 ,$13.26 ,$87.98 ,$27.25 ,$95.22 ,$72.45 ,$60.52 ,$60.52 ,$63.03 ,$60.52 ,$71.52 ,$93.15 ,$70.71 ,$11.99 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$11.87 ,$14.53 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100406,83655,HC LEAD 24HR URINE,301,1 ,$103.50 ,$68.31 ,$11.87 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$12.11 ,$62.10 ,$87.98 ,$72.45 ,$12.51 ,$12.51 ,$98.33 ,$78.66 ,$77.63 ,$20.59 ,$87.98 ,$12.11 ,$20.59 ,$20.59 ,$72.45 ,$63.03 ,$12.51 ,$12.11 ,$11.87 ,$24.22 ,$13.26 ,$87.98 ,$27.25 ,$95.22 ,$72.45 ,$60.52 ,$60.52 ,$63.03 ,$60.52 ,$71.52 ,$93.15 ,$70.71 ,$11.99 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$11.87 ,$14.53 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100407,83655,HC LEAD (2),301,1 ,$103.50 ,$68.31 ,$11.87 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$12.11 ,$62.10 ,$87.98 ,$72.45 ,$12.51 ,$12.51 ,$98.33 ,$78.66 ,$77.63 ,$20.59 ,$87.98 ,$12.11 ,$20.59 ,$20.59 ,$72.45 ,$63.03 ,$12.51 ,$12.11 ,$11.87 ,$24.22 ,$13.26 ,$87.98 ,$27.25 ,$95.22 ,$72.45 ,$60.52 ,$60.52 ,$63.03 ,$60.52 ,$71.52 ,$93.15 ,$70.71 ,$11.99 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$11.87 ,$14.53 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100408,83663,HC FETAL LUNG MATURITY,301,1 ,$622.15 ,$410.62 ,$13.65 ,$622.15 ,$13.65 ,$66.19 ,$66.19 ,$18.91 ,$373.29 ,$528.83 ,$435.51 ,$13.65 ,$13.65 ,$591.04 ,$472.83 ,$466.61 ,$32.15 ,$528.83 ,$18.91 ,$32.15 ,$32.15 ,$435.51 ,$378.89 ,$13.65 ,$18.91 ,$18.53 ,$37.82 ,$14.47 ,$528.83 ,$42.55 ,$572.38 ,$435.51 ,$94.55 ,$94.55 ,$378.89 ,$94.55 ,$429.91 ,$559.94 ,$425.05 ,$18.72 ,$491.50 ,$14.47 ,$22.69 ,$22.69 ,$18.53 ,$22.69 ,$447.95 ,$385.73 ,$447.95 ,$447.95 ,$497.72 
ST NICHOLAS HOSPITAL - ACUTE,30100409,83690,HC LIPASE,301,1 ,$89.70 ,$59.20 ,$6.75 ,$89.70 ,$7.12 ,$24.12 ,$24.12 ,$6.89 ,$53.82 ,$76.25 ,$62.79 ,$7.12 ,$7.12 ,$85.22 ,$68.17 ,$67.28 ,$11.71 ,$76.25 ,$6.89 ,$11.71 ,$11.71 ,$62.79 ,$54.63 ,$7.12 ,$6.89 ,$6.75 ,$13.78 ,$7.55 ,$76.25 ,$15.50 ,$82.52 ,$62.79 ,$34.44 ,$34.44 ,$54.63 ,$34.44 ,$61.98 ,$80.73 ,$61.28 ,$6.82 ,$70.86 ,$7.55 ,$8.27 ,$8.27 ,$6.75 ,$8.27 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100410,83695,HC LIPOPROTEIN,301,1 ,$89.70 ,$59.20 ,$14.03 ,$89.70 ,$14.80 ,$50.12 ,$50.12 ,$14.32 ,$53.82 ,$76.25 ,$62.79 ,$14.80 ,$14.80 ,$85.22 ,$68.17 ,$67.28 ,$24.34 ,$76.25 ,$14.32 ,$24.34 ,$24.34 ,$62.79 ,$54.63 ,$14.80 ,$14.32 ,$14.03 ,$28.64 ,$15.69 ,$76.25 ,$32.22 ,$82.52 ,$62.79 ,$64.70 ,$64.70 ,$54.63 ,$64.70 ,$61.98 ,$80.73 ,$61.28 ,$14.17 ,$70.86 ,$15.69 ,$17.18 ,$17.18 ,$14.03 ,$17.18 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100411,83701,HC VLDL,301,1 ,$211.60 ,$139.66 ,$32.56 ,$211.60 ,$32.56 ,$118.51 ,$118.51 ,$33.86 ,$126.96 ,$179.86 ,$148.12 ,$32.56 ,$32.56 ,$201.02 ,$160.82 ,$158.70 ,$57.56 ,$179.86 ,$33.86 ,$57.56 ,$57.56 ,$148.12 ,$128.86 ,$32.56 ,$33.86 ,$33.18 ,$67.72 ,$34.51 ,$179.86 ,$76.19 ,$194.67 ,$148.12 ,$124.05 ,$124.05 ,$128.86 ,$124.05 ,$146.22 ,$190.44 ,$144.57 ,$33.52 ,$167.16 ,$34.51 ,$40.63 ,$40.63 ,$33.18 ,$40.63 ,$152.35 ,$131.19 ,$152.35 ,$152.35 ,$169.28 
ST NICHOLAS HOSPITAL - ACUTE,30100413,83704,HC LP FRACTN ION MOBILITY,301,1 ,$282.90 ,$186.71 ,$33.51 ,$282.90 ,$35.33 ,$119.67 ,$119.67 ,$34.19 ,$169.74 ,$240.47 ,$198.03 ,$35.33 ,$35.33 ,$268.76 ,$215.00 ,$212.18 ,$58.12 ,$240.47 ,$34.19 ,$58.12 ,$58.12 ,$198.03 ,$172.29 ,$35.33 ,$34.19 ,$33.51 ,$68.38 ,$37.45 ,$240.47 ,$76.93 ,$260.27 ,$198.03 ,$157.68 ,$157.68 ,$172.29 ,$157.68 ,$195.48 ,$254.61 ,$193.28 ,$33.84 ,$223.49 ,$37.45 ,$41.03 ,$41.03 ,$33.51 ,$41.03 ,$203.69 ,$175.40 ,$203.69 ,$203.69 ,$226.32 
ST NICHOLAS HOSPITAL - ACUTE,30100414,83704,HC NMR LIPOPROFILE LIP,301,1 ,$148.35 ,$97.91 ,$33.51 ,$148.35 ,$35.33 ,$119.67 ,$119.67 ,$34.19 ,$89.01 ,$126.10 ,$103.85 ,$35.33 ,$35.33 ,$140.93 ,$112.75 ,$111.26 ,$58.12 ,$126.10 ,$34.19 ,$58.12 ,$58.12 ,$103.85 ,$90.35 ,$35.33 ,$34.19 ,$33.51 ,$68.38 ,$37.45 ,$126.10 ,$76.93 ,$136.48 ,$103.85 ,$148.35 ,$148.35 ,$90.35 ,$148.35 ,$102.51 ,$133.52 ,$101.35 ,$33.84 ,$117.20 ,$37.45 ,$41.03 ,$41.03 ,$33.51 ,$41.03 ,$106.81 ,$91.98 ,$106.81 ,$106.81 ,$118.68 
ST NICHOLAS HOSPITAL - ACUTE,30100415,83718,HC CHOLESTEROL HDL,301,1 ,$77.05 ,$50.85 ,$8.03 ,$77.05 ,$8.46 ,$28.67 ,$28.67 ,$8.19 ,$46.23 ,$65.49 ,$53.94 ,$8.46 ,$8.46 ,$73.20 ,$58.56 ,$57.79 ,$13.92 ,$65.49 ,$8.19 ,$13.92 ,$13.92 ,$53.94 ,$46.92 ,$8.46 ,$8.19 ,$8.03 ,$16.38 ,$8.97 ,$65.49 ,$18.43 ,$70.89 ,$53.94 ,$40.92 ,$40.92 ,$46.92 ,$40.92 ,$53.24 ,$69.35 ,$52.64 ,$8.10 ,$60.87 ,$8.97 ,$9.83 ,$9.83 ,$8.03 ,$9.83 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100416,83721,HC CHOLESTEROL LDL,301,1 ,$89.70 ,$59.20 ,$10.29 ,$89.70 ,$10.85 ,$36.75 ,$36.75 ,$10.50 ,$53.82 ,$76.25 ,$62.79 ,$10.85 ,$10.85 ,$85.22 ,$68.17 ,$67.28 ,$17.85 ,$76.25 ,$10.50 ,$17.85 ,$17.85 ,$62.79 ,$54.63 ,$10.85 ,$10.50 ,$10.29 ,$21.00 ,$11.50 ,$76.25 ,$23.63 ,$82.52 ,$62.79 ,$47.70 ,$47.70 ,$54.63 ,$47.70 ,$61.98 ,$80.73 ,$61.28 ,$10.40 ,$70.86 ,$11.50 ,$12.60 ,$12.60 ,$10.29 ,$12.60 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100417,83735,HC MAGNESIUM,301,1 ,$59.80 ,$39.47 ,$6.57 ,$59.80 ,$6.92 ,$23.45 ,$23.45 ,$6.70 ,$35.88 ,$50.83 ,$41.86 ,$6.92 ,$6.92 ,$56.81 ,$45.45 ,$44.85 ,$11.39 ,$50.83 ,$6.70 ,$11.39 ,$11.39 ,$41.86 ,$36.42 ,$6.92 ,$6.70 ,$6.57 ,$13.40 ,$7.34 ,$50.83 ,$15.08 ,$55.02 ,$41.86 ,$33.48 ,$33.48 ,$36.42 ,$33.48 ,$41.32 ,$53.82 ,$40.86 ,$6.63 ,$47.24 ,$7.34 ,$8.04 ,$8.04 ,$6.57 ,$8.04 ,$43.06 ,$37.08 ,$43.06 ,$43.06 ,$47.84 
ST NICHOLAS HOSPITAL - ACUTE,30100418,83785,HC MANGANESE (MAYO),301,1 ,$180.55 ,$119.16 ,$26.12 ,$180.55 ,$27.54 ,$93.28 ,$93.28 ,$26.65 ,$108.33 ,$153.47 ,$126.39 ,$27.54 ,$27.54 ,$171.52 ,$137.22 ,$135.41 ,$45.31 ,$153.47 ,$26.65 ,$45.31 ,$45.31 ,$126.39 ,$109.96 ,$27.54 ,$26.65 ,$26.12 ,$53.30 ,$29.19 ,$153.47 ,$59.96 ,$166.11 ,$126.39 ,$122.91 ,$122.91 ,$109.96 ,$122.91 ,$124.76 ,$162.50 ,$123.35 ,$26.38 ,$142.63 ,$29.19 ,$31.98 ,$31.98 ,$26.12 ,$31.98 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30100419,83785,HC MANGANESE,301,1 ,$180.55 ,$119.16 ,$26.12 ,$180.55 ,$27.54 ,$93.28 ,$93.28 ,$26.65 ,$108.33 ,$153.47 ,$126.39 ,$27.54 ,$27.54 ,$171.52 ,$137.22 ,$135.41 ,$45.31 ,$153.47 ,$26.65 ,$45.31 ,$45.31 ,$126.39 ,$109.96 ,$27.54 ,$26.65 ,$26.12 ,$53.30 ,$29.19 ,$153.47 ,$59.96 ,$166.11 ,$126.39 ,$122.91 ,$122.91 ,$109.96 ,$122.91 ,$124.76 ,$162.50 ,$123.35 ,$26.38 ,$142.63 ,$29.19 ,$31.98 ,$31.98 ,$26.12 ,$31.98 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30100421,82542,HC BILE ACIDS,301,1 ,$361.10 ,$238.33 ,$23.61 ,$361.10 ,$24.89 ,$84.32 ,$84.32 ,$24.09 ,$216.66 ,$306.94 ,$252.77 ,$24.89 ,$24.89 ,$343.05 ,$274.44 ,$270.83 ,$40.95 ,$306.94 ,$24.09 ,$40.95 ,$40.95 ,$252.77 ,$219.91 ,$24.89 ,$24.09 ,$23.61 ,$48.18 ,$26.38 ,$306.94 ,$54.20 ,$332.21 ,$252.77 ,$90.23 ,$90.23 ,$219.91 ,$90.23 ,$249.52 ,$324.99 ,$246.70 ,$23.84 ,$285.27 ,$26.38 ,$28.91 ,$28.91 ,$23.61 ,$28.91 ,$259.99 ,$223.88 ,$259.99 ,$259.99 ,$288.88 
ST NICHOLAS HOSPITAL - ACUTE,30100422,83789,HC CLOMIPRAMINE,301,1 ,$232.30 ,$153.32 ,$23.63 ,$232.30 ,$24.91 ,$84.39 ,$84.39 ,$24.11 ,$139.38 ,$197.46 ,$162.61 ,$24.91 ,$24.91 ,$220.69 ,$176.55 ,$174.23 ,$40.99 ,$197.46 ,$24.11 ,$40.99 ,$40.99 ,$162.61 ,$141.47 ,$24.91 ,$24.11 ,$23.63 ,$48.22 ,$26.40 ,$197.46 ,$54.25 ,$213.72 ,$162.61 ,$90.23 ,$90.23 ,$141.47 ,$90.23 ,$160.52 ,$209.07 ,$158.71 ,$23.86 ,$183.52 ,$26.40 ,$28.93 ,$28.93 ,$23.63 ,$28.93 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30100423,G0480,HC ETHYL GLUCUR/SULFATE,301,1 ,$180.00 ,$118.80 ,$63.95 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$114.43 ,$108.00 ,$153.00 ,$126.00 ,$63.95 ,$63.95 ,$171.00 ,$136.80 ,$135.00 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$180.00 ,$126.00 ,$109.62 ,$63.95 ,$114.43 ,$112.14 ,$180.00 ,$67.79 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$162.00 ,$122.98 ,$113.26 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30100424,80183,HC TRILEPTAL,301,1 ,$100.00 ,$66.00 ,$12.98 ,$100.00 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$60.00 ,$85.00 ,$70.00 ,$13.69 ,$13.69 ,$95.00 ,$76.00 ,$75.00 ,$22.53 ,$85.00 ,$13.25 ,$22.53 ,$22.53 ,$70.00 ,$60.90 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$85.00 ,$29.81 ,$92.00 ,$70.00 ,$66.27 ,$66.27 ,$60.90 ,$66.27 ,$69.10 ,$90.00 ,$68.32 ,$13.11 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100425,G0480,HC MEPROBAMATE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30100426,83825,HC MERCURY,301,1 ,$116.15 ,$76.66 ,$15.93 ,$116.15 ,$16.80 ,$56.91 ,$56.91 ,$16.26 ,$69.69 ,$98.73 ,$81.31 ,$16.80 ,$16.80 ,$110.34 ,$88.27 ,$87.11 ,$27.64 ,$98.73 ,$16.26 ,$27.64 ,$27.64 ,$81.31 ,$70.74 ,$16.80 ,$16.26 ,$15.93 ,$32.52 ,$17.81 ,$98.73 ,$36.59 ,$106.86 ,$81.31 ,$81.26 ,$81.26 ,$70.74 ,$81.26 ,$80.26 ,$104.54 ,$79.35 ,$16.09 ,$91.76 ,$17.81 ,$19.51 ,$19.51 ,$15.93 ,$19.51 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100427,83825,HC MERCURY URINE,301,1 ,$116.15 ,$76.66 ,$15.93 ,$116.15 ,$16.80 ,$56.91 ,$56.91 ,$16.26 ,$69.69 ,$98.73 ,$81.31 ,$16.80 ,$16.80 ,$110.34 ,$88.27 ,$87.11 ,$27.64 ,$98.73 ,$16.26 ,$27.64 ,$27.64 ,$81.31 ,$70.74 ,$16.80 ,$16.26 ,$15.93 ,$32.52 ,$17.81 ,$98.73 ,$36.59 ,$106.86 ,$81.31 ,$81.26 ,$81.26 ,$70.74 ,$81.26 ,$80.26 ,$104.54 ,$79.35 ,$16.09 ,$91.76 ,$17.81 ,$19.51 ,$19.51 ,$15.93 ,$19.51 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100428,83825,HC MERCURY BLOOD,301,1 ,$116.15 ,$76.66 ,$15.93 ,$116.15 ,$16.80 ,$56.91 ,$56.91 ,$16.26 ,$69.69 ,$98.73 ,$81.31 ,$16.80 ,$16.80 ,$110.34 ,$88.27 ,$87.11 ,$27.64 ,$98.73 ,$16.26 ,$27.64 ,$27.64 ,$81.31 ,$70.74 ,$16.80 ,$16.26 ,$15.93 ,$32.52 ,$17.81 ,$98.73 ,$36.59 ,$106.86 ,$81.31 ,$81.26 ,$81.26 ,$70.74 ,$81.26 ,$80.26 ,$104.54 ,$79.35 ,$16.09 ,$91.76 ,$17.81 ,$19.51 ,$19.51 ,$15.93 ,$19.51 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100429,83825,HC MERCURY 24HR URINE,301,1 ,$116.15 ,$76.66 ,$15.93 ,$116.15 ,$16.80 ,$56.91 ,$56.91 ,$16.26 ,$69.69 ,$98.73 ,$81.31 ,$16.80 ,$16.80 ,$110.34 ,$88.27 ,$87.11 ,$27.64 ,$98.73 ,$16.26 ,$27.64 ,$27.64 ,$81.31 ,$70.74 ,$16.80 ,$16.26 ,$15.93 ,$32.52 ,$17.81 ,$98.73 ,$36.59 ,$106.86 ,$81.31 ,$81.26 ,$81.26 ,$70.74 ,$81.26 ,$80.26 ,$104.54 ,$79.35 ,$16.09 ,$91.76 ,$17.81 ,$19.51 ,$19.51 ,$15.93 ,$19.51 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100430,83835,HC METANEPHRINES,301,1 ,$154.10 ,$101.71 ,$16.60 ,$154.10 ,$17.50 ,$59.29 ,$59.29 ,$16.94 ,$92.46 ,$130.99 ,$107.87 ,$17.50 ,$17.50 ,$146.40 ,$117.12 ,$115.58 ,$28.80 ,$130.99 ,$16.94 ,$28.80 ,$28.80 ,$107.87 ,$93.85 ,$17.50 ,$16.94 ,$16.60 ,$33.88 ,$18.55 ,$130.99 ,$38.12 ,$141.77 ,$107.87 ,$84.66 ,$84.66 ,$93.85 ,$84.66 ,$106.48 ,$138.69 ,$105.28 ,$16.77 ,$121.74 ,$18.55 ,$20.33 ,$20.33 ,$16.60 ,$20.33 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100431,83835,HC METANEPHRINES PLASMA,301,1 ,$154.10 ,$101.71 ,$16.60 ,$154.10 ,$17.50 ,$59.29 ,$59.29 ,$16.94 ,$92.46 ,$130.99 ,$107.87 ,$17.50 ,$17.50 ,$146.40 ,$117.12 ,$115.58 ,$28.80 ,$130.99 ,$16.94 ,$28.80 ,$28.80 ,$107.87 ,$93.85 ,$17.50 ,$16.94 ,$16.60 ,$33.88 ,$18.55 ,$130.99 ,$38.12 ,$141.77 ,$107.87 ,$84.66 ,$84.66 ,$93.85 ,$84.66 ,$106.48 ,$138.69 ,$105.28 ,$16.77 ,$121.74 ,$18.55 ,$20.33 ,$20.33 ,$16.60 ,$20.33 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100432,83835,HC METANEPHRINES RANDM URINE,301,1 ,$154.10 ,$101.71 ,$16.60 ,$154.10 ,$17.50 ,$59.29 ,$59.29 ,$16.94 ,$92.46 ,$130.99 ,$107.87 ,$17.50 ,$17.50 ,$146.40 ,$117.12 ,$115.58 ,$28.80 ,$130.99 ,$16.94 ,$28.80 ,$28.80 ,$107.87 ,$93.85 ,$17.50 ,$16.94 ,$16.60 ,$33.88 ,$18.55 ,$130.99 ,$38.12 ,$141.77 ,$107.87 ,$84.66 ,$84.66 ,$93.85 ,$84.66 ,$106.48 ,$138.69 ,$105.28 ,$16.77 ,$121.74 ,$18.55 ,$20.33 ,$20.33 ,$16.60 ,$20.33 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100433,80358,HC METHADONE,301,1 ,$210.00 ,$138.60 ,$0.38 ,$210.00 ,$0.38 ,$79.87 ,$79.87 , N/A ,$126.00 ,$178.50 ,$147.00 ,$0.38 ,$0.38 ,$199.50 ,$159.60 ,$157.50 ,$38.86 ,$178.50 , N/A ,$38.86 ,$38.86 ,$147.00 ,$127.89 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$178.50 , N/A ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 , N/A ,$165.90 ,$0.40 , N/A , N/A , N/A , N/A ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,30100434,83873,HC MYELIN BASIC PROTEIN,301,1 ,$128.80 ,$85.01 ,$16.86 ,$128.80 ,$17.77 ,$60.20 ,$60.20 ,$17.20 ,$77.28 ,$109.48 ,$90.16 ,$17.77 ,$17.77 ,$122.36 ,$97.89 ,$96.60 ,$29.24 ,$109.48 ,$17.20 ,$29.24 ,$29.24 ,$90.16 ,$78.44 ,$17.77 ,$17.20 ,$16.86 ,$34.40 ,$18.84 ,$109.48 ,$38.70 ,$118.50 ,$90.16 ,$85.98 ,$85.98 ,$78.44 ,$85.98 ,$89.00 ,$115.92 ,$88.00 ,$17.02 ,$101.75 ,$18.84 ,$20.64 ,$20.64 ,$16.86 ,$20.64 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100435,83874,HC MYOGLOBIN,301,1 ,$128.80 ,$85.01 ,$12.66 ,$128.80 ,$13.35 ,$45.22 ,$45.22 ,$12.92 ,$77.28 ,$109.48 ,$90.16 ,$13.35 ,$13.35 ,$122.36 ,$97.89 ,$96.60 ,$21.96 ,$109.48 ,$12.92 ,$21.96 ,$21.96 ,$90.16 ,$78.44 ,$13.35 ,$12.92 ,$12.66 ,$25.84 ,$14.15 ,$109.48 ,$29.07 ,$118.50 ,$90.16 ,$64.55 ,$64.55 ,$78.44 ,$64.55 ,$89.00 ,$115.92 ,$88.00 ,$12.79 ,$101.75 ,$14.15 ,$15.50 ,$15.50 ,$12.66 ,$15.50 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100436,83874,HC MYOGLOBIN URINE,301,1 ,$128.80 ,$85.01 ,$12.66 ,$128.80 ,$13.35 ,$45.22 ,$45.22 ,$12.92 ,$77.28 ,$109.48 ,$90.16 ,$13.35 ,$13.35 ,$122.36 ,$97.89 ,$96.60 ,$21.96 ,$109.48 ,$12.92 ,$21.96 ,$21.96 ,$90.16 ,$78.44 ,$13.35 ,$12.92 ,$12.66 ,$25.84 ,$14.15 ,$109.48 ,$29.07 ,$118.50 ,$90.16 ,$64.55 ,$64.55 ,$78.44 ,$64.55 ,$89.00 ,$115.92 ,$88.00 ,$12.79 ,$101.75 ,$14.15 ,$15.50 ,$15.50 ,$12.66 ,$15.50 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100437,83874,HC MYOGLOBIN URINE 2,301,1 ,$128.80 ,$85.01 ,$12.66 ,$128.80 ,$13.35 ,$45.22 ,$45.22 ,$12.92 ,$77.28 ,$109.48 ,$90.16 ,$13.35 ,$13.35 ,$122.36 ,$97.89 ,$96.60 ,$21.96 ,$109.48 ,$12.92 ,$21.96 ,$21.96 ,$90.16 ,$78.44 ,$13.35 ,$12.92 ,$12.66 ,$25.84 ,$14.15 ,$109.48 ,$29.07 ,$118.50 ,$90.16 ,$64.55 ,$64.55 ,$78.44 ,$64.55 ,$89.00 ,$115.92 ,$88.00 ,$12.79 ,$101.75 ,$14.15 ,$15.50 ,$15.50 ,$12.66 ,$15.50 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$296.70 ,$195.82 ,$38.47 ,$296.70 ,$40.57 ,$137.41 ,$137.41 ,$39.26 ,$178.02 ,$252.20 ,$207.69 ,$40.57 ,$40.57 ,$281.87 ,$225.49 ,$222.53 ,$66.74 ,$252.20 ,$39.26 ,$66.74 ,$66.74 ,$207.69 ,$180.69 ,$40.57 ,$39.26 ,$38.47 ,$78.52 ,$43.00 ,$252.20 ,$88.34 ,$272.96 ,$207.69 ,$169.66 ,$169.66 ,$180.69 ,$169.66 ,$205.02 ,$267.03 ,$202.71 ,$38.86 ,$234.39 ,$43.00 ,$47.11 ,$47.11 ,$38.47 ,$47.11 ,$213.62 ,$183.95 ,$213.62 ,$213.62 ,$237.36 
ST NICHOLAS HOSPITAL - ACUTE,30100439,83521,HC NEPHELOMETRY EA ANALYTE,301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.27 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.27 ,$17.27 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.27 ,$17.27 ,$16.92 ,$34.54 ,$18.31 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$58.91 ,$70.70 ,$70.74 ,$70.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.31 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100440,83521,HC NEPHELOMETRY EA AN (MAYO),301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.27 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.27 ,$17.27 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.27 ,$17.27 ,$16.92 ,$34.54 ,$18.31 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$58.91 ,$70.70 ,$70.74 ,$70.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.31 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100441,86160,HC C1 ESTERASE INHIB PRO QU,301,1 ,$103.50 ,$68.31 ,$11.76 ,$103.50 ,$12.40 ,$42.00 ,$42.00 ,$12.00 ,$62.10 ,$87.98 ,$72.45 ,$12.40 ,$12.40 ,$98.33 ,$78.66 ,$77.63 ,$20.40 ,$87.98 ,$12.00 ,$20.40 ,$20.40 ,$72.45 ,$63.03 ,$12.40 ,$12.00 ,$11.76 ,$24.00 ,$13.14 ,$87.98 ,$27.00 ,$95.22 ,$72.45 ,$60.01 ,$60.01 ,$63.03 ,$60.01 ,$71.52 ,$93.15 ,$70.71 ,$11.88 ,$81.77 ,$13.14 ,$14.40 ,$14.40 ,$11.76 ,$14.40 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100442,83883,HC NEPHELOMETRY EA AN (FREE),301,1 ,$146.05 ,$96.39 ,$13.33 ,$146.05 ,$14.05 ,$47.60 ,$47.60 ,$13.60 ,$87.63 ,$124.14 ,$102.24 ,$14.05 ,$14.05 ,$138.75 ,$111.00 ,$109.54 ,$23.12 ,$124.14 ,$13.60 ,$23.12 ,$23.12 ,$102.24 ,$88.94 ,$14.05 ,$13.60 ,$13.33 ,$27.20 ,$14.89 ,$124.14 ,$30.60 ,$134.37 ,$102.24 ,$67.92 ,$67.92 ,$88.94 ,$67.92 ,$100.92 ,$131.45 ,$99.78 ,$13.47 ,$115.38 ,$14.89 ,$16.32 ,$16.32 ,$13.33 ,$16.32 ,$105.16 ,$90.55 ,$105.16 ,$105.16 ,$116.84 
ST NICHOLAS HOSPITAL - ACUTE,30100443,83883,HC NEPHELOMETRY EA AN 2,301,1 ,$103.50 ,$68.31 ,$13.33 ,$103.50 ,$14.05 ,$47.60 ,$47.60 ,$13.60 ,$62.10 ,$87.98 ,$72.45 ,$14.05 ,$14.05 ,$98.33 ,$78.66 ,$77.63 ,$23.12 ,$87.98 ,$13.60 ,$23.12 ,$23.12 ,$72.45 ,$63.03 ,$14.05 ,$13.60 ,$13.33 ,$27.20 ,$14.89 ,$87.98 ,$30.60 ,$95.22 ,$72.45 ,$67.92 ,$67.92 ,$63.03 ,$67.92 ,$71.52 ,$93.15 ,$70.71 ,$13.47 ,$81.77 ,$14.89 ,$16.32 ,$16.32 ,$13.33 ,$16.32 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100444,G0480,HC NICOTINE,301,1 ,$63.00 ,$41.58 ,$37.80 ,$141.75 ,$63.00 ,$63.00 ,$63.00 ,$63.00 ,$37.80 ,$53.55 ,$44.10 ,$63.00 ,$63.00 ,$59.85 ,$47.88 ,$47.25 ,$63.00 ,$53.55 ,$63.00 ,$63.00 ,$63.00 ,$44.10 ,$38.37 ,$63.00 ,$63.00 ,$61.74 ,$63.00 ,$66.78 ,$53.55 ,$141.75 ,$57.96 ,$44.10 ,$63.00 ,$63.00 ,$38.37 ,$63.00 ,$43.53 ,$56.70 ,$43.04 ,$62.36 ,$49.77 ,$66.78 ,$63.00 ,$63.00 ,$61.74 ,$63.00 ,$45.36 ,$39.06 ,$45.36 ,$45.36 ,$50.40 
ST NICHOLAS HOSPITAL - ACUTE,30100445,G0480,HC NICOTINE W/METABOLITE,301,1 ,$120.00 ,$79.20 ,$63.95 ,$257.47 ,$63.95 ,$120.00 ,$120.00 ,$114.43 ,$72.00 ,$102.00 ,$84.00 ,$63.95 ,$63.95 ,$114.00 ,$91.20 ,$90.00 ,$120.00 ,$102.00 ,$114.43 ,$120.00 ,$120.00 ,$84.00 ,$73.08 ,$63.95 ,$114.43 ,$112.14 ,$120.00 ,$67.79 ,$102.00 ,$257.47 ,$110.40 ,$84.00 ,$120.00 ,$120.00 ,$73.08 ,$120.00 ,$82.92 ,$108.00 ,$81.98 ,$113.26 ,$94.80 ,$67.79 ,$120.00 ,$120.00 ,$112.14 ,$120.00 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30100460,84311,HC FUNGITELL (1-3)-B-D-GLUCAN,301,1 ,$411.70 ,$271.72 ,$7.94 ,$411.70 ,$8.37 ,$28.35 ,$28.35 ,$8.10 ,$247.02 ,$349.95 ,$288.19 ,$8.37 ,$8.37 ,$391.12 ,$312.89 ,$308.78 ,$13.77 ,$349.95 ,$8.10 ,$13.77 ,$13.77 ,$288.19 ,$250.73 ,$8.37 ,$8.10 ,$7.94 ,$16.20 ,$8.87 ,$349.95 ,$18.23 ,$378.76 ,$288.19 ,$34.95 ,$34.95 ,$250.73 ,$34.95 ,$284.48 ,$370.53 ,$281.27 ,$8.02 ,$325.24 ,$8.87 ,$9.72 ,$9.72 ,$7.94 ,$9.72 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,30100480,82261,HC BIOTINIDASE SERUM,301,1 ,$146.05 ,$96.39 ,$16.53 ,$146.05 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$87.63 ,$124.14 ,$102.24 ,$17.43 ,$17.43 ,$138.75 ,$111.00 ,$109.54 ,$28.68 ,$124.14 ,$16.87 ,$28.68 ,$28.68 ,$102.24 ,$88.94 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$124.14 ,$37.96 ,$134.37 ,$102.24 ,$72.02 ,$72.02 ,$88.94 ,$72.02 ,$100.92 ,$131.45 ,$99.78 ,$16.70 ,$115.38 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$105.16 ,$90.55 ,$105.16 ,$105.16 ,$116.84 
ST NICHOLAS HOSPITAL - ACUTE,30100481,82373,HC CDG SERUM,301,1 ,$210.45 ,$138.90 ,$10.38 ,$210.45 ,$10.38 ,$63.21 ,$63.21 ,$18.06 ,$126.27 ,$178.88 ,$147.32 ,$10.38 ,$10.38 ,$199.93 ,$159.94 ,$157.84 ,$30.70 ,$178.88 ,$18.06 ,$30.70 ,$30.70 ,$147.32 ,$128.16 ,$10.38 ,$18.06 ,$17.70 ,$36.12 ,$11.00 ,$178.88 ,$40.64 ,$193.61 ,$147.32 ,$90.23 ,$90.23 ,$128.16 ,$90.23 ,$145.42 ,$189.41 ,$143.78 ,$17.88 ,$166.26 ,$11.00 ,$21.67 ,$21.67 ,$17.70 ,$21.67 ,$151.52 ,$130.48 ,$151.52 ,$151.52 ,$168.36 
ST NICHOLAS HOSPITAL - ACUTE,30100482,82139,HC AMINO ACID QN CSF,301,1 ,$591.10 ,$390.13 ,$16.53 ,$591.10 ,$17.43 ,$59.05 ,$59.05 ,$16.87 ,$354.66 ,$502.44 ,$413.77 ,$17.43 ,$17.43 ,$561.55 ,$449.24 ,$443.33 ,$28.68 ,$502.44 ,$16.87 ,$28.68 ,$28.68 ,$413.77 ,$359.98 ,$17.43 ,$16.87 ,$16.53 ,$33.74 ,$18.48 ,$502.44 ,$37.96 ,$543.81 ,$413.77 ,$72.02 ,$72.02 ,$359.98 ,$72.02 ,$408.45 ,$531.99 ,$403.84 ,$16.70 ,$466.97 ,$18.48 ,$20.24 ,$20.24 ,$16.53 ,$20.24 ,$425.59 ,$366.48 ,$425.59 ,$425.59 ,$472.88 
ST NICHOLAS HOSPITAL - ACUTE,30100483,84210,HC PYRUVIC ACID CSF,301,1 ,$118.45 ,$78.18 ,$14.19 ,$118.45 ,$14.96 ,$50.68 ,$50.68 ,$14.48 ,$71.07 ,$100.68 ,$82.92 ,$14.96 ,$14.96 ,$112.53 ,$90.02 ,$88.84 ,$24.62 ,$100.68 ,$14.48 ,$24.62 ,$24.62 ,$82.92 ,$72.14 ,$14.96 ,$14.48 ,$14.19 ,$28.96 ,$15.86 ,$100.68 ,$32.58 ,$108.97 ,$82.92 ,$54.26 ,$54.26 ,$72.14 ,$54.26 ,$81.85 ,$106.61 ,$80.93 ,$14.33 ,$93.58 ,$15.86 ,$17.38 ,$17.38 ,$14.19 ,$17.38 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,30100484,83605,HC LACTIC ACID CSF,301,1 ,$154.10 ,$101.71 ,$11.34 ,$154.10 ,$11.96 ,$40.50 ,$40.50 ,$11.57 ,$92.46 ,$130.99 ,$107.87 ,$11.96 ,$11.96 ,$146.40 ,$117.12 ,$115.58 ,$19.67 ,$130.99 ,$11.57 ,$19.67 ,$19.67 ,$107.87 ,$93.85 ,$11.96 ,$11.57 ,$11.34 ,$23.14 ,$12.68 ,$130.99 ,$26.03 ,$141.77 ,$107.87 ,$53.38 ,$53.38 ,$93.85 ,$53.38 ,$106.48 ,$138.69 ,$105.28 ,$11.46 ,$121.74 ,$12.68 ,$13.88 ,$13.88 ,$11.34 ,$13.88 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100485,83605,HC LACTIC ACID SPINAL FLUID,301,1 ,$154.10 ,$101.71 ,$11.34 ,$154.10 ,$11.96 ,$40.50 ,$40.50 ,$11.57 ,$92.46 ,$130.99 ,$107.87 ,$11.96 ,$11.96 ,$146.40 ,$117.12 ,$115.58 ,$19.67 ,$130.99 ,$11.57 ,$19.67 ,$19.67 ,$107.87 ,$93.85 ,$11.96 ,$11.57 ,$11.34 ,$23.14 ,$12.68 ,$130.99 ,$26.03 ,$141.77 ,$107.87 ,$53.38 ,$53.38 ,$93.85 ,$53.38 ,$106.48 ,$138.69 ,$105.28 ,$11.46 ,$121.74 ,$12.68 ,$13.88 ,$13.88 ,$11.34 ,$13.88 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100486,80165,HC VALPROIC ACID FREE,301,1 ,$82.80 ,$54.65 ,$13.27 ,$82.80 ,$13.99 ,$47.39 ,$47.39 ,$13.54 ,$49.68 ,$70.38 ,$57.96 ,$13.99 ,$13.99 ,$78.66 ,$62.93 ,$62.10 ,$23.02 ,$70.38 ,$13.54 ,$23.02 ,$23.02 ,$57.96 ,$50.43 ,$13.99 ,$13.54 ,$13.27 ,$27.08 ,$14.83 ,$70.38 ,$30.47 ,$76.18 ,$57.96 ,$67.55 ,$67.55 ,$50.43 ,$67.55 ,$57.21 ,$74.52 ,$56.57 ,$13.41 ,$65.41 ,$14.83 ,$16.25 ,$16.25 ,$13.27 ,$16.25 ,$59.62 ,$51.34 ,$59.62 ,$59.62 ,$66.24 
ST NICHOLAS HOSPITAL - ACUTE,30100515,82542,HC CHROMATO QN SGL 6TGN 6MMPN RBC,301,1 ,$334.65 ,$220.87 ,$23.61 ,$334.65 ,$24.89 ,$84.32 ,$84.32 ,$24.09 ,$200.79 ,$284.45 ,$234.26 ,$24.89 ,$24.89 ,$317.92 ,$254.33 ,$250.99 ,$40.95 ,$284.45 ,$24.09 ,$40.95 ,$40.95 ,$234.26 ,$203.80 ,$24.89 ,$24.09 ,$23.61 ,$48.18 ,$26.38 ,$284.45 ,$54.20 ,$307.88 ,$234.26 ,$90.23 ,$90.23 ,$203.80 ,$90.23 ,$231.24 ,$301.19 ,$228.63 ,$23.84 ,$264.37 ,$26.38 ,$28.91 ,$28.91 ,$23.61 ,$28.91 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30100660,83915,HC NUCLEOTIDASE,301,1 ,$167.90 ,$110.81 ,$10.93 ,$167.90 ,$11.52 ,$39.03 ,$39.03 ,$11.15 ,$100.74 ,$142.72 ,$117.53 ,$11.52 ,$11.52 ,$159.51 ,$127.60 ,$125.93 ,$18.96 ,$142.72 ,$11.15 ,$18.96 ,$18.96 ,$117.53 ,$102.25 ,$11.52 ,$11.15 ,$10.93 ,$22.30 ,$12.21 ,$142.72 ,$25.09 ,$154.47 ,$117.53 ,$55.72 ,$55.72 ,$102.25 ,$55.72 ,$116.02 ,$151.11 ,$114.71 ,$11.03 ,$132.64 ,$12.21 ,$13.38 ,$13.38 ,$10.93 ,$13.38 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100661,83916,HC OLIGOCLONAL BANDS,301,1 ,$167.90 ,$110.81 ,$26.84 ,$167.90 ,$28.28 ,$95.87 ,$95.87 ,$27.39 ,$100.74 ,$142.72 ,$117.53 ,$28.28 ,$28.28 ,$159.51 ,$127.60 ,$125.93 ,$46.56 ,$142.72 ,$27.39 ,$46.56 ,$46.56 ,$117.53 ,$102.25 ,$28.28 ,$27.39 ,$26.84 ,$54.78 ,$29.98 ,$142.72 ,$61.63 ,$154.47 ,$117.53 ,$100.49 ,$100.49 ,$102.25 ,$100.49 ,$116.02 ,$151.11 ,$114.71 ,$27.11 ,$132.64 ,$29.98 ,$32.87 ,$32.87 ,$26.84 ,$32.87 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100662,83918,HC ORGANIC ACIDS QD,301,1 ,$760.15 ,$501.70 ,$23.13 ,$760.15 ,$23.14 ,$82.60 ,$82.60 ,$23.60 ,$456.09 ,$646.13 ,$532.11 ,$23.14 ,$23.14 ,$722.14 ,$577.71 ,$570.11 ,$40.12 ,$646.13 ,$23.60 ,$40.12 ,$40.12 ,$532.11 ,$462.93 ,$23.14 ,$23.60 ,$23.13 ,$47.20 ,$24.53 ,$646.13 ,$53.10 ,$699.34 ,$532.11 ,$82.25 ,$82.25 ,$462.93 ,$82.25 ,$525.26 ,$684.14 ,$519.33 ,$23.36 ,$600.52 ,$24.53 ,$28.32 ,$28.32 ,$23.13 ,$28.32 ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,30100663,83918,HC ORGANIC ACIDS QN,301,1 ,"$1,313.30 ",$866.78 ,$23.13 ,"$1,313.30 ",$23.14 ,$82.60 ,$82.60 ,$23.60 ,$787.98 ,"$1,116.31 ",$919.31 ,$23.14 ,$23.14 ,"$1,247.64 ",$998.11 ,$984.98 ,$40.12 ,"$1,116.31 ",$23.60 ,$40.12 ,$40.12 ,$919.31 ,$799.80 ,$23.14 ,$23.60 ,$23.13 ,$47.20 ,$24.53 ,"$1,116.31 ",$53.10 ,"$1,208.24 ",$919.31 ,$82.25 ,$82.25 ,$799.80 ,$82.25 ,$907.49 ,"$1,181.97 ",$897.25 ,$23.36 ,"$1,037.51 ",$24.53 ,$28.32 ,$28.32 ,$23.13 ,$28.32 ,$945.58 ,$814.25 ,$945.58 ,$945.58 ,"$1,050.64 "
ST NICHOLAS HOSPITAL - ACUTE,30100664,83918,HC ORGANIC ACIDS URINE,301,1 ,"$1,362.75 ",$899.42 ,$23.13 ,"$1,362.75 ",$23.14 ,$82.60 ,$82.60 ,$23.60 ,$817.65 ,"$1,158.34 ",$953.93 ,$23.14 ,$23.14 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$40.12 ,"$1,158.34 ",$23.60 ,$40.12 ,$40.12 ,$953.93 ,$829.91 ,$23.14 ,$23.60 ,$23.13 ,$47.20 ,$24.53 ,"$1,158.34 ",$53.10 ,"$1,253.73 ",$953.93 ,$82.25 ,$82.25 ,$829.91 ,$82.25 ,$941.66 ,"$1,226.48 ",$931.03 ,$23.36 ,"$1,076.57 ",$24.53 ,$28.32 ,$28.32 ,$23.13 ,$28.32 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,30100665,83918,HC ACYLGLYCINE,301,1 ,"$1,102.85 ",$727.88 ,$23.13 ,"$1,102.85 ",$23.14 ,$82.60 ,$82.60 ,$23.60 ,$661.71 ,$937.42 ,$772.00 ,$23.14 ,$23.14 ,"$1,047.71 ",$838.17 ,$827.14 ,$40.12 ,$937.42 ,$23.60 ,$40.12 ,$40.12 ,$772.00 ,$671.64 ,$23.14 ,$23.60 ,$23.13 ,$47.20 ,$24.53 ,$937.42 ,$53.10 ,"$1,014.62 ",$772.00 ,$82.25 ,$82.25 ,$671.64 ,$82.25 ,$762.07 ,$992.57 ,$753.47 ,$23.36 ,$871.25 ,$24.53 ,$28.32 ,$28.32 ,$23.13 ,$28.32 ,$794.05 ,$683.77 ,$794.05 ,$794.05 ,$882.28 
ST NICHOLAS HOSPITAL - ACUTE,30100666,83921,HC ORGANIC ACID SNG QN (MEHTYL),301,1 ,$141.45 ,$93.36 ,$20.79 ,$141.45 ,$21.92 ,$74.24 ,$74.24 ,$21.21 ,$84.87 ,$120.23 ,$99.02 ,$21.92 ,$21.92 ,$134.38 ,$107.50 ,$106.09 ,$36.06 ,$120.23 ,$21.21 ,$36.06 ,$36.06 ,$99.02 ,$86.14 ,$21.92 ,$21.21 ,$20.79 ,$42.42 ,$23.24 ,$120.23 ,$47.72 ,$130.13 ,$99.02 ,$82.25 ,$82.25 ,$86.14 ,$82.25 ,$97.74 ,$127.31 ,$96.64 ,$20.99 ,$111.75 ,$23.24 ,$25.45 ,$25.45 ,$20.79 ,$25.45 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100667,80364,HC OPIATES EXP,301,1 ,$37.00 ,$24.42 ,$0.38 ,$37.00 ,$0.38 ,$25.36 ,$25.36 , N/A ,$22.20 ,$31.45 ,$25.90 ,$0.38 ,$0.38 ,$35.15 ,$28.12 ,$27.75 ,$27.08 ,$31.45 , N/A ,$27.08 ,$27.08 ,$25.90 ,$22.53 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$31.45 , N/A ,$34.04 ,$25.90 ,$18.77 ,$22.52 ,$22.53 ,$22.52 ,$25.57 ,$33.30 ,$25.28 , N/A ,$29.23 ,$0.40 , N/A , N/A , N/A , N/A ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$29.60 
ST NICHOLAS HOSPITAL - ACUTE,30100668,83930,HC OSMOLALITY BLOOD,301,1 ,$57.50 ,$37.95 ,$6.48 ,$57.50 ,$6.83 ,$23.14 ,$23.14 ,$6.61 ,$34.50 ,$48.88 ,$40.25 ,$6.83 ,$6.83 ,$54.63 ,$43.70 ,$43.13 ,$11.24 ,$48.88 ,$6.61 ,$11.24 ,$11.24 ,$40.25 ,$35.02 ,$6.83 ,$6.61 ,$6.48 ,$13.22 ,$7.24 ,$48.88 ,$14.87 ,$52.90 ,$40.25 ,$33.04 ,$33.04 ,$35.02 ,$33.04 ,$39.73 ,$51.75 ,$39.28 ,$6.55 ,$45.43 ,$7.24 ,$7.93 ,$7.93 ,$6.48 ,$7.93 ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,30100669,83935,HC OSMOLALITY URINE,301,1 ,$60.95 ,$40.23 ,$6.68 ,$60.95 ,$7.05 ,$23.87 ,$23.87 ,$6.82 ,$36.57 ,$51.81 ,$42.67 ,$7.05 ,$7.05 ,$57.90 ,$46.32 ,$45.71 ,$11.59 ,$51.81 ,$6.82 ,$11.59 ,$11.59 ,$42.67 ,$37.12 ,$7.05 ,$6.82 ,$6.68 ,$13.64 ,$7.47 ,$51.81 ,$15.35 ,$56.07 ,$42.67 ,$34.07 ,$34.07 ,$37.12 ,$34.07 ,$42.12 ,$54.86 ,$41.64 ,$6.75 ,$48.15 ,$7.47 ,$8.18 ,$8.18 ,$6.68 ,$8.18 ,$43.88 ,$37.79 ,$43.88 ,$43.88 ,$48.76 
ST NICHOLAS HOSPITAL - ACUTE,30100670,83945,HC OXALATE,301,1 ,$69.00 ,$45.54 ,$14.16 ,$69.00 ,$14.93 ,$50.58 ,$50.58 ,$14.45 ,$41.40 ,$58.65 ,$48.30 ,$14.93 ,$14.93 ,$65.55 ,$52.44 ,$51.75 ,$24.57 ,$58.65 ,$14.45 ,$24.57 ,$24.57 ,$48.30 ,$42.02 ,$14.93 ,$14.45 ,$14.16 ,$28.90 ,$15.83 ,$58.65 ,$32.51 ,$63.48 ,$48.30 ,$64.33 ,$64.33 ,$42.02 ,$64.33 ,$47.68 ,$62.10 ,$47.14 ,$14.30 ,$54.51 ,$15.83 ,$17.34 ,$17.34 ,$14.16 ,$17.34 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30100671,83945,HC OXALATE 24 HR URINE,301,1 ,$143.75 ,$94.88 ,$14.16 ,$143.75 ,$14.93 ,$50.58 ,$50.58 ,$14.45 ,$86.25 ,$122.19 ,$100.63 ,$14.93 ,$14.93 ,$136.56 ,$109.25 ,$107.81 ,$24.57 ,$122.19 ,$14.45 ,$24.57 ,$24.57 ,$100.63 ,$87.54 ,$14.93 ,$14.45 ,$14.16 ,$28.90 ,$15.83 ,$122.19 ,$32.51 ,$132.25 ,$100.63 ,$64.33 ,$64.33 ,$87.54 ,$64.33 ,$99.33 ,$129.38 ,$98.21 ,$14.30 ,$113.56 ,$15.83 ,$17.34 ,$17.34 ,$14.16 ,$17.34 ,$103.50 ,$89.13 ,$103.50 ,$103.50 ,$115.00 
ST NICHOLAS HOSPITAL - ACUTE,30100672,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$361.10 ,$238.33 ,$40.45 ,$361.10 ,$42.65 ,$144.48 ,$144.48 ,$41.28 ,$216.66 ,$306.94 ,$252.77 ,$42.65 ,$42.65 ,$343.05 ,$274.44 ,$270.83 ,$70.18 ,$306.94 ,$41.28 ,$70.18 ,$70.18 ,$252.77 ,$219.91 ,$42.65 ,$41.28 ,$40.45 ,$82.56 ,$45.21 ,$306.94 ,$92.88 ,$332.21 ,$252.77 ,$206.29 ,$206.29 ,$219.91 ,$206.29 ,$249.52 ,$324.99 ,$246.70 ,$40.86 ,$285.27 ,$45.21 ,$49.54 ,$49.54 ,$40.45 ,$49.54 ,$259.99 ,$223.88 ,$259.99 ,$259.99 ,$288.88 
ST NICHOLAS HOSPITAL - ACUTE,30100673,83986,HC PH BODY FLUID,301,1 ,$31.05 ,$20.49 ,$3.51 ,$31.05 ,$3.70 ,$12.53 ,$12.53 ,$3.58 ,$18.63 ,$26.39 ,$21.74 ,$3.70 ,$3.70 ,$29.50 ,$23.60 ,$23.29 ,$6.09 ,$26.39 ,$3.58 ,$6.09 ,$6.09 ,$21.74 ,$18.91 ,$3.70 ,$3.58 ,$3.51 ,$7.16 ,$3.92 ,$26.39 ,$8.06 ,$28.57 ,$21.74 ,$17.88 ,$17.88 ,$18.91 ,$17.88 ,$21.46 ,$27.95 ,$21.21 ,$3.55 ,$24.53 ,$3.92 ,$4.30 ,$4.30 ,$3.51 ,$4.30 ,$22.36 ,$19.25 ,$22.36 ,$22.36 ,$24.84 
ST NICHOLAS HOSPITAL - ACUTE,30100674,83986,HC PH BODY FLUID (FECES),301,1 ,$31.05 ,$20.49 ,$3.51 ,$31.05 ,$3.70 ,$12.53 ,$12.53 ,$3.58 ,$18.63 ,$26.39 ,$21.74 ,$3.70 ,$3.70 ,$29.50 ,$23.60 ,$23.29 ,$6.09 ,$26.39 ,$3.58 ,$6.09 ,$6.09 ,$21.74 ,$18.91 ,$3.70 ,$3.58 ,$3.51 ,$7.16 ,$3.92 ,$26.39 ,$8.06 ,$28.57 ,$21.74 ,$17.88 ,$17.88 ,$18.91 ,$17.88 ,$21.46 ,$27.95 ,$21.21 ,$3.55 ,$24.53 ,$3.92 ,$4.30 ,$4.30 ,$3.51 ,$4.30 ,$22.36 ,$19.25 ,$22.36 ,$22.36 ,$24.84 
ST NICHOLAS HOSPITAL - ACUTE,30100675,83992,HC PHENCYCLIDINE (PCP),301,1 ,$128.80 ,$85.01 ,$20.67 ,$128.80 ,$20.67 ,$123.22 ,$123.22 , N/A ,$77.28 ,$109.48 ,$90.16 ,$20.67 ,$20.67 ,$122.36 ,$97.89 ,$96.60 ,$59.65 ,$109.48 , N/A ,$59.65 ,$59.65 ,$90.16 ,$78.44 ,$20.67 , N/A , N/A , N/A ,$21.91 ,$109.48 , N/A ,$118.50 ,$90.16 ,$73.45 ,$73.45 ,$78.44 ,$73.45 ,$89.00 ,$115.92 ,$88.00 , N/A ,$101.75 ,$21.91 ,$51.97 ,$51.97 , N/A ,$51.97 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100676,84030,HC NEWBORN SCREEN PKU,301,1 ,$244.95 ,$161.67 ,$5.39 ,$244.95 ,$5.68 ,$19.25 ,$19.25 ,$5.50 ,$146.97 ,$208.21 ,$171.47 ,$5.68 ,$5.68 ,$232.70 ,$186.16 ,$183.71 ,$9.35 ,$208.21 ,$5.50 ,$9.35 ,$9.35 ,$171.47 ,$149.17 ,$5.68 ,$5.50 ,$5.39 ,$11.00 ,$6.02 ,$208.21 ,$12.38 ,$225.35 ,$171.47 ,$27.48 ,$27.48 ,$149.17 ,$27.48 ,$169.26 ,$220.46 ,$167.35 ,$5.45 ,$193.51 ,$6.02 ,$6.60 ,$6.60 ,$5.39 ,$6.60 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30100677,84060,HC ACID PHOSPHATASE,301,1 ,$119.60 ,$78.94 ,$7.49 ,$119.60 ,$7.89 ,$26.74 ,$26.74 ,$7.64 ,$71.76 ,$101.66 ,$83.72 ,$7.89 ,$7.89 ,$113.62 ,$90.90 ,$89.70 ,$12.99 ,$101.66 ,$7.64 ,$12.99 ,$12.99 ,$83.72 ,$72.84 ,$7.89 ,$7.64 ,$7.49 ,$15.28 ,$8.36 ,$101.66 ,$17.19 ,$110.03 ,$83.72 ,$36.93 ,$36.93 ,$72.84 ,$36.93 ,$82.64 ,$107.64 ,$81.71 ,$7.57 ,$94.48 ,$8.36 ,$9.17 ,$9.17 ,$7.49 ,$9.17 ,$86.11 ,$74.15 ,$86.11 ,$86.11 ,$95.68 
ST NICHOLAS HOSPITAL - ACUTE,30100678,84066,HC PHOSPHATASE ACID PROSTATIC,301,1 ,$128.80 ,$85.01 ,$9.47 ,$128.80 ,$9.98 ,$33.81 ,$33.81 ,$9.66 ,$77.28 ,$109.48 ,$90.16 ,$9.98 ,$9.98 ,$122.36 ,$97.89 ,$96.60 ,$16.42 ,$109.48 ,$9.66 ,$16.42 ,$16.42 ,$90.16 ,$78.44 ,$9.98 ,$9.66 ,$9.47 ,$19.32 ,$10.58 ,$109.48 ,$21.74 ,$118.50 ,$90.16 ,$48.28 ,$48.28 ,$78.44 ,$48.28 ,$89.00 ,$115.92 ,$88.00 ,$9.56 ,$101.75 ,$10.58 ,$11.59 ,$11.59 ,$9.47 ,$11.59 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$32.20 ,$21.25 ,$5.08 ,$32.20 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$19.32 ,$27.37 ,$22.54 ,$5.35 ,$5.35 ,$30.59 ,$24.47 ,$24.15 ,$8.81 ,$27.37 ,$5.18 ,$8.81 ,$8.81 ,$22.54 ,$19.61 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$27.37 ,$11.66 ,$29.62 ,$22.54 ,$25.86 ,$25.86 ,$19.61 ,$25.86 ,$22.25 ,$28.98 ,$22.00 ,$5.13 ,$25.44 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$23.18 ,$19.96 ,$23.18 ,$23.18 ,$25.76 
ST NICHOLAS HOSPITAL - ACUTE,30100680,84075,HC ALKALINE PHOSPHATASE TOT,301,1 ,$46.00 ,$30.36 ,$5.08 ,$46.00 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$27.60 ,$39.10 ,$32.20 ,$5.35 ,$5.35 ,$43.70 ,$34.96 ,$34.50 ,$8.81 ,$39.10 ,$5.18 ,$8.81 ,$8.81 ,$32.20 ,$28.01 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$39.10 ,$11.66 ,$42.32 ,$32.20 ,$25.86 ,$25.86 ,$28.01 ,$25.86 ,$31.79 ,$41.40 ,$31.43 ,$5.13 ,$36.34 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30100681,84080,HC ALK PHOS ISOENZ,301,1 ,$128.80 ,$85.01 ,$14.48 ,$128.80 ,$15.27 ,$51.73 ,$51.73 ,$14.78 ,$77.28 ,$109.48 ,$90.16 ,$15.27 ,$15.27 ,$122.36 ,$97.89 ,$96.60 ,$25.13 ,$109.48 ,$14.78 ,$25.13 ,$25.13 ,$90.16 ,$78.44 ,$15.27 ,$14.78 ,$14.48 ,$29.56 ,$16.19 ,$109.48 ,$33.26 ,$118.50 ,$90.16 ,$73.89 ,$73.89 ,$78.44 ,$73.89 ,$89.00 ,$115.92 ,$88.00 ,$14.63 ,$101.75 ,$16.19 ,$17.74 ,$17.74 ,$14.48 ,$17.74 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100682,84081,HC PHOSPHATIDYLYCEROL (PG),301,1 ,$501.40 ,$330.92 ,$16.19 ,$501.40 ,$17.07 ,$57.82 ,$57.82 ,$16.52 ,$300.84 ,$426.19 ,$350.98 ,$17.07 ,$17.07 ,$476.33 ,$381.06 ,$376.05 ,$28.08 ,$426.19 ,$16.52 ,$28.08 ,$28.08 ,$350.98 ,$305.35 ,$17.07 ,$16.52 ,$16.19 ,$33.04 ,$18.09 ,$426.19 ,$37.17 ,$461.29 ,$350.98 ,$82.58 ,$82.58 ,$305.35 ,$82.58 ,$346.47 ,$451.26 ,$342.56 ,$16.36 ,$396.11 ,$18.09 ,$19.82 ,$19.82 ,$16.19 ,$19.82 ,$361.01 ,$310.87 ,$361.01 ,$361.01 ,$401.12 
ST NICHOLAS HOSPITAL - ACUTE,30100683,84087,HC PHOSPHATIDYLYCEROL (PG),301,1 ,$495.65 ,$327.13 ,$10.52 ,$495.65 ,$11.09 ,$37.56 ,$37.56 ,$10.73 ,$297.39 ,$421.30 ,$346.96 ,$11.09 ,$11.09 ,$470.87 ,$376.69 ,$371.74 ,$18.24 ,$421.30 ,$10.73 ,$18.24 ,$18.24 ,$346.96 ,$301.85 ,$11.09 ,$10.73 ,$10.52 ,$21.46 ,$11.76 ,$421.30 ,$24.14 ,$456.00 ,$346.96 ,$51.62 ,$51.62 ,$301.85 ,$51.62 ,$342.49 ,$446.09 ,$338.63 ,$10.62 ,$391.56 ,$11.76 ,$12.88 ,$12.88 ,$10.52 ,$12.88 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,30100684,84100,HC PHOSPHORUS,301,1 ,$41.40 ,$27.32 ,$4.65 ,$41.40 ,$4.90 ,$16.59 ,$16.59 ,$4.74 ,$24.84 ,$35.19 ,$28.98 ,$4.90 ,$4.90 ,$39.33 ,$31.46 ,$31.05 ,$8.06 ,$35.19 ,$4.74 ,$8.06 ,$8.06 ,$28.98 ,$25.21 ,$4.90 ,$4.74 ,$4.65 ,$9.48 ,$5.19 ,$35.19 ,$10.67 ,$38.09 ,$28.98 ,$23.67 ,$23.67 ,$25.21 ,$23.67 ,$28.61 ,$37.26 ,$28.28 ,$4.69 ,$32.71 ,$5.19 ,$5.69 ,$5.69 ,$4.65 ,$5.69 ,$29.81 ,$25.67 ,$29.81 ,$29.81 ,$33.12 
ST NICHOLAS HOSPITAL - ACUTE,30100685,84105,HC PHOSPHORUS URINE,301,1 ,$44.85 ,$29.60 ,$5.66 ,$44.85 ,$5.97 ,$20.23 ,$20.23 ,$5.78 ,$26.91 ,$38.12 ,$31.40 ,$5.97 ,$5.97 ,$42.61 ,$34.09 ,$33.64 ,$9.83 ,$38.12 ,$5.78 ,$9.83 ,$9.83 ,$31.40 ,$27.31 ,$5.97 ,$5.78 ,$5.66 ,$11.56 ,$6.33 ,$38.12 ,$13.01 ,$41.26 ,$31.40 ,$25.86 ,$25.86 ,$27.31 ,$25.86 ,$30.99 ,$40.37 ,$30.64 ,$5.72 ,$35.43 ,$6.33 ,$6.94 ,$6.94 ,$5.66 ,$6.94 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30100686,84110,HC PORPHOBILINOGEN QN,301,1 ,$71.30 ,$47.06 ,$8.27 ,$71.30 ,$8.72 ,$29.54 ,$29.54 ,$8.44 ,$42.78 ,$60.61 ,$49.91 ,$8.72 ,$8.72 ,$67.74 ,$54.19 ,$53.48 ,$14.35 ,$60.61 ,$8.44 ,$14.35 ,$14.35 ,$49.91 ,$43.42 ,$8.72 ,$8.44 ,$8.27 ,$16.88 ,$9.24 ,$60.61 ,$18.99 ,$65.60 ,$49.91 ,$42.17 ,$42.17 ,$43.42 ,$42.17 ,$49.27 ,$64.17 ,$48.71 ,$8.35 ,$56.33 ,$9.24 ,$10.13 ,$10.13 ,$8.27 ,$10.13 ,$51.34 ,$44.21 ,$51.34 ,$51.34 ,$57.04 
ST NICHOLAS HOSPITAL - ACUTE,30100687,84110,HC PORPHOBILINOGEN QN (24),301,1 ,$77.05 ,$50.85 ,$8.27 ,$77.05 ,$8.72 ,$29.54 ,$29.54 ,$8.44 ,$46.23 ,$65.49 ,$53.94 ,$8.72 ,$8.72 ,$73.20 ,$58.56 ,$57.79 ,$14.35 ,$65.49 ,$8.44 ,$14.35 ,$14.35 ,$53.94 ,$46.92 ,$8.72 ,$8.44 ,$8.27 ,$16.88 ,$9.24 ,$65.49 ,$18.99 ,$70.89 ,$53.94 ,$42.17 ,$42.17 ,$46.92 ,$42.17 ,$53.24 ,$69.35 ,$52.64 ,$8.35 ,$60.87 ,$9.24 ,$10.13 ,$10.13 ,$8.27 ,$10.13 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100688,84112,HC PLACENTAL ALPHA MICROGLOBULIN,301,1 ,$566.95 ,$374.19 ,$90.57 ,$566.95 ,$90.57 ,$343.39 ,$343.39 ,$98.11 ,$340.17 ,$481.91 ,$396.87 ,$90.57 ,$90.57 ,$538.60 ,$430.88 ,$425.21 ,$166.79 ,$481.91 ,$98.11 ,$166.79 ,$166.79 ,$396.87 ,$345.27 ,$90.57 ,$98.11 ,$96.15 ,$196.22 ,$96.00 ,$481.91 ,$220.75 ,$521.59 ,$396.87 ,$321.95 ,$321.95 ,$345.27 ,$321.95 ,$391.76 ,$510.26 ,$387.34 ,$97.11 ,$447.89 ,$96.00 ,$117.73 ,$117.73 ,$96.15 ,$117.73 ,$408.20 ,$351.51 ,$408.20 ,$408.20 ,$453.56 
ST NICHOLAS HOSPITAL - ACUTE,30100689,84120,HC PORPHYRINS QN FRACT,301,1 ,$154.10 ,$101.71 ,$14.42 ,$154.10 ,$15.20 ,$51.49 ,$51.49 ,$14.71 ,$92.46 ,$130.99 ,$107.87 ,$15.20 ,$15.20 ,$146.40 ,$117.12 ,$115.58 ,$25.01 ,$130.99 ,$14.71 ,$25.01 ,$25.01 ,$107.87 ,$93.85 ,$15.20 ,$14.71 ,$14.42 ,$29.42 ,$16.11 ,$130.99 ,$33.10 ,$141.77 ,$107.87 ,$73.53 ,$73.53 ,$93.85 ,$73.53 ,$106.48 ,$138.69 ,$105.28 ,$14.56 ,$121.74 ,$16.11 ,$17.65 ,$17.65 ,$14.42 ,$17.65 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100690,84120,HC PORPHYRINS QN FRACT RNDM,301,1 ,$193.20 ,$127.51 ,$14.42 ,$193.20 ,$15.20 ,$51.49 ,$51.49 ,$14.71 ,$115.92 ,$164.22 ,$135.24 ,$15.20 ,$15.20 ,$183.54 ,$146.83 ,$144.90 ,$25.01 ,$164.22 ,$14.71 ,$25.01 ,$25.01 ,$135.24 ,$117.66 ,$15.20 ,$14.71 ,$14.42 ,$29.42 ,$16.11 ,$164.22 ,$33.10 ,$177.74 ,$135.24 ,$73.53 ,$73.53 ,$117.66 ,$73.53 ,$133.50 ,$173.88 ,$131.99 ,$14.56 ,$152.63 ,$16.11 ,$17.65 ,$17.65 ,$14.42 ,$17.65 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30100691,84132,HC POTASSIUM,301,1 ,$40.25 ,$26.57 ,$4.66 ,$40.25 ,$4.92 ,$16.66 ,$16.66 ,$4.76 ,$24.15 ,$34.21 ,$28.18 ,$4.92 ,$4.92 ,$38.24 ,$30.59 ,$30.19 ,$8.09 ,$34.21 ,$4.76 ,$8.09 ,$8.09 ,$28.18 ,$24.51 ,$4.92 ,$4.76 ,$4.66 ,$9.52 ,$5.22 ,$34.21 ,$10.71 ,$37.03 ,$28.18 ,$22.97 ,$22.97 ,$24.51 ,$22.97 ,$27.81 ,$36.23 ,$27.50 ,$4.71 ,$31.80 ,$5.22 ,$5.71 ,$5.71 ,$4.66 ,$5.71 ,$28.98 ,$24.96 ,$28.98 ,$28.98 ,$32.20 
ST NICHOLAS HOSPITAL - ACUTE,30100692,84132,HC POTASSIUM ABG,301,1 ,$40.25 ,$26.57 ,$4.66 ,$40.25 ,$4.92 ,$16.66 ,$16.66 ,$4.76 ,$24.15 ,$34.21 ,$28.18 ,$4.92 ,$4.92 ,$38.24 ,$30.59 ,$30.19 ,$8.09 ,$34.21 ,$4.76 ,$8.09 ,$8.09 ,$28.18 ,$24.51 ,$4.92 ,$4.76 ,$4.66 ,$9.52 ,$5.22 ,$34.21 ,$10.71 ,$37.03 ,$28.18 ,$22.97 ,$22.97 ,$24.51 ,$22.97 ,$27.81 ,$36.23 ,$27.50 ,$4.71 ,$31.80 ,$5.22 ,$5.71 ,$5.71 ,$4.66 ,$5.71 ,$28.98 ,$24.96 ,$28.98 ,$28.98 ,$32.20 
ST NICHOLAS HOSPITAL - ACUTE,30100693,84132,HC POTASSIUM ISTAT,301,1 ,$40.25 ,$26.57 ,$4.66 ,$40.25 ,$4.92 ,$16.66 ,$16.66 ,$4.76 ,$24.15 ,$34.21 ,$28.18 ,$4.92 ,$4.92 ,$38.24 ,$30.59 ,$30.19 ,$8.09 ,$34.21 ,$4.76 ,$8.09 ,$8.09 ,$28.18 ,$24.51 ,$4.92 ,$4.76 ,$4.66 ,$9.52 ,$5.22 ,$34.21 ,$10.71 ,$37.03 ,$28.18 ,$22.97 ,$22.97 ,$24.51 ,$22.97 ,$27.81 ,$36.23 ,$27.50 ,$4.71 ,$31.80 ,$5.22 ,$5.71 ,$5.71 ,$4.66 ,$5.71 ,$28.98 ,$24.96 ,$28.98 ,$28.98 ,$32.20 
ST NICHOLAS HOSPITAL - ACUTE,30100694,84133,HC POTASSIUM URINE,301,1 ,$36.80 ,$24.29 ,$4.64 ,$36.80 ,$4.89 ,$16.56 ,$16.56 ,$4.73 ,$22.08 ,$31.28 ,$25.76 ,$4.89 ,$4.89 ,$34.96 ,$27.97 ,$27.60 ,$8.04 ,$31.28 ,$4.73 ,$8.04 ,$8.04 ,$25.76 ,$22.41 ,$4.89 ,$4.73 ,$4.64 ,$9.46 ,$5.18 ,$31.28 ,$10.64 ,$33.86 ,$25.76 ,$21.50 ,$21.50 ,$22.41 ,$21.50 ,$25.43 ,$33.12 ,$25.14 ,$4.68 ,$29.07 ,$5.18 ,$5.68 ,$5.68 ,$4.64 ,$5.68 ,$26.50 ,$22.82 ,$26.50 ,$26.50 ,$29.44 
ST NICHOLAS HOSPITAL - ACUTE,30100695,84134,HC PREALBUMIN,301,1 ,$57.50 ,$37.95 ,$7.85 ,$57.50 ,$7.85 ,$51.07 ,$51.07 ,$14.59 ,$34.50 ,$48.88 ,$40.25 ,$7.85 ,$7.85 ,$54.63 ,$43.70 ,$43.13 ,$24.80 ,$48.88 ,$14.59 ,$24.80 ,$24.80 ,$40.25 ,$35.02 ,$7.85 ,$14.59 ,$14.30 ,$29.18 ,$8.32 ,$48.88 ,$32.83 ,$52.90 ,$40.25 ,$27.92 ,$27.92 ,$35.02 ,$27.92 ,$39.73 ,$51.75 ,$39.28 ,$14.45 ,$45.43 ,$8.32 ,$17.51 ,$17.51 ,$14.30 ,$17.51 ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,30100696,84144,HC PROGESTERONE,301,1 ,$167.90 ,$110.81 ,$20.44 ,$167.90 ,$21.55 ,$73.01 ,$73.01 ,$20.86 ,$100.74 ,$142.72 ,$117.53 ,$21.55 ,$21.55 ,$159.51 ,$127.60 ,$125.93 ,$35.46 ,$142.72 ,$20.86 ,$35.46 ,$35.46 ,$117.53 ,$102.25 ,$21.55 ,$20.86 ,$20.44 ,$41.72 ,$22.84 ,$142.72 ,$46.94 ,$154.47 ,$117.53 ,$92.98 ,$92.98 ,$102.25 ,$92.98 ,$116.02 ,$151.11 ,$114.71 ,$20.65 ,$132.64 ,$22.84 ,$25.03 ,$25.03 ,$20.44 ,$25.03 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100697,84146,HC PROLACTIN,301,1 ,$167.90 ,$110.81 ,$18.99 ,$167.90 ,$20.03 ,$67.83 ,$67.83 ,$19.38 ,$100.74 ,$142.72 ,$117.53 ,$20.03 ,$20.03 ,$159.51 ,$127.60 ,$125.93 ,$32.95 ,$142.72 ,$19.38 ,$32.95 ,$32.95 ,$117.53 ,$102.25 ,$20.03 ,$19.38 ,$18.99 ,$38.76 ,$21.23 ,$142.72 ,$43.61 ,$154.47 ,$117.53 ,$96.86 ,$96.86 ,$102.25 ,$96.86 ,$116.02 ,$151.11 ,$114.71 ,$19.18 ,$132.64 ,$21.23 ,$23.26 ,$23.26 ,$18.99 ,$23.26 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100698,84153,HC PSA TOTAL,301,1 ,$167.90 ,$110.81 ,$18.02 ,$167.90 ,$19.00 ,$64.37 ,$64.37 ,$18.39 ,$100.74 ,$142.72 ,$117.53 ,$19.00 ,$19.00 ,$159.51 ,$127.60 ,$125.93 ,$31.26 ,$142.72 ,$18.39 ,$31.26 ,$31.26 ,$117.53 ,$102.25 ,$19.00 ,$18.39 ,$18.02 ,$36.78 ,$20.14 ,$142.72 ,$41.38 ,$154.47 ,$117.53 ,$91.92 ,$91.92 ,$102.25 ,$91.92 ,$116.02 ,$151.11 ,$114.71 ,$18.20 ,$132.64 ,$20.14 ,$22.07 ,$22.07 ,$18.02 ,$22.07 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100699,84154,HC PSA FREE,301,1 ,$167.90 ,$110.81 ,$18.02 ,$167.90 ,$19.00 ,$64.37 ,$64.37 ,$18.39 ,$100.74 ,$142.72 ,$117.53 ,$19.00 ,$19.00 ,$159.51 ,$127.60 ,$125.93 ,$31.26 ,$142.72 ,$18.39 ,$31.26 ,$31.26 ,$117.53 ,$102.25 ,$19.00 ,$18.39 ,$18.02 ,$36.78 ,$20.14 ,$142.72 ,$41.38 ,$154.47 ,$117.53 ,$91.92 ,$91.92 ,$102.25 ,$91.92 ,$116.02 ,$151.11 ,$114.71 ,$18.20 ,$132.64 ,$20.14 ,$22.07 ,$22.07 ,$18.02 ,$22.07 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100700,84155,HC PROTEIN TOTAL,301,1 ,$33.35 ,$22.01 ,$3.60 ,$33.35 ,$3.79 ,$12.85 ,$12.85 ,$3.67 ,$20.01 ,$28.35 ,$23.35 ,$3.79 ,$3.79 ,$31.68 ,$25.35 ,$25.01 ,$6.24 ,$28.35 ,$3.67 ,$6.24 ,$6.24 ,$23.35 ,$20.31 ,$3.79 ,$3.67 ,$3.60 ,$7.34 ,$4.02 ,$28.35 ,$8.26 ,$30.68 ,$23.35 ,$18.32 ,$18.32 ,$20.31 ,$18.32 ,$23.04 ,$30.02 ,$22.78 ,$3.64 ,$26.35 ,$4.02 ,$4.40 ,$4.40 ,$3.60 ,$4.40 ,$24.01 ,$20.68 ,$24.01 ,$24.01 ,$26.68 
ST NICHOLAS HOSPITAL - ACUTE,30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$40.25 ,$26.57 ,$3.60 ,$40.25 ,$3.79 ,$12.85 ,$12.85 ,$3.67 ,$24.15 ,$34.21 ,$28.18 ,$3.79 ,$3.79 ,$38.24 ,$30.59 ,$30.19 ,$6.24 ,$34.21 ,$3.67 ,$6.24 ,$6.24 ,$28.18 ,$24.51 ,$3.79 ,$3.67 ,$3.60 ,$7.34 ,$4.02 ,$34.21 ,$8.26 ,$37.03 ,$28.18 ,$18.32 ,$18.32 ,$24.51 ,$18.32 ,$27.81 ,$36.23 ,$27.50 ,$3.64 ,$31.80 ,$4.02 ,$4.40 ,$4.40 ,$3.60 ,$4.40 ,$28.98 ,$24.96 ,$28.98 ,$28.98 ,$32.20 
ST NICHOLAS HOSPITAL - ACUTE,30100702,84156,HC PROTEIN TOTAL 24HR URINE,301,1 ,$32.20 ,$21.25 ,$3.60 ,$32.20 ,$3.79 ,$12.85 ,$12.85 ,$3.67 ,$19.32 ,$27.37 ,$22.54 ,$3.79 ,$3.79 ,$30.59 ,$24.47 ,$24.15 ,$6.24 ,$27.37 ,$3.67 ,$6.24 ,$6.24 ,$22.54 ,$19.61 ,$3.79 ,$3.67 ,$3.60 ,$7.34 ,$4.02 ,$27.37 ,$8.26 ,$29.62 ,$22.54 ,$18.32 ,$18.32 ,$19.61 ,$18.32 ,$22.25 ,$28.98 ,$22.00 ,$3.64 ,$25.44 ,$4.02 ,$4.40 ,$4.40 ,$3.60 ,$4.40 ,$23.18 ,$19.96 ,$23.18 ,$23.18 ,$25.76 
ST NICHOLAS HOSPITAL - ACUTE,30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$60.95 ,$40.23 ,$3.92 ,$60.95 ,$4.13 ,$14.00 ,$14.00 ,$4.00 ,$36.57 ,$51.81 ,$42.67 ,$4.13 ,$4.13 ,$57.90 ,$46.32 ,$45.71 ,$6.80 ,$51.81 ,$4.00 ,$6.80 ,$6.80 ,$42.67 ,$37.12 ,$4.13 ,$4.00 ,$3.92 ,$8.00 ,$4.38 ,$51.81 ,$9.00 ,$56.07 ,$42.67 ,$18.32 ,$18.32 ,$37.12 ,$18.32 ,$42.12 ,$54.86 ,$41.64 ,$3.96 ,$48.15 ,$4.38 ,$4.80 ,$4.80 ,$3.92 ,$4.80 ,$43.88 ,$37.79 ,$43.88 ,$43.88 ,$48.76 
ST NICHOLAS HOSPITAL - ACUTE,30100704,84157,HC PROTEIN TOTAL SPINAL FLUID,301,1 ,$60.95 ,$40.23 ,$3.92 ,$60.95 ,$4.13 ,$14.00 ,$14.00 ,$4.00 ,$36.57 ,$51.81 ,$42.67 ,$4.13 ,$4.13 ,$57.90 ,$46.32 ,$45.71 ,$6.80 ,$51.81 ,$4.00 ,$6.80 ,$6.80 ,$42.67 ,$37.12 ,$4.13 ,$4.00 ,$3.92 ,$8.00 ,$4.38 ,$51.81 ,$9.00 ,$56.07 ,$42.67 ,$18.32 ,$18.32 ,$37.12 ,$18.32 ,$42.12 ,$54.86 ,$41.64 ,$3.96 ,$48.15 ,$4.38 ,$4.80 ,$4.80 ,$3.92 ,$4.80 ,$43.88 ,$37.79 ,$43.88 ,$43.88 ,$48.76 
ST NICHOLAS HOSPITAL - ACUTE,30100705,84165,HC PROTEIN ELECTROPHORESIS,301,1 ,$89.70 ,$59.20 ,$10.53 ,$89.70 ,$11.10 ,$37.59 ,$37.59 ,$10.74 ,$53.82 ,$76.25 ,$62.79 ,$11.10 ,$11.10 ,$85.22 ,$68.17 ,$67.28 ,$18.26 ,$76.25 ,$10.74 ,$18.26 ,$18.26 ,$62.79 ,$54.63 ,$11.10 ,$10.74 ,$10.53 ,$21.48 ,$11.77 ,$76.25 ,$24.17 ,$82.52 ,$62.79 ,$53.67 ,$53.67 ,$54.63 ,$53.67 ,$61.98 ,$80.73 ,$61.28 ,$10.63 ,$70.86 ,$11.77 ,$12.89 ,$12.89 ,$10.53 ,$12.89 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100706,84166,HC PROTEIN EP OTH FLUID,301,1 ,$154.10 ,$101.71 ,$17.47 ,$154.10 ,$18.42 ,$62.41 ,$62.41 ,$17.83 ,$92.46 ,$130.99 ,$107.87 ,$18.42 ,$18.42 ,$146.40 ,$117.12 ,$115.58 ,$30.31 ,$130.99 ,$17.83 ,$30.31 ,$30.31 ,$107.87 ,$93.85 ,$18.42 ,$17.83 ,$17.47 ,$35.66 ,$19.53 ,$130.99 ,$40.12 ,$141.77 ,$107.87 ,$89.13 ,$89.13 ,$93.85 ,$89.13 ,$106.48 ,$138.69 ,$105.28 ,$17.65 ,$121.74 ,$19.53 ,$21.40 ,$21.40 ,$17.47 ,$21.40 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100707,84166,HC PROTEIN EP OTH FLUID SF,301,1 ,$154.10 ,$101.71 ,$17.47 ,$154.10 ,$18.42 ,$62.41 ,$62.41 ,$17.83 ,$92.46 ,$130.99 ,$107.87 ,$18.42 ,$18.42 ,$146.40 ,$117.12 ,$115.58 ,$30.31 ,$130.99 ,$17.83 ,$30.31 ,$30.31 ,$107.87 ,$93.85 ,$18.42 ,$17.83 ,$17.47 ,$35.66 ,$19.53 ,$130.99 ,$40.12 ,$141.77 ,$107.87 ,$89.13 ,$89.13 ,$93.85 ,$89.13 ,$106.48 ,$138.69 ,$105.28 ,$17.65 ,$121.74 ,$19.53 ,$21.40 ,$21.40 ,$17.47 ,$21.40 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100708,84181,HC PROTEIN WESTERN BLOT,301,1 ,$182.85 ,$120.68 ,$16.69 ,$182.85 ,$17.60 ,$59.61 ,$59.61 ,$17.03 ,$109.71 ,$155.42 ,$128.00 ,$17.60 ,$17.60 ,$173.71 ,$138.97 ,$137.14 ,$28.95 ,$155.42 ,$17.03 ,$28.95 ,$28.95 ,$128.00 ,$111.36 ,$17.60 ,$17.03 ,$16.69 ,$34.06 ,$18.66 ,$155.42 ,$38.32 ,$168.22 ,$128.00 ,$85.14 ,$85.14 ,$111.36 ,$85.14 ,$126.35 ,$164.57 ,$124.92 ,$16.86 ,$144.45 ,$18.66 ,$20.44 ,$20.44 ,$16.69 ,$20.44 ,$131.65 ,$113.37 ,$131.65 ,$131.65 ,$146.28 
ST NICHOLAS HOSPITAL - ACUTE,30100709,84202,HC PROTOPORPHYRIN,301,1 ,$103.50 ,$68.31 ,$14.06 ,$103.50 ,$14.83 ,$50.23 ,$50.23 ,$14.35 ,$62.10 ,$87.98 ,$72.45 ,$14.83 ,$14.83 ,$98.33 ,$78.66 ,$77.63 ,$24.40 ,$87.98 ,$14.35 ,$24.40 ,$24.40 ,$72.45 ,$63.03 ,$14.83 ,$14.35 ,$14.06 ,$28.70 ,$15.72 ,$87.98 ,$32.29 ,$95.22 ,$72.45 ,$71.69 ,$71.69 ,$63.03 ,$71.69 ,$71.52 ,$93.15 ,$70.71 ,$14.20 ,$81.77 ,$15.72 ,$17.22 ,$17.22 ,$14.06 ,$17.22 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100710,84206,HC PROINSULIN,301,1 ,$334.65 ,$220.87 ,$25.05 ,$334.65 ,$25.05 ,$93.42 ,$93.42 ,$26.69 ,$200.79 ,$284.45 ,$234.26 ,$25.05 ,$25.05 ,$317.92 ,$254.33 ,$250.99 ,$45.37 ,$284.45 ,$26.69 ,$45.37 ,$45.37 ,$234.26 ,$203.80 ,$25.05 ,$26.69 ,$26.16 ,$53.38 ,$26.55 ,$284.45 ,$60.05 ,$307.88 ,$234.26 ,$89.02 ,$89.02 ,$203.80 ,$89.02 ,$231.24 ,$301.19 ,$228.63 ,$26.42 ,$264.37 ,$26.55 ,$32.03 ,$32.03 ,$26.16 ,$32.03 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30100711,84207,HC VITAMIN B6,301,1 ,$244.95 ,$161.67 ,$27.54 ,$244.95 ,$29.04 ,$98.35 ,$98.35 ,$28.10 ,$146.97 ,$208.21 ,$171.47 ,$29.04 ,$29.04 ,$232.70 ,$186.16 ,$183.71 ,$47.77 ,$208.21 ,$28.10 ,$47.77 ,$47.77 ,$171.47 ,$149.17 ,$29.04 ,$28.10 ,$27.54 ,$56.20 ,$30.78 ,$208.21 ,$63.23 ,$225.35 ,$171.47 ,$140.42 ,$140.42 ,$149.17 ,$140.42 ,$169.26 ,$220.46 ,$167.35 ,$27.81 ,$193.51 ,$30.78 ,$33.72 ,$33.72 ,$27.54 ,$33.72 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30100712,84210,HC PYRUVATE,301,1 ,$128.80 ,$85.01 ,$14.19 ,$128.80 ,$14.96 ,$50.68 ,$50.68 ,$14.48 ,$77.28 ,$109.48 ,$90.16 ,$14.96 ,$14.96 ,$122.36 ,$97.89 ,$96.60 ,$24.62 ,$109.48 ,$14.48 ,$24.62 ,$24.62 ,$90.16 ,$78.44 ,$14.96 ,$14.48 ,$14.19 ,$28.96 ,$15.86 ,$109.48 ,$32.58 ,$118.50 ,$90.16 ,$54.26 ,$54.26 ,$78.44 ,$54.26 ,$89.00 ,$115.92 ,$88.00 ,$14.33 ,$101.75 ,$15.86 ,$17.38 ,$17.38 ,$14.19 ,$17.38 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100713,84220,HC PYRUVATE KINASE,301,1 ,$261.05 ,$172.29 ,$9.25 ,$261.05 ,$9.75 ,$33.04 ,$33.04 ,$9.44 ,$156.63 ,$221.89 ,$182.74 ,$9.75 ,$9.75 ,$248.00 ,$198.40 ,$195.79 ,$16.05 ,$221.89 ,$9.44 ,$16.05 ,$16.05 ,$182.74 ,$158.98 ,$9.75 ,$9.44 ,$9.25 ,$18.88 ,$10.34 ,$221.89 ,$21.24 ,$240.17 ,$182.74 ,$47.19 ,$47.19 ,$158.98 ,$47.19 ,$180.39 ,$234.95 ,$178.35 ,$9.34 ,$206.23 ,$10.34 ,$11.33 ,$11.33 ,$9.25 ,$11.33 ,$187.96 ,$161.85 ,$187.96 ,$187.96 ,$208.84 
ST NICHOLAS HOSPITAL - ACUTE,30100714,84238,HC RECEPTOR ASSAY NON ENDO,301,1 ,$334.65 ,$220.87 ,$35.84 ,$334.65 ,$37.79 ,$128.00 ,$128.00 ,$36.57 ,$200.79 ,$284.45 ,$234.26 ,$37.79 ,$37.79 ,$317.92 ,$254.33 ,$250.99 ,$62.17 ,$284.45 ,$36.57 ,$62.17 ,$62.17 ,$234.26 ,$203.80 ,$37.79 ,$36.57 ,$35.84 ,$73.14 ,$40.06 ,$284.45 ,$82.28 ,$307.88 ,$234.26 ,$182.77 ,$182.77 ,$203.80 ,$182.77 ,$231.24 ,$301.19 ,$228.63 ,$36.20 ,$264.37 ,$40.06 ,$43.88 ,$43.88 ,$35.84 ,$43.88 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30100715,84244,HC RENIN,301,1 ,$193.20 ,$127.51 ,$21.55 ,$193.20 ,$22.72 ,$76.97 ,$76.97 ,$21.99 ,$115.92 ,$164.22 ,$135.24 ,$22.72 ,$22.72 ,$183.54 ,$146.83 ,$144.90 ,$37.38 ,$164.22 ,$21.99 ,$37.38 ,$37.38 ,$135.24 ,$117.66 ,$22.72 ,$21.99 ,$21.55 ,$43.98 ,$24.08 ,$164.22 ,$49.48 ,$177.74 ,$135.24 ,$109.94 ,$109.94 ,$117.66 ,$109.94 ,$133.50 ,$173.88 ,$131.99 ,$21.77 ,$152.63 ,$24.08 ,$26.39 ,$26.39 ,$21.55 ,$26.39 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30100716,84255,HC SELENIUM (MAYO),301,1 ,$328.90 ,$217.07 ,$25.02 ,$328.90 ,$26.38 ,$89.36 ,$89.36 ,$25.53 ,$197.34 ,$279.57 ,$230.23 ,$26.38 ,$26.38 ,$312.46 ,$249.96 ,$246.68 ,$43.40 ,$279.57 ,$25.53 ,$43.40 ,$43.40 ,$230.23 ,$200.30 ,$26.38 ,$25.53 ,$25.02 ,$51.06 ,$27.96 ,$279.57 ,$57.44 ,$302.59 ,$230.23 ,$127.60 ,$127.60 ,$200.30 ,$127.60 ,$227.27 ,$296.01 ,$224.70 ,$25.27 ,$259.83 ,$27.96 ,$30.64 ,$30.64 ,$25.02 ,$30.64 ,$236.81 ,$203.92 ,$236.81 ,$236.81 ,$263.12 
ST NICHOLAS HOSPITAL - ACUTE,30100717,84255,HC SELENIUM,301,1 ,$218.50 ,$144.21 ,$25.02 ,$218.50 ,$26.38 ,$89.36 ,$89.36 ,$25.53 ,$131.10 ,$185.73 ,$152.95 ,$26.38 ,$26.38 ,$207.58 ,$166.06 ,$163.88 ,$43.40 ,$185.73 ,$25.53 ,$43.40 ,$43.40 ,$152.95 ,$133.07 ,$26.38 ,$25.53 ,$25.02 ,$51.06 ,$27.96 ,$185.73 ,$57.44 ,$201.02 ,$152.95 ,$127.60 ,$127.60 ,$133.07 ,$127.60 ,$150.98 ,$196.65 ,$149.28 ,$25.27 ,$172.62 ,$27.96 ,$30.64 ,$30.64 ,$25.02 ,$30.64 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100718,84260,HC SEROTONIN,301,1 ,$218.50 ,$144.21 ,$30.36 ,$218.50 ,$32.01 ,$108.43 ,$108.43 ,$30.98 ,$131.10 ,$185.73 ,$152.95 ,$32.01 ,$32.01 ,$207.58 ,$166.06 ,$163.88 ,$52.67 ,$185.73 ,$30.98 ,$52.67 ,$52.67 ,$152.95 ,$133.07 ,$32.01 ,$30.98 ,$30.36 ,$61.96 ,$33.93 ,$185.73 ,$69.71 ,$201.02 ,$152.95 ,$154.82 ,$154.82 ,$133.07 ,$154.82 ,$150.98 ,$196.65 ,$149.28 ,$30.66 ,$172.62 ,$33.93 ,$37.18 ,$37.18 ,$30.36 ,$37.18 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100719,84260,HC SEROTONIN WHOLE BLOOD,301,1 ,$262.20 ,$173.05 ,$30.36 ,$262.20 ,$32.01 ,$108.43 ,$108.43 ,$30.98 ,$157.32 ,$222.87 ,$183.54 ,$32.01 ,$32.01 ,$249.09 ,$199.27 ,$196.65 ,$52.67 ,$222.87 ,$30.98 ,$52.67 ,$52.67 ,$183.54 ,$159.68 ,$32.01 ,$30.98 ,$30.36 ,$61.96 ,$33.93 ,$222.87 ,$69.71 ,$241.22 ,$183.54 ,$154.82 ,$154.82 ,$159.68 ,$154.82 ,$181.18 ,$235.98 ,$179.14 ,$30.66 ,$207.14 ,$33.93 ,$37.18 ,$37.18 ,$30.36 ,$37.18 ,$188.78 ,$162.56 ,$188.78 ,$188.78 ,$209.76 
ST NICHOLAS HOSPITAL - ACUTE,30100720,84270,HC SEX HORMONE BIND GLOB,301,1 ,$193.20 ,$127.51 ,$21.30 ,$193.20 ,$22.45 ,$76.06 ,$76.06 ,$21.73 ,$115.92 ,$164.22 ,$135.24 ,$22.45 ,$22.45 ,$183.54 ,$146.83 ,$144.90 ,$36.94 ,$164.22 ,$21.73 ,$36.94 ,$36.94 ,$135.24 ,$117.66 ,$22.45 ,$21.73 ,$21.30 ,$43.46 ,$23.80 ,$164.22 ,$48.89 ,$177.74 ,$135.24 ,$108.62 ,$108.62 ,$117.66 ,$108.62 ,$133.50 ,$173.88 ,$131.99 ,$21.51 ,$152.63 ,$23.80 ,$26.08 ,$26.08 ,$21.30 ,$26.08 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30100721,84295,HC SODIUM,301,1 ,$27.60 ,$18.22 ,$4.71 ,$27.60 ,$4.97 ,$16.84 ,$16.84 ,$4.81 ,$16.56 ,$23.46 ,$19.32 ,$4.97 ,$4.97 ,$26.22 ,$20.98 ,$20.70 ,$8.18 ,$23.46 ,$4.81 ,$8.18 ,$8.18 ,$19.32 ,$16.81 ,$4.97 ,$4.81 ,$4.71 ,$9.62 ,$5.27 ,$23.46 ,$10.82 ,$25.39 ,$19.32 ,$24.03 ,$24.03 ,$16.81 ,$24.03 ,$19.07 ,$24.84 ,$18.86 ,$4.76 ,$21.80 ,$5.27 ,$5.77 ,$5.77 ,$4.71 ,$5.77 ,$19.87 ,$17.11 ,$19.87 ,$19.87 ,$22.08 
ST NICHOLAS HOSPITAL - ACUTE,30100722,84295,HC SODIUM SERUM/PLSM/WB,301,1 ,$17.25 ,$11.39 ,$4.71 ,$17.25 ,$4.97 ,$16.84 ,$16.84 ,$4.81 ,$10.35 ,$14.66 ,$12.08 ,$4.97 ,$4.97 ,$16.39 ,$13.11 ,$12.94 ,$8.18 ,$14.66 ,$4.81 ,$8.18 ,$8.18 ,$12.08 ,$10.51 ,$4.97 ,$4.81 ,$4.71 ,$9.62 ,$5.27 ,$14.66 ,$10.82 ,$15.87 ,$12.08 ,$17.25 ,$17.25 ,$10.51 ,$17.25 ,$11.92 ,$15.53 ,$11.79 ,$4.76 ,$13.63 ,$5.27 ,$5.77 ,$5.77 ,$4.71 ,$5.77 ,$12.42 ,$10.70 ,$12.42 ,$12.42 ,$13.80 
ST NICHOLAS HOSPITAL - ACUTE,30100723,84295,HC SODIUM ISTAT,301,1 ,$27.60 ,$18.22 ,$4.71 ,$27.60 ,$4.97 ,$16.84 ,$16.84 ,$4.81 ,$16.56 ,$23.46 ,$19.32 ,$4.97 ,$4.97 ,$26.22 ,$20.98 ,$20.70 ,$8.18 ,$23.46 ,$4.81 ,$8.18 ,$8.18 ,$19.32 ,$16.81 ,$4.97 ,$4.81 ,$4.71 ,$9.62 ,$5.27 ,$23.46 ,$10.82 ,$25.39 ,$19.32 ,$24.03 ,$24.03 ,$16.81 ,$24.03 ,$19.07 ,$24.84 ,$18.86 ,$4.76 ,$21.80 ,$5.27 ,$5.77 ,$5.77 ,$4.71 ,$5.77 ,$19.87 ,$17.11 ,$19.87 ,$19.87 ,$22.08 
ST NICHOLAS HOSPITAL - ACUTE,30100724,84300,HC SODIUM URINE,301,1 ,$42.55 ,$28.08 ,$4.96 ,$42.55 ,$5.23 ,$17.71 ,$17.71 ,$5.06 ,$25.53 ,$36.17 ,$29.79 ,$5.23 ,$5.23 ,$40.42 ,$32.34 ,$31.91 ,$8.60 ,$36.17 ,$5.06 ,$8.60 ,$8.60 ,$29.79 ,$25.91 ,$5.23 ,$5.06 ,$4.96 ,$10.12 ,$5.54 ,$36.17 ,$11.39 ,$39.15 ,$29.79 ,$24.33 ,$24.33 ,$25.91 ,$24.33 ,$29.40 ,$38.30 ,$29.07 ,$5.01 ,$33.61 ,$5.54 ,$6.07 ,$6.07 ,$4.96 ,$6.07 ,$30.64 ,$26.38 ,$30.64 ,$30.64 ,$34.04 
ST NICHOLAS HOSPITAL - ACUTE,30100725,84302,HC SODIUM OTHER FLUID,301,1 ,$42.55 ,$28.08 ,$4.76 ,$42.55 ,$5.02 ,$17.01 ,$17.01 ,$4.86 ,$25.53 ,$36.17 ,$29.79 ,$5.02 ,$5.02 ,$40.42 ,$32.34 ,$31.91 ,$8.26 ,$36.17 ,$4.86 ,$8.26 ,$8.26 ,$29.79 ,$25.91 ,$5.02 ,$4.86 ,$4.76 ,$9.72 ,$5.32 ,$36.17 ,$10.94 ,$39.15 ,$29.79 ,$24.33 ,$24.33 ,$25.91 ,$24.33 ,$29.40 ,$38.30 ,$29.07 ,$4.81 ,$33.61 ,$5.32 ,$5.83 ,$5.83 ,$4.76 ,$5.83 ,$30.64 ,$26.38 ,$30.64 ,$30.64 ,$34.04 
ST NICHOLAS HOSPITAL - ACUTE,30100726,84305,HC SOMATOMEDINC,301,1 ,$193.20 ,$127.51 ,$20.83 ,$193.20 ,$21.97 ,$74.41 ,$74.41 ,$21.26 ,$115.92 ,$164.22 ,$135.24 ,$21.97 ,$21.97 ,$183.54 ,$146.83 ,$144.90 ,$36.14 ,$164.22 ,$21.26 ,$36.14 ,$36.14 ,$135.24 ,$117.66 ,$21.97 ,$21.26 ,$20.83 ,$42.52 ,$23.29 ,$164.22 ,$47.84 ,$177.74 ,$135.24 ,$106.24 ,$106.24 ,$117.66 ,$106.24 ,$133.50 ,$173.88 ,$131.99 ,$21.04 ,$152.63 ,$23.29 ,$25.51 ,$25.51 ,$20.83 ,$25.51 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30100727,84311,HC SPECTROPHOTOMETRY,301,1 ,$244.95 ,$161.67 ,$7.94 ,$244.95 ,$8.37 ,$28.35 ,$28.35 ,$8.10 ,$146.97 ,$208.21 ,$171.47 ,$8.37 ,$8.37 ,$232.70 ,$186.16 ,$183.71 ,$13.77 ,$208.21 ,$8.10 ,$13.77 ,$13.77 ,$171.47 ,$149.17 ,$8.37 ,$8.10 ,$7.94 ,$16.20 ,$8.87 ,$208.21 ,$18.23 ,$225.35 ,$171.47 ,$34.95 ,$34.95 ,$149.17 ,$34.95 ,$169.26 ,$220.46 ,$167.35 ,$8.02 ,$193.51 ,$8.87 ,$9.72 ,$9.72 ,$7.94 ,$9.72 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30100728,84376,HC SUGARS SINGLE QL,301,1 ,$77.05 ,$50.85 ,$5.39 ,$77.05 ,$5.68 ,$19.25 ,$19.25 ,$5.50 ,$46.23 ,$65.49 ,$53.94 ,$5.68 ,$5.68 ,$73.20 ,$58.56 ,$57.79 ,$9.35 ,$65.49 ,$5.50 ,$9.35 ,$9.35 ,$53.94 ,$46.92 ,$5.68 ,$5.50 ,$5.39 ,$11.00 ,$6.02 ,$65.49 ,$12.38 ,$70.89 ,$53.94 ,$27.48 ,$27.48 ,$46.92 ,$27.48 ,$53.24 ,$69.35 ,$52.64 ,$5.45 ,$60.87 ,$6.02 ,$6.60 ,$6.60 ,$5.39 ,$6.60 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100729,84376,HC SUGARS SINGLE (ACID HYDRO) QL,301,1 ,$79.35 ,$52.37 ,$5.39 ,$79.35 ,$5.68 ,$19.25 ,$19.25 ,$5.50 ,$47.61 ,$67.45 ,$55.55 ,$5.68 ,$5.68 ,$75.38 ,$60.31 ,$59.51 ,$9.35 ,$67.45 ,$5.50 ,$9.35 ,$9.35 ,$55.55 ,$48.32 ,$5.68 ,$5.50 ,$5.39 ,$11.00 ,$6.02 ,$67.45 ,$12.38 ,$73.00 ,$55.55 ,$27.48 ,$27.48 ,$48.32 ,$27.48 ,$54.83 ,$71.42 ,$54.21 ,$5.45 ,$62.69 ,$6.02 ,$6.60 ,$6.60 ,$5.39 ,$6.60 ,$57.13 ,$49.20 ,$57.13 ,$57.13 ,$63.48 
ST NICHOLAS HOSPITAL - ACUTE,30100730,84315,HC SPEC GRAVITY NON UR,301,1 ,$18.40 ,$12.14 ,$3.21 ,$18.40 ,$3.39 ,$11.48 ,$11.48 ,$3.28 ,$11.04 ,$15.64 ,$12.88 ,$3.39 ,$3.39 ,$17.48 ,$13.98 ,$13.80 ,$5.58 ,$15.64 ,$3.28 ,$5.58 ,$5.58 ,$12.88 ,$11.21 ,$3.39 ,$3.28 ,$3.21 ,$6.56 ,$3.59 ,$15.64 ,$7.38 ,$16.93 ,$12.88 ,$12.57 ,$12.57 ,$11.21 ,$12.57 ,$12.71 ,$16.56 ,$12.57 ,$3.24 ,$14.54 ,$3.59 ,$3.94 ,$3.94 ,$3.21 ,$3.94 ,$13.25 ,$11.41 ,$13.25 ,$13.25 ,$14.72 
ST NICHOLAS HOSPITAL - ACUTE,30100731,84392,HC SULFATE URINE,301,1 ,$41.40 ,$27.32 ,$5.38 ,$41.40 ,$5.67 ,$19.22 ,$19.22 ,$5.49 ,$24.84 ,$35.19 ,$28.98 ,$5.67 ,$5.67 ,$39.33 ,$31.46 ,$31.05 ,$9.33 ,$35.19 ,$5.49 ,$9.33 ,$9.33 ,$28.98 ,$25.21 ,$5.67 ,$5.49 ,$5.38 ,$10.98 ,$6.01 ,$35.19 ,$12.35 ,$38.09 ,$28.98 ,$23.74 ,$23.74 ,$25.21 ,$23.74 ,$28.61 ,$37.26 ,$28.28 ,$5.43 ,$32.71 ,$6.01 ,$6.59 ,$6.59 ,$5.38 ,$6.59 ,$29.81 ,$25.67 ,$29.81 ,$29.81 ,$33.12 
ST NICHOLAS HOSPITAL - ACUTE,30100732,84402,HC TESTOSTERONE FREE,301,1 ,$218.50 ,$144.21 ,$24.96 ,$218.50 ,$26.32 ,$89.15 ,$89.15 ,$25.47 ,$131.10 ,$185.73 ,$152.95 ,$26.32 ,$26.32 ,$207.58 ,$166.06 ,$163.88 ,$43.30 ,$185.73 ,$25.47 ,$43.30 ,$43.30 ,$152.95 ,$133.07 ,$26.32 ,$25.47 ,$24.96 ,$50.94 ,$27.90 ,$185.73 ,$57.31 ,$201.02 ,$152.95 ,$127.27 ,$127.27 ,$133.07 ,$127.27 ,$150.98 ,$196.65 ,$149.28 ,$25.21 ,$172.62 ,$27.90 ,$30.56 ,$30.56 ,$24.96 ,$30.56 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100733,84403,HC TESTOSTERONE TOTAL,301,1 ,$218.50 ,$144.21 ,$25.29 ,$218.50 ,$26.67 ,$90.34 ,$90.34 ,$25.81 ,$131.10 ,$185.73 ,$152.95 ,$26.67 ,$26.67 ,$207.58 ,$166.06 ,$163.88 ,$43.88 ,$185.73 ,$25.81 ,$43.88 ,$43.88 ,$152.95 ,$133.07 ,$26.67 ,$25.81 ,$25.29 ,$51.62 ,$28.27 ,$185.73 ,$58.07 ,$201.02 ,$152.95 ,$125.99 ,$125.99 ,$133.07 ,$125.99 ,$150.98 ,$196.65 ,$149.28 ,$25.55 ,$172.62 ,$28.27 ,$30.97 ,$30.97 ,$25.29 ,$30.97 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100734,84402,HC TESTOSTERONE FREE ASSAY,301,1 ,$218.50 ,$144.21 ,$24.96 ,$218.50 ,$26.32 ,$89.15 ,$89.15 ,$25.47 ,$131.10 ,$185.73 ,$152.95 ,$26.32 ,$26.32 ,$207.58 ,$166.06 ,$163.88 ,$43.30 ,$185.73 ,$25.47 ,$43.30 ,$43.30 ,$152.95 ,$133.07 ,$26.32 ,$25.47 ,$24.96 ,$50.94 ,$27.90 ,$185.73 ,$57.31 ,$201.02 ,$152.95 ,$127.27 ,$127.27 ,$133.07 ,$127.27 ,$150.98 ,$196.65 ,$149.28 ,$25.21 ,$172.62 ,$27.90 ,$30.56 ,$30.56 ,$24.96 ,$30.56 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100735,84425,HC VITAMIN B1,301,1 ,$154.10 ,$101.71 ,$20.81 ,$154.10 ,$21.94 ,$74.31 ,$74.31 ,$21.23 ,$92.46 ,$130.99 ,$107.87 ,$21.94 ,$21.94 ,$146.40 ,$117.12 ,$115.58 ,$36.09 ,$130.99 ,$21.23 ,$36.09 ,$36.09 ,$107.87 ,$93.85 ,$21.94 ,$21.23 ,$20.81 ,$42.46 ,$23.26 ,$130.99 ,$47.77 ,$141.77 ,$107.87 ,$106.09 ,$106.09 ,$93.85 ,$106.09 ,$106.48 ,$138.69 ,$105.28 ,$21.01 ,$121.74 ,$23.26 ,$25.48 ,$25.48 ,$20.81 ,$25.48 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30100736,84425,HC VITAMIN B1 PLASMA,301,1 ,$254.15 ,$167.74 ,$20.81 ,$254.15 ,$21.94 ,$74.31 ,$74.31 ,$21.23 ,$152.49 ,$216.03 ,$177.91 ,$21.94 ,$21.94 ,$241.44 ,$193.15 ,$190.61 ,$36.09 ,$216.03 ,$21.23 ,$36.09 ,$36.09 ,$177.91 ,$154.78 ,$21.94 ,$21.23 ,$20.81 ,$42.46 ,$23.26 ,$216.03 ,$47.77 ,$233.82 ,$177.91 ,$106.09 ,$106.09 ,$154.78 ,$106.09 ,$175.62 ,$228.74 ,$173.64 ,$21.01 ,$200.78 ,$23.26 ,$25.48 ,$25.48 ,$20.81 ,$25.48 ,$182.99 ,$157.57 ,$182.99 ,$182.99 ,$203.32 
ST NICHOLAS HOSPITAL - ACUTE,30100737,84432,HC THYROGLOBULIN,301,1 ,$141.45 ,$93.36 ,$15.74 ,$141.45 ,$16.59 ,$56.21 ,$56.21 ,$16.06 ,$84.87 ,$120.23 ,$99.02 ,$16.59 ,$16.59 ,$134.38 ,$107.50 ,$106.09 ,$27.30 ,$120.23 ,$16.06 ,$27.30 ,$27.30 ,$99.02 ,$86.14 ,$16.59 ,$16.06 ,$15.74 ,$32.12 ,$17.59 ,$120.23 ,$36.14 ,$130.13 ,$99.02 ,$80.27 ,$80.27 ,$86.14 ,$80.27 ,$97.74 ,$127.31 ,$96.64 ,$15.90 ,$111.75 ,$17.59 ,$19.27 ,$19.27 ,$15.74 ,$19.27 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100738,84432,HC THYROGLOBULIN 2,301,1 ,$411.70 ,$271.72 ,$15.74 ,$411.70 ,$16.59 ,$56.21 ,$56.21 ,$16.06 ,$247.02 ,$349.95 ,$288.19 ,$16.59 ,$16.59 ,$391.12 ,$312.89 ,$308.78 ,$27.30 ,$349.95 ,$16.06 ,$27.30 ,$27.30 ,$288.19 ,$250.73 ,$16.59 ,$16.06 ,$15.74 ,$32.12 ,$17.59 ,$349.95 ,$36.14 ,$378.76 ,$288.19 ,$80.27 ,$80.27 ,$250.73 ,$80.27 ,$284.48 ,$370.53 ,$281.27 ,$15.90 ,$325.24 ,$17.59 ,$19.27 ,$19.27 ,$15.74 ,$19.27 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,30100739,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$44.85 ,$29.60 ,$6.73 ,$44.85 ,$7.10 ,$24.05 ,$24.05 ,$6.87 ,$26.91 ,$38.12 ,$31.40 ,$7.10 ,$7.10 ,$42.61 ,$34.09 ,$33.64 ,$11.68 ,$38.12 ,$6.87 ,$11.68 ,$11.68 ,$31.40 ,$27.31 ,$7.10 ,$6.87 ,$6.73 ,$13.74 ,$7.53 ,$38.12 ,$15.46 ,$41.26 ,$31.40 ,$34.33 ,$34.33 ,$27.31 ,$34.33 ,$30.99 ,$40.37 ,$30.64 ,$6.80 ,$35.43 ,$7.53 ,$8.24 ,$8.24 ,$6.73 ,$8.24 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30100740,84439,HC T4 FREE,301,1 ,$77.05 ,$50.85 ,$8.84 ,$77.05 ,$9.32 ,$31.57 ,$31.57 ,$9.02 ,$46.23 ,$65.49 ,$53.94 ,$9.32 ,$9.32 ,$73.20 ,$58.56 ,$57.79 ,$15.33 ,$65.49 ,$9.02 ,$15.33 ,$15.33 ,$53.94 ,$46.92 ,$9.32 ,$9.02 ,$8.84 ,$18.04 ,$9.88 ,$65.49 ,$20.30 ,$70.89 ,$53.94 ,$45.06 ,$45.06 ,$46.92 ,$45.06 ,$53.24 ,$69.35 ,$52.64 ,$8.93 ,$60.87 ,$9.88 ,$10.82 ,$10.82 ,$8.84 ,$10.82 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100741,84439,HC T4/T4 FREE,301,1 ,$141.45 ,$93.36 ,$8.84 ,$141.45 ,$9.32 ,$31.57 ,$31.57 ,$9.02 ,$84.87 ,$120.23 ,$99.02 ,$9.32 ,$9.32 ,$134.38 ,$107.50 ,$106.09 ,$15.33 ,$120.23 ,$9.02 ,$15.33 ,$15.33 ,$99.02 ,$86.14 ,$9.32 ,$9.02 ,$8.84 ,$18.04 ,$9.88 ,$120.23 ,$20.30 ,$130.13 ,$99.02 ,$45.06 ,$45.06 ,$86.14 ,$45.06 ,$97.74 ,$127.31 ,$96.64 ,$8.93 ,$111.75 ,$9.88 ,$10.82 ,$10.82 ,$8.84 ,$10.82 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100742,84442,HC THYROXINE BIND GLOB,301,1 ,$93.15 ,$61.48 ,$14.48 ,$93.15 ,$15.27 ,$51.73 ,$51.73 ,$14.78 ,$55.89 ,$79.18 ,$65.21 ,$15.27 ,$15.27 ,$88.49 ,$70.79 ,$69.86 ,$25.13 ,$79.18 ,$14.78 ,$25.13 ,$25.13 ,$65.21 ,$56.73 ,$15.27 ,$14.78 ,$14.48 ,$29.56 ,$16.19 ,$79.18 ,$33.26 ,$85.70 ,$65.21 ,$73.89 ,$73.89 ,$56.73 ,$73.89 ,$64.37 ,$83.84 ,$63.64 ,$14.63 ,$73.59 ,$16.19 ,$17.74 ,$17.74 ,$14.48 ,$17.74 ,$67.07 ,$57.75 ,$67.07 ,$67.07 ,$74.52 
ST NICHOLAS HOSPITAL - ACUTE,30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$141.45 ,$93.36 ,$16.46 ,$141.45 ,$17.36 ,$58.80 ,$58.80 ,$16.80 ,$84.87 ,$120.23 ,$99.02 ,$17.36 ,$17.36 ,$134.38 ,$107.50 ,$106.09 ,$28.56 ,$120.23 ,$16.80 ,$28.56 ,$28.56 ,$99.02 ,$86.14 ,$17.36 ,$16.80 ,$16.46 ,$33.60 ,$18.40 ,$120.23 ,$37.80 ,$130.13 ,$99.02 ,$84.00 ,$84.00 ,$86.14 ,$84.00 ,$97.74 ,$127.31 ,$96.64 ,$16.63 ,$111.75 ,$18.40 ,$20.16 ,$20.16 ,$16.46 ,$20.16 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100744,84445,HC THYROID STIM IMMUNO GLOB,301,1 ,$334.65 ,$220.87 ,$32.70 ,$334.65 ,$32.70 ,$178.01 ,$178.01 ,$50.86 ,$200.79 ,$284.45 ,$234.26 ,$32.70 ,$32.70 ,$317.92 ,$254.33 ,$250.99 ,$86.46 ,$284.45 ,$50.86 ,$86.46 ,$86.46 ,$234.26 ,$203.80 ,$32.70 ,$50.86 ,$49.84 ,$101.72 ,$34.66 ,$284.45 ,$114.44 ,$307.88 ,$234.26 ,$116.24 ,$116.24 ,$203.80 ,$116.24 ,$231.24 ,$301.19 ,$228.63 ,$50.34 ,$264.37 ,$34.66 ,$61.03 ,$61.03 ,$49.84 ,$61.03 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30100745,84446,HC VITAMIN E,301,1 ,$128.80 ,$85.01 ,$13.90 ,$128.80 ,$14.65 ,$49.63 ,$49.63 ,$14.18 ,$77.28 ,$109.48 ,$90.16 ,$14.65 ,$14.65 ,$122.36 ,$97.89 ,$96.60 ,$24.11 ,$109.48 ,$14.18 ,$24.11 ,$24.11 ,$90.16 ,$78.44 ,$14.65 ,$14.18 ,$13.90 ,$28.36 ,$15.53 ,$109.48 ,$31.91 ,$118.50 ,$90.16 ,$70.85 ,$70.85 ,$78.44 ,$70.85 ,$89.00 ,$115.92 ,$88.00 ,$14.03 ,$101.75 ,$15.53 ,$17.02 ,$17.02 ,$13.90 ,$17.02 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100746,84450,HC AST,301,1 ,$44.85 ,$29.60 ,$5.08 ,$44.85 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$26.91 ,$38.12 ,$31.40 ,$5.35 ,$5.35 ,$42.61 ,$34.09 ,$33.64 ,$8.81 ,$38.12 ,$5.18 ,$8.81 ,$8.81 ,$31.40 ,$27.31 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$38.12 ,$11.66 ,$41.26 ,$31.40 ,$25.86 ,$25.86 ,$27.31 ,$25.86 ,$30.99 ,$40.37 ,$30.64 ,$5.13 ,$35.43 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30100747,84460,HC ALT,301,1 ,$46.00 ,$30.36 ,$5.19 ,$46.00 ,$5.48 ,$18.55 ,$18.55 ,$5.30 ,$27.60 ,$39.10 ,$32.20 ,$5.48 ,$5.48 ,$43.70 ,$34.96 ,$34.50 ,$9.01 ,$39.10 ,$5.30 ,$9.01 ,$9.01 ,$32.20 ,$28.01 ,$5.48 ,$5.30 ,$5.19 ,$10.60 ,$5.81 ,$39.10 ,$11.93 ,$42.32 ,$32.20 ,$26.45 ,$26.45 ,$28.01 ,$26.45 ,$31.79 ,$41.40 ,$31.43 ,$5.24 ,$36.34 ,$5.81 ,$6.36 ,$6.36 ,$5.19 ,$6.36 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30100748,84466,HC TRANSFERRIN,301,1 ,$62.10 ,$40.99 ,$12.50 ,$62.10 ,$13.18 ,$44.66 ,$44.66 ,$12.76 ,$37.26 ,$52.79 ,$43.47 ,$13.18 ,$13.18 ,$59.00 ,$47.20 ,$46.58 ,$21.69 ,$52.79 ,$12.76 ,$21.69 ,$21.69 ,$43.47 ,$37.82 ,$13.18 ,$12.76 ,$12.50 ,$25.52 ,$13.97 ,$52.79 ,$28.71 ,$57.13 ,$43.47 ,$62.10 ,$62.10 ,$37.82 ,$62.10 ,$42.91 ,$55.89 ,$42.43 ,$12.63 ,$49.06 ,$13.97 ,$15.31 ,$15.31 ,$12.50 ,$15.31 ,$44.71 ,$38.50 ,$44.71 ,$44.71 ,$49.68 
ST NICHOLAS HOSPITAL - ACUTE,30100749,84466,HC TRANSFERRIN SERUM/IRON,301,1 ,$128.80 ,$85.01 ,$12.50 ,$128.80 ,$13.18 ,$44.66 ,$44.66 ,$12.76 ,$77.28 ,$109.48 ,$90.16 ,$13.18 ,$13.18 ,$122.36 ,$97.89 ,$96.60 ,$21.69 ,$109.48 ,$12.76 ,$21.69 ,$21.69 ,$90.16 ,$78.44 ,$13.18 ,$12.76 ,$12.50 ,$25.52 ,$13.97 ,$109.48 ,$28.71 ,$118.50 ,$90.16 ,$63.82 ,$63.82 ,$78.44 ,$63.82 ,$89.00 ,$115.92 ,$88.00 ,$12.63 ,$101.75 ,$13.97 ,$15.31 ,$15.31 ,$12.50 ,$15.31 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100750,84478,HC TRIGLYCERIDES,301,1 ,$50.60 ,$33.40 ,$5.63 ,$50.60 ,$5.93 ,$20.09 ,$20.09 ,$5.74 ,$30.36 ,$43.01 ,$35.42 ,$5.93 ,$5.93 ,$48.07 ,$38.46 ,$37.95 ,$9.76 ,$43.01 ,$5.74 ,$9.76 ,$9.76 ,$35.42 ,$30.82 ,$5.93 ,$5.74 ,$5.63 ,$11.48 ,$6.29 ,$43.01 ,$12.92 ,$46.55 ,$35.42 ,$28.72 ,$28.72 ,$30.82 ,$28.72 ,$34.96 ,$45.54 ,$34.57 ,$5.68 ,$39.97 ,$6.29 ,$6.89 ,$6.89 ,$5.63 ,$6.89 ,$36.43 ,$31.37 ,$36.43 ,$36.43 ,$40.48 
ST NICHOLAS HOSPITAL - ACUTE,30100751,84478,HC TRIGLYCERIDES (VAP),301,1 ,$50.60 ,$33.40 ,$5.63 ,$50.60 ,$5.93 ,$20.09 ,$20.09 ,$5.74 ,$30.36 ,$43.01 ,$35.42 ,$5.93 ,$5.93 ,$48.07 ,$38.46 ,$37.95 ,$9.76 ,$43.01 ,$5.74 ,$9.76 ,$9.76 ,$35.42 ,$30.82 ,$5.93 ,$5.74 ,$5.63 ,$11.48 ,$6.29 ,$43.01 ,$12.92 ,$46.55 ,$35.42 ,$28.72 ,$28.72 ,$30.82 ,$28.72 ,$34.96 ,$45.54 ,$34.57 ,$5.68 ,$39.97 ,$6.29 ,$6.89 ,$6.89 ,$5.63 ,$6.89 ,$36.43 ,$31.37 ,$36.43 ,$36.43 ,$40.48 
ST NICHOLAS HOSPITAL - ACUTE,30100752,84478,HC TRICGLYCERIDES BODY FLUID,301,1 ,$50.60 ,$33.40 ,$5.63 ,$50.60 ,$5.93 ,$20.09 ,$20.09 ,$5.74 ,$30.36 ,$43.01 ,$35.42 ,$5.93 ,$5.93 ,$48.07 ,$38.46 ,$37.95 ,$9.76 ,$43.01 ,$5.74 ,$9.76 ,$9.76 ,$35.42 ,$30.82 ,$5.93 ,$5.74 ,$5.63 ,$11.48 ,$6.29 ,$43.01 ,$12.92 ,$46.55 ,$35.42 ,$28.72 ,$28.72 ,$30.82 ,$28.72 ,$34.96 ,$45.54 ,$34.57 ,$5.68 ,$39.97 ,$6.29 ,$6.89 ,$6.89 ,$5.63 ,$6.89 ,$36.43 ,$31.37 ,$36.43 ,$36.43 ,$40.48 
ST NICHOLAS HOSPITAL - ACUTE,30100753,84479,HC T3 UPTAKE,301,1 ,$77.05 ,$50.85 ,$6.34 ,$77.05 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$46.23 ,$65.49 ,$53.94 ,$6.69 ,$6.69 ,$73.20 ,$58.56 ,$57.79 ,$11.00 ,$65.49 ,$6.47 ,$11.00 ,$11.00 ,$53.94 ,$46.92 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$65.49 ,$14.56 ,$70.89 ,$53.94 ,$32.35 ,$32.35 ,$46.92 ,$32.35 ,$53.24 ,$69.35 ,$52.64 ,$6.40 ,$60.87 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100754,84480,HC T3 TOTAL,301,1 ,$128.80 ,$85.01 ,$13.90 ,$128.80 ,$14.65 ,$49.63 ,$49.63 ,$14.18 ,$77.28 ,$109.48 ,$90.16 ,$14.65 ,$14.65 ,$122.36 ,$97.89 ,$96.60 ,$24.11 ,$109.48 ,$14.18 ,$24.11 ,$24.11 ,$90.16 ,$78.44 ,$14.65 ,$14.18 ,$13.90 ,$28.36 ,$15.53 ,$109.48 ,$31.91 ,$118.50 ,$90.16 ,$70.85 ,$70.85 ,$78.44 ,$70.85 ,$89.00 ,$115.92 ,$88.00 ,$14.03 ,$101.75 ,$15.53 ,$17.02 ,$17.02 ,$13.90 ,$17.02 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100755,84481,HC T3 FREE,301,1 ,$103.50 ,$68.31 ,$16.60 ,$103.50 ,$16.62 ,$59.29 ,$59.29 ,$16.94 ,$62.10 ,$87.98 ,$72.45 ,$16.62 ,$16.62 ,$98.33 ,$78.66 ,$77.63 ,$28.80 ,$87.98 ,$16.94 ,$28.80 ,$28.80 ,$72.45 ,$63.03 ,$16.62 ,$16.94 ,$16.60 ,$33.88 ,$17.62 ,$87.98 ,$38.12 ,$95.22 ,$72.45 ,$59.06 ,$59.06 ,$63.03 ,$59.06 ,$71.52 ,$93.15 ,$70.71 ,$16.77 ,$81.77 ,$17.62 ,$20.33 ,$20.33 ,$16.60 ,$20.33 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100756,84481,HC TRIIODOTHYRONINE T3 FREE,301,1 ,$204.70 ,$135.10 ,$16.60 ,$204.70 ,$16.62 ,$59.29 ,$59.29 ,$16.94 ,$122.82 ,$174.00 ,$143.29 ,$16.62 ,$16.62 ,$194.47 ,$155.57 ,$153.53 ,$28.80 ,$174.00 ,$16.94 ,$28.80 ,$28.80 ,$143.29 ,$124.66 ,$16.62 ,$16.94 ,$16.60 ,$33.88 ,$17.62 ,$174.00 ,$38.12 ,$188.32 ,$143.29 ,$59.06 ,$59.06 ,$124.66 ,$59.06 ,$141.45 ,$184.23 ,$139.85 ,$16.77 ,$161.71 ,$17.62 ,$20.33 ,$20.33 ,$16.60 ,$20.33 ,$147.38 ,$126.91 ,$147.38 ,$147.38 ,$163.76 
ST NICHOLAS HOSPITAL - ACUTE,30100757,84482,HC T3 REVERSE,301,1 ,$77.05 ,$50.85 ,$10.82 ,$77.05 ,$10.82 ,$55.16 ,$55.16 ,$15.76 ,$46.23 ,$65.49 ,$53.94 ,$10.82 ,$10.82 ,$73.20 ,$58.56 ,$57.79 ,$26.79 ,$65.49 ,$15.76 ,$26.79 ,$26.79 ,$53.94 ,$46.92 ,$10.82 ,$15.76 ,$15.44 ,$31.52 ,$11.47 ,$65.49 ,$35.46 ,$70.89 ,$53.94 ,$38.47 ,$38.47 ,$46.92 ,$38.47 ,$53.24 ,$69.35 ,$52.64 ,$15.60 ,$60.87 ,$11.47 ,$18.91 ,$18.91 ,$15.44 ,$18.91 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100758,84484,HC TROPONIN QN,301,1 ,$116.15 ,$76.66 ,$12.22 ,$116.15 ,$12.89 ,$43.65 ,$43.65 ,$12.47 ,$69.69 ,$98.73 ,$81.31 ,$12.89 ,$12.89 ,$110.34 ,$88.27 ,$87.11 ,$21.20 ,$98.73 ,$12.47 ,$21.20 ,$21.20 ,$81.31 ,$70.74 ,$12.89 ,$12.47 ,$12.22 ,$24.94 ,$13.66 ,$98.73 ,$28.06 ,$106.86 ,$81.31 ,$49.16 ,$49.16 ,$70.74 ,$49.16 ,$80.26 ,$104.54 ,$79.35 ,$12.34 ,$91.76 ,$13.66 ,$14.96 ,$14.96 ,$12.22 ,$14.96 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100759,84488,HC TRYPSIN FECES QL,301,1 ,$106.95 ,$70.59 ,$7.15 ,$106.95 ,$7.54 ,$25.55 ,$25.55 ,$7.30 ,$64.17 ,$90.91 ,$74.87 ,$7.54 ,$7.54 ,$101.60 ,$81.28 ,$80.21 ,$12.41 ,$90.91 ,$7.30 ,$12.41 ,$12.41 ,$74.87 ,$65.13 ,$7.54 ,$7.30 ,$7.15 ,$14.60 ,$7.99 ,$90.91 ,$16.43 ,$98.39 ,$74.87 ,$36.49 ,$36.49 ,$65.13 ,$36.49 ,$73.90 ,$96.26 ,$73.07 ,$7.22 ,$84.49 ,$7.99 ,$8.76 ,$8.76 ,$7.15 ,$8.76 ,$77.00 ,$66.31 ,$77.00 ,$77.00 ,$85.56 
ST NICHOLAS HOSPITAL - ACUTE,30100761,84520,HC BUN,301,1 ,$34.50 ,$22.77 ,$3.87 ,$34.50 ,$4.08 ,$13.83 ,$13.83 ,$3.95 ,$20.70 ,$29.33 ,$24.15 ,$4.08 ,$4.08 ,$32.78 ,$26.22 ,$25.88 ,$6.72 ,$29.33 ,$3.95 ,$6.72 ,$6.72 ,$24.15 ,$21.01 ,$4.08 ,$3.95 ,$3.87 ,$7.90 ,$4.32 ,$29.33 ,$8.89 ,$31.74 ,$24.15 ,$19.75 ,$19.75 ,$21.01 ,$19.75 ,$23.84 ,$31.05 ,$23.57 ,$3.91 ,$27.26 ,$4.32 ,$4.74 ,$4.74 ,$3.87 ,$4.74 ,$24.84 ,$21.39 ,$24.84 ,$24.84 ,$27.60 
ST NICHOLAS HOSPITAL - ACUTE,30100762,84520,HC BUN BODY FLUID,301,1 ,$43.70 ,$28.84 ,$3.87 ,$43.70 ,$4.08 ,$13.83 ,$13.83 ,$3.95 ,$26.22 ,$37.15 ,$30.59 ,$4.08 ,$4.08 ,$41.52 ,$33.21 ,$32.78 ,$6.72 ,$37.15 ,$3.95 ,$6.72 ,$6.72 ,$30.59 ,$26.61 ,$4.08 ,$3.95 ,$3.87 ,$7.90 ,$4.32 ,$37.15 ,$8.89 ,$40.20 ,$30.59 ,$19.75 ,$19.75 ,$26.61 ,$19.75 ,$30.20 ,$39.33 ,$29.86 ,$3.91 ,$34.52 ,$4.32 ,$4.74 ,$4.74 ,$3.87 ,$4.74 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30100763,84520,HC BUN ISTAT,301,1 ,$43.70 ,$28.84 ,$3.87 ,$43.70 ,$4.08 ,$13.83 ,$13.83 ,$3.95 ,$26.22 ,$37.15 ,$30.59 ,$4.08 ,$4.08 ,$41.52 ,$33.21 ,$32.78 ,$6.72 ,$37.15 ,$3.95 ,$6.72 ,$6.72 ,$30.59 ,$26.61 ,$4.08 ,$3.95 ,$3.87 ,$7.90 ,$4.32 ,$37.15 ,$8.89 ,$40.20 ,$30.59 ,$19.75 ,$19.75 ,$26.61 ,$19.75 ,$30.20 ,$39.33 ,$29.86 ,$3.91 ,$34.52 ,$4.32 ,$4.74 ,$4.74 ,$3.87 ,$4.74 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30100764,84540,HC UREA URINE,301,1 ,$77.05 ,$50.85 ,$5.45 ,$77.05 ,$5.75 ,$19.46 ,$19.46 ,$5.56 ,$46.23 ,$65.49 ,$53.94 ,$5.75 ,$5.75 ,$73.20 ,$58.56 ,$57.79 ,$9.45 ,$65.49 ,$5.56 ,$9.45 ,$9.45 ,$53.94 ,$46.92 ,$5.75 ,$5.56 ,$5.45 ,$11.12 ,$6.10 ,$65.49 ,$12.51 ,$70.89 ,$53.94 ,$23.74 ,$23.74 ,$46.92 ,$23.74 ,$53.24 ,$69.35 ,$52.64 ,$5.51 ,$60.87 ,$6.10 ,$6.67 ,$6.67 ,$5.45 ,$6.67 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100765,84550,HC URIC ACID,301,1 ,$43.70 ,$28.84 ,$4.43 ,$43.70 ,$4.67 ,$15.82 ,$15.82 ,$4.52 ,$26.22 ,$37.15 ,$30.59 ,$4.67 ,$4.67 ,$41.52 ,$33.21 ,$32.78 ,$7.68 ,$37.15 ,$4.52 ,$7.68 ,$7.68 ,$30.59 ,$26.61 ,$4.67 ,$4.52 ,$4.43 ,$9.04 ,$4.95 ,$37.15 ,$10.17 ,$40.20 ,$30.59 ,$22.57 ,$22.57 ,$26.61 ,$22.57 ,$30.20 ,$39.33 ,$29.86 ,$4.48 ,$34.52 ,$4.95 ,$5.42 ,$5.42 ,$4.43 ,$5.42 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30100766,84560,HC URIC ACID OTH SRC,301,1 ,$41.40 ,$27.32 ,$4.98 ,$41.40 ,$5.25 ,$17.78 ,$17.78 ,$5.08 ,$24.84 ,$35.19 ,$28.98 ,$5.25 ,$5.25 ,$39.33 ,$31.46 ,$31.05 ,$8.64 ,$35.19 ,$5.08 ,$8.64 ,$8.64 ,$28.98 ,$25.21 ,$5.25 ,$5.08 ,$4.98 ,$10.16 ,$5.57 ,$35.19 ,$11.43 ,$38.09 ,$28.98 ,$23.74 ,$23.74 ,$25.21 ,$23.74 ,$28.61 ,$37.26 ,$28.28 ,$5.03 ,$32.71 ,$5.57 ,$6.10 ,$6.10 ,$4.98 ,$6.10 ,$29.81 ,$25.67 ,$29.81 ,$29.81 ,$33.12 
ST NICHOLAS HOSPITAL - ACUTE,30100767,84578,HC UROBILINOGEN,301,1 ,$28.75 ,$18.98 ,$4.38 ,$28.75 ,$4.58 ,$15.65 ,$15.65 ,$4.47 ,$17.25 ,$24.44 ,$20.13 ,$4.58 ,$4.58 ,$27.31 ,$21.85 ,$21.56 ,$7.60 ,$24.44 ,$4.47 ,$7.60 ,$7.60 ,$20.13 ,$17.51 ,$4.58 ,$4.47 ,$4.38 ,$8.94 ,$4.85 ,$24.44 ,$10.06 ,$26.45 ,$20.13 ,$16.23 ,$16.23 ,$17.51 ,$16.23 ,$19.87 ,$25.88 ,$19.64 ,$4.42 ,$22.71 ,$4.85 ,$5.36 ,$5.36 ,$4.38 ,$5.36 ,$20.70 ,$17.83 ,$20.70 ,$20.70 ,$23.00 
ST NICHOLAS HOSPITAL - ACUTE,30100768,84585,HC VANILLYLMAND AC (VMA),301,1 ,$128.80 ,$85.01 ,$15.19 ,$128.80 ,$16.02 ,$54.25 ,$54.25 ,$15.50 ,$77.28 ,$109.48 ,$90.16 ,$16.02 ,$16.02 ,$122.36 ,$97.89 ,$96.60 ,$26.35 ,$109.48 ,$15.50 ,$26.35 ,$26.35 ,$90.16 ,$78.44 ,$16.02 ,$15.50 ,$15.19 ,$31.00 ,$16.98 ,$109.48 ,$34.88 ,$118.50 ,$90.16 ,$77.45 ,$77.45 ,$78.44 ,$77.45 ,$89.00 ,$115.92 ,$88.00 ,$15.35 ,$101.75 ,$16.98 ,$18.60 ,$18.60 ,$15.19 ,$18.60 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100769,84586,HC VASOACTIVE INTEST PEPTIDE,301,1 ,$218.50 ,$144.21 ,$17.93 ,$218.50 ,$17.93 ,$123.66 ,$123.66 ,$35.33 ,$131.10 ,$185.73 ,$152.95 ,$17.93 ,$17.93 ,$207.58 ,$166.06 ,$163.88 ,$60.06 ,$185.73 ,$35.33 ,$60.06 ,$60.06 ,$152.95 ,$133.07 ,$17.93 ,$35.33 ,$34.62 ,$70.66 ,$19.01 ,$185.73 ,$79.49 ,$201.02 ,$152.95 ,$63.71 ,$63.71 ,$133.07 ,$63.71 ,$150.98 ,$196.65 ,$149.28 ,$34.97 ,$172.62 ,$19.01 ,$42.40 ,$42.40 ,$34.62 ,$42.40 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30100770,84588,HC VASOPRESSIN (ADH),301,1 ,$296.70 ,$195.82 ,$33.26 ,$296.70 ,$35.07 ,$118.79 ,$118.79 ,$33.94 ,$178.02 ,$252.20 ,$207.69 ,$35.07 ,$35.07 ,$281.87 ,$225.49 ,$222.53 ,$57.70 ,$252.20 ,$33.94 ,$57.70 ,$57.70 ,$207.69 ,$180.69 ,$35.07 ,$33.94 ,$33.26 ,$67.88 ,$37.17 ,$252.20 ,$76.37 ,$272.96 ,$207.69 ,$169.66 ,$169.66 ,$180.69 ,$169.66 ,$205.02 ,$267.03 ,$202.71 ,$33.59 ,$234.39 ,$37.17 ,$40.73 ,$40.73 ,$33.26 ,$40.73 ,$213.62 ,$183.95 ,$213.62 ,$213.62 ,$237.36 
ST NICHOLAS HOSPITAL - ACUTE,30100771,84590,HC VITAMIN A,301,1 ,$103.50 ,$68.31 ,$11.38 ,$103.50 ,$12.00 ,$40.64 ,$40.64 ,$11.61 ,$62.10 ,$87.98 ,$72.45 ,$12.00 ,$12.00 ,$98.33 ,$78.66 ,$77.63 ,$19.74 ,$87.98 ,$11.61 ,$19.74 ,$19.74 ,$72.45 ,$63.03 ,$12.00 ,$11.61 ,$11.38 ,$23.22 ,$12.72 ,$87.98 ,$26.12 ,$95.22 ,$72.45 ,$57.99 ,$57.99 ,$63.03 ,$57.99 ,$71.52 ,$93.15 ,$70.71 ,$11.50 ,$81.77 ,$12.72 ,$13.93 ,$13.93 ,$11.38 ,$13.93 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100772,84597,HC VITAMIN K,301,1 ,$450.80 ,$297.53 ,$13.45 ,$450.80 ,$14.18 ,$48.02 ,$48.02 ,$13.72 ,$270.48 ,$383.18 ,$315.56 ,$14.18 ,$14.18 ,$428.26 ,$342.61 ,$338.10 ,$23.32 ,$383.18 ,$13.72 ,$23.32 ,$23.32 ,$315.56 ,$274.54 ,$14.18 ,$13.72 ,$13.45 ,$27.44 ,$15.03 ,$383.18 ,$30.87 ,$414.74 ,$315.56 ,$68.54 ,$68.54 ,$274.54 ,$68.54 ,$311.50 ,$405.72 ,$307.99 ,$13.58 ,$356.13 ,$15.03 ,$16.46 ,$16.46 ,$13.45 ,$16.46 ,$324.58 ,$279.50 ,$324.58 ,$324.58 ,$360.64 
ST NICHOLAS HOSPITAL - ACUTE,30100773,80320,HC VOLATILES,301,1 ,$250.00 ,$165.00 ,$2.16 ,$250.00 ,$2.16 ,$79.87 ,$79.87 , N/A ,$150.00 ,$212.50 ,$175.00 ,$2.16 ,$2.16 ,$237.50 ,$190.00 ,$187.50 ,$38.86 ,$212.50 , N/A ,$38.86 ,$38.86 ,$175.00 ,$152.25 ,$2.16 , N/A , N/A , N/A ,$2.29 ,$212.50 , N/A ,$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$152.18 ,$172.75 ,$225.00 ,$170.80 , N/A ,$197.50 ,$2.29 , N/A , N/A , N/A , N/A ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,30100774,G0480,HC VOLATILES (STAT),301,1 ,$247.00 ,$163.02 ,$63.95 ,$257.47 ,$63.95 ,$247.00 ,$247.00 ,$114.43 ,$148.20 ,$209.95 ,$172.90 ,$63.95 ,$63.95 ,$234.65 ,$187.72 ,$185.25 ,$194.53 ,$209.95 ,$114.43 ,$194.53 ,$194.53 ,$172.90 ,$150.42 ,$63.95 ,$114.43 ,$112.14 ,$228.86 ,$67.79 ,$209.95 ,$257.47 ,$227.24 ,$172.90 ,$247.00 ,$247.00 ,$150.42 ,$247.00 ,$170.68 ,$222.30 ,$168.75 ,$113.26 ,$195.13 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$177.84 ,$153.14 ,$177.84 ,$177.84 ,$197.60 
ST NICHOLAS HOSPITAL - ACUTE,30100775,84166,HC ELECTRPHRTC FRAC/QUNT,301,1 ,$63.25 ,$41.75 ,$17.47 ,$63.25 ,$18.42 ,$62.41 ,$62.41 ,$17.83 ,$37.95 ,$53.76 ,$44.28 ,$18.42 ,$18.42 ,$60.09 ,$48.07 ,$47.44 ,$30.31 ,$53.76 ,$17.83 ,$30.31 ,$30.31 ,$44.28 ,$38.52 ,$18.42 ,$17.83 ,$17.47 ,$35.66 ,$19.53 ,$53.76 ,$40.12 ,$58.19 ,$44.28 ,$63.25 ,$63.25 ,$38.52 ,$63.25 ,$43.71 ,$56.93 ,$43.21 ,$17.65 ,$49.97 ,$19.53 ,$21.40 ,$21.40 ,$17.47 ,$21.40 ,$45.54 ,$39.22 ,$45.54 ,$45.54 ,$50.60 
ST NICHOLAS HOSPITAL - ACUTE,30100776,84630,HC ZINC,301,1 ,$89.70 ,$59.20 ,$11.16 ,$89.70 ,$11.77 ,$39.87 ,$39.87 ,$11.39 ,$53.82 ,$76.25 ,$62.79 ,$11.77 ,$11.77 ,$85.22 ,$68.17 ,$67.28 ,$19.36 ,$76.25 ,$11.39 ,$19.36 ,$19.36 ,$62.79 ,$54.63 ,$11.77 ,$11.39 ,$11.16 ,$22.78 ,$12.48 ,$76.25 ,$25.63 ,$82.52 ,$62.79 ,$51.80 ,$51.80 ,$54.63 ,$51.80 ,$61.98 ,$80.73 ,$61.28 ,$11.27 ,$70.86 ,$12.48 ,$13.67 ,$13.67 ,$11.16 ,$13.67 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30100777,84630,HC ZINC (MAYO),301,1 ,$195.50 ,$129.03 ,$11.16 ,$195.50 ,$11.77 ,$39.87 ,$39.87 ,$11.39 ,$117.30 ,$166.18 ,$136.85 ,$11.77 ,$11.77 ,$185.73 ,$148.58 ,$146.63 ,$19.36 ,$166.18 ,$11.39 ,$19.36 ,$19.36 ,$136.85 ,$119.06 ,$11.77 ,$11.39 ,$11.16 ,$22.78 ,$12.48 ,$166.18 ,$25.63 ,$179.86 ,$136.85 ,$51.80 ,$51.80 ,$119.06 ,$51.80 ,$135.09 ,$175.95 ,$133.57 ,$11.27 ,$154.45 ,$12.48 ,$13.67 ,$13.67 ,$11.16 ,$13.67 ,$140.76 ,$121.21 ,$140.76 ,$140.76 ,$156.40 
ST NICHOLAS HOSPITAL - ACUTE,30100778,84630,HC ZINC PLASMA,301,1 ,$39.10 ,$25.81 ,$11.16 ,$39.10 ,$11.77 ,$39.10 ,$39.10 ,$11.39 ,$23.46 ,$33.24 ,$27.37 ,$11.77 ,$11.77 ,$37.15 ,$29.72 ,$29.33 ,$19.36 ,$33.24 ,$11.39 ,$19.36 ,$19.36 ,$27.37 ,$23.81 ,$11.77 ,$11.39 ,$11.16 ,$22.78 ,$12.48 ,$33.24 ,$25.63 ,$35.97 ,$27.37 ,$39.10 ,$39.10 ,$23.81 ,$39.10 ,$27.02 ,$35.19 ,$26.71 ,$11.27 ,$30.89 ,$12.48 ,$13.67 ,$13.67 ,$11.16 ,$13.67 ,$28.15 ,$24.24 ,$28.15 ,$28.15 ,$31.28 
ST NICHOLAS HOSPITAL - ACUTE,30100780,82465,HC CHOLESTEROL (LMP),301,1 ,$100.05 ,$66.03 ,$4.26 ,$100.05 ,$4.49 ,$15.23 ,$15.23 ,$4.35 ,$60.03 ,$85.04 ,$70.04 ,$4.49 ,$4.49 ,$95.05 ,$76.04 ,$75.04 ,$7.40 ,$85.04 ,$4.35 ,$7.40 ,$7.40 ,$70.04 ,$60.93 ,$4.49 ,$4.35 ,$4.26 ,$8.70 ,$4.76 ,$85.04 ,$9.79 ,$92.05 ,$70.04 ,$21.72 ,$21.72 ,$60.93 ,$21.72 ,$69.13 ,$90.05 ,$68.35 ,$4.30 ,$79.04 ,$4.76 ,$5.22 ,$5.22 ,$4.26 ,$5.22 ,$72.04 ,$62.03 ,$72.04 ,$72.04 ,$80.04 
ST NICHOLAS HOSPITAL - ACUTE,30100781,82542,HC ZIPRASIDONE,301,1 ,$148.35 ,$97.91 ,$23.61 ,$148.35 ,$24.89 ,$84.32 ,$84.32 ,$24.09 ,$89.01 ,$126.10 ,$103.85 ,$24.89 ,$24.89 ,$140.93 ,$112.75 ,$111.26 ,$40.95 ,$126.10 ,$24.09 ,$40.95 ,$40.95 ,$103.85 ,$90.35 ,$24.89 ,$24.09 ,$23.61 ,$48.18 ,$26.38 ,$126.10 ,$54.20 ,$136.48 ,$103.85 ,$90.23 ,$90.23 ,$90.35 ,$90.23 ,$102.51 ,$133.52 ,$101.35 ,$23.84 ,$117.20 ,$26.38 ,$28.91 ,$28.91 ,$23.61 ,$28.91 ,$106.81 ,$91.98 ,$106.81 ,$106.81 ,$118.68 
ST NICHOLAS HOSPITAL - ACUTE,30100782,82664,HC CHOLESTEROL (LMP LPA),301,1 ,$257.60 ,$170.02 ,$48.31 ,$257.60 ,$48.31 ,$215.25 ,$215.25 ,$61.50 ,$154.56 ,$218.96 ,$180.32 ,$48.31 ,$48.31 ,$244.72 ,$195.78 ,$193.20 ,$104.55 ,$218.96 ,$61.50 ,$104.55 ,$104.55 ,$180.32 ,$156.88 ,$48.31 ,$61.50 ,$60.27 ,$123.00 ,$51.21 ,$218.96 ,$138.38 ,$236.99 ,$180.32 ,$171.71 ,$171.71 ,$156.88 ,$171.71 ,$178.00 ,$231.84 ,$175.99 ,$60.88 ,$203.50 ,$51.21 ,$73.80 ,$73.80 ,$60.27 ,$73.80 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30100800,84478,HC TRIGLYCERIDES (LMP),301,1 ,$115.00 ,$75.90 ,$5.63 ,$115.00 ,$5.93 ,$20.09 ,$20.09 ,$5.74 ,$69.00 ,$97.75 ,$80.50 ,$5.93 ,$5.93 ,$109.25 ,$87.40 ,$86.25 ,$9.76 ,$97.75 ,$5.74 ,$9.76 ,$9.76 ,$80.50 ,$70.04 ,$5.93 ,$5.74 ,$5.63 ,$11.48 ,$6.29 ,$97.75 ,$12.92 ,$105.80 ,$80.50 ,$28.72 ,$28.72 ,$70.04 ,$28.72 ,$79.47 ,$103.50 ,$78.57 ,$5.68 ,$90.85 ,$6.29 ,$6.89 ,$6.89 ,$5.63 ,$6.89 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,30100801,84681,HC C PEPTIDE,301,1 ,$116.15 ,$76.66 ,$7.34 ,$116.15 ,$7.34 ,$72.84 ,$72.84 ,$20.81 ,$69.69 ,$98.73 ,$81.31 ,$7.34 ,$7.34 ,$110.34 ,$88.27 ,$87.11 ,$35.38 ,$98.73 ,$20.81 ,$35.38 ,$35.38 ,$81.31 ,$70.74 ,$7.34 ,$20.81 ,$20.39 ,$41.62 ,$7.78 ,$98.73 ,$46.82 ,$106.86 ,$81.31 ,$26.08 ,$26.08 ,$70.74 ,$26.08 ,$80.26 ,$104.54 ,$79.35 ,$20.60 ,$91.76 ,$7.78 ,$24.97 ,$24.97 ,$20.39 ,$24.97 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100802,84702,HC HCG QN,301,1 ,$128.80 ,$85.01 ,$14.75 ,$128.80 ,$15.55 ,$52.68 ,$52.68 ,$15.05 ,$77.28 ,$109.48 ,$90.16 ,$15.55 ,$15.55 ,$122.36 ,$97.89 ,$96.60 ,$25.59 ,$109.48 ,$15.05 ,$25.59 ,$25.59 ,$90.16 ,$78.44 ,$15.55 ,$15.05 ,$14.75 ,$30.10 ,$16.48 ,$109.48 ,$33.86 ,$118.50 ,$90.16 ,$75.25 ,$75.25 ,$78.44 ,$75.25 ,$89.00 ,$115.92 ,$88.00 ,$14.90 ,$101.75 ,$16.48 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100803,84702,HC HCG QN (SUBUNIT),301,1 ,$23.00 ,$15.18 ,$13.80 ,$33.86 ,$15.55 ,$23.00 ,$23.00 ,$15.05 ,$13.80 ,$19.55 ,$16.10 ,$15.55 ,$15.55 ,$21.85 ,$17.48 ,$17.25 ,$23.00 ,$19.55 ,$15.05 ,$23.00 ,$23.00 ,$16.10 ,$14.01 ,$15.55 ,$15.05 ,$14.75 ,$23.00 ,$16.48 ,$19.55 ,$33.86 ,$21.16 ,$16.10 ,$23.00 ,$23.00 ,$14.01 ,$23.00 ,$15.89 ,$20.70 ,$15.71 ,$14.90 ,$18.17 ,$16.48 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$16.56 ,$14.26 ,$16.56 ,$16.56 ,$18.40 
ST NICHOLAS HOSPITAL - ACUTE,30100807,84702,HC HCG QN (BETA SUBUNIT),301,1 ,$46.00 ,$30.36 ,$14.75 ,$46.00 ,$15.55 ,$46.00 ,$46.00 ,$15.05 ,$27.60 ,$39.10 ,$32.20 ,$15.55 ,$15.55 ,$43.70 ,$34.96 ,$34.50 ,$25.59 ,$39.10 ,$15.05 ,$25.59 ,$25.59 ,$32.20 ,$28.01 ,$15.55 ,$15.05 ,$14.75 ,$30.10 ,$16.48 ,$39.10 ,$33.86 ,$42.32 ,$32.20 ,$46.00 ,$46.00 ,$28.01 ,$46.00 ,$31.79 ,$41.40 ,$31.43 ,$14.90 ,$36.34 ,$16.48 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30100808,84703,HC HCG QL,301,1 ,$77.05 ,$50.85 ,$7.37 ,$77.05 ,$7.77 ,$26.32 ,$26.32 ,$7.52 ,$46.23 ,$65.49 ,$53.94 ,$7.77 ,$7.77 ,$73.20 ,$58.56 ,$57.79 ,$12.78 ,$65.49 ,$7.52 ,$12.78 ,$12.78 ,$53.94 ,$46.92 ,$7.77 ,$7.52 ,$7.37 ,$15.04 ,$8.24 ,$65.49 ,$16.92 ,$70.89 ,$53.94 ,$37.59 ,$37.59 ,$46.92 ,$37.59 ,$53.24 ,$69.35 ,$52.64 ,$7.45 ,$60.87 ,$8.24 ,$9.02 ,$9.02 ,$7.37 ,$9.02 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100809,84999,HC CHEMISTRY UNLISTED,301,1 ,$21.85 ,$14.42 ,$0.36 ,$21.85 ,$0.36 ,$14.98 ,$14.98 , N/A ,$13.11 ,$18.57 ,$15.30 ,$0.36 ,$0.36 ,$20.76 ,$16.61 ,$16.39 , N/A ,$18.57 , N/A , N/A , N/A ,$15.30 ,$13.31 ,$0.36 , N/A , N/A , N/A ,$0.38 ,$18.57 ,$13.11 ,$20.10 ,$15.30 ,$11.08 ,$13.30 ,$13.31 ,$13.30 ,$15.10 ,$19.67 ,$14.93 , N/A ,$17.26 ,$0.38 , N/A , N/A , N/A , N/A ,$15.73 ,$13.55 ,$15.73 ,$15.73 ,$17.48 
ST NICHOLAS HOSPITAL - ACUTE,30100810,88720,HC BILICHECK TEST,301,1 ,$43.70 ,$28.84 ,$3.63 ,$43.70 ,$3.63 ,$17.57 ,$17.57 ,$5.02 ,$26.22 ,$37.15 ,$30.59 ,$3.63 ,$3.63 ,$41.52 ,$33.21 ,$32.78 ,$8.53 ,$37.15 ,$5.02 ,$8.53 ,$8.53 ,$30.59 ,$26.61 ,$3.63 ,$5.02 ,$4.92 ,$10.04 ,$3.85 ,$37.15 ,$11.30 ,$40.20 ,$30.59 ,$25.06 ,$25.06 ,$26.61 ,$25.06 ,$30.20 ,$39.33 ,$29.86 ,$4.97 ,$34.52 ,$3.85 ,$6.02 ,$6.02 ,$4.92 ,$6.02 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30100813,G0103,HC PSA ANNUAL SCREENING,301,1 ,$167.90 ,$110.81 ,$18.92 ,$167.90 ,$19.95 ,$67.59 ,$67.59 ,$19.31 ,$100.74 ,$142.72 ,$117.53 ,$19.95 ,$19.95 ,$159.51 ,$127.60 ,$125.93 ,$32.83 ,$142.72 ,$19.31 ,$32.83 ,$32.83 ,$117.53 ,$102.25 ,$19.95 ,$19.31 ,$18.92 ,$38.62 ,$21.15 ,$142.72 ,$43.45 ,$154.47 ,$117.53 ,$91.92 ,$91.92 ,$102.25 ,$91.92 ,$116.02 ,$151.11 ,$114.71 ,$19.11 ,$132.64 ,$21.15 ,$23.17 ,$23.17 ,$18.92 ,$23.17 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30100815,G0123,HC PAP SMEAR THIN PREP SCREEN,311,1 ,$173.65 ,$114.61 ,$19.85 ,$173.65 ,$20.93 ,$70.91 ,$70.91 ,$20.26 ,$104.19 ,$147.60 ,$121.56 ,$20.93 ,$20.93 ,$164.97 ,$131.97 ,$130.24 ,$34.44 ,$147.60 ,$20.26 ,$34.44 ,$34.44 ,$121.56 ,$105.75 ,$20.93 ,$20.26 ,$19.85 ,$40.52 ,$22.19 ,$147.60 ,$45.59 ,$159.76 ,$121.56 ,$101.26 ,$101.26 ,$105.75 ,$101.26 ,$119.99 ,$156.29 ,$118.64 ,$20.05 ,$137.18 ,$22.19 ,$24.31 ,$24.31 ,$19.85 ,$24.31 ,$125.03 ,$107.66 ,$125.03 ,$125.03 ,$138.92 
ST NICHOLAS HOSPITAL - ACUTE,30100818,84182,HC PROTEIN WEST BLOT BAND ID,301,1 ,$517.50 ,$341.55 ,$25.31 ,$517.50 ,$25.31 ,$102.24 ,$102.24 ,$29.21 ,$310.50 ,$439.88 ,$362.25 ,$25.31 ,$25.31 ,$491.63 ,$393.30 ,$388.13 ,$49.66 ,$439.88 ,$29.21 ,$49.66 ,$49.66 ,$362.25 ,$315.16 ,$25.31 ,$29.21 ,$28.63 ,$58.42 ,$26.83 ,$439.88 ,$65.72 ,$476.10 ,$362.25 ,$89.94 ,$89.94 ,$315.16 ,$89.94 ,$357.59 ,$465.75 ,$353.56 ,$28.91 ,$408.83 ,$26.83 ,$35.05 ,$35.05 ,$28.63 ,$35.05 ,$372.60 ,$320.85 ,$372.60 ,$372.60 ,$414.00 
ST NICHOLAS HOSPITAL - ACUTE,30100820,83664,HC LAMELLAR BODY CT,301,1 ,$188.60 ,$124.48 ,$6.82 ,$188.60 ,$6.82 ,$67.62 ,$67.62 ,$19.32 ,$113.16 ,$160.31 ,$132.02 ,$6.82 ,$6.82 ,$179.17 ,$143.34 ,$141.45 ,$32.84 ,$160.31 ,$19.32 ,$32.84 ,$32.84 ,$132.02 ,$114.86 ,$6.82 ,$19.32 ,$18.93 ,$38.64 ,$7.23 ,$160.31 ,$43.47 ,$173.51 ,$132.02 ,$94.55 ,$94.55 ,$114.86 ,$94.55 ,$130.32 ,$169.74 ,$128.85 ,$19.12 ,$148.99 ,$7.23 ,$23.18 ,$23.18 ,$18.93 ,$23.18 ,$135.79 ,$116.93 ,$135.79 ,$135.79 ,$150.88 
ST NICHOLAS HOSPITAL - ACUTE,30100821,80159,HC CLOZAPINE,301,1 ,$100.00 ,$66.00 ,$19.75 ,$100.00 ,$20.18 ,$70.53 ,$70.53 ,$20.15 ,$60.00 ,$85.00 ,$70.00 ,$20.18 ,$20.18 ,$95.00 ,$76.00 ,$75.00 ,$34.26 ,$85.00 ,$20.15 ,$34.26 ,$34.26 ,$70.00 ,$60.90 ,$20.18 ,$20.15 ,$19.75 ,$40.30 ,$21.39 ,$85.00 ,$45.34 ,$92.00 ,$70.00 ,$92.43 ,$92.43 ,$60.90 ,$92.43 ,$69.10 ,$90.00 ,$68.32 ,$19.94 ,$79.00 ,$21.39 ,$24.18 ,$24.18 ,$19.75 ,$24.18 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100822,83701,HC VAP HRF LIPOPROTEINS,301,1 ,$211.60 ,$139.66 ,$32.56 ,$211.60 ,$32.56 ,$118.51 ,$118.51 ,$33.86 ,$126.96 ,$179.86 ,$148.12 ,$32.56 ,$32.56 ,$201.02 ,$160.82 ,$158.70 ,$57.56 ,$179.86 ,$33.86 ,$57.56 ,$57.56 ,$148.12 ,$128.86 ,$32.56 ,$33.86 ,$33.18 ,$67.72 ,$34.51 ,$179.86 ,$76.19 ,$194.67 ,$148.12 ,$124.05 ,$124.05 ,$128.86 ,$124.05 ,$146.22 ,$190.44 ,$144.57 ,$33.52 ,$167.16 ,$34.51 ,$40.63 ,$40.63 ,$33.18 ,$40.63 ,$152.35 ,$131.19 ,$152.35 ,$152.35 ,$169.28 
ST NICHOLAS HOSPITAL - ACUTE,30100826,84403,HC TESTOSTERONE TOTAL ASSAY,301,1 ,$216.20 ,$142.69 ,$25.29 ,$216.20 ,$26.67 ,$90.34 ,$90.34 ,$25.81 ,$129.72 ,$183.77 ,$151.34 ,$26.67 ,$26.67 ,$205.39 ,$164.31 ,$162.15 ,$43.88 ,$183.77 ,$25.81 ,$43.88 ,$43.88 ,$151.34 ,$131.67 ,$26.67 ,$25.81 ,$25.29 ,$51.62 ,$28.27 ,$183.77 ,$58.07 ,$198.90 ,$151.34 ,$125.99 ,$125.99 ,$131.67 ,$125.99 ,$149.39 ,$194.58 ,$147.71 ,$25.55 ,$170.80 ,$28.27 ,$30.97 ,$30.97 ,$25.29 ,$30.97 ,$155.66 ,$134.04 ,$155.66 ,$155.66 ,$172.96 
ST NICHOLAS HOSPITAL - ACUTE,30100827,80081,HC OB PANEL WITH HIV,301,1 ,$463.45 ,$305.88 ,$73.36 ,$463.45 ,$77.35 ,$262.01 ,$262.01 ,$74.86 ,$278.07 ,$393.93 ,$324.42 ,$77.35 ,$77.35 ,$440.28 ,$352.22 ,$347.59 ,$127.26 ,$393.93 ,$74.86 ,$127.26 ,$127.26 ,$324.42 ,$282.24 ,$77.35 ,$74.86 ,$73.36 ,$149.72 ,$81.99 ,$393.93 ,$168.44 ,$426.37 ,$324.42 ,$373.57 ,$373.57 ,$282.24 ,$373.57 ,$320.24 ,$417.11 ,$316.63 ,$74.10 ,$366.13 ,$81.99 ,$89.83 ,$89.83 ,$73.36 ,$89.83 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,30100830,83986,HC NITRAZINE CHECK,301,1 ,$31.05 ,$20.49 ,$3.51 ,$31.05 ,$3.70 ,$12.53 ,$12.53 ,$3.58 ,$18.63 ,$26.39 ,$21.74 ,$3.70 ,$3.70 ,$29.50 ,$23.60 ,$23.29 ,$6.09 ,$26.39 ,$3.58 ,$6.09 ,$6.09 ,$21.74 ,$18.91 ,$3.70 ,$3.58 ,$3.51 ,$7.16 ,$3.92 ,$26.39 ,$8.06 ,$28.57 ,$21.74 ,$17.88 ,$17.88 ,$18.91 ,$17.88 ,$21.46 ,$27.95 ,$21.21 ,$3.55 ,$24.53 ,$3.92 ,$4.30 ,$4.30 ,$3.51 ,$4.30 ,$22.36 ,$19.25 ,$22.36 ,$22.36 ,$24.84 
ST NICHOLAS HOSPITAL - ACUTE,30100835,84481,HC T3 TOTAL/T3 FREE,301,1 ,$205.85 ,$135.86 ,$16.60 ,$205.85 ,$16.62 ,$59.29 ,$59.29 ,$16.94 ,$123.51 ,$174.97 ,$144.10 ,$16.62 ,$16.62 ,$195.56 ,$156.45 ,$154.39 ,$28.80 ,$174.97 ,$16.94 ,$28.80 ,$28.80 ,$144.10 ,$125.36 ,$16.62 ,$16.94 ,$16.60 ,$33.88 ,$17.62 ,$174.97 ,$38.12 ,$189.38 ,$144.10 ,$59.06 ,$59.06 ,$125.36 ,$59.06 ,$142.24 ,$185.27 ,$140.64 ,$16.77 ,$162.62 ,$17.62 ,$20.33 ,$20.33 ,$16.60 ,$20.33 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,30100838,83033,HC FETAL HGB QI,301,1 ,$63.25 ,$41.75 ,$7.84 ,$63.25 ,$8.27 ,$28.00 ,$28.00 ,$8.00 ,$37.95 ,$53.76 ,$44.28 ,$8.27 ,$8.27 ,$60.09 ,$48.07 ,$47.44 ,$13.60 ,$53.76 ,$8.00 ,$13.60 ,$13.60 ,$44.28 ,$38.52 ,$8.27 ,$8.00 ,$7.84 ,$16.00 ,$8.77 ,$53.76 ,$18.00 ,$58.19 ,$44.28 ,$29.78 ,$29.78 ,$38.52 ,$29.78 ,$43.71 ,$56.93 ,$43.21 ,$7.92 ,$49.97 ,$8.77 ,$9.60 ,$9.60 ,$7.84 ,$9.60 ,$45.54 ,$39.22 ,$45.54 ,$45.54 ,$50.60 
ST NICHOLAS HOSPITAL - ACUTE,30100840,82306,HC VITAMIN D 25 TOTAL,301,1 ,$257.60 ,$170.02 ,$29.01 ,$257.60 ,$30.59 ,$103.60 ,$103.60 ,$29.60 ,$154.56 ,$218.96 ,$180.32 ,$30.59 ,$30.59 ,$244.72 ,$195.78 ,$193.20 ,$50.32 ,$218.96 ,$29.60 ,$50.32 ,$50.32 ,$180.32 ,$156.88 ,$30.59 ,$29.60 ,$29.01 ,$59.20 ,$32.43 ,$218.96 ,$66.60 ,$236.99 ,$180.32 ,$148.01 ,$148.01 ,$156.88 ,$148.01 ,$178.00 ,$231.84 ,$175.99 ,$29.30 ,$203.50 ,$32.43 ,$35.52 ,$35.52 ,$29.01 ,$35.52 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30100845,82948,HC GLUCOSE BLOOD REAGENT STRIP,301,1 ,$19.55 ,$12.90 ,$4.45 ,$19.55 ,$4.45 ,$17.64 ,$17.64 ,$5.04 ,$11.73 ,$16.62 ,$13.69 ,$4.45 ,$4.45 ,$18.57 ,$14.86 ,$14.66 ,$8.57 ,$16.62 ,$5.04 ,$8.57 ,$8.57 ,$13.69 ,$11.91 ,$4.45 ,$5.04 ,$4.94 ,$10.08 ,$4.72 ,$16.62 ,$11.34 ,$17.99 ,$13.69 ,$15.83 ,$15.83 ,$11.91 ,$15.83 ,$13.51 ,$17.60 ,$13.36 ,$4.99 ,$15.44 ,$4.72 ,$6.05 ,$6.05 ,$4.94 ,$6.05 ,$14.08 ,$12.12 ,$14.08 ,$14.08 ,$15.64 
ST NICHOLAS HOSPITAL - ACUTE,30100860,84145,HC PROCALCITONIN,301,1 ,$232.30 ,$153.32 ,$26.68 ,$232.30 ,$28.13 ,$95.27 ,$95.27 ,$27.22 ,$139.38 ,$197.46 ,$162.61 ,$28.13 ,$28.13 ,$220.69 ,$176.55 ,$174.23 ,$46.27 ,$197.46 ,$27.22 ,$46.27 ,$46.27 ,$162.61 ,$141.47 ,$28.13 ,$27.22 ,$26.68 ,$54.44 ,$29.82 ,$197.46 ,$61.25 ,$213.72 ,$162.61 ,$133.86 ,$133.86 ,$141.47 ,$133.86 ,$160.52 ,$209.07 ,$158.71 ,$26.94 ,$183.52 ,$29.82 ,$32.66 ,$32.66 ,$26.68 ,$32.66 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30100950,G0328,HC OCCULT BLOOD FECAL SCRN - AMB,301,1 ,$143.75 ,$94.88 ,$0.34 ,$143.75 ,$0.34 ,$63.18 ,$63.18 ,$18.05 ,$86.25 ,$122.19 ,$100.63 ,$0.34 ,$0.34 ,$136.56 ,$109.25 ,$107.81 ,$30.69 ,$122.19 ,$18.05 ,$30.69 ,$30.69 ,$100.63 ,$87.54 ,$0.34 ,$18.05 ,$17.69 ,$36.10 ,$0.36 ,$122.19 ,$40.61 ,$132.25 ,$100.63 ,$79.50 ,$79.50 ,$87.54 ,$79.50 ,$99.33 ,$129.38 ,$98.21 ,$17.87 ,$113.56 ,$0.36 ,$21.66 ,$21.66 ,$17.69 ,$21.66 ,$103.50 ,$89.13 ,$103.50 ,$103.50 ,$115.00 
ST NICHOLAS HOSPITAL - ACUTE,30100951,82140,HC AMMONIA-STONE,301,1 ,$128.80 ,$85.01 ,$14.28 ,$128.80 ,$15.06 ,$51.00 ,$51.00 ,$14.57 ,$77.28 ,$109.48 ,$90.16 ,$15.06 ,$15.06 ,$122.36 ,$97.89 ,$96.60 ,$24.77 ,$109.48 ,$14.57 ,$24.77 ,$24.77 ,$90.16 ,$78.44 ,$15.06 ,$14.57 ,$14.28 ,$29.14 ,$15.96 ,$109.48 ,$32.78 ,$118.50 ,$90.16 ,$72.83 ,$72.83 ,$78.44 ,$72.83 ,$89.00 ,$115.92 ,$88.00 ,$14.43 ,$101.75 ,$15.96 ,$17.48 ,$17.48 ,$14.28 ,$17.48 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30100952,82340,HC CALCIUM URINE QN TIMED-STONE,301,1 ,$52.90 ,$34.91 ,$5.91 ,$52.90 ,$6.23 ,$21.11 ,$21.11 ,$6.03 ,$31.74 ,$44.97 ,$37.03 ,$6.23 ,$6.23 ,$50.26 ,$40.20 ,$39.68 ,$10.25 ,$44.97 ,$6.03 ,$10.25 ,$10.25 ,$37.03 ,$32.22 ,$6.23 ,$6.03 ,$5.91 ,$12.06 ,$6.60 ,$44.97 ,$13.57 ,$48.67 ,$37.03 ,$30.15 ,$30.15 ,$32.22 ,$30.15 ,$36.55 ,$47.61 ,$36.14 ,$5.97 ,$41.79 ,$6.60 ,$7.24 ,$7.24 ,$5.91 ,$7.24 ,$38.09 ,$32.80 ,$38.09 ,$38.09 ,$42.32 
ST NICHOLAS HOSPITAL - ACUTE,30100953,82507,HC CITRATE-STONE,301,1 ,$232.30 ,$153.32 ,$27.24 ,$232.30 ,$28.73 ,$97.30 ,$97.30 ,$27.80 ,$139.38 ,$197.46 ,$162.61 ,$28.73 ,$28.73 ,$220.69 ,$176.55 ,$174.23 ,$47.26 ,$197.46 ,$27.80 ,$47.26 ,$47.26 ,$162.61 ,$141.47 ,$28.73 ,$27.80 ,$27.24 ,$55.60 ,$30.45 ,$197.46 ,$62.55 ,$213.72 ,$162.61 ,$138.96 ,$138.96 ,$141.47 ,$138.96 ,$160.52 ,$209.07 ,$158.71 ,$27.52 ,$183.52 ,$30.45 ,$33.36 ,$33.36 ,$27.24 ,$33.36 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30100954,83735,HC MAGNESIUM-STONE,301,1 ,$59.80 ,$39.47 ,$6.57 ,$59.80 ,$6.92 ,$23.45 ,$23.45 ,$6.70 ,$35.88 ,$50.83 ,$41.86 ,$6.92 ,$6.92 ,$56.81 ,$45.45 ,$44.85 ,$11.39 ,$50.83 ,$6.70 ,$11.39 ,$11.39 ,$41.86 ,$36.42 ,$6.92 ,$6.70 ,$6.57 ,$13.40 ,$7.34 ,$50.83 ,$15.08 ,$55.02 ,$41.86 ,$33.48 ,$33.48 ,$36.42 ,$33.48 ,$41.32 ,$53.82 ,$40.86 ,$6.63 ,$47.24 ,$7.34 ,$8.04 ,$8.04 ,$6.57 ,$8.04 ,$43.06 ,$37.08 ,$43.06 ,$43.06 ,$47.84 
ST NICHOLAS HOSPITAL - ACUTE,30100955,83945,HC OXALATE-STONE,301,1 ,$113.85 ,$75.14 ,$14.16 ,$113.85 ,$14.93 ,$50.58 ,$50.58 ,$14.45 ,$68.31 ,$96.77 ,$79.70 ,$14.93 ,$14.93 ,$108.16 ,$86.53 ,$85.39 ,$24.57 ,$96.77 ,$14.45 ,$24.57 ,$24.57 ,$79.70 ,$69.33 ,$14.93 ,$14.45 ,$14.16 ,$28.90 ,$15.83 ,$96.77 ,$32.51 ,$104.74 ,$79.70 ,$64.33 ,$64.33 ,$69.33 ,$64.33 ,$78.67 ,$102.47 ,$77.78 ,$14.30 ,$89.94 ,$15.83 ,$17.34 ,$17.34 ,$14.16 ,$17.34 ,$81.97 ,$70.59 ,$81.97 ,$81.97 ,$91.08 
ST NICHOLAS HOSPITAL - ACUTE,30100956,83986,HC PH BODY FLUID-STONE,301,1 ,$31.05 ,$20.49 ,$3.51 ,$31.05 ,$3.70 ,$12.53 ,$12.53 ,$3.58 ,$18.63 ,$26.39 ,$21.74 ,$3.70 ,$3.70 ,$29.50 ,$23.60 ,$23.29 ,$6.09 ,$26.39 ,$3.58 ,$6.09 ,$6.09 ,$21.74 ,$18.91 ,$3.70 ,$3.58 ,$3.51 ,$7.16 ,$3.92 ,$26.39 ,$8.06 ,$28.57 ,$21.74 ,$17.88 ,$17.88 ,$18.91 ,$17.88 ,$21.46 ,$27.95 ,$21.21 ,$3.55 ,$24.53 ,$3.92 ,$4.30 ,$4.30 ,$3.51 ,$4.30 ,$22.36 ,$19.25 ,$22.36 ,$22.36 ,$24.84 
ST NICHOLAS HOSPITAL - ACUTE,30100957,84105,HC PHOSPHORUS URINE-STONE,301,1 ,$44.85 ,$29.60 ,$5.66 ,$44.85 ,$5.97 ,$20.23 ,$20.23 ,$5.78 ,$26.91 ,$38.12 ,$31.40 ,$5.97 ,$5.97 ,$42.61 ,$34.09 ,$33.64 ,$9.83 ,$38.12 ,$5.78 ,$9.83 ,$9.83 ,$31.40 ,$27.31 ,$5.97 ,$5.78 ,$5.66 ,$11.56 ,$6.33 ,$38.12 ,$13.01 ,$41.26 ,$31.40 ,$25.86 ,$25.86 ,$27.31 ,$25.86 ,$30.99 ,$40.37 ,$30.64 ,$5.72 ,$35.43 ,$6.33 ,$6.94 ,$6.94 ,$5.66 ,$6.94 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30100958,84133,HC POTASSIUM URINE-STONE,301,1 ,$36.80 ,$24.29 ,$4.64 ,$36.80 ,$4.89 ,$16.56 ,$16.56 ,$4.73 ,$22.08 ,$31.28 ,$25.76 ,$4.89 ,$4.89 ,$34.96 ,$27.97 ,$27.60 ,$8.04 ,$31.28 ,$4.73 ,$8.04 ,$8.04 ,$25.76 ,$22.41 ,$4.89 ,$4.73 ,$4.64 ,$9.46 ,$5.18 ,$31.28 ,$10.64 ,$33.86 ,$25.76 ,$21.50 ,$21.50 ,$22.41 ,$21.50 ,$25.43 ,$33.12 ,$25.14 ,$4.68 ,$29.07 ,$5.18 ,$5.68 ,$5.68 ,$4.64 ,$5.68 ,$26.50 ,$22.82 ,$26.50 ,$26.50 ,$29.44 
ST NICHOLAS HOSPITAL - ACUTE,30100959,84300,HC SODIUM URINE-STONE,301,1 ,$42.55 ,$28.08 ,$4.96 ,$42.55 ,$5.23 ,$17.71 ,$17.71 ,$5.06 ,$25.53 ,$36.17 ,$29.79 ,$5.23 ,$5.23 ,$40.42 ,$32.34 ,$31.91 ,$8.60 ,$36.17 ,$5.06 ,$8.60 ,$8.60 ,$29.79 ,$25.91 ,$5.23 ,$5.06 ,$4.96 ,$10.12 ,$5.54 ,$36.17 ,$11.39 ,$39.15 ,$29.79 ,$24.33 ,$24.33 ,$25.91 ,$24.33 ,$29.40 ,$38.30 ,$29.07 ,$5.01 ,$33.61 ,$5.54 ,$6.07 ,$6.07 ,$4.96 ,$6.07 ,$30.64 ,$26.38 ,$30.64 ,$30.64 ,$34.04 
ST NICHOLAS HOSPITAL - ACUTE,30100960,84560,HC URIC ACID OTH SOURCE-STONE,301,1 ,$41.40 ,$27.32 ,$4.98 ,$41.40 ,$5.25 ,$17.78 ,$17.78 ,$5.08 ,$24.84 ,$35.19 ,$28.98 ,$5.25 ,$5.25 ,$39.33 ,$31.46 ,$31.05 ,$8.64 ,$35.19 ,$5.08 ,$8.64 ,$8.64 ,$28.98 ,$25.21 ,$5.25 ,$5.08 ,$4.98 ,$10.16 ,$5.57 ,$35.19 ,$11.43 ,$38.09 ,$28.98 ,$23.74 ,$23.74 ,$25.21 ,$23.74 ,$28.61 ,$37.26 ,$28.28 ,$5.03 ,$32.71 ,$5.57 ,$6.10 ,$6.10 ,$4.98 ,$6.10 ,$29.81 ,$25.67 ,$29.81 ,$29.81 ,$33.12 
ST NICHOLAS HOSPITAL - ACUTE,30100961,83993,HC CALPROTECTIN STOOL,301,1 ,$180.55 ,$119.16 ,$19.24 ,$180.55 ,$20.28 ,$68.71 ,$68.71 ,$19.63 ,$108.33 ,$153.47 ,$126.39 ,$20.28 ,$20.28 ,$171.52 ,$137.22 ,$135.41 ,$33.37 ,$153.47 ,$19.63 ,$33.37 ,$33.37 ,$126.39 ,$109.96 ,$20.28 ,$19.63 ,$19.24 ,$39.26 ,$21.50 ,$153.47 ,$44.17 ,$166.11 ,$126.39 ,$98.11 ,$98.11 ,$109.96 ,$98.11 ,$124.76 ,$162.50 ,$123.35 ,$19.43 ,$142.63 ,$21.50 ,$23.56 ,$23.56 ,$19.24 ,$23.56 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30100962,82656,"HC ELASTASE,PANCREATIC EL1 FECAL QT",301,1 ,$244.95 ,$161.67 ,$11.30 ,$244.95 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$146.97 ,$208.21 ,$171.47 ,$11.91 ,$11.91 ,$232.70 ,$186.16 ,$183.71 ,$19.60 ,$208.21 ,$11.53 ,$19.60 ,$19.60 ,$171.47 ,$149.17 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$208.21 ,$25.94 ,$225.35 ,$171.47 ,$57.66 ,$57.66 ,$149.17 ,$57.66 ,$169.26 ,$220.46 ,$167.35 ,$11.42 ,$193.51 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30100965,80361,HC DIHYDROCODEINONE,301,1 ,$172.00 ,$113.52 ,$0.38 ,$172.00 ,$0.38 ,$79.87 ,$79.87 , N/A ,$103.20 ,$146.20 ,$120.40 ,$0.38 ,$0.38 ,$163.40 ,$130.72 ,$129.00 ,$38.86 ,$146.20 , N/A ,$38.86 ,$38.86 ,$120.40 ,$104.75 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$146.20 , N/A ,$158.24 ,$120.40 ,$87.24 ,$104.70 ,$104.75 ,$104.70 ,$118.85 ,$154.80 ,$117.51 , N/A ,$135.88 ,$0.40 , N/A , N/A , N/A , N/A ,$123.84 ,$106.64 ,$123.84 ,$123.84 ,$137.60 
ST NICHOLAS HOSPITAL - ACUTE,30100966,80324,"HC AMPHETAMINE CONFIRM GC/MS,UR",301,1 ,$90.00 ,$59.40 ,$0.38 ,$90.00 ,$0.38 ,$79.87 ,$79.87 , N/A ,$54.00 ,$76.50 ,$63.00 ,$0.38 ,$0.38 ,$85.50 ,$68.40 ,$67.50 ,$38.86 ,$76.50 , N/A ,$38.86 ,$38.86 ,$63.00 ,$54.81 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$76.50 , N/A ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$61.49 , N/A ,$71.10 ,$0.40 , N/A , N/A , N/A , N/A ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100968,83018,HC COBALT BLOOD,301,1 ,$141.45 ,$93.36 ,$21.52 ,$141.45 ,$22.69 ,$76.86 ,$76.86 ,$21.96 ,$84.87 ,$120.23 ,$99.02 ,$22.69 ,$22.69 ,$134.38 ,$107.50 ,$106.09 ,$37.33 ,$120.23 ,$21.96 ,$37.33 ,$37.33 ,$99.02 ,$86.14 ,$22.69 ,$21.96 ,$21.52 ,$43.92 ,$24.05 ,$120.23 ,$49.41 ,$130.13 ,$99.02 ,$109.76 ,$109.76 ,$86.14 ,$109.76 ,$97.74 ,$127.31 ,$96.64 ,$21.74 ,$111.75 ,$24.05 ,$26.35 ,$26.35 ,$21.52 ,$26.35 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100969,82705,HC FECAL FAT QUALITATIVE,301,1 ,$40.25 ,$26.57 ,$5.00 ,$40.25 ,$5.27 ,$17.85 ,$17.85 ,$5.10 ,$24.15 ,$34.21 ,$28.18 ,$5.27 ,$5.27 ,$38.24 ,$30.59 ,$30.19 ,$8.67 ,$34.21 ,$5.10 ,$8.67 ,$8.67 ,$28.18 ,$24.51 ,$5.27 ,$5.10 ,$5.00 ,$10.20 ,$5.59 ,$34.21 ,$11.48 ,$37.03 ,$28.18 ,$25.42 ,$25.42 ,$24.51 ,$25.42 ,$27.81 ,$36.23 ,$27.50 ,$5.05 ,$31.80 ,$5.59 ,$6.12 ,$6.12 ,$5.00 ,$6.12 ,$28.98 ,$24.96 ,$28.98 ,$28.98 ,$32.20 
ST NICHOLAS HOSPITAL - ACUTE,30100970,80180,HC MYCOPHENOLIC ACID,301,1 ,$90.00 ,$59.40 ,$17.69 ,$90.00 ,$18.65 ,$63.18 ,$63.18 ,$18.05 ,$54.00 ,$76.50 ,$63.00 ,$18.65 ,$18.65 ,$85.50 ,$68.40 ,$67.50 ,$30.69 ,$76.50 ,$18.05 ,$30.69 ,$30.69 ,$63.00 ,$54.81 ,$18.65 ,$18.05 ,$17.69 ,$36.10 ,$19.77 ,$76.50 ,$40.61 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$81.00 ,$61.49 ,$17.87 ,$71.10 ,$19.77 ,$21.66 ,$21.66 ,$17.69 ,$21.66 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100971,80361,HC PAIN MGMT OPIATES QN URINE,301,1 ,$25.00 ,$16.50 ,$0.38 ,$25.00 ,$0.38 ,$25.00 ,$25.00 , N/A ,$15.00 ,$21.25 ,$17.50 ,$0.38 ,$0.38 ,$23.75 ,$19.00 ,$18.75 ,$25.00 ,$21.25 , N/A ,$25.00 ,$25.00 ,$17.50 ,$15.23 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$21.25 , N/A ,$23.00 ,$17.50 ,$12.68 ,$15.22 ,$15.23 ,$15.22 ,$17.28 ,$22.50 ,$17.08 , N/A ,$19.75 ,$0.40 , N/A , N/A , N/A , N/A ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30100972,G0480,HC OPIATES 1 OR MORE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30100973,G0480,HC PAIN MGMT BENZO QN URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30100974,83516,HC TISSUE TRANGLUTAMINASE IGG AB,301,1 ,$67.85 ,$44.78 ,$11.30 ,$67.85 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$40.71 ,$57.67 ,$47.50 ,$11.91 ,$11.91 ,$64.46 ,$51.57 ,$50.89 ,$19.60 ,$57.67 ,$11.53 ,$19.60 ,$19.60 ,$47.50 ,$41.32 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$57.67 ,$25.94 ,$62.42 ,$47.50 ,$57.66 ,$57.66 ,$41.32 ,$57.66 ,$46.88 ,$61.07 ,$46.36 ,$11.42 ,$53.60 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$48.85 ,$42.07 ,$48.85 ,$48.85 ,$54.28 
ST NICHOLAS HOSPITAL - ACUTE,30100975,82784,HC TOTAL SERUM IGA BY NEPHELP,301,1 ,$81.65 ,$53.89 ,$9.11 ,$81.65 ,$9.61 ,$32.55 ,$32.55 ,$9.30 ,$48.99 ,$69.40 ,$57.16 ,$9.61 ,$9.61 ,$77.57 ,$62.05 ,$61.24 ,$15.81 ,$69.40 ,$9.30 ,$15.81 ,$15.81 ,$57.16 ,$49.72 ,$9.61 ,$9.30 ,$9.11 ,$18.60 ,$10.19 ,$69.40 ,$20.93 ,$75.12 ,$57.16 ,$46.45 ,$46.45 ,$49.72 ,$46.45 ,$56.42 ,$73.49 ,$55.78 ,$9.20 ,$64.50 ,$10.19 ,$11.16 ,$11.16 ,$9.11 ,$11.16 ,$58.79 ,$50.62 ,$58.79 ,$58.79 ,$65.32 
ST NICHOLAS HOSPITAL - ACUTE,30100976,84075,HC ALKALINE PHOSPHATASE BONE SPECIFIC,301,1 ,$35.65 ,$23.53 ,$5.08 ,$35.65 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$21.39 ,$30.30 ,$24.96 ,$5.35 ,$5.35 ,$33.87 ,$27.09 ,$26.74 ,$8.81 ,$30.30 ,$5.18 ,$8.81 ,$8.81 ,$24.96 ,$21.71 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$30.30 ,$11.66 ,$32.80 ,$24.96 ,$25.86 ,$25.86 ,$21.71 ,$25.86 ,$24.63 ,$32.09 ,$24.36 ,$5.13 ,$28.16 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$25.67 ,$22.10 ,$25.67 ,$25.67 ,$28.52 
ST NICHOLAS HOSPITAL - ACUTE,30100977,84181,HC FLUOR AB TITER,301,1 ,$69.00 ,$45.54 ,$16.69 ,$69.00 ,$17.60 ,$59.61 ,$59.61 ,$17.03 ,$41.40 ,$58.65 ,$48.30 ,$17.60 ,$17.60 ,$65.55 ,$52.44 ,$51.75 ,$28.95 ,$58.65 ,$17.03 ,$28.95 ,$28.95 ,$48.30 ,$42.02 ,$17.60 ,$17.03 ,$16.69 ,$34.06 ,$18.66 ,$58.65 ,$38.32 ,$63.48 ,$48.30 ,$69.00 ,$69.00 ,$42.02 ,$69.00 ,$47.68 ,$62.10 ,$47.14 ,$16.86 ,$54.51 ,$18.66 ,$20.44 ,$20.44 ,$16.69 ,$20.44 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30100978,83520,HC ANTI-MULLERIAN HORMONE,301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.85 ,$17.85 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$64.70 ,$64.70 ,$70.74 ,$64.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100979,G0480,HC TRAMADOL,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30100980,83498,HC 17 OH PROGESTERONE RESP TO ACTH,301,1 ,$228.85 ,$151.04 ,$26.63 ,$228.85 ,$28.07 ,$95.10 ,$95.10 ,$27.17 ,$137.31 ,$194.52 ,$160.20 ,$28.07 ,$28.07 ,$217.41 ,$173.93 ,$171.64 ,$46.19 ,$194.52 ,$27.17 ,$46.19 ,$46.19 ,$160.20 ,$139.37 ,$28.07 ,$27.17 ,$26.63 ,$54.34 ,$29.75 ,$194.52 ,$61.13 ,$210.54 ,$160.20 ,$135.81 ,$135.81 ,$139.37 ,$135.81 ,$158.14 ,$205.97 ,$156.35 ,$26.89 ,$180.79 ,$29.75 ,$32.60 ,$32.60 ,$26.63 ,$32.60 ,$164.77 ,$141.89 ,$164.77 ,$164.77 ,$183.08 
ST NICHOLAS HOSPITAL - ACUTE,30100981,82397,HC ALPHA SUBUNIT,301,1 ,$141.45 ,$93.36 ,$13.84 ,$141.45 ,$14.59 ,$49.42 ,$49.42 ,$14.12 ,$84.87 ,$120.23 ,$99.02 ,$14.59 ,$14.59 ,$134.38 ,$107.50 ,$106.09 ,$24.00 ,$120.23 ,$14.12 ,$24.00 ,$24.00 ,$99.02 ,$86.14 ,$14.59 ,$14.12 ,$13.84 ,$28.24 ,$15.47 ,$120.23 ,$31.77 ,$130.13 ,$99.02 ,$70.60 ,$70.60 ,$86.14 ,$70.60 ,$97.74 ,$127.31 ,$96.64 ,$13.97 ,$111.75 ,$15.47 ,$16.94 ,$16.94 ,$13.84 ,$16.94 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100982,82530,HC CORTISOL SALIVA 2 SAMPLES,301,1 ,$141.45 ,$93.36 ,$16.38 ,$141.45 ,$17.27 ,$58.49 ,$58.49 ,$16.71 ,$84.87 ,$120.23 ,$99.02 ,$17.27 ,$17.27 ,$134.38 ,$107.50 ,$106.09 ,$28.41 ,$120.23 ,$16.71 ,$28.41 ,$28.41 ,$99.02 ,$86.14 ,$17.27 ,$16.71 ,$16.38 ,$33.42 ,$18.31 ,$120.23 ,$37.60 ,$130.13 ,$99.02 ,$83.53 ,$83.53 ,$86.14 ,$83.53 ,$97.74 ,$127.31 ,$96.64 ,$16.54 ,$111.75 ,$18.31 ,$20.05 ,$20.05 ,$16.38 ,$20.05 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100983,80299,HC DEXAMETHASONE,301,1 ,$173.65 ,$114.61 ,$18.27 ,$173.65 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$104.19 ,$147.60 ,$121.56 ,$19.26 ,$19.26 ,$164.97 ,$131.97 ,$130.24 ,$31.69 ,$147.60 ,$18.64 ,$31.69 ,$31.69 ,$121.56 ,$105.75 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$147.60 ,$41.94 ,$159.76 ,$121.56 ,$68.43 ,$68.43 ,$105.75 ,$68.43 ,$119.99 ,$156.29 ,$118.64 ,$18.45 ,$137.18 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$125.03 ,$107.66 ,$125.03 ,$125.03 ,$138.92 
ST NICHOLAS HOSPITAL - ACUTE,30100984,83789,HC IODINE 24 HOUR URINE,301,1 ,$103.50 ,$68.31 ,$23.63 ,$103.50 ,$24.91 ,$84.39 ,$84.39 ,$24.11 ,$62.10 ,$87.98 ,$72.45 ,$24.91 ,$24.91 ,$98.33 ,$78.66 ,$77.63 ,$40.99 ,$87.98 ,$24.11 ,$40.99 ,$40.99 ,$72.45 ,$63.03 ,$24.91 ,$24.11 ,$23.63 ,$48.22 ,$26.40 ,$87.98 ,$54.25 ,$95.22 ,$72.45 ,$90.23 ,$90.23 ,$63.03 ,$90.23 ,$71.52 ,$93.15 ,$70.71 ,$23.86 ,$81.77 ,$26.40 ,$28.93 ,$28.93 ,$23.63 ,$28.93 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100985,83789,HC IODINE RANDOM URINE,301,1 ,$103.50 ,$68.31 ,$23.63 ,$103.50 ,$24.91 ,$84.39 ,$84.39 ,$24.11 ,$62.10 ,$87.98 ,$72.45 ,$24.91 ,$24.91 ,$98.33 ,$78.66 ,$77.63 ,$40.99 ,$87.98 ,$24.11 ,$40.99 ,$40.99 ,$72.45 ,$63.03 ,$24.91 ,$24.11 ,$23.63 ,$48.22 ,$26.40 ,$87.98 ,$54.25 ,$95.22 ,$72.45 ,$90.23 ,$90.23 ,$63.03 ,$90.23 ,$71.52 ,$93.15 ,$70.71 ,$23.86 ,$81.77 ,$26.40 ,$28.93 ,$28.93 ,$23.63 ,$28.93 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30100986,82533,HC ACTH STIM 3 SPECIMENS,301,1 ,$141.45 ,$93.36 ,$15.97 ,$141.45 ,$16.84 ,$57.05 ,$57.05 ,$16.30 ,$84.87 ,$120.23 ,$99.02 ,$16.84 ,$16.84 ,$134.38 ,$107.50 ,$106.09 ,$27.71 ,$120.23 ,$16.30 ,$27.71 ,$27.71 ,$99.02 ,$86.14 ,$16.84 ,$16.30 ,$15.97 ,$32.60 ,$17.85 ,$120.23 ,$36.68 ,$130.13 ,$99.02 ,$81.48 ,$81.48 ,$86.14 ,$81.48 ,$97.74 ,$127.31 ,$96.64 ,$16.13 ,$111.75 ,$17.85 ,$19.56 ,$19.56 ,$15.97 ,$19.56 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100987,82523,HC COLLAGEN CROSS LINKED 24 HR URINE,301,1 ,$141.45 ,$93.36 ,$14.65 ,$141.45 ,$14.65 ,$65.38 ,$65.38 ,$18.68 ,$84.87 ,$120.23 ,$99.02 ,$14.65 ,$14.65 ,$134.38 ,$107.50 ,$106.09 ,$31.76 ,$120.23 ,$18.68 ,$31.76 ,$31.76 ,$99.02 ,$86.14 ,$14.65 ,$18.68 ,$18.31 ,$37.36 ,$15.53 ,$120.23 ,$42.03 ,$130.13 ,$99.02 ,$52.09 ,$52.09 ,$86.14 ,$52.09 ,$97.74 ,$127.31 ,$96.64 ,$18.49 ,$111.75 ,$15.53 ,$22.42 ,$22.42 ,$18.31 ,$22.42 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100988,84439,HC T4 FREE DIRECT DIALYSIS,301,1 ,$77.05 ,$50.85 ,$8.84 ,$77.05 ,$9.32 ,$31.57 ,$31.57 ,$9.02 ,$46.23 ,$65.49 ,$53.94 ,$9.32 ,$9.32 ,$73.20 ,$58.56 ,$57.79 ,$15.33 ,$65.49 ,$9.02 ,$15.33 ,$15.33 ,$53.94 ,$46.92 ,$9.32 ,$9.02 ,$8.84 ,$18.04 ,$9.88 ,$65.49 ,$20.30 ,$70.89 ,$53.94 ,$45.06 ,$45.06 ,$46.92 ,$45.06 ,$53.24 ,$69.35 ,$52.64 ,$8.93 ,$60.87 ,$9.88 ,$10.82 ,$10.82 ,$8.84 ,$10.82 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30100989,84443,HC TSH WITH HAMA TREATMENT,301,1 ,$141.45 ,$93.36 ,$16.46 ,$141.45 ,$17.36 ,$58.80 ,$58.80 ,$16.80 ,$84.87 ,$120.23 ,$99.02 ,$17.36 ,$17.36 ,$134.38 ,$107.50 ,$106.09 ,$28.56 ,$120.23 ,$16.80 ,$28.56 ,$28.56 ,$99.02 ,$86.14 ,$17.36 ,$16.80 ,$16.46 ,$33.60 ,$18.40 ,$120.23 ,$37.80 ,$130.13 ,$99.02 ,$84.00 ,$84.00 ,$86.14 ,$84.00 ,$97.74 ,$127.31 ,$96.64 ,$16.63 ,$111.75 ,$18.40 ,$20.16 ,$20.16 ,$16.46 ,$20.16 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30100990,82523,HC C TELOPEPTIDE CTX,301,1 ,$116.15 ,$76.66 ,$14.65 ,$116.15 ,$14.65 ,$65.38 ,$65.38 ,$18.68 ,$69.69 ,$98.73 ,$81.31 ,$14.65 ,$14.65 ,$110.34 ,$88.27 ,$87.11 ,$31.76 ,$98.73 ,$18.68 ,$31.76 ,$31.76 ,$81.31 ,$70.74 ,$14.65 ,$18.68 ,$18.31 ,$37.36 ,$15.53 ,$98.73 ,$42.03 ,$106.86 ,$81.31 ,$52.09 ,$52.09 ,$70.74 ,$52.09 ,$80.26 ,$104.54 ,$79.35 ,$18.49 ,$91.76 ,$15.53 ,$22.42 ,$22.42 ,$18.31 ,$22.42 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100991,83519,HC THYROTROPIN BINDING INHIBITORY IG,301,1 ,$116.15 ,$76.66 ,$18.03 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$69.69 ,$98.73 ,$81.31 ,$19.00 ,$19.00 ,$110.34 ,$88.27 ,$87.11 ,$31.28 ,$98.73 ,$18.40 ,$31.28 ,$31.28 ,$81.31 ,$70.74 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$98.73 ,$41.40 ,$106.86 ,$81.31 ,$67.52 ,$67.52 ,$70.74 ,$67.52 ,$80.26 ,$104.54 ,$79.35 ,$18.21 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30100992,83519,HC TSH ANTIBODY,301,1 ,$116.15 ,$76.66 ,$18.03 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$69.69 ,$98.73 ,$81.31 ,$19.00 ,$19.00 ,$110.34 ,$88.27 ,$87.11 ,$31.28 ,$98.73 ,$18.40 ,$31.28 ,$31.28 ,$81.31 ,$70.74 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$98.73 ,$41.40 ,$106.86 ,$81.31 ,$67.52 ,$67.52 ,$70.74 ,$67.52 ,$80.26 ,$104.54 ,$79.35 ,$18.21 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30101003,82523,HC COLLAGEN CROSS LINKS ANY METHOD,301,1 ,$185.15 ,$122.20 ,$14.65 ,$185.15 ,$14.65 ,$65.38 ,$65.38 ,$18.68 ,$111.09 ,$157.38 ,$129.61 ,$14.65 ,$14.65 ,$175.89 ,$140.71 ,$138.86 ,$31.76 ,$157.38 ,$18.68 ,$31.76 ,$31.76 ,$129.61 ,$112.76 ,$14.65 ,$18.68 ,$18.31 ,$37.36 ,$15.53 ,$157.38 ,$42.03 ,$170.34 ,$129.61 ,$52.09 ,$52.09 ,$112.76 ,$52.09 ,$127.94 ,$166.64 ,$126.49 ,$18.49 ,$146.27 ,$15.53 ,$22.42 ,$22.42 ,$18.31 ,$22.42 ,$133.31 ,$114.79 ,$133.31 ,$133.31 ,$148.12 
ST NICHOLAS HOSPITAL - ACUTE,30101006,82787,HC IMMUNOGLOBULIN SUBCLASSES,301,1 ,$72.45 ,$47.82 ,$5.90 ,$72.45 ,$5.90 ,$28.07 ,$28.07 ,$8.02 ,$43.47 ,$61.58 ,$50.72 ,$5.90 ,$5.90 ,$68.83 ,$55.06 ,$54.34 ,$13.63 ,$61.58 ,$8.02 ,$13.63 ,$13.63 ,$50.72 ,$44.12 ,$5.90 ,$8.02 ,$7.86 ,$16.04 ,$6.25 ,$61.58 ,$18.05 ,$66.65 ,$50.72 ,$20.96 ,$20.96 ,$44.12 ,$20.96 ,$50.06 ,$65.21 ,$49.50 ,$7.94 ,$57.24 ,$6.25 ,$9.62 ,$9.62 ,$7.86 ,$9.62 ,$52.16 ,$44.92 ,$52.16 ,$52.16 ,$57.96 
ST NICHOLAS HOSPITAL - ACUTE,30101010,83520,HC IMMUNOASSAY QN OTHER,301,1 ,$180.55 ,$119.16 ,$16.92 ,$180.55 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$108.33 ,$153.47 ,$126.39 ,$17.85 ,$17.85 ,$171.52 ,$137.22 ,$135.41 ,$29.36 ,$153.47 ,$17.27 ,$29.36 ,$29.36 ,$126.39 ,$109.96 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$153.47 ,$38.86 ,$166.11 ,$126.39 ,$64.70 ,$64.70 ,$109.96 ,$64.70 ,$124.76 ,$162.50 ,$123.35 ,$17.09 ,$142.63 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30101023,G0103,HC PSA ANNUAL SCREENING,301,1 ,$141.45 ,$93.36 ,$18.92 ,$141.45 ,$19.95 ,$67.59 ,$67.59 ,$19.31 ,$84.87 ,$120.23 ,$99.02 ,$19.95 ,$19.95 ,$134.38 ,$107.50 ,$106.09 ,$32.83 ,$120.23 ,$19.31 ,$32.83 ,$32.83 ,$99.02 ,$86.14 ,$19.95 ,$19.31 ,$18.92 ,$38.62 ,$21.15 ,$120.23 ,$43.45 ,$130.13 ,$99.02 ,$91.92 ,$91.92 ,$86.14 ,$91.92 ,$97.74 ,$127.31 ,$96.64 ,$19.11 ,$111.75 ,$21.15 ,$23.17 ,$23.17 ,$18.92 ,$23.17 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30101024,G0480,HC DRUG CONFIRMATION EA PROC 1-7 CLASSES,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101030,80169,HC EVEROLIMUS,301,1 ,$190.00 ,$125.40 ,$13.46 ,$190.00 ,$14.19 ,$48.06 ,$48.06 ,$13.73 ,$114.00 ,$161.50 ,$133.00 ,$14.19 ,$14.19 ,$180.50 ,$144.40 ,$142.50 ,$23.34 ,$161.50 ,$13.73 ,$23.34 ,$23.34 ,$133.00 ,$115.71 ,$14.19 ,$13.73 ,$13.46 ,$27.46 ,$15.04 ,$161.50 ,$30.89 ,$174.80 ,$133.00 ,$68.62 ,$68.62 ,$115.71 ,$68.62 ,$131.29 ,$171.00 ,$129.81 ,$13.59 ,$150.10 ,$15.04 ,$16.48 ,$16.48 ,$13.46 ,$16.48 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30101045,80299,HC POSACONAZOLE,301,1 ,$248.40 ,$163.94 ,$18.27 ,$248.40 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$149.04 ,$211.14 ,$173.88 ,$19.26 ,$19.26 ,$235.98 ,$188.78 ,$186.30 ,$31.69 ,$211.14 ,$18.64 ,$31.69 ,$31.69 ,$173.88 ,$151.28 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$211.14 ,$41.94 ,$228.53 ,$173.88 ,$68.43 ,$68.43 ,$151.28 ,$68.43 ,$171.64 ,$223.56 ,$169.71 ,$18.45 ,$196.24 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$178.85 ,$154.01 ,$178.85 ,$178.85 ,$198.72 
ST NICHOLAS HOSPITAL - ACUTE,30101050,82610,HC CYSTATIN C,301,1 ,$141.45 ,$93.36 ,$18.15 ,$141.45 ,$19.00 ,$64.82 ,$64.82 ,$18.52 ,$84.87 ,$120.23 ,$99.02 ,$19.00 ,$19.00 ,$134.38 ,$107.50 ,$106.09 ,$31.48 ,$120.23 ,$18.52 ,$31.48 ,$31.48 ,$99.02 ,$86.14 ,$19.00 ,$18.52 ,$18.15 ,$37.04 ,$20.14 ,$120.23 ,$41.67 ,$130.13 ,$99.02 ,$67.92 ,$67.92 ,$86.14 ,$67.92 ,$97.74 ,$127.31 ,$96.64 ,$18.34 ,$111.75 ,$20.14 ,$22.22 ,$22.22 ,$18.15 ,$22.22 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30101051,83789,HC MASS/TANDEM SPEC TPMT ACTIVITY EACH SPECIMEN,301,1 ,$399.05 ,$263.37 ,$23.63 ,$399.05 ,$24.91 ,$84.39 ,$84.39 ,$24.11 ,$239.43 ,$339.19 ,$279.34 ,$24.91 ,$24.91 ,$379.10 ,$303.28 ,$299.29 ,$40.99 ,$339.19 ,$24.11 ,$40.99 ,$40.99 ,$279.34 ,$243.02 ,$24.91 ,$24.11 ,$23.63 ,$48.22 ,$26.40 ,$339.19 ,$54.25 ,$367.13 ,$279.34 ,$90.23 ,$90.23 ,$243.02 ,$90.23 ,$275.74 ,$359.15 ,$272.63 ,$23.86 ,$315.25 ,$26.40 ,$28.93 ,$28.93 ,$23.63 ,$28.93 ,$287.32 ,$247.41 ,$287.32 ,$287.32 ,$319.24 
ST NICHOLAS HOSPITAL - ACUTE,30101052,82642,HC DRUG CONFIRMATION DIHYDROTESTOSTERONE LC/MS/MS,301,1 ,$205.85 ,$135.86 ,$28.69 ,$205.85 ,$30.26 ,$102.48 ,$102.48 ,$29.28 ,$123.51 ,$174.97 ,$144.10 ,$30.26 ,$30.26 ,$195.56 ,$156.45 ,$154.39 ,$49.78 ,$174.97 ,$29.28 ,$49.78 ,$49.78 ,$144.10 ,$125.36 ,$30.26 ,$29.28 ,$28.69 ,$58.56 ,$32.08 ,$174.97 ,$65.88 ,$189.38 ,$144.10 ,$119.17 ,$119.17 ,$125.36 ,$119.17 ,$142.24 ,$185.27 ,$140.64 ,$28.98 ,$162.62 ,$32.08 ,$35.14 ,$35.14 ,$28.69 ,$35.14 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,30101053,80235,HC LACOSAMIDE LC/MS/MS,301,1 ,$110.00 ,$72.60 ,$21.69 ,$110.00 ,$21.69 ,$94.89 ,$94.89 ,$27.11 ,$66.00 ,$93.50 ,$77.00 ,$21.69 ,$21.69 ,$104.50 ,$83.60 ,$82.50 ,$46.09 ,$93.50 ,$27.11 ,$46.09 ,$46.09 ,$77.00 ,$66.99 ,$21.69 ,$27.11 ,$26.57 ,$54.22 ,$22.99 ,$93.50 ,$61.00 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 ,$26.83 ,$86.90 ,$22.99 ,$32.53 ,$32.53 ,$26.57 ,$32.53 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,30101054,83520,HC GANGLIOSIDE GQ1B AB IGG EIA,301,1 ,$116.15 ,$76.66 ,$16.92 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$69.69 ,$98.73 ,$81.31 ,$17.85 ,$17.85 ,$110.34 ,$88.27 ,$87.11 ,$29.36 ,$98.73 ,$17.27 ,$29.36 ,$29.36 ,$81.31 ,$70.74 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$98.73 ,$38.86 ,$106.86 ,$81.31 ,$64.70 ,$64.70 ,$70.74 ,$64.70 ,$80.26 ,$104.54 ,$79.35 ,$17.09 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30101055,83519,HC CALCIUM CHAN AB VOLTAGE-GATED,301,1 ,$116.15 ,$76.66 ,$18.03 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$69.69 ,$98.73 ,$81.31 ,$19.00 ,$19.00 ,$110.34 ,$88.27 ,$87.11 ,$31.28 ,$98.73 ,$18.40 ,$31.28 ,$31.28 ,$81.31 ,$70.74 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$98.73 ,$41.40 ,$106.86 ,$81.31 ,$67.52 ,$67.52 ,$70.74 ,$67.52 ,$80.26 ,$104.54 ,$79.35 ,$18.21 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30101057,84140,HC PREGNENOLONE,301,1 ,$121.90 ,$80.45 ,$20.26 ,$121.90 ,$21.36 ,$72.35 ,$72.35 ,$20.67 ,$73.14 ,$103.62 ,$85.33 ,$21.36 ,$21.36 ,$115.81 ,$92.64 ,$91.43 ,$35.14 ,$103.62 ,$20.67 ,$35.14 ,$35.14 ,$85.33 ,$74.24 ,$21.36 ,$20.67 ,$20.26 ,$41.34 ,$22.64 ,$103.62 ,$46.51 ,$112.15 ,$85.33 ,$103.35 ,$103.35 ,$74.24 ,$103.35 ,$84.23 ,$109.71 ,$83.28 ,$20.46 ,$96.30 ,$22.64 ,$24.80 ,$24.80 ,$20.26 ,$24.80 ,$87.77 ,$75.58 ,$87.77 ,$87.77 ,$97.52 
ST NICHOLAS HOSPITAL - ACUTE,30101058,82679,HC ESTRONE LC/MS/MS,301,1 ,$115.00 ,$75.90 ,$24.45 ,$115.00 ,$25.78 ,$87.33 ,$87.33 ,$24.95 ,$69.00 ,$97.75 ,$80.50 ,$25.78 ,$25.78 ,$109.25 ,$87.40 ,$86.25 ,$42.42 ,$97.75 ,$24.95 ,$42.42 ,$42.42 ,$80.50 ,$70.04 ,$25.78 ,$24.95 ,$24.45 ,$49.90 ,$27.33 ,$97.75 ,$56.14 ,$105.80 ,$80.50 ,$115.00 ,$115.00 ,$70.04 ,$115.00 ,$79.47 ,$103.50 ,$78.57 ,$24.70 ,$90.85 ,$27.33 ,$29.94 ,$29.94 ,$24.45 ,$29.94 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,30101066,G0480,HC IF PREGABALIN,301,1 ,$282.00 ,$186.12 ,$63.95 ,$282.00 ,$63.95 ,$282.00 ,$282.00 ,$114.43 ,$169.20 ,$239.70 ,$197.40 ,$63.95 ,$63.95 ,$267.90 ,$214.32 ,$211.50 ,$194.53 ,$239.70 ,$114.43 ,$194.53 ,$194.53 ,$197.40 ,$171.74 ,$63.95 ,$114.43 ,$112.14 ,$228.86 ,$67.79 ,$239.70 ,$257.47 ,$259.44 ,$197.40 ,$282.00 ,$282.00 ,$171.74 ,$282.00 ,$194.86 ,$253.80 ,$192.66 ,$113.26 ,$222.78 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$203.04 ,$174.84 ,$203.04 ,$203.04 ,$225.60 
ST NICHOLAS HOSPITAL - ACUTE,30101067,G0480,HC IF MARIJUANA GC/MS URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101068,84630,HC ZINC RBC,301,1 ,$92.00 ,$60.72 ,$11.16 ,$92.00 ,$11.77 ,$39.87 ,$39.87 ,$11.39 ,$55.20 ,$78.20 ,$64.40 ,$11.77 ,$11.77 ,$87.40 ,$69.92 ,$69.00 ,$19.36 ,$78.20 ,$11.39 ,$19.36 ,$19.36 ,$64.40 ,$56.03 ,$11.77 ,$11.39 ,$11.16 ,$22.78 ,$12.48 ,$78.20 ,$25.63 ,$84.64 ,$64.40 ,$51.80 ,$51.80 ,$56.03 ,$51.80 ,$63.57 ,$82.80 ,$62.85 ,$11.27 ,$72.68 ,$12.48 ,$13.67 ,$13.67 ,$11.16 ,$13.67 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,30101071,84432,HC THYROGLOBULIN MASS SPEC,301,1 ,$373.75 ,$246.68 ,$15.74 ,$373.75 ,$16.59 ,$56.21 ,$56.21 ,$16.06 ,$224.25 ,$317.69 ,$261.63 ,$16.59 ,$16.59 ,$355.06 ,$284.05 ,$280.31 ,$27.30 ,$317.69 ,$16.06 ,$27.30 ,$27.30 ,$261.63 ,$227.61 ,$16.59 ,$16.06 ,$15.74 ,$32.12 ,$17.59 ,$317.69 ,$36.14 ,$343.85 ,$261.63 ,$80.27 ,$80.27 ,$227.61 ,$80.27 ,$258.26 ,$336.38 ,$255.35 ,$15.90 ,$295.26 ,$17.59 ,$19.27 ,$19.27 ,$15.74 ,$19.27 ,$269.10 ,$231.73 ,$269.10 ,$269.10 ,$299.00 
ST NICHOLAS HOSPITAL - ACUTE,30101127,80299,HC THERAPEUTIC DRUG OTHER,301,1 ,$189.75 ,$125.24 ,$18.27 ,$189.75 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$113.85 ,$161.29 ,$132.83 ,$19.26 ,$19.26 ,$180.26 ,$144.21 ,$142.31 ,$31.69 ,$161.29 ,$18.64 ,$31.69 ,$31.69 ,$132.83 ,$115.56 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$161.29 ,$41.94 ,$174.57 ,$132.83 ,$68.43 ,$68.43 ,$115.56 ,$68.43 ,$131.12 ,$170.78 ,$129.64 ,$18.45 ,$149.90 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$136.62 ,$117.65 ,$136.62 ,$136.62 ,$151.80 
ST NICHOLAS HOSPITAL - ACUTE,30101466,82600,HC CYANIDE BLOOD,301,1 ,$167.90 ,$110.81 ,$19.01 ,$167.90 ,$20.05 ,$67.90 ,$67.90 ,$19.40 ,$100.74 ,$142.72 ,$117.53 ,$20.05 ,$20.05 ,$159.51 ,$127.60 ,$125.93 ,$32.98 ,$142.72 ,$19.40 ,$32.98 ,$32.98 ,$117.53 ,$102.25 ,$20.05 ,$19.40 ,$19.01 ,$38.80 ,$21.25 ,$142.72 ,$43.65 ,$154.47 ,$117.53 ,$96.94 ,$96.94 ,$102.25 ,$96.94 ,$116.02 ,$151.11 ,$114.71 ,$19.20 ,$132.64 ,$21.25 ,$23.28 ,$23.28 ,$19.01 ,$23.28 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30101467,84238,HC RECEPTOR ASSAY TRASFERRIN,301,1 ,$257.60 ,$170.02 ,$35.84 ,$257.60 ,$37.79 ,$128.00 ,$128.00 ,$36.57 ,$154.56 ,$218.96 ,$180.32 ,$37.79 ,$37.79 ,$244.72 ,$195.78 ,$193.20 ,$62.17 ,$218.96 ,$36.57 ,$62.17 ,$62.17 ,$180.32 ,$156.88 ,$37.79 ,$36.57 ,$35.84 ,$73.14 ,$40.06 ,$218.96 ,$82.28 ,$236.99 ,$180.32 ,$182.77 ,$182.77 ,$156.88 ,$182.77 ,$178.00 ,$231.84 ,$175.99 ,$36.20 ,$203.50 ,$40.06 ,$43.88 ,$43.88 ,$35.84 ,$43.88 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30101468,83013,HC H PYLORI BREATH TEST,301,1 ,$315.10 ,$207.97 ,$66.01 ,$315.10 ,$69.60 ,$235.76 ,$235.76 ,$67.36 ,$189.06 ,$267.84 ,$220.57 ,$69.60 ,$69.60 ,$299.35 ,$239.48 ,$236.33 ,$114.51 ,$267.84 ,$67.36 ,$114.51 ,$114.51 ,$220.57 ,$191.90 ,$69.60 ,$67.36 ,$66.01 ,$134.72 ,$73.78 ,$267.84 ,$151.56 ,$289.89 ,$220.57 ,$315.10 ,$315.10 ,$191.90 ,$315.10 ,$217.73 ,$283.59 ,$215.28 ,$66.67 ,$248.93 ,$73.78 ,$80.83 ,$80.83 ,$66.01 ,$80.83 ,$226.87 ,$195.36 ,$226.87 ,$226.87 ,$252.08 
ST NICHOLAS HOSPITAL - ACUTE,30101469,G0481,HC DRUG SCREEN DEFINITIVE 8-14 CLASSES,301,1 ,$270.00 ,$178.20 ,$98.39 ,$352.33 ,$98.39 ,$270.00 ,$270.00 ,$156.59 ,$162.00 ,$229.50 ,$189.00 ,$98.39 ,$98.39 ,$256.50 ,$205.20 ,$202.50 ,$266.20 ,$229.50 ,$156.59 ,$266.20 ,$266.20 ,$189.00 ,$164.43 ,$98.39 ,$156.59 ,$153.46 ,$270.00 ,$104.29 ,$229.50 ,$352.33 ,$248.40 ,$189.00 ,$270.00 ,$270.00 ,$164.43 ,$270.00 ,$186.57 ,$243.00 ,$184.46 ,$155.00 ,$213.30 ,$104.29 ,$187.91 ,$187.91 ,$153.46 ,$187.91 ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,30101470,G0482,HC DRUG SCREEN DEFINITIVE 15-21 CLASSES,301,1 ,$350.00 ,$231.00 ,$132.80 ,$447.17 ,$132.80 ,$350.00 ,$350.00 ,$198.74 ,$210.00 ,$297.50 ,$245.00 ,$132.80 ,$132.80 ,$332.50 ,$266.00 ,$262.50 ,$337.86 ,$297.50 ,$198.74 ,$337.86 ,$337.86 ,$245.00 ,$213.15 ,$132.80 ,$198.74 ,$194.77 ,$350.00 ,$140.77 ,$297.50 ,$447.17 ,$322.00 ,$245.00 ,$350.00 ,$350.00 ,$213.15 ,$350.00 ,$241.85 ,$315.00 ,$239.12 ,$196.72 ,$276.50 ,$140.77 ,$238.49 ,$238.49 ,$194.77 ,$238.49 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,30101471,G0483,HC DRUG SCREEN DEFINITIVE 22+ CLASSES,301,1 ,$515.00 ,$339.90 ,$172.18 ,$555.57 ,$172.18 ,$515.00 ,$515.00 ,$246.92 ,$309.00 ,$437.75 ,$360.50 ,$172.18 ,$172.18 ,$489.25 ,$391.40 ,$386.25 ,$419.76 ,$437.75 ,$246.92 ,$419.76 ,$419.76 ,$360.50 ,$313.64 ,$172.18 ,$246.92 ,$241.98 ,$493.84 ,$182.51 ,$437.75 ,$555.57 ,$473.80 ,$360.50 ,$515.00 ,$515.00 ,$313.64 ,$515.00 ,$355.87 ,$463.50 ,$351.85 ,$244.40 ,$406.85 ,$182.51 ,$296.30 ,$296.30 ,$241.98 ,$296.30 ,$370.80 ,$319.30 ,$370.80 ,$370.80 ,$412.00 
ST NICHOLAS HOSPITAL - ACUTE,30101501,84999,HC OSMOLALITY FECAL,301,1 ,$148.35 ,$97.91 ,$0.36 ,$148.35 ,$0.36 ,$101.68 ,$101.68 , N/A ,$89.01 ,$126.10 ,$103.85 ,$0.36 ,$0.36 ,$140.93 ,$112.75 ,$111.26 , N/A ,$126.10 , N/A , N/A , N/A ,$103.85 ,$90.35 ,$0.36 , N/A , N/A , N/A ,$0.38 ,$126.10 ,$89.01 ,$136.48 ,$103.85 ,$75.24 ,$90.30 ,$90.35 ,$90.30 ,$102.51 ,$133.52 ,$101.35 , N/A ,$117.20 ,$0.38 , N/A , N/A , N/A , N/A ,$106.81 ,$91.98 ,$106.81 ,$106.81 ,$118.68 
ST NICHOLAS HOSPITAL - ACUTE,30101502,83520,HC IMMUNOASSAY QN MYELIN ASSOC GLYCOPROTEIN,301,1 ,$178.25 ,$117.65 ,$16.92 ,$178.25 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$106.95 ,$151.51 ,$124.78 ,$17.85 ,$17.85 ,$169.34 ,$135.47 ,$133.69 ,$29.36 ,$151.51 ,$17.27 ,$29.36 ,$29.36 ,$124.78 ,$108.55 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$151.51 ,$38.86 ,$163.99 ,$124.78 ,$64.70 ,$64.70 ,$108.55 ,$64.70 ,$123.17 ,$160.43 ,$121.78 ,$17.09 ,$140.82 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$128.34 ,$110.52 ,$128.34 ,$128.34 ,$142.60 
ST NICHOLAS HOSPITAL - ACUTE,30101504,80285,HC VORICONAZOLE,301,1 ,$140.00 ,$92.40 ,$21.69 ,$140.00 ,$21.69 ,$94.89 ,$94.89 ,$27.11 ,$84.00 ,$119.00 ,$98.00 ,$21.69 ,$21.69 ,$133.00 ,$106.40 ,$105.00 ,$46.09 ,$119.00 ,$27.11 ,$46.09 ,$46.09 ,$98.00 ,$85.26 ,$21.69 ,$27.11 ,$26.57 ,$54.22 ,$22.99 ,$119.00 ,$61.00 ,$128.80 ,$98.00 ,$99.32 ,$99.32 ,$85.26 ,$99.32 ,$96.74 ,$126.00 ,$95.65 ,$26.83 ,$110.60 ,$22.99 ,$32.53 ,$32.53 ,$26.57 ,$32.53 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$112.00 
ST NICHOLAS HOSPITAL - ACUTE,30101506,G0483,HC DRUG SCREEN DEFINITIVE TOXICOLOGY URINE,301,1 ,"$1,000.00 ",$660.00 ,$172.18 ,"$1,000.00 ",$172.18 ,$864.22 ,$864.22 ,$246.92 ,$600.00 ,$850.00 ,$700.00 ,$172.18 ,$172.18 ,$950.00 ,$760.00 ,$750.00 ,$419.76 ,$850.00 ,$246.92 ,$419.76 ,$419.76 ,$700.00 ,$609.00 ,$172.18 ,$246.92 ,$241.98 ,$493.84 ,$182.51 ,$850.00 ,$555.57 ,$920.00 ,$700.00 ,$788.50 ,$788.50 ,$609.00 ,$788.50 ,$691.00 ,$900.00 ,$683.20 ,$244.40 ,$790.00 ,$182.51 ,$296.30 ,$296.30 ,$241.98 ,$296.30 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,30101507,80307,HC DRUG SCREEN MONITOR 1 FLUID ORAL,301,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30101508,G0480,HC TRICYCLIC QN URINE,301,1 ,$99.00 ,$65.34 ,$59.40 ,$222.75 ,$63.95 ,$99.00 ,$99.00 ,$99.00 ,$59.40 ,$84.15 ,$69.30 ,$63.95 ,$63.95 ,$94.05 ,$75.24 ,$74.25 ,$99.00 ,$84.15 ,$99.00 ,$99.00 ,$99.00 ,$69.30 ,$60.29 ,$63.95 ,$99.00 ,$97.02 ,$99.00 ,$67.79 ,$84.15 ,$222.75 ,$91.08 ,$69.30 ,$99.00 ,$99.00 ,$60.29 ,$99.00 ,$68.41 ,$89.10 ,$67.64 ,$97.99 ,$78.21 ,$67.79 ,$99.00 ,$99.00 ,$97.02 ,$99.00 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30101519,83520,HC POLYMERASE III RNA ANTIBODY,301,1 ,$113.85 ,$75.14 ,$16.92 ,$113.85 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$68.31 ,$96.77 ,$79.70 ,$17.85 ,$17.85 ,$108.16 ,$86.53 ,$85.39 ,$29.36 ,$96.77 ,$17.27 ,$29.36 ,$29.36 ,$79.70 ,$69.33 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$96.77 ,$38.86 ,$104.74 ,$79.70 ,$64.70 ,$64.70 ,$69.33 ,$64.70 ,$78.67 ,$102.47 ,$77.78 ,$17.09 ,$89.94 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$81.97 ,$70.59 ,$81.97 ,$81.97 ,$91.08 
ST NICHOLAS HOSPITAL - ACUTE,30101523,84181,HC NEURONAL NUCLEAR AB/WB,301,1 ,$226.55 ,$149.52 ,$16.69 ,$226.55 ,$17.60 ,$59.61 ,$59.61 ,$17.03 ,$135.93 ,$192.57 ,$158.59 ,$17.60 ,$17.60 ,$215.22 ,$172.18 ,$169.91 ,$28.95 ,$192.57 ,$17.03 ,$28.95 ,$28.95 ,$158.59 ,$137.97 ,$17.60 ,$17.03 ,$16.69 ,$34.06 ,$18.66 ,$192.57 ,$38.32 ,$208.43 ,$158.59 ,$85.14 ,$85.14 ,$137.97 ,$85.14 ,$156.55 ,$203.90 ,$154.78 ,$16.86 ,$178.97 ,$18.66 ,$20.44 ,$20.44 ,$16.69 ,$20.44 ,$163.12 ,$140.46 ,$163.12 ,$163.12 ,$181.24 
ST NICHOLAS HOSPITAL - ACUTE,30101528,82657,HC ENZYME ACT NONRAD SUBS DISACCHARIDASE,301,1 ,$296.70 ,$195.82 ,$21.73 ,$296.70 ,$22.91 ,$77.60 ,$77.60 ,$22.17 ,$178.02 ,$252.20 ,$207.69 ,$22.91 ,$22.91 ,$281.87 ,$225.49 ,$222.53 ,$37.69 ,$252.20 ,$22.17 ,$37.69 ,$37.69 ,$207.69 ,$180.69 ,$22.91 ,$22.17 ,$21.73 ,$44.34 ,$24.28 ,$252.20 ,$49.88 ,$272.96 ,$207.69 ,$90.23 ,$90.23 ,$180.69 ,$90.23 ,$205.02 ,$267.03 ,$202.71 ,$21.94 ,$234.39 ,$24.28 ,$26.60 ,$26.60 ,$21.73 ,$26.60 ,$213.62 ,$183.95 ,$213.62 ,$213.62 ,$237.36 
ST NICHOLAS HOSPITAL - ACUTE,30101594,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$96.60 ,$63.76 ,$5.92 ,$96.60 ,$6.24 ,$21.14 ,$21.14 ,$6.04 ,$57.96 ,$82.11 ,$67.62 ,$6.24 ,$6.24 ,$91.77 ,$73.42 ,$72.45 ,$10.27 ,$82.11 ,$6.04 ,$10.27 ,$10.27 ,$67.62 ,$58.83 ,$6.24 ,$6.04 ,$5.92 ,$12.08 ,$6.61 ,$82.11 ,$13.59 ,$88.87 ,$67.62 ,$30.15 ,$30.15 ,$58.83 ,$30.15 ,$66.75 ,$86.94 ,$66.00 ,$5.98 ,$76.31 ,$6.61 ,$7.25 ,$7.25 ,$5.92 ,$7.25 ,$69.55 ,$59.89 ,$69.55 ,$69.55 ,$77.28 
ST NICHOLAS HOSPITAL - ACUTE,30101595,83690,HC LIPASE,301,1 ,$205.85 ,$135.86 ,$6.75 ,$205.85 ,$7.12 ,$24.12 ,$24.12 ,$6.89 ,$123.51 ,$174.97 ,$144.10 ,$7.12 ,$7.12 ,$195.56 ,$156.45 ,$154.39 ,$11.71 ,$174.97 ,$6.89 ,$11.71 ,$11.71 ,$144.10 ,$125.36 ,$7.12 ,$6.89 ,$6.75 ,$13.78 ,$7.55 ,$174.97 ,$15.50 ,$189.38 ,$144.10 ,$34.44 ,$34.44 ,$125.36 ,$34.44 ,$142.24 ,$185.27 ,$140.64 ,$6.82 ,$162.62 ,$7.55 ,$8.27 ,$8.27 ,$6.75 ,$8.27 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,30101654,82642,HC DIHYDROTESTOSTERONE,301,1 ,$205.85 ,$135.86 ,$28.69 ,$205.85 ,$30.26 ,$102.48 ,$102.48 ,$29.28 ,$123.51 ,$174.97 ,$144.10 ,$30.26 ,$30.26 ,$195.56 ,$156.45 ,$154.39 ,$49.78 ,$174.97 ,$29.28 ,$49.78 ,$49.78 ,$144.10 ,$125.36 ,$30.26 ,$29.28 ,$28.69 ,$58.56 ,$32.08 ,$174.97 ,$65.88 ,$189.38 ,$144.10 ,$119.17 ,$119.17 ,$125.36 ,$119.17 ,$142.24 ,$185.27 ,$140.64 ,$28.98 ,$162.62 ,$32.08 ,$35.14 ,$35.14 ,$28.69 ,$35.14 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,30101666,84252,HC VITAMIN B-2 (RIBOFLAVIN),301,1 ,$172.50 ,$113.85 ,$19.84 ,$172.50 ,$20.91 ,$70.84 ,$70.84 ,$20.24 ,$103.50 ,$146.63 ,$120.75 ,$20.91 ,$20.91 ,$163.88 ,$131.10 ,$129.38 ,$34.41 ,$146.63 ,$20.24 ,$34.41 ,$34.41 ,$120.75 ,$105.05 ,$20.91 ,$20.24 ,$19.84 ,$40.48 ,$22.16 ,$146.63 ,$45.54 ,$158.70 ,$120.75 ,$101.15 ,$101.15 ,$105.05 ,$101.15 ,$119.20 ,$155.25 ,$117.85 ,$20.03 ,$136.28 ,$22.16 ,$24.29 ,$24.29 ,$19.84 ,$24.29 ,$124.20 ,$106.95 ,$124.20 ,$124.20 ,$138.00 
ST NICHOLAS HOSPITAL - ACUTE,30101672,84591,HC VITAMIN OTHER,301,1 ,$157.55 ,$103.98 ,$16.32 ,$157.55 ,$16.32 ,$59.71 ,$59.71 ,$17.06 ,$94.53 ,$133.92 ,$110.29 ,$16.32 ,$16.32 ,$149.67 ,$119.74 ,$118.16 ,$29.00 ,$133.92 ,$17.06 ,$29.00 ,$29.00 ,$110.29 ,$95.95 ,$16.32 ,$17.06 ,$16.72 ,$34.12 ,$17.30 ,$133.92 ,$38.39 ,$144.95 ,$110.29 ,$57.99 ,$57.99 ,$95.95 ,$57.99 ,$108.87 ,$141.80 ,$107.64 ,$16.89 ,$124.46 ,$17.30 ,$20.47 ,$20.47 ,$16.72 ,$20.47 ,$113.44 ,$97.68 ,$113.44 ,$113.44 ,$126.04 
ST NICHOLAS HOSPITAL - ACUTE,30101680,83520,HC IMMUNOASSAY PROTEIN QN CSF (PRION),301,1 ,$957.95 ,$632.25 ,$16.92 ,$957.95 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$574.77 ,$814.26 ,$670.57 ,$17.85 ,$17.85 ,$910.05 ,$728.04 ,$718.46 ,$29.36 ,$814.26 ,$17.27 ,$29.36 ,$29.36 ,$670.57 ,$583.39 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$814.26 ,$38.86 ,$881.31 ,$670.57 ,$64.70 ,$64.70 ,$583.39 ,$64.70 ,$661.94 ,$862.16 ,$654.47 ,$17.09 ,$756.78 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$689.72 ,$593.93 ,$689.72 ,$689.72 ,$766.36 
ST NICHOLAS HOSPITAL - ACUTE,30101683,83519,HC IMMUNOASSAY QN CHANNEL/NEURONAL AB,301,1 ,$242.65 ,$160.15 ,$18.03 ,$242.65 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$145.59 ,$206.25 ,$169.86 ,$19.00 ,$19.00 ,$230.52 ,$184.41 ,$181.99 ,$31.28 ,$206.25 ,$18.40 ,$31.28 ,$31.28 ,$169.86 ,$147.77 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$206.25 ,$41.40 ,$223.24 ,$169.86 ,$67.52 ,$67.52 ,$147.77 ,$67.52 ,$167.67 ,$218.39 ,$165.78 ,$18.21 ,$191.69 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$174.71 ,$150.44 ,$174.71 ,$174.71 ,$194.12 
ST NICHOLAS HOSPITAL - ACUTE,30101684,83520,HC IMMUNOASSAY QN STRIATIONAL AB,301,1 ,$194.35 ,$128.27 ,$16.92 ,$194.35 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$116.61 ,$165.20 ,$136.05 ,$17.85 ,$17.85 ,$184.63 ,$147.71 ,$145.76 ,$29.36 ,$165.20 ,$17.27 ,$29.36 ,$29.36 ,$136.05 ,$118.36 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$165.20 ,$38.86 ,$178.80 ,$136.05 ,$64.70 ,$64.70 ,$118.36 ,$64.70 ,$134.30 ,$174.92 ,$132.78 ,$17.09 ,$153.54 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$139.93 ,$120.50 ,$139.93 ,$139.93 ,$155.48 
ST NICHOLAS HOSPITAL - ACUTE,30101707,82542,"HC IODINE, SERUM/PLASMA",301,1 ,$230.00 ,$151.80 ,$23.61 ,$230.00 ,$24.89 ,$84.32 ,$84.32 ,$24.09 ,$138.00 ,$195.50 ,$161.00 ,$24.89 ,$24.89 ,$218.50 ,$174.80 ,$172.50 ,$40.95 ,$195.50 ,$24.09 ,$40.95 ,$40.95 ,$161.00 ,$140.07 ,$24.89 ,$24.09 ,$23.61 ,$48.18 ,$26.38 ,$195.50 ,$54.20 ,$211.60 ,$161.00 ,$90.23 ,$90.23 ,$140.07 ,$90.23 ,$158.93 ,$207.00 ,$157.14 ,$23.84 ,$181.70 ,$26.38 ,$28.91 ,$28.91 ,$23.61 ,$28.91 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,30101708,G0480,HC ALCOHOL METAB WITH CONFIRM,301,1 ,$219.00 ,$144.54 ,$63.95 ,$257.47 ,$63.95 ,$219.00 ,$219.00 ,$114.43 ,$131.40 ,$186.15 ,$153.30 ,$63.95 ,$63.95 ,$208.05 ,$166.44 ,$164.25 ,$194.53 ,$186.15 ,$114.43 ,$194.53 ,$194.53 ,$153.30 ,$133.37 ,$63.95 ,$114.43 ,$112.14 ,$219.00 ,$67.79 ,$186.15 ,$257.47 ,$201.48 ,$153.30 ,$219.00 ,$219.00 ,$133.37 ,$219.00 ,$151.33 ,$197.10 ,$149.62 ,$113.26 ,$173.01 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$157.68 ,$135.78 ,$157.68 ,$157.68 ,$175.20 
ST NICHOLAS HOSPITAL - ACUTE,30101721,83520,HC TSH RECEPTOR BINDING AB,301,1 ,$194.35 ,$128.27 ,$16.92 ,$194.35 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$116.61 ,$165.20 ,$136.05 ,$17.85 ,$17.85 ,$184.63 ,$147.71 ,$145.76 ,$29.36 ,$165.20 ,$17.27 ,$29.36 ,$29.36 ,$136.05 ,$118.36 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$165.20 ,$38.86 ,$178.80 ,$136.05 ,$64.70 ,$64.70 ,$118.36 ,$64.70 ,$134.30 ,$174.92 ,$132.78 ,$17.09 ,$153.54 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$139.93 ,$120.50 ,$139.93 ,$139.93 ,$155.48 
ST NICHOLAS HOSPITAL - ACUTE,30101737,82784,HC IMMUNOGLOBIN G,301,1 ,$44.85 ,$29.60 ,$9.11 ,$44.85 ,$9.61 ,$32.55 ,$32.55 ,$9.30 ,$26.91 ,$38.12 ,$31.40 ,$9.61 ,$9.61 ,$42.61 ,$34.09 ,$33.64 ,$15.81 ,$38.12 ,$9.30 ,$15.81 ,$15.81 ,$31.40 ,$27.31 ,$9.61 ,$9.30 ,$9.11 ,$18.60 ,$10.19 ,$38.12 ,$20.93 ,$41.26 ,$31.40 ,$44.85 ,$44.85 ,$27.31 ,$44.85 ,$30.99 ,$40.37 ,$30.64 ,$9.20 ,$35.43 ,$10.19 ,$11.16 ,$11.16 ,$9.11 ,$11.16 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30101738,G0480,HC PAIN MGMT TAPENTADOL QN -90,301,1 ,$78.00 ,$51.48 ,$46.80 ,$175.50 ,$63.95 ,$78.00 ,$78.00 ,$78.00 ,$46.80 ,$66.30 ,$54.60 ,$63.95 ,$63.95 ,$74.10 ,$59.28 ,$58.50 ,$78.00 ,$66.30 ,$78.00 ,$78.00 ,$78.00 ,$54.60 ,$47.50 ,$63.95 ,$78.00 ,$76.44 ,$78.00 ,$67.79 ,$66.30 ,$175.50 ,$71.76 ,$54.60 ,$78.00 ,$78.00 ,$47.50 ,$78.00 ,$53.90 ,$70.20 ,$53.29 ,$77.20 ,$61.62 ,$67.79 ,$78.00 ,$78.00 ,$76.44 ,$78.00 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30101741,84545,"HC UREA NITROGEN, CLEARANCE",301,1 ,$310.50 ,$204.93 ,$7.06 ,$310.50 ,$7.44 ,$25.20 ,$25.20 ,$7.20 ,$186.30 ,$263.93 ,$217.35 ,$7.44 ,$7.44 ,$294.98 ,$235.98 ,$232.88 ,$12.24 ,$263.93 ,$7.20 ,$12.24 ,$12.24 ,$217.35 ,$189.09 ,$7.44 ,$7.20 ,$7.06 ,$14.40 ,$7.89 ,$263.93 ,$16.20 ,$285.66 ,$217.35 ,$33.01 ,$33.01 ,$189.09 ,$33.01 ,$214.56 ,$279.45 ,$212.13 ,$7.12 ,$245.30 ,$7.89 ,$8.64 ,$8.64 ,$7.06 ,$8.64 ,$223.56 ,$192.51 ,$223.56 ,$223.56 ,$248.40 
ST NICHOLAS HOSPITAL - ACUTE,30101746,G0480,HC DRUG SCRN DEFINT 1-7 CLASS T1,301,1 ,$52.00 ,$34.32 ,$31.20 ,$117.00 ,$52.00 ,$52.00 ,$52.00 ,$52.00 ,$31.20 ,$44.20 ,$36.40 ,$52.00 ,$52.00 ,$49.40 ,$39.52 ,$39.00 ,$52.00 ,$44.20 ,$52.00 ,$52.00 ,$52.00 ,$36.40 ,$31.67 ,$52.00 ,$52.00 ,$50.96 ,$52.00 ,$55.12 ,$44.20 ,$117.00 ,$47.84 ,$36.40 ,$52.00 ,$52.00 ,$31.67 ,$52.00 ,$35.93 ,$46.80 ,$35.53 ,$51.47 ,$41.08 ,$55.12 ,$52.00 ,$52.00 ,$50.96 ,$52.00 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30101747,80362,HC OPIOIDS  AND  OPIATE ANALOGS 1/2,301,1 ,$52.00 ,$34.32 ,$0.38 ,$52.00 ,$0.38 ,$52.00 ,$52.00 , N/A ,$31.20 ,$44.20 ,$36.40 ,$0.38 ,$0.38 ,$49.40 ,$39.52 ,$39.00 ,$38.86 ,$44.20 , N/A ,$38.86 ,$38.86 ,$36.40 ,$31.67 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$31.65 ,$35.93 ,$46.80 ,$35.53 , N/A ,$41.08 ,$0.40 , N/A , N/A , N/A , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30101748,80372,HC DRUG SCREENING TAPENTADOL,301,1 ,$52.00 ,$34.32 ,$0.38 ,$52.00 ,$0.38 ,$52.00 ,$52.00 , N/A ,$31.20 ,$44.20 ,$36.40 ,$0.38 ,$0.38 ,$49.40 ,$39.52 ,$39.00 ,$38.86 ,$44.20 , N/A ,$38.86 ,$38.86 ,$36.40 ,$31.67 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$31.65 ,$35.93 ,$46.80 ,$35.53 , N/A ,$41.08 ,$0.40 , N/A , N/A , N/A , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30101749,80355,HC DRUG SCREENING GABAPENTIN NON-BLOOD,301,1 ,$52.00 ,$34.32 ,$0.38 ,$52.00 ,$0.38 ,$52.00 ,$52.00 , N/A ,$31.20 ,$44.20 ,$36.40 ,$0.38 ,$0.38 ,$49.40 ,$39.52 ,$39.00 ,$38.86 ,$44.20 , N/A ,$38.86 ,$38.86 ,$36.40 ,$31.67 ,$0.38 , N/A , N/A , N/A ,$0.40 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$31.65 ,$35.93 ,$46.80 ,$35.53 , N/A ,$41.08 ,$0.40 , N/A , N/A , N/A , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30101761,83520,HC PHOSPHOLIPASE A2 RECPT ANTIBODY,301,1 ,$296.80 ,$195.89 ,$16.92 ,$296.80 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$178.08 ,$252.28 ,$207.76 ,$17.85 ,$17.85 ,$281.96 ,$225.57 ,$222.60 ,$29.36 ,$252.28 ,$17.27 ,$29.36 ,$29.36 ,$207.76 ,$180.75 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$252.28 ,$38.86 ,$273.06 ,$207.76 ,$64.70 ,$64.70 ,$180.75 ,$64.70 ,$205.09 ,$267.12 ,$202.77 ,$17.09 ,$234.47 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$213.70 ,$184.02 ,$213.70 ,$213.70 ,$237.44 
ST NICHOLAS HOSPITAL - ACUTE,30101813,82608,HC B-12 BINDING CAPACITY-REF,301,1 ,$18.90 ,$12.47 ,$11.34 ,$32.22 ,$14.80 ,$18.90 ,$18.90 ,$14.32 ,$11.34 ,$16.07 ,$13.23 ,$14.80 ,$14.80 ,$17.96 ,$14.36 ,$14.18 ,$18.90 ,$16.07 ,$14.32 ,$18.90 ,$18.90 ,$13.23 ,$11.51 ,$14.80 ,$14.32 ,$14.03 ,$18.90 ,$15.69 ,$16.07 ,$32.22 ,$17.39 ,$13.23 ,$18.90 ,$18.90 ,$11.51 ,$18.90 ,$13.06 ,$17.01 ,$12.91 ,$14.17 ,$14.93 ,$15.69 ,$17.18 ,$17.18 ,$14.03 ,$17.18 ,$13.61 ,$11.72 ,$13.61 ,$13.61 ,$15.12 
ST NICHOLAS HOSPITAL - ACUTE,30101814,82540,HC ASSAY OF CREATINE-REF,301,1 ,$48.30 ,$31.88 ,$4.55 ,$48.30 ,$4.79 ,$16.24 ,$16.24 ,$4.64 ,$28.98 ,$41.06 ,$33.81 ,$4.79 ,$4.79 ,$45.89 ,$36.71 ,$36.23 ,$7.89 ,$41.06 ,$4.64 ,$7.89 ,$7.89 ,$33.81 ,$29.41 ,$4.79 ,$4.64 ,$4.55 ,$9.28 ,$5.08 ,$41.06 ,$10.44 ,$44.44 ,$33.81 ,$23.15 ,$23.15 ,$29.41 ,$23.15 ,$33.38 ,$43.47 ,$33.00 ,$4.60 ,$38.16 ,$5.08 ,$5.57 ,$5.57 ,$4.55 ,$5.57 ,$34.78 ,$29.95 ,$34.78 ,$34.78 ,$38.64 
ST NICHOLAS HOSPITAL - ACUTE,30101828,84433,HC ASSAY THIOPURINE S-METHYLTRANSFERASE,301,1 ,$399.05 ,$263.37 ,$0.36 ,$399.05 ,$0.36 ,$77.60 ,$77.60 ,$22.17 ,$239.43 ,$339.19 ,$279.34 ,$0.36 ,$0.36 ,$379.10 ,$303.28 ,$299.29 , N/A ,$339.19 ,$22.17 , N/A , N/A ,$279.34 ,$243.02 ,$0.36 ,$22.17 ,$21.73 ,$44.34 ,$0.38 ,$339.19 ,$49.88 ,$367.13 ,$279.34 ,$202.40 ,$242.90 ,$243.02 ,$242.90 ,$275.74 ,$359.15 ,$272.63 ,$21.94 ,$315.25 ,$0.38 ,$26.60 ,$26.60 ,$21.73 ,$26.60 ,$287.32 ,$247.41 ,$287.32 ,$287.32 ,$319.24 
ST NICHOLAS HOSPITAL - ACUTE,30101829,80299,HC THERAPEUTIC DRUG OTHER,301,1 ,$189.75 ,$125.24 ,$18.27 ,$189.75 ,$19.26 ,$65.24 ,$65.24 ,$18.64 ,$113.85 ,$161.29 ,$132.83 ,$19.26 ,$19.26 ,$180.26 ,$144.21 ,$142.31 ,$31.69 ,$161.29 ,$18.64 ,$31.69 ,$31.69 ,$132.83 ,$115.56 ,$19.26 ,$18.64 ,$18.27 ,$37.28 ,$20.42 ,$161.29 ,$41.94 ,$174.57 ,$132.83 ,$68.43 ,$68.43 ,$115.56 ,$68.43 ,$131.12 ,$170.78 ,$129.64 ,$18.45 ,$149.90 ,$20.42 ,$22.37 ,$22.37 ,$18.27 ,$22.37 ,$136.62 ,$117.65 ,$136.62 ,$136.62 ,$151.80 
ST NICHOLAS HOSPITAL - ACUTE,30101830,G0480,HC DRUG WARFARIN,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101831,81596,HC CHRONIC HEP C VIRUS ASSAYS,301,1 ,$303.67 ,$200.42 ,$70.75 ,$303.67 , N/A ,$252.67 ,$252.67 ,$72.19 ,$182.20 ,$258.12 ,$212.57 , N/A , N/A ,$288.49 ,$230.79 ,$227.75 ,$122.72 ,$258.12 ,$72.19 ,$122.72 ,$122.72 ,$212.57 ,$184.94 , N/A ,$72.19 ,$70.75 ,$144.38 , N/A ,$258.12 ,$162.43 ,$279.38 ,$212.57 ,$264.47 ,$264.47 ,$184.94 ,$264.47 ,$209.84 ,$273.30 ,$207.47 ,$71.45 ,$239.90 , N/A ,$86.63 ,$86.63 ,$70.75 ,$86.63 ,$218.64 ,$188.28 ,$218.64 ,$218.64 ,$242.94 
ST NICHOLAS HOSPITAL - ACUTE,30101832,80189,HC ITRACONAZOLE,301,1 ,$69.19 ,$45.67 ,$26.57 ,$69.19 ,$27.11 ,$69.19 ,$69.19 ,$27.11 ,$41.51 ,$58.81 ,$48.43 ,$27.11 ,$27.11 ,$65.73 ,$52.58 ,$51.89 ,$46.09 ,$58.81 ,$27.11 ,$46.09 ,$46.09 ,$48.43 ,$42.14 ,$27.11 ,$27.11 ,$26.57 ,$54.22 ,$28.74 ,$58.81 ,$61.00 ,$63.65 ,$48.43 ,$69.19 ,$69.19 ,$42.14 ,$69.19 ,$47.81 ,$62.27 ,$47.27 ,$26.83 ,$54.66 ,$28.74 ,$32.53 ,$32.53 ,$26.57 ,$32.53 ,$49.82 ,$42.90 ,$49.82 ,$49.82 ,$55.35 
ST NICHOLAS HOSPITAL - ACUTE,30101833,G0480,HC DRUG SCREEN (FLUNITRAZEPAM),301,1 ,$330.00 ,$217.80 ,$63.95 ,$330.00 ,$63.95 ,$330.00 ,$330.00 ,$114.43 ,$198.00 ,$280.50 ,$231.00 ,$63.95 ,$63.95 ,$313.50 ,$250.80 ,$247.50 ,$194.53 ,$280.50 ,$114.43 ,$194.53 ,$194.53 ,$231.00 ,$200.97 ,$63.95 ,$114.43 ,$112.14 ,$228.86 ,$67.79 ,$280.50 ,$257.47 ,$303.60 ,$231.00 ,$292.86 ,$292.86 ,$200.97 ,$292.86 ,$228.03 ,$297.00 ,$225.46 ,$113.26 ,$260.70 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$237.60 ,$204.60 ,$237.60 ,$237.60 ,$264.00 
ST NICHOLAS HOSPITAL - ACUTE,30101834,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT,301,1 ,$370.00 ,$244.20 ,$60.90 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$105.64 ,$259.00 ,$225.33 ,$63.40 ,$62.14 ,$60.90 ,$124.28 ,$67.20 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$292.38 ,$292.38 ,$225.33 ,$292.38 ,$255.67 ,$333.00 ,$252.78 ,$61.50 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$60.90 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30101835,80181,HC FLECAINIDE,301,1 ,$15.98 ,$10.55 ,$9.59 ,$35.96 ,$14.91 ,$15.98 ,$15.98 ,$15.98 ,$9.59 ,$13.58 ,$11.19 ,$14.91 ,$14.91 ,$15.18 ,$12.14 ,$11.99 ,$15.98 ,$13.58 ,$15.98 ,$15.98 ,$15.98 ,$11.19 ,$9.73 ,$14.91 ,$15.98 ,$15.66 ,$15.98 ,$15.80 ,$13.58 ,$35.96 ,$14.70 ,$11.19 ,$15.98 ,$15.98 ,$9.73 ,$15.98 ,$11.04 ,$14.38 ,$10.92 ,$15.82 ,$12.62 ,$15.80 ,$15.98 ,$15.98 ,$15.66 ,$15.98 ,$11.51 ,$9.91 ,$11.51 ,$11.51 ,$12.78 
ST NICHOLAS HOSPITAL - ACUTE,30101836,G0480,HC PHOSPHATIDYLETHANOL BLOOD TEST,301,1 ,$180.00 ,$118.80 ,$63.95 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$114.43 ,$108.00 ,$153.00 ,$126.00 ,$63.95 ,$63.95 ,$171.00 ,$136.80 ,$135.00 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$180.00 ,$126.00 ,$109.62 ,$63.95 ,$114.43 ,$112.14 ,$180.00 ,$67.79 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$162.00 ,$122.98 ,$113.26 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30101837,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$296.70 ,$195.82 ,$38.47 ,$296.70 ,$40.57 ,$137.41 ,$137.41 ,$39.26 ,$178.02 ,$252.20 ,$207.69 ,$40.57 ,$40.57 ,$281.87 ,$225.49 ,$222.53 ,$66.74 ,$252.20 ,$39.26 ,$66.74 ,$66.74 ,$207.69 ,$180.69 ,$40.57 ,$39.26 ,$38.47 ,$78.52 ,$43.00 ,$252.20 ,$88.34 ,$272.96 ,$207.69 ,$169.66 ,$169.66 ,$180.69 ,$169.66 ,$205.02 ,$267.03 ,$202.71 ,$38.86 ,$234.39 ,$43.00 ,$47.11 ,$47.11 ,$38.47 ,$47.11 ,$213.62 ,$183.95 ,$213.62 ,$213.62 ,$237.36 
ST NICHOLAS HOSPITAL - ACUTE,30101838,G0480,HC DRUG MONITORING AMPHETAMINES QN URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101839,83527,HC INSULIN FREE,301,1 ,$15.24 ,$10.06 ,$9.14 ,$29.14 ,$13.38 ,$15.24 ,$15.24 ,$12.95 ,$9.14 ,$12.95 ,$10.67 ,$13.38 ,$13.38 ,$14.48 ,$11.58 ,$11.43 ,$15.24 ,$12.95 ,$12.95 ,$15.24 ,$15.24 ,$10.67 ,$9.28 ,$13.38 ,$12.95 ,$12.69 ,$15.24 ,$14.18 ,$12.95 ,$29.14 ,$14.02 ,$10.67 ,$15.24 ,$15.24 ,$9.28 ,$15.24 ,$10.53 ,$13.72 ,$10.41 ,$12.82 ,$12.04 ,$14.18 ,$15.24 ,$15.24 ,$12.69 ,$15.24 ,$10.97 ,$9.45 ,$10.97 ,$10.97 ,$12.19 
ST NICHOLAS HOSPITAL - ACUTE,30101840,G0480,HC DRUG MONITORING BARBITURATES QN URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101841,G0480,HC DRUG MONITORING MARIJUANA METABOLITE QN URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101842,G0480,HC DRUG MONITORING COCAINE METABOLITE QN URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101843,G0480,HC DRUG MONITORING METHADONE METABOLITE QN URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101844,G0480,HC DRUG MONITORING PROPOXYPHENE METABOLITE QN URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101845,G0480,HC DRUG MONITORING ZOLPHIDEM QN URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101846,G0480,HC DRUG MONITORING PHENCYCLIDINE QN URINE,301,1 ,$160.00 ,$105.60 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$160.00 ,$112.00 ,$97.44 ,$63.95 ,$114.43 ,$112.14 ,$160.00 ,$67.79 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$109.31 ,$113.26 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101847,G0480,HC IMMUNOASSAY QN OTHER,301,1 ,$180.55 ,$119.16 ,$63.95 ,$257.47 ,$63.95 ,$180.55 ,$180.55 ,$114.43 ,$108.33 ,$153.47 ,$126.39 ,$63.95 ,$63.95 ,$171.52 ,$137.22 ,$135.41 ,$180.55 ,$153.47 ,$114.43 ,$180.55 ,$180.55 ,$126.39 ,$109.96 ,$63.95 ,$114.43 ,$112.14 ,$180.55 ,$67.79 ,$153.47 ,$257.47 ,$166.11 ,$126.39 ,$180.55 ,$180.55 ,$109.96 ,$180.55 ,$124.76 ,$162.50 ,$123.35 ,$113.26 ,$142.63 ,$67.79 ,$137.32 ,$137.32 ,$112.14 ,$137.32 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30101848,82978,HC GLUTATHIONE,301,1 ,$299.00 ,$197.34 ,$15.14 ,$299.00 ,$15.96 ,$54.08 ,$54.08 ,$15.45 ,$179.40 ,$254.15 ,$209.30 ,$15.96 ,$15.96 ,$284.05 ,$227.24 ,$224.25 ,$26.27 ,$254.15 ,$15.45 ,$26.27 ,$26.27 ,$209.30 ,$182.09 ,$15.96 ,$15.45 ,$15.14 ,$30.90 ,$16.92 ,$254.15 ,$34.76 ,$275.08 ,$209.30 ,$71.26 ,$71.26 ,$182.09 ,$71.26 ,$206.61 ,$269.10 ,$204.28 ,$15.29 ,$236.21 ,$16.92 ,$18.54 ,$18.54 ,$15.14 ,$18.54 ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$239.20 
ST NICHOLAS HOSPITAL - ACUTE,30101850,80151,HC DRUG ASSAY AMIODARONE,301,1 ,$16.76 ,$11.06 ,$10.06 ,$37.71 ,$14.91 ,$16.76 ,$16.76 ,$16.76 ,$10.06 ,$14.25 ,$11.73 ,$14.91 ,$14.91 ,$15.92 ,$12.74 ,$12.57 ,$16.76 ,$14.25 ,$16.76 ,$16.76 ,$16.76 ,$11.73 ,$10.21 ,$14.91 ,$16.76 ,$16.42 ,$16.76 ,$15.80 ,$14.25 ,$37.71 ,$15.42 ,$11.73 ,$16.76 ,$16.76 ,$10.21 ,$16.76 ,$11.58 ,$15.08 ,$11.45 ,$16.59 ,$13.24 ,$15.80 ,$16.76 ,$16.76 ,$16.42 ,$16.76 ,$12.07 ,$10.39 ,$12.07 ,$12.07 ,$13.41 
ST NICHOLAS HOSPITAL - ACUTE,30140264,82570,HC CREATININE OTH SOURCE-REF,301,1 ,$65.10 ,$42.97 ,$5.08 ,$65.10 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$39.06 ,$55.34 ,$45.57 ,$5.35 ,$5.35 ,$61.85 ,$49.48 ,$48.83 ,$8.81 ,$55.34 ,$5.18 ,$8.81 ,$8.81 ,$45.57 ,$39.65 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$55.34 ,$11.66 ,$59.89 ,$45.57 ,$25.86 ,$25.86 ,$39.65 ,$25.86 ,$44.98 ,$58.59 ,$44.48 ,$5.13 ,$51.43 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$46.87 ,$40.36 ,$46.87 ,$46.87 ,$52.08 
ST NICHOLAS HOSPITAL - ACUTE,30140363,83519,HC ACETYLCHOLINE RECPTR AB-REF,301,1 ,$283.50 ,$187.11 ,$18.03 ,$283.50 ,$19.00 ,$64.40 ,$64.40 ,$18.40 ,$170.10 ,$240.98 ,$198.45 ,$19.00 ,$19.00 ,$269.33 ,$215.46 ,$212.63 ,$31.28 ,$240.98 ,$18.40 ,$31.28 ,$31.28 ,$198.45 ,$172.65 ,$19.00 ,$18.40 ,$18.03 ,$36.80 ,$20.14 ,$240.98 ,$41.40 ,$260.82 ,$198.45 ,$67.52 ,$67.52 ,$172.65 ,$67.52 ,$195.90 ,$255.15 ,$193.69 ,$18.21 ,$223.97 ,$20.14 ,$22.08 ,$22.08 ,$18.03 ,$22.08 ,$204.12 ,$175.77 ,$204.12 ,$204.12 ,$226.80 
ST NICHOLAS HOSPITAL - ACUTE,30140436,83874,HC MYOGLOBIN URINE-REF,301,1 ,$46.16 ,$30.47 ,$12.66 ,$46.16 ,$13.35 ,$45.22 ,$45.22 ,$12.92 ,$27.70 ,$39.24 ,$32.31 ,$13.35 ,$13.35 ,$43.85 ,$35.08 ,$34.62 ,$21.96 ,$39.24 ,$12.92 ,$21.96 ,$21.96 ,$32.31 ,$28.11 ,$13.35 ,$12.92 ,$12.66 ,$25.84 ,$14.15 ,$39.24 ,$29.07 ,$42.47 ,$32.31 ,$46.16 ,$46.16 ,$28.11 ,$46.16 ,$31.90 ,$41.54 ,$31.54 ,$12.79 ,$36.47 ,$14.15 ,$15.50 ,$15.50 ,$12.66 ,$15.50 ,$33.24 ,$28.62 ,$33.24 ,$33.24 ,$36.93 
ST NICHOLAS HOSPITAL - ACUTE,30182005,83520,HC INTERLEUKIN 6 (IL-6),301,1 ,$194.35 ,$128.27 ,$16.92 ,$194.35 ,$17.85 ,$60.45 ,$60.45 ,$17.27 ,$116.61 ,$165.20 ,$136.05 ,$17.85 ,$17.85 ,$184.63 ,$147.71 ,$145.76 ,$29.36 ,$165.20 ,$17.27 ,$29.36 ,$29.36 ,$136.05 ,$118.36 ,$17.85 ,$17.27 ,$16.92 ,$34.54 ,$18.92 ,$165.20 ,$38.86 ,$178.80 ,$136.05 ,$64.70 ,$64.70 ,$118.36 ,$64.70 ,$134.30 ,$174.92 ,$132.78 ,$17.09 ,$153.54 ,$18.92 ,$20.72 ,$20.72 ,$16.92 ,$20.72 ,$139.93 ,$120.50 ,$139.93 ,$139.93 ,$155.48 
ST NICHOLAS HOSPITAL - ACUTE,30200101,86003,HC ALLERGEN IGE QN EA (LATEX/IGE),302,1 ,$28.75 ,$18.98 ,$4.57 ,$28.75 ,$4.57 ,$18.27 ,$18.27 ,$5.22 ,$17.25 ,$24.44 ,$20.13 ,$4.57 ,$4.57 ,$27.31 ,$21.85 ,$21.56 ,$8.87 ,$24.44 ,$5.22 ,$8.87 ,$8.87 ,$20.13 ,$17.51 ,$4.57 ,$5.22 ,$5.12 ,$10.44 ,$4.84 ,$24.44 ,$11.75 ,$26.45 ,$20.13 ,$16.23 ,$16.23 ,$17.51 ,$16.23 ,$19.87 ,$25.88 ,$19.64 ,$5.16 ,$22.71 ,$4.84 ,$6.26 ,$6.26 ,$5.12 ,$6.26 ,$20.70 ,$17.83 ,$20.70 ,$20.70 ,$23.00 
ST NICHOLAS HOSPITAL - ACUTE,30200102,86003,HC ALLERGEN IGE QN EA,302,1 ,$18.40 ,$12.14 ,$4.57 ,$18.40 ,$4.57 ,$18.27 ,$18.27 ,$5.22 ,$11.04 ,$15.64 ,$12.88 ,$4.57 ,$4.57 ,$17.48 ,$13.98 ,$13.80 ,$8.87 ,$15.64 ,$5.22 ,$8.87 ,$8.87 ,$12.88 ,$11.21 ,$4.57 ,$5.22 ,$5.12 ,$10.44 ,$4.84 ,$15.64 ,$11.75 ,$16.93 ,$12.88 ,$16.23 ,$16.23 ,$11.21 ,$16.23 ,$12.71 ,$16.56 ,$12.57 ,$5.16 ,$14.54 ,$4.84 ,$6.26 ,$6.26 ,$5.12 ,$6.26 ,$13.25 ,$11.41 ,$13.25 ,$13.25 ,$14.72 
ST NICHOLAS HOSPITAL - ACUTE,30200103,86021,HC LEUKO AB ID,302,1 ,$141.45 ,$93.36 ,$14.75 ,$141.45 ,$15.55 ,$52.68 ,$52.68 ,$15.05 ,$84.87 ,$120.23 ,$99.02 ,$15.55 ,$15.55 ,$134.38 ,$107.50 ,$106.09 ,$25.59 ,$120.23 ,$15.05 ,$25.59 ,$25.59 ,$99.02 ,$86.14 ,$15.55 ,$15.05 ,$14.75 ,$30.10 ,$16.48 ,$120.23 ,$33.86 ,$130.13 ,$99.02 ,$75.25 ,$75.25 ,$86.14 ,$75.25 ,$97.74 ,$127.31 ,$96.64 ,$14.90 ,$111.75 ,$16.48 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30200105,86021,HC LEUKO AB ID (ANCA),302,1 ,$89.70 ,$59.20 ,$14.75 ,$89.70 ,$15.55 ,$52.68 ,$52.68 ,$15.05 ,$53.82 ,$76.25 ,$62.79 ,$15.55 ,$15.55 ,$85.22 ,$68.17 ,$67.28 ,$25.59 ,$76.25 ,$15.05 ,$25.59 ,$25.59 ,$62.79 ,$54.63 ,$15.55 ,$15.05 ,$14.75 ,$30.10 ,$16.48 ,$76.25 ,$33.86 ,$82.52 ,$62.79 ,$75.25 ,$75.25 ,$54.63 ,$75.25 ,$61.98 ,$80.73 ,$61.28 ,$14.90 ,$70.86 ,$16.48 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200106,86021,HC LEUKO AB ID (MYELO),302,1 ,$116.15 ,$76.66 ,$14.75 ,$116.15 ,$15.55 ,$52.68 ,$52.68 ,$15.05 ,$69.69 ,$98.73 ,$81.31 ,$15.55 ,$15.55 ,$110.34 ,$88.27 ,$87.11 ,$25.59 ,$98.73 ,$15.05 ,$25.59 ,$25.59 ,$81.31 ,$70.74 ,$15.55 ,$15.05 ,$14.75 ,$30.10 ,$16.48 ,$98.73 ,$33.86 ,$106.86 ,$81.31 ,$75.25 ,$75.25 ,$70.74 ,$75.25 ,$80.26 ,$104.54 ,$79.35 ,$14.90 ,$91.76 ,$16.48 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200107,86021,HC LEUKO AB ID (PROTEIN),302,1 ,$116.15 ,$76.66 ,$14.75 ,$116.15 ,$15.55 ,$52.68 ,$52.68 ,$15.05 ,$69.69 ,$98.73 ,$81.31 ,$15.55 ,$15.55 ,$110.34 ,$88.27 ,$87.11 ,$25.59 ,$98.73 ,$15.05 ,$25.59 ,$25.59 ,$81.31 ,$70.74 ,$15.55 ,$15.05 ,$14.75 ,$30.10 ,$16.48 ,$98.73 ,$33.86 ,$106.86 ,$81.31 ,$75.25 ,$75.25 ,$70.74 ,$75.25 ,$80.26 ,$104.54 ,$79.35 ,$14.90 ,$91.76 ,$16.48 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200108,86022,HC PLATELET AB ID (HIT),302,1 ,$232.30 ,$153.32 ,$18.00 ,$232.30 ,$18.98 ,$64.30 ,$64.30 ,$18.37 ,$139.38 ,$197.46 ,$162.61 ,$18.98 ,$18.98 ,$220.69 ,$176.55 ,$174.23 ,$31.23 ,$197.46 ,$18.37 ,$31.23 ,$31.23 ,$162.61 ,$141.47 ,$18.98 ,$18.37 ,$18.00 ,$36.74 ,$20.12 ,$197.46 ,$41.33 ,$213.72 ,$162.61 ,$91.81 ,$91.81 ,$141.47 ,$91.81 ,$160.52 ,$209.07 ,$158.71 ,$18.18 ,$183.52 ,$20.12 ,$22.04 ,$22.04 ,$18.00 ,$22.04 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30200109,86022,HC PLATELET AB ID (HEPARIN),302,1 ,$244.95 ,$161.67 ,$18.00 ,$244.95 ,$18.98 ,$64.30 ,$64.30 ,$18.37 ,$146.97 ,$208.21 ,$171.47 ,$18.98 ,$18.98 ,$232.70 ,$186.16 ,$183.71 ,$31.23 ,$208.21 ,$18.37 ,$31.23 ,$31.23 ,$171.47 ,$149.17 ,$18.98 ,$18.37 ,$18.00 ,$36.74 ,$20.12 ,$208.21 ,$41.33 ,$225.35 ,$171.47 ,$91.81 ,$91.81 ,$149.17 ,$91.81 ,$169.26 ,$220.46 ,$167.35 ,$18.18 ,$193.51 ,$20.12 ,$22.04 ,$22.04 ,$18.00 ,$22.04 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30200111,86022,HC PLATELET AB ID (SEROTONIN),302,1 ,$502.55 ,$331.68 ,$18.00 ,$502.55 ,$18.98 ,$64.30 ,$64.30 ,$18.37 ,$301.53 ,$427.17 ,$351.79 ,$18.98 ,$18.98 ,$477.42 ,$381.94 ,$376.91 ,$31.23 ,$427.17 ,$18.37 ,$31.23 ,$31.23 ,$351.79 ,$306.05 ,$18.98 ,$18.37 ,$18.00 ,$36.74 ,$20.12 ,$427.17 ,$41.33 ,$462.35 ,$351.79 ,$91.81 ,$91.81 ,$306.05 ,$91.81 ,$347.26 ,$452.30 ,$343.34 ,$18.18 ,$397.01 ,$20.12 ,$22.04 ,$22.04 ,$18.00 ,$22.04 ,$361.84 ,$311.58 ,$361.84 ,$361.84 ,$402.04 
ST NICHOLAS HOSPITAL - ACUTE,30200113,86022,HC PLATELET AB-ID,302,1 ,$232.30 ,$153.32 ,$18.00 ,$232.30 ,$18.98 ,$64.30 ,$64.30 ,$18.37 ,$139.38 ,$197.46 ,$162.61 ,$18.98 ,$18.98 ,$220.69 ,$176.55 ,$174.23 ,$31.23 ,$197.46 ,$18.37 ,$31.23 ,$31.23 ,$162.61 ,$141.47 ,$18.98 ,$18.37 ,$18.00 ,$36.74 ,$20.12 ,$197.46 ,$41.33 ,$213.72 ,$162.61 ,$91.81 ,$91.81 ,$141.47 ,$91.81 ,$160.52 ,$209.07 ,$158.71 ,$18.18 ,$183.52 ,$20.12 ,$22.04 ,$22.04 ,$18.00 ,$22.04 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30200116,86022,HC PLATELET AB ID (NAT),302,1 ,$66.70 ,$44.02 ,$18.00 ,$66.70 ,$18.98 ,$64.30 ,$64.30 ,$18.37 ,$40.02 ,$56.70 ,$46.69 ,$18.98 ,$18.98 ,$63.37 ,$50.69 ,$50.03 ,$31.23 ,$56.70 ,$18.37 ,$31.23 ,$31.23 ,$46.69 ,$40.62 ,$18.98 ,$18.37 ,$18.00 ,$36.74 ,$20.12 ,$56.70 ,$41.33 ,$61.36 ,$46.69 ,$66.70 ,$66.70 ,$40.62 ,$66.70 ,$46.09 ,$60.03 ,$45.57 ,$18.18 ,$52.69 ,$20.12 ,$22.04 ,$22.04 ,$18.00 ,$22.04 ,$48.02 ,$41.35 ,$48.02 ,$48.02 ,$53.36 
ST NICHOLAS HOSPITAL - ACUTE,30200117,86022,HC PLATELET AB ID (HIT2),302,1 ,$232.30 ,$153.32 ,$18.00 ,$232.30 ,$18.98 ,$64.30 ,$64.30 ,$18.37 ,$139.38 ,$197.46 ,$162.61 ,$18.98 ,$18.98 ,$220.69 ,$176.55 ,$174.23 ,$31.23 ,$197.46 ,$18.37 ,$31.23 ,$31.23 ,$162.61 ,$141.47 ,$18.98 ,$18.37 ,$18.00 ,$36.74 ,$20.12 ,$197.46 ,$41.33 ,$213.72 ,$162.61 ,$91.81 ,$91.81 ,$141.47 ,$91.81 ,$160.52 ,$209.07 ,$158.71 ,$18.18 ,$183.52 ,$20.12 ,$22.04 ,$22.04 ,$18.00 ,$22.04 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30200118,86023,HC PLATELET ASSOC AB ID IGG,302,1 ,$116.15 ,$76.66 ,$12.21 ,$116.15 ,$12.87 ,$43.61 ,$43.61 ,$12.46 ,$69.69 ,$98.73 ,$81.31 ,$12.87 ,$12.87 ,$110.34 ,$88.27 ,$87.11 ,$21.18 ,$98.73 ,$12.46 ,$21.18 ,$21.18 ,$81.31 ,$70.74 ,$12.87 ,$12.46 ,$12.21 ,$24.92 ,$13.64 ,$98.73 ,$28.04 ,$106.86 ,$81.31 ,$62.28 ,$62.28 ,$70.74 ,$62.28 ,$80.26 ,$104.54 ,$79.35 ,$12.33 ,$91.76 ,$13.64 ,$14.95 ,$14.95 ,$12.21 ,$14.95 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200119,86038,HC ANA SCREEN,302,1 ,$89.70 ,$59.20 ,$11.85 ,$89.70 ,$12.49 ,$42.32 ,$42.32 ,$12.09 ,$53.82 ,$76.25 ,$62.79 ,$12.49 ,$12.49 ,$85.22 ,$68.17 ,$67.28 ,$20.55 ,$76.25 ,$12.09 ,$20.55 ,$20.55 ,$62.79 ,$54.63 ,$12.49 ,$12.09 ,$11.85 ,$24.18 ,$13.24 ,$76.25 ,$27.20 ,$82.52 ,$62.79 ,$52.09 ,$52.09 ,$54.63 ,$52.09 ,$61.98 ,$80.73 ,$61.28 ,$11.97 ,$70.86 ,$13.24 ,$14.51 ,$14.51 ,$11.85 ,$14.51 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200120,86039,HC ANA TITER,302,1 ,$103.50 ,$68.31 ,$10.94 ,$103.50 ,$11.53 ,$39.06 ,$39.06 ,$11.16 ,$62.10 ,$87.98 ,$72.45 ,$11.53 ,$11.53 ,$98.33 ,$78.66 ,$77.63 ,$18.97 ,$87.98 ,$11.16 ,$18.97 ,$18.97 ,$72.45 ,$63.03 ,$11.53 ,$11.16 ,$10.94 ,$22.32 ,$12.22 ,$87.98 ,$25.11 ,$95.22 ,$72.45 ,$55.80 ,$55.80 ,$63.03 ,$55.80 ,$71.52 ,$93.15 ,$70.71 ,$11.04 ,$81.77 ,$12.22 ,$13.39 ,$13.39 ,$10.94 ,$13.39 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200121,86060,HC ASO,302,1 ,$141.45 ,$93.36 ,$7.15 ,$141.45 ,$7.54 ,$25.55 ,$25.55 ,$7.30 ,$84.87 ,$120.23 ,$99.02 ,$7.54 ,$7.54 ,$134.38 ,$107.50 ,$106.09 ,$12.41 ,$120.23 ,$7.30 ,$12.41 ,$12.41 ,$99.02 ,$86.14 ,$7.54 ,$7.30 ,$7.15 ,$14.60 ,$7.99 ,$120.23 ,$16.43 ,$130.13 ,$99.02 ,$36.49 ,$36.49 ,$86.14 ,$36.49 ,$97.74 ,$127.31 ,$96.64 ,$7.22 ,$111.75 ,$7.99 ,$8.76 ,$8.76 ,$7.15 ,$8.76 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30200122,86063,HC ASO SCREEN,302,1 ,$120.75 ,$79.70 ,$5.65 ,$120.75 ,$5.96 ,$20.20 ,$20.20 ,$5.77 ,$72.45 ,$102.64 ,$84.53 ,$5.96 ,$5.96 ,$114.71 ,$91.77 ,$90.56 ,$9.81 ,$102.64 ,$5.77 ,$9.81 ,$9.81 ,$84.53 ,$73.54 ,$5.96 ,$5.77 ,$5.65 ,$11.54 ,$6.32 ,$102.64 ,$12.98 ,$111.09 ,$84.53 ,$28.83 ,$28.83 ,$73.54 ,$28.83 ,$83.44 ,$108.68 ,$82.50 ,$5.71 ,$95.39 ,$6.32 ,$6.92 ,$6.92 ,$5.65 ,$6.92 ,$86.94 ,$74.87 ,$86.94 ,$86.94 ,$96.60 
ST NICHOLAS HOSPITAL - ACUTE,30200123,86140,HC C-REACTIVE PROTEIN,302,1 ,$51.75 ,$34.16 ,$5.08 ,$51.75 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$31.05 ,$43.99 ,$36.23 ,$5.35 ,$5.35 ,$49.16 ,$39.33 ,$38.81 ,$8.81 ,$43.99 ,$5.18 ,$8.81 ,$8.81 ,$36.23 ,$31.52 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$43.99 ,$11.66 ,$47.61 ,$36.23 ,$25.86 ,$25.86 ,$31.52 ,$25.86 ,$35.76 ,$46.58 ,$35.36 ,$5.13 ,$40.88 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$37.26 ,$32.09 ,$37.26 ,$37.26 ,$41.40 
ST NICHOLAS HOSPITAL - ACUTE,30200124,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$193.20 ,$127.51 ,$12.69 ,$193.20 ,$13.38 ,$45.33 ,$45.33 ,$12.95 ,$115.92 ,$164.22 ,$135.24 ,$13.38 ,$13.38 ,$183.54 ,$146.83 ,$144.90 ,$22.02 ,$164.22 ,$12.95 ,$22.02 ,$22.02 ,$135.24 ,$117.66 ,$13.38 ,$12.95 ,$12.69 ,$25.90 ,$14.18 ,$164.22 ,$29.14 ,$177.74 ,$135.24 ,$64.70 ,$64.70 ,$117.66 ,$64.70 ,$133.50 ,$173.88 ,$131.99 ,$12.82 ,$152.63 ,$14.18 ,$15.54 ,$15.54 ,$12.69 ,$15.54 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30200125,86146,HC BETA 2 GLYCO AB,302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$89.08 ,$89.08 ,$25.45 ,$53.82 ,$76.25 ,$62.79 ,$8.17 ,$8.17 ,$85.22 ,$68.17 ,$67.28 ,$43.27 ,$76.25 ,$25.45 ,$43.27 ,$43.27 ,$62.79 ,$54.63 ,$8.17 ,$25.45 ,$24.94 ,$50.90 ,$8.66 ,$76.25 ,$57.26 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$25.19 ,$70.86 ,$8.66 ,$30.54 ,$30.54 ,$24.94 ,$30.54 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200126,86147,HC CARDIOLIPIN AB EA,302,1 ,$77.05 ,$50.85 ,$8.17 ,$77.05 ,$8.17 ,$77.05 ,$77.05 ,$25.45 ,$46.23 ,$65.49 ,$53.94 ,$8.17 ,$8.17 ,$73.20 ,$58.56 ,$57.79 ,$43.27 ,$65.49 ,$25.45 ,$43.27 ,$43.27 ,$53.94 ,$46.92 ,$8.17 ,$25.45 ,$24.94 ,$50.90 ,$8.66 ,$65.49 ,$57.26 ,$70.89 ,$53.94 ,$29.05 ,$29.05 ,$46.92 ,$29.05 ,$53.24 ,$69.35 ,$52.64 ,$25.19 ,$60.87 ,$8.66 ,$30.54 ,$30.54 ,$24.94 ,$30.54 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30200127,86147,HC CARDIOLIPIN AB EA (ANTI),302,1 ,$87.40 ,$57.68 ,$8.17 ,$87.40 ,$8.17 ,$87.40 ,$87.40 ,$25.45 ,$52.44 ,$74.29 ,$61.18 ,$8.17 ,$8.17 ,$83.03 ,$66.42 ,$65.55 ,$43.27 ,$74.29 ,$25.45 ,$43.27 ,$43.27 ,$61.18 ,$53.23 ,$8.17 ,$25.45 ,$24.94 ,$50.90 ,$8.66 ,$74.29 ,$57.26 ,$80.41 ,$61.18 ,$29.05 ,$29.05 ,$53.23 ,$29.05 ,$60.39 ,$78.66 ,$59.71 ,$25.19 ,$69.05 ,$8.66 ,$30.54 ,$30.54 ,$24.94 ,$30.54 ,$62.93 ,$54.19 ,$62.93 ,$62.93 ,$69.92 
ST NICHOLAS HOSPITAL - ACUTE,30200128,86147,HC CARDIOLIPIN AB EA (PHOSPH),302,1 ,$87.40 ,$57.68 ,$8.17 ,$87.40 ,$8.17 ,$87.40 ,$87.40 ,$25.45 ,$52.44 ,$74.29 ,$61.18 ,$8.17 ,$8.17 ,$83.03 ,$66.42 ,$65.55 ,$43.27 ,$74.29 ,$25.45 ,$43.27 ,$43.27 ,$61.18 ,$53.23 ,$8.17 ,$25.45 ,$24.94 ,$50.90 ,$8.66 ,$74.29 ,$57.26 ,$80.41 ,$61.18 ,$29.05 ,$29.05 ,$53.23 ,$29.05 ,$60.39 ,$78.66 ,$59.71 ,$25.19 ,$69.05 ,$8.66 ,$30.54 ,$30.54 ,$24.94 ,$30.54 ,$62.93 ,$54.19 ,$62.93 ,$62.93 ,$69.92 
ST NICHOLAS HOSPITAL - ACUTE,30200130,86160,HC COMPLEMENT AG EA (C3),302,1 ,$103.50 ,$68.31 ,$11.76 ,$103.50 ,$12.40 ,$42.00 ,$42.00 ,$12.00 ,$62.10 ,$87.98 ,$72.45 ,$12.40 ,$12.40 ,$98.33 ,$78.66 ,$77.63 ,$20.40 ,$87.98 ,$12.00 ,$20.40 ,$20.40 ,$72.45 ,$63.03 ,$12.40 ,$12.00 ,$11.76 ,$24.00 ,$13.14 ,$87.98 ,$27.00 ,$95.22 ,$72.45 ,$60.01 ,$60.01 ,$63.03 ,$60.01 ,$71.52 ,$93.15 ,$70.71 ,$11.88 ,$81.77 ,$13.14 ,$14.40 ,$14.40 ,$11.76 ,$14.40 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200131,86160,HC COMPLEMENT AG EA (C4),302,1 ,$103.50 ,$68.31 ,$11.76 ,$103.50 ,$12.40 ,$42.00 ,$42.00 ,$12.00 ,$62.10 ,$87.98 ,$72.45 ,$12.40 ,$12.40 ,$98.33 ,$78.66 ,$77.63 ,$20.40 ,$87.98 ,$12.00 ,$20.40 ,$20.40 ,$72.45 ,$63.03 ,$12.40 ,$12.00 ,$11.76 ,$24.00 ,$13.14 ,$87.98 ,$27.00 ,$95.22 ,$72.45 ,$60.01 ,$60.01 ,$63.03 ,$60.01 ,$71.52 ,$93.15 ,$70.71 ,$11.88 ,$81.77 ,$13.14 ,$14.40 ,$14.40 ,$11.76 ,$14.40 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200132,86160,HC COMPLEMENT AG EA,302,1 ,$205.85 ,$135.86 ,$11.76 ,$205.85 ,$12.40 ,$42.00 ,$42.00 ,$12.00 ,$123.51 ,$174.97 ,$144.10 ,$12.40 ,$12.40 ,$195.56 ,$156.45 ,$154.39 ,$20.40 ,$174.97 ,$12.00 ,$20.40 ,$20.40 ,$144.10 ,$125.36 ,$12.40 ,$12.00 ,$11.76 ,$24.00 ,$13.14 ,$174.97 ,$27.00 ,$189.38 ,$144.10 ,$60.01 ,$60.01 ,$125.36 ,$60.01 ,$142.24 ,$185.27 ,$140.64 ,$11.88 ,$162.62 ,$13.14 ,$14.40 ,$14.40 ,$11.76 ,$14.40 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,30200133,86161,HC C1 ESTERASE INHIBITOR,302,1 ,$98.90 ,$65.27 ,$11.76 ,$98.90 ,$12.40 ,$42.00 ,$42.00 ,$12.00 ,$59.34 ,$84.07 ,$69.23 ,$12.40 ,$12.40 ,$93.96 ,$75.16 ,$74.18 ,$20.40 ,$84.07 ,$12.00 ,$20.40 ,$20.40 ,$69.23 ,$60.23 ,$12.40 ,$12.00 ,$11.76 ,$24.00 ,$13.14 ,$84.07 ,$27.00 ,$90.99 ,$69.23 ,$60.01 ,$60.01 ,$60.23 ,$60.01 ,$68.34 ,$89.01 ,$67.57 ,$11.88 ,$78.13 ,$13.14 ,$14.40 ,$14.40 ,$11.76 ,$14.40 ,$71.21 ,$61.32 ,$71.21 ,$71.21 ,$79.12 
ST NICHOLAS HOSPITAL - ACUTE,30200134,86162,HC COMPLEMENT TOTAL,302,1 ,$167.90 ,$110.81 ,$19.91 ,$167.90 ,$21.00 ,$71.12 ,$71.12 ,$20.32 ,$100.74 ,$142.72 ,$117.53 ,$21.00 ,$21.00 ,$159.51 ,$127.60 ,$125.93 ,$34.54 ,$142.72 ,$20.32 ,$34.54 ,$34.54 ,$117.53 ,$102.25 ,$21.00 ,$20.32 ,$19.91 ,$40.64 ,$22.26 ,$142.72 ,$45.72 ,$154.47 ,$117.53 ,$94.55 ,$94.55 ,$102.25 ,$94.55 ,$116.02 ,$151.11 ,$114.71 ,$20.11 ,$132.64 ,$22.26 ,$24.38 ,$24.38 ,$19.91 ,$24.38 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30200135,86200,HC CCP AB,302,1 ,$116.15 ,$76.66 ,$12.69 ,$116.15 ,$13.38 ,$45.33 ,$45.33 ,$12.95 ,$69.69 ,$98.73 ,$81.31 ,$13.38 ,$13.38 ,$110.34 ,$88.27 ,$87.11 ,$22.02 ,$98.73 ,$12.95 ,$22.02 ,$22.02 ,$81.31 ,$70.74 ,$13.38 ,$12.95 ,$12.69 ,$25.90 ,$14.18 ,$98.73 ,$29.14 ,$106.86 ,$81.31 ,$64.70 ,$64.70 ,$70.74 ,$64.70 ,$80.26 ,$104.54 ,$79.35 ,$12.82 ,$91.76 ,$14.18 ,$15.54 ,$15.54 ,$12.69 ,$15.54 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200136,86215,HC DEOXYRIBONUCLEASE AB,302,1 ,$89.70 ,$59.20 ,$12.98 ,$89.70 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$53.82 ,$76.25 ,$62.79 ,$13.69 ,$13.69 ,$85.22 ,$68.17 ,$67.28 ,$22.53 ,$76.25 ,$13.25 ,$22.53 ,$22.53 ,$62.79 ,$54.63 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$76.25 ,$29.81 ,$82.52 ,$62.79 ,$62.79 ,$62.79 ,$54.63 ,$62.79 ,$61.98 ,$80.73 ,$61.28 ,$13.11 ,$70.86 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200137,86225,HC DNA DOUBLE STRAND AB,302,1 ,$116.15 ,$76.66 ,$13.47 ,$116.15 ,$14.20 ,$48.09 ,$48.09 ,$13.74 ,$69.69 ,$98.73 ,$81.31 ,$14.20 ,$14.20 ,$110.34 ,$88.27 ,$87.11 ,$23.36 ,$98.73 ,$13.74 ,$23.36 ,$23.36 ,$81.31 ,$70.74 ,$14.20 ,$13.74 ,$13.47 ,$27.48 ,$15.05 ,$98.73 ,$30.92 ,$106.86 ,$81.31 ,$68.65 ,$68.65 ,$70.74 ,$68.65 ,$80.26 ,$104.54 ,$79.35 ,$13.60 ,$91.76 ,$15.05 ,$16.49 ,$16.49 ,$13.47 ,$16.49 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200138,86235,HC ENA AB,302,1 ,$154.10 ,$101.71 ,$17.57 ,$154.10 ,$18.53 ,$62.76 ,$62.76 ,$17.93 ,$92.46 ,$130.99 ,$107.87 ,$18.53 ,$18.53 ,$146.40 ,$117.12 ,$115.58 ,$30.48 ,$130.99 ,$17.93 ,$30.48 ,$30.48 ,$107.87 ,$93.85 ,$18.53 ,$17.93 ,$17.57 ,$35.86 ,$19.64 ,$130.99 ,$40.34 ,$141.77 ,$107.87 ,$89.61 ,$89.61 ,$93.85 ,$89.61 ,$106.48 ,$138.69 ,$105.28 ,$17.75 ,$121.74 ,$19.64 ,$21.52 ,$21.52 ,$17.57 ,$21.52 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30200139,86235,HC ENA AB (SCL70),302,1 ,$154.10 ,$101.71 ,$17.57 ,$154.10 ,$18.53 ,$62.76 ,$62.76 ,$17.93 ,$92.46 ,$130.99 ,$107.87 ,$18.53 ,$18.53 ,$146.40 ,$117.12 ,$115.58 ,$30.48 ,$130.99 ,$17.93 ,$30.48 ,$30.48 ,$107.87 ,$93.85 ,$18.53 ,$17.93 ,$17.57 ,$35.86 ,$19.64 ,$130.99 ,$40.34 ,$141.77 ,$107.87 ,$89.61 ,$89.61 ,$93.85 ,$89.61 ,$106.48 ,$138.69 ,$105.28 ,$17.75 ,$121.74 ,$19.64 ,$21.52 ,$21.52 ,$17.57 ,$21.52 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30200140,86235,HC ENA AB (JO1),302,1 ,$154.10 ,$101.71 ,$17.57 ,$154.10 ,$18.53 ,$62.76 ,$62.76 ,$17.93 ,$92.46 ,$130.99 ,$107.87 ,$18.53 ,$18.53 ,$146.40 ,$117.12 ,$115.58 ,$30.48 ,$130.99 ,$17.93 ,$30.48 ,$30.48 ,$107.87 ,$93.85 ,$18.53 ,$17.93 ,$17.57 ,$35.86 ,$19.64 ,$130.99 ,$40.34 ,$141.77 ,$107.87 ,$89.61 ,$89.61 ,$93.85 ,$89.61 ,$106.48 ,$138.69 ,$105.28 ,$17.75 ,$121.74 ,$19.64 ,$21.52 ,$21.52 ,$17.57 ,$21.52 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30200141,86235,HC ENA AB (SSA/SSB),302,1 ,$154.10 ,$101.71 ,$17.57 ,$154.10 ,$18.53 ,$62.76 ,$62.76 ,$17.93 ,$92.46 ,$130.99 ,$107.87 ,$18.53 ,$18.53 ,$146.40 ,$117.12 ,$115.58 ,$30.48 ,$130.99 ,$17.93 ,$30.48 ,$30.48 ,$107.87 ,$93.85 ,$18.53 ,$17.93 ,$17.57 ,$35.86 ,$19.64 ,$130.99 ,$40.34 ,$141.77 ,$107.87 ,$89.61 ,$89.61 ,$93.85 ,$89.61 ,$106.48 ,$138.69 ,$105.28 ,$17.75 ,$121.74 ,$19.64 ,$21.52 ,$21.52 ,$17.57 ,$21.52 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30200142,86255,HC FLUOR AB SCR (MITOCHONDRIAL),302,1 ,$64.40 ,$42.50 ,$11.81 ,$64.40 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$38.64 ,$54.74 ,$45.08 ,$12.45 ,$12.45 ,$61.18 ,$48.94 ,$48.30 ,$20.49 ,$54.74 ,$12.05 ,$20.49 ,$20.49 ,$45.08 ,$39.22 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$54.74 ,$27.11 ,$59.25 ,$45.08 ,$60.23 ,$60.23 ,$39.22 ,$60.23 ,$44.50 ,$57.96 ,$44.00 ,$11.93 ,$50.88 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30200143,86255,HC FLUOR AB SCR (MUSCLE),302,1 ,$47.15 ,$31.12 ,$11.81 ,$47.15 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$28.29 ,$40.08 ,$33.01 ,$12.45 ,$12.45 ,$44.79 ,$35.83 ,$35.36 ,$20.49 ,$40.08 ,$12.05 ,$20.49 ,$20.49 ,$33.01 ,$28.71 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$40.08 ,$27.11 ,$43.38 ,$33.01 ,$47.15 ,$47.15 ,$28.71 ,$47.15 ,$32.58 ,$42.44 ,$32.21 ,$11.93 ,$37.25 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$33.95 ,$29.23 ,$33.95 ,$33.95 ,$37.72 
ST NICHOLAS HOSPITAL - ACUTE,30200144,86255,HC FLUOR AB SCR (RETICULIN),302,1 ,$149.50 ,$98.67 ,$11.81 ,$149.50 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$89.70 ,$127.08 ,$104.65 ,$12.45 ,$12.45 ,$142.03 ,$113.62 ,$112.13 ,$20.49 ,$127.08 ,$12.05 ,$20.49 ,$20.49 ,$104.65 ,$91.05 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$127.08 ,$27.11 ,$137.54 ,$104.65 ,$60.23 ,$60.23 ,$91.05 ,$60.23 ,$103.30 ,$134.55 ,$102.14 ,$11.93 ,$118.11 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$107.64 ,$92.69 ,$107.64 ,$107.64 ,$119.60 
ST NICHOLAS HOSPITAL - ACUTE,30200145,86255,HC FLUOR AB SCR (MAYO),302,1 ,$192.05 ,$126.75 ,$11.81 ,$192.05 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$115.23 ,$163.24 ,$134.44 ,$12.45 ,$12.45 ,$182.45 ,$145.96 ,$144.04 ,$20.49 ,$163.24 ,$12.05 ,$20.49 ,$20.49 ,$134.44 ,$116.96 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$163.24 ,$27.11 ,$176.69 ,$134.44 ,$60.23 ,$60.23 ,$116.96 ,$60.23 ,$132.71 ,$172.85 ,$131.21 ,$11.93 ,$151.72 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$138.28 ,$119.07 ,$138.28 ,$138.28 ,$153.64 
ST NICHOLAS HOSPITAL - ACUTE,30200146,86255,HC FLUOR AB SCR (ENDOMYSIAL),302,1 ,$128.80 ,$85.01 ,$11.81 ,$128.80 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$77.28 ,$109.48 ,$90.16 ,$12.45 ,$12.45 ,$122.36 ,$97.89 ,$96.60 ,$20.49 ,$109.48 ,$12.05 ,$20.49 ,$20.49 ,$90.16 ,$78.44 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$109.48 ,$27.11 ,$118.50 ,$90.16 ,$60.23 ,$60.23 ,$78.44 ,$60.23 ,$89.00 ,$115.92 ,$88.00 ,$11.93 ,$101.75 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200147,86255,HC FLUOR AB SCR (HU AB IFA),302,1 ,$180.55 ,$119.16 ,$11.81 ,$180.55 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$108.33 ,$153.47 ,$126.39 ,$12.45 ,$12.45 ,$171.52 ,$137.22 ,$135.41 ,$20.49 ,$153.47 ,$12.05 ,$20.49 ,$20.49 ,$126.39 ,$109.96 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$153.47 ,$27.11 ,$166.11 ,$126.39 ,$60.23 ,$60.23 ,$109.96 ,$60.23 ,$124.76 ,$162.50 ,$123.35 ,$11.93 ,$142.63 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30200148,86255,HC FLUOR AB SCR (PURKINJE),302,1 ,$180.55 ,$119.16 ,$11.81 ,$180.55 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$108.33 ,$153.47 ,$126.39 ,$12.45 ,$12.45 ,$171.52 ,$137.22 ,$135.41 ,$20.49 ,$153.47 ,$12.05 ,$20.49 ,$20.49 ,$126.39 ,$109.96 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$153.47 ,$27.11 ,$166.11 ,$126.39 ,$60.23 ,$60.23 ,$109.96 ,$60.23 ,$124.76 ,$162.50 ,$123.35 ,$11.93 ,$142.63 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30200149,86225,HC YO AB IFA,302,1 ,$116.15 ,$76.66 ,$13.47 ,$116.15 ,$14.20 ,$48.09 ,$48.09 ,$13.74 ,$69.69 ,$98.73 ,$81.31 ,$14.20 ,$14.20 ,$110.34 ,$88.27 ,$87.11 ,$23.36 ,$98.73 ,$13.74 ,$23.36 ,$23.36 ,$81.31 ,$70.74 ,$14.20 ,$13.74 ,$13.47 ,$27.48 ,$15.05 ,$98.73 ,$30.92 ,$106.86 ,$81.31 ,$68.65 ,$68.65 ,$70.74 ,$68.65 ,$80.26 ,$104.54 ,$79.35 ,$13.60 ,$91.76 ,$15.05 ,$16.49 ,$16.49 ,$13.47 ,$16.49 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200150,86256,HC FLUOR AB TITER (C ANCA),302,1 ,$103.50 ,$68.31 ,$11.81 ,$103.50 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$62.10 ,$87.98 ,$72.45 ,$12.45 ,$12.45 ,$98.33 ,$78.66 ,$77.63 ,$20.49 ,$87.98 ,$12.05 ,$20.49 ,$20.49 ,$72.45 ,$63.03 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$87.98 ,$27.11 ,$95.22 ,$72.45 ,$60.23 ,$60.23 ,$63.03 ,$60.23 ,$71.52 ,$93.15 ,$70.71 ,$11.93 ,$81.77 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200151,86256,HC FLUOR AB TITER (P ANCA),302,1 ,$103.50 ,$68.31 ,$11.81 ,$103.50 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$62.10 ,$87.98 ,$72.45 ,$12.45 ,$12.45 ,$98.33 ,$78.66 ,$77.63 ,$20.49 ,$87.98 ,$12.05 ,$20.49 ,$20.49 ,$72.45 ,$63.03 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$87.98 ,$27.11 ,$95.22 ,$72.45 ,$60.23 ,$60.23 ,$63.03 ,$60.23 ,$71.52 ,$93.15 ,$70.71 ,$11.93 ,$81.77 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200152,86256,HC FLUOR AB TITER (CAT SCRATCH),302,1 ,$74.75 ,$49.34 ,$11.81 ,$74.75 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$44.85 ,$63.54 ,$52.33 ,$12.45 ,$12.45 ,$71.01 ,$56.81 ,$56.06 ,$20.49 ,$63.54 ,$12.05 ,$20.49 ,$20.49 ,$52.33 ,$45.52 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$63.54 ,$27.11 ,$68.77 ,$52.33 ,$60.23 ,$60.23 ,$45.52 ,$60.23 ,$51.65 ,$67.28 ,$51.07 ,$11.93 ,$59.05 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$53.82 ,$46.35 ,$53.82 ,$53.82 ,$59.80 
ST NICHOLAS HOSPITAL - ACUTE,30200153,86256,HC FLUOR AB TITER (MITOCHONDRIAL),302,1 ,$105.80 ,$69.83 ,$11.81 ,$105.80 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$63.48 ,$89.93 ,$74.06 ,$12.45 ,$12.45 ,$100.51 ,$80.41 ,$79.35 ,$20.49 ,$89.93 ,$12.05 ,$20.49 ,$20.49 ,$74.06 ,$64.43 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$89.93 ,$27.11 ,$97.34 ,$74.06 ,$60.23 ,$60.23 ,$64.43 ,$60.23 ,$73.11 ,$95.22 ,$72.28 ,$11.93 ,$83.58 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$76.18 ,$65.60 ,$76.18 ,$76.18 ,$84.64 
ST NICHOLAS HOSPITAL - ACUTE,30200154,86256,HC FLUOR AB TITER (ENDOMYSIAL),302,1 ,$386.40 ,$255.02 ,$11.81 ,$386.40 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$231.84 ,$328.44 ,$270.48 ,$12.45 ,$12.45 ,$367.08 ,$293.66 ,$289.80 ,$20.49 ,$328.44 ,$12.05 ,$20.49 ,$20.49 ,$270.48 ,$235.32 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$328.44 ,$27.11 ,$355.49 ,$270.48 ,$60.23 ,$60.23 ,$235.32 ,$60.23 ,$267.00 ,$347.76 ,$263.99 ,$11.93 ,$305.26 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$278.21 ,$239.57 ,$278.21 ,$278.21 ,$309.12 
ST NICHOLAS HOSPITAL - ACUTE,30200155,86256,HC FLUOR AB TITER (RETICULAN),302,1 ,$69.00 ,$45.54 ,$11.81 ,$69.00 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$41.40 ,$58.65 ,$48.30 ,$12.45 ,$12.45 ,$65.55 ,$52.44 ,$51.75 ,$20.49 ,$58.65 ,$12.05 ,$20.49 ,$20.49 ,$48.30 ,$42.02 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$58.65 ,$27.11 ,$63.48 ,$48.30 ,$60.23 ,$60.23 ,$42.02 ,$60.23 ,$47.68 ,$62.10 ,$47.14 ,$11.93 ,$54.51 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30200156,86256,HC FLUOR AB TITER (MUSCLE),302,1 ,$118.45 ,$78.18 ,$11.81 ,$118.45 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$71.07 ,$100.68 ,$82.92 ,$12.45 ,$12.45 ,$112.53 ,$90.02 ,$88.84 ,$20.49 ,$100.68 ,$12.05 ,$20.49 ,$20.49 ,$82.92 ,$72.14 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$100.68 ,$27.11 ,$108.97 ,$82.92 ,$60.23 ,$60.23 ,$72.14 ,$60.23 ,$81.85 ,$106.61 ,$80.93 ,$11.93 ,$93.58 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,30200157,82677,HC ESTRIOL SERUM,302,1 ,$131.10 ,$86.53 ,$23.70 ,$131.10 ,$24.99 ,$84.63 ,$84.63 ,$24.18 ,$78.66 ,$111.44 ,$91.77 ,$24.99 ,$24.99 ,$124.55 ,$99.64 ,$98.33 ,$41.11 ,$111.44 ,$24.18 ,$41.11 ,$41.11 ,$91.77 ,$79.84 ,$24.99 ,$24.18 ,$23.70 ,$48.36 ,$26.49 ,$111.44 ,$54.41 ,$120.61 ,$91.77 ,$120.86 ,$120.86 ,$79.84 ,$120.86 ,$90.59 ,$117.99 ,$89.57 ,$23.93 ,$103.57 ,$26.49 ,$29.02 ,$29.02 ,$23.70 ,$29.02 ,$94.39 ,$81.28 ,$94.39 ,$94.39 ,$104.88 
ST NICHOLAS HOSPITAL - ACUTE,30200158,86300,HC TUMOR AG CA 15-3 (27.29),302,1 ,$180.55 ,$119.16 ,$20.39 ,$180.55 ,$21.50 ,$72.84 ,$72.84 ,$20.81 ,$108.33 ,$153.47 ,$126.39 ,$21.50 ,$21.50 ,$171.52 ,$137.22 ,$135.41 ,$35.38 ,$153.47 ,$20.81 ,$35.38 ,$35.38 ,$126.39 ,$109.96 ,$21.50 ,$20.81 ,$20.39 ,$41.62 ,$22.79 ,$153.47 ,$46.82 ,$166.11 ,$126.39 ,$104.01 ,$104.01 ,$109.96 ,$104.01 ,$124.76 ,$162.50 ,$123.35 ,$20.60 ,$142.63 ,$22.79 ,$24.97 ,$24.97 ,$20.39 ,$24.97 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30200159,86300,HC TUMOR AG CA 15-3 (27.29) 2,302,1 ,$150.65 ,$99.43 ,$20.39 ,$150.65 ,$21.50 ,$72.84 ,$72.84 ,$20.81 ,$90.39 ,$128.05 ,$105.46 ,$21.50 ,$21.50 ,$143.12 ,$114.49 ,$112.99 ,$35.38 ,$128.05 ,$20.81 ,$35.38 ,$35.38 ,$105.46 ,$91.75 ,$21.50 ,$20.81 ,$20.39 ,$41.62 ,$22.79 ,$128.05 ,$46.82 ,$138.60 ,$105.46 ,$104.01 ,$104.01 ,$91.75 ,$104.01 ,$104.10 ,$135.59 ,$102.92 ,$20.60 ,$119.01 ,$22.79 ,$24.97 ,$24.97 ,$20.39 ,$24.97 ,$108.47 ,$93.40 ,$108.47 ,$108.47 ,$120.52 
ST NICHOLAS HOSPITAL - ACUTE,30200160,86301,HC TUMOR AG CA 19-9,302,1 ,$180.55 ,$119.16 ,$20.39 ,$180.55 ,$21.50 ,$72.84 ,$72.84 ,$20.81 ,$108.33 ,$153.47 ,$126.39 ,$21.50 ,$21.50 ,$171.52 ,$137.22 ,$135.41 ,$35.38 ,$153.47 ,$20.81 ,$35.38 ,$35.38 ,$126.39 ,$109.96 ,$21.50 ,$20.81 ,$20.39 ,$41.62 ,$22.79 ,$153.47 ,$46.82 ,$166.11 ,$126.39 ,$104.01 ,$104.01 ,$109.96 ,$104.01 ,$124.76 ,$162.50 ,$123.35 ,$20.60 ,$142.63 ,$22.79 ,$24.97 ,$24.97 ,$20.39 ,$24.97 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30200161,86301,HC TUMOR AG CA 19-9 BODY FLUID,302,1 ,$180.55 ,$119.16 ,$20.39 ,$180.55 ,$21.50 ,$72.84 ,$72.84 ,$20.81 ,$108.33 ,$153.47 ,$126.39 ,$21.50 ,$21.50 ,$171.52 ,$137.22 ,$135.41 ,$35.38 ,$153.47 ,$20.81 ,$35.38 ,$35.38 ,$126.39 ,$109.96 ,$21.50 ,$20.81 ,$20.39 ,$41.62 ,$22.79 ,$153.47 ,$46.82 ,$166.11 ,$126.39 ,$104.01 ,$104.01 ,$109.96 ,$104.01 ,$124.76 ,$162.50 ,$123.35 ,$20.60 ,$142.63 ,$22.79 ,$24.97 ,$24.97 ,$20.39 ,$24.97 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30200162,86304,HC TUMOR AG CA 125,302,1 ,$180.55 ,$119.16 ,$20.39 ,$180.55 ,$21.50 ,$72.84 ,$72.84 ,$20.81 ,$108.33 ,$153.47 ,$126.39 ,$21.50 ,$21.50 ,$171.52 ,$137.22 ,$135.41 ,$35.38 ,$153.47 ,$20.81 ,$35.38 ,$35.38 ,$126.39 ,$109.96 ,$21.50 ,$20.81 ,$20.39 ,$41.62 ,$22.79 ,$153.47 ,$46.82 ,$166.11 ,$126.39 ,$104.01 ,$104.01 ,$109.96 ,$104.01 ,$124.76 ,$162.50 ,$123.35 ,$20.60 ,$142.63 ,$22.79 ,$24.97 ,$24.97 ,$20.39 ,$24.97 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$89.70 ,$59.20 ,$5.08 ,$89.70 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$53.82 ,$76.25 ,$62.79 ,$5.35 ,$5.35 ,$85.22 ,$68.17 ,$67.28 ,$8.81 ,$76.25 ,$5.18 ,$8.81 ,$8.81 ,$62.79 ,$54.63 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$76.25 ,$11.66 ,$82.52 ,$62.79 ,$25.86 ,$25.86 ,$54.63 ,$25.86 ,$61.98 ,$80.73 ,$61.28 ,$5.13 ,$70.86 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200164,86316,HC TUMOR AG OTHER AG QN,302,1 ,$193.20 ,$127.51 ,$20.39 ,$193.20 ,$21.50 ,$72.84 ,$72.84 ,$20.81 ,$115.92 ,$164.22 ,$135.24 ,$21.50 ,$21.50 ,$183.54 ,$146.83 ,$144.90 ,$35.38 ,$164.22 ,$20.81 ,$35.38 ,$35.38 ,$135.24 ,$117.66 ,$21.50 ,$20.81 ,$20.39 ,$41.62 ,$22.79 ,$164.22 ,$46.82 ,$177.74 ,$135.24 ,$104.01 ,$104.01 ,$117.66 ,$104.01 ,$133.50 ,$173.88 ,$131.99 ,$20.60 ,$152.63 ,$22.79 ,$24.97 ,$24.97 ,$20.39 ,$24.97 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30200165,86317,HC INFECTIOUS AB QN,302,1 ,$128.80 ,$85.01 ,$14.69 ,$128.80 ,$15.49 ,$52.47 ,$52.47 ,$14.99 ,$77.28 ,$109.48 ,$90.16 ,$15.49 ,$15.49 ,$122.36 ,$97.89 ,$96.60 ,$25.48 ,$109.48 ,$14.99 ,$25.48 ,$25.48 ,$90.16 ,$78.44 ,$15.49 ,$14.99 ,$14.69 ,$29.98 ,$16.42 ,$109.48 ,$33.73 ,$118.50 ,$90.16 ,$74.92 ,$74.92 ,$78.44 ,$74.92 ,$89.00 ,$115.92 ,$88.00 ,$14.84 ,$101.75 ,$16.42 ,$17.99 ,$17.99 ,$14.69 ,$17.99 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200166,86318,HC INFECTIOUS AB QL,302,1 ,$154.10 ,$101.71 ,$17.73 ,$154.10 ,$18.21 ,$63.32 ,$63.32 ,$18.09 ,$92.46 ,$130.99 ,$107.87 ,$18.21 ,$18.21 ,$146.40 ,$117.12 ,$115.58 ,$30.75 ,$130.99 ,$18.09 ,$30.75 ,$30.75 ,$107.87 ,$93.85 ,$18.21 ,$18.09 ,$17.73 ,$36.18 ,$19.30 ,$130.99 ,$40.70 ,$141.77 ,$107.87 ,$64.70 ,$64.70 ,$93.85 ,$64.70 ,$106.48 ,$138.69 ,$105.28 ,$17.90 ,$121.74 ,$19.30 ,$21.71 ,$21.71 ,$17.73 ,$21.71 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30200167,86331,HC IMMUNODIFF EL EA AG AB QL,302,1 ,$55.20 ,$36.43 ,$11.74 ,$55.20 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$33.12 ,$46.92 ,$38.64 ,$12.38 ,$12.38 ,$52.44 ,$41.95 ,$41.40 ,$20.37 ,$46.92 ,$11.98 ,$20.37 ,$20.37 ,$38.64 ,$33.62 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$46.92 ,$26.96 ,$50.78 ,$38.64 ,$55.20 ,$55.20 ,$33.62 ,$55.20 ,$38.14 ,$49.68 ,$37.71 ,$11.86 ,$43.61 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$39.74 ,$34.22 ,$39.74 ,$39.74 ,$44.16 
ST NICHOLAS HOSPITAL - ACUTE,30200168,86331,HC IMMUNODIFF EL EA AG AB QL (TEICH),302,1 ,$55.20 ,$36.43 ,$11.74 ,$55.20 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$33.12 ,$46.92 ,$38.64 ,$12.38 ,$12.38 ,$52.44 ,$41.95 ,$41.40 ,$20.37 ,$46.92 ,$11.98 ,$20.37 ,$20.37 ,$38.64 ,$33.62 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$46.92 ,$26.96 ,$50.78 ,$38.64 ,$55.20 ,$55.20 ,$33.62 ,$55.20 ,$38.14 ,$49.68 ,$37.71 ,$11.86 ,$43.61 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$39.74 ,$34.22 ,$39.74 ,$39.74 ,$44.16 
ST NICHOLAS HOSPITAL - ACUTE,30200169,86334,HC IMMUNOFIX ELECTRO SERUM,302,1 ,$193.20 ,$127.51 ,$21.89 ,$193.20 ,$23.08 ,$78.19 ,$78.19 ,$22.34 ,$115.92 ,$164.22 ,$135.24 ,$23.08 ,$23.08 ,$183.54 ,$146.83 ,$144.90 ,$37.98 ,$164.22 ,$22.34 ,$37.98 ,$37.98 ,$135.24 ,$117.66 ,$23.08 ,$22.34 ,$21.89 ,$44.68 ,$24.46 ,$164.22 ,$50.27 ,$177.74 ,$135.24 ,$111.66 ,$111.66 ,$117.66 ,$111.66 ,$133.50 ,$173.88 ,$131.99 ,$22.11 ,$152.63 ,$24.46 ,$26.81 ,$26.81 ,$21.89 ,$26.81 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30200170,86334,HC IMMUNOFIX ELECTRO REFLEX,302,1 ,$270.25 ,$178.37 ,$21.89 ,$270.25 ,$23.08 ,$78.19 ,$78.19 ,$22.34 ,$162.15 ,$229.71 ,$189.18 ,$23.08 ,$23.08 ,$256.74 ,$205.39 ,$202.69 ,$37.98 ,$229.71 ,$22.34 ,$37.98 ,$37.98 ,$189.18 ,$164.58 ,$23.08 ,$22.34 ,$21.89 ,$44.68 ,$24.46 ,$229.71 ,$50.27 ,$248.63 ,$189.18 ,$111.66 ,$111.66 ,$164.58 ,$111.66 ,$186.74 ,$243.23 ,$184.63 ,$22.11 ,$213.50 ,$24.46 ,$26.81 ,$26.81 ,$21.89 ,$26.81 ,$194.58 ,$167.56 ,$194.58 ,$194.58 ,$216.20 
ST NICHOLAS HOSPITAL - ACUTE,30200171,86335,HC IMMUNOFIX ELECTRO OTH,302,1 ,$257.60 ,$170.02 ,$28.76 ,$257.60 ,$30.33 ,$102.73 ,$102.73 ,$29.35 ,$154.56 ,$218.96 ,$180.32 ,$30.33 ,$30.33 ,$244.72 ,$195.78 ,$193.20 ,$49.90 ,$218.96 ,$29.35 ,$49.90 ,$49.90 ,$180.32 ,$156.88 ,$30.33 ,$29.35 ,$28.76 ,$58.70 ,$32.15 ,$218.96 ,$66.04 ,$236.99 ,$180.32 ,$146.69 ,$146.69 ,$156.88 ,$146.69 ,$178.00 ,$231.84 ,$175.99 ,$29.05 ,$203.50 ,$32.15 ,$35.22 ,$35.22 ,$28.76 ,$35.22 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30200172,86335,HC IMMUNOFIX ELECTRO OTH (TRANS),302,1 ,$257.60 ,$170.02 ,$28.76 ,$257.60 ,$30.33 ,$102.73 ,$102.73 ,$29.35 ,$154.56 ,$218.96 ,$180.32 ,$30.33 ,$30.33 ,$244.72 ,$195.78 ,$193.20 ,$49.90 ,$218.96 ,$29.35 ,$49.90 ,$49.90 ,$180.32 ,$156.88 ,$30.33 ,$29.35 ,$28.76 ,$58.70 ,$32.15 ,$218.96 ,$66.04 ,$236.99 ,$180.32 ,$146.69 ,$146.69 ,$156.88 ,$146.69 ,$178.00 ,$231.84 ,$175.99 ,$29.05 ,$203.50 ,$32.15 ,$35.22 ,$35.22 ,$28.76 ,$35.22 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30200173,86336,HC INHIBIN A,302,1 ,$141.45 ,$93.36 ,$15.28 ,$141.45 ,$16.11 ,$54.57 ,$54.57 ,$15.59 ,$84.87 ,$120.23 ,$99.02 ,$16.11 ,$16.11 ,$134.38 ,$107.50 ,$106.09 ,$26.50 ,$120.23 ,$15.59 ,$26.50 ,$26.50 ,$99.02 ,$86.14 ,$16.11 ,$15.59 ,$15.28 ,$31.18 ,$17.08 ,$120.23 ,$35.08 ,$130.13 ,$99.02 ,$77.89 ,$77.89 ,$86.14 ,$77.89 ,$97.74 ,$127.31 ,$96.64 ,$15.43 ,$111.75 ,$17.08 ,$18.71 ,$18.71 ,$15.28 ,$18.71 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30200174,86336,HC INHIBIN A (QUAD),302,1 ,$202.40 ,$133.58 ,$15.28 ,$202.40 ,$16.11 ,$54.57 ,$54.57 ,$15.59 ,$121.44 ,$172.04 ,$141.68 ,$16.11 ,$16.11 ,$192.28 ,$153.82 ,$151.80 ,$26.50 ,$172.04 ,$15.59 ,$26.50 ,$26.50 ,$141.68 ,$123.26 ,$16.11 ,$15.59 ,$15.28 ,$31.18 ,$17.08 ,$172.04 ,$35.08 ,$186.21 ,$141.68 ,$77.89 ,$77.89 ,$123.26 ,$77.89 ,$139.86 ,$182.16 ,$138.28 ,$15.43 ,$159.90 ,$17.08 ,$18.71 ,$18.71 ,$15.28 ,$18.71 ,$145.73 ,$125.49 ,$145.73 ,$145.73 ,$161.92 
ST NICHOLAS HOSPITAL - ACUTE,30200175,86337,HC INSULIN AB (HS),302,1 ,$293.25 ,$193.55 ,$20.98 ,$293.25 ,$22.12 ,$74.94 ,$74.94 ,$21.41 ,$175.95 ,$249.26 ,$205.28 ,$22.12 ,$22.12 ,$278.59 ,$222.87 ,$219.94 ,$36.40 ,$249.26 ,$21.41 ,$36.40 ,$36.40 ,$205.28 ,$178.59 ,$22.12 ,$21.41 ,$20.98 ,$42.82 ,$23.45 ,$249.26 ,$48.17 ,$269.79 ,$205.28 ,$107.01 ,$107.01 ,$178.59 ,$107.01 ,$202.64 ,$263.93 ,$200.35 ,$21.19 ,$231.67 ,$23.45 ,$25.69 ,$25.69 ,$20.98 ,$25.69 ,$211.14 ,$181.82 ,$211.14 ,$211.14 ,$234.60 
ST NICHOLAS HOSPITAL - ACUTE,30200176,86337,HC INSULIN AB,302,1 ,$270.25 ,$178.37 ,$20.98 ,$270.25 ,$22.12 ,$74.94 ,$74.94 ,$21.41 ,$162.15 ,$229.71 ,$189.18 ,$22.12 ,$22.12 ,$256.74 ,$205.39 ,$202.69 ,$36.40 ,$229.71 ,$21.41 ,$36.40 ,$36.40 ,$189.18 ,$164.58 ,$22.12 ,$21.41 ,$20.98 ,$42.82 ,$23.45 ,$229.71 ,$48.17 ,$248.63 ,$189.18 ,$107.01 ,$107.01 ,$164.58 ,$107.01 ,$186.74 ,$243.23 ,$184.63 ,$21.19 ,$213.50 ,$23.45 ,$25.69 ,$25.69 ,$20.98 ,$25.69 ,$194.58 ,$167.56 ,$194.58 ,$194.58 ,$216.20 
ST NICHOLAS HOSPITAL - ACUTE,30200177,86340,HC INTRINSIC FACTOR AB,302,1 ,$128.80 ,$85.01 ,$14.28 ,$128.80 ,$14.28 ,$52.78 ,$52.78 ,$15.08 ,$77.28 ,$109.48 ,$90.16 ,$14.28 ,$14.28 ,$122.36 ,$97.89 ,$96.60 ,$25.64 ,$109.48 ,$15.08 ,$25.64 ,$25.64 ,$90.16 ,$78.44 ,$14.28 ,$15.08 ,$14.78 ,$30.16 ,$15.14 ,$109.48 ,$33.93 ,$118.50 ,$90.16 ,$50.74 ,$50.74 ,$78.44 ,$50.74 ,$89.00 ,$115.92 ,$88.00 ,$14.93 ,$101.75 ,$15.14 ,$18.10 ,$18.10 ,$14.78 ,$18.10 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200178,86341,HC ISLET CELL AB,302,1 ,$116.15 ,$76.66 ,$19.88 ,$116.15 ,$19.88 ,$82.50 ,$82.50 ,$23.57 ,$69.69 ,$98.73 ,$81.31 ,$19.88 ,$19.88 ,$110.34 ,$88.27 ,$87.11 ,$40.07 ,$98.73 ,$23.57 ,$40.07 ,$40.07 ,$81.31 ,$70.74 ,$19.88 ,$23.57 ,$23.10 ,$47.14 ,$21.07 ,$98.73 ,$53.03 ,$106.86 ,$81.31 ,$70.67 ,$70.67 ,$70.74 ,$70.67 ,$80.26 ,$104.54 ,$79.35 ,$23.33 ,$91.76 ,$21.07 ,$28.28 ,$28.28 ,$23.10 ,$28.28 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200179,86355,HC B CELLS TOTAL COUNT (CD19),302,1 ,$289.80 ,$191.27 ,$36.98 ,$289.80 ,$38.99 ,$132.06 ,$132.06 ,$37.73 ,$173.88 ,$246.33 ,$202.86 ,$38.99 ,$38.99 ,$275.31 ,$220.25 ,$217.35 ,$64.14 ,$246.33 ,$37.73 ,$64.14 ,$64.14 ,$202.86 ,$176.49 ,$38.99 ,$37.73 ,$36.98 ,$75.46 ,$41.33 ,$246.33 ,$84.89 ,$266.62 ,$202.86 ,$188.52 ,$188.52 ,$176.49 ,$188.52 ,$200.25 ,$260.82 ,$197.99 ,$37.35 ,$228.94 ,$41.33 ,$45.28 ,$45.28 ,$36.98 ,$45.28 ,$208.66 ,$179.68 ,$208.66 ,$208.66 ,$231.84 
ST NICHOLAS HOSPITAL - ACUTE,30200180,86355,HC B CELLS TOTAL COUNT (CD20),302,1 ,$289.80 ,$191.27 ,$36.98 ,$289.80 ,$38.99 ,$132.06 ,$132.06 ,$37.73 ,$173.88 ,$246.33 ,$202.86 ,$38.99 ,$38.99 ,$275.31 ,$220.25 ,$217.35 ,$64.14 ,$246.33 ,$37.73 ,$64.14 ,$64.14 ,$202.86 ,$176.49 ,$38.99 ,$37.73 ,$36.98 ,$75.46 ,$41.33 ,$246.33 ,$84.89 ,$266.62 ,$202.86 ,$188.52 ,$188.52 ,$176.49 ,$188.52 ,$200.25 ,$260.82 ,$197.99 ,$37.35 ,$228.94 ,$41.33 ,$45.28 ,$45.28 ,$36.98 ,$45.28 ,$208.66 ,$179.68 ,$208.66 ,$208.66 ,$231.84 
ST NICHOLAS HOSPITAL - ACUTE,30200181,86355,HC B CELLS TOTAL COUNT,302,1 ,$334.65 ,$220.87 ,$36.98 ,$334.65 ,$38.99 ,$132.06 ,$132.06 ,$37.73 ,$200.79 ,$284.45 ,$234.26 ,$38.99 ,$38.99 ,$317.92 ,$254.33 ,$250.99 ,$64.14 ,$284.45 ,$37.73 ,$64.14 ,$64.14 ,$234.26 ,$203.80 ,$38.99 ,$37.73 ,$36.98 ,$75.46 ,$41.33 ,$284.45 ,$84.89 ,$307.88 ,$234.26 ,$188.52 ,$188.52 ,$203.80 ,$188.52 ,$231.24 ,$301.19 ,$228.63 ,$37.35 ,$264.37 ,$41.33 ,$45.28 ,$45.28 ,$36.98 ,$45.28 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30200182,86357,HC CD8 TOTAL COUNT,302,1 ,$334.65 ,$220.87 ,$36.98 ,$334.65 ,$38.99 ,$132.06 ,$132.06 ,$37.73 ,$200.79 ,$284.45 ,$234.26 ,$38.99 ,$38.99 ,$317.92 ,$254.33 ,$250.99 ,$64.14 ,$284.45 ,$37.73 ,$64.14 ,$64.14 ,$234.26 ,$203.80 ,$38.99 ,$37.73 ,$36.98 ,$75.46 ,$41.33 ,$284.45 ,$84.89 ,$307.88 ,$234.26 ,$188.52 ,$188.52 ,$203.80 ,$188.52 ,$231.24 ,$301.19 ,$228.63 ,$37.35 ,$264.37 ,$41.33 ,$45.28 ,$45.28 ,$36.98 ,$45.28 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30200184,86360,HC ABS T CELLS CD4 CD8 RATIO,302,1 ,$411.70 ,$271.72 ,$46.04 ,$411.70 ,$48.54 ,$164.43 ,$164.43 ,$46.98 ,$247.02 ,$349.95 ,$288.19 ,$48.54 ,$48.54 ,$391.12 ,$312.89 ,$308.78 ,$79.87 ,$349.95 ,$46.98 ,$79.87 ,$79.87 ,$288.19 ,$250.73 ,$48.54 ,$46.98 ,$46.04 ,$93.96 ,$51.45 ,$349.95 ,$105.71 ,$378.76 ,$288.19 ,$234.83 ,$234.83 ,$250.73 ,$234.83 ,$284.48 ,$370.53 ,$281.27 ,$46.50 ,$325.24 ,$51.45 ,$56.38 ,$56.38 ,$46.04 ,$56.38 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,30200185,86360,HC ABS T CELLS CD4 CD8 RATIO (MARKER),302,1 ,$411.70 ,$271.72 ,$46.04 ,$411.70 ,$48.54 ,$164.43 ,$164.43 ,$46.98 ,$247.02 ,$349.95 ,$288.19 ,$48.54 ,$48.54 ,$391.12 ,$312.89 ,$308.78 ,$79.87 ,$349.95 ,$46.98 ,$79.87 ,$79.87 ,$288.19 ,$250.73 ,$48.54 ,$46.98 ,$46.04 ,$93.96 ,$51.45 ,$349.95 ,$105.71 ,$378.76 ,$288.19 ,$234.83 ,$234.83 ,$250.73 ,$234.83 ,$284.48 ,$370.53 ,$281.27 ,$46.50 ,$325.24 ,$51.45 ,$56.38 ,$56.38 ,$46.04 ,$56.38 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,30200186,86360,HC ABS T CELLS CD4 CD8 RATIO (CD3),302,1 ,$411.70 ,$271.72 ,$46.04 ,$411.70 ,$48.54 ,$164.43 ,$164.43 ,$46.98 ,$247.02 ,$349.95 ,$288.19 ,$48.54 ,$48.54 ,$391.12 ,$312.89 ,$308.78 ,$79.87 ,$349.95 ,$46.98 ,$79.87 ,$79.87 ,$288.19 ,$250.73 ,$48.54 ,$46.98 ,$46.04 ,$93.96 ,$51.45 ,$349.95 ,$105.71 ,$378.76 ,$288.19 ,$234.83 ,$234.83 ,$250.73 ,$234.83 ,$284.48 ,$370.53 ,$281.27 ,$46.50 ,$325.24 ,$51.45 ,$56.38 ,$56.38 ,$46.04 ,$56.38 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,30200187,86361,HC T CELLS CD4 COUNT,302,1 ,$225.40 ,$148.76 ,$26.24 ,$225.40 ,$27.67 ,$93.73 ,$93.73 ,$26.78 ,$135.24 ,$191.59 ,$157.78 ,$27.67 ,$27.67 ,$214.13 ,$171.30 ,$169.05 ,$45.53 ,$191.59 ,$26.78 ,$45.53 ,$45.53 ,$157.78 ,$137.27 ,$27.67 ,$26.78 ,$26.24 ,$53.56 ,$29.33 ,$191.59 ,$60.26 ,$207.37 ,$157.78 ,$133.83 ,$133.83 ,$137.27 ,$133.83 ,$155.75 ,$202.86 ,$153.99 ,$26.51 ,$178.07 ,$29.33 ,$32.14 ,$32.14 ,$26.24 ,$32.14 ,$162.29 ,$139.75 ,$162.29 ,$162.29 ,$180.32 
ST NICHOLAS HOSPITAL - ACUTE,30200188,86376,HC MICROSOMAL AB (TPO),302,1 ,$128.80 ,$85.01 ,$14.26 ,$128.80 ,$15.03 ,$50.93 ,$50.93 ,$14.55 ,$77.28 ,$109.48 ,$90.16 ,$15.03 ,$15.03 ,$122.36 ,$97.89 ,$96.60 ,$24.74 ,$109.48 ,$14.55 ,$24.74 ,$24.74 ,$90.16 ,$78.44 ,$15.03 ,$14.55 ,$14.26 ,$29.10 ,$15.93 ,$109.48 ,$32.74 ,$118.50 ,$90.16 ,$72.72 ,$72.72 ,$78.44 ,$72.72 ,$89.00 ,$115.92 ,$88.00 ,$14.41 ,$101.75 ,$15.93 ,$17.46 ,$17.46 ,$14.26 ,$17.46 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200189,86376,HC MICROSOMAL AB,302,1 ,$128.80 ,$85.01 ,$14.26 ,$128.80 ,$15.03 ,$50.93 ,$50.93 ,$14.55 ,$77.28 ,$109.48 ,$90.16 ,$15.03 ,$15.03 ,$122.36 ,$97.89 ,$96.60 ,$24.74 ,$109.48 ,$14.55 ,$24.74 ,$24.74 ,$90.16 ,$78.44 ,$15.03 ,$14.55 ,$14.26 ,$29.10 ,$15.93 ,$109.48 ,$32.74 ,$118.50 ,$90.16 ,$72.72 ,$72.72 ,$78.44 ,$72.72 ,$89.00 ,$115.92 ,$88.00 ,$14.41 ,$101.75 ,$15.93 ,$17.46 ,$17.46 ,$14.26 ,$17.46 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200190,86376,HC MICROSOMAL AB (LIV/KID),302,1 ,$128.80 ,$85.01 ,$14.26 ,$128.80 ,$15.03 ,$50.93 ,$50.93 ,$14.55 ,$77.28 ,$109.48 ,$90.16 ,$15.03 ,$15.03 ,$122.36 ,$97.89 ,$96.60 ,$24.74 ,$109.48 ,$14.55 ,$24.74 ,$24.74 ,$90.16 ,$78.44 ,$15.03 ,$14.55 ,$14.26 ,$29.10 ,$15.93 ,$109.48 ,$32.74 ,$118.50 ,$90.16 ,$72.72 ,$72.72 ,$78.44 ,$72.72 ,$89.00 ,$115.92 ,$88.00 ,$14.41 ,$101.75 ,$15.93 ,$17.46 ,$17.46 ,$14.26 ,$17.46 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200191,86403,HC PARTICLE AGG SCREEN,302,1 ,$118.45 ,$78.18 ,$11.31 ,$118.45 ,$11.92 ,$40.39 ,$40.39 ,$11.54 ,$71.07 ,$100.68 ,$82.92 ,$11.92 ,$11.92 ,$112.53 ,$90.02 ,$88.84 ,$19.62 ,$100.68 ,$11.54 ,$19.62 ,$19.62 ,$82.92 ,$72.14 ,$11.92 ,$11.54 ,$11.31 ,$23.08 ,$12.64 ,$100.68 ,$25.97 ,$108.97 ,$82.92 ,$50.92 ,$50.92 ,$72.14 ,$50.92 ,$81.85 ,$106.61 ,$80.93 ,$11.43 ,$93.58 ,$12.64 ,$13.85 ,$13.85 ,$11.31 ,$13.85 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,30200193,86403,HC STREPTOZYME,302,1 ,$65.55 ,$43.26 ,$11.31 ,$65.55 ,$11.92 ,$40.39 ,$40.39 ,$11.54 ,$39.33 ,$55.72 ,$45.89 ,$11.92 ,$11.92 ,$62.27 ,$49.82 ,$49.16 ,$19.62 ,$55.72 ,$11.54 ,$19.62 ,$19.62 ,$45.89 ,$39.92 ,$11.92 ,$11.54 ,$11.31 ,$23.08 ,$12.64 ,$55.72 ,$25.97 ,$60.31 ,$45.89 ,$50.92 ,$50.92 ,$39.92 ,$50.92 ,$45.30 ,$59.00 ,$44.78 ,$11.43 ,$51.78 ,$12.64 ,$13.85 ,$13.85 ,$11.31 ,$13.85 ,$47.20 ,$40.64 ,$47.20 ,$47.20 ,$52.44 
ST NICHOLAS HOSPITAL - ACUTE,30200194,86403,HC CRYPTOCOCCUS AB,302,1 ,$104.65 ,$69.07 ,$11.31 ,$104.65 ,$11.92 ,$40.39 ,$40.39 ,$11.54 ,$62.79 ,$88.95 ,$73.26 ,$11.92 ,$11.92 ,$99.42 ,$79.53 ,$78.49 ,$19.62 ,$88.95 ,$11.54 ,$19.62 ,$19.62 ,$73.26 ,$63.73 ,$11.92 ,$11.54 ,$11.31 ,$23.08 ,$12.64 ,$88.95 ,$25.97 ,$96.28 ,$73.26 ,$50.92 ,$50.92 ,$63.73 ,$50.92 ,$72.31 ,$94.19 ,$71.50 ,$11.43 ,$82.67 ,$12.64 ,$13.85 ,$13.85 ,$11.31 ,$13.85 ,$75.35 ,$64.88 ,$75.35 ,$75.35 ,$83.72 
ST NICHOLAS HOSPITAL - ACUTE,30200195,86403,HC MAYO CRYPTOCOCCUS AG,302,1 ,$184.00 ,$121.44 ,$11.31 ,$184.00 ,$11.92 ,$40.39 ,$40.39 ,$11.54 ,$110.40 ,$156.40 ,$128.80 ,$11.92 ,$11.92 ,$174.80 ,$139.84 ,$138.00 ,$19.62 ,$156.40 ,$11.54 ,$19.62 ,$19.62 ,$128.80 ,$112.06 ,$11.92 ,$11.54 ,$11.31 ,$23.08 ,$12.64 ,$156.40 ,$25.97 ,$169.28 ,$128.80 ,$50.92 ,$50.92 ,$112.06 ,$50.92 ,$127.14 ,$165.60 ,$125.71 ,$11.43 ,$145.36 ,$12.64 ,$13.85 ,$13.85 ,$11.31 ,$13.85 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,30200196,86406,HC PARTICLE AGGLUT TITER,302,1 ,$92.00 ,$60.72 ,$9.85 ,$92.00 ,$9.85 ,$37.24 ,$37.24 ,$10.64 ,$55.20 ,$78.20 ,$64.40 ,$9.85 ,$9.85 ,$87.40 ,$69.92 ,$69.00 ,$18.09 ,$78.20 ,$10.64 ,$18.09 ,$18.09 ,$64.40 ,$56.03 ,$9.85 ,$10.64 ,$10.43 ,$21.28 ,$10.44 ,$78.20 ,$23.94 ,$84.64 ,$64.40 ,$34.99 ,$34.99 ,$56.03 ,$34.99 ,$63.57 ,$82.80 ,$62.85 ,$10.53 ,$72.68 ,$10.44 ,$12.77 ,$12.77 ,$10.43 ,$12.77 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,30200197,86430,HC RHEUMATOID FACTOR,302,1 ,$54.05 ,$35.67 ,$6.02 ,$54.05 ,$6.34 ,$21.49 ,$21.49 ,$6.14 ,$32.43 ,$45.94 ,$37.84 ,$6.34 ,$6.34 ,$51.35 ,$41.08 ,$40.54 ,$10.44 ,$45.94 ,$6.14 ,$10.44 ,$10.44 ,$37.84 ,$32.92 ,$6.34 ,$6.14 ,$6.02 ,$12.28 ,$6.72 ,$45.94 ,$13.82 ,$49.73 ,$37.84 ,$28.36 ,$28.36 ,$32.92 ,$28.36 ,$37.35 ,$48.65 ,$36.93 ,$6.08 ,$42.70 ,$6.72 ,$7.37 ,$7.37 ,$6.02 ,$7.37 ,$38.92 ,$33.51 ,$38.92 ,$38.92 ,$43.24 
ST NICHOLAS HOSPITAL - ACUTE,30200198,86431,HC RHEUMATOID FACTOR QN,302,1 ,$50.60 ,$33.40 ,$5.56 ,$50.60 ,$5.86 ,$19.85 ,$19.85 ,$5.67 ,$30.36 ,$43.01 ,$35.42 ,$5.86 ,$5.86 ,$48.07 ,$38.46 ,$37.95 ,$9.64 ,$43.01 ,$5.67 ,$9.64 ,$9.64 ,$35.42 ,$30.82 ,$5.86 ,$5.67 ,$5.56 ,$11.34 ,$6.21 ,$43.01 ,$12.76 ,$46.55 ,$35.42 ,$28.36 ,$28.36 ,$30.82 ,$28.36 ,$34.96 ,$45.54 ,$34.57 ,$5.62 ,$39.97 ,$6.21 ,$6.80 ,$6.80 ,$5.56 ,$6.80 ,$36.43 ,$31.37 ,$36.43 ,$36.43 ,$40.48 
ST NICHOLAS HOSPITAL - ACUTE,30200199,86480,HC TB QUANTIFERON GOLD,302,1 ,$540.50 ,$356.73 ,$60.74 ,$540.50 ,$64.04 ,$216.93 ,$216.93 ,$61.98 ,$324.30 ,$459.43 ,$378.35 ,$64.04 ,$64.04 ,$513.48 ,$410.78 ,$405.38 ,$105.37 ,$459.43 ,$61.98 ,$105.37 ,$105.37 ,$378.35 ,$329.16 ,$64.04 ,$61.98 ,$60.74 ,$123.96 ,$67.88 ,$459.43 ,$139.46 ,$497.26 ,$378.35 ,$309.79 ,$309.79 ,$329.16 ,$309.79 ,$373.49 ,$486.45 ,$369.27 ,$61.35 ,$427.00 ,$67.88 ,$74.38 ,$74.38 ,$60.74 ,$74.38 ,$389.16 ,$335.11 ,$389.16 ,$389.16 ,$432.40 
ST NICHOLAS HOSPITAL - ACUTE,30200200,86580,HC SKIN TEST TB INTRADERMAL,302,1 ,$77.05 ,$50.85 ,$0.34 ,$77.05 ,$0.34 ,$34.59 ,$34.59 ,$24.36 ,$46.23 ,$65.49 ,$53.94 ,$0.34 ,$0.34 ,$73.20 ,$58.56 ,$57.79 ,$16.05 ,$65.49 ,$24.36 ,$16.05 ,$16.05 ,$53.94 ,$46.92 ,$0.34 ,$24.36 ,$23.87 ,$48.72 ,$0.36 ,$65.49 ,$54.81 ,$70.89 ,$53.94 ,$39.08 ,$46.90 ,$46.92 ,$46.90 ,$53.24 ,$69.35 ,$52.64 ,$24.11 ,$60.87 ,$0.36 ,$27.59 ,$27.59 ,$23.87 ,$27.59 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30200201,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$36.80 ,$24.29 ,$4.18 ,$36.80 ,$4.41 ,$14.95 ,$14.95 ,$4.27 ,$22.08 ,$31.28 ,$25.76 ,$4.41 ,$4.41 ,$34.96 ,$27.97 ,$27.60 ,$7.26 ,$31.28 ,$4.27 ,$7.26 ,$7.26 ,$25.76 ,$22.41 ,$4.41 ,$4.27 ,$4.18 ,$8.54 ,$4.67 ,$31.28 ,$9.61 ,$33.86 ,$25.76 ,$21.32 ,$21.32 ,$22.41 ,$21.32 ,$25.43 ,$33.12 ,$25.14 ,$4.22 ,$29.07 ,$4.67 ,$5.12 ,$5.12 ,$4.18 ,$5.12 ,$26.50 ,$22.82 ,$26.50 ,$26.50 ,$29.44 
ST NICHOLAS HOSPITAL - ACUTE,30200203,86592,HC SYPHILIS VDRL RPR QL (CSF),302,1 ,$74.75 ,$49.34 ,$4.18 ,$74.75 ,$4.41 ,$14.95 ,$14.95 ,$4.27 ,$44.85 ,$63.54 ,$52.33 ,$4.41 ,$4.41 ,$71.01 ,$56.81 ,$56.06 ,$7.26 ,$63.54 ,$4.27 ,$7.26 ,$7.26 ,$52.33 ,$45.52 ,$4.41 ,$4.27 ,$4.18 ,$8.54 ,$4.67 ,$63.54 ,$9.61 ,$68.77 ,$52.33 ,$21.32 ,$21.32 ,$45.52 ,$21.32 ,$51.65 ,$67.28 ,$51.07 ,$4.22 ,$59.05 ,$4.67 ,$5.12 ,$5.12 ,$4.18 ,$5.12 ,$53.82 ,$46.35 ,$53.82 ,$53.82 ,$59.80 
ST NICHOLAS HOSPITAL - ACUTE,30200205,86602,HC ACTINOMYCES AB,302,1 ,$118.45 ,$78.18 ,$8.17 ,$118.45 ,$8.17 ,$35.63 ,$35.63 ,$10.18 ,$71.07 ,$100.68 ,$82.92 ,$8.17 ,$8.17 ,$112.53 ,$90.02 ,$88.84 ,$17.31 ,$100.68 ,$10.18 ,$17.31 ,$17.31 ,$82.92 ,$72.14 ,$8.17 ,$10.18 ,$9.98 ,$20.36 ,$8.66 ,$100.68 ,$22.91 ,$108.97 ,$82.92 ,$29.05 ,$29.05 ,$72.14 ,$29.05 ,$81.85 ,$106.61 ,$80.93 ,$10.07 ,$93.58 ,$8.66 ,$12.22 ,$12.22 ,$9.98 ,$12.22 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,30200206,86603,HC ADENOVIRUS AB,302,1 ,$67.85 ,$44.78 ,$8.17 ,$67.85 ,$8.17 ,$45.05 ,$45.05 ,$12.87 ,$40.71 ,$57.67 ,$47.50 ,$8.17 ,$8.17 ,$64.46 ,$51.57 ,$50.89 ,$21.88 ,$57.67 ,$12.87 ,$21.88 ,$21.88 ,$47.50 ,$41.32 ,$8.17 ,$12.87 ,$12.61 ,$25.74 ,$8.66 ,$57.67 ,$28.96 ,$62.42 ,$47.50 ,$29.05 ,$29.05 ,$41.32 ,$29.05 ,$46.88 ,$61.07 ,$46.36 ,$12.74 ,$53.60 ,$8.66 ,$15.44 ,$15.44 ,$12.61 ,$15.44 ,$48.85 ,$42.07 ,$48.85 ,$48.85 ,$54.28 
ST NICHOLAS HOSPITAL - ACUTE,30200207,86606,HC ASPERGILLUS AB,302,1 ,$78.20 ,$51.61 ,$8.17 ,$78.20 ,$8.17 ,$52.68 ,$52.68 ,$15.05 ,$46.92 ,$66.47 ,$54.74 ,$8.17 ,$8.17 ,$74.29 ,$59.43 ,$58.65 ,$25.59 ,$66.47 ,$15.05 ,$25.59 ,$25.59 ,$54.74 ,$47.62 ,$8.17 ,$15.05 ,$14.75 ,$30.10 ,$8.66 ,$66.47 ,$33.86 ,$71.94 ,$54.74 ,$29.05 ,$29.05 ,$47.62 ,$29.05 ,$54.04 ,$70.38 ,$53.43 ,$14.90 ,$61.78 ,$8.66 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$56.30 ,$48.48 ,$56.30 ,$56.30 ,$62.56 
ST NICHOLAS HOSPITAL - ACUTE,30200208,86606,HC ASPERGILLUS AB (ASPER),302,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$52.68 ,$52.68 ,$15.05 ,$38.64 ,$54.74 ,$45.08 ,$8.17 ,$8.17 ,$61.18 ,$48.94 ,$48.30 ,$25.59 ,$54.74 ,$15.05 ,$25.59 ,$25.59 ,$45.08 ,$39.22 ,$8.17 ,$15.05 ,$14.75 ,$30.10 ,$8.66 ,$54.74 ,$33.86 ,$59.25 ,$45.08 ,$29.05 ,$29.05 ,$39.22 ,$29.05 ,$44.50 ,$57.96 ,$44.00 ,$14.90 ,$50.88 ,$8.66 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30200209,86606,HC ASPERGILLUS AB (FLAV/FUM/NIGER),302,1 ,$13.80 ,$9.11 ,$8.17 ,$31.05 ,$8.17 ,$13.80 ,$13.80 ,$13.80 ,$8.28 ,$11.73 ,$9.66 ,$8.17 ,$8.17 ,$13.11 ,$10.49 ,$10.35 ,$13.80 ,$11.73 ,$13.80 ,$13.80 ,$13.80 ,$9.66 ,$8.40 ,$8.17 ,$13.80 ,$13.52 ,$13.80 ,$8.66 ,$11.73 ,$31.05 ,$12.70 ,$9.66 ,$13.80 ,$13.80 ,$8.40 ,$13.80 ,$9.54 ,$12.42 ,$9.43 ,$13.66 ,$10.90 ,$8.66 ,$13.80 ,$13.80 ,$13.52 ,$13.80 ,$9.94 ,$8.56 ,$9.94 ,$9.94 ,$11.04 
ST NICHOLAS HOSPITAL - ACUTE,30200210,86606,HC ASPERGILLIS AB (HS PNEUMO),302,1 ,$34.50 ,$22.77 ,$8.17 ,$34.50 ,$8.17 ,$34.50 ,$34.50 ,$15.05 ,$20.70 ,$29.33 ,$24.15 ,$8.17 ,$8.17 ,$32.78 ,$26.22 ,$25.88 ,$25.59 ,$29.33 ,$15.05 ,$25.59 ,$25.59 ,$24.15 ,$21.01 ,$8.17 ,$15.05 ,$14.75 ,$30.10 ,$8.66 ,$29.33 ,$33.86 ,$31.74 ,$24.15 ,$29.05 ,$29.05 ,$21.01 ,$29.05 ,$23.84 ,$31.05 ,$23.57 ,$14.90 ,$27.26 ,$8.66 ,$18.06 ,$18.06 ,$14.75 ,$18.06 ,$24.84 ,$21.39 ,$24.84 ,$24.84 ,$27.60 
ST NICHOLAS HOSPITAL - ACUTE,30200211,86609,HC BACTERIUM AB NOS,302,1 ,$40.25 ,$26.57 ,$8.17 ,$40.25 ,$8.17 ,$40.25 ,$40.25 ,$12.88 ,$24.15 ,$34.21 ,$28.18 ,$8.17 ,$8.17 ,$38.24 ,$30.59 ,$30.19 ,$21.90 ,$34.21 ,$12.88 ,$21.90 ,$21.90 ,$28.18 ,$24.51 ,$8.17 ,$12.88 ,$12.62 ,$25.76 ,$8.66 ,$34.21 ,$28.98 ,$37.03 ,$28.18 ,$29.05 ,$29.05 ,$24.51 ,$29.05 ,$27.81 ,$36.23 ,$27.50 ,$12.75 ,$31.80 ,$8.66 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$28.98 ,$24.96 ,$28.98 ,$28.98 ,$32.20 
ST NICHOLAS HOSPITAL - ACUTE,30200212,86611,HC BARTONELLA SCREEN AB,302,1 ,$65.55 ,$43.26 ,$8.17 ,$65.55 ,$8.17 ,$35.63 ,$35.63 ,$10.18 ,$39.33 ,$55.72 ,$45.89 ,$8.17 ,$8.17 ,$62.27 ,$49.82 ,$49.16 ,$17.31 ,$55.72 ,$10.18 ,$17.31 ,$17.31 ,$45.89 ,$39.92 ,$8.17 ,$10.18 ,$9.98 ,$20.36 ,$8.66 ,$55.72 ,$22.91 ,$60.31 ,$45.89 ,$29.05 ,$29.05 ,$39.92 ,$29.05 ,$45.30 ,$59.00 ,$44.78 ,$10.07 ,$51.78 ,$8.66 ,$12.22 ,$12.22 ,$9.98 ,$12.22 ,$47.20 ,$40.64 ,$47.20 ,$47.20 ,$52.44 
ST NICHOLAS HOSPITAL - ACUTE,30200213,86612,HC BLASTOMYCES AB,302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$45.15 ,$45.15 ,$12.90 ,$53.82 ,$76.25 ,$62.79 ,$8.17 ,$8.17 ,$85.22 ,$68.17 ,$67.28 ,$21.93 ,$76.25 ,$12.90 ,$21.93 ,$21.93 ,$62.79 ,$54.63 ,$8.17 ,$12.90 ,$12.64 ,$25.80 ,$8.66 ,$76.25 ,$29.03 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$12.77 ,$70.86 ,$8.66 ,$15.48 ,$15.48 ,$12.64 ,$15.48 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200214,86612,HC BLASTOMYCES AB (CF/ID),302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$45.15 ,$45.15 ,$12.90 ,$53.82 ,$76.25 ,$62.79 ,$8.17 ,$8.17 ,$85.22 ,$68.17 ,$67.28 ,$21.93 ,$76.25 ,$12.90 ,$21.93 ,$21.93 ,$62.79 ,$54.63 ,$8.17 ,$12.90 ,$12.64 ,$25.80 ,$8.66 ,$76.25 ,$29.03 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$12.77 ,$70.86 ,$8.66 ,$15.48 ,$15.48 ,$12.64 ,$15.48 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200215,86612,HC BLASTO AB ID,302,1 ,$13.80 ,$9.11 ,$8.17 ,$29.03 ,$8.17 ,$13.80 ,$13.80 ,$12.90 ,$8.28 ,$11.73 ,$9.66 ,$8.17 ,$8.17 ,$13.11 ,$10.49 ,$10.35 ,$13.80 ,$11.73 ,$12.90 ,$13.80 ,$13.80 ,$9.66 ,$8.40 ,$8.17 ,$12.90 ,$12.64 ,$13.80 ,$8.66 ,$11.73 ,$29.03 ,$12.70 ,$9.66 ,$13.80 ,$13.80 ,$8.40 ,$13.80 ,$9.54 ,$12.42 ,$9.43 ,$12.77 ,$10.90 ,$8.66 ,$13.80 ,$13.80 ,$12.64 ,$13.80 ,$9.94 ,$8.56 ,$9.94 ,$9.94 ,$11.04 
ST NICHOLAS HOSPITAL - ACUTE,30200216,86612,HC BLASTOMYCES AB (MAYO),302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$45.15 ,$45.15 ,$12.90 ,$53.82 ,$76.25 ,$62.79 ,$8.17 ,$8.17 ,$85.22 ,$68.17 ,$67.28 ,$21.93 ,$76.25 ,$12.90 ,$21.93 ,$21.93 ,$62.79 ,$54.63 ,$8.17 ,$12.90 ,$12.64 ,$25.80 ,$8.66 ,$76.25 ,$29.03 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$12.77 ,$70.86 ,$8.66 ,$15.48 ,$15.48 ,$12.64 ,$15.48 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200217,86617,HC LYME DISEASE AB CONFIRM (IGG),302,1 ,$141.45 ,$93.36 ,$15.18 ,$141.45 ,$16.01 ,$54.22 ,$54.22 ,$15.49 ,$84.87 ,$120.23 ,$99.02 ,$16.01 ,$16.01 ,$134.38 ,$107.50 ,$106.09 ,$26.33 ,$120.23 ,$15.49 ,$26.33 ,$26.33 ,$99.02 ,$86.14 ,$16.01 ,$15.49 ,$15.18 ,$30.98 ,$16.97 ,$120.23 ,$34.85 ,$130.13 ,$99.02 ,$77.41 ,$77.41 ,$86.14 ,$77.41 ,$97.74 ,$127.31 ,$96.64 ,$15.33 ,$111.75 ,$16.97 ,$18.59 ,$18.59 ,$15.18 ,$18.59 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30200218,86617,HC LYME DISEASE AB CONFIRM (IGM),302,1 ,$141.45 ,$93.36 ,$15.18 ,$141.45 ,$16.01 ,$54.22 ,$54.22 ,$15.49 ,$84.87 ,$120.23 ,$99.02 ,$16.01 ,$16.01 ,$134.38 ,$107.50 ,$106.09 ,$26.33 ,$120.23 ,$15.49 ,$26.33 ,$26.33 ,$99.02 ,$86.14 ,$16.01 ,$15.49 ,$15.18 ,$30.98 ,$16.97 ,$120.23 ,$34.85 ,$130.13 ,$99.02 ,$77.41 ,$77.41 ,$86.14 ,$77.41 ,$97.74 ,$127.31 ,$96.64 ,$15.33 ,$111.75 ,$16.97 ,$18.59 ,$18.59 ,$15.18 ,$18.59 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30200219,86618,HC LYME AB,302,1 ,$154.10 ,$101.71 ,$16.69 ,$154.10 ,$17.60 ,$59.61 ,$59.61 ,$17.03 ,$92.46 ,$130.99 ,$107.87 ,$17.60 ,$17.60 ,$146.40 ,$117.12 ,$115.58 ,$28.95 ,$130.99 ,$17.03 ,$28.95 ,$28.95 ,$107.87 ,$93.85 ,$17.60 ,$17.03 ,$16.69 ,$34.06 ,$18.66 ,$130.99 ,$38.32 ,$141.77 ,$107.87 ,$85.14 ,$85.14 ,$93.85 ,$85.14 ,$106.48 ,$138.69 ,$105.28 ,$16.86 ,$121.74 ,$18.66 ,$20.44 ,$20.44 ,$16.69 ,$20.44 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30200220,86622,HC BRUCELLA AB (IGG/IGM),302,1 ,$77.05 ,$50.85 ,$8.17 ,$77.05 ,$8.17 ,$31.26 ,$31.26 ,$8.93 ,$46.23 ,$65.49 ,$53.94 ,$8.17 ,$8.17 ,$73.20 ,$58.56 ,$57.79 ,$15.18 ,$65.49 ,$8.93 ,$15.18 ,$15.18 ,$53.94 ,$46.92 ,$8.17 ,$8.93 ,$8.75 ,$17.86 ,$8.66 ,$65.49 ,$20.09 ,$70.89 ,$53.94 ,$29.05 ,$29.05 ,$46.92 ,$29.05 ,$53.24 ,$69.35 ,$52.64 ,$8.84 ,$60.87 ,$8.66 ,$10.72 ,$10.72 ,$8.75 ,$10.72 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30200221,86622,HC BRUCELLA AB,302,1 ,$69.00 ,$45.54 ,$8.17 ,$69.00 ,$8.17 ,$31.26 ,$31.26 ,$8.93 ,$41.40 ,$58.65 ,$48.30 ,$8.17 ,$8.17 ,$65.55 ,$52.44 ,$51.75 ,$15.18 ,$58.65 ,$8.93 ,$15.18 ,$15.18 ,$48.30 ,$42.02 ,$8.17 ,$8.93 ,$8.75 ,$17.86 ,$8.66 ,$58.65 ,$20.09 ,$63.48 ,$48.30 ,$29.05 ,$29.05 ,$42.02 ,$29.05 ,$47.68 ,$62.10 ,$47.14 ,$8.84 ,$54.51 ,$8.66 ,$10.72 ,$10.72 ,$8.75 ,$10.72 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30200222,86628,HC CANDIDA AB,302,1 ,$71.30 ,$47.06 ,$8.17 ,$71.30 ,$8.17 ,$42.04 ,$42.04 ,$12.01 ,$42.78 ,$60.61 ,$49.91 ,$8.17 ,$8.17 ,$67.74 ,$54.19 ,$53.48 ,$20.42 ,$60.61 ,$12.01 ,$20.42 ,$20.42 ,$49.91 ,$43.42 ,$8.17 ,$12.01 ,$11.77 ,$24.02 ,$8.66 ,$60.61 ,$27.02 ,$65.60 ,$49.91 ,$29.05 ,$29.05 ,$43.42 ,$29.05 ,$49.27 ,$64.17 ,$48.71 ,$11.89 ,$56.33 ,$8.66 ,$14.41 ,$14.41 ,$11.77 ,$14.41 ,$51.34 ,$44.21 ,$51.34 ,$51.34 ,$57.04 
ST NICHOLAS HOSPITAL - ACUTE,30200223,86631,HC CHLAMYDIA AB,302,1 ,$69.00 ,$45.54 ,$8.17 ,$69.00 ,$8.17 ,$41.37 ,$41.37 ,$11.82 ,$41.40 ,$58.65 ,$48.30 ,$8.17 ,$8.17 ,$65.55 ,$52.44 ,$51.75 ,$20.09 ,$58.65 ,$11.82 ,$20.09 ,$20.09 ,$48.30 ,$42.02 ,$8.17 ,$11.82 ,$11.58 ,$23.64 ,$8.66 ,$58.65 ,$26.60 ,$63.48 ,$48.30 ,$29.05 ,$29.05 ,$42.02 ,$29.05 ,$47.68 ,$62.10 ,$47.14 ,$11.70 ,$54.51 ,$8.66 ,$14.18 ,$14.18 ,$11.58 ,$14.18 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30200224,86631,HC CHLAMYDIA AB IGG,302,1 ,$55.20 ,$36.43 ,$8.17 ,$55.20 ,$8.17 ,$41.37 ,$41.37 ,$11.82 ,$33.12 ,$46.92 ,$38.64 ,$8.17 ,$8.17 ,$52.44 ,$41.95 ,$41.40 ,$20.09 ,$46.92 ,$11.82 ,$20.09 ,$20.09 ,$38.64 ,$33.62 ,$8.17 ,$11.82 ,$11.58 ,$23.64 ,$8.66 ,$46.92 ,$26.60 ,$50.78 ,$38.64 ,$29.05 ,$29.05 ,$33.62 ,$29.05 ,$38.14 ,$49.68 ,$37.71 ,$11.70 ,$43.61 ,$8.66 ,$14.18 ,$14.18 ,$11.58 ,$14.18 ,$39.74 ,$34.22 ,$39.74 ,$39.74 ,$44.16 
ST NICHOLAS HOSPITAL - ACUTE,30200225,86631,HC CHLAMYDIA AB (GRP AB),302,1 ,$167.90 ,$110.81 ,$8.17 ,$167.90 ,$8.17 ,$41.37 ,$41.37 ,$11.82 ,$100.74 ,$142.72 ,$117.53 ,$8.17 ,$8.17 ,$159.51 ,$127.60 ,$125.93 ,$20.09 ,$142.72 ,$11.82 ,$20.09 ,$20.09 ,$117.53 ,$102.25 ,$8.17 ,$11.82 ,$11.58 ,$23.64 ,$8.66 ,$142.72 ,$26.60 ,$154.47 ,$117.53 ,$29.05 ,$29.05 ,$102.25 ,$29.05 ,$116.02 ,$151.11 ,$114.71 ,$11.70 ,$132.64 ,$8.66 ,$14.18 ,$14.18 ,$11.58 ,$14.18 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30200226,86631,HC CHLAMYDIA AB (PSITT IGG/IGA),302,1 ,$19.55 ,$12.90 ,$8.17 ,$26.60 ,$8.17 ,$19.55 ,$19.55 ,$11.82 ,$11.73 ,$16.62 ,$13.69 ,$8.17 ,$8.17 ,$18.57 ,$14.86 ,$14.66 ,$19.55 ,$16.62 ,$11.82 ,$19.55 ,$19.55 ,$13.69 ,$11.91 ,$8.17 ,$11.82 ,$11.58 ,$19.55 ,$8.66 ,$16.62 ,$26.60 ,$17.99 ,$13.69 ,$19.55 ,$19.55 ,$11.91 ,$19.55 ,$13.51 ,$17.60 ,$13.36 ,$11.70 ,$15.44 ,$8.66 ,$14.18 ,$14.18 ,$11.58 ,$14.18 ,$14.08 ,$12.12 ,$14.08 ,$14.08 ,$15.64 
ST NICHOLAS HOSPITAL - ACUTE,30200227,86631,HC CHLAMYDIA AB IGG 2,302,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$41.37 ,$41.37 ,$11.82 ,$38.64 ,$54.74 ,$45.08 ,$8.17 ,$8.17 ,$61.18 ,$48.94 ,$48.30 ,$20.09 ,$54.74 ,$11.82 ,$20.09 ,$20.09 ,$45.08 ,$39.22 ,$8.17 ,$11.82 ,$11.58 ,$23.64 ,$8.66 ,$54.74 ,$26.60 ,$59.25 ,$45.08 ,$29.05 ,$29.05 ,$39.22 ,$29.05 ,$44.50 ,$57.96 ,$44.00 ,$11.70 ,$50.88 ,$8.66 ,$14.18 ,$14.18 ,$11.58 ,$14.18 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30200228,86632,HC CHLAMYDIA AB IGM SEROLOGY,302,1 ,$69.00 ,$45.54 ,$8.17 ,$69.00 ,$8.17 ,$44.38 ,$44.38 ,$12.68 ,$41.40 ,$58.65 ,$48.30 ,$8.17 ,$8.17 ,$65.55 ,$52.44 ,$51.75 ,$21.56 ,$58.65 ,$12.68 ,$21.56 ,$21.56 ,$48.30 ,$42.02 ,$8.17 ,$12.68 ,$12.43 ,$25.36 ,$8.66 ,$58.65 ,$28.53 ,$63.48 ,$48.30 ,$29.05 ,$29.05 ,$42.02 ,$29.05 ,$47.68 ,$62.10 ,$47.14 ,$12.55 ,$54.51 ,$8.66 ,$15.22 ,$15.22 ,$12.43 ,$15.22 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30200229,86632,HC CHLAMYDIA AB IGM PSITTACI,302,1 ,$19.55 ,$12.90 ,$8.17 ,$28.53 ,$8.17 ,$19.55 ,$19.55 ,$12.68 ,$11.73 ,$16.62 ,$13.69 ,$8.17 ,$8.17 ,$18.57 ,$14.86 ,$14.66 ,$19.55 ,$16.62 ,$12.68 ,$19.55 ,$19.55 ,$13.69 ,$11.91 ,$8.17 ,$12.68 ,$12.43 ,$19.55 ,$8.66 ,$16.62 ,$28.53 ,$17.99 ,$13.69 ,$19.55 ,$19.55 ,$11.91 ,$19.55 ,$13.51 ,$17.60 ,$13.36 ,$12.55 ,$15.44 ,$8.66 ,$15.22 ,$15.22 ,$12.43 ,$15.22 ,$14.08 ,$12.12 ,$14.08 ,$14.08 ,$15.64 
ST NICHOLAS HOSPITAL - ACUTE,30200230,86632,HC CHLAMYDIA AB IGM,302,1 ,$63.25 ,$41.75 ,$8.17 ,$63.25 ,$8.17 ,$44.38 ,$44.38 ,$12.68 ,$37.95 ,$53.76 ,$44.28 ,$8.17 ,$8.17 ,$60.09 ,$48.07 ,$47.44 ,$21.56 ,$53.76 ,$12.68 ,$21.56 ,$21.56 ,$44.28 ,$38.52 ,$8.17 ,$12.68 ,$12.43 ,$25.36 ,$8.66 ,$53.76 ,$28.53 ,$58.19 ,$44.28 ,$29.05 ,$29.05 ,$38.52 ,$29.05 ,$43.71 ,$56.93 ,$43.21 ,$12.55 ,$49.97 ,$8.66 ,$15.22 ,$15.22 ,$12.43 ,$15.22 ,$45.54 ,$39.22 ,$45.54 ,$45.54 ,$50.60 
ST NICHOLAS HOSPITAL - ACUTE,30200231,86635,HC COCCIDIOIDES AB,302,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$40.15 ,$40.15 ,$11.47 ,$38.64 ,$54.74 ,$45.08 ,$8.17 ,$8.17 ,$61.18 ,$48.94 ,$48.30 ,$19.50 ,$54.74 ,$11.47 ,$19.50 ,$19.50 ,$45.08 ,$39.22 ,$8.17 ,$11.47 ,$11.24 ,$22.94 ,$8.66 ,$54.74 ,$25.81 ,$59.25 ,$45.08 ,$29.05 ,$29.05 ,$39.22 ,$29.05 ,$44.50 ,$57.96 ,$44.00 ,$11.35 ,$50.88 ,$8.66 ,$13.76 ,$13.76 ,$11.24 ,$13.76 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30200232,86635,HC COCCID AB,302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$40.15 ,$40.15 ,$11.47 ,$53.82 ,$76.25 ,$62.79 ,$8.17 ,$8.17 ,$85.22 ,$68.17 ,$67.28 ,$19.50 ,$76.25 ,$11.47 ,$19.50 ,$19.50 ,$62.79 ,$54.63 ,$8.17 ,$11.47 ,$11.24 ,$22.94 ,$8.66 ,$76.25 ,$25.81 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$11.35 ,$70.86 ,$8.66 ,$13.76 ,$13.76 ,$11.24 ,$13.76 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200233,86638,HC Q FEVER AB IGG,302,1 ,$82.80 ,$54.65 ,$8.17 ,$82.80 ,$8.17 ,$42.42 ,$42.42 ,$12.12 ,$49.68 ,$70.38 ,$57.96 ,$8.17 ,$8.17 ,$78.66 ,$62.93 ,$62.10 ,$20.60 ,$70.38 ,$12.12 ,$20.60 ,$20.60 ,$57.96 ,$50.43 ,$8.17 ,$12.12 ,$11.88 ,$24.24 ,$8.66 ,$70.38 ,$27.27 ,$76.18 ,$57.96 ,$29.05 ,$29.05 ,$50.43 ,$29.05 ,$57.21 ,$74.52 ,$56.57 ,$12.00 ,$65.41 ,$8.66 ,$14.54 ,$14.54 ,$11.88 ,$14.54 ,$59.62 ,$51.34 ,$59.62 ,$59.62 ,$66.24 
ST NICHOLAS HOSPITAL - ACUTE,30200234,86638,HC Q FEVER AB IGM,302,1 ,$82.80 ,$54.65 ,$8.17 ,$82.80 ,$8.17 ,$42.42 ,$42.42 ,$12.12 ,$49.68 ,$70.38 ,$57.96 ,$8.17 ,$8.17 ,$78.66 ,$62.93 ,$62.10 ,$20.60 ,$70.38 ,$12.12 ,$20.60 ,$20.60 ,$57.96 ,$50.43 ,$8.17 ,$12.12 ,$11.88 ,$24.24 ,$8.66 ,$70.38 ,$27.27 ,$76.18 ,$57.96 ,$29.05 ,$29.05 ,$50.43 ,$29.05 ,$57.21 ,$74.52 ,$56.57 ,$12.00 ,$65.41 ,$8.66 ,$14.54 ,$14.54 ,$11.88 ,$14.54 ,$59.62 ,$51.34 ,$59.62 ,$59.62 ,$66.24 
ST NICHOLAS HOSPITAL - ACUTE,30200235,86645,HC CMV AB IGM,302,1 ,$116.15 ,$76.66 ,$8.17 ,$116.15 ,$8.17 ,$58.98 ,$58.98 ,$16.85 ,$69.69 ,$98.73 ,$81.31 ,$8.17 ,$8.17 ,$110.34 ,$88.27 ,$87.11 ,$28.65 ,$98.73 ,$16.85 ,$28.65 ,$28.65 ,$81.31 ,$70.74 ,$8.17 ,$16.85 ,$16.51 ,$33.70 ,$8.66 ,$98.73 ,$37.91 ,$106.86 ,$81.31 ,$29.05 ,$29.05 ,$70.74 ,$29.05 ,$80.26 ,$104.54 ,$79.35 ,$16.68 ,$91.76 ,$8.66 ,$20.22 ,$20.22 ,$16.51 ,$20.22 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200236,86651,HC ENCEPHALITIS CALIFORNIA AB,302,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$46.17 ,$46.17 ,$13.19 ,$38.64 ,$54.74 ,$45.08 ,$8.17 ,$8.17 ,$61.18 ,$48.94 ,$48.30 ,$22.42 ,$54.74 ,$13.19 ,$22.42 ,$22.42 ,$45.08 ,$39.22 ,$8.17 ,$13.19 ,$12.93 ,$26.38 ,$8.66 ,$54.74 ,$29.68 ,$59.25 ,$45.08 ,$29.05 ,$29.05 ,$39.22 ,$29.05 ,$44.50 ,$57.96 ,$44.00 ,$13.05 ,$50.88 ,$8.66 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30200237,86652,HC ENCEPHALITIS EQUINE AB,302,1 ,$78.20 ,$51.61 ,$8.17 ,$78.20 ,$8.17 ,$46.17 ,$46.17 ,$13.19 ,$46.92 ,$66.47 ,$54.74 ,$8.17 ,$8.17 ,$74.29 ,$59.43 ,$58.65 ,$22.42 ,$66.47 ,$13.19 ,$22.42 ,$22.42 ,$54.74 ,$47.62 ,$8.17 ,$13.19 ,$12.93 ,$26.38 ,$8.66 ,$66.47 ,$29.68 ,$71.94 ,$54.74 ,$29.05 ,$29.05 ,$47.62 ,$29.05 ,$54.04 ,$70.38 ,$53.43 ,$13.05 ,$61.78 ,$8.66 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$56.30 ,$48.48 ,$56.30 ,$56.30 ,$62.56 
ST NICHOLAS HOSPITAL - ACUTE,30200238,86653,HC ENCEPHALITIS ST LOUIS AB,302,1 ,$79.35 ,$52.37 ,$8.17 ,$79.35 ,$8.17 ,$46.17 ,$46.17 ,$13.19 ,$47.61 ,$67.45 ,$55.55 ,$8.17 ,$8.17 ,$75.38 ,$60.31 ,$59.51 ,$22.42 ,$67.45 ,$13.19 ,$22.42 ,$22.42 ,$55.55 ,$48.32 ,$8.17 ,$13.19 ,$12.93 ,$26.38 ,$8.66 ,$67.45 ,$29.68 ,$73.00 ,$55.55 ,$29.05 ,$29.05 ,$48.32 ,$29.05 ,$54.83 ,$71.42 ,$54.21 ,$13.05 ,$62.69 ,$8.66 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$57.13 ,$49.20 ,$57.13 ,$57.13 ,$63.48 
ST NICHOLAS HOSPITAL - ACUTE,30200239,86654,HC ENCEPHALITIS WEST EQUINE AB,302,1 ,$78.20 ,$51.61 ,$8.17 ,$78.20 ,$8.17 ,$46.17 ,$46.17 ,$13.19 ,$46.92 ,$66.47 ,$54.74 ,$8.17 ,$8.17 ,$74.29 ,$59.43 ,$58.65 ,$22.42 ,$66.47 ,$13.19 ,$22.42 ,$22.42 ,$54.74 ,$47.62 ,$8.17 ,$13.19 ,$12.93 ,$26.38 ,$8.66 ,$66.47 ,$29.68 ,$71.94 ,$54.74 ,$29.05 ,$29.05 ,$47.62 ,$29.05 ,$54.04 ,$70.38 ,$53.43 ,$13.05 ,$61.78 ,$8.66 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$56.30 ,$48.48 ,$56.30 ,$56.30 ,$62.56 
ST NICHOLAS HOSPITAL - ACUTE,30200240,86658,HC ENTEROVIRUS A COXSACKIE,302,1 ,$77.05 ,$50.85 ,$8.17 ,$77.05 ,$8.17 ,$45.61 ,$45.61 ,$13.03 ,$46.23 ,$65.49 ,$53.94 ,$8.17 ,$8.17 ,$73.20 ,$58.56 ,$57.79 ,$22.15 ,$65.49 ,$13.03 ,$22.15 ,$22.15 ,$53.94 ,$46.92 ,$8.17 ,$13.03 ,$12.77 ,$26.06 ,$8.66 ,$65.49 ,$29.32 ,$70.89 ,$53.94 ,$29.05 ,$29.05 ,$46.92 ,$29.05 ,$53.24 ,$69.35 ,$52.64 ,$12.90 ,$60.87 ,$8.66 ,$15.64 ,$15.64 ,$12.77 ,$15.64 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30200241,86658,HC ENTEROVIRUS (POLIO TYP 1),302,1 ,$167.90 ,$110.81 ,$8.17 ,$167.90 ,$8.17 ,$45.61 ,$45.61 ,$13.03 ,$100.74 ,$142.72 ,$117.53 ,$8.17 ,$8.17 ,$159.51 ,$127.60 ,$125.93 ,$22.15 ,$142.72 ,$13.03 ,$22.15 ,$22.15 ,$117.53 ,$102.25 ,$8.17 ,$13.03 ,$12.77 ,$26.06 ,$8.66 ,$142.72 ,$29.32 ,$154.47 ,$117.53 ,$29.05 ,$29.05 ,$102.25 ,$29.05 ,$116.02 ,$151.11 ,$114.71 ,$12.90 ,$132.64 ,$8.66 ,$15.64 ,$15.64 ,$12.77 ,$15.64 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30200242,86658,HC ENTEROVIRUS (POLIO TYP 2),302,1 ,$54.05 ,$35.67 ,$8.17 ,$54.05 ,$8.17 ,$45.61 ,$45.61 ,$13.03 ,$32.43 ,$45.94 ,$37.84 ,$8.17 ,$8.17 ,$51.35 ,$41.08 ,$40.54 ,$22.15 ,$45.94 ,$13.03 ,$22.15 ,$22.15 ,$37.84 ,$32.92 ,$8.17 ,$13.03 ,$12.77 ,$26.06 ,$8.66 ,$45.94 ,$29.32 ,$49.73 ,$37.84 ,$29.05 ,$29.05 ,$32.92 ,$29.05 ,$37.35 ,$48.65 ,$36.93 ,$12.90 ,$42.70 ,$8.66 ,$15.64 ,$15.64 ,$12.77 ,$15.64 ,$38.92 ,$33.51 ,$38.92 ,$38.92 ,$43.24 
ST NICHOLAS HOSPITAL - ACUTE,30200243,86658,HC ENTEROVIRUS (POLIO TYP 3),302,1 ,$54.05 ,$35.67 ,$8.17 ,$54.05 ,$8.17 ,$45.61 ,$45.61 ,$13.03 ,$32.43 ,$45.94 ,$37.84 ,$8.17 ,$8.17 ,$51.35 ,$41.08 ,$40.54 ,$22.15 ,$45.94 ,$13.03 ,$22.15 ,$22.15 ,$37.84 ,$32.92 ,$8.17 ,$13.03 ,$12.77 ,$26.06 ,$8.66 ,$45.94 ,$29.32 ,$49.73 ,$37.84 ,$29.05 ,$29.05 ,$32.92 ,$29.05 ,$37.35 ,$48.65 ,$36.93 ,$12.90 ,$42.70 ,$8.66 ,$15.64 ,$15.64 ,$12.77 ,$15.64 ,$38.92 ,$33.51 ,$38.92 ,$38.92 ,$43.24 
ST NICHOLAS HOSPITAL - ACUTE,30200244,86663,HC EBV EARLY AG,302,1 ,$116.15 ,$76.66 ,$12.86 ,$116.15 ,$13.56 ,$45.92 ,$45.92 ,$13.12 ,$69.69 ,$98.73 ,$81.31 ,$13.56 ,$13.56 ,$110.34 ,$88.27 ,$87.11 ,$22.30 ,$98.73 ,$13.12 ,$22.30 ,$22.30 ,$81.31 ,$70.74 ,$13.56 ,$13.12 ,$12.86 ,$26.24 ,$14.37 ,$98.73 ,$29.52 ,$106.86 ,$81.31 ,$65.58 ,$65.58 ,$70.74 ,$65.58 ,$80.26 ,$104.54 ,$79.35 ,$12.98 ,$91.76 ,$14.37 ,$15.74 ,$15.74 ,$12.86 ,$15.74 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200245,86664,HC EBV NUCLEAR AG,302,1 ,$128.80 ,$85.01 ,$14.98 ,$128.80 ,$15.80 ,$53.52 ,$53.52 ,$15.29 ,$77.28 ,$109.48 ,$90.16 ,$15.80 ,$15.80 ,$122.36 ,$97.89 ,$96.60 ,$25.99 ,$109.48 ,$15.29 ,$25.99 ,$25.99 ,$90.16 ,$78.44 ,$15.80 ,$15.29 ,$14.98 ,$30.58 ,$16.75 ,$109.48 ,$34.40 ,$118.50 ,$90.16 ,$76.46 ,$76.46 ,$78.44 ,$76.46 ,$89.00 ,$115.92 ,$88.00 ,$15.13 ,$101.75 ,$16.75 ,$18.35 ,$18.35 ,$14.98 ,$18.35 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200246,86665,HC EBV VIRAL CAP,302,1 ,$154.10 ,$101.71 ,$17.78 ,$154.10 ,$18.74 ,$63.49 ,$63.49 ,$18.14 ,$92.46 ,$130.99 ,$107.87 ,$18.74 ,$18.74 ,$146.40 ,$117.12 ,$115.58 ,$30.84 ,$130.99 ,$18.14 ,$30.84 ,$30.84 ,$107.87 ,$93.85 ,$18.74 ,$18.14 ,$17.78 ,$36.28 ,$19.86 ,$130.99 ,$40.82 ,$141.77 ,$107.87 ,$90.67 ,$90.67 ,$93.85 ,$90.67 ,$106.48 ,$138.69 ,$105.28 ,$17.95 ,$121.74 ,$19.86 ,$21.77 ,$21.77 ,$17.78 ,$21.77 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30200247,86666,HC EHRICHIA AB,302,1 ,$44.85 ,$29.60 ,$8.17 ,$44.85 ,$8.17 ,$35.63 ,$35.63 ,$10.18 ,$26.91 ,$38.12 ,$31.40 ,$8.17 ,$8.17 ,$42.61 ,$34.09 ,$33.64 ,$17.31 ,$38.12 ,$10.18 ,$17.31 ,$17.31 ,$31.40 ,$27.31 ,$8.17 ,$10.18 ,$9.98 ,$20.36 ,$8.66 ,$38.12 ,$22.91 ,$41.26 ,$31.40 ,$29.05 ,$29.05 ,$27.31 ,$29.05 ,$30.99 ,$40.37 ,$30.64 ,$10.07 ,$35.43 ,$8.66 ,$12.22 ,$12.22 ,$9.98 ,$12.22 ,$32.29 ,$27.81 ,$32.29 ,$32.29 ,$35.88 
ST NICHOLAS HOSPITAL - ACUTE,30200248,86666,HC EHRICHIA AB (ANAPLASMA),302,1 ,$57.50 ,$37.95 ,$8.17 ,$57.50 ,$8.17 ,$35.63 ,$35.63 ,$10.18 ,$34.50 ,$48.88 ,$40.25 ,$8.17 ,$8.17 ,$54.63 ,$43.70 ,$43.13 ,$17.31 ,$48.88 ,$10.18 ,$17.31 ,$17.31 ,$40.25 ,$35.02 ,$8.17 ,$10.18 ,$9.98 ,$20.36 ,$8.66 ,$48.88 ,$22.91 ,$52.90 ,$40.25 ,$29.05 ,$29.05 ,$35.02 ,$29.05 ,$39.73 ,$51.75 ,$39.28 ,$10.07 ,$45.43 ,$8.66 ,$12.22 ,$12.22 ,$9.98 ,$12.22 ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,30200249,86668,HC FRANCISELLA AB,302,1 ,$77.05 ,$50.85 ,$13.88 ,$77.05 ,$14.63 ,$49.56 ,$49.56 ,$14.16 ,$46.23 ,$65.49 ,$53.94 ,$14.63 ,$14.63 ,$73.20 ,$58.56 ,$57.79 ,$24.07 ,$65.49 ,$14.16 ,$24.07 ,$24.07 ,$53.94 ,$46.92 ,$14.63 ,$14.16 ,$13.88 ,$28.32 ,$15.51 ,$65.49 ,$31.86 ,$70.89 ,$53.94 ,$51.99 ,$51.99 ,$46.92 ,$51.99 ,$53.24 ,$69.35 ,$52.64 ,$14.01 ,$60.87 ,$15.51 ,$16.99 ,$16.99 ,$13.88 ,$16.99 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30200250,86671,HC FUNGUS AB NOS,302,1 ,$59.80 ,$39.47 ,$7.15 ,$59.80 ,$7.15 ,$42.88 ,$42.88 ,$12.25 ,$35.88 ,$50.83 ,$41.86 ,$7.15 ,$7.15 ,$56.81 ,$45.45 ,$44.85 ,$20.83 ,$50.83 ,$12.25 ,$20.83 ,$20.83 ,$41.86 ,$36.42 ,$7.15 ,$12.25 ,$12.00 ,$24.50 ,$7.58 ,$50.83 ,$27.56 ,$55.02 ,$41.86 ,$25.42 ,$25.42 ,$36.42 ,$25.42 ,$41.32 ,$53.82 ,$40.86 ,$12.12 ,$47.24 ,$7.58 ,$14.70 ,$14.70 ,$12.00 ,$14.70 ,$43.06 ,$37.08 ,$43.06 ,$43.06 ,$47.84 
ST NICHOLAS HOSPITAL - ACUTE,30200251,86677,HC H PYLORI AB,302,1 ,$103.50 ,$68.31 ,$8.17 ,$103.50 ,$8.17 ,$58.98 ,$58.98 ,$16.85 ,$62.10 ,$87.98 ,$72.45 ,$8.17 ,$8.17 ,$98.33 ,$78.66 ,$77.63 ,$28.65 ,$87.98 ,$16.85 ,$28.65 ,$28.65 ,$72.45 ,$63.03 ,$8.17 ,$16.85 ,$16.51 ,$33.70 ,$8.66 ,$87.98 ,$37.91 ,$95.22 ,$72.45 ,$29.05 ,$29.05 ,$63.03 ,$29.05 ,$71.52 ,$93.15 ,$70.71 ,$16.68 ,$81.77 ,$8.66 ,$20.22 ,$20.22 ,$16.51 ,$20.22 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200252,86684,HC HAEMOPHILUS INFLUENZA AB,302,1 ,$180.55 ,$119.16 ,$15.52 ,$180.55 ,$16.37 ,$55.44 ,$55.44 ,$15.84 ,$108.33 ,$153.47 ,$126.39 ,$16.37 ,$16.37 ,$171.52 ,$137.22 ,$135.41 ,$26.93 ,$153.47 ,$15.84 ,$26.93 ,$26.93 ,$126.39 ,$109.96 ,$16.37 ,$15.84 ,$15.52 ,$31.68 ,$17.35 ,$153.47 ,$35.64 ,$166.11 ,$126.39 ,$79.17 ,$79.17 ,$109.96 ,$79.17 ,$124.76 ,$162.50 ,$123.35 ,$15.68 ,$142.63 ,$17.35 ,$19.01 ,$19.01 ,$15.52 ,$19.01 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30200253,86689,HC HIV WESTERN BLOT,302,1 ,$405.95 ,$267.93 ,$18.96 ,$405.95 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$243.57 ,$345.06 ,$284.17 ,$19.99 ,$19.99 ,$385.65 ,$308.52 ,$304.46 ,$32.90 ,$345.06 ,$19.35 ,$32.90 ,$32.90 ,$284.17 ,$247.22 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$345.06 ,$43.54 ,$373.47 ,$284.17 ,$96.72 ,$96.72 ,$247.22 ,$96.72 ,$280.51 ,$365.36 ,$277.35 ,$19.15 ,$320.70 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$292.28 ,$251.69 ,$292.28 ,$292.28 ,$324.76 
ST NICHOLAS HOSPITAL - ACUTE,30200254,86689,HC HIV REF WB,302,1 ,$79.35 ,$52.37 ,$18.96 ,$79.35 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$47.61 ,$67.45 ,$55.55 ,$19.99 ,$19.99 ,$75.38 ,$60.31 ,$59.51 ,$32.90 ,$67.45 ,$19.35 ,$32.90 ,$32.90 ,$55.55 ,$48.32 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$67.45 ,$43.54 ,$73.00 ,$55.55 ,$79.35 ,$79.35 ,$48.32 ,$79.35 ,$54.83 ,$71.42 ,$54.21 ,$19.15 ,$62.69 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$57.13 ,$49.20 ,$57.13 ,$57.13 ,$63.48 
ST NICHOLAS HOSPITAL - ACUTE,30200255,86689,HC HTLV AB WESTERN BLOT,302,1 ,$147.20 ,$97.15 ,$18.96 ,$147.20 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$88.32 ,$125.12 ,$103.04 ,$19.99 ,$19.99 ,$139.84 ,$111.87 ,$110.40 ,$32.90 ,$125.12 ,$19.35 ,$32.90 ,$32.90 ,$103.04 ,$89.64 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$125.12 ,$43.54 ,$135.42 ,$103.04 ,$96.72 ,$96.72 ,$89.64 ,$96.72 ,$101.72 ,$132.48 ,$100.57 ,$19.15 ,$116.29 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$105.98 ,$91.26 ,$105.98 ,$105.98 ,$117.76 
ST NICHOLAS HOSPITAL - ACUTE,30200256,86689,HC HIV1 WESTERN BLOT,302,1 ,$162.15 ,$107.02 ,$18.96 ,$162.15 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$97.29 ,$137.83 ,$113.51 ,$19.99 ,$19.99 ,$154.04 ,$123.23 ,$121.61 ,$32.90 ,$137.83 ,$19.35 ,$32.90 ,$32.90 ,$113.51 ,$98.75 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$137.83 ,$43.54 ,$149.18 ,$113.51 ,$96.72 ,$96.72 ,$98.75 ,$96.72 ,$112.05 ,$145.94 ,$110.78 ,$19.15 ,$128.10 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,30200257,86689,HC HIV2 WESTERN BLOT,302,1 ,$162.15 ,$107.02 ,$18.96 ,$162.15 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$97.29 ,$137.83 ,$113.51 ,$19.99 ,$19.99 ,$154.04 ,$123.23 ,$121.61 ,$32.90 ,$137.83 ,$19.35 ,$32.90 ,$32.90 ,$113.51 ,$98.75 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$137.83 ,$43.54 ,$149.18 ,$113.51 ,$96.72 ,$96.72 ,$98.75 ,$96.72 ,$112.05 ,$145.94 ,$110.78 ,$19.15 ,$128.10 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,30200258,86692,HC HEPATITIS D AB,302,1 ,$151.80 ,$100.19 ,$16.82 ,$151.80 ,$17.73 ,$60.06 ,$60.06 ,$17.16 ,$91.08 ,$129.03 ,$106.26 ,$17.73 ,$17.73 ,$144.21 ,$115.37 ,$113.85 ,$29.17 ,$129.03 ,$17.16 ,$29.17 ,$29.17 ,$106.26 ,$92.45 ,$17.73 ,$17.16 ,$16.82 ,$34.32 ,$18.79 ,$129.03 ,$38.61 ,$139.66 ,$106.26 ,$85.76 ,$85.76 ,$92.45 ,$85.76 ,$104.89 ,$136.62 ,$103.71 ,$16.98 ,$119.92 ,$18.79 ,$20.59 ,$20.59 ,$16.82 ,$20.59 ,$109.30 ,$94.12 ,$109.30 ,$109.30 ,$121.44 
ST NICHOLAS HOSPITAL - ACUTE,30200259,86694,HC HERPES SIMPLEX AB,302,1 ,$127.65 ,$84.25 ,$14.10 ,$127.65 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$76.59 ,$108.50 ,$89.36 ,$14.87 ,$14.87 ,$121.27 ,$97.01 ,$95.74 ,$24.46 ,$108.50 ,$14.39 ,$24.46 ,$24.46 ,$89.36 ,$77.74 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$108.50 ,$32.38 ,$117.44 ,$89.36 ,$71.95 ,$71.95 ,$77.74 ,$71.95 ,$88.21 ,$114.89 ,$87.21 ,$14.24 ,$100.84 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$91.91 ,$79.14 ,$91.91 ,$91.91 ,$102.12 
ST NICHOLAS HOSPITAL - ACUTE,30200260,86694,HC HERPES SIMPLEX AB (IGG),302,1 ,$127.65 ,$84.25 ,$14.10 ,$127.65 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$76.59 ,$108.50 ,$89.36 ,$14.87 ,$14.87 ,$121.27 ,$97.01 ,$95.74 ,$24.46 ,$108.50 ,$14.39 ,$24.46 ,$24.46 ,$89.36 ,$77.74 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$108.50 ,$32.38 ,$117.44 ,$89.36 ,$71.95 ,$71.95 ,$77.74 ,$71.95 ,$88.21 ,$114.89 ,$87.21 ,$14.24 ,$100.84 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$91.91 ,$79.14 ,$91.91 ,$91.91 ,$102.12 
ST NICHOLAS HOSPITAL - ACUTE,30200261,86695,HC HERPES SIMPLEX AB I,302,1 ,$116.15 ,$76.66 ,$12.93 ,$116.15 ,$13.63 ,$46.17 ,$46.17 ,$13.19 ,$69.69 ,$98.73 ,$81.31 ,$13.63 ,$13.63 ,$110.34 ,$88.27 ,$87.11 ,$22.42 ,$98.73 ,$13.19 ,$22.42 ,$22.42 ,$81.31 ,$70.74 ,$13.63 ,$13.19 ,$12.93 ,$26.38 ,$14.45 ,$98.73 ,$29.68 ,$106.86 ,$81.31 ,$65.94 ,$65.94 ,$70.74 ,$65.94 ,$80.26 ,$104.54 ,$79.35 ,$13.05 ,$91.76 ,$14.45 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200262,86695,HC HERPES SIMPLEX IGG I,302,1 ,$110.40 ,$72.86 ,$12.93 ,$110.40 ,$13.63 ,$46.17 ,$46.17 ,$13.19 ,$66.24 ,$93.84 ,$77.28 ,$13.63 ,$13.63 ,$104.88 ,$83.90 ,$82.80 ,$22.42 ,$93.84 ,$13.19 ,$22.42 ,$22.42 ,$77.28 ,$67.23 ,$13.63 ,$13.19 ,$12.93 ,$26.38 ,$14.45 ,$93.84 ,$29.68 ,$101.57 ,$77.28 ,$65.94 ,$65.94 ,$67.23 ,$65.94 ,$76.29 ,$99.36 ,$75.43 ,$13.05 ,$87.22 ,$14.45 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$79.49 ,$68.45 ,$79.49 ,$79.49 ,$88.32 
ST NICHOLAS HOSPITAL - ACUTE,30200263,86696,HC HERPES SIMPLEX AB II,302,1 ,$167.90 ,$110.81 ,$18.96 ,$167.90 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$100.74 ,$142.72 ,$117.53 ,$19.99 ,$19.99 ,$159.51 ,$127.60 ,$125.93 ,$32.90 ,$142.72 ,$19.35 ,$32.90 ,$32.90 ,$117.53 ,$102.25 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$142.72 ,$43.54 ,$154.47 ,$117.53 ,$96.72 ,$96.72 ,$102.25 ,$96.72 ,$116.02 ,$151.11 ,$114.71 ,$19.15 ,$132.64 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30200264,86696,HC HERPES SIMPLEX IGG II,302,1 ,$167.90 ,$110.81 ,$18.96 ,$167.90 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$100.74 ,$142.72 ,$117.53 ,$19.99 ,$19.99 ,$159.51 ,$127.60 ,$125.93 ,$32.90 ,$142.72 ,$19.35 ,$32.90 ,$32.90 ,$117.53 ,$102.25 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$142.72 ,$43.54 ,$154.47 ,$117.53 ,$96.72 ,$96.72 ,$102.25 ,$96.72 ,$116.02 ,$151.11 ,$114.71 ,$19.15 ,$132.64 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30200265,86698,HC HISTOPLASMA AB,302,1 ,$89.70 ,$59.20 ,$13.51 ,$89.70 ,$14.25 ,$48.27 ,$48.27 ,$13.79 ,$53.82 ,$76.25 ,$62.79 ,$14.25 ,$14.25 ,$85.22 ,$68.17 ,$67.28 ,$23.44 ,$76.25 ,$13.79 ,$23.44 ,$23.44 ,$62.79 ,$54.63 ,$14.25 ,$13.79 ,$13.51 ,$27.58 ,$15.11 ,$76.25 ,$31.03 ,$82.52 ,$62.79 ,$56.09 ,$56.09 ,$54.63 ,$56.09 ,$61.98 ,$80.73 ,$61.28 ,$13.65 ,$70.86 ,$15.11 ,$16.55 ,$16.55 ,$13.51 ,$16.55 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200266,86698,HC HISTOPLASMA AB (MAYO SCR),302,1 ,$89.70 ,$59.20 ,$13.51 ,$89.70 ,$14.25 ,$48.27 ,$48.27 ,$13.79 ,$53.82 ,$76.25 ,$62.79 ,$14.25 ,$14.25 ,$85.22 ,$68.17 ,$67.28 ,$23.44 ,$76.25 ,$13.79 ,$23.44 ,$23.44 ,$62.79 ,$54.63 ,$14.25 ,$13.79 ,$13.51 ,$27.58 ,$15.11 ,$76.25 ,$31.03 ,$82.52 ,$62.79 ,$56.09 ,$56.09 ,$54.63 ,$56.09 ,$61.98 ,$80.73 ,$61.28 ,$13.65 ,$70.86 ,$15.11 ,$16.55 ,$16.55 ,$13.51 ,$16.55 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200267,86698,HC HISTOPLASMA AB (MAYO),302,1 ,$193.20 ,$127.51 ,$13.51 ,$193.20 ,$14.25 ,$48.27 ,$48.27 ,$13.79 ,$115.92 ,$164.22 ,$135.24 ,$14.25 ,$14.25 ,$183.54 ,$146.83 ,$144.90 ,$23.44 ,$164.22 ,$13.79 ,$23.44 ,$23.44 ,$135.24 ,$117.66 ,$14.25 ,$13.79 ,$13.51 ,$27.58 ,$15.11 ,$164.22 ,$31.03 ,$177.74 ,$135.24 ,$56.09 ,$56.09 ,$117.66 ,$56.09 ,$133.50 ,$173.88 ,$131.99 ,$13.65 ,$152.63 ,$15.11 ,$16.55 ,$16.55 ,$13.51 ,$16.55 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30200268,86698,HC HISTOPLASMA AB (MYC),302,1 ,$13.80 ,$9.11 ,$8.28 ,$31.03 ,$13.80 ,$13.80 ,$13.80 ,$13.79 ,$8.28 ,$11.73 ,$9.66 ,$13.80 ,$13.80 ,$13.11 ,$10.49 ,$10.35 ,$13.80 ,$11.73 ,$13.79 ,$13.80 ,$13.80 ,$9.66 ,$8.40 ,$13.80 ,$13.79 ,$13.51 ,$13.80 ,$14.63 ,$11.73 ,$31.03 ,$12.70 ,$9.66 ,$13.80 ,$13.80 ,$8.40 ,$13.80 ,$9.54 ,$12.42 ,$9.43 ,$13.65 ,$10.90 ,$14.63 ,$13.80 ,$13.80 ,$13.51 ,$13.80 ,$9.94 ,$8.56 ,$9.94 ,$9.94 ,$11.04 
ST NICHOLAS HOSPITAL - ACUTE,30200269,86698,HC HISTOPLASMA AB (YEAST),302,1 ,$13.80 ,$9.11 ,$8.28 ,$31.03 ,$13.80 ,$13.80 ,$13.80 ,$13.79 ,$8.28 ,$11.73 ,$9.66 ,$13.80 ,$13.80 ,$13.11 ,$10.49 ,$10.35 ,$13.80 ,$11.73 ,$13.79 ,$13.80 ,$13.80 ,$9.66 ,$8.40 ,$13.80 ,$13.79 ,$13.51 ,$13.80 ,$14.63 ,$11.73 ,$31.03 ,$12.70 ,$9.66 ,$13.80 ,$13.80 ,$8.40 ,$13.80 ,$9.54 ,$12.42 ,$9.43 ,$13.65 ,$10.90 ,$14.63 ,$13.80 ,$13.80 ,$13.51 ,$13.80 ,$9.94 ,$8.56 ,$9.94 ,$9.94 ,$11.04 
ST NICHOLAS HOSPITAL - ACUTE,30200270,86703,HC HIV 1 HIV 2 AB SGL ASSAY,302,1 ,$116.15 ,$76.66 ,$13.44 ,$116.15 ,$14.17 ,$47.99 ,$47.99 ,$13.71 ,$69.69 ,$98.73 ,$81.31 ,$14.17 ,$14.17 ,$110.34 ,$88.27 ,$87.11 ,$23.31 ,$98.73 ,$13.71 ,$23.31 ,$23.31 ,$81.31 ,$70.74 ,$14.17 ,$13.71 ,$13.44 ,$27.42 ,$15.02 ,$98.73 ,$30.85 ,$106.86 ,$81.31 ,$68.51 ,$68.51 ,$70.74 ,$68.51 ,$80.26 ,$104.54 ,$79.35 ,$13.57 ,$91.76 ,$15.02 ,$16.45 ,$16.45 ,$13.44 ,$16.45 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200271,86704,HC HEP CORE AB,302,1 ,$103.50 ,$68.31 ,$11.81 ,$103.50 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$62.10 ,$87.98 ,$72.45 ,$12.45 ,$12.45 ,$98.33 ,$78.66 ,$77.63 ,$20.49 ,$87.98 ,$12.05 ,$20.49 ,$20.49 ,$72.45 ,$63.03 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$87.98 ,$27.11 ,$95.22 ,$72.45 ,$60.23 ,$60.23 ,$63.03 ,$60.23 ,$71.52 ,$93.15 ,$70.71 ,$11.93 ,$81.77 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200272,86704,HC HEP CORE AB (ATB),302,1 ,$124.20 ,$81.97 ,$11.81 ,$124.20 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$74.52 ,$105.57 ,$86.94 ,$12.45 ,$12.45 ,$117.99 ,$94.39 ,$93.15 ,$20.49 ,$105.57 ,$12.05 ,$20.49 ,$20.49 ,$86.94 ,$75.64 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$105.57 ,$27.11 ,$114.26 ,$86.94 ,$60.23 ,$60.23 ,$75.64 ,$60.23 ,$85.82 ,$111.78 ,$84.85 ,$11.93 ,$98.12 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,30200273,86706,HC HEP B SURFACE AB,302,1 ,$89.70 ,$59.20 ,$10.53 ,$89.70 ,$11.10 ,$37.59 ,$37.59 ,$10.74 ,$53.82 ,$76.25 ,$62.79 ,$11.10 ,$11.10 ,$85.22 ,$68.17 ,$67.28 ,$18.26 ,$76.25 ,$10.74 ,$18.26 ,$18.26 ,$62.79 ,$54.63 ,$11.10 ,$10.74 ,$10.53 ,$21.48 ,$11.77 ,$76.25 ,$24.17 ,$82.52 ,$62.79 ,$53.67 ,$53.67 ,$54.63 ,$53.67 ,$61.98 ,$80.73 ,$61.28 ,$10.63 ,$70.86 ,$11.77 ,$12.89 ,$12.89 ,$10.53 ,$12.89 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200274,86706,HC HEP B SURFACE AB (ATB),302,1 ,$67.85 ,$44.78 ,$10.53 ,$67.85 ,$11.10 ,$37.59 ,$37.59 ,$10.74 ,$40.71 ,$57.67 ,$47.50 ,$11.10 ,$11.10 ,$64.46 ,$51.57 ,$50.89 ,$18.26 ,$57.67 ,$10.74 ,$18.26 ,$18.26 ,$47.50 ,$41.32 ,$11.10 ,$10.74 ,$10.53 ,$21.48 ,$11.77 ,$57.67 ,$24.17 ,$62.42 ,$47.50 ,$53.67 ,$53.67 ,$41.32 ,$53.67 ,$46.88 ,$61.07 ,$46.36 ,$10.63 ,$53.60 ,$11.77 ,$12.89 ,$12.89 ,$10.53 ,$12.89 ,$48.85 ,$42.07 ,$48.85 ,$48.85 ,$54.28 
ST NICHOLAS HOSPITAL - ACUTE,30200275,86707,HC HEP B E AB,302,1 ,$77.05 ,$50.85 ,$11.34 ,$77.05 ,$11.96 ,$40.50 ,$40.50 ,$11.57 ,$46.23 ,$65.49 ,$53.94 ,$11.96 ,$11.96 ,$73.20 ,$58.56 ,$57.79 ,$19.67 ,$65.49 ,$11.57 ,$19.67 ,$19.67 ,$53.94 ,$46.92 ,$11.96 ,$11.57 ,$11.34 ,$23.14 ,$12.68 ,$65.49 ,$26.03 ,$70.89 ,$53.94 ,$57.81 ,$57.81 ,$46.92 ,$57.81 ,$53.24 ,$69.35 ,$52.64 ,$11.46 ,$60.87 ,$12.68 ,$13.88 ,$13.88 ,$11.34 ,$13.88 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30200276,86708,HC HEP A AB TOTAL,302,1 ,$89.70 ,$59.20 ,$12.14 ,$89.70 ,$12.80 ,$43.37 ,$43.37 ,$12.39 ,$53.82 ,$76.25 ,$62.79 ,$12.80 ,$12.80 ,$85.22 ,$68.17 ,$67.28 ,$21.06 ,$76.25 ,$12.39 ,$21.06 ,$21.06 ,$62.79 ,$54.63 ,$12.80 ,$12.39 ,$12.14 ,$24.78 ,$13.57 ,$76.25 ,$27.88 ,$82.52 ,$62.79 ,$61.91 ,$61.91 ,$54.63 ,$61.91 ,$61.98 ,$80.73 ,$61.28 ,$12.26 ,$70.86 ,$13.57 ,$14.87 ,$14.87 ,$12.14 ,$14.87 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200277,86709,HC HEP A AB IGM,302,1 ,$180.55 ,$119.16 ,$11.03 ,$180.55 ,$11.63 ,$39.41 ,$39.41 ,$11.26 ,$108.33 ,$153.47 ,$126.39 ,$11.63 ,$11.63 ,$171.52 ,$137.22 ,$135.41 ,$19.14 ,$153.47 ,$11.26 ,$19.14 ,$19.14 ,$126.39 ,$109.96 ,$11.63 ,$11.26 ,$11.03 ,$22.52 ,$12.33 ,$153.47 ,$25.34 ,$166.11 ,$126.39 ,$56.27 ,$56.27 ,$109.96 ,$56.27 ,$124.76 ,$162.50 ,$123.35 ,$11.14 ,$142.63 ,$12.33 ,$13.51 ,$13.51 ,$11.03 ,$13.51 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30200279,86713,HC LEGIONELLA AB (PNEUM),302,1 ,$116.15 ,$76.66 ,$14.99 ,$116.15 ,$15.81 ,$53.55 ,$53.55 ,$15.30 ,$69.69 ,$98.73 ,$81.31 ,$15.81 ,$15.81 ,$110.34 ,$88.27 ,$87.11 ,$26.01 ,$98.73 ,$15.30 ,$26.01 ,$26.01 ,$81.31 ,$70.74 ,$15.81 ,$15.30 ,$14.99 ,$30.60 ,$16.76 ,$98.73 ,$34.43 ,$106.86 ,$81.31 ,$76.49 ,$76.49 ,$70.74 ,$76.49 ,$80.26 ,$104.54 ,$79.35 ,$15.14 ,$91.76 ,$16.76 ,$18.36 ,$18.36 ,$14.99 ,$18.36 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200280,86713,HC LEGIONELLA AB (IGM),302,1 ,$116.15 ,$76.66 ,$14.99 ,$116.15 ,$15.81 ,$53.55 ,$53.55 ,$15.30 ,$69.69 ,$98.73 ,$81.31 ,$15.81 ,$15.81 ,$110.34 ,$88.27 ,$87.11 ,$26.01 ,$98.73 ,$15.30 ,$26.01 ,$26.01 ,$81.31 ,$70.74 ,$15.81 ,$15.30 ,$14.99 ,$30.60 ,$16.76 ,$98.73 ,$34.43 ,$106.86 ,$81.31 ,$76.49 ,$76.49 ,$70.74 ,$76.49 ,$80.26 ,$104.54 ,$79.35 ,$15.14 ,$91.76 ,$16.76 ,$18.36 ,$18.36 ,$14.99 ,$18.36 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200281,86720,HC LEPTOSPIRA AB,302,1 ,$113.85 ,$75.14 ,$8.17 ,$113.85 ,$8.17 ,$56.70 ,$56.70 ,$16.20 ,$68.31 ,$96.77 ,$79.70 ,$8.17 ,$8.17 ,$108.16 ,$86.53 ,$85.39 ,$27.54 ,$96.77 ,$16.20 ,$27.54 ,$27.54 ,$79.70 ,$69.33 ,$8.17 ,$16.20 ,$15.88 ,$32.40 ,$8.66 ,$96.77 ,$36.45 ,$104.74 ,$79.70 ,$29.05 ,$29.05 ,$69.33 ,$29.05 ,$78.67 ,$102.47 ,$77.78 ,$16.03 ,$89.94 ,$8.66 ,$19.44 ,$19.44 ,$15.88 ,$19.44 ,$81.97 ,$70.59 ,$81.97 ,$81.97 ,$91.08 
ST NICHOLAS HOSPITAL - ACUTE,30200282,86735,HC MUMPS AB,302,1 ,$141.45 ,$93.36 ,$12.79 ,$141.45 ,$13.48 ,$45.68 ,$45.68 ,$13.05 ,$84.87 ,$120.23 ,$99.02 ,$13.48 ,$13.48 ,$134.38 ,$107.50 ,$106.09 ,$22.19 ,$120.23 ,$13.05 ,$22.19 ,$22.19 ,$99.02 ,$86.14 ,$13.48 ,$13.05 ,$12.79 ,$26.10 ,$14.29 ,$120.23 ,$29.36 ,$130.13 ,$99.02 ,$65.21 ,$65.21 ,$86.14 ,$65.21 ,$97.74 ,$127.31 ,$96.64 ,$12.92 ,$111.75 ,$14.29 ,$15.66 ,$15.66 ,$12.79 ,$15.66 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30200283,86735,HC MUMPS QN,302,1 ,$51.75 ,$34.16 ,$12.79 ,$51.75 ,$13.48 ,$45.68 ,$45.68 ,$13.05 ,$31.05 ,$43.99 ,$36.23 ,$13.48 ,$13.48 ,$49.16 ,$39.33 ,$38.81 ,$22.19 ,$43.99 ,$13.05 ,$22.19 ,$22.19 ,$36.23 ,$31.52 ,$13.48 ,$13.05 ,$12.79 ,$26.10 ,$14.29 ,$43.99 ,$29.36 ,$47.61 ,$36.23 ,$51.75 ,$51.75 ,$31.52 ,$51.75 ,$35.76 ,$46.58 ,$35.36 ,$12.92 ,$40.88 ,$14.29 ,$15.66 ,$15.66 ,$12.79 ,$15.66 ,$37.26 ,$32.09 ,$37.26 ,$37.26 ,$41.40 
ST NICHOLAS HOSPITAL - ACUTE,30200284,86738,HC MYCOPLASMA AB,302,1 ,$89.70 ,$59.20 ,$12.98 ,$89.70 ,$13.68 ,$46.34 ,$46.34 ,$13.24 ,$53.82 ,$76.25 ,$62.79 ,$13.68 ,$13.68 ,$85.22 ,$68.17 ,$67.28 ,$22.51 ,$76.25 ,$13.24 ,$22.51 ,$22.51 ,$62.79 ,$54.63 ,$13.68 ,$13.24 ,$12.98 ,$26.48 ,$14.50 ,$76.25 ,$29.79 ,$82.52 ,$62.79 ,$66.20 ,$66.20 ,$54.63 ,$66.20 ,$61.98 ,$80.73 ,$61.28 ,$13.10 ,$70.86 ,$14.50 ,$15.89 ,$15.89 ,$12.98 ,$15.89 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200285,86744,HC NOCARDIA AB,302,1 ,$47.15 ,$31.12 ,$8.17 ,$47.15 ,$8.17 ,$47.15 ,$47.15 ,$15.99 ,$28.29 ,$40.08 ,$33.01 ,$8.17 ,$8.17 ,$44.79 ,$35.83 ,$35.36 ,$27.18 ,$40.08 ,$15.99 ,$27.18 ,$27.18 ,$33.01 ,$28.71 ,$8.17 ,$15.99 ,$15.67 ,$31.98 ,$8.66 ,$40.08 ,$35.98 ,$43.38 ,$33.01 ,$29.05 ,$29.05 ,$28.71 ,$29.05 ,$32.58 ,$42.44 ,$32.21 ,$15.83 ,$37.25 ,$8.66 ,$19.19 ,$19.19 ,$15.67 ,$19.19 ,$33.95 ,$29.23 ,$33.95 ,$33.95 ,$37.72 
ST NICHOLAS HOSPITAL - ACUTE,30200286,86747,HC PARVOVIRUS AB,302,1 ,$103.50 ,$68.31 ,$14.73 ,$103.50 ,$15.53 ,$52.61 ,$52.61 ,$15.03 ,$62.10 ,$87.98 ,$72.45 ,$15.53 ,$15.53 ,$98.33 ,$78.66 ,$77.63 ,$25.55 ,$87.98 ,$15.03 ,$25.55 ,$25.55 ,$72.45 ,$63.03 ,$15.53 ,$15.03 ,$14.73 ,$30.06 ,$16.46 ,$87.98 ,$33.82 ,$95.22 ,$72.45 ,$75.14 ,$75.14 ,$63.03 ,$75.14 ,$71.52 ,$93.15 ,$70.71 ,$14.88 ,$81.77 ,$16.46 ,$18.04 ,$18.04 ,$14.73 ,$18.04 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200287,86753,HC PROTOZOA AB,302,1 ,$55.20 ,$36.43 ,$8.17 ,$55.20 ,$8.17 ,$43.37 ,$43.37 ,$12.39 ,$33.12 ,$46.92 ,$38.64 ,$8.17 ,$8.17 ,$52.44 ,$41.95 ,$41.40 ,$21.06 ,$46.92 ,$12.39 ,$21.06 ,$21.06 ,$38.64 ,$33.62 ,$8.17 ,$12.39 ,$12.14 ,$24.78 ,$8.66 ,$46.92 ,$27.88 ,$50.78 ,$38.64 ,$29.05 ,$29.05 ,$33.62 ,$29.05 ,$38.14 ,$49.68 ,$37.71 ,$12.26 ,$43.61 ,$8.66 ,$14.87 ,$14.87 ,$12.14 ,$14.87 ,$39.74 ,$34.22 ,$39.74 ,$39.74 ,$44.16 
ST NICHOLAS HOSPITAL - ACUTE,30200288,86762,HC RUBELLA AB,302,1 ,$128.80 ,$85.01 ,$14.10 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$77.28 ,$109.48 ,$90.16 ,$14.87 ,$14.87 ,$122.36 ,$97.89 ,$96.60 ,$24.46 ,$109.48 ,$14.39 ,$24.46 ,$24.46 ,$90.16 ,$78.44 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$109.48 ,$32.38 ,$118.50 ,$90.16 ,$71.95 ,$71.95 ,$78.44 ,$71.95 ,$89.00 ,$115.92 ,$88.00 ,$14.24 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200289,86762,HC RUBELLA AB QN,302,1 ,$128.80 ,$85.01 ,$14.10 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$77.28 ,$109.48 ,$90.16 ,$14.87 ,$14.87 ,$122.36 ,$97.89 ,$96.60 ,$24.46 ,$109.48 ,$14.39 ,$24.46 ,$24.46 ,$90.16 ,$78.44 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$109.48 ,$32.38 ,$118.50 ,$90.16 ,$71.95 ,$71.95 ,$78.44 ,$71.95 ,$89.00 ,$115.92 ,$88.00 ,$14.24 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200290,86762,HC RUBELLA AB IGG/IGM,302,1 ,$133.40 ,$88.04 ,$14.10 ,$133.40 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$80.04 ,$113.39 ,$93.38 ,$14.87 ,$14.87 ,$126.73 ,$101.38 ,$100.05 ,$24.46 ,$113.39 ,$14.39 ,$24.46 ,$24.46 ,$93.38 ,$81.24 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$113.39 ,$32.38 ,$122.73 ,$93.38 ,$71.95 ,$71.95 ,$81.24 ,$71.95 ,$92.18 ,$120.06 ,$91.14 ,$14.24 ,$105.39 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$96.05 ,$82.71 ,$96.05 ,$96.05 ,$106.72 
ST NICHOLAS HOSPITAL - ACUTE,30200291,86765,HC RUBEOLA AB,302,1 ,$116.15 ,$76.66 ,$12.62 ,$116.15 ,$13.31 ,$45.08 ,$45.08 ,$12.88 ,$69.69 ,$98.73 ,$81.31 ,$13.31 ,$13.31 ,$110.34 ,$88.27 ,$87.11 ,$21.90 ,$98.73 ,$12.88 ,$21.90 ,$21.90 ,$81.31 ,$70.74 ,$13.31 ,$12.88 ,$12.62 ,$25.76 ,$14.11 ,$98.73 ,$28.98 ,$106.86 ,$81.31 ,$64.40 ,$64.40 ,$70.74 ,$64.40 ,$80.26 ,$104.54 ,$79.35 ,$12.75 ,$91.76 ,$14.11 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200292,86765,HC RUBEOLA AB QN,302,1 ,$116.15 ,$76.66 ,$12.62 ,$116.15 ,$13.31 ,$45.08 ,$45.08 ,$12.88 ,$69.69 ,$98.73 ,$81.31 ,$13.31 ,$13.31 ,$110.34 ,$88.27 ,$87.11 ,$21.90 ,$98.73 ,$12.88 ,$21.90 ,$21.90 ,$81.31 ,$70.74 ,$13.31 ,$12.88 ,$12.62 ,$25.76 ,$14.11 ,$98.73 ,$28.98 ,$106.86 ,$81.31 ,$64.40 ,$64.40 ,$70.74 ,$64.40 ,$80.26 ,$104.54 ,$79.35 ,$12.75 ,$91.76 ,$14.11 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200293,86765,HC RUBEOLA AB IGM,302,1 ,$163.30 ,$107.78 ,$12.62 ,$163.30 ,$13.31 ,$45.08 ,$45.08 ,$12.88 ,$97.98 ,$138.81 ,$114.31 ,$13.31 ,$13.31 ,$155.14 ,$124.11 ,$122.48 ,$21.90 ,$138.81 ,$12.88 ,$21.90 ,$21.90 ,$114.31 ,$99.45 ,$13.31 ,$12.88 ,$12.62 ,$25.76 ,$14.11 ,$138.81 ,$28.98 ,$150.24 ,$114.31 ,$64.40 ,$64.40 ,$99.45 ,$64.40 ,$112.84 ,$146.97 ,$111.57 ,$12.75 ,$129.01 ,$14.11 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$117.58 ,$101.25 ,$117.58 ,$117.58 ,$130.64 
ST NICHOLAS HOSPITAL - ACUTE,30200294,86768,HC SALMONELLA,302,1 ,$86.25 ,$56.93 ,$11.50 ,$86.25 ,$11.50 ,$46.17 ,$46.17 ,$13.19 ,$51.75 ,$73.31 ,$60.38 ,$11.50 ,$11.50 ,$81.94 ,$65.55 ,$64.69 ,$22.42 ,$73.31 ,$13.19 ,$22.42 ,$22.42 ,$60.38 ,$52.53 ,$11.50 ,$13.19 ,$12.93 ,$26.38 ,$12.19 ,$73.31 ,$29.68 ,$79.35 ,$60.38 ,$40.88 ,$40.88 ,$52.53 ,$40.88 ,$59.60 ,$77.63 ,$58.93 ,$13.05 ,$68.14 ,$12.19 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,30200295,86774,HC TETANUS AB,302,1 ,$128.80 ,$85.01 ,$14.50 ,$128.80 ,$15.29 ,$51.80 ,$51.80 ,$14.80 ,$77.28 ,$109.48 ,$90.16 ,$15.29 ,$15.29 ,$122.36 ,$97.89 ,$96.60 ,$25.16 ,$109.48 ,$14.80 ,$25.16 ,$25.16 ,$90.16 ,$78.44 ,$15.29 ,$14.80 ,$14.50 ,$29.60 ,$16.21 ,$109.48 ,$33.30 ,$118.50 ,$90.16 ,$73.97 ,$73.97 ,$78.44 ,$73.97 ,$89.00 ,$115.92 ,$88.00 ,$14.65 ,$101.75 ,$16.21 ,$17.76 ,$17.76 ,$14.50 ,$17.76 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200296,86777,HC TOXOPLASMA AB,302,1 ,$128.80 ,$85.01 ,$14.10 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$77.28 ,$109.48 ,$90.16 ,$14.87 ,$14.87 ,$122.36 ,$97.89 ,$96.60 ,$24.46 ,$109.48 ,$14.39 ,$24.46 ,$24.46 ,$90.16 ,$78.44 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$109.48 ,$32.38 ,$118.50 ,$90.16 ,$71.95 ,$71.95 ,$78.44 ,$71.95 ,$89.00 ,$115.92 ,$88.00 ,$14.24 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200297,86778,HC TOXOPLASMA AB IGM,302,1 ,$116.15 ,$76.66 ,$14.12 ,$116.15 ,$14.89 ,$50.44 ,$50.44 ,$14.41 ,$69.69 ,$98.73 ,$81.31 ,$14.89 ,$14.89 ,$110.34 ,$88.27 ,$87.11 ,$24.50 ,$98.73 ,$14.41 ,$24.50 ,$24.50 ,$81.31 ,$70.74 ,$14.89 ,$14.41 ,$14.12 ,$28.82 ,$15.78 ,$98.73 ,$32.42 ,$106.86 ,$81.31 ,$63.85 ,$63.85 ,$70.74 ,$63.85 ,$80.26 ,$104.54 ,$79.35 ,$14.26 ,$91.76 ,$15.78 ,$17.29 ,$17.29 ,$14.12 ,$17.29 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200298,86780,HC TREPONEMA P AB CONFIRM,302,1 ,$49.45 ,$32.64 ,$11.13 ,$49.45 ,$11.13 ,$46.34 ,$46.34 ,$13.24 ,$29.67 ,$42.03 ,$34.62 ,$11.13 ,$11.13 ,$46.98 ,$37.58 ,$37.09 ,$22.51 ,$42.03 ,$13.24 ,$22.51 ,$22.51 ,$34.62 ,$30.12 ,$11.13 ,$13.24 ,$12.98 ,$26.48 ,$11.80 ,$42.03 ,$29.79 ,$45.49 ,$34.62 ,$39.57 ,$39.57 ,$30.12 ,$39.57 ,$34.17 ,$44.51 ,$33.78 ,$13.10 ,$39.07 ,$11.80 ,$15.89 ,$15.89 ,$12.98 ,$15.89 ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,30200299,86787,HC VARICELLA ZOSTER ATB,302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$45.08 ,$45.08 ,$12.88 ,$53.82 ,$76.25 ,$62.79 ,$8.17 ,$8.17 ,$85.22 ,$68.17 ,$67.28 ,$21.90 ,$76.25 ,$12.88 ,$21.90 ,$21.90 ,$62.79 ,$54.63 ,$8.17 ,$12.88 ,$12.62 ,$25.76 ,$8.66 ,$76.25 ,$28.98 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$12.75 ,$70.86 ,$8.66 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200300,86787,HC VARICELLA ZOSTER IGM,302,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$45.08 ,$45.08 ,$12.88 ,$38.64 ,$54.74 ,$45.08 ,$8.17 ,$8.17 ,$61.18 ,$48.94 ,$48.30 ,$21.90 ,$54.74 ,$12.88 ,$21.90 ,$21.90 ,$45.08 ,$39.22 ,$8.17 ,$12.88 ,$12.62 ,$25.76 ,$8.66 ,$54.74 ,$28.98 ,$59.25 ,$45.08 ,$29.05 ,$29.05 ,$39.22 ,$29.05 ,$44.50 ,$57.96 ,$44.00 ,$12.75 ,$50.88 ,$8.66 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30200301,86787,HC VARICELLA ZOSTER QN,302,1 ,$51.75 ,$34.16 ,$8.17 ,$51.75 ,$8.17 ,$45.08 ,$45.08 ,$12.88 ,$31.05 ,$43.99 ,$36.23 ,$8.17 ,$8.17 ,$49.16 ,$39.33 ,$38.81 ,$21.90 ,$43.99 ,$12.88 ,$21.90 ,$21.90 ,$36.23 ,$31.52 ,$8.17 ,$12.88 ,$12.62 ,$25.76 ,$8.66 ,$43.99 ,$28.98 ,$47.61 ,$36.23 ,$29.05 ,$29.05 ,$31.52 ,$29.05 ,$35.76 ,$46.58 ,$35.36 ,$12.75 ,$40.88 ,$8.66 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$37.26 ,$32.09 ,$37.26 ,$37.26 ,$41.40 
ST NICHOLAS HOSPITAL - ACUTE,30200302,86787,HC VARICELLA ZOSTER IGG,302,1 ,$57.50 ,$37.95 ,$8.17 ,$57.50 ,$8.17 ,$45.08 ,$45.08 ,$12.88 ,$34.50 ,$48.88 ,$40.25 ,$8.17 ,$8.17 ,$54.63 ,$43.70 ,$43.13 ,$21.90 ,$48.88 ,$12.88 ,$21.90 ,$21.90 ,$40.25 ,$35.02 ,$8.17 ,$12.88 ,$12.62 ,$25.76 ,$8.66 ,$48.88 ,$28.98 ,$52.90 ,$40.25 ,$29.05 ,$29.05 ,$35.02 ,$29.05 ,$39.73 ,$51.75 ,$39.28 ,$12.75 ,$45.43 ,$8.66 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,30200303,86788,HC WEST NILE VIRUS AB IGM,302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$58.98 ,$58.98 ,$16.85 ,$53.82 ,$76.25 ,$62.79 ,$8.17 ,$8.17 ,$85.22 ,$68.17 ,$67.28 ,$28.65 ,$76.25 ,$16.85 ,$28.65 ,$28.65 ,$62.79 ,$54.63 ,$8.17 ,$16.85 ,$16.51 ,$33.70 ,$8.66 ,$76.25 ,$37.91 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$16.68 ,$70.86 ,$8.66 ,$20.22 ,$20.22 ,$16.51 ,$20.22 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200304,86789,HC WEST NILE AB,302,1 ,$103.50 ,$68.31 ,$14.10 ,$103.50 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$62.10 ,$87.98 ,$72.45 ,$14.87 ,$14.87 ,$98.33 ,$78.66 ,$77.63 ,$24.46 ,$87.98 ,$14.39 ,$24.46 ,$24.46 ,$72.45 ,$63.03 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$87.98 ,$32.38 ,$95.22 ,$72.45 ,$71.95 ,$71.95 ,$63.03 ,$71.95 ,$71.52 ,$93.15 ,$70.71 ,$14.24 ,$81.77 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200305,86790,HC HTLV I/II AB,302,1 ,$89.70 ,$59.20 ,$0.34 ,$89.70 ,$0.34 ,$45.08 ,$45.08 ,$12.88 ,$53.82 ,$76.25 ,$62.79 ,$0.34 ,$0.34 ,$85.22 ,$68.17 ,$67.28 ,$21.90 ,$76.25 ,$12.88 ,$21.90 ,$21.90 ,$62.79 ,$54.63 ,$0.34 ,$12.88 ,$12.62 ,$25.76 ,$0.36 ,$76.25 ,$28.98 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$12.75 ,$70.86 ,$0.36 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200306,86790,HC HHV6 IGM/IGG,302,1 ,$89.70 ,$59.20 ,$0.34 ,$89.70 ,$0.34 ,$45.08 ,$45.08 ,$12.88 ,$53.82 ,$76.25 ,$62.79 ,$0.34 ,$0.34 ,$85.22 ,$68.17 ,$67.28 ,$21.90 ,$76.25 ,$12.88 ,$21.90 ,$21.90 ,$62.79 ,$54.63 ,$0.34 ,$12.88 ,$12.62 ,$25.76 ,$0.36 ,$76.25 ,$28.98 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$12.75 ,$70.86 ,$0.36 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200307,86790,HC HERPES VIRUS 7 IGM/IGG,302,1 ,$89.70 ,$59.20 ,$0.34 ,$89.70 ,$0.34 ,$45.08 ,$45.08 ,$12.88 ,$53.82 ,$76.25 ,$62.79 ,$0.34 ,$0.34 ,$85.22 ,$68.17 ,$67.28 ,$21.90 ,$76.25 ,$12.88 ,$21.90 ,$21.90 ,$62.79 ,$54.63 ,$0.34 ,$12.88 ,$12.62 ,$25.76 ,$0.36 ,$76.25 ,$28.98 ,$82.52 ,$62.79 ,$29.05 ,$29.05 ,$54.63 ,$29.05 ,$61.98 ,$80.73 ,$61.28 ,$12.75 ,$70.86 ,$0.36 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200308,86790,HC HERPES VIRUS 8 IGM,302,1 ,$149.50 ,$98.67 ,$0.34 ,$149.50 ,$0.34 ,$45.08 ,$45.08 ,$12.88 ,$89.70 ,$127.08 ,$104.65 ,$0.34 ,$0.34 ,$142.03 ,$113.62 ,$112.13 ,$21.90 ,$127.08 ,$12.88 ,$21.90 ,$21.90 ,$104.65 ,$91.05 ,$0.34 ,$12.88 ,$12.62 ,$25.76 ,$0.36 ,$127.08 ,$28.98 ,$137.54 ,$104.65 ,$29.05 ,$29.05 ,$91.05 ,$29.05 ,$103.30 ,$134.55 ,$102.14 ,$12.75 ,$118.11 ,$0.36 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$107.64 ,$92.69 ,$107.64 ,$107.64 ,$119.60 
ST NICHOLAS HOSPITAL - ACUTE,30200309,86790,HC RABIES AB,302,1 ,$101.20 ,$66.79 ,$0.34 ,$101.20 ,$0.34 ,$45.08 ,$45.08 ,$12.88 ,$60.72 ,$86.02 ,$70.84 ,$0.34 ,$0.34 ,$96.14 ,$76.91 ,$75.90 ,$21.90 ,$86.02 ,$12.88 ,$21.90 ,$21.90 ,$70.84 ,$61.63 ,$0.34 ,$12.88 ,$12.62 ,$25.76 ,$0.36 ,$86.02 ,$28.98 ,$93.10 ,$70.84 ,$29.05 ,$29.05 ,$61.63 ,$29.05 ,$69.93 ,$91.08 ,$69.14 ,$12.75 ,$79.95 ,$0.36 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$72.86 ,$62.74 ,$72.86 ,$72.86 ,$80.96 
ST NICHOLAS HOSPITAL - ACUTE,30200310,86694,HC HSV IGM,302,1 ,$128.80 ,$85.01 ,$14.10 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$77.28 ,$109.48 ,$90.16 ,$14.87 ,$14.87 ,$122.36 ,$97.89 ,$96.60 ,$24.46 ,$109.48 ,$14.39 ,$24.46 ,$24.46 ,$90.16 ,$78.44 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$109.48 ,$32.38 ,$118.50 ,$90.16 ,$71.95 ,$71.95 ,$78.44 ,$71.95 ,$89.00 ,$115.92 ,$88.00 ,$14.24 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200312,86800,HC THYROGLOBULIN AB,302,1 ,$141.45 ,$93.36 ,$15.59 ,$141.45 ,$16.44 ,$55.69 ,$55.69 ,$15.91 ,$84.87 ,$120.23 ,$99.02 ,$16.44 ,$16.44 ,$134.38 ,$107.50 ,$106.09 ,$27.05 ,$120.23 ,$15.91 ,$27.05 ,$27.05 ,$99.02 ,$86.14 ,$16.44 ,$15.91 ,$15.59 ,$31.82 ,$17.43 ,$120.23 ,$35.80 ,$130.13 ,$99.02 ,$79.50 ,$79.50 ,$86.14 ,$79.50 ,$97.74 ,$127.31 ,$96.64 ,$15.75 ,$111.75 ,$17.43 ,$19.09 ,$19.09 ,$15.59 ,$19.09 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30200313,86800,HC THYROGLOBULIN ANTIBODY,302,1 ,$141.45 ,$93.36 ,$15.59 ,$141.45 ,$16.44 ,$55.69 ,$55.69 ,$15.91 ,$84.87 ,$120.23 ,$99.02 ,$16.44 ,$16.44 ,$134.38 ,$107.50 ,$106.09 ,$27.05 ,$120.23 ,$15.91 ,$27.05 ,$27.05 ,$99.02 ,$86.14 ,$16.44 ,$15.91 ,$15.59 ,$31.82 ,$17.43 ,$120.23 ,$35.80 ,$130.13 ,$99.02 ,$79.50 ,$79.50 ,$86.14 ,$79.50 ,$97.74 ,$127.31 ,$96.64 ,$15.75 ,$111.75 ,$17.43 ,$19.09 ,$19.09 ,$15.59 ,$19.09 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30200314,86803,HC HEP C AB,302,1 ,$128.80 ,$85.01 ,$13.98 ,$128.80 ,$14.75 ,$49.95 ,$49.95 ,$14.27 ,$77.28 ,$109.48 ,$90.16 ,$14.75 ,$14.75 ,$122.36 ,$97.89 ,$96.60 ,$24.26 ,$109.48 ,$14.27 ,$24.26 ,$24.26 ,$90.16 ,$78.44 ,$14.75 ,$14.27 ,$13.98 ,$28.54 ,$15.64 ,$109.48 ,$32.11 ,$118.50 ,$90.16 ,$71.33 ,$71.33 ,$78.44 ,$71.33 ,$89.00 ,$115.92 ,$88.00 ,$14.12 ,$101.75 ,$15.64 ,$17.12 ,$17.12 ,$13.98 ,$17.12 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200316,86804,HC HEP C AB CONFIRM,302,1 ,$188.60 ,$124.48 ,$15.18 ,$188.60 ,$16.01 ,$54.22 ,$54.22 ,$15.49 ,$113.16 ,$160.31 ,$132.02 ,$16.01 ,$16.01 ,$179.17 ,$143.34 ,$141.45 ,$26.33 ,$160.31 ,$15.49 ,$26.33 ,$26.33 ,$132.02 ,$114.86 ,$16.01 ,$15.49 ,$15.18 ,$30.98 ,$16.97 ,$160.31 ,$34.85 ,$173.51 ,$132.02 ,$77.41 ,$77.41 ,$114.86 ,$77.41 ,$130.32 ,$169.74 ,$128.85 ,$15.33 ,$148.99 ,$16.97 ,$18.59 ,$18.59 ,$15.18 ,$18.59 ,$135.79 ,$116.93 ,$135.79 ,$135.79 ,$150.88 
ST NICHOLAS HOSPITAL - ACUTE,30200317,86807,HC CYTOTOXIC PRA STND,302,1 ,$98.90 ,$65.27 ,$55.65 ,$176.96 ,$55.65 ,$98.90 ,$98.90 ,$78.65 ,$59.34 ,$84.07 ,$69.23 ,$55.65 ,$55.65 ,$93.96 ,$75.16 ,$74.18 ,$98.90 ,$84.07 ,$78.65 ,$98.90 ,$98.90 ,$69.23 ,$60.23 ,$55.65 ,$78.65 ,$77.08 ,$98.90 ,$58.99 ,$84.07 ,$176.96 ,$90.99 ,$69.23 ,$98.90 ,$98.90 ,$60.23 ,$98.90 ,$68.34 ,$89.01 ,$67.57 ,$77.85 ,$78.13 ,$58.99 ,$94.38 ,$94.38 ,$77.08 ,$94.38 ,$71.21 ,$61.32 ,$71.21 ,$71.21 ,$79.12 
ST NICHOLAS HOSPITAL - ACUTE,30200318,86807,HC CYTOTOXIC PRA STND SCR,302,1 ,$465.75 ,$307.40 ,$55.65 ,$465.75 ,$55.65 ,$275.28 ,$275.28 ,$78.65 ,$279.45 ,$395.89 ,$326.03 ,$55.65 ,$55.65 ,$442.46 ,$353.97 ,$349.31 ,$133.71 ,$395.89 ,$78.65 ,$133.71 ,$133.71 ,$326.03 ,$283.64 ,$55.65 ,$78.65 ,$77.08 ,$157.30 ,$58.99 ,$395.89 ,$176.96 ,$428.49 ,$326.03 ,$197.79 ,$197.79 ,$283.64 ,$197.79 ,$321.83 ,$419.18 ,$318.20 ,$77.85 ,$367.94 ,$58.99 ,$94.38 ,$94.38 ,$77.08 ,$94.38 ,$335.34 ,$288.77 ,$335.34 ,$335.34 ,$372.60 
ST NICHOLAS HOSPITAL - ACUTE,30200319,86808,HC CYTOTOXIC PRA QUICK SCR,302,1 ,$71.30 ,$47.06 ,$29.09 ,$71.30 ,$30.67 ,$71.30 ,$71.30 ,$29.68 ,$42.78 ,$60.61 ,$49.91 ,$30.67 ,$30.67 ,$67.74 ,$54.19 ,$53.48 ,$50.46 ,$60.61 ,$29.68 ,$50.46 ,$50.46 ,$49.91 ,$43.42 ,$30.67 ,$29.68 ,$29.09 ,$59.36 ,$32.51 ,$60.61 ,$66.78 ,$65.60 ,$49.91 ,$71.30 ,$71.30 ,$43.42 ,$71.30 ,$49.27 ,$64.17 ,$48.71 ,$29.38 ,$56.33 ,$32.51 ,$35.62 ,$35.62 ,$29.09 ,$35.62 ,$51.34 ,$44.21 ,$51.34 ,$51.34 ,$57.04 
ST NICHOLAS HOSPITAL - ACUTE,30200320,86808,HC CYTOTOXIC PRA QUICK (MTHD 1/2),302,1 ,$302.45 ,$199.62 ,$29.09 ,$302.45 ,$30.67 ,$103.88 ,$103.88 ,$29.68 ,$181.47 ,$257.08 ,$211.72 ,$30.67 ,$30.67 ,$287.33 ,$229.86 ,$226.84 ,$50.46 ,$257.08 ,$29.68 ,$50.46 ,$50.46 ,$211.72 ,$184.19 ,$30.67 ,$29.68 ,$29.09 ,$59.36 ,$32.51 ,$257.08 ,$66.78 ,$278.25 ,$211.72 ,$148.34 ,$148.34 ,$184.19 ,$148.34 ,$208.99 ,$272.21 ,$206.63 ,$29.38 ,$238.94 ,$32.51 ,$35.62 ,$35.62 ,$29.09 ,$35.62 ,$217.76 ,$187.52 ,$217.76 ,$217.76 ,$241.96 
ST NICHOLAS HOSPITAL - ACUTE,30200321,86808,HC CYTOTOXIC PRA QUICK,302,1 ,$98.90 ,$65.27 ,$29.09 ,$98.90 ,$30.67 ,$98.90 ,$98.90 ,$29.68 ,$59.34 ,$84.07 ,$69.23 ,$30.67 ,$30.67 ,$93.96 ,$75.16 ,$74.18 ,$50.46 ,$84.07 ,$29.68 ,$50.46 ,$50.46 ,$69.23 ,$60.23 ,$30.67 ,$29.68 ,$29.09 ,$59.36 ,$32.51 ,$84.07 ,$66.78 ,$90.99 ,$69.23 ,$98.90 ,$98.90 ,$60.23 ,$98.90 ,$68.34 ,$89.01 ,$67.57 ,$29.38 ,$78.13 ,$32.51 ,$35.62 ,$35.62 ,$29.09 ,$35.62 ,$71.21 ,$61.32 ,$71.21 ,$71.21 ,$79.12 
ST NICHOLAS HOSPITAL - ACUTE,30200322,86812,HC HLA TYPING SINGLE A/B/C,302,1 ,$270.25 ,$178.37 ,$25.29 ,$270.25 ,$26.67 ,$90.34 ,$90.34 ,$25.81 ,$162.15 ,$229.71 ,$189.18 ,$26.67 ,$26.67 ,$256.74 ,$205.39 ,$202.69 ,$43.88 ,$229.71 ,$25.81 ,$43.88 ,$43.88 ,$189.18 ,$164.58 ,$26.67 ,$25.81 ,$25.29 ,$51.62 ,$28.27 ,$229.71 ,$58.07 ,$248.63 ,$189.18 ,$128.99 ,$128.99 ,$164.58 ,$128.99 ,$186.74 ,$243.23 ,$184.63 ,$25.55 ,$213.50 ,$28.27 ,$30.97 ,$30.97 ,$25.29 ,$30.97 ,$194.58 ,$167.56 ,$194.58 ,$194.58 ,$216.20 
ST NICHOLAS HOSPITAL - ACUTE,30200323,86813,HC HLA TYPING MULTI A/B/C,302,1 ,$678.50 ,$447.81 ,$56.84 ,$678.50 ,$59.93 ,$203.00 ,$203.00 ,$58.00 ,$407.10 ,$576.73 ,$474.95 ,$59.93 ,$59.93 ,$644.58 ,$515.66 ,$508.88 ,$98.60 ,$576.73 ,$58.00 ,$98.60 ,$98.60 ,$474.95 ,$413.21 ,$59.93 ,$58.00 ,$56.84 ,$116.00 ,$63.53 ,$576.73 ,$130.50 ,$624.22 ,$474.95 ,$289.86 ,$289.86 ,$413.21 ,$289.86 ,$468.84 ,$610.65 ,$463.55 ,$57.41 ,$536.02 ,$63.53 ,$69.60 ,$69.60 ,$56.84 ,$69.60 ,$488.52 ,$420.67 ,$488.52 ,$488.52 ,$542.80 
ST NICHOLAS HOSPITAL - ACUTE,30200324,86849,HC IMMUNOASSAY UNLISTED (LEUKO),302,1 ,$71.30 ,$47.06 ,$0.34 ,$71.30 ,$0.34 ,$48.87 ,$48.87 , N/A ,$42.78 ,$60.61 ,$49.91 ,$0.34 ,$0.34 ,$67.74 ,$54.19 ,$53.48 , N/A ,$60.61 , N/A , N/A , N/A ,$49.91 ,$43.42 ,$0.34 , N/A , N/A , N/A ,$0.36 ,$60.61 ,$42.78 ,$65.60 ,$49.91 ,$36.16 ,$43.40 ,$43.42 ,$43.40 ,$49.27 ,$64.17 ,$48.71 , N/A ,$56.33 ,$0.36 , N/A , N/A , N/A , N/A ,$51.34 ,$44.21 ,$51.34 ,$51.34 ,$57.04 
ST NICHOLAS HOSPITAL - ACUTE,30200325,86849,HC IMMUNOASSAY UNLISTED (ABID),302,1 ,$98.90 ,$65.27 ,$0.34 ,$98.90 ,$0.34 ,$67.79 ,$67.79 , N/A ,$59.34 ,$84.07 ,$69.23 ,$0.34 ,$0.34 ,$93.96 ,$75.16 ,$74.18 , N/A ,$84.07 , N/A , N/A , N/A ,$69.23 ,$60.23 ,$0.34 , N/A , N/A , N/A ,$0.36 ,$84.07 ,$59.34 ,$90.99 ,$69.23 ,$50.16 ,$60.20 ,$60.23 ,$60.20 ,$68.34 ,$89.01 ,$67.57 , N/A ,$78.13 ,$0.36 , N/A , N/A , N/A , N/A ,$71.21 ,$61.32 ,$71.21 ,$71.21 ,$79.12 
ST NICHOLAS HOSPITAL - ACUTE,30200326,86849,HC IMMUNOASSAY UNLISTED,302,1 ,$185.15 ,$122.20 ,$0.34 ,$185.15 ,$0.34 ,$126.90 ,$126.90 , N/A ,$111.09 ,$157.38 ,$129.61 ,$0.34 ,$0.34 ,$175.89 ,$140.71 ,$138.86 , N/A ,$157.38 , N/A , N/A , N/A ,$129.61 ,$112.76 ,$0.34 , N/A , N/A , N/A ,$0.36 ,$157.38 ,$111.09 ,$170.34 ,$129.61 ,$93.91 ,$112.70 ,$112.76 ,$112.70 ,$127.94 ,$166.64 ,$126.49 , N/A ,$146.27 ,$0.36 , N/A , N/A , N/A , N/A ,$133.31 ,$114.79 ,$133.31 ,$133.31 ,$148.12 
ST NICHOLAS HOSPITAL - ACUTE,30200327,86850,HC AB SCREEN,302,1 ,$90.00 ,$59.40 ,$5.38 ,$110.11 ,$5.38 ,$34.20 ,$34.20 ,$48.94 ,$54.00 ,$76.50 ,$63.00 ,$5.38 ,$5.38 ,$85.50 ,$68.40 ,$67.50 ,$16.61 ,$76.50 ,$48.94 ,$16.61 ,$16.61 ,$63.00 ,$54.81 ,$5.38 ,$48.94 ,$47.96 ,$90.00 ,$5.70 ,$76.50 ,$110.11 ,$82.80 ,$63.00 ,$19.09 ,$19.09 ,$54.81 ,$19.09 ,$62.19 ,$81.00 ,$61.49 ,$48.44 ,$71.10 ,$5.70 ,$11.72 ,$11.72 ,$47.96 ,$11.72 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200329,86860,HC ELUTION,302,1 ,$146.00 ,$96.36 ,$4.75 ,$345.32 ,$4.75 ,$104.97 ,$104.97 ,$153.48 ,$87.60 ,$124.10 ,$102.20 ,$4.75 ,$4.75 ,$138.70 ,$110.96 ,$109.50 ,$49.81 ,$124.10 ,$153.48 ,$49.81 ,$49.81 ,$102.20 ,$88.91 ,$4.75 ,$153.48 ,$150.41 ,$146.00 ,$5.04 ,$124.10 ,$345.32 ,$134.32 ,$102.20 ,$74.05 ,$88.87 ,$88.91 ,$88.87 ,$100.89 ,$131.40 ,$99.75 ,$151.91 ,$115.34 ,$5.04 ,$146.00 ,$146.00 ,$150.41 ,$146.00 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200331,86870,HC RBC AB ID PANEL,302,1 ,$269.00 ,$177.54 ,$4.75 ,$711.75 ,$4.75 ,$143.76 ,$143.76 ,$316.33 ,$161.40 ,$228.65 ,$188.30 ,$4.75 ,$4.75 ,$255.55 ,$204.44 ,$201.75 ,$68.41 ,$228.65 ,$316.33 ,$68.41 ,$68.41 ,$188.30 ,$163.82 ,$4.75 ,$316.33 ,$310.00 ,$269.00 ,$5.04 ,$228.65 ,$711.75 ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$163.74 ,$185.88 ,$242.10 ,$183.78 ,$313.10 ,$212.51 ,$5.04 ,$269.00 ,$269.00 ,$310.00 ,$269.00 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30200334,86880,HC COOMBS DIRECT,302,1 ,$56.00 ,$36.96 ,$5.57 ,$126.23 ,$5.57 ,$18.87 ,$18.87 ,$56.10 ,$33.60 ,$47.60 ,$39.20 ,$5.57 ,$5.57 ,$53.20 ,$42.56 ,$42.00 ,$9.16 ,$47.60 ,$56.10 ,$9.16 ,$9.16 ,$39.20 ,$34.10 ,$5.57 ,$56.10 ,$54.98 ,$56.00 ,$5.90 ,$47.60 ,$126.23 ,$51.52 ,$39.20 ,$21.47 ,$21.47 ,$34.10 ,$21.47 ,$38.70 ,$50.40 ,$38.26 ,$55.53 ,$44.24 ,$5.90 ,$6.47 ,$6.47 ,$54.98 ,$6.47 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30200336,86880,HC ANTIHUMAN GLOBULIN TEST,302,1 ,$53.00 ,$34.98 ,$5.57 ,$126.23 ,$5.57 ,$18.87 ,$18.87 ,$56.10 ,$31.80 ,$45.05 ,$37.10 ,$5.57 ,$5.57 ,$50.35 ,$40.28 ,$39.75 ,$9.16 ,$45.05 ,$56.10 ,$9.16 ,$9.16 ,$37.10 ,$32.28 ,$5.57 ,$56.10 ,$54.98 ,$53.00 ,$5.90 ,$45.05 ,$126.23 ,$48.76 ,$37.10 ,$21.47 ,$21.47 ,$32.28 ,$21.47 ,$36.62 ,$47.70 ,$36.21 ,$55.53 ,$41.87 ,$5.90 ,$6.47 ,$6.47 ,$54.98 ,$6.47 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,30200338,86885,HC INDIRECT COOMBS,302,1 ,$80.00 ,$52.80 ,$5.91 ,$345.32 ,$5.91 ,$20.02 ,$20.02 ,$153.48 ,$48.00 ,$68.00 ,$56.00 ,$5.91 ,$5.91 ,$76.00 ,$60.80 ,$60.00 ,$9.72 ,$68.00 ,$153.48 ,$9.72 ,$9.72 ,$56.00 ,$48.72 ,$5.91 ,$153.48 ,$150.41 ,$80.00 ,$6.26 ,$68.00 ,$345.32 ,$73.60 ,$56.00 ,$28.61 ,$28.61 ,$48.72 ,$28.61 ,$55.28 ,$72.00 ,$54.66 ,$151.91 ,$63.20 ,$6.26 ,$6.86 ,$6.86 ,$150.41 ,$6.86 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,30200339,86885,HC INDIRECT COOMBS (ABID),302,1 ,$11.00 ,$7.26 ,$5.91 ,$345.32 ,$5.91 ,$11.00 ,$11.00 ,$153.48 ,$6.60 ,$9.35 ,$7.70 ,$5.91 ,$5.91 ,$10.45 ,$8.36 ,$8.25 ,$9.72 ,$9.35 ,$153.48 ,$9.72 ,$9.72 ,$7.70 ,$6.70 ,$5.91 ,$153.48 ,$150.41 ,$11.00 ,$6.26 ,$9.35 ,$345.32 ,$10.12 ,$7.70 ,$11.00 ,$11.00 ,$6.70 ,$11.00 ,$7.60 ,$9.90 ,$7.52 ,$151.91 ,$8.69 ,$6.26 ,$6.86 ,$6.86 ,$150.41 ,$6.86 ,$7.92 ,$6.82 ,$7.92 ,$7.92 ,$8.80 
ST NICHOLAS HOSPITAL - ACUTE,30200340,86886,HC INDIRECT TITER,302,1 ,$67.00 ,$44.22 ,$5.35 ,$345.32 ,$5.35 ,$18.13 ,$18.13 ,$153.48 ,$40.20 ,$56.95 ,$46.90 ,$5.35 ,$5.35 ,$63.65 ,$50.92 ,$50.25 ,$8.81 ,$56.95 ,$153.48 ,$8.81 ,$8.81 ,$46.90 ,$40.80 ,$5.35 ,$153.48 ,$150.41 ,$67.00 ,$5.67 ,$56.95 ,$345.32 ,$61.64 ,$46.90 ,$25.86 ,$25.86 ,$40.80 ,$25.86 ,$46.30 ,$60.30 ,$45.77 ,$151.91 ,$52.93 ,$5.67 ,$6.22 ,$6.22 ,$150.41 ,$6.22 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200342,86890,HC AUTOLOGOUS PROCESSING FEE,302,1 ,$381.00 ,$251.46 ,$2.35 ,$381.00 ,$2.35 ,$330.88 ,$330.88 ,$153.48 ,$228.60 ,$323.85 ,$266.70 ,$2.35 ,$2.35 ,$361.95 ,$289.56 ,$285.75 ,$156.52 ,$323.85 ,$153.48 ,$156.52 ,$156.52 ,$266.70 ,$232.03 ,$2.35 ,$153.48 ,$150.41 ,$306.96 ,$2.49 ,$323.85 ,$345.32 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$231.91 ,$263.27 ,$342.90 ,$260.30 ,$151.91 ,$300.99 ,$2.49 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$304.80 
ST NICHOLAS HOSPITAL - ACUTE,30200343,86891,HC BLOOD SALVAGE AUTOLOOUS INTRA,302,1 ,$504.00 ,$332.64 ,$2.35 ,"$1,705.22 ",$2.35 ,$466.66 ,$466.66 ,$757.87 ,$302.40 ,$428.40 ,$352.80 ,$2.35 ,$2.35 ,$478.80 ,$383.04 ,$378.00 ,$221.10 ,$428.40 ,$757.87 ,$221.10 ,$221.10 ,$352.80 ,$306.94 ,$2.35 ,$757.87 ,$742.71 ,$504.00 ,$2.49 ,$428.40 ,"$1,705.22 ",$463.68 ,$352.80 ,$255.63 ,$306.78 ,$306.94 ,$306.78 ,$348.26 ,$453.60 ,$344.33 ,$750.14 ,$398.16 ,$2.49 ,$504.00 ,$504.00 ,$742.71 ,$504.00 ,$362.88 ,$312.48 ,$362.88 ,$362.88 ,$403.20 
ST NICHOLAS HOSPITAL - ACUTE,30200344,86900,HC BLOOD TYPING ABO,302,1 ,$40.00 ,$26.40 ,$3.09 ,$254.98 ,$3.09 ,$10.47 ,$10.47 ,$113.32 ,$24.00 ,$34.00 ,$28.00 ,$3.09 ,$3.09 ,$38.00 ,$30.40 ,$30.00 ,$5.08 ,$34.00 ,$113.32 ,$5.08 ,$5.08 ,$28.00 ,$24.36 ,$3.09 ,$113.32 ,$111.05 ,$40.00 ,$3.28 ,$34.00 ,$254.98 ,$36.80 ,$28.00 ,$13.70 ,$13.70 ,$24.36 ,$13.70 ,$27.64 ,$36.00 ,$27.33 ,$112.16 ,$31.60 ,$3.28 ,$3.59 ,$3.59 ,$111.05 ,$3.59 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,30200346,86901,HC BLOOD TYPING RH,302,1 ,$44.00 ,$29.04 ,$3.09 ,$74.58 ,$3.09 ,$10.47 ,$10.47 ,$33.15 ,$26.40 ,$37.40 ,$30.80 ,$3.09 ,$3.09 ,$41.80 ,$33.44 ,$33.00 ,$5.08 ,$37.40 ,$33.15 ,$5.08 ,$5.08 ,$30.80 ,$26.80 ,$3.09 ,$33.15 ,$32.49 ,$44.00 ,$3.28 ,$37.40 ,$74.58 ,$40.48 ,$30.80 ,$13.70 ,$13.70 ,$26.80 ,$13.70 ,$30.40 ,$39.60 ,$30.06 ,$32.81 ,$34.76 ,$3.28 ,$3.59 ,$3.59 ,$32.49 ,$3.59 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$35.20 
ST NICHOLAS HOSPITAL - ACUTE,30200347,86901,HC BLOOD TYPING RH (CLINIC),302,1 ,$24.00 ,$15.84 ,$3.09 ,$74.58 ,$3.09 ,$10.47 ,$10.47 ,$33.15 ,$14.40 ,$20.40 ,$16.80 ,$3.09 ,$3.09 ,$22.80 ,$18.24 ,$18.00 ,$5.08 ,$20.40 ,$33.15 ,$5.08 ,$5.08 ,$16.80 ,$14.62 ,$3.09 ,$33.15 ,$32.49 ,$24.00 ,$3.28 ,$20.40 ,$74.58 ,$22.08 ,$16.80 ,$13.70 ,$13.70 ,$14.62 ,$13.70 ,$16.58 ,$21.60 ,$16.40 ,$32.81 ,$18.96 ,$3.28 ,$3.59 ,$3.59 ,$32.49 ,$3.59 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$19.20 
ST NICHOLAS HOSPITAL - ACUTE,30200349,86902,HC RBC AG SCR RGT SERUM,302,1 ,$78.00 ,$51.48 ,$5.37 ,$711.75 ,$5.37 ,$22.23 ,$22.23 ,$316.33 ,$46.80 ,$66.30 ,$54.60 ,$5.37 ,$5.37 ,$74.10 ,$59.28 ,$58.50 ,$10.80 ,$66.30 ,$316.33 ,$10.80 ,$10.80 ,$54.60 ,$47.50 ,$5.37 ,$316.33 ,$310.00 ,$78.00 ,$5.69 ,$66.30 ,$711.75 ,$71.76 ,$54.60 ,$19.12 ,$19.12 ,$47.50 ,$19.12 ,$53.90 ,$70.20 ,$53.29 ,$313.10 ,$61.62 ,$5.69 ,$7.62 ,$7.62 ,$310.00 ,$7.62 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200351,86902,HC RBC AG SCR RGT SERUM TYPE UNIT,302,1 ,$67.00 ,$44.22 ,$5.37 ,$711.75 ,$5.37 ,$22.23 ,$22.23 ,$316.33 ,$40.20 ,$56.95 ,$46.90 ,$5.37 ,$5.37 ,$63.65 ,$50.92 ,$50.25 ,$10.80 ,$56.95 ,$316.33 ,$10.80 ,$10.80 ,$46.90 ,$40.80 ,$5.37 ,$316.33 ,$310.00 ,$67.00 ,$5.69 ,$56.95 ,$711.75 ,$61.64 ,$46.90 ,$19.12 ,$19.12 ,$40.80 ,$19.12 ,$46.30 ,$60.30 ,$45.77 ,$313.10 ,$52.93 ,$5.69 ,$7.62 ,$7.62 ,$310.00 ,$7.62 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200352,86904,HC RBC AG SCR PAT SERUM,302,1 ,$86.00 ,$56.76 ,$13.37 ,$86.00 ,$13.37 ,$57.19 ,$57.19 ,$33.15 ,$51.60 ,$73.10 ,$60.20 ,$13.37 ,$13.37 ,$81.70 ,$65.36 ,$64.50 ,$27.78 ,$73.10 ,$33.15 ,$27.78 ,$27.78 ,$60.20 ,$52.37 ,$13.37 ,$33.15 ,$32.49 ,$66.30 ,$14.17 ,$73.10 ,$74.58 ,$79.12 ,$60.20 ,$47.52 ,$47.52 ,$52.37 ,$47.52 ,$59.43 ,$77.40 ,$58.76 ,$32.81 ,$67.94 ,$14.17 ,$19.61 ,$19.61 ,$32.49 ,$19.61 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,30200354,86905,HC ANTIGEN ID ONLY,302,1 ,$67.00 ,$44.22 ,$3.96 ,$711.75 ,$3.96 ,$13.41 ,$13.41 ,$316.33 ,$40.20 ,$56.95 ,$46.90 ,$3.96 ,$3.96 ,$63.65 ,$50.92 ,$50.25 ,$6.51 ,$56.95 ,$316.33 ,$6.51 ,$6.51 ,$46.90 ,$40.80 ,$3.96 ,$316.33 ,$310.00 ,$67.00 ,$4.20 ,$56.95 ,$711.75 ,$61.64 ,$46.90 ,$19.12 ,$19.12 ,$40.80 ,$19.12 ,$46.30 ,$60.30 ,$45.77 ,$313.10 ,$52.93 ,$4.20 ,$4.60 ,$4.60 ,$310.00 ,$4.60 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200356,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$157.00 ,$103.62 ,$4.75 ,$345.32 ,$4.75 ,$116.38 ,$116.38 ,$153.48 ,$94.20 ,$133.45 ,$109.90 ,$4.75 ,$4.75 ,$149.15 ,$119.32 ,$117.75 ,$55.27 ,$133.45 ,$153.48 ,$55.27 ,$55.27 ,$109.90 ,$95.61 ,$4.75 ,$153.48 ,$150.41 ,$157.00 ,$5.04 ,$133.45 ,$345.32 ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$95.57 ,$108.49 ,$141.30 ,$107.26 ,$151.91 ,$124.03 ,$5.04 ,$157.00 ,$157.00 ,$150.41 ,$157.00 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200358,86921,HC CROSSMATCH INCUBATION,302,1 ,$123.00 ,$81.18 ,$4.75 ,$345.32 ,$4.75 ,$104.97 ,$104.97 ,$153.48 ,$73.80 ,$104.55 ,$86.10 ,$4.75 ,$4.75 ,$116.85 ,$93.48 ,$92.25 ,$49.81 ,$104.55 ,$153.48 ,$49.81 ,$49.81 ,$86.10 ,$74.91 ,$4.75 ,$153.48 ,$150.41 ,$123.00 ,$5.04 ,$104.55 ,$345.32 ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$74.87 ,$84.99 ,$110.70 ,$84.03 ,$151.91 ,$97.17 ,$5.04 ,$123.00 ,$123.00 ,$150.41 ,$123.00 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200360,86922,HC CROSSMATCH AHG,302,1 ,$157.00 ,$103.62 ,$4.75 ,$345.32 ,$4.75 ,$124.37 ,$124.37 ,$153.48 ,$94.20 ,$133.45 ,$109.90 ,$4.75 ,$4.75 ,$149.15 ,$119.32 ,$117.75 ,$59.11 ,$133.45 ,$153.48 ,$59.11 ,$59.11 ,$109.90 ,$95.61 ,$4.75 ,$153.48 ,$150.41 ,$157.00 ,$5.04 ,$133.45 ,$345.32 ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$95.57 ,$108.49 ,$141.30 ,$107.26 ,$151.91 ,$124.03 ,$5.04 ,$157.00 ,$157.00 ,$150.41 ,$157.00 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200362,86923,HC CROSSMATCH ELECTRONIC,302,1 ,$157.00 ,$103.62 ,$4.75 ,$345.32 ,$4.75 ,$93.56 ,$93.56 ,$153.48 ,$94.20 ,$133.45 ,$109.90 ,$4.75 ,$4.75 ,$149.15 ,$119.32 ,$117.75 ,$44.34 ,$133.45 ,$153.48 ,$44.34 ,$44.34 ,$109.90 ,$95.61 ,$4.75 ,$153.48 ,$150.41 ,$157.00 ,$5.04 ,$133.45 ,$345.32 ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$95.57 ,$108.49 ,$141.30 ,$107.26 ,$151.91 ,$124.03 ,$5.04 ,$157.00 ,$157.00 ,$150.41 ,$157.00 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200363,86927,HC FFP THAWING EACH UNIT,302,1 ,$168.00 ,$110.88 ,$2.35 ,$345.32 ,$2.35 ,$66.18 ,$66.18 ,$153.48 ,$100.80 ,$142.80 ,$117.60 ,$2.35 ,$2.35 ,$159.60 ,$127.68 ,$126.00 ,$31.20 ,$142.80 ,$153.48 ,$31.20 ,$31.20 ,$117.60 ,$102.31 ,$2.35 ,$153.48 ,$150.41 ,$168.00 ,$2.49 ,$142.80 ,$345.32 ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$102.26 ,$116.09 ,$151.20 ,$114.78 ,$151.91 ,$132.72 ,$2.49 ,$168.00 ,$168.00 ,$150.41 ,$168.00 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30200365,86945,HC BLOOD PRODUCT IRRADIATION,302,1 ,$115.00 ,$75.90 ,$2.35 ,$115.00 ,$2.35 ,$96.98 ,$96.98 ,$33.15 ,$69.00 ,$97.75 ,$80.50 ,$2.35 ,$2.35 ,$109.25 ,$87.40 ,$86.25 ,$45.97 ,$97.75 ,$33.15 ,$45.97 ,$45.97 ,$80.50 ,$70.04 ,$2.35 ,$33.15 ,$32.49 ,$66.30 ,$2.49 ,$97.75 ,$74.58 ,$105.80 ,$80.50 ,$58.33 ,$70.00 ,$70.04 ,$70.00 ,$79.47 ,$103.50 ,$78.57 ,$32.81 ,$90.85 ,$2.49 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,30200366,86950,HC WBC CONC CMV NEG,302,1 ,"$1,725.00 ","$1,138.50 ",$2.35 ,"$1,725.00 ",$2.35 ,$253.29 ,$253.29 ,$153.48 ,"$1,035.00 ","$1,466.25 ","$1,207.50 ",$2.35 ,$2.35 ,"$1,638.75 ","$1,311.00 ","$1,293.75 ",$119.85 ,"$1,466.25 ",$153.48 ,$119.85 ,$119.85 ,"$1,207.50 ","$1,050.53 ",$2.35 ,$153.48 ,$150.41 ,$306.96 ,$2.49 ,"$1,466.25 ",$345.32 ,"$1,587.00 ","$1,207.50 ",$874.92 ,"$1,050.01 ","$1,050.53 ","$1,050.01 ","$1,191.98 ","$1,552.50 ","$1,178.52 ",$151.91 ,"$1,362.75 ",$2.49 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,"$1,242.00 ","$1,069.50 ","$1,242.00 ","$1,242.00 ","$1,380.00 "
ST NICHOLAS HOSPITAL - ACUTE,30200367,86950,HC WBC CONC CMV NEG (RC),302,1 ,"$1,698.00 ","$1,120.68 ",$2.35 ,"$1,698.00 ",$2.35 ,$253.29 ,$253.29 ,$153.48 ,"$1,018.80 ","$1,443.30 ","$1,188.60 ",$2.35 ,$2.35 ,"$1,613.10 ","$1,290.48 ","$1,273.50 ",$119.85 ,"$1,443.30 ",$153.48 ,$119.85 ,$119.85 ,"$1,188.60 ","$1,034.08 ",$2.35 ,$153.48 ,$150.41 ,$306.96 ,$2.49 ,"$1,443.30 ",$345.32 ,"$1,562.16 ","$1,188.60 ",$861.23 ,"$1,033.57 ","$1,034.08 ","$1,033.57 ","$1,173.32 ","$1,528.20 ","$1,160.07 ",$151.91 ,"$1,341.42 ",$2.49 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,"$1,222.56 ","$1,052.76 ","$1,222.56 ","$1,222.56 ","$1,358.40 "
ST NICHOLAS HOSPITAL - ACUTE,30200368,86965,HC BLOOD PRODUCT POOL,302,1 ,$127.00 ,$83.82 ,$2.35 ,$345.32 ,$2.35 ,$108.39 ,$108.39 ,$153.48 ,$76.20 ,$107.95 ,$88.90 ,$2.35 ,$2.35 ,$120.65 ,$96.52 ,$95.25 ,$51.44 ,$107.95 ,$153.48 ,$51.44 ,$51.44 ,$88.90 ,$77.34 ,$2.35 ,$153.48 ,$150.41 ,$127.00 ,$2.49 ,$107.95 ,$345.32 ,$116.84 ,$88.90 ,$64.41 ,$77.30 ,$77.34 ,$77.30 ,$87.76 ,$114.30 ,$86.77 ,$151.91 ,$100.33 ,$2.49 ,$127.00 ,$127.00 ,$150.41 ,$127.00 ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$101.60 
ST NICHOLAS HOSPITAL - ACUTE,30200369,86970,HC RBC PRETREAT CHEM,302,1 ,$115.00 ,$75.90 ,$2.35 ,$115.00 ,$2.35 ,$96.98 ,$96.98 ,$33.15 ,$69.00 ,$97.75 ,$80.50 ,$2.35 ,$2.35 ,$109.25 ,$87.40 ,$86.25 ,$45.97 ,$97.75 ,$33.15 ,$45.97 ,$45.97 ,$80.50 ,$70.04 ,$2.35 ,$33.15 ,$32.49 ,$66.30 ,$2.49 ,$97.75 ,$74.58 ,$105.80 ,$80.50 ,$58.33 ,$70.00 ,$70.04 ,$70.00 ,$79.47 ,$103.50 ,$78.57 ,$32.81 ,$90.85 ,$2.49 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,30200373,86403,HC PARTICLE AGG SCREEN (HAEMOPHILUS OR NEISSERIA),302,1 ,$132.25 ,$87.29 ,$11.31 ,$132.25 ,$11.92 ,$40.39 ,$40.39 ,$11.54 ,$79.35 ,$112.41 ,$92.58 ,$11.92 ,$11.92 ,$125.64 ,$100.51 ,$99.19 ,$19.62 ,$112.41 ,$11.54 ,$19.62 ,$19.62 ,$92.58 ,$80.54 ,$11.92 ,$11.54 ,$11.31 ,$23.08 ,$12.64 ,$112.41 ,$25.97 ,$121.67 ,$92.58 ,$50.92 ,$50.92 ,$80.54 ,$50.92 ,$91.38 ,$119.03 ,$90.35 ,$11.43 ,$104.48 ,$12.64 ,$13.85 ,$13.85 ,$11.31 ,$13.85 ,$95.22 ,$82.00 ,$95.22 ,$95.22 ,$105.80 
ST NICHOLAS HOSPITAL - ACUTE,30200375,86880,HC C3 DIRECT COOMBS,302,1 ,$52.00 ,$34.32 ,$5.57 ,$126.23 ,$5.57 ,$18.87 ,$18.87 ,$56.10 ,$31.20 ,$44.20 ,$36.40 ,$5.57 ,$5.57 ,$49.40 ,$39.52 ,$39.00 ,$9.16 ,$44.20 ,$56.10 ,$9.16 ,$9.16 ,$36.40 ,$31.67 ,$5.57 ,$56.10 ,$54.98 ,$52.00 ,$5.90 ,$44.20 ,$126.23 ,$47.84 ,$36.40 ,$21.47 ,$21.47 ,$31.67 ,$21.47 ,$35.93 ,$46.80 ,$35.53 ,$55.53 ,$41.08 ,$5.90 ,$6.47 ,$6.47 ,$54.98 ,$6.47 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30200376,86832,HC HLA AB ID CLASS I HIGH RES,302,1 ,"$1,043.05 ",$688.41 ,$139.23 ,"$1,043.05 ",$139.23 ,"$1,043.05 ","$1,043.05 ",$323.75 ,$625.83 ,$886.59 ,$730.14 ,$139.23 ,$139.23 ,$990.90 ,$792.72 ,$782.29 ,$550.38 ,$886.59 ,$323.75 ,$550.38 ,$550.38 ,$730.14 ,$635.22 ,$139.23 ,$323.75 ,$317.27 ,$647.50 ,$147.58 ,$886.59 ,$728.44 ,$959.61 ,$730.14 ,$634.12 ,$634.12 ,$635.22 ,$634.12 ,$720.75 ,$938.75 ,$712.61 ,$320.45 ,$824.01 ,$147.58 ,$388.50 ,$388.50 ,$317.27 ,$388.50 ,$751.00 ,$646.69 ,$751.00 ,$751.00 ,$834.44 
ST NICHOLAS HOSPITAL - ACUTE,30200380,86658,HC ENTEROVIRUS B COXSACKIE,302,1 ,$49.45 ,$32.64 ,$8.17 ,$49.45 ,$8.17 ,$45.61 ,$45.61 ,$13.03 ,$29.67 ,$42.03 ,$34.62 ,$8.17 ,$8.17 ,$46.98 ,$37.58 ,$37.09 ,$22.15 ,$42.03 ,$13.03 ,$22.15 ,$22.15 ,$34.62 ,$30.12 ,$8.17 ,$13.03 ,$12.77 ,$26.06 ,$8.66 ,$42.03 ,$29.32 ,$45.49 ,$34.62 ,$29.05 ,$29.05 ,$30.12 ,$29.05 ,$34.17 ,$44.51 ,$33.78 ,$12.90 ,$39.07 ,$8.66 ,$15.64 ,$15.64 ,$12.77 ,$15.64 ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,30200400,86235,HC ENA AB QUEST,302,1 ,$141.45 ,$93.36 ,$17.57 ,$141.45 ,$18.53 ,$62.76 ,$62.76 ,$17.93 ,$84.87 ,$120.23 ,$99.02 ,$18.53 ,$18.53 ,$134.38 ,$107.50 ,$106.09 ,$30.48 ,$120.23 ,$17.93 ,$30.48 ,$30.48 ,$99.02 ,$86.14 ,$18.53 ,$17.93 ,$17.57 ,$35.86 ,$19.64 ,$120.23 ,$40.34 ,$130.13 ,$99.02 ,$89.61 ,$89.61 ,$86.14 ,$89.61 ,$97.74 ,$127.31 ,$96.64 ,$17.75 ,$111.75 ,$19.64 ,$21.52 ,$21.52 ,$17.57 ,$21.52 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30200448,86757,HC RICKETTSIA IGG,302,1 ,$128.80 ,$85.01 ,$18.96 ,$128.80 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$77.28 ,$109.48 ,$90.16 ,$19.99 ,$19.99 ,$122.36 ,$97.89 ,$96.60 ,$32.90 ,$109.48 ,$19.35 ,$32.90 ,$32.90 ,$90.16 ,$78.44 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$109.48 ,$43.54 ,$118.50 ,$90.16 ,$96.72 ,$96.72 ,$78.44 ,$96.72 ,$89.00 ,$115.92 ,$88.00 ,$19.15 ,$101.75 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200449,86757,HC RICKETTSIA IGM,302,1 ,$128.80 ,$85.01 ,$18.96 ,$128.80 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$77.28 ,$109.48 ,$90.16 ,$19.99 ,$19.99 ,$122.36 ,$97.89 ,$96.60 ,$32.90 ,$109.48 ,$19.35 ,$32.90 ,$32.90 ,$90.16 ,$78.44 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$109.48 ,$43.54 ,$118.50 ,$90.16 ,$96.72 ,$96.72 ,$78.44 ,$96.72 ,$89.00 ,$115.92 ,$88.00 ,$19.15 ,$101.75 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200450,86635,HC COCCID AB IGG/IGM,302,1 ,$157.55 ,$103.98 ,$8.17 ,$157.55 ,$8.17 ,$40.15 ,$40.15 ,$11.47 ,$94.53 ,$133.92 ,$110.29 ,$8.17 ,$8.17 ,$149.67 ,$119.74 ,$118.16 ,$19.50 ,$133.92 ,$11.47 ,$19.50 ,$19.50 ,$110.29 ,$95.95 ,$8.17 ,$11.47 ,$11.24 ,$22.94 ,$8.66 ,$133.92 ,$25.81 ,$144.95 ,$110.29 ,$29.05 ,$29.05 ,$95.95 ,$29.05 ,$108.87 ,$141.80 ,$107.64 ,$11.35 ,$124.46 ,$8.66 ,$13.76 ,$13.76 ,$11.24 ,$13.76 ,$113.44 ,$97.68 ,$113.44 ,$113.44 ,$126.04 
ST NICHOLAS HOSPITAL - ACUTE,30200460,86038,HC ANA CENTROMERE B AB,302,1 ,$89.70 ,$59.20 ,$11.85 ,$89.70 ,$12.49 ,$42.32 ,$42.32 ,$12.09 ,$53.82 ,$76.25 ,$62.79 ,$12.49 ,$12.49 ,$85.22 ,$68.17 ,$67.28 ,$20.55 ,$76.25 ,$12.09 ,$20.55 ,$20.55 ,$62.79 ,$54.63 ,$12.49 ,$12.09 ,$11.85 ,$24.18 ,$13.24 ,$76.25 ,$27.20 ,$82.52 ,$62.79 ,$52.09 ,$52.09 ,$54.63 ,$52.09 ,$61.98 ,$80.73 ,$61.28 ,$11.97 ,$70.86 ,$13.24 ,$14.51 ,$14.51 ,$11.85 ,$14.51 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30200476,86985,HC SPLITTING BLOOD PRODUCT EA,302,1 ,$84.00 ,$55.44 ,$2.35 ,$345.32 ,$2.35 ,$84.00 ,$84.00 ,$153.48 ,$50.40 ,$71.40 ,$58.80 ,$2.35 ,$2.35 ,$79.80 ,$63.84 ,$63.00 ,$40.49 ,$71.40 ,$153.48 ,$40.49 ,$40.49 ,$58.80 ,$51.16 ,$2.35 ,$153.48 ,$150.41 ,$84.00 ,$2.49 ,$71.40 ,$345.32 ,$77.28 ,$58.80 ,$42.60 ,$51.13 ,$51.16 ,$51.13 ,$58.04 ,$75.60 ,$57.39 ,$151.91 ,$66.36 ,$2.49 ,$84.00 ,$84.00 ,$150.41 ,$84.00 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,30200477,86695,HC HSV IGM TITER TYPE I,302,1 ,$116.15 ,$76.66 ,$12.93 ,$116.15 ,$13.63 ,$46.17 ,$46.17 ,$13.19 ,$69.69 ,$98.73 ,$81.31 ,$13.63 ,$13.63 ,$110.34 ,$88.27 ,$87.11 ,$22.42 ,$98.73 ,$13.19 ,$22.42 ,$22.42 ,$81.31 ,$70.74 ,$13.63 ,$13.19 ,$12.93 ,$26.38 ,$14.45 ,$98.73 ,$29.68 ,$106.86 ,$81.31 ,$65.94 ,$65.94 ,$70.74 ,$65.94 ,$80.26 ,$104.54 ,$79.35 ,$13.05 ,$91.76 ,$14.45 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200478,86696,HC HSV IGM TITER TYPE 2,302,1 ,$167.90 ,$110.81 ,$18.96 ,$167.90 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$100.74 ,$142.72 ,$117.53 ,$19.99 ,$19.99 ,$159.51 ,$127.60 ,$125.93 ,$32.90 ,$142.72 ,$19.35 ,$32.90 ,$32.90 ,$117.53 ,$102.25 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$142.72 ,$43.54 ,$154.47 ,$117.53 ,$96.72 ,$96.72 ,$102.25 ,$96.72 ,$116.02 ,$151.11 ,$114.71 ,$19.15 ,$132.64 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30200480,86696,HC HSV TYPE 2 AB IGG,302,1 ,$167.90 ,$110.81 ,$18.96 ,$167.90 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$100.74 ,$142.72 ,$117.53 ,$19.99 ,$19.99 ,$159.51 ,$127.60 ,$125.93 ,$32.90 ,$142.72 ,$19.35 ,$32.90 ,$32.90 ,$117.53 ,$102.25 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$142.72 ,$43.54 ,$154.47 ,$117.53 ,$96.72 ,$96.72 ,$102.25 ,$96.72 ,$116.02 ,$151.11 ,$114.71 ,$19.15 ,$132.64 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30200481,86695,HC HSV TYPE 1 AB IGG,302,1 ,$116.15 ,$76.66 ,$12.93 ,$116.15 ,$13.63 ,$46.17 ,$46.17 ,$13.19 ,$69.69 ,$98.73 ,$81.31 ,$13.63 ,$13.63 ,$110.34 ,$88.27 ,$87.11 ,$22.42 ,$98.73 ,$13.19 ,$22.42 ,$22.42 ,$81.31 ,$70.74 ,$13.63 ,$13.19 ,$12.93 ,$26.38 ,$14.45 ,$98.73 ,$29.68 ,$106.86 ,$81.31 ,$65.94 ,$65.94 ,$70.74 ,$65.94 ,$80.26 ,$104.54 ,$79.35 ,$13.05 ,$91.76 ,$14.45 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30200482,86777,HC TOXOPLASMA AB IGG,302,1 ,$121.90 ,$80.45 ,$14.10 ,$121.90 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$73.14 ,$103.62 ,$85.33 ,$14.87 ,$14.87 ,$115.81 ,$92.64 ,$91.43 ,$24.46 ,$103.62 ,$14.39 ,$24.46 ,$24.46 ,$85.33 ,$74.24 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$103.62 ,$32.38 ,$112.15 ,$85.33 ,$71.95 ,$71.95 ,$74.24 ,$71.95 ,$84.23 ,$109.71 ,$83.28 ,$14.24 ,$96.30 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$87.77 ,$75.58 ,$87.77 ,$87.77 ,$97.52 
ST NICHOLAS HOSPITAL - ACUTE,30200483,86762,HC RUBELLA AB IGG MAYO,302,1 ,$133.40 ,$88.04 ,$14.10 ,$133.40 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$80.04 ,$113.39 ,$93.38 ,$14.87 ,$14.87 ,$126.73 ,$101.38 ,$100.05 ,$24.46 ,$113.39 ,$14.39 ,$24.46 ,$24.46 ,$93.38 ,$81.24 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$113.39 ,$32.38 ,$122.73 ,$93.38 ,$71.95 ,$71.95 ,$81.24 ,$71.95 ,$92.18 ,$120.06 ,$91.14 ,$14.24 ,$105.39 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$96.05 ,$82.71 ,$96.05 ,$96.05 ,$106.72 
ST NICHOLAS HOSPITAL - ACUTE,30200484,86644,HC CMV AB IGG,302,1 ,$126.50 ,$83.49 ,$14.10 ,$126.50 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$75.90 ,$107.53 ,$88.55 ,$14.87 ,$14.87 ,$120.18 ,$96.14 ,$94.88 ,$24.46 ,$107.53 ,$14.39 ,$24.46 ,$24.46 ,$88.55 ,$77.04 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$107.53 ,$32.38 ,$116.38 ,$88.55 ,$71.95 ,$71.95 ,$77.04 ,$71.95 ,$87.41 ,$113.85 ,$86.42 ,$14.24 ,$99.94 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$91.08 ,$78.43 ,$91.08 ,$91.08 ,$101.20 
ST NICHOLAS HOSPITAL - ACUTE,30200500,87804,HC INFLUENZA ASSAY W/OPTIC,302,1 ,$103.50 ,$68.31 ,$16.22 ,$103.50 ,$16.86 ,$57.93 ,$57.93 ,$16.55 ,$62.10 ,$87.98 ,$72.45 ,$16.86 ,$16.86 ,$98.33 ,$78.66 ,$77.63 ,$28.14 ,$87.98 ,$16.55 ,$28.14 ,$28.14 ,$72.45 ,$63.03 ,$16.86 ,$16.55 ,$16.22 ,$33.10 ,$17.87 ,$87.98 ,$37.24 ,$95.22 ,$72.45 ,$59.93 ,$59.93 ,$63.03 ,$59.93 ,$71.52 ,$93.15 ,$70.71 ,$16.39 ,$81.77 ,$17.87 ,$19.86 ,$19.86 ,$16.22 ,$19.86 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200511,86226,HC DNA SINGLE STRAND AB,302,1 ,$132.25 ,$87.29 ,$11.87 ,$132.25 ,$12.51 ,$42.39 ,$42.39 ,$12.11 ,$79.35 ,$112.41 ,$92.58 ,$12.51 ,$12.51 ,$125.64 ,$100.51 ,$99.19 ,$20.59 ,$112.41 ,$12.11 ,$20.59 ,$20.59 ,$92.58 ,$80.54 ,$12.51 ,$12.11 ,$11.87 ,$24.22 ,$13.26 ,$112.41 ,$27.25 ,$121.67 ,$92.58 ,$60.52 ,$60.52 ,$80.54 ,$60.52 ,$91.38 ,$119.03 ,$90.35 ,$11.99 ,$104.48 ,$13.26 ,$14.53 ,$14.53 ,$11.87 ,$14.53 ,$95.22 ,$82.00 ,$95.22 ,$95.22 ,$105.80 
ST NICHOLAS HOSPITAL - ACUTE,30200513,86256,HC FLUOR AB TITER,302,1 ,$98.90 ,$65.27 ,$11.81 ,$98.90 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$59.34 ,$84.07 ,$69.23 ,$12.45 ,$12.45 ,$93.96 ,$75.16 ,$74.18 ,$20.49 ,$84.07 ,$12.05 ,$20.49 ,$20.49 ,$69.23 ,$60.23 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$84.07 ,$27.11 ,$90.99 ,$69.23 ,$60.23 ,$60.23 ,$60.23 ,$60.23 ,$68.34 ,$89.01 ,$67.57 ,$11.93 ,$78.13 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$71.21 ,$61.32 ,$71.21 ,$71.21 ,$79.12 
ST NICHOLAS HOSPITAL - ACUTE,30200540,86701,HC HIV-1 AB,302,1 ,$103.50 ,$68.31 ,$8.71 ,$103.50 ,$9.19 ,$31.12 ,$31.12 ,$8.89 ,$62.10 ,$87.98 ,$72.45 ,$9.19 ,$9.19 ,$98.33 ,$78.66 ,$77.63 ,$15.11 ,$87.98 ,$8.89 ,$15.11 ,$15.11 ,$72.45 ,$63.03 ,$9.19 ,$8.89 ,$8.71 ,$17.78 ,$9.74 ,$87.98 ,$20.00 ,$95.22 ,$72.45 ,$44.40 ,$44.40 ,$63.03 ,$44.40 ,$71.52 ,$93.15 ,$70.71 ,$8.80 ,$81.77 ,$9.74 ,$10.67 ,$10.67 ,$8.71 ,$10.67 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200541,86702,HC HIV-2 AB,302,1 ,$103.50 ,$68.31 ,$13.25 ,$103.50 ,$13.97 ,$47.32 ,$47.32 ,$13.52 ,$62.10 ,$87.98 ,$72.45 ,$13.97 ,$13.97 ,$98.33 ,$78.66 ,$77.63 ,$22.98 ,$87.98 ,$13.52 ,$22.98 ,$22.98 ,$72.45 ,$63.03 ,$13.97 ,$13.52 ,$13.25 ,$27.04 ,$14.81 ,$87.98 ,$30.42 ,$95.22 ,$72.45 ,$67.55 ,$67.55 ,$63.03 ,$67.55 ,$71.52 ,$93.15 ,$70.71 ,$13.39 ,$81.77 ,$14.81 ,$16.22 ,$16.22 ,$13.25 ,$16.22 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$100.00 ,$324.30 ,$459.43 ,$378.35 ,$90.12 ,$90.12 ,$513.48 ,$410.78 ,$405.38 ,$170.00 ,$459.43 ,$100.00 ,$170.00 ,$170.00 ,$378.35 ,$329.16 ,$90.12 ,$100.00 ,$98.00 ,$200.00 ,$95.53 ,$459.43 ,$225.00 ,$497.26 ,$378.35 ,$374.48 ,$374.48 ,$329.16 ,$374.48 ,$373.49 ,$486.45 ,$369.27 ,$98.98 ,$427.00 ,$95.53 ,$120.00 ,$120.00 ,$98.00 ,$120.00 ,$389.16 ,$335.11 ,$389.16 ,$389.16 ,$432.40 
ST NICHOLAS HOSPITAL - ACUTE,30200582,86382,HC RABIES VACCINE RESPONSE TTR,302,1 ,$180.55 ,$119.16 ,$16.57 ,$180.55 ,$17.47 ,$59.19 ,$59.19 ,$16.91 ,$108.33 ,$153.47 ,$126.39 ,$17.47 ,$17.47 ,$171.52 ,$137.22 ,$135.41 ,$28.75 ,$153.47 ,$16.91 ,$28.75 ,$28.75 ,$126.39 ,$109.96 ,$17.47 ,$16.91 ,$16.57 ,$33.82 ,$18.52 ,$153.47 ,$38.05 ,$166.11 ,$126.39 ,$84.52 ,$84.52 ,$109.96 ,$84.52 ,$124.76 ,$162.50 ,$123.35 ,$16.74 ,$142.63 ,$18.52 ,$20.29 ,$20.29 ,$16.57 ,$20.29 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30200583,86382,HC POLIOVIRUS AB NEUTRALIZATION,302,1 ,$50.60 ,$33.40 ,$16.57 ,$50.60 ,$17.47 ,$50.60 ,$50.60 ,$16.91 ,$30.36 ,$43.01 ,$35.42 ,$17.47 ,$17.47 ,$48.07 ,$38.46 ,$37.95 ,$28.75 ,$43.01 ,$16.91 ,$28.75 ,$28.75 ,$35.42 ,$30.82 ,$17.47 ,$16.91 ,$16.57 ,$33.82 ,$18.52 ,$43.01 ,$38.05 ,$46.55 ,$35.42 ,$50.60 ,$50.60 ,$30.82 ,$50.60 ,$34.96 ,$45.54 ,$34.57 ,$16.74 ,$39.97 ,$18.52 ,$20.29 ,$20.29 ,$16.57 ,$20.29 ,$36.43 ,$31.37 ,$36.43 ,$36.43 ,$40.48 
ST NICHOLAS HOSPITAL - ACUTE,30200584,86658,HC ENTEROVIRUS PANEL CF SERUM,302,1 ,$167.90 ,$110.81 ,$8.17 ,$167.90 ,$8.17 ,$45.61 ,$45.61 ,$13.03 ,$100.74 ,$142.72 ,$117.53 ,$8.17 ,$8.17 ,$159.51 ,$127.60 ,$125.93 ,$22.15 ,$142.72 ,$13.03 ,$22.15 ,$22.15 ,$117.53 ,$102.25 ,$8.17 ,$13.03 ,$12.77 ,$26.06 ,$8.66 ,$142.72 ,$29.32 ,$154.47 ,$117.53 ,$29.05 ,$29.05 ,$102.25 ,$29.05 ,$116.02 ,$151.11 ,$114.71 ,$12.90 ,$132.64 ,$8.66 ,$15.64 ,$15.64 ,$12.77 ,$15.64 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30200585,86800,HC THYROGLOBULIN AB CANCER MONITORING,302,1 ,$57.50 ,$37.95 ,$15.59 ,$57.50 ,$16.44 ,$55.69 ,$55.69 ,$15.91 ,$34.50 ,$48.88 ,$40.25 ,$16.44 ,$16.44 ,$54.63 ,$43.70 ,$43.13 ,$27.05 ,$48.88 ,$15.91 ,$27.05 ,$27.05 ,$40.25 ,$35.02 ,$16.44 ,$15.91 ,$15.59 ,$31.82 ,$17.43 ,$48.88 ,$35.80 ,$52.90 ,$40.25 ,$57.50 ,$57.50 ,$35.02 ,$57.50 ,$39.73 ,$51.75 ,$39.28 ,$15.75 ,$45.43 ,$17.43 ,$19.09 ,$19.09 ,$15.59 ,$19.09 ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,30200586,86790,HC VIRUS AB DENGUE FEVER IGG/IGMA,302,1 ,$128.80 ,$85.01 ,$0.34 ,$128.80 ,$0.34 ,$45.08 ,$45.08 ,$12.88 ,$77.28 ,$109.48 ,$90.16 ,$0.34 ,$0.34 ,$122.36 ,$97.89 ,$96.60 ,$21.90 ,$109.48 ,$12.88 ,$21.90 ,$21.90 ,$90.16 ,$78.44 ,$0.34 ,$12.88 ,$12.62 ,$25.76 ,$0.36 ,$109.48 ,$28.98 ,$118.50 ,$90.16 ,$29.05 ,$29.05 ,$78.44 ,$29.05 ,$89.00 ,$115.92 ,$88.00 ,$12.75 ,$101.75 ,$0.36 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200587,86753,HC PROTOZOA AB ENTAMOEBA HISTOLYTICA IGG,302,1 ,$109.25 ,$72.11 ,$8.17 ,$109.25 ,$8.17 ,$43.37 ,$43.37 ,$12.39 ,$65.55 ,$92.86 ,$76.48 ,$8.17 ,$8.17 ,$103.79 ,$83.03 ,$81.94 ,$21.06 ,$92.86 ,$12.39 ,$21.06 ,$21.06 ,$76.48 ,$66.53 ,$8.17 ,$12.39 ,$12.14 ,$24.78 ,$8.66 ,$92.86 ,$27.88 ,$100.51 ,$76.48 ,$29.05 ,$29.05 ,$66.53 ,$29.05 ,$75.49 ,$98.33 ,$74.64 ,$12.26 ,$86.31 ,$8.66 ,$14.87 ,$14.87 ,$12.14 ,$14.87 ,$78.66 ,$67.74 ,$78.66 ,$78.66 ,$87.40 
ST NICHOLAS HOSPITAL - ACUTE,30200822,86705,HC HEP B CORE IGM,302,1 ,$193.20 ,$127.51 ,$11.53 ,$193.20 ,$12.16 ,$41.20 ,$41.20 ,$11.77 ,$115.92 ,$164.22 ,$135.24 ,$12.16 ,$12.16 ,$183.54 ,$146.83 ,$144.90 ,$20.01 ,$164.22 ,$11.77 ,$20.01 ,$20.01 ,$135.24 ,$117.66 ,$12.16 ,$11.77 ,$11.53 ,$23.54 ,$12.89 ,$164.22 ,$26.48 ,$177.74 ,$135.24 ,$58.87 ,$58.87 ,$117.66 ,$58.87 ,$133.50 ,$173.88 ,$131.99 ,$11.65 ,$152.63 ,$12.89 ,$14.12 ,$14.12 ,$11.53 ,$14.12 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30200824,86644,HC CMV AB,302,1 ,$128.80 ,$85.01 ,$14.10 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$14.39 ,$77.28 ,$109.48 ,$90.16 ,$14.87 ,$14.87 ,$122.36 ,$97.89 ,$96.60 ,$24.46 ,$109.48 ,$14.39 ,$24.46 ,$24.46 ,$90.16 ,$78.44 ,$14.87 ,$14.39 ,$14.10 ,$28.78 ,$15.76 ,$109.48 ,$32.38 ,$118.50 ,$90.16 ,$71.95 ,$71.95 ,$78.44 ,$71.95 ,$89.00 ,$115.92 ,$88.00 ,$14.24 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$14.10 ,$17.27 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30200825,86671,HC FUNGUS AB NOS 2-REF,302,1 ,$59.80 ,$39.47 ,$7.15 ,$59.80 ,$7.15 ,$42.88 ,$42.88 ,$12.25 ,$35.88 ,$50.83 ,$41.86 ,$7.15 ,$7.15 ,$56.81 ,$45.45 ,$44.85 ,$20.83 ,$50.83 ,$12.25 ,$20.83 ,$20.83 ,$41.86 ,$36.42 ,$7.15 ,$12.25 ,$12.00 ,$24.50 ,$7.58 ,$50.83 ,$27.56 ,$55.02 ,$41.86 ,$25.42 ,$25.42 ,$36.42 ,$25.42 ,$41.32 ,$53.82 ,$40.86 ,$12.12 ,$47.24 ,$7.58 ,$14.70 ,$14.70 ,$12.00 ,$14.70 ,$43.06 ,$37.08 ,$43.06 ,$43.06 ,$47.84 
ST NICHOLAS HOSPITAL - ACUTE,30200826,86735,HC MUMPS AB (DIAG),302,1 ,$77.05 ,$50.85 ,$12.79 ,$77.05 ,$13.48 ,$45.68 ,$45.68 ,$13.05 ,$46.23 ,$65.49 ,$53.94 ,$13.48 ,$13.48 ,$73.20 ,$58.56 ,$57.79 ,$22.19 ,$65.49 ,$13.05 ,$22.19 ,$22.19 ,$53.94 ,$46.92 ,$13.48 ,$13.05 ,$12.79 ,$26.10 ,$14.29 ,$65.49 ,$29.36 ,$70.89 ,$53.94 ,$65.21 ,$65.21 ,$46.92 ,$65.21 ,$53.24 ,$69.35 ,$52.64 ,$12.92 ,$60.87 ,$14.29 ,$15.66 ,$15.66 ,$12.79 ,$15.66 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30200830,87801,HC INFECT MLT  ORG AMP,302,1 ,$618.70 ,$408.34 ,$50.62 ,$618.70 ,$50.62 ,$245.70 ,$245.70 ,$70.20 ,$371.22 ,$525.90 ,$433.09 ,$50.62 ,$50.62 ,$587.77 ,$470.21 ,$464.03 ,$119.34 ,$525.90 ,$70.20 ,$119.34 ,$119.34 ,$433.09 ,$376.79 ,$50.62 ,$70.20 ,$68.80 ,$140.40 ,$53.66 ,$525.90 ,$157.95 ,$569.20 ,$433.09 ,$350.82 ,$350.82 ,$376.79 ,$350.82 ,$427.52 ,$556.83 ,$422.70 ,$69.48 ,$488.77 ,$53.66 ,$84.24 ,$84.24 ,$68.80 ,$84.24 ,$445.46 ,$383.59 ,$445.46 ,$445.46 ,$494.96 
ST NICHOLAS HOSPITAL - ACUTE,30200831,86832,HC HLA HIGH DEFINITION QL PANEL,302,1 ,$937.25 ,$618.59 ,$139.23 ,$937.25 ,$139.23 ,$937.25 ,$937.25 ,$323.75 ,$562.35 ,$796.66 ,$656.08 ,$139.23 ,$139.23 ,$890.39 ,$712.31 ,$702.94 ,$550.38 ,$796.66 ,$323.75 ,$550.38 ,$550.38 ,$656.08 ,$570.79 ,$139.23 ,$323.75 ,$317.27 ,$647.50 ,$147.58 ,$796.66 ,$728.44 ,$862.27 ,$656.08 ,$634.12 ,$634.12 ,$570.79 ,$634.12 ,$647.64 ,$843.53 ,$640.33 ,$320.45 ,$740.43 ,$147.58 ,$388.50 ,$388.50 ,$317.27 ,$388.50 ,$674.82 ,$581.10 ,$674.82 ,$674.82 ,$749.80 
ST NICHOLAS HOSPITAL - ACUTE,30200832,86611,HC BARTONELLA TITER,302,1 ,$72.45 ,$47.82 ,$8.17 ,$72.45 ,$8.17 ,$35.63 ,$35.63 ,$10.18 ,$43.47 ,$61.58 ,$50.72 ,$8.17 ,$8.17 ,$68.83 ,$55.06 ,$54.34 ,$17.31 ,$61.58 ,$10.18 ,$17.31 ,$17.31 ,$50.72 ,$44.12 ,$8.17 ,$10.18 ,$9.98 ,$20.36 ,$8.66 ,$61.58 ,$22.91 ,$66.65 ,$50.72 ,$29.05 ,$29.05 ,$44.12 ,$29.05 ,$50.06 ,$65.21 ,$49.50 ,$10.07 ,$57.24 ,$8.66 ,$12.22 ,$12.22 ,$9.98 ,$12.22 ,$52.16 ,$44.92 ,$52.16 ,$52.16 ,$57.96 
ST NICHOLAS HOSPITAL - ACUTE,30200833,86406,HC STREPTOZYME TITER,302,1 ,$88.55 ,$58.44 ,$9.85 ,$88.55 ,$9.85 ,$37.24 ,$37.24 ,$10.64 ,$53.13 ,$75.27 ,$61.99 ,$9.85 ,$9.85 ,$84.12 ,$67.30 ,$66.41 ,$18.09 ,$75.27 ,$10.64 ,$18.09 ,$18.09 ,$61.99 ,$53.93 ,$9.85 ,$10.64 ,$10.43 ,$21.28 ,$10.44 ,$75.27 ,$23.94 ,$81.47 ,$61.99 ,$34.99 ,$34.99 ,$53.93 ,$34.99 ,$61.19 ,$79.70 ,$60.50 ,$10.53 ,$69.95 ,$10.44 ,$12.77 ,$12.77 ,$10.43 ,$12.77 ,$63.76 ,$54.90 ,$63.76 ,$63.76 ,$70.84 
ST NICHOLAS HOSPITAL - ACUTE,30200834,86648,HC DIPTHERIA,302,1 ,$103.50 ,$68.31 ,$8.17 ,$103.50 ,$8.17 ,$53.24 ,$53.24 ,$15.21 ,$62.10 ,$87.98 ,$72.45 ,$8.17 ,$8.17 ,$98.33 ,$78.66 ,$77.63 ,$25.86 ,$87.98 ,$15.21 ,$25.86 ,$25.86 ,$72.45 ,$63.03 ,$8.17 ,$15.21 ,$14.91 ,$30.42 ,$8.66 ,$87.98 ,$34.22 ,$95.22 ,$72.45 ,$29.05 ,$29.05 ,$63.03 ,$29.05 ,$71.52 ,$93.15 ,$70.71 ,$15.05 ,$81.77 ,$8.66 ,$18.25 ,$18.25 ,$14.91 ,$18.25 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30200835,86790,HC HANTAVIRUS (SIN NOMBRE) ELISA,302,1 ,$78.20 ,$51.61 ,$0.34 ,$78.20 ,$0.34 ,$45.08 ,$45.08 ,$12.88 ,$46.92 ,$66.47 ,$54.74 ,$0.34 ,$0.34 ,$74.29 ,$59.43 ,$58.65 ,$21.90 ,$66.47 ,$12.88 ,$21.90 ,$21.90 ,$54.74 ,$47.62 ,$0.34 ,$12.88 ,$12.62 ,$25.76 ,$0.36 ,$66.47 ,$28.98 ,$71.94 ,$54.74 ,$29.05 ,$29.05 ,$47.62 ,$29.05 ,$54.04 ,$70.38 ,$53.43 ,$12.75 ,$61.78 ,$0.36 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$56.30 ,$48.48 ,$56.30 ,$56.30 ,$62.56 
ST NICHOLAS HOSPITAL - ACUTE,30200836,86790,HC HANTAVIRUS (SIN NOMBRE) IGG,302,1 ,$138.00 ,$91.08 ,$0.34 ,$138.00 ,$0.34 ,$45.08 ,$45.08 ,$12.88 ,$82.80 ,$117.30 ,$96.60 ,$0.34 ,$0.34 ,$131.10 ,$104.88 ,$103.50 ,$21.90 ,$117.30 ,$12.88 ,$21.90 ,$21.90 ,$96.60 ,$84.04 ,$0.34 ,$12.88 ,$12.62 ,$25.76 ,$0.36 ,$117.30 ,$28.98 ,$126.96 ,$96.60 ,$29.05 ,$29.05 ,$84.04 ,$29.05 ,$95.36 ,$124.20 ,$94.28 ,$12.75 ,$109.02 ,$0.36 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$99.36 ,$85.56 ,$99.36 ,$99.36 ,$110.40 
ST NICHOLAS HOSPITAL - ACUTE,30200837,86790,HC HANTAVIRUS (SIN NOMBRE) IGM,302,1 ,$78.20 ,$51.61 ,$0.34 ,$78.20 ,$0.34 ,$45.08 ,$45.08 ,$12.88 ,$46.92 ,$66.47 ,$54.74 ,$0.34 ,$0.34 ,$74.29 ,$59.43 ,$58.65 ,$21.90 ,$66.47 ,$12.88 ,$21.90 ,$21.90 ,$54.74 ,$47.62 ,$0.34 ,$12.88 ,$12.62 ,$25.76 ,$0.36 ,$66.47 ,$28.98 ,$71.94 ,$54.74 ,$29.05 ,$29.05 ,$47.62 ,$29.05 ,$54.04 ,$70.38 ,$53.43 ,$12.75 ,$61.78 ,$0.36 ,$15.46 ,$15.46 ,$12.62 ,$15.46 ,$56.30 ,$48.48 ,$56.30 ,$56.30 ,$62.56 
ST NICHOLAS HOSPITAL - ACUTE,30200841,86671,HC FUNGUS AB SACC CEREVISIAE,302,1 ,$169.05 ,$111.57 ,$7.15 ,$169.05 ,$7.15 ,$42.88 ,$42.88 ,$12.25 ,$101.43 ,$143.69 ,$118.34 ,$7.15 ,$7.15 ,$160.60 ,$128.48 ,$126.79 ,$20.83 ,$143.69 ,$12.25 ,$20.83 ,$20.83 ,$118.34 ,$102.95 ,$7.15 ,$12.25 ,$12.00 ,$24.50 ,$7.58 ,$143.69 ,$27.56 ,$155.53 ,$118.34 ,$25.42 ,$25.42 ,$102.95 ,$25.42 ,$116.81 ,$152.15 ,$115.50 ,$12.12 ,$133.55 ,$7.58 ,$14.70 ,$14.70 ,$12.00 ,$14.70 ,$121.72 ,$104.81 ,$121.72 ,$121.72 ,$135.24 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$16.89 ,"$1,236.48 ","$1,751.68 ","$1,442.56 ",$15.79 ,$15.79 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ",$28.71 ,"$1,751.68 ",$16.89 ,$28.71 ,$28.71 ,"$1,442.56 ","$1,255.03 ",$15.79 ,$16.89 ,$16.55 ,$33.78 ,$16.74 ,"$1,751.68 ",$38.00 ,"$1,895.94 ","$1,442.56 ",$71.95 ,$71.95 ,"$1,255.03 ",$71.95 ,"$1,424.01 ","$1,854.72 ","$1,407.94 ",$16.72 ,"$1,628.03 ",$16.74 ,$20.27 ,$20.27 ,$16.55 ,$20.27 ,"$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,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 ,$16.89 ,$484.38 ,$686.21 ,$565.11 ,$15.79 ,$15.79 ,$766.94 ,$613.55 ,$605.48 ,$28.71 ,$686.21 ,$16.89 ,$28.71 ,$28.71 ,$565.11 ,$491.65 ,$15.79 ,$16.89 ,$16.55 ,$33.78 ,$16.74 ,$686.21 ,$38.00 ,$742.72 ,$565.11 ,$71.95 ,$71.95 ,$491.65 ,$71.95 ,$557.84 ,$726.57 ,$551.55 ,$16.72 ,$637.77 ,$16.74 ,$20.27 ,$20.27 ,$16.55 ,$20.27 ,$581.26 ,$500.53 ,$581.26 ,$581.26 ,$645.84 
ST NICHOLAS HOSPITAL - ACUTE,30201080,G0472,HC HEPATITIS C SCREEN HIGH RISK,302,1 ,$124.20 ,$81.97 ,$1.13 ,$124.20 ,$1.13 ,$124.20 ,$124.20 ,$46.35 ,$74.52 ,$105.57 ,$86.94 ,$1.13 ,$1.13 ,$117.99 ,$94.39 ,$93.15 ,$78.80 ,$105.57 ,$46.35 ,$78.80 ,$78.80 ,$86.94 ,$75.64 ,$1.13 ,$46.35 ,$45.42 ,$92.70 ,$1.20 ,$105.57 ,$104.29 ,$114.26 ,$86.94 ,$71.22 ,$71.22 ,$75.64 ,$71.22 ,$85.82 ,$111.78 ,$84.85 ,$45.87 ,$98.12 ,$1.20 ,$55.62 ,$55.62 ,$45.42 ,$55.62 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,30201081,86695,HC HERPES SIMPLEX IGM I,302,1 ,$116.15 ,$76.66 ,$12.93 ,$116.15 ,$13.63 ,$46.17 ,$46.17 ,$13.19 ,$69.69 ,$98.73 ,$81.31 ,$13.63 ,$13.63 ,$110.34 ,$88.27 ,$87.11 ,$22.42 ,$98.73 ,$13.19 ,$22.42 ,$22.42 ,$81.31 ,$70.74 ,$13.63 ,$13.19 ,$12.93 ,$26.38 ,$14.45 ,$98.73 ,$29.68 ,$106.86 ,$81.31 ,$65.94 ,$65.94 ,$70.74 ,$65.94 ,$80.26 ,$104.54 ,$79.35 ,$13.05 ,$91.76 ,$14.45 ,$15.83 ,$15.83 ,$12.93 ,$15.83 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30201082,86696,HC HERPES SIMPLEX IGM II,302,1 ,$167.90 ,$110.81 ,$18.96 ,$167.90 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$100.74 ,$142.72 ,$117.53 ,$19.99 ,$19.99 ,$159.51 ,$127.60 ,$125.93 ,$32.90 ,$142.72 ,$19.35 ,$32.90 ,$32.90 ,$117.53 ,$102.25 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$142.72 ,$43.54 ,$154.47 ,$117.53 ,$96.72 ,$96.72 ,$102.25 ,$96.72 ,$116.02 ,$151.11 ,$114.71 ,$19.15 ,$132.64 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30201084,86008,HC ALLERGEN IGE QN/SEMI-QN RECOMB/COMP EA,302,1 ,$42.55 ,$28.08 ,$17.57 ,$42.55 ,$17.71 ,$42.55 ,$42.55 ,$17.93 ,$25.53 ,$36.17 ,$29.79 ,$17.71 ,$17.71 ,$40.42 ,$32.34 ,$31.91 ,$30.48 ,$36.17 ,$17.93 ,$30.48 ,$30.48 ,$29.79 ,$25.91 ,$17.71 ,$17.93 ,$17.57 ,$35.86 ,$18.77 ,$36.17 ,$40.34 ,$39.15 ,$29.79 ,$42.55 ,$42.55 ,$25.91 ,$42.55 ,$29.40 ,$38.30 ,$29.07 ,$17.75 ,$33.61 ,$18.77 ,$21.52 ,$21.52 ,$17.57 ,$21.52 ,$30.64 ,$26.38 ,$30.64 ,$30.64 ,$34.04 
ST NICHOLAS HOSPITAL - ACUTE,30201085,86481,HC TSPOT TB AG RESPONSE GAMMA INTER T-CELL SUSP,302,1 ,$334.65 ,$220.87 ,$90.12 ,$334.65 ,$90.12 ,$334.65 ,$334.65 ,$100.00 ,$200.79 ,$284.45 ,$234.26 ,$90.12 ,$90.12 ,$317.92 ,$254.33 ,$250.99 ,$170.00 ,$284.45 ,$100.00 ,$170.00 ,$170.00 ,$234.26 ,$203.80 ,$90.12 ,$100.00 ,$98.00 ,$200.00 ,$95.53 ,$284.45 ,$225.00 ,$307.88 ,$234.26 ,$334.65 ,$334.65 ,$203.80 ,$334.65 ,$231.24 ,$301.19 ,$228.63 ,$98.98 ,$264.37 ,$95.53 ,$120.00 ,$120.00 ,$98.00 ,$120.00 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30201087,86317,HC INFECTIOUS STREPTOCOCCUS PNEUMONIAE EA AB,302,1 ,$103.50 ,$68.31 ,$14.69 ,$103.50 ,$15.49 ,$52.47 ,$52.47 ,$14.99 ,$62.10 ,$87.98 ,$72.45 ,$15.49 ,$15.49 ,$98.33 ,$78.66 ,$77.63 ,$25.48 ,$87.98 ,$14.99 ,$25.48 ,$25.48 ,$72.45 ,$63.03 ,$15.49 ,$14.99 ,$14.69 ,$29.98 ,$16.42 ,$87.98 ,$33.73 ,$95.22 ,$72.45 ,$74.92 ,$74.92 ,$63.03 ,$74.92 ,$71.52 ,$93.15 ,$70.71 ,$14.84 ,$81.77 ,$16.42 ,$17.99 ,$17.99 ,$14.69 ,$17.99 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30201090,86780,HC TREPONEMA P AB SCREEN,302,1 ,$49.45 ,$32.64 ,$11.13 ,$49.45 ,$11.13 ,$46.34 ,$46.34 ,$13.24 ,$29.67 ,$42.03 ,$34.62 ,$11.13 ,$11.13 ,$46.98 ,$37.58 ,$37.09 ,$22.51 ,$42.03 ,$13.24 ,$22.51 ,$22.51 ,$34.62 ,$30.12 ,$11.13 ,$13.24 ,$12.98 ,$26.48 ,$11.80 ,$42.03 ,$29.79 ,$45.49 ,$34.62 ,$39.57 ,$39.57 ,$30.12 ,$39.57 ,$34.17 ,$44.51 ,$33.78 ,$13.10 ,$39.07 ,$11.80 ,$15.89 ,$15.89 ,$12.98 ,$15.89 ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,30201158,86255,HC FLUOR AB SCR CYTOP/NEURONAL AB,302,1 ,$161.00 ,$106.26 ,$11.81 ,$161.00 ,$12.45 ,$42.18 ,$42.18 ,$12.05 ,$96.60 ,$136.85 ,$112.70 ,$12.45 ,$12.45 ,$152.95 ,$122.36 ,$120.75 ,$20.49 ,$136.85 ,$12.05 ,$20.49 ,$20.49 ,$112.70 ,$98.05 ,$12.45 ,$12.05 ,$11.81 ,$24.10 ,$13.20 ,$136.85 ,$27.11 ,$148.12 ,$112.70 ,$60.23 ,$60.23 ,$98.05 ,$60.23 ,$111.25 ,$144.90 ,$110.00 ,$11.93 ,$127.19 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$115.92 ,$99.82 ,$115.92 ,$115.92 ,$128.80 
ST NICHOLAS HOSPITAL - ACUTE,30201159,87801,HC INFECT MLT ORG AMP BRD RAGNE BACT PCR,302,1 ,$618.70 ,$408.34 ,$50.62 ,$618.70 ,$50.62 ,$245.70 ,$245.70 ,$70.20 ,$371.22 ,$525.90 ,$433.09 ,$50.62 ,$50.62 ,$587.77 ,$470.21 ,$464.03 ,$119.34 ,$525.90 ,$70.20 ,$119.34 ,$119.34 ,$433.09 ,$376.79 ,$50.62 ,$70.20 ,$68.80 ,$140.40 ,$53.66 ,$525.90 ,$157.95 ,$569.20 ,$433.09 ,$350.82 ,$350.82 ,$376.79 ,$350.82 ,$427.52 ,$556.83 ,$422.70 ,$69.48 ,$488.77 ,$53.66 ,$84.24 ,$84.24 ,$68.80 ,$84.24 ,$445.46 ,$383.59 ,$445.46 ,$445.46 ,$494.96 
ST NICHOLAS HOSPITAL - ACUTE,30201182,86255,HC FLUOR AB SCR (CRITHIDIA TITER W/REFLEX)-REF,302,1 ,$20.70 ,$13.66 ,$11.81 ,$27.11 ,$12.45 ,$20.70 ,$20.70 ,$12.05 ,$12.42 ,$17.60 ,$14.49 ,$12.45 ,$12.45 ,$19.67 ,$15.73 ,$15.53 ,$20.49 ,$17.60 ,$12.05 ,$20.49 ,$20.49 ,$14.49 ,$12.61 ,$12.45 ,$12.05 ,$11.81 ,$20.70 ,$13.20 ,$17.60 ,$27.11 ,$19.04 ,$14.49 ,$20.70 ,$20.70 ,$12.61 ,$20.70 ,$14.30 ,$18.63 ,$14.14 ,$11.93 ,$16.35 ,$13.20 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$14.90 ,$12.83 ,$14.90 ,$14.90 ,$16.56 
ST NICHOLAS HOSPITAL - ACUTE,30201183,86015,HC ACTIN SMOOTH MUSCLE ANTIBODY EACH-REF,302,1 ,$76.03 ,$50.18 ,$11.81 ,$76.03 ,$11.91 ,$40.36 ,$40.36 ,$12.05 ,$45.62 ,$64.63 ,$53.22 ,$11.91 ,$11.91 ,$72.23 ,$57.78 ,$57.02 ,$20.49 ,$64.63 ,$12.05 ,$20.49 ,$20.49 ,$53.22 ,$46.30 ,$11.91 ,$12.05 ,$11.81 ,$24.10 ,$12.62 ,$64.63 ,$27.11 ,$69.95 ,$53.22 ,$38.56 ,$46.28 ,$46.30 ,$46.28 ,$52.54 ,$68.43 ,$51.94 ,$11.93 ,$60.06 ,$12.62 ,$13.84 ,$13.84 ,$11.81 ,$13.84 ,$54.74 ,$47.14 ,$54.74 ,$54.74 ,$60.82 
ST NICHOLAS HOSPITAL - ACUTE,30201198,86258,HC GLIADIN AB IGG IGA,302,1 ,$36.32 ,$23.97 ,$11.81 ,$36.32 ,$11.91 ,$36.32 ,$36.32 ,$12.05 ,$21.79 ,$30.87 ,$25.42 ,$11.91 ,$11.91 ,$34.50 ,$27.60 ,$27.24 ,$20.49 ,$30.87 ,$12.05 ,$20.49 ,$20.49 ,$25.42 ,$22.12 ,$11.91 ,$12.05 ,$11.81 ,$24.10 ,$12.62 ,$30.87 ,$27.11 ,$33.41 ,$25.42 ,$18.42 ,$22.11 ,$22.12 ,$22.11 ,$25.10 ,$32.69 ,$24.81 ,$11.93 ,$28.69 ,$12.62 ,$13.84 ,$13.84 ,$11.81 ,$13.84 ,$26.15 ,$22.52 ,$26.15 ,$26.15 ,$29.06 
ST NICHOLAS HOSPITAL - ACUTE,30201226,86364,HC TISS TRNSGLTMNASE EA IG CLAS,302,1 ,$36.32 ,$23.97 ,$11.30 ,$36.32 ,$11.91 ,$36.32 ,$36.32 ,$11.53 ,$21.79 ,$30.87 ,$25.42 ,$11.91 ,$11.91 ,$34.50 ,$27.60 ,$27.24 ,$19.60 ,$30.87 ,$11.53 ,$19.60 ,$19.60 ,$25.42 ,$22.12 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$30.87 ,$25.94 ,$33.41 ,$25.42 ,$18.42 ,$22.11 ,$22.12 ,$22.11 ,$25.10 ,$32.69 ,$24.81 ,$11.42 ,$28.69 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$26.15 ,$22.52 ,$26.15 ,$26.15 ,$29.06 
ST NICHOLAS HOSPITAL - ACUTE,30201227,86231,HC EMA EACH IG CLASS,302,1 ,$38.08 ,$25.13 ,$11.85 ,$38.08 ,$12.05 ,$38.08 ,$38.08 ,$12.09 ,$22.85 ,$32.37 ,$26.66 ,$12.05 ,$12.05 ,$36.18 ,$28.94 ,$28.56 ,$20.55 ,$32.37 ,$12.09 ,$20.55 ,$20.55 ,$26.66 ,$23.19 ,$12.05 ,$12.09 ,$11.85 ,$24.18 ,$12.77 ,$32.37 ,$27.20 ,$35.03 ,$26.66 ,$19.31 ,$23.18 ,$23.19 ,$23.18 ,$26.31 ,$34.27 ,$26.02 ,$11.97 ,$30.08 ,$12.77 ,$14.51 ,$14.51 ,$11.85 ,$14.51 ,$27.42 ,$23.61 ,$27.42 ,$27.42 ,$30.46 
ST NICHOLAS HOSPITAL - ACUTE,30201236,86596,HC VOLTAGE GTG CALC CHNL- REF,302,1 ,$57.75 ,$38.12 ,$11.81 ,$57.75 ,$12.05 ,$57.75 ,$57.75 ,$12.05 ,$34.65 ,$49.09 ,$40.43 ,$12.05 ,$12.05 ,$54.86 ,$43.89 ,$43.31 ,$20.49 ,$49.09 ,$12.05 ,$20.49 ,$20.49 ,$40.43 ,$35.17 ,$12.05 ,$12.05 ,$11.81 ,$24.10 ,$12.77 ,$49.09 ,$27.11 ,$53.13 ,$40.43 ,$29.29 ,$35.15 ,$35.17 ,$35.15 ,$39.91 ,$51.98 ,$39.45 ,$11.93 ,$45.62 ,$12.77 ,$22.08 ,$22.08 ,$11.81 ,$22.08 ,$41.58 ,$35.81 ,$41.58 ,$41.58 ,$46.20 
ST NICHOLAS HOSPITAL - ACUTE,30201239,86596,HC VOLTAGE-GTD CA CHNL ANTB EA-REF,302,1 ,$283.50 ,$187.11 ,$11.81 ,$283.50 ,$12.05 ,$64.40 ,$64.40 ,$12.05 ,$170.10 ,$240.98 ,$198.45 ,$12.05 ,$12.05 ,$269.33 ,$215.46 ,$212.63 ,$20.49 ,$240.98 ,$12.05 ,$20.49 ,$20.49 ,$198.45 ,$172.65 ,$12.05 ,$12.05 ,$11.81 ,$24.10 ,$12.77 ,$240.98 ,$27.11 ,$260.82 ,$198.45 ,$143.79 ,$172.57 ,$172.65 ,$172.57 ,$195.90 ,$255.15 ,$193.69 ,$11.93 ,$223.97 ,$12.77 ,$22.08 ,$22.08 ,$11.81 ,$22.08 ,$204.12 ,$175.77 ,$204.12 ,$204.12 ,$226.80 
ST NICHOLAS HOSPITAL - ACUTE,30201243,86317,HC INFECTIOUS AB QN,302,1 ,$128.80 ,$85.01 ,$14.69 ,$128.80 ,$15.49 ,$52.47 ,$52.47 ,$14.99 ,$77.28 ,$109.48 ,$90.16 ,$15.49 ,$15.49 ,$122.36 ,$97.89 ,$96.60 ,$25.48 ,$109.48 ,$14.99 ,$25.48 ,$25.48 ,$90.16 ,$78.44 ,$15.49 ,$14.99 ,$14.69 ,$29.98 ,$16.42 ,$109.48 ,$33.73 ,$118.50 ,$90.16 ,$74.92 ,$74.92 ,$78.44 ,$74.92 ,$89.00 ,$115.92 ,$88.00 ,$14.84 ,$101.75 ,$16.42 ,$17.99 ,$17.99 ,$14.69 ,$17.99 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30201244,86052,HC AQUAPORIN 4,302,1 ,$385.00 ,$254.10 ,$11.81 ,$385.00 ,$12.05 ,$42.18 ,$42.18 ,$12.05 ,$231.00 ,$327.25 ,$269.50 ,$12.05 ,$12.05 ,$365.75 ,$292.60 ,$288.75 ,$20.49 ,$327.25 ,$12.05 ,$20.49 ,$20.49 ,$269.50 ,$234.47 ,$12.05 ,$12.05 ,$11.81 ,$24.10 ,$12.77 ,$327.25 ,$27.11 ,$354.20 ,$269.50 ,$195.27 ,$234.35 ,$234.47 ,$234.35 ,$266.04 ,$346.50 ,$263.03 ,$11.93 ,$304.15 ,$12.77 ,$14.46 ,$14.46 ,$11.81 ,$14.46 ,$277.20 ,$238.70 ,$277.20 ,$277.20 ,$308.00 
ST NICHOLAS HOSPITAL - ACUTE,30201247,86231,HC EMA EACH IG CLASS,302,1 ,$38.08 ,$25.13 ,$11.85 ,$38.08 ,$12.05 ,$38.08 ,$38.08 ,$12.09 ,$22.85 ,$32.37 ,$26.66 ,$12.05 ,$12.05 ,$36.18 ,$28.94 ,$28.56 ,$20.55 ,$32.37 ,$12.09 ,$20.55 ,$20.55 ,$26.66 ,$23.19 ,$12.05 ,$12.09 ,$11.85 ,$24.18 ,$12.77 ,$32.37 ,$27.20 ,$35.03 ,$26.66 ,$19.31 ,$23.18 ,$23.19 ,$23.18 ,$26.31 ,$34.27 ,$26.02 ,$11.97 ,$30.08 ,$12.77 ,$14.51 ,$14.51 ,$11.85 ,$14.51 ,$27.42 ,$23.61 ,$27.42 ,$27.42 ,$30.46 
ST NICHOLAS HOSPITAL - ACUTE,30201248,86364,HC TISS TRNSGLTMNASE EA IG CLAS,302,1 ,$36.32 ,$23.97 ,$11.30 ,$36.32 ,$11.91 ,$36.32 ,$36.32 ,$11.53 ,$21.79 ,$30.87 ,$25.42 ,$11.91 ,$11.91 ,$34.50 ,$27.60 ,$27.24 ,$19.60 ,$30.87 ,$11.53 ,$19.60 ,$19.60 ,$25.42 ,$22.12 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$30.87 ,$25.94 ,$33.41 ,$25.42 ,$18.42 ,$22.11 ,$22.12 ,$22.11 ,$25.10 ,$32.69 ,$24.81 ,$11.42 ,$28.69 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$26.15 ,$22.52 ,$26.15 ,$26.15 ,$29.06 
ST NICHOLAS HOSPITAL - ACUTE,30201249,86593,HC SYPHILIS VDRL RPR QN,302,1 ,$54.05 ,$35.67 ,$4.31 ,$54.05 ,$4.55 ,$15.40 ,$15.40 ,$4.40 ,$32.43 ,$45.94 ,$37.84 ,$4.55 ,$4.55 ,$51.35 ,$41.08 ,$40.54 ,$7.48 ,$45.94 ,$4.40 ,$7.48 ,$7.48 ,$37.84 ,$32.92 ,$4.55 ,$4.40 ,$4.31 ,$8.80 ,$4.82 ,$45.94 ,$9.90 ,$49.73 ,$37.84 ,$21.98 ,$21.98 ,$32.92 ,$21.98 ,$37.35 ,$48.65 ,$36.93 ,$4.35 ,$42.70 ,$4.82 ,$5.28 ,$5.28 ,$4.31 ,$5.28 ,$38.92 ,$33.51 ,$38.92 ,$38.92 ,$43.24 
ST NICHOLAS HOSPITAL - ACUTE,30240102,86003,HC ALLERGEN IGE QN EA-REF,302,1 ,$11.62 ,$7.67 ,$4.57 ,$11.75 ,$4.57 ,$11.62 ,$11.62 ,$5.22 ,$6.97 ,$9.88 ,$8.13 ,$4.57 ,$4.57 ,$11.04 ,$8.83 ,$8.72 ,$8.87 ,$9.88 ,$5.22 ,$8.87 ,$8.87 ,$8.13 ,$7.08 ,$4.57 ,$5.22 ,$5.12 ,$10.44 ,$4.84 ,$9.88 ,$11.75 ,$10.69 ,$8.13 ,$11.62 ,$11.62 ,$7.08 ,$11.62 ,$8.03 ,$10.46 ,$7.94 ,$5.16 ,$9.18 ,$4.84 ,$6.26 ,$6.26 ,$5.12 ,$6.26 ,$8.37 ,$7.20 ,$8.37 ,$8.37 ,$9.30 
ST NICHOLAS HOSPITAL - ACUTE,30240129,86157,HC COLD AGGLUTININ TITER-REF,302,1 ,$11.50 ,$7.59 ,$6.90 ,$18.14 ,$8.17 ,$11.50 ,$11.50 ,$8.06 ,$6.90 ,$9.78 ,$8.05 ,$8.17 ,$8.17 ,$10.93 ,$8.74 ,$8.63 ,$11.50 ,$9.78 ,$8.06 ,$11.50 ,$11.50 ,$8.05 ,$7.00 ,$8.17 ,$8.06 ,$7.90 ,$11.50 ,$8.66 ,$9.78 ,$18.14 ,$10.58 ,$8.05 ,$11.50 ,$11.50 ,$7.00 ,$11.50 ,$7.95 ,$10.35 ,$7.86 ,$7.98 ,$9.09 ,$8.66 ,$9.67 ,$9.67 ,$7.90 ,$9.67 ,$8.28 ,$7.13 ,$8.28 ,$8.28 ,$9.20 
ST NICHOLAS HOSPITAL - ACUTE,30240192,86403,HC CRYPTOCOCAL ANTIGEN-REF,302,1 ,$23.00 ,$15.18 ,$11.31 ,$25.97 ,$11.92 ,$23.00 ,$23.00 ,$11.54 ,$13.80 ,$19.55 ,$16.10 ,$11.92 ,$11.92 ,$21.85 ,$17.48 ,$17.25 ,$19.62 ,$19.55 ,$11.54 ,$19.62 ,$19.62 ,$16.10 ,$14.01 ,$11.92 ,$11.54 ,$11.31 ,$23.00 ,$12.64 ,$19.55 ,$25.97 ,$21.16 ,$16.10 ,$23.00 ,$23.00 ,$14.01 ,$23.00 ,$15.89 ,$20.70 ,$15.71 ,$11.43 ,$18.17 ,$12.64 ,$13.85 ,$13.85 ,$11.31 ,$13.85 ,$16.56 ,$14.26 ,$16.56 ,$16.56 ,$18.40 
ST NICHOLAS HOSPITAL - ACUTE,30500098,85421,HC PLASMINOGEN ANTIGENIC,305,1 ,$164.45 ,$108.54 ,$9.98 ,$164.45 ,$10.52 ,$35.63 ,$35.63 ,$10.18 ,$98.67 ,$139.78 ,$115.12 ,$10.52 ,$10.52 ,$156.23 ,$124.98 ,$123.34 ,$17.31 ,$139.78 ,$10.18 ,$17.31 ,$17.31 ,$115.12 ,$100.15 ,$10.52 ,$10.18 ,$9.98 ,$20.36 ,$11.15 ,$139.78 ,$22.91 ,$151.29 ,$115.12 ,$50.92 ,$50.92 ,$100.15 ,$50.92 ,$113.64 ,$148.01 ,$112.35 ,$10.07 ,$129.92 ,$11.15 ,$12.22 ,$12.22 ,$9.98 ,$12.22 ,$118.40 ,$101.96 ,$118.40 ,$118.40 ,$131.56 
ST NICHOLAS HOSPITAL - ACUTE,30500101,85002,HC BLEEDING TIME,305,1 ,$148.35 ,$97.91 ,$4.72 ,$148.35 ,$4.77 ,$16.87 ,$16.87 ,$4.82 ,$89.01 ,$126.10 ,$103.85 ,$4.77 ,$4.77 ,$140.93 ,$112.75 ,$111.26 ,$8.19 ,$126.10 ,$4.82 ,$8.19 ,$8.19 ,$103.85 ,$90.35 ,$4.77 ,$4.82 ,$4.72 ,$9.64 ,$5.06 ,$126.10 ,$10.85 ,$136.48 ,$103.85 ,$16.96 ,$16.96 ,$90.35 ,$16.96 ,$102.51 ,$133.52 ,$101.35 ,$4.77 ,$117.20 ,$5.06 ,$5.78 ,$5.78 ,$4.72 ,$5.78 ,$106.81 ,$91.98 ,$106.81 ,$106.81 ,$118.68 
ST NICHOLAS HOSPITAL - ACUTE,30500102,85004,HC WBC W/AUTO DIFFERENTIAL,305,1 ,$49.45 ,$32.64 ,$6.34 ,$49.45 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$29.67 ,$42.03 ,$34.62 ,$6.69 ,$6.69 ,$46.98 ,$37.58 ,$37.09 ,$11.00 ,$42.03 ,$6.47 ,$11.00 ,$11.00 ,$34.62 ,$30.12 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$42.03 ,$14.56 ,$45.49 ,$34.62 ,$32.35 ,$32.35 ,$30.12 ,$32.35 ,$34.17 ,$44.51 ,$33.78 ,$6.40 ,$39.07 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$40.25 ,$26.57 ,$3.72 ,$40.25 ,$3.93 ,$13.30 ,$13.30 ,$3.80 ,$24.15 ,$34.21 ,$28.18 ,$3.93 ,$3.93 ,$38.24 ,$30.59 ,$30.19 ,$6.46 ,$34.21 ,$3.80 ,$6.46 ,$6.46 ,$28.18 ,$24.51 ,$3.93 ,$3.80 ,$3.72 ,$7.60 ,$4.17 ,$34.21 ,$8.55 ,$37.03 ,$28.18 ,$17.18 ,$17.18 ,$24.51 ,$17.18 ,$27.81 ,$36.23 ,$27.50 ,$3.76 ,$31.80 ,$4.17 ,$4.56 ,$4.56 ,$3.72 ,$4.56 ,$28.98 ,$24.96 ,$28.98 ,$28.98 ,$32.20 
ST NICHOLAS HOSPITAL - ACUTE,30500104,85014,HC HEMATOCRIT,305,1 ,$20.70 ,$13.66 ,$2.32 ,$20.70 ,$2.45 ,$8.30 ,$8.30 ,$2.37 ,$12.42 ,$17.60 ,$14.49 ,$2.45 ,$2.45 ,$19.67 ,$15.73 ,$15.53 ,$4.03 ,$17.60 ,$2.37 ,$4.03 ,$4.03 ,$14.49 ,$12.61 ,$2.45 ,$2.37 ,$2.32 ,$4.74 ,$2.60 ,$17.60 ,$5.33 ,$19.04 ,$14.49 ,$11.83 ,$11.83 ,$12.61 ,$11.83 ,$14.30 ,$18.63 ,$14.14 ,$2.34 ,$16.35 ,$2.60 ,$2.84 ,$2.84 ,$2.32 ,$2.84 ,$14.90 ,$12.83 ,$14.90 ,$14.90 ,$16.56 
ST NICHOLAS HOSPITAL - ACUTE,30500106,85018,HC HGB,305,1 ,$21.85 ,$14.42 ,$2.32 ,$21.85 ,$2.45 ,$8.30 ,$8.30 ,$2.37 ,$13.11 ,$18.57 ,$15.30 ,$2.45 ,$2.45 ,$20.76 ,$16.61 ,$16.39 ,$4.03 ,$18.57 ,$2.37 ,$4.03 ,$4.03 ,$15.30 ,$13.31 ,$2.45 ,$2.37 ,$2.32 ,$4.74 ,$2.60 ,$18.57 ,$5.33 ,$20.10 ,$15.30 ,$11.83 ,$11.83 ,$13.31 ,$11.83 ,$15.10 ,$19.67 ,$14.93 ,$2.34 ,$17.26 ,$2.60 ,$2.84 ,$2.84 ,$2.32 ,$2.84 ,$15.73 ,$13.55 ,$15.73 ,$15.73 ,$17.48 
ST NICHOLAS HOSPITAL - ACUTE,30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$77.05 ,$50.85 ,$7.61 ,$77.05 ,$8.03 ,$27.20 ,$27.20 ,$7.77 ,$46.23 ,$65.49 ,$53.94 ,$8.03 ,$8.03 ,$73.20 ,$58.56 ,$57.79 ,$13.21 ,$65.49 ,$7.77 ,$13.21 ,$13.21 ,$53.94 ,$46.92 ,$8.03 ,$7.77 ,$7.61 ,$15.54 ,$8.51 ,$65.49 ,$17.48 ,$70.89 ,$53.94 ,$38.87 ,$38.87 ,$46.92 ,$38.87 ,$53.24 ,$69.35 ,$52.64 ,$7.69 ,$60.87 ,$8.51 ,$9.32 ,$9.32 ,$7.61 ,$9.32 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30500108,85027,HC CBC W/O DIFF,305,1 ,$56.35 ,$37.19 ,$6.34 ,$56.35 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$33.81 ,$47.90 ,$39.45 ,$6.69 ,$6.69 ,$53.53 ,$42.83 ,$42.26 ,$11.00 ,$47.90 ,$6.47 ,$11.00 ,$11.00 ,$39.45 ,$34.32 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$47.90 ,$14.56 ,$51.84 ,$39.45 ,$32.35 ,$32.35 ,$34.32 ,$32.35 ,$38.94 ,$50.72 ,$38.50 ,$6.40 ,$44.52 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$40.57 ,$34.94 ,$40.57 ,$40.57 ,$45.08 
ST NICHOLAS HOSPITAL - ACUTE,30500109,85027,HC HISTOGRAM,305,1 ,$56.35 ,$37.19 ,$6.34 ,$56.35 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$33.81 ,$47.90 ,$39.45 ,$6.69 ,$6.69 ,$53.53 ,$42.83 ,$42.26 ,$11.00 ,$47.90 ,$6.47 ,$11.00 ,$11.00 ,$39.45 ,$34.32 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$47.90 ,$14.56 ,$51.84 ,$39.45 ,$32.35 ,$32.35 ,$34.32 ,$32.35 ,$38.94 ,$50.72 ,$38.50 ,$6.40 ,$44.52 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$40.57 ,$34.94 ,$40.57 ,$40.57 ,$45.08 
ST NICHOLAS HOSPITAL - ACUTE,30500110,85044,HC RETIC COUNT MANUAL,305,1 ,$167.90 ,$110.81 ,$4.22 ,$167.90 ,$4.45 ,$15.09 ,$15.09 ,$4.31 ,$100.74 ,$142.72 ,$117.53 ,$4.45 ,$4.45 ,$159.51 ,$127.60 ,$125.93 ,$7.33 ,$142.72 ,$4.31 ,$7.33 ,$7.33 ,$117.53 ,$102.25 ,$4.45 ,$4.31 ,$4.22 ,$8.62 ,$4.72 ,$142.72 ,$9.70 ,$154.47 ,$117.53 ,$21.50 ,$21.50 ,$102.25 ,$21.50 ,$116.02 ,$151.11 ,$114.71 ,$4.26 ,$132.64 ,$4.72 ,$5.17 ,$5.17 ,$4.22 ,$5.17 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30500111,85045,HC RETIC COUNT AUTO,305,1 ,$39.10 ,$25.81 ,$3.91 ,$39.10 ,$4.12 ,$13.97 ,$13.97 ,$3.99 ,$23.46 ,$33.24 ,$27.37 ,$4.12 ,$4.12 ,$37.15 ,$29.72 ,$29.33 ,$6.78 ,$33.24 ,$3.99 ,$6.78 ,$6.78 ,$27.37 ,$23.81 ,$4.12 ,$3.99 ,$3.91 ,$7.98 ,$4.37 ,$33.24 ,$8.98 ,$35.97 ,$27.37 ,$19.97 ,$19.97 ,$23.81 ,$19.97 ,$27.02 ,$35.19 ,$26.71 ,$3.95 ,$30.89 ,$4.37 ,$4.79 ,$4.79 ,$3.91 ,$4.79 ,$28.15 ,$24.24 ,$28.15 ,$28.15 ,$31.28 
ST NICHOLAS HOSPITAL - ACUTE,30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$21.85 ,$14.42 ,$2.49 ,$21.85 ,$2.62 ,$8.89 ,$8.89 ,$2.54 ,$13.11 ,$18.57 ,$15.30 ,$2.62 ,$2.62 ,$20.76 ,$16.61 ,$16.39 ,$4.32 ,$18.57 ,$2.54 ,$4.32 ,$4.32 ,$15.30 ,$13.31 ,$2.62 ,$2.54 ,$2.49 ,$5.08 ,$2.78 ,$18.57 ,$5.72 ,$20.10 ,$15.30 ,$12.68 ,$12.68 ,$13.31 ,$12.68 ,$15.10 ,$19.67 ,$14.93 ,$2.52 ,$17.26 ,$2.78 ,$3.05 ,$3.05 ,$2.49 ,$3.05 ,$15.73 ,$13.55 ,$15.73 ,$15.73 ,$17.48 
ST NICHOLAS HOSPITAL - ACUTE,30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$43.70 ,$28.84 ,$4.39 ,$43.70 ,$4.63 ,$15.68 ,$15.68 ,$4.48 ,$26.22 ,$37.15 ,$30.59 ,$4.63 ,$4.63 ,$41.52 ,$33.21 ,$32.78 ,$7.62 ,$37.15 ,$4.48 ,$7.62 ,$7.62 ,$30.59 ,$26.61 ,$4.63 ,$4.48 ,$4.39 ,$8.96 ,$4.91 ,$37.15 ,$10.08 ,$40.20 ,$30.59 ,$22.38 ,$22.38 ,$26.61 ,$22.38 ,$30.20 ,$39.33 ,$29.86 ,$4.43 ,$34.52 ,$4.91 ,$5.38 ,$5.38 ,$4.39 ,$5.38 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30500116,85097,HC BONE MARROW SMEAR INTERP,305,1 ,$525.55 ,$346.86 ,$17.87 ,"$1,705.22 ",$17.87 ,$162.43 ,$162.43 ,$757.87 ,$315.33 ,$446.72 ,$367.89 ,$17.87 ,$17.87 ,$499.27 ,$399.42 ,$394.16 ,$112.88 ,$446.72 ,$757.87 ,$112.88 ,$112.88 ,$367.89 ,$320.06 ,$17.87 ,$757.87 ,$742.71 ,$525.55 ,$18.94 ,$446.72 ,"$1,705.22 ",$483.51 ,$367.89 ,$266.56 ,$319.90 ,$320.06 ,$319.90 ,$363.16 ,$473.00 ,$359.06 ,$750.14 ,$415.18 ,$18.94 ,$525.55 ,$525.55 ,$742.71 ,$525.55 ,$378.40 ,$325.84 ,$378.40 ,$378.40 ,$420.44 
ST NICHOLAS HOSPITAL - ACUTE,30500117,85097,HC BONE MARROW SMEAR INTERP (MAYO),305,1 ,$525.55 ,$346.86 ,$17.87 ,"$1,705.22 ",$17.87 ,$162.43 ,$162.43 ,$757.87 ,$315.33 ,$446.72 ,$367.89 ,$17.87 ,$17.87 ,$499.27 ,$399.42 ,$394.16 ,$112.88 ,$446.72 ,$757.87 ,$112.88 ,$112.88 ,$367.89 ,$320.06 ,$17.87 ,$757.87 ,$742.71 ,$525.55 ,$18.94 ,$446.72 ,"$1,705.22 ",$483.51 ,$367.89 ,$266.56 ,$319.90 ,$320.06 ,$319.90 ,$363.16 ,$473.00 ,$359.06 ,$750.14 ,$415.18 ,$18.94 ,$525.55 ,$525.55 ,$742.71 ,$525.55 ,$378.40 ,$325.84 ,$378.40 ,$378.40 ,$420.44 
ST NICHOLAS HOSPITAL - ACUTE,30500119,85175,HC CLOT LYSIS TIME,305,1 ,$89.70 ,$59.20 ,$6.40 ,$89.70 ,$6.40 ,$71.30 ,$71.30 ,$20.37 ,$53.82 ,$76.25 ,$62.79 ,$6.40 ,$6.40 ,$85.22 ,$68.17 ,$67.28 ,$34.63 ,$76.25 ,$20.37 ,$34.63 ,$34.63 ,$62.79 ,$54.63 ,$6.40 ,$20.37 ,$19.96 ,$40.74 ,$6.78 ,$76.25 ,$45.83 ,$82.52 ,$62.79 ,$22.75 ,$22.75 ,$54.63 ,$22.75 ,$61.98 ,$80.73 ,$61.28 ,$20.16 ,$70.86 ,$6.78 ,$24.44 ,$24.44 ,$19.96 ,$24.44 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30500120,85018,HC HGB ANESTH,305,1 ,$186.30 ,$122.96 ,$2.32 ,$186.30 ,$2.45 ,$8.30 ,$8.30 ,$2.37 ,$111.78 ,$158.36 ,$130.41 ,$2.45 ,$2.45 ,$176.99 ,$141.59 ,$139.73 ,$4.03 ,$158.36 ,$2.37 ,$4.03 ,$4.03 ,$130.41 ,$113.46 ,$2.45 ,$2.37 ,$2.32 ,$4.74 ,$2.60 ,$158.36 ,$5.33 ,$171.40 ,$130.41 ,$11.83 ,$11.83 ,$113.46 ,$11.83 ,$128.73 ,$167.67 ,$127.28 ,$2.34 ,$147.18 ,$2.60 ,$2.84 ,$2.84 ,$2.32 ,$2.84 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,30500121,85210,HC FACTOR II PROTHROM SPEC,305,1 ,$116.15 ,$76.66 ,$8.17 ,$116.15 ,$8.17 ,$45.43 ,$45.43 ,$12.98 ,$69.69 ,$98.73 ,$81.31 ,$8.17 ,$8.17 ,$110.34 ,$88.27 ,$87.11 ,$22.07 ,$98.73 ,$12.98 ,$22.07 ,$22.07 ,$81.31 ,$70.74 ,$8.17 ,$12.98 ,$12.72 ,$25.96 ,$8.66 ,$98.73 ,$29.21 ,$106.86 ,$81.31 ,$29.05 ,$29.05 ,$70.74 ,$29.05 ,$80.26 ,$104.54 ,$79.35 ,$12.85 ,$91.76 ,$8.66 ,$15.58 ,$15.58 ,$12.72 ,$15.58 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30500123,85220,HC FACTOR V CLOTTING FACTOR,305,1 ,$193.20 ,$127.51 ,$17.30 ,$193.20 ,$18.24 ,$61.78 ,$61.78 ,$17.65 ,$115.92 ,$164.22 ,$135.24 ,$18.24 ,$18.24 ,$183.54 ,$146.83 ,$144.90 ,$30.01 ,$164.22 ,$17.65 ,$30.01 ,$30.01 ,$135.24 ,$117.66 ,$18.24 ,$17.65 ,$17.30 ,$35.30 ,$19.33 ,$164.22 ,$39.71 ,$177.74 ,$135.24 ,$88.18 ,$88.18 ,$117.66 ,$88.18 ,$133.50 ,$173.88 ,$131.99 ,$17.47 ,$152.63 ,$19.33 ,$21.18 ,$21.18 ,$17.30 ,$21.18 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30500125,85230,HC FACTOR VII PROCONVERTIN,305,1 ,$193.20 ,$127.51 ,$17.54 ,$193.20 ,$18.50 ,$62.65 ,$62.65 ,$17.90 ,$115.92 ,$164.22 ,$135.24 ,$18.50 ,$18.50 ,$183.54 ,$146.83 ,$144.90 ,$30.43 ,$164.22 ,$17.90 ,$30.43 ,$30.43 ,$135.24 ,$117.66 ,$18.50 ,$17.90 ,$17.54 ,$35.80 ,$19.61 ,$164.22 ,$40.28 ,$177.74 ,$135.24 ,$89.50 ,$89.50 ,$117.66 ,$89.50 ,$133.50 ,$173.88 ,$131.99 ,$17.72 ,$152.63 ,$19.61 ,$21.48 ,$21.48 ,$17.54 ,$21.48 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30500126,85240,HC FACTOR VIII AHG 1 STAGE,305,1 ,$116.15 ,$76.66 ,$9.84 ,$116.15 ,$9.84 ,$62.65 ,$62.65 ,$17.90 ,$69.69 ,$98.73 ,$81.31 ,$9.84 ,$9.84 ,$110.34 ,$88.27 ,$87.11 ,$30.43 ,$98.73 ,$17.90 ,$30.43 ,$30.43 ,$81.31 ,$70.74 ,$9.84 ,$17.90 ,$17.54 ,$35.80 ,$10.43 ,$98.73 ,$40.28 ,$106.86 ,$81.31 ,$34.95 ,$34.95 ,$70.74 ,$34.95 ,$80.26 ,$104.54 ,$79.35 ,$17.72 ,$91.76 ,$10.43 ,$21.48 ,$21.48 ,$17.54 ,$21.48 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30500128,85240,HC FACTOR VIII AHG (ASSAY),305,1 ,$210.45 ,$138.90 ,$9.84 ,$210.45 ,$9.84 ,$62.65 ,$62.65 ,$17.90 ,$126.27 ,$178.88 ,$147.32 ,$9.84 ,$9.84 ,$199.93 ,$159.94 ,$157.84 ,$30.43 ,$178.88 ,$17.90 ,$30.43 ,$30.43 ,$147.32 ,$128.16 ,$9.84 ,$17.90 ,$17.54 ,$35.80 ,$10.43 ,$178.88 ,$40.28 ,$193.61 ,$147.32 ,$34.95 ,$34.95 ,$128.16 ,$34.95 ,$145.42 ,$189.41 ,$143.78 ,$17.72 ,$166.26 ,$10.43 ,$21.48 ,$21.48 ,$17.54 ,$21.48 ,$151.52 ,$130.48 ,$151.52 ,$151.52 ,$168.36 
ST NICHOLAS HOSPITAL - ACUTE,30500130,85245,HC FACTOR VIII VW RISTOCTN,305,1 ,$213.90 ,$141.17 ,$22.48 ,$213.90 ,$23.70 ,$80.29 ,$80.29 ,$22.94 ,$128.34 ,$181.82 ,$149.73 ,$23.70 ,$23.70 ,$203.21 ,$162.56 ,$160.43 ,$39.00 ,$181.82 ,$22.94 ,$39.00 ,$39.00 ,$149.73 ,$130.27 ,$23.70 ,$22.94 ,$22.48 ,$45.88 ,$25.12 ,$181.82 ,$51.62 ,$196.79 ,$149.73 ,$114.67 ,$114.67 ,$130.27 ,$114.67 ,$147.80 ,$192.51 ,$146.14 ,$22.71 ,$168.98 ,$25.12 ,$27.53 ,$27.53 ,$22.48 ,$27.53 ,$154.01 ,$132.62 ,$154.01 ,$154.01 ,$171.12 
ST NICHOLAS HOSPITAL - ACUTE,30500131,85245,HC FACTOR VIII VW RISTOCTN,305,1 ,$205.85 ,$135.86 ,$22.48 ,$205.85 ,$23.70 ,$80.29 ,$80.29 ,$22.94 ,$123.51 ,$174.97 ,$144.10 ,$23.70 ,$23.70 ,$195.56 ,$156.45 ,$154.39 ,$39.00 ,$174.97 ,$22.94 ,$39.00 ,$39.00 ,$144.10 ,$125.36 ,$23.70 ,$22.94 ,$22.48 ,$45.88 ,$25.12 ,$174.97 ,$51.62 ,$189.38 ,$144.10 ,$114.67 ,$114.67 ,$125.36 ,$114.67 ,$142.24 ,$185.27 ,$140.64 ,$22.71 ,$162.62 ,$25.12 ,$27.53 ,$27.53 ,$22.48 ,$27.53 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,30500132,85246,HC FACTOR VIII VW ANTIGEN,305,1 ,$180.55 ,$119.16 ,$22.48 ,$180.55 ,$23.70 ,$80.29 ,$80.29 ,$22.94 ,$108.33 ,$153.47 ,$126.39 ,$23.70 ,$23.70 ,$171.52 ,$137.22 ,$135.41 ,$39.00 ,$153.47 ,$22.94 ,$39.00 ,$39.00 ,$126.39 ,$109.96 ,$23.70 ,$22.94 ,$22.48 ,$45.88 ,$25.12 ,$153.47 ,$51.62 ,$166.11 ,$126.39 ,$114.67 ,$114.67 ,$109.96 ,$114.67 ,$124.76 ,$162.50 ,$123.35 ,$22.71 ,$142.63 ,$25.12 ,$27.53 ,$27.53 ,$22.48 ,$27.53 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30500135,85246,HC FACTOR VIII VW AG (MAYO),305,1 ,$223.10 ,$147.25 ,$22.48 ,$223.10 ,$23.70 ,$80.29 ,$80.29 ,$22.94 ,$133.86 ,$189.64 ,$156.17 ,$23.70 ,$23.70 ,$211.95 ,$169.56 ,$167.33 ,$39.00 ,$189.64 ,$22.94 ,$39.00 ,$39.00 ,$156.17 ,$135.87 ,$23.70 ,$22.94 ,$22.48 ,$45.88 ,$25.12 ,$189.64 ,$51.62 ,$205.25 ,$156.17 ,$114.67 ,$114.67 ,$135.87 ,$114.67 ,$154.16 ,$200.79 ,$152.42 ,$22.71 ,$176.25 ,$25.12 ,$27.53 ,$27.53 ,$22.48 ,$27.53 ,$160.63 ,$138.32 ,$160.63 ,$160.63 ,$178.48 
ST NICHOLAS HOSPITAL - ACUTE,30500136,85247,HC FACTOR VIII VW MULTIM ANALY,305,1 ,$244.95 ,$161.67 ,$22.48 ,$244.95 ,$23.70 ,$80.29 ,$80.29 ,$22.94 ,$146.97 ,$208.21 ,$171.47 ,$23.70 ,$23.70 ,$232.70 ,$186.16 ,$183.71 ,$39.00 ,$208.21 ,$22.94 ,$39.00 ,$39.00 ,$171.47 ,$149.17 ,$23.70 ,$22.94 ,$22.48 ,$45.88 ,$25.12 ,$208.21 ,$51.62 ,$225.35 ,$171.47 ,$114.67 ,$114.67 ,$149.17 ,$114.67 ,$169.26 ,$220.46 ,$167.35 ,$22.71 ,$193.51 ,$25.12 ,$27.53 ,$27.53 ,$22.48 ,$27.53 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30500138,85250,HC FACTOR IX PTC OR CHRISTMAS,305,1 ,$257.60 ,$170.02 ,$18.66 ,$257.60 ,$19.67 ,$66.64 ,$66.64 ,$19.04 ,$154.56 ,$218.96 ,$180.32 ,$19.67 ,$19.67 ,$244.72 ,$195.78 ,$193.20 ,$32.37 ,$218.96 ,$19.04 ,$32.37 ,$32.37 ,$180.32 ,$156.88 ,$19.67 ,$19.04 ,$18.66 ,$38.08 ,$20.85 ,$218.96 ,$42.84 ,$236.99 ,$180.32 ,$95.14 ,$95.14 ,$156.88 ,$95.14 ,$178.00 ,$231.84 ,$175.99 ,$18.85 ,$203.50 ,$20.85 ,$22.85 ,$22.85 ,$18.66 ,$22.85 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30500140,85250,HC FACTOR IX (ASSAY),305,1 ,$255.30 ,$168.50 ,$18.66 ,$255.30 ,$19.67 ,$66.64 ,$66.64 ,$19.04 ,$153.18 ,$217.01 ,$178.71 ,$19.67 ,$19.67 ,$242.54 ,$194.03 ,$191.48 ,$32.37 ,$217.01 ,$19.04 ,$32.37 ,$32.37 ,$178.71 ,$155.48 ,$19.67 ,$19.04 ,$18.66 ,$38.08 ,$20.85 ,$217.01 ,$42.84 ,$234.88 ,$178.71 ,$95.14 ,$95.14 ,$155.48 ,$95.14 ,$176.41 ,$229.77 ,$174.42 ,$18.85 ,$201.69 ,$20.85 ,$22.85 ,$22.85 ,$18.66 ,$22.85 ,$183.82 ,$158.29 ,$183.82 ,$183.82 ,$204.24 
ST NICHOLAS HOSPITAL - ACUTE,30500142,85260,HC FACTOR X (STUART-POWER),305,1 ,$180.55 ,$119.16 ,$17.54 ,$180.55 ,$18.50 ,$62.65 ,$62.65 ,$17.90 ,$108.33 ,$153.47 ,$126.39 ,$18.50 ,$18.50 ,$171.52 ,$137.22 ,$135.41 ,$30.43 ,$153.47 ,$17.90 ,$30.43 ,$30.43 ,$126.39 ,$109.96 ,$18.50 ,$17.90 ,$17.54 ,$35.80 ,$19.61 ,$153.47 ,$40.28 ,$166.11 ,$126.39 ,$89.50 ,$89.50 ,$109.96 ,$89.50 ,$124.76 ,$162.50 ,$123.35 ,$17.72 ,$142.63 ,$19.61 ,$21.48 ,$21.48 ,$17.54 ,$21.48 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30500144,85270,HC FACTOR XI PTA,305,1 ,$193.20 ,$127.51 ,$17.54 ,$193.20 ,$18.50 ,$62.65 ,$62.65 ,$17.90 ,$115.92 ,$164.22 ,$135.24 ,$18.50 ,$18.50 ,$183.54 ,$146.83 ,$144.90 ,$30.43 ,$164.22 ,$17.90 ,$30.43 ,$30.43 ,$135.24 ,$117.66 ,$18.50 ,$17.90 ,$17.54 ,$35.80 ,$19.61 ,$164.22 ,$40.28 ,$177.74 ,$135.24 ,$89.50 ,$89.50 ,$117.66 ,$89.50 ,$133.50 ,$173.88 ,$131.99 ,$17.72 ,$152.63 ,$19.61 ,$21.48 ,$21.48 ,$17.54 ,$21.48 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30500146,85280,HC FACTOR XII HAGEMAN,305,1 ,$141.45 ,$93.36 ,$18.96 ,$141.45 ,$19.99 ,$67.73 ,$67.73 ,$19.35 ,$84.87 ,$120.23 ,$99.02 ,$19.99 ,$19.99 ,$134.38 ,$107.50 ,$106.09 ,$32.90 ,$120.23 ,$19.35 ,$32.90 ,$32.90 ,$99.02 ,$86.14 ,$19.99 ,$19.35 ,$18.96 ,$38.70 ,$21.19 ,$120.23 ,$43.54 ,$130.13 ,$99.02 ,$96.72 ,$96.72 ,$86.14 ,$96.72 ,$97.74 ,$127.31 ,$96.64 ,$19.15 ,$111.75 ,$21.19 ,$23.22 ,$23.22 ,$18.96 ,$23.22 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30500147,85291,HC FACTOR XIII FIBRIN SCRN,305,1 ,$64.40 ,$42.50 ,$8.93 ,$64.40 ,$9.41 ,$31.89 ,$31.89 ,$9.11 ,$38.64 ,$54.74 ,$45.08 ,$9.41 ,$9.41 ,$61.18 ,$48.94 ,$48.30 ,$15.49 ,$54.74 ,$9.11 ,$15.49 ,$15.49 ,$45.08 ,$39.22 ,$9.41 ,$9.11 ,$8.93 ,$18.22 ,$9.97 ,$54.74 ,$20.50 ,$59.25 ,$45.08 ,$44.47 ,$44.47 ,$39.22 ,$44.47 ,$44.50 ,$57.96 ,$44.00 ,$9.02 ,$50.88 ,$9.97 ,$10.93 ,$10.93 ,$8.93 ,$10.93 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30500150,85300,HC ANTITHROMBIN III,305,1 ,$167.90 ,$110.81 ,$11.61 ,$167.90 ,$12.24 ,$41.48 ,$41.48 ,$11.85 ,$100.74 ,$142.72 ,$117.53 ,$12.24 ,$12.24 ,$159.51 ,$127.60 ,$125.93 ,$20.15 ,$142.72 ,$11.85 ,$20.15 ,$20.15 ,$117.53 ,$102.25 ,$12.24 ,$11.85 ,$11.61 ,$23.70 ,$12.97 ,$142.72 ,$26.66 ,$154.47 ,$117.53 ,$59.24 ,$59.24 ,$102.25 ,$59.24 ,$116.02 ,$151.11 ,$114.71 ,$11.73 ,$132.64 ,$12.97 ,$14.22 ,$14.22 ,$11.61 ,$14.22 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30500151,85301,HC ANTITHROMBIN III AG,305,1 ,$116.15 ,$76.66 ,$10.59 ,$116.15 ,$11.17 ,$37.84 ,$37.84 ,$10.81 ,$69.69 ,$98.73 ,$81.31 ,$11.17 ,$11.17 ,$110.34 ,$88.27 ,$87.11 ,$18.38 ,$98.73 ,$10.81 ,$18.38 ,$18.38 ,$81.31 ,$70.74 ,$11.17 ,$10.81 ,$10.59 ,$21.62 ,$11.84 ,$98.73 ,$24.32 ,$106.86 ,$81.31 ,$54.04 ,$54.04 ,$70.74 ,$54.04 ,$80.26 ,$104.54 ,$79.35 ,$10.70 ,$91.76 ,$11.84 ,$12.97 ,$12.97 ,$10.59 ,$12.97 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30500153,85302,HC PROTEIN C AG,305,1 ,$167.90 ,$110.81 ,$11.77 ,$167.90 ,$12.41 ,$42.04 ,$42.04 ,$12.01 ,$100.74 ,$142.72 ,$117.53 ,$12.41 ,$12.41 ,$159.51 ,$127.60 ,$125.93 ,$20.42 ,$142.72 ,$12.01 ,$20.42 ,$20.42 ,$117.53 ,$102.25 ,$12.41 ,$12.01 ,$11.77 ,$24.02 ,$13.15 ,$142.72 ,$27.02 ,$154.47 ,$117.53 ,$60.08 ,$60.08 ,$102.25 ,$60.08 ,$116.02 ,$151.11 ,$114.71 ,$11.89 ,$132.64 ,$13.15 ,$14.41 ,$14.41 ,$11.77 ,$14.41 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30500154,85303,HC PROTEIN C ACTIVITY,305,1 ,$141.45 ,$93.36 ,$13.56 ,$141.45 ,$14.30 ,$48.44 ,$48.44 ,$13.84 ,$84.87 ,$120.23 ,$99.02 ,$14.30 ,$14.30 ,$134.38 ,$107.50 ,$106.09 ,$23.53 ,$120.23 ,$13.84 ,$23.53 ,$23.53 ,$99.02 ,$86.14 ,$14.30 ,$13.84 ,$13.56 ,$27.68 ,$15.16 ,$120.23 ,$31.14 ,$130.13 ,$99.02 ,$69.13 ,$69.13 ,$86.14 ,$69.13 ,$97.74 ,$127.31 ,$96.64 ,$13.70 ,$111.75 ,$15.16 ,$16.61 ,$16.61 ,$13.56 ,$16.61 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30500155,85303,HC PROTEIN C ACTIVITY (2),305,1 ,$100.05 ,$66.03 ,$13.56 ,$100.05 ,$14.30 ,$48.44 ,$48.44 ,$13.84 ,$60.03 ,$85.04 ,$70.04 ,$14.30 ,$14.30 ,$95.05 ,$76.04 ,$75.04 ,$23.53 ,$85.04 ,$13.84 ,$23.53 ,$23.53 ,$70.04 ,$60.93 ,$14.30 ,$13.84 ,$13.56 ,$27.68 ,$15.16 ,$85.04 ,$31.14 ,$92.05 ,$70.04 ,$69.13 ,$69.13 ,$60.93 ,$69.13 ,$69.13 ,$90.05 ,$68.35 ,$13.70 ,$79.04 ,$15.16 ,$16.61 ,$16.61 ,$13.56 ,$16.61 ,$72.04 ,$62.03 ,$72.04 ,$72.04 ,$80.04 
ST NICHOLAS HOSPITAL - ACUTE,30500156,85305,HC PROTEIN S TOTAL,305,1 ,$167.90 ,$110.81 ,$11.38 ,$167.90 ,$12.00 ,$40.64 ,$40.64 ,$11.61 ,$100.74 ,$142.72 ,$117.53 ,$12.00 ,$12.00 ,$159.51 ,$127.60 ,$125.93 ,$19.74 ,$142.72 ,$11.61 ,$19.74 ,$19.74 ,$117.53 ,$102.25 ,$12.00 ,$11.61 ,$11.38 ,$23.22 ,$12.72 ,$142.72 ,$26.12 ,$154.47 ,$117.53 ,$57.99 ,$57.99 ,$102.25 ,$57.99 ,$116.02 ,$151.11 ,$114.71 ,$11.50 ,$132.64 ,$12.72 ,$13.93 ,$13.93 ,$11.38 ,$13.93 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30500158,85306,HC PROTEIN S FREE (2),305,1 ,$154.10 ,$101.71 ,$15.01 ,$154.10 ,$15.83 ,$53.62 ,$53.62 ,$15.32 ,$92.46 ,$130.99 ,$107.87 ,$15.83 ,$15.83 ,$146.40 ,$117.12 ,$115.58 ,$26.04 ,$130.99 ,$15.32 ,$26.04 ,$26.04 ,$107.87 ,$93.85 ,$15.83 ,$15.32 ,$15.01 ,$30.64 ,$16.78 ,$130.99 ,$34.47 ,$141.77 ,$107.87 ,$71.40 ,$71.40 ,$93.85 ,$71.40 ,$106.48 ,$138.69 ,$105.28 ,$15.16 ,$121.74 ,$16.78 ,$18.38 ,$18.38 ,$15.01 ,$18.38 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30500159,85306,HC PROTEIN S FREE,305,1 ,$167.90 ,$110.81 ,$15.01 ,$167.90 ,$15.83 ,$53.62 ,$53.62 ,$15.32 ,$100.74 ,$142.72 ,$117.53 ,$15.83 ,$15.83 ,$159.51 ,$127.60 ,$125.93 ,$26.04 ,$142.72 ,$15.32 ,$26.04 ,$26.04 ,$117.53 ,$102.25 ,$15.83 ,$15.32 ,$15.01 ,$30.64 ,$16.78 ,$142.72 ,$34.47 ,$154.47 ,$117.53 ,$71.40 ,$71.40 ,$102.25 ,$71.40 ,$116.02 ,$151.11 ,$114.71 ,$15.16 ,$132.64 ,$16.78 ,$18.38 ,$18.38 ,$15.01 ,$18.38 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30500161,85306,HC PROTEIN S FREE ACT,305,1 ,$196.65 ,$129.79 ,$15.01 ,$196.65 ,$15.83 ,$53.62 ,$53.62 ,$15.32 ,$117.99 ,$167.15 ,$137.66 ,$15.83 ,$15.83 ,$186.82 ,$149.45 ,$147.49 ,$26.04 ,$167.15 ,$15.32 ,$26.04 ,$26.04 ,$137.66 ,$119.76 ,$15.83 ,$15.32 ,$15.01 ,$30.64 ,$16.78 ,$167.15 ,$34.47 ,$180.92 ,$137.66 ,$71.40 ,$71.40 ,$119.76 ,$71.40 ,$135.89 ,$176.99 ,$134.35 ,$15.16 ,$155.35 ,$16.78 ,$18.38 ,$18.38 ,$15.01 ,$18.38 ,$141.59 ,$121.92 ,$141.59 ,$141.59 ,$157.32 
ST NICHOLAS HOSPITAL - ACUTE,30500163,85306,HC PROTEIN S FREE QD,305,1 ,$204.70 ,$135.10 ,$15.01 ,$204.70 ,$15.83 ,$53.62 ,$53.62 ,$15.32 ,$122.82 ,$174.00 ,$143.29 ,$15.83 ,$15.83 ,$194.47 ,$155.57 ,$153.53 ,$26.04 ,$174.00 ,$15.32 ,$26.04 ,$26.04 ,$143.29 ,$124.66 ,$15.83 ,$15.32 ,$15.01 ,$30.64 ,$16.78 ,$174.00 ,$34.47 ,$188.32 ,$143.29 ,$71.40 ,$71.40 ,$124.66 ,$71.40 ,$141.45 ,$184.23 ,$139.85 ,$15.16 ,$161.71 ,$16.78 ,$18.38 ,$18.38 ,$15.01 ,$18.38 ,$147.38 ,$126.91 ,$147.38 ,$147.38 ,$163.76 
ST NICHOLAS HOSPITAL - ACUTE,30500164,85307,HC ACTIV PROTEIN C RESIST,305,1 ,$154.10 ,$101.71 ,$15.01 ,$154.10 ,$15.83 ,$53.62 ,$53.62 ,$15.32 ,$92.46 ,$130.99 ,$107.87 ,$15.83 ,$15.83 ,$146.40 ,$117.12 ,$115.58 ,$26.04 ,$130.99 ,$15.32 ,$26.04 ,$26.04 ,$107.87 ,$93.85 ,$15.83 ,$15.32 ,$15.01 ,$30.64 ,$16.78 ,$130.99 ,$34.47 ,$141.77 ,$107.87 ,$71.40 ,$71.40 ,$93.85 ,$71.40 ,$106.48 ,$138.69 ,$105.28 ,$15.16 ,$121.74 ,$16.78 ,$18.38 ,$18.38 ,$15.01 ,$18.38 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30500165,85335,HC FACTOR VIII INHIB,305,1 ,$257.60 ,$170.02 ,$12.61 ,$257.60 ,$13.30 ,$45.05 ,$45.05 ,$12.87 ,$154.56 ,$218.96 ,$180.32 ,$13.30 ,$13.30 ,$244.72 ,$195.78 ,$193.20 ,$21.88 ,$218.96 ,$12.87 ,$21.88 ,$21.88 ,$180.32 ,$156.88 ,$13.30 ,$12.87 ,$12.61 ,$25.74 ,$14.10 ,$218.96 ,$28.96 ,$236.99 ,$180.32 ,$64.33 ,$64.33 ,$156.88 ,$64.33 ,$178.00 ,$231.84 ,$175.99 ,$12.74 ,$203.50 ,$14.10 ,$15.44 ,$15.44 ,$12.61 ,$15.44 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30500166,85335,HC FACTOR IX INHIB,305,1 ,$262.20 ,$173.05 ,$12.61 ,$262.20 ,$13.30 ,$45.05 ,$45.05 ,$12.87 ,$157.32 ,$222.87 ,$183.54 ,$13.30 ,$13.30 ,$249.09 ,$199.27 ,$196.65 ,$21.88 ,$222.87 ,$12.87 ,$21.88 ,$21.88 ,$183.54 ,$159.68 ,$13.30 ,$12.87 ,$12.61 ,$25.74 ,$14.10 ,$222.87 ,$28.96 ,$241.22 ,$183.54 ,$64.33 ,$64.33 ,$159.68 ,$64.33 ,$181.18 ,$235.98 ,$179.14 ,$12.74 ,$207.14 ,$14.10 ,$15.44 ,$15.44 ,$12.61 ,$15.44 ,$188.78 ,$162.56 ,$188.78 ,$188.78 ,$209.76 
ST NICHOLAS HOSPITAL - ACUTE,30500167,85335,HC FACTOR INHIBITOR TEST,305,1 ,$302.45 ,$199.62 ,$12.61 ,$302.45 ,$13.30 ,$45.05 ,$45.05 ,$12.87 ,$181.47 ,$257.08 ,$211.72 ,$13.30 ,$13.30 ,$287.33 ,$229.86 ,$226.84 ,$21.88 ,$257.08 ,$12.87 ,$21.88 ,$21.88 ,$211.72 ,$184.19 ,$13.30 ,$12.87 ,$12.61 ,$25.74 ,$14.10 ,$257.08 ,$28.96 ,$278.25 ,$211.72 ,$64.33 ,$64.33 ,$184.19 ,$64.33 ,$208.99 ,$272.21 ,$206.63 ,$12.74 ,$238.94 ,$14.10 ,$15.44 ,$15.44 ,$12.61 ,$15.44 ,$217.76 ,$187.52 ,$217.76 ,$217.76 ,$241.96 
ST NICHOLAS HOSPITAL - ACUTE,30500168,85347,HC ACTIVATED CLOTTING TIME,305,1 ,$120.75 ,$79.70 ,$4.19 ,$120.75 ,$4.42 ,$14.98 ,$14.98 ,$4.28 ,$72.45 ,$102.64 ,$84.53 ,$4.42 ,$4.42 ,$114.71 ,$91.77 ,$90.56 ,$7.28 ,$102.64 ,$4.28 ,$7.28 ,$7.28 ,$84.53 ,$73.54 ,$4.42 ,$4.28 ,$4.19 ,$8.56 ,$4.69 ,$102.64 ,$9.63 ,$111.09 ,$84.53 ,$21.28 ,$21.28 ,$73.54 ,$21.28 ,$83.44 ,$108.68 ,$82.50 ,$4.23 ,$95.39 ,$4.69 ,$5.14 ,$5.14 ,$4.19 ,$5.14 ,$86.94 ,$74.87 ,$86.94 ,$86.94 ,$96.60 
ST NICHOLAS HOSPITAL - ACUTE,30500169,85347,HC ACTIVATED CLOTTING TIME (TEG),305,1 ,$89.70 ,$59.20 ,$4.19 ,$89.70 ,$4.42 ,$14.98 ,$14.98 ,$4.28 ,$53.82 ,$76.25 ,$62.79 ,$4.42 ,$4.42 ,$85.22 ,$68.17 ,$67.28 ,$7.28 ,$76.25 ,$4.28 ,$7.28 ,$7.28 ,$62.79 ,$54.63 ,$4.42 ,$4.28 ,$4.19 ,$8.56 ,$4.69 ,$76.25 ,$9.63 ,$82.52 ,$62.79 ,$21.28 ,$21.28 ,$54.63 ,$21.28 ,$61.98 ,$80.73 ,$61.28 ,$4.23 ,$70.86 ,$4.69 ,$5.14 ,$5.14 ,$4.19 ,$5.14 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30500171,85347,HC ACTIVATED CLOTTING TIME (IACT),305,1 ,$77.05 ,$50.85 ,$4.19 ,$77.05 ,$4.42 ,$14.98 ,$14.98 ,$4.28 ,$46.23 ,$65.49 ,$53.94 ,$4.42 ,$4.42 ,$73.20 ,$58.56 ,$57.79 ,$7.28 ,$65.49 ,$4.28 ,$7.28 ,$7.28 ,$53.94 ,$46.92 ,$4.42 ,$4.28 ,$4.19 ,$8.56 ,$4.69 ,$65.49 ,$9.63 ,$70.89 ,$53.94 ,$21.28 ,$21.28 ,$46.92 ,$21.28 ,$53.24 ,$69.35 ,$52.64 ,$4.23 ,$60.87 ,$4.69 ,$5.14 ,$5.14 ,$4.19 ,$5.14 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30500172,85347,HC ACTIVATED CLOTTING TIME (HRACT),305,1 ,$31.05 ,$20.49 ,$4.19 ,$31.05 ,$4.42 ,$14.98 ,$14.98 ,$4.28 ,$18.63 ,$26.39 ,$21.74 ,$4.42 ,$4.42 ,$29.50 ,$23.60 ,$23.29 ,$7.28 ,$26.39 ,$4.28 ,$7.28 ,$7.28 ,$21.74 ,$18.91 ,$4.42 ,$4.28 ,$4.19 ,$8.56 ,$4.69 ,$26.39 ,$9.63 ,$28.57 ,$21.74 ,$21.28 ,$21.28 ,$18.91 ,$21.28 ,$21.46 ,$27.95 ,$21.21 ,$4.23 ,$24.53 ,$4.69 ,$5.14 ,$5.14 ,$4.19 ,$5.14 ,$22.36 ,$19.25 ,$22.36 ,$22.36 ,$24.84 
ST NICHOLAS HOSPITAL - ACUTE,30500173,85347,HC ACTIVATED CLOTTING TIME (HDR),305,1 ,$25.30 ,$16.70 ,$4.19 ,$25.30 ,$4.42 ,$14.98 ,$14.98 ,$4.28 ,$15.18 ,$21.51 ,$17.71 ,$4.42 ,$4.42 ,$24.04 ,$19.23 ,$18.98 ,$7.28 ,$21.51 ,$4.28 ,$7.28 ,$7.28 ,$17.71 ,$15.41 ,$4.42 ,$4.28 ,$4.19 ,$8.56 ,$4.69 ,$21.51 ,$9.63 ,$23.28 ,$17.71 ,$21.28 ,$21.28 ,$15.41 ,$21.28 ,$17.48 ,$22.77 ,$17.29 ,$4.23 ,$19.99 ,$4.69 ,$5.14 ,$5.14 ,$4.19 ,$5.14 ,$18.22 ,$15.69 ,$18.22 ,$18.22 ,$20.24 
ST NICHOLAS HOSPITAL - ACUTE,30500174,85362,HC FDP/FSP AGGLUT SQ,305,1 ,$60.95 ,$40.23 ,$6.75 ,$60.95 ,$7.12 ,$24.12 ,$24.12 ,$6.89 ,$36.57 ,$51.81 ,$42.67 ,$7.12 ,$7.12 ,$57.90 ,$46.32 ,$45.71 ,$11.71 ,$51.81 ,$6.89 ,$11.71 ,$11.71 ,$42.67 ,$37.12 ,$7.12 ,$6.89 ,$6.75 ,$13.78 ,$7.55 ,$51.81 ,$15.50 ,$56.07 ,$42.67 ,$34.44 ,$34.44 ,$37.12 ,$34.44 ,$42.12 ,$54.86 ,$41.64 ,$6.82 ,$48.15 ,$7.55 ,$8.27 ,$8.27 ,$6.75 ,$8.27 ,$43.88 ,$37.79 ,$43.88 ,$43.88 ,$48.76 
ST NICHOLAS HOSPITAL - ACUTE,30500175,85379,HC D DIMER QN,305,1 ,$89.70 ,$59.20 ,$9.98 ,$89.70 ,$10.52 ,$35.63 ,$35.63 ,$10.18 ,$53.82 ,$76.25 ,$62.79 ,$10.52 ,$10.52 ,$85.22 ,$68.17 ,$67.28 ,$17.31 ,$76.25 ,$10.18 ,$17.31 ,$17.31 ,$62.79 ,$54.63 ,$10.52 ,$10.18 ,$9.98 ,$20.36 ,$11.15 ,$76.25 ,$22.91 ,$82.52 ,$62.79 ,$40.52 ,$40.52 ,$54.63 ,$40.52 ,$61.98 ,$80.73 ,$61.28 ,$10.07 ,$70.86 ,$11.15 ,$12.22 ,$12.22 ,$9.98 ,$12.22 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30500176,85384,HC FIBRINOGEN,305,1 ,$89.70 ,$59.20 ,$9.53 ,$89.70 ,$10.04 ,$34.02 ,$34.02 ,$9.72 ,$53.82 ,$76.25 ,$62.79 ,$10.04 ,$10.04 ,$85.22 ,$68.17 ,$67.28 ,$16.52 ,$76.25 ,$9.72 ,$16.52 ,$16.52 ,$62.79 ,$54.63 ,$10.04 ,$9.72 ,$9.53 ,$19.44 ,$10.64 ,$76.25 ,$21.87 ,$82.52 ,$62.79 ,$42.42 ,$42.42 ,$54.63 ,$42.42 ,$61.98 ,$80.73 ,$61.28 ,$9.62 ,$70.86 ,$10.64 ,$11.66 ,$11.66 ,$9.53 ,$11.66 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30500177,85384,HC FIBRINOGEN (TEG),305,1 ,$77.05 ,$50.85 ,$9.53 ,$77.05 ,$10.04 ,$34.02 ,$34.02 ,$9.72 ,$46.23 ,$65.49 ,$53.94 ,$10.04 ,$10.04 ,$73.20 ,$58.56 ,$57.79 ,$16.52 ,$65.49 ,$9.72 ,$16.52 ,$16.52 ,$53.94 ,$46.92 ,$10.04 ,$9.72 ,$9.53 ,$19.44 ,$10.64 ,$65.49 ,$21.87 ,$70.89 ,$53.94 ,$42.42 ,$42.42 ,$46.92 ,$42.42 ,$53.24 ,$69.35 ,$52.64 ,$9.62 ,$60.87 ,$10.64 ,$11.66 ,$11.66 ,$9.53 ,$11.66 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30500179,85385,HC FIBRINOGEN AG,305,1 ,$77.05 ,$50.85 ,$11.94 ,$77.05 ,$11.94 ,$50.61 ,$50.61 ,$14.46 ,$46.23 ,$65.49 ,$53.94 ,$11.94 ,$11.94 ,$73.20 ,$58.56 ,$57.79 ,$24.58 ,$65.49 ,$14.46 ,$24.58 ,$24.58 ,$53.94 ,$46.92 ,$11.94 ,$14.46 ,$14.17 ,$28.92 ,$12.66 ,$65.49 ,$32.54 ,$70.89 ,$53.94 ,$42.42 ,$42.42 ,$46.92 ,$42.42 ,$53.24 ,$69.35 ,$52.64 ,$14.31 ,$60.87 ,$12.66 ,$17.35 ,$17.35 ,$14.17 ,$17.35 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30500181,85410,HC ALPHA 2 ANTIPLASMIN,305,1 ,$232.30 ,$153.32 ,$7.56 ,$232.30 ,$7.97 ,$26.99 ,$26.99 ,$7.71 ,$139.38 ,$197.46 ,$162.61 ,$7.97 ,$7.97 ,$220.69 ,$176.55 ,$174.23 ,$13.11 ,$197.46 ,$7.71 ,$13.11 ,$13.11 ,$162.61 ,$141.47 ,$7.97 ,$7.71 ,$7.56 ,$15.42 ,$8.45 ,$197.46 ,$17.35 ,$213.72 ,$162.61 ,$38.54 ,$38.54 ,$141.47 ,$38.54 ,$160.52 ,$209.07 ,$158.71 ,$7.63 ,$183.52 ,$8.45 ,$9.25 ,$9.25 ,$7.56 ,$9.25 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30500182,85415,HC PLASMINGEN ACTIV INHIB,305,1 ,$287.50 ,$189.75 ,$16.85 ,$287.50 ,$17.76 ,$60.17 ,$60.17 ,$17.19 ,$172.50 ,$244.38 ,$201.25 ,$17.76 ,$17.76 ,$273.13 ,$218.50 ,$215.63 ,$29.22 ,$244.38 ,$17.19 ,$29.22 ,$29.22 ,$201.25 ,$175.09 ,$17.76 ,$17.19 ,$16.85 ,$34.38 ,$18.83 ,$244.38 ,$38.68 ,$264.50 ,$201.25 ,$85.95 ,$85.95 ,$175.09 ,$85.95 ,$198.66 ,$258.75 ,$196.42 ,$17.01 ,$227.13 ,$18.83 ,$20.63 ,$20.63 ,$16.85 ,$20.63 ,$207.00 ,$178.25 ,$207.00 ,$207.00 ,$230.00 
ST NICHOLAS HOSPITAL - ACUTE,30500184,85420,HC PLASMINOGEN ACTIVITY,305,1 ,$270.25 ,$178.37 ,$6.40 ,$270.25 ,$6.75 ,$22.86 ,$22.86 ,$6.53 ,$162.15 ,$229.71 ,$189.18 ,$6.75 ,$6.75 ,$256.74 ,$205.39 ,$202.69 ,$11.10 ,$229.71 ,$6.53 ,$11.10 ,$11.10 ,$189.18 ,$164.58 ,$6.75 ,$6.53 ,$6.40 ,$13.06 ,$7.16 ,$229.71 ,$14.69 ,$248.63 ,$189.18 ,$32.68 ,$32.68 ,$164.58 ,$32.68 ,$186.74 ,$243.23 ,$184.63 ,$6.47 ,$213.50 ,$7.16 ,$7.84 ,$7.84 ,$6.40 ,$7.84 ,$194.58 ,$167.56 ,$194.58 ,$194.58 ,$216.20 
ST NICHOLAS HOSPITAL - ACUTE,30500185,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$193.20 ,$127.51 ,$7.58 ,$193.20 ,$7.99 ,$27.06 ,$27.06 ,$7.73 ,$115.92 ,$164.22 ,$135.24 ,$7.99 ,$7.99 ,$183.54 ,$146.83 ,$144.90 ,$13.14 ,$164.22 ,$7.73 ,$13.14 ,$13.14 ,$135.24 ,$117.66 ,$7.99 ,$7.73 ,$7.58 ,$15.46 ,$8.47 ,$164.22 ,$17.39 ,$177.74 ,$135.24 ,$38.69 ,$38.69 ,$117.66 ,$38.69 ,$133.50 ,$173.88 ,$131.99 ,$7.65 ,$152.63 ,$8.47 ,$9.28 ,$9.28 ,$7.58 ,$9.28 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30500186,85461,HC FETAL HGB ROSETTE,305,1 ,$77.05 ,$50.85 ,$9.17 ,$77.05 ,$9.33 ,$32.76 ,$32.76 ,$9.36 ,$46.23 ,$65.49 ,$53.94 ,$9.33 ,$9.33 ,$73.20 ,$58.56 ,$57.79 ,$15.91 ,$65.49 ,$9.36 ,$15.91 ,$15.91 ,$53.94 ,$46.92 ,$9.33 ,$9.36 ,$9.17 ,$18.72 ,$9.89 ,$65.49 ,$21.06 ,$70.89 ,$53.94 ,$33.15 ,$33.15 ,$46.92 ,$33.15 ,$53.24 ,$69.35 ,$52.64 ,$9.26 ,$60.87 ,$9.89 ,$11.23 ,$11.23 ,$9.17 ,$11.23 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30500187,85520,HC HEPARIN ASSAY,305,1 ,$218.50 ,$144.21 ,$12.83 ,$218.50 ,$13.53 ,$45.82 ,$45.82 ,$13.09 ,$131.10 ,$185.73 ,$152.95 ,$13.53 ,$13.53 ,$207.58 ,$166.06 ,$163.88 ,$22.25 ,$185.73 ,$13.09 ,$22.25 ,$22.25 ,$152.95 ,$133.07 ,$13.53 ,$13.09 ,$12.83 ,$26.18 ,$14.34 ,$185.73 ,$29.45 ,$201.02 ,$152.95 ,$55.83 ,$55.83 ,$133.07 ,$55.83 ,$150.98 ,$196.65 ,$149.28 ,$12.96 ,$172.62 ,$14.34 ,$15.71 ,$15.71 ,$12.83 ,$15.71 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30500188,85520,HC HEPARIN ASSAY (LOW MOLE),305,1 ,$218.50 ,$144.21 ,$12.83 ,$218.50 ,$13.53 ,$45.82 ,$45.82 ,$13.09 ,$131.10 ,$185.73 ,$152.95 ,$13.53 ,$13.53 ,$207.58 ,$166.06 ,$163.88 ,$22.25 ,$185.73 ,$13.09 ,$22.25 ,$22.25 ,$152.95 ,$133.07 ,$13.53 ,$13.09 ,$12.83 ,$26.18 ,$14.34 ,$185.73 ,$29.45 ,$201.02 ,$152.95 ,$55.83 ,$55.83 ,$133.07 ,$55.83 ,$150.98 ,$196.65 ,$149.28 ,$12.96 ,$172.62 ,$14.34 ,$15.71 ,$15.71 ,$12.83 ,$15.71 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30500189,85520,HC HPT,305,1 ,$67.85 ,$44.78 ,$12.83 ,$67.85 ,$13.53 ,$45.82 ,$45.82 ,$13.09 ,$40.71 ,$57.67 ,$47.50 ,$13.53 ,$13.53 ,$64.46 ,$51.57 ,$50.89 ,$22.25 ,$57.67 ,$13.09 ,$22.25 ,$22.25 ,$47.50 ,$41.32 ,$13.53 ,$13.09 ,$12.83 ,$26.18 ,$14.34 ,$57.67 ,$29.45 ,$62.42 ,$47.50 ,$55.83 ,$55.83 ,$41.32 ,$55.83 ,$46.88 ,$61.07 ,$46.36 ,$12.96 ,$53.60 ,$14.34 ,$15.71 ,$15.71 ,$12.83 ,$15.71 ,$48.85 ,$42.07 ,$48.85 ,$48.85 ,$54.28 
ST NICHOLAS HOSPITAL - ACUTE,30500190,85540,HC LEUKOCYTE ALK PHOS,305,1 ,$161.00 ,$106.26 ,$8.43 ,$161.00 ,$8.89 ,$30.10 ,$30.10 ,$8.60 ,$96.60 ,$136.85 ,$112.70 ,$8.89 ,$8.89 ,$152.95 ,$122.36 ,$120.75 ,$14.62 ,$136.85 ,$8.60 ,$14.62 ,$14.62 ,$112.70 ,$98.05 ,$8.89 ,$8.60 ,$8.43 ,$17.20 ,$9.42 ,$136.85 ,$19.35 ,$148.12 ,$112.70 ,$43.01 ,$43.01 ,$98.05 ,$43.01 ,$111.25 ,$144.90 ,$110.00 ,$8.52 ,$127.19 ,$9.42 ,$10.32 ,$10.32 ,$8.43 ,$10.32 ,$115.92 ,$99.82 ,$115.92 ,$115.92 ,$128.80 
ST NICHOLAS HOSPITAL - ACUTE,30500191,85557,HC OSMOTIC FRAG RBC INCUB,305,1 ,$297.85 ,$196.58 ,$13.09 ,$297.85 ,$13.80 ,$46.76 ,$46.76 ,$13.36 ,$178.71 ,$253.17 ,$208.50 ,$13.80 ,$13.80 ,$282.96 ,$226.37 ,$223.39 ,$22.71 ,$253.17 ,$13.36 ,$22.71 ,$22.71 ,$208.50 ,$181.39 ,$13.80 ,$13.36 ,$13.09 ,$26.72 ,$14.63 ,$253.17 ,$30.06 ,$274.02 ,$208.50 ,$66.79 ,$66.79 ,$181.39 ,$66.79 ,$205.81 ,$268.07 ,$203.49 ,$13.22 ,$235.30 ,$14.63 ,$16.03 ,$16.03 ,$13.09 ,$16.03 ,$214.45 ,$184.67 ,$214.45 ,$214.45 ,$238.28 
ST NICHOLAS HOSPITAL - ACUTE,30500192,85576,HC PLATELET AGGREGATION EA,305,1 ,$244.95 ,$161.67 ,$24.41 ,$244.95 ,$25.74 ,$87.19 ,$87.19 ,$24.91 ,$146.97 ,$208.21 ,$171.47 ,$25.74 ,$25.74 ,$232.70 ,$186.16 ,$183.71 ,$42.35 ,$208.21 ,$24.91 ,$42.35 ,$42.35 ,$171.47 ,$149.17 ,$25.74 ,$24.91 ,$24.41 ,$49.82 ,$27.28 ,$208.21 ,$56.05 ,$225.35 ,$171.47 ,$107.38 ,$107.38 ,$149.17 ,$107.38 ,$169.26 ,$220.46 ,$167.35 ,$24.66 ,$193.51 ,$27.28 ,$29.89 ,$29.89 ,$24.41 ,$29.89 ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,30500193,85576,HC PLATELET AGGREGATION EA (TEG),305,1 ,$89.70 ,$59.20 ,$24.41 ,$89.70 ,$25.74 ,$87.19 ,$87.19 ,$24.91 ,$53.82 ,$76.25 ,$62.79 ,$25.74 ,$25.74 ,$85.22 ,$68.17 ,$67.28 ,$42.35 ,$76.25 ,$24.91 ,$42.35 ,$42.35 ,$62.79 ,$54.63 ,$25.74 ,$24.91 ,$24.41 ,$49.82 ,$27.28 ,$76.25 ,$56.05 ,$82.52 ,$62.79 ,$89.70 ,$89.70 ,$54.63 ,$89.70 ,$61.98 ,$80.73 ,$61.28 ,$24.66 ,$70.86 ,$27.28 ,$29.89 ,$29.89 ,$24.41 ,$29.89 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30500195,85576,HC PLATELET AGGREGATION EA (ASSAY),305,1 ,$118.45 ,$78.18 ,$24.41 ,$118.45 ,$25.74 ,$87.19 ,$87.19 ,$24.91 ,$71.07 ,$100.68 ,$82.92 ,$25.74 ,$25.74 ,$112.53 ,$90.02 ,$88.84 ,$42.35 ,$100.68 ,$24.91 ,$42.35 ,$42.35 ,$82.92 ,$72.14 ,$25.74 ,$24.91 ,$24.41 ,$49.82 ,$27.28 ,$100.68 ,$56.05 ,$108.97 ,$82.92 ,$107.38 ,$107.38 ,$72.14 ,$107.38 ,$81.85 ,$106.61 ,$80.93 ,$24.66 ,$93.58 ,$27.28 ,$29.89 ,$29.89 ,$24.41 ,$29.89 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$41.40 ,$27.32 ,$4.20 ,$41.40 ,$4.43 ,$15.02 ,$15.02 ,$4.29 ,$24.84 ,$35.19 ,$28.98 ,$4.43 ,$4.43 ,$39.33 ,$31.46 ,$31.05 ,$7.29 ,$35.19 ,$4.29 ,$7.29 ,$7.29 ,$28.98 ,$25.21 ,$4.43 ,$4.29 ,$4.20 ,$8.58 ,$4.70 ,$35.19 ,$9.65 ,$38.09 ,$28.98 ,$19.67 ,$19.67 ,$25.21 ,$19.67 ,$28.61 ,$37.26 ,$28.28 ,$4.24 ,$32.71 ,$4.70 ,$5.15 ,$5.15 ,$4.20 ,$5.15 ,$29.81 ,$25.67 ,$29.81 ,$29.81 ,$33.12 
ST NICHOLAS HOSPITAL - ACUTE,30500197,85611,HC PT MIX STUDY,305,1 ,$55.20 ,$36.43 ,$3.86 ,$55.20 ,$4.07 ,$13.79 ,$13.79 ,$3.94 ,$33.12 ,$46.92 ,$38.64 ,$4.07 ,$4.07 ,$52.44 ,$41.95 ,$41.40 ,$6.70 ,$46.92 ,$3.94 ,$6.70 ,$6.70 ,$38.64 ,$33.62 ,$4.07 ,$3.94 ,$3.86 ,$7.88 ,$4.31 ,$46.92 ,$8.87 ,$50.78 ,$38.64 ,$19.71 ,$19.71 ,$33.62 ,$19.71 ,$38.14 ,$49.68 ,$37.71 ,$3.90 ,$43.61 ,$4.31 ,$4.73 ,$4.73 ,$3.86 ,$4.73 ,$39.74 ,$34.22 ,$39.74 ,$39.74 ,$44.16 
ST NICHOLAS HOSPITAL - ACUTE,30500198,85613,HC RUSSELL VIPER VENOM SCR,305,1 ,$89.70 ,$59.20 ,$9.39 ,$89.70 ,$9.90 ,$33.53 ,$33.53 ,$9.58 ,$53.82 ,$76.25 ,$62.79 ,$9.90 ,$9.90 ,$85.22 ,$68.17 ,$67.28 ,$16.29 ,$76.25 ,$9.58 ,$16.29 ,$16.29 ,$62.79 ,$54.63 ,$9.90 ,$9.58 ,$9.39 ,$19.16 ,$10.49 ,$76.25 ,$21.56 ,$82.52 ,$62.79 ,$47.85 ,$47.85 ,$54.63 ,$47.85 ,$61.98 ,$80.73 ,$61.28 ,$9.49 ,$70.86 ,$10.49 ,$11.50 ,$11.50 ,$9.39 ,$11.50 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30500200,85613,HC RUSSELL VIPER VENOM CONF,305,1 ,$89.70 ,$59.20 ,$9.39 ,$89.70 ,$9.90 ,$33.53 ,$33.53 ,$9.58 ,$53.82 ,$76.25 ,$62.79 ,$9.90 ,$9.90 ,$85.22 ,$68.17 ,$67.28 ,$16.29 ,$76.25 ,$9.58 ,$16.29 ,$16.29 ,$62.79 ,$54.63 ,$9.90 ,$9.58 ,$9.39 ,$19.16 ,$10.49 ,$76.25 ,$21.56 ,$82.52 ,$62.79 ,$47.85 ,$47.85 ,$54.63 ,$47.85 ,$61.98 ,$80.73 ,$61.28 ,$9.49 ,$70.86 ,$10.49 ,$11.50 ,$11.50 ,$9.39 ,$11.50 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30500201,85613,HC RUSSELL VIPER VENOM DIL (DRVVT),305,1 ,$89.70 ,$59.20 ,$9.39 ,$89.70 ,$9.90 ,$33.53 ,$33.53 ,$9.58 ,$53.82 ,$76.25 ,$62.79 ,$9.90 ,$9.90 ,$85.22 ,$68.17 ,$67.28 ,$16.29 ,$76.25 ,$9.58 ,$16.29 ,$16.29 ,$62.79 ,$54.63 ,$9.90 ,$9.58 ,$9.39 ,$19.16 ,$10.49 ,$76.25 ,$21.56 ,$82.52 ,$62.79 ,$47.85 ,$47.85 ,$54.63 ,$47.85 ,$61.98 ,$80.73 ,$61.28 ,$9.49 ,$70.86 ,$10.49 ,$11.50 ,$11.50 ,$9.39 ,$11.50 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30500202,85613,HC RUSSELL VIPER VENOM DIL,305,1 ,$157.55 ,$103.98 ,$9.39 ,$157.55 ,$9.90 ,$33.53 ,$33.53 ,$9.58 ,$94.53 ,$133.92 ,$110.29 ,$9.90 ,$9.90 ,$149.67 ,$119.74 ,$118.16 ,$16.29 ,$133.92 ,$9.58 ,$16.29 ,$16.29 ,$110.29 ,$95.95 ,$9.90 ,$9.58 ,$9.39 ,$19.16 ,$10.49 ,$133.92 ,$21.56 ,$144.95 ,$110.29 ,$47.85 ,$47.85 ,$95.95 ,$47.85 ,$108.87 ,$141.80 ,$107.64 ,$9.49 ,$124.46 ,$10.49 ,$11.50 ,$11.50 ,$9.39 ,$11.50 ,$113.44 ,$97.68 ,$113.44 ,$113.44 ,$126.04 
ST NICHOLAS HOSPITAL - ACUTE,30500204,85651,HC SED RATE RBC NON AUTO,305,1 ,$52.90 ,$34.91 ,$4.01 ,$52.90 ,$4.01 ,$14.95 ,$14.95 ,$4.27 ,$31.74 ,$44.97 ,$37.03 ,$4.01 ,$4.01 ,$50.26 ,$40.20 ,$39.68 ,$7.26 ,$44.97 ,$4.27 ,$7.26 ,$7.26 ,$37.03 ,$32.22 ,$4.01 ,$4.27 ,$4.18 ,$8.54 ,$4.25 ,$44.97 ,$9.61 ,$48.67 ,$37.03 ,$17.73 ,$17.73 ,$32.22 ,$17.73 ,$36.55 ,$47.61 ,$36.14 ,$4.22 ,$41.79 ,$4.25 ,$5.12 ,$5.12 ,$4.18 ,$5.12 ,$38.09 ,$32.80 ,$38.09 ,$38.09 ,$42.32 
ST NICHOLAS HOSPITAL - ACUTE,30500205,85652,HC SED RATE AUTO,305,1 ,$46.00 ,$30.36 ,$2.65 ,$46.00 ,$2.79 ,$9.45 ,$9.45 ,$2.70 ,$27.60 ,$39.10 ,$32.20 ,$2.79 ,$2.79 ,$43.70 ,$34.96 ,$34.50 ,$4.59 ,$39.10 ,$2.70 ,$4.59 ,$4.59 ,$32.20 ,$28.01 ,$2.79 ,$2.70 ,$2.65 ,$5.40 ,$2.96 ,$39.10 ,$6.08 ,$42.32 ,$32.20 ,$13.52 ,$13.52 ,$28.01 ,$13.52 ,$31.79 ,$41.40 ,$31.43 ,$2.68 ,$36.34 ,$2.96 ,$3.24 ,$3.24 ,$2.65 ,$3.24 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30500206,85660,HC SICKLE CELL RBC,305,1 ,$77.05 ,$50.85 ,$5.40 ,$77.05 ,$5.69 ,$19.29 ,$19.29 ,$5.51 ,$46.23 ,$65.49 ,$53.94 ,$5.69 ,$5.69 ,$73.20 ,$58.56 ,$57.79 ,$9.37 ,$65.49 ,$5.51 ,$9.37 ,$9.37 ,$53.94 ,$46.92 ,$5.69 ,$5.51 ,$5.40 ,$11.02 ,$6.03 ,$65.49 ,$12.40 ,$70.89 ,$53.94 ,$27.59 ,$27.59 ,$46.92 ,$27.59 ,$53.24 ,$69.35 ,$52.64 ,$5.46 ,$60.87 ,$6.03 ,$6.61 ,$6.61 ,$5.40 ,$6.61 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30500207,85670,HC THROMBIN TIME PLASMA,305,1 ,$116.15 ,$76.66 ,$0.12 ,$116.15 ,$0.12 ,$20.20 ,$20.20 ,$5.77 ,$69.69 ,$98.73 ,$81.31 ,$0.12 ,$0.12 ,$110.34 ,$88.27 ,$87.11 ,$9.81 ,$98.73 ,$5.77 ,$9.81 ,$9.81 ,$81.31 ,$70.74 ,$0.12 ,$5.77 ,$5.65 ,$11.54 ,$0.13 ,$98.73 ,$12.98 ,$106.86 ,$81.31 ,$28.83 ,$28.83 ,$70.74 ,$28.83 ,$80.26 ,$104.54 ,$79.35 ,$5.71 ,$91.76 ,$0.13 ,$6.92 ,$6.92 ,$5.65 ,$6.92 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30500208,85705,HC HEX PHOSPHOLIPID NEUT,305,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$33.71 ,$33.71 ,$9.63 ,$38.64 ,$54.74 ,$45.08 ,$8.17 ,$8.17 ,$61.18 ,$48.94 ,$48.30 ,$16.37 ,$54.74 ,$9.63 ,$16.37 ,$16.37 ,$45.08 ,$39.22 ,$8.17 ,$9.63 ,$9.44 ,$19.26 ,$8.66 ,$54.74 ,$21.67 ,$59.25 ,$45.08 ,$29.05 ,$29.05 ,$39.22 ,$29.05 ,$44.50 ,$57.96 ,$44.00 ,$9.54 ,$50.88 ,$8.66 ,$11.56 ,$11.56 ,$9.44 ,$11.56 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30500209,85730,HC PTT (LUPUS),305,1 ,$59.80 ,$39.47 ,$5.89 ,$59.80 ,$6.21 ,$21.04 ,$21.04 ,$6.01 ,$35.88 ,$50.83 ,$41.86 ,$6.21 ,$6.21 ,$56.81 ,$45.45 ,$44.85 ,$10.22 ,$50.83 ,$6.01 ,$10.22 ,$10.22 ,$41.86 ,$36.42 ,$6.21 ,$6.01 ,$5.89 ,$12.02 ,$6.58 ,$50.83 ,$13.52 ,$55.02 ,$41.86 ,$30.00 ,$30.00 ,$36.42 ,$30.00 ,$41.32 ,$53.82 ,$40.86 ,$5.95 ,$47.24 ,$6.58 ,$7.21 ,$7.21 ,$5.89 ,$7.21 ,$43.06 ,$37.08 ,$43.06 ,$43.06 ,$47.84 
ST NICHOLAS HOSPITAL - ACUTE,30500210,85730,HC PTT (LUPUS ANTI),305,1 ,$100.05 ,$66.03 ,$5.89 ,$100.05 ,$6.21 ,$21.04 ,$21.04 ,$6.01 ,$60.03 ,$85.04 ,$70.04 ,$6.21 ,$6.21 ,$95.05 ,$76.04 ,$75.04 ,$10.22 ,$85.04 ,$6.01 ,$10.22 ,$10.22 ,$70.04 ,$60.93 ,$6.21 ,$6.01 ,$5.89 ,$12.02 ,$6.58 ,$85.04 ,$13.52 ,$92.05 ,$70.04 ,$30.00 ,$30.00 ,$60.93 ,$30.00 ,$69.13 ,$90.05 ,$68.35 ,$5.95 ,$79.04 ,$6.58 ,$7.21 ,$7.21 ,$5.89 ,$7.21 ,$72.04 ,$62.03 ,$72.04 ,$72.04 ,$80.04 
ST NICHOLAS HOSPITAL - ACUTE,30500211,85730,HC PTT,305,1 ,$64.40 ,$42.50 ,$5.89 ,$64.40 ,$6.21 ,$21.04 ,$21.04 ,$6.01 ,$38.64 ,$54.74 ,$45.08 ,$6.21 ,$6.21 ,$61.18 ,$48.94 ,$48.30 ,$10.22 ,$54.74 ,$6.01 ,$10.22 ,$10.22 ,$45.08 ,$39.22 ,$6.21 ,$6.01 ,$5.89 ,$12.02 ,$6.58 ,$54.74 ,$13.52 ,$59.25 ,$45.08 ,$30.00 ,$30.00 ,$39.22 ,$30.00 ,$44.50 ,$57.96 ,$44.00 ,$5.95 ,$50.88 ,$6.58 ,$7.21 ,$7.21 ,$5.89 ,$7.21 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30500212,85730,HC APTT,305,1 ,$118.45 ,$78.18 ,$5.89 ,$118.45 ,$6.21 ,$21.04 ,$21.04 ,$6.01 ,$71.07 ,$100.68 ,$82.92 ,$6.21 ,$6.21 ,$112.53 ,$90.02 ,$88.84 ,$10.22 ,$100.68 ,$6.01 ,$10.22 ,$10.22 ,$82.92 ,$72.14 ,$6.21 ,$6.01 ,$5.89 ,$12.02 ,$6.58 ,$100.68 ,$13.52 ,$108.97 ,$82.92 ,$30.00 ,$30.00 ,$72.14 ,$30.00 ,$81.85 ,$106.61 ,$80.93 ,$5.95 ,$93.58 ,$6.58 ,$7.21 ,$7.21 ,$5.89 ,$7.21 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,30500213,85732,HC PTT MIXING STUDY,305,1 ,$89.70 ,$59.20 ,$6.34 ,$89.70 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$53.82 ,$76.25 ,$62.79 ,$6.69 ,$6.69 ,$85.22 ,$68.17 ,$67.28 ,$11.00 ,$76.25 ,$6.47 ,$11.00 ,$11.00 ,$62.79 ,$54.63 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$76.25 ,$14.56 ,$82.52 ,$62.79 ,$32.35 ,$32.35 ,$54.63 ,$32.35 ,$61.98 ,$80.73 ,$61.28 ,$6.40 ,$70.86 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30500214,85732,HC PTT MIXING STUDY (LUPUS),305,1 ,$29.90 ,$19.73 ,$6.34 ,$29.90 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$17.94 ,$25.42 ,$20.93 ,$6.69 ,$6.69 ,$28.41 ,$22.72 ,$22.43 ,$11.00 ,$25.42 ,$6.47 ,$11.00 ,$11.00 ,$20.93 ,$18.21 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$25.42 ,$14.56 ,$27.51 ,$20.93 ,$29.90 ,$29.90 ,$18.21 ,$29.90 ,$20.66 ,$26.91 ,$20.43 ,$6.40 ,$23.62 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$21.53 ,$18.54 ,$21.53 ,$21.53 ,$23.92 
ST NICHOLAS HOSPITAL - ACUTE,30500215,85732,HC PTT MIXING STUDY (24) HR,305,1 ,$74.75 ,$49.34 ,$6.34 ,$74.75 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$44.85 ,$63.54 ,$52.33 ,$6.69 ,$6.69 ,$71.01 ,$56.81 ,$56.06 ,$11.00 ,$63.54 ,$6.47 ,$11.00 ,$11.00 ,$52.33 ,$45.52 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$63.54 ,$14.56 ,$68.77 ,$52.33 ,$32.35 ,$32.35 ,$45.52 ,$32.35 ,$51.65 ,$67.28 ,$51.07 ,$6.40 ,$59.05 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$53.82 ,$46.35 ,$53.82 ,$53.82 ,$59.80 
ST NICHOLAS HOSPITAL - ACUTE,30500216,85732,HC PTT MIXING STUDY (PLASMA),305,1 ,$180.55 ,$119.16 ,$6.34 ,$180.55 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$108.33 ,$153.47 ,$126.39 ,$6.69 ,$6.69 ,$171.52 ,$137.22 ,$135.41 ,$11.00 ,$153.47 ,$6.47 ,$11.00 ,$11.00 ,$126.39 ,$109.96 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$153.47 ,$14.56 ,$166.11 ,$126.39 ,$32.35 ,$32.35 ,$109.96 ,$32.35 ,$124.76 ,$162.50 ,$123.35 ,$6.40 ,$142.63 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30500217,85810,HC VISCOSITY,305,1 ,$103.50 ,$68.31 ,$11.44 ,$103.50 ,$12.06 ,$40.85 ,$40.85 ,$11.67 ,$62.10 ,$87.98 ,$72.45 ,$12.06 ,$12.06 ,$98.33 ,$78.66 ,$77.63 ,$19.84 ,$87.98 ,$11.67 ,$19.84 ,$19.84 ,$72.45 ,$63.03 ,$12.06 ,$11.67 ,$11.44 ,$23.34 ,$12.78 ,$87.98 ,$26.26 ,$95.22 ,$72.45 ,$58.32 ,$58.32 ,$63.03 ,$58.32 ,$71.52 ,$93.15 ,$70.71 ,$11.55 ,$81.77 ,$12.78 ,$14.00 ,$14.00 ,$11.44 ,$14.00 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30500220,85576,HC PLTMAP ADP 85576,305,1 ,$116.15 ,$76.66 ,$24.41 ,$116.15 ,$25.74 ,$87.19 ,$87.19 ,$24.91 ,$69.69 ,$98.73 ,$81.31 ,$25.74 ,$25.74 ,$110.34 ,$88.27 ,$87.11 ,$42.35 ,$98.73 ,$24.91 ,$42.35 ,$42.35 ,$81.31 ,$70.74 ,$25.74 ,$24.91 ,$24.41 ,$49.82 ,$27.28 ,$98.73 ,$56.05 ,$106.86 ,$81.31 ,$107.38 ,$107.38 ,$70.74 ,$107.38 ,$80.26 ,$104.54 ,$79.35 ,$24.66 ,$91.76 ,$27.28 ,$29.89 ,$29.89 ,$24.41 ,$29.89 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30500221,85576,HC PLTMAP AA 85576,305,1 ,$116.15 ,$76.66 ,$24.41 ,$116.15 ,$25.74 ,$87.19 ,$87.19 ,$24.91 ,$69.69 ,$98.73 ,$81.31 ,$25.74 ,$25.74 ,$110.34 ,$88.27 ,$87.11 ,$42.35 ,$98.73 ,$24.91 ,$42.35 ,$42.35 ,$81.31 ,$70.74 ,$25.74 ,$24.91 ,$24.41 ,$49.82 ,$27.28 ,$98.73 ,$56.05 ,$106.86 ,$81.31 ,$107.38 ,$107.38 ,$70.74 ,$107.38 ,$80.26 ,$104.54 ,$79.35 ,$24.66 ,$91.76 ,$27.28 ,$29.89 ,$29.89 ,$24.41 ,$29.89 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30500222,85576,HC PLT MAP TEG 85576,305,1 ,$116.15 ,$76.66 ,$24.41 ,$116.15 ,$25.74 ,$87.19 ,$87.19 ,$24.91 ,$69.69 ,$98.73 ,$81.31 ,$25.74 ,$25.74 ,$110.34 ,$88.27 ,$87.11 ,$42.35 ,$98.73 ,$24.91 ,$42.35 ,$42.35 ,$81.31 ,$70.74 ,$25.74 ,$24.91 ,$24.41 ,$49.82 ,$27.28 ,$98.73 ,$56.05 ,$106.86 ,$81.31 ,$107.38 ,$107.38 ,$70.74 ,$107.38 ,$80.26 ,$104.54 ,$79.35 ,$24.66 ,$91.76 ,$27.28 ,$29.89 ,$29.89 ,$24.41 ,$29.89 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30500223,85576,HC PLTINHIB ADP 85576,305,1 ,$167.90 ,$110.81 ,$24.41 ,$167.90 ,$25.74 ,$87.19 ,$87.19 ,$24.91 ,$100.74 ,$142.72 ,$117.53 ,$25.74 ,$25.74 ,$159.51 ,$127.60 ,$125.93 ,$42.35 ,$142.72 ,$24.91 ,$42.35 ,$42.35 ,$117.53 ,$102.25 ,$25.74 ,$24.91 ,$24.41 ,$49.82 ,$27.28 ,$142.72 ,$56.05 ,$154.47 ,$117.53 ,$107.38 ,$107.38 ,$102.25 ,$107.38 ,$116.02 ,$151.11 ,$114.71 ,$24.66 ,$132.64 ,$27.28 ,$29.89 ,$29.89 ,$24.41 ,$29.89 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30500224,85576,HC PLTINHIB TEG 85576,305,1 ,$167.90 ,$110.81 ,$24.41 ,$167.90 ,$25.74 ,$87.19 ,$87.19 ,$24.91 ,$100.74 ,$142.72 ,$117.53 ,$25.74 ,$25.74 ,$159.51 ,$127.60 ,$125.93 ,$42.35 ,$142.72 ,$24.91 ,$42.35 ,$42.35 ,$117.53 ,$102.25 ,$25.74 ,$24.91 ,$24.41 ,$49.82 ,$27.28 ,$142.72 ,$56.05 ,$154.47 ,$117.53 ,$107.38 ,$107.38 ,$102.25 ,$107.38 ,$116.02 ,$151.11 ,$114.71 ,$24.66 ,$132.64 ,$27.28 ,$29.89 ,$29.89 ,$24.41 ,$29.89 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30500225,85245,HC RISTOCETIN COFACT MAYO,305,1 ,$125.35 ,$82.73 ,$22.48 ,$125.35 ,$23.70 ,$80.29 ,$80.29 ,$22.94 ,$75.21 ,$106.55 ,$87.75 ,$23.70 ,$23.70 ,$119.08 ,$95.27 ,$94.01 ,$39.00 ,$106.55 ,$22.94 ,$39.00 ,$39.00 ,$87.75 ,$76.34 ,$23.70 ,$22.94 ,$22.48 ,$45.88 ,$25.12 ,$106.55 ,$51.62 ,$115.32 ,$87.75 ,$114.67 ,$114.67 ,$76.34 ,$114.67 ,$86.62 ,$112.82 ,$85.64 ,$22.71 ,$99.03 ,$25.12 ,$27.53 ,$27.53 ,$22.48 ,$27.53 ,$90.25 ,$77.72 ,$90.25 ,$90.25 ,$100.28 
ST NICHOLAS HOSPITAL - ACUTE,30500226,85246,HC VW FACTOR ANTIGEN MAYO,305,1 ,$331.20 ,$218.59 ,$22.48 ,$331.20 ,$23.70 ,$80.29 ,$80.29 ,$22.94 ,$198.72 ,$281.52 ,$231.84 ,$23.70 ,$23.70 ,$314.64 ,$251.71 ,$248.40 ,$39.00 ,$281.52 ,$22.94 ,$39.00 ,$39.00 ,$231.84 ,$201.70 ,$23.70 ,$22.94 ,$22.48 ,$45.88 ,$25.12 ,$281.52 ,$51.62 ,$304.70 ,$231.84 ,$114.67 ,$114.67 ,$201.70 ,$114.67 ,$228.86 ,$298.08 ,$226.28 ,$22.71 ,$261.65 ,$25.12 ,$27.53 ,$27.53 ,$22.48 ,$27.53 ,$238.46 ,$205.34 ,$238.46 ,$238.46 ,$264.96 
ST NICHOLAS HOSPITAL - ACUTE,30500227,85240,HC FACTOR VIII ASSAY MAYO,305,1 ,$254.15 ,$167.74 ,$9.84 ,$254.15 ,$9.84 ,$62.65 ,$62.65 ,$17.90 ,$152.49 ,$216.03 ,$177.91 ,$9.84 ,$9.84 ,$241.44 ,$193.15 ,$190.61 ,$30.43 ,$216.03 ,$17.90 ,$30.43 ,$30.43 ,$177.91 ,$154.78 ,$9.84 ,$17.90 ,$17.54 ,$35.80 ,$10.43 ,$216.03 ,$40.28 ,$233.82 ,$177.91 ,$34.95 ,$34.95 ,$154.78 ,$34.95 ,$175.62 ,$228.74 ,$173.64 ,$17.72 ,$200.78 ,$10.43 ,$21.48 ,$21.48 ,$17.54 ,$21.48 ,$182.99 ,$157.57 ,$182.99 ,$182.99 ,$203.32 
ST NICHOLAS HOSPITAL - ACUTE,30500228,85397,HC VW FACTOR ACTIVITY MAYO,305,1 ,$331.20 ,$218.59 ,$30.24 ,$331.20 ,$31.89 ,$108.01 ,$108.01 ,$30.86 ,$198.72 ,$281.52 ,$231.84 ,$31.89 ,$31.89 ,$314.64 ,$251.71 ,$248.40 ,$52.46 ,$281.52 ,$30.86 ,$52.46 ,$52.46 ,$231.84 ,$201.70 ,$31.89 ,$30.86 ,$30.24 ,$61.72 ,$33.80 ,$281.52 ,$69.44 ,$304.70 ,$231.84 ,$114.67 ,$114.67 ,$201.70 ,$114.67 ,$228.86 ,$298.08 ,$226.28 ,$30.55 ,$261.65 ,$33.80 ,$37.03 ,$37.03 ,$30.24 ,$37.03 ,$238.46 ,$205.34 ,$238.46 ,$238.46 ,$264.96 
ST NICHOLAS HOSPITAL - ACUTE,30500230,85055,HC IMMATURE PLATELET FRACTION,305,1 ,$232.30 ,$153.32 ,$18.97 ,$232.30 ,$18.97 ,$125.09 ,$125.09 ,$35.74 ,$139.38 ,$197.46 ,$162.61 ,$18.97 ,$18.97 ,$220.69 ,$176.55 ,$174.23 ,$60.76 ,$197.46 ,$35.74 ,$60.76 ,$60.76 ,$162.61 ,$141.47 ,$18.97 ,$35.74 ,$35.03 ,$71.48 ,$20.11 ,$197.46 ,$80.42 ,$213.72 ,$162.61 ,$133.83 ,$133.83 ,$141.47 ,$133.83 ,$160.52 ,$209.07 ,$158.71 ,$35.38 ,$183.52 ,$20.11 ,$42.89 ,$42.89 ,$35.03 ,$42.89 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30500231,85260,HC FACTOR X CHROMOGENIC,305,1 ,$218.50 ,$144.21 ,$17.54 ,$218.50 ,$18.50 ,$62.65 ,$62.65 ,$17.90 ,$131.10 ,$185.73 ,$152.95 ,$18.50 ,$18.50 ,$207.58 ,$166.06 ,$163.88 ,$30.43 ,$185.73 ,$17.90 ,$30.43 ,$30.43 ,$152.95 ,$133.07 ,$18.50 ,$17.90 ,$17.54 ,$35.80 ,$19.61 ,$185.73 ,$40.28 ,$201.02 ,$152.95 ,$89.50 ,$89.50 ,$133.07 ,$89.50 ,$150.98 ,$196.65 ,$149.28 ,$17.72 ,$172.62 ,$19.61 ,$21.48 ,$21.48 ,$17.54 ,$21.48 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,30500320,85048,HC BLOOD COUNT LEUKO AUTO WITH NEUTROPHIL,305,1 ,$43.70 ,$28.84 ,$2.49 ,$43.70 ,$2.62 ,$8.89 ,$8.89 ,$2.54 ,$26.22 ,$37.15 ,$30.59 ,$2.62 ,$2.62 ,$41.52 ,$33.21 ,$32.78 ,$4.32 ,$37.15 ,$2.54 ,$4.32 ,$4.32 ,$30.59 ,$26.61 ,$2.62 ,$2.54 ,$2.49 ,$5.08 ,$2.78 ,$37.15 ,$5.72 ,$40.20 ,$30.59 ,$12.68 ,$12.68 ,$26.61 ,$12.68 ,$30.20 ,$39.33 ,$29.86 ,$2.52 ,$34.52 ,$2.78 ,$3.05 ,$3.05 ,$2.49 ,$3.05 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30500321,85660,HC SICKLE CELL RBC (RC),305,1 ,$54.05 ,$35.67 ,$5.40 ,$54.05 ,$5.69 ,$19.29 ,$19.29 ,$5.51 ,$32.43 ,$45.94 ,$37.84 ,$5.69 ,$5.69 ,$51.35 ,$41.08 ,$40.54 ,$9.37 ,$45.94 ,$5.51 ,$9.37 ,$9.37 ,$37.84 ,$32.92 ,$5.69 ,$5.51 ,$5.40 ,$11.02 ,$6.03 ,$45.94 ,$12.40 ,$49.73 ,$37.84 ,$27.59 ,$27.59 ,$32.92 ,$27.59 ,$37.35 ,$48.65 ,$36.93 ,$5.46 ,$42.70 ,$6.03 ,$6.61 ,$6.61 ,$5.40 ,$6.61 ,$38.92 ,$33.51 ,$38.92 ,$38.92 ,$43.24 
ST NICHOLAS HOSPITAL - ACUTE,30500343,85549,HC MURAMIDASE,305,1 ,$101.20 ,$66.79 ,$18.37 ,$101.20 ,$19.37 ,$65.63 ,$65.63 ,$18.75 ,$60.72 ,$86.02 ,$70.84 ,$19.37 ,$19.37 ,$96.14 ,$76.91 ,$75.90 ,$31.88 ,$86.02 ,$18.75 ,$31.88 ,$31.88 ,$70.84 ,$61.63 ,$19.37 ,$18.75 ,$18.37 ,$37.50 ,$20.53 ,$86.02 ,$42.19 ,$93.10 ,$70.84 ,$93.75 ,$93.75 ,$61.63 ,$93.75 ,$69.93 ,$91.08 ,$69.14 ,$18.56 ,$79.95 ,$20.53 ,$22.50 ,$22.50 ,$18.37 ,$22.50 ,$72.86 ,$62.74 ,$72.86 ,$72.86 ,$80.96 
ST NICHOLAS HOSPITAL - ACUTE,30500827,85611,HC PT MIX STUDY (PLASMA),305,1 ,$138.00 ,$91.08 ,$3.86 ,$138.00 ,$4.07 ,$13.79 ,$13.79 ,$3.94 ,$82.80 ,$117.30 ,$96.60 ,$4.07 ,$4.07 ,$131.10 ,$104.88 ,$103.50 ,$6.70 ,$117.30 ,$3.94 ,$6.70 ,$6.70 ,$96.60 ,$84.04 ,$4.07 ,$3.94 ,$3.86 ,$7.88 ,$4.31 ,$117.30 ,$8.87 ,$126.96 ,$96.60 ,$19.71 ,$19.71 ,$84.04 ,$19.71 ,$95.36 ,$124.20 ,$94.28 ,$3.90 ,$109.02 ,$4.31 ,$4.73 ,$4.73 ,$3.86 ,$4.73 ,$99.36 ,$85.56 ,$99.36 ,$99.36 ,$110.40 
ST NICHOLAS HOSPITAL - ACUTE,30540180,85397,HC MBC ADAMTS13 ACTIVITY-REF,305,1 ,$287.50 ,$189.75 ,$30.24 ,$287.50 ,$31.89 ,$108.01 ,$108.01 ,$30.86 ,$172.50 ,$244.38 ,$201.25 ,$31.89 ,$31.89 ,$273.13 ,$218.50 ,$215.63 ,$52.46 ,$244.38 ,$30.86 ,$52.46 ,$52.46 ,$201.25 ,$175.09 ,$31.89 ,$30.86 ,$30.24 ,$61.72 ,$33.80 ,$244.38 ,$69.44 ,$264.50 ,$201.25 ,$114.67 ,$114.67 ,$175.09 ,$114.67 ,$198.66 ,$258.75 ,$196.42 ,$30.55 ,$227.13 ,$33.80 ,$37.03 ,$37.03 ,$30.24 ,$37.03 ,$207.00 ,$178.25 ,$207.00 ,$207.00 ,$230.00 
ST NICHOLAS HOSPITAL - ACUTE,30600096,87480,HC CANDIDA SPECIES DNA SCREEN,306,1 ,$180.55 ,$119.16 ,$19.65 ,$180.55 ,$20.72 ,$70.18 ,$70.18 ,$20.05 ,$108.33 ,$153.47 ,$126.39 ,$20.72 ,$20.72 ,$171.52 ,$137.22 ,$135.41 ,$34.09 ,$153.47 ,$20.05 ,$34.09 ,$34.09 ,$126.39 ,$109.96 ,$20.72 ,$20.05 ,$19.65 ,$40.10 ,$21.96 ,$153.47 ,$45.11 ,$166.11 ,$126.39 ,$100.23 ,$100.23 ,$109.96 ,$100.23 ,$124.76 ,$162.50 ,$123.35 ,$19.84 ,$142.63 ,$21.96 ,$24.06 ,$24.06 ,$19.65 ,$24.06 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30600097,87660,HC TRICHOMONAS DNA SCREEN,306,1 ,$180.55 ,$119.16 ,$19.65 ,$180.55 ,$20.72 ,$70.18 ,$70.18 ,$20.05 ,$108.33 ,$153.47 ,$126.39 ,$20.72 ,$20.72 ,$171.52 ,$137.22 ,$135.41 ,$34.09 ,$153.47 ,$20.05 ,$34.09 ,$34.09 ,$126.39 ,$109.96 ,$20.72 ,$20.05 ,$19.65 ,$40.10 ,$21.96 ,$153.47 ,$45.11 ,$166.11 ,$126.39 ,$100.23 ,$100.23 ,$109.96 ,$100.23 ,$124.76 ,$162.50 ,$123.35 ,$19.84 ,$142.63 ,$21.96 ,$24.06 ,$24.06 ,$19.65 ,$24.06 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30600098,87510,HC G VAGINALIS DNA SCREEN,306,1 ,$180.55 ,$119.16 ,$19.65 ,$180.55 ,$20.72 ,$70.18 ,$70.18 ,$20.05 ,$108.33 ,$153.47 ,$126.39 ,$20.72 ,$20.72 ,$171.52 ,$137.22 ,$135.41 ,$34.09 ,$153.47 ,$20.05 ,$34.09 ,$34.09 ,$126.39 ,$109.96 ,$20.72 ,$20.05 ,$19.65 ,$40.10 ,$21.96 ,$153.47 ,$45.11 ,$166.11 ,$126.39 ,$100.23 ,$100.23 ,$109.96 ,$100.23 ,$124.76 ,$162.50 ,$123.35 ,$19.84 ,$142.63 ,$21.96 ,$24.06 ,$24.06 ,$19.65 ,$24.06 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30600099,87496,HC CMV DNA QUAL PCR,306,1 ,$334.65 ,$220.87 ,$34.39 ,$334.65 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$200.79 ,$284.45 ,$234.26 ,$36.26 ,$36.26 ,$317.92 ,$254.33 ,$250.99 ,$59.65 ,$284.45 ,$35.09 ,$59.65 ,$59.65 ,$234.26 ,$203.80 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$284.45 ,$78.95 ,$307.88 ,$234.26 ,$175.37 ,$175.37 ,$203.80 ,$175.37 ,$231.24 ,$301.19 ,$228.63 ,$34.73 ,$264.37 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,30600101,87015,HC CONCENTRATION INFECTIOUS AGENT,306,1 ,$46.00 ,$30.36 ,$5.25 ,$46.00 ,$5.25 ,$23.38 ,$23.38 ,$6.68 ,$27.60 ,$39.10 ,$32.20 ,$5.25 ,$5.25 ,$43.70 ,$34.96 ,$34.50 ,$11.36 ,$39.10 ,$6.68 ,$11.36 ,$11.36 ,$32.20 ,$28.01 ,$5.25 ,$6.68 ,$6.55 ,$13.36 ,$5.57 ,$39.10 ,$15.03 ,$42.32 ,$32.20 ,$18.65 ,$18.65 ,$28.01 ,$18.65 ,$31.79 ,$41.40 ,$31.43 ,$6.61 ,$36.34 ,$5.57 ,$8.02 ,$8.02 ,$6.55 ,$8.02 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30600102,87040,HC BLOOD CULTURE,306,1 ,$128.80 ,$85.01 ,$10.11 ,$128.80 ,$10.66 ,$36.12 ,$36.12 ,$10.32 ,$77.28 ,$109.48 ,$90.16 ,$10.66 ,$10.66 ,$122.36 ,$97.89 ,$96.60 ,$17.54 ,$109.48 ,$10.32 ,$17.54 ,$17.54 ,$90.16 ,$78.44 ,$10.66 ,$10.32 ,$10.11 ,$20.64 ,$11.30 ,$109.48 ,$23.22 ,$118.50 ,$90.16 ,$51.62 ,$51.62 ,$78.44 ,$51.62 ,$89.00 ,$115.92 ,$88.00 ,$10.21 ,$101.75 ,$11.30 ,$12.38 ,$12.38 ,$10.11 ,$12.38 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30600103,87045,HC STOOL CULTURE,306,1 ,$89.70 ,$59.20 ,$9.25 ,$89.70 ,$9.75 ,$33.04 ,$33.04 ,$9.44 ,$53.82 ,$76.25 ,$62.79 ,$9.75 ,$9.75 ,$85.22 ,$68.17 ,$67.28 ,$16.05 ,$76.25 ,$9.44 ,$16.05 ,$16.05 ,$62.79 ,$54.63 ,$9.75 ,$9.44 ,$9.25 ,$18.88 ,$10.34 ,$76.25 ,$21.24 ,$82.52 ,$62.79 ,$47.19 ,$47.19 ,$54.63 ,$47.19 ,$61.98 ,$80.73 ,$61.28 ,$9.34 ,$70.86 ,$10.34 ,$11.33 ,$11.33 ,$9.25 ,$11.33 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600104,87046,HC STOOL CULTURE ADD ISO,306,1 ,$77.05 ,$50.85 ,$3.40 ,$77.05 ,$3.40 ,$33.04 ,$33.04 ,$9.44 ,$46.23 ,$65.49 ,$53.94 ,$3.40 ,$3.40 ,$73.20 ,$58.56 ,$57.79 ,$16.05 ,$65.49 ,$9.44 ,$16.05 ,$16.05 ,$53.94 ,$46.92 ,$3.40 ,$9.44 ,$9.25 ,$18.88 ,$3.60 ,$65.49 ,$21.24 ,$70.89 ,$53.94 ,$47.19 ,$47.19 ,$46.92 ,$47.19 ,$53.24 ,$69.35 ,$52.64 ,$9.34 ,$60.87 ,$3.60 ,$11.33 ,$11.33 ,$9.25 ,$11.33 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600105,87070,HC BODY FLUID CULTURE (ENVIRO),306,1 ,$41.40 ,$27.32 ,$8.45 ,$41.40 ,$8.91 ,$30.17 ,$30.17 ,$8.62 ,$24.84 ,$35.19 ,$28.98 ,$8.91 ,$8.91 ,$39.33 ,$31.46 ,$31.05 ,$14.65 ,$35.19 ,$8.62 ,$14.65 ,$14.65 ,$28.98 ,$25.21 ,$8.91 ,$8.62 ,$8.45 ,$17.24 ,$9.44 ,$35.19 ,$19.40 ,$38.09 ,$28.98 ,$41.40 ,$41.40 ,$25.21 ,$41.40 ,$28.61 ,$37.26 ,$28.28 ,$8.54 ,$32.71 ,$9.44 ,$10.34 ,$10.34 ,$8.45 ,$10.34 ,$29.81 ,$25.67 ,$29.81 ,$29.81 ,$33.12 
ST NICHOLAS HOSPITAL - ACUTE,30600106,87070,HC BODY FLUID CULTURE (THROAT),306,1 ,$75.90 ,$50.09 ,$8.45 ,$75.90 ,$8.91 ,$30.17 ,$30.17 ,$8.62 ,$45.54 ,$64.52 ,$53.13 ,$8.91 ,$8.91 ,$72.11 ,$57.68 ,$56.93 ,$14.65 ,$64.52 ,$8.62 ,$14.65 ,$14.65 ,$53.13 ,$46.22 ,$8.91 ,$8.62 ,$8.45 ,$17.24 ,$9.44 ,$64.52 ,$19.40 ,$69.83 ,$53.13 ,$43.05 ,$43.05 ,$46.22 ,$43.05 ,$52.45 ,$68.31 ,$51.85 ,$8.54 ,$59.96 ,$9.44 ,$10.34 ,$10.34 ,$8.45 ,$10.34 ,$54.65 ,$47.06 ,$54.65 ,$54.65 ,$60.72 
ST NICHOLAS HOSPITAL - ACUTE,30600107,87070,HC BODY FLUID CULTURE (MISC),306,1 ,$131.10 ,$86.53 ,$8.45 ,$131.10 ,$8.91 ,$30.17 ,$30.17 ,$8.62 ,$78.66 ,$111.44 ,$91.77 ,$8.91 ,$8.91 ,$124.55 ,$99.64 ,$98.33 ,$14.65 ,$111.44 ,$8.62 ,$14.65 ,$14.65 ,$91.77 ,$79.84 ,$8.91 ,$8.62 ,$8.45 ,$17.24 ,$9.44 ,$111.44 ,$19.40 ,$120.61 ,$91.77 ,$43.05 ,$43.05 ,$79.84 ,$43.05 ,$90.59 ,$117.99 ,$89.57 ,$8.54 ,$103.57 ,$9.44 ,$10.34 ,$10.34 ,$8.45 ,$10.34 ,$94.39 ,$81.28 ,$94.39 ,$94.39 ,$104.88 
ST NICHOLAS HOSPITAL - ACUTE,30600108,87081,HC BODY FLUID CULTURE (MRSA),306,1 ,$124.20 ,$81.97 ,$6.50 ,$124.20 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$74.52 ,$105.57 ,$86.94 ,$6.85 ,$6.85 ,$117.99 ,$94.39 ,$93.15 ,$11.27 ,$105.57 ,$6.63 ,$11.27 ,$11.27 ,$86.94 ,$75.64 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$105.57 ,$14.92 ,$114.26 ,$86.94 ,$33.15 ,$33.15 ,$75.64 ,$33.15 ,$85.82 ,$111.78 ,$84.85 ,$6.57 ,$98.12 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,30600109,87070,HC BODY FLUID CULTURE,306,1 ,$116.15 ,$76.66 ,$8.45 ,$116.15 ,$8.91 ,$30.17 ,$30.17 ,$8.62 ,$69.69 ,$98.73 ,$81.31 ,$8.91 ,$8.91 ,$110.34 ,$88.27 ,$87.11 ,$14.65 ,$98.73 ,$8.62 ,$14.65 ,$14.65 ,$81.31 ,$70.74 ,$8.91 ,$8.62 ,$8.45 ,$17.24 ,$9.44 ,$98.73 ,$19.40 ,$106.86 ,$81.31 ,$43.05 ,$43.05 ,$70.74 ,$43.05 ,$80.26 ,$104.54 ,$79.35 ,$8.54 ,$91.76 ,$9.44 ,$10.34 ,$10.34 ,$8.45 ,$10.34 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30600110,87070,HC WATER CULTURE,306,1 ,$14.95 ,$9.87 ,$8.45 ,$19.40 ,$8.91 ,$14.95 ,$14.95 ,$8.62 ,$8.97 ,$12.71 ,$10.47 ,$8.91 ,$8.91 ,$14.20 ,$11.36 ,$11.21 ,$14.65 ,$12.71 ,$8.62 ,$14.65 ,$14.65 ,$10.47 ,$9.10 ,$8.91 ,$8.62 ,$8.45 ,$14.95 ,$9.44 ,$12.71 ,$19.40 ,$13.75 ,$10.47 ,$14.95 ,$14.95 ,$9.10 ,$14.95 ,$10.33 ,$13.46 ,$10.21 ,$8.54 ,$11.81 ,$9.44 ,$10.34 ,$10.34 ,$8.45 ,$10.34 ,$10.76 ,$9.27 ,$10.76 ,$10.76 ,$11.96 
ST NICHOLAS HOSPITAL - ACUTE,30600111,87070,"HC BODY FLUID CULTURE (CSF, WOUND,MISC)",306,1 ,$196.65 ,$129.79 ,$8.45 ,$196.65 ,$8.91 ,$30.17 ,$30.17 ,$8.62 ,$117.99 ,$167.15 ,$137.66 ,$8.91 ,$8.91 ,$186.82 ,$149.45 ,$147.49 ,$14.65 ,$167.15 ,$8.62 ,$14.65 ,$14.65 ,$137.66 ,$119.76 ,$8.91 ,$8.62 ,$8.45 ,$17.24 ,$9.44 ,$167.15 ,$19.40 ,$180.92 ,$137.66 ,$43.05 ,$43.05 ,$119.76 ,$43.05 ,$135.89 ,$176.99 ,$134.35 ,$8.54 ,$155.35 ,$9.44 ,$10.34 ,$10.34 ,$8.45 ,$10.34 ,$141.59 ,$121.92 ,$141.59 ,$141.59 ,$157.32 
ST NICHOLAS HOSPITAL - ACUTE,30600115,87070,HC BODY FLUID CULTURE (CF),306,1 ,$309.35 ,$204.17 ,$8.45 ,$309.35 ,$8.91 ,$30.17 ,$30.17 ,$8.62 ,$185.61 ,$262.95 ,$216.55 ,$8.91 ,$8.91 ,$293.88 ,$235.11 ,$232.01 ,$14.65 ,$262.95 ,$8.62 ,$14.65 ,$14.65 ,$216.55 ,$188.39 ,$8.91 ,$8.62 ,$8.45 ,$17.24 ,$9.44 ,$262.95 ,$19.40 ,$284.60 ,$216.55 ,$43.05 ,$43.05 ,$188.39 ,$43.05 ,$213.76 ,$278.42 ,$211.35 ,$8.54 ,$244.39 ,$9.44 ,$10.34 ,$10.34 ,$8.45 ,$10.34 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600120,87075,HC CULTURE ANAEROBIC,306,1 ,$116.15 ,$76.66 ,$9.28 ,$116.15 ,$9.79 ,$33.15 ,$33.15 ,$9.47 ,$69.69 ,$98.73 ,$81.31 ,$9.79 ,$9.79 ,$110.34 ,$88.27 ,$87.11 ,$16.10 ,$98.73 ,$9.47 ,$16.10 ,$16.10 ,$81.31 ,$70.74 ,$9.79 ,$9.47 ,$9.28 ,$18.94 ,$10.38 ,$98.73 ,$21.31 ,$106.86 ,$81.31 ,$47.30 ,$47.30 ,$70.74 ,$47.30 ,$80.26 ,$104.54 ,$79.35 ,$9.37 ,$91.76 ,$10.38 ,$11.36 ,$11.36 ,$9.28 ,$11.36 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30600121,87076,HC CULTURE ANAEROBIC ID,306,1 ,$77.05 ,$50.85 ,$7.92 ,$77.05 ,$8.35 ,$28.28 ,$28.28 ,$8.08 ,$46.23 ,$65.49 ,$53.94 ,$8.35 ,$8.35 ,$73.20 ,$58.56 ,$57.79 ,$13.74 ,$65.49 ,$8.08 ,$13.74 ,$13.74 ,$53.94 ,$46.92 ,$8.35 ,$8.08 ,$7.92 ,$16.16 ,$8.85 ,$65.49 ,$18.18 ,$70.89 ,$53.94 ,$40.41 ,$40.41 ,$46.92 ,$40.41 ,$53.24 ,$69.35 ,$52.64 ,$8.00 ,$60.87 ,$8.85 ,$9.70 ,$9.70 ,$7.92 ,$9.70 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600122,87076,HC CULTURE ANAEROBIC ID (ORGANISM),306,1 ,$77.05 ,$50.85 ,$7.92 ,$77.05 ,$8.35 ,$28.28 ,$28.28 ,$8.08 ,$46.23 ,$65.49 ,$53.94 ,$8.35 ,$8.35 ,$73.20 ,$58.56 ,$57.79 ,$13.74 ,$65.49 ,$8.08 ,$13.74 ,$13.74 ,$53.94 ,$46.92 ,$8.35 ,$8.08 ,$7.92 ,$16.16 ,$8.85 ,$65.49 ,$18.18 ,$70.89 ,$53.94 ,$40.41 ,$40.41 ,$46.92 ,$40.41 ,$53.24 ,$69.35 ,$52.64 ,$8.00 ,$60.87 ,$8.85 ,$9.70 ,$9.70 ,$7.92 ,$9.70 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600123,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$77.05 ,$50.85 ,$7.92 ,$77.05 ,$8.35 ,$28.28 ,$28.28 ,$8.08 ,$46.23 ,$65.49 ,$53.94 ,$8.35 ,$8.35 ,$73.20 ,$58.56 ,$57.79 ,$13.74 ,$65.49 ,$8.08 ,$13.74 ,$13.74 ,$53.94 ,$46.92 ,$8.35 ,$8.08 ,$7.92 ,$16.16 ,$8.85 ,$65.49 ,$18.18 ,$70.89 ,$53.94 ,$40.41 ,$40.41 ,$46.92 ,$40.41 ,$53.24 ,$69.35 ,$52.64 ,$8.00 ,$60.87 ,$8.85 ,$9.70 ,$9.70 ,$7.92 ,$9.70 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600124,87081,HC CULTURE SCR (MRSA),306,1 ,$64.40 ,$42.50 ,$6.50 ,$64.40 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$38.64 ,$54.74 ,$45.08 ,$6.85 ,$6.85 ,$61.18 ,$48.94 ,$48.30 ,$11.27 ,$54.74 ,$6.63 ,$11.27 ,$11.27 ,$45.08 ,$39.22 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$54.74 ,$14.92 ,$59.25 ,$45.08 ,$33.15 ,$33.15 ,$39.22 ,$33.15 ,$44.50 ,$57.96 ,$44.00 ,$6.57 ,$50.88 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30600125,87081,HC CULTURE SCR (GRP B STREP),306,1 ,$85.10 ,$56.17 ,$6.50 ,$85.10 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$51.06 ,$72.34 ,$59.57 ,$6.85 ,$6.85 ,$80.85 ,$64.68 ,$63.83 ,$11.27 ,$72.34 ,$6.63 ,$11.27 ,$11.27 ,$59.57 ,$51.83 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$72.34 ,$14.92 ,$78.29 ,$59.57 ,$33.15 ,$33.15 ,$51.83 ,$33.15 ,$58.80 ,$76.59 ,$58.14 ,$6.57 ,$67.23 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$61.27 ,$52.76 ,$61.27 ,$61.27 ,$68.08 
ST NICHOLAS HOSPITAL - ACUTE,30600126,87081,HC CULTURE SCR (GC ONLY),306,1 ,$57.50 ,$37.95 ,$6.50 ,$57.50 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$34.50 ,$48.88 ,$40.25 ,$6.85 ,$6.85 ,$54.63 ,$43.70 ,$43.13 ,$11.27 ,$48.88 ,$6.63 ,$11.27 ,$11.27 ,$40.25 ,$35.02 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$48.88 ,$14.92 ,$52.90 ,$40.25 ,$33.15 ,$33.15 ,$35.02 ,$33.15 ,$39.73 ,$51.75 ,$39.28 ,$6.57 ,$45.43 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,30600127,87081,HC CULTURE SCR (LEGIONELLA),306,1 ,$57.50 ,$37.95 ,$6.50 ,$57.50 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$34.50 ,$48.88 ,$40.25 ,$6.85 ,$6.85 ,$54.63 ,$43.70 ,$43.13 ,$11.27 ,$48.88 ,$6.63 ,$11.27 ,$11.27 ,$40.25 ,$35.02 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$48.88 ,$14.92 ,$52.90 ,$40.25 ,$33.15 ,$33.15 ,$35.02 ,$33.15 ,$39.73 ,$51.75 ,$39.28 ,$6.57 ,$45.43 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,30600128,87081,HC CULTURE SCR (PERTUSSIS),306,1 ,$93.15 ,$61.48 ,$6.50 ,$93.15 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$55.89 ,$79.18 ,$65.21 ,$6.85 ,$6.85 ,$88.49 ,$70.79 ,$69.86 ,$11.27 ,$79.18 ,$6.63 ,$11.27 ,$11.27 ,$65.21 ,$56.73 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$79.18 ,$14.92 ,$85.70 ,$65.21 ,$33.15 ,$33.15 ,$56.73 ,$33.15 ,$64.37 ,$83.84 ,$63.64 ,$6.57 ,$73.59 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$67.07 ,$57.75 ,$67.07 ,$67.07 ,$74.52 
ST NICHOLAS HOSPITAL - ACUTE,30600129,87081,HC CULTURE SCR (GRP A STREP),306,1 ,$57.50 ,$37.95 ,$6.50 ,$57.50 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$34.50 ,$48.88 ,$40.25 ,$6.85 ,$6.85 ,$54.63 ,$43.70 ,$43.13 ,$11.27 ,$48.88 ,$6.63 ,$11.27 ,$11.27 ,$40.25 ,$35.02 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$48.88 ,$14.92 ,$52.90 ,$40.25 ,$33.15 ,$33.15 ,$35.02 ,$33.15 ,$39.73 ,$51.75 ,$39.28 ,$6.57 ,$45.43 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,30600130,87081,HC CULTURE SCR (VRE),306,1 ,$133.40 ,$88.04 ,$6.50 ,$133.40 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$80.04 ,$113.39 ,$93.38 ,$6.85 ,$6.85 ,$126.73 ,$101.38 ,$100.05 ,$11.27 ,$113.39 ,$6.63 ,$11.27 ,$11.27 ,$93.38 ,$81.24 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$113.39 ,$14.92 ,$122.73 ,$93.38 ,$33.15 ,$33.15 ,$81.24 ,$33.15 ,$92.18 ,$120.06 ,$91.14 ,$6.57 ,$105.39 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$96.05 ,$82.71 ,$96.05 ,$96.05 ,$106.72 
ST NICHOLAS HOSPITAL - ACUTE,30600131,87081,HC CULTURE (MRSA),306,1 ,$64.40 ,$42.50 ,$6.50 ,$64.40 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$38.64 ,$54.74 ,$45.08 ,$6.85 ,$6.85 ,$61.18 ,$48.94 ,$48.30 ,$11.27 ,$54.74 ,$6.63 ,$11.27 ,$11.27 ,$45.08 ,$39.22 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$54.74 ,$14.92 ,$59.25 ,$45.08 ,$33.15 ,$33.15 ,$39.22 ,$33.15 ,$44.50 ,$57.96 ,$44.00 ,$6.57 ,$50.88 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30600132,87081,HC CULTURE (CLO TEST),306,1 ,$57.50 ,$37.95 ,$6.50 ,$57.50 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$34.50 ,$48.88 ,$40.25 ,$6.85 ,$6.85 ,$54.63 ,$43.70 ,$43.13 ,$11.27 ,$48.88 ,$6.63 ,$11.27 ,$11.27 ,$40.25 ,$35.02 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$48.88 ,$14.92 ,$52.90 ,$40.25 ,$33.15 ,$33.15 ,$35.02 ,$33.15 ,$39.73 ,$51.75 ,$39.28 ,$6.57 ,$45.43 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,30600133,87081,HC CULTURE SCR (BRUCELLA),306,1 ,$73.60 ,$48.58 ,$6.50 ,$73.60 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$44.16 ,$62.56 ,$51.52 ,$6.85 ,$6.85 ,$69.92 ,$55.94 ,$55.20 ,$11.27 ,$62.56 ,$6.63 ,$11.27 ,$11.27 ,$51.52 ,$44.82 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$62.56 ,$14.92 ,$67.71 ,$51.52 ,$33.15 ,$33.15 ,$44.82 ,$33.15 ,$50.86 ,$66.24 ,$50.28 ,$6.57 ,$58.14 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$52.99 ,$45.63 ,$52.99 ,$52.99 ,$58.88 
ST NICHOLAS HOSPITAL - ACUTE,30600134,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$77.05 ,$50.85 ,$7.91 ,$77.05 ,$8.34 ,$28.25 ,$28.25 ,$8.07 ,$46.23 ,$65.49 ,$53.94 ,$8.34 ,$8.34 ,$73.20 ,$58.56 ,$57.79 ,$13.72 ,$65.49 ,$8.07 ,$13.72 ,$13.72 ,$53.94 ,$46.92 ,$8.34 ,$8.07 ,$7.91 ,$16.14 ,$8.84 ,$65.49 ,$18.16 ,$70.89 ,$53.94 ,$40.34 ,$40.34 ,$46.92 ,$40.34 ,$53.24 ,$69.35 ,$52.64 ,$7.99 ,$60.87 ,$8.84 ,$9.68 ,$9.68 ,$7.91 ,$9.68 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600135,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$77.05 ,$50.85 ,$7.93 ,$77.05 ,$8.36 ,$28.32 ,$28.32 ,$8.09 ,$46.23 ,$65.49 ,$53.94 ,$8.36 ,$8.36 ,$73.20 ,$58.56 ,$57.79 ,$13.75 ,$65.49 ,$8.09 ,$13.75 ,$13.75 ,$53.94 ,$46.92 ,$8.36 ,$8.09 ,$7.93 ,$16.18 ,$8.86 ,$65.49 ,$18.20 ,$70.89 ,$53.94 ,$40.48 ,$40.48 ,$46.92 ,$40.48 ,$53.24 ,$69.35 ,$52.64 ,$8.01 ,$60.87 ,$8.86 ,$9.71 ,$9.71 ,$7.93 ,$9.71 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600136,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL,306,1 ,$154.10 ,$101.71 ,$7.56 ,$154.10 ,$7.97 ,$26.99 ,$26.99 ,$7.71 ,$92.46 ,$130.99 ,$107.87 ,$7.97 ,$7.97 ,$146.40 ,$117.12 ,$115.58 ,$13.11 ,$130.99 ,$7.71 ,$13.11 ,$13.11 ,$107.87 ,$93.85 ,$7.97 ,$7.71 ,$7.56 ,$15.42 ,$8.45 ,$130.99 ,$17.35 ,$141.77 ,$107.87 ,$38.54 ,$38.54 ,$93.85 ,$38.54 ,$106.48 ,$138.69 ,$105.28 ,$7.63 ,$121.74 ,$8.45 ,$9.25 ,$9.25 ,$7.56 ,$9.25 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30600137,87101,HC CULTURE YEAST SKIN/HAIR/NAIL,306,1 ,$72.45 ,$47.82 ,$7.56 ,$72.45 ,$7.97 ,$26.99 ,$26.99 ,$7.71 ,$43.47 ,$61.58 ,$50.72 ,$7.97 ,$7.97 ,$68.83 ,$55.06 ,$54.34 ,$13.11 ,$61.58 ,$7.71 ,$13.11 ,$13.11 ,$50.72 ,$44.12 ,$7.97 ,$7.71 ,$7.56 ,$15.42 ,$8.45 ,$61.58 ,$17.35 ,$66.65 ,$50.72 ,$38.54 ,$38.54 ,$44.12 ,$38.54 ,$50.06 ,$65.21 ,$49.50 ,$7.63 ,$57.24 ,$8.45 ,$9.25 ,$9.25 ,$7.56 ,$9.25 ,$52.16 ,$44.92 ,$52.16 ,$52.16 ,$57.96 
ST NICHOLAS HOSPITAL - ACUTE,30600138,87102,HC CULTURE FUNGUS OTHER,306,1 ,$89.70 ,$59.20 ,$8.24 ,$89.70 ,$8.69 ,$29.44 ,$29.44 ,$8.41 ,$53.82 ,$76.25 ,$62.79 ,$8.69 ,$8.69 ,$85.22 ,$68.17 ,$67.28 ,$14.30 ,$76.25 ,$8.41 ,$14.30 ,$14.30 ,$62.79 ,$54.63 ,$8.69 ,$8.41 ,$8.24 ,$16.82 ,$9.21 ,$76.25 ,$18.92 ,$82.52 ,$62.79 ,$41.98 ,$41.98 ,$54.63 ,$41.98 ,$61.98 ,$80.73 ,$61.28 ,$8.32 ,$70.86 ,$9.21 ,$10.09 ,$10.09 ,$8.24 ,$10.09 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600139,87102,HC CULTURE YEAST OTHER,306,1 ,$77.05 ,$50.85 ,$8.24 ,$77.05 ,$8.69 ,$29.44 ,$29.44 ,$8.41 ,$46.23 ,$65.49 ,$53.94 ,$8.69 ,$8.69 ,$73.20 ,$58.56 ,$57.79 ,$14.30 ,$65.49 ,$8.41 ,$14.30 ,$14.30 ,$53.94 ,$46.92 ,$8.69 ,$8.41 ,$8.24 ,$16.82 ,$9.21 ,$65.49 ,$18.92 ,$70.89 ,$53.94 ,$41.98 ,$41.98 ,$46.92 ,$41.98 ,$53.24 ,$69.35 ,$52.64 ,$8.32 ,$60.87 ,$9.21 ,$10.09 ,$10.09 ,$8.24 ,$10.09 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600140,87103,HC CULTURE FUNGUS BLOOD,306,1 ,$193.20 ,$127.51 ,$12.68 ,$193.20 ,$12.68 ,$71.61 ,$71.61 ,$20.46 ,$115.92 ,$164.22 ,$135.24 ,$12.68 ,$12.68 ,$183.54 ,$146.83 ,$144.90 ,$34.78 ,$164.22 ,$20.46 ,$34.78 ,$34.78 ,$135.24 ,$117.66 ,$12.68 ,$20.46 ,$20.05 ,$40.92 ,$13.44 ,$164.22 ,$46.04 ,$177.74 ,$135.24 ,$45.06 ,$45.06 ,$117.66 ,$45.06 ,$133.50 ,$173.88 ,$131.99 ,$20.25 ,$152.63 ,$13.44 ,$24.55 ,$24.55 ,$20.05 ,$24.55 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,30600142,87106,HC CULTURE FUNGUS ID,306,1 ,$110.40 ,$72.86 ,$10.11 ,$110.40 ,$10.66 ,$36.12 ,$36.12 ,$10.32 ,$66.24 ,$93.84 ,$77.28 ,$10.66 ,$10.66 ,$104.88 ,$83.90 ,$82.80 ,$17.54 ,$93.84 ,$10.32 ,$17.54 ,$17.54 ,$77.28 ,$67.23 ,$10.66 ,$10.32 ,$10.11 ,$20.64 ,$11.30 ,$93.84 ,$23.22 ,$101.57 ,$77.28 ,$51.62 ,$51.62 ,$67.23 ,$51.62 ,$76.29 ,$99.36 ,$75.43 ,$10.21 ,$87.22 ,$11.30 ,$12.38 ,$12.38 ,$10.11 ,$12.38 ,$79.49 ,$68.45 ,$79.49 ,$79.49 ,$88.32 
ST NICHOLAS HOSPITAL - ACUTE,30600144,87106,HC CULTURE FUNGUS ID (MOLD),306,1 ,$152.95 ,$100.95 ,$10.11 ,$152.95 ,$10.66 ,$36.12 ,$36.12 ,$10.32 ,$91.77 ,$130.01 ,$107.07 ,$10.66 ,$10.66 ,$145.30 ,$116.24 ,$114.71 ,$17.54 ,$130.01 ,$10.32 ,$17.54 ,$17.54 ,$107.07 ,$93.15 ,$10.66 ,$10.32 ,$10.11 ,$20.64 ,$11.30 ,$130.01 ,$23.22 ,$140.71 ,$107.07 ,$51.62 ,$51.62 ,$93.15 ,$51.62 ,$105.69 ,$137.66 ,$104.50 ,$10.21 ,$120.83 ,$11.30 ,$12.38 ,$12.38 ,$10.11 ,$12.38 ,$110.12 ,$94.83 ,$110.12 ,$110.12 ,$122.36 
ST NICHOLAS HOSPITAL - ACUTE,30600145,87107,HC CULTURE FUNGUS ID MOLD,306,1 ,$89.70 ,$59.20 ,$10.11 ,$89.70 ,$10.66 ,$36.12 ,$36.12 ,$10.32 ,$53.82 ,$76.25 ,$62.79 ,$10.66 ,$10.66 ,$85.22 ,$68.17 ,$67.28 ,$17.54 ,$76.25 ,$10.32 ,$17.54 ,$17.54 ,$62.79 ,$54.63 ,$10.66 ,$10.32 ,$10.11 ,$20.64 ,$11.30 ,$76.25 ,$23.22 ,$82.52 ,$62.79 ,$51.62 ,$51.62 ,$54.63 ,$51.62 ,$61.98 ,$80.73 ,$61.28 ,$10.21 ,$70.86 ,$11.30 ,$12.38 ,$12.38 ,$10.11 ,$12.38 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600146,87109,HC CULTURE MYCOPLASMA,306,1 ,$103.50 ,$68.31 ,$14.01 ,$103.50 ,$14.01 ,$53.87 ,$53.87 ,$15.39 ,$62.10 ,$87.98 ,$72.45 ,$14.01 ,$14.01 ,$98.33 ,$78.66 ,$77.63 ,$26.16 ,$87.98 ,$15.39 ,$26.16 ,$26.16 ,$72.45 ,$63.03 ,$14.01 ,$15.39 ,$15.08 ,$30.78 ,$14.85 ,$87.98 ,$34.63 ,$95.22 ,$72.45 ,$49.79 ,$49.79 ,$63.03 ,$49.79 ,$71.52 ,$93.15 ,$70.71 ,$15.23 ,$81.77 ,$14.85 ,$18.47 ,$18.47 ,$15.08 ,$18.47 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30600147,87110,HC CULTURE CHLAMYDIA,306,1 ,$171.35 ,$113.09 ,$19.21 ,$171.35 ,$20.25 ,$68.60 ,$68.60 ,$19.60 ,$102.81 ,$145.65 ,$119.95 ,$20.25 ,$20.25 ,$162.78 ,$130.23 ,$128.51 ,$33.32 ,$145.65 ,$19.60 ,$33.32 ,$33.32 ,$119.95 ,$104.35 ,$20.25 ,$19.60 ,$19.21 ,$39.20 ,$21.47 ,$145.65 ,$44.10 ,$157.64 ,$119.95 ,$97.93 ,$97.93 ,$104.35 ,$97.93 ,$118.40 ,$154.22 ,$117.07 ,$19.40 ,$135.37 ,$21.47 ,$23.52 ,$23.52 ,$19.21 ,$23.52 ,$123.37 ,$106.24 ,$123.37 ,$123.37 ,$137.08 
ST NICHOLAS HOSPITAL - ACUTE,30600148,87116,HC CULTURE AFB/TB/MYCOBACT,306,1 ,$89.70 ,$59.20 ,$10.58 ,$89.70 ,$11.16 ,$37.80 ,$37.80 ,$10.80 ,$53.82 ,$76.25 ,$62.79 ,$11.16 ,$11.16 ,$85.22 ,$68.17 ,$67.28 ,$18.36 ,$76.25 ,$10.80 ,$18.36 ,$18.36 ,$62.79 ,$54.63 ,$11.16 ,$10.80 ,$10.58 ,$21.60 ,$11.83 ,$76.25 ,$24.30 ,$82.52 ,$62.79 ,$54.00 ,$54.00 ,$54.63 ,$54.00 ,$61.98 ,$80.73 ,$61.28 ,$10.69 ,$70.86 ,$11.83 ,$12.96 ,$12.96 ,$10.58 ,$12.96 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600149,87116,HC CULTURE AFB/TB/MYCOBACT (BLOOD),306,1 ,$186.30 ,$122.96 ,$10.58 ,$186.30 ,$11.16 ,$37.80 ,$37.80 ,$10.80 ,$111.78 ,$158.36 ,$130.41 ,$11.16 ,$11.16 ,$176.99 ,$141.59 ,$139.73 ,$18.36 ,$158.36 ,$10.80 ,$18.36 ,$18.36 ,$130.41 ,$113.46 ,$11.16 ,$10.80 ,$10.58 ,$21.60 ,$11.83 ,$158.36 ,$24.30 ,$171.40 ,$130.41 ,$54.00 ,$54.00 ,$113.46 ,$54.00 ,$128.73 ,$167.67 ,$127.28 ,$10.69 ,$147.18 ,$11.83 ,$12.96 ,$12.96 ,$10.58 ,$12.96 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,30600150,87116,HC CULTURE AFB/TB/MYCOBACT (SMEAR),306,1 ,$97.75 ,$64.52 ,$10.58 ,$97.75 ,$11.16 ,$37.80 ,$37.80 ,$10.80 ,$58.65 ,$83.09 ,$68.43 ,$11.16 ,$11.16 ,$92.86 ,$74.29 ,$73.31 ,$18.36 ,$83.09 ,$10.80 ,$18.36 ,$18.36 ,$68.43 ,$59.53 ,$11.16 ,$10.80 ,$10.58 ,$21.60 ,$11.83 ,$83.09 ,$24.30 ,$89.93 ,$68.43 ,$54.00 ,$54.00 ,$59.53 ,$54.00 ,$67.55 ,$87.98 ,$66.78 ,$10.69 ,$77.22 ,$11.83 ,$12.96 ,$12.96 ,$10.58 ,$12.96 ,$70.38 ,$60.61 ,$70.38 ,$70.38 ,$78.20 
ST NICHOLAS HOSPITAL - ACUTE,30600151,87118,HC MYCOBACTERIA ID BY HPLC,306,1 ,$180.55 ,$119.16 ,$14.32 ,$180.55 ,$15.10 ,$51.14 ,$51.14 ,$14.61 ,$108.33 ,$153.47 ,$126.39 ,$15.10 ,$15.10 ,$171.52 ,$137.22 ,$135.41 ,$24.84 ,$153.47 ,$14.61 ,$24.84 ,$24.84 ,$126.39 ,$109.96 ,$15.10 ,$14.61 ,$14.32 ,$29.22 ,$16.01 ,$153.47 ,$32.87 ,$166.11 ,$126.39 ,$54.70 ,$54.70 ,$109.96 ,$54.70 ,$124.76 ,$162.50 ,$123.35 ,$14.46 ,$142.63 ,$16.01 ,$17.53 ,$17.53 ,$14.32 ,$17.53 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30600152,87140,HC CLT TYP IF EA ANTISER (RESP),306,1 ,$21.85 ,$14.42 ,$5.46 ,$21.85 ,$5.76 ,$19.50 ,$19.50 ,$5.57 ,$13.11 ,$18.57 ,$15.30 ,$5.76 ,$5.76 ,$20.76 ,$16.61 ,$16.39 ,$9.47 ,$18.57 ,$5.57 ,$9.47 ,$9.47 ,$15.30 ,$13.31 ,$5.76 ,$5.57 ,$5.46 ,$11.14 ,$6.11 ,$18.57 ,$12.53 ,$20.10 ,$15.30 ,$21.85 ,$21.85 ,$13.31 ,$21.85 ,$15.10 ,$19.67 ,$14.93 ,$5.52 ,$17.26 ,$6.11 ,$6.68 ,$6.68 ,$5.46 ,$6.68 ,$15.73 ,$13.55 ,$15.73 ,$15.73 ,$17.48 
ST NICHOLAS HOSPITAL - ACUTE,30600153,87140,HC CLT TYP IF EA ANTISER (CHLAM PNEUMO 1),306,1 ,$43.70 ,$28.84 ,$5.46 ,$43.70 ,$5.76 ,$19.50 ,$19.50 ,$5.57 ,$26.22 ,$37.15 ,$30.59 ,$5.76 ,$5.76 ,$41.52 ,$33.21 ,$32.78 ,$9.47 ,$37.15 ,$5.57 ,$9.47 ,$9.47 ,$30.59 ,$26.61 ,$5.76 ,$5.57 ,$5.46 ,$11.14 ,$6.11 ,$37.15 ,$12.53 ,$40.20 ,$30.59 ,$22.79 ,$22.79 ,$26.61 ,$22.79 ,$30.20 ,$39.33 ,$29.86 ,$5.52 ,$34.52 ,$6.11 ,$6.68 ,$6.68 ,$5.46 ,$6.68 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30600154,87140,HC CLT TYP IF EA ANTISER (CHLAM PNEUMO 2),306,1 ,$43.70 ,$28.84 ,$5.46 ,$43.70 ,$5.76 ,$19.50 ,$19.50 ,$5.57 ,$26.22 ,$37.15 ,$30.59 ,$5.76 ,$5.76 ,$41.52 ,$33.21 ,$32.78 ,$9.47 ,$37.15 ,$5.57 ,$9.47 ,$9.47 ,$30.59 ,$26.61 ,$5.76 ,$5.57 ,$5.46 ,$11.14 ,$6.11 ,$37.15 ,$12.53 ,$40.20 ,$30.59 ,$22.79 ,$22.79 ,$26.61 ,$22.79 ,$30.20 ,$39.33 ,$29.86 ,$5.52 ,$34.52 ,$6.11 ,$6.68 ,$6.68 ,$5.46 ,$6.68 ,$31.46 ,$27.09 ,$31.46 ,$31.46 ,$34.96 
ST NICHOLAS HOSPITAL - ACUTE,30600155,87140,HC CLT TYP IF EA ANTISER (CHLAM TRACH),306,1 ,$64.40 ,$42.50 ,$5.46 ,$64.40 ,$5.76 ,$19.50 ,$19.50 ,$5.57 ,$38.64 ,$54.74 ,$45.08 ,$5.76 ,$5.76 ,$61.18 ,$48.94 ,$48.30 ,$9.47 ,$54.74 ,$5.57 ,$9.47 ,$9.47 ,$45.08 ,$39.22 ,$5.76 ,$5.57 ,$5.46 ,$11.14 ,$6.11 ,$54.74 ,$12.53 ,$59.25 ,$45.08 ,$22.79 ,$22.79 ,$39.22 ,$22.79 ,$44.50 ,$57.96 ,$44.00 ,$5.52 ,$50.88 ,$6.11 ,$6.68 ,$6.68 ,$5.46 ,$6.68 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30600156,87140,HC FLU CONFIRM,306,1 ,$24.15 ,$15.94 ,$5.46 ,$24.15 ,$5.76 ,$19.50 ,$19.50 ,$5.57 ,$14.49 ,$20.53 ,$16.91 ,$5.76 ,$5.76 ,$22.94 ,$18.35 ,$18.11 ,$9.47 ,$20.53 ,$5.57 ,$9.47 ,$9.47 ,$16.91 ,$14.71 ,$5.76 ,$5.57 ,$5.46 ,$11.14 ,$6.11 ,$20.53 ,$12.53 ,$22.22 ,$16.91 ,$22.79 ,$22.79 ,$14.71 ,$22.79 ,$16.69 ,$21.74 ,$16.50 ,$5.52 ,$19.08 ,$6.11 ,$6.68 ,$6.68 ,$5.46 ,$6.68 ,$17.39 ,$14.97 ,$17.39 ,$17.39 ,$19.32 
ST NICHOLAS HOSPITAL - ACUTE,30600157,87140,HC CLT TYP IF EA ANTISER (ADENO/ENTERO),306,1 ,$24.15 ,$15.94 ,$5.46 ,$24.15 ,$5.76 ,$19.50 ,$19.50 ,$5.57 ,$14.49 ,$20.53 ,$16.91 ,$5.76 ,$5.76 ,$22.94 ,$18.35 ,$18.11 ,$9.47 ,$20.53 ,$5.57 ,$9.47 ,$9.47 ,$16.91 ,$14.71 ,$5.76 ,$5.57 ,$5.46 ,$11.14 ,$6.11 ,$20.53 ,$12.53 ,$22.22 ,$16.91 ,$22.79 ,$22.79 ,$14.71 ,$22.79 ,$16.69 ,$21.74 ,$16.50 ,$5.52 ,$19.08 ,$6.11 ,$6.68 ,$6.68 ,$5.46 ,$6.68 ,$17.39 ,$14.97 ,$17.39 ,$17.39 ,$19.32 
ST NICHOLAS HOSPITAL - ACUTE,30600158,87143,HC CULTURE TYPE GLC OR HPLC,306,1 ,$127.65 ,$84.25 ,$12.27 ,$127.65 ,$12.94 ,$43.82 ,$43.82 ,$12.52 ,$76.59 ,$108.50 ,$89.36 ,$12.94 ,$12.94 ,$121.27 ,$97.01 ,$95.74 ,$21.28 ,$108.50 ,$12.52 ,$21.28 ,$21.28 ,$89.36 ,$77.74 ,$12.94 ,$12.52 ,$12.27 ,$25.04 ,$13.72 ,$108.50 ,$28.17 ,$117.44 ,$89.36 ,$62.61 ,$62.61 ,$77.74 ,$62.61 ,$88.21 ,$114.89 ,$87.21 ,$12.40 ,$100.84 ,$13.72 ,$15.02 ,$15.02 ,$12.27 ,$15.02 ,$91.91 ,$79.14 ,$91.91 ,$91.91 ,$102.12 
ST NICHOLAS HOSPITAL - ACUTE,30600159,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$152.95 ,$100.95 ,$5.08 ,$152.95 ,$5.35 ,$18.13 ,$18.13 ,$5.18 ,$91.77 ,$130.01 ,$107.07 ,$5.35 ,$5.35 ,$145.30 ,$116.24 ,$114.71 ,$8.81 ,$130.01 ,$5.18 ,$8.81 ,$8.81 ,$107.07 ,$93.15 ,$5.35 ,$5.18 ,$5.08 ,$10.36 ,$5.67 ,$130.01 ,$11.66 ,$140.71 ,$107.07 ,$25.86 ,$25.86 ,$93.15 ,$25.86 ,$105.69 ,$137.66 ,$104.50 ,$5.13 ,$120.83 ,$5.67 ,$6.22 ,$6.22 ,$5.08 ,$6.22 ,$110.12 ,$94.83 ,$110.12 ,$110.12 ,$122.36 
ST NICHOLAS HOSPITAL - ACUTE,30600160,87150,HC ID NUCLEAR ACID PROBE,306,1 ,$286.35 ,$188.99 ,$34.39 ,$286.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$171.81 ,$243.40 ,$200.45 ,$36.26 ,$36.26 ,$272.03 ,$217.63 ,$214.76 ,$59.65 ,$243.40 ,$35.09 ,$59.65 ,$59.65 ,$200.45 ,$174.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$243.40 ,$78.95 ,$263.44 ,$200.45 ,$175.37 ,$175.37 ,$174.39 ,$175.37 ,$197.87 ,$257.72 ,$195.63 ,$34.73 ,$226.22 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$206.17 ,$177.54 ,$206.17 ,$206.17 ,$229.08 
ST NICHOLAS HOSPITAL - ACUTE,30600161,87168,HC EXAM ARTHROPOD,306,1 ,$89.70 ,$59.20 ,$4.18 ,$89.70 ,$4.41 ,$14.95 ,$14.95 ,$4.27 ,$53.82 ,$76.25 ,$62.79 ,$4.41 ,$4.41 ,$85.22 ,$68.17 ,$67.28 ,$7.26 ,$76.25 ,$4.27 ,$7.26 ,$7.26 ,$62.79 ,$54.63 ,$4.41 ,$4.27 ,$4.18 ,$8.54 ,$4.67 ,$76.25 ,$9.61 ,$82.52 ,$62.79 ,$21.32 ,$21.32 ,$54.63 ,$21.32 ,$61.98 ,$80.73 ,$61.28 ,$4.22 ,$70.86 ,$4.67 ,$5.12 ,$5.12 ,$4.18 ,$5.12 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600162,87169,HC PARASITE ID,306,1 ,$89.70 ,$59.20 ,$4.22 ,$89.70 ,$4.45 ,$15.09 ,$15.09 ,$4.31 ,$53.82 ,$76.25 ,$62.79 ,$4.45 ,$4.45 ,$85.22 ,$68.17 ,$67.28 ,$7.33 ,$76.25 ,$4.31 ,$7.33 ,$7.33 ,$62.79 ,$54.63 ,$4.45 ,$4.31 ,$4.22 ,$8.62 ,$4.72 ,$76.25 ,$9.70 ,$82.52 ,$62.79 ,$21.32 ,$21.32 ,$54.63 ,$21.32 ,$61.98 ,$80.73 ,$61.28 ,$4.26 ,$70.86 ,$4.72 ,$5.17 ,$5.17 ,$4.22 ,$5.17 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600163,87172,HC PINWORM EXAM,306,1 ,$31.05 ,$20.49 ,$4.18 ,$31.05 ,$4.41 ,$14.95 ,$14.95 ,$4.27 ,$18.63 ,$26.39 ,$21.74 ,$4.41 ,$4.41 ,$29.50 ,$23.60 ,$23.29 ,$7.26 ,$26.39 ,$4.27 ,$7.26 ,$7.26 ,$21.74 ,$18.91 ,$4.41 ,$4.27 ,$4.18 ,$8.54 ,$4.67 ,$26.39 ,$9.61 ,$28.57 ,$21.74 ,$21.32 ,$21.32 ,$18.91 ,$21.32 ,$21.46 ,$27.95 ,$21.21 ,$4.22 ,$24.53 ,$4.67 ,$5.12 ,$5.12 ,$4.18 ,$5.12 ,$22.36 ,$19.25 ,$22.36 ,$22.36 ,$24.84 
ST NICHOLAS HOSPITAL - ACUTE,30600164,87177,HC SMEAR OVA PARASITE CONC/ID,306,1 ,$77.05 ,$50.85 ,$8.72 ,$77.05 ,$9.20 ,$31.15 ,$31.15 ,$8.90 ,$46.23 ,$65.49 ,$53.94 ,$9.20 ,$9.20 ,$73.20 ,$58.56 ,$57.79 ,$15.13 ,$65.49 ,$8.90 ,$15.13 ,$15.13 ,$53.94 ,$46.92 ,$9.20 ,$8.90 ,$8.72 ,$17.80 ,$9.75 ,$65.49 ,$20.03 ,$70.89 ,$53.94 ,$44.47 ,$44.47 ,$46.92 ,$44.47 ,$53.24 ,$69.35 ,$52.64 ,$8.81 ,$60.87 ,$9.75 ,$10.68 ,$10.68 ,$8.72 ,$10.68 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600166,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$89.70 ,$59.20 ,$4.65 ,$89.70 ,$4.91 ,$16.63 ,$16.63 ,$4.75 ,$53.82 ,$76.25 ,$62.79 ,$4.91 ,$4.91 ,$85.22 ,$68.17 ,$67.28 ,$8.08 ,$76.25 ,$4.75 ,$8.08 ,$8.08 ,$62.79 ,$54.63 ,$4.91 ,$4.75 ,$4.65 ,$9.50 ,$5.20 ,$76.25 ,$10.69 ,$82.52 ,$62.79 ,$23.74 ,$23.74 ,$54.63 ,$23.74 ,$61.98 ,$80.73 ,$61.28 ,$4.70 ,$70.86 ,$5.20 ,$5.70 ,$5.70 ,$4.65 ,$5.70 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600167,87181,HC SENSITIVITY STUDY AGAR (GRADIENT),306,1 ,$175.95 ,$116.13 ,$4.65 ,$175.95 ,$4.91 ,$16.63 ,$16.63 ,$4.75 ,$105.57 ,$149.56 ,$123.17 ,$4.91 ,$4.91 ,$167.15 ,$133.72 ,$131.96 ,$8.08 ,$149.56 ,$4.75 ,$8.08 ,$8.08 ,$123.17 ,$107.15 ,$4.91 ,$4.75 ,$4.65 ,$9.50 ,$5.20 ,$149.56 ,$10.69 ,$161.87 ,$123.17 ,$23.74 ,$23.74 ,$107.15 ,$23.74 ,$121.58 ,$158.36 ,$120.21 ,$4.70 ,$139.00 ,$5.20 ,$5.70 ,$5.70 ,$4.65 ,$5.70 ,$126.68 ,$109.09 ,$126.68 ,$126.68 ,$140.76 
ST NICHOLAS HOSPITAL - ACUTE,30600168,87184,HC SENSITIVITY DISK KB (HAEMOPHILUS),306,1 ,$64.40 ,$42.50 ,$7.33 ,$64.40 ,$7.73 ,$26.18 ,$26.18 ,$7.48 ,$38.64 ,$54.74 ,$45.08 ,$7.73 ,$7.73 ,$61.18 ,$48.94 ,$48.30 ,$12.72 ,$54.74 ,$7.48 ,$12.72 ,$12.72 ,$45.08 ,$39.22 ,$7.73 ,$7.48 ,$7.33 ,$14.96 ,$8.19 ,$54.74 ,$16.83 ,$59.25 ,$45.08 ,$34.47 ,$34.47 ,$39.22 ,$34.47 ,$44.50 ,$57.96 ,$44.00 ,$7.40 ,$50.88 ,$8.19 ,$8.98 ,$8.98 ,$7.33 ,$8.98 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30600169,87184,HC SENSITIVITY DISK KB,306,1 ,$87.40 ,$57.68 ,$7.33 ,$87.40 ,$7.73 ,$26.18 ,$26.18 ,$7.48 ,$52.44 ,$74.29 ,$61.18 ,$7.73 ,$7.73 ,$83.03 ,$66.42 ,$65.55 ,$12.72 ,$74.29 ,$7.48 ,$12.72 ,$12.72 ,$61.18 ,$53.23 ,$7.73 ,$7.48 ,$7.33 ,$14.96 ,$8.19 ,$74.29 ,$16.83 ,$80.41 ,$61.18 ,$34.47 ,$34.47 ,$53.23 ,$34.47 ,$60.39 ,$78.66 ,$59.71 ,$7.40 ,$69.05 ,$8.19 ,$8.98 ,$8.98 ,$7.33 ,$8.98 ,$62.93 ,$54.19 ,$62.93 ,$62.93 ,$69.92 
ST NICHOLAS HOSPITAL - ACUTE,30600171,87185,HC BETA LACTAMASE,306,1 ,$64.40 ,$42.50 ,$4.65 ,$64.40 ,$4.91 ,$16.63 ,$16.63 ,$4.75 ,$38.64 ,$54.74 ,$45.08 ,$4.91 ,$4.91 ,$61.18 ,$48.94 ,$48.30 ,$8.08 ,$54.74 ,$4.75 ,$8.08 ,$8.08 ,$45.08 ,$39.22 ,$4.91 ,$4.75 ,$4.65 ,$9.50 ,$5.20 ,$54.74 ,$10.69 ,$59.25 ,$45.08 ,$23.74 ,$23.74 ,$39.22 ,$23.74 ,$44.50 ,$57.96 ,$44.00 ,$4.70 ,$50.88 ,$5.20 ,$5.70 ,$5.70 ,$4.65 ,$5.70 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,30600172,87186,HC SENSITIVITY MIC,306,1 ,$77.05 ,$50.85 ,$8.48 ,$77.05 ,$8.94 ,$30.28 ,$30.28 ,$8.65 ,$46.23 ,$65.49 ,$53.94 ,$8.94 ,$8.94 ,$73.20 ,$58.56 ,$57.79 ,$14.71 ,$65.49 ,$8.65 ,$14.71 ,$14.71 ,$53.94 ,$46.92 ,$8.94 ,$8.65 ,$8.48 ,$17.30 ,$9.48 ,$65.49 ,$19.46 ,$70.89 ,$53.94 ,$43.23 ,$43.23 ,$46.92 ,$43.23 ,$53.24 ,$69.35 ,$52.64 ,$8.57 ,$60.87 ,$9.48 ,$10.38 ,$10.38 ,$8.48 ,$10.38 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600173,87186,HC SENSITIVITY MIC (SUSCEPT),306,1 ,$128.80 ,$85.01 ,$8.48 ,$128.80 ,$8.94 ,$30.28 ,$30.28 ,$8.65 ,$77.28 ,$109.48 ,$90.16 ,$8.94 ,$8.94 ,$122.36 ,$97.89 ,$96.60 ,$14.71 ,$109.48 ,$8.65 ,$14.71 ,$14.71 ,$90.16 ,$78.44 ,$8.94 ,$8.65 ,$8.48 ,$17.30 ,$9.48 ,$109.48 ,$19.46 ,$118.50 ,$90.16 ,$43.23 ,$43.23 ,$78.44 ,$43.23 ,$89.00 ,$115.92 ,$88.00 ,$8.57 ,$101.75 ,$9.48 ,$10.38 ,$10.38 ,$8.48 ,$10.38 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30600174,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$51.75 ,$34.16 ,$4.18 ,$51.75 ,$4.41 ,$14.95 ,$14.95 ,$4.27 ,$31.05 ,$43.99 ,$36.23 ,$4.41 ,$4.41 ,$49.16 ,$39.33 ,$38.81 ,$7.26 ,$43.99 ,$4.27 ,$7.26 ,$7.26 ,$36.23 ,$31.52 ,$4.41 ,$4.27 ,$4.18 ,$8.54 ,$4.67 ,$43.99 ,$9.61 ,$47.61 ,$36.23 ,$21.32 ,$21.32 ,$31.52 ,$21.32 ,$35.76 ,$46.58 ,$35.36 ,$4.22 ,$40.88 ,$4.67 ,$5.12 ,$5.12 ,$4.18 ,$5.12 ,$37.26 ,$32.09 ,$37.26 ,$37.26 ,$41.40 
ST NICHOLAS HOSPITAL - ACUTE,30600175,87205,HC URINE FOR EOSINOPHILS,306,1 ,$85.10 ,$56.17 ,$4.18 ,$85.10 ,$4.41 ,$14.95 ,$14.95 ,$4.27 ,$51.06 ,$72.34 ,$59.57 ,$4.41 ,$4.41 ,$80.85 ,$64.68 ,$63.83 ,$7.26 ,$72.34 ,$4.27 ,$7.26 ,$7.26 ,$59.57 ,$51.83 ,$4.41 ,$4.27 ,$4.18 ,$8.54 ,$4.67 ,$72.34 ,$9.61 ,$78.29 ,$59.57 ,$21.32 ,$21.32 ,$51.83 ,$21.32 ,$58.80 ,$76.59 ,$58.14 ,$4.22 ,$67.23 ,$4.67 ,$5.12 ,$5.12 ,$4.18 ,$5.12 ,$61.27 ,$52.76 ,$61.27 ,$61.27 ,$68.08 
ST NICHOLAS HOSPITAL - ACUTE,30600176,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$52.90 ,$34.91 ,$5.28 ,$52.90 ,$5.57 ,$18.87 ,$18.87 ,$5.39 ,$31.74 ,$44.97 ,$37.03 ,$5.57 ,$5.57 ,$50.26 ,$40.20 ,$39.68 ,$9.16 ,$44.97 ,$5.39 ,$9.16 ,$9.16 ,$37.03 ,$32.22 ,$5.57 ,$5.39 ,$5.28 ,$10.78 ,$5.90 ,$44.97 ,$12.13 ,$48.67 ,$37.03 ,$26.89 ,$26.89 ,$32.22 ,$26.89 ,$36.55 ,$47.61 ,$36.14 ,$5.33 ,$41.79 ,$5.90 ,$6.47 ,$6.47 ,$5.28 ,$6.47 ,$38.09 ,$32.80 ,$38.09 ,$38.09 ,$42.32 
ST NICHOLAS HOSPITAL - ACUTE,30600177,87206,HC SMEAR ACID FAST/FLUOR (FUNGUS),306,1 ,$154.10 ,$101.71 ,$5.28 ,$154.10 ,$5.57 ,$18.87 ,$18.87 ,$5.39 ,$92.46 ,$130.99 ,$107.87 ,$5.57 ,$5.57 ,$146.40 ,$117.12 ,$115.58 ,$9.16 ,$130.99 ,$5.39 ,$9.16 ,$9.16 ,$107.87 ,$93.85 ,$5.57 ,$5.39 ,$5.28 ,$10.78 ,$5.90 ,$130.99 ,$12.13 ,$141.77 ,$107.87 ,$26.89 ,$26.89 ,$93.85 ,$26.89 ,$106.48 ,$138.69 ,$105.28 ,$5.33 ,$121.74 ,$5.90 ,$6.47 ,$6.47 ,$5.28 ,$6.47 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30600178,87206,HC SMEAR ACID FAST/FLUOR (CRYPTO),306,1 ,$92.00 ,$60.72 ,$5.28 ,$92.00 ,$5.57 ,$18.87 ,$18.87 ,$5.39 ,$55.20 ,$78.20 ,$64.40 ,$5.57 ,$5.57 ,$87.40 ,$69.92 ,$69.00 ,$9.16 ,$78.20 ,$5.39 ,$9.16 ,$9.16 ,$64.40 ,$56.03 ,$5.57 ,$5.39 ,$5.28 ,$10.78 ,$5.90 ,$78.20 ,$12.13 ,$84.64 ,$64.40 ,$26.89 ,$26.89 ,$56.03 ,$26.89 ,$63.57 ,$82.80 ,$62.85 ,$5.33 ,$72.68 ,$5.90 ,$6.47 ,$6.47 ,$5.28 ,$6.47 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,30600179,87207,HC SPECIAL STAIN (MALARIA),306,1 ,$167.90 ,$110.81 ,$5.87 ,$167.90 ,$6.19 ,$20.97 ,$20.97 ,$5.99 ,$100.74 ,$142.72 ,$117.53 ,$6.19 ,$6.19 ,$159.51 ,$127.60 ,$125.93 ,$10.18 ,$142.72 ,$5.99 ,$10.18 ,$10.18 ,$117.53 ,$102.25 ,$6.19 ,$5.99 ,$5.87 ,$11.98 ,$6.56 ,$142.72 ,$13.48 ,$154.47 ,$117.53 ,$29.97 ,$29.97 ,$102.25 ,$29.97 ,$116.02 ,$151.11 ,$114.71 ,$5.93 ,$132.64 ,$6.56 ,$7.19 ,$7.19 ,$5.87 ,$7.19 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30600180,87207,HC SPECIAL STAIN (TZANCK EVAL),306,1 ,$85.10 ,$56.17 ,$5.87 ,$85.10 ,$6.19 ,$20.97 ,$20.97 ,$5.99 ,$51.06 ,$72.34 ,$59.57 ,$6.19 ,$6.19 ,$80.85 ,$64.68 ,$63.83 ,$10.18 ,$72.34 ,$5.99 ,$10.18 ,$10.18 ,$59.57 ,$51.83 ,$6.19 ,$5.99 ,$5.87 ,$11.98 ,$6.56 ,$72.34 ,$13.48 ,$78.29 ,$59.57 ,$29.97 ,$29.97 ,$51.83 ,$29.97 ,$58.80 ,$76.59 ,$58.14 ,$5.93 ,$67.23 ,$6.56 ,$7.19 ,$7.19 ,$5.87 ,$7.19 ,$61.27 ,$52.76 ,$61.27 ,$61.27 ,$68.08 
ST NICHOLAS HOSPITAL - ACUTE,30600181,87207,HC SPECIAL STAIN (HERPES),306,1 ,$93.15 ,$61.48 ,$5.87 ,$93.15 ,$6.19 ,$20.97 ,$20.97 ,$5.99 ,$55.89 ,$79.18 ,$65.21 ,$6.19 ,$6.19 ,$88.49 ,$70.79 ,$69.86 ,$10.18 ,$79.18 ,$5.99 ,$10.18 ,$10.18 ,$65.21 ,$56.73 ,$6.19 ,$5.99 ,$5.87 ,$11.98 ,$6.56 ,$79.18 ,$13.48 ,$85.70 ,$65.21 ,$29.97 ,$29.97 ,$56.73 ,$29.97 ,$64.37 ,$83.84 ,$63.64 ,$5.93 ,$73.59 ,$6.56 ,$7.19 ,$7.19 ,$5.87 ,$7.19 ,$67.07 ,$57.75 ,$67.07 ,$67.07 ,$74.52 
ST NICHOLAS HOSPITAL - ACUTE,30600182,87209,HC OVA  AND  PARASITE W/STAIN,306,1 ,$103.50 ,$68.31 ,$17.62 ,$103.50 ,$18.58 ,$62.93 ,$62.93 ,$17.98 ,$62.10 ,$87.98 ,$72.45 ,$18.58 ,$18.58 ,$98.33 ,$78.66 ,$77.63 ,$30.57 ,$87.98 ,$17.98 ,$30.57 ,$30.57 ,$72.45 ,$63.03 ,$18.58 ,$17.98 ,$17.62 ,$35.96 ,$19.69 ,$87.98 ,$40.46 ,$95.22 ,$72.45 ,$89.83 ,$89.83 ,$63.03 ,$89.83 ,$71.52 ,$93.15 ,$70.71 ,$17.80 ,$81.77 ,$19.69 ,$21.58 ,$21.58 ,$17.62 ,$21.58 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30600183,87210,HC SMEAR WET MOUNT,306,1 ,$36.80 ,$24.29 ,$5.70 ,$36.80 ,$6.00 ,$20.37 ,$20.37 ,$5.82 ,$22.08 ,$31.28 ,$25.76 ,$6.00 ,$6.00 ,$34.96 ,$27.97 ,$27.60 ,$9.89 ,$31.28 ,$5.82 ,$9.89 ,$9.89 ,$25.76 ,$22.41 ,$6.00 ,$5.82 ,$5.70 ,$11.64 ,$6.36 ,$31.28 ,$13.10 ,$33.86 ,$25.76 ,$21.32 ,$21.32 ,$22.41 ,$21.32 ,$25.43 ,$33.12 ,$25.14 ,$5.76 ,$29.07 ,$6.36 ,$6.98 ,$6.98 ,$5.70 ,$6.98 ,$26.50 ,$22.82 ,$26.50 ,$26.50 ,$29.44 
ST NICHOLAS HOSPITAL - ACUTE,30600184,87210,HC SMEAR WET MOUNT (FUNGUS),306,1 ,$51.75 ,$34.16 ,$5.70 ,$51.75 ,$6.00 ,$20.37 ,$20.37 ,$5.82 ,$31.05 ,$43.99 ,$36.23 ,$6.00 ,$6.00 ,$49.16 ,$39.33 ,$38.81 ,$9.89 ,$43.99 ,$5.82 ,$9.89 ,$9.89 ,$36.23 ,$31.52 ,$6.00 ,$5.82 ,$5.70 ,$11.64 ,$6.36 ,$43.99 ,$13.10 ,$47.61 ,$36.23 ,$21.32 ,$21.32 ,$31.52 ,$21.32 ,$35.76 ,$46.58 ,$35.36 ,$5.76 ,$40.88 ,$6.36 ,$6.98 ,$6.98 ,$5.70 ,$6.98 ,$37.26 ,$32.09 ,$37.26 ,$37.26 ,$41.40 
ST NICHOLAS HOSPITAL - ACUTE,30600185,87220,HC TISSUE KOH PREP,306,1 ,$60.95 ,$40.23 ,$4.18 ,$60.95 ,$4.41 ,$14.95 ,$14.95 ,$4.27 ,$36.57 ,$51.81 ,$42.67 ,$4.41 ,$4.41 ,$57.90 ,$46.32 ,$45.71 ,$7.26 ,$51.81 ,$4.27 ,$7.26 ,$7.26 ,$42.67 ,$37.12 ,$4.41 ,$4.27 ,$4.18 ,$8.54 ,$4.67 ,$51.81 ,$9.61 ,$56.07 ,$42.67 ,$21.32 ,$21.32 ,$37.12 ,$21.32 ,$42.12 ,$54.86 ,$41.64 ,$4.22 ,$48.15 ,$4.67 ,$5.12 ,$5.12 ,$4.18 ,$5.12 ,$43.88 ,$37.79 ,$43.88 ,$43.88 ,$48.76 
ST NICHOLAS HOSPITAL - ACUTE,30600186,87230,HC TOXIN ANTITOXIN ASSAY,306,1 ,$150.65 ,$99.43 ,$19.35 ,$150.65 ,$20.40 ,$69.09 ,$69.09 ,$19.74 ,$90.39 ,$128.05 ,$105.46 ,$20.40 ,$20.40 ,$143.12 ,$114.49 ,$112.99 ,$33.56 ,$128.05 ,$19.74 ,$33.56 ,$33.56 ,$105.46 ,$91.75 ,$20.40 ,$19.74 ,$19.35 ,$39.48 ,$21.62 ,$128.05 ,$44.42 ,$138.60 ,$105.46 ,$98.69 ,$98.69 ,$91.75 ,$98.69 ,$104.10 ,$135.59 ,$102.92 ,$19.54 ,$119.01 ,$21.62 ,$23.69 ,$23.69 ,$19.35 ,$23.69 ,$108.47 ,$93.40 ,$108.47 ,$108.47 ,$120.52 
ST NICHOLAS HOSPITAL - ACUTE,30600187,87252,HC CULTURE VIRUS ID TISS (CMV),306,1 ,$232.30 ,$153.32 ,$25.55 ,$232.30 ,$26.94 ,$91.25 ,$91.25 ,$26.07 ,$139.38 ,$197.46 ,$162.61 ,$26.94 ,$26.94 ,$220.69 ,$176.55 ,$174.23 ,$44.32 ,$197.46 ,$26.07 ,$44.32 ,$44.32 ,$162.61 ,$141.47 ,$26.94 ,$26.07 ,$25.55 ,$52.14 ,$28.56 ,$197.46 ,$58.66 ,$213.72 ,$162.61 ,$130.27 ,$130.27 ,$141.47 ,$130.27 ,$160.52 ,$209.07 ,$158.71 ,$25.80 ,$183.52 ,$28.56 ,$31.28 ,$31.28 ,$25.55 ,$31.28 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30600188,87252,HC CULTURE VIRUS ID TISS (HERPES),306,1 ,$232.30 ,$153.32 ,$25.55 ,$232.30 ,$26.94 ,$91.25 ,$91.25 ,$26.07 ,$139.38 ,$197.46 ,$162.61 ,$26.94 ,$26.94 ,$220.69 ,$176.55 ,$174.23 ,$44.32 ,$197.46 ,$26.07 ,$44.32 ,$44.32 ,$162.61 ,$141.47 ,$26.94 ,$26.07 ,$25.55 ,$52.14 ,$28.56 ,$197.46 ,$58.66 ,$213.72 ,$162.61 ,$130.27 ,$130.27 ,$141.47 ,$130.27 ,$160.52 ,$209.07 ,$158.71 ,$25.80 ,$183.52 ,$28.56 ,$31.28 ,$31.28 ,$25.55 ,$31.28 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30600189,87252,HC CULTURE VIRUS ID TISS (RESP),306,1 ,$131.10 ,$86.53 ,$25.55 ,$131.10 ,$26.94 ,$91.25 ,$91.25 ,$26.07 ,$78.66 ,$111.44 ,$91.77 ,$26.94 ,$26.94 ,$124.55 ,$99.64 ,$98.33 ,$44.32 ,$111.44 ,$26.07 ,$44.32 ,$44.32 ,$91.77 ,$79.84 ,$26.94 ,$26.07 ,$25.55 ,$52.14 ,$28.56 ,$111.44 ,$58.66 ,$120.61 ,$91.77 ,$130.27 ,$130.27 ,$79.84 ,$130.27 ,$90.59 ,$117.99 ,$89.57 ,$25.80 ,$103.57 ,$28.56 ,$31.28 ,$31.28 ,$25.55 ,$31.28 ,$94.39 ,$81.28 ,$94.39 ,$94.39 ,$104.88 
ST NICHOLAS HOSPITAL - ACUTE,30600190,87252,HC CULTURE VIRUS ID TISS (ADENO/ENTER),306,1 ,$143.75 ,$94.88 ,$25.55 ,$143.75 ,$26.94 ,$91.25 ,$91.25 ,$26.07 ,$86.25 ,$122.19 ,$100.63 ,$26.94 ,$26.94 ,$136.56 ,$109.25 ,$107.81 ,$44.32 ,$122.19 ,$26.07 ,$44.32 ,$44.32 ,$100.63 ,$87.54 ,$26.94 ,$26.07 ,$25.55 ,$52.14 ,$28.56 ,$122.19 ,$58.66 ,$132.25 ,$100.63 ,$130.27 ,$130.27 ,$87.54 ,$130.27 ,$99.33 ,$129.38 ,$98.21 ,$25.80 ,$113.56 ,$28.56 ,$31.28 ,$31.28 ,$25.55 ,$31.28 ,$103.50 ,$89.13 ,$103.50 ,$103.50 ,$115.00 
ST NICHOLAS HOSPITAL - ACUTE,30600193,87254,HC VIRUS ISOL SHELL ID (CMV),306,1 ,$167.90 ,$110.81 ,$7.06 ,$167.90 ,$7.06 ,$68.46 ,$68.46 ,$19.56 ,$100.74 ,$142.72 ,$117.53 ,$7.06 ,$7.06 ,$159.51 ,$127.60 ,$125.93 ,$33.25 ,$142.72 ,$19.56 ,$33.25 ,$33.25 ,$117.53 ,$102.25 ,$7.06 ,$19.56 ,$19.17 ,$39.12 ,$7.48 ,$142.72 ,$44.01 ,$154.47 ,$117.53 ,$97.74 ,$97.74 ,$102.25 ,$97.74 ,$116.02 ,$151.11 ,$114.71 ,$19.36 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$19.17 ,$23.47 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30600194,87254,HC VIRUS ISOL SHELL ID (RESP),306,1 ,$105.80 ,$69.83 ,$7.06 ,$105.80 ,$7.06 ,$68.46 ,$68.46 ,$19.56 ,$63.48 ,$89.93 ,$74.06 ,$7.06 ,$7.06 ,$100.51 ,$80.41 ,$79.35 ,$33.25 ,$89.93 ,$19.56 ,$33.25 ,$33.25 ,$74.06 ,$64.43 ,$7.06 ,$19.56 ,$19.17 ,$39.12 ,$7.48 ,$89.93 ,$44.01 ,$97.34 ,$74.06 ,$97.74 ,$97.74 ,$64.43 ,$97.74 ,$73.11 ,$95.22 ,$72.28 ,$19.36 ,$83.58 ,$7.48 ,$23.47 ,$23.47 ,$19.17 ,$23.47 ,$76.18 ,$65.60 ,$76.18 ,$76.18 ,$84.64 
ST NICHOLAS HOSPITAL - ACUTE,30600195,87254,HC VIRUS ISOL SHELL ID (VARI),306,1 ,$167.90 ,$110.81 ,$7.06 ,$167.90 ,$7.06 ,$68.46 ,$68.46 ,$19.56 ,$100.74 ,$142.72 ,$117.53 ,$7.06 ,$7.06 ,$159.51 ,$127.60 ,$125.93 ,$33.25 ,$142.72 ,$19.56 ,$33.25 ,$33.25 ,$117.53 ,$102.25 ,$7.06 ,$19.56 ,$19.17 ,$39.12 ,$7.48 ,$142.72 ,$44.01 ,$154.47 ,$117.53 ,$97.74 ,$97.74 ,$102.25 ,$97.74 ,$116.02 ,$151.11 ,$114.71 ,$19.36 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$19.17 ,$23.47 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$19.56 ,$100.74 ,$142.72 ,$117.53 ,$7.06 ,$7.06 ,$159.51 ,$127.60 ,$125.93 ,$33.25 ,$142.72 ,$19.56 ,$33.25 ,$33.25 ,$117.53 ,$102.25 ,$7.06 ,$19.56 ,$19.17 ,$39.12 ,$7.48 ,$142.72 ,$44.01 ,$154.47 ,$117.53 ,$97.74 ,$97.74 ,$102.25 ,$97.74 ,$116.02 ,$151.11 ,$114.71 ,$19.36 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$19.17 ,$23.47 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$19.56 ,$100.74 ,$142.72 ,$117.53 ,$7.06 ,$7.06 ,$159.51 ,$127.60 ,$125.93 ,$33.25 ,$142.72 ,$19.56 ,$33.25 ,$33.25 ,$117.53 ,$102.25 ,$7.06 ,$19.56 ,$19.17 ,$39.12 ,$7.48 ,$142.72 ,$44.01 ,$154.47 ,$117.53 ,$97.74 ,$97.74 ,$102.25 ,$97.74 ,$116.02 ,$151.11 ,$114.71 ,$19.36 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$19.17 ,$23.47 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$19.56 ,$100.74 ,$142.72 ,$117.53 ,$7.06 ,$7.06 ,$159.51 ,$127.60 ,$125.93 ,$33.25 ,$142.72 ,$19.56 ,$33.25 ,$33.25 ,$117.53 ,$102.25 ,$7.06 ,$19.56 ,$19.17 ,$39.12 ,$7.48 ,$142.72 ,$44.01 ,$154.47 ,$117.53 ,$97.74 ,$97.74 ,$102.25 ,$97.74 ,$116.02 ,$151.11 ,$114.71 ,$19.36 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$19.17 ,$23.47 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30600200,87260,HC IF ADENOVIRUS AG,306,1 ,$97.75 ,$64.52 ,$14.14 ,$97.75 ,$14.91 ,$50.51 ,$50.51 ,$14.43 ,$58.65 ,$83.09 ,$68.43 ,$14.91 ,$14.91 ,$92.86 ,$74.29 ,$73.31 ,$24.53 ,$83.09 ,$14.43 ,$24.53 ,$24.53 ,$68.43 ,$59.53 ,$14.91 ,$14.43 ,$14.14 ,$28.86 ,$15.80 ,$83.09 ,$32.47 ,$89.93 ,$68.43 ,$59.93 ,$59.93 ,$59.53 ,$59.93 ,$67.55 ,$87.98 ,$66.78 ,$14.28 ,$77.22 ,$15.80 ,$17.32 ,$17.32 ,$14.14 ,$17.32 ,$70.38 ,$60.61 ,$70.38 ,$70.38 ,$78.20 
ST NICHOLAS HOSPITAL - ACUTE,30600201,87270,HC IF CHLAMYDIA AG,306,1 ,$125.35 ,$82.73 ,$11.74 ,$125.35 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$75.21 ,$106.55 ,$87.75 ,$12.38 ,$12.38 ,$119.08 ,$95.27 ,$94.01 ,$20.37 ,$106.55 ,$11.98 ,$20.37 ,$20.37 ,$87.75 ,$76.34 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$106.55 ,$26.96 ,$115.32 ,$87.75 ,$59.93 ,$59.93 ,$76.34 ,$59.93 ,$86.62 ,$112.82 ,$85.64 ,$11.86 ,$99.03 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$90.25 ,$77.72 ,$90.25 ,$90.25 ,$100.28 
ST NICHOLAS HOSPITAL - ACUTE,30600202,87273,HC IF HERPES SIMPLEX 2 AG,306,1 ,$97.75 ,$64.52 ,$11.74 ,$97.75 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$58.65 ,$83.09 ,$68.43 ,$12.38 ,$12.38 ,$92.86 ,$74.29 ,$73.31 ,$20.37 ,$83.09 ,$11.98 ,$20.37 ,$20.37 ,$68.43 ,$59.53 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$83.09 ,$26.96 ,$89.93 ,$68.43 ,$59.93 ,$59.93 ,$59.53 ,$59.93 ,$67.55 ,$87.98 ,$66.78 ,$11.86 ,$77.22 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$70.38 ,$60.61 ,$70.38 ,$70.38 ,$78.20 
ST NICHOLAS HOSPITAL - ACUTE,30600203,87274,HC IF HERPES SIMPLEX 1 AG,306,1 ,$97.75 ,$64.52 ,$11.74 ,$97.75 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$58.65 ,$83.09 ,$68.43 ,$12.38 ,$12.38 ,$92.86 ,$74.29 ,$73.31 ,$20.37 ,$83.09 ,$11.98 ,$20.37 ,$20.37 ,$68.43 ,$59.53 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$83.09 ,$26.96 ,$89.93 ,$68.43 ,$59.93 ,$59.93 ,$59.53 ,$59.93 ,$67.55 ,$87.98 ,$66.78 ,$11.86 ,$77.22 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$70.38 ,$60.61 ,$70.38 ,$70.38 ,$78.20 
ST NICHOLAS HOSPITAL - ACUTE,30600204,87275,HC IF INFLUENZA B AG,306,1 ,$125.35 ,$82.73 ,$12.00 ,$125.35 ,$12.66 ,$42.88 ,$42.88 ,$12.25 ,$75.21 ,$106.55 ,$87.75 ,$12.66 ,$12.66 ,$119.08 ,$95.27 ,$94.01 ,$20.83 ,$106.55 ,$12.25 ,$20.83 ,$20.83 ,$87.75 ,$76.34 ,$12.66 ,$12.25 ,$12.00 ,$24.50 ,$13.42 ,$106.55 ,$27.56 ,$115.32 ,$87.75 ,$59.93 ,$59.93 ,$76.34 ,$59.93 ,$86.62 ,$112.82 ,$85.64 ,$12.12 ,$99.03 ,$13.42 ,$14.70 ,$14.70 ,$12.00 ,$14.70 ,$90.25 ,$77.72 ,$90.25 ,$90.25 ,$100.28 
ST NICHOLAS HOSPITAL - ACUTE,30600205,87276,HC IF INFLUENZA A AG,306,1 ,$125.35 ,$82.73 ,$15.75 ,$125.35 ,$16.61 ,$56.25 ,$56.25 ,$16.07 ,$75.21 ,$106.55 ,$87.75 ,$16.61 ,$16.61 ,$119.08 ,$95.27 ,$94.01 ,$27.32 ,$106.55 ,$16.07 ,$27.32 ,$27.32 ,$87.75 ,$76.34 ,$16.61 ,$16.07 ,$15.75 ,$32.14 ,$17.61 ,$106.55 ,$36.16 ,$115.32 ,$87.75 ,$59.93 ,$59.93 ,$76.34 ,$59.93 ,$86.62 ,$112.82 ,$85.64 ,$15.91 ,$99.03 ,$17.61 ,$19.28 ,$19.28 ,$15.75 ,$19.28 ,$90.25 ,$77.72 ,$90.25 ,$90.25 ,$100.28 
ST NICHOLAS HOSPITAL - ACUTE,30600206,87278,HC IF LEGIONELLA AG,306,1 ,$77.05 ,$50.85 ,$15.29 ,$77.05 ,$16.12 ,$54.60 ,$54.60 ,$15.60 ,$46.23 ,$65.49 ,$53.94 ,$16.12 ,$16.12 ,$73.20 ,$58.56 ,$57.79 ,$26.52 ,$65.49 ,$15.60 ,$26.52 ,$26.52 ,$53.94 ,$46.92 ,$16.12 ,$15.60 ,$15.29 ,$31.20 ,$17.09 ,$65.49 ,$35.10 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$15.44 ,$60.87 ,$17.09 ,$18.72 ,$18.72 ,$15.29 ,$18.72 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600207,87279,HC IF PARAFLUENZA AG,306,1 ,$97.75 ,$64.52 ,$16.10 ,$97.75 ,$16.86 ,$57.51 ,$57.51 ,$16.43 ,$58.65 ,$83.09 ,$68.43 ,$16.86 ,$16.86 ,$92.86 ,$74.29 ,$73.31 ,$27.93 ,$83.09 ,$16.43 ,$27.93 ,$27.93 ,$68.43 ,$59.53 ,$16.86 ,$16.43 ,$16.10 ,$32.86 ,$17.87 ,$83.09 ,$36.97 ,$89.93 ,$68.43 ,$59.93 ,$59.93 ,$59.53 ,$59.93 ,$67.55 ,$87.98 ,$66.78 ,$16.26 ,$77.22 ,$17.87 ,$19.72 ,$19.72 ,$16.10 ,$19.72 ,$70.38 ,$60.61 ,$70.38 ,$70.38 ,$78.20 
ST NICHOLAS HOSPITAL - ACUTE,30600208,87280,HC IF RSV AG,306,1 ,$128.80 ,$85.01 ,$13.15 ,$128.80 ,$13.87 ,$46.97 ,$46.97 ,$13.42 ,$77.28 ,$109.48 ,$90.16 ,$13.87 ,$13.87 ,$122.36 ,$97.89 ,$96.60 ,$22.81 ,$109.48 ,$13.42 ,$22.81 ,$22.81 ,$90.16 ,$78.44 ,$13.87 ,$13.42 ,$13.15 ,$26.84 ,$14.70 ,$109.48 ,$30.20 ,$118.50 ,$90.16 ,$59.93 ,$59.93 ,$78.44 ,$59.93 ,$89.00 ,$115.92 ,$88.00 ,$13.28 ,$101.75 ,$14.70 ,$16.10 ,$16.10 ,$13.15 ,$16.10 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30600209,87281,HC IF PNEUMOCYST CARINII AG,306,1 ,$128.80 ,$85.01 ,$11.74 ,$128.80 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$77.28 ,$109.48 ,$90.16 ,$12.38 ,$12.38 ,$122.36 ,$97.89 ,$96.60 ,$20.37 ,$109.48 ,$11.98 ,$20.37 ,$20.37 ,$90.16 ,$78.44 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$109.48 ,$26.96 ,$118.50 ,$90.16 ,$59.93 ,$59.93 ,$78.44 ,$59.93 ,$89.00 ,$115.92 ,$88.00 ,$11.86 ,$101.75 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30600210,87290,HC IF VARICELLA ZOETER AG,306,1 ,$125.35 ,$82.73 ,$13.15 ,$125.35 ,$13.87 ,$46.97 ,$46.97 ,$13.42 ,$75.21 ,$106.55 ,$87.75 ,$13.87 ,$13.87 ,$119.08 ,$95.27 ,$94.01 ,$22.81 ,$106.55 ,$13.42 ,$22.81 ,$22.81 ,$87.75 ,$76.34 ,$13.87 ,$13.42 ,$13.15 ,$26.84 ,$14.70 ,$106.55 ,$30.20 ,$115.32 ,$87.75 ,$59.93 ,$59.93 ,$76.34 ,$59.93 ,$86.62 ,$112.82 ,$85.64 ,$13.28 ,$99.03 ,$14.70 ,$16.10 ,$16.10 ,$13.15 ,$16.10 ,$90.25 ,$77.72 ,$90.25 ,$90.25 ,$100.28 
ST NICHOLAS HOSPITAL - ACUTE,30600211,87300,HC IF POLYVALENT MLT ORG AG,306,1 ,$97.75 ,$64.52 ,$8.66 ,$97.75 ,$8.66 ,$41.93 ,$41.93 ,$11.98 ,$58.65 ,$83.09 ,$68.43 ,$8.66 ,$8.66 ,$92.86 ,$74.29 ,$73.31 ,$20.37 ,$83.09 ,$11.98 ,$20.37 ,$20.37 ,$68.43 ,$59.53 ,$8.66 ,$11.98 ,$11.74 ,$23.96 ,$9.18 ,$83.09 ,$26.96 ,$89.93 ,$68.43 ,$59.93 ,$59.93 ,$59.53 ,$59.93 ,$67.55 ,$87.98 ,$66.78 ,$11.86 ,$77.22 ,$9.18 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$70.38 ,$60.61 ,$70.38 ,$70.38 ,$78.20 
ST NICHOLAS HOSPITAL - ACUTE,30600212,87305,HC EIA QL ASPERGILLUS AG,306,1 ,$154.10 ,$101.71 ,$11.74 ,$154.10 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$92.46 ,$130.99 ,$107.87 ,$12.38 ,$12.38 ,$146.40 ,$117.12 ,$115.58 ,$20.37 ,$130.99 ,$11.98 ,$20.37 ,$20.37 ,$107.87 ,$93.85 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$130.99 ,$26.96 ,$141.77 ,$107.87 ,$59.93 ,$59.93 ,$93.85 ,$59.93 ,$106.48 ,$138.69 ,$105.28 ,$11.86 ,$121.74 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30600213,87324,HC EIA QL CLOS DIFF TOXIN AG,306,1 ,$125.35 ,$82.73 ,$11.74 ,$125.35 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$75.21 ,$106.55 ,$87.75 ,$12.38 ,$12.38 ,$119.08 ,$95.27 ,$94.01 ,$20.37 ,$106.55 ,$11.98 ,$20.37 ,$20.37 ,$87.75 ,$76.34 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$106.55 ,$26.96 ,$115.32 ,$87.75 ,$59.93 ,$59.93 ,$76.34 ,$59.93 ,$86.62 ,$112.82 ,$85.64 ,$11.86 ,$99.03 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$90.25 ,$77.72 ,$90.25 ,$90.25 ,$100.28 
ST NICHOLAS HOSPITAL - ACUTE,30600214,87327,HC EIA QL CRYPTOCOCCUS AG,306,1 ,$125.35 ,$82.73 ,$13.15 ,$125.35 ,$13.87 ,$46.97 ,$46.97 ,$13.42 ,$75.21 ,$106.55 ,$87.75 ,$13.87 ,$13.87 ,$119.08 ,$95.27 ,$94.01 ,$22.81 ,$106.55 ,$13.42 ,$22.81 ,$22.81 ,$87.75 ,$76.34 ,$13.87 ,$13.42 ,$13.15 ,$26.84 ,$14.70 ,$106.55 ,$30.20 ,$115.32 ,$87.75 ,$59.93 ,$59.93 ,$76.34 ,$59.93 ,$86.62 ,$112.82 ,$85.64 ,$13.28 ,$99.03 ,$14.70 ,$16.10 ,$16.10 ,$13.15 ,$16.10 ,$90.25 ,$77.72 ,$90.25 ,$90.25 ,$100.28 
ST NICHOLAS HOSPITAL - ACUTE,30600215,87328,HC EIA QL CRYPTOSPORIDIUM AG,306,1 ,$55.20 ,$36.43 ,$13.54 ,$55.20 ,$14.28 ,$48.37 ,$48.37 ,$13.82 ,$33.12 ,$46.92 ,$38.64 ,$14.28 ,$14.28 ,$52.44 ,$41.95 ,$41.40 ,$23.49 ,$46.92 ,$13.82 ,$23.49 ,$23.49 ,$38.64 ,$33.62 ,$14.28 ,$13.82 ,$13.54 ,$27.64 ,$15.14 ,$46.92 ,$31.10 ,$50.78 ,$38.64 ,$55.20 ,$55.20 ,$33.62 ,$55.20 ,$38.14 ,$49.68 ,$37.71 ,$13.68 ,$43.61 ,$15.14 ,$16.58 ,$16.58 ,$13.54 ,$16.58 ,$39.74 ,$34.22 ,$39.74 ,$39.74 ,$44.16 
ST NICHOLAS HOSPITAL - ACUTE,30600216,87329,HC EIA QL GIARDIA AG,306,1 ,$77.05 ,$50.85 ,$11.74 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$46.23 ,$65.49 ,$53.94 ,$12.38 ,$12.38 ,$73.20 ,$58.56 ,$57.79 ,$20.37 ,$65.49 ,$11.98 ,$20.37 ,$20.37 ,$53.94 ,$46.92 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$65.49 ,$26.96 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$11.86 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600217,87338,HC EIA QL H PYLORI AG STOOL,306,1 ,$154.10 ,$101.71 ,$14.09 ,$154.10 ,$14.86 ,$50.33 ,$50.33 ,$14.38 ,$92.46 ,$130.99 ,$107.87 ,$14.86 ,$14.86 ,$146.40 ,$117.12 ,$115.58 ,$24.45 ,$130.99 ,$14.38 ,$24.45 ,$24.45 ,$107.87 ,$93.85 ,$14.86 ,$14.38 ,$14.09 ,$28.76 ,$15.75 ,$130.99 ,$32.36 ,$141.77 ,$107.87 ,$71.88 ,$71.88 ,$93.85 ,$71.88 ,$106.48 ,$138.69 ,$105.28 ,$14.23 ,$121.74 ,$15.75 ,$17.26 ,$17.26 ,$14.09 ,$17.26 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30600218,87340,HC EIA QL HEPATITIS B AG,306,1 ,$89.70 ,$59.20 ,$10.12 ,$89.70 ,$10.67 ,$36.16 ,$36.16 ,$10.33 ,$53.82 ,$76.25 ,$62.79 ,$10.67 ,$10.67 ,$85.22 ,$68.17 ,$67.28 ,$17.56 ,$76.25 ,$10.33 ,$17.56 ,$17.56 ,$62.79 ,$54.63 ,$10.67 ,$10.33 ,$10.12 ,$20.66 ,$11.31 ,$76.25 ,$23.24 ,$82.52 ,$62.79 ,$51.66 ,$51.66 ,$54.63 ,$51.66 ,$61.98 ,$80.73 ,$61.28 ,$10.22 ,$70.86 ,$11.31 ,$12.40 ,$12.40 ,$10.12 ,$12.40 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600220,87341,HC EIA QL HEPATITIS B AG NEUT,306,1 ,$89.70 ,$59.20 ,$10.12 ,$89.70 ,$10.67 ,$36.16 ,$36.16 ,$10.33 ,$53.82 ,$76.25 ,$62.79 ,$10.67 ,$10.67 ,$85.22 ,$68.17 ,$67.28 ,$17.56 ,$76.25 ,$10.33 ,$17.56 ,$17.56 ,$62.79 ,$54.63 ,$10.67 ,$10.33 ,$10.12 ,$20.66 ,$11.31 ,$76.25 ,$23.24 ,$82.52 ,$62.79 ,$51.66 ,$51.66 ,$54.63 ,$51.66 ,$61.98 ,$80.73 ,$61.28 ,$10.22 ,$70.86 ,$11.31 ,$12.40 ,$12.40 ,$10.12 ,$12.40 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600221,87350,HC HEPATITIS BE AG QL,306,1 ,$77.05 ,$50.85 ,$11.30 ,$77.05 ,$11.91 ,$40.36 ,$40.36 ,$11.53 ,$46.23 ,$65.49 ,$53.94 ,$11.91 ,$11.91 ,$73.20 ,$58.56 ,$57.79 ,$19.60 ,$65.49 ,$11.53 ,$19.60 ,$19.60 ,$53.94 ,$46.92 ,$11.91 ,$11.53 ,$11.30 ,$23.06 ,$12.62 ,$65.49 ,$25.94 ,$70.89 ,$53.94 ,$57.63 ,$57.63 ,$46.92 ,$57.63 ,$53.24 ,$69.35 ,$52.64 ,$11.42 ,$60.87 ,$12.62 ,$13.84 ,$13.84 ,$11.30 ,$13.84 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600222,87385,HC EIA QL HISTOPLASMA AG,306,1 ,$180.55 ,$119.16 ,$12.98 ,$180.55 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$108.33 ,$153.47 ,$126.39 ,$13.69 ,$13.69 ,$171.52 ,$137.22 ,$135.41 ,$22.53 ,$153.47 ,$13.25 ,$22.53 ,$22.53 ,$126.39 ,$109.96 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$153.47 ,$29.81 ,$166.11 ,$126.39 ,$59.93 ,$59.93 ,$109.96 ,$59.93 ,$124.76 ,$162.50 ,$123.35 ,$13.11 ,$142.63 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30600223,87385,HC EIA QL HISTOPLASMA AG (URINE),306,1 ,$167.90 ,$110.81 ,$12.98 ,$167.90 ,$13.69 ,$46.38 ,$46.38 ,$13.25 ,$100.74 ,$142.72 ,$117.53 ,$13.69 ,$13.69 ,$159.51 ,$127.60 ,$125.93 ,$22.53 ,$142.72 ,$13.25 ,$22.53 ,$22.53 ,$117.53 ,$102.25 ,$13.69 ,$13.25 ,$12.98 ,$26.50 ,$14.51 ,$142.72 ,$29.81 ,$154.47 ,$117.53 ,$59.93 ,$59.93 ,$102.25 ,$59.93 ,$116.02 ,$151.11 ,$114.71 ,$13.11 ,$132.64 ,$14.51 ,$15.90 ,$15.90 ,$12.98 ,$15.90 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30600224,87390,HC HIV 1 AG QL,306,1 ,$162.15 ,$107.02 ,$23.58 ,$162.15 ,$24.81 ,$84.21 ,$84.21 ,$24.06 ,$97.29 ,$137.83 ,$113.51 ,$24.81 ,$24.81 ,$154.04 ,$123.23 ,$121.61 ,$40.90 ,$137.83 ,$24.06 ,$40.90 ,$40.90 ,$113.51 ,$98.75 ,$24.81 ,$24.06 ,$23.58 ,$48.12 ,$26.30 ,$137.83 ,$54.14 ,$149.18 ,$113.51 ,$88.14 ,$88.14 ,$98.75 ,$88.14 ,$112.05 ,$145.94 ,$110.78 ,$23.81 ,$128.10 ,$26.30 ,$28.87 ,$28.87 ,$23.58 ,$28.87 ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$14.13 ,$55.89 ,$79.18 ,$65.21 ,$8.66 ,$8.66 ,$88.49 ,$70.79 ,$69.86 ,$24.02 ,$79.18 ,$14.13 ,$24.02 ,$24.02 ,$65.21 ,$56.73 ,$8.66 ,$14.13 ,$13.85 ,$28.26 ,$9.18 ,$79.18 ,$31.79 ,$85.70 ,$65.21 ,$59.93 ,$59.93 ,$56.73 ,$59.93 ,$64.37 ,$83.84 ,$63.64 ,$13.98 ,$73.59 ,$9.18 ,$16.96 ,$16.96 ,$13.85 ,$16.96 ,$67.07 ,$57.75 ,$67.07 ,$67.07 ,$74.52 
ST NICHOLAS HOSPITAL - ACUTE,30600226,87420,HC RSV AG QL,306,1 ,$128.80 ,$85.01 ,$13.63 ,$128.80 ,$14.37 ,$48.69 ,$48.69 ,$13.91 ,$77.28 ,$109.48 ,$90.16 ,$14.37 ,$14.37 ,$122.36 ,$97.89 ,$96.60 ,$23.65 ,$109.48 ,$13.91 ,$23.65 ,$23.65 ,$90.16 ,$78.44 ,$14.37 ,$13.91 ,$13.63 ,$27.82 ,$15.23 ,$109.48 ,$31.30 ,$118.50 ,$90.16 ,$59.93 ,$59.93 ,$78.44 ,$59.93 ,$89.00 ,$115.92 ,$88.00 ,$13.77 ,$101.75 ,$15.23 ,$16.69 ,$16.69 ,$13.63 ,$16.69 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30600227,87425,HC EIA QL ROTAVIRUS AG,306,1 ,$77.05 ,$50.85 ,$11.74 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$46.23 ,$65.49 ,$53.94 ,$12.38 ,$12.38 ,$73.20 ,$58.56 ,$57.79 ,$20.37 ,$65.49 ,$11.98 ,$20.37 ,$20.37 ,$53.94 ,$46.92 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$65.49 ,$26.96 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$11.86 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600228,87430,HC RAPID STREP,306,1 ,$103.50 ,$68.31 ,$16.47 ,$103.50 ,$16.86 ,$58.84 ,$58.84 ,$16.81 ,$62.10 ,$87.98 ,$72.45 ,$16.86 ,$16.86 ,$98.33 ,$78.66 ,$77.63 ,$28.58 ,$87.98 ,$16.81 ,$28.58 ,$28.58 ,$72.45 ,$63.03 ,$16.86 ,$16.81 ,$16.47 ,$33.62 ,$17.87 ,$87.98 ,$37.82 ,$95.22 ,$72.45 ,$59.93 ,$59.93 ,$63.03 ,$59.93 ,$71.52 ,$93.15 ,$70.71 ,$16.64 ,$81.77 ,$17.87 ,$20.17 ,$20.17 ,$16.47 ,$20.17 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30600229,87449,HC EIA QL MLT AG INF (RPD GRP B),306,1 ,$147.20 ,$97.15 ,$11.74 ,$147.20 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$88.32 ,$125.12 ,$103.04 ,$12.38 ,$12.38 ,$139.84 ,$111.87 ,$110.40 ,$20.37 ,$125.12 ,$11.98 ,$20.37 ,$20.37 ,$103.04 ,$89.64 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$125.12 ,$26.96 ,$135.42 ,$103.04 ,$59.93 ,$59.93 ,$89.64 ,$59.93 ,$101.72 ,$132.48 ,$100.57 ,$11.86 ,$116.29 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$105.98 ,$91.26 ,$105.98 ,$105.98 ,$117.76 
ST NICHOLAS HOSPITAL - ACUTE,30600230,87449,HC EIA QL MLT AG INF (LEGION),306,1 ,$77.05 ,$50.85 ,$11.74 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$46.23 ,$65.49 ,$53.94 ,$12.38 ,$12.38 ,$73.20 ,$58.56 ,$57.79 ,$20.37 ,$65.49 ,$11.98 ,$20.37 ,$20.37 ,$53.94 ,$46.92 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$65.49 ,$26.96 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$11.86 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600231,87449,HC EIA QL MLT AG INF (S. PNEUMO),306,1 ,$77.05 ,$50.85 ,$11.74 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$46.23 ,$65.49 ,$53.94 ,$12.38 ,$12.38 ,$73.20 ,$58.56 ,$57.79 ,$20.37 ,$65.49 ,$11.98 ,$20.37 ,$20.37 ,$53.94 ,$46.92 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$65.49 ,$26.96 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$11.86 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600232,87449,HC EIA QL MLT AG INF (NOROVIRUS),306,1 ,$77.05 ,$50.85 ,$11.74 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$46.23 ,$65.49 ,$53.94 ,$12.38 ,$12.38 ,$73.20 ,$58.56 ,$57.79 ,$20.37 ,$65.49 ,$11.98 ,$20.37 ,$20.37 ,$53.94 ,$46.92 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$65.49 ,$26.96 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$11.86 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600233,87449,HC EIA QL MLT AG INF (BLASTO),306,1 ,$77.05 ,$50.85 ,$11.74 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$46.23 ,$65.49 ,$53.94 ,$12.38 ,$12.38 ,$73.20 ,$58.56 ,$57.79 ,$20.37 ,$65.49 ,$11.98 ,$20.37 ,$20.37 ,$53.94 ,$46.92 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$65.49 ,$26.96 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$11.86 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600234,87449,HC EIA QL MLT AG INF (RPD FLU),306,1 ,$89.70 ,$59.20 ,$11.74 ,$89.70 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$53.82 ,$76.25 ,$62.79 ,$12.38 ,$12.38 ,$85.22 ,$68.17 ,$67.28 ,$20.37 ,$76.25 ,$11.98 ,$20.37 ,$20.37 ,$62.79 ,$54.63 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$76.25 ,$26.96 ,$82.52 ,$62.79 ,$59.93 ,$59.93 ,$54.63 ,$59.93 ,$61.98 ,$80.73 ,$61.28 ,$11.86 ,$70.86 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600235,87476,HC LYMES DNA DETECT PCR,306,1 ,$407.10 ,$268.69 ,$34.39 ,$407.10 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$244.26 ,$346.04 ,$284.97 ,$36.26 ,$36.26 ,$386.75 ,$309.40 ,$305.33 ,$59.65 ,$346.04 ,$35.09 ,$59.65 ,$59.65 ,$284.97 ,$247.92 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$346.04 ,$78.95 ,$374.53 ,$284.97 ,$175.37 ,$175.37 ,$247.92 ,$175.37 ,$281.31 ,$366.39 ,$278.13 ,$34.73 ,$321.61 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$293.11 ,$252.40 ,$293.11 ,$293.11 ,$325.68 
ST NICHOLAS HOSPITAL - ACUTE,30600236,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600237,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$309.35 ,$204.17 ,$36.52 ,$309.35 ,$38.51 ,$130.45 ,$130.45 ,$37.27 ,$185.61 ,$262.95 ,$216.55 ,$38.51 ,$38.51 ,$293.88 ,$235.11 ,$232.01 ,$63.36 ,$262.95 ,$37.27 ,$63.36 ,$63.36 ,$216.55 ,$188.39 ,$38.51 ,$37.27 ,$36.52 ,$74.54 ,$40.82 ,$262.95 ,$83.86 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$36.89 ,$244.39 ,$40.82 ,$44.72 ,$44.72 ,$36.52 ,$44.72 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600238,87497,HC CMV QN,306,1 ,$296.70 ,$195.82 ,$41.98 ,$296.70 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$178.02 ,$252.20 ,$207.69 ,$44.27 ,$44.27 ,$281.87 ,$225.49 ,$222.53 ,$72.83 ,$252.20 ,$42.84 ,$72.83 ,$72.83 ,$207.69 ,$180.69 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$252.20 ,$96.39 ,$272.96 ,$207.69 ,$214.09 ,$214.09 ,$180.69 ,$214.09 ,$205.02 ,$267.03 ,$202.71 ,$42.40 ,$234.39 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$213.62 ,$183.95 ,$213.62 ,$213.62 ,$237.36 
ST NICHOLAS HOSPITAL - ACUTE,30600239,87498,HC ENTEROVIRUS AMP PROBE,306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600240,87517,HC HEPATITIS B QN,306,1 ,$225.40 ,$148.76 ,$41.98 ,$225.40 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$135.24 ,$191.59 ,$157.78 ,$44.27 ,$44.27 ,$214.13 ,$171.30 ,$169.05 ,$72.83 ,$191.59 ,$42.84 ,$72.83 ,$72.83 ,$157.78 ,$137.27 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$191.59 ,$96.39 ,$207.37 ,$157.78 ,$214.09 ,$214.09 ,$137.27 ,$214.09 ,$155.75 ,$202.86 ,$153.99 ,$42.40 ,$178.07 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$162.29 ,$139.75 ,$162.29 ,$162.29 ,$180.32 
ST NICHOLAS HOSPITAL - ACUTE,30600241,87517,HC HEPATITIS B QN (PCR),306,1 ,$425.50 ,$280.83 ,$41.98 ,$425.50 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$255.30 ,$361.68 ,$297.85 ,$44.27 ,$44.27 ,$404.23 ,$323.38 ,$319.13 ,$72.83 ,$361.68 ,$42.84 ,$72.83 ,$72.83 ,$297.85 ,$259.13 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$361.68 ,$96.39 ,$391.46 ,$297.85 ,$214.09 ,$214.09 ,$259.13 ,$214.09 ,$294.02 ,$382.95 ,$290.70 ,$42.40 ,$336.15 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$306.36 ,$263.81 ,$306.36 ,$306.36 ,$340.40 
ST NICHOLAS HOSPITAL - ACUTE,30600242,87522,HC HEPATITIS C QN,306,1 ,$373.75 ,$246.68 ,$41.98 ,$373.75 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$224.25 ,$317.69 ,$261.63 ,$44.27 ,$44.27 ,$355.06 ,$284.05 ,$280.31 ,$72.83 ,$317.69 ,$42.84 ,$72.83 ,$72.83 ,$261.63 ,$227.61 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$317.69 ,$96.39 ,$343.85 ,$261.63 ,$214.09 ,$214.09 ,$227.61 ,$214.09 ,$258.26 ,$336.38 ,$255.35 ,$42.40 ,$295.26 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$269.10 ,$231.73 ,$269.10 ,$269.10 ,$299.00 
ST NICHOLAS HOSPITAL - ACUTE,30600243,87522,HC HEPATITIS C QN (BDNA),306,1 ,$282.90 ,$186.71 ,$41.98 ,$282.90 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$169.74 ,$240.47 ,$198.03 ,$44.27 ,$44.27 ,$268.76 ,$215.00 ,$212.18 ,$72.83 ,$240.47 ,$42.84 ,$72.83 ,$72.83 ,$198.03 ,$172.29 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$240.47 ,$96.39 ,$260.27 ,$198.03 ,$214.09 ,$214.09 ,$172.29 ,$214.09 ,$195.48 ,$254.61 ,$193.28 ,$42.40 ,$223.49 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$203.69 ,$175.40 ,$203.69 ,$203.69 ,$226.32 
ST NICHOLAS HOSPITAL - ACUTE,30600244,87529,HC HERPES SIMPLEX AMP,306,1 ,$205.85 ,$135.86 ,$34.39 ,$205.85 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$123.51 ,$174.97 ,$144.10 ,$36.26 ,$36.26 ,$195.56 ,$156.45 ,$154.39 ,$59.65 ,$174.97 ,$35.09 ,$59.65 ,$59.65 ,$144.10 ,$125.36 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$174.97 ,$78.95 ,$189.38 ,$144.10 ,$175.37 ,$175.37 ,$125.36 ,$175.37 ,$142.24 ,$185.27 ,$140.64 ,$34.73 ,$162.62 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,30600245,87535,HC PROBE HIV-1 AMP,306,1 ,$373.75 ,$246.68 ,$34.39 ,$373.75 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$224.25 ,$317.69 ,$261.63 ,$36.26 ,$36.26 ,$355.06 ,$284.05 ,$280.31 ,$59.65 ,$317.69 ,$35.09 ,$59.65 ,$59.65 ,$261.63 ,$227.61 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$317.69 ,$78.95 ,$343.85 ,$261.63 ,$175.37 ,$175.37 ,$227.61 ,$175.37 ,$258.26 ,$336.38 ,$255.35 ,$34.73 ,$295.26 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$269.10 ,$231.73 ,$269.10 ,$269.10 ,$299.00 
ST NICHOLAS HOSPITAL - ACUTE,30600246,87536,HC HIV-1 QN,306,1 ,$373.75 ,$246.68 ,$83.40 ,$373.75 ,$87.93 ,$297.85 ,$297.85 ,$85.10 ,$224.25 ,$317.69 ,$261.63 ,$87.93 ,$87.93 ,$355.06 ,$284.05 ,$280.31 ,$144.67 ,$317.69 ,$85.10 ,$144.67 ,$144.67 ,$261.63 ,$227.61 ,$87.93 ,$85.10 ,$83.40 ,$170.20 ,$93.21 ,$317.69 ,$191.48 ,$343.85 ,$261.63 ,$373.75 ,$373.75 ,$227.61 ,$373.75 ,$258.26 ,$336.38 ,$255.35 ,$84.23 ,$295.26 ,$93.21 ,$102.12 ,$102.12 ,$83.40 ,$102.12 ,$269.10 ,$231.73 ,$269.10 ,$269.10 ,$299.00 
ST NICHOLAS HOSPITAL - ACUTE,30600247,87536,HC HIV-1 QN (2ND GEN),306,1 ,$373.75 ,$246.68 ,$83.40 ,$373.75 ,$87.93 ,$297.85 ,$297.85 ,$85.10 ,$224.25 ,$317.69 ,$261.63 ,$87.93 ,$87.93 ,$355.06 ,$284.05 ,$280.31 ,$144.67 ,$317.69 ,$85.10 ,$144.67 ,$144.67 ,$261.63 ,$227.61 ,$87.93 ,$85.10 ,$83.40 ,$170.20 ,$93.21 ,$317.69 ,$191.48 ,$343.85 ,$261.63 ,$373.75 ,$373.75 ,$227.61 ,$373.75 ,$258.26 ,$336.38 ,$255.35 ,$84.23 ,$295.26 ,$93.21 ,$102.12 ,$102.12 ,$83.40 ,$102.12 ,$269.10 ,$231.73 ,$269.10 ,$269.10 ,$299.00 
ST NICHOLAS HOSPITAL - ACUTE,30600248,87556,HC MTB COMPLEX PCR,306,1 ,$257.60 ,$170.02 ,$40.85 ,$257.60 ,$43.07 ,$145.88 ,$145.88 ,$41.68 ,$154.56 ,$218.96 ,$180.32 ,$43.07 ,$43.07 ,$244.72 ,$195.78 ,$193.20 ,$70.86 ,$218.96 ,$41.68 ,$70.86 ,$70.86 ,$180.32 ,$156.88 ,$43.07 ,$41.68 ,$40.85 ,$83.36 ,$45.65 ,$218.96 ,$93.78 ,$236.99 ,$180.32 ,$175.37 ,$175.37 ,$156.88 ,$175.37 ,$178.00 ,$231.84 ,$175.99 ,$41.26 ,$203.50 ,$45.65 ,$50.02 ,$50.02 ,$40.85 ,$50.02 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30600249,87591,HC NEISSERIA AMP,306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600250,87624,HC HPV AMP,306,1 ,$162.15 ,$107.02 ,$34.39 ,$162.15 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$97.29 ,$137.83 ,$113.51 ,$36.26 ,$36.26 ,$154.04 ,$123.23 ,$121.61 ,$59.65 ,$137.83 ,$35.09 ,$59.65 ,$59.65 ,$113.51 ,$98.75 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$137.83 ,$78.95 ,$149.18 ,$113.51 ,$162.15 ,$162.15 ,$98.75 ,$162.15 ,$112.05 ,$145.94 ,$110.78 ,$34.73 ,$128.10 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,30600252,87624,HC HPV AMP,306,1 ,$151.80 ,$100.19 ,$34.39 ,$151.80 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$91.08 ,$129.03 ,$106.26 ,$36.26 ,$36.26 ,$144.21 ,$115.37 ,$113.85 ,$59.65 ,$129.03 ,$35.09 ,$59.65 ,$59.65 ,$106.26 ,$92.45 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$129.03 ,$78.95 ,$139.66 ,$106.26 ,$151.80 ,$151.80 ,$92.45 ,$151.80 ,$104.89 ,$136.62 ,$103.71 ,$34.73 ,$119.92 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$109.30 ,$94.12 ,$109.30 ,$109.30 ,$121.44 
ST NICHOLAS HOSPITAL - ACUTE,30600253,87624,HC HPV AMP (DNA),306,1 ,$162.15 ,$107.02 ,$34.39 ,$162.15 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$97.29 ,$137.83 ,$113.51 ,$36.26 ,$36.26 ,$154.04 ,$123.23 ,$121.61 ,$59.65 ,$137.83 ,$35.09 ,$59.65 ,$59.65 ,$113.51 ,$98.75 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$137.83 ,$78.95 ,$149.18 ,$113.51 ,$162.15 ,$162.15 ,$98.75 ,$162.15 ,$112.05 ,$145.94 ,$110.78 ,$34.73 ,$128.10 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,30600254,87640,HC STAPH AURE AMP PROBE,306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600255,87641,HC MRSA AMP,306,1 ,$141.45 ,$93.36 ,$34.39 ,$141.45 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$84.87 ,$120.23 ,$99.02 ,$36.26 ,$36.26 ,$134.38 ,$107.50 ,$106.09 ,$59.65 ,$120.23 ,$35.09 ,$59.65 ,$59.65 ,$99.02 ,$86.14 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$120.23 ,$78.95 ,$130.13 ,$99.02 ,$141.45 ,$141.45 ,$86.14 ,$141.45 ,$97.74 ,$127.31 ,$96.64 ,$34.73 ,$111.75 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,30600256,87798,HC INFECT AMP (BORDETELLA),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600257,87653,HC INFECT AMP (GRP B STREP),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600258,87798,HC INFECT AMP (PNEUMO),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600259,87798,HC INFECT AMP (WEST NILE),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600260,87798,HC INFECT AMP (PARVOVIRUS),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600261,87798,HC INFECT AMP (E CHAFF),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600262,87798,HC INFECT AMP (A PHAGO),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600263,87798,HC INFECT AMP (RSV),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600264,87798,HC INFECT AMP (INFLU),306,1 ,$71.30 ,$47.06 ,$34.39 ,$78.95 ,$36.26 ,$71.30 ,$71.30 ,$35.09 ,$42.78 ,$60.61 ,$49.91 ,$36.26 ,$36.26 ,$67.74 ,$54.19 ,$53.48 ,$59.65 ,$60.61 ,$35.09 ,$59.65 ,$59.65 ,$49.91 ,$43.42 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$60.61 ,$78.95 ,$65.60 ,$49.91 ,$71.30 ,$71.30 ,$43.42 ,$71.30 ,$49.27 ,$64.17 ,$48.71 ,$34.73 ,$56.33 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$51.34 ,$44.21 ,$51.34 ,$51.34 ,$57.04 
ST NICHOLAS HOSPITAL - ACUTE,30600265,87798,HC INFECT AMP (ENTEROVIRUS),306,1 ,$279.45 ,$184.44 ,$34.39 ,$279.45 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$167.67 ,$237.53 ,$195.62 ,$36.26 ,$36.26 ,$265.48 ,$212.38 ,$209.59 ,$59.65 ,$237.53 ,$35.09 ,$59.65 ,$59.65 ,$195.62 ,$170.19 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$237.53 ,$78.95 ,$257.09 ,$195.62 ,$175.37 ,$175.37 ,$170.19 ,$175.37 ,$193.10 ,$251.51 ,$190.92 ,$34.73 ,$220.77 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$201.20 ,$173.26 ,$201.20 ,$201.20 ,$223.56 
ST NICHOLAS HOSPITAL - ACUTE,30600267,87799,HC INFECT AGENT QN,306,1 ,$373.75 ,$246.68 ,$41.98 ,$373.75 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$224.25 ,$317.69 ,$261.63 ,$44.27 ,$44.27 ,$355.06 ,$284.05 ,$280.31 ,$72.83 ,$317.69 ,$42.84 ,$72.83 ,$72.83 ,$261.63 ,$227.61 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$317.69 ,$96.39 ,$343.85 ,$261.63 ,$214.09 ,$214.09 ,$227.61 ,$214.09 ,$258.26 ,$336.38 ,$255.35 ,$42.40 ,$295.26 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$269.10 ,$231.73 ,$269.10 ,$269.10 ,$299.00 
ST NICHOLAS HOSPITAL - ACUTE,30600268,87802,HC OPTICAL STREP B,306,1 ,$151.80 ,$100.19 ,$12.48 ,$151.80 ,$13.15 ,$44.56 ,$44.56 ,$12.73 ,$91.08 ,$129.03 ,$106.26 ,$13.15 ,$13.15 ,$144.21 ,$115.37 ,$113.85 ,$21.64 ,$129.03 ,$12.73 ,$21.64 ,$21.64 ,$106.26 ,$92.45 ,$13.15 ,$12.73 ,$12.48 ,$25.46 ,$13.94 ,$129.03 ,$28.64 ,$139.66 ,$106.26 ,$59.93 ,$59.93 ,$92.45 ,$59.93 ,$104.89 ,$136.62 ,$103.71 ,$12.60 ,$119.92 ,$13.94 ,$15.28 ,$15.28 ,$12.48 ,$15.28 ,$109.30 ,$94.12 ,$109.30 ,$109.30 ,$121.44 
ST NICHOLAS HOSPITAL - ACUTE,30600269,87807,HC QL RSV,306,1 ,$128.80 ,$85.01 ,$12.84 ,$128.80 ,$13.54 ,$45.85 ,$45.85 ,$13.10 ,$77.28 ,$109.48 ,$90.16 ,$13.54 ,$13.54 ,$122.36 ,$97.89 ,$96.60 ,$22.27 ,$109.48 ,$13.10 ,$22.27 ,$22.27 ,$90.16 ,$78.44 ,$13.54 ,$13.10 ,$12.84 ,$26.20 ,$14.35 ,$109.48 ,$29.48 ,$118.50 ,$90.16 ,$59.93 ,$59.93 ,$78.44 ,$59.93 ,$89.00 ,$115.92 ,$88.00 ,$12.97 ,$101.75 ,$14.35 ,$15.72 ,$15.72 ,$12.84 ,$15.72 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30600270,87880,HC OPTICAL STREP,306,1 ,$103.50 ,$68.31 ,$16.20 ,$103.50 ,$16.86 ,$57.86 ,$57.86 ,$16.53 ,$62.10 ,$87.98 ,$72.45 ,$16.86 ,$16.86 ,$98.33 ,$78.66 ,$77.63 ,$28.10 ,$87.98 ,$16.53 ,$28.10 ,$28.10 ,$72.45 ,$63.03 ,$16.86 ,$16.53 ,$16.20 ,$33.06 ,$17.87 ,$87.98 ,$37.19 ,$95.22 ,$72.45 ,$59.93 ,$59.93 ,$63.03 ,$59.93 ,$71.52 ,$93.15 ,$70.71 ,$16.37 ,$81.77 ,$17.87 ,$19.84 ,$19.84 ,$16.20 ,$19.84 ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,30600271,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$77.05 ,$50.85 ,$15.75 ,$77.05 ,$16.61 ,$56.25 ,$56.25 ,$16.07 ,$46.23 ,$65.49 ,$53.94 ,$16.61 ,$16.61 ,$73.20 ,$58.56 ,$57.79 ,$27.32 ,$65.49 ,$16.07 ,$27.32 ,$27.32 ,$53.94 ,$46.92 ,$16.61 ,$16.07 ,$15.75 ,$32.14 ,$17.61 ,$65.49 ,$36.16 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$15.91 ,$60.87 ,$17.61 ,$19.28 ,$19.28 ,$15.75 ,$19.28 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600272,87902,HC GENTOYPE HEP C,306,1 ,"$1,803.20 ","$1,190.11 ",$252.30 ,"$1,803.20 ",$266.02 ,$901.08 ,$901.08 ,$257.45 ,"$1,081.92 ","$1,532.72 ","$1,262.24 ",$266.02 ,$266.02 ,"$1,713.04 ","$1,370.43 ","$1,352.40 ",$437.67 ,"$1,532.72 ",$257.45 ,$437.67 ,$437.67 ,"$1,262.24 ","$1,098.15 ",$266.02 ,$257.45 ,$252.30 ,$514.90 ,$281.98 ,"$1,532.72 ",$579.26 ,"$1,658.94 ","$1,262.24 ","$1,286.69 ","$1,286.69 ","$1,098.15 ","$1,286.69 ","$1,246.01 ","$1,622.88 ","$1,231.95 ",$254.82 ,"$1,424.53 ",$281.98 ,$308.94 ,$308.94 ,$252.30 ,$308.94 ,"$1,298.30 ","$1,117.98 ","$1,298.30 ","$1,298.30 ","$1,442.56 "
ST NICHOLAS HOSPITAL - ACUTE,30600273,87801,HC INFECT MLT ORG AMP STAPH,306,1 ,$618.70 ,$408.34 ,$50.62 ,$618.70 ,$50.62 ,$245.70 ,$245.70 ,$70.20 ,$371.22 ,$525.90 ,$433.09 ,$50.62 ,$50.62 ,$587.77 ,$470.21 ,$464.03 ,$119.34 ,$525.90 ,$70.20 ,$119.34 ,$119.34 ,$433.09 ,$376.79 ,$50.62 ,$70.20 ,$68.80 ,$140.40 ,$53.66 ,$525.90 ,$157.95 ,$569.20 ,$433.09 ,$350.82 ,$350.82 ,$376.79 ,$350.82 ,$427.52 ,$556.83 ,$422.70 ,$69.48 ,$488.77 ,$53.66 ,$84.24 ,$84.24 ,$68.80 ,$84.24 ,$445.46 ,$383.59 ,$445.46 ,$445.46 ,$494.96 
ST NICHOLAS HOSPITAL - ACUTE,30600275,87153,HC MYCOBACTERIA ID BY DNA SEQUENCING,306,1 ,$772.80 ,$510.05 ,$113.05 ,$772.80 ,$119.20 ,$403.76 ,$403.76 ,$115.36 ,$463.68 ,$656.88 ,$540.96 ,$119.20 ,$119.20 ,$734.16 ,$587.33 ,$579.60 ,$196.11 ,$656.88 ,$115.36 ,$196.11 ,$196.11 ,$540.96 ,$470.64 ,$119.20 ,$115.36 ,$113.05 ,$230.72 ,$126.35 ,$656.88 ,$259.56 ,$710.98 ,$540.96 ,$576.56 ,$576.56 ,$470.64 ,$576.56 ,$534.00 ,$695.52 ,$527.98 ,$114.18 ,$610.51 ,$126.35 ,$138.43 ,$138.43 ,$113.05 ,$138.43 ,$556.42 ,$479.14 ,$556.42 ,$556.42 ,$618.24 
ST NICHOLAS HOSPITAL - ACUTE,30600280,87491,HC C TACH RNA TMA,306,1 ,$282.90 ,$186.71 ,$34.39 ,$282.90 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$169.74 ,$240.47 ,$198.03 ,$36.26 ,$36.26 ,$268.76 ,$215.00 ,$212.18 ,$59.65 ,$240.47 ,$35.09 ,$59.65 ,$59.65 ,$198.03 ,$172.29 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$240.47 ,$78.95 ,$260.27 ,$198.03 ,$175.37 ,$175.37 ,$172.29 ,$175.37 ,$195.48 ,$254.61 ,$193.28 ,$34.73 ,$223.49 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$203.69 ,$175.40 ,$203.69 ,$203.69 ,$226.32 
ST NICHOLAS HOSPITAL - ACUTE,30600281,87591,HC N GONOR RNA TMA,306,1 ,$282.90 ,$186.71 ,$34.39 ,$282.90 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$169.74 ,$240.47 ,$198.03 ,$36.26 ,$36.26 ,$268.76 ,$215.00 ,$212.18 ,$59.65 ,$240.47 ,$35.09 ,$59.65 ,$59.65 ,$198.03 ,$172.29 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$240.47 ,$78.95 ,$260.27 ,$198.03 ,$175.37 ,$175.37 ,$172.29 ,$175.37 ,$195.48 ,$254.61 ,$193.28 ,$34.73 ,$223.49 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$203.69 ,$175.40 ,$203.69 ,$203.69 ,$226.32 
ST NICHOLAS HOSPITAL - ACUTE,30600282,87899,HC INFECT AGENT DETECT OPT (SHIGA),306,1 ,$77.05 ,$50.85 ,$15.75 ,$77.05 ,$16.61 ,$56.25 ,$56.25 ,$16.07 ,$46.23 ,$65.49 ,$53.94 ,$16.61 ,$16.61 ,$73.20 ,$58.56 ,$57.79 ,$27.32 ,$65.49 ,$16.07 ,$27.32 ,$27.32 ,$53.94 ,$46.92 ,$16.61 ,$16.07 ,$15.75 ,$32.14 ,$17.61 ,$65.49 ,$36.16 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$15.91 ,$60.87 ,$17.61 ,$19.28 ,$19.28 ,$15.75 ,$19.28 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600283,87804,HC QL INFLUENZA A/B,306,1 ,$116.15 ,$76.66 ,$16.22 ,$116.15 ,$16.86 ,$57.93 ,$57.93 ,$16.55 ,$69.69 ,$98.73 ,$81.31 ,$16.86 ,$16.86 ,$110.34 ,$88.27 ,$87.11 ,$28.14 ,$98.73 ,$16.55 ,$28.14 ,$28.14 ,$81.31 ,$70.74 ,$16.86 ,$16.55 ,$16.22 ,$33.10 ,$17.87 ,$98.73 ,$37.24 ,$106.86 ,$81.31 ,$59.93 ,$59.93 ,$70.74 ,$59.93 ,$80.26 ,$104.54 ,$79.35 ,$16.39 ,$91.76 ,$17.87 ,$19.86 ,$19.86 ,$16.22 ,$19.86 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,30600285,87624,HC HPV HR GENOTYPES,306,1 ,$180.55 ,$119.16 ,$34.39 ,$180.55 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$108.33 ,$153.47 ,$126.39 ,$36.26 ,$36.26 ,$171.52 ,$137.22 ,$135.41 ,$59.65 ,$153.47 ,$35.09 ,$59.65 ,$59.65 ,$126.39 ,$109.96 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$153.47 ,$78.95 ,$166.11 ,$126.39 ,$174.97 ,$174.97 ,$109.96 ,$174.97 ,$124.76 ,$162.50 ,$123.35 ,$34.73 ,$142.63 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30600286,87625,HC HPV GENOTYPE 16 18/45,306,1 ,$180.55 ,$119.16 ,$38.30 ,$180.55 ,$38.30 ,$141.93 ,$141.93 ,$40.55 ,$108.33 ,$153.47 ,$126.39 ,$38.30 ,$38.30 ,$171.52 ,$137.22 ,$135.41 ,$68.94 ,$153.47 ,$40.55 ,$68.94 ,$68.94 ,$126.39 ,$109.96 ,$38.30 ,$40.55 ,$39.74 ,$81.10 ,$40.60 ,$153.47 ,$91.24 ,$166.11 ,$126.39 ,$174.97 ,$174.97 ,$109.96 ,$174.97 ,$124.76 ,$162.50 ,$123.35 ,$40.14 ,$142.63 ,$40.60 ,$48.66 ,$48.66 ,$39.74 ,$48.66 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,30600288,87633,HC RESP VIRUS MAP-TECH 17 TARGETS,306,1 ,"$1,030.40 ",$680.06 ,$408.44 ,"$1,030.40 ",$430.66 ,"$1,030.40 ","$1,030.40 ",$416.78 ,$618.24 ,$875.84 ,$721.28 ,$430.66 ,$430.66 ,$978.88 ,$783.10 ,$772.80 ,$708.53 ,$875.84 ,$416.78 ,$708.53 ,$708.53 ,$721.28 ,$627.51 ,$430.66 ,$416.78 ,$408.44 ,$833.56 ,$456.50 ,$875.84 ,$937.76 ,$947.97 ,$721.28 ,"$1,030.40 ","$1,030.40 ",$627.51 ,"$1,030.40 ",$712.01 ,$927.36 ,$703.97 ,$412.53 ,$814.02 ,$456.50 ,$500.14 ,$500.14 ,$408.44 ,$500.14 ,$741.89 ,$638.85 ,$741.89 ,$741.89 ,$824.32 
ST NICHOLAS HOSPITAL - ACUTE,30600289,87798,HC B. PERTUSSIS AP-TECH,306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600290,87486,HC C PNEUMONIAE AP-TECH,306,1 ,$257.60 ,$170.02 ,$34.39 ,$257.60 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$154.56 ,$218.96 ,$180.32 ,$36.26 ,$36.26 ,$244.72 ,$195.78 ,$193.20 ,$59.65 ,$218.96 ,$35.09 ,$59.65 ,$59.65 ,$180.32 ,$156.88 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$218.96 ,$78.95 ,$236.99 ,$180.32 ,$175.37 ,$175.37 ,$156.88 ,$175.37 ,$178.00 ,$231.84 ,$175.99 ,$34.73 ,$203.50 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30600291,87581,HC M PNEUMONIAS AP-TECH,306,1 ,$257.60 ,$170.02 ,$34.39 ,$257.60 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$154.56 ,$218.96 ,$180.32 ,$36.26 ,$36.26 ,$244.72 ,$195.78 ,$193.20 ,$59.65 ,$218.96 ,$35.09 ,$59.65 ,$59.65 ,$180.32 ,$156.88 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$218.96 ,$78.95 ,$236.99 ,$180.32 ,$175.37 ,$175.37 ,$156.88 ,$175.37 ,$178.00 ,$231.84 ,$175.99 ,$34.73 ,$203.50 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,30600292,87798,HC INFECT AMP (EA ORG) MENI,306,1 ,$236.90 ,$156.35 ,$34.39 ,$236.90 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$142.14 ,$201.37 ,$165.83 ,$36.26 ,$36.26 ,$225.06 ,$180.04 ,$177.68 ,$59.65 ,$201.37 ,$35.09 ,$59.65 ,$59.65 ,$165.83 ,$144.27 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$201.37 ,$78.95 ,$217.95 ,$165.83 ,$175.37 ,$175.37 ,$144.27 ,$175.37 ,$163.70 ,$213.21 ,$161.85 ,$34.73 ,$187.15 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$170.57 ,$146.88 ,$170.57 ,$170.57 ,$189.52 
ST NICHOLAS HOSPITAL - ACUTE,30600293,87653,HC INFECT AMP (STREP B) MENI,306,1 ,$236.90 ,$156.35 ,$34.39 ,$236.90 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$142.14 ,$201.37 ,$165.83 ,$36.26 ,$36.26 ,$225.06 ,$180.04 ,$177.68 ,$59.65 ,$201.37 ,$35.09 ,$59.65 ,$59.65 ,$165.83 ,$144.27 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$201.37 ,$78.95 ,$217.95 ,$165.83 ,$175.37 ,$175.37 ,$144.27 ,$175.37 ,$163.70 ,$213.21 ,$161.85 ,$34.73 ,$187.15 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$170.57 ,$146.88 ,$170.57 ,$170.57 ,$189.52 
ST NICHOLAS HOSPITAL - ACUTE,30600294,87496,HC INFECT AMP (CMV) MENI,306,1 ,$182.85 ,$120.68 ,$34.39 ,$182.85 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$109.71 ,$155.42 ,$128.00 ,$36.26 ,$36.26 ,$173.71 ,$138.97 ,$137.14 ,$59.65 ,$155.42 ,$35.09 ,$59.65 ,$59.65 ,$128.00 ,$111.36 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$155.42 ,$78.95 ,$168.22 ,$128.00 ,$175.37 ,$175.37 ,$111.36 ,$175.37 ,$126.35 ,$164.57 ,$124.92 ,$34.73 ,$144.45 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$131.65 ,$113.37 ,$131.65 ,$131.65 ,$146.28 
ST NICHOLAS HOSPITAL - ACUTE,30600295,87532,HC INFECT AMP (HHSV6) MENI,306,1 ,$182.85 ,$120.68 ,$34.39 ,$182.85 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$109.71 ,$155.42 ,$128.00 ,$36.26 ,$36.26 ,$173.71 ,$138.97 ,$137.14 ,$59.65 ,$155.42 ,$35.09 ,$59.65 ,$59.65 ,$128.00 ,$111.36 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$155.42 ,$78.95 ,$168.22 ,$128.00 ,$175.37 ,$175.37 ,$111.36 ,$175.37 ,$126.35 ,$164.57 ,$124.92 ,$34.73 ,$144.45 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$131.65 ,$113.37 ,$131.65 ,$131.65 ,$146.28 
ST NICHOLAS HOSPITAL - ACUTE,30600296,87529,HC INFECT AMP (HSV 1 OR 2) MENI,306,1 ,$182.85 ,$120.68 ,$34.39 ,$182.85 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$109.71 ,$155.42 ,$128.00 ,$36.26 ,$36.26 ,$173.71 ,$138.97 ,$137.14 ,$59.65 ,$155.42 ,$35.09 ,$59.65 ,$59.65 ,$128.00 ,$111.36 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$155.42 ,$78.95 ,$168.22 ,$128.00 ,$175.37 ,$175.37 ,$111.36 ,$175.37 ,$126.35 ,$164.57 ,$124.92 ,$34.73 ,$144.45 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$131.65 ,$113.37 ,$131.65 ,$131.65 ,$146.28 
ST NICHOLAS HOSPITAL - ACUTE,30600297,87798,HC BABESIA SPECIES PCR B,306,1 ,$89.70 ,$59.20 ,$34.39 ,$89.70 ,$36.26 ,$89.70 ,$89.70 ,$35.09 ,$53.82 ,$76.25 ,$62.79 ,$36.26 ,$36.26 ,$85.22 ,$68.17 ,$67.28 ,$59.65 ,$76.25 ,$35.09 ,$59.65 ,$59.65 ,$62.79 ,$54.63 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$76.25 ,$78.95 ,$82.52 ,$62.79 ,$89.70 ,$89.70 ,$54.63 ,$89.70 ,$61.98 ,$80.73 ,$61.28 ,$34.73 ,$70.86 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600298,87798,HC DETECT AGENT NOS DNA AMP,306,1 ,$89.70 ,$59.20 ,$34.39 ,$89.70 ,$36.26 ,$89.70 ,$89.70 ,$35.09 ,$53.82 ,$76.25 ,$62.79 ,$36.26 ,$36.26 ,$85.22 ,$68.17 ,$67.28 ,$59.65 ,$76.25 ,$35.09 ,$59.65 ,$59.65 ,$62.79 ,$54.63 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$76.25 ,$78.95 ,$82.52 ,$62.79 ,$89.70 ,$89.70 ,$54.63 ,$89.70 ,$61.98 ,$80.73 ,$61.28 ,$34.73 ,$70.86 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,30600306,87207,HC SPECIAL STAIN INCL BODIES/PARASITES,306,1 ,$77.05 ,$50.85 ,$5.87 ,$77.05 ,$6.19 ,$20.97 ,$20.97 ,$5.99 ,$46.23 ,$65.49 ,$53.94 ,$6.19 ,$6.19 ,$73.20 ,$58.56 ,$57.79 ,$10.18 ,$65.49 ,$5.99 ,$10.18 ,$10.18 ,$53.94 ,$46.92 ,$6.19 ,$5.99 ,$5.87 ,$11.98 ,$6.56 ,$65.49 ,$13.48 ,$70.89 ,$53.94 ,$29.97 ,$29.97 ,$46.92 ,$29.97 ,$53.24 ,$69.35 ,$52.64 ,$5.93 ,$60.87 ,$6.56 ,$7.19 ,$7.19 ,$5.87 ,$7.19 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600316,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB,306,1 ,$128.80 ,$85.01 ,$23.60 ,$128.80 ,$24.88 ,$84.28 ,$84.28 ,$24.08 ,$77.28 ,$109.48 ,$90.16 ,$24.88 ,$24.88 ,$122.36 ,$97.89 ,$96.60 ,$40.94 ,$109.48 ,$24.08 ,$40.94 ,$40.94 ,$90.16 ,$78.44 ,$24.88 ,$24.08 ,$23.60 ,$48.16 ,$26.37 ,$109.48 ,$54.18 ,$118.50 ,$90.16 ,$120.38 ,$120.38 ,$78.44 ,$120.38 ,$89.00 ,$115.92 ,$88.00 ,$23.83 ,$101.75 ,$26.37 ,$28.90 ,$28.90 ,$23.60 ,$28.90 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,30600318,87449,HC EIA QL MLT AG INF,306,1 ,$77.05 ,$50.85 ,$11.74 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$46.23 ,$65.49 ,$53.94 ,$12.38 ,$12.38 ,$73.20 ,$58.56 ,$57.79 ,$20.37 ,$65.49 ,$11.98 ,$20.37 ,$20.37 ,$53.94 ,$46.92 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$65.49 ,$26.96 ,$70.89 ,$53.94 ,$59.93 ,$59.93 ,$46.92 ,$59.93 ,$53.24 ,$69.35 ,$52.64 ,$11.86 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600332,87651,HC INFECT AMP (GRP A STREP),306,1 ,$285.20 ,$188.23 ,$34.39 ,$285.20 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$171.12 ,$242.42 ,$199.64 ,$36.26 ,$36.26 ,$270.94 ,$216.75 ,$213.90 ,$59.65 ,$242.42 ,$35.09 ,$59.65 ,$59.65 ,$199.64 ,$173.69 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$242.42 ,$78.95 ,$262.38 ,$199.64 ,$175.37 ,$175.37 ,$173.69 ,$175.37 ,$197.07 ,$256.68 ,$194.85 ,$34.73 ,$225.31 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$205.34 ,$176.82 ,$205.34 ,$205.34 ,$228.16 
ST NICHOLAS HOSPITAL - ACUTE,30600335,87799,HC INFECT AGENT QN BK VIRUS DNA,306,1 ,$373.75 ,$246.68 ,$41.98 ,$373.75 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$224.25 ,$317.69 ,$261.63 ,$44.27 ,$44.27 ,$355.06 ,$284.05 ,$280.31 ,$72.83 ,$317.69 ,$42.84 ,$72.83 ,$72.83 ,$261.63 ,$227.61 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$317.69 ,$96.39 ,$343.85 ,$261.63 ,$214.09 ,$214.09 ,$227.61 ,$214.09 ,$258.26 ,$336.38 ,$255.35 ,$42.40 ,$295.26 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$269.10 ,$231.73 ,$269.10 ,$269.10 ,$299.00 
ST NICHOLAS HOSPITAL - ACUTE,30600336,87507,HC IF AG DNA/RNA PROBE TQ 12-25 TARGETS,306,1 ,"$1,083.30 ",$714.98 ,$408.44 ,"$1,083.30 ",$430.66 ,"$1,083.30 ","$1,083.30 ",$416.78 ,$649.98 ,$920.81 ,$758.31 ,$430.66 ,$430.66 ,"$1,029.14 ",$823.31 ,$812.48 ,$708.53 ,$920.81 ,$416.78 ,$708.53 ,$708.53 ,$758.31 ,$659.73 ,$430.66 ,$416.78 ,$408.44 ,$833.56 ,$456.50 ,$920.81 ,$937.76 ,$996.64 ,$758.31 ,"$1,083.30 ","$1,083.30 ",$659.73 ,"$1,083.30 ",$748.56 ,$974.97 ,$740.11 ,$412.53 ,$855.81 ,$456.50 ,$500.14 ,$500.14 ,$408.44 ,$500.14 ,$779.98 ,$671.65 ,$779.98 ,$779.98 ,$866.64 
ST NICHOLAS HOSPITAL - ACUTE,30600339,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,"$1,030.40 ",$680.06 ,$408.44 ,"$1,030.40 ",$430.66 ,"$1,030.40 ","$1,030.40 ",$416.78 ,$618.24 ,$875.84 ,$721.28 ,$430.66 ,$430.66 ,$978.88 ,$783.10 ,$772.80 ,$708.53 ,$875.84 ,$416.78 ,$708.53 ,$708.53 ,$721.28 ,$627.51 ,$430.66 ,$416.78 ,$408.44 ,$833.56 ,$456.50 ,$875.84 ,$937.76 ,$947.97 ,$721.28 ,"$1,030.40 ","$1,030.40 ",$627.51 ,"$1,030.40 ",$712.01 ,$927.36 ,$703.97 ,$412.53 ,$814.02 ,$456.50 ,$500.14 ,$500.14 ,$408.44 ,$500.14 ,$741.89 ,$638.85 ,$741.89 ,$741.89 ,$824.32 
ST NICHOLAS HOSPITAL - ACUTE,30600341,87798,HC INFECT AMP (VZV VIRUS DNA QL RT PCR),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600343,87798,HC INFECT AMP (NOROVIRUS RNA QL RT PCR),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600344,87530,HC HSV QUANT  TYPE 1  AND  2 DNA QN RT PCR,306,1 ,$232.30 ,$153.32 ,$41.98 ,$232.30 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$139.38 ,$197.46 ,$162.61 ,$44.27 ,$44.27 ,$220.69 ,$176.55 ,$174.23 ,$72.83 ,$197.46 ,$42.84 ,$72.83 ,$72.83 ,$162.61 ,$141.47 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$197.46 ,$96.39 ,$213.72 ,$162.61 ,$214.09 ,$214.09 ,$141.47 ,$214.09 ,$160.52 ,$209.07 ,$158.71 ,$42.40 ,$183.52 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,30600345,87799,HC INFECT AGENT QN BK VIRUS DNA RT PCR URINE,306,1 ,$373.75 ,$246.68 ,$41.98 ,$373.75 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$224.25 ,$317.69 ,$261.63 ,$44.27 ,$44.27 ,$355.06 ,$284.05 ,$280.31 ,$72.83 ,$317.69 ,$42.84 ,$72.83 ,$72.83 ,$261.63 ,$227.61 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$317.69 ,$96.39 ,$343.85 ,$261.63 ,$214.09 ,$214.09 ,$227.61 ,$214.09 ,$258.26 ,$336.38 ,$255.35 ,$42.40 ,$295.26 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$269.10 ,$231.73 ,$269.10 ,$269.10 ,$299.00 
ST NICHOLAS HOSPITAL - ACUTE,30600346,87798,HC INFECT AMP (B PERTUSSIS/PARA DNA QL RTPCR),306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600347,87505,HC GI ENTERIC PATHOGEN PANEL 3-5 TARGETS,306,1 ,$502.55 ,$331.68 ,$125.72 ,$502.55 ,$132.56 ,$449.02 ,$449.02 ,$128.29 ,$301.53 ,$427.17 ,$351.79 ,$132.56 ,$132.56 ,$477.42 ,$381.94 ,$376.91 ,$218.09 ,$427.17 ,$128.29 ,$218.09 ,$218.09 ,$351.79 ,$306.05 ,$132.56 ,$128.29 ,$125.72 ,$256.58 ,$140.51 ,$427.17 ,$288.65 ,$462.35 ,$351.79 ,$502.55 ,$502.55 ,$306.05 ,$502.55 ,$347.26 ,$452.30 ,$343.34 ,$126.98 ,$397.01 ,$140.51 ,$153.95 ,$153.95 ,$125.72 ,$153.95 ,$361.84 ,$311.58 ,$361.84 ,$361.84 ,$402.04 
ST NICHOLAS HOSPITAL - ACUTE,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 ",$416.78 ,"$1,313.76 ","$1,861.16 ","$1,532.72 ",$333.42 ,$333.42 ,"$2,080.12 ","$1,664.10 ","$1,642.20 ",$708.53 ,"$1,861.16 ",$416.78 ,$708.53 ,$708.53 ,"$1,532.72 ","$1,333.47 ",$333.42 ,$416.78 ,$408.44 ,$833.56 ,$353.43 ,"$1,861.16 ",$937.76 ,"$2,014.43 ","$1,532.72 ","$2,094.50 ","$2,094.50 ","$1,333.47 ","$2,094.50 ","$1,513.01 ","$1,970.64 ","$1,495.93 ",$412.53 ,"$1,729.78 ",$353.43 ,$500.14 ,$500.14 ,$408.44 ,$500.14 ,"$1,576.51 ","$1,357.55 ","$1,576.51 ","$1,576.51 ","$1,751.68 "
ST NICHOLAS HOSPITAL - ACUTE,30600349,87798,HC INFECT AMP (ZIKA PCR SERUM),306,1 ,$376.05 ,$248.19 ,$34.39 ,$376.05 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$225.63 ,$319.64 ,$263.24 ,$36.26 ,$36.26 ,$357.25 ,$285.80 ,$282.04 ,$59.65 ,$319.64 ,$35.09 ,$59.65 ,$59.65 ,$263.24 ,$229.01 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$319.64 ,$78.95 ,$345.97 ,$263.24 ,$175.37 ,$175.37 ,$229.01 ,$175.37 ,$259.85 ,$338.45 ,$256.92 ,$34.73 ,$297.08 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$270.76 ,$233.15 ,$270.76 ,$270.76 ,$300.84 
ST NICHOLAS HOSPITAL - ACUTE,30600350,87798,HC INFECT AMP (ZIKA VIRUS REAL TIME PCR RNA QL),306,1 ,$644.00 ,$425.04 ,$34.39 ,$644.00 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$386.40 ,$547.40 ,$450.80 ,$36.26 ,$36.26 ,$611.80 ,$489.44 ,$483.00 ,$59.65 ,$547.40 ,$35.09 ,$59.65 ,$59.65 ,$450.80 ,$392.20 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$547.40 ,$78.95 ,$592.48 ,$450.80 ,$175.37 ,$175.37 ,$392.20 ,$175.37 ,$445.00 ,$579.60 ,$439.98 ,$34.73 ,$508.76 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,30600351,86628,HC CANDIDA AB  IGA IGG IBM,306,1 ,$47.15 ,$31.12 ,$8.17 ,$47.15 ,$8.17 ,$42.04 ,$42.04 ,$12.01 ,$28.29 ,$40.08 ,$33.01 ,$8.17 ,$8.17 ,$44.79 ,$35.83 ,$35.36 ,$20.42 ,$40.08 ,$12.01 ,$20.42 ,$20.42 ,$33.01 ,$28.71 ,$8.17 ,$12.01 ,$11.77 ,$24.02 ,$8.66 ,$40.08 ,$27.02 ,$43.38 ,$33.01 ,$29.05 ,$29.05 ,$28.71 ,$29.05 ,$32.58 ,$42.44 ,$32.21 ,$11.89 ,$37.25 ,$8.66 ,$14.41 ,$14.41 ,$11.77 ,$14.41 ,$33.95 ,$29.23 ,$33.95 ,$33.95 ,$37.72 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$28.07 ,$28.07 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$28.07 ,$35.09 ,$34.39 ,$70.18 ,$29.75 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$128.55 ,$128.55 ,$188.39 ,$128.55 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$29.75 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600406,87254,HC VIRUS ISOL SHELL ID,306,1 ,$143.75 ,$94.88 ,$7.06 ,$143.75 ,$7.06 ,$68.46 ,$68.46 ,$19.56 ,$86.25 ,$122.19 ,$100.63 ,$7.06 ,$7.06 ,$136.56 ,$109.25 ,$107.81 ,$33.25 ,$122.19 ,$19.56 ,$33.25 ,$33.25 ,$100.63 ,$87.54 ,$7.06 ,$19.56 ,$19.17 ,$39.12 ,$7.48 ,$122.19 ,$44.01 ,$132.25 ,$100.63 ,$97.74 ,$97.74 ,$87.54 ,$97.74 ,$99.33 ,$129.38 ,$98.21 ,$19.36 ,$113.56 ,$7.48 ,$23.47 ,$23.47 ,$19.17 ,$23.47 ,$103.50 ,$89.13 ,$103.50 ,$103.50 ,$115.00 
ST NICHOLAS HOSPITAL - ACUTE,30600478,87799,HC INFECT AGENT QN-90,306,1 ,$886.65 ,$585.19 ,$41.98 ,$886.65 ,$44.27 ,$149.94 ,$149.94 ,$42.84 ,$531.99 ,$753.65 ,$620.66 ,$44.27 ,$44.27 ,$842.32 ,$673.85 ,$664.99 ,$72.83 ,$753.65 ,$42.84 ,$72.83 ,$72.83 ,$620.66 ,$539.97 ,$44.27 ,$42.84 ,$41.98 ,$85.68 ,$46.93 ,$753.65 ,$96.39 ,$815.72 ,$620.66 ,$214.09 ,$214.09 ,$539.97 ,$214.09 ,$612.68 ,$797.99 ,$605.76 ,$42.40 ,$700.45 ,$46.93 ,$51.41 ,$51.41 ,$41.98 ,$51.41 ,$638.39 ,$549.72 ,$638.39 ,$638.39 ,$709.32 
ST NICHOLAS HOSPITAL - ACUTE,30600498,87506,HC GI ENTERIC PATHOGEN PANEL 6-8 TARGETS,306,1 ,$604.90 ,$399.23 ,$232.94 ,$604.90 ,$232.94 ,$604.90 ,$604.90 ,$262.99 ,$362.94 ,$514.17 ,$423.43 ,$232.94 ,$232.94 ,$574.66 ,$459.72 ,$453.68 ,$447.08 ,$514.17 ,$262.99 ,$447.08 ,$447.08 ,$423.43 ,$368.38 ,$232.94 ,$262.99 ,$257.73 ,$525.98 ,$246.92 ,$514.17 ,$591.73 ,$556.51 ,$423.43 ,$604.90 ,$604.90 ,$368.38 ,$604.90 ,$417.99 ,$544.41 ,$413.27 ,$260.31 ,$477.87 ,$246.92 ,$315.59 ,$315.59 ,$257.73 ,$315.59 ,$435.53 ,$375.04 ,$435.53 ,$435.53 ,$483.92 
ST NICHOLAS HOSPITAL - ACUTE,30600499,87506,HC GI ENTERIC PATHOGEN PANEL 9-11 TARGETS,306,1 ,$695.75 ,$459.20 ,$232.94 ,$695.75 ,$232.94 ,$695.75 ,$695.75 ,$262.99 ,$417.45 ,$591.39 ,$487.03 ,$232.94 ,$232.94 ,$660.96 ,$528.77 ,$521.81 ,$447.08 ,$591.39 ,$262.99 ,$447.08 ,$447.08 ,$487.03 ,$423.71 ,$232.94 ,$262.99 ,$257.73 ,$525.98 ,$246.92 ,$591.39 ,$591.73 ,$640.09 ,$487.03 ,$695.75 ,$695.75 ,$423.71 ,$695.75 ,$480.76 ,$626.18 ,$475.34 ,$260.31 ,$549.64 ,$246.92 ,$315.59 ,$315.59 ,$257.73 ,$315.59 ,$500.94 ,$431.37 ,$500.94 ,$500.94 ,$556.60 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$19.56 ,$100.74 ,$142.72 ,$117.53 ,$7.06 ,$7.06 ,$159.51 ,$127.60 ,$125.93 ,$33.25 ,$142.72 ,$19.56 ,$33.25 ,$33.25 ,$117.53 ,$102.25 ,$7.06 ,$19.56 ,$19.17 ,$39.12 ,$7.48 ,$142.72 ,$44.01 ,$154.47 ,$117.53 ,$97.74 ,$97.74 ,$102.25 ,$97.74 ,$116.02 ,$151.11 ,$114.71 ,$19.36 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$19.17 ,$23.47 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,30600501,87140,HC CLT TYP IF EA VIRAL RESP RAPID CULTURE REFLEX,306,1 ,$81.65 ,$53.89 ,$5.46 ,$81.65 ,$5.76 ,$19.50 ,$19.50 ,$5.57 ,$48.99 ,$69.40 ,$57.16 ,$5.76 ,$5.76 ,$77.57 ,$62.05 ,$61.24 ,$9.47 ,$69.40 ,$5.57 ,$9.47 ,$9.47 ,$57.16 ,$49.72 ,$5.76 ,$5.57 ,$5.46 ,$11.14 ,$6.11 ,$69.40 ,$12.53 ,$75.12 ,$57.16 ,$22.79 ,$22.79 ,$49.72 ,$22.79 ,$56.42 ,$73.49 ,$55.78 ,$5.52 ,$64.50 ,$6.11 ,$6.68 ,$6.68 ,$5.46 ,$6.68 ,$58.79 ,$50.62 ,$58.79 ,$58.79 ,$65.32 
ST NICHOLAS HOSPITAL - ACUTE,30600540,87798,HC IF AGENT PARAPERTUSSIS DNA DETECTION METHOD,306,1 ,$411.70 ,$271.72 ,$34.39 ,$411.70 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$247.02 ,$349.95 ,$288.19 ,$36.26 ,$36.26 ,$391.12 ,$312.89 ,$308.78 ,$59.65 ,$349.95 ,$35.09 ,$59.65 ,$59.65 ,$288.19 ,$250.73 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$349.95 ,$78.95 ,$378.76 ,$288.19 ,$175.37 ,$175.37 ,$250.73 ,$175.37 ,$284.48 ,$370.53 ,$281.27 ,$34.73 ,$325.24 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,30600594,87150,HC CULTURE TYPING ID AMP PROBE TECH,306,1 ,$77.05 ,$50.85 ,$34.39 ,$78.95 ,$36.26 ,$77.05 ,$77.05 ,$35.09 ,$46.23 ,$65.49 ,$53.94 ,$36.26 ,$36.26 ,$73.20 ,$58.56 ,$57.79 ,$59.65 ,$65.49 ,$35.09 ,$59.65 ,$59.65 ,$53.94 ,$46.92 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$65.49 ,$78.95 ,$70.89 ,$53.94 ,$77.05 ,$77.05 ,$46.92 ,$77.05 ,$53.24 ,$69.35 ,$52.64 ,$34.73 ,$60.87 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30600595,87798,HC INFECT AMP (TICK BORNE PCR PNL CHAIN REACTION),306,1 ,$228.85 ,$151.04 ,$34.39 ,$228.85 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$137.31 ,$194.52 ,$160.20 ,$36.26 ,$36.26 ,$217.41 ,$173.93 ,$171.64 ,$59.65 ,$194.52 ,$35.09 ,$59.65 ,$59.65 ,$160.20 ,$139.37 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$194.52 ,$78.95 ,$210.54 ,$160.20 ,$175.37 ,$175.37 ,$139.37 ,$175.37 ,$158.14 ,$205.97 ,$156.35 ,$34.73 ,$180.79 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$164.77 ,$141.89 ,$164.77 ,$164.77 ,$183.08 
ST NICHOLAS HOSPITAL - ACUTE,30600596,87801,HC INFECT MLT ORG AMP TICK,306,1 ,$446.20 ,$294.49 ,$50.62 ,$446.20 ,$50.62 ,$245.70 ,$245.70 ,$70.20 ,$267.72 ,$379.27 ,$312.34 ,$50.62 ,$50.62 ,$423.89 ,$339.11 ,$334.65 ,$119.34 ,$379.27 ,$70.20 ,$119.34 ,$119.34 ,$312.34 ,$271.74 ,$50.62 ,$70.20 ,$68.80 ,$140.40 ,$53.66 ,$379.27 ,$157.95 ,$410.50 ,$312.34 ,$350.82 ,$350.82 ,$271.74 ,$350.82 ,$308.32 ,$401.58 ,$304.84 ,$69.48 ,$352.50 ,$53.66 ,$84.24 ,$84.24 ,$68.80 ,$84.24 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,30600597,87186,HC SENSITIVITY MIC FUNGUS,306,1 ,$463.45 ,$305.88 ,$8.48 ,$463.45 ,$8.94 ,$30.28 ,$30.28 ,$8.65 ,$278.07 ,$393.93 ,$324.42 ,$8.94 ,$8.94 ,$440.28 ,$352.22 ,$347.59 ,$14.71 ,$393.93 ,$8.65 ,$14.71 ,$14.71 ,$324.42 ,$282.24 ,$8.94 ,$8.65 ,$8.48 ,$17.30 ,$9.48 ,$393.93 ,$19.46 ,$426.37 ,$324.42 ,$43.23 ,$43.23 ,$282.24 ,$43.23 ,$320.24 ,$417.11 ,$316.63 ,$8.57 ,$366.13 ,$9.48 ,$10.38 ,$10.38 ,$8.48 ,$10.38 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,30600616,87798,HC MYCOPL GENIT AMP PROBE,306,1 ,$309.35 ,$204.17 ,$34.39 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$36.26 ,$36.26 ,$293.88 ,$235.11 ,$232.01 ,$59.65 ,$262.95 ,$35.09 ,$59.65 ,$59.65 ,$216.55 ,$188.39 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$175.37 ,$175.37 ,$188.39 ,$175.37 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600622,87081,HC CULTURE (H PYLORI),306,1 ,$154.10 ,$101.71 ,$6.50 ,$154.10 ,$6.85 ,$23.21 ,$23.21 ,$6.63 ,$92.46 ,$130.99 ,$107.87 ,$6.85 ,$6.85 ,$146.40 ,$117.12 ,$115.58 ,$11.27 ,$130.99 ,$6.63 ,$11.27 ,$11.27 ,$107.87 ,$93.85 ,$6.85 ,$6.63 ,$6.50 ,$13.26 ,$7.26 ,$130.99 ,$14.92 ,$141.77 ,$107.87 ,$33.15 ,$33.15 ,$93.85 ,$33.15 ,$106.48 ,$138.69 ,$105.28 ,$6.57 ,$121.74 ,$7.26 ,$7.96 ,$7.96 ,$6.50 ,$7.96 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,30600624,87635,HC COVID-19 LAB TEST CDC,306,1 ,$164.00 ,$108.24 ,$50.28 ,$164.00 ,$51.31 ,$164.00 ,$164.00 ,$51.31 ,$98.40 ,$139.40 ,$114.80 ,$51.31 ,$51.31 ,$155.80 ,$124.64 ,$123.00 ,$87.23 ,$139.40 ,$51.31 ,$87.23 ,$87.23 ,$114.80 ,$99.88 ,$51.31 ,$51.31 ,$50.28 ,$102.62 ,$54.39 ,$139.40 ,$115.45 ,$150.88 ,$114.80 ,$164.00 ,$164.00 ,$99.88 ,$164.00 ,$113.32 ,$147.60 ,$112.04 ,$50.78 ,$129.56 ,$54.39 ,$61.57 ,$61.57 ,$50.28 ,$61.57 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$131.20 
ST NICHOLAS HOSPITAL - ACUTE,30600637,87635,HC COVID-19 LAB PCR TEST,306,1 ,$164.00 ,$108.24 ,$50.28 ,$164.00 ,$51.31 ,$164.00 ,$164.00 ,$51.31 ,$98.40 ,$139.40 ,$114.80 ,$51.31 ,$51.31 ,$155.80 ,$124.64 ,$123.00 ,$87.23 ,$139.40 ,$51.31 ,$87.23 ,$87.23 ,$114.80 ,$99.88 ,$51.31 ,$51.31 ,$50.28 ,$102.62 ,$54.39 ,$139.40 ,$115.45 ,$150.88 ,$114.80 ,$164.00 ,$164.00 ,$99.88 ,$164.00 ,$113.32 ,$147.60 ,$112.04 ,$50.78 ,$129.56 ,$54.39 ,$61.57 ,$61.57 ,$50.28 ,$61.57 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$131.20 
ST NICHOLAS HOSPITAL - ACUTE,30600647,87635,HC SARS-COV-2 COVID-19 AMP PRB,306,1 ,$164.00 ,$108.24 ,$50.28 ,$164.00 ,$51.31 ,$164.00 ,$164.00 ,$51.31 ,$98.40 ,$139.40 ,$114.80 ,$51.31 ,$51.31 ,$155.80 ,$124.64 ,$123.00 ,$87.23 ,$139.40 ,$51.31 ,$87.23 ,$87.23 ,$114.80 ,$99.88 ,$51.31 ,$51.31 ,$50.28 ,$102.62 ,$54.39 ,$139.40 ,$115.45 ,$150.88 ,$114.80 ,$164.00 ,$164.00 ,$99.88 ,$164.00 ,$113.32 ,$147.60 ,$112.04 ,$50.78 ,$129.56 ,$54.39 ,$61.57 ,$61.57 ,$50.28 ,$61.57 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$131.20 
ST NICHOLAS HOSPITAL - ACUTE,30600663,87593,HC INFECT AMP ORTHOPOXVIRUS/MONKEYPOX DNA,306,1 ,$113.00 ,$74.58 ,$0.90 ,$113.00 ,$0.90 ,$113.00 ,$113.00 , N/A ,$67.80 ,$96.05 ,$79.10 ,$0.90 ,$0.90 ,$107.35 ,$85.88 ,$84.75 ,$87.23 ,$96.05 , N/A ,$87.23 ,$87.23 ,$79.10 ,$68.82 ,$0.90 , N/A , N/A , N/A ,$0.95 ,$96.05 , N/A ,$103.96 ,$79.10 ,$57.31 ,$68.78 ,$68.82 ,$68.78 ,$78.08 ,$101.70 ,$77.20 , N/A ,$89.27 ,$0.95 ,$61.40 ,$61.40 , N/A ,$61.40 ,$81.36 ,$70.06 ,$81.36 ,$81.36 ,$90.40 
ST NICHOLAS HOSPITAL - ACUTE,30600665,87188,HC MACROTUBE DIL METH 5DRG PNL,306,1 ,$187.67 ,$123.86 ,$6.51 ,$187.67 ,$6.86 ,$23.24 ,$23.24 ,$6.64 ,$112.60 ,$159.52 ,$131.37 ,$6.86 ,$6.86 ,$178.29 ,$142.63 ,$140.75 ,$11.29 ,$159.52 ,$6.64 ,$11.29 ,$11.29 ,$131.37 ,$114.29 ,$6.86 ,$6.64 ,$6.51 ,$13.28 ,$7.27 ,$159.52 ,$14.94 ,$172.66 ,$131.37 ,$33.19 ,$33.19 ,$114.29 ,$33.19 ,$129.68 ,$168.90 ,$128.22 ,$6.58 ,$148.26 ,$7.27 ,$7.97 ,$7.97 ,$6.51 ,$7.97 ,$135.12 ,$116.36 ,$135.12 ,$135.12 ,$150.14 
ST NICHOLAS HOSPITAL - ACUTE,30600666,87449,HC EIA QL MLT AG INF (FUNGITELL),306,1 ,$411.70 ,$271.72 ,$11.74 ,$411.70 ,$12.38 ,$41.93 ,$41.93 ,$11.98 ,$247.02 ,$349.95 ,$288.19 ,$12.38 ,$12.38 ,$391.12 ,$312.89 ,$308.78 ,$20.37 ,$349.95 ,$11.98 ,$20.37 ,$20.37 ,$288.19 ,$250.73 ,$12.38 ,$11.98 ,$11.74 ,$23.96 ,$13.12 ,$349.95 ,$26.96 ,$378.76 ,$288.19 ,$59.93 ,$59.93 ,$250.73 ,$59.93 ,$284.48 ,$370.53 ,$281.27 ,$11.86 ,$325.24 ,$13.12 ,$14.38 ,$14.38 ,$11.74 ,$14.38 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,30600667,87468,HC ANAPLSMA PHGCYTOPHLM AMP PRB,306,1 ,$309.35 ,$204.17 ,$0.90 ,$309.35 ,$0.90 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$0.90 ,$0.90 ,$293.88 ,$235.11 ,$232.01 , N/A ,$262.95 ,$35.09 , N/A , N/A ,$216.55 ,$188.39 ,$0.90 ,$35.09 ,$34.39 ,$70.18 ,$0.95 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$156.90 ,$188.30 ,$188.39 ,$188.30 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$0.95 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600668,87469,HC BABESIA MICROTI AMP PRB,306,1 ,$129.60 ,$85.54 ,$0.90 ,$129.60 ,$0.90 ,$122.82 ,$122.82 ,$35.09 ,$77.76 ,$110.16 ,$90.72 ,$0.90 ,$0.90 ,$123.12 ,$98.50 ,$97.20 , N/A ,$110.16 ,$35.09 , N/A , N/A ,$90.72 ,$78.93 ,$0.90 ,$35.09 ,$34.39 ,$70.18 ,$0.95 ,$110.16 ,$78.95 ,$119.23 ,$90.72 ,$65.73 ,$78.89 ,$78.93 ,$78.89 ,$89.55 ,$116.64 ,$88.54 ,$34.73 ,$102.38 ,$0.95 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$93.31 ,$80.35 ,$93.31 ,$93.31 ,$103.68 
ST NICHOLAS HOSPITAL - ACUTE,30600669,87478,HC BORRELIA MIYAMOTOI AMP PRB,306,1 ,$129.60 ,$85.54 ,$0.90 ,$129.60 ,$0.90 ,$122.82 ,$122.82 ,$35.09 ,$77.76 ,$110.16 ,$90.72 ,$0.90 ,$0.90 ,$123.12 ,$98.50 ,$97.20 , N/A ,$110.16 ,$35.09 , N/A , N/A ,$90.72 ,$78.93 ,$0.90 ,$35.09 ,$34.39 ,$70.18 ,$0.95 ,$110.16 ,$78.95 ,$119.23 ,$90.72 ,$65.73 ,$78.89 ,$78.93 ,$78.89 ,$89.55 ,$116.64 ,$88.54 ,$34.73 ,$102.38 ,$0.95 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$93.31 ,$80.35 ,$93.31 ,$93.31 ,$103.68 
ST NICHOLAS HOSPITAL - ACUTE,30600670,87484,HC EHRLICHA CHAFFEENSIS AMP PRB,306,1 ,$309.35 ,$204.17 ,$0.90 ,$309.35 ,$0.90 ,$122.82 ,$122.82 ,$35.09 ,$185.61 ,$262.95 ,$216.55 ,$0.90 ,$0.90 ,$293.88 ,$235.11 ,$232.01 , N/A ,$262.95 ,$35.09 , N/A , N/A ,$216.55 ,$188.39 ,$0.90 ,$35.09 ,$34.39 ,$70.18 ,$0.95 ,$262.95 ,$78.95 ,$284.60 ,$216.55 ,$156.90 ,$188.30 ,$188.39 ,$188.30 ,$213.76 ,$278.42 ,$211.35 ,$34.73 ,$244.39 ,$0.95 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,30600671,87662,HC ZIKA VIRUS DNA/RNA AMP PROBE,306,1 ,$644.00 ,$425.04 ,$50.28 ,$644.00 ,$50.68 ,$179.59 ,$179.59 ,$51.31 ,$386.40 ,$547.40 ,$450.80 ,$50.68 ,$50.68 ,$611.80 ,$489.44 ,$483.00 ,$87.23 ,$547.40 ,$51.31 ,$87.23 ,$87.23 ,$450.80 ,$392.20 ,$50.68 ,$51.31 ,$50.28 ,$102.62 ,$53.72 ,$547.40 ,$115.45 ,$592.48 ,$450.80 ,$232.08 ,$232.08 ,$392.20 ,$232.08 ,$445.00 ,$579.60 ,$439.98 ,$50.78 ,$508.76 ,$53.72 ,$61.57 ,$61.57 ,$50.28 ,$61.57 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,30682011,87635,HC COVID-19 LAB TEST NON-CDC,306,1 ,$164.00 ,$108.24 ,$50.28 ,$164.00 ,$51.31 ,$164.00 ,$164.00 ,$51.31 ,$98.40 ,$139.40 ,$114.80 ,$51.31 ,$51.31 ,$155.80 ,$124.64 ,$123.00 ,$87.23 ,$139.40 ,$51.31 ,$87.23 ,$87.23 ,$114.80 ,$99.88 ,$51.31 ,$51.31 ,$50.28 ,$102.62 ,$54.39 ,$139.40 ,$115.45 ,$150.88 ,$114.80 ,$164.00 ,$164.00 ,$99.88 ,$164.00 ,$113.32 ,$147.60 ,$112.04 ,$50.78 ,$129.56 ,$54.39 ,$61.57 ,$61.57 ,$50.28 ,$61.57 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$131.20 
ST NICHOLAS HOSPITAL - ACUTE,30682013,87635,HC COVID-19 LAB TEST,306,1 ,$164.00 ,$108.24 ,$50.28 ,$164.00 ,$51.31 ,$164.00 ,$164.00 ,$51.31 ,$98.40 ,$139.40 ,$114.80 ,$51.31 ,$51.31 ,$155.80 ,$124.64 ,$123.00 ,$87.23 ,$139.40 ,$51.31 ,$87.23 ,$87.23 ,$114.80 ,$99.88 ,$51.31 ,$51.31 ,$50.28 ,$102.62 ,$54.39 ,$139.40 ,$115.45 ,$150.88 ,$114.80 ,$164.00 ,$164.00 ,$99.88 ,$164.00 ,$113.32 ,$147.60 ,$112.04 ,$50.78 ,$129.56 ,$54.39 ,$61.57 ,$61.57 ,$50.28 ,$61.57 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$131.20 
ST NICHOLAS HOSPITAL - ACUTE,30682014,86769,HC SARS-COV-2 COVID-19 ANTIBODY,306,1 ,$100.05 ,$66.03 ,$41.29 ,$100.05 ,$42.13 ,$100.05 ,$100.05 ,$42.13 ,$60.03 ,$85.04 ,$70.04 ,$42.13 ,$42.13 ,$95.05 ,$76.04 ,$75.04 ,$71.62 ,$85.04 ,$42.13 ,$71.62 ,$71.62 ,$70.04 ,$60.93 ,$42.13 ,$42.13 ,$41.29 ,$84.26 ,$44.66 ,$85.04 ,$94.79 ,$92.05 ,$70.04 ,$100.05 ,$100.05 ,$60.93 ,$100.05 ,$69.13 ,$90.05 ,$68.35 ,$41.70 ,$79.04 ,$44.66 ,$50.56 ,$50.56 ,$41.29 ,$50.56 ,$72.04 ,$62.03 ,$72.04 ,$72.04 ,$80.04 
ST NICHOLAS HOSPITAL - ACUTE,30682021,86769,HC SARS-COV-2 COVID-19 ANTIBODY IN-HOUSE,306,1 ,$100.05 ,$66.03 ,$41.29 ,$100.05 ,$42.13 ,$100.05 ,$100.05 ,$42.13 ,$60.03 ,$85.04 ,$70.04 ,$42.13 ,$42.13 ,$95.05 ,$76.04 ,$75.04 ,$71.62 ,$85.04 ,$42.13 ,$71.62 ,$71.62 ,$70.04 ,$60.93 ,$42.13 ,$42.13 ,$41.29 ,$84.26 ,$44.66 ,$85.04 ,$94.79 ,$92.05 ,$70.04 ,$100.05 ,$100.05 ,$60.93 ,$100.05 ,$69.13 ,$90.05 ,$68.35 ,$41.70 ,$79.04 ,$44.66 ,$50.56 ,$50.56 ,$41.29 ,$50.56 ,$72.04 ,$62.03 ,$72.04 ,$72.04 ,$80.04 
ST NICHOLAS HOSPITAL - ACUTE,30682023,87426,HC SARS COVID ANTIGEN TEST,306,1 ,$96.60 ,$63.76 ,$34.62 ,$96.60 ,$35.33 ,$96.60 ,$96.60 ,$35.33 ,$57.96 ,$82.11 ,$67.62 ,$35.33 ,$35.33 ,$91.77 ,$73.42 ,$72.45 ,$60.06 ,$82.11 ,$35.33 ,$60.06 ,$60.06 ,$67.62 ,$58.83 ,$35.33 ,$35.33 ,$34.62 ,$70.66 ,$37.45 ,$82.11 ,$79.49 ,$88.87 ,$67.62 ,$96.60 ,$96.60 ,$58.83 ,$96.60 ,$66.75 ,$86.94 ,$66.00 ,$34.97 ,$76.31 ,$37.45 ,$54.44 ,$54.44 ,$34.62 ,$54.44 ,$69.55 ,$59.89 ,$69.55 ,$69.55 ,$77.28 
ST NICHOLAS HOSPITAL - ACUTE,30682024,87635,HC SARS-COV-2 COVID-19 TEST,306,1 ,$164.00 ,$108.24 ,$50.28 ,$164.00 ,$51.31 ,$164.00 ,$164.00 ,$51.31 ,$98.40 ,$139.40 ,$114.80 ,$51.31 ,$51.31 ,$155.80 ,$124.64 ,$123.00 ,$87.23 ,$139.40 ,$51.31 ,$87.23 ,$87.23 ,$114.80 ,$99.88 ,$51.31 ,$51.31 ,$50.28 ,$102.62 ,$54.39 ,$139.40 ,$115.45 ,$150.88 ,$114.80 ,$164.00 ,$164.00 ,$99.88 ,$164.00 ,$113.32 ,$147.60 ,$112.04 ,$50.78 ,$129.56 ,$54.39 ,$61.57 ,$61.57 ,$50.28 ,$61.57 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$131.20 
ST NICHOLAS HOSPITAL - ACUTE,30682027,87661,HC TRICHOMONAS VAGINALIS AMPLIF,306,1 ,$195.50 ,$129.03 ,$34.39 ,$195.50 ,$36.26 ,$122.82 ,$122.82 ,$35.09 ,$117.30 ,$166.18 ,$136.85 ,$36.26 ,$36.26 ,$185.73 ,$148.58 ,$146.63 ,$59.65 ,$166.18 ,$35.09 ,$59.65 ,$59.65 ,$136.85 ,$119.06 ,$36.26 ,$35.09 ,$34.39 ,$70.18 ,$38.44 ,$166.18 ,$78.95 ,$179.86 ,$136.85 ,$175.37 ,$175.37 ,$119.06 ,$175.37 ,$135.09 ,$175.95 ,$133.57 ,$34.73 ,$154.45 ,$38.44 ,$42.11 ,$42.11 ,$34.39 ,$42.11 ,$140.76 ,$121.21 ,$140.76 ,$140.76 ,$156.40 
ST NICHOLAS HOSPITAL - ACUTE,30700101,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$49.45 ,$32.64 ,$3.11 ,$49.45 ,$3.28 ,$11.10 ,$11.10 ,$3.17 ,$29.67 ,$42.03 ,$34.62 ,$3.28 ,$3.28 ,$46.98 ,$37.58 ,$37.09 ,$5.39 ,$42.03 ,$3.17 ,$5.39 ,$5.39 ,$34.62 ,$30.12 ,$3.28 ,$3.17 ,$3.11 ,$6.34 ,$3.48 ,$42.03 ,$7.13 ,$45.49 ,$34.62 ,$15.83 ,$15.83 ,$30.12 ,$15.83 ,$34.17 ,$44.51 ,$33.78 ,$3.14 ,$39.07 ,$3.48 ,$3.80 ,$3.80 ,$3.11 ,$3.80 ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,30700102,81003,HC URINALYSIS DIP STICK,307,1 ,$29.90 ,$19.73 ,$2.20 ,$29.90 ,$2.32 ,$7.88 ,$7.88 ,$2.25 ,$17.94 ,$25.42 ,$20.93 ,$2.32 ,$2.32 ,$28.41 ,$22.72 ,$22.43 ,$3.83 ,$25.42 ,$2.25 ,$3.83 ,$3.83 ,$20.93 ,$18.21 ,$2.32 ,$2.25 ,$2.20 ,$4.50 ,$2.46 ,$25.42 ,$5.06 ,$27.51 ,$20.93 ,$11.21 ,$11.21 ,$18.21 ,$11.21 ,$20.66 ,$26.91 ,$20.43 ,$2.22 ,$23.62 ,$2.46 ,$2.70 ,$2.70 ,$2.20 ,$2.70 ,$21.53 ,$18.54 ,$21.53 ,$21.53 ,$23.92 
ST NICHOLAS HOSPITAL - ACUTE,30700104,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$35.65 ,$23.53 ,$2.20 ,$35.65 ,$2.32 ,$7.88 ,$7.88 ,$2.25 ,$21.39 ,$30.30 ,$24.96 ,$2.32 ,$2.32 ,$33.87 ,$27.09 ,$26.74 ,$3.83 ,$30.30 ,$2.25 ,$3.83 ,$3.83 ,$24.96 ,$21.71 ,$2.32 ,$2.25 ,$2.20 ,$4.50 ,$2.46 ,$30.30 ,$5.06 ,$32.80 ,$24.96 ,$11.21 ,$11.21 ,$21.71 ,$11.21 ,$24.63 ,$32.09 ,$24.36 ,$2.22 ,$28.16 ,$2.46 ,$2.70 ,$2.70 ,$2.20 ,$2.70 ,$25.67 ,$22.10 ,$25.67 ,$25.67 ,$28.52 
ST NICHOLAS HOSPITAL - ACUTE,30700105,81003,HC URINE ONE TEST ONLY,307,1 ,$24.15 ,$15.94 ,$2.20 ,$24.15 ,$2.32 ,$7.88 ,$7.88 ,$2.25 ,$14.49 ,$20.53 ,$16.91 ,$2.32 ,$2.32 ,$22.94 ,$18.35 ,$18.11 ,$3.83 ,$20.53 ,$2.25 ,$3.83 ,$3.83 ,$16.91 ,$14.71 ,$2.32 ,$2.25 ,$2.20 ,$4.50 ,$2.46 ,$20.53 ,$5.06 ,$22.22 ,$16.91 ,$11.21 ,$11.21 ,$14.71 ,$11.21 ,$16.69 ,$21.74 ,$16.50 ,$2.22 ,$19.08 ,$2.46 ,$2.70 ,$2.70 ,$2.20 ,$2.70 ,$17.39 ,$14.97 ,$17.39 ,$17.39 ,$19.32 
ST NICHOLAS HOSPITAL - ACUTE,30700106,81003,HC URINALYSIS BLOOD,307,1 ,$46.00 ,$30.36 ,$2.20 ,$46.00 ,$2.32 ,$7.88 ,$7.88 ,$2.25 ,$27.60 ,$39.10 ,$32.20 ,$2.32 ,$2.32 ,$43.70 ,$34.96 ,$34.50 ,$3.83 ,$39.10 ,$2.25 ,$3.83 ,$3.83 ,$32.20 ,$28.01 ,$2.32 ,$2.25 ,$2.20 ,$4.50 ,$2.46 ,$39.10 ,$5.06 ,$42.32 ,$32.20 ,$11.21 ,$11.21 ,$28.01 ,$11.21 ,$31.79 ,$41.40 ,$31.43 ,$2.22 ,$36.34 ,$2.46 ,$2.70 ,$2.70 ,$2.20 ,$2.70 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30700107,81003,HC URINALYSIS GLUCOSE,307,1 ,$19.55 ,$12.90 ,$2.20 ,$19.55 ,$2.32 ,$7.88 ,$7.88 ,$2.25 ,$11.73 ,$16.62 ,$13.69 ,$2.32 ,$2.32 ,$18.57 ,$14.86 ,$14.66 ,$3.83 ,$16.62 ,$2.25 ,$3.83 ,$3.83 ,$13.69 ,$11.91 ,$2.32 ,$2.25 ,$2.20 ,$4.50 ,$2.46 ,$16.62 ,$5.06 ,$17.99 ,$13.69 ,$11.21 ,$11.21 ,$11.91 ,$11.21 ,$13.51 ,$17.60 ,$13.36 ,$2.22 ,$15.44 ,$2.46 ,$2.70 ,$2.70 ,$2.20 ,$2.70 ,$14.08 ,$12.12 ,$14.08 ,$14.08 ,$15.64 
ST NICHOLAS HOSPITAL - ACUTE,30700108,81003,HC URINALYSIS ACETONE OR PH,307,1 ,$28.75 ,$18.98 ,$2.20 ,$28.75 ,$2.32 ,$7.88 ,$7.88 ,$2.25 ,$17.25 ,$24.44 ,$20.13 ,$2.32 ,$2.32 ,$27.31 ,$21.85 ,$21.56 ,$3.83 ,$24.44 ,$2.25 ,$3.83 ,$3.83 ,$20.13 ,$17.51 ,$2.32 ,$2.25 ,$2.20 ,$4.50 ,$2.46 ,$24.44 ,$5.06 ,$26.45 ,$20.13 ,$11.21 ,$11.21 ,$17.51 ,$11.21 ,$19.87 ,$25.88 ,$19.64 ,$2.22 ,$22.71 ,$2.46 ,$2.70 ,$2.70 ,$2.20 ,$2.70 ,$20.70 ,$17.83 ,$20.70 ,$20.70 ,$23.00 
ST NICHOLAS HOSPITAL - ACUTE,30700109,81003,HC URINALYSIS PROTEIN,307,1 ,$28.75 ,$18.98 ,$2.20 ,$28.75 ,$2.32 ,$7.88 ,$7.88 ,$2.25 ,$17.25 ,$24.44 ,$20.13 ,$2.32 ,$2.32 ,$27.31 ,$21.85 ,$21.56 ,$3.83 ,$24.44 ,$2.25 ,$3.83 ,$3.83 ,$20.13 ,$17.51 ,$2.32 ,$2.25 ,$2.20 ,$4.50 ,$2.46 ,$24.44 ,$5.06 ,$26.45 ,$20.13 ,$11.21 ,$11.21 ,$17.51 ,$11.21 ,$19.87 ,$25.88 ,$19.64 ,$2.22 ,$22.71 ,$2.46 ,$2.70 ,$2.70 ,$2.20 ,$2.70 ,$20.70 ,$17.83 ,$20.70 ,$20.70 ,$23.00 
ST NICHOLAS HOSPITAL - ACUTE,30700110,81003,HC URINALYSIS KETONE,307,1 ,$28.75 ,$18.98 ,$2.20 ,$28.75 ,$2.32 ,$7.88 ,$7.88 ,$2.25 ,$17.25 ,$24.44 ,$20.13 ,$2.32 ,$2.32 ,$27.31 ,$21.85 ,$21.56 ,$3.83 ,$24.44 ,$2.25 ,$3.83 ,$3.83 ,$20.13 ,$17.51 ,$2.32 ,$2.25 ,$2.20 ,$4.50 ,$2.46 ,$24.44 ,$5.06 ,$26.45 ,$20.13 ,$11.21 ,$11.21 ,$17.51 ,$11.21 ,$19.87 ,$25.88 ,$19.64 ,$2.22 ,$22.71 ,$2.46 ,$2.70 ,$2.70 ,$2.20 ,$2.70 ,$20.70 ,$17.83 ,$20.70 ,$20.70 ,$23.00 
ST NICHOLAS HOSPITAL - ACUTE,30700111,81003,HC URINALYSIS SPECIFIC GRAVITY,307,1 ,$19.55 ,$12.90 ,$2.20 ,$19.55 ,$2.32 ,$7.88 ,$7.88 ,$2.25 ,$11.73 ,$16.62 ,$13.69 ,$2.32 ,$2.32 ,$18.57 ,$14.86 ,$14.66 ,$3.83 ,$16.62 ,$2.25 ,$3.83 ,$3.83 ,$13.69 ,$11.91 ,$2.32 ,$2.25 ,$2.20 ,$4.50 ,$2.46 ,$16.62 ,$5.06 ,$17.99 ,$13.69 ,$11.21 ,$11.21 ,$11.91 ,$11.21 ,$13.51 ,$17.60 ,$13.36 ,$2.22 ,$15.44 ,$2.46 ,$2.70 ,$2.70 ,$2.20 ,$2.70 ,$14.08 ,$12.12 ,$14.08 ,$14.08 ,$15.64 
ST NICHOLAS HOSPITAL - ACUTE,30700113,81005,HC REDUCING SUBSTANCES,307,1 ,$81.65 ,$53.89 ,$2.13 ,$81.65 ,$2.24 ,$7.60 ,$7.60 ,$2.17 ,$48.99 ,$69.40 ,$57.16 ,$2.24 ,$2.24 ,$77.57 ,$62.05 ,$61.24 ,$3.69 ,$69.40 ,$2.17 ,$3.69 ,$3.69 ,$57.16 ,$49.72 ,$2.24 ,$2.17 ,$2.13 ,$4.34 ,$2.37 ,$69.40 ,$4.88 ,$75.12 ,$57.16 ,$10.84 ,$10.84 ,$49.72 ,$10.84 ,$56.42 ,$73.49 ,$55.78 ,$2.15 ,$64.50 ,$2.37 ,$2.60 ,$2.60 ,$2.13 ,$2.60 ,$58.79 ,$50.62 ,$58.79 ,$58.79 ,$65.32 
ST NICHOLAS HOSPITAL - ACUTE,30700114,81005,HC QUALITATIVE SUGARS SCREEN,307,1 ,$83.95 ,$55.41 ,$2.13 ,$83.95 ,$2.24 ,$7.60 ,$7.60 ,$2.17 ,$50.37 ,$71.36 ,$58.77 ,$2.24 ,$2.24 ,$79.75 ,$63.80 ,$62.96 ,$3.69 ,$71.36 ,$2.17 ,$3.69 ,$3.69 ,$58.77 ,$51.13 ,$2.24 ,$2.17 ,$2.13 ,$4.34 ,$2.37 ,$71.36 ,$4.88 ,$77.23 ,$58.77 ,$10.84 ,$10.84 ,$51.13 ,$10.84 ,$58.01 ,$75.56 ,$57.35 ,$2.15 ,$66.32 ,$2.37 ,$2.60 ,$2.60 ,$2.13 ,$2.60 ,$60.44 ,$52.05 ,$60.44 ,$60.44 ,$67.16 
ST NICHOLAS HOSPITAL - ACUTE,30700115,81015,HC URINALYSIS MICRO ONLY,307,1 ,$27.60 ,$18.22 ,$2.99 ,$27.60 ,$3.15 ,$10.68 ,$10.68 ,$3.05 ,$16.56 ,$23.46 ,$19.32 ,$3.15 ,$3.15 ,$26.22 ,$20.98 ,$20.70 ,$5.19 ,$23.46 ,$3.05 ,$5.19 ,$5.19 ,$19.32 ,$16.81 ,$3.15 ,$3.05 ,$2.99 ,$6.10 ,$3.34 ,$23.46 ,$6.86 ,$25.39 ,$19.32 ,$15.20 ,$15.20 ,$16.81 ,$15.20 ,$19.07 ,$24.84 ,$18.86 ,$3.02 ,$21.80 ,$3.34 ,$3.66 ,$3.66 ,$2.99 ,$3.66 ,$19.87 ,$17.11 ,$19.87 ,$19.87 ,$22.08 
ST NICHOLAS HOSPITAL - ACUTE,30700116,81025,HC URINE PREGNANCY TEST,307,1 ,$77.05 ,$50.85 ,$8.44 ,$77.05 ,$8.90 ,$30.14 ,$30.14 ,$8.61 ,$46.23 ,$65.49 ,$53.94 ,$8.90 ,$8.90 ,$73.20 ,$58.56 ,$57.79 ,$14.64 ,$65.49 ,$8.61 ,$14.64 ,$14.64 ,$53.94 ,$46.92 ,$8.90 ,$8.61 ,$8.44 ,$17.22 ,$9.43 ,$65.49 ,$19.37 ,$70.89 ,$53.94 ,$31.62 ,$31.62 ,$46.92 ,$31.62 ,$53.24 ,$69.35 ,$52.64 ,$8.53 ,$60.87 ,$9.43 ,$10.33 ,$10.33 ,$8.44 ,$10.33 ,$55.48 ,$47.77 ,$55.48 ,$55.48 ,$61.64 
ST NICHOLAS HOSPITAL - ACUTE,30700117,81050,HC VOLUME MEASUREMENT URINE,307,1 ,$28.75 ,$18.98 ,$3.57 ,$28.75 ,$3.76 ,$12.74 ,$12.74 ,$3.64 ,$17.25 ,$24.44 ,$20.13 ,$3.76 ,$3.76 ,$27.31 ,$21.85 ,$21.56 ,$6.19 ,$24.44 ,$3.64 ,$6.19 ,$6.19 ,$20.13 ,$17.51 ,$3.76 ,$3.64 ,$3.57 ,$7.28 ,$3.99 ,$24.44 ,$8.19 ,$26.45 ,$20.13 ,$14.98 ,$14.98 ,$17.51 ,$14.98 ,$19.87 ,$25.88 ,$19.64 ,$3.61 ,$22.71 ,$3.99 ,$4.37 ,$4.37 ,$3.57 ,$4.37 ,$20.70 ,$17.83 ,$20.70 ,$20.70 ,$23.00 
ST NICHOLAS HOSPITAL - ACUTE,30900001,N/A,HC SLIDE PROCESSING FEE,309,1 ,$12.65 ,$8.35 ,$6.20 ,$12.65 , N/A ,$8.67 ,$8.67 , N/A ,$7.59 ,$10.75 ,$8.86 , N/A , N/A ,$12.02 ,$9.61 ,$9.49 , N/A ,$10.75 , N/A , N/A , N/A ,$8.86 ,$7.70 , N/A , N/A , N/A , N/A , N/A ,$10.75 , N/A ,$11.64 ,$8.86 ,$6.42 ,$7.70 ,$7.70 ,$7.70 ,$8.74 ,$11.39 ,$8.64 , N/A ,$9.99 , N/A ,$6.20 ,$6.20 , N/A ,$6.20 ,$9.11 ,$7.84 ,$9.11 ,$9.11 ,$10.12 
ST NICHOLAS HOSPITAL - ACUTE,30900002,89300,HC POST VASECTOMY SEMEN ANALYSIS,309,1 ,$95.45 ,$63.00 ,$9.64 ,$95.45 ,$10.17 ,$34.44 ,$34.44 ,$9.84 ,$57.27 ,$81.13 ,$66.82 ,$10.17 ,$10.17 ,$90.68 ,$72.54 ,$71.59 ,$16.73 ,$81.13 ,$9.84 ,$16.73 ,$16.73 ,$66.82 ,$58.13 ,$10.17 ,$9.84 ,$9.64 ,$19.68 ,$10.78 ,$81.13 ,$22.14 ,$87.81 ,$66.82 ,$44.58 ,$44.58 ,$58.13 ,$44.58 ,$65.96 ,$85.91 ,$65.21 ,$9.74 ,$75.41 ,$10.78 ,$11.81 ,$11.81 ,$9.64 ,$11.81 ,$68.72 ,$59.18 ,$68.72 ,$68.72 ,$76.36 
ST NICHOLAS HOSPITAL - ACUTE,30900199,87254,HC VIRUS ISOL SHELL ID,309,1 ,$159.85 ,$105.50 ,$7.06 ,$159.85 ,$7.06 ,$68.46 ,$68.46 ,$19.56 ,$95.91 ,$135.87 ,$111.90 ,$7.06 ,$7.06 ,$151.86 ,$121.49 ,$119.89 ,$33.25 ,$135.87 ,$19.56 ,$33.25 ,$33.25 ,$111.90 ,$97.35 ,$7.06 ,$19.56 ,$19.17 ,$39.12 ,$7.48 ,$135.87 ,$44.01 ,$147.06 ,$111.90 ,$97.74 ,$97.74 ,$97.35 ,$97.74 ,$110.46 ,$143.87 ,$109.21 ,$19.36 ,$126.28 ,$7.48 ,$23.47 ,$23.47 ,$19.17 ,$23.47 ,$115.09 ,$99.11 ,$115.09 ,$115.09 ,$127.88 
ST NICHOLAS HOSPITAL - ACUTE,30900200,81168,HC CCND1/IGH TRANSLOCATION ANALYSIS,309,1 ,$621.93 ,$410.47 ,$165.85 ,$621.93 ,$165.85 ,$621.93 ,$621.93 ,$207.31 ,$373.16 ,$528.64 ,$435.35 ,$165.85 ,$165.85 ,$590.83 ,$472.67 ,$466.45 ,$352.43 ,$528.64 ,$207.31 ,$352.43 ,$352.43 ,$435.35 ,$378.76 ,$165.85 ,$207.31 ,$203.16 ,$414.62 ,$175.80 ,$528.64 ,$466.45 ,$572.18 ,$435.35 ,$315.44 ,$378.57 ,$378.76 ,$378.57 ,$429.75 ,$559.74 ,$424.90 ,$205.19 ,$491.32 ,$175.80 ,$248.77 ,$248.77 ,$203.16 ,$248.77 ,$447.79 ,$385.60 ,$447.79 ,$447.79 ,$497.54 
ST NICHOLAS HOSPITAL - ACUTE,30900201,81278,HC IGH@/BCL2 TRANSLOCATION ALYS,309,1 ,$370.00 ,$244.20 ,$165.85 ,$466.45 ,$165.85 ,$370.00 ,$370.00 ,$207.31 ,$222.00 ,$314.50 ,$259.00 ,$165.85 ,$165.85 ,$351.50 ,$281.20 ,$277.50 ,$352.43 ,$314.50 ,$207.31 ,$352.43 ,$352.43 ,$259.00 ,$225.33 ,$165.85 ,$207.31 ,$203.16 ,$370.00 ,$175.80 ,$314.50 ,$466.45 ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$333.00 ,$252.78 ,$205.19 ,$292.30 ,$175.80 ,$248.77 ,$248.77 ,$203.16 ,$248.77 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,31000001,N/A,HC AUTOPSY PER BLOCK-CLINICS,310,1 ,$19.55 ,$12.90 ,$9.58 ,$19.55 , N/A ,$13.40 ,$13.40 , N/A ,$11.73 ,$16.62 ,$13.69 , N/A , N/A ,$18.57 ,$14.86 ,$14.66 , N/A ,$16.62 , N/A , N/A , N/A ,$13.69 ,$11.91 , N/A , N/A , N/A , N/A , N/A ,$16.62 , N/A ,$17.99 ,$13.69 ,$9.92 ,$11.90 ,$11.91 ,$11.90 ,$13.51 ,$17.60 ,$13.36 , N/A ,$15.44 , N/A ,$9.58 ,$9.58 , N/A ,$9.58 ,$14.08 ,$12.12 ,$14.08 ,$14.08 ,$15.64 
ST NICHOLAS HOSPITAL - ACUTE,31000002,N/A,HC AUTOPSY PER BLOCK-IN HOUSE,310,1 ,$42.55 ,$28.08 ,$20.85 ,$42.55 , N/A ,$29.16 ,$29.16 , N/A ,$25.53 ,$36.17 ,$29.79 , N/A , N/A ,$40.42 ,$32.34 ,$31.91 , N/A ,$36.17 , N/A , N/A , N/A ,$29.79 ,$25.91 , N/A , N/A , N/A , N/A , N/A ,$36.17 , N/A ,$39.15 ,$29.79 ,$21.58 ,$25.90 ,$25.91 ,$25.90 ,$29.40 ,$38.30 ,$29.07 , N/A ,$33.61 , N/A ,$20.85 ,$20.85 , N/A ,$20.85 ,$30.64 ,$26.38 ,$30.64 ,$30.64 ,$34.04 
ST NICHOLAS HOSPITAL - ACUTE,31000003,N/A,HC MORGUE USE,310,1 ,$257.60 ,$170.02 ,$126.22 ,$257.60 , N/A ,$176.56 ,$176.56 , N/A ,$154.56 ,$218.96 ,$180.32 , N/A , N/A ,$244.72 ,$195.78 ,$193.20 , N/A ,$218.96 , N/A , N/A , N/A ,$180.32 ,$156.88 , N/A , N/A , N/A , N/A , N/A ,$218.96 , N/A ,$236.99 ,$180.32 ,$130.65 ,$156.80 ,$156.88 ,$156.80 ,$178.00 ,$231.84 ,$175.99 , N/A ,$203.50 , N/A ,$126.22 ,$126.22 , N/A ,$126.22 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,31000006,88312,HC AUTOPSY SPECIAL STAIN LEVEL I,310,1 ,$32.20 ,$21.25 ,$1.25 ,$110.11 ,$1.25 ,$32.20 ,$32.20 ,$48.94 ,$19.32 ,$27.37 ,$22.54 ,$1.25 ,$1.25 ,$30.59 ,$24.47 ,$24.15 ,$32.20 ,$27.37 ,$48.94 ,$32.20 ,$32.20 ,$22.54 ,$19.61 ,$1.25 ,$48.94 ,$47.96 ,$32.20 ,$1.33 ,$27.37 ,$110.11 ,$29.62 ,$22.54 ,$16.33 ,$19.60 ,$19.61 ,$19.60 ,$22.25 ,$28.98 ,$22.00 ,$48.44 ,$25.44 ,$1.33 ,$32.20 ,$32.20 ,$47.96 ,$32.20 ,$23.18 ,$19.96 ,$23.18 ,$23.18 ,$25.76 
ST NICHOLAS HOSPITAL - ACUTE,31000007,88312,HC AUTOPSY SPECIAL STAIN LEVEL II,310,1 ,$39.10 ,$25.81 ,$1.25 ,$110.11 ,$1.25 ,$39.10 ,$39.10 ,$48.94 ,$23.46 ,$33.24 ,$27.37 ,$1.25 ,$1.25 ,$37.15 ,$29.72 ,$29.33 ,$39.10 ,$33.24 ,$48.94 ,$39.10 ,$39.10 ,$27.37 ,$23.81 ,$1.25 ,$48.94 ,$47.96 ,$39.10 ,$1.33 ,$33.24 ,$110.11 ,$35.97 ,$27.37 ,$19.83 ,$23.80 ,$23.81 ,$23.80 ,$27.02 ,$35.19 ,$26.71 ,$48.44 ,$30.89 ,$1.33 ,$39.10 ,$39.10 ,$47.96 ,$39.10 ,$28.15 ,$24.24 ,$28.15 ,$28.15 ,$31.28 
ST NICHOLAS HOSPITAL - ACUTE,31000008,88341,HC AUTOPSY IMMUNOPEROXIDASE QL,310,1 ,$56.35 ,$37.19 ,$3.61 ,$56.35 ,$3.61 ,$56.35 ,$56.35 , N/A ,$33.81 ,$47.90 ,$39.45 ,$3.61 ,$3.61 ,$53.53 ,$42.83 ,$42.26 ,$56.35 ,$47.90 , N/A ,$56.35 ,$56.35 ,$39.45 ,$34.32 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$47.90 , N/A ,$51.84 ,$39.45 ,$28.58 ,$34.30 ,$34.32 ,$34.30 ,$38.94 ,$50.72 ,$38.50 , N/A ,$44.52 ,$3.83 ,$56.35 ,$56.35 , N/A ,$56.35 ,$40.57 ,$34.94 ,$40.57 ,$40.57 ,$45.08 
ST NICHOLAS HOSPITAL - ACUTE,31000009,88360,HC AUTOPSY IMMUNOPEROXIDASE QN,310,1 ,$64.40 ,$42.50 ,$3.61 ,$345.32 ,$3.61 ,$64.40 ,$64.40 ,$153.48 ,$38.64 ,$54.74 ,$45.08 ,$3.61 ,$3.61 ,$61.18 ,$48.94 ,$48.30 ,$64.40 ,$54.74 ,$153.48 ,$64.40 ,$64.40 ,$45.08 ,$39.22 ,$3.61 ,$153.48 ,$150.41 ,$64.40 ,$3.83 ,$54.74 ,$345.32 ,$59.25 ,$45.08 ,$32.66 ,$39.20 ,$39.22 ,$39.20 ,$44.50 ,$57.96 ,$44.00 ,$151.91 ,$50.88 ,$3.83 ,$64.40 ,$64.40 ,$150.41 ,$64.40 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,31000010,81206,HC BCR/ABL1 GENE MAJOR BP,310,1 ,$978.65 ,$645.91 ,$160.68 ,$978.65 ,$169.42 ,$573.86 ,$573.86 ,$163.96 ,$587.19 ,$831.85 ,$685.06 ,$169.42 ,$169.42 ,$929.72 ,$743.77 ,$733.99 ,$278.73 ,$831.85 ,$163.96 ,$278.73 ,$278.73 ,$685.06 ,$596.00 ,$169.42 ,$163.96 ,$160.68 ,$327.92 ,$179.59 ,$831.85 ,$368.91 ,$900.36 ,$685.06 ,$819.49 ,$819.49 ,$596.00 ,$819.49 ,$676.25 ,$880.79 ,$668.61 ,$162.29 ,$773.13 ,$179.59 ,$196.75 ,$196.75 ,$160.68 ,$196.75 ,$704.63 ,$606.76 ,$704.63 ,$704.63 ,$782.92 
ST NICHOLAS HOSPITAL - ACUTE,31000011,81206,HC BCR/ABL1 GENE MAJOR BP QUEST,310,1 ,$540.50 ,$356.73 ,$160.68 ,$540.50 ,$169.42 ,$540.50 ,$540.50 ,$163.96 ,$324.30 ,$459.43 ,$378.35 ,$169.42 ,$169.42 ,$513.48 ,$410.78 ,$405.38 ,$278.73 ,$459.43 ,$163.96 ,$278.73 ,$278.73 ,$378.35 ,$329.16 ,$169.42 ,$163.96 ,$160.68 ,$327.92 ,$179.59 ,$459.43 ,$368.91 ,$497.26 ,$378.35 ,$540.50 ,$540.50 ,$329.16 ,$540.50 ,$373.49 ,$486.45 ,$369.27 ,$162.29 ,$427.00 ,$179.59 ,$196.75 ,$196.75 ,$160.68 ,$196.75 ,$389.16 ,$335.11 ,$389.16 ,$389.16 ,$432.40 
ST NICHOLAS HOSPITAL - ACUTE,31000012,81207,HC BCR/ABL1 GENE MINOR BP,310,1 ,"$1,184.50 ",$781.77 ,$141.94 ,"$1,184.50 ",$149.66 ,$506.94 ,$506.94 ,$144.84 ,$710.70 ,"$1,006.83 ",$829.15 ,$149.66 ,$149.66 ,"$1,125.28 ",$900.22 ,$888.38 ,$246.23 ,"$1,006.83 ",$144.84 ,$246.23 ,$246.23 ,$829.15 ,$721.36 ,$149.66 ,$144.84 ,$141.94 ,$289.68 ,$158.64 ,"$1,006.83 ",$325.89 ,"$1,089.74 ",$829.15 ,$723.87 ,$723.87 ,$721.36 ,$723.87 ,$818.49 ,"$1,066.05 ",$809.25 ,$143.36 ,$935.76 ,$158.64 ,$173.81 ,$173.81 ,$141.94 ,$173.81 ,$852.84 ,$734.39 ,$852.84 ,$852.84 ,$947.60 
ST NICHOLAS HOSPITAL - ACUTE,31000013,81226,HC CYP2D6 GENE COM VARIANTS,310,1 ,"$2,060.80 ","$1,360.13 ",$11.23 ,"$2,060.80 ",$11.23 ,"$1,578.19 ","$1,578.19 ",$450.91 ,"$1,236.48 ","$1,751.68 ","$1,442.56 ",$11.23 ,$11.23 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ",$766.55 ,"$1,751.68 ",$450.91 ,$766.55 ,$766.55 ,"$1,442.56 ","$1,255.03 ",$11.23 ,$450.91 ,$441.89 ,$901.82 ,$11.90 ,"$1,751.68 ","$1,014.55 ","$1,895.94 ","$1,442.56 ","$1,654.40 ","$1,654.40 ","$1,255.03 ","$1,654.40 ","$1,424.01 ","$1,854.72 ","$1,407.94 ",$446.31 ,"$1,628.03 ",$11.90 ,$541.09 ,$541.09 ,$441.89 ,$541.09 ,"$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,31000014,81228,HC CYTOGEN MICRARRAY COPY NO,310,1 ,"$2,601.30 ","$1,716.86 ",$516.91 ,"$2,601.30 ",$516.91 ,"$2,601.30 ","$2,601.30 ",$900.00 ,"$1,560.78 ","$2,211.11 ","$1,820.91 ",$516.91 ,$516.91 ,"$2,471.24 ","$1,976.99 ","$1,950.98 ","$1,530.00 ","$2,211.11 ",$900.00 ,"$1,530.00 ","$1,530.00 ","$1,820.91 ","$1,584.19 ",$516.91 ,$900.00 ,$882.00 ,"$1,800.00 ",$547.92 ,"$2,211.11 ","$2,025.00 ","$2,393.20 ","$1,820.91 ","$2,601.30 ","$2,601.30 ","$1,584.19 ","$2,601.30 ","$1,797.50 ","$2,341.17 ","$1,777.21 ",$890.82 ,"$2,055.03 ",$547.92 ,"$1,080.00 ","$1,080.00 ",$882.00 ,"$1,080.00 ","$1,872.94 ","$1,612.81 ","$1,872.94 ","$1,872.94 ","$2,081.04 "
ST NICHOLAS HOSPITAL - ACUTE,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 ,$65.69 ,$185.61 ,$262.95 ,$216.55 ,$53.70 ,$53.70 ,$293.88 ,$235.11 ,$232.01 ,$111.67 ,$262.95 ,$65.69 ,$111.67 ,$111.67 ,$216.55 ,$188.39 ,$53.70 ,$65.69 ,$64.38 ,$131.38 ,$56.92 ,$262.95 ,$147.80 ,$284.60 ,$216.55 ,$245.93 ,$245.93 ,$188.39 ,$245.93 ,$213.76 ,$278.42 ,$211.35 ,$65.02 ,$244.39 ,$56.92 ,$78.83 ,$78.83 ,$64.38 ,$78.83 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,31000016,81241,HC F5 GENE ANAL LEIDEN VAR,310,1 ,$309.35 ,$204.17 ,$66.70 ,$309.35 ,$66.70 ,$256.80 ,$256.80 ,$73.37 ,$185.61 ,$262.95 ,$216.55 ,$66.70 ,$66.70 ,$293.88 ,$235.11 ,$232.01 ,$124.73 ,$262.95 ,$73.37 ,$124.73 ,$124.73 ,$216.55 ,$188.39 ,$66.70 ,$73.37 ,$71.90 ,$146.74 ,$70.70 ,$262.95 ,$165.08 ,$284.60 ,$216.55 ,$305.43 ,$305.43 ,$188.39 ,$305.43 ,$213.76 ,$278.42 ,$211.35 ,$72.62 ,$244.39 ,$70.70 ,$88.04 ,$88.04 ,$71.90 ,$88.04 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,31000017,81243,HC FMR1 GENE CHARACTERZTN,310,1 ,$309.35 ,$204.17 ,$54.46 ,$309.35 ,$54.46 ,$199.64 ,$199.64 , N/A ,$185.61 ,$262.95 ,$216.55 ,$54.46 ,$54.46 ,$293.88 ,$235.11 ,$232.01 ,$96.97 ,$262.95 , N/A ,$96.97 ,$96.97 ,$216.55 ,$188.39 ,$54.46 , N/A , N/A , N/A ,$57.73 ,$262.95 ,$185.61 ,$284.60 ,$216.55 ,$208.97 ,$208.97 ,$188.39 ,$208.97 ,$213.76 ,$278.42 ,$211.35 , N/A ,$244.39 ,$57.73 ,$68.45 ,$68.45 , N/A ,$68.45 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,31000018,81256,HC HFE GENE,310,1 ,$554.30 ,$365.84 ,$64.05 ,$554.30 ,$67.54 ,$228.76 ,$228.76 ,$65.36 ,$332.58 ,$471.16 ,$388.01 ,$67.54 ,$67.54 ,$526.59 ,$421.27 ,$415.73 ,$111.11 ,$471.16 ,$65.36 ,$111.11 ,$111.11 ,$388.01 ,$337.57 ,$67.54 ,$65.36 ,$64.05 ,$130.72 ,$71.59 ,$471.16 ,$147.06 ,$509.96 ,$388.01 ,$326.67 ,$326.67 ,$337.57 ,$326.67 ,$383.02 ,$498.87 ,$378.70 ,$64.69 ,$437.90 ,$71.59 ,$78.43 ,$78.43 ,$64.05 ,$78.43 ,$399.10 ,$343.67 ,$399.10 ,$399.10 ,$443.44 
ST NICHOLAS HOSPITAL - ACUTE,31000019,81261,HC IGH GENE REARRNG AMP METH,310,1 ,"$2,084.95 ","$1,376.07 ",$194.03 ,"$2,084.95 ",$204.58 ,$692.97 ,$692.97 ,$197.99 ,"$1,250.97 ","$1,772.21 ","$1,459.47 ",$204.58 ,$204.58 ,"$1,980.70 ","$1,584.56 ","$1,563.71 ",$336.58 ,"$1,772.21 ",$197.99 ,$336.58 ,$336.58 ,"$1,459.47 ","$1,269.73 ",$204.58 ,$197.99 ,$194.03 ,$395.98 ,$216.85 ,"$1,772.21 ",$445.48 ,"$1,918.15 ","$1,459.47 ",$989.55 ,$989.55 ,"$1,269.73 ",$989.55 ,"$1,440.70 ","$1,876.46 ","$1,424.44 ",$195.97 ,"$1,647.11 ",$216.85 ,$237.59 ,$237.59 ,$194.03 ,$237.59 ,"$1,501.16 ","$1,292.67 ","$1,501.16 ","$1,501.16 ","$1,667.96 "
ST NICHOLAS HOSPITAL - ACUTE,31000020,81264,HC IGK REARRANGE CLONAL POP,310,1 ,"$2,084.95 ","$1,376.07 ",$162.98 ,"$2,084.95 ",$162.98 ,$604.56 ,$604.56 ,$172.73 ,"$1,250.97 ","$1,772.21 ","$1,459.47 ",$162.98 ,$162.98 ,"$1,980.70 ","$1,584.56 ","$1,563.71 ",$293.64 ,"$1,772.21 ",$172.73 ,$293.64 ,$293.64 ,"$1,459.47 ","$1,269.73 ",$162.98 ,$172.73 ,$169.28 ,$345.46 ,$172.76 ,"$1,772.21 ",$388.64 ,"$1,918.15 ","$1,459.47 ",$746.33 ,$746.33 ,"$1,269.73 ",$746.33 ,"$1,440.70 ","$1,876.46 ","$1,424.44 ",$170.97 ,"$1,647.11 ",$172.76 ,$207.28 ,$207.28 ,$169.28 ,$207.28 ,"$1,501.16 ","$1,292.67 ","$1,501.16 ","$1,501.16 ","$1,667.96 "
ST NICHOLAS HOSPITAL - ACUTE,31000021,81275,HC KRAS GENE,310,1 ,"$1,210.95 ",$799.23 ,$157.98 ,"$1,210.95 ",$157.98 ,$676.38 ,$676.38 ,$193.25 ,$726.57 ,"$1,029.31 ",$847.67 ,$157.98 ,$157.98 ,"$1,150.40 ",$920.32 ,$908.21 ,$328.53 ,"$1,029.31 ",$193.25 ,$328.53 ,$328.53 ,$847.67 ,$737.47 ,$157.98 ,$193.25 ,$189.38 ,$386.50 ,$167.46 ,"$1,029.31 ",$434.81 ,"$1,114.07 ",$847.67 ,$723.47 ,$723.47 ,$737.47 ,$723.47 ,$836.77 ,"$1,089.86 ",$827.32 ,$191.28 ,$956.65 ,$167.46 ,$231.90 ,$231.90 ,$189.38 ,$231.90 ,$871.88 ,$750.79 ,$871.88 ,$871.88 ,$968.76 
ST NICHOLAS HOSPITAL - ACUTE,31000022,81291,HC MTHFR ISOLATION,310,1 ,$386.40 ,$255.02 ,$1.46 ,$386.40 ,$1.46 ,$228.69 ,$228.69 ,$65.34 ,$231.84 ,$328.44 ,$270.48 ,$1.46 ,$1.46 ,$367.08 ,$293.66 ,$289.80 ,$111.08 ,$328.44 ,$65.34 ,$111.08 ,$111.08 ,$270.48 ,$235.32 ,$1.46 ,$65.34 ,$64.03 ,$130.68 ,$1.55 ,$328.44 ,$147.02 ,$355.49 ,$270.48 ,$218.16 ,$218.16 ,$235.32 ,$218.16 ,$267.00 ,$347.76 ,$263.99 ,$64.67 ,$305.26 ,$1.55 ,$78.41 ,$78.41 ,$64.03 ,$78.41 ,$278.21 ,$239.57 ,$278.21 ,$278.21 ,$309.12 
ST NICHOLAS HOSPITAL - ACUTE,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 ",$348.56 ,$842.49 ,"$1,193.53 ",$982.91 ,$316.03 ,$316.03 ,"$1,333.94 ","$1,067.15 ","$1,053.11 ",$592.55 ,"$1,193.53 ",$348.56 ,$592.55 ,$592.55 ,$982.91 ,$855.13 ,$316.03 ,$348.56 ,$341.59 ,$697.12 ,$334.99 ,"$1,193.53 ",$784.26 ,"$1,291.82 ",$982.91 ,"$1,404.15 ","$1,404.15 ",$855.13 ,"$1,404.15 ",$970.27 ,"$1,263.74 ",$959.32 ,$345.01 ,"$1,109.28 ",$334.99 ,$418.27 ,$418.27 ,$341.59 ,$418.27 ,"$1,010.99 ",$870.57 ,"$1,010.99 ","$1,010.99 ","$1,123.32 "
ST NICHOLAS HOSPITAL - ACUTE,31000024,81291,HC MTHFR GENE BC,310,1 ,$386.40 ,$255.02 ,$1.46 ,$386.40 ,$1.46 ,$228.69 ,$228.69 ,$65.34 ,$231.84 ,$328.44 ,$270.48 ,$1.46 ,$1.46 ,$367.08 ,$293.66 ,$289.80 ,$111.08 ,$328.44 ,$65.34 ,$111.08 ,$111.08 ,$270.48 ,$235.32 ,$1.46 ,$65.34 ,$64.03 ,$130.68 ,$1.55 ,$328.44 ,$147.02 ,$355.49 ,$270.48 ,$218.16 ,$218.16 ,$235.32 ,$218.16 ,$267.00 ,$347.76 ,$263.99 ,$64.67 ,$305.26 ,$1.55 ,$78.41 ,$78.41 ,$64.03 ,$78.41 ,$278.21 ,$239.57 ,$278.21 ,$278.21 ,$309.12 
ST NICHOLAS HOSPITAL - ACUTE,31000025,81301,HC HNCP MICROSATL INSTABLTY,310,1 ,$672.75 ,$444.02 ,$316.03 ,$784.26 ,$316.03 ,$672.75 ,$672.75 ,$348.56 ,$403.65 ,$571.84 ,$470.93 ,$316.03 ,$316.03 ,$639.11 ,$511.29 ,$504.56 ,$592.55 ,$571.84 ,$348.56 ,$592.55 ,$592.55 ,$470.93 ,$409.70 ,$316.03 ,$348.56 ,$341.59 ,$672.75 ,$334.99 ,$571.84 ,$784.26 ,$618.93 ,$470.93 ,$672.75 ,$672.75 ,$409.70 ,$672.75 ,$464.87 ,$605.48 ,$459.62 ,$345.01 ,$531.47 ,$334.99 ,$418.27 ,$418.27 ,$341.59 ,$418.27 ,$484.38 ,$417.11 ,$484.38 ,$484.38 ,$538.20 
ST NICHOLAS HOSPITAL - ACUTE,31000026,81315,HC PML/RARAL COM BRKPNTS,310,1 ,"$1,120.10 ",$739.27 ,$203.16 ,"$1,120.10 ",$214.21 ,$725.59 ,$725.59 ,$207.31 ,$672.06 ,$952.09 ,$784.07 ,$214.21 ,$214.21 ,"$1,064.10 ",$851.28 ,$840.08 ,$352.43 ,$952.09 ,$207.31 ,$352.43 ,$352.43 ,$784.07 ,$682.14 ,$214.21 ,$207.31 ,$203.16 ,$414.62 ,$227.06 ,$952.09 ,$466.45 ,"$1,030.49 ",$784.07 ,"$1,036.15 ","$1,036.15 ",$682.14 ,"$1,036.15 ",$773.99 ,"$1,008.09 ",$765.25 ,$205.19 ,$884.88 ,$227.06 ,$248.77 ,$248.77 ,$203.16 ,$248.77 ,$806.47 ,$694.46 ,$806.47 ,$806.47 ,$896.08 
ST NICHOLAS HOSPITAL - ACUTE,31000027,81331,HC SNRPN/UBE3A GENE,310,1 ,$425.50 ,$280.83 ,$50.05 ,$425.50 ,$52.77 ,$178.75 ,$178.75 ,$51.07 ,$255.30 ,$361.68 ,$297.85 ,$52.77 ,$52.77 ,$404.23 ,$323.38 ,$319.13 ,$86.82 ,$361.68 ,$51.07 ,$86.82 ,$86.82 ,$297.85 ,$259.13 ,$52.77 ,$51.07 ,$50.05 ,$102.14 ,$55.94 ,$361.68 ,$114.91 ,$391.46 ,$297.85 ,$187.09 ,$187.09 ,$259.13 ,$187.09 ,$294.02 ,$382.95 ,$290.70 ,$50.55 ,$336.15 ,$55.94 ,$61.28 ,$61.28 ,$50.05 ,$61.28 ,$306.36 ,$263.81 ,$306.36 ,$306.36 ,$340.40 
ST NICHOLAS HOSPITAL - ACUTE,31000028,81332,HC SERPINA1 GENE,310,1 ,"$1,221.30 ",$806.06 ,$1.46 ,"$1,221.30 ",$1.46 ,$152.78 ,$152.78 ,$43.65 ,$732.78 ,"$1,038.11 ",$854.91 ,$1.46 ,$1.46 ,"$1,160.24 ",$928.19 ,$915.98 ,$74.21 ,"$1,038.11 ",$43.65 ,$74.21 ,$74.21 ,$854.91 ,$743.77 ,$1.46 ,$43.65 ,$42.78 ,$87.30 ,$1.55 ,"$1,038.11 ",$98.21 ,"$1,123.60 ",$854.91 ,$218.16 ,$218.16 ,$743.77 ,$218.16 ,$843.92 ,"$1,099.17 ",$834.39 ,$43.21 ,$964.83 ,$1.55 ,$52.38 ,$52.38 ,$42.78 ,$52.38 ,$879.34 ,$757.21 ,$879.34 ,$879.34 ,$977.04 
ST NICHOLAS HOSPITAL - ACUTE,31000029,81383,HC HLA II TYPING ALLELE HR,310,1 ,$818.80 ,$540.41 ,$106.95 ,$818.80 ,$112.76 ,$381.96 ,$381.96 ,$109.13 ,$491.28 ,$695.98 ,$573.16 ,$112.76 ,$112.76 ,$777.86 ,$622.29 ,$614.10 ,$185.52 ,$695.98 ,$109.13 ,$185.52 ,$185.52 ,$573.16 ,$498.65 ,$112.76 ,$109.13 ,$106.95 ,$218.26 ,$119.53 ,$695.98 ,$245.54 ,$753.30 ,$573.16 ,$545.42 ,$545.42 ,$498.65 ,$545.42 ,$565.79 ,$736.92 ,$559.40 ,$108.02 ,$646.85 ,$119.53 ,$130.96 ,$130.96 ,$106.95 ,$130.96 ,$589.54 ,$507.66 ,$589.54 ,$589.54 ,$655.04 
ST NICHOLAS HOSPITAL - ACUTE,31000030,81400,HC DPD MOPATH PROCEDURE L1,310,1 ,$483.00 ,$318.78 ,$51.17 ,$483.00 ,$51.17 ,$223.86 ,$223.86 ,$63.96 ,$289.80 ,$410.55 ,$338.10 ,$51.17 ,$51.17 ,$458.85 ,$367.08 ,$362.25 ,$108.73 ,$410.55 ,$63.96 ,$108.73 ,$108.73 ,$338.10 ,$294.15 ,$51.17 ,$63.96 ,$62.68 ,$127.92 ,$54.24 ,$410.55 ,$143.91 ,$444.36 ,$338.10 ,$234.32 ,$234.32 ,$294.15 ,$234.32 ,$333.75 ,$434.70 ,$329.99 ,$63.31 ,$381.57 ,$54.24 ,$76.75 ,$76.75 ,$62.68 ,$76.75 ,$347.76 ,$299.46 ,$347.76 ,$347.76 ,$386.40 
ST NICHOLAS HOSPITAL - ACUTE,31000031,81401,HC HUNT MOPATH PROCEDURE L2,310,1 ,$515.20 ,$340.03 ,$109.60 ,$515.20 ,$109.60 ,$479.50 ,$479.50 , N/A ,$309.12 ,$437.92 ,$360.64 ,$109.60 ,$109.60 ,$489.44 ,$391.55 ,$386.40 ,$232.90 ,$437.92 , N/A ,$232.90 ,$232.90 ,$360.64 ,$313.76 ,$109.60 , N/A , N/A , N/A ,$116.18 ,$437.92 ,$309.12 ,$473.98 ,$360.64 ,$501.90 ,$501.90 ,$313.76 ,$501.90 ,$356.00 ,$463.68 ,$351.98 , N/A ,$407.01 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 ,$370.94 ,$319.42 ,$370.94 ,$370.94 ,$412.16 
ST NICHOLAS HOSPITAL - ACUTE,31000032,81402,HC TCR MOPATH PROCED L3,310,1 ,$676.20 ,$446.29 ,$120.26 ,$676.20 ,$120.26 ,$526.16 ,$526.16 , N/A ,$405.72 ,$574.77 ,$473.34 ,$120.26 ,$120.26 ,$642.39 ,$513.91 ,$507.15 ,$255.56 ,$574.77 , N/A ,$255.56 ,$255.56 ,$473.34 ,$411.81 ,$120.26 , N/A , N/A , N/A ,$127.48 ,$574.77 ,$405.72 ,$622.10 ,$473.34 ,$550.73 ,$550.73 ,$411.81 ,$550.73 ,$467.25 ,$608.58 ,$461.98 , N/A ,$534.20 ,$127.48 ,$180.40 ,$180.40 , N/A ,$180.40 ,$486.86 ,$419.24 ,$486.86 ,$486.86 ,$540.96 
ST NICHOLAS HOSPITAL - ACUTE,31000033,81270,HC JAK2 GENE,310,1 ,$644.00 ,$425.04 ,$89.83 ,$644.00 ,$94.71 ,$320.81 ,$320.81 ,$91.66 ,$386.40 ,$547.40 ,$450.80 ,$94.71 ,$94.71 ,$611.80 ,$489.44 ,$483.00 ,$155.82 ,$547.40 ,$91.66 ,$155.82 ,$155.82 ,$450.80 ,$392.20 ,$94.71 ,$91.66 ,$89.83 ,$183.32 ,$100.39 ,$547.40 ,$206.24 ,$592.48 ,$450.80 ,$458.16 ,$458.16 ,$392.20 ,$458.16 ,$445.00 ,$579.60 ,$439.98 ,$90.73 ,$508.76 ,$100.39 ,$109.99 ,$109.99 ,$89.83 ,$109.99 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,31000050,81241,HC FACTOR V GENE ANALYSIS (HR2),310,1 ,$478.40 ,$315.74 ,$66.70 ,$478.40 ,$66.70 ,$256.80 ,$256.80 ,$73.37 ,$287.04 ,$406.64 ,$334.88 ,$66.70 ,$66.70 ,$454.48 ,$363.58 ,$358.80 ,$124.73 ,$406.64 ,$73.37 ,$124.73 ,$124.73 ,$334.88 ,$291.35 ,$66.70 ,$73.37 ,$71.90 ,$146.74 ,$70.70 ,$406.64 ,$165.08 ,$440.13 ,$334.88 ,$305.43 ,$305.43 ,$291.35 ,$305.43 ,$330.57 ,$430.56 ,$326.84 ,$72.62 ,$377.94 ,$70.70 ,$88.04 ,$88.04 ,$71.90 ,$88.04 ,$344.45 ,$296.61 ,$344.45 ,$344.45 ,$382.72 
ST NICHOLAS HOSPITAL - ACUTE,31000051,81220,HC CFTR GENE ANALYSIS,310,1 ,$940.70 ,$620.86 ,$210.00 ,"$1,252.35 ",$210.00 ,$940.70 ,$940.70 ,$556.60 ,$564.42 ,$799.60 ,$658.49 ,$210.00 ,$210.00 ,$893.67 ,$714.93 ,$705.53 ,$940.70 ,$799.60 ,$556.60 ,$940.70 ,$940.70 ,$658.49 ,$572.89 ,$210.00 ,$556.60 ,$545.47 ,$940.70 ,$222.60 ,$799.60 ,"$1,252.35 ",$865.44 ,$658.49 ,$940.70 ,$940.70 ,$572.89 ,$940.70 ,$650.02 ,$846.63 ,$642.69 ,$550.93 ,$743.15 ,$222.60 ,$667.92 ,$667.92 ,$545.47 ,$667.92 ,$677.30 ,$583.23 ,$677.30 ,$677.30 ,$752.56 
ST NICHOLAS HOSPITAL - ACUTE,31000052,81332,HC SERPINA1 GENE ANALYSIS (AAT),310,1 ,$862.50 ,$569.25 ,$1.46 ,$862.50 ,$1.46 ,$152.78 ,$152.78 ,$43.65 ,$517.50 ,$733.13 ,$603.75 ,$1.46 ,$1.46 ,$819.38 ,$655.50 ,$646.88 ,$74.21 ,$733.13 ,$43.65 ,$74.21 ,$74.21 ,$603.75 ,$525.26 ,$1.46 ,$43.65 ,$42.78 ,$87.30 ,$1.55 ,$733.13 ,$98.21 ,$793.50 ,$603.75 ,$218.16 ,$218.16 ,$525.26 ,$218.16 ,$595.99 ,$776.25 ,$589.26 ,$43.21 ,$681.38 ,$1.55 ,$52.38 ,$52.38 ,$42.78 ,$52.38 ,$621.00 ,$534.75 ,$621.00 ,$621.00 ,$690.00 
ST NICHOLAS HOSPITAL - ACUTE,31000053,81342,HC TRG GENE ARRANGEMENT ANALYSIS,310,1 ,"$1,509.95 ",$996.57 ,$197.47 ,"$1,509.95 ",$208.21 ,$705.25 ,$705.25 ,$201.50 ,$905.97 ,"$1,283.46 ","$1,056.97 ",$208.21 ,$208.21 ,"$1,434.45 ","$1,147.56 ","$1,132.46 ",$342.55 ,"$1,283.46 ",$201.50 ,$342.55 ,$342.55 ,"$1,056.97 ",$919.56 ,$208.21 ,$201.50 ,$197.47 ,$403.00 ,$220.70 ,"$1,283.46 ",$453.38 ,"$1,389.15 ","$1,056.97 ","$1,007.10 ","$1,007.10 ",$919.56 ,"$1,007.10 ","$1,043.38 ","$1,358.96 ","$1,031.60 ",$199.45 ,"$1,192.86 ",$220.70 ,$241.80 ,$241.80 ,$197.47 ,$241.80 ,"$1,087.16 ",$936.17 ,"$1,087.16 ","$1,087.16 ","$1,207.96 "
ST NICHOLAS HOSPITAL - ACUTE,31000054,81261,HC AMPLIFIED METH IG GRA,310,1 ,$566.95 ,$374.19 ,$194.03 ,$566.95 ,$204.58 ,$566.95 ,$566.95 ,$197.99 ,$340.17 ,$481.91 ,$396.87 ,$204.58 ,$204.58 ,$538.60 ,$430.88 ,$425.21 ,$336.58 ,$481.91 ,$197.99 ,$336.58 ,$336.58 ,$396.87 ,$345.27 ,$204.58 ,$197.99 ,$194.03 ,$395.98 ,$216.85 ,$481.91 ,$445.48 ,$521.59 ,$396.87 ,$566.95 ,$566.95 ,$345.27 ,$566.95 ,$391.76 ,$510.26 ,$387.34 ,$195.97 ,$447.89 ,$216.85 ,$237.59 ,$237.59 ,$194.03 ,$237.59 ,$408.20 ,$351.51 ,$408.20 ,$408.20 ,$453.56 
ST NICHOLAS HOSPITAL - ACUTE,31000055,81264,HC EVAL CLONAL POP IG GRA,310,1 ,$566.95 ,$374.19 ,$162.98 ,$566.95 ,$162.98 ,$566.95 ,$566.95 ,$172.73 ,$340.17 ,$481.91 ,$396.87 ,$162.98 ,$162.98 ,$538.60 ,$430.88 ,$425.21 ,$293.64 ,$481.91 ,$172.73 ,$293.64 ,$293.64 ,$396.87 ,$345.27 ,$162.98 ,$172.73 ,$169.28 ,$345.46 ,$172.76 ,$481.91 ,$388.64 ,$521.59 ,$396.87 ,$566.95 ,$566.95 ,$345.27 ,$566.95 ,$391.76 ,$510.26 ,$387.34 ,$170.97 ,$447.89 ,$172.76 ,$207.28 ,$207.28 ,$169.28 ,$207.28 ,$408.20 ,$351.51 ,$408.20 ,$408.20 ,$453.56 
ST NICHOLAS HOSPITAL - ACUTE,31000060,81241,HC F5 GENE ANAL LEIDEN VAR,310,1 ,$428.95 ,$283.11 ,$66.70 ,$428.95 ,$66.70 ,$256.80 ,$256.80 ,$73.37 ,$257.37 ,$364.61 ,$300.27 ,$66.70 ,$66.70 ,$407.50 ,$326.00 ,$321.71 ,$124.73 ,$364.61 ,$73.37 ,$124.73 ,$124.73 ,$300.27 ,$261.23 ,$66.70 ,$73.37 ,$71.90 ,$146.74 ,$70.70 ,$364.61 ,$165.08 ,$394.63 ,$300.27 ,$305.43 ,$305.43 ,$261.23 ,$305.43 ,$296.40 ,$386.06 ,$293.06 ,$72.62 ,$338.87 ,$70.70 ,$88.04 ,$88.04 ,$71.90 ,$88.04 ,$308.84 ,$265.95 ,$308.84 ,$308.84 ,$343.16 
ST NICHOLAS HOSPITAL - ACUTE,31000061,81256,HC HFE GENE ANALYSIS,310,1 ,$105.80 ,$69.83 ,$63.48 ,$147.06 ,$67.54 ,$105.80 ,$105.80 ,$65.36 ,$63.48 ,$89.93 ,$74.06 ,$67.54 ,$67.54 ,$100.51 ,$80.41 ,$79.35 ,$105.80 ,$89.93 ,$65.36 ,$105.80 ,$105.80 ,$74.06 ,$64.43 ,$67.54 ,$65.36 ,$64.05 ,$105.80 ,$71.59 ,$89.93 ,$147.06 ,$97.34 ,$74.06 ,$105.80 ,$105.80 ,$64.43 ,$105.80 ,$73.11 ,$95.22 ,$72.28 ,$64.69 ,$83.58 ,$71.59 ,$78.43 ,$78.43 ,$64.05 ,$78.43 ,$76.18 ,$65.60 ,$76.18 ,$76.18 ,$84.64 
ST NICHOLAS HOSPITAL - ACUTE,31000062,81270,HC JAK2 GENE ANALYSIS,310,1 ,"$1,391.50 ",$918.39 ,$89.83 ,"$1,391.50 ",$94.71 ,$320.81 ,$320.81 ,$91.66 ,$834.90 ,"$1,182.78 ",$974.05 ,$94.71 ,$94.71 ,"$1,321.93 ","$1,057.54 ","$1,043.63 ",$155.82 ,"$1,182.78 ",$91.66 ,$155.82 ,$155.82 ,$974.05 ,$847.42 ,$94.71 ,$91.66 ,$89.83 ,$183.32 ,$100.39 ,"$1,182.78 ",$206.24 ,"$1,280.18 ",$974.05 ,$458.16 ,$458.16 ,$847.42 ,$458.16 ,$961.53 ,"$1,252.35 ",$950.67 ,$90.73 ,"$1,099.29 ",$100.39 ,$109.99 ,$109.99 ,$89.83 ,$109.99 ,"$1,001.88 ",$862.73 ,"$1,001.88 ","$1,001.88 ","$1,113.20 "
ST NICHOLAS HOSPITAL - ACUTE,31000073,81207,HC BCR/ABL1 GENE MINOR BP QUEST,310,1 ,$386.40 ,$255.02 ,$141.94 ,$386.40 ,$149.66 ,$386.40 ,$386.40 ,$144.84 ,$231.84 ,$328.44 ,$270.48 ,$149.66 ,$149.66 ,$367.08 ,$293.66 ,$289.80 ,$246.23 ,$328.44 ,$144.84 ,$246.23 ,$246.23 ,$270.48 ,$235.32 ,$149.66 ,$144.84 ,$141.94 ,$289.68 ,$158.64 ,$328.44 ,$325.89 ,$355.49 ,$270.48 ,$386.40 ,$386.40 ,$235.32 ,$386.40 ,$267.00 ,$347.76 ,$263.99 ,$143.36 ,$305.26 ,$158.64 ,$173.81 ,$173.81 ,$141.94 ,$173.81 ,$278.21 ,$239.57 ,$278.21 ,$278.21 ,$309.12 
ST NICHOLAS HOSPITAL - ACUTE,31000101,83540,HC IRON LIVER TISSUE,310,1 ,$128.80 ,$85.01 ,$6.34 ,$128.80 ,$6.69 ,$22.65 ,$22.65 ,$6.47 ,$77.28 ,$109.48 ,$90.16 ,$6.69 ,$6.69 ,$122.36 ,$97.89 ,$96.60 ,$11.00 ,$109.48 ,$6.47 ,$11.00 ,$11.00 ,$90.16 ,$78.44 ,$6.69 ,$6.47 ,$6.34 ,$12.94 ,$7.09 ,$109.48 ,$14.56 ,$118.50 ,$90.16 ,$32.35 ,$32.35 ,$78.44 ,$32.35 ,$89.00 ,$115.92 ,$88.00 ,$6.40 ,$101.75 ,$7.09 ,$7.76 ,$7.76 ,$6.34 ,$7.76 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,31000102,80500,HC CLINAL PATH CONSULT LTD,310,1 ,$175.95 ,$116.13 ,$36.26 ,$175.95 , N/A ,$58.34 ,$58.34 , N/A ,$105.57 ,$149.56 ,$123.17 , N/A , N/A ,$167.15 ,$133.72 ,$131.96 ,$36.26 ,$149.56 , N/A ,$36.26 ,$36.26 ,$123.17 ,$107.15 , N/A , N/A , N/A , N/A , N/A ,$149.56 , N/A ,$161.87 ,$123.17 ,$89.24 ,$107.10 ,$107.15 ,$107.10 ,$121.58 ,$158.36 ,$120.21 , N/A ,$139.00 , N/A ,$86.22 ,$86.22 , N/A ,$86.22 ,$126.68 ,$109.09 ,$126.68 ,$126.68 ,$140.76 
ST NICHOLAS HOSPITAL - ACUTE,31000105,81313,HC PROSTATE CANCER ANTIGEN 3,310,1 ,"$1,545.60 ","$1,020.10 ",$4.90 ,"$1,545.60 ",$4.90 ,$892.68 ,$892.68 ,$255.05 ,$927.36 ,"$1,313.76 ","$1,081.92 ",$4.90 ,$4.90 ,"$1,468.32 ","$1,174.66 ","$1,159.20 ",$433.59 ,"$1,313.76 ",$255.05 ,$433.59 ,$433.59 ,"$1,081.92 ",$941.27 ,$4.90 ,$255.05 ,$249.95 ,$510.10 ,$5.19 ,"$1,313.76 ",$573.86 ,"$1,421.95 ","$1,081.92 ",$953.46 ,$953.46 ,$941.27 ,$953.46 ,"$1,068.01 ","$1,391.04 ","$1,055.95 ",$252.45 ,"$1,221.02 ",$5.19 ,$306.06 ,$306.06 ,$249.95 ,$306.06 ,"$1,112.83 ",$958.27 ,"$1,112.83 ","$1,112.83 ","$1,236.48 "
ST NICHOLAS HOSPITAL - ACUTE,31000106,81401,HC MOPATH PROC L2,310,1 ,$527.85 ,$348.38 ,$109.60 ,$527.85 ,$109.60 ,$479.50 ,$479.50 , N/A ,$316.71 ,$448.67 ,$369.50 ,$109.60 ,$109.60 ,$501.46 ,$401.17 ,$395.89 ,$232.90 ,$448.67 , N/A ,$232.90 ,$232.90 ,$369.50 ,$321.46 ,$109.60 , N/A , N/A , N/A ,$116.18 ,$448.67 ,$316.71 ,$485.62 ,$369.50 ,$501.90 ,$501.90 ,$321.46 ,$501.90 ,$364.74 ,$475.07 ,$360.63 , N/A ,$417.00 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 ,$380.05 ,$327.27 ,$380.05 ,$380.05 ,$422.28 
ST NICHOLAS HOSPITAL - ACUTE,31000109,81170,HC ABL1 GENE ANALYSIS KINASE DOMAIN,310,1 ,$540.50 ,$356.73 ,$195.07 ,$675.00 ,$195.07 ,$540.50 ,$540.50 ,$300.00 ,$324.30 ,$459.43 ,$378.35 ,$195.07 ,$195.07 ,$513.48 ,$410.78 ,$405.38 ,$510.00 ,$459.43 ,$300.00 ,$510.00 ,$510.00 ,$378.35 ,$329.16 ,$195.07 ,$300.00 ,$294.00 ,$540.50 ,$206.77 ,$459.43 ,$675.00 ,$497.26 ,$378.35 ,$540.50 ,$540.50 ,$329.16 ,$540.50 ,$373.49 ,$486.45 ,$369.27 ,$296.94 ,$427.00 ,$206.77 ,$360.00 ,$360.00 ,$294.00 ,$360.00 ,$389.16 ,$335.11 ,$389.16 ,$389.16 ,$432.40 
ST NICHOLAS HOSPITAL - ACUTE,31000110,81218,HC CEBPA GENE ANALYSIS FULL SEQUENCE,310,1 ,$540.50 ,$356.73 ,$195.07 ,$544.28 ,$195.07 ,$540.50 ,$540.50 ,$241.90 ,$324.30 ,$459.43 ,$378.35 ,$195.07 ,$195.07 ,$513.48 ,$410.78 ,$405.38 ,$411.23 ,$459.43 ,$241.90 ,$411.23 ,$411.23 ,$378.35 ,$329.16 ,$195.07 ,$241.90 ,$237.06 ,$483.80 ,$206.77 ,$459.43 ,$544.28 ,$497.26 ,$378.35 ,$540.50 ,$540.50 ,$329.16 ,$540.50 ,$373.49 ,$486.45 ,$369.27 ,$239.43 ,$427.00 ,$206.77 ,$290.28 ,$290.28 ,$237.06 ,$290.28 ,$389.16 ,$335.11 ,$389.16 ,$389.16 ,$432.40 
ST NICHOLAS HOSPITAL - ACUTE,31000111,81219,HC CALR GENE ANALYSIS EXON 9,310,1 ,$540.50 ,$356.73 ,$98.08 ,$540.50 ,$98.08 ,$425.71 ,$425.71 ,$121.63 ,$324.30 ,$459.43 ,$378.35 ,$98.08 ,$98.08 ,$513.48 ,$410.78 ,$405.38 ,$206.77 ,$459.43 ,$121.63 ,$206.77 ,$206.77 ,$378.35 ,$329.16 ,$98.08 ,$121.63 ,$119.20 ,$243.26 ,$103.96 ,$459.43 ,$273.67 ,$497.26 ,$378.35 ,$540.50 ,$540.50 ,$329.16 ,$540.50 ,$373.49 ,$486.45 ,$369.27 ,$120.39 ,$427.00 ,$103.96 ,$145.96 ,$145.96 ,$119.20 ,$145.96 ,$389.16 ,$335.11 ,$389.16 ,$389.16 ,$432.40 
ST NICHOLAS HOSPITAL - ACUTE,31000112,81226,HC CYP2D6 GENE ANALYSIS COMMON VARIANTS,310,1 ,$695.75 ,$459.20 ,$11.23 ,"$1,014.55 ",$11.23 ,$695.75 ,$695.75 ,$450.91 ,$417.45 ,$591.39 ,$487.03 ,$11.23 ,$11.23 ,$660.96 ,$528.77 ,$521.81 ,$695.75 ,$591.39 ,$450.91 ,$695.75 ,$695.75 ,$487.03 ,$423.71 ,$11.23 ,$450.91 ,$441.89 ,$695.75 ,$11.90 ,$591.39 ,"$1,014.55 ",$640.09 ,$487.03 ,$695.75 ,$695.75 ,$423.71 ,$695.75 ,$480.76 ,$626.18 ,$475.34 ,$446.31 ,$549.64 ,$11.90 ,$541.09 ,$541.09 ,$441.89 ,$541.09 ,$500.94 ,$431.37 ,$500.94 ,$500.94 ,$556.60 
ST NICHOLAS HOSPITAL - ACUTE,31000113,81245,HC FLT3 GENE ANALYSIS INT TANDEM DUP VARIANTS,310,1 ,$322.00 ,$212.52 ,$132.74 ,$372.40 ,$132.74 ,$322.00 ,$322.00 ,$165.51 ,$193.20 ,$273.70 ,$225.40 ,$132.74 ,$132.74 ,$305.90 ,$244.72 ,$241.50 ,$281.37 ,$273.70 ,$165.51 ,$281.37 ,$281.37 ,$225.40 ,$196.10 ,$132.74 ,$165.51 ,$162.20 ,$322.00 ,$140.70 ,$273.70 ,$372.40 ,$296.24 ,$225.40 ,$322.00 ,$322.00 ,$196.10 ,$322.00 ,$222.50 ,$289.80 ,$219.99 ,$163.83 ,$254.38 ,$140.70 ,$198.61 ,$198.61 ,$162.20 ,$198.61 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,31000114,81246,HC FL53 GENE ANALYSIS TYROSINE KINASE VARIANTS,310,1 ,$270.25 ,$178.37 ,$81.34 ,$270.25 ,$85.76 ,$270.25 ,$270.25 ,$83.00 ,$162.15 ,$229.71 ,$189.18 ,$85.76 ,$85.76 ,$256.74 ,$205.39 ,$202.69 ,$141.10 ,$229.71 ,$83.00 ,$141.10 ,$141.10 ,$189.18 ,$164.58 ,$85.76 ,$83.00 ,$81.34 ,$166.00 ,$90.91 ,$229.71 ,$186.75 ,$248.63 ,$189.18 ,$270.25 ,$270.25 ,$164.58 ,$270.25 ,$186.74 ,$243.23 ,$184.63 ,$82.15 ,$213.50 ,$90.91 ,$99.60 ,$99.60 ,$81.34 ,$99.60 ,$194.58 ,$167.56 ,$194.58 ,$194.58 ,$216.20 
ST NICHOLAS HOSPITAL - ACUTE,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 , N/A ,$432.63 ,$612.89 ,$504.74 ,$105.67 ,$105.67 ,$685.00 ,$548.00 ,$540.79 ,$173.84 ,$612.89 , N/A ,$173.84 ,$173.84 ,$504.74 ,$439.12 ,$105.67 , N/A , N/A , N/A ,$112.01 ,$612.89 ,$432.63 ,$663.37 ,$504.74 ,$374.63 ,$374.63 ,$439.12 ,$374.63 ,$498.25 ,$648.95 ,$492.62 , N/A ,$569.63 ,$112.01 ,$122.71 ,$122.71 , N/A ,$122.71 ,$519.16 ,$447.05 ,$519.16 ,$519.16 ,$576.84 
ST NICHOLAS HOSPITAL - ACUTE,31000116,81261,HC IGH GENE ANALYSIS REARRANGEMENT AMP,310,1 ,$684.25 ,$451.61 ,$194.03 ,$684.25 ,$204.58 ,$684.25 ,$684.25 ,$197.99 ,$410.55 ,$581.61 ,$478.98 ,$204.58 ,$204.58 ,$650.04 ,$520.03 ,$513.19 ,$336.58 ,$581.61 ,$197.99 ,$336.58 ,$336.58 ,$478.98 ,$416.71 ,$204.58 ,$197.99 ,$194.03 ,$395.98 ,$216.85 ,$581.61 ,$445.48 ,$629.51 ,$478.98 ,$684.25 ,$684.25 ,$416.71 ,$684.25 ,$472.82 ,$615.83 ,$467.48 ,$195.97 ,$540.56 ,$216.85 ,$237.59 ,$237.59 ,$194.03 ,$237.59 ,$492.66 ,$424.24 ,$492.66 ,$492.66 ,$547.40 
ST NICHOLAS HOSPITAL - ACUTE,31000117,81263,HC IGH VAR REG SOMATIC MUTATION ANALYSIS,310,1 ,$888.95 ,$586.71 ,$288.63 ,$888.95 ,$304.33 ,$888.95 ,$888.95 ,$294.52 ,$533.37 ,$755.61 ,$622.27 ,$304.33 ,$304.33 ,$844.50 ,$675.60 ,$666.71 ,$500.68 ,$755.61 ,$294.52 ,$500.68 ,$500.68 ,$622.27 ,$541.37 ,$304.33 ,$294.52 ,$288.63 ,$589.04 ,$322.59 ,$755.61 ,$662.67 ,$817.83 ,$622.27 ,$888.95 ,$888.95 ,$541.37 ,$888.95 ,$614.26 ,$800.06 ,$607.33 ,$291.52 ,$702.27 ,$322.59 ,$353.42 ,$353.42 ,$288.63 ,$353.42 ,$640.04 ,$551.15 ,$640.04 ,$640.04 ,$711.16 
ST NICHOLAS HOSPITAL - ACUTE,31000118,81272,HC V KIT GENE ANALYSIS TARGETED SEQ,310,1 ,$644.00 ,$425.04 ,$195.07 ,$741.40 ,$195.07 ,$644.00 ,$644.00 ,$329.51 ,$386.40 ,$547.40 ,$450.80 ,$195.07 ,$195.07 ,$611.80 ,$489.44 ,$483.00 ,$560.17 ,$547.40 ,$329.51 ,$560.17 ,$560.17 ,$450.80 ,$392.20 ,$195.07 ,$329.51 ,$322.92 ,$644.00 ,$206.77 ,$547.40 ,$741.40 ,$592.48 ,$450.80 ,$644.00 ,$644.00 ,$392.20 ,$644.00 ,$445.00 ,$579.60 ,$439.98 ,$326.15 ,$508.76 ,$206.77 ,$395.41 ,$395.41 ,$322.92 ,$395.41 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,31000119,81315,HC PML/RARALPHA ANALYSIS COMMON BRKPNTS QL/QN,310,1 ,$656.65 ,$433.39 ,$203.16 ,$656.65 ,$214.21 ,$656.65 ,$656.65 ,$207.31 ,$393.99 ,$558.15 ,$459.66 ,$214.21 ,$214.21 ,$623.82 ,$499.05 ,$492.49 ,$352.43 ,$558.15 ,$207.31 ,$352.43 ,$352.43 ,$459.66 ,$399.90 ,$214.21 ,$207.31 ,$203.16 ,$414.62 ,$227.06 ,$558.15 ,$466.45 ,$604.12 ,$459.66 ,$656.65 ,$656.65 ,$399.90 ,$656.65 ,$453.75 ,$590.99 ,$448.62 ,$205.19 ,$518.75 ,$227.06 ,$248.77 ,$248.77 ,$203.16 ,$248.77 ,$472.79 ,$407.12 ,$472.79 ,$472.79 ,$525.32 
ST NICHOLAS HOSPITAL - ACUTE,31000120,81350,HC UGT1A1 GENE ANALYSIS COM VARIANTS,310,1 ,$805.00 ,$531.30 ,$229.32 ,$805.00 , N/A ,$805.00 ,$805.00 ,$234.00 ,$483.00 ,$684.25 ,$563.50 , N/A , N/A ,$764.75 ,$611.80 ,$603.75 ,$397.80 ,$684.25 ,$234.00 ,$397.80 ,$397.80 ,$563.50 ,$490.25 , N/A ,$234.00 ,$229.32 ,$468.00 , N/A ,$684.25 ,$526.50 ,$740.60 ,$563.50 ,$805.00 ,$805.00 ,$490.25 ,$805.00 ,$556.26 ,$724.50 ,$549.98 ,$231.61 ,$635.95 , N/A ,$280.80 ,$280.80 ,$229.32 ,$280.80 ,$579.60 ,$499.10 ,$579.60 ,$579.60 ,$644.00 
ST NICHOLAS HOSPITAL - ACUTE,31000121,81401,HC MOPATH PROC (ABL),310,1 ,$644.00 ,$425.04 ,$109.60 ,$644.00 ,$109.60 ,$479.50 ,$479.50 , N/A ,$386.40 ,$547.40 ,$450.80 ,$109.60 ,$109.60 ,$611.80 ,$489.44 ,$483.00 ,$232.90 ,$547.40 , N/A ,$232.90 ,$232.90 ,$450.80 ,$392.20 ,$109.60 , N/A , N/A , N/A ,$116.18 ,$547.40 ,$386.40 ,$592.48 ,$450.80 ,$501.90 ,$501.90 ,$392.20 ,$501.90 ,$445.00 ,$579.60 ,$439.98 , N/A ,$508.76 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,31000123,81401,HC MOPATH PROC (CBFB),310,1 ,$644.00 ,$425.04 ,$109.60 ,$644.00 ,$109.60 ,$479.50 ,$479.50 , N/A ,$386.40 ,$547.40 ,$450.80 ,$109.60 ,$109.60 ,$611.80 ,$489.44 ,$483.00 ,$232.90 ,$547.40 , N/A ,$232.90 ,$232.90 ,$450.80 ,$392.20 ,$109.60 , N/A , N/A , N/A ,$116.18 ,$547.40 ,$386.40 ,$592.48 ,$450.80 ,$501.90 ,$501.90 ,$392.20 ,$501.90 ,$445.00 ,$579.60 ,$439.98 , N/A ,$508.76 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,31000124,81402,HC MOPATH PROC (BCL2) L3,310,1 ,$644.00 ,$425.04 ,$120.26 ,$644.00 ,$120.26 ,$526.16 ,$526.16 , N/A ,$386.40 ,$547.40 ,$450.80 ,$120.26 ,$120.26 ,$611.80 ,$489.44 ,$483.00 ,$255.56 ,$547.40 , N/A ,$255.56 ,$255.56 ,$450.80 ,$392.20 ,$120.26 , N/A , N/A , N/A ,$127.48 ,$547.40 ,$386.40 ,$592.48 ,$450.80 ,$550.73 ,$550.73 ,$392.20 ,$550.73 ,$445.00 ,$579.60 ,$439.98 , N/A ,$508.76 ,$127.48 ,$180.40 ,$180.40 , N/A ,$180.40 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,31000134,81210,HC BRAF GENE ANALYS V600E VAR-90,310,1 ,$999.35 ,$659.57 ,$143.40 ,$999.35 ,$143.40 ,$613.90 ,$613.90 ,$175.40 ,$599.61 ,$849.45 ,$699.55 ,$143.40 ,$143.40 ,$949.38 ,$759.51 ,$749.51 ,$298.18 ,$849.45 ,$175.40 ,$298.18 ,$298.18 ,$699.55 ,$608.60 ,$143.40 ,$175.40 ,$171.89 ,$350.80 ,$152.00 ,$849.45 ,$394.65 ,$919.40 ,$699.55 ,$656.68 ,$656.68 ,$608.60 ,$656.68 ,$690.55 ,$899.42 ,$682.76 ,$173.61 ,$789.49 ,$152.00 ,$210.48 ,$210.48 ,$171.89 ,$210.48 ,$719.53 ,$619.60 ,$719.53 ,$719.53 ,$799.48 
ST NICHOLAS HOSPITAL - ACUTE,31000202,81229,HC CYTOGENOMIC MICROARRAY ASSAY,310,1 ,"$2,447.20 ","$1,615.15 ",$608.00 ,"$2,610.00 ",$608.00 ,"$2,447.20 ","$2,447.20 ","$1,160.00 ","$1,468.32 ","$2,080.12 ","$1,713.04 ",$608.00 ,$608.00 ,"$2,324.84 ","$1,859.87 ","$1,835.40 ","$1,972.00 ","$2,080.12 ","$1,160.00 ","$1,972.00 ","$1,972.00 ","$1,713.04 ","$1,490.34 ",$608.00 ,"$1,160.00 ","$1,136.80 ","$2,320.00 ",$644.48 ,"$2,080.12 ","$2,610.00 ","$2,251.42 ","$1,713.04 ","$2,447.20 ","$2,447.20 ","$1,490.34 ","$2,447.20 ","$1,691.02 ","$2,202.48 ","$1,671.93 ","$1,148.17 ","$1,933.29 ",$644.48 ,"$1,392.00 ","$1,392.00 ","$1,136.80 ","$1,392.00 ","$1,761.98 ","$1,517.26 ","$1,761.98 ","$1,761.98 ","$1,957.76 "
ST NICHOLAS HOSPITAL - ACUTE,31000210,81235,HC EGFR GENE COM VARIANTS 29 PANEL,310,1 ,"$1,545.60 ","$1,020.10 ",$264.01 ,"$1,545.60 ",$264.01 ,"$1,136.03 ","$1,136.03 ",$324.58 ,$927.36 ,"$1,313.76 ","$1,081.92 ",$264.01 ,$264.01 ,"$1,468.32 ","$1,174.66 ","$1,159.20 ",$551.79 ,"$1,313.76 ",$324.58 ,$551.79 ,$551.79 ,"$1,081.92 ",$941.27 ,$264.01 ,$324.58 ,$318.09 ,$649.16 ,$279.85 ,"$1,313.76 ",$730.31 ,"$1,421.95 ","$1,081.92 ","$1,208.99 ","$1,208.99 ",$941.27 ,"$1,208.99 ","$1,068.01 ","$1,391.04 ","$1,055.95 ",$321.27 ,"$1,221.02 ",$279.85 ,$389.50 ,$389.50 ,$318.09 ,$389.50 ,"$1,112.83 ",$958.27 ,"$1,112.83 ","$1,112.83 ","$1,236.48 "
ST NICHOLAS HOSPITAL - ACUTE,31000211,81210,HC BRAF GENE ANALYS V600E VAR,310,1 ,$618.70 ,$408.34 ,$143.40 ,$618.70 ,$143.40 ,$613.90 ,$613.90 ,$175.40 ,$371.22 ,$525.90 ,$433.09 ,$143.40 ,$143.40 ,$587.77 ,$470.21 ,$464.03 ,$298.18 ,$525.90 ,$175.40 ,$298.18 ,$298.18 ,$433.09 ,$376.79 ,$143.40 ,$175.40 ,$171.89 ,$350.80 ,$152.00 ,$525.90 ,$394.65 ,$569.20 ,$433.09 ,$618.70 ,$618.70 ,$376.79 ,$618.70 ,$427.52 ,$556.83 ,$422.70 ,$173.61 ,$488.77 ,$152.00 ,$210.48 ,$210.48 ,$171.89 ,$210.48 ,$445.46 ,$383.59 ,$445.46 ,$445.46 ,$494.96 
ST NICHOLAS HOSPITAL - ACUTE,31000212,81445,HC GENE SEQ SOLID ORGAN NEOPLASM 5-50 GENES,310,1 ,"$2,576.00 ","$1,700.16 ",$478.33 ,"$2,576.00 ",$478.33 ,"$2,092.69 ","$2,092.69 ",$597.91 ,"$1,545.60 ","$2,189.60 ","$1,803.20 ",$478.33 ,$478.33 ,"$2,447.20 ","$1,957.76 ","$1,932.00 ","$1,016.45 ","$2,189.60 ",$597.91 ,"$1,016.45 ","$1,016.45 ","$1,803.20 ","$1,568.78 ",$478.33 ,$597.91 ,$585.95 ,"$1,195.82 ",$507.03 ,"$2,189.60 ","$1,345.30 ","$2,369.92 ","$1,803.20 ","$2,190.44 ","$2,190.44 ","$1,568.78 ","$2,190.44 ","$1,780.02 ","$2,318.40 ","$1,759.92 ",$591.81 ,"$2,035.04 ",$507.03 ,$717.49 ,$717.49 ,$585.95 ,$717.49 ,"$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$2,060.80 "
ST NICHOLAS HOSPITAL - ACUTE,31000231,81229,HC CHROMOSOMAL MICROARRAY,310,1 ,"$3,091.20 ","$2,040.19 ",$608.00 ,"$3,091.20 ",$608.00 ,"$3,091.20 ","$3,091.20 ","$1,160.00 ","$1,854.72 ","$2,627.52 ","$2,163.84 ",$608.00 ,$608.00 ,"$2,936.64 ","$2,349.31 ","$2,318.40 ","$1,972.00 ","$2,627.52 ","$1,160.00 ","$1,972.00 ","$1,972.00 ","$2,163.84 ","$1,882.54 ",$608.00 ,"$1,160.00 ","$1,136.80 ","$2,320.00 ",$644.48 ,"$2,627.52 ","$2,610.00 ","$2,843.90 ","$2,163.84 ","$3,091.20 ","$3,091.20 ","$1,882.54 ","$3,091.20 ","$2,136.02 ","$2,782.08 ","$2,111.91 ","$1,148.17 ","$2,442.05 ",$644.48 ,"$1,392.00 ","$1,392.00 ","$1,136.80 ","$1,392.00 ","$2,225.66 ","$1,916.54 ","$2,225.66 ","$2,225.66 ","$2,472.96 "
ST NICHOLAS HOSPITAL - ACUTE,31000235,81219,HC MUTATION ANALYSIS CALRETICULIN,310,1 ,$676.20 ,$446.29 ,$98.08 ,$676.20 ,$98.08 ,$425.71 ,$425.71 ,$121.63 ,$405.72 ,$574.77 ,$473.34 ,$98.08 ,$98.08 ,$642.39 ,$513.91 ,$507.15 ,$206.77 ,$574.77 ,$121.63 ,$206.77 ,$206.77 ,$473.34 ,$411.81 ,$98.08 ,$121.63 ,$119.20 ,$243.26 ,$103.96 ,$574.77 ,$273.67 ,$622.10 ,$473.34 ,$606.97 ,$606.97 ,$411.81 ,$606.97 ,$467.25 ,$608.58 ,$461.98 ,$120.39 ,$534.20 ,$103.96 ,$145.96 ,$145.96 ,$119.20 ,$145.96 ,$486.86 ,$419.24 ,$486.86 ,$486.86 ,$540.96 
ST NICHOLAS HOSPITAL - ACUTE,31000236,81403,HC MOLECULAR PATH MUTATION ANALYSIS EXON 12,310,1 ,$515.20 ,$340.03 ,$148.16 ,$515.20 ,$148.16 ,$515.20 ,$515.20 , N/A ,$309.12 ,$437.92 ,$360.64 ,$148.16 ,$148.16 ,$489.44 ,$391.55 ,$386.40 ,$314.84 ,$437.92 , N/A ,$314.84 ,$314.84 ,$360.64 ,$313.76 ,$148.16 , N/A , N/A , N/A ,$157.05 ,$437.92 ,$309.12 ,$473.98 ,$360.64 ,$515.20 ,$515.20 ,$313.76 ,$515.20 ,$356.00 ,$463.68 ,$351.98 , N/A ,$407.01 ,$157.05 ,$222.24 ,$222.24 , N/A ,$222.24 ,$370.94 ,$319.42 ,$370.94 ,$370.94 ,$412.16 
ST NICHOLAS HOSPITAL - ACUTE,31000237,81402,HC MOLECULAR PATH MUTATION ANALYSIS MPL,310,1 ,$483.00 ,$318.78 ,$120.26 ,$483.00 ,$120.26 ,$483.00 ,$483.00 , N/A ,$289.80 ,$410.55 ,$338.10 ,$120.26 ,$120.26 ,$458.85 ,$367.08 ,$362.25 ,$255.56 ,$410.55 , N/A ,$255.56 ,$255.56 ,$338.10 ,$294.15 ,$120.26 , N/A , N/A , N/A ,$127.48 ,$410.55 ,$289.80 ,$444.36 ,$338.10 ,$483.00 ,$483.00 ,$294.15 ,$483.00 ,$333.75 ,$434.70 ,$329.99 , N/A ,$381.57 ,$127.48 ,$180.40 ,$180.40 , N/A ,$180.40 ,$347.76 ,$299.46 ,$347.76 ,$347.76 ,$386.40 
ST NICHOLAS HOSPITAL - ACUTE,31000238,81479,HC MUTATION ANALYSIS CSF3R,310,1 ,$386.40 ,$255.02 ,$1.46 ,$386.40 ,$1.46 ,$264.84 ,$264.84 , N/A ,$231.84 ,$328.44 ,$270.48 ,$1.46 ,$1.46 ,$367.08 ,$293.66 ,$289.80 , N/A ,$328.44 , N/A , N/A , N/A ,$270.48 ,$235.32 ,$1.46 , N/A , N/A , N/A ,$1.55 ,$328.44 ,$231.84 ,$355.49 ,$270.48 ,$195.98 ,$235.20 ,$235.32 ,$235.20 ,$267.00 ,$347.76 ,$263.99 , N/A ,$305.26 ,$1.55 , N/A , N/A , N/A , N/A ,$278.21 ,$239.57 ,$278.21 ,$278.21 ,$309.12 
ST NICHOLAS HOSPITAL - ACUTE,31000239,81270,HC JAK2 MUTATION ANALYSIS,310,1 ,$463.45 ,$305.88 ,$89.83 ,$463.45 ,$94.71 ,$320.81 ,$320.81 ,$91.66 ,$278.07 ,$393.93 ,$324.42 ,$94.71 ,$94.71 ,$440.28 ,$352.22 ,$347.59 ,$155.82 ,$393.93 ,$91.66 ,$155.82 ,$155.82 ,$324.42 ,$282.24 ,$94.71 ,$91.66 ,$89.83 ,$183.32 ,$100.39 ,$393.93 ,$206.24 ,$426.37 ,$324.42 ,$458.16 ,$458.16 ,$282.24 ,$458.16 ,$320.24 ,$417.11 ,$316.63 ,$90.73 ,$366.13 ,$100.39 ,$109.99 ,$109.99 ,$89.83 ,$109.99 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,31000244,81271,HC HTT GENE ANALYSIS DETECT ABNORMAL ALLELES,310,1 ,$508.30 ,$335.48 ,$109.60 ,$508.30 ,$109.60 ,$479.50 ,$479.50 ,$137.00 ,$304.98 ,$432.06 ,$355.81 ,$109.60 ,$109.60 ,$482.89 ,$386.31 ,$381.23 ,$232.90 ,$432.06 ,$137.00 ,$232.90 ,$232.90 ,$355.81 ,$309.55 ,$109.60 ,$137.00 ,$134.26 ,$274.00 ,$116.18 ,$432.06 ,$308.25 ,$467.64 ,$355.81 ,$501.90 ,$501.90 ,$309.55 ,$501.90 ,$351.24 ,$457.47 ,$347.27 ,$135.60 ,$401.56 ,$116.18 ,$164.40 ,$164.40 ,$134.26 ,$164.40 ,$365.98 ,$315.15 ,$365.98 ,$365.98 ,$406.64 
ST NICHOLAS HOSPITAL - ACUTE,31000265,81445,HC GENE SEQ NEOPLASM 5-50 GENES LUNG W/REARRANG TUMOR,310,1 ,"$3,864.00 ","$2,550.24 ",$478.33 ,"$3,864.00 ",$478.33 ,"$2,092.69 ","$2,092.69 ",$597.91 ,"$2,318.40 ","$3,284.40 ","$2,704.80 ",$478.33 ,$478.33 ,"$3,670.80 ","$2,936.64 ","$2,898.00 ","$1,016.45 ","$3,284.40 ",$597.91 ,"$1,016.45 ","$1,016.45 ","$2,704.80 ","$2,353.18 ",$478.33 ,$597.91 ,$585.95 ,"$1,195.82 ",$507.03 ,"$3,284.40 ","$1,345.30 ","$3,554.88 ","$2,704.80 ","$2,190.44 ","$2,190.44 ","$2,353.18 ","$2,190.44 ","$2,670.02 ","$3,477.60 ","$2,639.88 ",$591.81 ,"$3,052.56 ",$507.03 ,$717.49 ,$717.49 ,$585.95 ,$717.49 ,"$2,782.08 ","$2,395.68 ","$2,782.08 ","$2,782.08 ","$3,091.20 "
ST NICHOLAS HOSPITAL - ACUTE,31000273,81270,HC JAK2 V617F MUTATION DETECTION B/BM,310,1 ,$491.05 ,$324.09 ,$89.83 ,$491.05 ,$94.71 ,$320.81 ,$320.81 ,$91.66 ,$294.63 ,$417.39 ,$343.74 ,$94.71 ,$94.71 ,$466.50 ,$373.20 ,$368.29 ,$155.82 ,$417.39 ,$91.66 ,$155.82 ,$155.82 ,$343.74 ,$299.05 ,$94.71 ,$91.66 ,$89.83 ,$183.32 ,$100.39 ,$417.39 ,$206.24 ,$451.77 ,$343.74 ,$458.16 ,$458.16 ,$299.05 ,$458.16 ,$339.32 ,$441.95 ,$335.49 ,$90.73 ,$387.93 ,$100.39 ,$109.99 ,$109.99 ,$89.83 ,$109.99 ,$353.56 ,$304.45 ,$353.56 ,$353.56 ,$392.84 
ST NICHOLAS HOSPITAL - ACUTE,31000274,81305,HC MYD88 L265P GENE MUTATION ANALYSIS,310,1 ,$883.20 ,$582.91 ,$140.32 ,$883.20 ,$140.32 ,$613.90 ,$613.90 ,$175.40 ,$529.92 ,$750.72 ,$618.24 ,$140.32 ,$140.32 ,$839.04 ,$671.23 ,$662.40 ,$298.18 ,$750.72 ,$175.40 ,$298.18 ,$298.18 ,$618.24 ,$537.87 ,$140.32 ,$175.40 ,$171.89 ,$350.80 ,$148.74 ,$750.72 ,$394.65 ,$812.54 ,$618.24 ,$642.58 ,$642.58 ,$537.87 ,$642.58 ,$610.29 ,$794.88 ,$603.40 ,$173.61 ,$697.73 ,$148.74 ,$210.48 ,$210.48 ,$171.89 ,$210.48 ,$635.90 ,$547.58 ,$635.90 ,$635.90 ,$706.56 
ST NICHOLAS HOSPITAL - ACUTE,31000308,81208,HC BCR/ABL1 GENE OTH BP QL/QN,310,1 ,$355.97 ,$234.94 ,$175.54 ,$482.90 ,$175.54 ,$355.97 ,$355.97 ,$214.62 ,$213.58 ,$302.57 ,$249.18 ,$175.54 ,$175.54 ,$338.17 ,$270.54 ,$266.98 ,$355.97 ,$302.57 ,$214.62 ,$355.97 ,$355.97 ,$249.18 ,$216.79 ,$175.54 ,$214.62 ,$210.33 ,$355.97 ,$186.07 ,$302.57 ,$482.90 ,$327.49 ,$249.18 ,$355.97 ,$355.97 ,$216.79 ,$355.97 ,$245.98 ,$320.37 ,$243.20 ,$212.43 ,$281.22 ,$186.07 ,$257.54 ,$257.54 ,$210.33 ,$257.54 ,$256.30 ,$220.70 ,$256.30 ,$256.30 ,$284.78 
ST NICHOLAS HOSPITAL - ACUTE,31000313,81405,HC MOLECULAR PATH PROC LEVEL 6,310,1 ,$205.85 ,$135.86 ,$123.51 ,$218.20 ,$205.85 ,$205.85 ,$205.85 , N/A ,$123.51 ,$174.97 ,$144.10 ,$205.85 ,$205.85 ,$195.56 ,$156.45 ,$154.39 ,$205.85 ,$174.97 , N/A ,$205.85 ,$205.85 ,$144.10 ,$125.36 ,$205.85 , N/A , N/A , N/A ,$218.20 ,$174.97 ,$123.51 ,$189.38 ,$144.10 ,$205.85 ,$205.85 ,$125.36 ,$205.85 ,$142.24 ,$185.27 ,$140.64 , N/A ,$162.62 ,$218.20 ,$205.85 ,$205.85 , N/A ,$205.85 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,31040107,81311,HC NRAS GENE VARIANTS EXON 2 AND 3,310,1 ,$876.30 ,$578.36 ,$175.10 ,$876.30 ,$175.10 ,$876.30 ,$876.30 ,$295.79 ,$525.78 ,$744.86 ,$613.41 ,$175.10 ,$175.10 ,$832.49 ,$665.99 ,$657.23 ,$502.84 ,$744.86 ,$295.79 ,$502.84 ,$502.84 ,$613.41 ,$533.67 ,$175.10 ,$295.79 ,$289.87 ,$591.58 ,$185.61 ,$744.86 ,$665.53 ,$806.20 ,$613.41 ,$876.30 ,$876.30 ,$533.67 ,$876.30 ,$605.52 ,$788.67 ,$598.69 ,$292.77 ,$692.28 ,$185.61 ,$354.95 ,$354.95 ,$289.87 ,$354.95 ,$630.94 ,$543.31 ,$630.94 ,$630.94 ,$701.04 
ST NICHOLAS HOSPITAL - ACUTE,31040108,81404,HC MOLECULAR PATH PROC LEVEL 5,310,1 ,$515.20 ,$340.03 ,$219.86 ,$515.20 ,$219.86 ,$515.20 ,$515.20 , N/A ,$309.12 ,$437.92 ,$360.64 ,$219.86 ,$219.86 ,$489.44 ,$391.55 ,$386.40 ,$467.21 ,$437.92 , N/A ,$467.21 ,$467.21 ,$360.64 ,$313.76 ,$219.86 , N/A , N/A , N/A ,$233.05 ,$437.92 ,$309.12 ,$473.98 ,$360.64 ,$515.20 ,$515.20 ,$313.76 ,$515.20 ,$356.00 ,$463.68 ,$351.98 , N/A ,$407.01 ,$233.05 ,$329.80 ,$329.80 , N/A ,$329.80 ,$370.94 ,$319.42 ,$370.94 ,$370.94 ,$412.16 
ST NICHOLAS HOSPITAL - ACUTE,31100101,88104,HC CYTOPATH FLD SMEAR,311,1 ,$193.20 ,$127.51 ,$1.19 ,$193.20 ,$1.19 ,$133.85 ,$133.85 ,$33.15 ,$115.92 ,$164.22 ,$135.24 ,$1.19 ,$1.19 ,$183.54 ,$146.83 ,$144.90 ,$113.25 ,$164.22 ,$33.15 ,$113.25 ,$113.25 ,$135.24 ,$117.66 ,$1.19 ,$33.15 ,$32.49 ,$66.30 ,$1.26 ,$164.22 ,$74.58 ,$177.74 ,$135.24 ,$97.99 ,$117.60 ,$117.66 ,$117.60 ,$133.50 ,$173.88 ,$131.99 ,$32.81 ,$152.63 ,$1.26 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,31100102,88108,HC CYTOPATH CONCENTRATION,311,1 ,$270.25 ,$178.37 ,$1.19 ,$270.25 ,$1.19 ,$140.70 ,$140.70 ,$33.15 ,$162.15 ,$229.71 ,$189.18 ,$1.19 ,$1.19 ,$256.74 ,$205.39 ,$202.69 ,$108.34 ,$229.71 ,$33.15 ,$108.34 ,$108.34 ,$189.18 ,$164.58 ,$1.19 ,$33.15 ,$32.49 ,$66.30 ,$1.26 ,$229.71 ,$74.58 ,$248.63 ,$189.18 ,$137.07 ,$164.50 ,$164.58 ,$164.50 ,$186.74 ,$243.23 ,$184.63 ,$32.81 ,$213.50 ,$1.26 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$194.58 ,$167.56 ,$194.58 ,$194.58 ,$216.20 
ST NICHOLAS HOSPITAL - ACUTE,31100103,88108,HC CYTOPATH CONCENTRATION (BF),311,1 ,$249.55 ,$164.70 ,$1.19 ,$249.55 ,$1.19 ,$140.70 ,$140.70 ,$33.15 ,$149.73 ,$212.12 ,$174.69 ,$1.19 ,$1.19 ,$237.07 ,$189.66 ,$187.16 ,$108.34 ,$212.12 ,$33.15 ,$108.34 ,$108.34 ,$174.69 ,$151.98 ,$1.19 ,$33.15 ,$32.49 ,$66.30 ,$1.26 ,$212.12 ,$74.58 ,$229.59 ,$174.69 ,$126.57 ,$151.90 ,$151.98 ,$151.90 ,$172.44 ,$224.60 ,$170.49 ,$32.81 ,$197.14 ,$1.26 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$179.68 ,$154.72 ,$179.68 ,$179.68 ,$199.64 
ST NICHOLAS HOSPITAL - ACUTE,31100104,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$218.50 ,$144.21 ,$1.19 ,$218.50 ,$1.19 ,$130.43 ,$130.43 ,$48.94 ,$131.10 ,$185.73 ,$152.95 ,$1.19 ,$1.19 ,$207.58 ,$166.06 ,$163.88 ,$109.79 ,$185.73 ,$48.94 ,$109.79 ,$109.79 ,$152.95 ,$133.07 ,$1.19 ,$48.94 ,$47.96 ,$97.88 ,$1.26 ,$185.73 ,$110.11 ,$201.02 ,$152.95 ,$110.82 ,$133.00 ,$133.07 ,$133.00 ,$150.98 ,$196.65 ,$149.28 ,$48.44 ,$172.62 ,$1.26 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,31100107,88142,HC THINPREP PAP,311,1 ,$180.55 ,$119.16 ,$19.85 ,$180.55 ,$20.93 ,$70.91 ,$70.91 ,$20.26 ,$108.33 ,$153.47 ,$126.39 ,$20.93 ,$20.93 ,$171.52 ,$137.22 ,$135.41 ,$34.44 ,$153.47 ,$20.26 ,$34.44 ,$34.44 ,$126.39 ,$109.96 ,$20.93 ,$20.26 ,$19.85 ,$40.52 ,$22.19 ,$153.47 ,$45.59 ,$166.11 ,$126.39 ,$101.26 ,$101.26 ,$109.96 ,$101.26 ,$124.76 ,$162.50 ,$123.35 ,$20.05 ,$142.63 ,$22.19 ,$24.31 ,$24.31 ,$19.85 ,$24.31 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,31100108,88150,HC PAP SMEAR DIAG UP TO 3 SLIDES,311,1 ,$93.15 ,$61.48 ,$14.86 ,$93.15 ,$14.86 ,$55.72 ,$55.72 ,$17.31 ,$55.89 ,$79.18 ,$65.21 ,$14.86 ,$14.86 ,$88.49 ,$70.79 ,$69.86 ,$29.43 ,$79.18 ,$17.31 ,$29.43 ,$29.43 ,$65.21 ,$56.73 ,$14.86 ,$17.31 ,$16.96 ,$34.62 ,$15.75 ,$79.18 ,$38.95 ,$85.70 ,$65.21 ,$52.83 ,$52.83 ,$56.73 ,$52.83 ,$64.37 ,$83.84 ,$63.64 ,$17.13 ,$73.59 ,$15.75 ,$18.14 ,$18.14 ,$16.96 ,$18.14 ,$67.07 ,$57.75 ,$67.07 ,$67.07 ,$74.52 
ST NICHOLAS HOSPITAL - ACUTE,31100109,88155,HC CYTOPATH MATURATION INDEX,311,1 ,$51.75 ,$34.16 ,$8.42 ,$51.75 ,$8.42 ,$51.28 ,$51.28 ,$14.65 ,$31.05 ,$43.99 ,$36.23 ,$8.42 ,$8.42 ,$49.16 ,$39.33 ,$38.81 ,$24.91 ,$43.99 ,$14.65 ,$24.91 ,$24.91 ,$36.23 ,$31.52 ,$8.42 ,$14.65 ,$14.36 ,$29.30 ,$8.93 ,$43.99 ,$32.96 ,$47.61 ,$36.23 ,$29.97 ,$29.97 ,$31.52 ,$29.97 ,$35.76 ,$46.58 ,$35.36 ,$14.50 ,$40.88 ,$8.93 ,$17.58 ,$17.58 ,$14.36 ,$17.58 ,$37.26 ,$32.09 ,$37.26 ,$37.26 ,$41.40 
ST NICHOLAS HOSPITAL - ACUTE,31100110,88160,HC CYTOPATH SMEAR NON GYN,311,1 ,$218.50 ,$144.21 ,$1.19 ,$218.50 ,$1.19 ,$154.39 ,$154.39 ,$24.36 ,$131.10 ,$185.73 ,$152.95 ,$1.19 ,$1.19 ,$207.58 ,$166.06 ,$163.88 ,$122.93 ,$185.73 ,$24.36 ,$122.93 ,$122.93 ,$152.95 ,$133.07 ,$1.19 ,$24.36 ,$23.87 ,$48.72 ,$1.26 ,$185.73 ,$54.81 ,$201.02 ,$152.95 ,$110.82 ,$133.00 ,$133.07 ,$133.00 ,$150.98 ,$196.65 ,$149.28 ,$24.11 ,$172.62 ,$1.26 ,$27.59 ,$27.59 ,$23.87 ,$27.59 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,31100111,88160,HC CYTOPATH SMEAR NON GYN (TZANK),311,1 ,$218.50 ,$144.21 ,$1.19 ,$218.50 ,$1.19 ,$154.39 ,$154.39 ,$24.36 ,$131.10 ,$185.73 ,$152.95 ,$1.19 ,$1.19 ,$207.58 ,$166.06 ,$163.88 ,$122.93 ,$185.73 ,$24.36 ,$122.93 ,$122.93 ,$152.95 ,$133.07 ,$1.19 ,$24.36 ,$23.87 ,$48.72 ,$1.26 ,$185.73 ,$54.81 ,$201.02 ,$152.95 ,$110.82 ,$133.00 ,$133.07 ,$133.00 ,$150.98 ,$196.65 ,$149.28 ,$24.11 ,$172.62 ,$1.26 ,$27.59 ,$27.59 ,$23.87 ,$27.59 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,31100112,88162,HC CYTOPATH SMEAR OVER 5 SLIDES,311,1 ,$322.00 ,$212.52 ,$1.19 ,$322.00 ,$1.19 ,$249.45 ,$249.45 ,$48.94 ,$193.20 ,$273.70 ,$225.40 ,$1.19 ,$1.19 ,$305.90 ,$244.72 ,$241.50 ,$194.82 ,$273.70 ,$48.94 ,$194.82 ,$194.82 ,$225.40 ,$196.10 ,$1.19 ,$48.94 ,$47.96 ,$97.88 ,$1.26 ,$273.70 ,$110.11 ,$296.24 ,$225.40 ,$163.32 ,$196.00 ,$196.10 ,$196.00 ,$222.50 ,$289.80 ,$219.99 ,$48.44 ,$254.38 ,$1.26 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,31100113,88164,HC CYTOPATH SCR BETHESDA,311,1 ,$79.35 ,$52.37 ,$14.86 ,$79.35 ,$14.86 ,$55.72 ,$55.72 ,$17.31 ,$47.61 ,$67.45 ,$55.55 ,$14.86 ,$14.86 ,$75.38 ,$60.31 ,$59.51 ,$29.43 ,$67.45 ,$17.31 ,$29.43 ,$29.43 ,$55.55 ,$48.32 ,$14.86 ,$17.31 ,$16.96 ,$34.62 ,$15.75 ,$67.45 ,$38.95 ,$73.00 ,$55.55 ,$52.83 ,$52.83 ,$48.32 ,$52.83 ,$54.83 ,$71.42 ,$54.21 ,$17.13 ,$62.69 ,$15.75 ,$18.14 ,$18.14 ,$16.96 ,$18.14 ,$57.13 ,$49.20 ,$57.13 ,$57.13 ,$63.48 
ST NICHOLAS HOSPITAL - ACUTE,31100114,88172,HC FINE NEEDLE EVAL,311,1 ,$162.15 ,$107.02 ,$2.61 ,$345.32 ,$2.61 ,$64.25 ,$64.25 ,$153.48 ,$97.29 ,$137.83 ,$113.51 ,$2.61 ,$2.61 ,$154.04 ,$123.23 ,$121.61 ,$91.56 ,$137.83 ,$153.48 ,$91.56 ,$91.56 ,$113.51 ,$98.75 ,$2.61 ,$153.48 ,$150.41 ,$162.15 ,$2.77 ,$137.83 ,$345.32 ,$149.18 ,$113.51 ,$82.24 ,$98.70 ,$98.75 ,$98.70 ,$112.05 ,$145.94 ,$110.78 ,$151.91 ,$128.10 ,$2.77 ,$162.15 ,$162.15 ,$150.41 ,$162.15 ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,31100115,88173,HC FINE NEEDLE INTERP,311,1 ,$463.45 ,$305.88 ,$2.40 ,$463.45 ,$2.40 ,$291.24 ,$291.24 ,$48.94 ,$278.07 ,$393.93 ,$324.42 ,$2.40 ,$2.40 ,$440.28 ,$352.22 ,$347.59 ,$265.05 ,$393.93 ,$48.94 ,$265.05 ,$265.05 ,$324.42 ,$282.24 ,$2.40 ,$48.94 ,$47.96 ,$97.88 ,$2.54 ,$393.93 ,$110.11 ,$426.37 ,$324.42 ,$235.06 ,$282.10 ,$282.24 ,$282.10 ,$320.24 ,$417.11 ,$316.63 ,$48.44 ,$366.13 ,$2.54 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,31100116,88177,HC FINE NEEDLE EVAL ADDL,311,1 ,$116.15 ,$76.66 ,$1.19 ,$116.15 ,$1.19 ,$23.96 ,$23.96 , N/A ,$69.69 ,$98.73 ,$81.31 ,$1.19 ,$1.19 ,$110.34 ,$88.27 ,$87.11 ,$48.45 ,$98.73 , N/A ,$48.45 ,$48.45 ,$81.31 ,$70.74 ,$1.19 , N/A , N/A , N/A ,$1.26 ,$98.73 , N/A ,$106.86 ,$81.31 ,$58.91 ,$70.70 ,$70.74 ,$70.70 ,$80.26 ,$104.54 ,$79.35 , N/A ,$91.76 ,$1.26 ,$8.66 ,$8.66 , N/A ,$8.66 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,31100117,88182,HC T AND B CELL QN FLOWCYT,311,1 ,$173.65 ,$114.61 ,$1.19 ,$173.65 ,$1.19 ,$173.65 ,$173.65 ,$48.94 ,$104.19 ,$147.60 ,$121.56 ,$1.19 ,$1.19 ,$164.97 ,$131.97 ,$130.24 ,$173.65 ,$147.60 ,$48.94 ,$173.65 ,$173.65 ,$121.56 ,$105.75 ,$1.19 ,$48.94 ,$47.96 ,$97.88 ,$1.26 ,$147.60 ,$110.11 ,$159.76 ,$121.56 ,$88.08 ,$105.70 ,$105.75 ,$105.70 ,$119.99 ,$156.29 ,$118.64 ,$48.44 ,$137.18 ,$1.26 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$125.03 ,$107.66 ,$125.03 ,$125.03 ,$138.92 
ST NICHOLAS HOSPITAL - ACUTE,31100118,88182,HC T AND B CELL QN FLOWCYT (DNA CELL CYCLE),311,1 ,$708.40 ,$467.54 ,$1.19 ,$708.40 ,$1.19 ,$361.98 ,$361.98 ,$48.94 ,$425.04 ,$602.14 ,$495.88 ,$1.19 ,$1.19 ,$672.98 ,$538.38 ,$531.30 ,$261.99 ,$602.14 ,$48.94 ,$261.99 ,$261.99 ,$495.88 ,$431.42 ,$1.19 ,$48.94 ,$47.96 ,$97.88 ,$1.26 ,$602.14 ,$110.11 ,$651.73 ,$495.88 ,$359.30 ,$431.20 ,$431.42 ,$431.20 ,$489.50 ,$637.56 ,$483.98 ,$48.44 ,$559.64 ,$1.26 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$510.05 ,$439.21 ,$510.05 ,$510.05 ,$566.72 
ST NICHOLAS HOSPITAL - ACUTE,31100119,88184,HC FLOW CYTO 1ST MARKER (CD4),311,1 ,$35.65 ,$23.53 ,$2.61 ,$711.75 ,$2.61 ,$35.65 ,$35.65 ,$316.33 ,$21.39 ,$30.30 ,$24.96 ,$2.61 ,$2.61 ,$33.87 ,$27.09 ,$26.74 ,$35.65 ,$30.30 ,$316.33 ,$35.65 ,$35.65 ,$24.96 ,$21.71 ,$2.61 ,$316.33 ,$310.00 ,$35.65 ,$2.77 ,$30.30 ,$711.75 ,$32.80 ,$24.96 ,$18.08 ,$21.70 ,$21.71 ,$21.70 ,$24.63 ,$32.09 ,$24.36 ,$313.10 ,$28.16 ,$2.77 ,$35.65 ,$35.65 ,$310.00 ,$35.65 ,$25.67 ,$22.10 ,$25.67 ,$25.67 ,$28.52 
ST NICHOLAS HOSPITAL - ACUTE,31100120,88184,HC FLOW CYTO 1ST MARKER (PCLI),311,1 ,$88.55 ,$58.44 ,$2.61 ,$711.75 ,$2.61 ,$88.55 ,$88.55 ,$316.33 ,$53.13 ,$75.27 ,$61.99 ,$2.61 ,$2.61 ,$84.12 ,$67.30 ,$66.41 ,$88.55 ,$75.27 ,$316.33 ,$88.55 ,$88.55 ,$61.99 ,$53.93 ,$2.61 ,$316.33 ,$310.00 ,$88.55 ,$2.77 ,$75.27 ,$711.75 ,$81.47 ,$61.99 ,$44.91 ,$53.90 ,$53.93 ,$53.90 ,$61.19 ,$79.70 ,$60.50 ,$313.10 ,$69.95 ,$2.77 ,$88.55 ,$88.55 ,$310.00 ,$88.55 ,$63.76 ,$54.90 ,$63.76 ,$63.76 ,$70.84 
ST NICHOLAS HOSPITAL - ACUTE,31100121,88184,HC FLOW CYTO 1ST MARKER,311,1 ,$540.50 ,$356.73 ,$2.61 ,$711.75 ,$2.61 ,$226.63 ,$226.63 ,$316.33 ,$324.30 ,$459.43 ,$378.35 ,$2.61 ,$2.61 ,$513.48 ,$410.78 ,$405.38 ,$120.77 ,$459.43 ,$316.33 ,$120.77 ,$120.77 ,$378.35 ,$329.16 ,$2.61 ,$316.33 ,$310.00 ,$540.50 ,$2.77 ,$459.43 ,$711.75 ,$497.26 ,$378.35 ,$274.14 ,$329.00 ,$329.16 ,$329.00 ,$373.49 ,$486.45 ,$369.27 ,$313.10 ,$427.00 ,$2.77 ,$340.09 ,$340.09 ,$310.00 ,$340.09 ,$389.16 ,$335.11 ,$389.16 ,$389.16 ,$432.40 
ST NICHOLAS HOSPITAL - ACUTE,31100122,88184,HC FLOW CYTO 1ST MARKER (MM),311,1 ,$174.80 ,$115.37 ,$2.61 ,$711.75 ,$2.61 ,$174.80 ,$174.80 ,$316.33 ,$104.88 ,$148.58 ,$122.36 ,$2.61 ,$2.61 ,$166.06 ,$132.85 ,$131.10 ,$120.77 ,$148.58 ,$316.33 ,$120.77 ,$120.77 ,$122.36 ,$106.45 ,$2.61 ,$316.33 ,$310.00 ,$174.80 ,$2.77 ,$148.58 ,$711.75 ,$160.82 ,$122.36 ,$88.66 ,$106.40 ,$106.45 ,$106.40 ,$120.79 ,$157.32 ,$119.42 ,$313.10 ,$138.09 ,$2.77 ,$174.80 ,$174.80 ,$310.00 ,$174.80 ,$125.86 ,$108.38 ,$125.86 ,$125.86 ,$139.84 
ST NICHOLAS HOSPITAL - ACUTE,31100124,88185,HC FLOW CYTO EA ADD MARKER (PCLI),311,1 ,$88.55 ,$58.44 ,$1.19 ,$88.55 ,$1.19 ,$73.02 ,$73.02 , N/A ,$53.13 ,$75.27 ,$61.99 ,$1.19 ,$1.19 ,$84.12 ,$67.30 ,$66.41 ,$38.86 ,$75.27 , N/A ,$38.86 ,$38.86 ,$61.99 ,$53.93 ,$1.19 , N/A , N/A , N/A ,$1.26 ,$75.27 , N/A ,$81.47 ,$61.99 ,$44.91 ,$53.90 ,$53.93 ,$53.90 ,$61.19 ,$79.70 ,$60.50 , N/A ,$69.95 ,$1.26 ,$26.86 ,$26.86 , N/A ,$26.86 ,$63.76 ,$54.90 ,$63.76 ,$63.76 ,$70.84 
ST NICHOLAS HOSPITAL - ACUTE,31100125,88185,HC FLOW CYTO EA ADD MARKER (PNH),311,1 ,$89.70 ,$59.20 ,$1.19 ,$89.70 ,$1.19 ,$73.02 ,$73.02 , N/A ,$53.82 ,$76.25 ,$62.79 ,$1.19 ,$1.19 ,$85.22 ,$68.17 ,$67.28 ,$38.86 ,$76.25 , N/A ,$38.86 ,$38.86 ,$62.79 ,$54.63 ,$1.19 , N/A , N/A , N/A ,$1.26 ,$76.25 , N/A ,$82.52 ,$62.79 ,$45.50 ,$54.60 ,$54.63 ,$54.60 ,$61.98 ,$80.73 ,$61.28 , N/A ,$70.86 ,$1.26 ,$26.86 ,$26.86 , N/A ,$26.86 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,31100126,88185,HC FLOW CYTO EA ADD MARKER,311,1 ,$334.65 ,$220.87 ,$1.19 ,$334.65 ,$1.19 ,$73.02 ,$73.02 , N/A ,$200.79 ,$284.45 ,$234.26 ,$1.19 ,$1.19 ,$317.92 ,$254.33 ,$250.99 ,$38.86 ,$284.45 , N/A ,$38.86 ,$38.86 ,$234.26 ,$203.80 ,$1.19 , N/A , N/A , N/A ,$1.26 ,$284.45 , N/A ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 , N/A ,$264.37 ,$1.26 ,$26.86 ,$26.86 , N/A ,$26.86 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31100128,88185,HC T AND B MAKERS ADDL,311,1 ,$88.55 ,$58.44 ,$1.19 ,$88.55 ,$1.19 ,$73.02 ,$73.02 , N/A ,$53.13 ,$75.27 ,$61.99 ,$1.19 ,$1.19 ,$84.12 ,$67.30 ,$66.41 ,$38.86 ,$75.27 , N/A ,$38.86 ,$38.86 ,$61.99 ,$53.93 ,$1.19 , N/A , N/A , N/A ,$1.26 ,$75.27 , N/A ,$81.47 ,$61.99 ,$44.91 ,$53.90 ,$53.93 ,$53.90 ,$61.19 ,$79.70 ,$60.50 , N/A ,$69.95 ,$1.26 ,$26.86 ,$26.86 , N/A ,$26.86 ,$63.76 ,$54.90 ,$63.76 ,$63.76 ,$70.84 
ST NICHOLAS HOSPITAL - ACUTE,31100131,88230,HC TISSUE CLT NONNEO (CHROMO),311,1 ,$645.15 ,$425.80 ,$70.04 ,$645.15 ,$70.04 ,$407.72 ,$407.72 ,$116.49 ,$387.09 ,$548.38 ,$451.61 ,$70.04 ,$70.04 ,$612.89 ,$490.31 ,$483.86 ,$198.03 ,$548.38 ,$116.49 ,$198.03 ,$198.03 ,$451.61 ,$392.90 ,$70.04 ,$116.49 ,$114.16 ,$232.98 ,$74.24 ,$548.38 ,$262.10 ,$593.54 ,$451.61 ,$248.93 ,$248.93 ,$392.90 ,$248.93 ,$445.80 ,$580.64 ,$440.77 ,$115.30 ,$509.67 ,$74.24 ,$139.79 ,$139.79 ,$114.16 ,$139.79 ,$464.51 ,$399.99 ,$464.51 ,$464.51 ,$516.12 
ST NICHOLAS HOSPITAL - ACUTE,31100132,88230,HC TISSUE CLT NONNEO (FRAG X),311,1 ,$181.70 ,$119.92 ,$70.04 ,$262.10 ,$70.04 ,$181.70 ,$181.70 ,$116.49 ,$109.02 ,$154.45 ,$127.19 ,$70.04 ,$70.04 ,$172.62 ,$138.09 ,$136.28 ,$181.70 ,$154.45 ,$116.49 ,$181.70 ,$181.70 ,$127.19 ,$110.66 ,$70.04 ,$116.49 ,$114.16 ,$181.70 ,$74.24 ,$154.45 ,$262.10 ,$167.16 ,$127.19 ,$181.70 ,$181.70 ,$110.66 ,$181.70 ,$125.55 ,$163.53 ,$124.14 ,$115.30 ,$143.54 ,$74.24 ,$139.79 ,$139.79 ,$114.16 ,$139.79 ,$130.82 ,$112.65 ,$130.82 ,$130.82 ,$145.36 
ST NICHOLAS HOSPITAL - ACUTE,31100133,88230,HC TISSUE CLT NONNEO (HRS),311,1 ,$343.85 ,$226.94 ,$70.04 ,$343.85 ,$70.04 ,$343.85 ,$343.85 ,$116.49 ,$206.31 ,$292.27 ,$240.70 ,$70.04 ,$70.04 ,$326.66 ,$261.33 ,$257.89 ,$198.03 ,$292.27 ,$116.49 ,$198.03 ,$198.03 ,$240.70 ,$209.40 ,$70.04 ,$116.49 ,$114.16 ,$232.98 ,$74.24 ,$292.27 ,$262.10 ,$316.34 ,$240.70 ,$248.93 ,$248.93 ,$209.40 ,$248.93 ,$237.60 ,$309.47 ,$234.92 ,$115.30 ,$271.64 ,$74.24 ,$139.79 ,$139.79 ,$114.16 ,$139.79 ,$247.57 ,$213.19 ,$247.57 ,$247.57 ,$275.08 
ST NICHOLAS HOSPITAL - ACUTE,31100134,88230,HC TISSUE CLT NONNEO (FXS),311,1 ,$135.70 ,$89.56 ,$70.04 ,$262.10 ,$70.04 ,$135.70 ,$135.70 ,$116.49 ,$81.42 ,$115.35 ,$94.99 ,$70.04 ,$70.04 ,$128.92 ,$103.13 ,$101.78 ,$135.70 ,$115.35 ,$116.49 ,$135.70 ,$135.70 ,$94.99 ,$82.64 ,$70.04 ,$116.49 ,$114.16 ,$135.70 ,$74.24 ,$115.35 ,$262.10 ,$124.84 ,$94.99 ,$135.70 ,$135.70 ,$82.64 ,$135.70 ,$93.77 ,$122.13 ,$92.71 ,$115.30 ,$107.20 ,$74.24 ,$135.70 ,$135.70 ,$114.16 ,$135.70 ,$97.70 ,$84.13 ,$97.70 ,$97.70 ,$108.56 
ST NICHOLAS HOSPITAL - ACUTE,31100135,88230,HC TISSUE CLT NONNEO (MAYO),311,1 ,$642.85 ,$424.28 ,$70.04 ,$642.85 ,$70.04 ,$407.72 ,$407.72 ,$116.49 ,$385.71 ,$546.42 ,$450.00 ,$70.04 ,$70.04 ,$610.71 ,$488.57 ,$482.14 ,$198.03 ,$546.42 ,$116.49 ,$198.03 ,$198.03 ,$450.00 ,$391.50 ,$70.04 ,$116.49 ,$114.16 ,$232.98 ,$74.24 ,$546.42 ,$262.10 ,$591.42 ,$450.00 ,$248.93 ,$248.93 ,$391.50 ,$248.93 ,$444.21 ,$578.57 ,$439.20 ,$115.30 ,$507.85 ,$74.24 ,$139.79 ,$139.79 ,$114.16 ,$139.79 ,$462.85 ,$398.57 ,$462.85 ,$462.85 ,$514.28 
ST NICHOLAS HOSPITAL - ACUTE,31100136,88230,HC TISSUE CLT NONNEO (LYMPHO),311,1 ,$520.95 ,$343.83 ,$70.04 ,$520.95 ,$70.04 ,$407.72 ,$407.72 ,$116.49 ,$312.57 ,$442.81 ,$364.67 ,$70.04 ,$70.04 ,$494.90 ,$395.92 ,$390.71 ,$198.03 ,$442.81 ,$116.49 ,$198.03 ,$198.03 ,$364.67 ,$317.26 ,$70.04 ,$116.49 ,$114.16 ,$232.98 ,$74.24 ,$442.81 ,$262.10 ,$479.27 ,$364.67 ,$248.93 ,$248.93 ,$317.26 ,$248.93 ,$359.98 ,$468.86 ,$355.91 ,$115.30 ,$411.55 ,$74.24 ,$139.79 ,$139.79 ,$114.16 ,$139.79 ,$375.08 ,$322.99 ,$375.08 ,$375.08 ,$416.76 
ST NICHOLAS HOSPITAL - ACUTE,31100137,88233,HC TISSUE CULT SKIN/OTH SOLID,311,1 ,$458.85 ,$302.84 ,$70.04 ,$458.85 ,$70.04 ,$458.85 ,$458.85 ,$140.73 ,$275.31 ,$390.02 ,$321.20 ,$70.04 ,$70.04 ,$435.91 ,$348.73 ,$344.14 ,$239.24 ,$390.02 ,$140.73 ,$239.24 ,$239.24 ,$321.20 ,$279.44 ,$70.04 ,$140.73 ,$137.92 ,$281.46 ,$74.24 ,$390.02 ,$316.64 ,$422.14 ,$321.20 ,$248.93 ,$248.93 ,$279.44 ,$248.93 ,$317.07 ,$412.97 ,$313.49 ,$139.30 ,$362.49 ,$74.24 ,$168.88 ,$168.88 ,$137.92 ,$168.88 ,$330.37 ,$284.49 ,$330.37 ,$330.37 ,$367.08 
ST NICHOLAS HOSPITAL - ACUTE,31100138,88233,HC TISSUE CULT SKIN/OTH SOLID (CHROMO),311,1 ,"$1,051.10 ",$693.73 ,$70.04 ,"$1,051.10 ",$70.04 ,$492.56 ,$492.56 ,$140.73 ,$630.66 ,$893.44 ,$735.77 ,$70.04 ,$70.04 ,$998.55 ,$798.84 ,$788.33 ,$239.24 ,$893.44 ,$140.73 ,$239.24 ,$239.24 ,$735.77 ,$640.12 ,$70.04 ,$140.73 ,$137.92 ,$281.46 ,$74.24 ,$893.44 ,$316.64 ,$967.01 ,$735.77 ,$248.93 ,$248.93 ,$640.12 ,$248.93 ,$726.31 ,$945.99 ,$718.11 ,$139.30 ,$830.37 ,$74.24 ,$168.88 ,$168.88 ,$137.92 ,$168.88 ,$756.79 ,$651.68 ,$756.79 ,$756.79 ,$840.88 
ST NICHOLAS HOSPITAL - ACUTE,31100139,88235,HC TISSUE CULT AMNIO/CHORION,311,1 ,$692.30 ,$456.92 ,$70.04 ,$692.30 ,$70.04 ,$526.05 ,$526.05 ,$150.30 ,$415.38 ,$588.46 ,$484.61 ,$70.04 ,$70.04 ,$657.69 ,$526.15 ,$519.23 ,$255.51 ,$588.46 ,$150.30 ,$255.51 ,$255.51 ,$484.61 ,$421.61 ,$70.04 ,$150.30 ,$147.29 ,$300.60 ,$74.24 ,$588.46 ,$338.18 ,$636.92 ,$484.61 ,$248.93 ,$248.93 ,$421.61 ,$248.93 ,$478.38 ,$623.07 ,$472.98 ,$148.76 ,$546.92 ,$74.24 ,$180.36 ,$180.36 ,$147.29 ,$180.36 ,$498.46 ,$429.23 ,$498.46 ,$498.46 ,$553.84 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$143.75 ,$302.91 ,$429.12 ,$353.40 ,$70.04 ,$70.04 ,$479.61 ,$383.69 ,$378.64 ,$244.38 ,$429.12 ,$143.75 ,$244.38 ,$244.38 ,$353.40 ,$307.45 ,$70.04 ,$143.75 ,$140.87 ,$287.50 ,$74.24 ,$429.12 ,$323.44 ,$464.46 ,$353.40 ,$248.93 ,$248.93 ,$307.45 ,$248.93 ,$348.85 ,$454.37 ,$344.91 ,$142.29 ,$398.83 ,$74.24 ,$172.50 ,$172.50 ,$140.87 ,$172.50 ,$363.49 ,$313.01 ,$363.49 ,$363.49 ,$403.88 
ST NICHOLAS HOSPITAL - ACUTE,31100142,88237,HC TISSUE CULT BONE/BLD (DC),311,1 ,$588.80 ,$388.61 ,$70.04 ,$588.80 ,$70.04 ,$503.13 ,$503.13 ,$143.75 ,$353.28 ,$500.48 ,$412.16 ,$70.04 ,$70.04 ,$559.36 ,$447.49 ,$441.60 ,$244.38 ,$500.48 ,$143.75 ,$244.38 ,$244.38 ,$412.16 ,$358.58 ,$70.04 ,$143.75 ,$140.87 ,$287.50 ,$74.24 ,$500.48 ,$323.44 ,$541.70 ,$412.16 ,$248.93 ,$248.93 ,$358.58 ,$248.93 ,$406.86 ,$529.92 ,$402.27 ,$142.29 ,$465.15 ,$74.24 ,$172.50 ,$172.50 ,$140.87 ,$172.50 ,$423.94 ,$365.06 ,$423.94 ,$423.94 ,$471.04 
ST NICHOLAS HOSPITAL - ACUTE,31100143,88237,HC TISSUE CULT BONE/BLD (CHROMO),311,1 ,$422.05 ,$278.55 ,$70.04 ,$422.05 ,$70.04 ,$422.05 ,$422.05 ,$143.75 ,$253.23 ,$358.74 ,$295.44 ,$70.04 ,$70.04 ,$400.95 ,$320.76 ,$316.54 ,$244.38 ,$358.74 ,$143.75 ,$244.38 ,$244.38 ,$295.44 ,$257.03 ,$70.04 ,$143.75 ,$140.87 ,$287.50 ,$74.24 ,$358.74 ,$323.44 ,$388.29 ,$295.44 ,$248.93 ,$248.93 ,$257.03 ,$248.93 ,$291.64 ,$379.85 ,$288.34 ,$142.29 ,$333.42 ,$74.24 ,$172.50 ,$172.50 ,$140.87 ,$172.50 ,$303.88 ,$261.67 ,$303.88 ,$303.88 ,$337.64 
ST NICHOLAS HOSPITAL - ACUTE,31100144,88237,HC TISSUE CULT BONE/BLD,311,1 ,$422.05 ,$278.55 ,$70.04 ,$422.05 ,$70.04 ,$422.05 ,$422.05 ,$143.75 ,$253.23 ,$358.74 ,$295.44 ,$70.04 ,$70.04 ,$400.95 ,$320.76 ,$316.54 ,$244.38 ,$358.74 ,$143.75 ,$244.38 ,$244.38 ,$295.44 ,$257.03 ,$70.04 ,$143.75 ,$140.87 ,$287.50 ,$74.24 ,$358.74 ,$323.44 ,$388.29 ,$295.44 ,$248.93 ,$248.93 ,$257.03 ,$248.93 ,$291.64 ,$379.85 ,$288.34 ,$142.29 ,$333.42 ,$74.24 ,$172.50 ,$172.50 ,$140.87 ,$172.50 ,$303.88 ,$261.67 ,$303.88 ,$303.88 ,$337.64 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$143.75 ,$253.23 ,$358.74 ,$295.44 ,$70.04 ,$70.04 ,$400.95 ,$320.76 ,$316.54 ,$244.38 ,$358.74 ,$143.75 ,$244.38 ,$244.38 ,$295.44 ,$257.03 ,$70.04 ,$143.75 ,$140.87 ,$287.50 ,$74.24 ,$358.74 ,$323.44 ,$388.29 ,$295.44 ,$248.93 ,$248.93 ,$257.03 ,$248.93 ,$291.64 ,$379.85 ,$288.34 ,$142.29 ,$333.42 ,$74.24 ,$172.50 ,$172.50 ,$140.87 ,$172.50 ,$303.88 ,$261.67 ,$303.88 ,$303.88 ,$337.64 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$143.75 ,$253.23 ,$358.74 ,$295.44 ,$70.04 ,$70.04 ,$400.95 ,$320.76 ,$316.54 ,$244.38 ,$358.74 ,$143.75 ,$244.38 ,$244.38 ,$295.44 ,$257.03 ,$70.04 ,$143.75 ,$140.87 ,$287.50 ,$74.24 ,$358.74 ,$323.44 ,$388.29 ,$295.44 ,$248.93 ,$248.93 ,$257.03 ,$248.93 ,$291.64 ,$379.85 ,$288.34 ,$142.29 ,$333.42 ,$74.24 ,$172.50 ,$172.50 ,$140.87 ,$172.50 ,$303.88 ,$261.67 ,$303.88 ,$303.88 ,$337.64 
ST NICHOLAS HOSPITAL - ACUTE,31100148,88239,HC TISSUE CULT TUMOR,311,1 ,$570.40 ,$376.46 ,$70.04 ,$570.40 ,$70.04 ,$516.32 ,$516.32 ,$147.52 ,$342.24 ,$484.84 ,$399.28 ,$70.04 ,$70.04 ,$541.88 ,$433.50 ,$427.80 ,$250.78 ,$484.84 ,$147.52 ,$250.78 ,$250.78 ,$399.28 ,$347.37 ,$70.04 ,$147.52 ,$144.57 ,$295.04 ,$74.24 ,$484.84 ,$331.92 ,$524.77 ,$399.28 ,$248.93 ,$248.93 ,$347.37 ,$248.93 ,$394.15 ,$513.36 ,$389.70 ,$146.02 ,$450.62 ,$74.24 ,$177.02 ,$177.02 ,$144.57 ,$177.02 ,$410.69 ,$353.65 ,$410.69 ,$410.69 ,$456.32 
ST NICHOLAS HOSPITAL - ACUTE,31100150,88239,HC TISSUE CULT TUMOR (LYM),311,1 ,$745.20 ,$491.83 ,$70.04 ,$745.20 ,$70.04 ,$516.32 ,$516.32 ,$147.52 ,$447.12 ,$633.42 ,$521.64 ,$70.04 ,$70.04 ,$707.94 ,$566.35 ,$558.90 ,$250.78 ,$633.42 ,$147.52 ,$250.78 ,$250.78 ,$521.64 ,$453.83 ,$70.04 ,$147.52 ,$144.57 ,$295.04 ,$74.24 ,$633.42 ,$331.92 ,$685.58 ,$521.64 ,$248.93 ,$248.93 ,$453.83 ,$248.93 ,$514.93 ,$670.68 ,$509.12 ,$146.02 ,$588.71 ,$74.24 ,$177.02 ,$177.02 ,$144.57 ,$177.02 ,$536.54 ,$462.02 ,$536.54 ,$536.54 ,$596.16 
ST NICHOLAS HOSPITAL - ACUTE,31100151,88240,HC CRYOPRESERVATION,311,1 ,$56.35 ,$37.19 ,$9.83 ,$56.35 ,$9.83 ,$45.75 ,$45.75 ,$13.07 ,$33.81 ,$47.90 ,$39.45 ,$9.83 ,$9.83 ,$53.53 ,$42.83 ,$42.26 ,$22.22 ,$47.90 ,$13.07 ,$22.22 ,$22.22 ,$39.45 ,$34.32 ,$9.83 ,$13.07 ,$12.81 ,$26.14 ,$10.42 ,$47.90 ,$29.41 ,$51.84 ,$39.45 ,$34.91 ,$34.91 ,$34.32 ,$34.91 ,$38.94 ,$50.72 ,$38.50 ,$12.94 ,$44.52 ,$10.42 ,$15.68 ,$15.68 ,$12.81 ,$15.68 ,$40.57 ,$34.94 ,$40.57 ,$40.57 ,$45.08 
ST NICHOLAS HOSPITAL - ACUTE,31100152,88248,HC FXS CHROM ANALYSIS,311,1 ,$323.15 ,$213.28 ,$169.71 ,$389.63 ,$178.94 ,$323.15 ,$323.15 ,$173.17 ,$193.89 ,$274.68 ,$226.21 ,$178.94 ,$178.94 ,$306.99 ,$245.59 ,$242.36 ,$294.39 ,$274.68 ,$173.17 ,$294.39 ,$294.39 ,$226.21 ,$196.80 ,$178.94 ,$173.17 ,$169.71 ,$323.15 ,$189.68 ,$274.68 ,$389.63 ,$297.30 ,$226.21 ,$323.15 ,$323.15 ,$196.80 ,$323.15 ,$223.30 ,$290.84 ,$220.78 ,$171.40 ,$255.29 ,$189.68 ,$207.80 ,$207.80 ,$169.71 ,$207.80 ,$232.67 ,$200.35 ,$232.67 ,$232.67 ,$258.52 
ST NICHOLAS HOSPITAL - ACUTE,31100153,88262,HC CHROM COUNT 15-20/2 (QD),311,1 ,$806.15 ,$532.06 ,$122.98 ,$806.15 ,$129.67 ,$439.22 ,$439.22 ,$125.49 ,$483.69 ,$685.23 ,$564.31 ,$129.67 ,$129.67 ,$765.84 ,$612.67 ,$604.61 ,$213.33 ,$685.23 ,$125.49 ,$213.33 ,$213.33 ,$564.31 ,$490.95 ,$129.67 ,$125.49 ,$122.98 ,$250.98 ,$137.45 ,$685.23 ,$282.35 ,$741.66 ,$564.31 ,$622.94 ,$622.94 ,$490.95 ,$622.94 ,$557.05 ,$725.54 ,$550.76 ,$124.21 ,$636.86 ,$137.45 ,$150.59 ,$150.59 ,$122.98 ,$150.59 ,$580.43 ,$499.81 ,$580.43 ,$580.43 ,$644.92 
ST NICHOLAS HOSPITAL - ACUTE,31100154,88262,HC CHROM COUNT 15-20/2 (FRAG X),311,1 ,$179.40 ,$118.40 ,$107.64 ,$282.35 ,$129.67 ,$179.40 ,$179.40 ,$125.49 ,$107.64 ,$152.49 ,$125.58 ,$129.67 ,$129.67 ,$170.43 ,$136.34 ,$134.55 ,$179.40 ,$152.49 ,$125.49 ,$179.40 ,$179.40 ,$125.58 ,$109.25 ,$129.67 ,$125.49 ,$122.98 ,$179.40 ,$137.45 ,$152.49 ,$282.35 ,$165.05 ,$125.58 ,$179.40 ,$179.40 ,$109.25 ,$179.40 ,$123.97 ,$161.46 ,$122.57 ,$124.21 ,$141.73 ,$137.45 ,$150.59 ,$150.59 ,$122.98 ,$150.59 ,$129.17 ,$111.23 ,$129.17 ,$129.17 ,$143.52 
ST NICHOLAS HOSPITAL - ACUTE,31100155,88299,HC CYTOGENIC STUDY (LYMPH),311,1 ,$533.60 ,$352.18 ,$1.46 ,$533.60 ,$1.46 ,$365.73 ,$365.73 ,$48.94 ,$320.16 ,$453.56 ,$373.52 ,$1.46 ,$1.46 ,$506.92 ,$405.54 ,$400.20 , N/A ,$453.56 ,$48.94 , N/A , N/A ,$373.52 ,$324.96 ,$1.46 ,$48.94 ,$47.96 ,$97.88 ,$1.55 ,$453.56 ,$110.11 ,$490.91 ,$373.52 ,$270.64 ,$324.80 ,$324.96 ,$324.80 ,$368.72 ,$480.24 ,$364.56 ,$48.44 ,$421.54 ,$1.55 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$384.19 ,$330.83 ,$384.19 ,$384.19 ,$426.88 
ST NICHOLAS HOSPITAL - ACUTE,31100156,88262,HC CHROM COUNT 15-20/2 (HRS),311,1 ,$341.55 ,$225.42 ,$122.98 ,$341.55 ,$129.67 ,$341.55 ,$341.55 ,$125.49 ,$204.93 ,$290.32 ,$239.09 ,$129.67 ,$129.67 ,$324.47 ,$259.58 ,$256.16 ,$213.33 ,$290.32 ,$125.49 ,$213.33 ,$213.33 ,$239.09 ,$208.00 ,$129.67 ,$125.49 ,$122.98 ,$250.98 ,$137.45 ,$290.32 ,$282.35 ,$314.23 ,$239.09 ,$341.55 ,$341.55 ,$208.00 ,$341.55 ,$236.01 ,$307.40 ,$233.35 ,$124.21 ,$269.82 ,$137.45 ,$150.59 ,$150.59 ,$122.98 ,$150.59 ,$245.92 ,$211.76 ,$245.92 ,$245.92 ,$273.24 
ST NICHOLAS HOSPITAL - ACUTE,31100157,88262,HC CHROM COUNT 15-20/2 (MAYO),311,1 ,$874.00 ,$576.84 ,$122.98 ,$874.00 ,$129.67 ,$439.22 ,$439.22 ,$125.49 ,$524.40 ,$742.90 ,$611.80 ,$129.67 ,$129.67 ,$830.30 ,$664.24 ,$655.50 ,$213.33 ,$742.90 ,$125.49 ,$213.33 ,$213.33 ,$611.80 ,$532.27 ,$129.67 ,$125.49 ,$122.98 ,$250.98 ,$137.45 ,$742.90 ,$282.35 ,$804.08 ,$611.80 ,$622.94 ,$622.94 ,$532.27 ,$622.94 ,$603.93 ,$786.60 ,$597.12 ,$124.21 ,$690.46 ,$137.45 ,$150.59 ,$150.59 ,$122.98 ,$150.59 ,$629.28 ,$541.88 ,$629.28 ,$629.28 ,$699.20 
ST NICHOLAS HOSPITAL - ACUTE,31100160,88262,HC CHROM COUNT 15-20/2 (KARO),311,1 ,$572.70 ,$377.98 ,$122.98 ,$572.70 ,$129.67 ,$439.22 ,$439.22 ,$125.49 ,$343.62 ,$486.80 ,$400.89 ,$129.67 ,$129.67 ,$544.07 ,$435.25 ,$429.53 ,$213.33 ,$486.80 ,$125.49 ,$213.33 ,$213.33 ,$400.89 ,$348.77 ,$129.67 ,$125.49 ,$122.98 ,$250.98 ,$137.45 ,$486.80 ,$282.35 ,$526.88 ,$400.89 ,$572.70 ,$572.70 ,$348.77 ,$572.70 ,$395.74 ,$515.43 ,$391.27 ,$124.21 ,$452.43 ,$137.45 ,$150.59 ,$150.59 ,$122.98 ,$150.59 ,$412.34 ,$355.07 ,$412.34 ,$412.34 ,$458.16 
ST NICHOLAS HOSPITAL - ACUTE,31100161,88262,HC CHROM COUNT 15-20/2,311,1 ,$558.90 ,$368.87 ,$122.98 ,$558.90 ,$129.67 ,$439.22 ,$439.22 ,$125.49 ,$335.34 ,$475.07 ,$391.23 ,$129.67 ,$129.67 ,$530.96 ,$424.76 ,$419.18 ,$213.33 ,$475.07 ,$125.49 ,$213.33 ,$213.33 ,$391.23 ,$340.37 ,$129.67 ,$125.49 ,$122.98 ,$250.98 ,$137.45 ,$475.07 ,$282.35 ,$514.19 ,$391.23 ,$558.90 ,$558.90 ,$340.37 ,$558.90 ,$386.20 ,$503.01 ,$381.84 ,$124.21 ,$441.53 ,$137.45 ,$150.59 ,$150.59 ,$122.98 ,$150.59 ,$402.41 ,$346.52 ,$402.41 ,$402.41 ,$447.12 
ST NICHOLAS HOSPITAL - ACUTE,31100162,88262,HC CHROM COUNT 15-20/2 (AUTOP),311,1 ,$583.05 ,$384.81 ,$122.98 ,$583.05 ,$129.67 ,$439.22 ,$439.22 ,$125.49 ,$349.83 ,$495.59 ,$408.14 ,$129.67 ,$129.67 ,$553.90 ,$443.12 ,$437.29 ,$213.33 ,$495.59 ,$125.49 ,$213.33 ,$213.33 ,$408.14 ,$355.08 ,$129.67 ,$125.49 ,$122.98 ,$250.98 ,$137.45 ,$495.59 ,$282.35 ,$536.41 ,$408.14 ,$583.05 ,$583.05 ,$355.08 ,$583.05 ,$402.89 ,$524.75 ,$398.34 ,$124.21 ,$460.61 ,$137.45 ,$150.59 ,$150.59 ,$122.98 ,$150.59 ,$419.80 ,$361.49 ,$419.80 ,$419.80 ,$466.44 
ST NICHOLAS HOSPITAL - ACUTE,31100163,88262,HC CHROM COUNT 15-20/2 (LYM),311,1 ,$834.90 ,$551.03 ,$122.98 ,$834.90 ,$129.67 ,$439.22 ,$439.22 ,$125.49 ,$500.94 ,$709.67 ,$584.43 ,$129.67 ,$129.67 ,$793.16 ,$634.52 ,$626.18 ,$213.33 ,$709.67 ,$125.49 ,$213.33 ,$213.33 ,$584.43 ,$508.45 ,$129.67 ,$125.49 ,$122.98 ,$250.98 ,$137.45 ,$709.67 ,$282.35 ,$768.11 ,$584.43 ,$622.94 ,$622.94 ,$508.45 ,$622.94 ,$576.92 ,$751.41 ,$570.40 ,$124.21 ,$659.57 ,$137.45 ,$150.59 ,$150.59 ,$122.98 ,$150.59 ,$601.13 ,$517.64 ,$601.13 ,$601.13 ,$667.92 
ST NICHOLAS HOSPITAL - ACUTE,31100164,88299,HC CYTOGENIC STUDY (STLBRT1),311,1 ,$523.25 ,$345.35 ,$1.46 ,$523.25 ,$1.46 ,$358.64 ,$358.64 ,$48.94 ,$313.95 ,$444.76 ,$366.28 ,$1.46 ,$1.46 ,$497.09 ,$397.67 ,$392.44 , N/A ,$444.76 ,$48.94 , N/A , N/A ,$366.28 ,$318.66 ,$1.46 ,$48.94 ,$47.96 ,$97.88 ,$1.55 ,$444.76 ,$110.11 ,$481.39 ,$366.28 ,$265.39 ,$318.50 ,$318.66 ,$318.50 ,$361.57 ,$470.93 ,$357.48 ,$48.44 ,$413.37 ,$1.55 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$376.74 ,$324.42 ,$376.74 ,$376.74 ,$418.60 
ST NICHOLAS HOSPITAL - ACUTE,31100165,88264,HC CYTOGENIC STUDY (HEMA BLD),311,1 ,"$1,054.55 ",$696.00 ,$141.72 ,"$1,054.55 ",$149.43 ,$506.14 ,$506.14 ,$144.61 ,$632.73 ,$896.37 ,$738.19 ,$149.43 ,$149.43 ,"$1,001.82 ",$801.46 ,$790.91 ,$245.84 ,$896.37 ,$144.61 ,$245.84 ,$245.84 ,$738.19 ,$642.22 ,$149.43 ,$144.61 ,$141.72 ,$289.22 ,$158.40 ,$896.37 ,$325.37 ,$970.19 ,$738.19 ,$622.94 ,$622.94 ,$642.22 ,$622.94 ,$728.69 ,$949.10 ,$720.47 ,$143.14 ,$833.09 ,$158.40 ,$173.53 ,$173.53 ,$141.72 ,$173.53 ,$759.28 ,$653.82 ,$759.28 ,$759.28 ,$843.64 
ST NICHOLAS HOSPITAL - ACUTE,31100166,88264,HC CHROM ANLYS ANALYZE 20,311,1 ,"$1,054.55 ",$696.00 ,$141.72 ,"$1,054.55 ",$149.43 ,$506.14 ,$506.14 ,$144.61 ,$632.73 ,$896.37 ,$738.19 ,$149.43 ,$149.43 ,"$1,001.82 ",$801.46 ,$790.91 ,$245.84 ,$896.37 ,$144.61 ,$245.84 ,$245.84 ,$738.19 ,$642.22 ,$149.43 ,$144.61 ,$141.72 ,$289.22 ,$158.40 ,$896.37 ,$325.37 ,$970.19 ,$738.19 ,$622.94 ,$622.94 ,$642.22 ,$622.94 ,$728.69 ,$949.10 ,$720.47 ,$143.14 ,$833.09 ,$158.40 ,$173.53 ,$173.53 ,$141.72 ,$173.53 ,$759.28 ,$653.82 ,$759.28 ,$759.28 ,$843.64 
ST NICHOLAS HOSPITAL - ACUTE,31100167,88264,HC CHROM ANLYS ANALZYE 20 (KARO),311,1 ,"$1,054.55 ",$696.00 ,$141.72 ,"$1,054.55 ",$149.43 ,$506.14 ,$506.14 ,$144.61 ,$632.73 ,$896.37 ,$738.19 ,$149.43 ,$149.43 ,"$1,001.82 ",$801.46 ,$790.91 ,$245.84 ,$896.37 ,$144.61 ,$245.84 ,$245.84 ,$738.19 ,$642.22 ,$149.43 ,$144.61 ,$141.72 ,$289.22 ,$158.40 ,$896.37 ,$325.37 ,$970.19 ,$738.19 ,$622.94 ,$622.94 ,$642.22 ,$622.94 ,$728.69 ,$949.10 ,$720.47 ,$143.14 ,$833.09 ,$158.40 ,$173.53 ,$173.53 ,$141.72 ,$173.53 ,$759.28 ,$653.82 ,$759.28 ,$759.28 ,$843.64 
ST NICHOLAS HOSPITAL - ACUTE,31100168,88264,HC CHROM ANLYS ANALZYE 20 (DC),311,1 ,"$1,054.55 ",$696.00 ,$141.72 ,"$1,054.55 ",$149.43 ,$506.14 ,$506.14 ,$144.61 ,$632.73 ,$896.37 ,$738.19 ,$149.43 ,$149.43 ,"$1,001.82 ",$801.46 ,$790.91 ,$245.84 ,$896.37 ,$144.61 ,$245.84 ,$245.84 ,$738.19 ,$642.22 ,$149.43 ,$144.61 ,$141.72 ,$289.22 ,$158.40 ,$896.37 ,$325.37 ,$970.19 ,$738.19 ,$622.94 ,$622.94 ,$642.22 ,$622.94 ,$728.69 ,$949.10 ,$720.47 ,$143.14 ,$833.09 ,$158.40 ,$173.53 ,$173.53 ,$141.72 ,$173.53 ,$759.28 ,$653.82 ,$759.28 ,$759.28 ,$843.64 
ST NICHOLAS HOSPITAL - ACUTE,31100169,88264,HC CYTOGENIC STUDY (BM),311,1 ,"$1,054.55 ",$696.00 ,$141.72 ,"$1,054.55 ",$149.43 ,$506.14 ,$506.14 ,$144.61 ,$632.73 ,$896.37 ,$738.19 ,$149.43 ,$149.43 ,"$1,001.82 ",$801.46 ,$790.91 ,$245.84 ,$896.37 ,$144.61 ,$245.84 ,$245.84 ,$738.19 ,$642.22 ,$149.43 ,$144.61 ,$141.72 ,$289.22 ,$158.40 ,$896.37 ,$325.37 ,$970.19 ,$738.19 ,$622.94 ,$622.94 ,$642.22 ,$622.94 ,$728.69 ,$949.10 ,$720.47 ,$143.14 ,$833.09 ,$158.40 ,$173.53 ,$173.53 ,$141.72 ,$173.53 ,$759.28 ,$653.82 ,$759.28 ,$759.28 ,$843.64 
ST NICHOLAS HOSPITAL - ACUTE,31100170,88299,HC CYTOGENIC STUDY (SOLID),311,1 ,$683.10 ,$450.85 ,$1.46 ,$683.10 ,$1.46 ,$468.20 ,$468.20 ,$48.94 ,$409.86 ,$580.64 ,$478.17 ,$1.46 ,$1.46 ,$648.95 ,$519.16 ,$512.33 , N/A ,$580.64 ,$48.94 , N/A , N/A ,$478.17 ,$416.01 ,$1.46 ,$48.94 ,$47.96 ,$97.88 ,$1.55 ,$580.64 ,$110.11 ,$628.45 ,$478.17 ,$346.47 ,$415.80 ,$416.01 ,$415.80 ,$472.02 ,$614.79 ,$466.69 ,$48.44 ,$539.65 ,$1.55 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$491.83 ,$423.52 ,$491.83 ,$491.83 ,$546.48 
ST NICHOLAS HOSPITAL - ACUTE,31100172,88271,HC MCG DNA PROBE (HER2),311,1 ,$285.20 ,$188.23 ,$20.36 ,$285.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$171.12 ,$242.42 ,$199.64 ,$20.36 ,$20.36 ,$270.94 ,$216.75 ,$213.90 ,$36.41 ,$242.42 ,$21.42 ,$36.41 ,$36.41 ,$199.64 ,$173.69 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$242.42 ,$48.20 ,$262.38 ,$199.64 ,$72.35 ,$72.35 ,$173.69 ,$72.35 ,$197.07 ,$256.68 ,$194.85 ,$21.20 ,$225.31 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$205.34 ,$176.82 ,$205.34 ,$205.34 ,$228.16 
ST NICHOLAS HOSPITAL - ACUTE,31100173,88271,HC MCG DNA PROBE (PARDER WILLI),311,1 ,$496.80 ,$327.89 ,$20.36 ,$496.80 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$298.08 ,$422.28 ,$347.76 ,$20.36 ,$20.36 ,$471.96 ,$377.57 ,$372.60 ,$36.41 ,$422.28 ,$21.42 ,$36.41 ,$36.41 ,$347.76 ,$302.55 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$422.28 ,$48.20 ,$457.06 ,$347.76 ,$72.35 ,$72.35 ,$302.55 ,$72.35 ,$343.29 ,$447.12 ,$339.41 ,$21.20 ,$392.47 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$357.70 ,$308.02 ,$357.70 ,$357.70 ,$397.44 
ST NICHOLAS HOSPITAL - ACUTE,31100174,88271,HC MCG DNA PROBE(FISH),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100175,88271,HC MCG DNA PROBE (FISH B CELL),311,1 ,$347.30 ,$229.22 ,$20.36 ,$347.30 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$208.38 ,$295.21 ,$243.11 ,$20.36 ,$20.36 ,$329.94 ,$263.95 ,$260.48 ,$36.41 ,$295.21 ,$21.42 ,$36.41 ,$36.41 ,$243.11 ,$211.51 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$295.21 ,$48.20 ,$319.52 ,$243.11 ,$72.35 ,$72.35 ,$211.51 ,$72.35 ,$239.98 ,$312.57 ,$237.28 ,$21.20 ,$274.37 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$250.06 ,$215.33 ,$250.06 ,$250.06 ,$277.84 
ST NICHOLAS HOSPITAL - ACUTE,31100177,88271,HC MCG DNA PROBE (FISH DNA),311,1 ,$217.35 ,$143.45 ,$20.36 ,$217.35 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$130.41 ,$184.75 ,$152.15 ,$20.36 ,$20.36 ,$206.48 ,$165.19 ,$163.01 ,$36.41 ,$184.75 ,$21.42 ,$36.41 ,$36.41 ,$152.15 ,$132.37 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$184.75 ,$48.20 ,$199.96 ,$152.15 ,$72.35 ,$72.35 ,$132.37 ,$72.35 ,$150.19 ,$195.62 ,$148.49 ,$21.20 ,$171.71 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$156.49 ,$134.76 ,$156.49 ,$156.49 ,$173.88 
ST NICHOLAS HOSPITAL - ACUTE,31100178,88271,HC MCG DNA PROBE (T CELL),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100180,88271,HC MCG DNA PROBE (AML),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100181,88271,HC MCG DNA PROBE (MYCN),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100182,88271,HC MCG DNA PROBE (MDS),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100183,88271,HC MCG DNA PROBE (EACH),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100184,88271,HC MCG DNA PROBE (T CELL FISH),311,1 ,$217.35 ,$143.45 ,$20.36 ,$217.35 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$130.41 ,$184.75 ,$152.15 ,$20.36 ,$20.36 ,$206.48 ,$165.19 ,$163.01 ,$36.41 ,$184.75 ,$21.42 ,$36.41 ,$36.41 ,$152.15 ,$132.37 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$184.75 ,$48.20 ,$199.96 ,$152.15 ,$72.35 ,$72.35 ,$132.37 ,$72.35 ,$150.19 ,$195.62 ,$148.49 ,$21.20 ,$171.71 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$156.49 ,$134.76 ,$156.49 ,$156.49 ,$173.88 
ST NICHOLAS HOSPITAL - ACUTE,31100185,88271,HC MCG DNA PROBE (CLL),311,1 ,$248.40 ,$163.94 ,$20.36 ,$248.40 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$149.04 ,$211.14 ,$173.88 ,$20.36 ,$20.36 ,$235.98 ,$188.78 ,$186.30 ,$36.41 ,$211.14 ,$21.42 ,$36.41 ,$36.41 ,$173.88 ,$151.28 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$211.14 ,$48.20 ,$228.53 ,$173.88 ,$72.35 ,$72.35 ,$151.28 ,$72.35 ,$171.64 ,$223.56 ,$169.71 ,$21.20 ,$196.24 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$178.85 ,$154.01 ,$178.85 ,$178.85 ,$198.72 
ST NICHOLAS HOSPITAL - ACUTE,31100186,88271,HC MCG DNA PROBE (BCR),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100188,88271,HC MCG DNA PROBE (B CELL ALL),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100189,88271,HC MCG DNA PROBE (T CELL LYMPH),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$74.52 ,$105.57 ,$86.94 ,$20.36 ,$20.36 ,$117.99 ,$94.39 ,$93.15 ,$36.41 ,$105.57 ,$21.42 ,$36.41 ,$36.41 ,$86.94 ,$75.64 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$105.57 ,$48.20 ,$114.26 ,$86.94 ,$72.35 ,$72.35 ,$75.64 ,$72.35 ,$85.82 ,$111.78 ,$84.85 ,$21.20 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100191,88273,HC MCG CHROM INSITU 10-30 (PARDER WILLI),311,1 ,$570.40 ,$376.46 ,$34.11 ,$570.40 ,$35.97 ,$121.84 ,$121.84 ,$34.81 ,$342.24 ,$484.84 ,$399.28 ,$35.97 ,$35.97 ,$541.88 ,$433.50 ,$427.80 ,$59.18 ,$484.84 ,$34.81 ,$59.18 ,$59.18 ,$399.28 ,$347.37 ,$35.97 ,$34.81 ,$34.11 ,$69.62 ,$38.13 ,$484.84 ,$78.32 ,$524.77 ,$399.28 ,$160.61 ,$160.61 ,$347.37 ,$160.61 ,$394.15 ,$513.36 ,$389.70 ,$34.46 ,$450.62 ,$38.13 ,$41.77 ,$41.77 ,$34.11 ,$41.77 ,$410.69 ,$353.65 ,$410.69 ,$410.69 ,$456.32 
ST NICHOLAS HOSPITAL - ACUTE,31100192,88273,HC MCG CHROM INSITU 10-30,311,1 ,$217.35 ,$143.45 ,$34.11 ,$217.35 ,$35.97 ,$121.84 ,$121.84 ,$34.81 ,$130.41 ,$184.75 ,$152.15 ,$35.97 ,$35.97 ,$206.48 ,$165.19 ,$163.01 ,$59.18 ,$184.75 ,$34.81 ,$59.18 ,$59.18 ,$152.15 ,$132.37 ,$35.97 ,$34.81 ,$34.11 ,$69.62 ,$38.13 ,$184.75 ,$78.32 ,$199.96 ,$152.15 ,$160.61 ,$160.61 ,$132.37 ,$160.61 ,$150.19 ,$195.62 ,$148.49 ,$34.46 ,$171.71 ,$38.13 ,$41.77 ,$41.77 ,$34.11 ,$41.77 ,$156.49 ,$134.76 ,$156.49 ,$156.49 ,$173.88 
ST NICHOLAS HOSPITAL - ACUTE,31100193,88274,HC MCG INTERPHASE INSITU 25 (HER2),311,1 ,$248.40 ,$163.94 ,$41.53 ,$248.40 ,$43.79 ,$148.33 ,$148.33 ,$42.38 ,$149.04 ,$211.14 ,$173.88 ,$43.79 ,$43.79 ,$235.98 ,$188.78 ,$186.30 ,$72.05 ,$211.14 ,$42.38 ,$72.05 ,$72.05 ,$173.88 ,$151.28 ,$43.79 ,$42.38 ,$41.53 ,$84.76 ,$46.42 ,$211.14 ,$95.36 ,$228.53 ,$173.88 ,$173.98 ,$173.98 ,$151.28 ,$173.98 ,$171.64 ,$223.56 ,$169.71 ,$41.94 ,$196.24 ,$46.42 ,$50.86 ,$50.86 ,$41.53 ,$50.86 ,$178.85 ,$154.01 ,$178.85 ,$178.85 ,$198.72 
ST NICHOLAS HOSPITAL - ACUTE,31100194,88274,HC MCG INTERPHASE INSITU 25 (MYCN),311,1 ,$248.40 ,$163.94 ,$41.53 ,$248.40 ,$43.79 ,$148.33 ,$148.33 ,$42.38 ,$149.04 ,$211.14 ,$173.88 ,$43.79 ,$43.79 ,$235.98 ,$188.78 ,$186.30 ,$72.05 ,$211.14 ,$42.38 ,$72.05 ,$72.05 ,$173.88 ,$151.28 ,$43.79 ,$42.38 ,$41.53 ,$84.76 ,$46.42 ,$211.14 ,$95.36 ,$228.53 ,$173.88 ,$173.98 ,$173.98 ,$151.28 ,$173.98 ,$171.64 ,$223.56 ,$169.71 ,$41.94 ,$196.24 ,$46.42 ,$50.86 ,$50.86 ,$41.53 ,$50.86 ,$178.85 ,$154.01 ,$178.85 ,$178.85 ,$198.72 
ST NICHOLAS HOSPITAL - ACUTE,31100195,88275,HC MCG INTERPH INSITU 100 (CML),311,1 ,$334.65 ,$220.87 ,$50.17 ,$334.65 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$200.79 ,$284.45 ,$234.26 ,$52.89 ,$52.89 ,$317.92 ,$254.33 ,$250.99 ,$87.02 ,$284.45 ,$51.19 ,$87.02 ,$87.02 ,$234.26 ,$203.80 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$284.45 ,$115.18 ,$307.88 ,$234.26 ,$200.72 ,$200.72 ,$203.80 ,$200.72 ,$231.24 ,$301.19 ,$228.63 ,$50.67 ,$264.37 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31100196,88275,HC MCG INTERPH INSITU 100 (B CELL FISH),311,1 ,$683.10 ,$450.85 ,$50.17 ,$683.10 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$409.86 ,$580.64 ,$478.17 ,$52.89 ,$52.89 ,$648.95 ,$519.16 ,$512.33 ,$87.02 ,$580.64 ,$51.19 ,$87.02 ,$87.02 ,$478.17 ,$416.01 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$580.64 ,$115.18 ,$628.45 ,$478.17 ,$200.72 ,$200.72 ,$416.01 ,$200.72 ,$472.02 ,$614.79 ,$466.69 ,$50.67 ,$539.65 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$491.83 ,$423.52 ,$491.83 ,$491.83 ,$546.48 
ST NICHOLAS HOSPITAL - ACUTE,31100197,88275,HC MCG INTERPH INSITU 100 ADDITIONAL,311,1 ,$124.20 ,$81.97 ,$50.17 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$51.19 ,$74.52 ,$105.57 ,$86.94 ,$52.89 ,$52.89 ,$117.99 ,$94.39 ,$93.15 ,$87.02 ,$105.57 ,$51.19 ,$87.02 ,$87.02 ,$86.94 ,$75.64 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$105.57 ,$115.18 ,$114.26 ,$86.94 ,$124.20 ,$124.20 ,$75.64 ,$124.20 ,$85.82 ,$111.78 ,$84.85 ,$50.67 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100198,88275,HC MCG INTERPH INSITU 100 (T CELL),311,1 ,$162.15 ,$107.02 ,$50.17 ,$162.15 ,$52.89 ,$162.15 ,$162.15 ,$51.19 ,$97.29 ,$137.83 ,$113.51 ,$52.89 ,$52.89 ,$154.04 ,$123.23 ,$121.61 ,$87.02 ,$137.83 ,$51.19 ,$87.02 ,$87.02 ,$113.51 ,$98.75 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$137.83 ,$115.18 ,$149.18 ,$113.51 ,$162.15 ,$162.15 ,$98.75 ,$162.15 ,$112.05 ,$145.94 ,$110.78 ,$50.67 ,$128.10 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,31100199,88275,HC MCG INTERPH INSITU 100 (B CELL LYMPH),311,1 ,$261.05 ,$172.29 ,$50.17 ,$261.05 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$156.63 ,$221.89 ,$182.74 ,$52.89 ,$52.89 ,$248.00 ,$198.40 ,$195.79 ,$87.02 ,$221.89 ,$51.19 ,$87.02 ,$87.02 ,$182.74 ,$158.98 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$221.89 ,$115.18 ,$240.17 ,$182.74 ,$200.72 ,$200.72 ,$158.98 ,$200.72 ,$180.39 ,$234.95 ,$178.35 ,$50.67 ,$206.23 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$187.96 ,$161.85 ,$187.96 ,$187.96 ,$208.84 
ST NICHOLAS HOSPITAL - ACUTE,31100200,88275,HC MCG INTERPH INSITU 100 (AML),311,1 ,$261.05 ,$172.29 ,$50.17 ,$261.05 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$156.63 ,$221.89 ,$182.74 ,$52.89 ,$52.89 ,$248.00 ,$198.40 ,$195.79 ,$87.02 ,$221.89 ,$51.19 ,$87.02 ,$87.02 ,$182.74 ,$158.98 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$221.89 ,$115.18 ,$240.17 ,$182.74 ,$200.72 ,$200.72 ,$158.98 ,$200.72 ,$180.39 ,$234.95 ,$178.35 ,$50.67 ,$206.23 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$187.96 ,$161.85 ,$187.96 ,$187.96 ,$208.84 
ST NICHOLAS HOSPITAL - ACUTE,31100201,88275,HC MCG INTERPH INSITU 100 (MDS),311,1 ,$372.60 ,$245.92 ,$50.17 ,$372.60 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$223.56 ,$316.71 ,$260.82 ,$52.89 ,$52.89 ,$353.97 ,$283.18 ,$279.45 ,$87.02 ,$316.71 ,$51.19 ,$87.02 ,$87.02 ,$260.82 ,$226.91 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$316.71 ,$115.18 ,$342.79 ,$260.82 ,$200.72 ,$200.72 ,$226.91 ,$200.72 ,$257.47 ,$335.34 ,$254.56 ,$50.67 ,$294.35 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$268.27 ,$231.01 ,$268.27 ,$268.27 ,$298.08 
ST NICHOLAS HOSPITAL - ACUTE,31100202,88275,HC MCG INTERPH INSITU 100 (PCPD),311,1 ,$124.20 ,$81.97 ,$50.17 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$51.19 ,$74.52 ,$105.57 ,$86.94 ,$52.89 ,$52.89 ,$117.99 ,$94.39 ,$93.15 ,$87.02 ,$105.57 ,$51.19 ,$87.02 ,$87.02 ,$86.94 ,$75.64 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$105.57 ,$115.18 ,$114.26 ,$86.94 ,$124.20 ,$124.20 ,$75.64 ,$124.20 ,$85.82 ,$111.78 ,$84.85 ,$50.67 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100203,88275,HC MCG INTERPH INSITU 100 (T CELL FISH),311,1 ,$217.35 ,$143.45 ,$50.17 ,$217.35 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$130.41 ,$184.75 ,$152.15 ,$52.89 ,$52.89 ,$206.48 ,$165.19 ,$163.01 ,$87.02 ,$184.75 ,$51.19 ,$87.02 ,$87.02 ,$152.15 ,$132.37 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$184.75 ,$115.18 ,$199.96 ,$152.15 ,$200.72 ,$200.72 ,$132.37 ,$200.72 ,$150.19 ,$195.62 ,$148.49 ,$50.67 ,$171.71 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$156.49 ,$134.76 ,$156.49 ,$156.49 ,$173.88 
ST NICHOLAS HOSPITAL - ACUTE,31100204,88275,HC MCG INTERPH INSITU 100 (CLL),311,1 ,$124.20 ,$81.97 ,$50.17 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$51.19 ,$74.52 ,$105.57 ,$86.94 ,$52.89 ,$52.89 ,$117.99 ,$94.39 ,$93.15 ,$87.02 ,$105.57 ,$51.19 ,$87.02 ,$87.02 ,$86.94 ,$75.64 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$105.57 ,$115.18 ,$114.26 ,$86.94 ,$124.20 ,$124.20 ,$75.64 ,$124.20 ,$85.82 ,$111.78 ,$84.85 ,$50.67 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100205,88275,HC MCG INTERPH INSITU 100 (BCR),311,1 ,$248.40 ,$163.94 ,$50.17 ,$248.40 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$149.04 ,$211.14 ,$173.88 ,$52.89 ,$52.89 ,$235.98 ,$188.78 ,$186.30 ,$87.02 ,$211.14 ,$51.19 ,$87.02 ,$87.02 ,$173.88 ,$151.28 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$211.14 ,$115.18 ,$228.53 ,$173.88 ,$200.72 ,$200.72 ,$151.28 ,$200.72 ,$171.64 ,$223.56 ,$169.71 ,$50.67 ,$196.24 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$178.85 ,$154.01 ,$178.85 ,$178.85 ,$198.72 
ST NICHOLAS HOSPITAL - ACUTE,31100206,88275,HC MCG INTERPH INSITU 100 (B CELL),311,1 ,$280.60 ,$185.20 ,$50.17 ,$280.60 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$168.36 ,$238.51 ,$196.42 ,$52.89 ,$52.89 ,$266.57 ,$213.26 ,$210.45 ,$87.02 ,$238.51 ,$51.19 ,$87.02 ,$87.02 ,$196.42 ,$170.89 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$238.51 ,$115.18 ,$258.15 ,$196.42 ,$200.72 ,$200.72 ,$170.89 ,$200.72 ,$193.89 ,$252.54 ,$191.71 ,$50.67 ,$221.67 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$202.03 ,$173.97 ,$202.03 ,$202.03 ,$224.48 
ST NICHOLAS HOSPITAL - ACUTE,31100207,88275,HC MCG INTERPH INSITU 100 (B CELL ALL),311,1 ,$124.20 ,$81.97 ,$50.17 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$51.19 ,$74.52 ,$105.57 ,$86.94 ,$52.89 ,$52.89 ,$117.99 ,$94.39 ,$93.15 ,$87.02 ,$105.57 ,$51.19 ,$87.02 ,$87.02 ,$86.94 ,$75.64 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$105.57 ,$115.18 ,$114.26 ,$86.94 ,$124.20 ,$124.20 ,$75.64 ,$124.20 ,$85.82 ,$111.78 ,$84.85 ,$50.67 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100208,88275,HC MCG INTERPH INSITU 100 (T CELL LYMPH),311,1 ,$124.20 ,$81.97 ,$50.17 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$51.19 ,$74.52 ,$105.57 ,$86.94 ,$52.89 ,$52.89 ,$117.99 ,$94.39 ,$93.15 ,$87.02 ,$105.57 ,$51.19 ,$87.02 ,$87.02 ,$86.94 ,$75.64 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$105.57 ,$115.18 ,$114.26 ,$86.94 ,$124.20 ,$124.20 ,$75.64 ,$124.20 ,$85.82 ,$111.78 ,$84.85 ,$50.67 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,31100209,88275,HC MCG INTERPH INSITU 100 (T CELL LYMPHOMA),311,1 ,$217.35 ,$143.45 ,$50.17 ,$217.35 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$130.41 ,$184.75 ,$152.15 ,$52.89 ,$52.89 ,$206.48 ,$165.19 ,$163.01 ,$87.02 ,$184.75 ,$51.19 ,$87.02 ,$87.02 ,$152.15 ,$132.37 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$184.75 ,$115.18 ,$199.96 ,$152.15 ,$200.72 ,$200.72 ,$132.37 ,$200.72 ,$150.19 ,$195.62 ,$148.49 ,$50.67 ,$171.71 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$156.49 ,$134.76 ,$156.49 ,$156.49 ,$173.88 
ST NICHOLAS HOSPITAL - ACUTE,31100210,88275,HC MCG INTERPH INSITU 100 (B CELL LYMPHOMA),311,1 ,$290.40 ,$191.66 ,$50.17 ,$290.40 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$174.24 ,$246.84 ,$203.28 ,$52.89 ,$52.89 ,$275.88 ,$220.70 ,$217.80 ,$87.02 ,$246.84 ,$51.19 ,$87.02 ,$87.02 ,$203.28 ,$176.85 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$246.84 ,$115.18 ,$267.17 ,$203.28 ,$200.72 ,$200.72 ,$176.85 ,$200.72 ,$200.67 ,$261.36 ,$198.40 ,$50.67 ,$229.42 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$209.09 ,$180.05 ,$209.09 ,$209.09 ,$232.32 
ST NICHOLAS HOSPITAL - ACUTE,31100211,88280,HC CHROM ADDL KARYO,311,1 ,$310.50 ,$204.93 ,$32.80 ,$310.50 ,$34.58 ,$117.15 ,$117.15 ,$33.47 ,$186.30 ,$263.93 ,$217.35 ,$34.58 ,$34.58 ,$294.98 ,$235.98 ,$232.88 ,$56.90 ,$263.93 ,$33.47 ,$56.90 ,$56.90 ,$217.35 ,$189.09 ,$34.58 ,$33.47 ,$32.80 ,$66.94 ,$36.65 ,$263.93 ,$75.31 ,$285.66 ,$217.35 ,$125.44 ,$125.44 ,$189.09 ,$125.44 ,$214.56 ,$279.45 ,$212.13 ,$33.12 ,$245.30 ,$36.65 ,$40.16 ,$40.16 ,$32.80 ,$40.16 ,$223.56 ,$192.51 ,$223.56 ,$223.56 ,$248.40 
ST NICHOLAS HOSPITAL - ACUTE,31100212,88280,HC CHROM ADDL KARYO (T),311,1 ,$358.80 ,$236.81 ,$32.80 ,$358.80 ,$34.58 ,$117.15 ,$117.15 ,$33.47 ,$215.28 ,$304.98 ,$251.16 ,$34.58 ,$34.58 ,$340.86 ,$272.69 ,$269.10 ,$56.90 ,$304.98 ,$33.47 ,$56.90 ,$56.90 ,$251.16 ,$218.51 ,$34.58 ,$33.47 ,$32.80 ,$66.94 ,$36.65 ,$304.98 ,$75.31 ,$330.10 ,$251.16 ,$125.44 ,$125.44 ,$218.51 ,$125.44 ,$247.93 ,$322.92 ,$245.13 ,$33.12 ,$283.45 ,$36.65 ,$40.16 ,$40.16 ,$32.80 ,$40.16 ,$258.34 ,$222.46 ,$258.34 ,$258.34 ,$287.04 
ST NICHOLAS HOSPITAL - ACUTE,31100213,88280,HC CHROM ADDL KARYO (L),311,1 ,$212.75 ,$140.42 ,$32.80 ,$212.75 ,$34.58 ,$117.15 ,$117.15 ,$33.47 ,$127.65 ,$180.84 ,$148.93 ,$34.58 ,$34.58 ,$202.11 ,$161.69 ,$159.56 ,$56.90 ,$180.84 ,$33.47 ,$56.90 ,$56.90 ,$148.93 ,$129.56 ,$34.58 ,$33.47 ,$32.80 ,$66.94 ,$36.65 ,$180.84 ,$75.31 ,$195.73 ,$148.93 ,$125.44 ,$125.44 ,$129.56 ,$125.44 ,$147.01 ,$191.48 ,$145.35 ,$33.12 ,$168.07 ,$36.65 ,$40.16 ,$40.16 ,$32.80 ,$40.16 ,$153.18 ,$131.91 ,$153.18 ,$153.18 ,$170.20 
ST NICHOLAS HOSPITAL - ACUTE,31100214,88289,HC CHROM ADDL HIGH RES (HRS),311,1 ,$343.85 ,$226.94 ,$33.74 ,$343.85 ,$35.58 ,$120.51 ,$120.51 ,$34.43 ,$206.31 ,$292.27 ,$240.70 ,$35.58 ,$35.58 ,$326.66 ,$261.33 ,$257.89 ,$58.53 ,$292.27 ,$34.43 ,$58.53 ,$58.53 ,$240.70 ,$209.40 ,$35.58 ,$34.43 ,$33.74 ,$68.86 ,$37.71 ,$292.27 ,$77.47 ,$316.34 ,$240.70 ,$172.11 ,$172.11 ,$209.40 ,$172.11 ,$237.60 ,$309.47 ,$234.92 ,$34.07 ,$271.64 ,$37.71 ,$41.32 ,$41.32 ,$33.74 ,$41.32 ,$247.57 ,$213.19 ,$247.57 ,$247.57 ,$275.08 
ST NICHOLAS HOSPITAL - ACUTE,31100215,88289,HC CHROM ADDL HIGH RES (FXS),311,1 ,$135.70 ,$89.56 ,$33.74 ,$135.70 ,$35.58 ,$120.51 ,$120.51 ,$34.43 ,$81.42 ,$115.35 ,$94.99 ,$35.58 ,$35.58 ,$128.92 ,$103.13 ,$101.78 ,$58.53 ,$115.35 ,$34.43 ,$58.53 ,$58.53 ,$94.99 ,$82.64 ,$35.58 ,$34.43 ,$33.74 ,$68.86 ,$37.71 ,$115.35 ,$77.47 ,$124.84 ,$94.99 ,$135.70 ,$135.70 ,$82.64 ,$135.70 ,$93.77 ,$122.13 ,$92.71 ,$34.07 ,$107.20 ,$37.71 ,$41.32 ,$41.32 ,$33.74 ,$41.32 ,$97.70 ,$84.13 ,$97.70 ,$97.70 ,$108.56 
ST NICHOLAS HOSPITAL - ACUTE,31100218,P3000,HC PAP SMEAR SCREEN (UP TO 3),311,1 ,$75.90 ,$50.09 ,$14.86 ,$75.90 ,$14.86 ,$55.72 ,$55.72 ,$17.31 ,$45.54 ,$64.52 ,$53.13 ,$14.86 ,$14.86 ,$72.11 ,$57.68 ,$56.93 ,$29.43 ,$64.52 ,$17.31 ,$29.43 ,$29.43 ,$53.13 ,$46.22 ,$14.86 ,$17.31 ,$16.96 ,$34.62 ,$15.75 ,$64.52 ,$38.95 ,$69.83 ,$53.13 ,$52.83 ,$52.83 ,$46.22 ,$52.83 ,$52.45 ,$68.31 ,$51.85 ,$17.13 ,$59.96 ,$15.75 ,$18.14 ,$18.14 ,$16.96 ,$18.14 ,$54.65 ,$47.06 ,$54.65 ,$54.65 ,$60.72 
ST NICHOLAS HOSPITAL - ACUTE,31100219,P3000,HC PAP SMEAR SLIDE SCREEN,311,1 ,$65.55 ,$43.26 ,$14.86 ,$65.55 ,$14.86 ,$55.72 ,$55.72 ,$17.31 ,$39.33 ,$55.72 ,$45.89 ,$14.86 ,$14.86 ,$62.27 ,$49.82 ,$49.16 ,$29.43 ,$55.72 ,$17.31 ,$29.43 ,$29.43 ,$45.89 ,$39.92 ,$14.86 ,$17.31 ,$16.96 ,$34.62 ,$15.75 ,$55.72 ,$38.95 ,$60.31 ,$45.89 ,$52.83 ,$52.83 ,$39.92 ,$52.83 ,$45.30 ,$59.00 ,$44.78 ,$17.13 ,$51.78 ,$15.75 ,$18.14 ,$18.14 ,$16.96 ,$18.14 ,$47.20 ,$40.64 ,$47.20 ,$47.20 ,$52.44 
ST NICHOLAS HOSPITAL - ACUTE,31100220,88274,HC INTERPHASE 20-99 CELLS FISH,311,1 ,$149.50 ,$98.67 ,$41.53 ,$149.50 ,$43.79 ,$148.33 ,$148.33 ,$42.38 ,$89.70 ,$127.08 ,$104.65 ,$43.79 ,$43.79 ,$142.03 ,$113.62 ,$112.13 ,$72.05 ,$127.08 ,$42.38 ,$72.05 ,$72.05 ,$104.65 ,$91.05 ,$43.79 ,$42.38 ,$41.53 ,$84.76 ,$46.42 ,$127.08 ,$95.36 ,$137.54 ,$104.65 ,$149.50 ,$149.50 ,$91.05 ,$149.50 ,$103.30 ,$134.55 ,$102.14 ,$41.94 ,$118.11 ,$46.42 ,$50.86 ,$50.86 ,$41.53 ,$50.86 ,$107.64 ,$92.69 ,$107.64 ,$107.64 ,$119.60 
ST NICHOLAS HOSPITAL - ACUTE,31100221,88271,HC MCG DNA PROBE (B CELL),311,1 ,$151.80 ,$100.19 ,$20.36 ,$151.80 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$91.08 ,$129.03 ,$106.26 ,$20.36 ,$20.36 ,$144.21 ,$115.37 ,$113.85 ,$36.41 ,$129.03 ,$21.42 ,$36.41 ,$36.41 ,$106.26 ,$92.45 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$129.03 ,$48.20 ,$139.66 ,$106.26 ,$72.35 ,$72.35 ,$92.45 ,$72.35 ,$104.89 ,$136.62 ,$103.71 ,$21.20 ,$119.92 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$109.30 ,$94.12 ,$109.30 ,$109.30 ,$121.44 
ST NICHOLAS HOSPITAL - ACUTE,31100222,88299,HC CYTOGENIC STUDY,311,1 ,$611.80 ,$403.79 ,$1.46 ,$611.80 ,$1.46 ,$419.33 ,$419.33 ,$48.94 ,$367.08 ,$520.03 ,$428.26 ,$1.46 ,$1.46 ,$581.21 ,$464.97 ,$458.85 , N/A ,$520.03 ,$48.94 , N/A , N/A ,$428.26 ,$372.59 ,$1.46 ,$48.94 ,$47.96 ,$97.88 ,$1.55 ,$520.03 ,$110.11 ,$562.86 ,$428.26 ,$310.31 ,$372.40 ,$372.59 ,$372.40 ,$422.75 ,$550.62 ,$417.98 ,$48.44 ,$483.32 ,$1.55 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$440.50 ,$379.32 ,$440.50 ,$440.50 ,$489.44 
ST NICHOLAS HOSPITAL - ACUTE,31100223,88280,HC ADDITIONAL KARYO EACH (DC),311,1 ,$269.10 ,$177.61 ,$32.80 ,$269.10 ,$34.58 ,$117.15 ,$117.15 ,$33.47 ,$161.46 ,$228.74 ,$188.37 ,$34.58 ,$34.58 ,$255.65 ,$204.52 ,$201.83 ,$56.90 ,$228.74 ,$33.47 ,$56.90 ,$56.90 ,$188.37 ,$163.88 ,$34.58 ,$33.47 ,$32.80 ,$66.94 ,$36.65 ,$228.74 ,$75.31 ,$247.57 ,$188.37 ,$125.44 ,$125.44 ,$163.88 ,$125.44 ,$185.95 ,$242.19 ,$183.85 ,$33.12 ,$212.59 ,$36.65 ,$40.16 ,$40.16 ,$32.80 ,$40.16 ,$193.75 ,$166.84 ,$193.75 ,$193.75 ,$215.28 
ST NICHOLAS HOSPITAL - ACUTE,31100232,88271,HC MCG DNA PROBE (QST EACH),311,1 ,$186.30 ,$122.96 ,$20.36 ,$186.30 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$111.78 ,$158.36 ,$130.41 ,$20.36 ,$20.36 ,$176.99 ,$141.59 ,$139.73 ,$36.41 ,$158.36 ,$21.42 ,$36.41 ,$36.41 ,$130.41 ,$113.46 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$158.36 ,$48.20 ,$171.40 ,$130.41 ,$72.35 ,$72.35 ,$113.46 ,$72.35 ,$128.73 ,$167.67 ,$127.28 ,$21.20 ,$147.18 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,31100233,88275,HC MCG INTERPH INSITU 100 (FISH MDS MY),311,1 ,$278.30 ,$183.68 ,$50.17 ,$278.30 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$166.98 ,$236.56 ,$194.81 ,$52.89 ,$52.89 ,$264.39 ,$211.51 ,$208.73 ,$87.02 ,$236.56 ,$51.19 ,$87.02 ,$87.02 ,$194.81 ,$169.48 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$236.56 ,$115.18 ,$256.04 ,$194.81 ,$200.72 ,$200.72 ,$169.48 ,$200.72 ,$192.31 ,$250.47 ,$190.13 ,$50.67 ,$219.86 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$200.38 ,$172.55 ,$200.38 ,$200.38 ,$222.64 
ST NICHOLAS HOSPITAL - ACUTE,31100234,88275,HC MCG INTERPH INSITU 100 (FISH AMLM3/BURKITT),311,1 ,$278.30 ,$183.68 ,$50.17 ,$278.30 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$166.98 ,$236.56 ,$194.81 ,$52.89 ,$52.89 ,$264.39 ,$211.51 ,$208.73 ,$87.02 ,$236.56 ,$51.19 ,$87.02 ,$87.02 ,$194.81 ,$169.48 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$236.56 ,$115.18 ,$256.04 ,$194.81 ,$200.72 ,$200.72 ,$169.48 ,$200.72 ,$192.31 ,$250.47 ,$190.13 ,$50.67 ,$219.86 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$200.38 ,$172.55 ,$200.38 ,$200.38 ,$222.64 
ST NICHOLAS HOSPITAL - ACUTE,31100235,88275,HC MCG INTERPH INSITU 100 (FISH AML/HES/AMLETO/IGH),311,1 ,$278.30 ,$183.68 ,$50.17 ,$278.30 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$166.98 ,$236.56 ,$194.81 ,$52.89 ,$52.89 ,$264.39 ,$211.51 ,$208.73 ,$87.02 ,$236.56 ,$51.19 ,$87.02 ,$87.02 ,$194.81 ,$169.48 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$236.56 ,$115.18 ,$256.04 ,$194.81 ,$200.72 ,$200.72 ,$169.48 ,$200.72 ,$192.31 ,$250.47 ,$190.13 ,$50.67 ,$219.86 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$200.38 ,$172.55 ,$200.38 ,$200.38 ,$222.64 
ST NICHOLAS HOSPITAL - ACUTE,31100236,88275,HC MCG INTERPH INSITU 100 (FISH ESO),311,1 ,$290.95 ,$192.03 ,$50.17 ,$290.95 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$174.57 ,$247.31 ,$203.67 ,$52.89 ,$52.89 ,$276.40 ,$221.12 ,$218.21 ,$87.02 ,$247.31 ,$51.19 ,$87.02 ,$87.02 ,$203.67 ,$177.19 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$247.31 ,$115.18 ,$267.67 ,$203.67 ,$200.72 ,$200.72 ,$177.19 ,$200.72 ,$201.05 ,$261.86 ,$198.78 ,$50.67 ,$229.85 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$209.48 ,$180.39 ,$209.48 ,$209.48 ,$232.76 
ST NICHOLAS HOSPITAL - ACUTE,31100237,88275,HC MCG INTERPH INSITU 100 (FISH IGHBCL2/MCL),311,1 ,$323.15 ,$213.28 ,$50.17 ,$323.15 ,$52.89 ,$179.17 ,$179.17 ,$51.19 ,$193.89 ,$274.68 ,$226.21 ,$52.89 ,$52.89 ,$306.99 ,$245.59 ,$242.36 ,$87.02 ,$274.68 ,$51.19 ,$87.02 ,$87.02 ,$226.21 ,$196.80 ,$52.89 ,$51.19 ,$50.17 ,$102.38 ,$56.06 ,$274.68 ,$115.18 ,$297.30 ,$226.21 ,$200.72 ,$200.72 ,$196.80 ,$200.72 ,$223.30 ,$290.84 ,$220.78 ,$50.67 ,$255.29 ,$56.06 ,$61.43 ,$61.43 ,$50.17 ,$61.43 ,$232.67 ,$200.35 ,$232.67 ,$232.67 ,$258.52 
ST NICHOLAS HOSPITAL - ACUTE,31100285,88271,HC MCG DNA PROBE(FISH) LUNG CANCER ROS1,311,1 ,$980.95 ,$647.43 ,$20.36 ,$980.95 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$588.57 ,$833.81 ,$686.67 ,$20.36 ,$20.36 ,$931.90 ,$745.52 ,$735.71 ,$36.41 ,$833.81 ,$21.42 ,$36.41 ,$36.41 ,$686.67 ,$597.40 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$833.81 ,$48.20 ,$902.47 ,$686.67 ,$72.35 ,$72.35 ,$597.40 ,$72.35 ,$677.84 ,$882.86 ,$670.19 ,$21.20 ,$774.95 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$706.28 ,$608.19 ,$706.28 ,$706.28 ,$784.76 
ST NICHOLAS HOSPITAL - ACUTE,31100286,88271,HC MCG DNA PROBE(FISH) LUNG CANCER ALK,311,1 ,$868.25 ,$573.05 ,$20.36 ,$868.25 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$520.95 ,$738.01 ,$607.78 ,$20.36 ,$20.36 ,$824.84 ,$659.87 ,$651.19 ,$36.41 ,$738.01 ,$21.42 ,$36.41 ,$36.41 ,$607.78 ,$528.76 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$738.01 ,$48.20 ,$798.79 ,$607.78 ,$72.35 ,$72.35 ,$528.76 ,$72.35 ,$599.96 ,$781.43 ,$593.19 ,$21.20 ,$685.92 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$625.14 ,$538.32 ,$625.14 ,$625.14 ,$694.60 
ST NICHOLAS HOSPITAL - ACUTE,31100309,88121,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC COMP ASSIST,311,1 ,$677.35 ,$447.05 ,$2.61 ,$677.35 ,$2.61 ,$677.35 ,$677.35 ,$153.48 ,$406.41 ,$575.75 ,$474.15 ,$2.61 ,$2.61 ,$643.48 ,$514.79 ,$508.01 ,$677.35 ,$575.75 ,$153.48 ,$677.35 ,$677.35 ,$474.15 ,$412.51 ,$2.61 ,$153.48 ,$150.41 ,$306.96 ,$2.77 ,$575.75 ,$345.32 ,$623.16 ,$474.15 ,$343.55 ,$412.30 ,$412.51 ,$412.30 ,$468.05 ,$609.62 ,$462.77 ,$151.91 ,$535.11 ,$2.77 ,$340.09 ,$340.09 ,$150.41 ,$340.09 ,$487.69 ,$419.96 ,$487.69 ,$487.69 ,$541.88 
ST NICHOLAS HOSPITAL - ACUTE,31100315,88271,HC PLASMA CELL PROLIF SORT FISH PROBE/REPORT,311,1 ,$510.60 ,$337.00 ,$20.36 ,$510.60 ,$20.36 ,$74.97 ,$74.97 ,$21.42 ,$306.36 ,$434.01 ,$357.42 ,$20.36 ,$20.36 ,$485.07 ,$388.06 ,$382.95 ,$36.41 ,$434.01 ,$21.42 ,$36.41 ,$36.41 ,$357.42 ,$310.96 ,$20.36 ,$21.42 ,$20.99 ,$42.84 ,$21.58 ,$434.01 ,$48.20 ,$469.75 ,$357.42 ,$72.35 ,$72.35 ,$310.96 ,$72.35 ,$352.82 ,$459.54 ,$348.84 ,$21.20 ,$403.37 ,$21.58 ,$25.70 ,$25.70 ,$20.99 ,$25.70 ,$367.63 ,$316.57 ,$367.63 ,$367.63 ,$408.48 
ST NICHOLAS HOSPITAL - ACUTE,31100316,88184,HC PCPDS PRE ANAL CELL SORT BM 1 MARKER,311,1 ,$101.20 ,$66.79 ,$2.61 ,$711.75 ,$2.61 ,$101.20 ,$101.20 ,$316.33 ,$60.72 ,$86.02 ,$70.84 ,$2.61 ,$2.61 ,$96.14 ,$76.91 ,$75.90 ,$101.20 ,$86.02 ,$316.33 ,$101.20 ,$101.20 ,$70.84 ,$61.63 ,$2.61 ,$316.33 ,$310.00 ,$101.20 ,$2.77 ,$86.02 ,$711.75 ,$93.10 ,$70.84 ,$51.33 ,$61.60 ,$61.63 ,$61.60 ,$69.93 ,$91.08 ,$69.14 ,$313.10 ,$79.95 ,$2.77 ,$101.20 ,$101.20 ,$310.00 ,$101.20 ,$72.86 ,$62.74 ,$72.86 ,$72.86 ,$80.96 
ST NICHOLAS HOSPITAL - ACUTE,31100317,88185,HC PCPDS PRE ANAL CELL SORT BM ADDNT MARKER,311,1 ,$33.35 ,$22.01 ,$1.19 ,$33.35 ,$1.19 ,$33.35 ,$33.35 , N/A ,$20.01 ,$28.35 ,$23.35 ,$1.19 ,$1.19 ,$31.68 ,$25.35 ,$25.01 ,$33.35 ,$28.35 , N/A ,$33.35 ,$33.35 ,$23.35 ,$20.31 ,$1.19 , N/A , N/A , N/A ,$1.26 ,$28.35 , N/A ,$30.68 ,$23.35 ,$16.92 ,$20.30 ,$20.31 ,$20.30 ,$23.04 ,$30.02 ,$22.78 , N/A ,$26.35 ,$1.26 ,$26.86 ,$26.86 , N/A ,$26.86 ,$24.01 ,$20.68 ,$24.01 ,$24.01 ,$26.68 
ST NICHOLAS HOSPITAL - ACUTE,31200101,88300,HC GROSS ONLY LEVEL I,312,1 ,$125.35 ,$82.73 ,$1.25 ,$125.35 ,$1.25 ,$35.73 ,$35.73 ,$24.36 ,$75.21 ,$106.55 ,$87.75 ,$1.25 ,$1.25 ,$119.08 ,$95.27 ,$94.01 ,$25.77 ,$106.55 ,$24.36 ,$25.77 ,$25.77 ,$87.75 ,$76.34 ,$1.25 ,$24.36 ,$23.87 ,$48.72 ,$1.33 ,$106.55 ,$54.81 ,$115.32 ,$87.75 ,$63.58 ,$76.30 ,$76.34 ,$76.30 ,$86.62 ,$112.82 ,$85.64 ,$24.11 ,$99.03 ,$1.33 ,$27.59 ,$27.59 ,$23.87 ,$27.59 ,$90.25 ,$77.72 ,$90.25 ,$90.25 ,$100.28 
ST NICHOLAS HOSPITAL - ACUTE,31200102,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$257.60 ,$170.02 ,$1.25 ,$257.60 ,$1.25 ,$82.51 ,$82.51 ,$24.36 ,$154.56 ,$218.96 ,$180.32 ,$1.25 ,$1.25 ,$244.72 ,$195.78 ,$193.20 ,$53.28 ,$218.96 ,$24.36 ,$53.28 ,$53.28 ,$180.32 ,$156.88 ,$1.25 ,$24.36 ,$23.87 ,$48.72 ,$1.33 ,$218.96 ,$54.81 ,$236.99 ,$180.32 ,$130.65 ,$156.80 ,$156.88 ,$156.80 ,$178.00 ,$231.84 ,$175.99 ,$24.11 ,$203.50 ,$1.33 ,$27.59 ,$27.59 ,$23.87 ,$27.59 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,31200103,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$322.00 ,$212.52 ,$1.25 ,$322.00 ,$1.25 ,$100.76 ,$100.76 ,$48.94 ,$193.20 ,$273.70 ,$225.40 ,$1.25 ,$1.25 ,$305.90 ,$244.72 ,$241.50 ,$69.41 ,$273.70 ,$48.94 ,$69.41 ,$69.41 ,$225.40 ,$196.10 ,$1.25 ,$48.94 ,$47.96 ,$97.88 ,$1.33 ,$273.70 ,$110.11 ,$296.24 ,$225.40 ,$163.32 ,$196.00 ,$196.10 ,$196.00 ,$222.50 ,$289.80 ,$219.99 ,$48.44 ,$254.38 ,$1.33 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,31200105,88305,HC CELLIENT CELL BLOCK,312,1 ,$131.10 ,$86.53 ,$1.25 ,$131.10 ,$1.25 ,$113.31 ,$113.31 ,$48.94 ,$78.66 ,$111.44 ,$91.77 ,$1.25 ,$1.25 ,$124.55 ,$99.64 ,$98.33 ,$117.45 ,$111.44 ,$48.94 ,$117.45 ,$117.45 ,$91.77 ,$79.84 ,$1.25 ,$48.94 ,$47.96 ,$97.88 ,$1.33 ,$111.44 ,$110.11 ,$120.61 ,$91.77 ,$66.49 ,$79.80 ,$79.84 ,$79.80 ,$90.59 ,$117.99 ,$89.57 ,$48.44 ,$103.57 ,$1.33 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$94.39 ,$81.28 ,$94.39 ,$94.39 ,$104.88 
ST NICHOLAS HOSPITAL - ACUTE,31200108,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$386.40 ,$255.02 ,$1.25 ,$386.40 ,$1.25 ,$113.31 ,$113.31 ,$48.94 ,$231.84 ,$328.44 ,$270.48 ,$1.25 ,$1.25 ,$367.08 ,$293.66 ,$289.80 ,$117.45 ,$328.44 ,$48.94 ,$117.45 ,$117.45 ,$270.48 ,$235.32 ,$1.25 ,$48.94 ,$47.96 ,$97.88 ,$1.33 ,$328.44 ,$110.11 ,$355.49 ,$270.48 ,$195.98 ,$235.20 ,$235.32 ,$235.20 ,$267.00 ,$347.76 ,$263.99 ,$48.44 ,$305.26 ,$1.33 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$278.21 ,$239.57 ,$278.21 ,$278.21 ,$309.12 
ST NICHOLAS HOSPITAL - ACUTE,31200109,88305,HC GROSS  AND  MICRO LEVEL IV (BM),312,1 ,$328.90 ,$217.07 ,$1.25 ,$328.90 ,$1.25 ,$113.31 ,$113.31 ,$48.94 ,$197.34 ,$279.57 ,$230.23 ,$1.25 ,$1.25 ,$312.46 ,$249.96 ,$246.68 ,$117.45 ,$279.57 ,$48.94 ,$117.45 ,$117.45 ,$230.23 ,$200.30 ,$1.25 ,$48.94 ,$47.96 ,$97.88 ,$1.33 ,$279.57 ,$110.11 ,$302.59 ,$230.23 ,$166.82 ,$200.20 ,$200.30 ,$200.20 ,$227.27 ,$296.01 ,$224.70 ,$48.44 ,$259.83 ,$1.33 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$236.81 ,$203.92 ,$236.81 ,$236.81 ,$263.12 
ST NICHOLAS HOSPITAL - ACUTE,31200110,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,"$1,262.70 ",$833.38 ,$3.61 ,"$1,262.70 ",$3.61 ,$683.73 ,$683.73 ,$316.33 ,$757.62 ,"$1,073.30 ",$883.89 ,$3.61 ,$3.61 ,"$1,199.57 ",$959.65 ,$947.03 ,$474.50 ,"$1,073.30 ",$316.33 ,$474.50 ,$474.50 ,$883.89 ,$768.98 ,$3.61 ,$316.33 ,$310.00 ,$632.66 ,$3.83 ,"$1,073.30 ",$711.75 ,"$1,161.68 ",$883.89 ,$640.44 ,$768.61 ,$768.98 ,$768.61 ,$872.53 ,"$1,136.43 ",$862.68 ,$313.10 ,$997.53 ,$3.83 ,$340.09 ,$340.09 ,$310.00 ,$340.09 ,$909.14 ,$782.87 ,$909.14 ,$909.14 ,"$1,010.16 "
ST NICHOLAS HOSPITAL - ACUTE,31200112,88307,HC GROSS  AND  MICRO LEVEL V ( >3),312,1 ,"$1,262.70 ",$833.38 ,$3.61 ,"$1,262.70 ",$3.61 ,$683.73 ,$683.73 ,$316.33 ,$757.62 ,"$1,073.30 ",$883.89 ,$3.61 ,$3.61 ,"$1,199.57 ",$959.65 ,$947.03 ,$474.50 ,"$1,073.30 ",$316.33 ,$474.50 ,$474.50 ,$883.89 ,$768.98 ,$3.61 ,$316.33 ,$310.00 ,$632.66 ,$3.83 ,"$1,073.30 ",$711.75 ,"$1,161.68 ",$883.89 ,$640.44 ,$768.61 ,$768.98 ,$768.61 ,$872.53 ,"$1,136.43 ",$862.68 ,$313.10 ,$997.53 ,$3.83 ,$340.09 ,$340.09 ,$310.00 ,$340.09 ,$909.14 ,$782.87 ,$909.14 ,$909.14 ,"$1,010.16 "
ST NICHOLAS HOSPITAL - ACUTE,31200113,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,"$1,803.20 ","$1,190.11 ",$3.61 ,"$1,803.20 ",$3.61 ,$975.82 ,$975.82 ,$757.87 ,"$1,081.92 ","$1,532.72 ","$1,262.24 ",$3.61 ,$3.61 ,"$1,713.04 ","$1,370.43 ","$1,352.40 ",$718.23 ,"$1,532.72 ",$757.87 ,$718.23 ,$718.23 ,"$1,262.24 ","$1,098.15 ",$3.61 ,$757.87 ,$742.71 ,"$1,515.74 ",$3.83 ,"$1,532.72 ","$1,705.22 ","$1,658.94 ","$1,262.24 ",$914.58 ,"$1,097.61 ","$1,098.15 ","$1,097.61 ","$1,246.01 ","$1,622.88 ","$1,231.95 ",$750.14 ,"$1,424.53 ",$3.83 ,$753.84 ,$753.84 ,$742.71 ,$753.84 ,"$1,298.30 ","$1,117.98 ","$1,298.30 ","$1,298.30 ","$1,442.56 "
ST NICHOLAS HOSPITAL - ACUTE,31200115,88309,HC GROSS  AND  MICRO LEVEL VI ( >5),312,1 ,"$1,803.20 ","$1,190.11 ",$3.61 ,"$1,803.20 ",$3.61 ,$975.82 ,$975.82 ,$757.87 ,"$1,081.92 ","$1,532.72 ","$1,262.24 ",$3.61 ,$3.61 ,"$1,713.04 ","$1,370.43 ","$1,352.40 ",$718.23 ,"$1,532.72 ",$757.87 ,$718.23 ,$718.23 ,"$1,262.24 ","$1,098.15 ",$3.61 ,$757.87 ,$742.71 ,"$1,515.74 ",$3.83 ,"$1,532.72 ","$1,705.22 ","$1,658.94 ","$1,262.24 ",$914.58 ,"$1,097.61 ","$1,098.15 ","$1,097.61 ","$1,246.01 ","$1,622.88 ","$1,231.95 ",$750.14 ,"$1,424.53 ",$3.83 ,$753.84 ,$753.84 ,$742.71 ,$753.84 ,"$1,298.30 ","$1,117.98 ","$1,298.30 ","$1,298.30 ","$1,442.56 "
ST NICHOLAS HOSPITAL - ACUTE,31200116,88311,HC DECALCIFICATION,312,1 ,$89.70 ,$59.20 ,$1.25 ,$89.70 ,$1.25 ,$27.74 ,$27.74 , N/A ,$53.82 ,$76.25 ,$62.79 ,$1.25 ,$1.25 ,$85.22 ,$68.17 ,$67.28 ,$33.34 ,$76.25 , N/A ,$33.34 ,$33.34 ,$62.79 ,$54.63 ,$1.25 , N/A , N/A , N/A ,$1.33 ,$76.25 , N/A ,$82.52 ,$62.79 ,$45.50 ,$54.60 ,$54.63 ,$54.60 ,$61.98 ,$80.73 ,$61.28 , N/A ,$70.86 ,$1.33 ,$10.82 ,$10.82 , N/A ,$10.82 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,31200119,88312,HC SPECIAL STAIN I (STEINER),312,1 ,$180.55 ,$119.16 ,$1.25 ,$180.55 ,$1.25 ,$180.55 ,$180.55 ,$48.94 ,$108.33 ,$153.47 ,$126.39 ,$1.25 ,$1.25 ,$171.52 ,$137.22 ,$135.41 ,$180.55 ,$153.47 ,$48.94 ,$180.55 ,$180.55 ,$126.39 ,$109.96 ,$1.25 ,$48.94 ,$47.96 ,$97.88 ,$1.33 ,$153.47 ,$110.11 ,$166.11 ,$126.39 ,$91.58 ,$109.90 ,$109.96 ,$109.90 ,$124.76 ,$162.50 ,$123.35 ,$48.44 ,$142.63 ,$1.33 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,31200120,88312,HC SPECIAL STAIN I (WARTHIN-STARRY),312,1 ,$162.15 ,$107.02 ,$1.25 ,$162.15 ,$1.25 ,$162.15 ,$162.15 ,$48.94 ,$97.29 ,$137.83 ,$113.51 ,$1.25 ,$1.25 ,$154.04 ,$123.23 ,$121.61 ,$162.15 ,$137.83 ,$48.94 ,$162.15 ,$162.15 ,$113.51 ,$98.75 ,$1.25 ,$48.94 ,$47.96 ,$97.88 ,$1.33 ,$137.83 ,$110.11 ,$149.18 ,$113.51 ,$82.24 ,$98.70 ,$98.75 ,$98.70 ,$112.05 ,$145.94 ,$110.78 ,$48.44 ,$128.10 ,$1.33 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,31200122,88312,HC SPECIAL STAIN I (AFB),312,1 ,$184.00 ,$121.44 ,$1.25 ,$184.00 ,$1.25 ,$184.00 ,$184.00 ,$48.94 ,$110.40 ,$156.40 ,$128.80 ,$1.25 ,$1.25 ,$174.80 ,$139.84 ,$138.00 ,$184.00 ,$156.40 ,$48.94 ,$184.00 ,$184.00 ,$128.80 ,$112.06 ,$1.25 ,$48.94 ,$47.96 ,$97.88 ,$1.33 ,$156.40 ,$110.11 ,$169.28 ,$128.80 ,$93.32 ,$112.00 ,$112.06 ,$112.00 ,$127.14 ,$165.60 ,$125.71 ,$48.44 ,$145.36 ,$1.33 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,31200123,88312,HC SPECIAL STAIN I,312,1 ,$411.70 ,$271.72 ,$1.25 ,$411.70 ,$1.25 ,$290.16 ,$290.16 ,$48.94 ,$247.02 ,$349.95 ,$288.19 ,$1.25 ,$1.25 ,$391.12 ,$312.89 ,$308.78 ,$184.16 ,$349.95 ,$48.94 ,$184.16 ,$184.16 ,$288.19 ,$250.73 ,$1.25 ,$48.94 ,$47.96 ,$97.88 ,$1.33 ,$349.95 ,$110.11 ,$378.76 ,$288.19 ,$208.81 ,$250.60 ,$250.73 ,$250.60 ,$284.48 ,$370.53 ,$281.27 ,$48.44 ,$325.24 ,$1.33 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,31200124,88312,HC SPECIAL STAIN I (GIEMSA OR PAS),312,1 ,$411.70 ,$271.72 ,$1.25 ,$411.70 ,$1.25 ,$290.16 ,$290.16 ,$48.94 ,$247.02 ,$349.95 ,$288.19 ,$1.25 ,$1.25 ,$391.12 ,$312.89 ,$308.78 ,$184.16 ,$349.95 ,$48.94 ,$184.16 ,$184.16 ,$288.19 ,$250.73 ,$1.25 ,$48.94 ,$47.96 ,$97.88 ,$1.33 ,$349.95 ,$110.11 ,$378.76 ,$288.19 ,$208.81 ,$250.60 ,$250.73 ,$250.60 ,$284.48 ,$370.53 ,$281.27 ,$48.44 ,$325.24 ,$1.33 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$296.42 ,$255.25 ,$296.42 ,$296.42 ,$329.36 
ST NICHOLAS HOSPITAL - ACUTE,31200125,88313,HC SPECIAL STAIN II,312,1 ,$334.65 ,$220.87 ,$1.25 ,$334.65 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$200.79 ,$284.45 ,$234.26 ,$1.25 ,$1.25 ,$317.92 ,$254.33 ,$250.99 ,$133.50 ,$284.45 ,$33.15 ,$133.50 ,$133.50 ,$234.26 ,$203.80 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$284.45 ,$74.58 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$32.81 ,$264.37 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31200126,88313,HC SPECIAL STAIN II (OIL RED),312,1 ,$334.65 ,$220.87 ,$1.25 ,$334.65 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$200.79 ,$284.45 ,$234.26 ,$1.25 ,$1.25 ,$317.92 ,$254.33 ,$250.99 ,$133.50 ,$284.45 ,$33.15 ,$133.50 ,$133.50 ,$234.26 ,$203.80 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$284.45 ,$74.58 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$32.81 ,$264.37 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31200127,88313,HC SPECIAL STAIN II (SUDAN BLACK),312,1 ,$334.65 ,$220.87 ,$1.25 ,$334.65 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$200.79 ,$284.45 ,$234.26 ,$1.25 ,$1.25 ,$317.92 ,$254.33 ,$250.99 ,$133.50 ,$284.45 ,$33.15 ,$133.50 ,$133.50 ,$234.26 ,$203.80 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$284.45 ,$74.58 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$32.81 ,$264.37 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31200128,88313,HC SPECIAL STAIN II (MISC),312,1 ,$334.65 ,$220.87 ,$1.25 ,$334.65 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$200.79 ,$284.45 ,$234.26 ,$1.25 ,$1.25 ,$317.92 ,$254.33 ,$250.99 ,$133.50 ,$284.45 ,$33.15 ,$133.50 ,$133.50 ,$234.26 ,$203.80 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$284.45 ,$74.58 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$32.81 ,$264.37 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31200129,88313,HC SPECIAL STAIN II (MAST CELL),312,1 ,$164.45 ,$108.54 ,$1.25 ,$164.45 ,$1.25 ,$164.45 ,$164.45 ,$33.15 ,$98.67 ,$139.78 ,$115.12 ,$1.25 ,$1.25 ,$156.23 ,$124.98 ,$123.34 ,$133.50 ,$139.78 ,$33.15 ,$133.50 ,$133.50 ,$115.12 ,$100.15 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$139.78 ,$74.58 ,$151.29 ,$115.12 ,$83.41 ,$100.10 ,$100.15 ,$100.10 ,$113.64 ,$148.01 ,$112.35 ,$32.81 ,$129.92 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$118.40 ,$101.96 ,$118.40 ,$118.40 ,$131.56 
ST NICHOLAS HOSPITAL - ACUTE,31200130,88313,HC SPECIAL STAIN II (CONGO RED),312,1 ,$184.00 ,$121.44 ,$1.25 ,$184.00 ,$1.25 ,$184.00 ,$184.00 ,$33.15 ,$110.40 ,$156.40 ,$128.80 ,$1.25 ,$1.25 ,$174.80 ,$139.84 ,$138.00 ,$133.50 ,$156.40 ,$33.15 ,$133.50 ,$133.50 ,$128.80 ,$112.06 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$156.40 ,$74.58 ,$169.28 ,$128.80 ,$93.32 ,$112.00 ,$112.06 ,$112.00 ,$127.14 ,$165.60 ,$125.71 ,$32.81 ,$145.36 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,31200131,88313,HC SPECIAL STAIN II (FE),312,1 ,$184.00 ,$121.44 ,$1.25 ,$184.00 ,$1.25 ,$184.00 ,$184.00 ,$33.15 ,$110.40 ,$156.40 ,$128.80 ,$1.25 ,$1.25 ,$174.80 ,$139.84 ,$138.00 ,$133.50 ,$156.40 ,$33.15 ,$133.50 ,$133.50 ,$128.80 ,$112.06 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$156.40 ,$74.58 ,$169.28 ,$128.80 ,$93.32 ,$112.00 ,$112.06 ,$112.00 ,$127.14 ,$165.60 ,$125.71 ,$32.81 ,$145.36 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,31200132,88313,HC SPECIAL STAIN II (PAS),312,1 ,$184.00 ,$121.44 ,$1.25 ,$184.00 ,$1.25 ,$184.00 ,$184.00 ,$33.15 ,$110.40 ,$156.40 ,$128.80 ,$1.25 ,$1.25 ,$174.80 ,$139.84 ,$138.00 ,$133.50 ,$156.40 ,$33.15 ,$133.50 ,$133.50 ,$128.80 ,$112.06 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$156.40 ,$74.58 ,$169.28 ,$128.80 ,$93.32 ,$112.00 ,$112.06 ,$112.00 ,$127.14 ,$165.60 ,$125.71 ,$32.81 ,$145.36 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,31200133,88313,HC SPECIAL STAIN II (ALCIAN BLUE/PAS),312,1 ,$315.10 ,$207.97 ,$1.25 ,$315.10 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$189.06 ,$267.84 ,$220.57 ,$1.25 ,$1.25 ,$299.35 ,$239.48 ,$236.33 ,$133.50 ,$267.84 ,$33.15 ,$133.50 ,$133.50 ,$220.57 ,$191.90 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$267.84 ,$74.58 ,$289.89 ,$220.57 ,$159.82 ,$191.80 ,$191.90 ,$191.80 ,$217.73 ,$283.59 ,$215.28 ,$32.81 ,$248.93 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$226.87 ,$195.36 ,$226.87 ,$226.87 ,$252.08 
ST NICHOLAS HOSPITAL - ACUTE,31200134,88313,HC SPECIAL STAIN II (ELASTIC),312,1 ,$288.65 ,$190.51 ,$1.25 ,$288.65 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$173.19 ,$245.35 ,$202.06 ,$1.25 ,$1.25 ,$274.22 ,$219.37 ,$216.49 ,$133.50 ,$245.35 ,$33.15 ,$133.50 ,$133.50 ,$202.06 ,$175.79 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$245.35 ,$74.58 ,$265.56 ,$202.06 ,$146.40 ,$175.70 ,$175.79 ,$175.70 ,$199.46 ,$259.79 ,$197.21 ,$32.81 ,$228.03 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$207.83 ,$178.96 ,$207.83 ,$207.83 ,$230.92 
ST NICHOLAS HOSPITAL - ACUTE,31200135,88313,HC SPECIAL STAIN II (HALE'S COLLOIDAL FE),312,1 ,$293.25 ,$193.55 ,$1.25 ,$293.25 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$175.95 ,$249.26 ,$205.28 ,$1.25 ,$1.25 ,$278.59 ,$222.87 ,$219.94 ,$133.50 ,$249.26 ,$33.15 ,$133.50 ,$133.50 ,$205.28 ,$178.59 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$249.26 ,$74.58 ,$269.79 ,$205.28 ,$148.74 ,$178.50 ,$178.59 ,$178.50 ,$202.64 ,$263.93 ,$200.35 ,$32.81 ,$231.67 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$211.14 ,$181.82 ,$211.14 ,$211.14 ,$234.60 
ST NICHOLAS HOSPITAL - ACUTE,31200136,88313,HC SPECIAL STAIN II (MUCICARMINE),312,1 ,$293.25 ,$193.55 ,$1.25 ,$293.25 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$175.95 ,$249.26 ,$205.28 ,$1.25 ,$1.25 ,$278.59 ,$222.87 ,$219.94 ,$133.50 ,$249.26 ,$33.15 ,$133.50 ,$133.50 ,$205.28 ,$178.59 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$249.26 ,$74.58 ,$269.79 ,$205.28 ,$148.74 ,$178.50 ,$178.59 ,$178.50 ,$202.64 ,$263.93 ,$200.35 ,$32.81 ,$231.67 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$211.14 ,$181.82 ,$211.14 ,$211.14 ,$234.60 
ST NICHOLAS HOSPITAL - ACUTE,31200137,88313,HC SPECIAL STAIN II (ALCIAN BL W/HYALUR),312,1 ,$293.25 ,$193.55 ,$1.25 ,$293.25 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$175.95 ,$249.26 ,$205.28 ,$1.25 ,$1.25 ,$278.59 ,$222.87 ,$219.94 ,$133.50 ,$249.26 ,$33.15 ,$133.50 ,$133.50 ,$205.28 ,$178.59 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$249.26 ,$74.58 ,$269.79 ,$205.28 ,$148.74 ,$178.50 ,$178.59 ,$178.50 ,$202.64 ,$263.93 ,$200.35 ,$32.81 ,$231.67 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$211.14 ,$181.82 ,$211.14 ,$211.14 ,$234.60 
ST NICHOLAS HOSPITAL - ACUTE,31200138,88313,HC SPECIAL STAIN II (ARGENTAFFIN),312,1 ,$293.25 ,$193.55 ,$1.25 ,$293.25 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$175.95 ,$249.26 ,$205.28 ,$1.25 ,$1.25 ,$278.59 ,$222.87 ,$219.94 ,$133.50 ,$249.26 ,$33.15 ,$133.50 ,$133.50 ,$205.28 ,$178.59 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$249.26 ,$74.58 ,$269.79 ,$205.28 ,$148.74 ,$178.50 ,$178.59 ,$178.50 ,$202.64 ,$263.93 ,$200.35 ,$32.81 ,$231.67 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$211.14 ,$181.82 ,$211.14 ,$211.14 ,$234.60 
ST NICHOLAS HOSPITAL - ACUTE,31200139,88313,HC SPECIAL STAIN II (BIELSCHOWSKY SILVER),312,1 ,$293.25 ,$193.55 ,$1.25 ,$293.25 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$175.95 ,$249.26 ,$205.28 ,$1.25 ,$1.25 ,$278.59 ,$222.87 ,$219.94 ,$133.50 ,$249.26 ,$33.15 ,$133.50 ,$133.50 ,$205.28 ,$178.59 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$249.26 ,$74.58 ,$269.79 ,$205.28 ,$148.74 ,$178.50 ,$178.59 ,$178.50 ,$202.64 ,$263.93 ,$200.35 ,$32.81 ,$231.67 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$211.14 ,$181.82 ,$211.14 ,$211.14 ,$234.60 
ST NICHOLAS HOSPITAL - ACUTE,31200140,88313,HC SPECIAL STAIN II (ALCIAN/PAS W DIASTASE),312,1 ,$293.25 ,$193.55 ,$1.25 ,$293.25 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$175.95 ,$249.26 ,$205.28 ,$1.25 ,$1.25 ,$278.59 ,$222.87 ,$219.94 ,$133.50 ,$249.26 ,$33.15 ,$133.50 ,$133.50 ,$205.28 ,$178.59 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$249.26 ,$74.58 ,$269.79 ,$205.28 ,$148.74 ,$178.50 ,$178.59 ,$178.50 ,$202.64 ,$263.93 ,$200.35 ,$32.81 ,$231.67 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$211.14 ,$181.82 ,$211.14 ,$211.14 ,$234.60 
ST NICHOLAS HOSPITAL - ACUTE,31200142,88313,HC SPECIAL STAIN II (RHODAMINE),312,1 ,$293.25 ,$193.55 ,$1.25 ,$293.25 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$175.95 ,$249.26 ,$205.28 ,$1.25 ,$1.25 ,$278.59 ,$222.87 ,$219.94 ,$133.50 ,$249.26 ,$33.15 ,$133.50 ,$133.50 ,$205.28 ,$178.59 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$249.26 ,$74.58 ,$269.79 ,$205.28 ,$148.74 ,$178.50 ,$178.59 ,$178.50 ,$202.64 ,$263.93 ,$200.35 ,$32.81 ,$231.67 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$211.14 ,$181.82 ,$211.14 ,$211.14 ,$234.60 
ST NICHOLAS HOSPITAL - ACUTE,31200143,88313,HC SPECIAL STAIN II (TRICHROME),312,1 ,$184.00 ,$121.44 ,$1.25 ,$184.00 ,$1.25 ,$184.00 ,$184.00 ,$33.15 ,$110.40 ,$156.40 ,$128.80 ,$1.25 ,$1.25 ,$174.80 ,$139.84 ,$138.00 ,$133.50 ,$156.40 ,$33.15 ,$133.50 ,$133.50 ,$128.80 ,$112.06 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$156.40 ,$74.58 ,$169.28 ,$128.80 ,$93.32 ,$112.00 ,$112.06 ,$112.00 ,$127.14 ,$165.60 ,$125.71 ,$32.81 ,$145.36 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,31200144,88313,HC SPECIAL STAIN II (RETICULUM),312,1 ,$288.65 ,$190.51 ,$1.25 ,$288.65 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$173.19 ,$245.35 ,$202.06 ,$1.25 ,$1.25 ,$274.22 ,$219.37 ,$216.49 ,$133.50 ,$245.35 ,$33.15 ,$133.50 ,$133.50 ,$202.06 ,$175.79 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$245.35 ,$74.58 ,$265.56 ,$202.06 ,$146.40 ,$175.70 ,$175.79 ,$175.70 ,$199.46 ,$259.79 ,$197.21 ,$32.81 ,$228.03 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$207.83 ,$178.96 ,$207.83 ,$207.83 ,$230.92 
ST NICHOLAS HOSPITAL - ACUTE,31200145,88313,HC SPECIAL STAIN II (ALCIAN BLUE),312,1 ,$315.10 ,$207.97 ,$1.25 ,$315.10 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$189.06 ,$267.84 ,$220.57 ,$1.25 ,$1.25 ,$299.35 ,$239.48 ,$236.33 ,$133.50 ,$267.84 ,$33.15 ,$133.50 ,$133.50 ,$220.57 ,$191.90 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$267.84 ,$74.58 ,$289.89 ,$220.57 ,$159.82 ,$191.80 ,$191.90 ,$191.80 ,$217.73 ,$283.59 ,$215.28 ,$32.81 ,$248.93 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$226.87 ,$195.36 ,$226.87 ,$226.87 ,$252.08 
ST NICHOLAS HOSPITAL - ACUTE,31200146,88313,HC SPECIAL STAIN II (PAS W/DIGEST),312,1 ,$315.10 ,$207.97 ,$1.25 ,$315.10 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$189.06 ,$267.84 ,$220.57 ,$1.25 ,$1.25 ,$299.35 ,$239.48 ,$236.33 ,$133.50 ,$267.84 ,$33.15 ,$133.50 ,$133.50 ,$220.57 ,$191.90 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$267.84 ,$74.58 ,$289.89 ,$220.57 ,$159.82 ,$191.80 ,$191.90 ,$191.80 ,$217.73 ,$283.59 ,$215.28 ,$32.81 ,$248.93 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$226.87 ,$195.36 ,$226.87 ,$226.87 ,$252.08 
ST NICHOLAS HOSPITAL - ACUTE,31200147,88313,HC SPECIAL STAIN II (RENAL BX LGHT MICRO),312,1 ,"$1,062.60 ",$701.32 ,$1.25 ,"$1,062.60 ",$1.25 ,$230.83 ,$230.83 ,$33.15 ,$637.56 ,$903.21 ,$743.82 ,$1.25 ,$1.25 ,"$1,009.47 ",$807.58 ,$796.95 ,$133.50 ,$903.21 ,$33.15 ,$133.50 ,$133.50 ,$743.82 ,$647.12 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$903.21 ,$74.58 ,$977.59 ,$743.82 ,$538.95 ,$646.80 ,$647.12 ,$646.80 ,$734.26 ,$956.34 ,$725.97 ,$32.81 ,$839.45 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$765.07 ,$658.81 ,$765.07 ,$765.07 ,$850.08 
ST NICHOLAS HOSPITAL - ACUTE,31200150,88313,HC SPECIAL STAIN II (WARTHIN STARRY),312,1 ,$167.90 ,$110.81 ,$1.25 ,$167.90 ,$1.25 ,$167.90 ,$167.90 ,$33.15 ,$100.74 ,$142.72 ,$117.53 ,$1.25 ,$1.25 ,$159.51 ,$127.60 ,$125.93 ,$133.50 ,$142.72 ,$33.15 ,$133.50 ,$133.50 ,$117.53 ,$102.25 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$142.72 ,$74.58 ,$154.47 ,$117.53 ,$85.16 ,$102.20 ,$102.25 ,$102.20 ,$116.02 ,$151.11 ,$114.71 ,$32.81 ,$132.64 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$120.89 ,$104.10 ,$120.89 ,$120.89 ,$134.32 
ST NICHOLAS HOSPITAL - ACUTE,31200151,88313,HC SPECIAL STAIN II (ESTERASE MIX),312,1 ,$132.25 ,$87.29 ,$1.25 ,$132.25 ,$1.25 ,$132.25 ,$132.25 ,$33.15 ,$79.35 ,$112.41 ,$92.58 ,$1.25 ,$1.25 ,$125.64 ,$100.51 ,$99.19 ,$132.25 ,$112.41 ,$33.15 ,$132.25 ,$132.25 ,$92.58 ,$80.54 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$112.41 ,$74.58 ,$121.67 ,$92.58 ,$67.08 ,$80.50 ,$80.54 ,$80.50 ,$91.38 ,$119.03 ,$90.35 ,$32.81 ,$104.48 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$95.22 ,$82.00 ,$95.22 ,$95.22 ,$105.80 
ST NICHOLAS HOSPITAL - ACUTE,31200152,88313,HC SPECIAL STAIN II (ESTERASE SPEC),312,1 ,$196.65 ,$129.79 ,$1.25 ,$196.65 ,$1.25 ,$196.65 ,$196.65 ,$33.15 ,$117.99 ,$167.15 ,$137.66 ,$1.25 ,$1.25 ,$186.82 ,$149.45 ,$147.49 ,$133.50 ,$167.15 ,$33.15 ,$133.50 ,$133.50 ,$137.66 ,$119.76 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$167.15 ,$74.58 ,$180.92 ,$137.66 ,$99.74 ,$119.70 ,$119.76 ,$119.70 ,$135.89 ,$176.99 ,$134.35 ,$32.81 ,$155.35 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$141.59 ,$121.92 ,$141.59 ,$141.59 ,$157.32 
ST NICHOLAS HOSPITAL - ACUTE,31200153,88313,HC SPECIAL STAIN II (ESTERASE NONSPEC),312,1 ,$211.60 ,$139.66 ,$1.25 ,$211.60 ,$1.25 ,$211.60 ,$211.60 ,$33.15 ,$126.96 ,$179.86 ,$148.12 ,$1.25 ,$1.25 ,$201.02 ,$160.82 ,$158.70 ,$133.50 ,$179.86 ,$33.15 ,$133.50 ,$133.50 ,$148.12 ,$128.86 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$179.86 ,$74.58 ,$194.67 ,$148.12 ,$107.32 ,$128.80 ,$128.86 ,$128.80 ,$146.22 ,$190.44 ,$144.57 ,$32.81 ,$167.16 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$152.35 ,$131.19 ,$152.35 ,$152.35 ,$169.28 
ST NICHOLAS HOSPITAL - ACUTE,31200155,88313,HC HISTOCHEM CHEMICAL STAIN,312,1 ,$301.30 ,$198.86 ,$1.25 ,$301.30 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$180.78 ,$256.11 ,$210.91 ,$1.25 ,$1.25 ,$286.24 ,$228.99 ,$225.98 ,$133.50 ,$256.11 ,$33.15 ,$133.50 ,$133.50 ,$210.91 ,$183.49 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$256.11 ,$74.58 ,$277.20 ,$210.91 ,$152.82 ,$183.40 ,$183.49 ,$183.40 ,$208.20 ,$271.17 ,$205.85 ,$32.81 ,$238.03 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$216.94 ,$186.81 ,$216.94 ,$216.94 ,$241.04 
ST NICHOLAS HOSPITAL - ACUTE,31200156,88319,HC HISTOCHEM ENZYME STAIN,312,1 ,$282.90 ,$186.71 ,$3.61 ,"$1,705.22 ",$3.61 ,$282.90 ,$282.90 ,$757.87 ,$169.74 ,$240.47 ,$198.03 ,$3.61 ,$3.61 ,$268.76 ,$215.00 ,$212.18 ,$221.53 ,$240.47 ,$757.87 ,$221.53 ,$221.53 ,$198.03 ,$172.29 ,$3.61 ,$757.87 ,$742.71 ,$282.90 ,$3.83 ,$240.47 ,"$1,705.22 ",$260.27 ,$198.03 ,$143.49 ,$172.20 ,$172.29 ,$172.20 ,$195.48 ,$254.61 ,$193.28 ,$750.14 ,$223.49 ,$3.83 ,$282.90 ,$282.90 ,$742.71 ,$282.90 ,$203.69 ,$175.40 ,$203.69 ,$203.69 ,$226.32 
ST NICHOLAS HOSPITAL - ACUTE,31200157,88319,HC HISTOCHEM ENZYME STAIN (LEUKO),312,1 ,$282.90 ,$186.71 ,$3.61 ,"$1,705.22 ",$3.61 ,$282.90 ,$282.90 ,$757.87 ,$169.74 ,$240.47 ,$198.03 ,$3.61 ,$3.61 ,$268.76 ,$215.00 ,$212.18 ,$221.53 ,$240.47 ,$757.87 ,$221.53 ,$221.53 ,$198.03 ,$172.29 ,$3.61 ,$757.87 ,$742.71 ,$282.90 ,$3.83 ,$240.47 ,"$1,705.22 ",$260.27 ,$198.03 ,$143.49 ,$172.20 ,$172.29 ,$172.20 ,$195.48 ,$254.61 ,$193.28 ,$750.14 ,$223.49 ,$3.83 ,$282.90 ,$282.90 ,$742.71 ,$282.90 ,$203.69 ,$175.40 ,$203.69 ,$203.69 ,$226.32 
ST NICHOLAS HOSPITAL - ACUTE,31200159,88321,HC CONSULT REFERRED SLIDES,312,1 ,$286.35 ,$188.99 ,$2.40 ,$286.35 ,$2.40 ,$281.66 ,$281.66 ,$33.15 ,$171.81 ,$243.40 ,$200.45 ,$2.40 ,$2.40 ,$272.03 ,$217.63 ,$214.76 ,$158.83 ,$243.40 ,$33.15 ,$158.83 ,$158.83 ,$200.45 ,$174.39 ,$2.40 ,$33.15 ,$32.49 ,$66.30 ,$2.54 ,$243.40 ,$74.58 ,$263.44 ,$200.45 ,$145.24 ,$174.30 ,$174.39 ,$174.30 ,$197.87 ,$257.72 ,$195.63 ,$32.81 ,$226.22 ,$2.54 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$206.17 ,$177.54 ,$206.17 ,$206.17 ,$229.08 
ST NICHOLAS HOSPITAL - ACUTE,31200162,88321,HC CONSULT REFERRED SLIDES (MUSCLE),312,1 ,$847.55 ,$559.38 ,$2.40 ,$847.55 ,$2.40 ,$281.66 ,$281.66 ,$33.15 ,$508.53 ,$720.42 ,$593.29 ,$2.40 ,$2.40 ,$805.17 ,$644.14 ,$635.66 ,$158.83 ,$720.42 ,$33.15 ,$158.83 ,$158.83 ,$593.29 ,$516.16 ,$2.40 ,$33.15 ,$32.49 ,$66.30 ,$2.54 ,$720.42 ,$74.58 ,$779.75 ,$593.29 ,$429.88 ,$515.90 ,$516.16 ,$515.90 ,$585.66 ,$762.80 ,$579.05 ,$32.81 ,$669.56 ,$2.54 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$610.24 ,$525.48 ,$610.24 ,$610.24 ,$678.04 
ST NICHOLAS HOSPITAL - ACUTE,31200163,88321,HC CONSULT REFERRED SLIDES (MAYO),312,1 ,$592.25 ,$390.89 ,$2.40 ,$592.25 ,$2.40 ,$281.66 ,$281.66 ,$33.15 ,$355.35 ,$503.41 ,$414.58 ,$2.40 ,$2.40 ,$562.64 ,$450.11 ,$444.19 ,$158.83 ,$503.41 ,$33.15 ,$158.83 ,$158.83 ,$414.58 ,$360.68 ,$2.40 ,$33.15 ,$32.49 ,$66.30 ,$2.54 ,$503.41 ,$74.58 ,$544.87 ,$414.58 ,$300.39 ,$360.50 ,$360.68 ,$360.50 ,$409.24 ,$533.03 ,$404.63 ,$32.81 ,$467.88 ,$2.54 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$426.42 ,$367.20 ,$426.42 ,$426.42 ,$473.80 
ST NICHOLAS HOSPITAL - ACUTE,31200164,88323,HC CONSULT/SLIDE PREP,312,1 ,$476.10 ,$314.23 ,$2.40 ,$476.10 ,$2.40 ,$89.35 ,$89.35 ,$48.94 ,$285.66 ,$404.69 ,$333.27 ,$2.40 ,$2.40 ,$452.30 ,$361.84 ,$357.08 ,$189.52 ,$404.69 ,$48.94 ,$189.52 ,$189.52 ,$333.27 ,$289.94 ,$2.40 ,$48.94 ,$47.96 ,$97.88 ,$2.54 ,$404.69 ,$110.11 ,$438.01 ,$333.27 ,$241.48 ,$289.80 ,$289.94 ,$289.80 ,$328.99 ,$428.49 ,$325.27 ,$48.44 ,$376.12 ,$2.54 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$342.79 ,$295.18 ,$342.79 ,$342.79 ,$380.88 
ST NICHOLAS HOSPITAL - ACUTE,31200165,88323,HC CONSULT/SLIDE PREP (CUTAN),312,1 ,$85.10 ,$56.17 ,$2.40 ,$110.11 ,$2.40 ,$85.10 ,$85.10 ,$48.94 ,$51.06 ,$72.34 ,$59.57 ,$2.40 ,$2.40 ,$80.85 ,$64.68 ,$63.83 ,$85.10 ,$72.34 ,$48.94 ,$85.10 ,$85.10 ,$59.57 ,$51.83 ,$2.40 ,$48.94 ,$47.96 ,$85.10 ,$2.54 ,$72.34 ,$110.11 ,$78.29 ,$59.57 ,$43.16 ,$51.80 ,$51.83 ,$51.80 ,$58.80 ,$76.59 ,$58.14 ,$48.44 ,$67.23 ,$2.54 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$61.27 ,$52.76 ,$61.27 ,$61.27 ,$68.08 
ST NICHOLAS HOSPITAL - ACUTE,31200167,88325,HC CONSULT PATH REV/REP (CYTO),312,1 ,"$1,288.00 ",$850.08 ,$2.40 ,"$1,288.00 ",$2.40 ,$457.89 ,$457.89 ,$153.48 ,$772.80 ,"$1,094.80 ",$901.60 ,$2.40 ,$2.40 ,"$1,223.60 ",$978.88 ,$966.00 ,$256.11 ,"$1,094.80 ",$153.48 ,$256.11 ,$256.11 ,$901.60 ,$784.39 ,$2.40 ,$153.48 ,$150.41 ,$306.96 ,$2.54 ,"$1,094.80 ",$345.32 ,"$1,184.96 ",$901.60 ,$653.27 ,$784.01 ,$784.39 ,$784.01 ,$890.01 ,"$1,159.20 ",$879.96 ,$151.91 ,"$1,017.52 ",$2.54 ,$59.36 ,$59.36 ,$150.41 ,$59.36 ,$927.36 ,$798.56 ,$927.36 ,$927.36 ,"$1,030.40 "
ST NICHOLAS HOSPITAL - ACUTE,31200168,88325,HC CONSULT PATH REV/REP (PERI NERVE),312,1 ,"$1,288.00 ",$850.08 ,$2.40 ,"$1,288.00 ",$2.40 ,$457.89 ,$457.89 ,$153.48 ,$772.80 ,"$1,094.80 ",$901.60 ,$2.40 ,$2.40 ,"$1,223.60 ",$978.88 ,$966.00 ,$256.11 ,"$1,094.80 ",$153.48 ,$256.11 ,$256.11 ,$901.60 ,$784.39 ,$2.40 ,$153.48 ,$150.41 ,$306.96 ,$2.54 ,"$1,094.80 ",$345.32 ,"$1,184.96 ",$901.60 ,$653.27 ,$784.01 ,$784.39 ,$784.01 ,$890.01 ,"$1,159.20 ",$879.96 ,$151.91 ,"$1,017.52 ",$2.54 ,$59.36 ,$59.36 ,$150.41 ,$59.36 ,$927.36 ,$798.56 ,$927.36 ,$927.36 ,"$1,030.40 "
ST NICHOLAS HOSPITAL - ACUTE,31200169,88325,HC CONSULT PATH REV/REP (HEMATOPATH),312,1 ,"$1,288.00 ",$850.08 ,$2.40 ,"$1,288.00 ",$2.40 ,$457.89 ,$457.89 ,$153.48 ,$772.80 ,"$1,094.80 ",$901.60 ,$2.40 ,$2.40 ,"$1,223.60 ",$978.88 ,$966.00 ,$256.11 ,"$1,094.80 ",$153.48 ,$256.11 ,$256.11 ,$901.60 ,$784.39 ,$2.40 ,$153.48 ,$150.41 ,$306.96 ,$2.54 ,"$1,094.80 ",$345.32 ,"$1,184.96 ",$901.60 ,$653.27 ,$784.01 ,$784.39 ,$784.01 ,$890.01 ,"$1,159.20 ",$879.96 ,$151.91 ,"$1,017.52 ",$2.54 ,$59.36 ,$59.36 ,$150.41 ,$59.36 ,$927.36 ,$798.56 ,$927.36 ,$927.36 ,"$1,030.40 "
ST NICHOLAS HOSPITAL - ACUTE,31200170,88325,HC CONSULT PATH REV/REP (RENAL PATH),312,1 ,"$1,288.00 ",$850.08 ,$2.40 ,"$1,288.00 ",$2.40 ,$457.89 ,$457.89 ,$153.48 ,$772.80 ,"$1,094.80 ",$901.60 ,$2.40 ,$2.40 ,"$1,223.60 ",$978.88 ,$966.00 ,$256.11 ,"$1,094.80 ",$153.48 ,$256.11 ,$256.11 ,$901.60 ,$784.39 ,$2.40 ,$153.48 ,$150.41 ,$306.96 ,$2.54 ,"$1,094.80 ",$345.32 ,"$1,184.96 ",$901.60 ,$653.27 ,$784.01 ,$784.39 ,$784.01 ,$890.01 ,"$1,159.20 ",$879.96 ,$151.91 ,"$1,017.52 ",$2.54 ,$59.36 ,$59.36 ,$150.41 ,$59.36 ,$927.36 ,$798.56 ,$927.36 ,$927.36 ,"$1,030.40 "
ST NICHOLAS HOSPITAL - ACUTE,31200171,88325,HC CONSULT PATH REV/REP,312,1 ,"$1,288.00 ",$850.08 ,$2.40 ,"$1,288.00 ",$2.40 ,$457.89 ,$457.89 ,$153.48 ,$772.80 ,"$1,094.80 ",$901.60 ,$2.40 ,$2.40 ,"$1,223.60 ",$978.88 ,$966.00 ,$256.11 ,"$1,094.80 ",$153.48 ,$256.11 ,$256.11 ,$901.60 ,$784.39 ,$2.40 ,$153.48 ,$150.41 ,$306.96 ,$2.54 ,"$1,094.80 ",$345.32 ,"$1,184.96 ",$901.60 ,$653.27 ,$784.01 ,$784.39 ,$784.01 ,$890.01 ,"$1,159.20 ",$879.96 ,$151.91 ,"$1,017.52 ",$2.54 ,$59.36 ,$59.36 ,$150.41 ,$59.36 ,$927.36 ,$798.56 ,$927.36 ,$927.36 ,"$1,030.40 "
ST NICHOLAS HOSPITAL - ACUTE,31200173,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$296.70 ,$195.82 ,$2.40 ,$345.32 ,$2.40 ,$136.13 ,$136.13 ,$153.48 ,$178.02 ,$252.20 ,$207.69 ,$2.40 ,$2.40 ,$281.87 ,$225.49 ,$222.53 ,$168.15 ,$252.20 ,$153.48 ,$168.15 ,$168.15 ,$207.69 ,$180.69 ,$2.40 ,$153.48 ,$150.41 ,$296.70 ,$2.54 ,$252.20 ,$345.32 ,$272.96 ,$207.69 ,$150.49 ,$180.60 ,$180.69 ,$180.60 ,$205.02 ,$267.03 ,$202.71 ,$151.91 ,$234.39 ,$2.54 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$213.62 ,$183.95 ,$213.62 ,$213.62 ,$237.36 
ST NICHOLAS HOSPITAL - ACUTE,31200174,88332,HC CONSULT PATH SURG ADDL FROZEN,312,1 ,$218.50 ,$144.21 ,$2.40 ,$218.50 ,$2.40 ,$80.23 ,$80.23 , N/A ,$131.10 ,$185.73 ,$152.95 ,$2.40 ,$2.40 ,$207.58 ,$166.06 ,$163.88 ,$90.17 ,$185.73 , N/A ,$90.17 ,$90.17 ,$152.95 ,$133.07 ,$2.40 , N/A , N/A , N/A ,$2.54 ,$185.73 , N/A ,$201.02 ,$152.95 ,$110.82 ,$133.00 ,$133.07 ,$133.00 ,$150.98 ,$196.65 ,$149.28 , N/A ,$172.62 ,$2.54 ,$27.72 ,$27.72 , N/A ,$27.72 ,$157.32 ,$135.47 ,$157.32 ,$157.32 ,$174.80 
ST NICHOLAS HOSPITAL - ACUTE,31200175,88333,HC CONSULT PATH SURG CYTO INIT,312,1 ,$141.45 ,$93.36 ,$2.40 ,"$1,705.22 ",$2.40 ,$107.61 ,$107.61 ,$757.87 ,$84.87 ,$120.23 ,$99.02 ,$2.40 ,$2.40 ,$134.38 ,$107.50 ,$106.09 ,$141.45 ,$120.23 ,$757.87 ,$141.45 ,$141.45 ,$99.02 ,$86.14 ,$2.40 ,$757.87 ,$742.71 ,$141.45 ,$2.54 ,$120.23 ,"$1,705.22 ",$130.13 ,$99.02 ,$71.74 ,$86.10 ,$86.14 ,$86.10 ,$97.74 ,$127.31 ,$96.64 ,$750.14 ,$111.75 ,$2.54 ,$141.45 ,$141.45 ,$742.71 ,$141.45 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,31200176,88334,HC CONSULT PATH SURG EA ADDL,312,1 ,$200.10 ,$132.07 ,$2.40 ,$200.10 ,$2.40 ,$63.89 ,$63.89 , N/A ,$120.06 ,$170.09 ,$140.07 ,$2.40 ,$2.40 ,$190.10 ,$152.08 ,$150.08 ,$93.13 ,$170.09 , N/A ,$93.13 ,$93.13 ,$140.07 ,$121.86 ,$2.40 , N/A , N/A , N/A ,$2.54 ,$170.09 , N/A ,$184.09 ,$140.07 ,$101.49 ,$121.80 ,$121.86 ,$121.80 ,$138.27 ,$180.09 ,$136.71 , N/A ,$158.08 ,$2.54 ,$21.65 ,$21.65 , N/A ,$21.65 ,$144.07 ,$124.06 ,$144.07 ,$144.07 ,$160.08 
ST NICHOLAS HOSPITAL - ACUTE,31200177,88341,HC IMMUNOHISTOCHEM EA AB,312,1 ,$116.15 ,$76.66 ,$3.61 ,$116.15 ,$3.61 ,$116.15 ,$116.15 , N/A ,$69.69 ,$98.73 ,$81.31 ,$3.61 ,$3.61 ,$110.34 ,$88.27 ,$87.11 ,$116.15 ,$98.73 , N/A ,$116.15 ,$116.15 ,$81.31 ,$70.74 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$98.73 , N/A ,$106.86 ,$81.31 ,$58.91 ,$70.70 ,$70.74 ,$70.70 ,$80.26 ,$104.54 ,$79.35 , N/A ,$91.76 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,31200182,88341,HC IMMUNOHISTOCHEM EA AB T2,312,1 ,$315.10 ,$207.97 ,$3.61 ,$315.10 ,$3.61 ,$203.09 ,$203.09 , N/A ,$189.06 ,$267.84 ,$220.57 ,$3.61 ,$3.61 ,$299.35 ,$239.48 ,$236.33 ,$141.90 ,$267.84 , N/A ,$141.90 ,$141.90 ,$220.57 ,$191.90 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$267.84 , N/A ,$289.89 ,$220.57 ,$159.82 ,$191.80 ,$191.90 ,$191.80 ,$217.73 ,$283.59 ,$215.28 , N/A ,$248.93 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$226.87 ,$195.36 ,$226.87 ,$226.87 ,$252.08 
ST NICHOLAS HOSPITAL - ACUTE,31200183,88341,HC IMMUNOHISTOCHEM EA AB T3,312,1 ,$393.30 ,$259.58 ,$3.61 ,$393.30 ,$3.61 ,$203.09 ,$203.09 , N/A ,$235.98 ,$334.31 ,$275.31 ,$3.61 ,$3.61 ,$373.64 ,$298.91 ,$294.98 ,$141.90 ,$334.31 , N/A ,$141.90 ,$141.90 ,$275.31 ,$239.52 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$334.31 , N/A ,$361.84 ,$275.31 ,$199.48 ,$239.40 ,$239.52 ,$239.40 ,$271.77 ,$353.97 ,$268.70 , N/A ,$310.71 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$283.18 ,$243.85 ,$283.18 ,$283.18 ,$314.64 
ST NICHOLAS HOSPITAL - ACUTE,31200184,88341,HC IMMUNOHISTOCHEM EA AB T4,312,1 ,$312.80 ,$206.45 ,$3.61 ,$312.80 ,$3.61 ,$203.09 ,$203.09 , N/A ,$187.68 ,$265.88 ,$218.96 ,$3.61 ,$3.61 ,$297.16 ,$237.73 ,$234.60 ,$141.90 ,$265.88 , N/A ,$141.90 ,$141.90 ,$218.96 ,$190.50 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$265.88 , N/A ,$287.78 ,$218.96 ,$158.65 ,$190.40 ,$190.50 ,$190.40 ,$216.14 ,$281.52 ,$213.71 , N/A ,$247.11 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$225.22 ,$193.94 ,$225.22 ,$225.22 ,$250.24 
ST NICHOLAS HOSPITAL - ACUTE,31200185,88341,HC IMMUNOHISTOCHEM EA AB T5,312,1 ,$420.90 ,$277.79 ,$3.61 ,$420.90 ,$3.61 ,$203.09 ,$203.09 , N/A ,$252.54 ,$357.77 ,$294.63 ,$3.61 ,$3.61 ,$399.86 ,$319.88 ,$315.68 ,$141.90 ,$357.77 , N/A ,$141.90 ,$141.90 ,$294.63 ,$256.33 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$357.77 , N/A ,$387.23 ,$294.63 ,$213.48 ,$256.20 ,$256.33 ,$256.20 ,$290.84 ,$378.81 ,$287.56 , N/A ,$332.51 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$303.05 ,$260.96 ,$303.05 ,$303.05 ,$336.72 
ST NICHOLAS HOSPITAL - ACUTE,31200186,88346,HC IF DIRECT,312,1 ,$116.15 ,$76.66 ,$3.61 ,$711.75 ,$3.61 ,$116.15 ,$116.15 ,$316.33 ,$69.69 ,$98.73 ,$81.31 ,$3.61 ,$3.61 ,$110.34 ,$88.27 ,$87.11 ,$116.15 ,$98.73 ,$316.33 ,$116.15 ,$116.15 ,$81.31 ,$70.74 ,$3.61 ,$316.33 ,$310.00 ,$116.15 ,$3.83 ,$98.73 ,$711.75 ,$106.86 ,$81.31 ,$58.91 ,$70.70 ,$70.74 ,$70.70 ,$80.26 ,$104.54 ,$79.35 ,$313.10 ,$91.76 ,$3.83 ,$116.15 ,$116.15 ,$310.00 ,$116.15 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,31200187,88346,HC IF DIRECT (RENAL BX),312,1 ,$116.15 ,$76.66 ,$3.61 ,$711.75 ,$3.61 ,$116.15 ,$116.15 ,$316.33 ,$69.69 ,$98.73 ,$81.31 ,$3.61 ,$3.61 ,$110.34 ,$88.27 ,$87.11 ,$116.15 ,$98.73 ,$316.33 ,$116.15 ,$116.15 ,$81.31 ,$70.74 ,$3.61 ,$316.33 ,$310.00 ,$116.15 ,$3.83 ,$98.73 ,$711.75 ,$106.86 ,$81.31 ,$58.91 ,$70.70 ,$70.74 ,$70.70 ,$80.26 ,$104.54 ,$79.35 ,$313.10 ,$91.76 ,$3.83 ,$116.15 ,$116.15 ,$310.00 ,$116.15 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,31200188,88346,HC IF DIRECT (CUTANEOUS),312,1 ,$116.15 ,$76.66 ,$3.61 ,$711.75 ,$3.61 ,$116.15 ,$116.15 ,$316.33 ,$69.69 ,$98.73 ,$81.31 ,$3.61 ,$3.61 ,$110.34 ,$88.27 ,$87.11 ,$116.15 ,$98.73 ,$316.33 ,$116.15 ,$116.15 ,$81.31 ,$70.74 ,$3.61 ,$316.33 ,$310.00 ,$116.15 ,$3.83 ,$98.73 ,$711.75 ,$106.86 ,$81.31 ,$58.91 ,$70.70 ,$70.74 ,$70.70 ,$80.26 ,$104.54 ,$79.35 ,$313.10 ,$91.76 ,$3.83 ,$116.15 ,$116.15 ,$310.00 ,$116.15 ,$83.63 ,$72.01 ,$83.63 ,$83.63 ,$92.92 
ST NICHOLAS HOSPITAL - ACUTE,31200189,88348,HC ELECTRON MICRO DIAG,312,1 ,"$3,864.00 ","$2,550.24 ",$3.61 ,"$3,864.00 ",$3.61 ,"$1,265.92 ","$1,265.92 ",$757.87 ,"$2,318.40 ","$3,284.40 ","$2,704.80 ",$3.61 ,$3.61 ,"$3,670.80 ","$2,936.64 ","$2,898.00 ",$772.34 ,"$3,284.40 ",$757.87 ,$772.34 ,$772.34 ,"$2,704.80 ","$2,353.18 ",$3.61 ,$757.87 ,$742.71 ,"$1,515.74 ",$3.83 ,"$3,284.40 ","$1,705.22 ","$3,554.88 ","$2,704.80 ","$1,959.82 ","$2,352.02 ","$2,353.18 ","$2,352.02 ","$2,670.02 ","$3,477.60 ","$2,639.88 ",$750.14 ,"$3,052.56 ",$3.83 ,$753.84 ,$753.84 ,$742.71 ,$753.84 ,"$2,782.08 ","$2,395.68 ","$2,782.08 ","$2,782.08 ","$3,091.20 "
ST NICHOLAS HOSPITAL - ACUTE,31200190,88348,HC ELECTRON MICRO DIAG MAYO,312,1 ,"$1,880.25 ","$1,240.97 ",$3.61 ,"$1,880.25 ",$3.61 ,"$1,265.92 ","$1,265.92 ",$757.87 ,"$1,128.15 ","$1,598.21 ","$1,316.18 ",$3.61 ,$3.61 ,"$1,786.24 ","$1,428.99 ","$1,410.19 ",$772.34 ,"$1,598.21 ",$757.87 ,$772.34 ,$772.34 ,"$1,316.18 ","$1,145.07 ",$3.61 ,$757.87 ,$742.71 ,"$1,515.74 ",$3.83 ,"$1,598.21 ","$1,705.22 ","$1,729.83 ","$1,316.18 ",$953.66 ,"$1,144.51 ","$1,145.07 ","$1,144.51 ","$1,299.25 ","$1,692.23 ","$1,284.59 ",$750.14 ,"$1,485.40 ",$3.83 ,$753.84 ,$753.84 ,$742.71 ,$753.84 ,"$1,353.78 ","$1,165.76 ","$1,353.78 ","$1,353.78 ","$1,504.20 "
ST NICHOLAS HOSPITAL - ACUTE,31200191,88360,HC MORPHO ANLYS TUMOR MAN (PR),312,1 ,$463.45 ,$305.88 ,$3.61 ,$463.45 ,$3.61 ,$266.20 ,$266.20 ,$153.48 ,$278.07 ,$393.93 ,$324.42 ,$3.61 ,$3.61 ,$440.28 ,$352.22 ,$347.59 ,$194.36 ,$393.93 ,$153.48 ,$194.36 ,$194.36 ,$324.42 ,$282.24 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$393.93 ,$345.32 ,$426.37 ,$324.42 ,$235.06 ,$282.10 ,$282.24 ,$282.10 ,$320.24 ,$417.11 ,$316.63 ,$151.91 ,$366.13 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,31200192,88360,HC MORPHO ANLYS TUMOR MAN (ER),312,1 ,$463.45 ,$305.88 ,$3.61 ,$463.45 ,$3.61 ,$266.20 ,$266.20 ,$153.48 ,$278.07 ,$393.93 ,$324.42 ,$3.61 ,$3.61 ,$440.28 ,$352.22 ,$347.59 ,$194.36 ,$393.93 ,$153.48 ,$194.36 ,$194.36 ,$324.42 ,$282.24 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$393.93 ,$345.32 ,$426.37 ,$324.42 ,$235.06 ,$282.10 ,$282.24 ,$282.10 ,$320.24 ,$417.11 ,$316.63 ,$151.91 ,$366.13 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,31200193,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$463.45 ,$305.88 ,$3.61 ,$463.45 ,$3.61 ,$266.20 ,$266.20 ,$153.48 ,$278.07 ,$393.93 ,$324.42 ,$3.61 ,$3.61 ,$440.28 ,$352.22 ,$347.59 ,$194.36 ,$393.93 ,$153.48 ,$194.36 ,$194.36 ,$324.42 ,$282.24 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$393.93 ,$345.32 ,$426.37 ,$324.42 ,$235.06 ,$282.10 ,$282.24 ,$282.10 ,$320.24 ,$417.11 ,$316.63 ,$151.91 ,$366.13 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,31200194,88360,HC MORPHO ANLYS TUMOR MAN (HER2),312,1 ,$463.45 ,$305.88 ,$3.61 ,$463.45 ,$3.61 ,$266.20 ,$266.20 ,$153.48 ,$278.07 ,$393.93 ,$324.42 ,$3.61 ,$3.61 ,$440.28 ,$352.22 ,$347.59 ,$194.36 ,$393.93 ,$153.48 ,$194.36 ,$194.36 ,$324.42 ,$282.24 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$393.93 ,$345.32 ,$426.37 ,$324.42 ,$235.06 ,$282.10 ,$282.24 ,$282.10 ,$320.24 ,$417.11 ,$316.63 ,$151.91 ,$366.13 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,31200201,88360,HC MORPHO ANLYS TUMOR MAN (DCMH),312,1 ,$366.85 ,$242.12 ,$3.61 ,$366.85 ,$3.61 ,$266.20 ,$266.20 ,$153.48 ,$220.11 ,$311.82 ,$256.80 ,$3.61 ,$3.61 ,$348.51 ,$278.81 ,$275.14 ,$194.36 ,$311.82 ,$153.48 ,$194.36 ,$194.36 ,$256.80 ,$223.41 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$311.82 ,$345.32 ,$337.50 ,$256.80 ,$186.07 ,$223.30 ,$223.41 ,$223.30 ,$253.49 ,$330.17 ,$250.63 ,$151.91 ,$289.81 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$264.13 ,$227.45 ,$264.13 ,$264.13 ,$293.48 
ST NICHOLAS HOSPITAL - ACUTE,31200202,88361,HC MORPHO ANLYS COMP ASSIST,312,1 ,$550.85 ,$363.56 ,$3.61 ,$711.75 ,$3.61 ,$258.22 ,$258.22 ,$316.33 ,$330.51 ,$468.22 ,$385.60 ,$3.61 ,$3.61 ,$523.31 ,$418.65 ,$413.14 ,$194.65 ,$468.22 ,$316.33 ,$194.65 ,$194.65 ,$385.60 ,$335.47 ,$3.61 ,$316.33 ,$310.00 ,$550.85 ,$3.83 ,$468.22 ,$711.75 ,$506.78 ,$385.60 ,$279.39 ,$335.30 ,$335.47 ,$335.30 ,$380.64 ,$495.77 ,$376.34 ,$313.10 ,$435.17 ,$3.83 ,$340.09 ,$340.09 ,$310.00 ,$340.09 ,$396.61 ,$341.53 ,$396.61 ,$396.61 ,$440.68 
ST NICHOLAS HOSPITAL - ACUTE,31200203,88363,HC EXAM ARCHIVE TISS MOL ANLYS,312,1 ,$143.75 ,$94.88 ,$1.19 ,$143.75 ,$1.19 ,$64.93 ,$64.93 ,$24.36 ,$86.25 ,$122.19 ,$100.63 ,$1.19 ,$1.19 ,$136.56 ,$109.25 ,$107.81 ,$37.55 ,$122.19 ,$24.36 ,$37.55 ,$37.55 ,$100.63 ,$87.54 ,$1.19 ,$24.36 ,$23.87 ,$48.72 ,$1.26 ,$122.19 ,$54.81 ,$132.25 ,$100.63 ,$72.91 ,$87.50 ,$87.54 ,$87.50 ,$99.33 ,$129.38 ,$98.21 ,$24.11 ,$113.56 ,$1.26 ,$27.59 ,$27.59 ,$23.87 ,$27.59 ,$103.50 ,$89.13 ,$103.50 ,$103.50 ,$115.00 
ST NICHOLAS HOSPITAL - ACUTE,31200204,88365,HC IN SITU HYBRID (FISH),312,1 ,$640.55 ,$422.76 ,$3.61 ,$640.55 ,$3.61 ,$457.10 ,$457.10 ,$153.48 ,$384.33 ,$544.47 ,$448.39 ,$3.61 ,$3.61 ,$608.52 ,$486.82 ,$480.41 ,$295.87 ,$544.47 ,$153.48 ,$295.87 ,$295.87 ,$448.39 ,$390.10 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$544.47 ,$345.32 ,$589.31 ,$448.39 ,$324.89 ,$389.90 ,$390.10 ,$389.90 ,$442.62 ,$576.50 ,$437.62 ,$151.91 ,$506.03 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$461.20 ,$397.14 ,$461.20 ,$461.20 ,$512.44 
ST NICHOLAS HOSPITAL - ACUTE,31200207,88365,HC IN SITU HYBRID (FISH) HER2,312,1 ,$640.55 ,$422.76 ,$3.61 ,$640.55 ,$3.61 ,$457.10 ,$457.10 ,$153.48 ,$384.33 ,$544.47 ,$448.39 ,$3.61 ,$3.61 ,$608.52 ,$486.82 ,$480.41 ,$295.87 ,$544.47 ,$153.48 ,$295.87 ,$295.87 ,$448.39 ,$390.10 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$544.47 ,$345.32 ,$589.31 ,$448.39 ,$324.89 ,$389.90 ,$390.10 ,$389.90 ,$442.62 ,$576.50 ,$437.62 ,$151.91 ,$506.03 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$461.20 ,$397.14 ,$461.20 ,$461.20 ,$512.44 
ST NICHOLAS HOSPITAL - ACUTE,31200208,88368,HC MORPHO ANLYS IN SITU HYBRID,312,1 ,$476.10 ,$314.23 ,$3.61 ,$711.75 ,$3.61 ,$317.91 ,$317.91 ,$316.33 ,$285.66 ,$404.69 ,$333.27 ,$3.61 ,$3.61 ,$452.30 ,$361.84 ,$357.08 ,$233.48 ,$404.69 ,$316.33 ,$233.48 ,$233.48 ,$333.27 ,$289.94 ,$3.61 ,$316.33 ,$310.00 ,$476.10 ,$3.83 ,$404.69 ,$711.75 ,$438.01 ,$333.27 ,$241.48 ,$289.80 ,$289.94 ,$289.80 ,$328.99 ,$428.49 ,$325.27 ,$313.10 ,$376.12 ,$3.83 ,$340.09 ,$340.09 ,$310.00 ,$340.09 ,$342.79 ,$295.18 ,$342.79 ,$342.79 ,$380.88 
ST NICHOLAS HOSPITAL - ACUTE,31200210,88399,HC ACGH ARRAY,312,1 ,"$2,363.25 ","$1,559.75 ",$1.19 ,"$2,363.25 ",$1.19 ,"$1,619.77 ","$1,619.77 ",$48.94 ,"$1,417.95 ","$2,008.76 ","$1,654.28 ",$1.19 ,$1.19 ,"$2,245.09 ","$1,796.07 ","$1,772.44 ", N/A ,"$2,008.76 ",$48.94 , N/A , N/A ,"$1,654.28 ","$1,439.22 ",$1.19 ,$48.94 ,$47.96 ,$97.88 ,$1.26 ,"$2,008.76 ",$110.11 ,"$2,174.19 ","$1,654.28 ","$1,198.64 ","$1,438.51 ","$1,439.22 ","$1,438.51 ","$1,633.01 ","$2,126.93 ","$1,614.57 ",$48.44 ,"$1,866.97 ",$1.26 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,"$1,701.54 ","$1,465.22 ","$1,701.54 ","$1,701.54 ","$1,890.60 "
ST NICHOLAS HOSPITAL - ACUTE,31200212,G0416,HC PROSTATE NEEDLE BX SAMPLING 1-20 SPEC,312,1 ,$599.15 ,$395.44 ,$3.61 ,$711.75 ,$3.61 ,$593.60 ,$593.60 ,$316.33 ,$359.49 ,$509.28 ,$419.41 ,$3.61 ,$3.61 ,$569.19 ,$455.35 ,$449.36 ,$593.39 ,$509.28 ,$316.33 ,$593.39 ,$593.39 ,$419.41 ,$364.88 ,$3.61 ,$316.33 ,$310.00 ,$599.15 ,$3.83 ,$509.28 ,$711.75 ,$551.22 ,$419.41 ,$303.89 ,$364.70 ,$364.88 ,$364.70 ,$414.01 ,$539.24 ,$409.34 ,$313.10 ,$473.33 ,$3.83 ,$340.09 ,$340.09 ,$310.00 ,$340.09 ,$431.39 ,$371.47 ,$431.39 ,$431.39 ,$479.32 
ST NICHOLAS HOSPITAL - ACUTE,31200213,88313,HC SPECIAL STAIN II (BM CLOT),312,1 ,$249.55 ,$164.70 ,$1.25 ,$249.55 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$149.73 ,$212.12 ,$174.69 ,$1.25 ,$1.25 ,$237.07 ,$189.66 ,$187.16 ,$133.50 ,$212.12 ,$33.15 ,$133.50 ,$133.50 ,$174.69 ,$151.98 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$212.12 ,$74.58 ,$229.59 ,$174.69 ,$126.57 ,$151.90 ,$151.98 ,$151.90 ,$172.44 ,$224.60 ,$170.49 ,$32.81 ,$197.14 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$179.68 ,$154.72 ,$179.68 ,$179.68 ,$199.64 
ST NICHOLAS HOSPITAL - ACUTE,31200214,88348,HC ELECTROMICROSCOPE SCAN,312,1 ,"$1,288.00 ",$850.08 ,$3.61 ,"$1,705.22 ",$3.61 ,"$1,265.92 ","$1,265.92 ",$757.87 ,$772.80 ,"$1,094.80 ",$901.60 ,$3.61 ,$3.61 ,"$1,223.60 ",$978.88 ,$966.00 ,$772.34 ,"$1,094.80 ",$757.87 ,$772.34 ,$772.34 ,$901.60 ,$784.39 ,$3.61 ,$757.87 ,$742.71 ,"$1,288.00 ",$3.83 ,"$1,094.80 ","$1,705.22 ","$1,184.96 ",$901.60 ,$653.27 ,$784.01 ,$784.39 ,$784.01 ,$890.01 ,"$1,159.20 ",$879.96 ,$750.14 ,"$1,017.52 ",$3.83 ,$753.84 ,$753.84 ,$742.71 ,$753.84 ,$927.36 ,$798.56 ,$927.36 ,$927.36 ,"$1,030.40 "
ST NICHOLAS HOSPITAL - ACUTE,31200215,88341,HC MLH-1 IMMUNOSTAIN,312,1 ,$425.50 ,$280.83 ,$3.61 ,$425.50 ,$3.61 ,$203.09 ,$203.09 , N/A ,$255.30 ,$361.68 ,$297.85 ,$3.61 ,$3.61 ,$404.23 ,$323.38 ,$319.13 ,$141.90 ,$361.68 , N/A ,$141.90 ,$141.90 ,$297.85 ,$259.13 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$361.68 , N/A ,$391.46 ,$297.85 ,$215.81 ,$259.00 ,$259.13 ,$259.00 ,$294.02 ,$382.95 ,$290.70 , N/A ,$336.15 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$306.36 ,$263.81 ,$306.36 ,$306.36 ,$340.40 
ST NICHOLAS HOSPITAL - ACUTE,31200216,88341,HC MSH-2 IMMUNOSTAIN,312,1 ,$425.50 ,$280.83 ,$3.61 ,$425.50 ,$3.61 ,$203.09 ,$203.09 , N/A ,$255.30 ,$361.68 ,$297.85 ,$3.61 ,$3.61 ,$404.23 ,$323.38 ,$319.13 ,$141.90 ,$361.68 , N/A ,$141.90 ,$141.90 ,$297.85 ,$259.13 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$361.68 , N/A ,$391.46 ,$297.85 ,$215.81 ,$259.00 ,$259.13 ,$259.00 ,$294.02 ,$382.95 ,$290.70 , N/A ,$336.15 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$306.36 ,$263.81 ,$306.36 ,$306.36 ,$340.40 
ST NICHOLAS HOSPITAL - ACUTE,31200217,88341,HC MSH-3 IMMUNOSTAIN,312,1 ,$425.50 ,$280.83 ,$3.61 ,$425.50 ,$3.61 ,$203.09 ,$203.09 , N/A ,$255.30 ,$361.68 ,$297.85 ,$3.61 ,$3.61 ,$404.23 ,$323.38 ,$319.13 ,$141.90 ,$361.68 , N/A ,$141.90 ,$141.90 ,$297.85 ,$259.13 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$361.68 , N/A ,$391.46 ,$297.85 ,$215.81 ,$259.00 ,$259.13 ,$259.00 ,$294.02 ,$382.95 ,$290.70 , N/A ,$336.15 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$306.36 ,$263.81 ,$306.36 ,$306.36 ,$340.40 
ST NICHOLAS HOSPITAL - ACUTE,31200218,88341,HC PMS-2 IMMUNOSTAIN,312,1 ,$425.50 ,$280.83 ,$3.61 ,$425.50 ,$3.61 ,$203.09 ,$203.09 , N/A ,$255.30 ,$361.68 ,$297.85 ,$3.61 ,$3.61 ,$404.23 ,$323.38 ,$319.13 ,$141.90 ,$361.68 , N/A ,$141.90 ,$141.90 ,$297.85 ,$259.13 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$361.68 , N/A ,$391.46 ,$297.85 ,$215.81 ,$259.00 ,$259.13 ,$259.00 ,$294.02 ,$382.95 ,$290.70 , N/A ,$336.15 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$306.36 ,$263.81 ,$306.36 ,$306.36 ,$340.40 
ST NICHOLAS HOSPITAL - ACUTE,31200220,88342,HC IMMUNOHISTOCHEM AB-INITIAL,312,1 ,$334.65 ,$220.87 ,$3.61 ,$345.32 ,$3.61 ,$222.85 ,$222.85 ,$153.48 ,$200.79 ,$284.45 ,$234.26 ,$3.61 ,$3.61 ,$317.92 ,$254.33 ,$250.99 ,$164.37 ,$284.45 ,$153.48 ,$164.37 ,$164.37 ,$234.26 ,$203.80 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$284.45 ,$345.32 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$151.91 ,$264.37 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31200221,88341,HC IP STAIN ADDITIONAL,312,1 ,$425.50 ,$280.83 ,$3.61 ,$425.50 ,$3.61 ,$203.09 ,$203.09 , N/A ,$255.30 ,$361.68 ,$297.85 ,$3.61 ,$3.61 ,$404.23 ,$323.38 ,$319.13 ,$141.90 ,$361.68 , N/A ,$141.90 ,$141.90 ,$297.85 ,$259.13 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$361.68 , N/A ,$391.46 ,$297.85 ,$215.81 ,$259.00 ,$259.13 ,$259.00 ,$294.02 ,$382.95 ,$290.70 , N/A ,$336.15 ,$3.83 ,$77.52 ,$77.52 , N/A ,$77.52 ,$306.36 ,$263.81 ,$306.36 ,$306.36 ,$340.40 
ST NICHOLAS HOSPITAL - ACUTE,31200226,88323,HC CONSULT SLIDE PREP LV II,312,1 ,$515.20 ,$340.03 ,$2.40 ,$515.20 ,$2.40 ,$89.35 ,$89.35 ,$48.94 ,$309.12 ,$437.92 ,$360.64 ,$2.40 ,$2.40 ,$489.44 ,$391.55 ,$386.40 ,$189.52 ,$437.92 ,$48.94 ,$189.52 ,$189.52 ,$360.64 ,$313.76 ,$2.40 ,$48.94 ,$47.96 ,$97.88 ,$2.54 ,$437.92 ,$110.11 ,$473.98 ,$360.64 ,$261.31 ,$313.60 ,$313.76 ,$313.60 ,$356.00 ,$463.68 ,$351.98 ,$48.44 ,$407.01 ,$2.54 ,$59.36 ,$59.36 ,$47.96 ,$59.36 ,$370.94 ,$319.42 ,$370.94 ,$370.94 ,$412.16 
ST NICHOLAS HOSPITAL - ACUTE,31200228,81479,HC IBD SCREEN-UNLISTED,312,1 ,$205.85 ,$135.86 ,$1.46 ,$205.85 ,$1.46 ,$141.09 ,$141.09 , N/A ,$123.51 ,$174.97 ,$144.10 ,$1.46 ,$1.46 ,$195.56 ,$156.45 ,$154.39 , N/A ,$174.97 , N/A , N/A , N/A ,$144.10 ,$125.36 ,$1.46 , N/A , N/A , N/A ,$1.55 ,$174.97 ,$123.51 ,$189.38 ,$144.10 ,$104.41 ,$125.30 ,$125.36 ,$125.30 ,$142.24 ,$185.27 ,$140.64 , N/A ,$162.62 ,$1.55 , N/A , N/A , N/A , N/A ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,31200229,88368,HC I KAPPA ISH,312,1 ,"$1,030.40 ",$680.06 ,$3.61 ,"$1,030.40 ",$3.61 ,$317.91 ,$317.91 ,$316.33 ,$618.24 ,$875.84 ,$721.28 ,$3.61 ,$3.61 ,$978.88 ,$783.10 ,$772.80 ,$233.48 ,$875.84 ,$316.33 ,$233.48 ,$233.48 ,$721.28 ,$627.51 ,$3.61 ,$316.33 ,$310.00 ,$632.66 ,$3.83 ,$875.84 ,$711.75 ,$947.97 ,$721.28 ,$522.62 ,$627.20 ,$627.51 ,$627.20 ,$712.01 ,$927.36 ,$703.97 ,$313.10 ,$814.02 ,$3.83 ,$340.09 ,$340.09 ,$310.00 ,$340.09 ,$741.89 ,$638.85 ,$741.89 ,$741.89 ,$824.32 
ST NICHOLAS HOSPITAL - ACUTE,31200230,88369,HC I LAMBDA ISH-ADDITIONAL,312,1 ,$463.45 ,$305.88 ,$3.61 ,$463.45 ,$3.61 ,$278.75 ,$278.75 , N/A ,$278.07 ,$393.93 ,$324.42 ,$3.61 ,$3.61 ,$440.28 ,$352.22 ,$347.59 ,$200.50 ,$393.93 , N/A ,$200.50 ,$200.50 ,$324.42 ,$282.24 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$393.93 , N/A ,$426.37 ,$324.42 ,$235.06 ,$282.10 ,$282.24 ,$282.10 ,$320.24 ,$417.11 ,$316.63 , N/A ,$366.13 ,$3.83 ,$99.18 ,$99.18 , N/A ,$99.18 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,31200231,88313,HC PERIODIC ACID SCHIFF STAIN II,312,1 ,$334.65 ,$220.87 ,$1.25 ,$334.65 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$200.79 ,$284.45 ,$234.26 ,$1.25 ,$1.25 ,$317.92 ,$254.33 ,$250.99 ,$133.50 ,$284.45 ,$33.15 ,$133.50 ,$133.50 ,$234.26 ,$203.80 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$284.45 ,$74.58 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$32.81 ,$264.37 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31200232,88313,HC MASSONS TRICHROME STAIN II,312,1 ,$334.65 ,$220.87 ,$1.25 ,$334.65 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$200.79 ,$284.45 ,$234.26 ,$1.25 ,$1.25 ,$317.92 ,$254.33 ,$250.99 ,$133.50 ,$284.45 ,$33.15 ,$133.50 ,$133.50 ,$234.26 ,$203.80 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$284.45 ,$74.58 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$32.81 ,$264.37 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31200233,88313,HC JONES METH SILVER STAIN II,312,1 ,$334.65 ,$220.87 ,$1.25 ,$334.65 ,$1.25 ,$230.83 ,$230.83 ,$33.15 ,$200.79 ,$284.45 ,$234.26 ,$1.25 ,$1.25 ,$317.92 ,$254.33 ,$250.99 ,$133.50 ,$284.45 ,$33.15 ,$133.50 ,$133.50 ,$234.26 ,$203.80 ,$1.25 ,$33.15 ,$32.49 ,$66.30 ,$1.33 ,$284.45 ,$74.58 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$32.81 ,$264.37 ,$1.33 ,$40.12 ,$40.12 ,$32.49 ,$40.12 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,31200234,88346,HC IGG1 IF,312,1 ,$175.95 ,$116.13 ,$3.61 ,$711.75 ,$3.61 ,$175.95 ,$175.95 ,$316.33 ,$105.57 ,$149.56 ,$123.17 ,$3.61 ,$3.61 ,$167.15 ,$133.72 ,$131.96 ,$175.95 ,$149.56 ,$316.33 ,$175.95 ,$175.95 ,$123.17 ,$107.15 ,$3.61 ,$316.33 ,$310.00 ,$175.95 ,$3.83 ,$149.56 ,$711.75 ,$161.87 ,$123.17 ,$89.24 ,$107.10 ,$107.15 ,$107.10 ,$121.58 ,$158.36 ,$120.21 ,$313.10 ,$139.00 ,$3.83 ,$175.95 ,$175.95 ,$310.00 ,$175.95 ,$126.68 ,$109.09 ,$126.68 ,$126.68 ,$140.76 
ST NICHOLAS HOSPITAL - ACUTE,31200235,88381,HC MICRODISSECTION MANUAL,312,1 ,$322.00 ,$212.52 ,$1.25 ,$322.00 ,$1.25 ,$322.00 ,$322.00 , N/A ,$193.20 ,$273.70 ,$225.40 ,$1.25 ,$1.25 ,$305.90 ,$244.72 ,$241.50 ,$322.00 ,$273.70 , N/A ,$322.00 ,$322.00 ,$225.40 ,$196.10 ,$1.25 , N/A , N/A , N/A ,$1.33 ,$273.70 , N/A ,$296.24 ,$225.40 ,$163.32 ,$196.00 ,$196.10 ,$196.00 ,$222.50 ,$289.80 ,$219.99 , N/A ,$254.38 ,$1.33 ,$188.39 ,$188.39 , N/A ,$188.39 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,31200236,88346,HC IGG3 IF,312,1 ,$175.95 ,$116.13 ,$3.61 ,$711.75 ,$3.61 ,$175.95 ,$175.95 ,$316.33 ,$105.57 ,$149.56 ,$123.17 ,$3.61 ,$3.61 ,$167.15 ,$133.72 ,$131.96 ,$175.95 ,$149.56 ,$316.33 ,$175.95 ,$175.95 ,$123.17 ,$107.15 ,$3.61 ,$316.33 ,$310.00 ,$175.95 ,$3.83 ,$149.56 ,$711.75 ,$161.87 ,$123.17 ,$89.24 ,$107.10 ,$107.15 ,$107.10 ,$121.58 ,$158.36 ,$120.21 ,$313.10 ,$139.00 ,$3.83 ,$175.95 ,$175.95 ,$310.00 ,$175.95 ,$126.68 ,$109.09 ,$126.68 ,$126.68 ,$140.76 
ST NICHOLAS HOSPITAL - ACUTE,31200237,88346,HC IGG4 IF,312,1 ,$175.95 ,$116.13 ,$3.61 ,$711.75 ,$3.61 ,$175.95 ,$175.95 ,$316.33 ,$105.57 ,$149.56 ,$123.17 ,$3.61 ,$3.61 ,$167.15 ,$133.72 ,$131.96 ,$175.95 ,$149.56 ,$316.33 ,$175.95 ,$175.95 ,$123.17 ,$107.15 ,$3.61 ,$316.33 ,$310.00 ,$175.95 ,$3.83 ,$149.56 ,$711.75 ,$161.87 ,$123.17 ,$89.24 ,$107.10 ,$107.15 ,$107.10 ,$121.58 ,$158.36 ,$120.21 ,$313.10 ,$139.00 ,$3.83 ,$175.95 ,$175.95 ,$310.00 ,$175.95 ,$126.68 ,$109.09 ,$126.68 ,$126.68 ,$140.76 
ST NICHOLAS HOSPITAL - ACUTE,31200238,88346,HC IGG2 IF,312,1 ,$175.95 ,$116.13 ,$3.61 ,$711.75 ,$3.61 ,$175.95 ,$175.95 ,$316.33 ,$105.57 ,$149.56 ,$123.17 ,$3.61 ,$3.61 ,$167.15 ,$133.72 ,$131.96 ,$175.95 ,$149.56 ,$316.33 ,$175.95 ,$175.95 ,$123.17 ,$107.15 ,$3.61 ,$316.33 ,$310.00 ,$175.95 ,$3.83 ,$149.56 ,$711.75 ,$161.87 ,$123.17 ,$89.24 ,$107.10 ,$107.15 ,$107.10 ,$121.58 ,$158.36 ,$120.21 ,$313.10 ,$139.00 ,$3.83 ,$175.95 ,$175.95 ,$310.00 ,$175.95 ,$126.68 ,$109.09 ,$126.68 ,$126.68 ,$140.76 
ST NICHOLAS HOSPITAL - ACUTE,31200239,88368,HC HER2 DUAL ISH,312,1 ,"$1,030.40 ",$680.06 ,$3.61 ,"$1,030.40 ",$3.61 ,$317.91 ,$317.91 ,$316.33 ,$618.24 ,$875.84 ,$721.28 ,$3.61 ,$3.61 ,$978.88 ,$783.10 ,$772.80 ,$233.48 ,$875.84 ,$316.33 ,$233.48 ,$233.48 ,$721.28 ,$627.51 ,$3.61 ,$316.33 ,$310.00 ,$632.66 ,$3.83 ,$875.84 ,$711.75 ,$947.97 ,$721.28 ,$522.62 ,$627.20 ,$627.51 ,$627.20 ,$712.01 ,$927.36 ,$703.97 ,$313.10 ,$814.02 ,$3.83 ,$340.09 ,$340.09 ,$310.00 ,$340.09 ,$741.89 ,$638.85 ,$741.89 ,$741.89 ,$824.32 
ST NICHOLAS HOSPITAL - ACUTE,31200240,88365,HC EPSTEIN BARR ISH,312,1 ,$399.05 ,$263.37 ,$3.61 ,$399.05 ,$3.61 ,$399.05 ,$399.05 ,$153.48 ,$239.43 ,$339.19 ,$279.34 ,$3.61 ,$3.61 ,$379.10 ,$303.28 ,$299.29 ,$295.87 ,$339.19 ,$153.48 ,$295.87 ,$295.87 ,$279.34 ,$243.02 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$339.19 ,$345.32 ,$367.13 ,$279.34 ,$202.40 ,$242.90 ,$243.02 ,$242.90 ,$275.74 ,$359.15 ,$272.63 ,$151.91 ,$315.25 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$287.32 ,$247.41 ,$287.32 ,$287.32 ,$319.24 
ST NICHOLAS HOSPITAL - ACUTE,31200241,88369,HC HER2 DUAL ISH - ADDITIONAL,312,1 ,$463.45 ,$305.88 ,$3.61 ,$463.45 ,$3.61 ,$278.75 ,$278.75 , N/A ,$278.07 ,$393.93 ,$324.42 ,$3.61 ,$3.61 ,$440.28 ,$352.22 ,$347.59 ,$200.50 ,$393.93 , N/A ,$200.50 ,$200.50 ,$324.42 ,$282.24 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$393.93 , N/A ,$426.37 ,$324.42 ,$235.06 ,$282.10 ,$282.24 ,$282.10 ,$320.24 ,$417.11 ,$316.63 , N/A ,$366.13 ,$3.83 ,$99.18 ,$99.18 , N/A ,$99.18 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,31200242,88368,HC ISH,312,1 ,$357.65 ,$236.05 ,$3.61 ,$711.75 ,$3.61 ,$317.91 ,$317.91 ,$316.33 ,$214.59 ,$304.00 ,$250.36 ,$3.61 ,$3.61 ,$339.77 ,$271.81 ,$268.24 ,$233.48 ,$304.00 ,$316.33 ,$233.48 ,$233.48 ,$250.36 ,$217.81 ,$3.61 ,$316.33 ,$310.00 ,$357.65 ,$3.83 ,$304.00 ,$711.75 ,$329.04 ,$250.36 ,$181.40 ,$217.70 ,$217.81 ,$217.70 ,$247.14 ,$321.89 ,$244.35 ,$313.10 ,$282.54 ,$3.83 ,$340.09 ,$340.09 ,$310.00 ,$340.09 ,$257.51 ,$221.74 ,$257.51 ,$257.51 ,$286.12 
ST NICHOLAS HOSPITAL - ACUTE,31200243,88369,HC ISH ADDITIONAL,312,1 ,$357.65 ,$236.05 ,$3.61 ,$357.65 ,$3.61 ,$278.75 ,$278.75 , N/A ,$214.59 ,$304.00 ,$250.36 ,$3.61 ,$3.61 ,$339.77 ,$271.81 ,$268.24 ,$200.50 ,$304.00 , N/A ,$200.50 ,$200.50 ,$250.36 ,$217.81 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$304.00 , N/A ,$329.04 ,$250.36 ,$181.40 ,$217.70 ,$217.81 ,$217.70 ,$247.14 ,$321.89 ,$244.35 , N/A ,$282.54 ,$3.83 ,$99.18 ,$99.18 , N/A ,$99.18 ,$257.51 ,$221.74 ,$257.51 ,$257.51 ,$286.12 
ST NICHOLAS HOSPITAL - ACUTE,31200245,88350,HC IMMUNOFLUOR PER SPEC EA ADDN SINGLE STAIN,312,1 ,$270.25 ,$178.37 ,$3.61 ,$270.25 ,$3.61 ,$270.25 ,$270.25 , N/A ,$162.15 ,$229.71 ,$189.18 ,$3.61 ,$3.61 ,$256.74 ,$205.39 ,$202.69 ,$190.88 ,$229.71 , N/A ,$190.88 ,$190.88 ,$189.18 ,$164.58 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$229.71 , N/A ,$248.63 ,$189.18 ,$137.07 ,$164.50 ,$164.58 ,$164.50 ,$186.74 ,$243.23 ,$184.63 , N/A ,$213.50 ,$3.83 ,$76.66 ,$76.66 , N/A ,$76.66 ,$194.58 ,$167.56 ,$194.58 ,$194.58 ,$216.20 
ST NICHOLAS HOSPITAL - ACUTE,31200251,88350,HC IMMUNOFLUOR PER SPEC EA ADDL STAIN (CUTANEOUS),312,1 ,$141.45 ,$93.36 ,$3.61 ,$141.45 ,$3.61 ,$141.45 ,$141.45 , N/A ,$84.87 ,$120.23 ,$99.02 ,$3.61 ,$3.61 ,$134.38 ,$107.50 ,$106.09 ,$141.45 ,$120.23 , N/A ,$141.45 ,$141.45 ,$99.02 ,$86.14 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$120.23 , N/A ,$130.13 ,$99.02 ,$71.74 ,$86.10 ,$86.14 ,$86.10 ,$97.74 ,$127.31 ,$96.64 , N/A ,$111.75 ,$3.83 ,$76.66 ,$76.66 , N/A ,$76.66 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,31200278,88364,HC IN SITU HYBRID(FISH) EA ADL-90,312,1 ,$640.55 ,$422.76 ,$3.61 ,$640.55 ,$3.61 ,$348.35 ,$348.35 , N/A ,$384.33 ,$544.47 ,$448.39 ,$3.61 ,$3.61 ,$608.52 ,$486.82 ,$480.41 ,$224.03 ,$544.47 , N/A ,$224.03 ,$224.03 ,$448.39 ,$390.10 ,$3.61 , N/A , N/A , N/A ,$3.83 ,$544.47 , N/A ,$589.31 ,$448.39 ,$324.89 ,$389.90 ,$390.10 ,$389.90 ,$442.62 ,$576.50 ,$437.62 , N/A ,$506.03 ,$3.83 ,$125.16 ,$125.16 , N/A ,$125.16 ,$461.20 ,$397.14 ,$461.20 ,$461.20 ,$512.44 
ST NICHOLAS HOSPITAL - ACUTE,31200284,88377,HC MORPH ANLZ INST HYB EA MTPL-90,312,1 ,$599.15 ,$395.44 ,$3.61 ,$599.15 ,$3.61 ,$599.15 ,$599.15 ,$153.48 ,$359.49 ,$509.28 ,$419.41 ,$3.61 ,$3.61 ,$569.19 ,$455.35 ,$449.36 ,$599.15 ,$509.28 ,$153.48 ,$599.15 ,$599.15 ,$419.41 ,$364.88 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$509.28 ,$345.32 ,$551.22 ,$419.41 ,$303.89 ,$364.70 ,$364.88 ,$364.70 ,$414.01 ,$539.24 ,$409.34 ,$151.91 ,$473.33 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$431.39 ,$371.47 ,$431.39 ,$431.39 ,$479.32 
ST NICHOLAS HOSPITAL - ACUTE,31200291,88360,HC MORPHO ANALYSIS TUMOR MANUAL PD-L1,312,1 ,$463.45 ,$305.88 ,$3.61 ,$463.45 ,$3.61 ,$266.20 ,$266.20 ,$153.48 ,$278.07 ,$393.93 ,$324.42 ,$3.61 ,$3.61 ,$440.28 ,$352.22 ,$347.59 ,$194.36 ,$393.93 ,$153.48 ,$194.36 ,$194.36 ,$324.42 ,$282.24 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$393.93 ,$345.32 ,$426.37 ,$324.42 ,$235.06 ,$282.10 ,$282.24 ,$282.10 ,$320.24 ,$417.11 ,$316.63 ,$151.91 ,$366.13 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,31200318,88381,HC MICRODISSECTION MANUAL LUNG PANEL,312,1 ,$141.45 ,$93.36 ,$1.25 ,$141.45 ,$1.25 ,$141.45 ,$141.45 , N/A ,$84.87 ,$120.23 ,$99.02 ,$1.25 ,$1.25 ,$134.38 ,$107.50 ,$106.09 ,$141.45 ,$120.23 , N/A ,$141.45 ,$141.45 ,$99.02 ,$86.14 ,$1.25 , N/A , N/A , N/A ,$1.33 ,$120.23 , N/A ,$130.13 ,$99.02 ,$71.74 ,$86.10 ,$86.14 ,$86.10 ,$97.74 ,$127.31 ,$96.64 , N/A ,$111.75 ,$1.33 ,$141.45 ,$141.45 , N/A ,$141.45 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,31200322,88377,HC M/PHM TRC ALYS ISHQUANT/ SEMIQ,312,1 ,$715.30 ,$472.10 ,$3.61 ,$715.30 ,$3.61 ,$715.30 ,$715.30 ,$153.48 ,$429.18 ,$608.01 ,$500.71 ,$3.61 ,$3.61 ,$679.54 ,$543.63 ,$536.48 ,$649.26 ,$608.01 ,$153.48 ,$649.26 ,$649.26 ,$500.71 ,$435.62 ,$3.61 ,$153.48 ,$150.41 ,$306.96 ,$3.83 ,$608.01 ,$345.32 ,$658.08 ,$500.71 ,$362.80 ,$435.40 ,$435.62 ,$435.40 ,$494.27 ,$643.77 ,$488.69 ,$151.91 ,$565.09 ,$3.83 ,$172.20 ,$172.20 ,$150.41 ,$172.20 ,$515.02 ,$443.49 ,$515.02 ,$515.02 ,$572.24 
ST NICHOLAS HOSPITAL - ACUTE,32000002,21116,HC TMJ INJECTION,361,1 ,$672.75 ,$444.02 ,$10.77 ,$672.75 ,$10.77 ,$672.75 ,$672.75 , N/A ,$403.65 ,$571.84 ,$470.93 ,$10.77 ,$10.77 ,$639.11 ,$511.29 ,$504.56 ,$672.75 ,$571.84 , N/A ,$672.75 ,$672.75 ,$470.93 ,$409.70 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$571.84 , N/A ,$618.93 ,$470.93 ,$341.22 ,$409.50 ,$409.70 ,$409.50 ,$464.87 ,$605.48 ,$459.62 , N/A ,$531.47 ,$11.42 ,$672.75 ,$672.75 , N/A ,$672.75 ,$484.38 ,$417.11 ,$484.38 ,$484.38 ,$538.20 
ST NICHOLAS HOSPITAL - ACUTE,32000003,22510,HC VERTEBROPLASTY INJ PERC THOR,320,1 ,"$6,325.00 ","$4,174.50 ",$168.92 ,"$6,536.75 ",$168.92 ,"$4,335.16 ","$4,335.16 ","$2,905.22 ","$3,795.00 ","$5,376.25 ","$4,427.50 ",$168.92 ,$168.92 ,"$6,008.75 ","$4,807.00 ","$4,743.75 ",$824.45 ,"$5,376.25 ","$2,905.22 ",$824.45 ,$824.45 ,"$4,427.50 ","$3,851.93 ",$168.92 ,"$2,905.22 ","$2,847.12 ","$5,810.44 ",$179.06 ,"$5,376.25 ","$6,536.75 ","$5,819.00 ","$4,427.50 ","$3,273.50 ","$4,091.88 ","$3,851.93 ","$4,091.88 ","$4,370.58 ","$5,692.50 ","$4,321.24 ","$2,875.58 ","$4,996.75 ",$179.06 ,$459.00 ,$459.00 ,"$2,847.12 ",$459.00 ,"$4,554.00 ","$3,921.50 ","$4,554.00 ","$4,554.00 ","$5,060.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000004,22511,HC VERTEBROPLASTY INJ PERC LUMBAR,320,1 ,"$6,325.00 ","$4,174.50 ",$168.92 ,"$6,536.75 ",$168.92 ,"$4,335.16 ","$4,335.16 ","$2,905.22 ","$3,795.00 ","$5,376.25 ","$4,427.50 ",$168.92 ,$168.92 ,"$6,008.75 ","$4,807.00 ","$4,743.75 ",$774.33 ,"$5,376.25 ","$2,905.22 ",$774.33 ,$774.33 ,"$4,427.50 ","$3,851.93 ",$168.92 ,"$2,905.22 ","$2,847.12 ","$5,810.44 ",$179.06 ,"$5,376.25 ","$6,536.75 ","$5,819.00 ","$4,427.50 ","$3,273.50 ","$4,091.88 ","$3,851.93 ","$4,091.88 ","$4,370.58 ","$5,692.50 ","$4,321.24 ","$2,875.58 ","$4,996.75 ",$179.06 ,$459.00 ,$459.00 ,"$2,847.12 ",$459.00 ,"$4,554.00 ","$3,921.50 ","$4,554.00 ","$4,554.00 ","$5,060.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000005,22512,HC VERTEBROPLASTY INJ PERC ADDL,320,1 ,"$6,325.00 ","$4,174.50 ",$168.92 ,"$6,325.00 ",$168.92 ,"$4,335.16 ","$4,335.16 ", N/A ,"$3,795.00 ","$5,376.25 ","$4,427.50 ",$168.92 ,$168.92 ,"$6,008.75 ","$4,807.00 ","$4,743.75 ",$387.53 ,"$5,376.25 ", N/A ,$387.53 ,$387.53 ,"$4,427.50 ","$3,851.93 ",$168.92 , N/A , N/A , N/A ,$179.06 ,"$5,376.25 ", N/A ,"$5,819.00 ","$4,427.50 ","$3,208.04 ","$3,850.03 ","$3,851.93 ","$3,850.03 ","$4,370.58 ","$5,692.50 ","$4,321.24 ", N/A ,"$4,996.75 ",$179.06 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$4,554.00 ","$3,921.50 ","$4,554.00 ","$4,554.00 ","$5,060.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$760.15 ,$501.70 ,$16.16 ,$760.15 ,$16.16 ,$521.01 ,$521.01 , N/A ,$456.09 ,$646.13 ,$532.11 ,$16.16 ,$16.16 ,$722.14 ,$577.71 ,$570.11 ,$96.72 ,$646.13 , N/A ,$96.72 ,$96.72 ,$532.11 ,$462.93 ,$16.16 , N/A , N/A , N/A ,$17.13 ,$646.13 , N/A ,$699.34 ,$532.11 ,$385.55 ,$462.70 ,$462.93 ,$462.70 ,$525.26 ,$684.14 ,$519.33 , N/A ,$600.52 ,$17.13 ,$459.00 ,$459.00 , N/A ,$459.00 ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$760.15 ,$501.70 ,$16.16 ,$760.15 ,$16.16 ,$521.01 ,$521.01 , N/A ,$456.09 ,$646.13 ,$532.11 ,$16.16 ,$16.16 ,$722.14 ,$577.71 ,$570.11 ,$96.72 ,$646.13 , N/A ,$96.72 ,$96.72 ,$532.11 ,$462.93 ,$16.16 , N/A , N/A , N/A ,$17.13 ,$646.13 , N/A ,$699.34 ,$532.11 ,$385.55 ,$462.70 ,$462.93 ,$462.70 ,$525.26 ,$684.14 ,$519.33 , N/A ,$600.52 ,$17.13 ,$459.00 ,$459.00 , N/A ,$459.00 ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,32000010,24220,HC ARTHROGRAM INJ ELBOW,320,1 ,$760.15 ,$501.70 ,$10.77 ,$760.15 ,$10.77 ,$521.01 ,$521.01 , N/A ,$456.09 ,$646.13 ,$532.11 ,$10.77 ,$10.77 ,$722.14 ,$577.71 ,$570.11 ,$128.37 ,$646.13 , N/A ,$128.37 ,$128.37 ,$532.11 ,$462.93 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$646.13 , N/A ,$699.34 ,$532.11 ,$385.55 ,$462.70 ,$462.93 ,$462.70 ,$525.26 ,$684.14 ,$519.33 , N/A ,$600.52 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$760.15 ,$501.70 ,$10.77 ,$760.15 ,$10.77 ,$521.01 ,$521.01 , N/A ,$456.09 ,$646.13 ,$532.11 ,$10.77 ,$10.77 ,$722.14 ,$577.71 ,$570.11 ,$140.73 ,$646.13 , N/A ,$140.73 ,$140.73 ,$532.11 ,$462.93 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$646.13 , N/A ,$699.34 ,$532.11 ,$385.55 ,$462.70 ,$462.93 ,$462.70 ,$525.26 ,$684.14 ,$519.33 , N/A ,$600.52 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$760.15 ,$501.70 ,$10.77 ,$760.15 ,$10.77 ,$521.01 ,$521.01 , N/A ,$456.09 ,$646.13 ,$532.11 ,$10.77 ,$10.77 ,$722.14 ,$577.71 ,$570.11 ,$130.97 ,$646.13 , N/A ,$130.97 ,$130.97 ,$532.11 ,$462.93 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$646.13 , N/A ,$699.34 ,$532.11 ,$385.55 ,$462.70 ,$462.93 ,$462.70 ,$525.26 ,$684.14 ,$519.33 , N/A ,$600.52 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,32000013,27095,HC INJ ARTHROGRAPHY HIP,320,1 ,$760.15 ,$501.70 ,$10.77 ,$760.15 ,$10.77 ,$521.01 ,$521.01 , N/A ,$456.09 ,$646.13 ,$532.11 ,$10.77 ,$10.77 ,$722.14 ,$577.71 ,$570.11 ,$155.86 ,$646.13 , N/A ,$155.86 ,$155.86 ,$532.11 ,$462.93 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$646.13 , N/A ,$699.34 ,$532.11 ,$385.55 ,$462.70 ,$462.93 ,$462.70 ,$525.26 ,$684.14 ,$519.33 , N/A ,$600.52 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,32000014,27324,HC BX SOFT TX THIGH/KNEE DEEP,361,1 ,"$4,832.30 ","$3,189.32 ",$62.90 ,"$5,672.82 ",$62.90 ,"$4,832.30 ","$4,832.30 ","$2,521.25 ","$2,899.38 ","$4,107.46 ","$3,382.61 ",$62.90 ,$62.90 ,"$4,590.69 ","$3,672.55 ","$3,624.23 ","$2,929.00 ","$4,107.46 ","$2,521.25 ","$2,929.00 ","$2,929.00 ","$3,382.61 ","$2,942.87 ",$62.90 ,"$2,521.25 ","$2,470.82 ","$4,832.30 ",$66.67 ,"$4,107.46 ","$5,672.82 ","$4,445.72 ","$3,382.61 ","$2,747.95 ","$3,435.21 ","$2,942.87 ","$3,435.21 ","$3,339.12 ","$4,349.07 ","$3,301.43 ","$2,495.53 ","$3,817.52 ",$66.67 ,"$4,832.30 ","$4,832.30 ","$2,470.82 ","$4,832.30 ","$3,479.26 ","$2,996.03 ","$3,479.26 ","$3,479.26 ","$3,865.84 "
ST NICHOLAS HOSPITAL - ACUTE,32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$731.40 ,$482.72 ,$16.16 ,$731.40 ,$16.16 ,$501.30 ,$501.30 , N/A ,$438.84 ,$621.69 ,$511.98 ,$16.16 ,$16.16 ,$694.83 ,$555.86 ,$548.55 ,$77.45 ,$621.69 , N/A ,$77.45 ,$77.45 ,$511.98 ,$445.42 ,$16.16 , N/A , N/A , N/A ,$17.13 ,$621.69 , N/A ,$672.89 ,$511.98 ,$370.97 ,$445.20 ,$445.42 ,$445.20 ,$505.40 ,$658.26 ,$499.69 , N/A ,$577.81 ,$17.13 ,$459.00 ,$459.00 , N/A ,$459.00 ,$526.61 ,$453.47 ,$526.61 ,$526.61 ,$585.12 
ST NICHOLAS HOSPITAL - ACUTE,32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$731.40 ,$482.72 ,$16.16 ,$731.40 ,$16.16 ,$501.30 ,$501.30 , N/A ,$438.84 ,$621.69 ,$511.98 ,$16.16 ,$16.16 ,$694.83 ,$555.86 ,$548.55 ,$77.45 ,$621.69 , N/A ,$77.45 ,$77.45 ,$511.98 ,$445.42 ,$16.16 , N/A , N/A , N/A ,$17.13 ,$621.69 , N/A ,$672.89 ,$511.98 ,$370.97 ,$445.20 ,$445.42 ,$445.20 ,$505.40 ,$658.26 ,$499.69 , N/A ,$577.81 ,$17.13 ,$459.00 ,$459.00 , N/A ,$459.00 ,$526.61 ,$453.47 ,$526.61 ,$526.61 ,$585.12 
ST NICHOLAS HOSPITAL - ACUTE,32000016,27648,HC ARTHROGRAM INJ ANKLE,320,1 ,$760.15 ,$501.70 ,$10.77 ,$760.15 ,$10.77 ,$521.01 ,$521.01 , N/A ,$456.09 ,$646.13 ,$532.11 ,$10.77 ,$10.77 ,$722.14 ,$577.71 ,$570.11 ,$97.68 ,$646.13 , N/A ,$97.68 ,$97.68 ,$532.11 ,$462.93 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$646.13 , N/A ,$699.34 ,$532.11 ,$385.55 ,$462.70 ,$462.93 ,$462.70 ,$525.26 ,$684.14 ,$519.33 , N/A ,$600.52 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,32000017,28899,HC UNLISTED PROCEDURE TOE OR FOOT,361,1 ,$678.50 ,$447.81 ,$15.68 ,$678.50 ,$15.68 ,$678.50 ,$678.50 ,$202.04 ,$407.10 ,$576.73 ,$474.95 ,$15.68 ,$15.68 ,$644.58 ,$515.66 ,$508.88 ,$678.50 ,$576.73 ,$202.04 ,$678.50 ,$678.50 ,$474.95 ,$413.21 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$576.73 ,$454.59 ,$624.22 ,$474.95 ,$344.14 ,$413.00 ,$413.21 ,$413.00 ,$468.84 ,$610.65 ,$463.55 ,$199.98 ,$536.02 ,$16.62 ,$678.50 ,$678.50 ,$198.00 ,$678.50 ,$488.52 ,$420.67 ,$488.52 ,$488.52 ,$542.80 
ST NICHOLAS HOSPITAL - ACUTE,32000018,32550,HC INSERT CATH PLEURAL INDWELL W/,320,1 ,"$4,832.30 ","$3,189.32 ",$33.66 ,"$7,778.08 ",$33.66 ,"$3,312.06 ","$3,312.06 ","$3,456.92 ","$2,899.38 ","$4,107.46 ","$3,382.61 ",$33.66 ,$33.66 ,"$4,590.69 ","$3,672.55 ","$3,624.23 ",$385.73 ,"$4,107.46 ","$3,456.92 ",$385.73 ,$385.73 ,"$3,382.61 ","$2,942.87 ",$33.66 ,"$3,456.92 ","$3,387.78 ","$4,832.30 ",$35.68 ,"$4,107.46 ","$7,778.08 ","$4,445.72 ","$3,382.61 ","$3,273.50 ","$4,091.88 ","$2,942.87 ","$4,091.88 ","$3,339.12 ","$4,349.07 ","$3,301.43 ","$3,421.66 ","$3,817.52 ",$35.68 ,$459.00 ,$459.00 ,"$3,387.78 ",$459.00 ,"$3,479.26 ","$2,996.03 ","$3,479.26 ","$3,479.26 ","$3,865.84 "
ST NICHOLAS HOSPITAL - ACUTE,32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$1,362.75 ",$899.42 ,$33.66 ,"$3,267.32 ",$33.66 ,$934.03 ,$934.03 ,"$1,452.14 ",$817.65 ,"$1,158.34 ",$953.93 ,$33.66 ,$33.66 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$289.40 ,"$1,158.34 ","$1,452.14 ",$289.40 ,$289.40 ,$953.93 ,$829.91 ,$33.66 ,"$1,452.14 ","$1,423.10 ","$1,362.75 ",$35.68 ,"$1,158.34 ","$3,267.32 ","$1,253.73 ",$953.93 ,"$1,362.75 ","$1,362.75 ",$829.91 ,"$1,362.75 ",$941.66 ,"$1,226.48 ",$931.03 ,"$1,437.33 ","$1,076.57 ",$35.68 ,$459.00 ,$459.00 ,"$1,423.10 ",$459.00 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000020,32552,HC REMOVAL TUNNELED PLEURAL CATH,320,1 ,"$1,611.15 ","$1,063.36 ",$33.66 ,"$1,611.15 ",$33.66 ,"$1,104.28 ","$1,104.28 ",$564.62 ,$966.69 ,"$1,369.48 ","$1,127.81 ",$33.66 ,$33.66 ,"$1,530.59 ","$1,224.47 ","$1,208.36 ",$299.10 ,"$1,369.48 ",$564.62 ,$299.10 ,$299.10 ,"$1,127.81 ",$981.19 ,$33.66 ,$564.62 ,$553.33 ,"$1,129.24 ",$35.68 ,"$1,369.48 ","$1,270.39 ","$1,482.26 ","$1,127.81 ","$1,611.15 ","$1,611.15 ",$981.19 ,"$1,611.15 ","$1,113.30 ","$1,450.04 ","$1,100.74 ",$558.86 ,"$1,272.81 ",$35.68 ,$459.00 ,$459.00 ,$553.33 ,$459.00 ,"$1,160.03 ",$998.91 ,"$1,160.03 ","$1,160.03 ","$1,288.92 "
ST NICHOLAS HOSPITAL - ACUTE,32000021,32561,HC INSTILL FIBRO CHEST TUBE INIT,320,1 ,$870.00 ,$574.20 ,$33.66 ,"$1,270.39 ",$33.66 ,$596.30 ,$596.30 ,$564.62 ,$522.00 ,$739.50 ,$609.00 ,$33.66 ,$33.66 ,$826.50 ,$661.20 ,$652.50 ,$128.66 ,$739.50 ,$564.62 ,$128.66 ,$128.66 ,$609.00 ,$529.83 ,$33.66 ,$564.62 ,$553.33 ,$870.00 ,$35.68 ,$739.50 ,"$1,270.39 ",$800.40 ,$609.00 ,$870.00 ,$870.00 ,$529.83 ,$870.00 ,$601.17 ,$783.00 ,$594.38 ,$558.86 ,$687.30 ,$35.68 ,$459.00 ,$459.00 ,$553.33 ,$459.00 ,$626.40 ,$539.40 ,$626.40 ,$626.40 ,$696.00 
ST NICHOLAS HOSPITAL - ACUTE,32000022,32562,HC INSTILL FIBRO CHEST TUBE SUBSQ DAY,320,1 ,$870.00 ,$574.20 ,$33.66 ,"$1,270.39 ",$33.66 ,$596.30 ,$596.30 ,$564.62 ,$522.00 ,$739.50 ,$609.00 ,$33.66 ,$33.66 ,$826.50 ,$661.20 ,$652.50 ,$114.94 ,$739.50 ,$564.62 ,$114.94 ,$114.94 ,$609.00 ,$529.83 ,$33.66 ,$564.62 ,$553.33 ,$870.00 ,$35.68 ,$739.50 ,"$1,270.39 ",$800.40 ,$609.00 ,$870.00 ,$870.00 ,$529.83 ,$870.00 ,$601.17 ,$783.00 ,$594.38 ,$558.86 ,$687.30 ,$35.68 ,$459.00 ,$459.00 ,$553.33 ,$459.00 ,$626.40 ,$539.40 ,$626.40 ,$626.40 ,$696.00 
ST NICHOLAS HOSPITAL - ACUTE,32000026,36000,HC IV START > 3YR OLD,320,1 ,$139.00 ,$91.74 ,$2.32 ,$139.00 ,$2.32 ,$95.27 ,$95.27 , N/A ,$83.40 ,$118.15 ,$97.30 ,$2.32 ,$2.32 ,$132.05 ,$105.64 ,$104.25 ,$17.57 ,$118.15 , N/A ,$17.57 ,$17.57 ,$97.30 ,$84.65 ,$2.32 , N/A , N/A , N/A ,$2.46 ,$118.15 , N/A ,$127.88 ,$97.30 ,$70.50 ,$84.61 ,$84.65 ,$84.61 ,$96.05 ,$125.10 ,$94.96 , N/A ,$109.81 ,$2.46 ,$139.00 ,$139.00 , N/A ,$139.00 ,$100.08 ,$86.18 ,$100.08 ,$100.08 ,$111.20 
ST NICHOLAS HOSPITAL - ACUTE,32000027,36002,HC INJ PSEUDOANEURYSM (THROMBIN),320,1 ,$717.00 ,$473.22 ,$37.49 ,"$1,270.39 ",$37.49 ,$491.43 ,$491.43 ,$564.62 ,$430.20 ,$609.45 ,$501.90 ,$37.49 ,$37.49 ,$681.15 ,$544.92 ,$537.75 ,$195.51 ,$609.45 ,$564.62 ,$195.51 ,$195.51 ,$501.90 ,$436.65 ,$37.49 ,$564.62 ,$553.33 ,$717.00 ,$39.74 ,$609.45 ,"$1,270.39 ",$659.64 ,$501.90 ,$717.00 ,$717.00 ,$436.65 ,$717.00 ,$495.45 ,$645.30 ,$489.85 ,$558.86 ,$566.43 ,$39.74 ,$459.00 ,$459.00 ,$553.33 ,$459.00 ,$516.24 ,$444.54 ,$516.24 ,$516.24 ,$573.60 
ST NICHOLAS HOSPITAL - ACUTE,32000028,36005,HC VENOGRAM INJECTION 36005,320,1 ,$824.00 ,$543.84 ,$23.19 ,$824.00 ,$23.19 ,$564.77 ,$564.77 , N/A ,$494.40 ,$700.40 ,$576.80 ,$23.19 ,$23.19 ,$782.80 ,$626.24 ,$618.00 ,$88.85 ,$700.40 , N/A ,$88.85 ,$88.85 ,$576.80 ,$501.82 ,$23.19 , N/A , N/A , N/A ,$24.58 ,$700.40 , N/A ,$758.08 ,$576.80 ,$417.93 ,$501.57 ,$501.82 ,$501.57 ,$569.38 ,$741.60 ,$562.96 , N/A ,$650.96 ,$24.58 ,$459.00 ,$459.00 , N/A ,$459.00 ,$593.28 ,$510.88 ,$593.28 ,$593.28 ,$659.20 
ST NICHOLAS HOSPITAL - ACUTE,32000029,36410,HC VENIPUNCTURE > AGE 3 REQUIR MD,361,1 ,$124.20 ,$81.97 ,$2.32 ,$124.20 ,$2.32 ,$124.20 ,$124.20 , N/A ,$74.52 ,$105.57 , N/A ,$2.32 ,$2.32 ,$117.99 ,$94.39 ,$93.15 ,$124.20 ,$105.57 , N/A ,$124.20 ,$124.20 ,$86.94 ,$75.64 ,$2.32 , N/A , N/A , N/A ,$2.46 ,$105.57 , N/A ,$114.26 ,$86.94 ,$62.99 ,$75.60 ,$75.64 ,$75.60 ,$85.82 ,$111.78 ,$84.85 , N/A ,$98.12 ,$2.46 , N/A , N/A , N/A , N/A ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,32000030,36598,HC CONTRAST INJ CV CATH W/FLUORO,320,1 ,$631.35 ,$416.69 ,$10.77 ,$631.35 ,$10.77 ,$432.73 ,$432.73 ,$201.61 ,$378.81 ,$536.65 ,$441.95 ,$10.77 ,$10.77 ,$599.78 ,$479.83 ,$473.51 ,$68.78 ,$536.65 ,$201.61 ,$68.78 ,$68.78 ,$441.95 ,$384.49 ,$10.77 ,$201.61 ,$197.58 ,$403.22 ,$11.42 ,$536.65 ,$453.63 ,$580.84 ,$441.95 ,$320.22 ,$384.30 ,$384.49 ,$384.30 ,$436.26 ,$568.22 ,$431.34 ,$199.56 ,$498.77 ,$11.42 ,$459.00 ,$459.00 ,$197.58 ,$459.00 ,$454.57 ,$391.44 ,$454.57 ,$454.57 ,$505.08 
ST NICHOLAS HOSPITAL - ACUTE,32000032,42400,HC BX GLAND SALIVARY NEEDLE,320,1 ,"$1,362.75 ",$899.42 ,$42.01 ,"$1,425.14 ",$42.01 ,$934.03 ,$934.03 ,$633.39 ,$817.65 ,"$1,158.34 ",$953.93 ,$42.01 ,$42.01 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$102.79 ,"$1,158.34 ",$633.39 ,$102.79 ,$102.79 ,$953.93 ,$829.91 ,$42.01 ,$633.39 ,$620.72 ,"$1,266.78 ",$44.53 ,"$1,158.34 ","$1,425.14 ","$1,253.73 ",$953.93 ,"$1,362.75 ","$1,362.75 ",$829.91 ,"$1,362.75 ",$941.66 ,"$1,226.48 ",$931.03 ,$626.93 ,"$1,076.57 ",$44.53 ,$459.00 ,$459.00 ,$620.72 ,$459.00 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000033,42550,HC SIALOGRAM INJECTION,320,1 ,$492.20 ,$324.85 ,$10.77 ,$492.20 ,$10.77 ,$337.35 ,$337.35 , N/A ,$295.32 ,$418.37 ,$344.54 ,$10.77 ,$10.77 ,$467.59 ,$374.07 ,$369.15 ,$119.60 ,$418.37 , N/A ,$119.60 ,$119.60 ,$344.54 ,$299.75 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$418.37 , N/A ,$452.82 ,$344.54 ,$249.64 ,$299.60 ,$299.75 ,$299.60 ,$340.11 ,$442.98 ,$336.27 , N/A ,$388.84 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$354.38 ,$305.16 ,$354.38 ,$354.38 ,$393.76 
ST NICHOLAS HOSPITAL - ACUTE,32000034,43274,HC ERCP W/PLACE STENT,320,1 ,"$3,160.00 ","$2,085.60 ",$149.65 ,"$11,508.62 ",$149.65 ,"$2,165.86 ","$2,165.86 ","$5,114.94 ","$1,896.00 ","$2,686.00 ","$2,212.00 ",$149.65 ,$149.65 ,"$3,002.00 ","$2,401.60 ","$2,370.00 ",$879.08 ,"$2,686.00 ","$5,114.94 ",$879.08 ,$879.08 ,"$2,212.00 ","$1,924.44 ",$149.65 ,"$5,114.94 ","$5,012.64 ","$3,160.00 ",$158.63 ,"$2,686.00 ","$11,508.62 ","$2,907.20 ","$2,212.00 ","$2,747.95 ","$3,435.21 ","$1,924.44 ","$3,435.21 ","$2,183.56 ","$2,844.00 ","$2,158.91 ","$5,062.77 ","$2,496.40 ",$158.63 ,$459.00 ,$459.00 ,"$5,012.64 ",$459.00 ,"$2,275.20 ","$1,959.20 ","$2,275.20 ","$2,275.20 ","$2,528.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000035,43752,HC PLACE TUBE NASOGASTRIC,320,1 ,$495.65 ,$327.13 ,$16.75 ,$829.14 ,$16.75 ,$339.72 ,$339.72 ,$368.51 ,$297.39 ,$421.30 ,$346.96 ,$16.75 ,$16.75 ,$470.87 ,$376.69 ,$371.74 ,$76.94 ,$421.30 ,$368.51 ,$76.94 ,$76.94 ,$346.96 ,$301.85 ,$16.75 ,$368.51 ,$361.14 ,$495.65 ,$17.76 ,$421.30 ,$829.14 ,$456.00 ,$346.96 ,$251.39 ,$301.70 ,$301.85 ,$301.70 ,$342.49 ,$446.09 ,$338.63 ,$364.76 ,$391.56 ,$17.76 ,$459.00 ,$459.00 ,$361.14 ,$459.00 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,32000036,43761,HC REPOSITION G-TUBE,320,1 ,"$1,040.75 ",$686.90 ,$16.75 ,"$1,040.75 ",$16.75 ,$713.33 ,$713.33 ,$209.71 ,$624.45 ,$884.64 ,$728.53 ,$16.75 ,$16.75 ,$988.71 ,$790.97 ,$780.56 ,$195.45 ,$884.64 ,$209.71 ,$195.45 ,$195.45 ,$728.53 ,$633.82 ,$16.75 ,$209.71 ,$205.52 ,$419.42 ,$17.76 ,$884.64 ,$471.85 ,$957.49 ,$728.53 ,$527.87 ,$633.50 ,$633.82 ,$633.50 ,$719.16 ,$936.68 ,$711.04 ,$207.57 ,$822.19 ,$17.76 ,$459.00 ,$459.00 ,$205.52 ,$459.00 ,$749.34 ,$645.27 ,$749.34 ,$749.34 ,$832.60 
ST NICHOLAS HOSPITAL - ACUTE,32000038,44500,HC INTRO TUBE GI LONG,320,1 ,$650.90 ,$429.59 ,$16.75 ,"$1,812.82 ",$16.75 ,$446.13 ,$446.13 ,$805.70 ,$390.54 ,$553.27 ,$455.63 ,$16.75 ,$16.75 ,$618.36 ,$494.68 ,$488.18 ,$37.21 ,$553.27 ,$805.70 ,$37.21 ,$37.21 ,$455.63 ,$396.40 ,$16.75 ,$805.70 ,$789.59 ,$650.90 ,$17.76 ,$553.27 ,"$1,812.82 ",$598.83 ,$455.63 ,$650.90 ,$650.90 ,$396.40 ,$650.90 ,$449.77 ,$585.81 ,$444.69 ,$797.48 ,$514.21 ,$17.76 ,$459.00 ,$459.00 ,$789.59 ,$459.00 ,$468.65 ,$403.56 ,$468.65 ,$468.65 ,$520.72 
ST NICHOLAS HOSPITAL - ACUTE,32000043,47536,HC CHG PERC BIL DRAIN CATH,320,1 ,"$2,875.00 ","$1,897.50 ",$82.11 ,"$7,778.08 ",$82.11 ,"$1,970.53 ","$1,970.53 ","$3,456.92 ","$1,725.00 ","$2,443.75 ","$2,012.50 ",$82.11 ,$82.11 ,"$2,731.25 ","$2,185.00 ","$2,156.25 ",$250.35 ,"$2,443.75 ","$3,456.92 ",$250.35 ,$250.35 ,"$2,012.50 ","$1,750.88 ",$82.11 ,"$3,456.92 ","$3,387.78 ","$2,875.00 ",$87.04 ,"$2,443.75 ","$7,778.08 ","$2,645.00 ","$2,012.50 ","$3,273.50 ","$4,091.88 ","$1,750.88 ","$4,091.88 ","$1,986.63 ","$2,587.50 ","$1,964.20 ","$3,421.66 ","$2,271.25 ",$87.04 ,$459.00 ,$459.00 ,"$3,387.78 ",$459.00 ,"$2,070.00 ","$1,782.50 ","$2,070.00 ","$2,070.00 ","$2,300.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000044,47535,HC REVISE/REINSERT TUBE TRNSHEPAT,320,1 ,"$4,128.50 ","$2,724.81 ",$82.11 ,"$7,778.08 ",$82.11 ,"$2,829.67 ","$2,829.67 ","$3,456.92 ","$2,477.10 ","$3,509.23 ","$2,889.95 ",$82.11 ,$82.11 ,"$3,922.08 ","$3,137.66 ","$3,096.38 ",$372.87 ,"$3,509.23 ","$3,456.92 ",$372.87 ,$372.87 ,"$2,889.95 ","$2,514.26 ",$82.11 ,"$3,456.92 ","$3,387.78 ","$4,128.50 ",$87.04 ,"$3,509.23 ","$7,778.08 ","$3,798.22 ","$2,889.95 ","$3,273.50 ","$4,091.88 ","$2,514.26 ","$4,091.88 ","$2,852.79 ","$3,715.65 ","$2,820.59 ","$3,421.66 ","$3,261.52 ",$87.04 ,$459.00 ,$459.00 ,"$3,387.78 ",$459.00 ,"$2,972.52 ","$2,559.67 ","$2,972.52 ","$2,972.52 ","$3,302.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000045,47542,HC ENDO BILIARY W/DIL BILI DUCT,320,1 ,"$2,875.00 ","$1,897.50 ",$202.70 ,"$2,875.00 ",$202.70 ,"$1,970.53 ","$1,970.53 ", N/A ,"$1,725.00 ","$2,443.75 ","$2,012.50 ",$202.70 ,$202.70 ,"$2,731.25 ","$2,185.00 ","$2,156.25 ",$258.42 ,"$2,443.75 ", N/A ,$258.42 ,$258.42 ,"$2,012.50 ","$1,750.88 ",$202.70 , N/A , N/A , N/A ,$214.86 ,"$2,443.75 ", N/A ,"$2,645.00 ","$2,012.50 ","$1,458.20 ","$1,750.01 ","$1,750.88 ","$1,750.01 ","$1,986.63 ","$2,587.50 ","$1,964.20 ", N/A ,"$2,271.25 ",$214.86 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$2,070.00 ","$1,782.50 ","$2,070.00 ","$2,070.00 ","$2,300.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000046,47539,HC ENDO BILIARY DIL DUCT W/STENT,320,1 ,"$2,973.90 ","$1,962.77 ",$82.11 ,"$11,445.88 ",$82.11 ,"$2,038.31 ","$2,038.31 ","$5,087.06 ","$1,784.34 ","$2,527.82 ","$2,081.73 ",$82.11 ,$82.11 ,"$2,825.21 ","$2,260.16 ","$2,230.43 ",$805.22 ,"$2,527.82 ","$5,087.06 ",$805.22 ,$805.22 ,"$2,081.73 ","$1,811.11 ",$82.11 ,"$5,087.06 ","$4,985.32 ","$2,973.90 ",$87.04 ,"$2,527.82 ","$11,445.88 ","$2,735.99 ","$2,081.73 ","$4,535.48 ","$5,669.62 ","$1,811.11 ","$5,669.62 ","$2,054.96 ","$2,676.51 ","$2,031.77 ","$5,035.17 ","$2,349.38 ",$87.04 ,$459.00 ,$459.00 ,"$4,985.32 ",$459.00 ,"$2,141.21 ","$1,843.82 ","$2,141.21 ","$2,141.21 ","$2,379.12 "
ST NICHOLAS HOSPITAL - ACUTE,32000049,49406,HC DRAIN ABSC PERITONEAL PERC,320,1 ,"$4,715.00 ","$3,111.90 ",$25.31 ,"$4,715.00 ",$25.31 ,"$3,231.66 ","$3,231.66 ","$1,463.56 ","$2,829.00 ","$4,007.75 ","$3,300.50 ",$25.31 ,$25.31 ,"$4,479.25 ","$3,583.40 ","$3,536.25 ",$371.95 ,"$4,007.75 ","$1,463.56 ",$371.95 ,$371.95 ,"$3,300.50 ","$2,871.44 ",$25.31 ,"$1,463.56 ","$1,434.29 ","$2,927.12 ",$26.83 ,"$4,007.75 ","$3,293.01 ","$4,337.80 ","$3,300.50 ","$1,998.41 ","$2,497.74 ","$2,871.44 ","$2,497.74 ","$3,258.07 ","$4,243.50 ","$3,221.29 ","$1,448.64 ","$3,724.85 ",$26.83 ,$459.00 ,$459.00 ,"$1,434.29 ",$459.00 ,"$3,394.80 ","$2,923.30 ","$3,394.80 ","$3,394.80 ","$3,772.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000051,49406,HC DRN ABSC RETROPERITONEAL PERC,320,1 ,"$5,024.35 ","$3,316.07 ",$25.31 ,"$5,024.35 ",$25.31 ,"$3,443.69 ","$3,443.69 ","$1,463.56 ","$3,014.61 ","$4,270.70 ","$3,517.05 ",$25.31 ,$25.31 ,"$4,773.13 ","$3,818.51 ","$3,768.26 ",$371.95 ,"$4,270.70 ","$1,463.56 ",$371.95 ,$371.95 ,"$3,517.05 ","$3,059.83 ",$25.31 ,"$1,463.56 ","$1,434.29 ","$2,927.12 ",$26.83 ,"$4,270.70 ","$3,293.01 ","$4,622.40 ","$3,517.05 ","$1,998.41 ","$2,497.74 ","$3,059.83 ","$2,497.74 ","$3,471.83 ","$4,521.92 ","$3,432.64 ","$1,448.64 ","$3,969.24 ",$26.83 ,$459.00 ,$459.00 ,"$1,434.29 ",$459.00 ,"$3,617.53 ","$3,115.10 ","$3,617.53 ","$3,617.53 ","$4,019.48 "
ST NICHOLAS HOSPITAL - ACUTE,32000052,49400,HC INJ PERITONEAL CAVITY,361,1 ,$641.70 ,$423.52 ,$10.77 ,$641.70 ,$10.77 ,$641.70 ,$641.70 , N/A ,$385.02 ,$545.45 ,$449.19 ,$10.77 ,$10.77 ,$609.62 ,$487.69 ,$481.28 ,$641.70 ,$545.45 , N/A ,$641.70 ,$641.70 ,$449.19 ,$390.80 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$545.45 , N/A ,$590.36 ,$449.19 ,$325.47 ,$390.60 ,$390.80 ,$390.60 ,$443.41 ,$577.53 ,$438.41 , N/A ,$506.94 ,$11.42 ,$641.70 ,$641.70 , N/A ,$641.70 ,$462.02 ,$397.85 ,$462.02 ,$462.02 ,$513.36 
ST NICHOLAS HOSPITAL - ACUTE,32000053,49423,HC EXCHG CATH ABSC/CYST DRAIN,320,1 ,"$2,300.00 ","$1,518.00 ",$25.31 ,"$3,824.53 ",$25.31 ,"$1,576.42 ","$1,576.42 ","$1,699.79 ","$1,380.00 ","$1,955.00 ","$1,610.00 ",$25.31 ,$25.31 ,"$2,185.00 ","$1,748.00 ","$1,725.00 ",$134.83 ,"$1,955.00 ","$1,699.79 ",$134.83 ,$134.83 ,"$1,610.00 ","$1,400.70 ",$25.31 ,"$1,699.79 ","$1,665.79 ","$2,300.00 ",$26.83 ,"$1,955.00 ","$3,824.53 ","$2,116.00 ","$1,610.00 ","$1,998.41 ","$2,300.00 ","$1,400.70 ","$2,300.00 ","$1,589.30 ","$2,070.00 ","$1,571.36 ","$1,682.45 ","$1,817.00 ",$26.83 ,$459.00 ,$459.00 ,"$1,665.79 ",$459.00 ,"$1,656.00 ","$1,426.00 ","$1,656.00 ","$1,656.00 ","$1,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000054,49424,HC INJ CONTRAST ABSC/CYST,320,1 ,$790.81 ,$521.93 ,$10.77 ,$790.81 ,$10.77 ,$542.02 ,$542.02 , N/A ,$474.49 ,$672.19 ,$553.57 ,$10.77 ,$10.77 ,$751.27 ,$601.02 ,$593.11 ,$71.71 ,$672.19 , N/A ,$71.71 ,$71.71 ,$553.57 ,$481.60 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$672.19 , N/A ,$727.55 ,$553.57 ,$401.10 ,$481.37 ,$481.60 ,$481.37 ,$546.45 ,$711.73 ,$540.28 , N/A ,$624.74 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$569.38 ,$490.30 ,$569.38 ,$569.38 ,$632.65 
ST NICHOLAS HOSPITAL - ACUTE,32000055,49427,HC INJ PREV PLACED SHUNT,320,1 ,$563.50 ,$371.91 ,$10.77 ,$563.50 ,$10.77 ,$386.22 ,$386.22 , N/A ,$338.10 ,$478.98 ,$394.45 ,$10.77 ,$10.77 ,$535.33 ,$428.26 ,$422.63 ,$74.13 ,$478.98 , N/A ,$74.13 ,$74.13 ,$394.45 ,$343.17 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$478.98 , N/A ,$518.42 ,$394.45 ,$285.81 ,$343.00 ,$343.17 ,$343.00 ,$389.38 ,$507.15 ,$384.98 , N/A ,$445.17 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$405.72 ,$349.37 ,$405.72 ,$405.72 ,$450.80 
ST NICHOLAS HOSPITAL - ACUTE,32000056,49440,HC INSERT GASTRO TUBE FLUORO,320,1 ,"$2,105.65 ","$1,389.73 ",$16.75 ,"$3,824.53 ",$16.75 ,"$1,443.21 ","$1,443.21 ","$1,699.79 ","$1,263.39 ","$1,789.80 ","$1,473.96 ",$16.75 ,$16.75 ,"$2,000.37 ","$1,600.29 ","$1,579.24 ",$388.21 ,"$1,789.80 ","$1,699.79 ",$388.21 ,$388.21 ,"$1,473.96 ","$1,282.34 ",$16.75 ,"$1,699.79 ","$1,665.79 ","$2,105.65 ",$17.76 ,"$1,789.80 ","$3,824.53 ","$1,937.20 ","$1,473.96 ","$1,998.41 ","$2,105.65 ","$1,282.34 ","$2,105.65 ","$1,455.00 ","$1,895.09 ","$1,438.58 ","$1,682.45 ","$1,663.46 ",$17.76 ,$459.00 ,$459.00 ,"$1,665.79 ",$459.00 ,"$1,516.07 ","$1,305.50 ","$1,516.07 ","$1,516.07 ","$1,684.52 "
ST NICHOLAS HOSPITAL - ACUTE,32000057,49441,HC INSERT DUODEN/JEJUN TBE FLUORO,320,1 ,"$3,667.35 ","$2,420.45 ",$16.75 ,"$3,824.53 ",$16.75 ,"$2,513.60 ","$2,513.60 ","$1,699.79 ","$2,200.41 ","$3,117.25 ","$2,567.15 ",$16.75 ,$16.75 ,"$3,483.98 ","$2,787.19 ","$2,750.51 ",$452.25 ,"$3,117.25 ","$1,699.79 ",$452.25 ,$452.25 ,"$2,567.15 ","$2,233.42 ",$16.75 ,"$1,699.79 ","$1,665.79 ","$3,399.58 ",$17.76 ,"$3,117.25 ","$3,824.53 ","$3,373.96 ","$2,567.15 ","$1,998.41 ","$2,497.74 ","$2,233.42 ","$2,497.74 ","$2,534.14 ","$3,300.62 ","$2,505.53 ","$1,682.45 ","$2,897.21 ",$17.76 ,$459.00 ,$459.00 ,"$1,665.79 ",$459.00 ,"$2,640.49 ","$2,273.76 ","$2,640.49 ","$2,640.49 ","$2,933.88 "
ST NICHOLAS HOSPITAL - ACUTE,32000058,49442,HC INSERT CECOS/OTHR TBE FLUORO,320,1 ,"$3,469.55 ","$2,289.90 ",$78.16 ,"$3,469.55 ",$78.16 ,"$2,378.03 ","$2,378.03 ","$1,056.92 ","$2,081.73 ","$2,949.12 ","$2,428.69 ",$78.16 ,$78.16 ,"$3,296.07 ","$2,636.86 ","$2,602.16 ",$398.60 ,"$2,949.12 ","$1,056.92 ",$398.60 ,$398.60 ,"$2,428.69 ","$2,112.96 ",$78.16 ,"$1,056.92 ","$1,035.78 ","$2,113.84 ",$82.85 ,"$2,949.12 ","$2,378.07 ","$3,191.99 ","$2,428.69 ","$1,998.41 ","$2,497.74 ","$2,112.96 ","$2,497.74 ","$2,397.46 ","$3,122.60 ","$2,370.40 ","$1,046.14 ","$2,740.94 ",$82.85 ,$459.00 ,$459.00 ,"$1,035.78 ",$459.00 ,"$2,498.08 ","$2,151.12 ","$2,498.08 ","$2,498.08 ","$2,775.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000059,49446,HC CHG G-TB TO GJ-TB PERC FLUORO,320,1 ,"$2,354.05 ","$1,553.67 ",$16.75 ,"$3,824.53 ",$16.75 ,"$1,613.47 ","$1,613.47 ","$1,699.79 ","$1,412.43 ","$2,000.94 ","$1,647.84 ",$16.75 ,$16.75 ,"$2,236.35 ","$1,789.08 ","$1,765.54 ",$279.39 ,"$2,000.94 ","$1,699.79 ",$279.39 ,$279.39 ,"$1,647.84 ","$1,433.62 ",$16.75 ,"$1,699.79 ","$1,665.79 ","$2,354.05 ",$17.76 ,"$2,000.94 ","$3,824.53 ","$2,165.73 ","$1,647.84 ","$1,998.41 ","$2,354.05 ","$1,433.62 ","$2,354.05 ","$1,626.65 ","$2,118.65 ","$1,608.29 ","$1,682.45 ","$1,859.70 ",$17.76 ,$459.00 ,$459.00 ,"$1,665.79 ",$459.00 ,"$1,694.92 ","$1,459.51 ","$1,694.92 ","$1,694.92 ","$1,883.24 "
ST NICHOLAS HOSPITAL - ACUTE,32000060,49450,HC RPLC G/CEC/OTH TB UNDER FLUORO,320,1 ,"$2,793.35 ","$1,843.61 ",$16.75 ,"$2,793.35 ",$16.75 ,"$1,914.56 ","$1,914.56 ",$805.70 ,"$1,676.01 ","$2,374.35 ","$1,955.35 ",$16.75 ,$16.75 ,"$2,653.68 ","$2,122.95 ","$2,095.01 ",$125.91 ,"$2,374.35 ",$805.70 ,$125.91 ,$125.91 ,"$1,955.35 ","$1,701.15 ",$16.75 ,$805.70 ,$789.59 ,"$1,611.40 ",$17.76 ,"$2,374.35 ","$1,812.82 ","$2,569.88 ","$1,955.35 ","$1,998.41 ","$2,497.74 ","$1,701.15 ","$2,497.74 ","$1,930.20 ","$2,514.02 ","$1,908.42 ",$797.48 ,"$2,206.75 ",$17.76 ,$459.00 ,$459.00 ,$789.59 ,$459.00 ,"$2,011.21 ","$1,731.88 ","$2,011.21 ","$2,011.21 ","$2,234.68 "
ST NICHOLAS HOSPITAL - ACUTE,32000061,49451,HC RPLC DUODEN/JEJUN TB FLUORO,320,1 ,"$1,486.95 ",$981.39 ,$16.75 ,"$1,812.82 ",$16.75 ,"$1,019.16 ","$1,019.16 ",$805.70 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$16.75 ,$16.75 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$168.92 ,"$1,263.91 ",$805.70 ,$168.92 ,$168.92 ,"$1,040.87 ",$905.55 ,$16.75 ,$805.70 ,$789.59 ,"$1,486.95 ",$17.76 ,"$1,263.91 ","$1,812.82 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ",$797.48 ,"$1,174.69 ",$17.76 ,$459.00 ,$459.00 ,$789.59 ,$459.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,32000062,49452,HC RPLC GASTRO-JEJUN TB FLUORO,361,1 ,"$1,362.75 ",$899.42 ,$16.75 ,"$1,812.82 ",$16.75 ,"$1,362.75 ","$1,362.75 ",$805.70 ,$817.65 ,"$1,158.34 ",$953.93 ,$16.75 ,$16.75 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ","$1,362.75 ","$1,158.34 ",$805.70 ,"$1,362.75 ","$1,362.75 ",$953.93 ,$829.91 ,$16.75 ,$805.70 ,$789.59 ,"$1,362.75 ",$17.76 ,"$1,158.34 ","$1,812.82 ","$1,253.73 ",$953.93 ,"$1,362.75 ","$1,362.75 ",$829.91 ,"$1,362.75 ",$941.66 ,"$1,226.48 ",$931.03 ,$797.48 ,"$1,076.57 ",$17.76 ,"$1,362.75 ","$1,362.75 ",$789.59 ,"$1,362.75 ",$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000063,49465,HC INJ CNTR W/FLUOR EVAL G/D/J TB,320,1 ,$545.10 ,$359.77 ,$4.15 ,$545.10 ,$4.15 ,$373.61 ,$373.61 ,$227.92 ,$327.06 ,$463.34 ,$381.57 ,$4.15 ,$4.15 ,$517.85 ,$414.28 ,$408.83 ,$58.90 ,$463.34 ,$227.92 ,$58.90 ,$58.90 ,$381.57 ,$331.97 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$463.34 ,$512.81 ,$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 ,$225.60 ,$430.63 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,32000065,49999,HC ABD/PERITONEUM/OMNTM UNLSTD,320,1 ,"$2,760.00 ","$1,821.60 ",$25.31 ,"$2,760.00 ",$25.31 ,"$1,891.70 ","$1,891.70 ",$805.70 ,"$1,656.00 ","$2,346.00 ","$1,932.00 ",$25.31 ,$25.31 ,"$2,622.00 ","$2,097.60 ","$2,070.00 ", N/A ,"$2,346.00 ",$805.70 , N/A , N/A ,"$1,932.00 ","$1,680.84 ",$25.31 ,$805.70 ,$789.59 ,"$1,611.40 ",$26.83 ,"$2,346.00 ","$1,812.82 ","$2,539.20 ","$1,932.00 ","$1,998.41 ","$2,497.74 ","$1,680.84 ","$2,497.74 ","$1,907.16 ","$2,484.00 ","$1,885.63 ",$797.48 ,"$2,180.40 ",$26.83 ,$459.00 ,$459.00 ,$789.59 ,$459.00 ,"$1,987.20 ","$1,711.20 ","$1,987.20 ","$1,987.20 ","$2,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000066,49405,HC DRN ABSC PERIRENAL  PERC,320,1 ,"$1,610.00 ","$1,062.60 ",$25.31 ,"$3,293.01 ",$25.31 ,"$1,103.49 ","$1,103.49 ","$1,463.56 ",$966.00 ,"$1,368.50 ","$1,127.00 ",$25.31 ,$25.31 ,"$1,529.50 ","$1,223.60 ","$1,207.50 ",$371.95 ,"$1,368.50 ","$1,463.56 ",$371.95 ,$371.95 ,"$1,127.00 ",$980.49 ,$25.31 ,"$1,463.56 ","$1,434.29 ","$1,610.00 ",$26.83 ,"$1,368.50 ","$3,293.01 ","$1,481.20 ","$1,127.00 ","$1,610.00 ","$1,610.00 ",$980.49 ,"$1,610.00 ","$1,112.51 ","$1,449.00 ","$1,099.95 ","$1,448.64 ","$1,271.90 ",$26.83 ,$459.00 ,$459.00 ,"$1,434.29 ",$459.00 ,"$1,159.20 ",$998.20 ,"$1,159.20 ","$1,159.20 ","$1,288.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000067,50382,HC CHANGE URETERAL STENT PERCU,320,1 ,"$4,583.90 ","$3,025.37 ",$52.09 ,"$4,583.90 ",$52.09 ,"$3,141.81 ","$3,141.81 ","$1,810.36 ","$2,750.34 ","$3,896.32 ","$3,208.73 ",$52.09 ,$52.09 ,"$4,354.71 ","$3,483.76 ","$3,437.93 ",$479.66 ,"$3,896.32 ","$1,810.36 ",$479.66 ,$479.66 ,"$3,208.73 ","$2,791.60 ",$52.09 ,"$1,810.36 ","$1,774.15 ","$3,620.72 ",$55.22 ,"$3,896.32 ","$4,073.32 ","$4,217.19 ","$3,208.73 ","$2,747.95 ","$3,435.21 ","$2,791.60 ","$3,435.21 ","$3,167.47 ","$4,125.51 ","$3,131.72 ","$1,791.89 ","$3,621.28 ",$55.22 ,$459.00 ,$459.00 ,"$1,774.15 ",$459.00 ,"$3,300.41 ","$2,842.02 ","$3,300.41 ","$3,300.41 ","$3,667.12 "
ST NICHOLAS HOSPITAL - ACUTE,32000068,50384,HC REM URETERAL STENT PERCU,320,1 ,"$3,221.15 ","$2,125.96 ",$52.09 ,"$4,073.32 ",$52.09 ,"$2,207.78 ","$2,207.78 ","$1,810.36 ","$1,932.69 ","$2,737.98 ","$2,254.81 ",$52.09 ,$52.09 ,"$3,060.09 ","$2,448.07 ","$2,415.86 ",$432.18 ,"$2,737.98 ","$1,810.36 ",$432.18 ,$432.18 ,"$2,254.81 ","$1,961.68 ",$52.09 ,"$1,810.36 ","$1,774.15 ","$3,221.15 ",$55.22 ,"$2,737.98 ","$4,073.32 ","$2,963.46 ","$2,254.81 ","$2,747.95 ","$3,435.21 ","$1,961.68 ","$3,435.21 ","$2,225.81 ","$2,899.04 ","$2,200.69 ","$1,791.89 ","$2,544.71 ",$55.22 ,$459.00 ,$459.00 ,"$1,774.15 ",$459.00 ,"$2,319.23 ","$1,997.11 ","$2,319.23 ","$2,319.23 ","$2,576.92 "
ST NICHOLAS HOSPITAL - ACUTE,32000069,50385,HC URETERAL STENT CHNG USING SNARE,320,1 ,"$4,025.00 ","$2,656.50 ",$52.09 ,"$4,073.32 ",$52.09 ,"$2,758.74 ","$2,758.74 ","$1,810.36 ","$2,415.00 ","$3,421.25 ","$2,817.50 ",$52.09 ,$52.09 ,"$3,823.75 ","$3,059.00 ","$3,018.75 ",$411.54 ,"$3,421.25 ","$1,810.36 ",$411.54 ,$411.54 ,"$2,817.50 ","$2,451.23 ",$52.09 ,"$1,810.36 ","$1,774.15 ","$3,620.72 ",$55.22 ,"$3,421.25 ","$4,073.32 ","$3,703.00 ","$2,817.50 ","$2,747.95 ","$3,435.21 ","$2,451.23 ","$3,435.21 ","$2,781.28 ","$3,622.50 ","$2,749.88 ","$1,791.89 ","$3,179.75 ",$55.22 ,$459.00 ,$459.00 ,"$1,774.15 ",$459.00 ,"$2,898.00 ","$2,495.50 ","$2,898.00 ","$2,898.00 ","$3,220.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000070,50386,HC URETERAL STENT REMOVAL USNG SNARE,320,1 ,"$1,725.00 ","$1,138.50 ",$52.09 ,"$4,073.32 ",$52.09 ,"$1,182.32 ","$1,182.32 ","$1,810.36 ","$1,035.00 ","$1,466.25 ","$1,207.50 ",$52.09 ,$52.09 ,"$1,638.75 ","$1,311.00 ","$1,293.75 ",$307.50 ,"$1,466.25 ","$1,810.36 ",$307.50 ,$307.50 ,"$1,207.50 ","$1,050.53 ",$52.09 ,"$1,810.36 ","$1,774.15 ","$1,725.00 ",$55.22 ,"$1,466.25 ","$4,073.32 ","$1,587.00 ","$1,207.50 ","$2,747.95 ","$3,435.21 ","$1,050.53 ","$3,435.21 ","$1,191.98 ","$1,552.50 ","$1,178.52 ","$1,791.89 ","$1,362.75 ",$55.22 ,$459.00 ,$459.00 ,"$1,774.15 ",$459.00 ,"$1,242.00 ","$1,069.50 ","$1,242.00 ","$1,242.00 ","$1,380.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000071,50387,HC CHANGE EXT/INT URET STENT,320,1 ,"$2,515.05 ","$1,659.93 ",$52.09 ,"$4,073.32 ",$52.09 ,"$1,723.82 ","$1,723.82 ","$1,810.36 ","$1,509.03 ","$2,137.79 ","$1,760.54 ",$52.09 ,$52.09 ,"$2,389.30 ","$1,911.44 ","$1,886.29 ",$158.49 ,"$2,137.79 ","$1,810.36 ",$158.49 ,$158.49 ,"$1,760.54 ","$1,531.67 ",$52.09 ,"$1,810.36 ","$1,774.15 ","$2,515.05 ",$55.22 ,"$2,137.79 ","$4,073.32 ","$2,313.85 ","$1,760.54 ","$1,998.41 ","$2,497.74 ","$1,531.67 ","$2,497.74 ","$1,737.90 ","$2,263.55 ","$1,718.28 ","$1,791.89 ","$1,986.89 ",$55.22 ,$459.00 ,$459.00 ,"$1,774.15 ",$459.00 ,"$1,810.84 ","$1,559.33 ","$1,810.84 ","$1,810.84 ","$2,012.04 "
ST NICHOLAS HOSPITAL - ACUTE,32000072,50389,HC REM NEPHRO TUBE FLUORO,320,1 ,"$1,150.00 ",$759.00 ,$13.57 ,"$1,373.25 ",$13.57 ,$788.21 ,$788.21 ,$610.33 ,$690.00 ,$977.50 ,$805.00 ,$13.57 ,$13.57 ,"$1,092.50 ",$874.00 ,$862.50 ,$101.91 ,$977.50 ,$610.33 ,$101.91 ,$101.91 ,$805.00 ,$700.35 ,$13.57 ,$610.33 ,$598.12 ,"$1,150.00 ",$14.38 ,$977.50 ,"$1,373.25 ","$1,058.00 ",$805.00 ,"$1,150.00 ","$1,150.00 ",$700.35 ,"$1,150.00 ",$794.65 ,"$1,035.00 ",$785.68 ,$604.10 ,$908.50 ,$14.38 ,$459.00 ,$459.00 ,$598.12 ,$459.00 ,$828.00 ,$713.00 ,$828.00 ,$828.00 ,$920.00 
ST NICHOLAS HOSPITAL - ACUTE,32000077,50693,HC INTRO GUIDE RENAL PELVIS URET DIL,320,1 ,"$3,469.55 ","$2,289.90 ",$152.95 ,"$7,038.44 ",$152.95 ,"$2,378.03 ","$2,378.03 ","$3,128.20 ","$2,081.73 ","$2,949.12 ","$2,428.69 ",$152.95 ,$152.95 ,"$3,296.07 ","$2,636.86 ","$2,602.16 ",$388.31 ,"$2,949.12 ","$3,128.20 ",$388.31 ,$388.31 ,"$2,428.69 ","$2,112.96 ",$152.95 ,"$3,128.20 ","$3,065.64 ","$3,469.55 ",$162.13 ,"$2,949.12 ","$7,038.44 ","$3,191.99 ","$2,428.69 ","$4,910.25 ","$6,137.82 ","$2,112.96 ","$6,137.82 ","$2,397.46 ","$3,122.60 ","$2,370.40 ","$3,096.29 ","$2,740.94 ",$162.13 ,$459.00 ,$459.00 ,"$3,065.64 ",$459.00 ,"$2,498.08 ","$2,151.12 ","$2,498.08 ","$2,498.08 ","$2,775.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000077,50693,HC INTRO GUIDE RENAL PELVIS URET DIL,320,1 ,"$3,469.55 ","$2,289.90 ",$152.95 ,"$7,038.44 ",$152.95 ,"$2,378.03 ","$2,378.03 ","$3,128.20 ","$2,081.73 ","$2,949.12 ","$2,428.69 ",$152.95 ,$152.95 ,"$3,296.07 ","$2,636.86 ","$2,602.16 ",$388.31 ,"$2,949.12 ","$3,128.20 ",$388.31 ,$388.31 ,"$2,428.69 ","$2,112.96 ",$152.95 ,"$3,128.20 ","$3,065.64 ","$3,469.55 ",$162.13 ,"$2,949.12 ","$7,038.44 ","$3,191.99 ","$2,428.69 ","$4,910.25 ","$6,137.82 ","$2,112.96 ","$6,137.82 ","$2,397.46 ","$3,122.60 ","$2,370.40 ","$3,096.29 ","$2,740.94 ",$162.13 ,$459.00 ,$459.00 ,"$3,065.64 ",$459.00 ,"$2,498.08 ","$2,151.12 ","$2,498.08 ","$2,498.08 ","$2,775.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000078,50396,HC MANOMETRIC STUDIES-NEPHROSTOMY,320,1 ,$892.40 ,$588.98 ,$13.57 ,"$1,373.25 ",$13.57 ,$611.65 ,$611.65 ,$610.33 ,$535.44 ,$758.54 ,$624.68 ,$13.57 ,$13.57 ,$847.78 ,$678.22 ,$669.30 ,$223.90 ,$758.54 ,$610.33 ,$223.90 ,$223.90 ,$624.68 ,$543.47 ,$13.57 ,$610.33 ,$598.12 ,$892.40 ,$14.38 ,$758.54 ,"$1,373.25 ",$821.01 ,$624.68 ,$892.40 ,$892.40 ,$543.47 ,$892.40 ,$616.65 ,$803.16 ,$609.69 ,$604.10 ,$705.00 ,$14.38 ,$459.00 ,$459.00 ,$598.12 ,$459.00 ,$642.53 ,$553.29 ,$642.53 ,$642.53 ,$713.92 
ST NICHOLAS HOSPITAL - ACUTE,32000079,50435,HC CHANGE NEPHROSTOMY TUBE,320,1 ,"$3,221.15 ","$2,125.96 ",$78.13 ,"$4,073.32 ",$78.13 ,"$2,207.78 ","$2,207.78 ","$1,810.36 ","$1,932.69 ","$2,737.98 ","$2,254.81 ",$78.13 ,$78.13 ,"$3,060.09 ","$2,448.07 ","$2,415.86 ",$190.63 ,"$2,737.98 ","$1,810.36 ",$190.63 ,$190.63 ,"$2,254.81 ","$1,961.68 ",$78.13 ,"$1,810.36 ","$1,774.15 ","$3,221.15 ",$82.82 ,"$2,737.98 ","$4,073.32 ","$2,963.46 ","$2,254.81 ","$2,656.71 ","$3,221.15 ","$1,961.68 ","$3,221.15 ","$2,225.81 ","$2,899.04 ","$2,200.69 ","$1,791.89 ","$2,544.71 ",$82.82 ,$459.00 ,$459.00 ,"$1,774.15 ",$459.00 ,"$2,319.23 ","$1,997.11 ","$2,319.23 ","$2,319.23 ","$2,576.92 "
ST NICHOLAS HOSPITAL - ACUTE,32000079,50435,HC CHANGE NEPHROSTOMY TUBE,320,1 ,"$3,221.15 ","$2,125.96 ",$78.13 ,"$4,073.32 ",$78.13 ,"$2,207.78 ","$2,207.78 ","$1,810.36 ","$1,932.69 ","$2,737.98 ","$2,254.81 ",$78.13 ,$78.13 ,"$3,060.09 ","$2,448.07 ","$2,415.86 ",$190.63 ,"$2,737.98 ","$1,810.36 ",$190.63 ,$190.63 ,"$2,254.81 ","$1,961.68 ",$78.13 ,"$1,810.36 ","$1,774.15 ","$3,221.15 ",$82.82 ,"$2,737.98 ","$4,073.32 ","$2,963.46 ","$2,254.81 ","$2,656.71 ","$3,221.15 ","$1,961.68 ","$3,221.15 ","$2,225.81 ","$2,899.04 ","$2,200.69 ","$1,791.89 ","$2,544.71 ",$82.82 ,$459.00 ,$459.00 ,"$1,774.15 ",$459.00 ,"$2,319.23 ","$1,997.11 ","$2,319.23 ","$2,319.23 ","$2,576.92 "
ST NICHOLAS HOSPITAL - ACUTE,32000080,50553,HC ENDO RENAL ESTAB W/CATH,320,1 ,"$3,375.00 ","$2,227.50 ",$101.96 ,"$10,325.99 ",$101.96 ,"$2,313.23 ","$2,313.23 ","$4,589.33 ","$2,025.00 ","$2,868.75 ","$2,362.50 ",$101.96 ,$101.96 ,"$3,206.25 ","$2,565.00 ","$2,531.25 ",$595.46 ,"$2,868.75 ","$4,589.33 ",$595.46 ,$595.46 ,"$2,362.50 ","$2,055.38 ",$101.96 ,"$4,589.33 ","$4,497.54 ","$3,375.00 ",$108.08 ,"$2,868.75 ","$10,325.99 ","$3,105.00 ","$2,362.50 ","$2,747.95 ","$3,435.21 ","$2,055.38 ","$3,435.21 ","$2,332.13 ","$3,037.50 ","$2,305.80 ","$4,542.52 ","$2,666.25 ",$108.08 ,$459.00 ,$459.00 ,"$4,497.54 ",$459.00 ,"$2,430.00 ","$2,092.50 ","$2,430.00 ","$2,430.00 ","$2,700.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000083,50690,HC INJ ILEAL CONDUIT,320,1 ,$708.40 ,$467.54 ,$10.77 ,$708.40 ,$10.77 ,$485.54 ,$485.54 , N/A ,$425.04 ,$602.14 ,$495.88 ,$10.77 ,$10.77 ,$672.98 ,$538.38 ,$531.30 ,$134.69 ,$602.14 , N/A ,$134.69 ,$134.69 ,$495.88 ,$431.42 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$602.14 , N/A ,$651.73 ,$495.88 ,$359.30 ,$431.20 ,$431.42 ,$431.20 ,$489.50 ,$637.56 ,$483.98 , N/A ,$559.64 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$510.05 ,$439.21 ,$510.05 ,$510.05 ,$566.72 
ST NICHOLAS HOSPITAL - ACUTE,32000085,51600,HC INJ CYSTOGRAM,320,1 ,$604.90 ,$399.23 ,$10.77 ,$604.90 ,$10.77 ,$414.60 ,$414.60 , N/A ,$362.94 ,$514.17 ,$423.43 ,$10.77 ,$10.77 ,$574.66 ,$459.72 ,$453.68 ,$83.76 ,$514.17 , N/A ,$83.76 ,$83.76 ,$423.43 ,$368.38 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$514.17 , N/A ,$556.51 ,$423.43 ,$306.81 ,$368.20 ,$368.38 ,$368.20 ,$417.99 ,$544.41 ,$413.27 , N/A ,$477.87 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$435.53 ,$375.04 ,$435.53 ,$435.53 ,$483.92 
ST NICHOLAS HOSPITAL - ACUTE,32000086,51610,HC INJ URETHROCYSTOGRAM RETRO,320,1 ,$656.65 ,$433.39 ,$10.77 ,$656.65 ,$10.77 ,$450.07 ,$450.07 , N/A ,$393.99 ,$558.15 ,$459.66 ,$10.77 ,$10.77 ,$623.82 ,$499.05 ,$492.49 ,$123.08 ,$558.15 , N/A ,$123.08 ,$123.08 ,$459.66 ,$399.90 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$558.15 , N/A ,$604.12 ,$459.66 ,$333.05 ,$399.70 ,$399.90 ,$399.70 ,$453.75 ,$590.99 ,$448.62 , N/A ,$518.75 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$472.79 ,$407.12 ,$472.79 ,$472.79 ,$525.32 
ST NICHOLAS HOSPITAL - ACUTE,32000087,58340,HC CATH/INTRO SALINE/CONTRAST SIS,320,1 ,$656.65 ,$433.39 ,$10.77 ,$656.65 ,$10.77 ,$450.07 ,$450.07 , N/A ,$393.99 ,$558.15 ,$459.66 ,$10.77 ,$10.77 ,$623.82 ,$499.05 ,$492.49 ,$109.72 ,$558.15 , N/A ,$109.72 ,$109.72 ,$459.66 ,$399.90 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$558.15 , N/A ,$604.12 ,$459.66 ,$333.05 ,$399.70 ,$399.90 ,$399.70 ,$453.75 ,$590.99 ,$448.62 , N/A ,$518.75 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$472.79 ,$407.12 ,$472.79 ,$472.79 ,$525.32 
ST NICHOLAS HOSPITAL - ACUTE,32000089,61070,HC PUNCT ASP/INJ SHUNT TUBE,320,1 ,"$1,003.95 ",$662.61 ,$13.98 ,"$1,414.97 ",$13.98 ,$688.11 ,$688.11 ,$628.88 ,$602.37 ,$853.36 ,$702.77 ,$13.98 ,$13.98 ,$953.75 ,$763.00 ,$752.96 ,$106.46 ,$853.36 ,$628.88 ,$106.46 ,$106.46 ,$702.77 ,$611.41 ,$13.98 ,$628.88 ,$616.30 ,"$1,003.95 ",$14.82 ,$853.36 ,"$1,414.97 ",$923.63 ,$702.77 ,"$1,003.95 ","$1,003.95 ",$611.41 ,"$1,003.95 ",$693.73 ,$903.56 ,$685.90 ,$622.47 ,$793.12 ,$14.82 ,$459.00 ,$459.00 ,$616.30 ,$459.00 ,$722.84 ,$622.45 ,$722.84 ,$722.84 ,$803.16 
ST NICHOLAS HOSPITAL - ACUTE,32000090,62272,HC LUMBAR PUNCTURE DRAIN,320,1 ,"$1,028.10 ",$678.55 ,$30.03 ,"$1,414.97 ",$30.03 ,$704.66 ,$704.66 ,$628.88 ,$616.86 ,$873.89 ,$719.67 ,$30.03 ,$30.03 ,$976.70 ,$781.36 ,$771.08 ,$164.68 ,$873.89 ,$628.88 ,$164.68 ,$164.68 ,$719.67 ,$626.11 ,$30.03 ,$628.88 ,$616.30 ,"$1,028.10 ",$31.83 ,$873.89 ,"$1,414.97 ",$945.85 ,$719.67 ,"$1,028.10 ","$1,028.10 ",$626.11 ,"$1,028.10 ",$710.42 ,$925.29 ,$702.40 ,$622.47 ,$812.20 ,$31.83 ,$459.00 ,$459.00 ,$616.30 ,$459.00 ,$740.23 ,$637.42 ,$740.23 ,$740.23 ,$822.48 
ST NICHOLAS HOSPITAL - ACUTE,32000091,62284,HC INJ MYELOGRAM,320,1 ,"$1,069.50 ",$705.87 ,$10.77 ,"$1,069.50 ",$10.77 ,$733.04 ,$733.04 , N/A ,$641.70 ,$909.08 ,$748.65 ,$10.77 ,$10.77 ,"$1,016.03 ",$812.82 ,$802.13 ,$161.72 ,$909.08 , N/A ,$161.72 ,$161.72 ,$748.65 ,$651.33 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$909.08 , N/A ,$983.94 ,$748.65 ,$542.45 ,$651.00 ,$651.33 ,$651.00 ,$739.02 ,$962.55 ,$730.68 , N/A ,$844.91 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$770.04 ,$663.09 ,$770.04 ,$770.04 ,$855.60 
ST NICHOLAS HOSPITAL - ACUTE,32000093,62290,HC INJ DISKOGRAM LUMBAR EA LEVEL,320,1 ,"$2,189.60 ","$1,445.14 ",$10.77 ,"$2,189.60 ",$10.77 ,"$1,500.75 ","$1,500.75 ", N/A ,"$1,313.76 ","$1,861.16 ","$1,532.72 ",$10.77 ,$10.77 ,"$2,080.12 ","$1,664.10 ","$1,642.20 ",$305.37 ,"$1,861.16 ", N/A ,$305.37 ,$305.37 ,"$1,532.72 ","$1,333.47 ",$10.77 , N/A , N/A , N/A ,$11.42 ,"$1,861.16 ", N/A ,"$2,014.43 ","$1,532.72 ","$1,110.57 ","$1,332.81 ","$1,333.47 ","$1,332.81 ","$1,513.01 ","$1,970.64 ","$1,495.93 ", N/A ,"$1,729.78 ",$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$1,576.51 ","$1,357.55 ","$1,576.51 ","$1,576.51 ","$1,751.68 "
ST NICHOLAS HOSPITAL - ACUTE,32000094,62291,HC INJ DISKOGRAM CERVICAL EA LVL,320,1 ,"$1,352.40 ",$892.58 ,$10.77 ,"$1,352.40 ",$10.77 ,$926.94 ,$926.94 , N/A ,$811.44 ,"$1,149.54 ",$946.68 ,$10.77 ,$10.77 ,"$1,284.78 ","$1,027.82 ","$1,014.30 ",$283.49 ,"$1,149.54 ", N/A ,$283.49 ,$283.49 ,$946.68 ,$823.61 ,$10.77 , N/A , N/A , N/A ,$11.42 ,"$1,149.54 ", N/A ,"$1,244.21 ",$946.68 ,$685.94 ,$823.21 ,$823.61 ,$823.21 ,$934.51 ,"$1,217.16 ",$923.96 , N/A ,"$1,068.40 ",$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$973.73 ,$838.49 ,$973.73 ,$973.73 ,"$1,081.92 "
ST NICHOLAS HOSPITAL - ACUTE,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$290.59 ,$191.79 ,$1.93 ,$290.59 ,$1.93 ,$97.42 ,$80.52 ,$84.79 ,$174.35 ,$247.00 ,$203.41 ,$1.93 ,$1.93 ,$276.06 ,$220.85 ,$217.94 ,$47.07 ,$247.00 ,$84.79 ,$47.07 ,$47.07 ,$203.41 ,$176.97 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$247.00 ,$190.79 ,$267.34 ,$203.41 ,$215.92 ,$215.92 ,$176.97 ,$215.92 ,$200.80 ,$261.53 ,$198.53 ,$83.93 ,$229.57 ,$2.05 ,$290.59 ,$290.59 ,$83.09 ,$290.59 ,$209.22 ,$180.17 ,$209.22 ,$209.22 ,$232.47 
ST NICHOLAS HOSPITAL - ACUTE,32000099,70030,HC FOREIGN BODY EYE BOTH,320,1 ,$290.59 ,$191.79 ,$1.93 ,$290.59 ,$1.93 ,$97.42 ,$80.52 ,$84.79 ,$174.35 ,$247.00 ,$203.41 ,$1.93 ,$1.93 ,$276.06 ,$220.85 ,$217.94 ,$47.07 ,$247.00 ,$84.79 ,$47.07 ,$47.07 ,$203.41 ,$176.97 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$247.00 ,$190.79 ,$267.34 ,$203.41 ,$215.92 ,$215.92 ,$176.97 ,$215.92 ,$200.80 ,$261.53 ,$198.53 ,$83.93 ,$229.57 ,$2.05 ,$290.59 ,$290.59 ,$83.09 ,$290.59 ,$209.22 ,$180.17 ,$209.22 ,$209.22 ,$232.47 
ST NICHOLAS HOSPITAL - ACUTE,32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$132.05 ,$105.35 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$62.24 ,$413.87 ,$104.31 ,$62.24 ,$62.24 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$342.19 ,$342.19 ,$296.53 ,$342.19 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000101,70130,HC MASTOIDS MN 3VW PER SIDE,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$191.63 ,$153.63 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$91.29 ,$333.63 ,$104.31 ,$91.29 ,$91.29 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000103,70140,HC FACIAL BONES < 3 VIEWS,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$91.88 ,$77.76 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$44.44 ,$333.63 ,$84.79 ,$44.44 ,$44.44 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$144.52 ,$116.38 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$68.18 ,$413.87 ,$104.31 ,$68.18 ,$68.18 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$342.19 ,$342.19 ,$296.53 ,$342.19 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$122.36 ,$98.45 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$58.96 ,$333.63 ,$84.79 ,$58.96 ,$58.96 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$144.52 ,$115.01 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$68.18 ,$413.87 ,$104.31 ,$68.18 ,$68.18 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$215.92 ,$215.92 ,$296.53 ,$215.92 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000107,70210,HC XRAY SINUS WATERS VIEW,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$98.80 ,$87.41 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$47.07 ,$333.63 ,$84.79 ,$47.07 ,$47.07 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$112.66 ,$101.21 ,$84.79 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$53.67 ,$413.87 ,$84.79 ,$53.67 ,$53.67 ,$340.84 ,$296.53 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$413.87 ,$190.79 ,$447.96 ,$340.84 ,$215.92 ,$215.92 ,$296.53 ,$215.92 ,$336.45 ,$438.22 ,$332.66 ,$83.93 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$83.09 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000109,70240,HC SELLA TURCICA,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$98.80 ,$83.27 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$47.07 ,$333.63 ,$84.79 ,$47.07 ,$47.07 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$111.27 ,$97.07 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$53.67 ,$333.63 ,$104.31 ,$53.67 ,$53.67 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$129.28 ,$115.01 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$61.58 ,$413.87 ,$104.31 ,$61.58 ,$61.58 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$342.19 ,$342.19 ,$296.53 ,$342.19 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$173.62 ,$142.60 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$82.04 ,$333.63 ,$84.79 ,$82.04 ,$82.04 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000114,70336,HC MRI TMJ,320,1 ,"$3,864.00 ","$2,550.24 ",$8.63 ,"$3,864.00 ",$8.63 ,$932.21 ,$932.21 ,$227.92 ,"$2,318.40 ","$3,284.40 ","$2,704.80 ",$8.63 ,$8.63 ,"$3,670.80 ","$2,936.64 ","$2,898.00 ",$410.27 ,"$3,284.40 ",$227.92 ,$410.27 ,$410.27 ,"$2,704.80 ","$2,353.18 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$3,284.40 ",$512.81 ,"$3,554.88 ","$2,704.80 ","$1,109.82 ","$1,109.82 ","$2,353.18 ","$1,109.82 ","$2,670.02 ","$3,477.60 ","$2,639.88 ",$225.60 ,"$3,052.56 ",$9.15 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,"$2,782.08 ","$2,395.68 ","$2,782.08 ","$2,782.08 ","$3,091.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000115,70355,HC XRAY PAN MANDIBLE/MAXLA,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$32.30 ,$33.61 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$16.05 ,$333.63 ,$84.79 ,$16.05 ,$16.05 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$160.50 ,$160.50 ,$239.03 ,$160.50 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$383.99 ,$253.43 ,$1.93 ,$383.99 ,$1.93 ,$93.26 ,$83.27 ,$84.79 ,$230.39 ,$326.39 ,$268.79 ,$1.93 ,$1.93 ,$364.79 ,$291.83 ,$287.99 ,$45.10 ,$326.39 ,$84.79 ,$45.10 ,$45.10 ,$268.79 ,$233.85 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$326.39 ,$190.79 ,$353.27 ,$268.79 ,$215.92 ,$215.92 ,$233.85 ,$215.92 ,$265.34 ,$345.59 ,$262.34 ,$83.93 ,$303.35 ,$2.05 ,$383.99 ,$383.99 ,$83.09 ,$383.99 ,$276.47 ,$238.07 ,$276.47 ,$276.47 ,$307.19 
ST NICHOLAS HOSPITAL - ACUTE,32000120,70390,HC XRAY SIALOGRAPHY,320,1 ,$645.51 ,$426.04 ,$4.15 ,$645.51 ,$4.15 ,$424.39 ,$324.70 ,$227.92 ,$387.31 ,$548.68 ,$451.86 ,$4.15 ,$4.15 ,$613.23 ,$490.59 ,$484.13 ,$198.19 ,$548.68 ,$227.92 ,$198.19 ,$198.19 ,$451.86 ,$393.12 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$548.68 ,$512.81 ,$593.87 ,$451.86 ,$645.51 ,$645.51 ,$393.12 ,$645.51 ,$446.05 ,$580.96 ,$441.01 ,$225.60 ,$509.95 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$464.77 ,$400.22 ,$464.77 ,$464.77 ,$516.41 
ST NICHOLAS HOSPITAL - ACUTE,32000121,71045,HC XR CHEST 1V,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$69.71 ,$59.82 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$33.87 ,$274.47 ,$84.79 ,$33.87 ,$33.87 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000122,71045,HC XR CHEST 1V OR,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$69.71 ,$59.82 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$33.87 ,$274.47 ,$84.79 ,$33.87 ,$33.87 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000124,71045,HC XR CHEST 1V EMPLOYEE,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$69.71 ,$59.82 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$33.87 ,$274.47 ,$84.79 ,$33.87 ,$33.87 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000125,71045,HC XR CHEST 1V PORTABLE,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$69.71 ,$59.82 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$33.87 ,$274.47 ,$84.79 ,$33.87 ,$33.87 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000126,71045,HC XR CHEST 1V INFANT,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$69.71 ,$59.82 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$33.87 ,$274.47 ,$84.79 ,$33.87 ,$33.87 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000127,71046,HC XR CHEST 2V,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$94.65 ,$79.14 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$45.76 ,$274.47 ,$84.79 ,$45.76 ,$45.76 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000128,71046,HC XR CHEST 2V CORPORATE,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$94.65 ,$79.14 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$45.76 ,$274.47 ,$84.79 ,$45.76 ,$45.76 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000129,71046,HC XR CHEST 2V PORTABLE,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$94.65 ,$79.14 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$45.76 ,$274.47 ,$84.79 ,$45.76 ,$45.76 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000130,71047,HC XR CHEST 2V W/LORDOTIC,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$120.97 ,$98.45 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$57.63 ,$274.47 ,$84.79 ,$57.63 ,$57.63 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000133,71048,HC XR CHEST 4+V,320,1 ,$441.60 ,$291.46 ,$1.93 ,$441.60 ,$1.93 ,$129.28 ,$102.59 ,$104.31 ,$264.96 ,$375.36 ,$309.12 ,$1.93 ,$1.93 ,$419.52 ,$335.62 ,$331.20 ,$62.26 ,$375.36 ,$104.31 ,$62.26 ,$62.26 ,$309.12 ,$268.93 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$375.36 ,$234.71 ,$406.27 ,$309.12 ,$424.99 ,$424.99 ,$268.93 ,$424.99 ,$305.15 ,$397.44 ,$301.70 ,$103.24 ,$348.86 ,$2.05 ,$441.60 ,$441.60 ,$102.22 ,$441.60 ,$317.95 ,$273.79 ,$317.95 ,$317.95 ,$353.28 
ST NICHOLAS HOSPITAL - ACUTE,32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$322.90 ,$213.11 ,$1.93 ,$322.90 ,$1.93 ,$94.65 ,$79.14 ,$84.79 ,$193.74 ,$274.47 ,$226.03 ,$1.93 ,$1.93 ,$306.76 ,$245.40 ,$242.18 ,$45.76 ,$274.47 ,$84.79 ,$45.76 ,$45.76 ,$226.03 ,$196.65 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$274.47 ,$190.79 ,$297.07 ,$226.03 ,$230.65 ,$230.65 ,$196.65 ,$230.65 ,$223.12 ,$290.61 ,$220.61 ,$83.93 ,$255.09 ,$2.05 ,$322.90 ,$322.90 ,$83.09 ,$322.90 ,$232.49 ,$200.20 ,$232.49 ,$232.49 ,$258.32 
ST NICHOLAS HOSPITAL - ACUTE,32000137,71100,HC XR RIBS 2V UNI,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$107.12 ,$88.79 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$51.70 ,$333.63 ,$84.79 ,$51.70 ,$51.70 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$594.06 ,$392.08 ,$1.93 ,$594.06 ,$1.93 ,$120.97 ,$98.45 ,$104.31 ,$356.44 ,$504.95 ,$415.84 ,$1.93 ,$1.93 ,$564.36 ,$451.49 ,$445.55 ,$58.28 ,$504.95 ,$104.31 ,$58.28 ,$58.28 ,$415.84 ,$361.78 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$504.95 ,$234.71 ,$546.54 ,$415.84 ,$342.19 ,$342.19 ,$361.78 ,$342.19 ,$410.50 ,$534.65 ,$405.86 ,$103.24 ,$469.31 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$427.72 ,$368.32 ,$427.72 ,$427.72 ,$475.25 
ST NICHOLAS HOSPITAL - ACUTE,32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$123.74 ,$101.21 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$59.61 ,$413.87 ,$104.31 ,$59.61 ,$59.61 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$342.19 ,$342.19 ,$296.53 ,$342.19 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,$594.06 ,$392.08 ,$1.93 ,$594.06 ,$1.93 ,$154.22 ,$124.66 ,$104.31 ,$356.44 ,$504.95 ,$415.84 ,$1.93 ,$1.93 ,$564.36 ,$451.49 ,$445.55 ,$73.47 ,$504.95 ,$104.31 ,$73.47 ,$73.47 ,$415.84 ,$361.78 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$504.95 ,$234.71 ,$546.54 ,$415.84 ,$342.19 ,$342.19 ,$361.78 ,$342.19 ,$410.50 ,$534.65 ,$405.86 ,$103.24 ,$469.31 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$427.72 ,$368.32 ,$427.72 ,$427.72 ,$475.25 
ST NICHOLAS HOSPITAL - ACUTE,32000141,71120,HC XR STERNUM 2+V,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$100.19 ,$80.52 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$47.72 ,$333.63 ,$84.79 ,$47.72 ,$47.72 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000142,71130,HC XR STERNOCLAVIC JT 3+V,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$127.90 ,$101.21 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$60.93 ,$333.63 ,$84.79 ,$60.93 ,$60.93 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,870.00 ",$396.03 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$174.21 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000148,71270,HC CT CHEST W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000150,71275,HC CTA CHEST W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$13.58 ,"$2,600.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$13.58 ,$13.58 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,099.21 ","$1,099.21 ","$1,583.40 ","$1,099.21 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$8.63 ,"$3,622.50 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$8.63 ,$8.63 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$3,079.13 ",$512.81 ,"$3,332.70 ","$2,535.75 ","$1,109.82 ","$1,109.82 ","$2,206.10 ","$1,109.82 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$225.60 ,"$2,861.78 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$14.78 ,"$3,622.50 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$722.97 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$14.78 ,$14.78 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$722.97 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$14.78 ,$722.97 ,$708.51 ,"$1,445.94 ",$15.67 ,"$3,079.13 ","$1,626.69 ","$3,332.70 ","$2,535.75 ","$1,605.70 ","$1,605.70 ","$2,206.10 ","$1,605.70 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$715.60 ,"$2,861.78 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$708.51 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000153,71552,HC MRI CHEST W AND W/O CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$14.78 ,"$3,622.50 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$14.78 ,$14.78 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$3,079.13 ",$809.07 ,"$3,332.70 ","$2,535.75 ","$1,855.81 ","$1,855.81 ","$2,206.10 ","$1,855.81 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$355.93 ,"$2,861.78 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$415.84 ,$274.45 ,$1.93 ,$415.84 ,$1.93 ,$68.32 ,$58.44 ,$84.79 ,$249.50 ,$353.46 ,$291.09 ,$1.93 ,$1.93 ,$395.05 ,$316.04 ,$311.88 ,$33.21 ,$353.46 ,$84.79 ,$33.21 ,$33.21 ,$291.09 ,$253.25 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$353.46 ,$190.79 ,$382.57 ,$291.09 ,$215.92 ,$215.92 ,$253.25 ,$215.92 ,$287.35 ,$374.26 ,$284.10 ,$83.93 ,$328.51 ,$2.05 ,$415.84 ,$415.84 ,$83.09 ,$415.84 ,$299.40 ,$257.82 ,$299.40 ,$299.40 ,$332.67 
ST NICHOLAS HOSPITAL - ACUTE,32000156,72020,HC XR C-SPINE 1V,320,1 ,$415.84 ,$274.45 ,$1.93 ,$415.84 ,$1.93 ,$68.32 ,$58.44 ,$84.79 ,$249.50 ,$353.46 ,$291.09 ,$1.93 ,$1.93 ,$395.05 ,$316.04 ,$311.88 ,$33.21 ,$353.46 ,$84.79 ,$33.21 ,$33.21 ,$291.09 ,$253.25 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$353.46 ,$190.79 ,$382.57 ,$291.09 ,$215.92 ,$215.92 ,$253.25 ,$215.92 ,$287.35 ,$374.26 ,$284.10 ,$83.93 ,$328.51 ,$2.05 ,$415.84 ,$415.84 ,$83.09 ,$415.84 ,$299.40 ,$257.82 ,$299.40 ,$299.40 ,$332.67 
ST NICHOLAS HOSPITAL - ACUTE,32000157,72020,HC XR SPINE 1V (L SPINE/ T SPINE) OR,320,1 ,$415.84 ,$274.45 ,$1.93 ,$415.84 ,$1.93 ,$68.32 ,$58.44 ,$84.79 ,$249.50 ,$353.46 ,$291.09 ,$1.93 ,$1.93 ,$395.05 ,$316.04 ,$311.88 ,$33.21 ,$353.46 ,$84.79 ,$33.21 ,$33.21 ,$291.09 ,$253.25 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$353.46 ,$190.79 ,$382.57 ,$291.09 ,$215.92 ,$215.92 ,$253.25 ,$215.92 ,$287.35 ,$374.26 ,$284.10 ,$83.93 ,$328.51 ,$2.05 ,$415.84 ,$415.84 ,$83.09 ,$415.84 ,$299.40 ,$257.82 ,$299.40 ,$299.40 ,$332.67 
ST NICHOLAS HOSPITAL - ACUTE,32000158,72020,HC XR SPINE 1V (C SPINE/L SPINE),320,1 ,$415.84 ,$274.45 ,$1.93 ,$415.84 ,$1.93 ,$68.32 ,$58.44 ,$84.79 ,$249.50 ,$353.46 ,$291.09 ,$1.93 ,$1.93 ,$395.05 ,$316.04 ,$311.88 ,$33.21 ,$353.46 ,$84.79 ,$33.21 ,$33.21 ,$291.09 ,$253.25 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$353.46 ,$190.79 ,$382.57 ,$291.09 ,$215.92 ,$215.92 ,$253.25 ,$215.92 ,$287.35 ,$374.26 ,$284.10 ,$83.93 ,$328.51 ,$2.05 ,$415.84 ,$415.84 ,$83.09 ,$415.84 ,$299.40 ,$257.82 ,$299.40 ,$299.40 ,$332.67 
ST NICHOLAS HOSPITAL - ACUTE,32000160,72020,HC XR SPINE 1V (T SPINE),320,1 ,$415.84 ,$274.45 ,$1.93 ,$415.84 ,$1.93 ,$68.32 ,$58.44 ,$84.79 ,$249.50 ,$353.46 ,$291.09 ,$1.93 ,$1.93 ,$395.05 ,$316.04 ,$311.88 ,$33.21 ,$353.46 ,$84.79 ,$33.21 ,$33.21 ,$291.09 ,$253.25 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$353.46 ,$190.79 ,$382.57 ,$291.09 ,$215.92 ,$215.92 ,$253.25 ,$215.92 ,$287.35 ,$374.26 ,$284.10 ,$83.93 ,$328.51 ,$2.05 ,$415.84 ,$415.84 ,$83.09 ,$415.84 ,$299.40 ,$257.82 ,$299.40 ,$299.40 ,$332.67 
ST NICHOLAS HOSPITAL - ACUTE,32000161,72020,HC XR L-SPINE 1V,320,1 ,$415.84 ,$274.45 ,$1.93 ,$415.84 ,$1.93 ,$68.32 ,$58.44 ,$84.79 ,$249.50 ,$353.46 ,$291.09 ,$1.93 ,$1.93 ,$395.05 ,$316.04 ,$311.88 ,$33.21 ,$353.46 ,$84.79 ,$33.21 ,$33.21 ,$291.09 ,$253.25 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$353.46 ,$190.79 ,$382.57 ,$291.09 ,$215.92 ,$215.92 ,$253.25 ,$215.92 ,$287.35 ,$374.26 ,$284.10 ,$83.93 ,$328.51 ,$2.05 ,$415.84 ,$415.84 ,$83.09 ,$415.84 ,$299.40 ,$257.82 ,$299.40 ,$299.40 ,$332.67 
ST NICHOLAS HOSPITAL - ACUTE,32000162,72040,HC XR C-SPINE 2V,320,1 ,$522.98 ,$345.17 ,$1.93 ,$522.98 ,$1.93 ,$118.20 ,$97.07 ,$84.79 ,$313.79 ,$444.53 ,$366.09 ,$1.93 ,$1.93 ,$496.83 ,$397.46 ,$392.24 ,$56.97 ,$444.53 ,$84.79 ,$56.97 ,$56.97 ,$366.09 ,$318.49 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$444.53 ,$190.79 ,$481.14 ,$366.09 ,$215.92 ,$215.92 ,$318.49 ,$215.92 ,$361.38 ,$470.68 ,$357.30 ,$83.93 ,$413.15 ,$2.05 ,$459.00 ,$459.00 ,$83.09 ,$459.00 ,$376.55 ,$324.25 ,$376.55 ,$376.55 ,$418.38 
ST NICHOLAS HOSPITAL - ACUTE,32000163,72040,HC XR C-SPINE 3V,320,1 ,$522.98 ,$345.17 ,$1.93 ,$522.98 ,$1.93 ,$118.20 ,$97.07 ,$84.79 ,$313.79 ,$444.53 ,$366.09 ,$1.93 ,$1.93 ,$496.83 ,$397.46 ,$392.24 ,$56.97 ,$444.53 ,$84.79 ,$56.97 ,$56.97 ,$366.09 ,$318.49 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$444.53 ,$190.79 ,$481.14 ,$366.09 ,$215.92 ,$215.92 ,$318.49 ,$215.92 ,$361.38 ,$470.68 ,$357.30 ,$83.93 ,$413.15 ,$2.05 ,$459.00 ,$459.00 ,$83.09 ,$459.00 ,$376.55 ,$324.25 ,$376.55 ,$376.55 ,$418.38 
ST NICHOLAS HOSPITAL - ACUTE,32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$522.98 ,$345.17 ,$1.93 ,$522.98 ,$1.93 ,$118.20 ,$97.07 ,$84.79 ,$313.79 ,$444.53 ,$366.09 ,$1.93 ,$1.93 ,$496.83 ,$397.46 ,$392.24 ,$56.97 ,$444.53 ,$84.79 ,$56.97 ,$56.97 ,$366.09 ,$318.49 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$444.53 ,$190.79 ,$481.14 ,$366.09 ,$215.92 ,$215.92 ,$318.49 ,$215.92 ,$361.38 ,$470.68 ,$357.30 ,$83.93 ,$413.15 ,$2.05 ,$459.00 ,$459.00 ,$83.09 ,$459.00 ,$376.55 ,$324.25 ,$376.55 ,$376.55 ,$418.38 
ST NICHOLAS HOSPITAL - ACUTE,32000165,72040,HC XR C-SPINE CLEAR 3V,320,1 ,$522.98 ,$345.17 ,$1.93 ,$522.98 ,$1.93 ,$118.20 ,$97.07 ,$84.79 ,$313.79 ,$444.53 ,$366.09 ,$1.93 ,$1.93 ,$496.83 ,$397.46 ,$392.24 ,$56.97 ,$444.53 ,$84.79 ,$56.97 ,$56.97 ,$366.09 ,$318.49 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$444.53 ,$190.79 ,$481.14 ,$366.09 ,$215.92 ,$215.92 ,$318.49 ,$215.92 ,$361.38 ,$470.68 ,$357.30 ,$83.93 ,$413.15 ,$2.05 ,$459.00 ,$459.00 ,$83.09 ,$459.00 ,$376.55 ,$324.25 ,$376.55 ,$376.55 ,$418.38 
ST NICHOLAS HOSPITAL - ACUTE,32000167,72040,HC XR C-SPINE 2-3V OBLS,320,1 ,$522.98 ,$345.17 ,$1.93 ,$522.98 ,$1.93 ,$118.20 ,$97.07 ,$84.79 ,$313.79 ,$444.53 ,$366.09 ,$1.93 ,$1.93 ,$496.83 ,$397.46 ,$392.24 ,$56.97 ,$444.53 ,$84.79 ,$56.97 ,$56.97 ,$366.09 ,$318.49 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$444.53 ,$190.79 ,$481.14 ,$366.09 ,$215.92 ,$215.92 ,$318.49 ,$215.92 ,$361.38 ,$470.68 ,$357.30 ,$83.93 ,$413.15 ,$2.05 ,$459.00 ,$459.00 ,$83.09 ,$459.00 ,$376.55 ,$324.25 ,$376.55 ,$376.55 ,$418.38 
ST NICHOLAS HOSPITAL - ACUTE,32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,$557.99 ,$368.27 ,$1.93 ,$557.99 ,$1.93 ,$165.30 ,$132.94 ,$104.31 ,$334.79 ,$474.29 ,$390.59 ,$1.93 ,$1.93 ,$530.09 ,$424.07 ,$418.49 ,$79.40 ,$474.29 ,$104.31 ,$79.40 ,$79.40 ,$390.59 ,$339.82 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$474.29 ,$234.71 ,$513.35 ,$390.59 ,$342.19 ,$342.19 ,$339.82 ,$342.19 ,$385.57 ,$502.19 ,$381.22 ,$103.24 ,$440.81 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$401.75 ,$345.95 ,$401.75 ,$401.75 ,$446.39 
ST NICHOLAS HOSPITAL - ACUTE,32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,$724.54 ,$478.20 ,$1.93 ,$724.54 ,$1.93 ,$197.17 ,$160.53 ,$104.31 ,$434.72 ,$615.86 ,$507.18 ,$1.93 ,$1.93 ,$688.31 ,$550.65 ,$543.41 ,$94.59 ,$615.86 ,$104.31 ,$94.59 ,$94.59 ,$507.18 ,$441.24 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$615.86 ,$234.71 ,$666.58 ,$507.18 ,$342.19 ,$342.19 ,$441.24 ,$342.19 ,$500.66 ,$652.09 ,$495.01 ,$103.24 ,$572.39 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$521.67 ,$449.21 ,$521.67 ,$521.67 ,$579.63 
ST NICHOLAS HOSPITAL - ACUTE,32000172,72070,HC XR T-SPINE 2V,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$94.65 ,$87.41 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$45.76 ,$333.63 ,$104.31 ,$45.76 ,$45.76 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000174,72072,HC XR T-SPINE 3V,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$116.81 ,$97.07 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$56.31 ,$333.63 ,$104.31 ,$56.31 ,$56.31 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$342.19 ,$342.19 ,$239.03 ,$342.19 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$451.91 ,$298.26 ,$1.93 ,$451.91 ,$1.93 ,$119.58 ,$97.07 ,$104.31 ,$271.15 ,$384.12 ,$316.34 ,$1.93 ,$1.93 ,$429.31 ,$343.45 ,$338.93 ,$57.63 ,$384.12 ,$104.31 ,$57.63 ,$57.63 ,$316.34 ,$275.21 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$384.12 ,$234.71 ,$415.76 ,$316.34 ,$215.92 ,$215.92 ,$275.21 ,$215.92 ,$312.27 ,$406.72 ,$308.74 ,$103.24 ,$357.01 ,$2.05 ,$451.91 ,$451.91 ,$102.22 ,$451.91 ,$325.38 ,$280.18 ,$325.38 ,$325.38 ,$361.53 
ST NICHOLAS HOSPITAL - ACUTE,32000179,72100,HC XR L-SPINE 2-3V CORPORATE,320,1 ,$451.91 ,$298.26 ,$1.93 ,$451.91 ,$1.93 ,$119.58 ,$97.07 ,$104.31 ,$271.15 ,$384.12 ,$316.34 ,$1.93 ,$1.93 ,$429.31 ,$343.45 ,$338.93 ,$57.63 ,$384.12 ,$104.31 ,$57.63 ,$57.63 ,$316.34 ,$275.21 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$384.12 ,$234.71 ,$415.76 ,$316.34 ,$215.92 ,$215.92 ,$275.21 ,$215.92 ,$312.27 ,$406.72 ,$308.74 ,$103.24 ,$357.01 ,$2.05 ,$451.91 ,$451.91 ,$102.22 ,$451.91 ,$325.38 ,$280.18 ,$325.38 ,$325.38 ,$361.53 
ST NICHOLAS HOSPITAL - ACUTE,32000180,72100,HC XR L-SPINE 2V OR,320,1 ,$451.91 ,$298.26 ,$1.93 ,$451.91 ,$1.93 ,$119.58 ,$97.07 ,$104.31 ,$271.15 ,$384.12 ,$316.34 ,$1.93 ,$1.93 ,$429.31 ,$343.45 ,$338.93 ,$57.63 ,$384.12 ,$104.31 ,$57.63 ,$57.63 ,$316.34 ,$275.21 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$384.12 ,$234.71 ,$415.76 ,$316.34 ,$215.92 ,$215.92 ,$275.21 ,$215.92 ,$312.27 ,$406.72 ,$308.74 ,$103.24 ,$357.01 ,$2.05 ,$451.91 ,$451.91 ,$102.22 ,$451.91 ,$325.38 ,$280.18 ,$325.38 ,$325.38 ,$361.53 
ST NICHOLAS HOSPITAL - ACUTE,32000181,72110,HC XR L-SPINE 4+V,320,1 ,$724.54 ,$478.20 ,$1.93 ,$724.54 ,$1.93 ,$159.76 ,$135.70 ,$104.31 ,$434.72 ,$615.86 ,$507.18 ,$1.93 ,$1.93 ,$688.31 ,$550.65 ,$543.41 ,$76.77 ,$615.86 ,$104.31 ,$76.77 ,$76.77 ,$507.18 ,$441.24 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$615.86 ,$234.71 ,$666.58 ,$507.18 ,$342.19 ,$342.19 ,$441.24 ,$342.19 ,$500.66 ,$652.09 ,$495.01 ,$103.24 ,$572.39 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$521.67 ,$449.21 ,$521.67 ,$521.67 ,$579.63 
ST NICHOLAS HOSPITAL - ACUTE,32000182,72110,HC XR L-SPINE 5V OBLIQUES,320,1 ,$724.54 ,$478.20 ,$1.93 ,$724.54 ,$1.93 ,$159.76 ,$135.70 ,$104.31 ,$434.72 ,$615.86 ,$507.18 ,$1.93 ,$1.93 ,$688.31 ,$550.65 ,$543.41 ,$76.77 ,$615.86 ,$104.31 ,$76.77 ,$76.77 ,$507.18 ,$441.24 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$615.86 ,$234.71 ,$666.58 ,$507.18 ,$342.19 ,$342.19 ,$441.24 ,$342.19 ,$500.66 ,$652.09 ,$495.01 ,$103.24 ,$572.39 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$521.67 ,$449.21 ,$521.67 ,$521.67 ,$579.63 
ST NICHOLAS HOSPITAL - ACUTE,32000183,72120,HC XR L-SPINE BENDING ONLY MIN 4V,320,1 ,$724.54 ,$478.20 ,$1.93 ,$724.54 ,$1.93 ,$123.74 ,$121.90 ,$104.31 ,$434.72 ,$615.86 ,$507.18 ,$1.93 ,$1.93 ,$688.31 ,$550.65 ,$543.41 ,$58.96 ,$615.86 ,$104.31 ,$58.96 ,$58.96 ,$507.18 ,$441.24 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$615.86 ,$234.71 ,$666.58 ,$507.18 ,$342.19 ,$342.19 ,$441.24 ,$342.19 ,$500.66 ,$652.09 ,$495.01 ,$103.24 ,$572.39 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$521.67 ,$449.21 ,$521.67 ,$521.67 ,$579.63 
ST NICHOLAS HOSPITAL - ACUTE,32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,$724.54 ,$478.20 ,$1.93 ,$724.54 ,$1.93 ,$195.79 ,$160.53 ,$104.31 ,$434.72 ,$615.86 ,$507.18 ,$1.93 ,$1.93 ,$688.31 ,$550.65 ,$543.41 ,$93.28 ,$615.86 ,$104.31 ,$93.28 ,$93.28 ,$507.18 ,$441.24 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$615.86 ,$234.71 ,$666.58 ,$507.18 ,$342.19 ,$342.19 ,$441.24 ,$342.19 ,$500.66 ,$652.09 ,$495.01 ,$103.24 ,$572.39 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$521.67 ,$449.21 ,$521.67 ,$521.67 ,$579.63 
ST NICHOLAS HOSPITAL - ACUTE,32000186,72170,HC XR PELVIS 1-2V,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$79.41 ,$92.93 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$38.50 ,$333.63 ,$104.31 ,$38.50 ,$38.50 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000188,72170,HC XR PELVIS 1-2V FROG,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$79.41 ,$92.93 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$38.50 ,$333.63 ,$104.31 ,$38.50 ,$38.50 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000189,72190,HC XR PELVIS CMPL 3+V,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$123.74 ,$110.87 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$59.61 ,$333.63 ,$104.31 ,$59.61 ,$59.61 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$116.81 ,$97.07 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$56.31 ,$333.63 ,$104.31 ,$56.31 ,$56.31 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$98.80 ,$83.27 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$47.74 ,$333.63 ,$84.79 ,$47.74 ,$47.74 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000194,62302,HC XR MYELOGRAM C-SPINE,320,1 ,"$2,601.30 ","$1,716.86 ",$19.92 ,"$2,601.30 ",$19.92 ,"$1,782.93 ","$1,782.93 ",$722.97 ,"$1,560.78 ","$2,211.11 ","$1,820.91 ",$19.92 ,$19.92 ,"$2,471.24 ","$1,976.99 ","$1,950.98 ",$230.54 ,"$2,211.11 ",$722.97 ,$230.54 ,$230.54 ,"$1,820.91 ","$1,584.19 ",$19.92 ,$722.97 ,$708.51 ,"$1,445.94 ",$21.12 ,"$2,211.11 ","$1,626.69 ","$2,393.20 ","$1,820.91 ","$1,771.14 ","$2,213.66 ","$1,584.19 ","$2,213.66 ","$1,797.50 ","$2,341.17 ","$1,777.21 ",$715.60 ,"$2,055.03 ",$21.12 ,$459.00 ,$459.00 ,$708.51 ,$459.00 ,"$1,872.94 ","$1,612.81 ","$1,872.94 ","$1,872.94 ","$2,081.04 "
ST NICHOLAS HOSPITAL - ACUTE,32000195,62303,HC XR MYELOGRAM T-SPINE,320,1 ,"$2,105.65 ","$1,389.73 ",$19.92 ,"$2,105.65 ",$19.92 ,"$1,443.21 ","$1,443.21 ",$722.97 ,"$1,263.39 ","$1,789.80 ","$1,473.96 ",$19.92 ,$19.92 ,"$2,000.37 ","$1,600.29 ","$1,579.24 ",$230.54 ,"$1,789.80 ",$722.97 ,$230.54 ,$230.54 ,"$1,473.96 ","$1,282.34 ",$19.92 ,$722.97 ,$708.51 ,"$1,445.94 ",$21.12 ,"$1,789.80 ","$1,626.69 ","$1,937.20 ","$1,473.96 ","$1,771.14 ","$2,105.65 ","$1,282.34 ","$2,105.65 ","$1,455.00 ","$1,895.09 ","$1,438.58 ",$715.60 ,"$1,663.46 ",$21.12 ,$459.00 ,$459.00 ,$708.51 ,$459.00 ,"$1,516.07 ","$1,305.50 ","$1,516.07 ","$1,516.07 ","$1,684.52 "
ST NICHOLAS HOSPITAL - ACUTE,32000196,62304,HC XR MYELOGRAM L-SPINE,320,1 ,"$2,105.65 ","$1,389.73 ",$19.92 ,"$2,105.65 ",$19.92 ,"$1,443.21 ","$1,443.21 ",$722.97 ,"$1,263.39 ","$1,789.80 ","$1,473.96 ",$19.92 ,$19.92 ,"$2,000.37 ","$1,600.29 ","$1,579.24 ",$227.10 ,"$1,789.80 ",$722.97 ,$227.10 ,$227.10 ,"$1,473.96 ","$1,282.34 ",$19.92 ,$722.97 ,$708.51 ,"$1,445.94 ",$21.12 ,"$1,789.80 ","$1,626.69 ","$1,937.20 ","$1,473.96 ","$1,771.14 ","$2,105.65 ","$1,282.34 ","$2,105.65 ","$1,455.00 ","$1,895.09 ","$1,438.58 ",$715.60 ,"$1,663.46 ",$21.12 ,$459.00 ,$459.00 ,$708.51 ,$459.00 ,"$1,516.07 ","$1,305.50 ","$1,516.07 ","$1,516.07 ","$1,684.52 "
ST NICHOLAS HOSPITAL - ACUTE,32000197,62305,HC XR MYELOGRAM >2 REGIONS,320,1 ,"$2,478.25 ","$1,635.65 ",$19.92 ,"$2,478.25 ",$19.92 ,"$1,698.59 ","$1,698.59 ",$722.97 ,"$1,486.95 ","$2,106.51 ","$1,734.78 ",$19.92 ,$19.92 ,"$2,354.34 ","$1,883.47 ","$1,858.69 ",$236.69 ,"$2,106.51 ",$722.97 ,$236.69 ,$236.69 ,"$1,734.78 ","$1,509.25 ",$19.92 ,$722.97 ,$708.51 ,"$1,445.94 ",$21.12 ,"$2,106.51 ","$1,626.69 ","$2,279.99 ","$1,734.78 ","$1,771.14 ","$2,213.66 ","$1,509.25 ","$2,213.66 ","$1,712.47 ","$2,230.43 ","$1,693.14 ",$715.60 ,"$1,957.82 ",$21.12 ,$459.00 ,$459.00 ,$708.51 ,$459.00 ,"$1,784.34 ","$1,536.52 ","$1,784.34 ","$1,784.34 ","$1,982.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000198,72285,HC XR DISKOGRAM C- OR T-SPINE,320,1 ,"$2,376.22 ","$1,568.31 ",$19.92 ,"$3,947.35 ",$19.92 ,$295.54 ,$223.99 ,"$1,754.38 ","$1,425.73 ","$2,019.79 ","$1,663.35 ",$19.92 ,$19.92 ,"$2,257.41 ","$1,805.93 ","$1,782.17 ",$145.41 ,"$2,019.79 ","$1,754.38 ",$145.41 ,$145.41 ,"$1,663.35 ","$1,447.12 ",$19.92 ,"$1,754.38 ","$1,719.29 ","$2,376.22 ",$21.12 ,"$2,019.79 ","$3,947.35 ","$2,186.12 ","$1,663.35 ","$2,376.22 ","$2,376.22 ","$1,447.12 ","$2,376.22 ","$1,641.97 ","$2,138.60 ","$1,623.43 ","$1,736.48 ","$1,877.21 ",$21.12 ,$459.00 ,$459.00 ,"$1,719.29 ",$459.00 ,"$1,710.88 ","$1,473.26 ","$1,710.88 ","$1,710.88 ","$1,900.98 "
ST NICHOLAS HOSPITAL - ACUTE,32000200,72295,HC XR DISKOGRAM L-SPINE,320,1 ,"$3,089.09 ","$2,038.80 ",$19.92 ,"$3,947.35 ",$19.92 ,$299.69 ,$229.51 ,"$1,754.38 ","$1,853.45 ","$2,625.73 ","$2,162.36 ",$19.92 ,$19.92 ,"$2,934.64 ","$2,347.71 ","$2,316.82 ",$141.45 ,"$2,625.73 ","$1,754.38 ",$141.45 ,$141.45 ,"$2,162.36 ","$1,881.26 ",$19.92 ,"$1,754.38 ","$1,719.29 ","$3,089.09 ",$21.12 ,"$2,625.73 ","$3,947.35 ","$2,841.96 ","$2,162.36 ","$3,089.09 ","$3,089.09 ","$1,881.26 ","$3,089.09 ","$2,134.56 ","$2,780.18 ","$2,110.47 ","$1,736.48 ","$2,440.38 ",$21.12 ,$459.00 ,$459.00 ,"$1,719.29 ",$459.00 ,"$2,224.14 ","$1,915.24 ","$2,224.14 ","$2,224.14 ","$2,471.27 "
ST NICHOLAS HOSPITAL - ACUTE,32000201,73000,HC XRAY CLAVICLE,320,1 ,$415.84 ,$274.45 ,$1.93 ,$415.84 ,$1.93 ,$98.80 ,$79.14 ,$84.79 ,$249.50 ,$353.46 ,$291.09 ,$1.93 ,$1.93 ,$395.05 ,$316.04 ,$311.88 ,$47.74 ,$353.46 ,$84.79 ,$47.74 ,$47.74 ,$291.09 ,$253.25 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$353.46 ,$190.79 ,$382.57 ,$291.09 ,$215.92 ,$215.92 ,$253.25 ,$215.92 ,$287.35 ,$374.26 ,$284.10 ,$83.93 ,$328.51 ,$2.05 ,$415.84 ,$415.84 ,$83.09 ,$415.84 ,$299.40 ,$257.82 ,$299.40 ,$299.40 ,$332.67 
ST NICHOLAS HOSPITAL - ACUTE,32000202,73000,HC XRAY CLAVICLE 2V OR,320,1 ,$415.84 ,$274.45 ,$1.93 ,$415.84 ,$1.93 ,$98.80 ,$79.14 ,$84.79 ,$249.50 ,$353.46 ,$291.09 ,$1.93 ,$1.93 ,$395.05 ,$316.04 ,$311.88 ,$47.74 ,$353.46 ,$84.79 ,$47.74 ,$47.74 ,$291.09 ,$253.25 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$353.46 ,$190.79 ,$382.57 ,$291.09 ,$215.92 ,$215.92 ,$253.25 ,$215.92 ,$287.35 ,$374.26 ,$284.10 ,$83.93 ,$328.51 ,$2.05 ,$415.84 ,$415.84 ,$83.09 ,$415.84 ,$299.40 ,$257.82 ,$299.40 ,$299.40 ,$332.67 
ST NICHOLAS HOSPITAL - ACUTE,32000204,73010,HC XRAY SCAPULA,320,1 ,$439.18 ,$289.86 ,$1.93 ,$439.18 ,$1.93 ,$61.40 ,$87.41 ,$104.31 ,$263.51 ,$373.30 ,$307.43 ,$1.93 ,$1.93 ,$417.22 ,$333.78 ,$329.39 ,$29.25 ,$373.30 ,$104.31 ,$29.25 ,$29.25 ,$307.43 ,$267.46 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$373.30 ,$234.71 ,$404.05 ,$307.43 ,$215.92 ,$215.92 ,$267.46 ,$215.92 ,$303.47 ,$395.26 ,$300.05 ,$103.24 ,$346.95 ,$2.05 ,$439.18 ,$439.18 ,$102.22 ,$439.18 ,$316.21 ,$272.29 ,$316.21 ,$316.21 ,$351.34 
ST NICHOLAS HOSPITAL - ACUTE,32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$57.24 ,$59.82 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$27.94 ,$333.63 ,$84.79 ,$27.94 ,$27.94 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$104.34 ,$79.14 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$50.37 ,$333.63 ,$84.79 ,$50.37 ,$50.37 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$104.34 ,$79.14 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$50.37 ,$333.63 ,$84.79 ,$50.37 ,$50.37 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000209,73030,HC XRAY SHOULDER TRAUMA (MIN 2V),320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$104.34 ,$79.14 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$50.37 ,$333.63 ,$84.79 ,$50.37 ,$50.37 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$2,060.80 ","$1,360.13 ",$6.22 ,"$2,060.80 ",$6.22 ,$439.63 ,$321.94 ,$359.59 ,"$1,236.48 ","$1,751.68 ","$1,442.56 ",$6.22 ,$6.22 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ",$208.10 ,"$1,751.68 ",$359.59 ,$208.10 ,$208.10 ,"$1,442.56 ","$1,255.03 ",$6.22 ,$359.59 ,$352.40 ,$719.18 ,$6.59 ,"$1,751.68 ",$809.07 ,"$1,895.94 ","$1,442.56 ","$1,916.33 ","$1,916.33 ","$1,255.03 ","$1,916.33 ","$1,424.01 ","$1,854.72 ","$1,407.94 ",$355.93 ,"$1,628.03 ",$6.59 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,"$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$2,060.80 ","$1,360.13 ",$6.22 ,"$2,060.80 ",$6.22 ,$439.63 ,$321.94 ,$359.59 ,"$1,236.48 ","$1,751.68 ","$1,442.56 ",$6.22 ,$6.22 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ",$208.10 ,"$1,751.68 ",$359.59 ,$208.10 ,$208.10 ,"$1,442.56 ","$1,255.03 ",$6.22 ,$359.59 ,$352.40 ,$719.18 ,$6.59 ,"$1,751.68 ",$809.07 ,"$1,895.94 ","$1,442.56 ","$1,916.33 ","$1,916.33 ","$1,255.03 ","$1,916.33 ","$1,424.01 ","$1,854.72 ","$1,407.94 ",$355.93 ,"$1,628.03 ",$6.59 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,"$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$79.41 ,$102.59 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$38.50 ,$333.63 ,$84.79 ,$38.50 ,$38.50 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$98.80 ,$83.27 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$47.74 ,$333.63 ,$84.79 ,$47.74 ,$47.74 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$98.80 ,$83.27 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$47.74 ,$333.63 ,$84.79 ,$47.74 ,$47.74 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$86.33 ,$72.24 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$41.80 ,$333.63 ,$84.79 ,$41.80 ,$41.80 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$86.33 ,$72.24 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$41.80 ,$333.63 ,$84.79 ,$41.80 ,$41.80 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000219,73070,HC XRAY ELBOW (2 V) OR,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$86.33 ,$72.24 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$41.80 ,$333.63 ,$84.79 ,$41.80 ,$41.80 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$98.80 ,$80.52 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$47.74 ,$333.63 ,$84.79 ,$47.74 ,$47.74 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$98.80 ,$80.52 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$47.74 ,$333.63 ,$84.79 ,$47.74 ,$47.74 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000222,73085,HC XRAY ELBOW ARTHRO,320,1 ,"$1,120.10 ",$739.27 ,$4.15 ,"$1,120.10 ",$4.15 ,$357.88 ,$298.49 ,$359.59 ,$672.06 ,$952.09 ,$784.07 ,$4.15 ,$4.15 ,"$1,064.10 ",$851.28 ,$840.08 ,$167.85 ,$952.09 ,$359.59 ,$167.85 ,$167.85 ,$784.07 ,$682.14 ,$4.15 ,$359.59 ,$352.40 ,$719.18 ,$4.40 ,$952.09 ,$809.07 ,"$1,030.49 ",$784.07 ,"$1,120.10 ","$1,120.10 ",$682.14 ,"$1,120.10 ",$773.99 ,"$1,008.09 ",$765.25 ,$355.93 ,$884.88 ,$4.40 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,$806.47 ,$694.46 ,$806.47 ,$806.47 ,$896.08 
ST NICHOLAS HOSPITAL - ACUTE,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$87.72 ,$75.00 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$42.46 ,$333.63 ,$84.79 ,$42.46 ,$42.46 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$87.72 ,$75.00 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$42.46 ,$333.63 ,$84.79 ,$42.46 ,$42.46 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$98.80 ,$79.14 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$47.07 ,$333.63 ,$104.31 ,$47.07 ,$47.07 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$342.19 ,$342.19 ,$239.03 ,$342.19 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$105.73 ,$90.17 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$51.05 ,$333.63 ,$84.79 ,$51.05 ,$51.05 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$105.73 ,$90.17 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$51.05 ,$333.63 ,$84.79 ,$51.05 ,$51.05 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$133.44 ,$106.73 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$64.23 ,$333.63 ,$84.79 ,$64.23 ,$64.23 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$133.44 ,$106.73 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$64.23 ,$333.63 ,$84.79 ,$64.23 ,$64.23 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000235,73110,HC XRAY WRIST COMP MIN 3 V + NAVIC,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$133.44 ,$106.73 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$64.23 ,$333.63 ,$84.79 ,$64.23 ,$64.23 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,"$1,033.23 ",$681.93 ,$4.15 ,"$1,033.23 ",$4.15 ,$459.02 ,$346.77 ,$359.59 ,$619.94 ,$878.25 ,$723.26 ,$4.15 ,$4.15 ,$981.57 ,$785.25 ,$774.92 ,$215.35 ,$878.25 ,$359.59 ,$215.35 ,$215.35 ,$723.26 ,$629.24 ,$4.15 ,$359.59 ,$352.40 ,$719.18 ,$4.40 ,$878.25 ,$809.07 ,$950.57 ,$723.26 ,"$1,033.23 ","$1,033.23 ",$629.24 ,"$1,033.23 ",$713.96 ,$929.91 ,$705.90 ,$355.93 ,$816.25 ,$4.40 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,$743.93 ,$640.60 ,$743.93 ,$743.93 ,$826.58 
ST NICHOLAS HOSPITAL - ACUTE,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$94.65 ,$79.14 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$45.76 ,$333.63 ,$104.31 ,$45.76 ,$45.76 ,$274.75 ,$239.03 ,$2.89 ,$104.31 ,$102.22 ,$208.62 ,$3.06 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$94.65 ,$79.14 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$45.76 ,$333.63 ,$104.31 ,$45.76 ,$45.76 ,$274.75 ,$239.03 ,$2.89 ,$104.31 ,$102.22 ,$208.62 ,$3.06 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$115.43 ,$94.31 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$56.31 ,$333.63 ,$84.79 ,$56.31 ,$56.31 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$115.43 ,$94.31 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$56.31 ,$333.63 ,$84.79 ,$56.31 ,$56.31 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$126.51 ,$102.59 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$61.60 ,$333.63 ,$84.79 ,$61.60 ,$61.60 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000243,73140,HC XRAY FINGER MIN 2 VIEWS MULTI,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$126.51 ,$102.59 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$61.60 ,$333.63 ,$84.79 ,$61.60 ,$61.60 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$2,060.80 ","$1,360.13 ",$4.15 ,"$2,060.80 ",$4.15 ,$443.78 ,$323.32 ,$359.59 ,"$1,236.48 ","$1,751.68 ","$1,442.56 ",$4.15 ,$4.15 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ",$204.16 ,"$1,751.68 ",$359.59 ,$204.16 ,$204.16 ,"$1,442.56 ","$1,255.03 ",$4.15 ,$359.59 ,$352.40 ,$719.18 ,$4.40 ,"$1,751.68 ",$809.07 ,"$1,895.94 ","$1,442.56 ","$1,277.55 ","$1,277.55 ","$1,255.03 ","$1,277.55 ","$1,424.01 ","$1,854.72 ","$1,407.94 ",$355.93 ,"$1,628.03 ",$4.40 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,"$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000253,73525,HC XRAY HIP ARTHRGRPHY OR,320,1 ,"$2,060.80 ","$1,360.13 ",$4.15 ,"$2,060.80 ",$4.15 ,$443.78 ,$323.32 ,$359.59 ,"$1,236.48 ","$1,751.68 ","$1,442.56 ",$4.15 ,$4.15 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ",$204.16 ,"$1,751.68 ",$359.59 ,$204.16 ,$204.16 ,"$1,442.56 ","$1,255.03 ",$4.15 ,$359.59 ,$352.40 ,$719.18 ,$4.40 ,"$1,751.68 ",$809.07 ,"$1,895.94 ","$1,442.56 ","$1,277.55 ","$1,277.55 ","$1,255.03 ","$1,277.55 ","$1,424.01 ","$1,854.72 ","$1,407.94 ",$355.93 ,"$1,628.03 ",$4.40 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,"$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$107.12 ,$91.55 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$51.70 ,$333.63 ,$84.79 ,$51.70 ,$51.70 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$107.12 ,$91.55 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$51.70 ,$333.63 ,$84.79 ,$51.70 ,$51.70 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$130.67 ,$106.73 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$62.26 ,$333.63 ,$84.79 ,$62.26 ,$62.26 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$130.67 ,$106.73 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$62.26 ,$333.63 ,$84.79 ,$62.26 ,$62.26 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$145.91 ,$116.38 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$70.17 ,$333.63 ,$104.31 ,$70.17 ,$70.17 ,$274.75 ,$239.03 ,$2.89 ,$104.31 ,$102.22 ,$208.62 ,$3.06 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$145.91 ,$116.38 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$70.17 ,$333.63 ,$104.31 ,$70.17 ,$70.17 ,$274.75 ,$239.03 ,$2.89 ,$104.31 ,$102.22 ,$208.62 ,$3.06 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000267,73565,HC XR KNEE STAND,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$132.05 ,$109.49 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$62.26 ,$333.63 ,$84.79 ,$62.26 ,$62.26 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,188.11 ",$784.15 ,$6.22 ,"$1,188.11 ",$6.22 ,$501.97 ,$381.26 ,$359.59 ,$712.87 ,"$1,009.89 ",$831.68 ,$6.22 ,$6.22 ,"$1,128.70 ",$902.96 ,$891.08 ,$193.58 ,"$1,009.89 ",$359.59 ,$193.58 ,$193.58 ,$831.68 ,$723.56 ,$6.22 ,$359.59 ,$352.40 ,$719.18 ,$6.59 ,"$1,009.89 ",$809.07 ,"$1,093.06 ",$831.68 ,"$1,188.11 ","$1,188.11 ",$723.56 ,"$1,188.11 ",$820.98 ,"$1,069.30 ",$811.72 ,$355.93 ,$938.61 ,$6.59 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,$855.44 ,$736.63 ,$855.44 ,$855.44 ,$950.49 
ST NICHOLAS HOSPITAL - ACUTE,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,188.11 ",$784.15 ,$6.22 ,"$1,188.11 ",$6.22 ,$501.97 ,$381.26 ,$359.59 ,$712.87 ,"$1,009.89 ",$831.68 ,$6.22 ,$6.22 ,"$1,128.70 ",$902.96 ,$891.08 ,$193.58 ,"$1,009.89 ",$359.59 ,$193.58 ,$193.58 ,$831.68 ,$723.56 ,$6.22 ,$359.59 ,$352.40 ,$719.18 ,$6.59 ,"$1,009.89 ",$809.07 ,"$1,093.06 ",$831.68 ,"$1,188.11 ","$1,188.11 ",$723.56 ,"$1,188.11 ",$820.98 ,"$1,069.30 ",$811.72 ,$355.93 ,$938.61 ,$6.59 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,$855.44 ,$736.63 ,$855.44 ,$855.44 ,$950.49 
ST NICHOLAS HOSPITAL - ACUTE,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$97.42 ,$81.90 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$47.07 ,$333.63 ,$84.79 ,$47.07 ,$47.07 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$97.42 ,$81.90 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$47.07 ,$333.63 ,$84.79 ,$47.07 ,$47.07 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$98.80 ,$79.14 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$47.07 ,$333.63 ,$84.79 ,$47.07 ,$47.07 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$98.80 ,$79.14 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$47.07 ,$333.63 ,$84.79 ,$47.07 ,$47.07 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$100.19 ,$86.03 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$48.40 ,$333.63 ,$84.79 ,$48.40 ,$48.40 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$100.19 ,$86.03 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$48.40 ,$333.63 ,$84.79 ,$48.40 ,$48.40 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$116.81 ,$94.31 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$56.31 ,$333.63 ,$84.79 ,$56.31 ,$56.31 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$116.81 ,$94.31 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$56.31 ,$333.63 ,$84.79 ,$56.31 ,$56.31 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000278,73615,HC XRAY ARTHRO ANKLE,320,1 ,"$1,544.54 ","$1,019.40 ",$4.15 ,"$1,544.54 ",$4.15 ,$442.40 ,$345.39 ,$359.59 ,$926.72 ,"$1,312.86 ","$1,081.18 ",$4.15 ,$4.15 ,"$1,467.31 ","$1,173.85 ","$1,158.41 ",$203.48 ,"$1,312.86 ",$359.59 ,$203.48 ,$203.48 ,"$1,081.18 ",$940.62 ,$4.15 ,$359.59 ,$352.40 ,$719.18 ,$4.40 ,"$1,312.86 ",$809.07 ,"$1,420.98 ","$1,081.18 ","$1,277.55 ","$1,277.55 ",$940.62 ,"$1,277.55 ","$1,067.28 ","$1,390.09 ","$1,055.23 ",$355.93 ,"$1,220.19 ",$4.40 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,"$1,112.07 ",$957.61 ,"$1,112.07 ","$1,112.07 ","$1,235.63 "
ST NICHOLAS HOSPITAL - ACUTE,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$84.95 ,$73.62 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$41.12 ,$333.63 ,$84.79 ,$41.12 ,$41.12 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$84.95 ,$73.62 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$41.12 ,$333.63 ,$84.79 ,$41.12 ,$41.12 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000280,73620,HC XRAY FOOT (2 V) OR,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$84.95 ,$73.62 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$41.12 ,$333.63 ,$84.79 ,$41.12 ,$41.12 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$108.50 ,$87.41 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$51.70 ,$333.63 ,$84.79 ,$51.70 ,$51.70 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$108.50 ,$87.41 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$51.70 ,$333.63 ,$84.79 ,$51.70 ,$51.70 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$86.33 ,$72.24 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$41.14 ,$333.63 ,$84.79 ,$41.14 ,$41.14 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$86.33 ,$72.24 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$41.14 ,$333.63 ,$84.79 ,$41.14 ,$41.14 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$93.26 ,$84.65 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$45.10 ,$333.63 ,$84.79 ,$45.10 ,$45.10 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$93.26 ,$84.65 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$45.10 ,$333.63 ,$84.79 ,$45.10 ,$45.10 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$323.88 ,$323.88 ,$239.03 ,$323.88 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$383.99 ,$253.43 ,$1.93 ,$383.99 ,$1.93 ,$87.72 ,$73.62 ,$84.79 ,$230.39 ,$326.39 ,$268.79 ,$1.93 ,$1.93 ,$364.79 ,$291.83 ,$287.99 ,$41.80 ,$326.39 ,$84.79 ,$41.80 ,$41.80 ,$268.79 ,$233.85 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$326.39 ,$190.79 ,$353.27 ,$268.79 ,$230.65 ,$230.65 ,$233.85 ,$230.65 ,$265.34 ,$345.59 ,$262.34 ,$83.93 ,$303.35 ,$2.05 ,$383.99 ,$383.99 ,$83.09 ,$383.99 ,$276.47 ,$238.07 ,$276.47 ,$276.47 ,$307.19 
ST NICHOLAS HOSPITAL - ACUTE,32000292,74018,HC XRAY ABDOMEN 1V SHUNTOGRAM,320,1 ,$383.99 ,$253.43 ,$1.93 ,$383.99 ,$1.93 ,$87.72 ,$73.62 ,$84.79 ,$230.39 ,$326.39 ,$268.79 ,$1.93 ,$1.93 ,$364.79 ,$291.83 ,$287.99 ,$41.80 ,$326.39 ,$84.79 ,$41.80 ,$41.80 ,$268.79 ,$233.85 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$326.39 ,$190.79 ,$353.27 ,$268.79 ,$230.65 ,$230.65 ,$233.85 ,$230.65 ,$265.34 ,$345.59 ,$262.34 ,$83.93 ,$303.35 ,$2.05 ,$383.99 ,$383.99 ,$83.09 ,$383.99 ,$276.47 ,$238.07 ,$276.47 ,$276.47 ,$307.19 
ST NICHOLAS HOSPITAL - ACUTE,32000294,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V),320,1 ,$383.99 ,$253.43 ,$1.93 ,$383.99 ,$1.93 ,$105.73 ,$88.79 ,$104.31 ,$230.39 ,$326.39 ,$268.79 ,$1.93 ,$1.93 ,$364.79 ,$291.83 ,$287.99 ,$51.02 ,$326.39 ,$104.31 ,$51.02 ,$51.02 ,$268.79 ,$233.85 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$326.39 ,$234.71 ,$353.27 ,$268.79 ,$383.99 ,$383.99 ,$233.85 ,$383.99 ,$265.34 ,$345.59 ,$262.34 ,$103.24 ,$303.35 ,$2.05 ,$383.99 ,$383.99 ,$102.22 ,$383.99 ,$276.47 ,$238.07 ,$276.47 ,$276.47 ,$307.19 
ST NICHOLAS HOSPITAL - ACUTE,32000295,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V BABY PORT),320,1 ,$383.99 ,$253.43 ,$1.93 ,$383.99 ,$1.93 ,$105.73 ,$88.79 ,$104.31 ,$230.39 ,$326.39 ,$268.79 ,$1.93 ,$1.93 ,$364.79 ,$291.83 ,$287.99 ,$51.02 ,$326.39 ,$104.31 ,$51.02 ,$51.02 ,$268.79 ,$233.85 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$326.39 ,$234.71 ,$353.27 ,$268.79 ,$383.99 ,$383.99 ,$233.85 ,$383.99 ,$265.34 ,$345.59 ,$262.34 ,$103.24 ,$303.35 ,$2.05 ,$383.99 ,$383.99 ,$102.22 ,$383.99 ,$276.47 ,$238.07 ,$276.47 ,$276.47 ,$307.19 
ST NICHOLAS HOSPITAL - ACUTE,32000296,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V BABY,320,1 ,$383.99 ,$253.43 ,$1.93 ,$383.99 ,$1.93 ,$105.73 ,$88.79 ,$104.31 ,$230.39 ,$326.39 ,$268.79 ,$1.93 ,$1.93 ,$364.79 ,$291.83 ,$287.99 ,$51.02 ,$326.39 ,$104.31 ,$51.02 ,$51.02 ,$268.79 ,$233.85 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$326.39 ,$234.71 ,$353.27 ,$268.79 ,$383.99 ,$383.99 ,$233.85 ,$383.99 ,$265.34 ,$345.59 ,$262.34 ,$103.24 ,$303.35 ,$2.05 ,$383.99 ,$383.99 ,$102.22 ,$383.99 ,$276.47 ,$238.07 ,$276.47 ,$276.47 ,$307.19 
ST NICHOLAS HOSPITAL - ACUTE,32000297,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V)FLAT,320,1 ,$383.99 ,$253.43 ,$1.93 ,$383.99 ,$1.93 ,$105.73 ,$88.79 ,$104.31 ,$230.39 ,$326.39 ,$268.79 ,$1.93 ,$1.93 ,$364.79 ,$291.83 ,$287.99 ,$51.02 ,$326.39 ,$104.31 ,$51.02 ,$51.02 ,$268.79 ,$233.85 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$326.39 ,$234.71 ,$353.27 ,$268.79 ,$383.99 ,$383.99 ,$233.85 ,$383.99 ,$265.34 ,$345.59 ,$262.34 ,$103.24 ,$303.35 ,$2.05 ,$383.99 ,$383.99 ,$102.22 ,$383.99 ,$276.47 ,$238.07 ,$276.47 ,$276.47 ,$307.19 
ST NICHOLAS HOSPITAL - ACUTE,32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,$545.88 ,$360.28 ,$1.93 ,$545.88 ,$1.93 ,$143.14 ,$116.38 ,$104.31 ,$327.53 ,$464.00 ,$382.12 ,$1.93 ,$1.93 ,$518.59 ,$414.87 ,$409.41 ,$68.18 ,$464.00 ,$104.31 ,$68.18 ,$68.18 ,$382.12 ,$332.44 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$464.00 ,$234.71 ,$502.21 ,$382.12 ,$342.19 ,$342.19 ,$332.44 ,$342.19 ,$377.20 ,$491.29 ,$372.95 ,$103.24 ,$431.25 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$393.03 ,$338.45 ,$393.03 ,$393.03 ,$436.70 
ST NICHOLAS HOSPITAL - ACUTE,32000299,74190,HC S AND I PERITONEOGRAM,320,1 ,$685.99 ,$452.75 ,$4.15 ,"$1,104.87 ",$4.15 ,$132.41 ,$129.78 ,$491.05 ,$411.59 ,$583.09 ,$480.19 ,$4.15 ,$4.15 ,$651.69 ,$521.35 ,$514.49 ,$108.14 ,$583.09 ,$491.05 ,$108.14 ,$108.14 ,$480.19 ,$417.77 ,$4.15 ,$491.05 ,$481.23 ,$685.99 ,$4.40 ,$583.09 ,"$1,104.87 ",$631.11 ,$480.19 ,$685.99 ,$685.99 ,$417.77 ,$685.99 ,$474.02 ,$617.39 ,$468.67 ,$486.04 ,$541.93 ,$4.40 ,$459.00 ,$459.00 ,$481.23 ,$459.00 ,$493.91 ,$425.31 ,$493.91 ,$493.91 ,$548.79 
ST NICHOLAS HOSPITAL - ACUTE,32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$627.87 ,$414.39 ,$1.93 ,$627.87 ,$1.93 ,$298.31 ,$243.31 ,$176.01 ,$376.72 ,$533.69 ,$439.51 ,$1.93 ,$1.93 ,$596.48 ,$477.18 ,$470.90 ,$140.14 ,$533.69 ,$176.01 ,$140.14 ,$140.14 ,$439.51 ,$382.37 ,$1.93 ,$176.01 ,$172.49 ,$352.02 ,$2.05 ,$533.69 ,$396.03 ,$577.64 ,$439.51 ,$383.43 ,$383.43 ,$382.37 ,$383.43 ,$433.86 ,$565.08 ,$428.96 ,$174.21 ,$496.02 ,$2.05 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$452.07 ,$389.28 ,$452.07 ,$452.07 ,$502.30 
ST NICHOLAS HOSPITAL - ACUTE,32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,$639.29 ,$421.93 ,$4.15 ,$639.29 ,$4.15 ,$434.08 ,$389.54 ,$176.01 ,$383.57 ,$543.40 ,$447.50 ,$4.15 ,$4.15 ,$607.33 ,$485.86 ,$479.47 ,$201.52 ,$543.40 ,$176.01 ,$201.52 ,$201.52 ,$447.50 ,$389.33 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$543.40 ,$396.03 ,$588.15 ,$447.50 ,$383.43 ,$383.43 ,$389.33 ,$383.43 ,$441.75 ,$575.36 ,$436.76 ,$174.21 ,$505.04 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$460.29 ,$396.36 ,$460.29 ,$460.29 ,$511.43 
ST NICHOLAS HOSPITAL - ACUTE,32000302,74240,HC XRAY UPPER GI TRACT,320,1 ,$639.29 ,$421.93 ,$4.15 ,$639.29 ,$4.15 ,$364.81 ,$338.50 ,$176.01 ,$383.57 ,$543.40 ,$447.50 ,$4.15 ,$4.15 ,$607.33 ,$485.86 ,$479.47 ,$171.15 ,$543.40 ,$176.01 ,$171.15 ,$171.15 ,$447.50 ,$389.33 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$543.40 ,$396.03 ,$588.15 ,$447.50 ,$569.39 ,$569.39 ,$389.33 ,$569.39 ,$441.75 ,$575.36 ,$436.76 ,$174.21 ,$505.04 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$460.29 ,$396.36 ,$460.29 ,$460.29 ,$511.43 
ST NICHOLAS HOSPITAL - ACUTE,32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,$987.99 ,$652.07 ,$4.15 ,$987.99 ,$4.15 ,$420.23 ,$393.68 ,$176.01 ,$592.79 ,$839.79 ,$691.59 ,$4.15 ,$4.15 ,$938.59 ,$750.87 ,$740.99 ,$196.21 ,$839.79 ,$176.01 ,$196.21 ,$196.21 ,$691.59 ,$601.69 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$839.79 ,$396.03 ,$908.95 ,$691.59 ,$569.39 ,$569.39 ,$601.69 ,$569.39 ,$682.70 ,$889.19 ,$674.99 ,$174.21 ,$780.51 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$711.35 ,$612.55 ,$711.35 ,$711.35 ,$790.39 
ST NICHOLAS HOSPITAL - ACUTE,32000307,74246,HC XRAY ESOPHAGUS/UGI W AIR,320,1 ,$987.99 ,$652.07 ,$4.15 ,$987.99 ,$4.15 ,$420.23 ,$393.68 ,$176.01 ,$592.79 ,$839.79 ,$691.59 ,$4.15 ,$4.15 ,$938.59 ,$750.87 ,$740.99 ,$196.21 ,$839.79 ,$176.01 ,$196.21 ,$196.21 ,$691.59 ,$601.69 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$839.79 ,$396.03 ,$908.95 ,$691.59 ,$569.39 ,$569.39 ,$601.69 ,$569.39 ,$682.70 ,$889.19 ,$674.99 ,$174.21 ,$780.51 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$711.35 ,$612.55 ,$711.35 ,$711.35 ,$790.39 
ST NICHOLAS HOSPITAL - ACUTE,32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$744.11 ,$491.11 ,$4.15 ,$744.11 ,$4.15 ,$362.04 ,$345.39 ,$176.01 ,$446.47 ,$632.49 ,$520.88 ,$4.15 ,$4.15 ,$706.90 ,$565.52 ,$558.08 ,$169.82 ,$632.49 ,$176.01 ,$169.82 ,$169.82 ,$520.88 ,$453.16 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$632.49 ,$396.03 ,$684.58 ,$520.88 ,$383.43 ,$383.43 ,$453.16 ,$383.43 ,$514.18 ,$669.70 ,$508.38 ,$174.21 ,$587.85 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$535.76 ,$461.35 ,$535.76 ,$535.76 ,$595.29 
ST NICHOLAS HOSPITAL - ACUTE,32000312,74018,HC SITZ MARKER STUDY,320,1 ,$383.99 ,$253.43 ,$1.93 ,$383.99 ,$1.93 ,$87.72 ,$73.62 ,$84.79 ,$230.39 ,$326.39 ,$268.79 ,$1.93 ,$1.93 ,$364.79 ,$291.83 ,$287.99 ,$41.80 ,$326.39 ,$84.79 ,$41.80 ,$41.80 ,$268.79 ,$233.85 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$326.39 ,$190.79 ,$353.27 ,$268.79 ,$230.65 ,$230.65 ,$233.85 ,$230.65 ,$265.34 ,$345.59 ,$262.34 ,$83.93 ,$303.35 ,$2.05 ,$383.99 ,$383.99 ,$83.09 ,$383.99 ,$276.47 ,$238.07 ,$276.47 ,$276.47 ,$307.19 
ST NICHOLAS HOSPITAL - ACUTE,32000314,74251,HC SMALL BOWEL VIA ENTEROCLY TUBE,320,1 ,"$1,139.51 ",$752.08 ,$4.15 ,"$1,139.51 ",$4.15 ,"$1,139.51 ","$1,139.51 ",$176.01 ,$683.71 ,$968.58 ,$797.66 ,$4.15 ,$4.15 ,"$1,082.53 ",$866.03 ,$854.63 ,$631.13 ,$968.58 ,$176.01 ,$631.13 ,$631.13 ,$797.66 ,$693.96 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$968.58 ,$396.03 ,"$1,048.35 ",$797.66 ,$569.39 ,$569.39 ,$693.96 ,$569.39 ,$787.40 ,"$1,025.56 ",$778.51 ,$174.21 ,$900.21 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$820.45 ,$706.50 ,$820.45 ,$820.45 ,$911.61 
ST NICHOLAS HOSPITAL - ACUTE,32000315,74270,HC XRAY COLON BARIUM,320,1 ,$790.81 ,$521.93 ,$4.15 ,$790.81 ,$4.15 ,$452.10 ,$490.25 ,$176.01 ,$474.49 ,$672.19 ,$553.57 ,$4.15 ,$4.15 ,$751.27 ,$601.02 ,$593.11 ,$211.42 ,$672.19 ,$176.01 ,$211.42 ,$211.42 ,$553.57 ,$481.60 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$672.19 ,$396.03 ,$727.55 ,$553.57 ,$569.39 ,$569.39 ,$481.60 ,$569.39 ,$546.45 ,$711.73 ,$540.28 ,$174.21 ,$624.74 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$569.38 ,$490.30 ,$569.38 ,$569.38 ,$632.65 
ST NICHOLAS HOSPITAL - ACUTE,32000318,74270,HC XRAY BARM ENEMA/COLSTMY,320,1 ,$790.81 ,$521.93 ,$4.15 ,$790.81 ,$4.15 ,$452.10 ,$490.25 ,$176.01 ,$474.49 ,$672.19 ,$553.57 ,$4.15 ,$4.15 ,$751.27 ,$601.02 ,$593.11 ,$211.42 ,$672.19 ,$176.01 ,$211.42 ,$211.42 ,$553.57 ,$481.60 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$672.19 ,$396.03 ,$727.55 ,$553.57 ,$569.39 ,$569.39 ,$481.60 ,$569.39 ,$546.45 ,$711.73 ,$540.28 ,$174.21 ,$624.74 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$569.38 ,$490.30 ,$569.38 ,$569.38 ,$632.65 
ST NICHOLAS HOSPITAL - ACUTE,32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,$790.81 ,$521.93 ,$4.15 ,$790.81 ,$4.15 ,$452.10 ,$490.25 ,$176.01 ,$474.49 ,$672.19 ,$553.57 ,$4.15 ,$4.15 ,$751.27 ,$601.02 ,$593.11 ,$211.42 ,$672.19 ,$176.01 ,$211.42 ,$211.42 ,$553.57 ,$481.60 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$672.19 ,$396.03 ,$727.55 ,$553.57 ,$569.39 ,$569.39 ,$481.60 ,$569.39 ,$546.45 ,$711.73 ,$540.28 ,$174.21 ,$624.74 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$569.38 ,$490.30 ,$569.38 ,$569.38 ,$632.65 
ST NICHOLAS HOSPITAL - ACUTE,32000320,74280,HC XRAY COLON BARIUM AIR CONTRAST,320,1 ,"$1,139.51 ",$752.08 ,$4.15 ,"$1,139.51 ",$4.15 ,$697.32 ,$688.91 ,$176.01 ,$683.71 ,$968.58 ,$797.66 ,$4.15 ,$4.15 ,"$1,082.53 ",$866.03 ,$854.63 ,$325.79 ,$968.58 ,$176.01 ,$325.79 ,$325.79 ,$797.66 ,$693.96 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$968.58 ,$396.03 ,"$1,048.35 ",$797.66 ,$569.39 ,$569.39 ,$693.96 ,$569.39 ,$787.40 ,"$1,025.56 ",$778.51 ,$174.21 ,$900.21 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$820.45 ,$706.50 ,$820.45 ,$820.45 ,$911.61 
ST NICHOLAS HOSPITAL - ACUTE,32000322,74283,HC THERAPEUTIC COLON,320,1 ,$876.30 ,$578.36 ,$4.15 ,$876.30 ,$4.15 ,$671.00 ,$505.43 ,$176.01 ,$525.78 ,$744.86 ,$613.41 ,$4.15 ,$4.15 ,$832.49 ,$665.99 ,$657.23 ,$312.38 ,$744.86 ,$176.01 ,$312.38 ,$312.38 ,$613.41 ,$533.67 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$744.86 ,$396.03 ,$806.20 ,$613.41 ,$569.39 ,$569.39 ,$533.67 ,$569.39 ,$605.52 ,$788.67 ,$598.69 ,$174.21 ,$692.28 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$630.94 ,$543.31 ,$630.94 ,$630.94 ,$701.04 
ST NICHOLAS HOSPITAL - ACUTE,32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,$802.22 ,$529.47 ,$6.83 ,$802.22 ,$6.83 ,$95.95 ,$129.42 , N/A ,$481.33 ,$681.89 ,$561.55 ,$6.83 ,$6.83 ,$762.11 ,$609.69 ,$601.67 ,$98.26 ,$681.89 , N/A ,$98.26 ,$98.26 ,$561.55 ,$488.55 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$681.89 , N/A ,$738.04 ,$561.55 ,$406.89 ,$488.31 ,$488.55 ,$488.31 ,$554.33 ,$722.00 ,$548.08 , N/A ,$633.75 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$577.60 ,$497.38 ,$577.60 ,$577.60 ,$641.78 
ST NICHOLAS HOSPITAL - ACUTE,32000325,47531,HC XRAY CHOLANGIOGRAM THRU CATH,320,1 ,"$1,932.00 ","$1,275.12 ",$57.71 ,"$7,778.08 ",$57.71 ,"$1,324.19 ","$1,324.19 ","$3,456.92 ","$1,159.20 ","$1,642.20 ","$1,352.40 ",$57.71 ,$57.71 ,"$1,835.40 ","$1,468.32 ","$1,449.00 ",$134.50 ,"$1,642.20 ","$3,456.92 ",$134.50 ,$134.50 ,"$1,352.40 ","$1,176.59 ",$57.71 ,"$3,456.92 ","$3,387.78 ","$1,932.00 ",$61.17 ,"$1,642.20 ","$7,778.08 ","$1,777.44 ","$1,352.40 ","$3,273.50 ","$4,091.88 ","$1,176.59 ","$4,091.88 ","$1,335.01 ","$1,738.80 ","$1,319.94 ","$3,421.66 ","$1,526.28 ",$61.17 ,$459.00 ,$459.00 ,"$3,387.78 ",$459.00 ,"$1,391.04 ","$1,197.84 ","$1,391.04 ","$1,391.04 ","$1,545.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000326,47532,HC PERCUTAN CHOLANGIOGRAM,320,1 ,"$2,447.20 ","$1,615.15 ",$57.71 ,"$7,778.08 ",$57.71 ,"$1,677.31 ","$1,677.31 ","$3,456.92 ","$1,468.32 ","$2,080.12 ","$1,713.04 ",$57.71 ,$57.71 ,"$2,324.84 ","$1,859.87 ","$1,835.40 ",$400.53 ,"$2,080.12 ","$3,456.92 ",$400.53 ,$400.53 ,"$1,713.04 ","$1,490.34 ",$57.71 ,"$3,456.92 ","$3,387.78 ","$2,447.20 ",$61.17 ,"$2,080.12 ","$7,778.08 ","$2,251.42 ","$1,713.04 ","$3,273.50 ","$4,091.88 ","$1,490.34 ","$4,091.88 ","$1,691.02 ","$2,202.48 ","$1,671.93 ","$3,421.66 ","$1,933.29 ",$61.17 ,$459.00 ,$459.00 ,"$3,387.78 ",$459.00 ,"$1,761.98 ","$1,517.26 ","$1,761.98 ","$1,761.98 ","$1,957.76 "
ST NICHOLAS HOSPITAL - ACUTE,32000327,47544,HC XRAY REM BILE DUCT STONE,320,1 ,"$4,096.30 ","$2,703.56 ",$202.70 ,"$4,096.30 ",$202.70 ,"$2,807.60 ","$2,807.60 ", N/A ,"$2,457.78 ","$3,481.86 ","$2,867.41 ",$202.70 ,$202.70 ,"$3,891.49 ","$3,113.19 ","$3,072.23 ",$296.66 ,"$3,481.86 ", N/A ,$296.66 ,$296.66 ,"$2,867.41 ","$2,494.65 ",$202.70 , N/A , N/A , N/A ,$214.86 ,"$3,481.86 ", N/A ,"$3,768.60 ","$2,867.41 ","$2,077.64 ","$2,493.42 ","$2,494.65 ","$2,493.42 ","$2,830.54 ","$3,686.67 ","$2,798.59 ", N/A ,"$3,236.08 ",$214.86 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$2,949.34 ","$2,539.71 ","$2,949.34 ","$2,949.34 ","$3,277.04 "
ST NICHOLAS HOSPITAL - ACUTE,32000328,74328,HC XRAY ERCP BILIARY ONLY,320,1 ,"$1,150.92 ",$759.61 ,$6.83 ,"$1,150.92 ",$6.83 ,$212.69 ,$315.03 , N/A ,$690.55 ,$978.28 ,$805.64 ,$6.83 ,$6.83 ,"$1,093.37 ",$874.70 ,$863.19 ,$260.86 ,$978.28 , N/A ,$260.86 ,$260.86 ,$805.64 ,$700.91 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$978.28 , N/A ,"$1,058.85 ",$805.64 ,$583.75 ,$700.57 ,$700.91 ,$700.57 ,$795.29 ,"$1,035.83 ",$786.31 , N/A ,$909.23 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$828.66 ,$713.57 ,$828.66 ,$828.66 ,$920.74 
ST NICHOLAS HOSPITAL - ACUTE,32000329,74329,HC ERCP PANCREATIC,320,1 ,"$1,150.92 ",$759.61 ,$6.83 ,"$1,150.92 ",$6.83 ,$168.87 ,$251.45 , N/A ,$690.55 ,$978.28 ,$805.64 ,$6.83 ,$6.83 ,"$1,093.37 ",$874.70 ,$863.19 ,$260.86 ,$978.28 , N/A ,$260.86 ,$260.86 ,$805.64 ,$700.91 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$978.28 , N/A ,"$1,058.85 ",$805.64 ,$583.75 ,$700.57 ,$700.91 ,$700.57 ,$795.29 ,"$1,035.83 ",$786.31 , N/A ,$909.23 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$828.66 ,$713.57 ,$828.66 ,$828.66 ,$920.74 
ST NICHOLAS HOSPITAL - ACUTE,32000330,74330,HC XRAY ERCP CATH BILIARY AND PANCREAS,320,1 ,"$1,511.04 ",$997.29 ,$6.83 ,"$1,511.04 ",$6.83 ,$308.64 ,$466.52 , N/A ,$906.62 ,"$1,284.38 ","$1,057.73 ",$6.83 ,$6.83 ,"$1,435.49 ","$1,148.39 ","$1,133.28 ",$260.86 ,"$1,284.38 ", N/A ,$260.86 ,$260.86 ,"$1,057.73 ",$920.22 ,$6.83 , N/A , N/A , N/A ,$7.24 ,"$1,284.38 ", N/A ,"$1,390.16 ","$1,057.73 ",$766.40 ,$919.77 ,$920.22 ,$919.77 ,"$1,044.13 ","$1,359.94 ","$1,032.34 ", N/A ,"$1,193.72 ",$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$1,087.95 ",$936.84 ,"$1,087.95 ","$1,087.95 ","$1,208.83 "
ST NICHOLAS HOSPITAL - ACUTE,32000331,74340,HC INTRODUCTION LONG GI TUBE,320,1 ,$668.35 ,$441.11 ,$6.83 ,$668.35 ,$6.83 ,$308.64 ,$308.13 , N/A ,$401.01 ,$568.10 ,$467.85 ,$6.83 ,$6.83 ,$634.93 ,$507.95 ,$501.26 ,$216.99 ,$568.10 , N/A ,$216.99 ,$216.99 ,$467.85 ,$407.03 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$568.10 , N/A ,$614.88 ,$467.85 ,$338.99 ,$406.82 ,$407.03 ,$406.82 ,$461.83 ,$601.52 ,$456.62 , N/A ,$528.00 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$481.21 ,$414.38 ,$481.21 ,$481.21 ,$534.68 
ST NICHOLAS HOSPITAL - ACUTE,32000333,74363,HC BILIARY DILITAT W OR W/O STENT,320,1 ,"$1,778.80 ","$1,174.01 ",$6.83 ,"$1,778.80 ",$6.83 ,$305.43 ,$303.49 , N/A ,"$1,067.28 ","$1,511.98 ","$1,245.16 ",$6.83 ,$6.83 ,"$1,689.86 ","$1,351.89 ","$1,334.10 ",$216.99 ,"$1,511.98 ", N/A ,$216.99 ,$216.99 ,"$1,245.16 ","$1,083.29 ",$6.83 , N/A , N/A , N/A ,$7.24 ,"$1,511.98 ", N/A ,"$1,636.50 ","$1,245.16 ",$902.21 ,"$1,082.76 ","$1,083.29 ","$1,082.76 ","$1,229.15 ","$1,600.92 ","$1,215.28 ", N/A ,"$1,405.25 ",$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$1,280.74 ","$1,102.86 ","$1,280.74 ","$1,280.74 ","$1,423.04 "
ST NICHOLAS HOSPITAL - ACUTE,32000335,74400,HC XRAY IVP W OR W/O TOMO,320,1 ,$929.87 ,$613.71 ,$4.15 ,$929.87 ,$4.15 ,$477.03 ,$366.09 ,$176.01 ,$557.92 ,$790.39 ,$650.91 ,$4.15 ,$4.15 ,$883.38 ,$706.70 ,$697.40 ,$223.51 ,$790.39 ,$176.01 ,$223.51 ,$223.51 ,$650.91 ,$566.29 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$790.39 ,$396.03 ,$855.48 ,$650.91 ,$929.87 ,$929.87 ,$566.29 ,$929.87 ,$642.54 ,$836.88 ,$635.29 ,$174.21 ,$734.60 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$669.51 ,$576.52 ,$669.51 ,$669.51 ,$743.90 
ST NICHOLAS HOSPITAL - ACUTE,32000337,74410,HC XRAY UROGRAM IVP DRIP TECH,320,1 ,$929.87 ,$613.71 ,$4.15 ,$929.87 ,$4.15 ,$496.43 ,$374.37 ,$176.01 ,$557.92 ,$790.39 ,$650.91 ,$4.15 ,$4.15 ,$883.38 ,$706.70 ,$697.40 ,$234.73 ,$790.39 ,$176.01 ,$234.73 ,$234.73 ,$650.91 ,$566.29 ,$4.15 ,$176.01 ,$172.49 ,$352.02 ,$4.40 ,$790.39 ,$396.03 ,$855.48 ,$650.91 ,$929.87 ,$929.87 ,$566.29 ,$929.87 ,$642.54 ,$836.88 ,$635.29 ,$174.21 ,$734.60 ,$4.40 ,$459.00 ,$459.00 ,$172.49 ,$459.00 ,$669.51 ,$576.52 ,$669.51 ,$669.51 ,$743.90 
ST NICHOLAS HOSPITAL - ACUTE,32000339,74420,HC XRAY UROGRAM RETROGRADE,320,1 ,$766.94 ,$506.18 ,$4.15 ,$809.07 ,$4.15 ,$216.57 ,$177.09 ,$359.59 ,$460.16 ,$651.90 ,$536.86 ,$4.15 ,$4.15 ,$728.59 ,$582.87 ,$575.21 ,$104.49 ,$651.90 ,$359.59 ,$104.49 ,$104.49 ,$536.86 ,$467.07 ,$4.15 ,$359.59 ,$352.40 ,$719.18 ,$4.40 ,$651.90 ,$809.07 ,$705.58 ,$536.86 ,$766.94 ,$766.94 ,$467.07 ,$766.94 ,$529.96 ,$690.25 ,$523.97 ,$355.93 ,$605.88 ,$4.40 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,$552.20 ,$475.50 ,$552.20 ,$552.20 ,$613.55 
ST NICHOLAS HOSPITAL - ACUTE,32000340,74425,HC XRAY UROGRAM ANTEGRADE,320,1 ,$766.94 ,$506.18 ,$4.15 ,$809.07 ,$4.15 ,$478.42 ,$525.66 ,$359.59 ,$460.16 ,$651.90 ,$536.86 ,$4.15 ,$4.15 ,$728.59 ,$582.87 ,$575.21 ,$224.60 ,$651.90 ,$359.59 ,$224.60 ,$224.60 ,$536.86 ,$467.07 ,$4.15 ,$359.59 ,$352.40 ,$719.18 ,$4.40 ,$651.90 ,$809.07 ,$705.58 ,$536.86 ,$766.94 ,$766.94 ,$467.07 ,$766.94 ,$529.96 ,$690.25 ,$523.97 ,$355.93 ,$605.88 ,$4.40 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,$552.20 ,$475.50 ,$552.20 ,$552.20 ,$613.55 
ST NICHOLAS HOSPITAL - ACUTE,32000341,50431,HC ANGIO NEPHROSTGRAM,320,1 ,$876.30 ,$578.36 ,$13.57 ,"$1,373.25 ",$13.57 ,$600.62 ,$600.62 ,$610.33 ,$525.78 ,$744.86 ,$613.41 ,$13.57 ,$13.57 ,$832.49 ,$665.99 ,$657.23 ,$126.34 ,$744.86 ,$610.33 ,$126.34 ,$126.34 ,$613.41 ,$533.67 ,$13.57 ,$610.33 ,$598.12 ,$876.30 ,$14.38 ,$744.86 ,"$1,373.25 ",$806.20 ,$613.41 ,$876.30 ,$876.30 ,$533.67 ,$876.30 ,$605.52 ,$788.67 ,$598.69 ,$604.10 ,$692.28 ,$14.38 ,$459.00 ,$459.00 ,$598.12 ,$459.00 ,$630.94 ,$543.31 ,$630.94 ,$630.94 ,$701.04 
ST NICHOLAS HOSPITAL - ACUTE,32000342,74425,HC XR UROGRAM ANTE (LOOPOGRAM SVG),320,1 ,$766.94 ,$506.18 ,$4.15 ,$809.07 ,$4.15 ,$478.42 ,$525.66 ,$359.59 ,$460.16 ,$651.90 ,$536.86 ,$4.15 ,$4.15 ,$728.59 ,$582.87 ,$575.21 ,$224.60 ,$651.90 ,$359.59 ,$224.60 ,$224.60 ,$536.86 ,$467.07 ,$4.15 ,$359.59 ,$352.40 ,$719.18 ,$4.40 ,$651.90 ,$809.07 ,$705.58 ,$536.86 ,$766.94 ,$766.94 ,$467.07 ,$766.94 ,$529.96 ,$690.25 ,$523.97 ,$355.93 ,$605.88 ,$4.40 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,$552.20 ,$475.50 ,$552.20 ,$552.20 ,$613.55 
ST NICHOLAS HOSPITAL - ACUTE,32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,$976.57 ,$644.54 ,$4.15 ,$976.57 ,$4.15 ,$105.73 ,$88.79 ,$359.59 ,$585.94 ,$830.08 ,$683.60 ,$4.15 ,$4.15 ,$927.74 ,$742.19 ,$732.43 ,$51.68 ,$830.08 ,$359.59 ,$51.68 ,$51.68 ,$683.60 ,$594.73 ,$4.15 ,$359.59 ,$352.40 ,$719.18 ,$4.40 ,$830.08 ,$809.07 ,$898.44 ,$683.60 ,$969.86 ,$969.86 ,$594.73 ,$969.86 ,$674.81 ,$878.91 ,$667.19 ,$355.93 ,$771.49 ,$4.40 ,$459.00 ,$459.00 ,$352.40 ,$459.00 ,$703.13 ,$605.47 ,$703.13 ,$703.13 ,$781.26 
ST NICHOLAS HOSPITAL - ACUTE,32000344,74450,HC CYSTOURETHROGRAM RETROGRADE,320,1 ,$929.87 ,$613.71 ,$4.15 ,$929.87 ,$4.15 ,$205.76 ,$201.68 ,$227.92 ,$557.92 ,$790.39 ,$650.91 ,$4.15 ,$4.15 ,$883.38 ,$706.70 ,$697.40 ,$120.64 ,$790.39 ,$227.92 ,$120.64 ,$120.64 ,$650.91 ,$566.29 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$790.39 ,$512.81 ,$855.48 ,$650.91 ,$929.87 ,$929.87 ,$566.29 ,$929.87 ,$642.54 ,$836.88 ,$635.29 ,$225.60 ,$734.60 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$669.51 ,$576.52 ,$669.51 ,$669.51 ,$743.90 
ST NICHOLAS HOSPITAL - ACUTE,32000345,74450,HC CYSTOURETHROGRAM RETRO OR,320,1 ,$929.87 ,$613.71 ,$4.15 ,$929.87 ,$4.15 ,$205.76 ,$201.68 ,$227.92 ,$557.92 ,$790.39 ,$650.91 ,$4.15 ,$4.15 ,$883.38 ,$706.70 ,$697.40 ,$120.64 ,$790.39 ,$227.92 ,$120.64 ,$120.64 ,$650.91 ,$566.29 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$790.39 ,$512.81 ,$855.48 ,$650.91 ,$929.87 ,$929.87 ,$566.29 ,$929.87 ,$642.54 ,$836.88 ,$635.29 ,$225.60 ,$734.60 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$669.51 ,$576.52 ,$669.51 ,$669.51 ,$743.90 
ST NICHOLAS HOSPITAL - ACUTE,32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,$929.87 ,$613.71 ,$4.15 ,$929.87 ,$4.15 ,$377.28 ,$286.07 ,$227.92 ,$557.92 ,$790.39 ,$650.91 ,$4.15 ,$4.15 ,$883.38 ,$706.70 ,$697.40 ,$177.10 ,$790.39 ,$227.92 ,$177.10 ,$177.10 ,$650.91 ,$566.29 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$790.39 ,$512.81 ,$855.48 ,$650.91 ,$929.87 ,$929.87 ,$566.29 ,$929.87 ,$642.54 ,$836.88 ,$635.29 ,$225.60 ,$734.60 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$669.51 ,$576.52 ,$669.51 ,$669.51 ,$743.90 
ST NICHOLAS HOSPITAL - ACUTE,32000348,74470,HC RENAL CYST STUDY S AND I,320,1 ,$778.35 ,$513.71 ,$4.15 ,"$1,104.87 ",$4.15 ,$176.23 ,$172.74 ,$491.05 ,$467.01 ,$661.60 ,$544.85 ,$4.15 ,$4.15 ,$739.43 ,$591.55 ,$583.76 ,$103.36 ,$661.60 ,$491.05 ,$103.36 ,$103.36 ,$544.85 ,$474.02 ,$4.15 ,$491.05 ,$481.23 ,$778.35 ,$4.40 ,$661.60 ,"$1,104.87 ",$716.08 ,$544.85 ,$778.35 ,$778.35 ,$474.02 ,$778.35 ,$537.84 ,$700.52 ,$531.77 ,$486.04 ,$614.90 ,$4.40 ,$459.00 ,$459.00 ,$481.23 ,$459.00 ,$560.41 ,$482.58 ,$560.41 ,$560.41 ,$622.68 
ST NICHOLAS HOSPITAL - ACUTE,32000349,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT,320,1 ,"$4,715.00 ","$3,111.90 ",$78.13 ,"$7,038.44 ",$78.13 ,"$3,231.66 ","$3,231.66 ","$3,128.20 ","$2,829.00 ","$4,007.75 ","$3,300.50 ",$78.13 ,$78.13 ,"$4,479.25 ","$3,583.40 ","$3,536.25 ",$390.87 ,"$4,007.75 ","$3,128.20 ",$390.87 ,$390.87 ,"$3,300.50 ","$2,871.44 ",$78.13 ,"$3,128.20 ","$3,065.64 ","$4,715.00 ",$82.82 ,"$4,007.75 ","$7,038.44 ","$4,337.80 ","$3,300.50 ","$4,121.93 ","$5,152.82 ","$2,871.44 ","$5,152.82 ","$3,258.07 ","$4,243.50 ","$3,221.29 ","$3,096.29 ","$3,724.85 ",$82.82 ,$459.00 ,$459.00 ,"$3,065.64 ",$459.00 ,"$3,394.80 ","$2,923.30 ","$3,394.80 ","$3,394.80 ","$3,772.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000349,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT,320,1 ,"$4,715.00 ","$3,111.90 ",$78.13 ,"$7,038.44 ",$78.13 ,"$3,231.66 ","$3,231.66 ","$3,128.20 ","$2,829.00 ","$4,007.75 ","$3,300.50 ",$78.13 ,$78.13 ,"$4,479.25 ","$3,583.40 ","$3,536.25 ",$390.87 ,"$4,007.75 ","$3,128.20 ",$390.87 ,$390.87 ,"$3,300.50 ","$2,871.44 ",$78.13 ,"$3,128.20 ","$3,065.64 ","$4,715.00 ",$82.82 ,"$4,007.75 ","$7,038.44 ","$4,337.80 ","$3,300.50 ","$4,121.93 ","$5,152.82 ","$2,871.44 ","$5,152.82 ","$3,258.07 ","$4,243.50 ","$3,221.29 ","$3,096.29 ","$3,724.85 ",$82.82 ,$459.00 ,$459.00 ,"$3,065.64 ",$459.00 ,"$3,394.80 ","$2,923.30 ","$3,394.80 ","$3,394.80 ","$3,772.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000352,74485,"HC DILITATN NEPHRO,URETER,URETHRA",320,1 ,"$1,975.98 ","$1,304.15 ",$6.83 ,"$4,073.32 ",$6.83 ,$338.49 ,$258.48 ,"$1,810.36 ","$1,185.59 ","$1,679.58 ","$1,383.19 ",$6.83 ,$6.83 ,"$1,877.18 ","$1,501.74 ","$1,481.99 ",$159.26 ,"$1,679.58 ","$1,810.36 ",$159.26 ,$159.26 ,"$1,383.19 ","$1,203.37 ",$6.83 ,"$1,810.36 ","$1,774.15 ","$1,975.98 ",$7.24 ,"$1,679.58 ","$4,073.32 ","$1,817.90 ","$1,383.19 ","$1,975.98 ","$1,975.98 ","$1,203.37 ","$1,975.98 ","$1,365.40 ","$1,778.38 ","$1,349.99 ","$1,791.89 ","$1,561.02 ",$7.24 ,$459.00 ,$459.00 ,"$1,774.15 ",$459.00 ,"$1,422.71 ","$1,225.11 ","$1,422.71 ","$1,422.71 ","$1,580.78 "
ST NICHOLAS HOSPITAL - ACUTE,32000352,74485,"HC DILITATN NEPHRO,URETER,URETHRA",320,1 ,"$1,975.98 ","$1,304.15 ",$6.83 ,"$4,073.32 ",$6.83 ,$338.49 ,$258.48 ,"$1,810.36 ","$1,185.59 ","$1,679.58 ","$1,383.19 ",$6.83 ,$6.83 ,"$1,877.18 ","$1,501.74 ","$1,481.99 ",$159.26 ,"$1,679.58 ","$1,810.36 ",$159.26 ,$159.26 ,"$1,383.19 ","$1,203.37 ",$6.83 ,"$1,810.36 ","$1,774.15 ","$1,975.98 ",$7.24 ,"$1,679.58 ","$4,073.32 ","$1,817.90 ","$1,383.19 ","$1,975.98 ","$1,975.98 ","$1,203.37 ","$1,975.98 ","$1,365.40 ","$1,778.38 ","$1,349.99 ","$1,791.89 ","$1,561.02 ",$7.24 ,$459.00 ,$459.00 ,"$1,774.15 ",$459.00 ,"$1,422.71 ","$1,225.11 ","$1,422.71 ","$1,422.71 ","$1,580.78 "
ST NICHOLAS HOSPITAL - ACUTE,32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,$778.35 ,$513.71 ,$4.15 ,$778.35 ,$4.15 ,$331.56 ,$244.69 ,$227.92 ,$467.01 ,$661.60 ,$544.85 ,$4.15 ,$4.15 ,$739.43 ,$591.55 ,$583.76 ,$153.98 ,$661.60 ,$227.92 ,$153.98 ,$153.98 ,$544.85 ,$474.02 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$661.60 ,$512.81 ,$716.08 ,$544.85 ,$778.35 ,$778.35 ,$474.02 ,$778.35 ,$537.84 ,$700.52 ,$531.77 ,$225.60 ,$614.90 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$560.41 ,$482.58 ,$560.41 ,$560.41 ,$622.68 
ST NICHOLAS HOSPITAL - ACUTE,32000355,75605,HC THORACIC AORTA,320,1 ,"$4,765.60 ","$3,145.30 ",$133.76 ,"$11,286.91 ",$151.22 ,$280.73 ,$302.63 ,"$5,016.41 ","$2,859.36 ","$4,050.76 ","$3,335.92 ",$151.22 ,$151.22 ,"$4,527.32 ","$3,621.86 ","$3,574.20 ",$133.76 ,"$4,050.76 ","$5,016.41 ",$133.76 ,$133.76 ,"$3,335.92 ","$2,902.25 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$4,765.60 ",$160.29 ,"$4,050.76 ","$11,286.91 ","$4,384.35 ","$3,335.92 ","$4,765.60 ","$4,765.60 ","$2,902.25 ","$4,765.60 ","$3,293.03 ","$4,289.04 ","$3,255.86 ","$4,965.24 ","$3,764.82 ",$160.29 ,$459.00 ,$459.00 ,"$4,916.08 ",$459.00 ,"$3,431.23 ","$2,954.67 ","$3,431.23 ","$3,431.23 ","$3,812.48 "
ST NICHOLAS HOSPITAL - ACUTE,32000356,75625,HC ABDOMINAL AORTAGRAM 75625,320,1 ,"$4,765.60 ","$3,145.30 ",$57.71 ,"$6,541.82 ",$57.71 ,$251.20 ,$295.73 ,"$2,907.47 ","$2,859.36 ","$4,050.76 ","$3,335.92 ",$57.71 ,$57.71 ,"$4,527.32 ","$3,621.86 ","$3,574.20 ",$118.35 ,"$4,050.76 ","$2,907.47 ",$118.35 ,$118.35 ,"$3,335.92 ","$2,902.25 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$4,765.60 ",$61.17 ,"$4,050.76 ","$6,541.82 ","$4,384.35 ","$3,335.92 ","$4,765.60 ","$4,765.60 ","$2,902.25 ","$4,765.60 ","$3,293.03 ","$4,289.04 ","$3,255.86 ","$2,877.81 ","$3,764.82 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$3,431.23 ","$2,954.67 ","$3,431.23 ","$3,431.23 ","$3,812.48 "
ST NICHOLAS HOSPITAL - ACUTE,32000357,75630,HC AORTA WITH RUNOFF 75630,320,1 ,"$5,023.20 ","$3,315.31 ",$57.71 ,"$6,541.82 ",$57.71 ,$269.21 ,$301.25 ,"$2,907.47 ","$3,013.92 ","$4,269.72 ","$3,516.24 ",$57.71 ,$57.71 ,"$4,772.04 ","$3,817.63 ","$3,767.40 ",$126.94 ,"$4,269.72 ","$2,907.47 ",$126.94 ,$126.94 ,"$3,516.24 ","$3,059.13 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$5,023.20 ",$61.17 ,"$4,269.72 ","$6,541.82 ","$4,621.34 ","$3,516.24 ","$5,023.20 ","$5,023.20 ","$3,059.13 ","$5,023.20 ","$3,471.03 ","$4,520.88 ","$3,431.85 ","$2,877.81 ","$3,968.33 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$3,616.70 ","$3,114.38 ","$3,616.70 ","$3,616.70 ","$4,018.56 "
ST NICHOLAS HOSPITAL - ACUTE,32000370,75705,HC ANGIO SPINAL,320,1 ,"$2,576.00 ","$1,700.16 ",$151.22 ,"$11,286.91 ",$151.22 ,$534.27 ,$523.86 ,"$5,016.41 ","$1,545.60 ","$2,189.60 ","$1,803.20 ",$151.22 ,$151.22 ,"$2,447.20 ","$1,957.76 ","$1,932.00 ",$262.22 ,"$2,189.60 ","$5,016.41 ",$262.22 ,$262.22 ,"$1,803.20 ","$1,568.78 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$2,576.00 ",$160.29 ,"$2,189.60 ","$11,286.91 ","$2,369.92 ","$1,803.20 ","$2,576.00 ","$2,576.00 ","$1,568.78 ","$2,576.00 ","$1,780.02 ","$2,318.40 ","$1,759.92 ","$4,965.24 ","$2,035.04 ",$160.29 ,$459.00 ,$459.00 ,"$4,916.08 ",$459.00 ,"$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$2,060.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000371,75710,HC ANGIO EXTREMITY UNI 75710,320,1 ,"$2,060.80 ","$1,360.13 ",$57.71 ,"$6,541.82 ",$57.71 ,$287.23 ,$313.66 ,"$2,907.47 ","$1,236.48 ","$1,751.68 ","$1,442.56 ",$57.71 ,$57.71 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ",$135.73 ,"$1,751.68 ","$2,907.47 ",$135.73 ,$135.73 ,"$1,442.56 ","$1,255.03 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$2,060.80 ",$61.17 ,"$1,751.68 ","$6,541.82 ","$1,895.94 ","$1,442.56 ","$2,060.80 ","$2,060.80 ","$1,255.03 ","$2,060.80 ","$1,424.01 ","$1,854.72 ","$1,407.94 ","$2,877.81 ","$1,628.03 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000372,75710,HC ANGIO EXTREMITY UNI OR,320,1 ,"$2,060.80 ","$1,360.13 ",$57.71 ,"$6,541.82 ",$57.71 ,$287.23 ,$313.66 ,"$2,907.47 ","$1,236.48 ","$1,751.68 ","$1,442.56 ",$57.71 ,$57.71 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ",$135.73 ,"$1,751.68 ","$2,907.47 ",$135.73 ,$135.73 ,"$1,442.56 ","$1,255.03 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$2,060.80 ",$61.17 ,"$1,751.68 ","$6,541.82 ","$1,895.94 ","$1,442.56 ","$2,060.80 ","$2,060.80 ","$1,255.03 ","$2,060.80 ","$1,424.01 ","$1,854.72 ","$1,407.94 ","$2,877.81 ","$1,628.03 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000373,75716,HC ANGIO EXTREMITY BILAT 75716,320,1 ,"$3,091.20 ","$2,040.19 ",$57.71 ,"$6,541.82 ",$57.71 ,$295.97 ,$317.80 ,"$2,907.47 ","$1,854.72 ","$2,627.52 ","$2,163.84 ",$57.71 ,$57.71 ,"$2,936.64 ","$2,349.31 ","$2,318.40 ",$141.00 ,"$2,627.52 ","$2,907.47 ",$141.00 ,$141.00 ,"$2,163.84 ","$1,882.54 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$3,091.20 ",$61.17 ,"$2,627.52 ","$6,541.82 ","$2,843.90 ","$2,163.84 ","$3,091.20 ","$3,091.20 ","$1,882.54 ","$3,091.20 ","$2,136.02 ","$2,782.08 ","$2,111.91 ","$2,877.81 ","$2,442.05 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,225.66 ","$1,916.54 ","$2,225.66 ","$2,225.66 ","$2,472.96 "
ST NICHOLAS HOSPITAL - ACUTE,32000375,36251,HC ANGIO SEL RENAL UNILA 36251,320,1 ,"$3,735.20 ","$2,465.23 ",$151.22 ,"$6,541.82 ",$151.22 ,"$2,560.11 ","$2,560.11 ","$2,907.47 ","$2,241.12 ","$3,174.92 ","$2,614.64 ",$151.22 ,$151.22 ,"$3,548.44 ","$2,838.75 ","$2,801.40 ",$471.60 ,"$3,174.92 ","$2,907.47 ",$471.60 ,$471.60 ,"$2,614.64 ","$2,274.74 ",$151.22 ,"$2,907.47 ","$2,849.32 ","$3,735.20 ",$160.29 ,"$3,174.92 ","$6,541.82 ","$3,436.38 ","$2,614.64 ","$3,273.50 ","$4,091.88 ","$2,274.74 ","$4,091.88 ","$2,581.02 ","$3,361.68 ","$2,551.89 ","$2,877.81 ","$2,950.81 ",$160.29 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,689.34 ","$2,315.82 ","$2,689.34 ","$2,689.34 ","$2,988.16 "
ST NICHOLAS HOSPITAL - ACUTE,32000376,36252,HC ANGIO SEL RENAL BILAT 36252,320,1 ,"$3,735.20 ","$2,465.23 ",$151.22 ,"$6,541.82 ",$151.22 ,"$2,560.11 ","$2,560.11 ","$2,907.47 ","$2,241.12 ","$3,174.92 ","$2,614.64 ",$151.22 ,$151.22 ,"$3,548.44 ","$2,838.75 ","$2,801.40 ",$645.69 ,"$3,174.92 ","$2,907.47 ",$645.69 ,$645.69 ,"$2,614.64 ","$2,274.74 ",$151.22 ,"$2,907.47 ","$2,849.32 ","$3,735.20 ",$160.29 ,"$3,174.92 ","$6,541.82 ","$3,436.38 ","$2,614.64 ","$3,273.50 ","$4,091.88 ","$2,274.74 ","$4,091.88 ","$2,581.02 ","$3,361.68 ","$2,551.89 ","$2,877.81 ","$2,950.81 ",$160.29 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,689.34 ","$2,315.82 ","$2,689.34 ","$2,689.34 ","$2,988.16 "
ST NICHOLAS HOSPITAL - ACUTE,32000378,75726,"HC ANGIO VISERAL, SEL, OR SUPRASEL 75726",320,1 ,"$2,576.00 ","$1,700.16 ",$151.22 ,"$11,286.91 ",$151.22 ,$319.53 ,$346.77 ,"$5,016.41 ","$1,545.60 ","$2,189.60 ","$1,803.20 ",$151.22 ,$151.22 ,"$2,447.20 ","$1,957.76 ","$1,932.00 ",$152.89 ,"$2,189.60 ","$5,016.41 ",$152.89 ,$152.89 ,"$1,803.20 ","$1,568.78 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$2,576.00 ",$160.29 ,"$2,189.60 ","$11,286.91 ","$2,369.92 ","$1,803.20 ","$2,576.00 ","$2,576.00 ","$1,568.78 ","$2,576.00 ","$1,780.02 ","$2,318.40 ","$1,759.92 ","$4,965.24 ","$2,035.04 ",$160.29 ,$459.00 ,$459.00 ,"$4,916.08 ",$459.00 ,"$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$2,060.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000382,75731,HC ANGIO ADRENAL UNILATERAL,320,1 ,"$3,348.80 ","$2,210.21 ",$57.71 ,"$6,541.82 ",$57.71 ,$399.88 ,$425.91 ,"$2,907.47 ","$2,009.28 ","$2,846.48 ","$2,344.16 ",$57.71 ,$57.71 ,"$3,181.36 ","$2,545.09 ","$2,511.60 ",$194.24 ,"$2,846.48 ","$2,907.47 ",$194.24 ,$194.24 ,"$2,344.16 ","$2,039.42 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$3,348.80 ",$61.17 ,"$2,846.48 ","$6,541.82 ","$3,080.90 ","$2,344.16 ","$3,348.80 ","$3,348.80 ","$2,039.42 ","$3,348.80 ","$2,314.02 ","$3,013.92 ","$2,287.90 ","$2,877.81 ","$2,645.55 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,411.14 ","$2,076.26 ","$2,411.14 ","$2,411.14 ","$2,679.04 "
ST NICHOLAS HOSPITAL - ACUTE,32000383,75733,HC ANGIO ADRENAL BILATERAL,320,1 ,"$6,568.80 ","$4,335.41 ",$57.71 ,"$6,568.80 ",$57.71 ,$439.55 ,$449.86 ,"$2,907.47 ","$3,941.28 ","$5,583.48 ","$4,598.16 ",$57.71 ,$57.71 ,"$6,240.36 ","$4,992.29 ","$4,926.60 ",$213.38 ,"$5,583.48 ","$2,907.47 ",$213.38 ,$213.38 ,"$4,598.16 ","$4,000.40 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$5,814.94 ",$61.17 ,"$5,583.48 ","$6,541.82 ","$6,043.30 ","$4,598.16 ","$6,568.80 ","$6,568.80 ","$4,000.40 ","$6,568.80 ","$4,539.04 ","$5,911.92 ","$4,487.80 ","$2,877.81 ","$5,189.35 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$4,729.54 ","$4,072.66 ","$4,729.54 ","$4,729.54 ","$5,255.04 "
ST NICHOLAS HOSPITAL - ACUTE,32000384,75736,HC ANGIO PELVIC SELECT,320,1 ,"$2,576.00 ","$1,700.16 ",$151.22 ,"$11,286.91 ",$151.22 ,$366.63 ,$387.28 ,"$5,016.41 ","$1,545.60 ","$2,189.60 ","$1,803.20 ",$151.22 ,$151.22 ,"$2,447.20 ","$1,957.76 ","$1,932.00 ",$178.39 ,"$2,189.60 ","$5,016.41 ",$178.39 ,$178.39 ,"$1,803.20 ","$1,568.78 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$2,576.00 ",$160.29 ,"$2,189.60 ","$11,286.91 ","$2,369.92 ","$1,803.20 ","$2,576.00 ","$2,576.00 ","$1,568.78 ","$2,576.00 ","$1,780.02 ","$2,318.40 ","$1,759.92 ","$4,965.24 ","$2,035.04 ",$160.29 ,$459.00 ,$459.00 ,"$4,916.08 ",$459.00 ,"$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$2,060.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000385,75741,HC ANGIO PULMONARY UNILAT,320,1 ,"$3,864.00 ","$2,550.24 ",$57.71 ,"$6,541.82 ",$57.71 ,$292.77 ,$320.56 ,"$2,907.47 ","$2,318.40 ","$3,284.40 ","$2,704.80 ",$57.71 ,$57.71 ,"$3,670.80 ","$2,936.64 ","$2,898.00 ",$139.69 ,"$3,284.40 ","$2,907.47 ",$139.69 ,$139.69 ,"$2,704.80 ","$2,353.18 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$3,864.00 ",$61.17 ,"$3,284.40 ","$6,541.82 ","$3,554.88 ","$2,704.80 ","$3,864.00 ","$3,864.00 ","$2,353.18 ","$3,864.00 ","$2,670.02 ","$3,477.60 ","$2,639.88 ","$2,877.81 ","$3,052.56 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,782.08 ","$2,395.68 ","$2,782.08 ","$2,782.08 ","$3,091.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000386,75743,HC ANGIO PULMONARY BILAT,320,1 ,"$4,508.00 ","$2,975.28 ",$57.71 ,"$6,541.82 ",$57.71 ,$297.36 ,$324.70 ,"$2,907.47 ","$2,704.80 ","$3,831.80 ","$3,155.60 ",$57.71 ,$57.71 ,"$4,282.60 ","$3,426.08 ","$3,381.00 ",$142.33 ,"$3,831.80 ","$2,907.47 ",$142.33 ,$142.33 ,"$3,155.60 ","$2,745.37 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$4,508.00 ",$61.17 ,"$3,831.80 ","$6,541.82 ","$4,147.36 ","$3,155.60 ","$4,508.00 ","$4,508.00 ","$2,745.37 ","$4,508.00 ","$3,115.03 ","$4,057.20 ","$3,079.87 ","$2,877.81 ","$3,561.32 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$3,245.76 ","$2,794.96 ","$3,245.76 ","$3,245.76 ","$3,606.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000387,75746,HC ANGIO PULMONARY NONSELECT,320,1 ,"$3,091.20 ","$2,040.19 ",$57.71 ,"$6,541.82 ",$57.71 ,$333.38 ,$355.05 ,"$2,907.47 ","$1,854.72 ","$2,627.52 ","$2,163.84 ",$57.71 ,$57.71 ,"$2,936.64 ","$2,349.31 ","$2,318.40 ",$162.13 ,"$2,627.52 ","$2,907.47 ",$162.13 ,$162.13 ,"$2,163.84 ","$1,882.54 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$3,091.20 ",$61.17 ,"$2,627.52 ","$6,541.82 ","$2,843.90 ","$2,163.84 ","$3,091.20 ","$3,091.20 ","$1,882.54 ","$3,091.20 ","$2,136.02 ","$2,782.08 ","$2,111.91 ","$2,877.81 ","$2,442.05 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,225.66 ","$1,916.54 ","$2,225.66 ","$2,225.66 ","$2,472.96 "
ST NICHOLAS HOSPITAL - ACUTE,32000388,75756,HC ANGIO INTERNAL MAMMARY,320,1 ,"$2,576.00 ","$1,700.16 ",$57.71 ,"$6,541.82 ",$57.71 ,$427.59 ,$435.57 ,"$2,907.47 ","$1,545.60 ","$2,189.60 ","$1,803.20 ",$57.71 ,$57.71 ,"$2,447.20 ","$1,957.76 ","$1,932.00 ",$210.08 ,"$2,189.60 ","$2,907.47 ",$210.08 ,$210.08 ,"$1,803.20 ","$1,568.78 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$2,576.00 ",$61.17 ,"$2,189.60 ","$6,541.82 ","$2,369.92 ","$1,803.20 ","$2,576.00 ","$2,576.00 ","$1,568.78 ","$2,576.00 ","$1,780.02 ","$2,318.40 ","$1,759.92 ","$2,877.81 ","$2,035.04 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$2,060.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000389,75774,HC ANGIO EA VESSEL ADDL 75774,320,1 ,"$1,288.00 ",$850.08 ,$101.19 ,"$1,288.00 ",$151.22 ,$212.41 ,$252.96 , N/A ,$772.80 ,"$1,094.80 ",$901.60 ,$151.22 ,$151.22 ,"$1,223.60 ",$978.88 ,$966.00 ,$101.19 ,"$1,094.80 ", N/A ,$101.19 ,$101.19 ,$901.60 ,$784.39 ,$151.22 , N/A , N/A , N/A ,$160.29 ,"$1,094.80 ", N/A ,"$1,184.96 ",$901.60 ,$653.27 ,$784.01 ,$784.39 ,$784.01 ,$890.01 ,"$1,159.20 ",$879.96 , N/A ,"$1,017.52 ",$160.29 ,$459.00 ,$459.00 , N/A ,$459.00 ,$927.36 ,$798.56 ,$927.36 ,$927.36 ,"$1,030.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000391,75803,HC LYMPHANGIOGRAPHY LEGS,320,1 ,"$2,576.00 ","$1,700.16 ",$37.49 ,"$3,267.32 ",$37.49 ,$777.40 ,$761.98 ,"$1,452.14 ","$1,545.60 ","$2,189.60 ","$1,803.20 ",$37.49 ,$37.49 ,"$2,447.20 ","$1,957.76 ","$1,932.00 ",$448.11 ,"$2,189.60 ","$1,452.14 ",$448.11 ,$448.11 ,"$1,803.20 ","$1,568.78 ",$37.49 ,"$1,452.14 ","$1,423.10 ","$2,576.00 ",$39.74 ,"$2,189.60 ","$3,267.32 ","$2,369.92 ","$1,803.20 ","$2,576.00 ","$2,576.00 ","$1,568.78 ","$2,576.00 ","$1,780.02 ","$2,318.40 ","$1,759.92 ","$1,437.33 ","$2,035.04 ",$39.74 ,$459.00 ,$459.00 ,"$1,423.10 ",$459.00 ,"$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$2,060.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000392,75807,HC LYMPHANGIOGRAPHY ABDOM,320,1 ,"$2,447.20 ","$1,615.15 ",$57.71 ,"$6,541.82 ",$57.71 ,$835.07 ,$818.51 ,"$2,907.47 ","$1,468.32 ","$2,080.12 ","$1,713.04 ",$57.71 ,$57.71 ,"$2,324.84 ","$1,859.87 ","$1,835.40 ",$757.80 ,"$2,080.12 ","$2,907.47 ",$757.80 ,$757.80 ,"$1,713.04 ","$1,490.34 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$2,447.20 ",$61.17 ,"$2,080.12 ","$6,541.82 ","$2,251.42 ","$1,713.04 ","$2,447.20 ","$2,447.20 ","$1,490.34 ","$2,447.20 ","$1,691.02 ","$2,202.48 ","$1,671.93 ","$2,877.81 ","$1,933.29 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$1,761.98 ","$1,517.26 ","$1,761.98 ","$1,761.98 ","$1,957.76 "
ST NICHOLAS HOSPITAL - ACUTE,32000393,75809,HC SHUNTOGRAM NONVASCULAR,320,1 ,$650.70 ,$429.46 ,$4.15 ,$650.70 ,$4.15 ,$245.66 ,$276.42 ,$104.31 ,$390.42 ,$553.10 ,$455.49 ,$4.15 ,$4.15 ,$618.17 ,$494.53 ,$488.03 ,$117.03 ,$553.10 ,$104.31 ,$117.03 ,$117.03 ,$455.49 ,$396.28 ,$4.15 ,$104.31 ,$102.22 ,$208.62 ,$4.40 ,$553.10 ,$234.71 ,$598.64 ,$455.49 ,$342.19 ,$342.19 ,$396.28 ,$342.19 ,$449.63 ,$585.63 ,$444.56 ,$103.24 ,$514.05 ,$4.40 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$468.50 ,$403.43 ,$468.50 ,$468.50 ,$520.56 
ST NICHOLAS HOSPITAL - ACUTE,32000394,75810,HC SPLENOPORTOGRAPHY,320,1 ,"$4,121.60 ","$2,720.26 ",$37.49 ,"$6,541.82 ",$37.49 ,"$1,526.65 ","$1,496.38 ","$2,907.47 ","$2,472.96 ","$3,503.36 ","$2,885.12 ",$37.49 ,$37.49 ,"$3,915.52 ","$3,132.42 ","$3,091.20 ","$1,041.34 ","$3,503.36 ","$2,907.47 ","$1,041.34 ","$1,041.34 ","$2,885.12 ","$2,510.05 ",$37.49 ,"$2,907.47 ","$2,849.32 ","$4,121.60 ",$39.74 ,"$3,503.36 ","$6,541.82 ","$3,791.87 ","$2,885.12 ","$4,121.60 ","$4,121.60 ","$2,510.05 ","$4,121.60 ","$2,848.03 ","$3,709.44 ","$2,815.88 ","$2,877.81 ","$3,256.06 ",$39.74 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,967.55 ","$2,555.39 ","$2,967.55 ","$2,967.55 ","$3,297.28 "
ST NICHOLAS HOSPITAL - ACUTE,32000395,75820,HC VENOGRAM EXTREMITY UNI 75820,320,1 ,"$1,674.40 ","$1,105.10 ",$37.49 ,"$3,267.32 ",$37.49 ,$252.59 ,$297.11 ,"$1,452.14 ","$1,004.64 ","$1,423.24 ","$1,172.08 ",$37.49 ,$37.49 ,"$1,590.68 ","$1,272.54 ","$1,255.80 ",$119.00 ,"$1,423.24 ","$1,452.14 ",$119.00 ,$119.00 ,"$1,172.08 ","$1,019.71 ",$37.49 ,"$1,452.14 ","$1,423.10 ","$1,674.40 ",$39.74 ,"$1,423.24 ","$3,267.32 ","$1,540.45 ","$1,172.08 ","$1,674.40 ","$1,674.40 ","$1,019.71 ","$1,674.40 ","$1,157.01 ","$1,506.96 ","$1,143.95 ","$1,437.33 ","$1,322.78 ",$39.74 ,$459.00 ,$459.00 ,"$1,423.10 ",$459.00 ,"$1,205.57 ","$1,038.13 ","$1,205.57 ","$1,205.57 ","$1,339.52 "
ST NICHOLAS HOSPITAL - ACUTE,32000397,75822,HC VENOGRAM EXTREMITY BILAT,320,1 ,"$2,060.80 ","$1,360.13 ",$37.49 ,"$3,267.32 ",$37.49 ,$271.99 ,$304.01 ,"$1,452.14 ","$1,236.48 ","$1,751.68 ","$1,442.56 ",$37.49 ,$37.49 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ",$128.90 ,"$1,751.68 ","$1,452.14 ",$128.90 ,$128.90 ,"$1,442.56 ","$1,255.03 ",$37.49 ,"$1,452.14 ","$1,423.10 ","$2,060.80 ",$39.74 ,"$1,751.68 ","$3,267.32 ","$1,895.94 ","$1,442.56 ","$2,060.80 ","$2,060.80 ","$1,255.03 ","$2,060.80 ","$1,424.01 ","$1,854.72 ","$1,407.94 ","$1,437.33 ","$1,628.03 ",$39.74 ,$459.00 ,$459.00 ,"$1,423.10 ",$459.00 ,"$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,32000398,75825,HC VENOGRAPHY CAVAL INFERIOR,320,1 ,"$3,735.20 ","$2,465.23 ",$57.71 ,"$6,541.82 ",$57.71 ,$255.36 ,$288.83 ,"$2,907.47 ","$2,241.12 ","$3,174.92 ","$2,614.64 ",$57.71 ,$57.71 ,"$3,548.44 ","$2,838.75 ","$2,801.40 ",$121.65 ,"$3,174.92 ","$2,907.47 ",$121.65 ,$121.65 ,"$2,614.64 ","$2,274.74 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$3,735.20 ",$61.17 ,"$3,174.92 ","$6,541.82 ","$3,436.38 ","$2,614.64 ","$3,735.20 ","$3,735.20 ","$2,274.74 ","$3,735.20 ","$2,581.02 ","$3,361.68 ","$2,551.89 ","$2,877.81 ","$2,950.81 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,689.34 ","$2,315.82 ","$2,689.34 ","$2,689.34 ","$2,988.16 "
ST NICHOLAS HOSPITAL - ACUTE,32000399,75827,HC VENOGRAPHY CAVAL SUPERIOR,320,1 ,"$2,962.40 ","$1,955.18 ",$37.49 ,"$3,267.32 ",$37.49 ,$277.53 ,$305.39 ,"$1,452.14 ","$1,777.44 ","$2,518.04 ","$2,073.68 ",$37.49 ,$37.49 ,"$2,814.28 ","$2,251.42 ","$2,221.80 ",$130.89 ,"$2,518.04 ","$1,452.14 ",$130.89 ,$130.89 ,"$2,073.68 ","$1,804.10 ",$37.49 ,"$1,452.14 ","$1,423.10 ","$2,904.28 ",$39.74 ,"$2,518.04 ","$3,267.32 ","$2,725.41 ","$2,073.68 ","$2,962.40 ","$2,962.40 ","$1,804.10 ","$2,962.40 ","$2,047.02 ","$2,666.16 ","$2,023.91 ","$1,437.33 ","$2,340.30 ",$39.74 ,$459.00 ,$459.00 ,"$1,423.10 ",$459.00 ,"$2,132.93 ","$1,836.69 ","$2,132.93 ","$2,132.93 ","$2,369.92 "
ST NICHOLAS HOSPITAL - ACUTE,32000400,75831,HC VENOGRAM RENAL UNILAT,320,1 ,"$3,477.60 ","$2,295.22 ",$57.71 ,"$6,541.82 ",$57.71 ,$281.68 ,$313.66 ,"$2,907.47 ","$2,086.56 ","$2,955.96 ","$2,434.32 ",$57.71 ,$57.71 ,"$3,303.72 ","$2,642.98 ","$2,608.20 ",$135.73 ,"$2,955.96 ","$2,907.47 ",$135.73 ,$135.73 ,"$2,434.32 ","$2,117.86 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$3,477.60 ",$61.17 ,"$2,955.96 ","$6,541.82 ","$3,199.39 ","$2,434.32 ","$3,477.60 ","$3,477.60 ","$2,117.86 ","$3,477.60 ","$2,403.02 ","$3,129.84 ","$2,375.90 ","$2,877.81 ","$2,747.30 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,503.87 ","$2,156.11 ","$2,503.87 ","$2,503.87 ","$2,782.08 "
ST NICHOLAS HOSPITAL - ACUTE,32000401,75833,HC VENOGRAM RENAL BILAT,320,1 ,"$3,864.00 ","$2,550.24 ",$57.71 ,"$6,541.82 ",$57.71 ,$322.30 ,$340.38 ,"$2,907.47 ","$2,318.40 ","$3,284.40 ","$2,704.80 ",$57.71 ,$57.71 ,"$3,670.80 ","$2,936.64 ","$2,898.00 ",$153.55 ,"$3,284.40 ","$2,907.47 ",$153.55 ,$153.55 ,"$2,704.80 ","$2,353.18 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$3,864.00 ",$61.17 ,"$3,284.40 ","$6,541.82 ","$3,554.88 ","$2,704.80 ","$3,864.00 ","$3,864.00 ","$2,353.18 ","$3,864.00 ","$2,670.02 ","$3,477.60 ","$2,639.88 ","$2,877.81 ","$3,052.56 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,782.08 ","$2,395.68 ","$2,782.08 ","$2,782.08 ","$3,091.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000402,75840,HC VENOGRAM ADRENAL UNILAT,320,1 ,"$3,091.20 ","$2,040.19 ",$57.71 ,"$6,541.82 ",$57.71 ,$309.39 ,$337.12 ,"$2,907.47 ","$1,854.72 ","$2,627.52 ","$2,163.84 ",$57.71 ,$57.71 ,"$2,936.64 ","$2,349.31 ","$2,318.40 ",$148.28 ,"$2,627.52 ","$2,907.47 ",$148.28 ,$148.28 ,"$2,163.84 ","$1,882.54 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$3,091.20 ",$61.17 ,"$2,627.52 ","$6,541.82 ","$2,843.90 ","$2,163.84 ","$3,091.20 ","$3,091.20 ","$1,882.54 ","$3,091.20 ","$2,136.02 ","$2,782.08 ","$2,111.91 ","$2,877.81 ","$2,442.05 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,225.66 ","$1,916.54 ","$2,225.66 ","$2,225.66 ","$2,472.96 "
ST NICHOLAS HOSPITAL - ACUTE,32000403,75842,HC VENOGRAM ADRENAL BILAT,320,1 ,"$3,348.80 ","$2,210.21 ",$151.22 ,"$11,286.91 ",$151.22 ,$359.70 ,$387.28 ,"$5,016.41 ","$2,009.28 ","$2,846.48 ","$2,344.16 ",$151.22 ,$151.22 ,"$3,181.36 ","$2,545.09 ","$2,511.60 ",$174.00 ,"$2,846.48 ","$5,016.41 ",$174.00 ,$174.00 ,"$2,344.16 ","$2,039.42 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$3,348.80 ",$160.29 ,"$2,846.48 ","$11,286.91 ","$3,080.90 ","$2,344.16 ","$3,348.80 ","$3,348.80 ","$2,039.42 ","$3,348.80 ","$2,314.02 ","$3,013.92 ","$2,287.90 ","$4,965.24 ","$2,645.55 ",$160.29 ,$459.00 ,$459.00 ,"$4,916.08 ",$459.00 ,"$2,411.14 ","$2,076.26 ","$2,411.14 ","$2,411.14 ","$2,679.04 "
ST NICHOLAS HOSPITAL - ACUTE,32000404,75860,HC VENOGRAPHY SINUS/ JUGULAR,320,1 ,"$2,447.20 ","$1,615.15 ",$57.71 ,"$6,541.82 ",$57.71 ,$301.08 ,$328.84 ,"$2,907.47 ","$1,468.32 ","$2,080.12 ","$1,713.04 ",$57.71 ,$57.71 ,"$2,324.84 ","$1,859.87 ","$1,835.40 ",$143.64 ,"$2,080.12 ","$2,907.47 ",$143.64 ,$143.64 ,"$1,713.04 ","$1,490.34 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$2,447.20 ",$61.17 ,"$2,080.12 ","$6,541.82 ","$2,251.42 ","$1,713.04 ","$2,447.20 ","$2,447.20 ","$1,490.34 ","$2,447.20 ","$1,691.02 ","$2,202.48 ","$1,671.93 ","$2,877.81 ","$1,933.29 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$1,761.98 ","$1,517.26 ","$1,761.98 ","$1,761.98 ","$1,957.76 "
ST NICHOLAS HOSPITAL - ACUTE,32000406,75870,HC VENOGRAM SUPERIOR SAGITTAL,320,1 ,"$2,318.40 ","$1,530.14 ",$37.49 ,"$6,541.82 ",$37.49 ,$424.39 ,$477.83 ,"$2,907.47 ","$1,391.04 ","$1,970.64 ","$1,622.88 ",$37.49 ,$37.49 ,"$2,202.48 ","$1,761.98 ","$1,738.80 ",$193.81 ,"$1,970.64 ","$2,907.47 ",$193.81 ,$193.81 ,"$1,622.88 ","$1,411.91 ",$37.49 ,"$2,907.47 ","$2,849.32 ","$2,318.40 ",$39.74 ,"$1,970.64 ","$6,541.82 ","$2,132.93 ","$1,622.88 ","$1,196.92 ","$1,196.92 ","$1,411.91 ","$1,196.92 ","$1,602.01 ","$2,086.56 ","$1,583.93 ","$2,877.81 ","$1,831.54 ",$39.74 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$1,669.25 ","$1,437.41 ","$1,669.25 ","$1,669.25 ","$1,854.72 "
ST NICHOLAS HOSPITAL - ACUTE,32000407,75872,HC VENOGRAM EPIDURAL,320,1 ,"$2,704.80 ","$1,785.17 ",$37.49 ,"$2,704.80 ",$37.49 ,$309.39 ,$337.12 ,$564.62 ,"$1,622.88 ","$2,299.08 ","$1,893.36 ",$37.49 ,$37.49 ,"$2,569.56 ","$2,055.65 ","$2,028.60 ",$148.28 ,"$2,299.08 ",$564.62 ,$148.28 ,$148.28 ,"$1,893.36 ","$1,647.22 ",$37.49 ,$564.62 ,$553.33 ,"$1,129.24 ",$39.74 ,"$2,299.08 ","$1,270.39 ","$2,488.42 ","$1,893.36 ","$2,704.80 ","$2,704.80 ","$1,647.22 ","$2,704.80 ","$1,869.02 ","$2,434.32 ","$1,847.92 ",$558.86 ,"$2,136.79 ",$39.74 ,$459.00 ,$459.00 ,$553.33 ,$459.00 ,"$1,947.46 ","$1,676.98 ","$1,947.46 ","$1,947.46 ","$2,163.84 "
ST NICHOLAS HOSPITAL - ACUTE,32000408,75880,HC VENOGRAM ORBITAL,320,1 ,"$1,674.40 ","$1,105.10 ",$37.49 ,"$1,674.40 ",$37.49 ,$308.01 ,$335.74 ,$564.62 ,"$1,004.64 ","$1,423.24 ","$1,172.08 ",$37.49 ,$37.49 ,"$1,590.68 ","$1,272.54 ","$1,255.80 ",$147.60 ,"$1,423.24 ",$564.62 ,$147.60 ,$147.60 ,"$1,172.08 ","$1,019.71 ",$37.49 ,$564.62 ,$553.33 ,"$1,129.24 ",$39.74 ,"$1,423.24 ","$1,270.39 ","$1,540.45 ","$1,172.08 ","$1,674.40 ","$1,674.40 ","$1,019.71 ","$1,674.40 ","$1,157.01 ","$1,506.96 ","$1,143.95 ",$558.86 ,"$1,322.78 ",$39.74 ,$459.00 ,$459.00 ,$553.33 ,$459.00 ,"$1,205.57 ","$1,038.13 ","$1,205.57 ","$1,205.57 ","$1,339.52 "
ST NICHOLAS HOSPITAL - ACUTE,32000409,75885,HC TRANSHEPATIC PORTOGRAPHY W/ HEMO,320,1 ,"$4,121.60 ","$2,720.26 ",$57.71 ,"$6,541.82 ",$57.71 ,$295.54 ,$326.08 ,"$2,907.47 ","$2,472.96 ","$3,503.36 ","$2,885.12 ",$57.71 ,$57.71 ,"$3,915.52 ","$3,132.42 ","$3,091.20 ",$142.33 ,"$3,503.36 ","$2,907.47 ",$142.33 ,$142.33 ,"$2,885.12 ","$2,510.05 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$4,121.60 ",$61.17 ,"$3,503.36 ","$6,541.82 ","$3,791.87 ","$2,885.12 ","$4,121.60 ","$4,121.60 ","$2,510.05 ","$4,121.60 ","$2,848.03 ","$3,709.44 ","$2,815.88 ","$2,877.81 ","$3,256.06 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,967.55 ","$2,555.39 ","$2,967.55 ","$2,967.55 ","$3,297.28 "
ST NICHOLAS HOSPITAL - ACUTE,32000411,75889,HC VENOGRAM HEPATIC W/HEMO,320,1 ,$892.40 ,$588.98 ,$57.71 ,"$6,541.82 ",$57.71 ,$298.31 ,$327.46 ,"$2,907.47 ",$535.44 ,$758.54 ,$624.68 ,$57.71 ,$57.71 ,$847.78 ,$678.22 ,$669.30 ,$142.99 ,$758.54 ,"$2,907.47 ",$142.99 ,$142.99 ,$624.68 ,$543.47 ,$57.71 ,"$2,907.47 ","$2,849.32 ",$892.40 ,$61.17 ,$758.54 ,"$6,541.82 ",$821.01 ,$624.68 ,$892.40 ,$892.40 ,$543.47 ,$892.40 ,$616.65 ,$803.16 ,$609.69 ,"$2,877.81 ",$705.00 ,$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,$642.53 ,$553.29 ,$642.53 ,$642.53 ,$713.92 
ST NICHOLAS HOSPITAL - ACUTE,32000412,75891,HC VENOGRAM HEPATIC W/O HEMO,320,1 ,"$3,992.80 ","$2,635.25 ",$57.71 ,"$6,541.82 ",$57.71 ,$299.69 ,$331.60 ,"$2,907.47 ","$2,395.68 ","$3,393.88 ","$2,794.96 ",$57.71 ,$57.71 ,"$3,793.16 ","$3,034.53 ","$2,994.60 ",$143.64 ,"$3,393.88 ","$2,907.47 ",$143.64 ,$143.64 ,"$2,794.96 ","$2,431.62 ",$57.71 ,"$2,907.47 ","$2,849.32 ","$3,992.80 ",$61.17 ,"$3,393.88 ","$6,541.82 ","$3,673.38 ","$2,794.96 ","$3,992.80 ","$3,992.80 ","$2,431.62 ","$3,992.80 ","$2,759.02 ","$3,593.52 ","$2,727.88 ","$2,877.81 ","$3,154.31 ",$61.17 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,"$2,874.82 ","$2,475.54 ","$2,874.82 ","$2,874.82 ","$3,194.24 "
ST NICHOLAS HOSPITAL - ACUTE,32000413,75893,HC VENOGRAM SAMPLING CATH,320,1 ,"$5,409.60 ","$3,570.34 ",$151.22 ,"$11,286.91 ",$151.22 ,$323.25 ,$350.91 ,"$5,016.41 ","$3,245.76 ","$4,598.16 ","$3,786.72 ",$151.22 ,$151.22 ,"$5,139.12 ","$4,111.30 ","$4,057.20 ",$155.51 ,"$4,598.16 ","$5,016.41 ",$155.51 ,$155.51 ,"$3,786.72 ","$3,294.45 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$5,409.60 ",$160.29 ,"$4,598.16 ","$11,286.91 ","$4,976.83 ","$3,786.72 ","$5,409.60 ","$5,409.60 ","$3,294.45 ","$5,409.60 ","$3,738.03 ","$4,868.64 ","$3,695.84 ","$4,965.24 ","$4,273.58 ",$160.29 ,$459.00 ,$459.00 ,"$4,916.08 ",$459.00 ,"$3,894.91 ","$3,353.95 ","$3,894.91 ","$3,894.91 ","$4,327.68 "
ST NICHOLAS HOSPITAL - ACUTE,32000414,75894,HC TRANSCATH EMBOLIZATION 75894,320,1 ,"$4,881.83 ","$3,222.01 ",$6.83 ,"$4,881.83 ",$6.83 ,"$3,680.28 ","$3,655.43 ", N/A ,"$2,929.10 ","$4,149.56 ","$3,417.28 ",$6.83 ,$6.83 ,"$4,637.74 ","$3,710.19 ","$3,661.37 ","$1,995.47 ","$4,149.56 ", N/A ,"$1,995.47 ","$1,995.47 ","$3,417.28 ","$2,973.03 ",$6.83 , N/A , N/A , N/A ,$7.24 ,"$4,149.56 ", N/A ,"$4,491.28 ","$3,417.28 ","$2,476.06 ","$2,971.57 ","$2,973.03 ","$2,971.57 ","$3,373.34 ","$4,393.65 ","$3,335.27 ", N/A ,"$3,856.65 ",$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$3,514.92 ","$3,026.73 ","$3,514.92 ","$3,514.92 ","$3,905.46 "
ST NICHOLAS HOSPITAL - ACUTE,32000417,75898,HC TRANSCATH ANGIO EXIST 75898,320,1 ,"$1,288.00 ",$850.08 ,$37.49 ,"$6,541.82 ",$37.49 ,$173.02 ,$169.59 ,"$2,907.47 ",$772.80 ,"$1,094.80 ",$901.60 ,$37.49 ,$37.49 ,"$1,223.60 ",$978.88 ,$966.00 ,$86.90 ,"$1,094.80 ","$2,907.47 ",$86.90 ,$86.90 ,$901.60 ,$784.39 ,$37.49 ,"$2,907.47 ","$2,849.32 ","$1,288.00 ",$39.74 ,"$1,094.80 ","$6,541.82 ","$1,184.96 ",$901.60 ,"$1,288.00 ","$1,288.00 ",$784.39 ,"$1,288.00 ",$890.01 ,"$1,159.20 ",$879.96 ,"$2,877.81 ","$1,017.52 ",$39.74 ,$459.00 ,$459.00 ,"$2,849.32 ",$459.00 ,$927.36 ,$798.56 ,$927.36 ,$927.36 ,"$1,030.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000421,75901,HC REMOVE PERICATH OBST CV CATH,320,1 ,$926.90 ,$611.75 ,$6.83 ,$926.90 ,$6.83 ,$898.65 ,$682.01 , N/A ,$556.14 ,$787.87 ,$648.83 ,$6.83 ,$6.83 ,$880.56 ,$704.44 ,$695.18 ,$412.91 ,$787.87 , N/A ,$412.91 ,$412.91 ,$648.83 ,$564.48 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$787.87 , N/A ,$852.75 ,$648.83 ,$470.12 ,$564.20 ,$564.48 ,$564.20 ,$640.49 ,$834.21 ,$633.26 , N/A ,$732.25 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$667.37 ,$574.68 ,$667.37 ,$667.37 ,$741.52 
ST NICHOLAS HOSPITAL - ACUTE,32000422,75902,HC REMOVE INTRALUMN OBST CV CATH,320,1 ,$772.80 ,$510.05 ,$6.83 ,$772.80 ,$6.83 ,$312.16 ,$230.89 , N/A ,$463.68 ,$656.88 ,$540.96 ,$6.83 ,$6.83 ,$734.16 ,$587.33 ,$579.60 ,$142.78 ,$656.88 , N/A ,$142.78 ,$142.78 ,$540.96 ,$470.64 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$656.88 , N/A ,$710.98 ,$540.96 ,$391.96 ,$470.40 ,$470.64 ,$470.40 ,$534.00 ,$695.52 ,$527.98 , N/A ,$610.51 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$556.42 ,$479.14 ,$556.42 ,$556.42 ,$618.24 
ST NICHOLAS HOSPITAL - ACUTE,32000423,37191,HC IVC FILTER PLACEMENT 37191,320,1 ,"$9,545.00 ","$6,299.70 ",$124.43 ,"$11,286.91 ",$124.43 ,"$6,542.14 ","$6,542.14 ","$5,016.41 ","$5,727.00 ","$8,113.25 ","$6,681.50 ",$124.43 ,$124.43 ,"$9,067.75 ","$7,254.20 ","$7,158.75 ",$413.55 ,"$8,113.25 ","$5,016.41 ",$413.55 ,$413.55 ,"$6,681.50 ","$5,812.91 ",$124.43 ,"$5,016.41 ","$4,916.08 ","$9,545.00 ",$131.90 ,"$8,113.25 ","$11,286.91 ","$8,781.40 ","$6,681.50 ","$4,535.48 ","$5,669.62 ","$5,812.91 ","$5,669.62 ","$6,595.60 ","$8,590.50 ","$6,521.14 ","$4,965.24 ","$7,540.55 ",$131.90 ,$459.00 ,$459.00 ,"$4,916.08 ",$459.00 ,"$6,872.40 ","$5,917.90 ","$6,872.40 ","$6,872.40 ","$7,636.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000435,75970,HC TRANSCATH BX,320,1 ,"$2,905.85 ","$1,917.86 ",$6.83 ,"$2,905.85 ",$6.83 ,"$1,501.28 ","$1,526.73 ", N/A ,"$1,743.51 ","$2,469.97 ","$2,034.10 ",$6.83 ,$6.83 ,"$2,760.56 ","$2,208.45 ","$2,179.39 ",$953.54 ,"$2,469.97 ", N/A ,$953.54 ,$953.54 ,"$2,034.10 ","$1,769.66 ",$6.83 , N/A , N/A , N/A ,$7.24 ,"$2,469.97 ", N/A ,"$2,673.38 ","$2,034.10 ","$1,473.85 ","$1,768.79 ","$1,769.66 ","$1,768.79 ","$2,007.94 ","$2,615.27 ","$1,985.28 ", N/A ,"$2,295.62 ",$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$2,092.21 ","$1,801.63 ","$2,092.21 ","$2,092.21 ","$2,324.68 "
ST NICHOLAS HOSPITAL - ACUTE,32000436,75970,HC TRANSCATH BX TRNJUG LIVER,320,1 ,"$2,905.85 ","$1,917.86 ",$6.83 ,"$2,905.85 ",$6.83 ,"$1,501.28 ","$1,526.73 ", N/A ,"$1,743.51 ","$2,469.97 ","$2,034.10 ",$6.83 ,$6.83 ,"$2,760.56 ","$2,208.45 ","$2,179.39 ",$953.54 ,"$2,469.97 ", N/A ,$953.54 ,$953.54 ,"$2,034.10 ","$1,769.66 ",$6.83 , N/A , N/A , N/A ,$7.24 ,"$2,469.97 ", N/A ,"$2,673.38 ","$2,034.10 ","$1,473.85 ","$1,768.79 ","$1,769.66 ","$1,768.79 ","$2,007.94 ","$2,615.27 ","$1,985.28 ", N/A ,"$2,295.62 ",$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$2,092.21 ","$1,801.63 ","$2,092.21 ","$2,092.21 ","$2,324.68 "
ST NICHOLAS HOSPITAL - ACUTE,32000438,47533,HC TRANSHEPATIC DRAINAGE,320,1 ,"$7,557.80 ","$4,988.15 ",$82.11 ,"$7,778.08 ",$82.11 ,"$5,180.12 ","$5,180.12 ","$3,456.92 ","$4,534.68 ","$6,424.13 ","$5,290.46 ",$82.11 ,$82.11 ,"$7,179.91 ","$5,743.93 ","$5,668.35 ",$502.56 ,"$6,424.13 ","$3,456.92 ",$502.56 ,$502.56 ,"$5,290.46 ","$4,602.70 ",$82.11 ,"$3,456.92 ","$3,387.78 ","$6,913.84 ",$87.04 ,"$6,424.13 ","$7,778.08 ","$6,953.18 ","$5,290.46 ","$3,273.50 ","$4,091.88 ","$4,602.70 ","$4,091.88 ","$5,222.44 ","$6,802.02 ","$5,163.49 ","$3,421.66 ","$5,970.66 ",$87.04 ,$459.00 ,$459.00 ,"$3,387.78 ",$459.00 ,"$5,441.62 ","$4,685.84 ","$5,441.62 ","$5,441.62 ","$6,046.24 "
ST NICHOLAS HOSPITAL - ACUTE,32000439,47534,HC PLACE BILIARY DRAINAGE CATH,320,1 ,"$7,929.25 ","$5,233.31 ",$82.11 ,"$7,929.25 ",$82.11 ,"$5,434.71 ","$5,434.71 ","$3,456.92 ","$4,757.55 ","$6,739.86 ","$5,550.48 ",$82.11 ,$82.11 ,"$7,532.79 ","$6,026.23 ","$5,946.94 ",$703.38 ,"$6,739.86 ","$3,456.92 ",$703.38 ,$703.38 ,"$5,550.48 ","$4,828.91 ",$82.11 ,"$3,456.92 ","$3,387.78 ","$6,913.84 ",$87.04 ,"$6,739.86 ","$7,778.08 ","$7,294.91 ","$5,550.48 ","$3,273.50 ","$4,091.88 ","$4,828.91 ","$4,091.88 ","$5,479.11 ","$7,136.33 ","$5,417.26 ","$3,421.66 ","$6,264.11 ",$87.04 ,$459.00 ,$459.00 ,"$3,387.78 ",$459.00 ,"$5,709.06 ","$4,916.14 ","$5,709.06 ","$5,709.06 ","$6,343.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000440,75984,HC CHANGE PERC DRAINAGE TUBE OR CATH,320,1 ,$907.04 ,$598.65 ,$6.83 ,$907.04 ,$6.83 ,$248.43 ,$261.24 , N/A ,$544.22 ,$770.98 ,$634.93 ,$6.83 ,$6.83 ,$861.69 ,$689.35 ,$680.28 ,$116.36 ,$770.98 , N/A ,$116.36 ,$116.36 ,$634.93 ,$552.39 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$770.98 , N/A ,$834.48 ,$634.93 ,$460.05 ,$552.12 ,$552.39 ,$552.12 ,$626.76 ,$816.34 ,$619.69 , N/A ,$716.56 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$653.07 ,$562.36 ,$653.07 ,$653.07 ,$725.63 
ST NICHOLAS HOSPITAL - ACUTE,32000440,75984,HC CHANGE PERC DRAINAGE TUBE OR CATH,320,1 ,$907.04 ,$598.65 ,$6.83 ,$907.04 ,$6.83 ,$248.43 ,$261.24 , N/A ,$544.22 ,$770.98 ,$634.93 ,$6.83 ,$6.83 ,$861.69 ,$689.35 ,$680.28 ,$116.36 ,$770.98 , N/A ,$116.36 ,$116.36 ,$634.93 ,$552.39 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$770.98 , N/A ,$834.48 ,$634.93 ,$460.05 ,$552.12 ,$552.39 ,$552.12 ,$626.76 ,$816.34 ,$619.69 , N/A ,$716.56 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$653.07 ,$562.36 ,$653.07 ,$653.07 ,$725.63 
ST NICHOLAS HOSPITAL - ACUTE,32000444,49406,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER,320,1 ,"$1,495.00 ",$986.70 ,$25.31 ,"$3,293.01 ",$25.31 ,"$1,024.67 ","$1,024.67 ","$1,463.56 ",$897.00 ,"$1,270.75 ","$1,046.50 ",$25.31 ,$25.31 ,"$1,420.25 ","$1,136.20 ","$1,121.25 ",$371.95 ,"$1,270.75 ","$1,463.56 ",$371.95 ,$371.95 ,"$1,046.50 ",$910.46 ,$25.31 ,"$1,463.56 ","$1,434.29 ","$1,495.00 ",$26.83 ,"$1,270.75 ","$3,293.01 ","$1,375.40 ","$1,046.50 ","$1,495.00 ","$1,495.00 ",$910.46 ,"$1,495.00 ","$1,033.05 ","$1,345.50 ","$1,021.38 ","$1,448.64 ","$1,181.05 ",$26.83 ,$459.00 ,$459.00 ,"$1,434.29 ",$459.00 ,"$1,076.40 ",$926.90 ,"$1,076.40 ","$1,076.40 ","$1,196.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000445,75989,HC GUID FOR PERC DRAIN ABSCESS,320,1 ,"$1,511.04 ",$997.29 ,$6.83 ,"$1,511.04 ",$6.83 ,$245.66 ,$243.31 , N/A ,$906.62 ,"$1,284.38 ","$1,057.73 ",$6.83 ,$6.83 ,"$1,435.49 ","$1,148.39 ","$1,133.28 ",$114.39 ,"$1,284.38 ", N/A ,$114.39 ,$114.39 ,"$1,057.73 ",$920.22 ,$6.83 , N/A , N/A , N/A ,$7.24 ,"$1,284.38 ", N/A ,"$1,390.16 ","$1,057.73 ",$766.40 ,$919.77 ,$920.22 ,$919.77 ,"$1,044.13 ","$1,359.94 ","$1,032.34 ", N/A ,"$1,193.72 ",$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$1,087.95 ",$936.84 ,"$1,087.95 ","$1,087.95 ","$1,208.83 "
ST NICHOLAS HOSPITAL - ACUTE,32000446,75989,HC GUID FOR PERC CHEST TUBE INSERTION,320,1 ,"$1,511.04 ",$997.29 ,$6.83 ,"$1,511.04 ",$6.83 ,$245.66 ,$243.31 , N/A ,$906.62 ,"$1,284.38 ","$1,057.73 ",$6.83 ,$6.83 ,"$1,435.49 ","$1,148.39 ","$1,133.28 ",$114.39 ,"$1,284.38 ", N/A ,$114.39 ,$114.39 ,"$1,057.73 ",$920.22 ,$6.83 , N/A , N/A , N/A ,$7.24 ,"$1,284.38 ", N/A ,"$1,390.16 ","$1,057.73 ",$766.40 ,$919.77 ,$920.22 ,$919.77 ,"$1,044.13 ","$1,359.94 ","$1,032.34 ", N/A ,"$1,193.72 ",$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$1,087.95 ",$936.84 ,"$1,087.95 ","$1,087.95 ","$1,208.83 "
ST NICHOLAS HOSPITAL - ACUTE,32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$644.00 ,$425.04 ,$4.15 ,$644.00 ,$4.15 ,$114.04 ,$121.90 ,$227.92 ,$386.40 ,$547.40 ,$450.80 ,$4.15 ,$4.15 ,$611.80 ,$489.44 ,$483.00 ,$55.00 ,$547.40 ,$227.92 ,$55.00 ,$55.00 ,$450.80 ,$392.20 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$547.40 ,$512.81 ,$592.48 ,$450.80 ,$589.85 ,$589.85 ,$392.20 ,$589.85 ,$445.00 ,$579.60 ,$439.98 ,$225.60 ,$508.76 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,32000450,76000,HC FLUORO CARM < 1 HR,320,1 ,$644.00 ,$425.04 ,$4.15 ,$644.00 ,$4.15 ,$114.04 ,$121.90 ,$227.92 ,$386.40 ,$547.40 ,$450.80 ,$4.15 ,$4.15 ,$611.80 ,$489.44 ,$483.00 ,$55.00 ,$547.40 ,$227.92 ,$55.00 ,$55.00 ,$450.80 ,$392.20 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$547.40 ,$512.81 ,$592.48 ,$450.80 ,$589.85 ,$589.85 ,$392.20 ,$589.85 ,$445.00 ,$579.60 ,$439.98 ,$225.60 ,$508.76 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,32000452,N/A,HC FLUORO  OARM/CARM <1 HR OR,360,1 ,"$1,046.22 ",$690.51 ,$530.64 ,"$1,046.22 ", N/A , N/A , N/A , N/A ,$627.73 ,$889.29 ,$732.35 , N/A , N/A ,$993.91 ,$795.13 ,$784.67 , N/A ,$889.29 , N/A , N/A , N/A ,$732.35 ,$637.15 , N/A , N/A , N/A , N/A , N/A ,$889.29 , N/A ,$962.52 ,$732.35 ,$530.64 ,$636.83 ,$637.15 ,$636.83 ,$722.94 ,$941.60 ,$714.78 , N/A ,$826.51 , N/A , N/A , N/A , N/A , N/A ,$753.28 ,$648.66 ,$753.28 ,$753.28 ,$836.98 
ST NICHOLAS HOSPITAL - ACUTE,32000453,N/A,HC FLUOROSCOPY UP TO 1 HR SEED OR,360,1 ,"$1,046.22 ",$690.51 ,$530.64 ,"$1,046.22 ", N/A , N/A , N/A , N/A ,$627.73 ,$889.29 ,$732.35 , N/A , N/A ,$993.91 ,$795.13 ,$784.67 , N/A ,$889.29 , N/A , N/A , N/A ,$732.35 ,$637.15 , N/A , N/A , N/A , N/A , N/A ,$889.29 , N/A ,$962.52 ,$732.35 ,$530.64 ,$636.83 ,$637.15 ,$636.83 ,$722.94 ,$941.60 ,$714.78 , N/A ,$826.51 , N/A , N/A , N/A , N/A , N/A ,$753.28 ,$648.66 ,$753.28 ,$753.28 ,$836.98 
ST NICHOLAS HOSPITAL - ACUTE,32000455,N/A,HC FLUORO MINI CARM < 1 HR OR,360,1 ,"$1,046.22 ",$690.51 ,$530.64 ,"$1,046.22 ", N/A , N/A , N/A , N/A ,$627.73 ,$889.29 ,$732.35 , N/A , N/A ,$993.91 ,$795.13 ,$784.67 , N/A ,$889.29 , N/A , N/A , N/A ,$732.35 ,$637.15 , N/A , N/A , N/A , N/A , N/A ,$889.29 , N/A ,$962.52 ,$732.35 ,$530.64 ,$636.83 ,$637.15 ,$636.83 ,$722.94 ,$941.60 ,$714.78 , N/A ,$826.51 , N/A , N/A , N/A , N/A , N/A ,$753.28 ,$648.66 ,$753.28 ,$753.28 ,$836.98 
ST NICHOLAS HOSPITAL - ACUTE,32000456,N/A,HC CARM FLUORO > 1 HR OR,360,1 ,"$1,113.00 ",$734.58 ,$564.51 ,"$1,113.00 ", N/A , N/A , N/A , N/A ,$667.80 ,$946.05 ,$779.10 , N/A , N/A ,"$1,057.35 ",$845.88 ,$834.75 , N/A ,$946.05 , N/A , N/A , N/A ,$779.10 ,$677.82 , N/A , N/A , N/A , N/A , N/A ,$946.05 , N/A ,"$1,023.96 ",$779.10 ,$564.51 ,$677.48 ,$677.82 ,$677.48 ,$769.08 ,"$1,001.70 ",$760.40 , N/A ,$879.27 , N/A , N/A , N/A , N/A , N/A ,$801.36 ,$690.06 ,$801.36 ,$801.36 ,$890.40 
ST NICHOLAS HOSPITAL - ACUTE,32000464,76010,HC BABYGRAM,320,1 ,$348.70 ,$230.14 ,$1.93 ,$348.70 ,$1.93 ,$86.33 ,$69.48 ,$84.79 ,$209.22 ,$296.40 ,$244.09 ,$1.93 ,$1.93 ,$331.27 ,$265.01 ,$261.53 ,$41.80 ,$296.40 ,$84.79 ,$41.80 ,$41.80 ,$244.09 ,$212.36 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$296.40 ,$190.79 ,$320.80 ,$244.09 ,$215.92 ,$215.92 ,$212.36 ,$215.92 ,$240.95 ,$313.83 ,$238.23 ,$83.93 ,$275.47 ,$2.05 ,$348.70 ,$348.70 ,$83.09 ,$348.70 ,$251.06 ,$216.19 ,$251.06 ,$251.06 ,$278.96 
ST NICHOLAS HOSPITAL - ACUTE,32000465,76080,HC ABSCESS FISTULA OR SINUS TRACT,320,1 ,$755.52 ,$498.64 ,$4.15 ,"$1,104.87 ",$4.15 ,$147.29 ,$119.14 ,$491.05 ,$453.31 ,$642.19 ,$528.86 ,$4.15 ,$4.15 ,$717.74 ,$574.20 ,$566.64 ,$69.50 ,$642.19 ,$491.05 ,$69.50 ,$69.50 ,$528.86 ,$460.11 ,$4.15 ,$491.05 ,$481.23 ,$755.52 ,$4.40 ,$642.19 ,"$1,104.87 ",$695.08 ,$528.86 ,$755.52 ,$755.52 ,$460.11 ,$755.52 ,$522.06 ,$679.97 ,$516.17 ,$486.04 ,$596.86 ,$4.40 ,$459.00 ,$459.00 ,$481.23 ,$459.00 ,$543.97 ,$468.42 ,$543.97 ,$543.97 ,$604.42 
ST NICHOLAS HOSPITAL - ACUTE,32000466,76080,HC ABSCESS FISTULA DRAINAGE CATH CHECK,320,1 ,$755.52 ,$498.64 ,$4.15 ,"$1,104.87 ",$4.15 ,$147.29 ,$119.14 ,$491.05 ,$453.31 ,$642.19 ,$528.86 ,$4.15 ,$4.15 ,$717.74 ,$574.20 ,$566.64 ,$69.50 ,$642.19 ,$491.05 ,$69.50 ,$69.50 ,$528.86 ,$460.11 ,$4.15 ,$491.05 ,$481.23 ,$755.52 ,$4.40 ,$642.19 ,"$1,104.87 ",$695.08 ,$528.86 ,$755.52 ,$755.52 ,$460.11 ,$755.52 ,$522.06 ,$679.97 ,$516.17 ,$486.04 ,$596.86 ,$4.40 ,$459.00 ,$459.00 ,$481.23 ,$459.00 ,$543.97 ,$468.42 ,$543.97 ,$543.97 ,$604.42 
ST NICHOLAS HOSPITAL - ACUTE,32000467,76098,HC RADIOLOGICAL EXAM SURG SPEC,320,1 ,$430.54 ,$284.16 ,$4.15 ,"$1,104.87 ",$4.15 ,$104.34 ,$32.23 ,$491.05 ,$258.32 ,$365.96 ,$301.38 ,$4.15 ,$4.15 ,$409.01 ,$327.21 ,$322.91 ,$53.01 ,$365.96 ,$491.05 ,$53.01 ,$53.01 ,$301.38 ,$262.20 ,$4.15 ,$491.05 ,$481.23 ,$430.54 ,$4.40 ,$365.96 ,"$1,104.87 ",$396.10 ,$301.38 ,$430.54 ,$430.54 ,$262.20 ,$430.54 ,$297.50 ,$387.49 ,$294.14 ,$486.04 ,$340.13 ,$4.40 ,$430.54 ,$430.54 ,$481.23 ,$430.54 ,$309.99 ,$266.93 ,$309.99 ,$309.99 ,$344.43 
ST NICHOLAS HOSPITAL - ACUTE,32000472,76101,HC RADIOLOGICAL EXAM COMPLEX UNI,320,1 ,$929.87 ,$613.71 ,$149.34 ,$929.87 , N/A ,$254.34 ,$254.34 , N/A ,$557.92 ,$790.39 ,$650.91 , N/A , N/A ,$883.38 ,$706.70 ,$697.40 ,$149.34 ,$790.39 , N/A ,$149.34 ,$149.34 ,$650.91 ,$566.29 , N/A , N/A , N/A , N/A , N/A ,$790.39 , N/A ,$855.48 ,$650.91 ,$471.63 ,$566.01 ,$566.29 ,$566.01 ,$642.54 ,$836.88 ,$635.29 , N/A ,$734.60 , N/A ,$459.00 ,$459.00 , N/A ,$459.00 ,$669.51 ,$576.52 ,$669.51 ,$669.51 ,$743.90 
ST NICHOLAS HOSPITAL - ACUTE,32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,$579.60 ,$382.54 ,$6.83 ,$579.60 ,$6.83 ,$350.96 ,$277.80 , N/A ,$347.76 ,$492.66 ,$405.72 ,$6.83 ,$6.83 ,$550.62 ,$440.50 ,$434.70 ,$163.90 ,$492.66 , N/A ,$163.90 ,$163.90 ,$405.72 ,$352.98 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$492.66 , N/A ,$533.23 ,$405.72 ,$293.97 ,$352.80 ,$352.98 ,$352.80 ,$400.50 ,$521.64 ,$395.98 , N/A ,$457.88 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$417.31 ,$359.35 ,$417.31 ,$417.31 ,$463.68 
ST NICHOLAS HOSPITAL - ACUTE,32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,$644.00 ,$425.04 ,$6.83 ,$644.00 ,$6.83 ,$371.74 ,$284.69 , N/A ,$386.40 ,$547.40 ,$450.80 ,$6.83 ,$6.83 ,$611.80 ,$489.44 ,$483.00 ,$177.74 ,$547.40 , N/A ,$177.74 ,$177.74 ,$450.80 ,$392.20 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$547.40 , N/A ,$592.48 ,$450.80 ,$326.64 ,$392.00 ,$392.20 ,$392.00 ,$445.00 ,$579.60 ,$439.98 , N/A ,$508.76 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,32000477,77002,HC FLUORO NEEDLE PLACEMENT BX ASP IN,320,1 ,$644.00 ,$425.04 ,$6.83 ,$644.00 ,$6.83 ,$371.74 ,$284.69 , N/A ,$386.40 ,$547.40 ,$450.80 ,$6.83 ,$6.83 ,$611.80 ,$489.44 ,$483.00 ,$177.74 ,$547.40 , N/A ,$177.74 ,$177.74 ,$450.80 ,$392.20 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$547.40 , N/A ,$592.48 ,$450.80 ,$326.64 ,$392.00 ,$392.20 ,$392.00 ,$445.00 ,$579.60 ,$439.98 , N/A ,$508.76 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,32000478,77002,HC FLUORO NEEDLE PLACEMENT LOCAL,320,1 ,$644.00 ,$425.04 ,$6.83 ,$644.00 ,$6.83 ,$371.74 ,$284.69 , N/A ,$386.40 ,$547.40 ,$450.80 ,$6.83 ,$6.83 ,$611.80 ,$489.44 ,$483.00 ,$177.74 ,$547.40 , N/A ,$177.74 ,$177.74 ,$450.80 ,$392.20 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$547.40 , N/A ,$592.48 ,$450.80 ,$326.64 ,$392.00 ,$392.20 ,$392.00 ,$445.00 ,$579.60 ,$439.98 , N/A ,$508.76 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,32000479,77002,HC FLUORO NEEDLE PLACEMENT HIP,320,1 ,$644.00 ,$425.04 ,$6.83 ,$644.00 ,$6.83 ,$371.74 ,$284.69 , N/A ,$386.40 ,$547.40 ,$450.80 ,$6.83 ,$6.83 ,$611.80 ,$489.44 ,$483.00 ,$177.74 ,$547.40 , N/A ,$177.74 ,$177.74 ,$450.80 ,$392.20 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$547.40 , N/A ,$592.48 ,$450.80 ,$326.64 ,$392.00 ,$392.20 ,$392.00 ,$445.00 ,$579.60 ,$439.98 , N/A ,$508.76 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,32000481,77003,HC FLUORO NEEDLE LOCALIZATION,320,1 ,$708.40 ,$467.54 ,$6.83 ,$708.40 ,$6.83 ,$319.09 ,$262.62 , N/A ,$425.04 ,$602.14 ,$495.88 ,$6.83 ,$6.83 ,$672.98 ,$538.38 ,$531.30 ,$153.32 ,$602.14 , N/A ,$153.32 ,$153.32 ,$495.88 ,$431.42 ,$6.83 , N/A , N/A , N/A ,$7.24 ,$602.14 , N/A ,$651.73 ,$495.88 ,$359.30 ,$431.20 ,$431.42 ,$431.20 ,$489.50 ,$637.56 ,$483.98 , N/A ,$559.64 ,$7.24 ,$459.00 ,$459.00 , N/A ,$459.00 ,$510.05 ,$439.21 ,$510.05 ,$510.05 ,$566.72 
ST NICHOLAS HOSPITAL - ACUTE,32000483,19283,HC MAMM STER GUIDE BRST NDL PL,320,1 ,"$1,495.00 ",$986.70 ,$46.22 ,"$1,495.00 ",$46.22 ,"$1,024.67 ","$1,024.67 ",$633.39 ,$897.00 ,"$1,270.75 ","$1,046.50 ",$46.22 ,$46.22 ,"$1,420.25 ","$1,136.20 ","$1,121.25 ",$191.47 ,"$1,270.75 ",$633.39 ,$191.47 ,$191.47 ,"$1,046.50 ",$910.46 ,$46.22 ,$633.39 ,$620.72 ,"$1,266.78 ",$48.99 ,"$1,270.75 ","$1,425.14 ","$1,375.40 ","$1,046.50 ","$1,495.00 ","$1,495.00 ",$910.46 ,"$1,495.00 ","$1,033.05 ","$1,345.50 ","$1,021.38 ",$626.93 ,"$1,181.05 ",$48.99 ,$459.00 ,$459.00 ,$620.72 ,$459.00 ,"$1,076.40 ",$926.90 ,"$1,076.40 ","$1,076.40 ","$1,196.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000486,19283,HC MAMM STER GUIDE BRST STEREO CORE,320,1 ,"$1,495.00 ",$986.70 ,$46.22 ,"$1,495.00 ",$46.22 ,"$1,024.67 ","$1,024.67 ",$633.39 ,$897.00 ,"$1,270.75 ","$1,046.50 ",$46.22 ,$46.22 ,"$1,420.25 ","$1,136.20 ","$1,121.25 ",$191.47 ,"$1,270.75 ",$633.39 ,$191.47 ,$191.47 ,"$1,046.50 ",$910.46 ,$46.22 ,$633.39 ,$620.72 ,"$1,266.78 ",$48.99 ,"$1,270.75 ","$1,425.14 ","$1,375.40 ","$1,046.50 ","$1,495.00 ","$1,495.00 ",$910.46 ,"$1,495.00 ","$1,033.05 ","$1,345.50 ","$1,021.38 ",$626.93 ,"$1,181.05 ",$48.99 ,$459.00 ,$459.00 ,$620.72 ,$459.00 ,"$1,076.40 ",$926.90 ,"$1,076.40 ","$1,076.40 ","$1,196.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$3,450.00 ","$2,277.00 ",$69.34 ,"$5,672.82 ",$69.34 ,"$2,364.63 ","$2,364.63 ","$2,521.25 ","$2,070.00 ","$2,932.50 ","$2,415.00 ",$69.34 ,$69.34 ,"$3,277.50 ","$2,622.00 ","$2,587.50 ",$314.51 ,"$2,932.50 ","$2,521.25 ",$314.51 ,$314.51 ,"$2,415.00 ","$2,101.05 ",$69.34 ,"$2,521.25 ","$2,470.82 ","$3,450.00 ",$73.50 ,"$2,932.50 ","$5,672.82 ","$3,174.00 ","$2,415.00 ","$2,997.62 ","$3,450.00 ","$2,101.05 ","$3,450.00 ","$2,383.95 ","$3,105.00 ","$2,357.04 ","$2,495.53 ","$2,725.50 ",$73.50 ,$459.00 ,$459.00 ,"$2,470.82 ",$459.00 ,"$2,484.00 ","$2,139.00 ","$2,484.00 ","$2,484.00 ","$2,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$3,450.00 ","$2,277.00 ",$69.34 ,"$5,672.82 ",$69.34 ,"$2,364.63 ","$2,364.63 ","$2,521.25 ","$2,070.00 ","$2,932.50 ","$2,415.00 ",$69.34 ,$69.34 ,"$3,277.50 ","$2,622.00 ","$2,587.50 ",$314.51 ,"$2,932.50 ","$2,521.25 ",$314.51 ,$314.51 ,"$2,415.00 ","$2,101.05 ",$69.34 ,"$2,521.25 ","$2,470.82 ","$3,450.00 ",$73.50 ,"$2,932.50 ","$5,672.82 ","$3,174.00 ","$2,415.00 ","$2,997.62 ","$3,450.00 ","$2,101.05 ","$3,450.00 ","$2,383.95 ","$3,105.00 ","$2,357.04 ","$2,495.53 ","$2,725.50 ",$73.50 ,$459.00 ,$459.00 ,"$2,470.82 ",$459.00 ,"$2,484.00 ","$2,139.00 ","$2,484.00 ","$2,484.00 ","$2,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000488,19284,HC MAMM STER GUIDE BRST MAMMT STEREO CORE ADDN,361,1 ,$172.50 ,$113.85 ,$46.22 ,"$2,497.74 ",$46.22 ,$172.50 ,$172.50 , N/A ,$103.50 ,$146.63 ,$120.75 ,$46.22 ,$46.22 ,$163.88 ,$131.10 ,$129.38 ,$172.50 ,$146.63 , N/A ,$172.50 ,$172.50 ,$120.75 ,$105.05 ,$46.22 , N/A , N/A , N/A ,$48.99 ,$146.63 , N/A ,$158.70 ,$120.75 ,"$1,998.41 ","$2,497.74 ",$105.05 ,"$2,497.74 ",$119.20 ,$155.25 ,$117.85 , N/A ,$136.28 ,$48.99 ,$172.50 ,$172.50 , N/A ,$172.50 ,$124.20 ,$106.95 ,$124.20 ,$124.20 ,$138.00 
ST NICHOLAS HOSPITAL - ACUTE,32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,$851.00 ,$561.66 ,$46.22 ,"$3,293.01 ",$46.22 ,$583.28 ,$583.28 ,"$1,463.56 ",$510.60 ,$723.35 ,$595.70 ,$46.22 ,$46.22 ,$808.45 ,$646.76 ,$638.25 ,$191.04 ,$723.35 ,"$1,463.56 ",$191.04 ,$191.04 ,$595.70 ,$518.26 ,$46.22 ,"$1,463.56 ","$1,434.29 ",$851.00 ,$48.99 ,$723.35 ,"$3,293.01 ",$782.92 ,$595.70 ,$851.00 ,$851.00 ,$518.26 ,$851.00 ,$588.04 ,$765.90 ,$581.40 ,"$1,448.64 ",$672.29 ,$48.99 ,$459.00 ,$459.00 ,"$1,434.29 ",$459.00 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$680.80 
ST NICHOLAS HOSPITAL - ACUTE,32000490,77053,HC GALACTOGRAM SINGLE DUCT,320,1 ,$861.07 ,$568.31 ,$4.15 ,$861.07 ,$4.15 ,$148.68 ,$152.25 ,$227.92 ,$516.64 ,$731.91 ,$602.75 ,$4.15 ,$4.15 ,$818.02 ,$654.41 ,$645.80 ,$71.48 ,$731.91 ,$227.92 ,$71.48 ,$71.48 ,$602.75 ,$524.39 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$731.91 ,$512.81 ,$792.18 ,$602.75 ,$861.07 ,$861.07 ,$524.39 ,$861.07 ,$595.00 ,$774.96 ,$588.28 ,$225.60 ,$680.25 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$619.97 ,$533.86 ,$619.97 ,$619.97 ,$688.86 
ST NICHOLAS HOSPITAL - ACUTE,32000491,77054,HC GALACTOGRAM MULTI DUCT,320,1 ,$861.07 ,$568.31 ,$4.15 ,$861.07 ,$4.15 ,$195.79 ,$201.92 ,$227.92 ,$516.64 ,$731.91 ,$602.75 ,$4.15 ,$4.15 ,$818.02 ,$654.41 ,$645.80 ,$94.61 ,$731.91 ,$227.92 ,$94.61 ,$94.61 ,$602.75 ,$524.39 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$731.91 ,$512.81 ,$792.18 ,$602.75 ,$861.07 ,$861.07 ,$524.39 ,$861.07 ,$595.00 ,$774.96 ,$588.28 ,$225.60 ,$680.25 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$619.97 ,$533.86 ,$619.97 ,$619.97 ,$688.86 
ST NICHOLAS HOSPITAL - ACUTE,32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$132.05 ,$88.79 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$62.91 ,$413.87 ,$104.31 ,$62.91 ,$62.91 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$215.92 ,$215.92 ,$296.53 ,$215.92 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000493,77074,HC BONE SURVEY LIMITED,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$183.32 ,$172.95 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$87.33 ,$413.87 ,$104.31 ,$87.33 ,$87.33 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$342.19 ,$342.19 ,$296.53 ,$342.19 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,$641.79 ,$423.58 ,$4.15 ,$641.79 ,$4.15 ,$302.47 ,$251.58 ,$104.31 ,$385.07 ,$545.52 ,$449.25 ,$4.15 ,$4.15 ,$609.70 ,$487.76 ,$481.34 ,$144.98 ,$545.52 ,$104.31 ,$144.98 ,$144.98 ,$449.25 ,$390.85 ,$4.15 ,$104.31 ,$102.22 ,$208.62 ,$4.40 ,$545.52 ,$234.71 ,$590.45 ,$449.25 ,$342.19 ,$342.19 ,$390.85 ,$342.19 ,$443.48 ,$577.61 ,$438.47 ,$103.24 ,$507.01 ,$4.40 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$462.09 ,$397.91 ,$462.09 ,$462.09 ,$513.43 
ST NICHOLAS HOSPITAL - ACUTE,32000495,77076,HC OSSEOUS SURVEY INFANT,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$305.24 ,$254.34 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$146.29 ,$413.87 ,$104.31 ,$146.29 ,$146.29 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$342.19 ,$342.19 ,$296.53 ,$342.19 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000496,77080,HC BONE DENSITY DXA,320,1 ,$736.20 ,$485.89 ,$2.73 ,$736.20 ,$2.73 ,$112.66 ,$116.38 ,$104.31 ,$441.72 ,$625.77 ,$515.34 ,$2.73 ,$2.73 ,$699.39 ,$559.51 ,$552.15 ,$56.31 ,$625.77 ,$104.31 ,$56.31 ,$56.31 ,$515.34 ,$448.35 ,$2.73 ,$104.31 ,$102.22 ,$208.62 ,$2.89 ,$625.77 ,$234.71 ,$677.30 ,$515.34 ,$339.47 ,$339.47 ,$448.35 ,$339.47 ,$508.71 ,$662.58 ,$502.97 ,$103.24 ,$581.60 ,$2.89 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$530.06 ,$456.44 ,$530.06 ,$530.06 ,$588.96 
ST NICHOLAS HOSPITAL - ACUTE,32000499,0238T,HC TRNLUM PERIP ATHRC ILIAC ARTY 0238T,320,1 ,"$14,867.20 ","$9,812.35 ",$376.97 ,"$37,722.01 ",$376.97 ,"$10,189.98 ","$10,189.98 ","$16,765.34 ","$8,920.32 ","$12,637.12 ","$10,407.04 ",$376.97 ,$376.97 ,"$14,123.84 ","$11,299.07 ","$11,150.40 ","$14,867.20 ","$12,637.12 ","$16,765.34 ","$14,867.20 ","$14,867.20 ","$10,407.04 ","$9,054.12 ",$376.97 ,"$16,765.34 ","$16,430.03 ","$14,867.20 ",$399.59 ,"$12,637.12 ","$37,722.01 ","$13,677.82 ","$10,407.04 ","$4,887.30 ","$6,108.86 ","$9,054.12 ","$6,108.86 ","$10,273.24 ","$13,380.48 ","$10,157.27 ","$16,594.33 ","$11,745.09 ",$399.59 ,$459.00 ,$459.00 ,"$16,430.03 ",$459.00 ,"$10,704.38 ","$9,217.66 ","$10,704.38 ","$10,704.38 ","$11,893.76 "
ST NICHOLAS HOSPITAL - ACUTE,32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$644.00 ,$425.04 ,$4.15 ,$644.00 ,$4.15 ,$114.04 ,$121.90 ,$227.92 ,$386.40 ,$547.40 ,$450.80 ,$4.15 ,$4.15 ,$611.80 ,$489.44 ,$483.00 ,$55.00 ,$547.40 ,$227.92 ,$55.00 ,$55.00 ,$450.80 ,$392.20 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$547.40 ,$512.81 ,$592.48 ,$450.80 ,$589.85 ,$589.85 ,$392.20 ,$589.85 ,$445.00 ,$579.60 ,$439.98 ,$225.60 ,$508.76 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,32000503,20501,HC INJ TRACT SINOGRAM DIAG,320,1 ,$519.80 ,$343.07 ,$10.77 ,$519.80 ,$10.77 ,$356.27 ,$356.27 , N/A ,$311.88 ,$441.83 ,$363.86 ,$10.77 ,$10.77 ,$493.81 ,$395.05 ,$389.85 ,$70.83 ,$441.83 , N/A ,$70.83 ,$70.83 ,$363.86 ,$316.56 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$441.83 , N/A ,$478.22 ,$363.86 ,$263.64 ,$316.40 ,$316.56 ,$316.40 ,$359.18 ,$467.82 ,$355.13 , N/A ,$410.64 ,$11.42 ,$459.00 ,$459.00 , N/A ,$459.00 ,$374.26 ,$322.28 ,$374.26 ,$374.26 ,$415.84 
ST NICHOLAS HOSPITAL - ACUTE,32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,$446.20 ,$294.49 ,$8.46 ,$597.07 ,$8.46 ,$305.83 ,$305.83 ,$265.36 ,$267.72 ,$379.27 ,$312.34 ,$8.46 ,$8.46 ,$423.89 ,$339.11 ,$334.65 ,$71.36 ,$379.27 ,$265.36 ,$71.36 ,$71.36 ,$312.34 ,$271.74 ,$8.46 ,$265.36 ,$260.05 ,$446.20 ,$8.97 ,$379.27 ,$597.07 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$262.65 ,$352.50 ,$8.97 ,$446.20 ,$446.20 ,$260.05 ,$446.20 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,32000506,20553,HC INJ TRIGGER PT 3+ MUSC GROUP,320,1 ,$495.65 ,$327.13 ,$8.46 ,$597.07 ,$8.46 ,$339.72 ,$339.72 ,$265.36 ,$297.39 ,$421.30 ,$346.96 ,$8.46 ,$8.46 ,$470.87 ,$376.69 ,$371.74 ,$81.34 ,$421.30 ,$265.36 ,$81.34 ,$81.34 ,$346.96 ,$301.85 ,$8.46 ,$265.36 ,$260.05 ,$495.65 ,$8.97 ,$421.30 ,$597.07 ,$456.00 ,$346.96 ,$251.39 ,$301.70 ,$301.85 ,$301.70 ,$342.49 ,$446.09 ,$338.63 ,$262.65 ,$391.56 ,$8.97 ,$459.00 ,$459.00 ,$260.05 ,$459.00 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,32000508,74775,HC VAGINOGRAM,320,1 ,$929.87 ,$613.71 ,$4.15 ,$929.87 ,$4.15 ,$208.53 ,$204.40 ,$227.92 ,$557.92 ,$790.39 ,$650.91 ,$4.15 ,$4.15 ,$883.38 ,$706.70 ,$697.40 ,$120.64 ,$790.39 ,$227.92 ,$120.64 ,$120.64 ,$650.91 ,$566.29 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$790.39 ,$512.81 ,$855.48 ,$650.91 ,$929.87 ,$929.87 ,$566.29 ,$929.87 ,$642.54 ,$836.88 ,$635.29 ,$225.60 ,$734.60 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$669.51 ,$576.52 ,$669.51 ,$669.51 ,$743.90 
ST NICHOLAS HOSPITAL - ACUTE,32000509,77072,HC BONE AGE STUDIES,320,1 ,$630.12 ,$415.88 ,$1.93 ,$630.12 ,$1.93 ,$69.71 ,$55.68 ,$104.31 ,$378.07 ,$535.60 ,$441.08 ,$1.93 ,$1.93 ,$598.61 ,$478.89 ,$472.59 ,$33.21 ,$535.60 ,$104.31 ,$33.21 ,$33.21 ,$441.08 ,$383.74 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$535.60 ,$234.71 ,$579.71 ,$441.08 ,$215.92 ,$215.92 ,$383.74 ,$215.92 ,$435.41 ,$567.11 ,$430.50 ,$103.24 ,$497.79 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$453.69 ,$390.67 ,$453.69 ,$453.69 ,$504.10 
ST NICHOLAS HOSPITAL - ACUTE,32000515,G0278,HC ILIAC ARTERY ANGIO W CATH G0278,320,1 ,$785.45 ,$518.40 ,$24.62 ,$785.45 ,$151.22 ,$52.29 ,$538.35 , N/A ,$471.27 ,$667.63 ,$549.82 ,$151.22 ,$151.22 ,$746.18 ,$596.94 ,$589.09 ,$24.62 ,$667.63 , N/A ,$24.62 ,$24.62 ,$549.82 ,$478.34 ,$151.22 , N/A , N/A , N/A ,$160.29 ,$667.63 , N/A ,$722.61 ,$549.82 ,$398.38 ,$478.10 ,$478.34 ,$478.10 ,$542.75 ,$706.91 ,$536.62 , N/A ,$620.51 ,$160.29 ,$459.00 ,$459.00 , N/A ,$459.00 ,$565.52 ,$486.98 ,$565.52 ,$565.52 ,$628.36 
ST NICHOLAS HOSPITAL - ACUTE,32000525,N/A,HC CARM FLUORO <1 HR OR,360,1 ,"$1,046.22 ",$690.51 ,$530.64 ,"$1,046.22 ", N/A , N/A , N/A , N/A ,$627.73 ,$889.29 ,$732.35 , N/A , N/A ,$993.91 ,$795.13 ,$784.67 , N/A ,$889.29 , N/A , N/A , N/A ,$732.35 ,$637.15 , N/A , N/A , N/A , N/A , N/A ,$889.29 , N/A ,$962.52 ,$732.35 ,$530.64 ,$636.83 ,$637.15 ,$636.83 ,$722.94 ,$941.60 ,$714.78 , N/A ,$826.51 , N/A , N/A , N/A , N/A , N/A ,$753.28 ,$648.66 ,$753.28 ,$753.28 ,$836.98 
ST NICHOLAS HOSPITAL - ACUTE,32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,"$1,362.75 ",$899.42 ,$33.66 ,"$1,362.75 ",$33.66 ,$934.03 ,$934.03 ,$564.62 ,$817.65 ,"$1,158.34 ",$953.93 ,$33.66 ,$33.66 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$169.06 ,"$1,158.34 ",$564.62 ,$169.06 ,$169.06 ,$953.93 ,$829.91 ,$33.66 ,$564.62 ,$553.33 ,"$1,129.24 ",$35.68 ,"$1,158.34 ","$1,270.39 ","$1,253.73 ",$953.93 ,"$1,362.75 ","$1,362.75 ",$829.91 ,"$1,362.75 ",$941.66 ,"$1,226.48 ",$931.03 ,$558.86 ,"$1,076.57 ",$35.68 ,$459.00 ,$459.00 ,$553.33 ,$459.00 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$1,486.95 ",$981.39 ,$50.49 ,"$1,905.58 ",$50.49 ,"$1,019.16 ","$1,019.16 ",$846.92 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$50.49 ,$50.49 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$210.88 ,"$1,263.91 ",$846.92 ,$210.88 ,$210.88 ,"$1,040.87 ",$905.55 ,$50.49 ,$846.92 ,$829.98 ,"$1,486.95 ",$53.52 ,"$1,263.91 ","$1,905.58 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ",$838.28 ,"$1,174.69 ",$53.52 ,$459.00 ,$459.00 ,$829.98 ,$459.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$1,486.95 ",$981.39 ,$50.49 ,"$1,905.58 ",$50.49 ,"$1,019.16 ","$1,019.16 ",$846.92 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$50.49 ,$50.49 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$210.88 ,"$1,263.91 ",$846.92 ,$210.88 ,$210.88 ,"$1,040.87 ",$905.55 ,$50.49 ,$846.92 ,$829.98 ,"$1,486.95 ",$53.52 ,"$1,263.91 ","$1,905.58 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ",$838.28 ,"$1,174.69 ",$53.52 ,$459.00 ,$459.00 ,$829.98 ,$459.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,32000532,32556,HC PLEURAL DRAINAGE W/O IMAGING 32556,450,1 ,"$1,362.75 ",$899.42 ,$33.66 ,"$3,824.53 ",$33.66 ,$934.03 ,$934.03 ,"$1,699.79 ",$817.65 ,"$1,158.34 ",$953.93 ,$33.66 ,$33.66 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$885.79 ,"$1,158.34 ","$1,699.79 ",$885.79 ,$885.79 ,$953.93 ,$829.91 ,$33.66 ,"$1,699.79 ","$1,665.79 ","$1,362.75 ",$35.68 ,"$1,158.34 ","$3,824.53 ","$1,253.73 ",$953.93 ,$691.19 ,$829.51 ,$829.91 ,$829.51 ,$941.66 ,"$1,226.48 ",$931.03 ,"$1,682.45 ","$1,076.57 ",$35.68 ,$700.00 ,$700.00 ,"$1,665.79 ",$700.00 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000533,32557,HC PLEURAL DRAINAGE W/IMAGING 32557,320,1 ,"$2,229.85 ","$1,471.70 ",$33.66 ,"$3,267.32 ",$33.66 ,"$1,528.34 ","$1,528.34 ","$1,452.14 ","$1,337.91 ","$1,895.37 ","$1,560.90 ",$33.66 ,$33.66 ,"$2,118.36 ","$1,694.69 ","$1,672.39 ",$286.65 ,"$1,895.37 ","$1,452.14 ",$286.65 ,$286.65 ,"$1,560.90 ","$1,357.98 ",$33.66 ,"$1,452.14 ","$1,423.10 ","$2,229.85 ",$35.68 ,"$1,895.37 ","$3,267.32 ","$2,051.46 ","$1,560.90 ","$1,771.14 ","$2,213.66 ","$1,357.98 ","$2,213.66 ","$1,540.83 ","$2,006.87 ","$1,523.43 ","$1,437.33 ","$1,761.58 ",$35.68 ,$459.00 ,$459.00 ,"$1,423.10 ",$459.00 ,"$1,605.49 ","$1,382.51 ","$1,605.49 ","$1,605.49 ","$1,783.88 "
ST NICHOLAS HOSPITAL - ACUTE,32000540,N/A,HC FLUORO OARM  > 1 HR OR,360,1 ,"$1,113.00 ",$734.58 ,$564.51 ,"$1,113.00 ", N/A , N/A , N/A , N/A ,$667.80 ,$946.05 ,$779.10 , N/A , N/A ,"$1,057.35 ",$845.88 ,$834.75 , N/A ,$946.05 , N/A , N/A , N/A ,$779.10 ,$677.82 , N/A , N/A , N/A , N/A , N/A ,$946.05 , N/A ,"$1,023.96 ",$779.10 ,$564.51 ,$677.48 ,$677.82 ,$677.48 ,$769.08 ,"$1,001.70 ",$760.40 , N/A ,$879.27 , N/A , N/A , N/A , N/A , N/A ,$801.36 ,$690.06 ,$801.36 ,$801.36 ,$890.40 
ST NICHOLAS HOSPITAL - ACUTE,32000542,20551,HC INJ TENDON ORIGIN,320,1 ,$495.65 ,$327.13 ,$8.46 ,$597.07 ,$8.46 ,$339.72 ,$339.72 ,$265.36 ,$297.39 ,$421.30 ,$346.96 ,$8.46 ,$8.46 ,$470.87 ,$376.69 ,$371.74 ,$74.74 ,$421.30 ,$265.36 ,$74.74 ,$74.74 ,$346.96 ,$301.85 ,$8.46 ,$265.36 ,$260.05 ,$495.65 ,$8.97 ,$421.30 ,$597.07 ,$456.00 ,$346.96 ,$251.39 ,$301.70 ,$301.85 ,$301.70 ,$342.49 ,$446.09 ,$338.63 ,$262.65 ,$391.56 ,$8.97 ,$459.00 ,$459.00 ,$260.05 ,$459.00 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,32000548,51100,HC ASPIRATE BLADDER BY NEEDLE,320,1 ,$458.85 ,$302.84 ,$13.57 ,$471.85 ,$13.57 ,$314.50 ,$314.50 ,$209.71 ,$275.31 ,$390.02 ,$321.20 ,$13.57 ,$13.57 ,$435.91 ,$348.73 ,$344.14 ,$74.19 ,$390.02 ,$209.71 ,$74.19 ,$74.19 ,$321.20 ,$279.44 ,$13.57 ,$209.71 ,$205.52 ,$419.42 ,$14.38 ,$390.02 ,$471.85 ,$422.14 ,$321.20 ,$232.73 ,$279.30 ,$279.44 ,$279.30 ,$317.07 ,$412.97 ,$313.49 ,$207.57 ,$362.49 ,$14.38 ,$458.85 ,$458.85 ,$205.52 ,$458.85 ,$330.37 ,$284.49 ,$330.37 ,$330.37 ,$367.08 
ST NICHOLAS HOSPITAL - ACUTE,32000560,49460,HC MECHAN REMOVAL OF OBSTRUCT MATERIAL FROM G/J/D TUBE FLUOR/CONT,320,1 ,"$1,265.00 ",$834.90 ,$16.75 ,"$1,812.82 ",$16.75 ,$867.03 ,$867.03 ,$805.70 ,$759.00 ,"$1,075.25 ",$885.50 ,$16.75 ,$16.75 ,"$1,201.75 ",$961.40 ,$948.75 ,$94.38 ,"$1,075.25 ",$805.70 ,$94.38 ,$94.38 ,$885.50 ,$770.39 ,$16.75 ,$805.70 ,$789.59 ,"$1,265.00 ",$17.76 ,"$1,075.25 ","$1,812.82 ","$1,163.80 ",$885.50 ,"$1,265.00 ","$1,265.00 ",$770.39 ,"$1,265.00 ",$874.12 ,"$1,138.50 ",$864.25 ,$797.48 ,$999.35 ,$17.76 ,$459.00 ,$459.00 ,$789.59 ,$459.00 ,$910.80 ,$784.30 ,$910.80 ,$910.80 ,"$1,012.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000561,49405,HC ABSCESS DRAIN KIDN/LIV/SPLN/LUNG VISERAL 49405,320,1 ,"$1,610.00 ","$1,062.60 ",$25.31 ,"$3,293.01 ",$25.31 ,"$1,103.49 ","$1,103.49 ","$1,463.56 ",$966.00 ,"$1,368.50 ","$1,127.00 ",$25.31 ,$25.31 ,"$1,529.50 ","$1,223.60 ","$1,207.50 ",$371.95 ,"$1,368.50 ","$1,463.56 ",$371.95 ,$371.95 ,"$1,127.00 ",$980.49 ,$25.31 ,"$1,463.56 ","$1,434.29 ","$1,610.00 ",$26.83 ,"$1,368.50 ","$3,293.01 ","$1,481.20 ","$1,127.00 ","$1,610.00 ","$1,610.00 ",$980.49 ,"$1,610.00 ","$1,112.51 ","$1,449.00 ","$1,099.95 ","$1,448.64 ","$1,271.90 ",$26.83 ,$459.00 ,$459.00 ,"$1,434.29 ",$459.00 ,"$1,159.20 ",$998.20 ,"$1,159.20 ","$1,159.20 ","$1,288.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000562,49406,HC ABSCESS DRAIN PERI/ RETROPER PERC 49406,320,1 ,"$1,610.00 ","$1,062.60 ",$25.31 ,"$3,293.01 ",$25.31 ,"$1,103.49 ","$1,103.49 ","$1,463.56 ",$966.00 ,"$1,368.50 ","$1,127.00 ",$25.31 ,$25.31 ,"$1,529.50 ","$1,223.60 ","$1,207.50 ",$371.95 ,"$1,368.50 ","$1,463.56 ",$371.95 ,$371.95 ,"$1,127.00 ",$980.49 ,$25.31 ,"$1,463.56 ","$1,434.29 ","$1,610.00 ",$26.83 ,"$1,368.50 ","$3,293.01 ","$1,481.20 ","$1,127.00 ","$1,610.00 ","$1,610.00 ",$980.49 ,"$1,610.00 ","$1,112.51 ","$1,449.00 ","$1,099.95 ","$1,448.64 ","$1,271.90 ",$26.83 ,$459.00 ,$459.00 ,"$1,434.29 ",$459.00 ,"$1,159.20 ",$998.20 ,"$1,159.20 ","$1,159.20 ","$1,288.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000563,49407,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER TV OR TR,320,1 ,"$1,610.00 ","$1,062.60 ",$25.31 ,"$3,293.01 ",$25.31 ,"$1,103.49 ","$1,103.49 ","$1,463.56 ",$966.00 ,"$1,368.50 ","$1,127.00 ",$25.31 ,$25.31 ,"$1,529.50 ","$1,223.60 ","$1,207.50 ",$392.62 ,"$1,368.50 ","$1,463.56 ",$392.62 ,$392.62 ,"$1,127.00 ",$980.49 ,$25.31 ,"$1,463.56 ","$1,434.29 ","$1,610.00 ",$26.83 ,"$1,368.50 ","$3,293.01 ","$1,481.20 ","$1,127.00 ","$1,610.00 ","$1,610.00 ",$980.49 ,"$1,610.00 ","$1,112.51 ","$1,449.00 ","$1,099.95 ","$1,448.64 ","$1,271.90 ",$26.83 ,$459.00 ,$459.00 ,"$1,434.29 ",$459.00 ,"$1,159.20 ",$998.20 ,"$1,159.20 ","$1,159.20 ","$1,288.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000564,0075T,HC STENT VERTEBRAL EXTRACRANIAL 0075T,320,1 ,"$9,539.25 ","$6,295.91 ",$205.34 ,"$9,539.25 ",$205.34 ,"$6,538.20 ","$6,538.20 ", N/A ,"$5,723.55 ","$8,108.36 ","$6,677.48 ",$205.34 ,$205.34 ,"$9,062.29 ","$7,249.83 ","$7,154.44 ","$1,538.07 ","$8,108.36 ", N/A ,"$1,538.07 ","$1,538.07 ","$6,677.48 ","$5,809.40 ",$205.34 , N/A , N/A , N/A ,$217.66 ,"$8,108.36 ", N/A ,"$8,776.11 ","$6,677.48 ","$4,838.31 ","$5,806.54 ","$5,809.40 ","$5,806.54 ","$6,591.62 ","$8,585.33 ","$6,517.22 ", N/A ,"$7,536.01 ",$217.66 ,$459.00 ,$459.00 , N/A ,$459.00 ,"$6,868.26 ","$5,914.34 ","$6,868.26 ","$6,868.26 ","$7,631.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000565,37218,HC STENT CAROTID INTRATHORACIC 37218,320,1 ,"$1,177.00 ",$776.82 ,$397.02 ,"$1,177.00 ",$397.02 ,$806.72 ,$806.72 , N/A ,$706.20 ,"$1,000.45 ",$823.90 ,$397.02 ,$397.02 ,"$1,118.15 ",$894.52 ,$882.75 ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,177.00 ","$1,177.00 ",$823.90 ,$716.79 ,$397.02 , N/A , N/A , N/A ,$420.84 ,"$1,000.45 ", N/A ,"$1,082.84 ",$823.90 ,$596.97 ,$716.44 ,$716.79 ,$716.44 ,$813.31 ,"$1,059.30 ",$804.13 , N/A ,$929.83 ,$420.84 ,$459.00 ,$459.00 , N/A ,$459.00 ,$847.44 ,$729.74 ,$847.44 ,$847.44 ,$941.60 
ST NICHOLAS HOSPITAL - ACUTE,32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$122.36 ,$97.07 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$58.96 ,$333.63 ,$84.79 ,$58.96 ,$58.96 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000568,70190,HC XR EYE SOCKETS,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$112.66 ,$98.45 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$53.01 ,$333.63 ,$84.79 ,$53.01 ,$53.01 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000570,72081,HC XR SPINE/CERV SCOLIOSIS 1 VW,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$102.59 ,$102.59 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$59.61 ,$333.63 ,$84.79 ,$59.61 ,$59.61 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$223.70 ,$223.70 ,$239.03 ,$223.70 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$188.12 ,$188.12 ,$104.31 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$109.12 ,$333.63 ,$104.31 ,$109.12 ,$109.12 ,$274.75 ,$239.03 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$333.63 ,$234.71 ,$361.10 ,$274.75 ,$370.51 ,$370.51 ,$239.03 ,$370.51 ,$271.22 ,$353.25 ,$268.16 ,$103.24 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$102.22 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000572,72083,HC XR SPINE/CERV SCOLIOSIS 4-5VW,320,1 ,$439.18 ,$289.86 ,$1.93 ,$439.18 ,$1.93 ,$225.37 ,$225.37 ,$104.31 ,$263.51 ,$373.30 ,$307.43 ,$1.93 ,$1.93 ,$417.22 ,$333.78 ,$329.39 ,$122.30 ,$373.30 ,$104.31 ,$122.30 ,$122.30 ,$307.43 ,$267.46 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$373.30 ,$234.71 ,$404.05 ,$307.43 ,$439.18 ,$439.18 ,$267.46 ,$439.18 ,$303.47 ,$395.26 ,$300.05 ,$103.24 ,$346.95 ,$2.05 ,$439.18 ,$439.18 ,$102.22 ,$439.18 ,$316.21 ,$272.29 ,$316.21 ,$316.21 ,$351.34 
ST NICHOLAS HOSPITAL - ACUTE,32000573,72084,HC XR SPINE/CERV SCOLIOSIS 6+VW,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$264.00 ,$264.00 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$156.19 ,$413.87 ,$104.31 ,$156.19 ,$156.19 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$486.91 ,$486.91 ,$296.53 ,$486.91 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$81.90 ,$81.90 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$47.07 ,$333.63 ,$84.79 ,$47.07 ,$47.07 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$223.70 ,$223.70 ,$239.03 ,$223.70 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$439.18 ,$289.86 ,$1.93 ,$439.18 ,$1.93 ,$121.90 ,$121.90 ,$84.79 ,$263.51 ,$373.30 ,$307.43 ,$1.93 ,$1.93 ,$417.22 ,$333.78 ,$329.39 ,$71.48 ,$373.30 ,$84.79 ,$71.48 ,$71.48 ,$307.43 ,$267.46 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$373.30 ,$190.79 ,$404.05 ,$307.43 ,$223.70 ,$223.70 ,$267.46 ,$223.70 ,$303.47 ,$395.26 ,$300.05 ,$83.93 ,$346.95 ,$2.05 ,$439.18 ,$439.18 ,$83.09 ,$439.18 ,$316.21 ,$272.29 ,$316.21 ,$316.21 ,$351.34 
ST NICHOLAS HOSPITAL - ACUTE,32000576,73503,HC XR HIP W/PELVIS UNI 4+VWS,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$152.25 ,$152.25 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$91.29 ,$413.87 ,$104.31 ,$91.29 ,$91.29 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$370.51 ,$370.51 ,$296.53 ,$370.51 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$486.91 ,$321.36 ,$1.93 ,$486.91 ,$1.93 ,$103.97 ,$103.97 ,$104.31 ,$292.15 ,$413.87 ,$340.84 ,$1.93 ,$1.93 ,$462.56 ,$370.05 ,$365.18 ,$60.27 ,$413.87 ,$104.31 ,$60.27 ,$60.27 ,$340.84 ,$296.53 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$413.87 ,$234.71 ,$447.96 ,$340.84 ,$370.51 ,$370.51 ,$296.53 ,$370.51 ,$336.45 ,$438.22 ,$332.66 ,$103.24 ,$384.66 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$350.58 ,$301.88 ,$350.58 ,$350.58 ,$389.53 
ST NICHOLAS HOSPITAL - ACUTE,32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$534.65 ,$352.87 ,$1.93 ,$534.65 ,$1.93 ,$134.32 ,$134.32 ,$104.31 ,$320.79 ,$454.45 ,$374.26 ,$1.93 ,$1.93 ,$507.92 ,$406.33 ,$400.99 ,$78.08 ,$454.45 ,$104.31 ,$78.08 ,$78.08 ,$374.26 ,$325.60 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$454.45 ,$234.71 ,$491.88 ,$374.26 ,$370.51 ,$370.51 ,$325.60 ,$370.51 ,$369.44 ,$481.19 ,$365.27 ,$103.24 ,$422.37 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$384.95 ,$331.48 ,$384.95 ,$384.95 ,$427.72 
ST NICHOLAS HOSPITAL - ACUTE,32000579,73523,HC XR HIP W/PELVIS BIL 5+VIEWS,320,1 ,$582.39 ,$384.38 ,$1.93 ,$582.39 ,$1.93 ,$163.29 ,$163.29 ,$104.31 ,$349.43 ,$495.03 ,$407.67 ,$1.93 ,$1.93 ,$553.27 ,$442.62 ,$436.79 ,$92.62 ,$495.03 ,$104.31 ,$92.62 ,$92.62 ,$407.67 ,$354.68 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$495.03 ,$234.71 ,$535.80 ,$407.67 ,$582.39 ,$582.39 ,$354.68 ,$582.39 ,$402.43 ,$524.15 ,$397.89 ,$103.24 ,$460.09 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$419.32 ,$361.08 ,$419.32 ,$419.32 ,$465.91 
ST NICHOLAS HOSPITAL - ACUTE,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$76.38 ,$76.38 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$41.80 ,$333.63 ,$84.79 ,$41.80 ,$41.80 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$223.70 ,$223.70 ,$239.03 ,$223.70 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$92.93 ,$92.93 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$53.01 ,$333.63 ,$84.79 ,$53.01 ,$53.01 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$335.55 ,$335.55 ,$239.03 ,$335.55 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$392.50 ,$259.05 ,$2.89 ,$392.50 ,$2.89 ,$92.93 ,$92.93 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$2.89 ,$2.89 ,$372.88 ,$298.30 ,$294.38 ,$53.01 ,$333.63 ,$84.79 ,$53.01 ,$53.01 ,$274.75 ,$239.03 ,$2.89 ,$84.79 ,$83.09 ,$169.58 ,$3.06 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$335.55 ,$335.55 ,$239.03 ,$335.55 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$3.06 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,32000586,72265,HC XR MYELOGRAPHY L-SPINE,320,1 ,"$2,389.70 ","$1,577.20 ",$19.92 ,"$2,389.70 ",$19.92 ,$291.38 ,$218.47 ,$722.97 ,"$1,433.82 ","$2,031.25 ","$1,672.79 ",$19.92 ,$19.92 ,"$2,270.22 ","$1,816.17 ","$1,792.28 ",$138.81 ,"$2,031.25 ",$722.97 ,$138.81 ,$138.81 ,"$1,672.79 ","$1,455.33 ",$19.92 ,$722.97 ,$708.51 ,"$1,445.94 ",$21.12 ,"$2,031.25 ","$1,626.69 ","$2,198.52 ","$1,672.79 ","$2,249.23 ","$2,249.23 ","$1,455.33 ","$2,249.23 ","$1,651.28 ","$2,150.73 ","$1,632.64 ",$715.60 ,"$1,887.86 ",$21.12 ,$459.00 ,$459.00 ,$708.51 ,$459.00 ,"$1,720.58 ","$1,481.61 ","$1,720.58 ","$1,720.58 ","$1,911.76 "
ST NICHOLAS HOSPITAL - ACUTE,32000604,70371,HC SPEECH EVAL W/CINE/VIDEO RECORDING,320,1 ,$685.99 ,$452.75 ,$4.15 ,$685.99 ,$4.15 ,$267.83 ,$214.33 ,$227.92 ,$411.59 ,$583.09 ,$480.19 ,$4.15 ,$4.15 ,$651.69 ,$521.35 ,$514.49 ,$133.52 ,$583.09 ,$227.92 ,$133.52 ,$133.52 ,$480.19 ,$417.77 ,$4.15 ,$227.92 ,$223.36 ,$455.84 ,$4.40 ,$583.09 ,$512.81 ,$631.11 ,$480.19 ,$589.85 ,$589.85 ,$417.77 ,$589.85 ,$474.02 ,$617.39 ,$468.67 ,$225.60 ,$541.93 ,$4.40 ,$459.00 ,$459.00 ,$223.36 ,$459.00 ,$493.91 ,$425.31 ,$493.91 ,$493.91 ,$548.79 
ST NICHOLAS HOSPITAL - ACUTE,32000611,G1004,HC RAD AUC CDSM NATL DECISION SUPPORT COMPANY,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000612,74248,HC XRAY SMALL INTESTINE FOLLOW THRU STUDY,320,1 ,$174.35 ,$115.07 ,$4.15 ,$174.35 ,$4.15 ,$174.35 ,$174.35 , N/A ,$104.61 ,$148.20 ,$122.05 ,$4.15 ,$4.15 ,$165.63 ,$132.51 ,$130.76 ,$99.88 ,$148.20 , N/A ,$99.88 ,$99.88 ,$122.05 ,$106.18 ,$4.15 , N/A , N/A , N/A ,$4.40 ,$148.20 , N/A ,$160.40 ,$122.05 ,$88.43 ,$106.13 ,$106.18 ,$106.13 ,$120.48 ,$156.92 ,$119.12 , N/A ,$137.74 ,$4.40 ,$174.35 ,$174.35 , N/A ,$174.35 ,$125.53 ,$108.10 ,$125.53 ,$125.53 ,$139.48 
ST NICHOLAS HOSPITAL - ACUTE,32000613,G1002,HC RAD AUC CDSM MEDCURRENT,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000614,G1003,HC RAD AUC CDSM MEDICALIS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000615,G1005,HC RAD AUC CDSM NATIONAL IMAGING ASSOCIATES,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000616,G1006,HC RAD AUC CDSM TEST APPROPRIATE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000617,G1007,HC RAD AUC CDSM AIM SPECIALTY HEALTH,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000618,G1008,HC RAD AUC CDSM CRANBERRY PEAK,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000619,G1009,HC RAD AUC CDSM SAGE HEALTH MGMT SOLUTIONS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000620,G1010,HC RAD AUC CDSM STANSON,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000621,G1011,HC RAD AUC CDSM QUALIFIED TOOL NOS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000623,G1001,HC RAD AUC CDSM EVICORE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,33300001,C1717,HC HDR BRACHYTX SOURCE IR192,333,1 ,"$1,159.20 ",$765.07 ,$7.94 ,"$1,159.20 ",$7.94 ,$794.52 ,$794.52 ,$335.71 ,$695.52 ,$985.32 ,$811.44 ,$7.94 ,$7.94 ,"$1,101.24 ",$880.99 ,$869.40 ,$753.48 ,$985.32 ,$335.71 ,$753.48 ,$753.48 ,$811.44 ,$705.95 ,$7.94 ,$335.71 ,$329.00 ,$671.42 ,$8.42 ,$985.32 ,$755.35 ,"$1,066.46 ",$811.44 ,$587.95 ,$705.61 ,$705.95 ,$705.61 ,$801.01 ,"$1,043.28 ",$791.97 ,$332.29 ,$915.77 ,$8.42 ,"$1,159.20 ","$1,159.20 ",$329.00 ,"$1,159.20 ",$834.62 ,$718.70 ,$834.62 ,$834.62 ,$927.36 
ST NICHOLAS HOSPITAL - ACUTE,33300006,C2639,HC IODINE 125 PER SOURCE NON STRANDED,333,1 ,$135.70 ,$89.56 ,$7.94 ,$135.70 ,$7.94 ,$93.01 ,$93.01 ,$35.31 ,$81.42 ,$115.35 ,$94.99 ,$7.94 ,$7.94 ,$128.92 ,$103.13 ,$101.78 ,$88.21 ,$115.35 ,$35.31 ,$88.21 ,$88.21 ,$94.99 ,$82.64 ,$7.94 ,$35.31 ,$34.60 ,$70.62 ,$8.42 ,$115.35 ,$79.45 ,$124.84 ,$94.99 ,$68.83 ,$82.60 ,$82.64 ,$82.60 ,$93.77 ,$122.13 ,$92.71 ,$34.95 ,$107.20 ,$8.42 ,$135.70 ,$135.70 ,$34.60 ,$135.70 ,$97.70 ,$84.13 ,$97.70 ,$97.70 ,$108.56 
ST NICHOLAS HOSPITAL - ACUTE,33300009,77285,HC SIMULATION INTERMED,333,1 ,"$1,510.00 ",$996.60 ,$6.50 ,"$1,510.00 ",$6.50 ,"$1,510.00 ","$1,510.00 ",$350.11 ,$906.00 ,"$1,283.50 ","$1,057.00 ",$6.50 ,$6.50 ,"$1,434.50 ","$1,147.60 ","$1,132.50 ",$981.50 ,"$1,283.50 ",$350.11 ,$981.50 ,$981.50 ,"$1,057.00 ",$919.59 ,$6.50 ,$350.11 ,$343.11 ,$700.22 ,$6.89 ,"$1,283.50 ",$787.75 ,"$1,389.20 ","$1,057.00 ","$1,172.30 ","$1,172.30 ",$919.59 ,"$1,172.30 ","$1,043.41 ","$1,359.00 ","$1,031.63 ",$346.54 ,"$1,192.90 ",$6.89 ,"$1,510.00 ","$1,510.00 ",$343.11 ,"$1,510.00 ","$1,087.20 ",$936.20 ,"$1,087.20 ","$1,087.20 ","$1,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300010,77290,HC SIMULATION COMPLEX,333,1 ,"$3,129.00 ","$2,065.14 ",$6.50 ,"$3,129.00 ",$6.50 ,"$1,542.89 ","$1,668.41 ",$350.11 ,"$1,877.40 ","$2,659.65 ","$2,190.30 ",$6.50 ,$6.50 ,"$2,972.55 ","$2,378.04 ","$2,346.75 ","$2,033.85 ","$2,659.65 ",$350.11 ,"$2,033.85 ","$2,033.85 ","$2,190.30 ","$1,905.56 ",$6.50 ,$350.11 ,$343.11 ,$700.22 ,$6.89 ,"$2,659.65 ",$787.75 ,"$2,878.68 ","$2,190.30 ","$1,172.30 ","$1,172.30 ","$1,905.56 ","$1,172.30 ","$2,162.14 ","$2,816.10 ","$2,137.73 ",$346.54 ,"$2,471.91 ",$6.89 ,"$1,901.00 ","$1,901.00 ",$343.11 ,"$1,901.00 ","$2,252.88 ","$1,939.98 ","$2,252.88 ","$2,252.88 ","$2,503.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300011,77295,HC SIMULATION 3-D,333,1 ,"$7,013.00 ","$4,628.58 ",$38.31 ,"$7,013.00 ",$38.31 ,"$1,014.43 ","$1,035.80 ","$1,308.49 ","$4,207.80 ","$5,961.05 ","$4,909.10 ",$38.31 ,$38.31 ,"$6,662.35 ","$5,329.88 ","$5,259.75 ","$4,558.45 ","$5,961.05 ","$1,308.49 ","$4,558.45 ","$4,558.45 ","$4,909.10 ","$4,270.92 ",$38.31 ,"$1,308.49 ","$1,282.32 ","$2,616.98 ",$40.61 ,"$5,961.05 ","$2,944.11 ","$6,451.96 ","$4,909.10 ","$3,901.97 ","$3,901.97 ","$4,270.92 ","$3,901.97 ","$4,845.98 ","$6,311.70 ","$4,791.28 ","$1,295.14 ","$5,540.27 ",$40.61 ,"$1,901.00 ","$1,901.00 ","$1,282.32 ","$1,901.00 ","$5,049.36 ","$4,348.06 ","$5,049.36 ","$5,049.36 ","$5,610.40 "
ST NICHOLAS HOSPITAL - ACUTE,33300015,77300,HC DOSIMETRY CALCULATION BASIC,333,1 ,$842.00 ,$555.72 ,$6.50 ,$842.00 ,$6.50 ,$132.05 ,$131.56 ,$130.18 ,$505.20 ,$715.70 ,$589.40 ,$6.50 ,$6.50 ,$799.90 ,$639.92 ,$631.50 ,$547.30 ,$715.70 ,$130.18 ,$547.30 ,$547.30 ,$589.40 ,$512.78 ,$6.50 ,$130.18 ,$127.58 ,$260.36 ,$6.89 ,$715.70 ,$292.90 ,$774.64 ,$589.40 ,$431.62 ,$431.62 ,$512.78 ,$431.62 ,$581.82 ,$757.80 ,$575.25 ,$128.85 ,$665.18 ,$6.89 ,$842.00 ,$842.00 ,$127.58 ,$842.00 ,$606.24 ,$522.04 ,$606.24 ,$606.24 ,$673.60 
ST NICHOLAS HOSPITAL - ACUTE,33300016,77300,HC DOSIMETRY CALCULATION,333,1 ,$842.00 ,$555.72 ,$6.50 ,$842.00 ,$6.50 ,$132.05 ,$131.56 ,$130.18 ,$505.20 ,$715.70 ,$589.40 ,$6.50 ,$6.50 ,$799.90 ,$639.92 ,$631.50 ,$547.30 ,$715.70 ,$130.18 ,$547.30 ,$547.30 ,$589.40 ,$512.78 ,$6.50 ,$130.18 ,$127.58 ,$260.36 ,$6.89 ,$715.70 ,$292.90 ,$774.64 ,$589.40 ,$431.62 ,$431.62 ,$512.78 ,$431.62 ,$581.82 ,$757.80 ,$575.25 ,$128.85 ,$665.18 ,$6.89 ,$842.00 ,$842.00 ,$127.58 ,$842.00 ,$606.24 ,$522.04 ,$606.24 ,$606.24 ,$673.60 
ST NICHOLAS HOSPITAL - ACUTE,33300017,77301,HC IMRT TX PLAN,333,1 ,"$5,610.00 ","$3,702.60 ",$38.31 ,"$5,610.00 ",$38.31 ,"$5,610.00 ","$5,610.00 ","$1,308.49 ","$3,366.00 ","$4,768.50 ","$3,927.00 ",$38.31 ,$38.31 ,"$5,329.50 ","$4,263.60 ","$4,207.50 ","$3,646.50 ","$4,768.50 ","$1,308.49 ","$3,646.50 ","$3,646.50 ","$3,927.00 ","$3,416.49 ",$38.31 ,"$1,308.49 ","$1,282.32 ","$2,616.98 ",$40.61 ,"$4,768.50 ","$2,944.11 ","$5,161.20 ","$3,927.00 ","$3,901.97 ","$3,901.97 ","$3,416.49 ","$3,901.97 ","$3,876.51 ","$5,049.00 ","$3,832.75 ","$1,295.14 ","$4,431.90 ",$40.61 ,"$1,901.00 ","$1,901.00 ","$1,282.32 ","$1,901.00 ","$4,039.20 ","$3,478.20 ","$4,039.20 ","$4,039.20 ","$4,488.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300019,77306,HC ISODOSE PLAN SIMPLE COMPUTER PLAN,333,1 ,$831.00 ,$548.46 ,$4.25 ,$831.00 ,$4.25 ,$294.59 ,$296.23 ,$350.11 ,$498.60 ,$706.35 ,$581.70 ,$4.25 ,$4.25 ,$789.45 ,$631.56 ,$623.25 ,$540.15 ,$706.35 ,$350.11 ,$540.15 ,$540.15 ,$581.70 ,$506.08 ,$4.25 ,$350.11 ,$343.11 ,$700.22 ,$4.51 ,$706.35 ,$787.75 ,$764.52 ,$581.70 ,$419.26 ,$419.26 ,$506.08 ,$419.26 ,$574.22 ,$747.90 ,$567.74 ,$346.54 ,$656.49 ,$4.51 ,$831.00 ,$831.00 ,$343.11 ,$831.00 ,$598.32 ,$515.22 ,$598.32 ,$598.32 ,$664.80 
ST NICHOLAS HOSPITAL - ACUTE,33300023,77307,HC ISODOSE PLAN COMPLEX COMPUTER PLAN,333,1 ,"$3,129.00 ","$2,065.14 ",$6.50 ,"$3,129.00 ",$6.50 ,$533.76 ,$535.40 ,$350.11 ,"$1,877.40 ","$2,659.65 ","$2,190.30 ",$6.50 ,$6.50 ,"$2,972.55 ","$2,378.04 ","$2,346.75 ","$2,033.85 ","$2,659.65 ",$350.11 ,"$2,033.85 ","$2,033.85 ","$2,190.30 ","$1,905.56 ",$6.50 ,$350.11 ,$343.11 ,$700.22 ,$6.89 ,"$2,659.65 ",$787.75 ,"$2,878.68 ","$2,190.30 ",$419.26 ,$419.26 ,"$1,905.56 ",$419.26 ,"$2,162.14 ","$2,816.10 ","$2,137.73 ",$346.54 ,"$2,471.91 ",$6.89 ,"$1,901.00 ","$1,901.00 ",$343.11 ,"$1,901.00 ","$2,252.88 ","$1,939.98 ","$2,252.88 ","$2,252.88 ","$2,503.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300024,77321,HC PORT PLAN SPECIAL,333,1 ,"$1,942.00 ","$1,281.72 ",$6.50 ,"$1,942.00 ",$6.50 ,$176.39 ,$170.19 ,$350.11 ,"$1,165.20 ","$1,650.70 ","$1,359.40 ",$6.50 ,$6.50 ,"$1,844.90 ","$1,475.92 ","$1,456.50 ","$1,262.30 ","$1,650.70 ",$350.11 ,"$1,262.30 ","$1,262.30 ","$1,359.40 ","$1,182.68 ",$6.50 ,$350.11 ,$343.11 ,$700.22 ,$6.89 ,"$1,650.70 ",$787.75 ,"$1,786.64 ","$1,359.40 ","$1,172.30 ","$1,172.30 ","$1,182.68 ","$1,172.30 ","$1,341.92 ","$1,747.80 ","$1,326.77 ",$346.54 ,"$1,534.18 ",$6.89 ,"$1,901.00 ","$1,901.00 ",$343.11 ,"$1,901.00 ","$1,398.24 ","$1,204.04 ","$1,398.24 ","$1,398.24 ","$1,553.60 "
ST NICHOLAS HOSPITAL - ACUTE,33300027,77318,HC BRACHY ISODOSE PLAN COMPLEX,333,1 ,"$1,834.00 ","$1,210.44 ",$6.50 ,"$1,834.00 ",$6.50 ,"$1,223.12 ",$899.73 ,$350.11 ,"$1,100.40 ","$1,558.90 ","$1,283.80 ",$6.50 ,$6.50 ,"$1,742.30 ","$1,393.84 ","$1,375.50 ","$1,192.10 ","$1,558.90 ",$350.11 ,"$1,192.10 ","$1,192.10 ","$1,283.80 ","$1,116.91 ",$6.50 ,$350.11 ,$343.11 ,$700.22 ,$6.89 ,"$1,558.90 ",$787.75 ,"$1,687.28 ","$1,283.80 ","$1,165.35 ","$1,165.35 ","$1,116.91 ","$1,165.35 ","$1,267.29 ","$1,650.60 ","$1,252.99 ",$346.54 ,"$1,448.86 ",$6.89 ,"$1,834.00 ","$1,834.00 ",$343.11 ,"$1,834.00 ","$1,320.48 ","$1,137.08 ","$1,320.48 ","$1,320.48 ","$1,467.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300029,77331,HC DOSIMETRY CALCULATION SPECIAL,333,1 ,$604.00 ,$398.64 ,$4.25 ,$604.00 ,$4.25 ,$75.25 ,$73.62 ,$130.18 ,$362.40 ,$513.40 ,$422.80 ,$4.25 ,$4.25 ,$573.80 ,$459.04 ,$453.00 ,$392.60 ,$513.40 ,$130.18 ,$392.60 ,$392.60 ,$422.80 ,$367.84 ,$4.25 ,$130.18 ,$127.58 ,$260.36 ,$4.51 ,$513.40 ,$292.90 ,$555.68 ,$422.80 ,$431.62 ,$431.62 ,$367.84 ,$431.62 ,$417.36 ,$543.60 ,$412.65 ,$128.85 ,$477.16 ,$4.51 ,$604.00 ,$604.00 ,$127.58 ,$604.00 ,$434.88 ,$374.48 ,$434.88 ,$434.88 ,$483.20 
ST NICHOLAS HOSPITAL - ACUTE,33300030,77332,HC TREATMENT DEVICE SIMPLE,333,1 ,$723.00 ,$477.18 ,$4.25 ,$723.00 ,$4.25 ,$58.62 ,$110.87 ,$130.18 ,$433.80 ,$614.55 ,$506.10 ,$4.25 ,$4.25 ,$686.85 ,$549.48 ,$542.25 ,$469.95 ,$614.55 ,$130.18 ,$469.95 ,$469.95 ,$506.10 ,$440.31 ,$4.25 ,$130.18 ,$127.58 ,$260.36 ,$4.51 ,$614.55 ,$292.90 ,$665.16 ,$506.10 ,$723.00 ,$723.00 ,$440.31 ,$723.00 ,$499.59 ,$650.70 ,$493.95 ,$128.85 ,$571.17 ,$4.51 ,$723.00 ,$723.00 ,$127.58 ,$723.00 ,$520.56 ,$448.26 ,$520.56 ,$520.56 ,$578.40 
ST NICHOLAS HOSPITAL - ACUTE,33300031,77333,HC TREATMENT DEVICE INTERM,333,1 ,"$1,079.00 ",$712.14 ,$4.25 ,"$1,079.00 ",$4.25 ,$407.76 ,$272.28 ,$130.18 ,$647.40 ,$917.15 ,$755.30 ,$4.25 ,$4.25 ,"$1,025.05 ",$820.04 ,$809.25 ,$701.35 ,$917.15 ,$130.18 ,$701.35 ,$701.35 ,$755.30 ,$657.11 ,$4.25 ,$130.18 ,$127.58 ,$260.36 ,$4.51 ,$917.15 ,$292.90 ,$992.68 ,$755.30 ,$803.78 ,$803.78 ,$657.11 ,$803.78 ,$745.59 ,$971.10 ,$737.17 ,$128.85 ,$852.41 ,$4.51 ,"$1,079.00 ","$1,079.00 ",$127.58 ,"$1,079.00 ",$776.88 ,$668.98 ,$776.88 ,$776.88 ,$863.20 
ST NICHOLAS HOSPITAL - ACUTE,33300032,77334,HC TREATMENT DEVICE COMPLEX,333,1 ,"$2,050.00 ","$1,353.00 ",$6.50 ,"$2,050.00 ",$6.50 ,$259.52 ,$264.00 ,$350.11 ,"$1,230.00 ","$1,742.50 ","$1,435.00 ",$6.50 ,$6.50 ,"$1,947.50 ","$1,558.00 ","$1,537.50 ","$1,332.50 ","$1,742.50 ",$350.11 ,"$1,332.50 ","$1,332.50 ","$1,435.00 ","$1,248.45 ",$6.50 ,$350.11 ,$343.11 ,$700.22 ,$6.89 ,"$1,742.50 ",$787.75 ,"$1,886.00 ","$1,435.00 ",$803.78 ,$803.78 ,"$1,248.45 ",$803.78 ,"$1,416.55 ","$1,845.00 ","$1,400.56 ",$346.54 ,"$1,619.50 ",$6.89 ,"$1,901.00 ","$1,901.00 ",$343.11 ,"$1,901.00 ","$1,476.00 ","$1,271.00 ","$1,476.00 ","$1,476.00 ","$1,640.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300033,77336,HC MEDICAL PHYSICS CONTINUING,333,1 ,$896.00 ,$591.36 ,$4.25 ,$896.00 ,$4.25 ,$329.07 ,$306.51 ,$130.18 ,$537.60 ,$761.60 ,$627.20 ,$4.25 ,$4.25 ,$851.20 ,$680.96 ,$672.00 ,$582.40 ,$761.60 ,$130.18 ,$582.40 ,$582.40 ,$627.20 ,$545.66 ,$4.25 ,$130.18 ,$127.58 ,$260.36 ,$4.51 ,$761.60 ,$292.90 ,$824.32 ,$627.20 ,$431.62 ,$431.62 ,$545.66 ,$431.62 ,$619.14 ,$806.40 ,$612.15 ,$128.85 ,$707.84 ,$4.51 ,$896.00 ,$896.00 ,$127.58 ,$896.00 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,33300034,77338,HC MLC DEVICE FOR IMRT,333,1 ,"$2,697.00 ","$1,780.02 ",$6.50 ,"$2,697.00 ",$6.50 ,$946.03 ,"$1,065.28 ",$350.11 ,"$1,618.20 ","$2,292.45 ","$1,887.90 ",$6.50 ,$6.50 ,"$2,562.15 ","$2,049.72 ","$2,022.75 ","$1,753.05 ","$2,292.45 ",$350.11 ,"$1,753.05 ","$1,753.05 ","$1,887.90 ","$1,642.47 ",$6.50 ,$350.11 ,$343.11 ,$700.22 ,$6.89 ,"$2,292.45 ",$787.75 ,"$2,481.24 ","$1,887.90 ","$1,172.30 ","$1,172.30 ","$1,642.47 ","$1,172.30 ","$1,863.63 ","$2,427.30 ","$1,842.59 ",$346.54 ,"$2,130.63 ",$6.89 ,"$1,901.00 ","$1,901.00 ",$343.11 ,"$1,901.00 ","$1,941.84 ","$1,672.14 ","$1,941.84 ","$1,941.84 ","$2,157.60 "
ST NICHOLAS HOSPITAL - ACUTE,33300036,77370,HC SPECIAL MED PHYSICS CONSULT,333,1 ,"$1,510.00 ",$996.60 ,$4.25 ,"$1,510.00 ",$4.25 ,$524.77 ,$475.06 ,$130.18 ,$906.00 ,"$1,283.50 ","$1,057.00 ",$4.25 ,$4.25 ,"$1,434.50 ","$1,147.60 ","$1,132.50 ",$981.50 ,"$1,283.50 ",$130.18 ,$981.50 ,$981.50 ,"$1,057.00 ",$919.59 ,$4.25 ,$130.18 ,$127.58 ,$260.36 ,$4.51 ,"$1,283.50 ",$292.90 ,"$1,389.20 ","$1,057.00 ",$431.62 ,$431.62 ,$919.59 ,$431.62 ,"$1,043.41 ","$1,359.00 ","$1,031.63 ",$128.85 ,"$1,192.90 ",$4.51 ,"$1,510.00 ","$1,510.00 ",$127.58 ,"$1,510.00 ","$1,087.20 ",$936.20 ,"$1,087.20 ","$1,087.20 ","$1,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300037,77402,HC RAD THRPY SIMPLE >1MEV,333,1 ,"$1,187.00 ",$783.42 ,$6.40 ,"$1,187.00 ",$6.40 ,$540.76 ,$557.85 ,$119.45 ,$712.20 ,"$1,008.95 ",$830.90 ,$6.40 ,$6.40 ,"$1,127.65 ",$902.12 ,$890.25 ,$771.55 ,"$1,008.95 ",$119.45 ,$771.55 ,$771.55 ,$830.90 ,$722.88 ,$6.40 ,$119.45 ,$117.06 ,$238.90 ,$6.78 ,"$1,008.95 ",$268.77 ,"$1,092.04 ",$830.90 ,$392.51 ,$392.51 ,$722.88 ,$392.51 ,$820.22 ,"$1,068.30 ",$810.96 ,$118.23 ,$937.73 ,$6.78 ,"$1,187.00 ","$1,187.00 ",$117.06 ,"$1,187.00 ",$854.64 ,$735.94 ,$854.64 ,$854.64 ,$949.60 
ST NICHOLAS HOSPITAL - ACUTE,33300041,77407,HC RAD THRPY INTERMEDIATE,333,1 ,"$1,079.00 ",$712.14 ,$6.40 ,"$1,079.00 ",$6.40 ,$741.66 ,$767.54 ,$256.62 ,$647.40 ,$917.15 ,$755.30 ,$6.40 ,$6.40 ,"$1,025.05 ",$820.04 ,$809.25 ,$701.35 ,$917.15 ,$256.62 ,$701.35 ,$701.35 ,$755.30 ,$657.11 ,$6.40 ,$256.62 ,$251.49 ,$513.24 ,$6.78 ,$917.15 ,$577.39 ,$992.68 ,$755.30 ,$392.51 ,$392.51 ,$657.11 ,$392.51 ,$745.59 ,$971.10 ,$737.17 ,$254.01 ,$852.41 ,$6.78 ,"$1,079.00 ","$1,079.00 ",$251.49 ,"$1,079.00 ",$776.88 ,$668.98 ,$776.88 ,$776.88 ,$863.20 
ST NICHOLAS HOSPITAL - ACUTE,33300045,77412,HC RAD THRPY COMPLEX,333,1 ,"$1,510.00 ",$996.60 ,$6.40 ,"$1,510.00 ",$6.40 ,$984.55 ,"$1,026.91 ",$256.62 ,$906.00 ,"$1,283.50 ","$1,057.00 ",$6.40 ,$6.40 ,"$1,434.50 ","$1,147.60 ","$1,132.50 ",$981.50 ,"$1,283.50 ",$256.62 ,$981.50 ,$981.50 ,"$1,057.00 ",$919.59 ,$6.40 ,$256.62 ,$251.49 ,$513.24 ,$6.78 ,"$1,283.50 ",$577.39 ,"$1,389.20 ","$1,057.00 ",$723.91 ,$723.91 ,$919.59 ,$723.91 ,"$1,043.41 ","$1,359.00 ","$1,031.63 ",$254.01 ,"$1,192.90 ",$6.78 ,"$1,510.00 ","$1,510.00 ",$251.49 ,"$1,510.00 ","$1,087.20 ",$936.20 ,"$1,087.20 ","$1,087.20 ","$1,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300051,77386,HC IMRT TREATMENT COMPLEX,333,1 ,"$3,992.00 ","$2,634.72 ",$16.73 ,"$3,992.00 ",$16.73 ,"$1,497.09 ","$1,384.34 ",$558.73 ,"$2,395.20 ","$3,393.20 ","$2,794.40 ",$16.73 ,$16.73 ,"$3,792.40 ","$3,033.92 ","$2,994.00 ","$2,594.80 ","$3,393.20 ",$558.73 ,"$2,594.80 ","$2,594.80 ","$2,794.40 ","$2,431.13 ",$16.73 ,$558.73 ,$547.56 ,"$1,117.46 ",$17.73 ,"$3,393.20 ","$1,257.14 ","$3,672.64 ","$2,794.40 ","$1,881.09 ","$1,881.09 ","$2,431.13 ","$1,881.09 ","$2,758.47 ","$3,592.80 ","$2,727.33 ",$553.03 ,"$3,153.68 ",$17.73 ,"$1,901.00 ","$1,901.00 ",$547.56 ,"$1,901.00 ","$2,874.24 ","$2,475.04 ","$2,874.24 ","$2,874.24 ","$3,193.60 "
ST NICHOLAS HOSPITAL - ACUTE,33300052,77417,HC PORT FILMS,333,1 ,$572.00 ,$377.52 ,$1.93 ,$572.00 ,$1.93 ,$50.31 ,$43.27 , N/A ,$343.20 ,$486.20 ,$400.40 ,$1.93 ,$1.93 ,$543.40 ,$434.72 ,$429.00 ,$371.80 ,$486.20 , N/A ,$371.80 ,$371.80 ,$400.40 ,$348.35 ,$1.93 , N/A , N/A , N/A ,$2.05 ,$486.20 , N/A ,$526.24 ,$400.40 ,$290.12 ,$348.18 ,$348.35 ,$348.18 ,$395.25 ,$514.80 ,$390.79 , N/A ,$451.88 ,$2.05 ,$572.00 ,$572.00 , N/A ,$572.00 ,$411.84 ,$354.64 ,$411.84 ,$411.84 ,$457.60 
ST NICHOLAS HOSPITAL - ACUTE,33300053,77417,HC PORT FILMS 5+ SRS SRT IMRT,333,1 ,$572.00 ,$377.52 ,$1.93 ,$572.00 ,$1.93 ,$50.31 ,$43.27 , N/A ,$343.20 ,$486.20 ,$400.40 ,$1.93 ,$1.93 ,$543.40 ,$434.72 ,$429.00 ,$371.80 ,$486.20 , N/A ,$371.80 ,$371.80 ,$400.40 ,$348.35 ,$1.93 , N/A , N/A , N/A ,$2.05 ,$486.20 , N/A ,$526.24 ,$400.40 ,$290.12 ,$348.18 ,$348.35 ,$348.18 ,$395.25 ,$514.80 ,$390.79 , N/A ,$451.88 ,$2.05 ,$572.00 ,$572.00 , N/A ,$572.00 ,$411.84 ,$354.64 ,$411.84 ,$411.84 ,$457.60 
ST NICHOLAS HOSPITAL - ACUTE,33300054,77385,HC IMRT TREATMENT SIMPLE,333,1 ,"$3,560.00 ","$2,349.60 ",$16.73 ,"$3,560.00 ",$16.73 ,"$1,495.35 ","$1,382.84 ",$558.73 ,"$2,136.00 ","$3,026.00 ","$2,492.00 ",$16.73 ,$16.73 ,"$3,382.00 ","$2,705.60 ","$2,670.00 ","$2,314.00 ","$3,026.00 ",$558.73 ,"$2,314.00 ","$2,314.00 ","$2,492.00 ","$2,168.04 ",$16.73 ,$558.73 ,$547.56 ,"$1,117.46 ",$17.73 ,"$3,026.00 ","$1,257.14 ","$3,275.20 ","$2,492.00 ","$1,881.09 ","$1,881.09 ","$2,168.04 ","$1,881.09 ","$2,459.96 ","$3,204.00 ","$2,432.19 ",$553.03 ,"$2,812.40 ",$17.73 ,"$1,901.00 ","$1,901.00 ",$547.56 ,"$1,901.00 ","$2,563.20 ","$2,207.20 ","$2,563.20 ","$2,563.20 ","$2,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300055,77387,HC STEREOSCOPIC X RAY GUIDANCE,333,1 ,$507.00 ,$334.62 ,$4.25 ,$507.00 ,$4.25 ,$507.00 ,$310.80 , N/A ,$304.20 ,$430.95 ,$354.90 ,$4.25 ,$4.25 ,$481.65 ,$385.32 ,$380.25 ,$329.55 ,$430.95 , N/A ,$329.55 ,$329.55 ,$354.90 ,$308.76 ,$4.25 , N/A , N/A , N/A ,$4.51 ,$430.95 , N/A ,$466.44 ,$354.90 ,$257.15 ,$308.61 ,$308.76 ,$308.61 ,$350.34 ,$456.30 ,$346.38 , N/A ,$400.53 ,$4.51 ,$507.00 ,$507.00 , N/A ,$507.00 ,$365.04 ,$314.34 ,$365.04 ,$365.04 ,$405.60 
ST NICHOLAS HOSPITAL - ACUTE,33300057,77470,HC SPECIAL TREATMENT PROCEDURE,333,1 ,"$2,374.00 ","$1,566.84 ",$16.73 ,"$2,374.00 ",$16.73 ,$116.81 ,$98.45 ,$558.73 ,"$1,424.40 ","$2,017.90 ","$1,661.80 ",$16.73 ,$16.73 ,"$2,255.30 ","$1,804.24 ","$1,780.50 ","$1,543.10 ","$2,017.90 ",$558.73 ,"$1,543.10 ","$1,543.10 ","$1,661.80 ","$1,445.77 ",$16.73 ,$558.73 ,$547.56 ,"$1,117.46 ",$17.73 ,"$2,017.90 ","$1,257.14 ","$2,184.08 ","$1,661.80 ","$1,555.77 ","$1,555.77 ","$1,445.77 ","$1,555.77 ","$1,640.43 ","$2,136.60 ","$1,621.92 ",$553.03 ,"$1,875.46 ",$17.73 ,"$1,901.00 ","$1,901.00 ",$547.56 ,"$1,901.00 ","$1,709.28 ","$1,471.88 ","$1,709.28 ","$1,709.28 ","$1,899.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300058,77470,HC SPECIAL TREATMENT PROCEDURE IMRT HDT BID SRS,333,1 ,"$2,374.00 ","$1,566.84 ",$16.73 ,"$2,374.00 ",$16.73 ,$116.81 ,$98.45 ,$558.73 ,"$1,424.40 ","$2,017.90 ","$1,661.80 ",$16.73 ,$16.73 ,"$2,255.30 ","$1,804.24 ","$1,780.50 ","$1,543.10 ","$2,017.90 ",$558.73 ,"$1,543.10 ","$1,543.10 ","$1,661.80 ","$1,445.77 ",$16.73 ,$558.73 ,$547.56 ,"$1,117.46 ",$17.73 ,"$2,017.90 ","$1,257.14 ","$2,184.08 ","$1,661.80 ","$1,555.77 ","$1,555.77 ","$1,445.77 ","$1,555.77 ","$1,640.43 ","$2,136.60 ","$1,621.92 ",$553.03 ,"$1,875.46 ",$17.73 ,"$1,901.00 ","$1,901.00 ",$547.56 ,"$1,901.00 ","$1,709.28 ","$1,471.88 ","$1,709.28 ","$1,709.28 ","$1,899.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300065,77778,HC INTERSTITIAL APPL-COMPLE,333,1 ,"$5,826.00 ","$3,845.16 ",$50.09 ,"$5,826.00 ",$50.09 ,"$1,789.18 ","$1,507.86 ",$704.40 ,"$3,495.60 ","$4,952.10 ","$4,078.20 ",$50.09 ,$50.09 ,"$5,534.70 ","$4,427.76 ","$4,369.50 ","$3,786.90 ","$4,952.10 ",$704.40 ,"$3,786.90 ","$3,786.90 ","$4,078.20 ","$3,548.03 ",$50.09 ,$704.40 ,$690.31 ,"$1,408.80 ",$53.10 ,"$4,952.10 ","$1,584.90 ","$5,359.92 ","$4,078.20 ","$3,757.01 ","$3,757.01 ","$3,548.03 ","$3,757.01 ","$4,025.77 ","$5,243.40 ","$3,980.32 ",$697.21 ,"$4,602.54 ",$53.10 ,"$1,901.00 ","$1,901.00 ",$690.31 ,"$1,901.00 ","$4,194.72 ","$3,612.12 ","$4,194.72 ","$4,194.72 ","$4,660.80 "
ST NICHOLAS HOSPITAL - ACUTE,33300072,77373,HC SRT TREATMENT,333,1 ,"$10,573.00 ","$6,978.18 ",$50.09 ,"$10,573.00 ",$50.09 ,"$4,143.35 ","$5,033.04 ","$1,725.03 ","$6,343.80 ","$8,987.05 ","$7,401.10 ",$50.09 ,$50.09 ,"$10,044.35 ","$8,035.48 ","$7,929.75 ","$6,872.45 ","$8,987.05 ","$1,725.03 ","$6,872.45 ","$6,872.45 ","$7,401.10 ","$6,438.96 ",$50.09 ,"$1,725.03 ","$1,690.53 ","$3,450.06 ",$53.10 ,"$8,987.05 ","$3,881.32 ","$9,727.16 ","$7,401.10 ","$7,233.61 ","$7,233.61 ","$6,438.96 ","$7,233.61 ","$7,305.94 ","$9,515.70 ","$7,223.47 ","$1,707.43 ","$8,352.67 ",$53.10 ,"$4,197.00 ","$4,197.00 ","$1,690.53 ","$4,197.00 ","$7,612.56 ","$6,555.26 ","$7,612.56 ","$7,612.56 ","$8,458.40 "
ST NICHOLAS HOSPITAL - ACUTE,33300084,77293,HC RESPIRATORY MOTION MGMT SIM,333,1 ,$629.32 ,$415.35 ,$4.25 ,$629.32 ,$4.25 ,$629.32 ,$629.32 , N/A ,$377.59 ,$534.92 ,$440.52 ,$4.25 ,$4.25 ,$597.85 ,$478.28 ,$471.99 ,$409.06 ,$534.92 , N/A ,$409.06 ,$409.06 ,$440.52 ,$383.26 ,$4.25 , N/A , N/A , N/A ,$4.51 ,$534.92 , N/A ,$578.97 ,$440.52 ,$319.19 ,$383.07 ,$383.26 ,$383.07 ,$434.86 ,$566.39 ,$429.95 , N/A ,$497.16 ,$4.51 ,$629.32 ,$629.32 , N/A ,$629.32 ,$453.11 ,$390.18 ,$453.11 ,$453.11 ,$503.46 
ST NICHOLAS HOSPITAL - ACUTE,33301001,31575,HC LARYNGOSCOPY FLEX FIBEROPTC,333,1 ,$275.00 ,$181.50 ,$5.60 ,$392.54 ,$5.60 ,$188.49 ,$188.49 ,$174.46 ,$165.00 ,$233.75 ,$192.50 ,$5.60 ,$5.60 ,$261.25 ,$209.00 ,$206.25 ,$178.75 ,$233.75 ,$174.46 ,$178.75 ,$178.75 ,$192.50 ,$167.48 ,$5.60 ,$174.46 ,$170.97 ,$275.00 ,$5.94 ,$233.75 ,$392.54 ,$253.00 ,$192.50 ,$139.48 ,$167.39 ,$167.48 ,$167.39 ,$190.03 ,$247.50 ,$187.88 ,$172.68 ,$217.25 ,$5.94 ,$275.00 ,$275.00 ,$170.97 ,$275.00 ,$198.00 ,$170.50 ,$198.00 ,$198.00 ,$220.00 
ST NICHOLAS HOSPITAL - ACUTE,33301002,49411,HC PLCMT INSTST DEV ABD/PELV/RETR,333,1 ,"$4,047.47 ","$2,671.33 ",$38.31 ,"$4,047.47 ",$38.31 ,"$2,774.14 ","$2,774.14 ","$1,308.49 ","$2,428.48 ","$3,440.35 ","$2,833.23 ",$38.31 ,$38.31 ,"$3,845.10 ","$3,076.08 ","$3,035.60 ","$2,630.86 ","$3,440.35 ","$1,308.49 ","$2,630.86 ","$2,630.86 ","$2,833.23 ","$2,464.91 ",$38.31 ,"$1,308.49 ","$1,282.32 ","$2,616.98 ",$40.61 ,"$3,440.35 ","$2,944.11 ","$3,723.67 ","$2,833.23 ","$1,998.41 ","$2,497.74 ","$2,464.91 ","$2,497.74 ","$2,796.80 ","$3,642.72 ","$2,765.23 ","$1,295.14 ","$3,197.50 ",$40.61 ,"$1,901.00 ","$1,901.00 ","$1,282.32 ","$1,901.00 ","$2,914.18 ","$2,509.43 ","$2,914.18 ","$2,914.18 ","$3,237.98 "
ST NICHOLAS HOSPITAL - ACUTE,33301005,77280,HC SIMULATION SMP,333,1 ,"$1,079.00 ",$712.14 ,$4.25 ,"$1,079.00 ",$4.25 ,$948.09 ,$934.47 ,$130.18 ,$647.40 ,$917.15 ,$755.30 ,$4.25 ,$4.25 ,"$1,025.05 ",$820.04 ,$809.25 ,$701.35 ,$917.15 ,$130.18 ,$701.35 ,$701.35 ,$755.30 ,$657.11 ,$4.25 ,$130.18 ,$127.58 ,$260.36 ,$4.51 ,$917.15 ,$292.90 ,$992.68 ,$755.30 ,$431.62 ,$431.62 ,$657.11 ,$431.62 ,$745.59 ,$971.10 ,$737.17 ,$128.85 ,$852.41 ,$4.51 ,"$1,079.00 ","$1,079.00 ",$127.58 ,"$1,079.00 ",$776.88 ,$668.98 ,$776.88 ,$776.88 ,$863.20 
ST NICHOLAS HOSPITAL - ACUTE,33301008,77399,HC IMAGE FUSION DOSIMETRY,333,1 ,$281.00 ,$185.46 ,$4.25 ,$292.90 ,$4.25 ,$192.60 ,$192.60 ,$130.18 ,$168.60 ,$238.85 ,$196.70 ,$4.25 ,$4.25 ,$266.95 ,$213.56 ,$210.75 ,$182.65 ,$238.85 ,$130.18 ,$182.65 ,$182.65 ,$196.70 ,$171.13 ,$4.25 ,$130.18 ,$127.58 ,$260.36 ,$4.51 ,$238.85 ,$292.90 ,$258.52 ,$196.70 ,$281.00 ,$281.00 ,$171.13 ,$281.00 ,$194.17 ,$252.90 ,$191.98 ,$128.85 ,$221.99 ,$4.51 ,$281.00 ,$281.00 ,$127.58 ,$281.00 ,$202.32 ,$174.22 ,$202.32 ,$202.32 ,$224.80 
ST NICHOLAS HOSPITAL - ACUTE,33500003,96409,HC CHEMO IV PUSH SINGLE/INIT,335,1 ,$662.53 ,$437.27 ,$1.59 ,$662.53 ,$1.59 ,$454.10 ,$454.10 ,$201.61 ,$397.52 ,$563.15 ,$463.77 ,$1.59 ,$1.59 ,$629.40 ,$503.52 ,$496.90 ,$430.64 ,$563.15 ,$201.61 ,$430.64 ,$430.64 ,$463.77 ,$403.48 ,$1.59 ,$201.61 ,$197.58 ,$403.22 ,$1.69 ,$563.15 ,$453.63 ,$609.53 ,$463.77 ,$336.04 ,$403.28 ,$403.48 ,$403.28 ,$457.81 ,$596.28 ,$452.64 ,$199.56 ,$523.40 ,$1.69 ,$662.53 ,$662.53 ,$197.58 ,$662.53 ,$477.02 ,$410.77 ,$477.02 ,$477.02 ,$530.02 
ST NICHOLAS HOSPITAL - ACUTE,33500004,96411,HC CHEMO IV PUSH ADDL DRUG,335,1 ,$380.00 ,$250.80 ,$1.59 ,$380.00 ,$1.59 ,$260.45 ,$260.45 ,$65.85 ,$228.00 ,$323.00 ,$266.00 ,$1.59 ,$1.59 ,$361.00 ,$288.80 ,$285.00 ,$247.00 ,$323.00 ,$65.85 ,$247.00 ,$247.00 ,$266.00 ,$231.42 ,$1.59 ,$65.85 ,$64.53 ,$131.70 ,$1.69 ,$323.00 ,$148.16 ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$231.31 ,$262.58 ,$342.00 ,$259.62 ,$65.18 ,$300.20 ,$1.69 ,$380.00 ,$380.00 ,$64.53 ,$380.00 ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$304.00 
ST NICHOLAS HOSPITAL - ACUTE,33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,"$1,018.44 ",$672.17 ,$10.04 ,"$1,018.44 ",$10.04 ,$698.04 ,$698.04 ,$324.64 ,$611.06 ,$865.67 ,$712.91 ,$10.04 ,$10.04 ,$967.52 ,$774.01 ,$763.83 ,$661.99 ,$865.67 ,$324.64 ,$661.99 ,$661.99 ,$712.91 ,$620.23 ,$10.04 ,$324.64 ,$318.15 ,$649.28 ,$10.64 ,$865.67 ,$730.43 ,$936.96 ,$712.91 ,$516.55 ,$619.92 ,$620.23 ,$619.92 ,$703.74 ,$916.60 ,$695.80 ,$321.33 ,$804.57 ,$10.64 ,"$1,018.44 ","$1,018.44 ",$318.15 ,"$1,018.44 ",$733.28 ,$631.43 ,$733.28 ,$733.28 ,$814.75 
ST NICHOLAS HOSPITAL - ACUTE,33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$257.35 ,$169.85 ,$17.55 ,$257.35 ,$17.55 ,$176.39 ,$176.39 ,$65.85 ,$154.41 ,$218.75 ,$180.15 ,$17.55 ,$17.55 ,$244.48 ,$195.59 ,$193.01 ,$167.28 ,$218.75 ,$65.85 ,$167.28 ,$167.28 ,$180.15 ,$156.73 ,$17.55 ,$65.85 ,$64.53 ,$131.70 ,$18.60 ,$218.75 ,$148.16 ,$236.76 ,$180.15 ,$130.53 ,$156.65 ,$156.73 ,$156.65 ,$177.83 ,$231.62 ,$175.82 ,$65.18 ,$203.31 ,$18.60 ,$257.35 ,$257.35 ,$64.53 ,$257.35 ,$185.29 ,$159.56 ,$185.29 ,$185.29 ,$205.88 
ST NICHOLAS HOSPITAL - ACUTE,33500008,96417,HC CHEMO IV INFUSION EA ADDL <1H,335,1 ,$367.95 ,$242.85 ,$10.04 ,$367.95 ,$10.04 ,$252.19 ,$252.19 ,$65.85 ,$220.77 ,$312.76 ,$257.57 ,$10.04 ,$10.04 ,$349.55 ,$279.64 ,$275.96 ,$239.17 ,$312.76 ,$65.85 ,$239.17 ,$239.17 ,$257.57 ,$224.08 ,$10.04 ,$65.85 ,$64.53 ,$131.70 ,$10.64 ,$312.76 ,$148.16 ,$338.51 ,$257.57 ,$186.62 ,$223.97 ,$224.08 ,$223.97 ,$254.25 ,$331.16 ,$251.38 ,$65.18 ,$290.68 ,$10.64 ,$367.95 ,$367.95 ,$64.53 ,$367.95 ,$264.92 ,$228.13 ,$264.92 ,$264.92 ,$294.36 
ST NICHOLAS HOSPITAL - ACUTE,33500012,96450,HC CHEMO CNS,335,1 ,"$1,115.90 ",$736.49 ,$17.55 ,"$1,115.90 ",$17.55 ,$764.84 ,$764.84 ,$324.64 ,$669.54 ,$948.52 ,$781.13 ,$17.55 ,$17.55 ,"$1,060.11 ",$848.08 ,$836.93 ,$725.34 ,$948.52 ,$324.64 ,$725.34 ,$725.34 ,$781.13 ,$679.58 ,$17.55 ,$324.64 ,$318.15 ,$649.28 ,$18.60 ,$948.52 ,$730.43 ,"$1,026.63 ",$781.13 ,$565.98 ,$679.25 ,$679.58 ,$679.25 ,$771.09 ,"$1,004.31 ",$762.38 ,$321.33 ,$881.56 ,$18.60 ,"$1,115.90 ","$1,115.90 ",$318.15 ,"$1,115.90 ",$803.45 ,$691.86 ,$803.45 ,$803.45 ,$892.72 
ST NICHOLAS HOSPITAL - ACUTE,33500013,96402,HC CHEMOTHERAPY INJECTION-HORMONAL ANTI-NEO,335,1 ,$257.35 ,$169.85 ,$1.59 ,$257.35 ,$1.59 ,$176.39 ,$176.39 ,$65.85 ,$154.41 ,$218.75 ,$180.15 ,$1.59 ,$1.59 ,$244.48 ,$195.59 ,$193.01 ,$167.28 ,$218.75 ,$65.85 ,$167.28 ,$167.28 ,$180.15 ,$156.73 ,$1.59 ,$65.85 ,$64.53 ,$131.70 ,$1.69 ,$218.75 ,$148.16 ,$236.76 ,$180.15 ,$130.53 ,$156.65 ,$156.73 ,$156.65 ,$177.83 ,$231.62 ,$175.82 ,$65.18 ,$203.31 ,$1.69 ,$257.35 ,$257.35 ,$64.53 ,$257.35 ,$185.29 ,$159.56 ,$185.29 ,$185.29 ,$205.88 
ST NICHOLAS HOSPITAL - ACUTE,34000002,78012,HC THYROID UPTAKE SGL/MULT 78012,340,1 ,$512.00 ,$337.92 ,$12.96 ,$853.54 ,$12.96 ,$291.30 ,$283.81 ,$379.35 ,$307.20 ,$435.20 ,$358.40 ,$12.96 ,$12.96 ,$486.40 ,$389.12 ,$384.00 ,$332.80 ,$435.20 ,$379.35 ,$332.80 ,$332.80 ,$358.40 ,$311.81 ,$12.96 ,$379.35 ,$371.76 ,$512.00 ,$13.74 ,$435.20 ,$853.54 ,$471.04 ,$358.40 ,$512.00 ,$512.00 ,$311.81 ,$512.00 ,$353.79 ,$460.80 ,$349.80 ,$375.48 ,$404.48 ,$13.74 ,$512.00 ,$512.00 ,$371.76 ,$512.00 ,$368.64 ,$317.44 ,$368.64 ,$368.64 ,$409.60 
ST NICHOLAS HOSPITAL - ACUTE,34000004,78014,HC NM THYROID IMAGING SGL OR MULT UPTAKE 78014,340,1 ,"$1,569.00 ","$1,035.54 ",$12.96 ,"$1,569.00 ",$12.96 ,$835.79 ,$859.60 ,$379.35 ,$941.40 ,"$1,333.65 ","$1,098.30 ",$12.96 ,$12.96 ,"$1,490.55 ","$1,192.44 ","$1,176.75 ","$1,019.85 ","$1,333.65 ",$379.35 ,"$1,019.85 ","$1,019.85 ","$1,098.30 ",$955.52 ,$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,333.65 ",$853.54 ,"$1,443.48 ","$1,098.30 ","$1,080.32 ","$1,080.32 ",$955.52 ,"$1,080.32 ","$1,084.18 ","$1,412.10 ","$1,071.94 ",$375.48 ,"$1,239.51 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,129.68 ",$972.78 ,"$1,129.68 ","$1,129.68 ","$1,255.20 "
ST NICHOLAS HOSPITAL - ACUTE,34000006,78013,HC NM THYROID SCAN,340,1 ,$994.00 ,$656.04 ,$12.96 ,$994.00 ,$12.96 ,$687.54 ,$689.91 ,$379.35 ,$596.40 ,$844.90 ,$695.80 ,$12.96 ,$12.96 ,$944.30 ,$755.44 ,$745.50 ,$646.10 ,$844.90 ,$379.35 ,$646.10 ,$646.10 ,$695.80 ,$605.35 ,$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,$844.90 ,$853.54 ,$914.48 ,$695.80 ,$690.46 ,$690.46 ,$605.35 ,$690.46 ,$686.85 ,$894.60 ,$679.10 ,$375.48 ,$785.26 ,$13.74 ,$994.00 ,$994.00 ,$371.76 ,$994.00 ,$715.68 ,$616.28 ,$715.68 ,$715.68 ,$795.20 
ST NICHOLAS HOSPITAL - ACUTE,34000007,78018,HC NM THYROID CA METS WHOLE BODY,340,1 ,"$2,092.00 ","$1,380.72 ",$12.96 ,"$2,092.00 ",$12.96 ,"$1,063.44 ","$1,080.83 ",$492.39 ,"$1,255.20 ","$1,778.20 ","$1,464.40 ",$12.96 ,$12.96 ,"$1,987.40 ","$1,589.92 ","$1,569.00 ","$1,359.80 ","$1,778.20 ",$492.39 ,"$1,359.80 ","$1,359.80 ","$1,464.40 ","$1,274.03 ",$12.96 ,$492.39 ,$482.54 ,$984.78 ,$13.74 ,"$1,778.20 ","$1,107.88 ","$1,924.64 ","$1,464.40 ","$1,441.12 ","$1,441.12 ","$1,274.03 ","$1,441.12 ","$1,445.57 ","$1,882.80 ","$1,429.25 ",$487.36 ,"$1,652.68 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,673.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000009,78070,HC PARATHRYOID IMAGING 78070,340,1 ,"$1,673.00 ","$1,104.18 ",$32.58 ,"$1,673.00 ",$32.58 ,$992.34 ,"$1,032.04 ",$379.35 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$32.58 ,$32.58 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$379.35 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ","$1,018.86 ",$32.58 ,$379.35 ,$371.76 ,$758.70 ,$34.53 ,"$1,422.05 ",$853.54 ,"$1,539.16 ","$1,171.10 ","$1,080.32 ","$1,080.32 ","$1,018.86 ","$1,080.32 ","$1,156.04 ","$1,505.70 ","$1,142.99 ",$375.48 ,"$1,321.67 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000010,78102,"HC BONE MARROW IMAGING, LTD",340,1 ,"$1,046.00 ",$690.36 ,$12.96 ,"$1,046.00 ",$12.96 ,$571.17 ,$568.51 ,$379.35 ,$627.60 ,$889.10 ,$732.20 ,$12.96 ,$12.96 ,$993.70 ,$794.96 ,$784.50 ,$679.90 ,$889.10 ,$379.35 ,$679.90 ,$679.90 ,$732.20 ,$637.01 ,$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,$889.10 ,$853.54 ,$962.32 ,$732.20 ,"$1,046.00 ","$1,046.00 ",$637.01 ,"$1,046.00 ",$722.79 ,$941.40 ,$714.63 ,$375.48 ,$826.34 ,$13.74 ,"$1,046.00 ","$1,046.00 ",$371.76 ,"$1,046.00 ",$753.12 ,$648.52 ,$753.12 ,$753.12 ,$836.80 
ST NICHOLAS HOSPITAL - ACUTE,34000011,78104,HC BONE MARROW IMAGING WHOLE BODY,340,1 ,"$1,360.00 ",$897.60 ,$12.96 ,"$1,360.00 ",$12.96 ,$826.09 ,$832.01 ,$379.35 ,$816.00 ,"$1,156.00 ",$952.00 ,$12.96 ,$12.96 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$379.35 ,$884.00 ,$884.00 ,$952.00 ,$828.24 ,$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,156.00 ",$853.54 ,"$1,251.20 ",$952.00 ,"$1,303.95 ","$1,303.95 ",$828.24 ,"$1,303.95 ",$939.76 ,"$1,224.00 ",$929.15 ,$375.48 ,"$1,074.40 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000014,78195,HC LYMPH NODE IMAGING,340,1 ,"$2,092.00 ","$1,380.72 ",$32.58 ,"$2,092.00 ",$32.58 ,"$1,156.26 ","$1,182.92 ",$492.39 ,"$1,255.20 ","$1,778.20 ","$1,464.40 ",$32.58 ,$32.58 ,"$1,987.40 ","$1,589.92 ","$1,569.00 ","$1,359.80 ","$1,778.20 ",$492.39 ,"$1,359.80 ","$1,359.80 ","$1,464.40 ","$1,274.03 ",$32.58 ,$492.39 ,$482.54 ,$984.78 ,$34.53 ,"$1,778.20 ","$1,107.88 ","$1,924.64 ","$1,464.40 ","$1,303.95 ","$1,303.95 ","$1,274.03 ","$1,303.95 ","$1,445.57 ","$1,882.80 ","$1,429.25 ",$487.36 ,"$1,652.68 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,673.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000015,78201,HC LIVER IMAGING STATIC,340,1 ,"$1,150.00 ",$759.00 ,$32.58 ,"$1,150.00 ",$32.58 ,$662.61 ,$671.97 ,$492.39 ,$690.00 ,$977.50 ,$805.00 ,$32.58 ,$32.58 ,"$1,092.50 ",$874.00 ,$862.50 ,$747.50 ,$977.50 ,$492.39 ,$747.50 ,$747.50 ,$805.00 ,$700.35 ,$32.58 ,$492.39 ,$482.54 ,$984.78 ,$34.53 ,$977.50 ,"$1,107.88 ","$1,058.00 ",$805.00 ,"$1,150.00 ","$1,150.00 ",$700.35 ,"$1,150.00 ",$794.65 ,"$1,035.00 ",$785.68 ,$487.36 ,$908.50 ,$34.53 ,"$1,150.00 ","$1,150.00 ",$482.54 ,"$1,150.00 ",$828.00 ,$713.00 ,$828.00 ,$828.00 ,$920.00 
ST NICHOLAS HOSPITAL - ACUTE,34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$1,360.00 ",$897.60 ,$32.58 ,"$1,360.00 ",$32.58 ,$673.69 ,$676.11 ,$379.35 ,$816.00 ,"$1,156.00 ",$952.00 ,$32.58 ,$32.58 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$379.35 ,$884.00 ,$884.00 ,$952.00 ,$828.24 ,$32.58 ,$379.35 ,$371.76 ,$758.70 ,$34.53 ,"$1,156.00 ",$853.54 ,"$1,251.20 ",$952.00 ,"$1,360.00 ","$1,360.00 ",$828.24 ,"$1,360.00 ",$939.76 ,"$1,224.00 ",$929.15 ,$375.48 ,"$1,074.40 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000022,78226,HC HEPATOBILIARY SCAN,340,1 ,"$2,092.00 ","$1,380.72 ",$12.96 ,"$2,092.00 ",$12.96 ,"$1,128.56 ","$1,166.36 ",$379.35 ,"$1,255.20 ","$1,778.20 ","$1,464.40 ",$12.96 ,$12.96 ,"$1,987.40 ","$1,589.92 ","$1,569.00 ","$1,359.80 ","$1,778.20 ",$379.35 ,"$1,359.80 ","$1,359.80 ","$1,464.40 ","$1,274.03 ",$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,778.20 ",$853.54 ,"$1,924.64 ","$1,464.40 ","$1,402.71 ","$1,402.71 ","$1,274.03 ","$1,402.71 ","$1,445.57 ","$1,882.80 ","$1,429.25 ",$375.48 ,"$1,652.68 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,673.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000024,78261,HC GASTRIC MUCOSA IMAGING,340,1 ,"$1,046.00 ",$690.36 ,$12.96 ,"$1,046.00 ",$12.96 ,$688.93 ,$688.53 ,$379.35 ,$627.60 ,$889.10 ,$732.20 ,$12.96 ,$12.96 ,$993.70 ,$794.96 ,$784.50 ,$679.90 ,$889.10 ,$379.35 ,$679.90 ,$679.90 ,$732.20 ,$637.01 ,$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,$889.10 ,$853.54 ,$962.32 ,$732.20 ,"$1,046.00 ","$1,046.00 ",$637.01 ,"$1,046.00 ",$722.79 ,$941.40 ,$714.63 ,$375.48 ,$826.34 ,$13.74 ,"$1,046.00 ","$1,046.00 ",$371.76 ,"$1,046.00 ",$753.12 ,$648.52 ,$753.12 ,$753.12 ,$836.80 
ST NICHOLAS HOSPITAL - ACUTE,34000026,78264,HC GASTRIC EMPTYING STUDY,340,1 ,"$1,673.00 ","$1,104.18 ",$12.96 ,"$1,673.00 ",$12.96 ,"$1,139.64 ","$1,176.02 ",$379.35 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$12.96 ,$12.96 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$379.35 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ","$1,018.86 ",$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,422.05 ",$853.54 ,"$1,539.16 ","$1,171.10 ","$1,218.99 ","$1,218.99 ","$1,018.86 ","$1,218.99 ","$1,156.04 ","$1,505.70 ","$1,142.99 ",$375.48 ,"$1,321.67 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000027,78278,HC GI BLEED SCAN,340,1 ,"$1,883.00 ","$1,242.78 ",$32.58 ,"$1,883.00 ",$32.58 ,"$1,171.50 ","$1,192.58 ",$379.35 ,"$1,129.80 ","$1,600.55 ","$1,318.10 ",$32.58 ,$32.58 ,"$1,788.85 ","$1,431.08 ","$1,412.25 ","$1,223.95 ","$1,600.55 ",$379.35 ,"$1,223.95 ","$1,223.95 ","$1,318.10 ","$1,146.75 ",$32.58 ,$379.35 ,$371.76 ,$758.70 ,$34.53 ,"$1,600.55 ",$853.54 ,"$1,732.36 ","$1,318.10 ","$1,218.99 ","$1,218.99 ","$1,146.75 ","$1,218.99 ","$1,301.15 ","$1,694.70 ","$1,286.47 ",$375.48 ,"$1,487.57 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,355.76 ","$1,167.46 ","$1,355.76 ","$1,355.76 ","$1,506.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000028,78290,HC SM BOWEL MECKEL'S SCAN,340,1 ,"$1,778.00 ","$1,173.48 ",$12.96 ,"$1,778.00 ",$12.96 ,"$1,157.65 ","$1,180.16 ",$379.35 ,"$1,066.80 ","$1,511.30 ","$1,244.60 ",$12.96 ,$12.96 ,"$1,689.10 ","$1,351.28 ","$1,333.50 ","$1,155.70 ","$1,511.30 ",$379.35 ,"$1,155.70 ","$1,155.70 ","$1,244.60 ","$1,082.80 ",$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,511.30 ",$853.54 ,"$1,635.76 ","$1,244.60 ","$1,218.99 ","$1,218.99 ","$1,082.80 ","$1,218.99 ","$1,228.60 ","$1,600.20 ","$1,214.73 ",$375.48 ,"$1,404.62 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,280.16 ","$1,102.36 ","$1,280.16 ","$1,280.16 ","$1,422.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000029,78300,HC BONE SCAN LIMITED,340,1 ,"$1,360.00 ",$897.60 ,$12.96 ,"$1,360.00 ",$12.96 ,$770.67 ,$791.50 ,$379.35 ,$816.00 ,"$1,156.00 ",$952.00 ,$12.96 ,$12.96 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$379.35 ,$884.00 ,$884.00 ,$952.00 ,$828.24 ,$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,156.00 ",$853.54 ,"$1,251.20 ",$952.00 ,"$1,219.62 ","$1,219.62 ",$828.24 ,"$1,219.62 ",$939.76 ,"$1,224.00 ",$929.15 ,$375.48 ,"$1,074.40 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000031,78306,HC BONE SCAN WHOLE BODY,340,1 ,"$1,987.00 ","$1,311.42 ",$12.96 ,"$1,987.00 ",$12.96 ,$995.12 ,"$1,033.42 ",$379.35 ,"$1,192.20 ","$1,688.95 ","$1,390.90 ",$12.96 ,$12.96 ,"$1,887.65 ","$1,510.12 ","$1,490.25 ","$1,291.55 ","$1,688.95 ",$379.35 ,"$1,291.55 ","$1,291.55 ","$1,390.90 ","$1,210.08 ",$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,688.95 ",$853.54 ,"$1,828.04 ","$1,390.90 ","$1,219.62 ","$1,219.62 ","$1,210.08 ","$1,219.62 ","$1,373.02 ","$1,788.30 ","$1,357.52 ",$375.48 ,"$1,569.73 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,430.64 ","$1,231.94 ","$1,430.64 ","$1,430.64 ","$1,589.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000033,78315,HC BONE SCAN/3 PHASE,340,1 ,"$2,196.00 ","$1,449.36 ",$12.96 ,"$2,196.00 ",$12.96 ,"$1,157.65 ","$1,177.40 ",$379.35 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$12.96 ,$12.96 ,"$2,086.20 ","$1,668.96 ","$1,647.00 ","$1,427.40 ","$1,866.60 ",$379.35 ,"$1,427.40 ","$1,427.40 ","$1,537.20 ","$1,337.36 ",$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,866.60 ",$853.54 ,"$2,020.32 ","$1,537.20 ","$1,219.62 ","$1,219.62 ","$1,337.36 ","$1,219.62 ","$1,517.44 ","$1,976.40 ","$1,500.31 ",$375.48 ,"$1,734.84 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,756.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000035,78451,HC HT MUSCLE IMAGE SPECT SINGLE,340,1 ,"$4,393.00 ","$2,899.38 ",$32.58 ,"$4,393.00 ",$32.58 ,"$1,066.21 ","$1,080.83 ","$1,295.42 ","$2,635.80 ","$3,734.05 ","$3,075.10 ",$32.58 ,$32.58 ,"$4,173.35 ","$3,338.68 ","$3,294.75 ","$2,855.45 ","$3,734.05 ","$1,295.42 ","$2,855.45 ","$2,855.45 ","$3,075.10 ","$2,675.34 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,590.84 ",$34.53 ,"$3,734.05 ","$2,914.68 ","$4,041.56 ","$3,075.10 ","$4,343.30 ","$4,343.30 ","$2,675.34 ","$4,343.30 ","$3,035.56 ","$3,953.70 ","$3,001.30 ","$1,282.20 ","$3,470.47 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$3,162.96 ","$2,723.66 ","$3,162.96 ","$3,162.96 ","$3,514.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000036,78451,HC HT MUSCLE IMAGE SPECT SINGLE REST ONLY,340,1 ,"$4,393.00 ","$2,899.38 ",$32.58 ,"$4,393.00 ",$32.58 ,"$1,066.21 ","$1,080.83 ","$1,295.42 ","$2,635.80 ","$3,734.05 ","$3,075.10 ",$32.58 ,$32.58 ,"$4,173.35 ","$3,338.68 ","$3,294.75 ","$2,855.45 ","$3,734.05 ","$1,295.42 ","$2,855.45 ","$2,855.45 ","$3,075.10 ","$2,675.34 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,590.84 ",$34.53 ,"$3,734.05 ","$2,914.68 ","$4,041.56 ","$3,075.10 ","$4,343.30 ","$4,343.30 ","$2,675.34 ","$4,343.30 ","$3,035.56 ","$3,953.70 ","$3,001.30 ","$1,282.20 ","$3,470.47 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$3,162.96 ","$2,723.66 ","$3,162.96 ","$3,162.96 ","$3,514.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000037,78452,HC HT MUSCLE IMAGE SPECT MULTI,340,1 ,"$4,811.00 ","$3,175.26 ",$32.58 ,"$4,811.00 ",$32.58 ,"$1,539.96 ","$1,561.92 ","$1,295.42 ","$2,886.60 ","$4,089.35 ","$3,367.70 ",$32.58 ,$32.58 ,"$4,570.45 ","$3,656.36 ","$3,608.25 ","$3,127.15 ","$4,089.35 ","$1,295.42 ","$3,127.15 ","$3,127.15 ","$3,367.70 ","$2,929.90 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,590.84 ",$34.53 ,"$4,089.35 ","$2,914.68 ","$4,426.12 ","$3,367.70 ","$4,343.30 ","$4,343.30 ","$2,929.90 ","$4,343.30 ","$3,324.40 ","$4,329.90 ","$3,286.88 ","$1,282.20 ","$3,800.69 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$3,463.92 ","$2,982.82 ","$3,463.92 ","$3,463.92 ","$3,848.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000044,78472,HC MUGA RESTING SGL,340,1 ,"$2,196.00 ","$1,449.36 ",$12.96 ,"$2,196.00 ",$12.96 ,$705.55 ,$717.50 ,$379.35 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$12.96 ,$12.96 ,"$2,086.20 ","$1,668.96 ","$1,647.00 ","$1,427.40 ","$1,866.60 ",$379.35 ,"$1,427.40 ","$1,427.40 ","$1,537.20 ","$1,337.36 ",$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,866.60 ",$853.54 ,"$2,020.32 ","$1,537.20 ","$1,442.38 ","$1,442.38 ","$1,337.36 ","$1,442.38 ","$1,517.44 ","$1,976.40 ","$1,500.31 ",$375.48 ,"$1,734.84 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,756.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000045,78473,HC MUGA RESTING MULTI,340,1 ,"$2,301.00 ","$1,518.66 ",$12.96 ,"$2,301.00 ",$12.96 ,$855.18 ,$866.50 ,$379.35 ,"$1,380.60 ","$1,955.85 ","$1,610.70 ",$12.96 ,$12.96 ,"$2,185.95 ","$1,748.76 ","$1,725.75 ","$1,495.65 ","$1,955.85 ",$379.35 ,"$1,495.65 ","$1,495.65 ","$1,610.70 ","$1,401.31 ",$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,955.85 ",$853.54 ,"$2,116.92 ","$1,610.70 ","$1,442.38 ","$1,442.38 ","$1,401.31 ","$1,442.38 ","$1,589.99 ","$2,070.90 ","$1,572.04 ",$375.48 ,"$1,817.79 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,656.72 ","$1,426.62 ","$1,656.72 ","$1,656.72 ","$1,840.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000046,78499,HC THALLIUM VIABILITY,340,1 ,"$1,360.00 ",$897.60 ,$12.96 ,"$1,360.00 ",$12.96 ,$932.14 ,$932.14 ,$379.35 ,$816.00 ,"$1,156.00 ",$952.00 ,$12.96 ,$12.96 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$379.35 ,$884.00 ,$884.00 ,$952.00 ,$828.24 ,$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,156.00 ",$853.54 ,"$1,251.20 ",$952.00 ,"$1,360.00 ","$1,360.00 ",$828.24 ,"$1,360.00 ",$939.76 ,"$1,224.00 ",$929.15 ,$375.48 ,"$1,074.40 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000047,78580,HC LUNG PERFUS,340,1 ,"$1,569.00 ","$1,035.54 ",$32.58 ,"$1,569.00 ",$32.58 ,$781.75 ,$801.66 ,$379.35 ,$941.40 ,"$1,333.65 ","$1,098.30 ",$32.58 ,$32.58 ,"$1,490.55 ","$1,192.44 ","$1,176.75 ","$1,019.85 ","$1,333.65 ",$379.35 ,"$1,019.85 ","$1,019.85 ","$1,098.30 ",$955.52 ,$32.58 ,$379.35 ,$371.76 ,$758.70 ,$34.53 ,"$1,333.65 ",$853.54 ,"$1,443.48 ","$1,098.30 ","$1,152.11 ","$1,152.11 ",$955.52 ,"$1,152.11 ","$1,084.18 ","$1,412.10 ","$1,071.94 ",$375.48 ,"$1,239.51 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,129.68 ",$972.78 ,"$1,129.68 ","$1,129.68 ","$1,255.20 "
ST NICHOLAS HOSPITAL - ACUTE,34000048,78582,HC LUNG SCAN-VENT/PERF,340,1 ,"$1,673.00 ","$1,104.18 ",$32.58 ,"$1,673.00 ",$32.58 ,"$1,095.30 ","$1,119.46 ",$492.39 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$32.58 ,$32.58 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$492.39 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ","$1,018.86 ",$32.58 ,$492.39 ,$482.54 ,$984.78 ,$34.53 ,"$1,422.05 ","$1,107.88 ","$1,539.16 ","$1,171.10 ","$1,622.19 ","$1,622.19 ","$1,018.86 ","$1,622.19 ","$1,156.04 ","$1,505.70 ","$1,142.99 ",$487.36 ,"$1,321.67 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000049,78582,HC LUNG PERFUS  AND  SCAN,340,1 ,"$1,673.00 ","$1,104.18 ",$32.58 ,"$1,673.00 ",$32.58 ,"$1,095.30 ","$1,119.46 ",$492.39 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$32.58 ,$32.58 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$492.39 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ","$1,018.86 ",$32.58 ,$492.39 ,$482.54 ,$984.78 ,$34.53 ,"$1,422.05 ","$1,107.88 ","$1,539.16 ","$1,171.10 ","$1,622.19 ","$1,622.19 ","$1,018.86 ","$1,622.19 ","$1,156.04 ","$1,505.70 ","$1,142.99 ",$487.36 ,"$1,321.67 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000050,78579,HC PULM VENT W/IMG,340,1 ,"$1,673.00 ","$1,104.18 ",$32.58 ,"$1,673.00 ",$32.58 ,$637.67 ,$643.88 ,$379.35 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$32.58 ,$32.58 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$379.35 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ","$1,018.86 ",$32.58 ,$379.35 ,$371.76 ,$758.70 ,$34.53 ,"$1,422.05 ",$853.54 ,"$1,539.16 ","$1,171.10 ","$1,152.11 ","$1,152.11 ","$1,018.86 ","$1,152.11 ","$1,156.04 ","$1,505.70 ","$1,142.99 ",$375.48 ,"$1,321.67 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000051,78582,HC PULM VENT  AND  PERF W/IMG   L,340,1 ,"$1,673.00 ","$1,104.18 ",$32.58 ,"$1,673.00 ",$32.58 ,"$1,095.30 ","$1,119.46 ",$492.39 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$32.58 ,$32.58 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$492.39 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ","$1,018.86 ",$32.58 ,$492.39 ,$482.54 ,$984.78 ,$34.53 ,"$1,422.05 ","$1,107.88 ","$1,539.16 ","$1,171.10 ","$1,622.19 ","$1,622.19 ","$1,018.86 ","$1,622.19 ","$1,156.04 ","$1,505.70 ","$1,142.99 ",$487.36 ,"$1,321.67 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000052,78579,HC LUNG SCAN-VENTILATION,340,1 ,"$1,673.00 ","$1,104.18 ",$32.58 ,"$1,673.00 ",$32.58 ,$637.67 ,$643.88 ,$379.35 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$32.58 ,$32.58 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$379.35 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ","$1,018.86 ",$32.58 ,$379.35 ,$371.76 ,$758.70 ,$34.53 ,"$1,422.05 ",$853.54 ,"$1,539.16 ","$1,171.10 ","$1,152.11 ","$1,152.11 ","$1,018.86 ","$1,152.11 ","$1,156.04 ","$1,505.70 ","$1,142.99 ",$375.48 ,"$1,321.67 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000056,78630,HC CISTERNOGRAPHY,340,1 ,"$2,615.00 ","$1,725.90 ",$32.58 ,"$2,615.00 ",$32.58 ,"$1,189.52 ","$1,207.75 ",$492.39 ,"$1,569.00 ","$2,222.75 ","$1,830.50 ",$32.58 ,$32.58 ,"$2,484.25 ","$1,987.40 ","$1,961.25 ","$1,699.75 ","$2,222.75 ",$492.39 ,"$1,699.75 ","$1,699.75 ","$1,830.50 ","$1,592.54 ",$32.58 ,$492.39 ,$482.54 ,$984.78 ,$34.53 ,"$2,222.75 ","$1,107.88 ","$2,405.80 ","$1,830.50 ","$2,007.40 ","$2,007.40 ","$1,592.54 ","$2,007.40 ","$1,806.97 ","$2,353.50 ","$1,786.57 ",$487.36 ,"$2,065.85 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,882.80 ","$1,621.30 ","$1,882.80 ","$1,882.80 ","$2,092.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000058,78650,HC CSF LEAK DETECTION,340,1 ,"$2,615.00 ","$1,725.90 ",$32.58 ,"$2,914.68 ",$32.58 ,$983.08 ,$985.64 ,"$1,295.42 ","$1,569.00 ","$2,222.75 ","$1,830.50 ",$32.58 ,$32.58 ,"$2,484.25 ","$1,987.40 ","$1,961.25 ","$1,699.75 ","$2,222.75 ","$1,295.42 ","$1,699.75 ","$1,699.75 ","$1,830.50 ","$1,592.54 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,590.84 ",$34.53 ,"$2,222.75 ","$2,914.68 ","$2,405.80 ","$1,830.50 ","$2,007.40 ","$2,007.40 ","$1,592.54 ","$2,007.40 ","$1,806.97 ","$2,353.50 ","$1,786.57 ","$1,282.20 ","$2,065.85 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$1,882.80 ","$1,621.30 ","$1,882.80 ","$1,882.80 ","$2,092.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000062,78707,HC KIDNEY SCAN W/FLOW AND FUNCTION,340,1 ,"$2,405.00 ","$1,587.30 ",$12.96 ,"$2,405.00 ",$12.96 ,$727.72 ,$738.19 ,$492.39 ,"$1,443.00 ","$2,044.25 ","$1,683.50 ",$12.96 ,$12.96 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ",$492.39 ,"$1,563.25 ","$1,563.25 ","$1,683.50 ","$1,464.65 ",$12.96 ,$492.39 ,$482.54 ,$984.78 ,$13.74 ,"$2,044.25 ","$1,107.88 ","$2,212.60 ","$1,683.50 ","$1,570.05 ","$1,570.05 ","$1,464.65 ","$1,570.05 ","$1,661.86 ","$2,164.50 ","$1,643.10 ",$487.36 ,"$1,899.95 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000063,78708,HC KIDNEY W/PHARMACLGCL INTER,340,1 ,"$2,405.00 ","$1,587.30 ",$12.96 ,"$2,405.00 ",$12.96 ,$482.93 ,$466.92 ,$492.39 ,"$1,443.00 ","$2,044.25 ","$1,683.50 ",$12.96 ,$12.96 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ",$492.39 ,"$1,563.25 ","$1,563.25 ","$1,683.50 ","$1,464.65 ",$12.96 ,$492.39 ,$482.54 ,$984.78 ,$13.74 ,"$2,044.25 ","$1,107.88 ","$2,212.60 ","$1,683.50 ","$1,570.05 ","$1,570.05 ","$1,464.65 ","$1,570.05 ","$1,661.86 ","$2,164.50 ","$1,643.10 ",$487.36 ,"$1,899.95 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000066,78740,HC URETERAL REFLUX STUDY,340,1 ,"$1,464.00 ",$966.24 ,$12.96 ,"$1,464.00 ",$12.96 ,$745.73 ,$757.51 ,$379.35 ,$878.40 ,"$1,244.40 ","$1,024.80 ",$12.96 ,$12.96 ,"$1,390.80 ","$1,112.64 ","$1,098.00 ",$951.60 ,"$1,244.40 ",$379.35 ,$951.60 ,$951.60 ,"$1,024.80 ",$891.58 ,$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,244.40 ",$853.54 ,"$1,346.88 ","$1,024.80 ","$1,464.00 ","$1,464.00 ",$891.58 ,"$1,464.00 ","$1,011.62 ","$1,317.60 ","$1,000.20 ",$375.48 ,"$1,156.56 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,054.08 ",$907.68 ,"$1,054.08 ","$1,054.08 ","$1,171.20 "
ST NICHOLAS HOSPITAL - ACUTE,34000068,78800,HC TUMOR LOCAL LIMITED,340,1 ,"$1,255.00 ",$828.30 ,$32.58 ,"$1,255.00 ",$32.58 ,$866.27 ,$637.49 ,$379.35 ,$753.00 ,"$1,066.75 ",$878.50 ,$32.58 ,$32.58 ,"$1,192.25 ",$953.80 ,$941.25 ,$815.75 ,"$1,066.75 ",$379.35 ,$815.75 ,$815.75 ,$878.50 ,$764.30 ,$32.58 ,$379.35 ,$371.76 ,$758.70 ,$34.53 ,"$1,066.75 ",$853.54 ,"$1,154.60 ",$878.50 ,"$1,255.00 ","$1,255.00 ",$764.30 ,"$1,255.00 ",$867.21 ,"$1,129.50 ",$857.42 ,$375.48 ,$991.45 ,$34.53 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ",$903.60 ,$778.10 ,$903.60 ,$903.60 ,"$1,004.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000070,78802,HC TUMOR IMAGE-WHOLE BODY-1 DAY,340,1 ,"$2,092.00 ","$1,380.72 ",$32.58 ,"$2,914.68 ",$32.58 ,"$1,061.62 ","$1,115.32 ","$1,295.42 ","$1,255.20 ","$1,778.20 ","$1,464.40 ",$32.58 ,$32.58 ,"$1,987.40 ","$1,589.92 ","$1,569.00 ","$1,359.80 ","$1,778.20 ","$1,295.42 ","$1,359.80 ","$1,359.80 ","$1,464.40 ","$1,274.03 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,092.00 ",$34.53 ,"$1,778.20 ","$2,914.68 ","$1,924.64 ","$1,464.40 ","$2,092.00 ","$2,092.00 ","$1,274.03 ","$2,092.00 ","$1,445.57 ","$1,882.80 ","$1,429.25 ","$1,282.20 ","$1,652.68 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,673.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$2,405.00 ","$1,587.30 ",$32.58 ,"$2,914.68 ",$32.58 ,"$1,296.20 ","$1,145.67 ","$1,295.42 ","$1,443.00 ","$2,044.25 ","$1,683.50 ",$32.58 ,$32.58 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ","$1,295.42 ","$1,563.25 ","$1,563.25 ","$1,683.50 ","$1,464.65 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,405.00 ",$34.53 ,"$2,044.25 ","$2,914.68 ","$2,212.60 ","$1,683.50 ","$2,405.00 ","$2,405.00 ","$1,464.65 ","$2,405.00 ","$1,661.86 ","$2,164.50 ","$1,643.10 ","$1,282.20 ","$1,899.95 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000072,78803,HC TUMOR IMAGING (SPECT) MIBG,340,1 ,"$2,405.00 ","$1,587.30 ",$32.58 ,"$2,914.68 ",$32.58 ,"$1,296.20 ","$1,145.67 ","$1,295.42 ","$1,443.00 ","$2,044.25 ","$1,683.50 ",$32.58 ,$32.58 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ","$1,295.42 ","$1,563.25 ","$1,563.25 ","$1,683.50 ","$1,464.65 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,405.00 ",$34.53 ,"$2,044.25 ","$2,914.68 ","$2,212.60 ","$1,683.50 ","$2,405.00 ","$2,405.00 ","$1,464.65 ","$2,405.00 ","$1,661.86 ","$2,164.50 ","$1,643.10 ","$1,282.20 ","$1,899.95 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000075,78803,HC TUMOR IMAGING (SPECT) OCTREO,340,1 ,"$2,405.00 ","$1,587.30 ",$32.58 ,"$2,914.68 ",$32.58 ,"$1,296.20 ","$1,145.67 ","$1,295.42 ","$1,443.00 ","$2,044.25 ","$1,683.50 ",$32.58 ,$32.58 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ","$1,295.42 ","$1,563.25 ","$1,563.25 ","$1,683.50 ","$1,464.65 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,405.00 ",$34.53 ,"$2,044.25 ","$2,914.68 ","$2,212.60 ","$1,683.50 ","$2,405.00 ","$2,405.00 ","$1,464.65 ","$2,405.00 ","$1,661.86 ","$2,164.50 ","$1,643.10 ","$1,282.20 ","$1,899.95 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000077,78804,HC TUMOR/INF-WHOLE BODY-MULT DAY,340,1 ,"$4,811.00 ","$3,175.26 ",$32.58 ,"$4,811.00 ",$32.58 ,"$2,361.97 ","$2,049.41 ","$1,295.42 ","$2,886.60 ","$4,089.35 ","$3,367.70 ",$32.58 ,$32.58 ,"$4,570.45 ","$3,656.36 ","$3,608.25 ","$3,127.15 ","$4,089.35 ","$1,295.42 ","$3,127.15 ","$3,127.15 ","$3,367.70 ","$2,929.90 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,590.84 ",$34.53 ,"$4,089.35 ","$2,914.68 ","$4,426.12 ","$3,367.70 ","$4,357.62 ","$4,357.62 ","$2,929.90 ","$4,357.62 ","$3,324.40 ","$4,329.90 ","$3,286.88 ","$1,282.20 ","$3,800.69 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$3,463.92 ","$2,982.82 ","$3,463.92 ","$3,463.92 ","$3,848.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000081,79005,HC NM RADIOPAHARM THRPY ORAL,340,1 ,"$1,360.00 ",$897.60 ,$9.62 ,"$1,360.00 ",$9.62 ,$207.30 ,$192.76 ,$243.74 ,$816.00 ,"$1,156.00 ",$952.00 ,$9.62 ,$9.62 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$243.74 ,$884.00 ,$884.00 ,$952.00 ,$828.24 ,$9.62 ,$243.74 ,$238.87 ,$487.48 ,$10.20 ,"$1,156.00 ",$548.41 ,"$1,251.20 ",$952.00 ,$963.09 ,$963.09 ,$828.24 ,$963.09 ,$939.76 ,"$1,224.00 ",$929.15 ,$241.26 ,"$1,074.40 ",$10.20 ,"$1,219.00 ","$1,219.00 ",$238.87 ,"$1,219.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000082,79005,HC NM RADIOPAHARM THRPY HYPERTHYROID,340,1 ,"$1,360.00 ",$897.60 ,$9.62 ,"$1,360.00 ",$9.62 ,$207.30 ,$192.76 ,$243.74 ,$816.00 ,"$1,156.00 ",$952.00 ,$9.62 ,$9.62 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$243.74 ,$884.00 ,$884.00 ,$952.00 ,$828.24 ,$9.62 ,$243.74 ,$238.87 ,$487.48 ,$10.20 ,"$1,156.00 ",$548.41 ,"$1,251.20 ",$952.00 ,$963.09 ,$963.09 ,$828.24 ,$963.09 ,$939.76 ,"$1,224.00 ",$929.15 ,$241.26 ,"$1,074.40 ",$10.20 ,"$1,219.00 ","$1,219.00 ",$238.87 ,"$1,219.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000083,79101,HC NM RADIOPAHARM THRPY IV,340,1 ,"$1,569.00 ","$1,035.54 ",$9.62 ,"$1,569.00 ",$9.62 ,$215.62 ,$192.26 ,$243.74 ,$941.40 ,"$1,333.65 ","$1,098.30 ",$9.62 ,$9.62 ,"$1,490.55 ","$1,192.44 ","$1,176.75 ","$1,019.85 ","$1,333.65 ",$243.74 ,"$1,019.85 ","$1,019.85 ","$1,098.30 ",$955.52 ,$9.62 ,$243.74 ,$238.87 ,$487.48 ,$10.20 ,"$1,333.65 ",$548.41 ,"$1,443.48 ","$1,098.30 ",$963.09 ,$963.09 ,$955.52 ,$963.09 ,"$1,084.18 ","$1,412.10 ","$1,071.94 ",$241.26 ,"$1,239.51 ",$10.20 ,"$1,219.00 ","$1,219.00 ",$238.87 ,"$1,219.00 ","$1,129.68 ",$972.78 ,"$1,129.68 ","$1,129.68 ","$1,255.20 "
ST NICHOLAS HOSPITAL - ACUTE,34000091,78598,HC NM PULM VENT AND PERF DIFF W/IMG,340,1 ,"$1,673.00 ","$1,104.18 ",$32.58 ,"$1,673.00 ",$32.58 ,"$1,026.98 ","$1,049.10 ",$492.39 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$32.58 ,$32.58 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$492.39 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ","$1,018.86 ",$32.58 ,$492.39 ,$482.54 ,$984.78 ,$34.53 ,"$1,422.05 ","$1,107.88 ","$1,539.16 ","$1,171.10 ","$1,622.19 ","$1,622.19 ","$1,018.86 ","$1,622.19 ","$1,156.04 ","$1,505.70 ","$1,142.99 ",$487.36 ,"$1,321.67 ",$34.53 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000092,78227,HC NM HEPATOBILIARY DUCTS W/PHARM,340,1 ,"$2,196.00 ","$1,449.36 ",$12.96 ,"$2,196.00 ",$12.96 ,"$1,536.75 ","$1,595.91 ",$492.39 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$12.96 ,$12.96 ,"$2,086.20 ","$1,668.96 ","$1,647.00 ","$1,427.40 ","$1,866.60 ",$492.39 ,"$1,427.40 ","$1,427.40 ","$1,537.20 ","$1,337.36 ",$12.96 ,$492.39 ,$482.54 ,$984.78 ,$13.74 ,"$1,866.60 ","$1,107.88 ","$2,020.32 ","$1,537.20 ","$1,402.71 ","$1,402.71 ","$1,337.36 ","$1,402.71 ","$1,517.44 ","$1,976.40 ","$1,500.31 ",$487.36 ,"$1,734.84 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$482.54 ,"$1,219.00 ","$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,756.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000093,78071,HC PARATHYROID IMG W/SPECT 78071,340,1 ,"$2,301.00 ","$1,518.66 ",$12.96 ,"$2,301.00 ",$12.96 ,"$1,139.64 ","$1,182.92 ",$379.35 ,"$1,380.60 ","$1,955.85 ","$1,610.70 ",$12.96 ,$12.96 ,"$2,185.95 ","$1,748.76 ","$1,725.75 ","$1,495.65 ","$1,955.85 ",$379.35 ,"$1,495.65 ","$1,495.65 ","$1,610.70 ","$1,401.31 ",$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,"$1,955.85 ",$853.54 ,"$2,116.92 ","$1,610.70 ","$2,301.00 ","$2,301.00 ","$1,401.31 ","$2,301.00 ","$1,589.99 ","$2,070.90 ","$1,572.04 ",$375.48 ,"$1,817.79 ",$13.74 ,"$1,219.00 ","$1,219.00 ",$371.76 ,"$1,219.00 ","$1,656.72 ","$1,426.62 ","$1,656.72 ","$1,656.72 ","$1,840.80 "
ST NICHOLAS HOSPITAL - ACUTE,34100007,A9538,HC NM PYROPHOSPHATE 99M VIAL,343,1 ,$103.50 ,$68.31 ,$46.65 ,$103.50 , N/A ,$70.94 ,$70.94 , N/A ,$62.10 ,$87.98 , N/A , N/A , N/A ,$98.33 ,$78.66 ,$77.63 ,$46.65 ,$87.98 , N/A ,$46.65 ,$46.65 ,$72.45 ,$63.03 , N/A , N/A , N/A , N/A , N/A ,$87.98 , N/A ,$95.22 ,$72.45 ,$52.50 ,$63.00 ,$63.03 ,$63.00 ,$71.52 ,$93.15 ,$70.71 , N/A ,$81.77 , N/A , N/A , N/A , N/A , N/A ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,34100020,0042T,HC CT CEREBRAL PERFUSION W/BLOOD FLOW,351,1 ,"$2,100.00 ","$1,386.00 ",$10.99 ,"$2,100.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ", N/A ,"$1,260.00 ","$1,785.00 ","$1,470.00 ",$10.99 ,$10.99 ,"$1,995.00 ","$1,596.00 ","$1,575.00 ","$1,218.00 ","$1,785.00 ", N/A ,"$1,218.00 ","$1,218.00 ","$1,470.00 ","$1,278.90 ",$10.99 , N/A , N/A , N/A ,$11.65 ,"$1,785.00 ", N/A ,"$1,932.00 ","$1,470.00 ","$1,065.12 ","$1,278.27 ","$1,278.90 ","$1,278.27 ","$1,451.10 ","$1,890.00 ","$1,434.72 ", N/A ,"$1,659.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ", N/A ,"$1,161.00 ","$1,512.00 ","$1,302.00 ","$1,512.00 ","$1,512.00 ","$1,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,34100033,78831,HC TUMOR LOCAL SPECT MULT AREA 1 DAY OR SGL AREA W/MULT DAYS,341,1 ,"$2,562.00 ","$1,690.92 ",$32.58 ,"$2,914.68 ",$32.58 ,"$2,418.77 ","$2,435.98 ","$1,295.42 ","$1,537.20 ","$2,177.70 ","$1,793.40 ",$32.58 ,$32.58 ,"$2,433.90 ","$1,947.12 ","$1,921.50 ","$1,665.30 ","$2,177.70 ","$1,295.42 ","$1,665.30 ","$1,665.30 ","$1,793.40 ","$1,560.26 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,562.00 ",$34.53 ,"$2,177.70 ","$2,914.68 ","$2,357.04 ","$1,793.40 ","$2,562.00 ","$2,562.00 ","$1,560.26 ","$2,562.00 ","$1,770.34 ","$2,305.80 ","$1,750.36 ","$1,282.20 ","$2,023.98 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$1,844.64 ","$1,588.44 ","$1,844.64 ","$1,844.64 ","$2,049.60 "
ST NICHOLAS HOSPITAL - ACUTE,34100034,78830,HC TUMOR IMAGING SPECT W/CT SGL AREA 1 DAY,341,1 ,"$2,562.00 ","$1,690.92 ",$32.58 ,"$2,914.68 ",$32.58 ,"$1,617.62 ","$1,641.77 ","$1,295.42 ","$1,537.20 ","$2,177.70 ","$1,793.40 ",$32.58 ,$32.58 ,"$2,433.90 ","$1,947.12 ","$1,921.50 ","$1,665.30 ","$2,177.70 ","$1,295.42 ","$1,665.30 ","$1,665.30 ","$1,793.40 ","$1,560.26 ",$32.58 ,"$1,295.42 ","$1,269.51 ","$2,562.00 ",$34.53 ,"$2,177.70 ","$2,914.68 ","$2,357.04 ","$1,793.40 ","$2,562.00 ","$2,562.00 ","$1,560.26 ","$2,562.00 ","$1,770.34 ","$2,305.80 ","$1,750.36 ","$1,282.20 ","$2,023.98 ",$34.53 ,"$1,219.00 ","$1,219.00 ","$1,269.51 ","$1,219.00 ","$1,844.64 ","$1,588.44 ","$1,844.64 ","$1,844.64 ","$2,049.60 "
ST NICHOLAS HOSPITAL - ACUTE,34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$522.10 ,$344.59 ,$197.68 ,$522.10 , N/A ,$357.85 ,$357.85 , N/A ,$313.26 ,$443.79 , N/A , N/A , N/A ,$496.00 ,$396.80 ,$391.58 ,$197.68 ,$443.79 , N/A ,$197.68 ,$197.68 ,$365.47 ,$317.96 , N/A , N/A , N/A , N/A , N/A ,$443.79 , N/A ,$480.33 ,$365.47 ,$264.81 ,$317.80 ,$317.96 ,$317.80 ,$360.77 ,$469.89 ,$356.70 , N/A ,$412.46 , N/A , N/A , N/A , N/A , N/A ,$375.91 ,$323.70 ,$375.91 ,$375.91 ,$417.68 
ST NICHOLAS HOSPITAL - ACUTE,34300004,A9503,HC DIAGNUCLIDE MDP UP TO 30MCI,343,1 ,$186.30 ,$122.96 ,$94.49 ,$186.30 , N/A ,$127.69 ,$127.69 , N/A ,$111.78 ,$158.36 , N/A , N/A , N/A ,$176.99 ,$141.59 ,$139.73 ,$158.63 ,$158.36 , N/A ,$158.63 ,$158.63 ,$130.41 ,$113.46 , N/A , N/A , N/A , N/A , N/A ,$158.36 , N/A ,$171.40 ,$130.41 ,$94.49 ,$113.40 ,$113.46 ,$113.40 ,$128.73 ,$167.67 ,$127.28 , N/A ,$147.18 , N/A , N/A , N/A , N/A , N/A ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,34300006,A9505,HC DIAGNUCLIDE THALL 201 PER MCI,343,1 ,$154.10 ,$101.71 ,$61.91 ,$154.10 , N/A ,$105.62 ,$105.62 , N/A ,$92.46 ,$130.99 , N/A , N/A , N/A ,$146.40 ,$117.12 ,$115.58 ,$61.91 ,$130.99 , N/A ,$61.91 ,$61.91 ,$107.87 ,$93.85 , N/A , N/A , N/A , N/A , N/A ,$130.99 , N/A ,$141.77 ,$107.87 ,$78.16 ,$93.80 ,$93.85 ,$93.80 ,$106.48 ,$138.69 ,$105.28 , N/A ,$121.74 , N/A , N/A , N/A , N/A , N/A ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,34300007,A9507,HC DIAGNUCLIDE PROSTASCINT,343,1 ,"$7,856.80 ","$5,185.49 ","$2,790.99 ","$7,856.80 ", N/A ,"$5,385.05 ","$5,385.05 ", N/A ,"$4,714.08 ","$6,678.28 ", N/A , N/A , N/A ,"$7,463.96 ","$5,971.17 ","$5,892.60 ","$2,790.99 ","$6,678.28 ", N/A ,"$2,790.99 ","$2,790.99 ","$5,499.76 ","$4,784.79 ", N/A , N/A , N/A , N/A , N/A ,"$6,678.28 ", N/A ,"$7,228.26 ","$5,499.76 ","$3,984.97 ","$4,782.43 ","$4,784.79 ","$4,782.43 ","$5,429.05 ","$7,071.12 ","$5,367.77 ", N/A ,"$6,206.87 ", N/A , N/A , N/A , N/A , N/A ,"$5,656.90 ","$4,871.22 ","$5,656.90 ","$5,656.90 ","$6,285.44 "
ST NICHOLAS HOSPITAL - ACUTE,34300009,A9512,HC TECHNETIUM TC99 PERTECH PER MCI,343,1 ,$57.50 ,$37.95 ,$29.16 ,$57.50 , N/A ,$39.41 ,$39.41 , N/A ,$34.50 ,$48.88 , N/A , N/A , N/A ,$54.63 ,$43.70 ,$43.13 ,$37.37 ,$48.88 , N/A ,$37.37 ,$37.37 ,$40.25 ,$35.02 , N/A , N/A , N/A , N/A , N/A ,$48.88 , N/A ,$52.90 ,$40.25 ,$29.16 ,$35.00 ,$35.02 ,$35.00 ,$39.73 ,$51.75 ,$39.28 , N/A ,$45.43 , N/A , N/A , N/A , N/A , N/A ,$41.40 ,$35.65 ,$41.40 ,$41.40 ,$46.00 
ST NICHOLAS HOSPITAL - ACUTE,34300010,A9516,HC DIAGNUCLIDE I123 CAPS 100 MICR,343,1 ,$96.60 ,$63.76 ,$49.00 ,$96.60 , N/A ,$66.21 ,$66.21 , N/A ,$57.96 ,$82.11 , N/A , N/A , N/A ,$91.77 ,$73.42 ,$72.45 ,$96.60 ,$82.11 , N/A ,$96.60 ,$96.60 ,$67.62 ,$58.83 , N/A , N/A , N/A , N/A , N/A ,$82.11 , N/A ,$88.87 ,$67.62 ,$49.00 ,$58.80 ,$58.83 ,$58.80 ,$66.75 ,$86.94 ,$66.00 , N/A ,$76.31 , N/A , N/A , N/A , N/A , N/A ,$69.55 ,$59.89 ,$69.55 ,$69.55 ,$77.28 
ST NICHOLAS HOSPITAL - ACUTE,34300011,A9517,HC DIAGNUCLIDE I131 CAPS PER MCI,343,1 ,$241.50 ,$159.39 ,$16.26 ,$241.50 ,$16.26 ,$165.52 ,$165.52 ,$23.73 ,$144.90 ,$205.28 ,$169.05 ,$16.26 ,$16.26 ,$229.43 ,$183.54 ,$181.13 ,$72.83 ,$205.28 ,$23.73 ,$72.83 ,$72.83 ,$169.05 ,$147.07 ,$16.26 ,$23.73 ,$23.26 ,$47.46 ,$17.24 ,$205.28 ,$53.39 ,$222.18 ,$169.05 ,$30.00 ,$30.00 ,$147.07 ,$30.00 ,$166.88 ,$217.35 ,$164.99 ,$23.49 ,$190.79 ,$17.24 ,$39.15 ,$39.15 ,$23.26 ,$39.15 ,$173.88 ,$149.73 ,$173.88 ,$173.88 ,$193.20 
ST NICHOLAS HOSPITAL - ACUTE,34300012,A9521,HC DIAGNUCLIDE CERETEC,343,1 ,"$2,987.70 ","$1,971.88 ","$1,515.36 ","$2,987.70 ", N/A ,"$2,047.77 ","$2,047.77 ", N/A ,"$1,792.62 ","$2,539.55 ", N/A , N/A , N/A ,"$2,838.32 ","$2,270.65 ","$2,240.78 ","$2,987.70 ","$2,539.55 ", N/A ,"$2,987.70 ","$2,987.70 ","$2,091.39 ","$1,819.51 ", N/A , N/A , N/A , N/A , N/A ,"$2,539.55 ", N/A ,"$2,748.68 ","$2,091.39 ","$1,515.36 ","$1,818.61 ","$1,819.51 ","$1,818.61 ","$2,064.50 ","$2,688.93 ","$2,041.20 ", N/A ,"$2,360.28 ", N/A , N/A , N/A , N/A , N/A ,"$2,151.14 ","$1,852.37 ","$2,151.14 ","$2,151.14 ","$2,390.16 "
ST NICHOLAS HOSPITAL - ACUTE,34300014,A9528,HC DIAGNUCLIDE I131 NECK/CHST,343,1 ,$244.95 ,$161.67 ,$69.16 ,$244.95 , N/A ,$167.89 ,$167.89 , N/A ,$146.97 ,$208.21 , N/A , N/A , N/A ,$232.70 ,$186.16 ,$183.71 ,$69.16 ,$208.21 , N/A ,$69.16 ,$69.16 ,$171.47 ,$149.17 , N/A , N/A , N/A , N/A , N/A ,$208.21 , N/A ,$225.35 ,$171.47 ,$124.24 ,$149.10 ,$149.17 ,$149.10 ,$169.26 ,$220.46 ,$167.35 , N/A ,$193.51 , N/A , N/A , N/A , N/A , N/A ,$176.36 ,$151.87 ,$176.36 ,$176.36 ,$195.96 
ST NICHOLAS HOSPITAL - ACUTE,34300015,A9530,HC THERAPEUTIC ISOTOPE SOLUTION PER MCI,343,1 ,$64.40 ,$42.50 ,$16.26 ,$64.40 ,$16.26 ,$44.14 ,$44.14 ,$22.71 ,$38.64 ,$54.74 ,$45.08 ,$16.26 ,$16.26 ,$61.18 ,$48.94 ,$48.30 ,$41.86 ,$54.74 ,$22.71 ,$41.86 ,$41.86 ,$45.08 ,$39.22 ,$16.26 ,$22.71 ,$22.26 ,$45.42 ,$17.24 ,$54.74 ,$51.10 ,$59.25 ,$45.08 ,$19.37 ,$19.37 ,$39.22 ,$19.37 ,$44.50 ,$57.96 ,$44.00 ,$22.48 ,$50.88 ,$17.24 ,$37.47 ,$37.47 ,$22.26 ,$37.47 ,$46.37 ,$39.93 ,$46.37 ,$46.37 ,$51.52 
ST NICHOLAS HOSPITAL - ACUTE,34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$232.30 ,$153.32 ,$101.56 ,$232.30 , N/A ,$159.22 ,$159.22 , N/A ,$139.38 ,$197.46 , N/A , N/A , N/A ,$220.69 ,$176.55 ,$174.23 ,$101.56 ,$197.46 , N/A ,$101.56 ,$101.56 ,$162.61 ,$141.47 , N/A , N/A , N/A , N/A , N/A ,$197.46 , N/A ,$213.72 ,$162.61 ,$117.82 ,$141.40 ,$141.47 ,$141.40 ,$160.52 ,$209.07 ,$158.71 , N/A ,$183.52 , N/A , N/A , N/A , N/A , N/A ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,34300017,A9539,HC DIAGNUCLIDE DTPA KIDNEY PER DOSE,343,1 ,$200.10 ,$132.07 ,$63.92 ,$200.10 , N/A ,$137.15 ,$137.15 , N/A ,$120.06 ,$170.09 , N/A , N/A , N/A ,$190.10 ,$152.08 ,$150.08 ,$63.92 ,$170.09 , N/A ,$63.92 ,$63.92 ,$140.07 ,$121.86 , N/A , N/A , N/A , N/A , N/A ,$170.09 , N/A ,$184.09 ,$140.07 ,$101.49 ,$121.80 ,$121.86 ,$121.80 ,$138.27 ,$180.09 ,$136.71 , N/A ,$158.08 , N/A , N/A , N/A , N/A , N/A ,$144.07 ,$124.06 ,$144.07 ,$144.07 ,$160.08 
ST NICHOLAS HOSPITAL - ACUTE,34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$811.90 ,$535.85 ,$61.20 ,$811.90 , N/A ,$556.48 ,$556.48 , N/A ,$487.14 ,$690.12 , N/A , N/A , N/A ,$771.31 ,$617.04 ,$608.93 ,$61.20 ,$690.12 , N/A ,$61.20 ,$61.20 ,$568.33 ,$494.45 , N/A , N/A , N/A , N/A , N/A ,$690.12 , N/A ,$746.95 ,$568.33 ,$411.80 ,$494.20 ,$494.45 ,$494.20 ,$561.02 ,$730.71 ,$554.69 , N/A ,$641.40 , N/A , N/A , N/A , N/A , N/A ,$584.57 ,$503.38 ,$584.57 ,$584.57 ,$649.52 
ST NICHOLAS HOSPITAL - ACUTE,34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,$309.35 ,$204.17 ,$156.90 ,$309.35 , N/A ,$212.03 ,$212.03 , N/A ,$185.61 ,$262.95 , N/A , N/A , N/A ,$293.88 ,$235.11 ,$232.01 ,$309.35 ,$262.95 , N/A ,$309.35 ,$309.35 ,$216.55 ,$188.39 , N/A , N/A , N/A , N/A , N/A ,$262.95 , N/A ,$284.60 ,$216.55 ,$156.90 ,$188.30 ,$188.39 ,$188.30 ,$213.76 ,$278.42 ,$211.35 , N/A ,$244.39 , N/A , N/A , N/A , N/A , N/A ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,34300024,A9547,HC DIAGNUCLIDE IN OXINE .5 MCI,343,1 ,"$3,348.80 ","$2,210.21 ","$1,698.51 ","$3,348.80 ", N/A ,"$2,295.27 ","$2,295.27 ", N/A ,"$2,009.28 ","$2,846.48 ", N/A , N/A , N/A ,"$3,181.36 ","$2,545.09 ","$2,511.60 ","$3,348.80 ","$2,846.48 ", N/A ,"$3,348.80 ","$3,348.80 ","$2,344.16 ","$2,039.42 ", N/A , N/A , N/A , N/A , N/A ,"$2,846.48 ", N/A ,"$3,080.90 ","$2,344.16 ","$1,698.51 ","$2,038.41 ","$2,039.42 ","$2,038.41 ","$2,314.02 ","$3,013.92 ","$2,287.90 ", N/A ,"$2,645.55 ", N/A , N/A , N/A , N/A , N/A ,"$2,411.14 ","$2,076.26 ","$2,411.14 ","$2,411.14 ","$2,679.04 "
ST NICHOLAS HOSPITAL - ACUTE,34300025,A9548,HC DIAGNUCLIDE IN-111 WB PER.5MCI,343,1 ,"$5,583.25 ","$3,684.95 ",$842.91 ,"$5,583.25 ", N/A ,"$3,826.76 ","$3,826.76 ", N/A ,"$3,349.95 ","$4,745.76 ", N/A , N/A , N/A ,"$5,304.09 ","$4,243.27 ","$4,187.44 ",$842.91 ,"$4,745.76 ", N/A ,$842.91 ,$842.91 ,"$3,908.28 ","$3,400.20 ", N/A , N/A , N/A , N/A , N/A ,"$4,745.76 ", N/A ,"$5,136.59 ","$3,908.28 ","$2,831.82 ","$3,398.52 ","$3,400.20 ","$3,398.52 ","$3,858.03 ","$5,024.93 ","$3,814.48 ", N/A ,"$4,410.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,019.94 ","$3,461.62 ","$4,019.94 ","$4,019.94 ","$4,466.60 "
ST NICHOLAS HOSPITAL - ACUTE,34300026,A9548,HC DIAGNUCLIDE IN-111 DTPA,343,1 ,"$5,583.25 ","$3,684.95 ",$842.91 ,"$5,583.25 ", N/A ,"$3,826.76 ","$3,826.76 ", N/A ,"$3,349.95 ","$4,745.76 ", N/A , N/A , N/A ,"$5,304.09 ","$4,243.27 ","$4,187.44 ",$842.91 ,"$4,745.76 ", N/A ,$842.91 ,$842.91 ,"$3,908.28 ","$3,400.20 ", N/A , N/A , N/A , N/A , N/A ,"$4,745.76 ", N/A ,"$5,136.59 ","$3,908.28 ","$2,831.82 ","$3,398.52 ","$3,400.20 ","$3,398.52 ","$3,858.03 ","$5,024.93 ","$3,814.48 ", N/A ,"$4,410.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,019.94 ","$3,461.62 ","$4,019.94 ","$4,019.94 ","$4,466.60 "
ST NICHOLAS HOSPITAL - ACUTE,34300029,A9552,HC DIAGNUCLIDE 18FDG,343,1 ,"$1,339.75 ",$884.24 ,$679.52 ,"$1,339.75 ", N/A ,$918.26 ,$918.26 , N/A ,$803.85 ,"$1,138.79 ", N/A , N/A , N/A ,"$1,272.76 ","$1,018.21 ","$1,004.81 ",$897.04 ,"$1,138.79 ", N/A ,$897.04 ,$897.04 ,$937.83 ,$815.91 , N/A , N/A , N/A , N/A , N/A ,"$1,138.79 ", N/A ,"$1,232.57 ",$937.83 ,$679.52 ,$815.51 ,$815.91 ,$815.51 ,$925.77 ,"$1,205.78 ",$915.32 , N/A ,"$1,058.40 ", N/A , N/A , N/A , N/A , N/A ,$964.62 ,$830.65 ,$964.62 ,$964.62 ,"$1,071.80 "
ST NICHOLAS HOSPITAL - ACUTE,34300031,A9556,HC DIAGNUCLIDE GA67 PER MCI,343,1 ,$141.45 ,$93.36 ,$71.74 ,$141.45 , N/A ,$96.95 ,$96.95 , N/A ,$84.87 ,$120.23 , N/A , N/A , N/A ,$134.38 ,$107.50 ,$106.09 ,$141.45 ,$120.23 , N/A ,$141.45 ,$141.45 ,$99.02 ,$86.14 , N/A , N/A , N/A , N/A , N/A ,$120.23 , N/A ,$130.13 ,$99.02 ,$71.74 ,$86.10 ,$86.14 ,$86.10 ,$97.74 ,$127.31 ,$96.64 , N/A ,$111.75 , N/A , N/A , N/A , N/A , N/A ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,34300035,A9560,HC TC99M GI BLD MUGA UP TO 30MCI,343,1 ,$399.05 ,$263.37 ,$181.24 ,$399.05 , N/A ,$273.51 ,$273.51 , N/A ,$239.43 ,$339.19 , N/A , N/A , N/A ,$379.10 ,$303.28 ,$299.29 ,$181.24 ,$339.19 , N/A ,$181.24 ,$181.24 ,$279.34 ,$243.02 , N/A , N/A , N/A , N/A , N/A ,$339.19 , N/A ,$367.13 ,$279.34 ,$202.40 ,$242.90 ,$243.02 ,$242.90 ,$275.74 ,$359.15 ,$272.63 , N/A ,$315.25 , N/A , N/A , N/A , N/A , N/A ,$287.32 ,$247.41 ,$287.32 ,$287.32 ,$319.24 
ST NICHOLAS HOSPITAL - ACUTE,34300036,A9560,HC RBC TAG KIT WITH TC99,343,1 ,$399.05 ,$263.37 ,$181.24 ,$399.05 , N/A ,$273.51 ,$273.51 , N/A ,$239.43 ,$339.19 , N/A , N/A , N/A ,$379.10 ,$303.28 ,$299.29 ,$181.24 ,$339.19 , N/A ,$181.24 ,$181.24 ,$279.34 ,$243.02 , N/A , N/A , N/A , N/A , N/A ,$339.19 , N/A ,$367.13 ,$279.34 ,$202.40 ,$242.90 ,$243.02 ,$242.90 ,$275.74 ,$359.15 ,$272.63 , N/A ,$315.25 , N/A , N/A , N/A , N/A , N/A ,$287.32 ,$247.41 ,$287.32 ,$287.32 ,$319.24 
ST NICHOLAS HOSPITAL - ACUTE,34300037,A9562,HC DIAG NUCLDE MAG 3 PER DOSE,343,1 ,"$1,133.90 ",$748.37 ,$575.11 ,"$1,133.90 ", N/A ,$777.18 ,$777.18 , N/A ,$680.34 ,$963.82 , N/A , N/A , N/A ,"$1,077.21 ",$861.76 ,$850.43 ,"$1,133.90 ",$963.82 , N/A ,"$1,133.90 ","$1,133.90 ",$793.73 ,$690.55 , N/A , N/A , N/A , N/A , N/A ,$963.82 , N/A ,"$1,043.19 ",$793.73 ,$575.11 ,$690.20 ,$690.55 ,$690.20 ,$783.52 ,"$1,020.51 ",$774.68 , N/A ,$895.78 , N/A , N/A , N/A , N/A , N/A ,$816.41 ,$703.02 ,$816.41 ,$816.41 ,$907.12 
ST NICHOLAS HOSPITAL - ACUTE,34300038,A9572,HC DIAGNUCLIDE OCTREOTIDE PER DOSE UP TO 6MCI,343,1 ,"$9,009.10 ","$5,946.01 ","$4,569.42 ","$9,009.10 ", N/A ,"$6,174.84 ","$6,174.84 ", N/A ,"$5,405.46 ","$7,657.74 ", N/A , N/A , N/A ,"$8,558.65 ","$6,846.92 ","$6,756.83 ","$9,009.10 ","$7,657.74 ", N/A ,"$9,009.10 ","$9,009.10 ","$6,306.37 ","$5,486.54 ", N/A , N/A , N/A , N/A , N/A ,"$7,657.74 ", N/A ,"$8,288.37 ","$6,306.37 ","$4,569.42 ","$5,483.84 ","$5,486.54 ","$5,483.84 ","$6,225.29 ","$8,108.19 ","$6,155.02 ", N/A ,"$7,117.19 ", N/A , N/A , N/A , N/A , N/A ,"$6,486.55 ","$5,585.64 ","$6,486.55 ","$6,486.55 ","$7,207.28 "
ST NICHOLAS HOSPITAL - ACUTE,34300039,A9582,HC DIAGNUCLIDE I 123 MIBG,343,1 ,"$7,998.25 ","$5,278.85 ","$4,056.71 ","$7,998.25 ", N/A ,"$5,482.00 ","$5,482.00 ", N/A ,"$4,798.95 ","$6,798.51 ", N/A , N/A , N/A ,"$7,598.34 ","$6,078.67 ","$5,998.69 ","$7,998.25 ","$6,798.51 ", N/A ,"$7,998.25 ","$7,998.25 ","$5,598.78 ","$4,870.93 ", N/A , N/A , N/A , N/A , N/A ,"$6,798.51 ", N/A ,"$7,358.39 ","$5,598.78 ","$4,056.71 ","$4,868.53 ","$4,870.93 ","$4,868.53 ","$5,526.79 ","$7,198.43 ","$5,464.40 ", N/A ,"$6,318.62 ", N/A , N/A , N/A , N/A , N/A ,"$5,758.74 ","$4,958.92 ","$5,758.74 ","$5,758.74 ","$6,398.60 "
ST NICHOLAS HOSPITAL - ACUTE,34300041,J2805,HC DIAGNUCLIDE CCK,636,1 ,$287.70 ,$189.88 ,$1.81 ,$287.70 ,$1.81 ,$261.63 ,$174.42 , N/A ,$172.62 ,$244.55 ,$201.39 ,$1.81 ,$1.81 ,$273.32 ,$218.65 ,$215.78 ,$209.25 ,$244.55 , N/A ,$209.25 ,$209.25 ,$201.39 ,$175.21 ,$1.81 , N/A , N/A , N/A ,$1.92 ,$244.55 , N/A ,$264.68 ,$201.39 ,$168.61 ,$168.61 ,$175.21 ,$168.61 ,$198.80 ,$258.93 ,$196.56 , N/A ,$227.28 ,$1.92 , N/A , N/A , N/A , N/A ,$207.14 ,$178.37 ,$207.14 ,$207.14 ,$230.16 
ST NICHOLAS HOSPITAL - ACUTE,34300049,A9509,HC DIAGNUCLIDE I123 CAP PER MILLICURIE,343,1 ,$618.70 ,$408.34 ,$313.80 ,$618.70 , N/A ,$424.06 ,$424.06 , N/A ,$371.22 ,$525.90 , N/A , N/A , N/A ,$587.77 ,$470.21 ,$464.03 ,$618.70 ,$525.90 , N/A ,$618.70 ,$618.70 ,$433.09 ,$376.79 , N/A , N/A , N/A , N/A , N/A ,$525.90 , N/A ,$569.20 ,$433.09 ,$313.80 ,$376.60 ,$376.79 ,$376.60 ,$427.52 ,$556.83 ,$422.70 , N/A ,$488.77 , N/A , N/A , N/A , N/A , N/A ,$445.46 ,$383.59 ,$445.46 ,$445.46 ,$494.96 
ST NICHOLAS HOSPITAL - ACUTE,34300052,A9539,HC DIAGNUCLIDE DTPA AEROSOL,343,1 ,$200.10 ,$132.07 ,$63.92 ,$200.10 , N/A ,$137.15 ,$137.15 , N/A ,$120.06 ,$170.09 , N/A , N/A , N/A ,$190.10 ,$152.08 ,$150.08 ,$63.92 ,$170.09 , N/A ,$63.92 ,$63.92 ,$140.07 ,$121.86 , N/A , N/A , N/A , N/A , N/A ,$170.09 , N/A ,$184.09 ,$140.07 ,$101.49 ,$121.80 ,$121.86 ,$121.80 ,$138.27 ,$180.09 ,$136.71 , N/A ,$158.08 , N/A , N/A , N/A , N/A , N/A ,$144.07 ,$124.06 ,$144.07 ,$144.07 ,$160.08 
ST NICHOLAS HOSPITAL - ACUTE,34300053,A9606,HC NUCLIDE XOFIGO PER MICROCURIE,636,1 ,$217.35 ,$143.45 ,$130.41 ,$491.88 ,$464.04 , N/A , N/A ,$154.38 ,$130.41 ,$184.75 ,$152.15 ,$464.04 ,$217.35 ,$206.48 ,$165.19 ,$163.01 ,$217.35 ,$184.75 ,$154.38 ,$217.35 ,$217.35 ,$152.15 ,$132.37 ,$464.04 ,$154.38 ,$151.29 ,$217.35 ,$230.39 ,$184.75 ,$347.35 ,$199.96 ,$152.15 , N/A , N/A ,$132.37 , N/A ,$150.19 ,$195.62 ,$148.49 ,$152.80 ,$171.71 ,$491.88 ,$217.35 ,$217.35 ,$151.29 ,$217.35 ,$156.49 ,$134.76 ,$156.49 ,$156.49 ,$173.88 
ST NICHOLAS HOSPITAL - ACUTE,34300054,A9587,HC GALLIUM GA-68 DOTATATE DIAG 0.1 MCI,343,1 ,$162.15 ,$107.02 ,$82.24 ,$162.15 , N/A ,$111.14 ,$111.14 , N/A ,$97.29 ,$137.83 , N/A , N/A , N/A ,$154.04 ,$123.23 ,$121.61 ,$113.34 ,$137.83 , N/A ,$113.34 ,$113.34 ,$113.51 ,$98.75 , N/A , N/A , N/A , N/A , N/A ,$137.83 , N/A ,$149.18 ,$113.51 ,$82.24 ,$98.70 ,$98.75 ,$98.70 ,$112.05 ,$145.94 ,$110.78 , N/A ,$128.10 , N/A , N/A , N/A , N/A , N/A ,$116.75 ,$100.53 ,$116.75 ,$116.75 ,$129.72 
ST NICHOLAS HOSPITAL - ACUTE,34300055,A9588,HC FLUCICLOVINE F-18 DIAG 1 MCI,343,1 ,"$1,094.80 ",$722.57 ,$555.28 ,"$1,094.80 ", N/A ,$750.38 ,$750.38 , N/A ,$656.88 ,$930.58 , N/A , N/A , N/A ,"$1,040.06 ",$832.05 ,$821.10 ,$979.20 ,$930.58 , N/A ,$979.20 ,$979.20 ,$766.36 ,$666.73 , N/A , N/A , N/A , N/A , N/A ,$930.58 , N/A ,"$1,007.22 ",$766.36 ,$555.28 ,$666.40 ,$666.73 ,$666.40 ,$756.51 ,$985.32 ,$747.97 , N/A ,$864.89 , N/A , N/A , N/A , N/A , N/A ,$788.26 ,$678.78 ,$788.26 ,$788.26 ,$875.84 
ST NICHOLAS HOSPITAL - ACUTE,34300060,A9520,HC DIAGNUCLIDE TC-99 TILMANOCEPT DIAG UP TO 0.5 MCI,343,1 ,"$1,344.35 ",$887.27 ,$681.85 ,"$1,344.35 ", N/A ,$921.42 ,$921.42 , N/A ,$806.61 ,"$1,142.70 ", N/A , N/A , N/A ,"$1,277.13 ","$1,021.71 ","$1,008.26 ",$958.39 ,"$1,142.70 ", N/A ,$958.39 ,$958.39 ,$941.05 ,$818.71 , N/A , N/A , N/A , N/A , N/A ,"$1,142.70 ", N/A ,"$1,236.80 ",$941.05 ,$681.85 ,$818.31 ,$818.71 ,$818.31 ,$928.95 ,"$1,209.92 ",$918.46 , N/A ,"$1,062.04 ", N/A , N/A , N/A , N/A , N/A ,$967.93 ,$833.50 ,$967.93 ,$967.93 ,"$1,075.48 "
ST NICHOLAS HOSPITAL - ACUTE,34300066,Q9969,HC TC-99M NON-HUE ADD-ON PER STUDY DOSE,343,1 ,$12.65 ,$8.35 ,$6.42 ,$22.50 , N/A ,$8.67 ,$8.67 ,$10.00 ,$7.59 ,$10.75 , N/A , N/A , N/A ,$12.02 ,$9.61 ,$9.49 ,$8.22 ,$10.75 ,$10.00 ,$8.22 ,$8.22 ,$8.86 ,$7.70 , N/A ,$10.00 ,$9.80 ,$12.65 , N/A ,$10.75 ,$22.50 ,$11.64 ,$8.86 ,$6.42 ,$7.70 ,$7.70 ,$7.70 ,$8.74 ,$11.39 ,$8.64 ,$9.90 ,$9.99 , N/A ,$12.65 ,$12.65 ,$9.80 ,$12.65 ,$9.11 ,$7.84 ,$9.11 ,$9.11 ,$10.12 
ST NICHOLAS HOSPITAL - ACUTE,34300071,A9592,HC COPPER CU-64 DOTATATE DIAGNOSTIC 1 MILLICURIE,343,1 ,"$2,850.00 ","$1,881.00 ",$951.21 ,"$2,850.00 ", N/A ,"$1,953.39 ","$1,953.39 ",$970.62 ,"$1,710.00 ","$2,422.50 ","$1,995.00 ", N/A , N/A ,"$2,707.50 ","$2,166.00 ","$2,137.50 ","$1,375.95 ","$2,422.50 ",$970.62 ,"$1,375.95 ","$1,375.95 ","$1,995.00 ","$1,735.65 ", N/A ,$970.62 ,$951.21 ,"$1,941.24 ", N/A ,"$2,422.50 ","$2,183.89 ","$2,622.00 ","$1,995.00 ","$1,445.52 ","$1,734.80 ","$1,735.65 ","$1,734.80 ","$1,969.35 ","$2,565.00 ","$1,947.12 ",$960.72 ,"$2,251.50 ", N/A ,"$1,558.01 ","$1,558.01 ",$951.21 ,"$1,558.01 ","$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$2,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,34300072,A9595,"HC PIFLUFOLASTAT F-18, DIAGNOSTIC, 1 MILLICURIE",343,1 ,"$1,579.00 ","$1,042.14 ",$568.74 ,"$1,579.00 ",$850.00 ,"$1,082.25 ","$1,082.25 ",$580.35 ,$947.40 ,"$1,342.15 ","$1,105.30 ",$850.00 ,$850.00 ,"$1,500.05 ","$1,200.04 ","$1,184.25 ",$912.85 ,"$1,342.15 ",$580.35 ,$912.85 ,$912.85 ,"$1,105.30 ",$961.61 ,$850.00 ,$580.35 ,$568.74 ,"$1,160.70 ",$901.00 ,"$1,342.15 ","$1,305.79 ","$1,452.68 ","$1,105.30 ",$800.87 ,$961.14 ,$961.61 ,$961.14 ,"$1,091.09 ","$1,421.10 ","$1,078.77 ",$574.43 ,"$1,247.41 ",$901.00 ,$920.75 ,$920.75 ,$568.74 ,$920.75 ,"$1,136.88 ",$978.98 ,"$1,136.88 ","$1,136.88 ","$1,263.20 "
ST NICHOLAS HOSPITAL - ACUTE,35000002,20615,HC ASP/INJ CYST BONE,350,1 ,"$1,139.65 ",$752.17 ,$16.55 ,"$1,425.14 ",$16.55 ,"$1,139.65 ","$1,139.65 ",$633.39 ,$683.79 ,$968.70 ,$797.76 ,$16.55 ,$16.55 ,"$1,082.67 ",$866.13 ,$854.74 ,"$1,139.65 ",$968.70 ,$633.39 ,"$1,139.65 ","$1,139.65 ",$797.76 ,$694.05 ,$16.55 ,$633.39 ,$620.72 ,"$1,139.65 ",$17.54 ,$968.70 ,"$1,425.14 ","$1,048.48 ",$797.76 ,"$1,139.65 ","$1,139.65 ",$694.05 ,"$1,139.65 ",$787.50 ,"$1,025.69 ",$778.61 ,$626.93 ,$900.32 ,$17.54 ,"$1,139.65 ","$1,139.65 ",$620.72 ,"$1,139.65 ",$820.55 ,$706.58 ,$820.55 ,$820.55 ,$911.72 
ST NICHOLAS HOSPITAL - ACUTE,35000003,20982,HC ABLATION BONE TUMOR RADIOFREQUENCY,350,1 ,"$6,070.85 ","$4,006.76 ",$62.90 ,"$14,525.73 ",$62.90 ,"$1,231.00 ","$1,231.00 ","$6,455.88 ","$3,642.51 ","$5,160.22 ","$4,249.60 ",$62.90 ,$62.90 ,"$5,767.31 ","$4,613.85 ","$4,553.14 ","$1,218.00 ","$5,160.22 ","$6,455.88 ","$1,218.00 ","$1,218.00 ","$4,249.60 ","$3,697.15 ",$62.90 ,"$6,455.88 ","$6,326.76 ","$6,070.85 ",$66.67 ,"$5,160.22 ","$14,525.73 ","$5,585.18 ","$4,249.60 ","$3,501.86 ","$4,377.05 ","$3,697.15 ","$4,377.05 ","$4,194.96 ","$5,463.77 ","$4,147.60 ","$6,390.03 ","$4,795.97 ",$66.67 ,"$1,161.00 ","$1,161.00 ","$6,326.76 ","$1,161.00 ","$4,371.01 ","$3,763.93 ","$4,371.01 ","$4,371.01 ","$4,856.68 "
ST NICHOLAS HOSPITAL - ACUTE,35000006,21550,HC BX TISSUE NECK/THORAX,350,1 ,"$2,725.50 ","$1,798.83 ",$82.31 ,"$3,293.01 ",$82.31 ,"$1,231.00 ","$1,231.00 ","$1,463.56 ","$1,635.30 ","$2,316.68 ","$1,907.85 ",$82.31 ,$82.31 ,"$2,589.23 ","$2,071.38 ","$2,044.13 ","$1,218.00 ","$2,316.68 ","$1,463.56 ","$1,218.00 ","$1,218.00 ","$1,907.85 ","$1,659.83 ",$82.31 ,"$1,463.56 ","$1,434.29 ","$2,725.50 ",$87.25 ,"$2,316.68 ","$3,293.01 ","$2,507.46 ","$1,907.85 ","$1,998.41 ","$2,497.74 ","$1,659.83 ","$2,497.74 ","$1,883.32 ","$2,452.95 ","$1,862.06 ","$1,448.64 ","$2,153.15 ",$87.25 ,"$1,161.00 ","$1,161.00 ","$1,434.29 ","$1,161.00 ","$1,962.36 ","$1,689.81 ","$1,962.36 ","$1,962.36 ","$2,180.40 "
ST NICHOLAS HOSPITAL - ACUTE,35000013,32400,HC BX PLEURA NEEDLE PERC,361,1 ,"$1,265.00 ",$834.90 ,$33.66 ,"$3,293.01 ",$33.66 ,"$1,265.00 ","$1,265.00 ","$1,463.56 ",$759.00 ,"$1,075.25 ",$885.50 ,$33.66 ,$33.66 ,"$1,201.75 ",$961.40 ,$948.75 ,"$1,265.00 ","$1,075.25 ","$1,463.56 ","$1,265.00 ","$1,265.00 ",$885.50 ,$770.39 ,$33.66 ,"$1,463.56 ","$1,434.29 ","$1,265.00 ",$35.68 ,"$1,075.25 ","$3,293.01 ","$1,163.80 ",$885.50 ,"$1,265.00 ","$1,265.00 ",$770.39 ,"$1,265.00 ",$874.12 ,"$1,138.50 ",$864.25 ,"$1,448.64 ",$999.35 ,$35.68 ,"$1,265.00 ","$1,265.00 ","$1,434.29 ","$1,265.00 ",$910.80 ,$784.30 ,$910.80 ,$910.80 ,"$1,012.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000018,47000,HC BX LIVER NEEDLE PERC,350,1 ,"$1,982.60 ","$1,308.52 ",$25.31 ,"$3,293.01 ",$25.31 ,"$1,231.00 ","$1,231.00 ","$1,463.56 ","$1,189.56 ","$1,685.21 ","$1,387.82 ",$25.31 ,$25.31 ,"$1,883.47 ","$1,506.78 ","$1,486.95 ","$1,218.00 ","$1,685.21 ","$1,463.56 ","$1,218.00 ","$1,218.00 ","$1,387.82 ","$1,207.40 ",$25.31 ,"$1,463.56 ","$1,434.29 ","$1,982.60 ",$26.83 ,"$1,685.21 ","$3,293.01 ","$1,823.99 ","$1,387.82 ","$1,982.60 ","$1,982.60 ","$1,207.40 ","$1,982.60 ","$1,369.98 ","$1,784.34 ","$1,354.51 ","$1,448.64 ","$1,566.25 ",$26.83 ,"$1,161.00 ","$1,161.00 ","$1,434.29 ","$1,161.00 ","$1,427.47 ","$1,229.21 ","$1,427.47 ","$1,427.47 ","$1,586.08 "
ST NICHOLAS HOSPITAL - ACUTE,35000019,47001,HC BIOPSY LIVER OTHER PROC,350,1 ,"$2,679.50 ","$1,768.47 ",$25.31 ,"$2,679.50 ",$25.31 ,"$1,231.00 ","$1,231.00 ", N/A ,"$1,607.70 ","$2,277.58 ","$1,875.65 ",$25.31 ,$25.31 ,"$2,545.53 ","$2,036.42 ","$2,009.63 ","$1,218.00 ","$2,277.58 ", N/A ,"$1,218.00 ","$1,218.00 ","$1,875.65 ","$1,631.82 ",$25.31 , N/A , N/A , N/A ,$26.83 ,"$2,277.58 ", N/A ,"$2,465.14 ","$1,875.65 ","$1,359.04 ","$1,631.01 ","$1,631.82 ","$1,631.01 ","$1,851.53 ","$2,411.55 ","$1,830.63 ", N/A ,"$2,116.81 ",$26.83 ,"$1,161.00 ","$1,161.00 ", N/A ,"$1,161.00 ","$1,929.24 ","$1,661.29 ","$1,929.24 ","$1,929.24 ","$2,143.60 "
ST NICHOLAS HOSPITAL - ACUTE,35000020,49405,HC PERC DRN ABSC/HEM/CYST VISCERAL,350,1 ,"$1,610.00 ","$1,062.60 ",$25.31 ,"$3,293.01 ",$25.31 ,"$1,231.00 ","$1,231.00 ","$1,463.56 ",$966.00 ,"$1,368.50 ","$1,127.00 ",$25.31 ,$25.31 ,"$1,529.50 ","$1,223.60 ","$1,207.50 ","$1,218.00 ","$1,368.50 ","$1,463.56 ","$1,218.00 ","$1,218.00 ","$1,127.00 ",$980.49 ,$25.31 ,"$1,463.56 ","$1,434.29 ","$1,610.00 ",$26.83 ,"$1,368.50 ","$3,293.01 ","$1,481.20 ","$1,127.00 ","$1,610.00 ","$1,610.00 ",$980.49 ,"$1,610.00 ","$1,112.51 ","$1,449.00 ","$1,099.95 ","$1,448.64 ","$1,271.90 ",$26.83 ,"$1,161.00 ","$1,161.00 ","$1,434.29 ","$1,161.00 ","$1,159.20 ",$998.20 ,"$1,159.20 ","$1,159.20 ","$1,288.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000021,47382,HC ABLATION TUMR LIVER RADIO PERC,350,1 ,"$8,280.00 ","$5,464.80 ",$202.70 ,"$11,445.88 ",$202.70 ,"$1,231.00 ","$1,231.00 ","$5,087.06 ","$4,968.00 ","$7,038.00 ","$5,796.00 ",$202.70 ,$202.70 ,"$7,866.00 ","$6,292.80 ","$6,210.00 ","$1,218.00 ","$7,038.00 ","$5,087.06 ","$1,218.00 ","$1,218.00 ","$5,796.00 ","$5,042.52 ",$202.70 ,"$5,087.06 ","$4,985.32 ","$8,280.00 ",$214.86 ,"$7,038.00 ","$11,445.88 ","$7,617.60 ","$5,796.00 ","$4,535.48 ","$5,669.62 ","$5,042.52 ","$5,669.62 ","$5,721.48 ","$7,452.00 ","$5,656.90 ","$5,035.17 ","$6,541.20 ",$214.86 ,"$1,161.00 ","$1,161.00 ","$4,985.32 ","$1,161.00 ","$5,961.60 ","$5,133.60 ","$5,961.60 ","$5,961.60 ","$6,624.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000023,48102,HC BX PANCREAS NEEDLE PERC,350,1 ,"$1,610.00 ","$1,062.60 ",$25.31 ,"$3,293.01 ",$25.31 ,"$1,231.00 ","$1,231.00 ","$1,463.56 ",$966.00 ,"$1,368.50 ","$1,127.00 ",$25.31 ,$25.31 ,"$1,529.50 ","$1,223.60 ","$1,207.50 ","$1,218.00 ","$1,368.50 ","$1,463.56 ","$1,218.00 ","$1,218.00 ","$1,127.00 ",$980.49 ,$25.31 ,"$1,463.56 ","$1,434.29 ","$1,610.00 ",$26.83 ,"$1,368.50 ","$3,293.01 ","$1,481.20 ","$1,127.00 ","$1,610.00 ","$1,610.00 ",$980.49 ,"$1,610.00 ","$1,112.51 ","$1,449.00 ","$1,099.95 ","$1,448.64 ","$1,271.90 ",$26.83 ,"$1,161.00 ","$1,161.00 ","$1,434.29 ","$1,161.00 ","$1,159.20 ",$998.20 ,"$1,159.20 ","$1,159.20 ","$1,288.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000025,49180,HC ABDOM/RETRO/MASS BIOP,350,1 ,"$1,734.20 ","$1,144.57 ",$25.31 ,"$3,293.01 ",$25.31 ,"$1,231.00 ","$1,231.00 ","$1,463.56 ","$1,040.52 ","$1,474.07 ","$1,213.94 ",$25.31 ,$25.31 ,"$1,647.49 ","$1,317.99 ","$1,300.65 ","$1,218.00 ","$1,474.07 ","$1,463.56 ","$1,218.00 ","$1,218.00 ","$1,213.94 ","$1,056.13 ",$25.31 ,"$1,463.56 ","$1,434.29 ","$1,734.20 ",$26.83 ,"$1,474.07 ","$3,293.01 ","$1,595.46 ","$1,213.94 ","$1,734.20 ","$1,734.20 ","$1,056.13 ","$1,734.20 ","$1,198.33 ","$1,560.78 ","$1,184.81 ","$1,448.64 ","$1,370.02 ",$26.83 ,"$1,161.00 ","$1,161.00 ","$1,434.29 ","$1,161.00 ","$1,248.62 ","$1,075.20 ","$1,248.62 ","$1,248.62 ","$1,387.36 "
ST NICHOLAS HOSPITAL - ACUTE,35000026,50200,"HC PERC BIOPSY/KIDNEY, NEEDLE",350,1 ,"$1,982.60 ","$1,308.52 ",$52.09 ,"$3,293.01 ",$52.09 ,"$1,231.00 ","$1,231.00 ","$1,463.56 ","$1,189.56 ","$1,685.21 ","$1,387.82 ",$52.09 ,$52.09 ,"$1,883.47 ","$1,506.78 ","$1,486.95 ","$1,218.00 ","$1,685.21 ","$1,463.56 ","$1,218.00 ","$1,218.00 ","$1,387.82 ","$1,207.40 ",$52.09 ,"$1,463.56 ","$1,434.29 ","$1,982.60 ",$55.22 ,"$1,685.21 ","$3,293.01 ","$1,823.99 ","$1,387.82 ","$1,982.60 ","$1,982.60 ","$1,207.40 ","$1,982.60 ","$1,369.98 ","$1,784.34 ","$1,354.51 ","$1,448.64 ","$1,566.25 ",$55.22 ,"$1,161.00 ","$1,161.00 ","$1,434.29 ","$1,161.00 ","$1,427.47 ","$1,229.21 ","$1,427.47 ","$1,427.47 ","$1,586.08 "
ST NICHOLAS HOSPITAL - ACUTE,35000027,50390,HC RENAL CYST/PELVIS ASP/INJ,350,1 ,"$1,734.20 ","$1,144.57 ",$13.57 ,"$1,734.20 ",$13.57 ,"$1,231.00 ","$1,231.00 ",$633.39 ,"$1,040.52 ","$1,474.07 ","$1,213.94 ",$13.57 ,$13.57 ,"$1,647.49 ","$1,317.99 ","$1,300.65 ","$1,218.00 ","$1,474.07 ",$633.39 ,"$1,218.00 ","$1,218.00 ","$1,213.94 ","$1,056.13 ",$13.57 ,$633.39 ,$620.72 ,"$1,266.78 ",$14.38 ,"$1,474.07 ","$1,425.14 ","$1,595.46 ","$1,213.94 ","$1,734.20 ","$1,734.20 ","$1,056.13 ","$1,734.20 ","$1,198.33 ","$1,560.78 ","$1,184.81 ",$626.93 ,"$1,370.02 ",$14.38 ,"$1,161.00 ","$1,161.00 ",$620.72 ,"$1,161.00 ","$1,248.62 ","$1,075.20 ","$1,248.62 ","$1,248.62 ","$1,387.36 "
ST NICHOLAS HOSPITAL - ACUTE,35000028,60100,HC BX THYROID NEEDLE PERC,350,1 ,"$1,090.20 ",$719.53 ,$23.54 ,"$1,425.14 ",$23.54 ,"$1,090.20 ","$1,090.20 ",$633.39 ,$654.12 ,$926.67 ,$763.14 ,$23.54 ,$23.54 ,"$1,035.69 ",$828.55 ,$817.65 ,"$1,090.20 ",$926.67 ,$633.39 ,"$1,090.20 ","$1,090.20 ",$763.14 ,$663.93 ,$23.54 ,$633.39 ,$620.72 ,"$1,090.20 ",$24.95 ,$926.67 ,"$1,425.14 ","$1,002.98 ",$763.14 ,"$1,090.20 ","$1,090.20 ",$663.93 ,"$1,090.20 ",$753.33 ,$981.18 ,$744.82 ,$626.93 ,$861.26 ,$24.95 ,"$1,090.20 ","$1,090.20 ",$620.72 ,"$1,090.20 ",$784.94 ,$675.92 ,$784.94 ,$784.94 ,$872.16 
ST NICHOLAS HOSPITAL - ACUTE,35000035,64680,HC DEST NERVE CELIAC PLEXUS,350,1 ,"$1,982.60 ","$1,308.52 ",$37.48 ,"$1,982.60 ",$37.48 ,"$1,231.00 ","$1,231.00 ",$831.73 ,"$1,189.56 ","$1,685.21 ","$1,387.82 ",$37.48 ,$37.48 ,"$1,883.47 ","$1,506.78 ","$1,486.95 ","$1,218.00 ","$1,685.21 ",$831.73 ,"$1,218.00 ","$1,218.00 ","$1,387.82 ","$1,207.40 ",$37.48 ,$831.73 ,$815.10 ,"$1,663.46 ",$39.73 ,"$1,685.21 ","$1,871.39 ","$1,823.99 ","$1,387.82 ","$1,771.14 ","$1,982.60 ","$1,207.40 ","$1,982.60 ","$1,369.98 ","$1,784.34 ","$1,354.51 ",$823.25 ,"$1,566.25 ",$39.73 ,"$1,161.00 ","$1,161.00 ",$815.10 ,"$1,161.00 ","$1,427.47 ","$1,229.21 ","$1,427.47 ","$1,427.47 ","$1,586.08 "
ST NICHOLAS HOSPITAL - ACUTE,35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$10.99 ,"$1,800.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$10.99 ,$10.99 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$10.99 ,$104.31 ,$102.22 ,$208.62 ,$11.65 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,870.00 ",$396.03 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$174.21 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000038,70470,HC CT HEAD/BRAIN W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,870.00 ",$396.03 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$174.21 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000042,70482,HC CT ORBIT/IAC/EAR W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000044,70486,HC CT SINUSES UNENHANCED/STEREOTACTIC,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,870.00 ",$396.03 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$174.21 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000046,70488,HC CT MAX/FACIAL W AND W/O CONTRAST,350,1 ,"$2,400.00 ","$1,584.00 ",$10.99 ,"$2,400.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$10.99 ,$10.99 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ","$1,218.00 ","$2,040.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,680.00 ","$1,461.60 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,040.00 ",$396.03 ,"$2,208.00 ","$1,680.00 ","$1,055.70 ","$1,055.70 ","$1,461.60 ","$1,055.70 ","$1,658.40 ","$2,160.00 ","$1,639.68 ",$174.21 ,"$1,896.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,870.00 ",$396.03 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$174.21 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000049,70492,HC CT NECK SFT TISS W AND WO CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$2,600.00 ","$1,716.00 ",$13.58 ,"$2,600.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$13.58 ,$13.58 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,099.21 ","$1,099.21 ","$1,583.40 ","$1,099.21 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$1,400.00 ",$924.00 ,$13.58 ,"$1,400.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,$840.00 ,"$1,190.00 ",$980.00 ,$13.58 ,$13.58 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ","$1,218.00 ","$1,190.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ",$980.00 ,$852.60 ,$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$1,190.00 ",$396.03 ,"$1,288.00 ",$980.00 ,"$1,099.21 ","$1,099.21 ",$852.60 ,"$1,099.21 ",$967.40 ,"$1,260.00 ",$956.48 ,$174.21 ,"$1,106.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000052,70540,HC MRI ORBIT/FACE/NECK W/O CON,610,1 ,"$3,362.80 ","$2,219.45 ",$8.63 ,"$3,362.80 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$8.63 ,$8.63 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$2,858.38 ",$512.81 ,"$3,093.78 ","$2,353.96 ","$1,109.82 ","$1,109.82 ","$2,047.95 ","$1,109.82 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$225.60 ,"$2,656.61 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000055,72126,HC CT C-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$359.59 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$359.59 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$359.59 ,$352.40 ,$719.18 ,$11.65 ,"$1,870.00 ",$809.07 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$355.93 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$352.40 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000056,72127,HC CT C-SPINE W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,870.00 ",$396.03 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$174.21 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000060,72130,HC CT T-SPINE W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$359.59 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$359.59 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$359.59 ,$352.40 ,$719.18 ,$11.65 ,"$1,870.00 ",$809.07 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$355.93 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$352.40 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000063,72133,HC CT L-SPINE W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000064,72191,HC CTA PELVIS W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$13.58 ,"$2,600.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$13.58 ,$13.58 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,099.21 ","$1,099.21 ","$1,583.40 ","$1,099.21 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,870.00 ",$396.03 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$174.21 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000067,72194,HC CT PELVIS W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000068,N/A,HC CT GUIDED VERTEBROPLASTY PERC,350,1 ,"$1,046.22 ",$690.51 ,$530.64 ,"$1,046.22 ", N/A ,"$1,046.22 ","$1,046.22 ", N/A ,$627.73 ,$889.29 ,$732.35 , N/A , N/A ,$993.91 ,$795.13 ,$784.67 ,"$1,046.22 ",$889.29 , N/A ,"$1,046.22 ","$1,046.22 ",$732.35 ,$637.15 , N/A , N/A , N/A , N/A , N/A ,$889.29 , N/A ,$962.52 ,$732.35 ,$530.64 ,$636.83 ,$637.15 ,$636.83 ,$722.94 ,$941.60 ,$714.78 , N/A ,$826.51 , N/A ,"$1,046.22 ","$1,046.22 ", N/A ,"$1,046.22 ",$753.28 ,$648.66 ,$753.28 ,$753.28 ,$836.98 
ST NICHOLAS HOSPITAL - ACUTE,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,800.00 ","$1,188.00 ",$6.00 ,"$1,800.00 ",$6.00 ,"$1,231.00 ","$1,231.00 ",$222.21 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$6.00 ,$6.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$222.21 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$6.00 ,$222.21 ,$217.77 ,$444.42 ,$6.36 ,"$1,530.00 ",$499.96 ,"$1,656.00 ","$1,260.00 ",$714.23 ,$714.23 ,"$1,096.20 ",$714.23 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$219.94 ,"$1,422.00 ",$6.36 ,"$1,161.00 ","$1,161.00 ",$217.77 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,800.00 ","$1,188.00 ",$6.00 ,"$1,800.00 ",$6.00 ,"$1,231.00 ","$1,231.00 ",$222.21 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$6.00 ,$6.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$222.21 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$6.00 ,$222.21 ,$217.77 ,$444.42 ,$6.36 ,"$1,530.00 ",$499.96 ,"$1,656.00 ","$1,260.00 ",$714.23 ,$714.23 ,"$1,096.20 ",$714.23 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$219.94 ,"$1,422.00 ",$6.36 ,"$1,161.00 ","$1,161.00 ",$217.77 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$359.59 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$359.59 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$359.59 ,$352.40 ,$719.18 ,$11.65 ,"$1,870.00 ",$809.07 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$355.93 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$352.40 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$2,400.00 ","$1,584.00 ",$10.99 ,"$2,400.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$10.99 ,$10.99 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ","$1,218.00 ","$2,040.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,680.00 ","$1,461.60 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,040.00 ",$396.03 ,"$2,208.00 ","$1,680.00 ","$1,055.70 ","$1,055.70 ","$1,461.60 ","$1,055.70 ","$1,658.40 ","$2,160.00 ","$1,639.68 ",$174.21 ,"$1,896.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000073,73206,HC CT ANGIO UPPER EXTREM W/WO CONT,350,1 ,"$2,600.00 ","$1,716.00 ",$13.58 ,"$2,600.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$13.58 ,$13.58 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,099.21 ","$1,099.21 ","$1,583.40 ","$1,099.21 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$1,800.00 ","$1,188.00 ",$6.00 ,"$1,800.00 ",$6.00 ,"$1,231.00 ","$1,231.00 ",$222.21 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$6.00 ,$6.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$222.21 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$6.00 ,$222.21 ,$217.77 ,$444.42 ,$6.36 ,"$1,530.00 ",$499.96 ,"$1,656.00 ","$1,260.00 ",$714.23 ,$714.23 ,"$1,096.20 ",$714.23 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$219.94 ,"$1,422.00 ",$6.36 ,"$1,161.00 ","$1,161.00 ",$217.77 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$1,800.00 ","$1,188.00 ",$6.00 ,"$1,800.00 ",$6.00 ,"$1,231.00 ","$1,231.00 ",$222.21 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$6.00 ,$6.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$222.21 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$6.00 ,$222.21 ,$217.77 ,$444.42 ,$6.36 ,"$1,530.00 ",$499.96 ,"$1,656.00 ","$1,260.00 ",$714.23 ,$714.23 ,"$1,096.20 ",$714.23 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$219.94 ,"$1,422.00 ",$6.36 ,"$1,161.00 ","$1,161.00 ",$217.77 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,870.00 ",$396.03 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$174.21 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$2,600.00 ","$1,716.00 ",$13.58 ,"$2,600.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$13.58 ,$13.58 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,099.21 ","$1,099.21 ","$1,583.40 ","$1,099.21 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$4.00 ,"$1,800.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.00 ,$4.00 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,530.00 ",$234.71 ,"$1,656.00 ","$1,260.00 ",$476.15 ,$476.15 ,"$1,096.20 ",$476.15 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$103.24 ,"$1,422.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$2,200.00 ","$1,452.00 ",$10.99 ,"$2,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$10.99 ,$10.99 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,218.00 ","$1,870.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,540.00 ","$1,339.80 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,870.00 ",$396.03 ,"$2,024.00 ","$1,540.00 ",$937.45 ,$937.45 ,"$1,339.80 ",$937.45 ,"$1,520.20 ","$1,980.00 ","$1,503.04 ",$174.21 ,"$1,738.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000081,74170,HC CT ABDOMEN W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$10.99 ,"$2,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$10.99 ,$10.99 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,055.70 ","$1,055.70 ","$1,583.40 ","$1,055.70 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000082,74175,HC CTA ABDOMEN W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$13.58 ,"$2,600.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$13.58 ,$13.58 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,099.21 ","$1,099.21 ","$1,583.40 ","$1,099.21 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$3,600.00 ","$2,376.00 ",$10.99 ,"$3,600.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$227.92 ,"$2,160.00 ","$3,060.00 ","$2,520.00 ",$10.99 ,$10.99 ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,218.00 ","$3,060.00 ",$227.92 ,"$1,218.00 ","$1,218.00 ","$2,520.00 ","$2,192.40 ",$10.99 ,$227.92 ,$223.36 ,$455.84 ,$11.65 ,"$3,060.00 ",$512.81 ,"$3,312.00 ","$2,520.00 ",$910.32 ,$910.32 ,"$2,192.40 ",$910.32 ,"$2,487.60 ","$3,240.00 ","$2,459.52 ",$225.60 ,"$2,844.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$223.36 ,"$1,161.00 ","$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$4,200.00 ","$2,772.00 ",$10.99 ,"$4,200.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$359.59 ,"$2,520.00 ","$3,570.00 ","$2,940.00 ",$10.99 ,$10.99 ,"$3,990.00 ","$3,192.00 ","$3,150.00 ","$1,218.00 ","$3,570.00 ",$359.59 ,"$1,218.00 ","$1,218.00 ","$2,940.00 ","$2,557.80 ",$10.99 ,$359.59 ,$352.40 ,$719.18 ,$11.65 ,"$3,570.00 ",$809.07 ,"$3,864.00 ","$2,940.00 ","$1,468.81 ","$1,468.81 ","$2,557.80 ","$1,468.81 ","$2,902.20 ","$3,780.00 ","$2,869.44 ",$355.93 ,"$3,318.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$352.40 ,"$1,161.00 ","$3,024.00 ","$2,604.00 ","$3,024.00 ","$3,024.00 ","$3,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000085,74178,HC CT ABDOMEN/PELVIS W AND W/O CONTR,350,1 ,"$4,900.00 ","$3,234.00 ",$10.99 ,"$4,900.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$359.59 ,"$2,940.00 ","$4,165.00 ","$3,430.00 ",$10.99 ,$10.99 ,"$4,655.00 ","$3,724.00 ","$3,675.00 ","$1,218.00 ","$4,165.00 ",$359.59 ,"$1,218.00 ","$1,218.00 ","$3,430.00 ","$2,984.10 ",$10.99 ,$359.59 ,$352.40 ,$719.18 ,$11.65 ,"$4,165.00 ",$809.07 ,"$4,508.00 ","$3,430.00 ","$1,468.81 ","$1,468.81 ","$2,984.10 ","$1,468.81 ","$3,385.90 ","$4,410.00 ","$3,347.68 ",$355.93 ,"$3,871.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$352.40 ,"$1,161.00 ","$3,528.00 ","$3,038.00 ","$3,528.00 ","$3,528.00 ","$3,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000086,74261,HC CT VIRTUAL COLONOSCOPY DX,350,1 ,"$1,600.00 ","$1,056.00 ",$4.00 ,"$1,600.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$104.31 ,$960.00 ,"$1,360.00 ","$1,120.00 ",$4.00 ,$4.00 ,"$1,520.00 ","$1,216.00 ","$1,200.00 ","$1,218.00 ","$1,360.00 ",$104.31 ,"$1,218.00 ","$1,218.00 ","$1,120.00 ",$974.40 ,$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,"$1,360.00 ",$234.71 ,"$1,472.00 ","$1,120.00 ",$476.15 ,$476.15 ,$974.40 ,$476.15 ,"$1,105.60 ","$1,440.00 ","$1,093.12 ",$103.24 ,"$1,264.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$102.22 ,"$1,161.00 ","$1,152.00 ",$992.00 ,"$1,152.00 ","$1,152.00 ","$1,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000087,75571,HC CT HRT W/O DYE W/CA TEST,350,1 ,"$1,600.00 ","$1,056.00 ",$4.00 ,"$1,600.00 ",$4.00 ,"$1,231.00 ","$1,231.00 ",$84.79 ,$960.00 ,"$1,360.00 ","$1,120.00 ",$4.00 ,$4.00 ,"$1,520.00 ","$1,216.00 ","$1,200.00 ","$1,218.00 ","$1,360.00 ",$84.79 ,"$1,218.00 ","$1,218.00 ","$1,120.00 ",$974.40 ,$4.00 ,$84.79 ,$83.09 ,$169.58 ,$4.24 ,"$1,360.00 ",$190.79 ,"$1,472.00 ","$1,120.00 ",$83.22 ,$83.22 ,$974.40 ,$83.22 ,"$1,105.60 ","$1,440.00 ","$1,093.12 ",$83.93 ,"$1,264.00 ",$4.24 ,"$1,161.00 ","$1,161.00 ",$83.09 ,"$1,161.00 ","$1,152.00 ",$992.00 ,"$1,152.00 ","$1,152.00 ","$1,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000088,N/A,HC CT HRT W/O DYE W/CA TEST (PROMO),350,1 ,$100.00 ,$66.00 ,$50.72 ,$100.00 , N/A ,$100.00 ,$100.00 , N/A ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$100.00 ,$85.00 , N/A ,$100.00 ,$100.00 ,$70.00 ,$60.90 , N/A , N/A , N/A , N/A , N/A ,$85.00 , N/A ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 , N/A ,$79.00 , N/A ,$100.00 ,$100.00 , N/A ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,35000089,75572,HC CT HEART WO/W CONT FUNCT EVAL,350,1 ,"$1,800.00 ","$1,188.00 ",$10.99 ,"$1,800.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$10.99 ,$10.99 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,530.00 ",$396.03 ,"$1,656.00 ","$1,260.00 ",$835.83 ,$835.83 ,"$1,096.20 ",$835.83 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$174.21 ,"$1,422.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000090,75573,HC CT HRT W/3D IMAGE CONGEN,350,1 ,"$1,800.00 ","$1,188.00 ",$10.99 ,"$1,800.00 ",$10.99 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$10.99 ,$10.99 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$10.99 ,$176.01 ,$172.49 ,$352.02 ,$11.65 ,"$1,530.00 ",$396.03 ,"$1,656.00 ","$1,260.00 ",$835.83 ,$835.83 ,"$1,096.20 ",$835.83 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$174.21 ,"$1,422.00 ",$11.65 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000091,75574,HC CT CARD ANGIO W/CALC SCORING,350,1 ,"$1,800.00 ","$1,188.00 ",$13.58 ,"$1,800.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$13.58 ,$13.58 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$1,530.00 ",$396.03 ,"$1,656.00 ","$1,260.00 ",$835.83 ,$835.83 ,"$1,096.20 ",$835.83 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$174.21 ,"$1,422.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000094,75574,HC CTA HEART CORONARY W/CONTRAST 3D POST,350,1 ,"$1,800.00 ","$1,188.00 ",$13.58 ,"$1,800.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$13.58 ,$13.58 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,218.00 ","$1,530.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,260.00 ","$1,096.20 ",$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$1,530.00 ",$396.03 ,"$1,656.00 ","$1,260.00 ",$835.83 ,$835.83 ,"$1,096.20 ",$835.83 ,"$1,243.80 ","$1,620.00 ","$1,229.76 ",$174.21 ,"$1,422.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$2,600.00 ","$1,716.00 ",$13.58 ,"$2,600.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$176.01 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$13.58 ,$13.58 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,218.00 ","$2,210.00 ",$176.01 ,"$1,218.00 ","$1,218.00 ","$1,820.00 ","$1,583.40 ",$13.58 ,$176.01 ,$172.49 ,$352.02 ,$14.39 ,"$2,210.00 ",$396.03 ,"$2,392.00 ","$1,820.00 ","$1,099.21 ","$1,099.21 ","$1,583.40 ","$1,099.21 ","$1,796.60 ","$2,340.00 ","$1,776.32 ",$174.21 ,"$2,054.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$172.49 ,"$1,161.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000099,76376,HC 3D RENDER CT NOT REQUIRE INDEP,350,1 ,$798.10 ,$526.75 ,$404.80 ,$798.10 , N/A ,$798.10 ,$798.10 , N/A ,$478.86 ,$678.39 ,$558.67 , N/A , N/A ,$758.20 ,$606.56 ,$598.58 ,$798.10 ,$678.39 , N/A ,$798.10 ,$798.10 ,$558.67 ,$486.04 , N/A , N/A , N/A , N/A , N/A ,$678.39 , N/A ,$734.25 ,$558.67 ,$404.80 ,$485.80 ,$486.04 ,$485.80 ,$551.49 ,$718.29 ,$545.26 , N/A ,$630.50 , N/A ,$798.10 ,$798.10 , N/A ,$798.10 ,$574.63 ,$494.82 ,$574.63 ,$574.63 ,$638.48 
ST NICHOLAS HOSPITAL - ACUTE,35000100,76377,HC 3D RENDER CT REQUIRES INDEPENDENT,350,1 ,$901.60 ,$595.06 ,$457.29 ,$901.60 , N/A ,$901.60 ,$901.60 , N/A ,$540.96 ,$766.36 ,$631.12 , N/A , N/A ,$856.52 ,$685.22 ,$676.20 ,$901.60 ,$766.36 , N/A ,$901.60 ,$901.60 ,$631.12 ,$549.07 , N/A , N/A , N/A , N/A , N/A ,$766.36 , N/A ,$829.47 ,$631.12 ,$457.29 ,$548.80 ,$549.07 ,$548.80 ,$623.01 ,$811.44 ,$615.97 , N/A ,$712.26 , N/A ,$901.60 ,$901.60 , N/A ,$901.60 ,$649.15 ,$558.99 ,$649.15 ,$649.15 ,$721.28 
ST NICHOLAS HOSPITAL - ACUTE,35000101,76380,HC CT LMTD OR LOCALIZ FU STUDY,350,1 ,"$1,100.00 ",$726.00 ,$4.00 ,"$1,100.00 ",$4.00 ,"$1,100.00 ","$1,100.00 ",$84.79 ,$660.00 ,$935.00 ,$770.00 ,$4.00 ,$4.00 ,"$1,045.00 ",$836.00 ,$825.00 ,"$1,100.00 ",$935.00 ,$84.79 ,"$1,100.00 ","$1,100.00 ",$770.00 ,$669.90 ,$4.00 ,$84.79 ,$83.09 ,$169.58 ,$4.24 ,$935.00 ,$190.79 ,"$1,012.00 ",$770.00 ,$299.55 ,$299.55 ,$669.90 ,$299.55 ,$760.10 ,$990.00 ,$751.52 ,$83.93 ,$869.00 ,$4.24 ,"$1,100.00 ","$1,100.00 ",$83.09 ,"$1,100.00 ",$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,35000103,76497,HC UNLISTED CT PROC,350,1 ,$475.00 ,$313.50 ,$4.00 ,$475.00 ,$4.00 ,$475.00 ,$475.00 ,$84.79 ,$285.00 ,$403.75 ,$332.50 ,$4.00 ,$4.00 ,$451.25 ,$361.00 ,$356.25 ,$475.00 ,$403.75 ,$84.79 ,$475.00 ,$475.00 ,$332.50 ,$289.28 ,$4.00 ,$84.79 ,$83.09 ,$169.58 ,$4.24 ,$403.75 ,$190.79 ,$437.00 ,$332.50 ,$299.55 ,$299.55 ,$289.28 ,$299.55 ,$328.23 ,$427.50 ,$324.52 ,$83.93 ,$375.25 ,$4.24 ,$475.00 ,$475.00 ,$83.09 ,$475.00 ,$342.00 ,$294.50 ,$342.00 ,$342.00 ,$380.00 
ST NICHOLAS HOSPITAL - ACUTE,35000104,77011,HC CT GUIDED LOCALIZATION STEREO,350,1 ,"$1,700.00 ","$1,122.00 ",$3.07 ,"$1,700.00 ",$3.07 ,"$1,231.00 ","$1,231.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$3.07 ,$3.07 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,218.00 ","$1,445.00 ", N/A ,"$1,218.00 ","$1,218.00 ","$1,190.00 ","$1,035.30 ",$3.07 , N/A , N/A , N/A ,$3.25 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,161.44 ", N/A ,"$1,343.00 ",$3.25 ,"$1,161.00 ","$1,161.00 ", N/A ,"$1,161.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000105,77011,HC CT GUIDED LOCALIZATION STEREO SINUS,350,1 ,"$1,700.00 ","$1,122.00 ",$3.07 ,"$1,700.00 ",$3.07 ,"$1,231.00 ","$1,231.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$3.07 ,$3.07 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,218.00 ","$1,445.00 ", N/A ,"$1,218.00 ","$1,218.00 ","$1,190.00 ","$1,035.30 ",$3.07 , N/A , N/A , N/A ,$3.25 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,161.44 ", N/A ,"$1,343.00 ",$3.25 ,"$1,161.00 ","$1,161.00 ", N/A ,"$1,161.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000106,77012,HC CT GUIDED NEEDLE PLACEMENT,350,1 ,"$1,700.00 ","$1,122.00 ",$3.07 ,"$1,700.00 ",$3.07 ,"$1,231.00 ","$1,231.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$3.07 ,$3.07 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,218.00 ","$1,445.00 ", N/A ,"$1,218.00 ","$1,218.00 ","$1,190.00 ","$1,035.30 ",$3.07 , N/A , N/A , N/A ,$3.25 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,161.44 ", N/A ,"$1,343.00 ",$3.25 ,"$1,161.00 ","$1,161.00 ", N/A ,"$1,161.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000108,77012,HC CT GUIDED NEEDLE PLACEMENT JOINT INJ,350,1 ,"$1,700.00 ","$1,122.00 ",$3.07 ,"$1,700.00 ",$3.07 ,"$1,231.00 ","$1,231.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$3.07 ,$3.07 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,218.00 ","$1,445.00 ", N/A ,"$1,218.00 ","$1,218.00 ","$1,190.00 ","$1,035.30 ",$3.07 , N/A , N/A , N/A ,$3.25 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,161.44 ", N/A ,"$1,343.00 ",$3.25 ,"$1,161.00 ","$1,161.00 ", N/A ,"$1,161.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000110,77014,HC CT GUIDED THRPY PLACEMENT,350,1 ,"$1,700.00 ","$1,122.00 ",$3.07 ,"$1,700.00 ",$3.07 ,"$1,231.00 ","$1,231.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$3.07 ,$3.07 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,218.00 ","$1,445.00 ", N/A ,"$1,218.00 ","$1,218.00 ","$1,190.00 ","$1,035.30 ",$3.07 , N/A , N/A , N/A ,$3.25 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,161.44 ", N/A ,"$1,343.00 ",$3.25 ,"$1,161.00 ","$1,161.00 ", N/A ,"$1,161.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000111,77014,HC CT GUIDED THRPY PLACEMENT UNENHAN,350,1 ,"$1,700.00 ","$1,122.00 ",$3.07 ,"$1,700.00 ",$3.07 ,"$1,231.00 ","$1,231.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$3.07 ,$3.07 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,218.00 ","$1,445.00 ", N/A ,"$1,218.00 ","$1,218.00 ","$1,190.00 ","$1,035.30 ",$3.07 , N/A , N/A , N/A ,$3.25 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,161.44 ", N/A ,"$1,343.00 ",$3.25 ,"$1,161.00 ","$1,161.00 ", N/A ,"$1,161.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000112,77387,HC CT GUIDED THRPY PLACEMENT CONE BEAM,350,1 ,$507.00 ,$334.62 ,$4.25 ,$507.00 ,$4.25 ,$507.00 ,$507.00 , N/A ,$304.20 ,$430.95 ,$354.90 ,$4.25 ,$4.25 ,$481.65 ,$385.32 ,$380.25 ,$507.00 ,$430.95 , N/A ,$507.00 ,$507.00 ,$354.90 ,$308.76 ,$4.25 , N/A , N/A , N/A ,$4.51 ,$430.95 , N/A ,$466.44 ,$354.90 ,$257.15 ,$308.61 ,$308.76 ,$308.61 ,$350.34 ,$456.30 ,$346.38 , N/A ,$400.53 ,$4.51 ,$507.00 ,$507.00 , N/A ,$507.00 ,$365.04 ,$314.34 ,$365.04 ,$365.04 ,$405.60 
ST NICHOLAS HOSPITAL - ACUTE,35000113,51102,HC ASPIRATION OF BLADDER AND INSERT SUPRAPUBIC CATH,350,1 ,"$3,964.05 ","$2,616.27 ",$54.25 ,"$4,073.32 ",$54.25 ,"$1,231.00 ","$1,231.00 ","$1,810.36 ","$2,378.43 ","$3,369.44 ","$2,774.84 ",$54.25 ,$54.25 ,"$3,765.85 ","$3,012.68 ","$2,973.04 ","$1,218.00 ","$3,369.44 ","$1,810.36 ","$1,218.00 ","$1,218.00 ","$2,774.84 ","$2,414.11 ",$54.25 ,"$1,810.36 ","$1,774.15 ","$3,620.72 ",$57.51 ,"$3,369.44 ","$4,073.32 ","$3,646.93 ","$2,774.84 ","$2,747.95 ","$3,435.21 ","$2,414.11 ","$3,435.21 ","$2,739.16 ","$3,567.65 ","$2,708.24 ","$1,791.89 ","$3,131.60 ",$57.51 ,"$1,161.00 ","$1,161.00 ","$1,774.15 ","$1,161.00 ","$2,854.12 ","$2,457.71 ","$2,854.12 ","$2,854.12 ","$3,171.24 "
ST NICHOLAS HOSPITAL - ACUTE,35000116,64510,HC INJECT STELLATE GANGLION,350,1 ,"$1,647.95 ","$1,087.65 ",$37.48 ,"$1,871.39 ",$37.48 ,"$1,231.00 ","$1,231.00 ",$831.73 ,$988.77 ,"$1,400.76 ","$1,153.57 ",$37.48 ,$37.48 ,"$1,565.55 ","$1,252.44 ","$1,235.96 ","$1,218.00 ","$1,400.76 ",$831.73 ,"$1,218.00 ","$1,218.00 ","$1,153.57 ","$1,003.60 ",$37.48 ,$831.73 ,$815.10 ,"$1,647.95 ",$39.73 ,"$1,400.76 ","$1,871.39 ","$1,516.11 ","$1,153.57 ","$1,647.95 ","$1,647.95 ","$1,003.60 ","$1,647.95 ","$1,138.73 ","$1,483.16 ","$1,125.88 ",$823.25 ,"$1,301.88 ",$39.73 ,"$1,161.00 ","$1,161.00 ",$815.10 ,"$1,161.00 ","$1,186.52 ","$1,021.73 ","$1,186.52 ","$1,186.52 ","$1,318.36 "
ST NICHOLAS HOSPITAL - ACUTE,35000120,74174,HC CT ANGIO ABD/PELV W  AND  WO CONTRAST,350,1 ,"$4,800.00 ","$3,168.00 ",$13.58 ,"$4,800.00 ",$13.58 ,"$1,231.00 ","$1,231.00 ",$359.59 ,"$2,880.00 ","$4,080.00 ","$3,360.00 ",$13.58 ,$13.58 ,"$4,560.00 ","$3,648.00 ","$3,600.00 ","$1,218.00 ","$4,080.00 ",$359.59 ,"$1,218.00 ","$1,218.00 ","$3,360.00 ","$2,923.20 ",$13.58 ,$359.59 ,$352.40 ,$719.18 ,$14.39 ,"$4,080.00 ",$809.07 ,"$4,416.00 ","$3,360.00 ","$1,468.81 ","$1,468.81 ","$2,923.20 ","$1,468.81 ","$3,316.80 ","$4,320.00 ","$3,279.36 ",$355.93 ,"$3,792.00 ",$14.39 ,"$1,161.00 ","$1,161.00 ",$352.40 ,"$1,161.00 ","$3,456.00 ","$2,976.00 ","$3,456.00 ","$3,456.00 ","$3,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000132,G0260,HC INJECTION SACRO JOINT W/ ANESTH,350,1 ,"$2,105.65 ","$1,389.73 ",$16.55 ,"$2,105.65 ",$16.55 ,"$1,231.00 ","$1,231.00 ",$628.88 ,"$1,263.39 ","$1,789.80 ","$1,473.96 ",$16.55 ,$16.55 ,"$2,000.37 ","$1,600.29 ","$1,579.24 ","$1,218.00 ","$1,789.80 ",$628.88 ,"$1,218.00 ","$1,218.00 ","$1,473.96 ","$1,282.34 ",$16.55 ,$628.88 ,$616.30 ,"$1,257.76 ",$17.54 ,"$1,789.80 ","$1,414.97 ","$1,937.20 ","$1,473.96 ","$2,105.65 ","$2,105.65 ","$1,282.34 ","$2,105.65 ","$1,455.00 ","$1,895.09 ","$1,438.58 ",$622.47 ,"$1,663.46 ",$17.54 ,"$1,161.00 ","$1,161.00 ",$616.30 ,"$1,161.00 ","$1,516.07 ","$1,305.50 ","$1,516.07 ","$1,516.07 ","$1,684.52 "
ST NICHOLAS HOSPITAL - ACUTE,35000132,G0260,HC INJECTION SACRO JOINT W/ ANESTH,350,1 ,"$2,105.65 ","$1,389.73 ",$16.55 ,"$2,105.65 ",$16.55 ,"$1,231.00 ","$1,231.00 ",$628.88 ,"$1,263.39 ","$1,789.80 ","$1,473.96 ",$16.55 ,$16.55 ,"$2,000.37 ","$1,600.29 ","$1,579.24 ","$1,218.00 ","$1,789.80 ",$628.88 ,"$1,218.00 ","$1,218.00 ","$1,473.96 ","$1,282.34 ",$16.55 ,$628.88 ,$616.30 ,"$1,257.76 ",$17.54 ,"$1,789.80 ","$1,414.97 ","$1,937.20 ","$1,473.96 ","$2,105.65 ","$2,105.65 ","$1,282.34 ","$2,105.65 ","$1,455.00 ","$1,895.09 ","$1,438.58 ",$622.47 ,"$1,663.46 ",$17.54 ,"$1,161.00 ","$1,161.00 ",$616.30 ,"$1,161.00 ","$1,516.07 ","$1,305.50 ","$1,516.07 ","$1,516.07 ","$1,684.52 "
ST NICHOLAS HOSPITAL - ACUTE,35000135,22513,HC VERTEBROPLASTY INJ PERC THOR  KYPHOPLASTY,350,1 ,"$5,980.00 ","$3,946.80 ",$168.92 ,"$14,525.73 ",$168.92 ,"$1,231.00 ","$1,231.00 ","$6,455.88 ","$3,588.00 ","$5,083.00 ","$4,186.00 ",$168.92 ,$168.92 ,"$5,681.00 ","$4,544.80 ","$4,485.00 ","$1,218.00 ","$5,083.00 ","$6,455.88 ","$1,218.00 ","$1,218.00 ","$4,186.00 ","$3,641.82 ",$168.92 ,"$6,455.88 ","$6,326.76 ","$5,980.00 ",$179.06 ,"$5,083.00 ","$14,525.73 ","$5,501.60 ","$4,186.00 ","$4,535.48 ","$5,669.62 ","$3,641.82 ","$5,669.62 ","$4,132.18 ","$5,382.00 ","$4,085.54 ","$6,390.03 ","$4,724.20 ",$179.06 ,"$1,161.00 ","$1,161.00 ","$6,326.76 ","$1,161.00 ","$4,305.60 ","$3,707.60 ","$4,305.60 ","$4,305.60 ","$4,784.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000136,22514,HC VERTEBROPLASTY INJ PERC LUMBAR KYPHOPLASTY,350,1 ,"$5,980.00 ","$3,946.80 ",$168.92 ,"$14,525.73 ",$168.92 ,"$1,231.00 ","$1,231.00 ","$6,455.88 ","$3,588.00 ","$5,083.00 ","$4,186.00 ",$168.92 ,$168.92 ,"$5,681.00 ","$4,544.80 ","$4,485.00 ","$1,218.00 ","$5,083.00 ","$6,455.88 ","$1,218.00 ","$1,218.00 ","$4,186.00 ","$3,641.82 ",$168.92 ,"$6,455.88 ","$6,326.76 ","$5,980.00 ",$179.06 ,"$5,083.00 ","$14,525.73 ","$5,501.60 ","$4,186.00 ","$4,535.48 ","$5,669.62 ","$3,641.82 ","$5,669.62 ","$4,132.18 ","$5,382.00 ","$4,085.54 ","$6,390.03 ","$4,724.20 ",$179.06 ,"$1,161.00 ","$1,161.00 ","$6,326.76 ","$1,161.00 ","$4,305.60 ","$3,707.60 ","$4,305.60 ","$4,305.60 ","$4,784.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000137,22515,HC VERTEBROPLASTY INJ PERC EA ADDNT THOR OR LUMB KYPHO,350,1 ,"$5,980.00 ","$3,946.80 ",$168.92 ,"$5,980.00 ",$168.92 ,"$1,231.00 ","$1,231.00 ", N/A ,"$3,588.00 ","$5,083.00 ","$4,186.00 ",$168.92 ,$168.92 ,"$5,681.00 ","$4,544.80 ","$4,485.00 ","$1,218.00 ","$5,083.00 ", N/A ,"$1,218.00 ","$1,218.00 ","$4,186.00 ","$3,641.82 ",$168.92 , N/A , N/A , N/A ,$179.06 ,"$5,083.00 ", N/A ,"$5,501.60 ","$4,186.00 ","$3,033.06 ","$3,640.03 ","$3,641.82 ","$3,640.03 ","$4,132.18 ","$5,382.00 ","$4,085.54 ", N/A ,"$4,724.20 ",$179.06 ,"$1,161.00 ","$1,161.00 ", N/A ,"$1,161.00 ","$4,305.60 ","$3,707.60 ","$4,305.60 ","$4,305.60 ","$4,784.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000151,G0288,HC CT RECONSTRUCTION AORTA FOR VASC SURG,350,1 ,$220.00 ,$145.20 ,$111.58 ,$220.00 , N/A ,$220.00 ,$220.00 , N/A ,$132.00 ,$187.00 ,$154.00 , N/A , N/A ,$209.00 ,$167.20 ,$165.00 ,$220.00 ,$187.00 , N/A ,$220.00 ,$220.00 ,$154.00 ,$133.98 , N/A , N/A , N/A , N/A , N/A ,$187.00 , N/A ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 , N/A ,$173.80 , N/A ,$220.00 ,$220.00 , N/A ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,35000154,71271,HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST,350,1 ,"$1,100.00 ",$726.00 ,$4.00 ,"$1,100.00 ",$4.00 ,"$1,100.00 ","$1,100.00 ",$104.31 ,$660.00 ,$935.00 ,$770.00 ,$4.00 ,$4.00 ,"$1,045.00 ",$836.00 ,$825.00 ,"$1,100.00 ",$935.00 ,$104.31 ,"$1,100.00 ","$1,100.00 ",$770.00 ,$669.90 ,$4.00 ,$104.31 ,$102.22 ,$208.62 ,$4.24 ,$935.00 ,$234.71 ,"$1,012.00 ",$770.00 ,$286.39 ,$286.39 ,$669.90 ,$286.39 ,$760.10 ,$990.00 ,$751.52 ,$103.24 ,$869.00 ,$4.24 ,"$1,100.00 ","$1,100.00 ",$102.22 ,"$1,100.00 ",$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,36000002,N/A,HC MINOR PROCEDURE,360,1 ,$167.48 ,$110.54 ,$84.95 ,$167.48 , N/A , N/A , N/A , N/A ,$100.49 ,$142.36 ,$117.24 , N/A , N/A ,$159.11 ,$127.28 ,$125.61 , N/A ,$142.36 , N/A , N/A , N/A ,$117.24 ,$102.00 , N/A , N/A , N/A , N/A , N/A ,$142.36 , N/A ,$154.08 ,$117.24 ,$84.95 ,$101.95 ,$102.00 ,$101.95 ,$115.73 ,$150.73 ,$114.42 , N/A ,$132.31 , N/A , N/A , N/A , N/A , N/A ,$120.59 ,$103.84 ,$120.59 ,$120.59 ,$133.98 
ST NICHOLAS HOSPITAL - ACUTE,36000003,N/A,HC SCHEDULED PROCEDURE,360,1 ,"$1,780.80 ","$1,175.33 ",$903.22 ,"$1,780.80 ", N/A , N/A , N/A , N/A ,"$1,068.48 ","$1,513.68 ","$1,246.56 ", N/A , N/A ,"$1,691.76 ","$1,353.41 ","$1,335.60 ", N/A ,"$1,513.68 ", N/A , N/A , N/A ,"$1,246.56 ","$1,084.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,513.68 ", N/A ,"$1,638.34 ","$1,246.56 ",$903.22 ,"$1,083.97 ","$1,084.51 ","$1,083.97 ","$1,230.53 ","$1,602.72 ","$1,216.64 ", N/A ,"$1,406.83 ", N/A , N/A , N/A , N/A , N/A ,"$1,282.18 ","$1,104.10 ","$1,282.18 ","$1,282.18 ","$1,424.64 "
ST NICHOLAS HOSPITAL - ACUTE,36000004,N/A,HC SCHEDULED PROCEDURE LIMITED,360,1 ,$991.10 ,$654.13 ,$502.69 ,$991.10 , N/A , N/A , N/A , N/A ,$594.66 ,$842.44 ,$693.77 , N/A , N/A ,$941.55 ,$753.24 ,$743.33 , N/A ,$842.44 , N/A , N/A , N/A ,$693.77 ,$603.58 , N/A , N/A , N/A , N/A , N/A ,$842.44 , N/A ,$911.81 ,$693.77 ,$502.69 ,$603.28 ,$603.58 ,$603.28 ,$684.85 ,$891.99 ,$677.12 , N/A ,$782.97 , N/A , N/A , N/A , N/A , N/A ,$713.59 ,$614.48 ,$713.59 ,$713.59 ,$792.88 
ST NICHOLAS HOSPITAL - ACUTE,36000011,N/A,HC HYPOTHERMIA TOTAL BODY,360,1 ,$456.86 ,$301.53 ,$231.72 ,$456.86 , N/A , N/A , N/A , N/A ,$274.12 ,$388.33 ,$319.80 , N/A , N/A ,$434.02 ,$347.21 ,$342.65 , N/A ,$388.33 , N/A , N/A , N/A ,$319.80 ,$278.23 , N/A , N/A , N/A , N/A , N/A ,$388.33 , N/A ,$420.31 ,$319.80 ,$231.72 ,$278.09 ,$278.23 ,$278.09 ,$315.69 ,$411.17 ,$312.13 , N/A ,$360.92 , N/A , N/A , N/A , N/A , N/A ,$328.94 ,$283.25 ,$328.94 ,$328.94 ,$365.49 
ST NICHOLAS HOSPITAL - ACUTE,36000017,N/A,HC XRAY HIP PINNING OR,360,1 ,"$1,113.00 ",$734.58 ,$564.51 ,"$1,113.00 ", N/A , N/A , N/A , N/A ,$667.80 ,$946.05 ,$779.10 , N/A , N/A ,"$1,057.35 ",$845.88 ,$834.75 , N/A ,$946.05 , N/A , N/A , N/A ,$779.10 ,$677.82 , N/A , N/A , N/A , N/A , N/A ,$946.05 , N/A ,"$1,023.96 ",$779.10 ,$564.51 ,$677.48 ,$677.82 ,$677.48 ,$769.08 ,"$1,001.70 ",$760.40 , N/A ,$879.27 , N/A , N/A , N/A , N/A , N/A ,$801.36 ,$690.06 ,$801.36 ,$801.36 ,$890.40 
ST NICHOLAS HOSPITAL - ACUTE,36000018,N/A,HC FLUORO FOR BRONCHOSCOPY,360,1 ,"$1,335.60 ",$881.50 ,$677.42 ,"$1,335.60 ", N/A , N/A , N/A , N/A ,$801.36 ,"$1,135.26 ",$934.92 , N/A , N/A ,"$1,268.82 ","$1,015.06 ","$1,001.70 ", N/A ,"$1,135.26 ", N/A , N/A , N/A ,$934.92 ,$813.38 , N/A , N/A , N/A , N/A , N/A ,"$1,135.26 ", N/A ,"$1,228.75 ",$934.92 ,$677.42 ,$812.98 ,$813.38 ,$812.98 ,$922.90 ,"$1,202.04 ",$912.48 , N/A ,"$1,055.12 ", N/A , N/A , N/A , N/A , N/A ,$961.63 ,$828.07 ,$961.63 ,$961.63 ,"$1,068.48 "
ST NICHOLAS HOSPITAL - ACUTE,36000022,N/A,HC UMBILICAL CANNULATION,360,1 ,$234.26 ,$154.61 ,$118.82 ,$234.26 , N/A , N/A , N/A , N/A ,$140.56 ,$199.12 ,$163.98 , N/A , N/A ,$222.55 ,$178.04 ,$175.70 , N/A ,$199.12 , N/A , N/A , N/A ,$163.98 ,$142.66 , N/A , N/A , N/A , N/A , N/A ,$199.12 , N/A ,$215.52 ,$163.98 ,$118.82 ,$142.59 ,$142.66 ,$142.59 ,$161.87 ,$210.83 ,$160.05 , N/A ,$185.07 , N/A , N/A , N/A , N/A , N/A ,$168.67 ,$145.24 ,$168.67 ,$168.67 ,$187.41 
ST NICHOLAS HOSPITAL - ACUTE,36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$334.65 ,$220.87 ,$5.80 ,$396.55 ,$5.80 ,$334.65 ,$334.65 ,$176.25 ,$200.79 ,$284.45 ,$234.26 ,$5.80 ,$5.80 ,$317.92 ,$254.33 ,$250.99 ,$334.65 ,$284.45 ,$176.25 ,$334.65 ,$334.65 ,$234.26 ,$203.80 ,$5.80 ,$176.25 ,$172.72 ,$334.65 ,$6.15 ,$284.45 ,$396.55 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$174.45 ,$264.37 ,$6.15 ,$334.65 ,$334.65 ,$172.72 ,$334.65 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,36000029,10140,HC I AND D HEMATOMA/SEROMA/FLUID,360,1 ,"$2,229.85 ","$1,471.70 ",$38.33 ,"$3,293.01 ",$38.33 ,"$2,229.85 ","$2,229.85 ","$1,463.56 ","$1,337.91 ","$1,895.37 ","$1,560.90 ",$38.33 ,$38.33 ,"$2,118.36 ","$1,694.69 ","$1,672.39 ","$2,229.85 ","$1,895.37 ","$1,463.56 ","$2,229.85 ","$2,229.85 ","$1,560.90 ","$1,357.98 ",$38.33 ,"$1,463.56 ","$1,434.29 ","$2,229.85 ",$40.63 ,"$1,895.37 ","$3,293.01 ","$2,051.46 ","$1,560.90 ","$1,998.41 ","$2,229.85 ","$1,357.98 ","$2,229.85 ","$1,540.83 ","$2,006.87 ","$1,523.43 ","$1,448.64 ","$1,761.58 ",$40.63 ,"$2,229.85 ","$2,229.85 ","$1,434.29 ","$2,229.85 ","$1,605.49 ","$1,382.51 ","$1,605.49 ","$1,605.49 ","$1,783.88 "
ST NICHOLAS HOSPITAL - ACUTE,36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$532.45 ,$351.42 ,$5.80 ,$819.26 ,$5.80 ,$532.45 ,$532.45 ,$364.12 ,$319.47 ,$452.58 ,$372.72 ,$5.80 ,$5.80 ,$505.83 ,$404.66 ,$399.34 ,$532.45 ,$452.58 ,$364.12 ,$532.45 ,$532.45 ,$372.72 ,$324.26 ,$5.80 ,$364.12 ,$356.84 ,$532.45 ,$6.15 ,$452.58 ,$819.26 ,$489.85 ,$372.72 ,$270.06 ,$324.10 ,$324.26 ,$324.10 ,$367.92 ,$479.21 ,$363.77 ,$360.40 ,$420.64 ,$6.15 ,$532.45 ,$532.45 ,$356.84 ,$532.45 ,$383.36 ,$330.12 ,$383.36 ,$383.36 ,$425.96 
ST NICHOLAS HOSPITAL - ACUTE,36000035,10030,HC GUIDE CATHET FLUID DRAINAGE,360,1 ,"$1,486.95 ",$981.39 ,$38.33 ,"$1,486.95 ",$38.33 ,"$1,486.95 ","$1,486.95 ",$633.39 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$38.33 ,$38.33 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ","$1,486.95 ","$1,263.91 ",$633.39 ,"$1,486.95 ","$1,486.95 ","$1,040.87 ",$905.55 ,$38.33 ,$633.39 ,$620.72 ,"$1,266.78 ",$40.63 ,"$1,263.91 ","$1,425.14 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ",$626.93 ,"$1,174.69 ",$40.63 ,"$1,486.95 ","$1,486.95 ",$620.72 ,"$1,486.95 ","$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,36000050,12031,HC WOUND REPAIR INTERMEDIATE FACIL,761,1 ,$805.00 ,$531.30 ,$13.09 ,$819.26 ,$13.09 ,$805.00 ,$805.00 ,$364.12 ,$483.00 ,$684.25 ,$563.50 ,$13.09 ,$13.09 ,$764.75 ,$611.80 ,$603.75 ,$805.00 ,$684.25 ,$364.12 ,$805.00 ,$805.00 ,$563.50 ,$490.25 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$684.25 ,$819.26 ,$740.60 ,$563.50 ,$408.30 ,$490.00 ,$490.25 ,$490.00 ,$556.26 ,$724.50 ,$549.98 ,$360.40 ,$635.95 ,$13.88 ,$474.95 ,$474.95 ,$356.84 ,$474.95 ,$579.60 ,$499.10 ,$579.60 ,$579.60 ,$644.00 
ST NICHOLAS HOSPITAL - ACUTE,36000078,19000,HC ASP CYST BREAST,360,1 ,$916.55 ,$604.92 ,$23.54 ,"$1,425.14 ",$23.54 ,$916.55 ,$916.55 ,$633.39 ,$549.93 ,$779.07 ,$641.59 ,$23.54 ,$23.54 ,$870.72 ,$696.58 ,$687.41 ,$916.55 ,$779.07 ,$633.39 ,$916.55 ,$916.55 ,$641.59 ,$558.18 ,$23.54 ,$633.39 ,$620.72 ,$916.55 ,$24.95 ,$779.07 ,"$1,425.14 ",$843.23 ,$641.59 ,$916.55 ,$916.55 ,$558.18 ,$916.55 ,$633.34 ,$824.90 ,$626.19 ,$626.93 ,$724.07 ,$24.95 ,$916.55 ,$916.55 ,$620.72 ,$916.55 ,$659.92 ,$568.26 ,$659.92 ,$659.92 ,$733.24 
ST NICHOLAS HOSPITAL - ACUTE,36000079,19001,HC ASP CYST BREAST EA ADDL,360,1 ,$470.35 ,$310.43 ,$23.54 ,"$2,213.66 ",$23.54 ,$470.35 ,$470.35 , N/A ,$282.21 ,$399.80 ,$329.25 ,$23.54 ,$23.54 ,$446.83 ,$357.47 ,$352.76 ,$470.35 ,$399.80 , N/A ,$470.35 ,$470.35 ,$329.25 ,$286.44 ,$23.54 , N/A , N/A , N/A ,$24.95 ,$399.80 , N/A ,$432.72 ,$329.25 ,"$1,771.14 ","$2,213.66 ",$286.44 ,"$2,213.66 ",$325.01 ,$423.32 ,$321.34 , N/A ,$371.58 ,$24.95 ,$470.35 ,$470.35 , N/A ,$470.35 ,$338.65 ,$291.62 ,$338.65 ,$338.65 ,$376.28 
ST NICHOLAS HOSPITAL - ACUTE,36000080,19020,HC BREAST ABSCESS DRAINAGE,360,1 ,"$3,083.15 ","$2,034.88 ",$46.22 ,"$3,435.21 ",$46.22 ,"$3,083.15 ","$3,083.15 ","$1,463.56 ","$1,849.89 ","$2,620.68 ","$2,158.21 ",$46.22 ,$46.22 ,"$2,928.99 ","$2,343.19 ","$2,312.36 ","$3,083.15 ","$2,620.68 ","$1,463.56 ","$3,083.15 ","$3,083.15 ","$2,158.21 ","$1,877.64 ",$46.22 ,"$1,463.56 ","$1,434.29 ","$2,927.12 ",$48.99 ,"$2,620.68 ","$3,293.01 ","$2,836.50 ","$2,158.21 ","$2,747.95 ","$3,435.21 ","$1,877.64 ","$3,435.21 ","$2,130.46 ","$2,774.84 ","$2,106.41 ","$1,448.64 ","$2,435.69 ",$48.99 ,"$3,083.15 ","$3,083.15 ","$1,434.29 ","$3,083.15 ","$2,219.87 ","$1,911.55 ","$2,219.87 ","$2,219.87 ","$2,466.52 "
ST NICHOLAS HOSPITAL - ACUTE,36000081,19030,HC INJECTION GALACTOGRAM,360,1 ,$364.55 ,$240.60 ,$10.77 ,$364.55 ,$10.77 ,$364.55 ,$364.55 , N/A ,$218.73 ,$309.87 ,$255.19 ,$10.77 ,$10.77 ,$346.32 ,$277.06 ,$273.41 ,$364.55 ,$309.87 , N/A ,$364.55 ,$364.55 ,$255.19 ,$222.01 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$309.87 , N/A ,$335.39 ,$255.19 ,$184.90 ,$221.90 ,$222.01 ,$221.90 ,$251.90 ,$328.10 ,$249.06 , N/A ,$287.99 ,$11.42 ,$364.55 ,$364.55 , N/A ,$364.55 ,$262.48 ,$226.02 ,$262.48 ,$262.48 ,$291.64 
ST NICHOLAS HOSPITAL - ACUTE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,600.00 ","$3,036.00 ",$69.34 ,"$5,672.82 ",$69.34 ,"$4,469.00 ","$4,010.00 ","$2,521.25 ","$2,760.00 ","$3,910.00 ","$3,220.00 ",$69.34 ,$69.34 ,"$4,370.00 ","$3,496.00 ","$3,450.00 ","$4,600.00 ","$3,910.00 ","$2,521.25 ","$4,600.00 ","$4,600.00 ","$3,220.00 ","$2,801.40 ",$69.34 ,"$2,521.25 ","$2,470.82 ","$4,600.00 ",$73.50 ,"$3,910.00 ","$5,672.82 ","$4,232.00 ","$3,220.00 ","$2,997.62 ","$3,746.61 ","$2,801.40 ","$3,746.61 ","$3,178.60 ","$4,140.00 ","$3,142.72 ","$2,495.53 ","$3,634.00 ",$73.50 ,"$4,600.00 ","$4,600.00 ","$2,470.82 ","$4,600.00 ","$3,312.00 ","$2,852.00 ","$3,312.00 ","$3,312.00 ","$3,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,600.00 ","$3,036.00 ",$69.34 ,"$5,672.82 ",$69.34 ,"$4,469.00 ","$4,010.00 ","$2,521.25 ","$2,760.00 ","$3,910.00 ","$3,220.00 ",$69.34 ,$69.34 ,"$4,370.00 ","$3,496.00 ","$3,450.00 ","$4,600.00 ","$3,910.00 ","$2,521.25 ","$4,600.00 ","$4,600.00 ","$3,220.00 ","$2,801.40 ",$69.34 ,"$2,521.25 ","$2,470.82 ","$4,600.00 ",$73.50 ,"$3,910.00 ","$5,672.82 ","$4,232.00 ","$3,220.00 ","$2,997.62 ","$3,746.61 ","$2,801.40 ","$3,746.61 ","$3,178.60 ","$4,140.00 ","$3,142.72 ","$2,495.53 ","$3,634.00 ",$73.50 ,"$4,600.00 ","$4,600.00 ","$2,470.82 ","$4,600.00 ","$3,312.00 ","$2,852.00 ","$3,312.00 ","$3,312.00 ","$3,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$1,725.00 ","$1,138.50 ",$46.22 ,"$1,725.00 ",$46.22 ,"$1,725.00 ","$1,725.00 ",$633.39 ,"$1,035.00 ","$1,466.25 ","$1,207.50 ",$46.22 ,$46.22 ,"$1,638.75 ","$1,311.00 ","$1,293.75 ","$1,725.00 ","$1,466.25 ",$633.39 ,"$1,725.00 ","$1,725.00 ","$1,207.50 ","$1,050.53 ",$46.22 ,$633.39 ,$620.72 ,"$1,266.78 ",$48.99 ,"$1,466.25 ","$1,425.14 ","$1,587.00 ","$1,207.50 ","$1,725.00 ","$1,725.00 ","$1,050.53 ","$1,725.00 ","$1,191.98 ","$1,552.50 ","$1,178.52 ",$626.93 ,"$1,362.75 ",$48.99 ,"$1,725.00 ","$1,725.00 ",$620.72 ,"$1,725.00 ","$1,242.00 ","$1,069.50 ","$1,242.00 ","$1,242.00 ","$1,380.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000086,19286,HC PLCMNT NEEDLE LOC WIRE BRST ADDL,360,1 ,$149.50 ,$98.67 ,$46.22 ,"$2,497.74 ",$46.22 ,$149.50 ,$149.50 , N/A ,$89.70 ,$127.08 ,$104.65 ,$46.22 ,$46.22 ,$142.03 ,$113.62 ,$112.13 ,$149.50 ,$127.08 , N/A ,$149.50 ,$149.50 ,$104.65 ,$91.05 ,$46.22 , N/A , N/A , N/A ,$48.99 ,$127.08 , N/A ,$137.54 ,$104.65 ,"$1,998.41 ","$2,497.74 ",$91.05 ,"$2,497.74 ",$103.30 ,$134.55 ,$102.14 , N/A ,$118.11 ,$48.99 ,$149.50 ,$149.50 , N/A ,$149.50 ,$107.64 ,$92.69 ,$107.64 ,$107.64 ,$119.60 
ST NICHOLAS HOSPITAL - ACUTE,36000088,20206,HC BX MUSCLE NEEDLE PERC,360,1 ,"$1,486.95 ",$981.39 ,$23.54 ,"$3,293.01 ",$23.54 ,"$1,486.95 ","$1,486.95 ","$1,463.56 ",$892.17 ,"$1,263.91 ","$1,040.87 ",$23.54 ,$23.54 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ","$1,486.95 ","$1,263.91 ","$1,463.56 ","$1,486.95 ","$1,486.95 ","$1,040.87 ",$905.55 ,$23.54 ,"$1,463.56 ","$1,434.29 ","$1,486.95 ",$24.95 ,"$1,263.91 ","$3,293.01 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ","$1,448.64 ","$1,174.69 ",$24.95 ,"$1,486.95 ","$1,486.95 ","$1,434.29 ","$1,486.95 ","$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,36000089,20220,HC BX BONE NEEDLE SUPERFIC FAC,360,1 ,"$1,734.20 ","$1,144.57 ",$23.54 ,"$3,293.01 ",$23.54 ,"$1,734.20 ","$1,734.20 ","$1,463.56 ","$1,040.52 ","$1,474.07 ","$1,213.94 ",$23.54 ,$23.54 ,"$1,647.49 ","$1,317.99 ","$1,300.65 ","$1,734.20 ","$1,474.07 ","$1,463.56 ","$1,734.20 ","$1,734.20 ","$1,213.94 ","$1,056.13 ",$23.54 ,"$1,463.56 ","$1,434.29 ","$1,734.20 ",$24.95 ,"$1,474.07 ","$3,293.01 ","$1,595.46 ","$1,213.94 ","$1,734.20 ","$1,734.20 ","$1,056.13 ","$1,734.20 ","$1,198.33 ","$1,560.78 ","$1,184.81 ","$1,448.64 ","$1,370.02 ",$24.95 ,"$1,734.20 ","$1,734.20 ","$1,434.29 ","$1,734.20 ","$1,248.62 ","$1,075.20 ","$1,248.62 ","$1,248.62 ","$1,387.36 "
ST NICHOLAS HOSPITAL - ACUTE,36000090,20225,HC BX BONE NEEDLE DEEP,360,1 ,"$2,725.50 ","$1,798.83 ",$62.90 ,"$3,293.01 ",$62.90 ,"$2,725.50 ","$2,725.50 ","$1,463.56 ","$1,635.30 ","$2,316.68 ","$1,907.85 ",$62.90 ,$62.90 ,"$2,589.23 ","$2,071.38 ","$2,044.13 ","$2,725.50 ","$2,316.68 ","$1,463.56 ","$2,725.50 ","$2,725.50 ","$1,907.85 ","$1,659.83 ",$62.90 ,"$1,463.56 ","$1,434.29 ","$2,725.50 ",$66.67 ,"$2,316.68 ","$3,293.01 ","$2,507.46 ","$1,907.85 ","$1,998.41 ","$2,497.74 ","$1,659.83 ","$2,497.74 ","$1,883.32 ","$2,452.95 ","$1,862.06 ","$1,448.64 ","$2,153.15 ",$66.67 ,"$2,725.50 ","$2,725.50 ","$1,434.29 ","$2,725.50 ","$1,962.36 ","$1,689.81 ","$1,962.36 ","$1,962.36 ","$2,180.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000101,29085,HC CAST APPL; HAND AND FOREARM,360,1 ,$290.95 ,$192.03 ,$6.17 ,$320.09 ,$6.17 ,$290.95 ,$290.95 ,$142.26 ,$174.57 ,$247.31 ,$203.67 ,$6.17 ,$6.17 ,$276.40 ,$221.12 ,$218.21 ,$290.95 ,$247.31 ,$142.26 ,$290.95 ,$290.95 ,$203.67 ,$177.19 ,$6.17 ,$142.26 ,$139.41 ,$284.52 ,$6.54 ,$247.31 ,$320.09 ,$267.67 ,$203.67 ,$147.57 ,$177.10 ,$177.19 ,$177.10 ,$201.05 ,$261.86 ,$198.78 ,$140.81 ,$229.85 ,$6.54 ,$290.95 ,$290.95 ,$139.41 ,$290.95 ,$209.48 ,$180.39 ,$209.48 ,$209.48 ,$232.76 
ST NICHOLAS HOSPITAL - ACUTE,36000108,19082,HC BREAST LOC BX PERC STEREO ADDN LESION,360,1 ,$287.50 ,$189.75 ,$46.22 ,"$2,497.74 ",$46.22 ,$287.50 ,$287.50 , N/A ,$172.50 ,$244.38 ,$201.25 ,$46.22 ,$46.22 ,$273.13 ,$218.50 ,$215.63 ,$287.50 ,$244.38 , N/A ,$287.50 ,$287.50 ,$201.25 ,$175.09 ,$46.22 , N/A , N/A , N/A ,$48.99 ,$244.38 , N/A ,$264.50 ,$201.25 ,"$1,998.41 ","$2,497.74 ",$175.09 ,"$2,497.74 ",$198.66 ,$258.75 ,$196.42 , N/A ,$227.13 ,$48.99 ,$287.50 ,$287.50 , N/A ,$287.50 ,$207.00 ,$178.25 ,$207.00 ,$207.00 ,$230.00 
ST NICHOLAS HOSPITAL - ACUTE,36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,$264.50 ,$174.57 ,$46.22 ,"$2,497.74 ",$46.22 ,$264.50 ,$264.50 , N/A ,$158.70 ,$224.83 ,$185.15 ,$46.22 ,$46.22 ,$251.28 ,$201.02 ,$198.38 ,$264.50 ,$224.83 , N/A ,$264.50 ,$264.50 ,$185.15 ,$161.08 ,$46.22 , N/A , N/A , N/A ,$48.99 ,$224.83 , N/A ,$243.34 ,$185.15 ,"$1,998.41 ","$2,497.74 ",$161.08 ,"$2,497.74 ",$182.77 ,$238.05 ,$180.71 , N/A ,$208.96 ,$48.99 ,$264.50 ,$264.50 , N/A ,$264.50 ,$190.44 ,$163.99 ,$190.44 ,$190.44 ,$211.60 
ST NICHOLAS HOSPITAL - ACUTE,36000110,19085,HC BX BREAST 1ST LESION MR IMAG,360,1 ,"$1,150.00 ",$759.00 ,$46.22 ,"$3,293.01 ",$46.22 ,"$1,150.00 ","$1,150.00 ","$1,463.56 ",$690.00 ,$977.50 ,$805.00 ,$46.22 ,$46.22 ,"$1,092.50 ",$874.00 ,$862.50 ,"$1,150.00 ",$977.50 ,"$1,463.56 ","$1,150.00 ","$1,150.00 ",$805.00 ,$700.35 ,$46.22 ,"$1,463.56 ","$1,434.29 ","$1,150.00 ",$48.99 ,$977.50 ,"$3,293.01 ","$1,058.00 ",$805.00 ,"$1,150.00 ","$1,150.00 ",$700.35 ,"$1,150.00 ",$794.65 ,"$1,035.00 ",$785.68 ,"$1,448.64 ",$908.50 ,$48.99 ,"$1,150.00 ","$1,150.00 ","$1,434.29 ","$1,150.00 ",$828.00 ,$713.00 ,$828.00 ,$828.00 ,$920.00 
ST NICHOLAS HOSPITAL - ACUTE,36000111,19086,HC BX BREAST ADDN LESION MR IMAG,360,1 ,$322.00 ,$212.52 ,$46.22 ,"$2,497.74 ",$46.22 ,$322.00 ,$322.00 , N/A ,$193.20 ,$273.70 ,$225.40 ,$46.22 ,$46.22 ,$305.90 ,$244.72 ,$241.50 ,$322.00 ,$273.70 , N/A ,$322.00 ,$322.00 ,$225.40 ,$196.10 ,$46.22 , N/A , N/A , N/A ,$48.99 ,$273.70 , N/A ,$296.24 ,$225.40 ,"$1,998.41 ","$2,497.74 ",$196.10 ,"$2,497.74 ",$222.50 ,$289.80 ,$219.99 , N/A ,$254.38 ,$48.99 ,$322.00 ,$322.00 , N/A ,$322.00 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,36000112,19287,HC PERCUTAN DEV BREAST 1ST MR GUIDE,360,1 ,$391.00 ,$258.06 ,$46.22 ,"$1,425.14 ",$46.22 ,$391.00 ,$391.00 ,$633.39 ,$234.60 ,$332.35 ,$273.70 ,$46.22 ,$46.22 ,$371.45 ,$297.16 ,$293.25 ,$391.00 ,$332.35 ,$633.39 ,$391.00 ,$391.00 ,$273.70 ,$238.12 ,$46.22 ,$633.39 ,$620.72 ,$391.00 ,$48.99 ,$332.35 ,"$1,425.14 ",$359.72 ,$273.70 ,$391.00 ,$391.00 ,$238.12 ,$391.00 ,$270.18 ,$351.90 ,$267.13 ,$626.93 ,$308.89 ,$48.99 ,$391.00 ,$391.00 ,$620.72 ,$391.00 ,$281.52 ,$242.42 ,$281.52 ,$281.52 ,$312.80 
ST NICHOLAS HOSPITAL - ACUTE,36000113,19288,HC PERCUTAN DEV BREAST ADDN MR GUIDE,360,1 ,$120.75 ,$79.70 ,$46.22 ,"$2,497.74 ",$46.22 ,$120.75 ,$120.75 , N/A ,$72.45 ,$102.64 ,$84.53 ,$46.22 ,$46.22 ,$114.71 ,$91.77 ,$90.56 ,$120.75 ,$102.64 , N/A ,$120.75 ,$120.75 ,$84.53 ,$73.54 ,$46.22 , N/A , N/A , N/A ,$48.99 ,$102.64 , N/A ,$111.09 ,$84.53 ,"$1,998.41 ","$2,497.74 ",$73.54 ,"$2,497.74 ",$83.44 ,$108.68 ,$82.50 , N/A ,$95.39 ,$48.99 ,$120.75 ,$120.75 , N/A ,$120.75 ,$86.94 ,$74.87 ,$86.94 ,$86.94 ,$96.60 
ST NICHOLAS HOSPITAL - ACUTE,36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,$172.50 ,$113.85 ,$46.22 ,"$2,497.74 ",$46.22 ,$172.50 ,$172.50 , N/A ,$103.50 ,$146.63 ,$120.75 ,$46.22 ,$46.22 ,$163.88 ,$131.10 ,$129.38 ,$172.50 ,$146.63 , N/A ,$172.50 ,$172.50 ,$120.75 ,$105.05 ,$46.22 , N/A , N/A , N/A ,$48.99 ,$146.63 , N/A ,$158.70 ,$120.75 ,"$1,998.41 ","$2,497.74 ",$105.05 ,"$2,497.74 ",$119.20 ,$155.25 ,$117.85 , N/A ,$136.28 ,$48.99 ,$172.50 ,$172.50 , N/A ,$172.50 ,$124.20 ,$106.95 ,$124.20 ,$124.20 ,$138.00 
ST NICHOLAS HOSPITAL - ACUTE,36000115,19284,HC BREAST STEREO NDL LOC BX ADDN LESION,360,1 ,$172.50 ,$113.85 ,$46.22 ,"$2,497.74 ",$46.22 ,$172.50 ,$172.50 , N/A ,$103.50 ,$146.63 ,$120.75 ,$46.22 ,$46.22 ,$163.88 ,$131.10 ,$129.38 ,$172.50 ,$146.63 , N/A ,$172.50 ,$172.50 ,$120.75 ,$105.05 ,$46.22 , N/A , N/A , N/A ,$48.99 ,$146.63 , N/A ,$158.70 ,$120.75 ,"$1,998.41 ","$2,497.74 ",$105.05 ,"$2,497.74 ",$119.20 ,$155.25 ,$117.85 , N/A ,$136.28 ,$48.99 ,$172.50 ,$172.50 , N/A ,$172.50 ,$124.20 ,$106.95 ,$124.20 ,$124.20 ,$138.00 
ST NICHOLAS HOSPITAL - ACUTE,36000116,19286,HC BREAST NDL LOC BX ULTRA  ADDN LESION,360,1 ,$149.50 ,$98.67 ,$46.22 ,"$2,497.74 ",$46.22 ,$149.50 ,$149.50 , N/A ,$89.70 ,$127.08 ,$104.65 ,$46.22 ,$46.22 ,$142.03 ,$113.62 ,$112.13 ,$149.50 ,$127.08 , N/A ,$149.50 ,$149.50 ,$104.65 ,$91.05 ,$46.22 , N/A , N/A , N/A ,$48.99 ,$127.08 , N/A ,$137.54 ,$104.65 ,"$1,998.41 ","$2,497.74 ",$91.05 ,"$2,497.74 ",$103.30 ,$134.55 ,$102.14 , N/A ,$118.11 ,$48.99 ,$149.50 ,$149.50 , N/A ,$149.50 ,$107.64 ,$92.69 ,$107.64 ,$107.64 ,$119.60 
ST NICHOLAS HOSPITAL - ACUTE,36000119,36471,HC INJ SCLEROSING SOLUTN MULT VEIN,360,1 ,$409.40 ,$270.20 ,$21.15 ,$819.26 ,$21.15 ,$409.40 ,$409.40 ,$364.12 ,$245.64 ,$347.99 ,$286.58 ,$21.15 ,$21.15 ,$388.93 ,$311.14 ,$307.05 ,$409.40 ,$347.99 ,$364.12 ,$409.40 ,$409.40 ,$286.58 ,$249.32 ,$21.15 ,$364.12 ,$356.84 ,$409.40 ,$22.42 ,$347.99 ,$819.26 ,$376.65 ,$286.58 ,$207.65 ,$249.20 ,$249.32 ,$249.20 ,$282.90 ,$368.46 ,$279.70 ,$360.40 ,$323.43 ,$22.42 ,$409.40 ,$409.40 ,$356.84 ,$409.40 ,$294.77 ,$253.83 ,$294.77 ,$294.77 ,$327.52 
ST NICHOLAS HOSPITAL - ACUTE,36000120,36481,HC CATH VEIN PORTAL PERC,360,1 ,"$1,955.00 ","$1,290.30 ",$23.19 ,"$1,955.00 ",$23.19 ,"$1,955.00 ","$1,955.00 ", N/A ,"$1,173.00 ","$1,661.75 ","$1,368.50 ",$23.19 ,$23.19 ,"$1,857.25 ","$1,485.80 ","$1,466.25 ","$1,955.00 ","$1,661.75 ", N/A ,"$1,955.00 ","$1,955.00 ","$1,368.50 ","$1,190.60 ",$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,661.75 ", N/A ,"$1,798.60 ","$1,368.50 ",$991.58 ,"$1,190.01 ","$1,190.60 ","$1,190.01 ","$1,350.91 ","$1,759.50 ","$1,335.66 ", N/A ,"$1,544.45 ",$24.58 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$1,407.60 ","$1,212.10 ","$1,407.60 ","$1,407.60 ","$1,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000121,36500,HC CATH VENOUS BLOOD SELECT SMPL,360,1 ,"$1,150.00 ",$759.00 ,$23.19 ,"$1,150.00 ",$23.19 ,"$1,150.00 ","$1,150.00 ", N/A ,$690.00 ,$977.50 ,$805.00 ,$23.19 ,$23.19 ,"$1,092.50 ",$874.00 ,$862.50 ,"$1,150.00 ",$977.50 , N/A ,"$1,150.00 ","$1,150.00 ",$805.00 ,$700.35 ,$23.19 , N/A , N/A , N/A ,$24.58 ,$977.50 , N/A ,"$1,058.00 ",$805.00 ,$583.28 ,$700.01 ,$700.35 ,$700.01 ,$794.65 ,"$1,035.00 ",$785.68 , N/A ,$908.50 ,$24.58 ,"$1,150.00 ","$1,150.00 ", N/A ,"$1,150.00 ",$828.00 ,$713.00 ,$828.00 ,$828.00 ,$920.00 
ST NICHOLAS HOSPITAL - ACUTE,36000122,36555,HC INS CATH CV NON-TUNL <5 YRS,360,1 ,"$3,592.60 ","$2,371.12 ",$38.41 ,"$6,541.82 ",$38.41 ,"$3,592.60 ","$3,592.60 ","$2,907.47 ","$2,155.56 ","$3,053.71 ","$2,514.82 ",$38.41 ,$38.41 ,"$3,412.97 ","$2,730.38 ","$2,694.45 ","$2,929.00 ","$3,053.71 ","$2,907.47 ","$2,929.00 ","$2,929.00 ","$2,514.82 ","$2,187.89 ",$38.41 ,"$2,907.47 ","$2,849.32 ","$3,592.60 ",$40.71 ,"$3,053.71 ","$6,541.82 ","$3,305.19 ","$2,514.82 ","$1,771.14 ","$2,213.66 ","$2,187.89 ","$2,213.66 ","$2,482.49 ","$3,233.34 ","$2,454.46 ","$2,877.81 ","$2,838.15 ",$40.71 ,"$2,747.00 ","$2,747.00 ","$2,849.32 ","$2,747.00 ","$2,586.67 ","$2,227.41 ","$2,586.67 ","$2,586.67 ","$2,874.08 "
ST NICHOLAS HOSPITAL - ACUTE,36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$3,096.95 ","$2,043.99 ",$38.41 ,"$6,541.82 ",$38.41 ,"$3,096.95 ","$3,096.95 ","$2,907.47 ","$1,858.17 ","$2,632.41 ","$2,167.87 ",$38.41 ,$38.41 ,"$2,942.10 ","$2,353.68 ","$2,322.71 ","$2,929.00 ","$2,632.41 ","$2,907.47 ","$2,929.00 ","$2,929.00 ","$2,167.87 ","$1,886.04 ",$38.41 ,"$2,907.47 ","$2,849.32 ","$3,096.95 ",$40.71 ,"$2,632.41 ","$6,541.82 ","$2,849.19 ","$2,167.87 ","$1,771.14 ","$2,213.66 ","$1,886.04 ","$2,213.66 ","$2,139.99 ","$2,787.26 ","$2,115.84 ","$2,877.81 ","$2,446.59 ",$40.71 ,"$2,747.00 ","$2,747.00 ","$2,849.32 ","$2,747.00 ","$2,229.80 ","$1,920.11 ","$2,229.80 ","$2,229.80 ","$2,477.56 "
ST NICHOLAS HOSPITAL - ACUTE,36000124,36557,HC INSERT TUNNELED CVC <5 YEARS OLD,360,1 ,"$2,961.25 ","$1,954.43 ",$74.89 ,"$11,286.91 ",$74.89 ,"$2,961.25 ","$2,961.25 ","$5,016.41 ","$1,776.75 ","$2,517.06 ","$2,072.88 ",$74.89 ,$74.89 ,"$2,813.19 ","$2,250.55 ","$2,220.94 ","$2,961.25 ","$2,517.06 ","$5,016.41 ","$2,961.25 ","$2,961.25 ","$2,072.88 ","$1,803.40 ",$74.89 ,"$5,016.41 ","$4,916.08 ","$2,961.25 ",$79.38 ,"$2,517.06 ","$11,286.91 ","$2,724.35 ","$2,072.88 ","$4,535.48 ","$5,669.62 ","$1,803.40 ","$5,669.62 ","$2,046.22 ","$2,665.13 ","$2,023.13 ","$4,965.24 ","$2,339.39 ",$79.38 ,"$2,961.25 ","$2,961.25 ","$4,916.08 ","$2,961.25 ","$2,132.10 ","$1,835.98 ","$2,132.10 ","$2,132.10 ","$2,369.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000125,36558,HC INSERT TUNNELED CVC > 5 YEARS OLD,360,1 ,"$5,326.80 ","$3,515.69 ",$74.89 ,"$6,541.82 ",$74.89 ,"$5,326.80 ","$5,326.80 ","$2,907.47 ","$3,196.08 ","$4,527.78 ","$3,728.76 ",$74.89 ,$74.89 ,"$5,060.46 ","$4,048.37 ","$3,995.10 ","$4,807.00 ","$4,527.78 ","$2,907.47 ","$4,807.00 ","$4,807.00 ","$3,728.76 ","$3,244.02 ",$74.89 ,"$2,907.47 ","$2,849.32 ","$5,326.80 ",$79.38 ,"$4,527.78 ","$6,541.82 ","$4,900.66 ","$3,728.76 ","$3,273.50 ","$4,091.88 ","$3,244.02 ","$4,091.88 ","$3,680.82 ","$4,794.12 ","$3,639.27 ","$2,877.81 ","$4,208.17 ",$79.38 ,"$5,326.80 ","$5,326.80 ","$2,849.32 ","$5,326.80 ","$3,835.30 ","$3,302.62 ","$3,835.30 ","$3,835.30 ","$4,261.44 "
ST NICHOLAS HOSPITAL - ACUTE,36000126,36560,HC INS DEVICE CV W/PORT <5 YRS,360,1 ,"$5,451.00 ","$3,597.66 ",$74.89 ,"$6,541.82 ",$74.89 ,"$5,451.00 ","$5,451.00 ","$2,907.47 ","$3,270.60 ","$4,633.35 ","$3,815.70 ",$74.89 ,$74.89 ,"$5,178.45 ","$4,142.76 ","$4,088.25 ","$5,451.00 ","$4,633.35 ","$2,907.47 ","$5,451.00 ","$5,451.00 ","$3,815.70 ","$3,319.66 ",$74.89 ,"$2,907.47 ","$2,849.32 ","$5,451.00 ",$79.38 ,"$4,633.35 ","$6,541.82 ","$5,014.92 ","$3,815.70 ","$3,273.50 ","$4,091.88 ","$3,319.66 ","$4,091.88 ","$3,766.64 ","$4,905.90 ","$3,724.12 ","$2,877.81 ","$4,306.29 ",$79.38 ,"$5,451.00 ","$5,451.00 ","$2,849.32 ","$5,451.00 ","$3,924.72 ","$3,379.62 ","$3,924.72 ","$3,924.72 ","$4,360.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000127,36561,HC INSERT TUNEL CV CATH>5YR W/PORT,360,1 ,"$6,813.75 ","$4,497.08 ",$74.89 ,"$6,813.75 ",$74.89 ,"$6,813.75 ","$6,813.75 ","$2,907.47 ","$4,088.25 ","$5,791.69 ","$4,769.63 ",$74.89 ,$74.89 ,"$6,473.06 ","$5,178.45 ","$5,110.31 ","$6,813.75 ","$5,791.69 ","$2,907.47 ","$6,813.75 ","$6,813.75 ","$4,769.63 ","$4,149.57 ",$74.89 ,"$2,907.47 ","$2,849.32 ","$5,814.94 ",$79.38 ,"$5,791.69 ","$6,541.82 ","$6,268.65 ","$4,769.63 ","$3,273.50 ","$4,091.88 ","$4,149.57 ","$4,091.88 ","$4,708.30 ","$6,132.38 ","$4,655.15 ","$2,877.81 ","$5,382.86 ",$79.38 ,"$6,800.00 ","$6,800.00 ","$2,849.32 ","$6,800.00 ","$4,905.90 ","$4,224.53 ","$4,905.90 ","$4,905.90 ","$5,451.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000131,36568,HC INS CATH PERIPH CV W/O PORT <5,360,1 ,"$1,486.95 ",$981.39 ,$38.41 ,"$3,267.32 ",$38.41 ,"$1,486.95 ","$1,486.95 ","$1,452.14 ",$892.17 ,"$1,263.91 ","$1,040.87 ",$38.41 ,$38.41 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ","$1,486.95 ","$1,263.91 ","$1,452.14 ","$1,486.95 ","$1,486.95 ","$1,040.87 ",$905.55 ,$38.41 ,"$1,452.14 ","$1,423.10 ","$1,486.95 ",$40.71 ,"$1,263.91 ","$3,267.32 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ","$1,437.33 ","$1,174.69 ",$40.71 ,"$1,486.95 ","$1,486.95 ","$1,423.10 ","$1,486.95 ","$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$1,858.40 ","$1,226.54 ",$38.41 ,"$3,267.32 ",$38.41 ,"$1,858.40 ","$1,858.40 ","$1,452.14 ","$1,115.04 ","$1,579.64 ","$1,300.88 ",$38.41 ,$38.41 ,"$1,765.48 ","$1,412.38 ","$1,393.80 ","$1,858.40 ","$1,579.64 ","$1,452.14 ","$1,858.40 ","$1,858.40 ","$1,300.88 ","$1,131.77 ",$38.41 ,"$1,452.14 ","$1,423.10 ","$1,858.40 ",$40.71 ,"$1,579.64 ","$3,267.32 ","$1,709.73 ","$1,300.88 ","$1,771.14 ","$1,858.40 ","$1,131.77 ","$1,858.40 ","$1,284.15 ","$1,672.56 ","$1,269.66 ","$1,437.33 ","$1,468.14 ",$40.71 ,"$1,858.40 ","$1,858.40 ","$1,423.10 ","$1,858.40 ","$1,338.05 ","$1,152.21 ","$1,338.05 ","$1,338.05 ","$1,486.72 "
ST NICHOLAS HOSPITAL - ACUTE,36000134,36578,HC REPLACE CATH CV W/PORT/PUMP,360,1 ,"$3,418.95 ","$2,256.51 ",$24.70 ,"$6,541.82 ",$24.70 ,"$3,418.95 ","$3,418.95 ","$2,907.47 ","$2,051.37 ","$2,906.11 ","$2,393.27 ",$24.70 ,$24.70 ,"$3,248.00 ","$2,598.40 ","$2,564.21 ","$3,418.95 ","$2,906.11 ","$2,907.47 ","$3,418.95 ","$3,418.95 ","$2,393.27 ","$2,082.14 ",$24.70 ,"$2,907.47 ","$2,849.32 ","$3,418.95 ",$26.18 ,"$2,906.11 ","$6,541.82 ","$3,145.43 ","$2,393.27 ","$3,273.50 ","$4,091.88 ","$2,082.14 ","$4,091.88 ","$2,362.49 ","$3,077.06 ","$2,335.83 ","$2,877.81 ","$2,700.97 ",$26.18 ,"$3,418.95 ","$3,418.95 ","$2,849.32 ","$3,418.95 ","$2,461.64 ","$2,119.75 ","$2,461.64 ","$2,461.64 ","$2,735.16 "
ST NICHOLAS HOSPITAL - ACUTE,36000135,36580,HC REPL CATH CV NON-TNL W/O PORT,360,1 ,"$2,973.90 ","$1,962.77 ",$38.41 ,"$3,267.32 ",$38.41 ,"$2,973.90 ","$2,973.90 ","$1,452.14 ","$1,784.34 ","$2,527.82 ","$2,081.73 ",$38.41 ,$38.41 ,"$2,825.21 ","$2,260.16 ","$2,230.43 ","$2,929.00 ","$2,527.82 ","$1,452.14 ","$2,929.00 ","$2,929.00 ","$2,081.73 ","$1,811.11 ",$38.41 ,"$1,452.14 ","$1,423.10 ","$2,904.28 ",$40.71 ,"$2,527.82 ","$3,267.32 ","$2,735.99 ","$2,081.73 ","$1,771.14 ","$2,213.66 ","$1,811.11 ","$2,213.66 ","$2,054.96 ","$2,676.51 ","$2,031.77 ","$1,437.33 ","$2,349.38 ",$40.71 ,"$2,747.00 ","$2,747.00 ","$1,423.10 ","$2,747.00 ","$2,141.21 ","$1,843.82 ","$2,141.21 ","$2,141.21 ","$2,379.12 "
ST NICHOLAS HOSPITAL - ACUTE,36000136,36581,HC REPL CATH CV TNL W/O PORT,360,1 ,"$4,583.90 ","$3,025.37 ",$74.89 ,"$6,541.82 ",$74.89 ,"$4,583.90 ","$4,583.90 ","$2,907.47 ","$2,750.34 ","$3,896.32 ","$3,208.73 ",$74.89 ,$74.89 ,"$4,354.71 ","$3,483.76 ","$3,437.93 ","$4,583.90 ","$3,896.32 ","$2,907.47 ","$4,583.90 ","$4,583.90 ","$3,208.73 ","$2,791.60 ",$74.89 ,"$2,907.47 ","$2,849.32 ","$4,583.90 ",$79.38 ,"$3,896.32 ","$6,541.82 ","$4,217.19 ","$3,208.73 ","$3,273.50 ","$4,091.88 ","$2,791.60 ","$4,091.88 ","$3,167.47 ","$4,125.51 ","$3,131.72 ","$2,877.81 ","$3,621.28 ",$79.38 ,"$4,583.90 ","$4,583.90 ","$2,849.32 ","$4,583.90 ","$3,300.41 ","$2,842.02 ","$3,300.41 ","$3,300.41 ","$3,667.12 "
ST NICHOLAS HOSPITAL - ACUTE,36000137,36582,HC REPL DEVICE CV TNL W/PORT,360,1 ,"$6,937.95 ","$4,579.05 ",$74.89 ,"$6,937.95 ",$74.89 ,"$6,937.95 ","$6,937.95 ","$2,907.47 ","$4,162.77 ","$5,897.26 ","$4,856.57 ",$74.89 ,$74.89 ,"$6,591.05 ","$5,272.84 ","$5,203.46 ","$6,937.95 ","$5,897.26 ","$2,907.47 ","$6,937.95 ","$6,937.95 ","$4,856.57 ","$4,225.21 ",$74.89 ,"$2,907.47 ","$2,849.32 ","$5,814.94 ",$79.38 ,"$5,897.26 ","$6,541.82 ","$6,382.91 ","$4,856.57 ","$3,273.50 ","$4,091.88 ","$4,225.21 ","$4,091.88 ","$4,794.12 ","$6,244.16 ","$4,740.01 ","$2,877.81 ","$5,480.98 ",$79.38 ,"$6,800.00 ","$6,800.00 ","$2,849.32 ","$6,800.00 ","$4,995.32 ","$4,301.53 ","$4,995.32 ","$4,995.32 ","$5,550.36 "
ST NICHOLAS HOSPITAL - ACUTE,36000139,36584,HC REPL PICC W/O PORT/PUMP,360,1 ,"$2,725.50 ","$1,798.83 ",$38.41 ,"$3,267.32 ",$38.41 ,"$2,725.50 ","$2,725.50 ","$1,452.14 ","$1,635.30 ","$2,316.68 ","$1,907.85 ",$38.41 ,$38.41 ,"$2,589.23 ","$2,071.38 ","$2,044.13 ","$2,725.50 ","$2,316.68 ","$1,452.14 ","$2,725.50 ","$2,725.50 ","$1,907.85 ","$1,659.83 ",$38.41 ,"$1,452.14 ","$1,423.10 ","$2,725.50 ",$40.71 ,"$2,316.68 ","$3,267.32 ","$2,507.46 ","$1,907.85 ","$1,771.14 ","$2,213.66 ","$1,659.83 ","$2,213.66 ","$1,883.32 ","$2,452.95 ","$1,862.06 ","$1,437.33 ","$2,153.15 ",$40.71 ,"$2,725.50 ","$2,725.50 ","$1,423.10 ","$2,725.50 ","$1,962.36 ","$1,689.81 ","$1,962.36 ","$1,962.36 ","$2,180.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,"$1,238.55 ",$817.44 ,$24.70 ,"$1,270.39 ",$24.70 ,"$1,238.55 ","$1,238.55 ",$564.62 ,$743.13 ,"$1,052.77 ",$866.99 ,$24.70 ,$24.70 ,"$1,176.62 ",$941.30 ,$928.91 ,"$1,238.55 ","$1,052.77 ",$564.62 ,"$1,238.55 ","$1,238.55 ",$866.99 ,$754.28 ,$24.70 ,$564.62 ,$553.33 ,"$1,129.24 ",$26.18 ,"$1,052.77 ","$1,270.39 ","$1,139.47 ",$866.99 ,"$1,238.55 ","$1,238.55 ",$754.28 ,"$1,238.55 ",$855.84 ,"$1,114.70 ",$846.18 ,$558.86 ,$978.45 ,$26.18 ,"$1,238.55 ","$1,238.55 ",$553.33 ,"$1,238.55 ",$891.76 ,$767.90 ,$891.76 ,$891.76 ,$990.84 
ST NICHOLAS HOSPITAL - ACUTE,36000142,36590,HC REM TNL CV ACC W/PORT/PUMP,360,1 ,"$2,725.50 ","$1,798.83 ",$24.70 ,"$3,267.32 ",$24.70 ,"$2,725.50 ","$2,292.00 ","$1,452.14 ","$1,635.30 ","$2,316.68 ","$1,907.85 ",$24.70 ,$24.70 ,"$2,589.23 ","$2,071.38 ","$2,044.13 ","$2,725.50 ","$2,316.68 ","$1,452.14 ","$2,725.50 ","$2,725.50 ","$1,907.85 ","$1,659.83 ",$24.70 ,"$1,452.14 ","$1,423.10 ","$2,725.50 ",$26.18 ,"$2,316.68 ","$3,267.32 ","$2,507.46 ","$1,907.85 ","$1,998.41 ","$2,497.74 ","$1,659.83 ","$2,497.74 ","$1,883.32 ","$2,452.95 ","$1,862.06 ","$1,437.33 ","$2,153.15 ",$26.18 ,"$2,725.50 ","$2,725.50 ","$1,423.10 ","$2,725.50 ","$1,962.36 ","$1,689.81 ","$1,962.36 ","$1,962.36 ","$2,180.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000144,36595,HC REM PERICATHETER MAT CV DEV,360,1 ,"$4,583.90 ","$3,025.37 ",$24.70 ,"$6,541.82 ",$24.70 ,"$4,583.90 ","$4,583.90 ","$2,907.47 ","$2,750.34 ","$3,896.32 ","$3,208.73 ",$24.70 ,$24.70 ,"$4,354.71 ","$3,483.76 ","$3,437.93 ","$4,583.90 ","$3,896.32 ","$2,907.47 ","$4,583.90 ","$4,583.90 ","$3,208.73 ","$2,791.60 ",$24.70 ,"$2,907.47 ","$2,849.32 ","$4,583.90 ",$26.18 ,"$3,896.32 ","$6,541.82 ","$4,217.19 ","$3,208.73 ","$3,273.50 ","$4,091.88 ","$2,791.60 ","$4,091.88 ","$3,167.47 ","$4,125.51 ","$3,131.72 ","$2,877.81 ","$3,621.28 ",$26.18 ,"$4,583.90 ","$4,583.90 ","$2,849.32 ","$4,583.90 ","$3,300.41 ","$2,842.02 ","$3,300.41 ","$3,300.41 ","$3,667.12 "
ST NICHOLAS HOSPITAL - ACUTE,36000145,36596,HC REM INTRALUM MAT CV LUMEN,360,1 ,"$2,050.45 ","$1,353.30 ",$24.70 ,"$3,267.32 ",$24.70 ,"$2,050.45 ","$2,050.45 ","$1,452.14 ","$1,230.27 ","$1,742.88 ","$1,435.32 ",$24.70 ,$24.70 ,"$1,947.93 ","$1,558.34 ","$1,537.84 ","$2,050.45 ","$1,742.88 ","$1,452.14 ","$2,050.45 ","$2,050.45 ","$1,435.32 ","$1,248.72 ",$24.70 ,"$1,452.14 ","$1,423.10 ","$2,050.45 ",$26.18 ,"$1,742.88 ","$3,267.32 ","$1,886.41 ","$1,435.32 ","$1,771.14 ","$2,050.45 ","$1,248.72 ","$2,050.45 ","$1,416.86 ","$1,845.41 ","$1,400.87 ","$1,437.33 ","$1,619.86 ",$26.18 ,"$2,050.45 ","$2,050.45 ","$1,423.10 ","$2,050.45 ","$1,476.32 ","$1,271.28 ","$1,476.32 ","$1,476.32 ","$1,640.36 "
ST NICHOLAS HOSPITAL - ACUTE,36000146,36597,HC REPOSITION CENTRAL VENOUS CATH,360,1 ,"$2,354.05 ","$1,553.67 ",$24.70 ,"$3,267.32 ",$24.70 ,"$2,354.05 ","$2,354.05 ","$1,452.14 ","$1,412.43 ","$2,000.94 ","$1,647.84 ",$24.70 ,$24.70 ,"$2,236.35 ","$1,789.08 ","$1,765.54 ","$2,354.05 ","$2,000.94 ","$1,452.14 ","$2,354.05 ","$2,354.05 ","$1,647.84 ","$1,433.62 ",$24.70 ,"$1,452.14 ","$1,423.10 ","$2,354.05 ",$26.18 ,"$2,000.94 ","$3,267.32 ","$2,165.73 ","$1,647.84 ","$1,771.14 ","$2,213.66 ","$1,433.62 ","$2,213.66 ","$1,626.65 ","$2,118.65 ","$1,608.29 ","$1,437.33 ","$1,859.70 ",$26.18 ,"$2,354.05 ","$2,354.05 ","$1,423.10 ","$2,354.05 ","$1,694.92 ","$1,459.51 ","$1,694.92 ","$1,694.92 ","$1,883.24 "
ST NICHOLAS HOSPITAL - ACUTE,36000148,36620,HC CATH/CANN ARTERY PERC 36620,360,1 ,$696.00 ,$459.36 ,$23.19 ,$696.00 ,$23.19 ,$696.00 ,$696.00 , N/A ,$417.60 ,$591.60 ,$487.20 ,$23.19 ,$23.19 ,$661.20 ,$528.96 ,$522.00 ,$696.00 ,$591.60 , N/A ,$696.00 ,$696.00 ,$487.20 ,$423.86 ,$23.19 , N/A , N/A , N/A ,$24.58 ,$591.60 , N/A ,$640.32 ,$487.20 ,$353.01 ,$423.66 ,$423.86 ,$423.66 ,$480.94 ,$626.40 ,$475.51 , N/A ,$549.84 ,$24.58 ,$696.00 ,$696.00 , N/A ,$696.00 ,$501.12 ,$431.52 ,$501.12 ,$501.12 ,$556.80 
ST NICHOLAS HOSPITAL - ACUTE,36000149,36810,HC HEMODIAYLSIS CATH INSERTION,360,1 ,"$4,168.00 ","$2,750.88 ",$74.89 ,"$6,541.82 ",$74.89 ,"$4,168.00 ","$4,168.00 ","$2,907.47 ","$2,500.80 ","$3,542.80 ","$2,917.60 ",$74.89 ,$74.89 ,"$3,959.60 ","$3,167.68 ","$3,126.00 ","$4,168.00 ","$3,542.80 ","$2,907.47 ","$4,168.00 ","$4,168.00 ","$2,917.60 ","$2,538.31 ",$74.89 ,"$2,907.47 ","$2,849.32 ","$4,168.00 ",$79.38 ,"$3,542.80 ","$6,541.82 ","$3,834.56 ","$2,917.60 ","$3,273.50 ","$4,091.88 ","$2,538.31 ","$4,091.88 ","$2,880.09 ","$3,751.20 ","$2,847.58 ","$2,877.81 ","$3,292.72 ",$79.38 ,"$4,168.00 ","$4,168.00 ","$2,849.32 ","$4,168.00 ","$3,000.96 ","$2,584.16 ","$3,000.96 ","$3,000.96 ","$3,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000154,37182,HC TIPS,360,1 ,"$14,867.20 ","$9,812.35 ",$376.97 ,"$14,867.20 ",$376.97 ,"$10,885.00 ","$8,164.00 ", N/A ,"$8,920.32 ","$12,637.12 ","$10,407.04 ",$376.97 ,$376.97 ,"$14,123.84 ","$11,299.07 ","$11,150.40 ","$7,276.00 ","$12,637.12 ", N/A ,"$7,276.00 ","$7,276.00 ","$10,407.04 ","$9,054.12 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$12,637.12 ", N/A ,"$13,677.82 ","$10,407.04 ","$4,887.30 ","$6,108.86 ","$9,054.12 ","$6,108.86 ","$10,273.24 ","$13,380.48 ","$10,157.27 ", N/A ,"$11,745.09 ",$399.59 ,"$10,341.00 ","$10,341.00 ", N/A ,"$10,341.00 ","$10,704.38 ","$9,217.66 ","$10,704.38 ","$10,704.38 ","$11,893.76 "
ST NICHOLAS HOSPITAL - ACUTE,36000156,37183,HC TIPS REVISION,360,1 ,"$13,628.65 ","$8,994.91 ",$205.34 ,"$13,628.65 ",$205.34 ,"$13,628.65 ","$10,885.00 ","$5,090.23 ","$8,177.19 ","$11,584.35 ","$9,540.06 ",$205.34 ,$205.34 ,"$12,947.22 ","$10,357.77 ","$10,221.49 ","$7,276.00 ","$11,584.35 ","$5,090.23 ","$7,276.00 ","$7,276.00 ","$9,540.06 ","$8,299.85 ",$205.34 ,"$5,090.23 ","$4,988.43 ","$10,180.46 ",$217.66 ,"$11,584.35 ","$11,453.02 ","$12,538.36 ","$9,540.06 ","$4,887.30 ","$6,108.86 ","$8,299.85 ","$6,108.86 ","$9,417.40 ","$12,265.79 ","$9,311.09 ","$5,038.31 ","$10,766.63 ",$217.66 ,"$10,341.00 ","$10,341.00 ","$4,988.43 ","$10,341.00 ","$9,812.63 ","$8,449.76 ","$9,812.63 ","$9,812.63 ","$10,902.92 "
ST NICHOLAS HOSPITAL - ACUTE,36000157,38220,HC ASP BONE MARROW ONLY,360,1 ,"$1,238.55 ",$817.44 ,$51.28 ,"$3,293.01 ",$51.28 ,"$1,238.55 ","$1,238.55 ","$1,463.56 ",$743.13 ,"$1,052.77 ",$866.99 ,$51.28 ,$51.28 ,"$1,176.62 ",$941.30 ,$928.91 ,"$1,238.55 ","$1,052.77 ","$1,463.56 ","$1,238.55 ","$1,238.55 ",$866.99 ,$754.28 ,$51.28 ,"$1,463.56 ","$1,434.29 ","$1,238.55 ",$54.36 ,"$1,052.77 ","$3,293.01 ","$1,139.47 ",$866.99 ,"$1,238.55 ","$1,238.55 ",$754.28 ,"$1,238.55 ",$855.84 ,"$1,114.70 ",$846.18 ,"$1,448.64 ",$978.45 ,$54.36 ,"$1,238.55 ","$1,238.55 ","$1,434.29 ","$1,238.55 ",$891.76 ,$767.90 ,$891.76 ,$891.76 ,$990.84 
ST NICHOLAS HOSPITAL - ACUTE,36000158,38221,HC BX BONE MARROW ONLY,360,1 ,$892.40 ,$588.98 ,$51.28 ,"$3,293.01 ",$51.28 ,$892.40 ,$892.40 ,"$1,463.56 ",$535.44 ,$758.54 ,$624.68 ,$51.28 ,$51.28 ,$847.78 ,$678.22 ,$669.30 ,$892.40 ,$758.54 ,"$1,463.56 ",$892.40 ,$892.40 ,$624.68 ,$543.47 ,$51.28 ,"$1,463.56 ","$1,434.29 ",$892.40 ,$54.36 ,$758.54 ,"$3,293.01 ",$821.01 ,$624.68 ,$892.40 ,$892.40 ,$543.47 ,$892.40 ,$616.65 ,$803.16 ,$609.69 ,"$1,448.64 ",$705.00 ,$54.36 ,$892.40 ,$892.40 ,"$1,434.29 ",$892.40 ,$642.53 ,$553.29 ,$642.53 ,$642.53 ,$713.92 
ST NICHOLAS HOSPITAL - ACUTE,36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$2,229.85 ","$1,471.70 ",$41.96 ,"$3,293.01 ",$41.96 ,"$2,229.85 ","$2,229.85 ","$1,463.56 ","$1,337.91 ","$1,895.37 ","$1,560.90 ",$41.96 ,$41.96 ,"$2,118.36 ","$1,694.69 ","$1,672.39 ","$2,229.85 ","$1,895.37 ","$1,463.56 ","$2,229.85 ","$2,229.85 ","$1,560.90 ","$1,357.98 ",$41.96 ,"$1,463.56 ","$1,434.29 ","$2,229.85 ",$44.48 ,"$1,895.37 ","$3,293.01 ","$2,051.46 ","$1,560.90 ","$1,998.41 ","$2,229.85 ","$1,357.98 ","$2,229.85 ","$1,540.83 ","$2,006.87 ","$1,523.43 ","$1,448.64 ","$1,761.58 ",$44.48 ,"$2,229.85 ","$2,229.85 ","$1,434.29 ","$2,229.85 ","$1,605.49 ","$1,382.51 ","$1,605.49 ","$1,605.49 ","$1,783.88 "
ST NICHOLAS HOSPITAL - ACUTE,36000161,38792,HC INJ LYMPH NODE NO IMAGING,360,1 ,$978.65 ,$645.91 ,$12.96 ,$978.65 ,$12.96 ,$978.65 ,$978.65 ,$379.35 ,$587.19 ,$831.85 ,$685.06 ,$12.96 ,$12.96 ,$929.72 ,$743.77 ,$733.99 ,$978.65 ,$831.85 ,$379.35 ,$978.65 ,$978.65 ,$685.06 ,$596.00 ,$12.96 ,$379.35 ,$371.76 ,$758.70 ,$13.74 ,$831.85 ,$853.54 ,$900.36 ,$685.06 ,$496.37 ,$595.70 ,$596.00 ,$595.70 ,$676.25 ,$880.79 ,$668.61 ,$375.48 ,$773.13 ,$13.74 ,$978.65 ,$978.65 ,$371.76 ,$978.65 ,$704.63 ,$606.76 ,$704.63 ,$704.63 ,$782.92 
ST NICHOLAS HOSPITAL - ACUTE,36000162,38999,HC HEMIC OR LYMPHATIC SYSTEM UNLISTED,360,1 ,"$2,185.00 ","$1,442.10 ",$104.56 ,"$2,185.00 ",$104.56 ,"$2,185.00 ","$2,185.00 ",$397.96 ,"$1,311.00 ","$1,857.25 ","$1,529.50 ",$104.56 ,$104.56 ,"$2,075.75 ","$1,660.60 ","$1,638.75 ","$2,185.00 ","$1,857.25 ",$397.96 ,"$2,185.00 ","$2,185.00 ","$1,529.50 ","$1,330.67 ",$104.56 ,$397.96 ,$390.00 ,$795.92 ,$110.83 ,"$1,857.25 ",$895.42 ,"$2,010.20 ","$1,529.50 ","$1,108.23 ","$1,330.01 ","$1,330.67 ","$1,330.01 ","$1,509.84 ","$1,966.50 ","$1,492.79 ",$393.90 ,"$1,726.15 ",$110.83 ,"$1,945.00 ","$1,945.00 ",$390.00 ,"$1,945.00 ","$1,573.20 ","$1,354.70 ","$1,573.20 ","$1,573.20 ","$1,748.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000163,43246,HC PLACE G-TUBE PERC,360,1 ,"$2,205.00 ","$1,455.30 ",$33.91 ,"$3,824.53 ",$33.91 ,"$2,205.00 ","$2,205.00 ","$1,699.79 ","$1,323.00 ","$1,874.25 ","$1,543.50 ",$33.91 ,$33.91 ,"$2,094.75 ","$1,675.80 ","$1,653.75 ","$2,205.00 ","$1,874.25 ","$1,699.79 ","$2,205.00 ","$2,205.00 ","$1,543.50 ","$1,342.85 ",$33.91 ,"$1,699.79 ","$1,665.79 ","$2,205.00 ",$35.94 ,"$1,874.25 ","$3,824.53 ","$2,028.60 ","$1,543.50 ","$1,998.41 ","$2,205.00 ","$1,342.85 ","$2,205.00 ","$1,523.66 ","$1,984.50 ","$1,506.46 ","$1,682.45 ","$1,741.95 ",$35.94 ,"$2,205.00 ","$2,205.00 ","$1,665.79 ","$2,205.00 ","$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,764.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000167,44640,HC TISSUE CLOSURE INTESTNL FISTULA,360,1 ,$253.00 ,$166.98 ,$151.80 ,$253.00 ,$156.10 ,$253.00 ,$253.00 , N/A ,$151.80 ,$215.05 ,$177.10 ,$156.10 ,$156.10 ,$240.35 ,$192.28 ,$189.75 ,$253.00 ,$215.05 , N/A ,$253.00 ,$253.00 ,$177.10 ,$154.08 ,$156.10 , N/A , N/A , N/A ,$165.47 ,$215.05 , N/A ,$232.76 ,$177.10 , N/A , N/A ,$154.08 , N/A ,$174.82 ,$227.70 ,$172.85 , N/A ,$199.87 ,$165.47 ,$253.00 ,$253.00 , N/A ,$253.00 ,$182.16 ,$156.86 ,$182.16 ,$182.16 ,$202.40 
ST NICHOLAS HOSPITAL - ACUTE,36000168,44799,"HC UNLISTED PROC, INTESTINE",360,1 ,$575.00 ,$379.50 ,$66.96 ,"$1,812.82 ",$66.96 ,$575.00 ,$575.00 ,$805.70 ,$345.00 ,$488.75 ,$402.50 ,$66.96 ,$66.96 ,$546.25 ,$437.00 ,$431.25 ,$575.00 ,$488.75 ,$805.70 ,$575.00 ,$575.00 ,$402.50 ,$350.18 ,$66.96 ,$805.70 ,$789.59 ,$575.00 ,$70.98 ,$488.75 ,"$1,812.82 ",$529.00 ,$402.50 ,$575.00 ,$575.00 ,$350.18 ,$575.00 ,$397.33 ,$517.50 ,$392.84 ,$797.48 ,$454.25 ,$70.98 ,$575.00 ,$575.00 ,$789.59 ,$575.00 ,$414.00 ,$356.50 ,$414.00 ,$414.00 ,$460.00 
ST NICHOLAS HOSPITAL - ACUTE,36000171,47490,HC CHOLECYSTOSTOMY PERC,360,1 ,"$3,910.00 ","$2,580.60 ",$82.11 ,"$7,778.08 ",$82.11 ,"$3,910.00 ","$3,910.00 ","$3,456.92 ","$2,346.00 ","$3,323.50 ","$2,737.00 ",$82.11 ,$82.11 ,"$3,714.50 ","$2,971.60 ","$2,932.50 ","$2,929.00 ","$3,323.50 ","$3,456.92 ","$2,929.00 ","$2,929.00 ","$2,737.00 ","$2,381.19 ",$82.11 ,"$3,456.92 ","$3,387.78 ","$3,910.00 ",$87.04 ,"$3,323.50 ","$7,778.08 ","$3,597.20 ","$2,737.00 ","$3,273.50 ","$4,091.88 ","$2,381.19 ","$4,091.88 ","$2,701.81 ","$3,519.00 ","$2,671.31 ","$3,421.66 ","$3,088.90 ",$87.04 ,"$3,910.00 ","$3,910.00 ","$3,387.78 ","$3,910.00 ","$2,815.20 ","$2,424.20 ","$2,815.20 ","$2,815.20 ","$3,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000175,49220,HC STAGING CELIOTOMY,360,1 ,$638.25 ,$421.25 ,$323.72 ,$638.25 , N/A , N/A , N/A , N/A ,$382.95 ,$542.51 ,$446.78 , N/A , N/A ,$606.34 ,$485.07 ,$478.69 ,$638.25 ,$542.51 , N/A ,$638.25 ,$638.25 ,$446.78 ,$388.69 , N/A , N/A , N/A , N/A , N/A ,$542.51 , N/A ,$587.19 ,$446.78 ,$323.72 ,$388.50 ,$388.69 ,$388.50 ,$441.03 ,$574.43 ,$436.05 , N/A ,$504.22 , N/A , N/A , N/A , N/A , N/A ,$459.54 ,$395.72 ,$459.54 ,$459.54 ,$510.60 
ST NICHOLAS HOSPITAL - ACUTE,36000176,49418,HC INSERT INTRAPERITONEAL CATH,360,1 ,"$7,557.80 ","$4,988.15 ",$127.20 ,"$7,778.08 ",$127.20 ,"$7,557.80 ","$7,448.00 ","$3,456.92 ","$4,534.68 ","$6,424.13 ","$5,290.46 ",$127.20 ,$127.20 ,"$7,179.91 ","$5,743.93 ","$5,668.35 ","$7,276.00 ","$6,424.13 ","$3,456.92 ","$7,276.00 ","$7,276.00 ","$5,290.46 ","$4,602.70 ",$127.20 ,"$3,456.92 ","$3,387.78 ","$6,913.84 ",$134.83 ,"$6,424.13 ","$7,778.08 ","$6,953.18 ","$5,290.46 ","$3,273.50 ","$4,091.88 ","$4,602.70 ","$4,091.88 ","$5,222.44 ","$6,802.02 ","$5,163.49 ","$3,421.66 ","$5,970.66 ",$134.83 ,"$6,800.00 ","$6,800.00 ","$3,387.78 ","$6,800.00 ","$5,441.62 ","$4,685.84 ","$5,441.62 ","$5,441.62 ","$6,046.24 "
ST NICHOLAS HOSPITAL - ACUTE,36000177,49421,HC INS CATH DRAIN PERITONEAL PERM,360,1 ,"$5,353.25 ","$3,533.15 ",$127.20 ,"$7,778.08 ",$127.20 ,"$5,353.25 ","$5,353.25 ","$3,456.92 ","$3,211.95 ","$4,550.26 ","$3,747.28 ",$127.20 ,$127.20 ,"$5,085.59 ","$4,068.47 ","$4,014.94 ","$2,929.00 ","$4,550.26 ","$3,456.92 ","$2,929.00 ","$2,929.00 ","$3,747.28 ","$3,260.13 ",$127.20 ,"$3,456.92 ","$3,387.78 ","$5,353.25 ",$134.83 ,"$4,550.26 ","$7,778.08 ","$4,924.99 ","$3,747.28 ","$3,273.50 ","$4,091.88 ","$3,260.13 ","$4,091.88 ","$3,699.10 ","$4,817.93 ","$3,657.34 ","$3,421.66 ","$4,229.07 ",$134.83 ,"$5,353.25 ","$5,353.25 ","$3,387.78 ","$5,353.25 ","$3,854.34 ","$3,319.02 ","$3,854.34 ","$3,854.34 ","$4,282.60 "
ST NICHOLAS HOSPITAL - ACUTE,36000178,49422,HC REM CATH INTRAPERITONEAL,360,1 ,"$5,451.00 ","$3,597.66 ",$25.31 ,"$6,541.82 ",$25.31 ,"$5,451.00 ","$5,451.00 ","$2,907.47 ","$3,270.60 ","$4,633.35 ","$3,815.70 ",$25.31 ,$25.31 ,"$5,178.45 ","$4,142.76 ","$4,088.25 ","$2,929.00 ","$4,633.35 ","$2,907.47 ","$2,929.00 ","$2,929.00 ","$3,815.70 ","$3,319.66 ",$25.31 ,"$2,907.47 ","$2,849.32 ","$5,451.00 ",$26.83 ,"$4,633.35 ","$6,541.82 ","$5,014.92 ","$3,815.70 ","$3,273.50 ","$4,091.88 ","$3,319.66 ","$4,091.88 ","$3,766.64 ","$4,905.90 ","$3,724.12 ","$2,877.81 ","$4,306.29 ",$26.83 ,"$5,451.00 ","$5,451.00 ","$2,849.32 ","$5,451.00 ","$3,924.72 ","$3,379.62 ","$3,924.72 ","$3,924.72 ","$4,360.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000183,51710,HC CHG TUBE CYSTOSTOMY CPLX,360,1 ,"$2,229.85 ","$1,471.70 ",$13.57 ,"$2,229.85 ",$13.57 ,"$2,229.85 ","$2,229.85 ",$610.33 ,"$1,337.91 ","$1,895.37 ","$1,560.90 ",$13.57 ,$13.57 ,"$2,118.36 ","$1,694.69 ","$1,672.39 ","$2,229.85 ","$1,895.37 ",$610.33 ,"$2,229.85 ","$2,229.85 ","$1,560.90 ","$1,357.98 ",$13.57 ,$610.33 ,$598.12 ,"$1,220.66 ",$14.38 ,"$1,895.37 ","$1,373.25 ","$2,051.46 ","$1,560.90 ","$1,771.14 ","$2,213.66 ","$1,357.98 ","$2,213.66 ","$1,540.83 ","$2,006.87 ","$1,523.43 ",$604.10 ,"$1,761.58 ",$14.38 ,"$2,229.85 ","$2,229.85 ",$598.12 ,"$2,229.85 ","$1,605.49 ","$1,382.51 ","$1,605.49 ","$1,605.49 ","$1,783.88 "
ST NICHOLAS HOSPITAL - ACUTE,36000187,54150,HC CIRCUMCISION OP,360,1 ,"$1,486.95 ",$981.39 ,$68.85 ,"$4,073.32 ",$68.85 ,"$1,486.95 ","$1,486.95 ","$1,810.36 ",$892.17 ,"$1,263.91 ","$1,040.87 ",$68.85 ,$68.85 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ","$1,486.95 ","$1,263.91 ","$1,810.36 ","$1,486.95 ","$1,486.95 ","$1,040.87 ",$905.55 ,$68.85 ,"$1,810.36 ","$1,774.15 ","$1,486.95 ",$72.98 ,"$1,263.91 ","$4,073.32 ","$1,367.99 ","$1,040.87 ","$2,747.95 ","$3,435.21 ",$905.55 ,"$3,435.21 ","$1,027.48 ","$1,338.26 ","$1,015.88 ","$1,791.89 ","$1,174.69 ",$72.98 ,"$1,486.95 ","$1,486.95 ","$1,774.15 ","$1,486.95 ","$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,36000188,55700,HC BX PROSTATE NEEDLE/PUNCH,360,1 ,"$2,849.70 ","$1,880.80 ",$55.36 ,"$4,073.32 ",$55.36 ,"$2,849.70 ","$2,849.70 ","$1,810.36 ","$1,709.82 ","$2,422.25 ","$1,994.79 ",$55.36 ,$55.36 ,"$2,707.22 ","$2,165.77 ","$2,137.28 ","$2,849.70 ","$2,422.25 ","$1,810.36 ","$2,849.70 ","$2,849.70 ","$1,994.79 ","$1,735.47 ",$55.36 ,"$1,810.36 ","$1,774.15 ","$2,849.70 ",$58.68 ,"$2,422.25 ","$4,073.32 ","$2,621.72 ","$1,994.79 ","$1,998.41 ","$2,497.74 ","$1,735.47 ","$2,497.74 ","$1,969.14 ","$2,564.73 ","$1,946.92 ","$1,791.89 ","$2,251.26 ",$58.68 ,"$2,849.70 ","$2,849.70 ","$1,774.15 ","$2,849.70 ","$2,051.78 ","$1,766.81 ","$2,051.78 ","$2,051.78 ","$2,279.76 "
ST NICHOLAS HOSPITAL - ACUTE,36000189,58100,HC BIOPSY OF UTERUS PERCUTANEOUS,360,1 ,$631.35 ,$416.69 ,$17.19 ,$631.35 ,$17.19 ,$631.35 ,$631.35 ,$173.85 ,$378.81 ,$536.65 ,$441.95 ,$17.19 ,$17.19 ,$599.78 ,$479.83 ,$473.51 ,$631.35 ,$536.65 ,$173.85 ,$631.35 ,$631.35 ,$441.95 ,$384.49 ,$17.19 ,$173.85 ,$170.37 ,$347.70 ,$18.22 ,$536.65 ,$391.17 ,$580.84 ,$441.95 ,$320.22 ,$384.30 ,$384.49 ,$384.30 ,$436.26 ,$568.22 ,$431.34 ,$172.08 ,$498.77 ,$18.22 ,$631.35 ,$631.35 ,$170.37 ,$631.35 ,$454.57 ,$391.44 ,$454.57 ,$454.57 ,$505.08 
ST NICHOLAS HOSPITAL - ACUTE,36000190,61624,HC OCC/EMB TRANSCATH CNS PERC,360,1 ,"$5,980.00 ","$3,946.80 ",$397.02 ,"$6,108.86 ",$397.02 ,"$5,980.00 ","$5,980.00 ", N/A ,"$3,588.00 ","$5,083.00 ","$4,186.00 ",$397.02 ,$397.02 ,"$5,681.00 ","$4,544.80 ","$4,485.00 ","$2,929.00 ","$5,083.00 ", N/A ,"$2,929.00 ","$2,929.00 ","$4,186.00 ","$3,641.82 ",$397.02 , N/A , N/A , N/A ,$420.84 ,"$5,083.00 ", N/A ,"$5,501.60 ","$4,186.00 ","$4,887.30 ","$6,108.86 ","$3,641.82 ","$6,108.86 ","$4,132.18 ","$5,382.00 ","$4,085.54 ", N/A ,"$4,724.20 ",$420.84 ,"$5,980.00 ","$5,980.00 ", N/A ,"$5,980.00 ","$4,305.60 ","$3,707.60 ","$4,305.60 ","$4,305.60 ","$4,784.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000191,61626,HC OCC/EMB TRANSCATH EXT CRAN VSS,360,1 ,"$13,800.00 ","$9,108.00 ",$397.02 ,"$23,311.22 ",$397.02 ,"$13,800.00 ","$12,891.00 ","$10,360.54 ","$8,280.00 ","$11,730.00 ","$9,660.00 ",$397.02 ,$397.02 ,"$13,110.00 ","$10,488.00 ","$10,350.00 ","$7,276.00 ","$11,730.00 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$9,660.00 ","$8,404.20 ",$397.02 ,"$10,360.54 ","$10,153.33 ","$13,800.00 ",$420.84 ,"$11,730.00 ","$23,311.22 ","$12,696.00 ","$9,660.00 ","$4,887.30 ","$6,108.86 ","$8,404.20 ","$6,108.86 ","$9,535.80 ","$12,420.00 ","$9,428.16 ","$10,254.87 ","$10,902.00 ",$420.84 ,"$10,341.00 ","$10,341.00 ","$10,153.33 ","$10,341.00 ","$9,936.00 ","$8,556.00 ","$9,936.00 ","$9,936.00 ","$11,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000193,62267,HC DISC ASPIRATION,360,1 ,"$1,734.20 ","$1,144.57 ",$30.03 ,"$1,734.20 ",$30.03 ,"$1,734.20 ","$1,734.20 ",$633.39 ,"$1,040.52 ","$1,474.07 ","$1,213.94 ",$30.03 ,$30.03 ,"$1,647.49 ","$1,317.99 ","$1,300.65 ","$1,734.20 ","$1,474.07 ",$633.39 ,"$1,734.20 ","$1,734.20 ","$1,213.94 ","$1,056.13 ",$30.03 ,$633.39 ,$620.72 ,"$1,266.78 ",$31.83 ,"$1,474.07 ","$1,425.14 ","$1,595.46 ","$1,213.94 ","$1,734.20 ","$1,734.20 ","$1,056.13 ","$1,734.20 ","$1,198.33 ","$1,560.78 ","$1,184.81 ",$626.93 ,"$1,370.02 ",$31.83 ,"$1,734.20 ","$1,734.20 ",$620.72 ,"$1,734.20 ","$1,248.62 ","$1,075.20 ","$1,248.62 ","$1,248.62 ","$1,387.36 "
ST NICHOLAS HOSPITAL - ACUTE,36000194,62270,HC LUMBAR PUNCTURE,360,1 ,"$1,238.55 ",$817.44 ,$30.03 ,"$1,414.97 ",$30.03 ,"$1,238.55 ","$1,238.55 ",$628.88 ,$743.13 ,"$1,052.77 ",$866.99 ,$30.03 ,$30.03 ,"$1,176.62 ",$941.30 ,$928.91 ,"$1,238.55 ","$1,052.77 ",$628.88 ,"$1,238.55 ","$1,238.55 ",$866.99 ,$754.28 ,$30.03 ,$628.88 ,$616.30 ,"$1,238.55 ",$31.83 ,"$1,052.77 ","$1,414.97 ","$1,139.47 ",$866.99 ,"$1,238.55 ","$1,238.55 ",$754.28 ,"$1,238.55 ",$855.84 ,"$1,114.70 ",$846.18 ,$622.47 ,$978.45 ,$31.83 ,"$1,238.55 ","$1,238.55 ",$616.30 ,"$1,238.55 ",$891.76 ,$767.90 ,$891.76 ,$891.76 ,$990.84 
ST NICHOLAS HOSPITAL - ACUTE,36000195,10160,HC ASP BULLA FAC,761,1 ,$532.45 ,$351.42 ,$5.80 ,$819.26 ,$5.80 ,$532.45 ,$532.45 ,$364.12 ,$319.47 ,$452.58 ,$372.72 ,$5.80 ,$5.80 ,$505.83 ,$404.66 ,$399.34 ,$532.45 ,$452.58 ,$364.12 ,$532.45 ,$532.45 ,$372.72 ,$324.26 ,$5.80 ,$364.12 ,$356.84 ,$532.45 ,$6.15 ,$452.58 ,$819.26 ,$489.85 ,$372.72 ,$270.06 ,$324.10 ,$324.26 ,$324.10 ,$367.92 ,$479.21 ,$363.77 ,$360.40 ,$420.64 ,$6.15 ,$314.15 ,$314.15 ,$356.84 ,$314.15 ,$383.36 ,$330.12 ,$383.36 ,$383.36 ,$425.96 
ST NICHOLAS HOSPITAL - ACUTE,36000223,36575,HC REPAIR CATH CV W/O PORT/PUMP,360,1 ,"$2,075.75 ","$1,370.00 ",$24.70 ,"$2,075.75 ",$24.70 ,"$2,075.75 ","$2,075.75 ",$564.62 ,"$1,245.45 ","$1,764.39 ","$1,453.03 ",$24.70 ,$24.70 ,"$1,971.96 ","$1,577.57 ","$1,556.81 ","$2,075.75 ","$1,764.39 ",$564.62 ,"$2,075.75 ","$2,075.75 ","$1,453.03 ","$1,264.13 ",$24.70 ,$564.62 ,$553.33 ,"$1,129.24 ",$26.18 ,"$1,764.39 ","$1,270.39 ","$1,909.69 ","$1,453.03 ","$1,771.14 ","$2,075.75 ","$1,264.13 ","$2,075.75 ","$1,434.34 ","$1,868.18 ","$1,418.15 ",$558.86 ,"$1,639.84 ",$26.18 ,"$2,075.75 ","$2,075.75 ",$553.33 ,"$2,075.75 ","$1,494.54 ","$1,286.97 ","$1,494.54 ","$1,494.54 ","$1,660.60 "
ST NICHOLAS HOSPITAL - ACUTE,36000240,42300,HC DRAIN ABSC PAROTID SMP,360,1 ,"$1,982.60 ","$1,308.52 ",$42.01 ,"$3,048.36 ",$42.01 ,"$1,982.60 ","$1,982.60 ","$1,354.82 ","$1,189.56 ","$1,685.21 ","$1,387.82 ",$42.01 ,$42.01 ,"$1,883.47 ","$1,506.78 ","$1,486.95 ","$1,982.60 ","$1,685.21 ","$1,354.82 ","$1,982.60 ","$1,982.60 ","$1,387.82 ","$1,207.40 ",$42.01 ,"$1,354.82 ","$1,327.72 ","$1,982.60 ",$44.53 ,"$1,685.21 ","$3,048.36 ","$1,823.99 ","$1,387.82 ","$1,982.60 ","$1,982.60 ","$1,207.40 ","$1,982.60 ","$1,369.98 ","$1,784.34 ","$1,354.51 ","$1,341.00 ","$1,566.25 ",$44.53 ,"$1,982.60 ","$1,982.60 ","$1,327.72 ","$1,982.60 ","$1,427.47 ","$1,229.21 ","$1,427.47 ","$1,427.47 ","$1,586.08 "
ST NICHOLAS HOSPITAL - ACUTE,36000250,49419,HC INSERT TUN IP CATH W/PORT,360,1 ,"$5,469.40 ","$3,609.80 ",$127.20 ,"$11,286.91 ",$127.20 ,"$5,469.40 ","$5,469.40 ","$5,016.41 ","$3,281.64 ","$4,648.99 ","$3,828.58 ",$127.20 ,$127.20 ,"$5,195.93 ","$4,156.74 ","$4,102.05 ","$2,929.00 ","$4,648.99 ","$5,016.41 ","$2,929.00 ","$2,929.00 ","$3,828.58 ","$3,330.86 ",$127.20 ,"$5,016.41 ","$4,916.08 ","$5,469.40 ",$134.83 ,"$4,648.99 ","$11,286.91 ","$5,031.85 ","$3,828.58 ","$4,535.48 ","$5,669.62 ","$3,330.86 ","$5,669.62 ","$3,779.36 ","$4,922.46 ","$3,736.69 ","$4,965.24 ","$4,320.83 ",$134.83 ,"$5,469.40 ","$5,469.40 ","$4,916.08 ","$5,469.40 ","$3,937.97 ","$3,391.03 ","$3,937.97 ","$3,937.97 ","$4,375.52 "
ST NICHOLAS HOSPITAL - ACUTE,36000300,64635,HC RADIOFREQ;LUMBO/SACRAL;SINGLE,360,1 ,"$3,680.00 ","$2,428.80 ",$30.03 ,"$3,947.35 ",$30.03 ,"$3,680.00 ","$3,680.00 ","$1,754.38 ","$2,208.00 ","$3,128.00 ","$2,576.00 ",$30.03 ,$30.03 ,"$3,496.00 ","$2,796.80 ","$2,760.00 ","$3,680.00 ","$3,128.00 ","$1,754.38 ","$3,680.00 ","$3,680.00 ","$2,576.00 ","$2,241.12 ",$30.03 ,"$1,754.38 ","$1,719.29 ","$3,508.76 ",$31.83 ,"$3,128.00 ","$3,947.35 ","$3,385.60 ","$2,576.00 ","$2,747.95 ","$3,435.21 ","$2,241.12 ","$3,435.21 ","$2,542.88 ","$3,312.00 ","$2,514.18 ","$1,736.48 ","$2,907.20 ",$31.83 ,"$3,680.00 ","$3,680.00 ","$1,719.29 ","$3,680.00 ","$2,649.60 ","$2,281.60 ","$2,649.60 ","$2,649.60 ","$2,944.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000301,64636,HC RADIOFREQ;LUMBO/SACRAL;ADDTL,360,1 ,$805.00 ,$531.30 ,$30.03 ,"$2,213.66 ",$30.03 ,$805.00 ,$805.00 , N/A ,$483.00 ,$684.25 ,$563.50 ,$30.03 ,$30.03 ,$764.75 ,$611.80 ,$603.75 ,$805.00 ,$684.25 , N/A ,$805.00 ,$805.00 ,$563.50 ,$490.25 ,$30.03 , N/A , N/A , N/A ,$31.83 ,$684.25 , N/A ,$740.60 ,$563.50 ,"$1,771.14 ","$2,213.66 ",$490.25 ,"$2,213.66 ",$556.26 ,$724.50 ,$549.98 , N/A ,$635.95 ,$31.83 ,$805.00 ,$805.00 , N/A ,$805.00 ,$579.60 ,$499.10 ,$579.60 ,$579.60 ,$644.00 
ST NICHOLAS HOSPITAL - ACUTE,36000302,64633,HC RADIOFREQ;CERV/THOR;SINGLE,360,1 ,"$3,680.00 ","$2,428.80 ",$30.03 ,"$3,947.35 ",$30.03 ,"$3,680.00 ","$3,680.00 ","$1,754.38 ","$2,208.00 ","$3,128.00 ","$2,576.00 ",$30.03 ,$30.03 ,"$3,496.00 ","$2,796.80 ","$2,760.00 ","$3,680.00 ","$3,128.00 ","$1,754.38 ","$3,680.00 ","$3,680.00 ","$2,576.00 ","$2,241.12 ",$30.03 ,"$1,754.38 ","$1,719.29 ","$3,508.76 ",$31.83 ,"$3,128.00 ","$3,947.35 ","$3,385.60 ","$2,576.00 ","$2,747.95 ","$3,435.21 ","$2,241.12 ","$3,435.21 ","$2,542.88 ","$3,312.00 ","$2,514.18 ","$1,736.48 ","$2,907.20 ",$31.83 ,"$3,680.00 ","$3,680.00 ","$1,719.29 ","$3,680.00 ","$2,649.60 ","$2,281.60 ","$2,649.60 ","$2,649.60 ","$2,944.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000303,64634,HC RADIOFREQ;CERV/THOR;ADDTL,360,1 ,$805.00 ,$531.30 ,$30.03 ,"$2,213.66 ",$30.03 ,$805.00 ,$805.00 , N/A ,$483.00 ,$684.25 ,$563.50 ,$30.03 ,$30.03 ,$764.75 ,$611.80 ,$603.75 ,$805.00 ,$684.25 , N/A ,$805.00 ,$805.00 ,$563.50 ,$490.25 ,$30.03 , N/A , N/A , N/A ,$31.83 ,$684.25 , N/A ,$740.60 ,$563.50 ,"$1,771.14 ","$2,213.66 ",$490.25 ,"$2,213.66 ",$556.26 ,$724.50 ,$549.98 , N/A ,$635.95 ,$31.83 ,$805.00 ,$805.00 , N/A ,$805.00 ,$579.60 ,$499.10 ,$579.60 ,$579.60 ,$644.00 
ST NICHOLAS HOSPITAL - ACUTE,36000304,64640,HC RADIOFREQ;PERIPHERAL NERVE,360,1 ,"$2,663.40 ","$1,757.84 ",$37.48 ,"$2,663.40 ",$37.48 ,"$2,663.40 ","$2,292.00 ",$831.73 ,"$1,598.04 ","$2,263.89 ","$1,864.38 ",$37.48 ,$37.48 ,"$2,530.23 ","$2,024.18 ","$1,997.55 ","$2,663.40 ","$2,263.89 ",$831.73 ,"$2,663.40 ","$2,663.40 ","$1,864.38 ","$1,622.01 ",$37.48 ,$831.73 ,$815.10 ,"$1,663.46 ",$39.73 ,"$2,263.89 ","$1,871.39 ","$2,450.33 ","$1,864.38 ","$1,771.14 ","$2,213.66 ","$1,622.01 ","$2,213.66 ","$1,840.41 ","$2,397.06 ","$1,819.63 ",$823.25 ,"$2,104.09 ",$39.73 ,"$2,663.40 ","$2,663.40 ",$815.10 ,"$2,663.40 ","$1,917.65 ","$1,651.31 ","$1,917.65 ","$1,917.65 ","$2,130.72 "
ST NICHOLAS HOSPITAL - ACUTE,36000311,64420,HC INJ INTERCOSTAL NERVE;SINGLE,360,1 ,$923.45 ,$609.48 ,$13.98 ,"$1,414.97 ",$13.98 ,$923.45 ,$923.45 ,$628.88 ,$554.07 ,$784.93 ,$646.42 ,$13.98 ,$13.98 ,$877.28 ,$701.82 ,$692.59 ,$923.45 ,$784.93 ,$628.88 ,$923.45 ,$923.45 ,$646.42 ,$562.38 ,$13.98 ,$628.88 ,$616.30 ,$923.45 ,$14.82 ,$784.93 ,"$1,414.97 ",$849.57 ,$646.42 ,$923.45 ,$923.45 ,$562.38 ,$923.45 ,$638.10 ,$831.11 ,$630.90 ,$622.47 ,$729.53 ,$14.82 ,$923.45 ,$923.45 ,$616.30 ,$923.45 ,$664.88 ,$572.54 ,$664.88 ,$664.88 ,$738.76 
ST NICHOLAS HOSPITAL - ACUTE,36000313,64493,HC INJ FACET LUMBO SACRAL;SINGLE,360,1 ,"$2,849.70 ","$1,880.80 ",$30.03 ,"$2,849.70 ",$30.03 ,"$2,849.70 ","$2,292.00 ",$831.73 ,"$1,709.82 ","$2,422.25 ","$1,994.79 ",$30.03 ,$30.03 ,"$2,707.22 ","$2,165.77 ","$2,137.28 ","$2,849.70 ","$2,422.25 ",$831.73 ,"$2,849.70 ","$2,849.70 ","$1,994.79 ","$1,735.47 ",$30.03 ,$831.73 ,$815.10 ,"$1,663.46 ",$31.83 ,"$2,422.25 ","$1,871.39 ","$2,621.72 ","$1,994.79 ","$1,771.14 ","$2,213.66 ","$1,735.47 ","$2,213.66 ","$1,969.14 ","$2,564.73 ","$1,946.92 ",$823.25 ,"$2,251.26 ",$31.83 ,"$2,747.00 ","$2,747.00 ",$815.10 ,"$2,747.00 ","$2,051.78 ","$1,766.81 ","$2,051.78 ","$2,051.78 ","$2,279.76 "
ST NICHOLAS HOSPITAL - ACUTE,36000314,64494,HC INJ FACET LUMBO/SACRAL;2ND LEVEL,360,1 ,$495.65 ,$327.13 ,$30.03 ,"$2,213.66 ",$30.03 ,$495.65 ,$495.65 , N/A ,$297.39 ,$421.30 ,$346.96 ,$30.03 ,$30.03 ,$470.87 ,$376.69 ,$371.74 ,$495.65 ,$421.30 , N/A ,$495.65 ,$495.65 ,$346.96 ,$301.85 ,$30.03 , N/A , N/A , N/A ,$31.83 ,$421.30 , N/A ,$456.00 ,$346.96 ,"$1,771.14 ","$2,213.66 ",$301.85 ,"$2,213.66 ",$342.49 ,$446.09 ,$338.63 , N/A ,$391.56 ,$31.83 ,$495.65 ,$495.65 , N/A ,$495.65 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,36000315,64495,HC INJ FACET LUMBO/SACRAL;3RD LEVEL,360,1 ,$495.65 ,$327.13 ,$30.03 ,"$2,213.66 ",$30.03 ,$495.65 ,$495.65 , N/A ,$297.39 ,$421.30 ,$346.96 ,$30.03 ,$30.03 ,$470.87 ,$376.69 ,$371.74 ,$495.65 ,$421.30 , N/A ,$495.65 ,$495.65 ,$346.96 ,$301.85 ,$30.03 , N/A , N/A , N/A ,$31.83 ,$421.30 , N/A ,$456.00 ,$346.96 ,"$1,771.14 ","$2,213.66 ",$301.85 ,"$2,213.66 ",$342.49 ,$446.09 ,$338.63 , N/A ,$391.56 ,$31.83 ,$495.65 ,$495.65 , N/A ,$495.65 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,36000316,64490,HC INJ FACET CER/THORACIC;SINGLE,360,1 ,"$2,849.70 ","$1,880.80 ",$30.03 ,"$2,849.70 ",$30.03 ,"$2,849.70 ","$2,292.00 ",$831.73 ,"$1,709.82 ","$2,422.25 ","$1,994.79 ",$30.03 ,$30.03 ,"$2,707.22 ","$2,165.77 ","$2,137.28 ","$2,849.70 ","$2,422.25 ",$831.73 ,"$2,849.70 ","$2,849.70 ","$1,994.79 ","$1,735.47 ",$30.03 ,$831.73 ,$815.10 ,"$1,663.46 ",$31.83 ,"$2,422.25 ","$1,871.39 ","$2,621.72 ","$1,994.79 ","$1,771.14 ","$2,213.66 ","$1,735.47 ","$2,213.66 ","$1,969.14 ","$2,564.73 ","$1,946.92 ",$823.25 ,"$2,251.26 ",$31.83 ,"$2,747.00 ","$2,747.00 ",$815.10 ,"$2,747.00 ","$2,051.78 ","$1,766.81 ","$2,051.78 ","$2,051.78 ","$2,279.76 "
ST NICHOLAS HOSPITAL - ACUTE,36000317,64491,HC INJ FACET CER/THORACIC 2ND LEVEL,360,1 ,$495.65 ,$327.13 ,$30.03 ,"$2,213.66 ",$30.03 ,$495.65 ,$495.65 , N/A ,$297.39 ,$421.30 ,$346.96 ,$30.03 ,$30.03 ,$470.87 ,$376.69 ,$371.74 ,$495.65 ,$421.30 , N/A ,$495.65 ,$495.65 ,$346.96 ,$301.85 ,$30.03 , N/A , N/A , N/A ,$31.83 ,$421.30 , N/A ,$456.00 ,$346.96 ,"$1,771.14 ","$2,213.66 ",$301.85 ,"$2,213.66 ",$342.49 ,$446.09 ,$338.63 , N/A ,$391.56 ,$31.83 ,$495.65 ,$495.65 , N/A ,$495.65 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,36000318,64492,HC INJ FACET CER/THORACIC 3RD LEVEL,360,1 ,$460.00 ,$303.60 ,$30.03 ,"$2,213.66 ",$30.03 ,$460.00 ,$460.00 , N/A ,$276.00 ,$391.00 ,$322.00 ,$30.03 ,$30.03 ,$437.00 ,$349.60 ,$345.00 ,$460.00 ,$391.00 , N/A ,$460.00 ,$460.00 ,$322.00 ,$280.14 ,$30.03 , N/A , N/A , N/A ,$31.83 ,$391.00 , N/A ,$423.20 ,$322.00 ,"$1,771.14 ","$2,213.66 ",$280.14 ,"$2,213.66 ",$317.86 ,$414.00 ,$314.27 , N/A ,$363.40 ,$31.83 ,$460.00 ,$460.00 , N/A ,$460.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,36000322,64479,HC INJ TRANSF CERV/THORACIC SINGLE,360,1 ,"$1,772.15 ","$1,169.62 ",$30.03 ,"$1,871.39 ",$30.03 ,"$1,772.15 ","$1,772.15 ",$831.73 ,"$1,063.29 ","$1,506.33 ","$1,240.51 ",$30.03 ,$30.03 ,"$1,683.54 ","$1,346.83 ","$1,329.11 ","$1,772.15 ","$1,506.33 ",$831.73 ,"$1,772.15 ","$1,772.15 ","$1,240.51 ","$1,079.24 ",$30.03 ,$831.73 ,$815.10 ,"$1,663.46 ",$31.83 ,"$1,506.33 ","$1,871.39 ","$1,630.38 ","$1,240.51 ","$1,771.14 ","$1,772.15 ","$1,079.24 ","$1,772.15 ","$1,224.56 ","$1,594.94 ","$1,210.73 ",$823.25 ,"$1,400.00 ",$31.83 ,"$1,772.15 ","$1,772.15 ",$815.10 ,"$1,772.15 ","$1,275.95 ","$1,098.73 ","$1,275.95 ","$1,275.95 ","$1,417.72 "
ST NICHOLAS HOSPITAL - ACUTE,36000323,64480,HC INJ TRANSF CERV/THORACIC ADDL,360,1 ,$903.90 ,$596.57 ,$30.03 ,"$2,213.66 ",$30.03 ,$903.90 ,$903.90 , N/A ,$542.34 ,$768.32 ,$632.73 ,$30.03 ,$30.03 ,$858.71 ,$686.96 ,$677.93 ,$903.90 ,$768.32 , N/A ,$903.90 ,$903.90 ,$632.73 ,$550.48 ,$30.03 , N/A , N/A , N/A ,$31.83 ,$768.32 , N/A ,$831.59 ,$632.73 ,"$1,771.14 ","$2,213.66 ",$550.48 ,"$2,213.66 ",$624.59 ,$813.51 ,$617.54 , N/A ,$714.08 ,$31.83 ,$903.90 ,$903.90 , N/A ,$903.90 ,$650.81 ,$560.42 ,$650.81 ,$650.81 ,$723.12 
ST NICHOLAS HOSPITAL - ACUTE,36000324,64483,HC INJ TRANSF LUMBAR SACRAL SINGLE,360,1 ,"$2,229.85 ","$1,471.70 ",$30.03 ,"$2,229.85 ",$30.03 ,"$2,229.85 ","$2,229.85 ",$831.73 ,"$1,337.91 ","$1,895.37 ","$1,560.90 ",$30.03 ,$30.03 ,"$2,118.36 ","$1,694.69 ","$1,672.39 ","$2,229.85 ","$1,895.37 ",$831.73 ,"$2,229.85 ","$2,229.85 ","$1,560.90 ","$1,357.98 ",$30.03 ,$831.73 ,$815.10 ,"$1,663.46 ",$31.83 ,"$1,895.37 ","$1,871.39 ","$2,051.46 ","$1,560.90 ","$1,771.14 ","$2,213.66 ","$1,357.98 ","$2,213.66 ","$1,540.83 ","$2,006.87 ","$1,523.43 ",$823.25 ,"$1,761.58 ",$31.83 ,"$2,229.85 ","$2,229.85 ",$815.10 ,"$2,229.85 ","$1,605.49 ","$1,382.51 ","$1,605.49 ","$1,605.49 ","$1,783.88 "
ST NICHOLAS HOSPITAL - ACUTE,36000325,64484,HC INJ TRANSF LUMBAR SACRAL ADDL,360,1 ,$903.90 ,$596.57 ,$30.03 ,"$2,213.66 ",$30.03 ,$903.90 ,$903.90 , N/A ,$542.34 ,$768.32 ,$632.73 ,$30.03 ,$30.03 ,$858.71 ,$686.96 ,$677.93 ,$903.90 ,$768.32 , N/A ,$903.90 ,$903.90 ,$632.73 ,$550.48 ,$30.03 , N/A , N/A , N/A ,$31.83 ,$768.32 , N/A ,$831.59 ,$632.73 ,"$1,771.14 ","$2,213.66 ",$550.48 ,"$2,213.66 ",$624.59 ,$813.51 ,$617.54 , N/A ,$714.08 ,$31.83 ,$903.90 ,$903.90 , N/A ,$903.90 ,$650.81 ,$560.42 ,$650.81 ,$650.81 ,$723.12 
ST NICHOLAS HOSPITAL - ACUTE,36000326,64405,HC NERVE BLOCK; OCCIPITAL,360,1 ,"$1,152.30 ",$760.52 ,$13.98 ,"$1,152.30 ",$13.98 ,"$1,152.30 ","$1,152.30 ",$265.36 ,$691.38 ,$979.46 ,$806.61 ,$13.98 ,$13.98 ,"$1,094.69 ",$875.75 ,$864.23 ,"$1,152.30 ",$979.46 ,$265.36 ,"$1,152.30 ","$1,152.30 ",$806.61 ,$701.75 ,$13.98 ,$265.36 ,$260.05 ,$530.72 ,$14.82 ,$979.46 ,$597.07 ,"$1,060.12 ",$806.61 ,$584.45 ,$701.41 ,$701.75 ,$701.41 ,$796.24 ,"$1,037.07 ",$787.25 ,$262.65 ,$910.32 ,$14.82 ,"$1,152.30 ","$1,152.30 ",$260.05 ,"$1,152.30 ",$829.66 ,$714.43 ,$829.66 ,$829.66 ,$921.84 
ST NICHOLAS HOSPITAL - ACUTE,36000328,64418,HC NERVE BLOCK;SUPRACAPULAR,360,1 ,"$2,126.35 ","$1,403.39 ",$13.98 ,"$2,126.35 ",$13.98 ,"$2,126.35 ","$2,126.35 ",$628.88 ,"$1,275.81 ","$1,807.40 ","$1,488.45 ",$13.98 ,$13.98 ,"$2,020.03 ","$1,616.03 ","$1,594.76 ","$2,126.35 ","$1,807.40 ",$628.88 ,"$2,126.35 ","$2,126.35 ","$1,488.45 ","$1,294.95 ",$13.98 ,$628.88 ,$616.30 ,"$1,257.76 ",$14.82 ,"$1,807.40 ","$1,414.97 ","$1,956.24 ","$1,488.45 ","$1,771.14 ","$2,126.35 ","$1,294.95 ","$2,126.35 ","$1,469.31 ","$1,913.72 ","$1,452.72 ",$622.47 ,"$1,679.82 ",$14.82 ,"$2,126.35 ","$2,126.35 ",$616.30 ,"$2,126.35 ","$1,530.97 ","$1,318.34 ","$1,530.97 ","$1,530.97 ","$1,701.08 "
ST NICHOLAS HOSPITAL - ACUTE,36000335,N/A,HC HEMORRHOIDECTOMY,360,1 ,"$2,464.35 ","$1,626.47 ","$1,249.92 ","$2,464.35 ", N/A , N/A , N/A , N/A ,"$1,478.61 ","$2,094.70 ","$1,725.05 ", N/A , N/A ,"$2,341.13 ","$1,872.91 ","$1,848.26 ", N/A ,"$2,094.70 ", N/A , N/A , N/A ,"$1,725.05 ","$1,500.79 ", N/A , N/A , N/A , N/A , N/A ,"$2,094.70 ", N/A ,"$2,267.20 ","$1,725.05 ","$1,249.92 ","$1,500.05 ","$1,500.79 ","$1,500.05 ","$1,702.87 ","$2,217.92 ","$1,683.64 ", N/A ,"$1,946.84 ", N/A , N/A , N/A , N/A , N/A ,"$1,774.33 ","$1,527.90 ","$1,774.33 ","$1,774.33 ","$1,971.48 "
ST NICHOLAS HOSPITAL - ACUTE,36000339,64461,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC SINGLE,360,1 ,$954.50 ,$629.97 ,$30.03 ,"$1,414.97 ",$30.03 ,$954.50 ,$954.50 ,$628.88 ,$572.70 ,$811.33 ,$668.15 ,$30.03 ,$30.03 ,$906.78 ,$725.42 ,$715.88 ,$954.50 ,$811.33 ,$628.88 ,$954.50 ,$954.50 ,$668.15 ,$581.29 ,$30.03 ,$628.88 ,$616.30 ,$954.50 ,$31.83 ,$811.33 ,"$1,414.97 ",$878.14 ,$668.15 ,$954.50 ,$954.50 ,$581.29 ,$954.50 ,$659.56 ,$859.05 ,$652.11 ,$622.47 ,$754.06 ,$31.83 ,$954.50 ,$954.50 ,$616.30 ,$954.50 ,$687.24 ,$591.79 ,$687.24 ,$687.24 ,$763.60 
ST NICHOLAS HOSPITAL - ACUTE,36000340,64462,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC 2ND AND ADDN ADD ON,360,1 ,$247.25 ,$163.19 ,$30.03 ,"$2,213.66 ",$30.03 ,$247.25 ,$247.25 , N/A ,$148.35 ,$210.16 ,$173.08 ,$30.03 ,$30.03 ,$234.89 ,$187.91 ,$185.44 ,$247.25 ,$210.16 , N/A ,$247.25 ,$247.25 ,$173.08 ,$150.58 ,$30.03 , N/A , N/A , N/A ,$31.83 ,$210.16 , N/A ,$227.47 ,$173.08 ,"$1,771.14 ","$2,213.66 ",$150.58 ,"$2,213.66 ",$170.85 ,$222.53 ,$168.92 , N/A ,$195.33 ,$31.83 ,$247.25 ,$247.25 , N/A ,$247.25 ,$178.02 ,$153.30 ,$178.02 ,$178.02 ,$197.80 
ST NICHOLAS HOSPITAL - ACUTE,36000341,64463,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC CATH CONTINUOUS,360,1 ,$910.80 ,$601.13 ,$30.03 ,"$1,414.97 ",$30.03 ,$910.80 ,$910.80 ,$628.88 ,$546.48 ,$774.18 ,$637.56 ,$30.03 ,$30.03 ,$865.26 ,$692.21 ,$683.10 ,$910.80 ,$774.18 ,$628.88 ,$910.80 ,$910.80 ,$637.56 ,$554.68 ,$30.03 ,$628.88 ,$616.30 ,$910.80 ,$31.83 ,$774.18 ,"$1,414.97 ",$837.94 ,$637.56 ,$910.80 ,$910.80 ,$554.68 ,$910.80 ,$629.36 ,$819.72 ,$622.26 ,$622.47 ,$719.53 ,$31.83 ,$910.80 ,$910.80 ,$616.30 ,$910.80 ,$655.78 ,$564.70 ,$655.78 ,$655.78 ,$728.64 
ST NICHOLAS HOSPITAL - ACUTE,36000440,31622,HC BRONCHOSCOPY DIAG W/W/O WASHING,360,1 ,"$2,900.00 ","$1,914.00 ",$59.62 ,"$3,510.44 ",$59.62 ,"$2,900.00 ","$2,900.00 ","$1,560.19 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$59.62 ,$59.62 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ","$1,560.19 ","$2,900.00 ","$2,900.00 ","$2,030.00 ","$1,766.10 ",$59.62 ,"$1,560.19 ","$1,528.99 ","$2,900.00 ",$63.20 ,"$2,465.00 ","$3,510.44 ","$2,668.00 ","$2,030.00 ","$1,998.41 ","$2,497.74 ","$1,766.10 ","$2,497.74 ","$2,003.90 ","$2,610.00 ","$1,981.28 ","$1,544.27 ","$2,291.00 ",$63.20 ,"$2,900.00 ","$2,900.00 ","$1,528.99 ","$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000569,64486,HC TAP BLOCK W/INJ UNILT,360,1 ,"$1,090.20 ",$719.53 ,$13.98 ,"$1,090.20 ",$13.98 ,"$1,090.20 ","$1,090.20 ", N/A ,$654.12 ,$926.67 ,$763.14 ,$13.98 ,$13.98 ,"$1,035.69 ",$828.55 ,$817.65 ,"$1,090.20 ",$926.67 , N/A ,"$1,090.20 ","$1,090.20 ",$763.14 ,$663.93 ,$13.98 , N/A , N/A , N/A ,$14.82 ,$926.67 , N/A ,"$1,002.98 ",$763.14 ,$552.95 ,$663.60 ,$663.93 ,$663.60 ,$753.33 ,$981.18 ,$744.82 , N/A ,$861.26 ,$14.82 ,"$1,090.20 ","$1,090.20 ", N/A ,"$1,090.20 ",$784.94 ,$675.92 ,$784.94 ,$784.94 ,$872.16 
ST NICHOLAS HOSPITAL - ACUTE,36000587,59300,HC EPISIOTOMY/VAGINAL REPAIR,360,1 ,"$8,149.05 ","$5,378.37 ",$69.86 ,"$8,149.05 ",$69.86 ,"$4,469.00 ","$4,010.00 ","$2,759.58 ","$4,889.43 ","$6,926.69 ","$5,704.34 ",$69.86 ,$69.86 ,"$7,741.60 ","$6,193.28 ","$6,111.79 ","$4,807.00 ","$6,926.69 ","$2,759.58 ","$4,807.00 ","$4,807.00 ","$5,704.34 ","$4,962.77 ",$69.86 ,"$2,759.58 ","$2,704.39 ","$5,519.16 ",$74.05 ,"$6,926.69 ","$6,209.06 ","$7,497.13 ","$5,704.34 ","$2,747.95 ","$3,435.21 ","$4,962.77 ","$3,435.21 ","$5,630.99 ","$7,334.15 ","$5,567.43 ","$2,731.44 ","$6,437.75 ",$74.05 ,"$5,171.00 ","$5,171.00 ","$2,704.39 ","$5,171.00 ","$5,867.32 ","$5,052.41 ","$5,867.32 ","$5,867.32 ","$6,519.24 "
ST NICHOLAS HOSPITAL - ACUTE,36000690,34701,HC ENDOVASC RPR AORTA GRAFT OTHER THAN RUPTURE,360,1 ,"$24,610.00 ","$16,242.60 ",$581.21 ,"$24,610.00 ",$581.21 ,"$20,624.00 ","$12,891.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ",$581.21 ,$581.21 ,"$23,379.50 ","$18,703.60 ","$18,457.50 ","$7,276.00 ","$20,918.50 ", N/A ,"$7,276.00 ","$7,276.00 ","$17,227.00 ","$14,987.49 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ", N/A , N/A ,"$14,987.49 ", N/A ,"$17,005.51 ","$22,149.00 ","$16,813.55 ", N/A ,"$19,441.90 ",$616.08 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000691,34702,HC ENDOVASC RPR AORTA GRAFT W/RUPTURE,360,1 ,"$34,240.00 ","$22,598.40 ",$581.21 ,"$34,240.00 ",$581.21 ,"$20,624.00 ","$12,891.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ",$581.21 ,$581.21 ,"$32,528.00 ","$26,022.40 ","$25,680.00 ","$7,276.00 ","$29,104.00 ", N/A ,"$7,276.00 ","$7,276.00 ","$23,968.00 ","$20,852.16 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$29,104.00 ", N/A ,"$31,500.80 ","$23,968.00 ", N/A , N/A ,"$20,852.16 ", N/A ,"$23,659.84 ","$30,816.00 ","$23,392.77 ", N/A ,"$27,049.60 ",$616.08 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$27,392.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000692,34703,HC ENDOVASC RPR AORTA-UNILAC GRAFT OTHER THAN RUPTURE,360,1 ,"$24,610.00 ","$16,242.60 ",$581.21 ,"$24,610.00 ",$581.21 ,"$20,624.00 ","$12,891.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ",$581.21 ,$581.21 ,"$23,379.50 ","$18,703.60 ","$18,457.50 ","$7,276.00 ","$20,918.50 ", N/A ,"$7,276.00 ","$7,276.00 ","$17,227.00 ","$14,987.49 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ", N/A , N/A ,"$14,987.49 ", N/A ,"$17,005.51 ","$22,149.00 ","$16,813.55 ", N/A ,"$19,441.90 ",$616.08 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000693,34704,HC ENDOVASC RPR AORTA-UNILAC GRAFT W/RUPTURE,360,1 ,"$34,240.00 ","$22,598.40 ",$581.21 ,"$34,240.00 ",$581.21 ,"$20,624.00 ","$12,891.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ",$581.21 ,$581.21 ,"$32,528.00 ","$26,022.40 ","$25,680.00 ","$7,276.00 ","$29,104.00 ", N/A ,"$7,276.00 ","$7,276.00 ","$23,968.00 ","$20,852.16 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$29,104.00 ", N/A ,"$31,500.80 ","$23,968.00 ", N/A , N/A ,"$20,852.16 ", N/A ,"$23,659.84 ","$30,816.00 ","$23,392.77 ", N/A ,"$27,049.60 ",$616.08 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$27,392.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000694,34705,HC ENDOVASC RPR AORTA-BILIAC GRAFT OTHER THAN RUPTURE,360,1 ,"$24,610.00 ","$16,242.60 ",$581.21 ,"$24,610.00 ",$581.21 ,"$20,624.00 ","$12,891.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ",$581.21 ,$581.21 ,"$23,379.50 ","$18,703.60 ","$18,457.50 ","$7,276.00 ","$20,918.50 ", N/A ,"$7,276.00 ","$7,276.00 ","$17,227.00 ","$14,987.49 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ", N/A , N/A ,"$14,987.49 ", N/A ,"$17,005.51 ","$22,149.00 ","$16,813.55 ", N/A ,"$19,441.90 ",$616.08 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000695,34706,HC ENDOVASC RPR AORTA-BILIAC GRAFT W/RUPTURE,360,1 ,"$34,240.00 ","$22,598.40 ",$581.21 ,"$34,240.00 ",$581.21 ,"$20,624.00 ","$12,891.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ",$581.21 ,$581.21 ,"$32,528.00 ","$26,022.40 ","$25,680.00 ","$7,276.00 ","$29,104.00 ", N/A ,"$7,276.00 ","$7,276.00 ","$23,968.00 ","$20,852.16 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$29,104.00 ", N/A ,"$31,500.80 ","$23,968.00 ", N/A , N/A ,"$20,852.16 ", N/A ,"$23,659.84 ","$30,816.00 ","$23,392.77 ", N/A ,"$27,049.60 ",$616.08 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$27,392.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000696,34709,HC PLACE PROSTH ILIAC ARTERY PER VESSEL,360,1 ,"$3,531.00 ","$2,330.46 ",$581.21 ,"$6,233.42 ",$581.21 ,"$3,531.00 ","$3,531.00 ", N/A ,"$2,118.60 ","$3,001.35 ","$2,471.70 ",$581.21 ,$581.21 ,"$3,354.45 ","$2,683.56 ","$2,648.25 ","$3,531.00 ","$3,001.35 ", N/A ,"$3,531.00 ","$3,531.00 ","$2,471.70 ","$2,150.38 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$3,001.35 ", N/A ,"$3,248.52 ","$2,471.70 ","$4,986.74 ","$6,233.42 ","$2,150.38 ","$6,233.42 ","$2,439.92 ","$3,177.90 ","$2,412.38 ", N/A ,"$2,789.49 ",$616.08 ,"$3,531.00 ","$3,531.00 ", N/A ,"$3,531.00 ","$2,542.32 ","$2,189.22 ","$2,542.32 ","$2,542.32 ","$2,824.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000697,34710,HC PLACE PROSTH REPAIR ABDOM ARTERY INIT VESSEL,360,1 ,"$24,610.00 ","$16,242.60 ",$581.21 ,"$24,610.00 ",$581.21 ,"$18,332.00 ","$10,885.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ",$581.21 ,$581.21 ,"$23,379.50 ","$18,703.60 ","$18,457.50 ","$7,276.00 ","$20,918.50 ", N/A ,"$7,276.00 ","$7,276.00 ","$17,227.00 ","$14,987.49 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ", N/A , N/A ,"$14,987.49 ", N/A ,"$17,005.51 ","$22,149.00 ","$16,813.55 ", N/A ,"$19,441.90 ",$616.08 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000698,34711,HC PLACE PROSTH REPAIR ABDOM ARTERY EA ADDL VESSEL,360,1 ,"$3,531.00 ","$2,330.46 ",$581.21 ,"$6,233.42 ",$581.21 ,"$3,531.00 ","$3,531.00 ", N/A ,"$2,118.60 ","$3,001.35 ","$2,471.70 ",$581.21 ,$581.21 ,"$3,354.45 ","$2,683.56 ","$2,648.25 ","$3,531.00 ","$3,001.35 ", N/A ,"$3,531.00 ","$3,531.00 ","$2,471.70 ","$2,150.38 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$3,001.35 ", N/A ,"$3,248.52 ","$2,471.70 ","$4,986.74 ","$6,233.42 ","$2,150.38 ","$6,233.42 ","$2,439.92 ","$3,177.90 ","$2,412.38 ", N/A ,"$2,789.49 ",$616.08 ,"$3,531.00 ","$3,531.00 ", N/A ,"$3,531.00 ","$2,542.32 ","$2,189.22 ","$2,542.32 ","$2,542.32 ","$2,824.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000699,34707,HC ENDOVASC RPR ILIAC ARTERY OTHER THAN RUPTURE,360,1 ,"$24,610.00 ","$16,242.60 ",$581.21 ,"$24,610.00 ",$581.21 ,"$18,332.00 ","$10,885.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ",$581.21 ,$581.21 ,"$23,379.50 ","$18,703.60 ","$18,457.50 ","$7,276.00 ","$20,918.50 ", N/A ,"$7,276.00 ","$7,276.00 ","$17,227.00 ","$14,987.49 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ", N/A , N/A ,"$14,987.49 ", N/A ,"$17,005.51 ","$22,149.00 ","$16,813.55 ", N/A ,"$19,441.90 ",$616.08 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000700,34708,HC ENDOVASC RPR ILIAC ARTERY W/RUPTURE,360,1 ,"$34,240.00 ","$22,598.40 ",$581.21 ,"$34,240.00 ",$581.21 ,"$18,332.00 ","$10,885.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ",$581.21 ,$581.21 ,"$32,528.00 ","$26,022.40 ","$25,680.00 ","$7,276.00 ","$29,104.00 ", N/A ,"$7,276.00 ","$7,276.00 ","$23,968.00 ","$20,852.16 ",$581.21 , N/A , N/A , N/A ,$616.08 ,"$29,104.00 ", N/A ,"$31,500.80 ","$23,968.00 ", N/A , N/A ,"$20,852.16 ", N/A ,"$23,659.84 ","$30,816.00 ","$23,392.77 ", N/A ,"$27,049.60 ",$616.08 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$27,392.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000722,N/A,HC BRONCHOSCOPY W/DILATION/FX REDUCTION,360,1 ,"$3,561.60 ","$2,350.66 ","$1,806.44 ","$3,561.60 ", N/A , N/A , N/A , N/A ,"$2,136.96 ","$3,027.36 ","$2,493.12 ", N/A , N/A ,"$3,383.52 ","$2,706.82 ","$2,671.20 ", N/A ,"$3,027.36 ", N/A , N/A , N/A ,"$2,493.12 ","$2,169.01 ", N/A , N/A , N/A , N/A , N/A ,"$3,027.36 ", N/A ,"$3,276.67 ","$2,493.12 ","$1,806.44 ","$2,167.95 ","$2,169.01 ","$2,167.95 ","$2,461.07 ","$3,205.44 ","$2,433.29 ", N/A ,"$2,813.66 ", N/A , N/A , N/A , N/A , N/A ,"$2,564.35 ","$2,208.19 ","$2,564.35 ","$2,564.35 ","$2,849.28 "
ST NICHOLAS HOSPITAL - ACUTE,36000747,65426,HC EXCIS/TRANSP PTERYGIUM W/GRAFT,360,1 ,"$7,180.60 ","$4,739.20 ",$115.40 ,"$7,180.60 ",$115.40 ,"$4,469.00 ","$4,010.00 ","$2,063.48 ","$4,308.36 ","$6,103.51 ","$5,026.42 ",$115.40 ,$115.40 ,"$6,821.57 ","$5,457.26 ","$5,385.45 ","$7,180.60 ","$6,103.51 ","$2,063.48 ","$7,180.60 ","$7,180.60 ","$5,026.42 ","$4,372.99 ",$115.40 ,"$2,063.48 ","$2,022.21 ","$4,126.96 ",$122.32 ,"$6,103.51 ","$4,642.83 ","$6,606.15 ","$5,026.42 ","$2,747.95 ","$3,435.21 ","$4,372.99 ","$3,435.21 ","$4,961.79 ","$6,462.54 ","$4,905.79 ","$2,042.43 ","$5,672.67 ",$122.32 ,"$5,171.00 ","$5,171.00 ","$2,022.21 ","$5,171.00 ","$5,170.03 ","$4,451.97 ","$5,170.03 ","$5,170.03 ","$5,744.48 "
ST NICHOLAS HOSPITAL - ACUTE,36000750,31599,HC LARYNX SURG PROC UNLISTED,360,1 ,$709.55 ,$468.30 ,$51.06 ,$709.55 ,$51.06 ,$709.55 ,$709.55 ,$202.84 ,$425.73 ,$603.12 ,$496.69 ,$51.06 ,$51.06 ,$674.07 ,$539.26 ,$532.16 ,$709.55 ,$603.12 ,$202.84 ,$709.55 ,$709.55 ,$496.69 ,$432.12 ,$51.06 ,$202.84 ,$198.78 ,$405.68 ,$54.12 ,$603.12 ,$456.39 ,$652.79 ,$496.69 ,$359.88 ,$431.90 ,$432.12 ,$431.90 ,$490.30 ,$638.60 ,$484.76 ,$200.77 ,$560.54 ,$54.12 ,$709.55 ,$709.55 ,$198.78 ,$709.55 ,$510.88 ,$439.92 ,$510.88 ,$510.88 ,$567.64 
ST NICHOLAS HOSPITAL - ACUTE,36000752,45390,HC COLONOSCOPY W/RESECTION,360,1 ,"$7,347.00 ","$4,849.02 ",$72.66 ,"$7,347.00 ",$72.66 ,"$4,469.00 ","$4,010.00 ","$2,507.80 ","$4,408.20 ","$6,244.95 ","$5,142.90 ",$72.66 ,$72.66 ,"$6,979.65 ","$5,583.72 ","$5,510.25 ","$7,276.00 ","$6,244.95 ","$2,507.80 ","$7,276.00 ","$7,276.00 ","$5,142.90 ","$4,474.32 ",$72.66 ,"$2,507.80 ","$2,457.64 ","$5,015.60 ",$77.02 ,"$6,244.95 ","$5,642.56 ","$6,759.24 ","$5,142.90 ","$1,998.41 ","$2,497.74 ","$4,474.32 ","$2,497.74 ","$5,076.78 ","$6,612.30 ","$5,019.47 ","$2,482.22 ","$5,804.13 ",$77.02 ,"$4,106.00 ","$4,106.00 ","$2,457.64 ","$4,106.00 ","$5,289.84 ","$4,555.14 ","$5,289.84 ","$5,289.84 ","$5,877.60 "
ST NICHOLAS HOSPITAL - ACUTE,36000761,54115,HC REMOVAL FOREIGN BODY DEEP PENILE TISSUE,360,1 ,"$8,462.85 ","$5,585.48 ",$68.85 ,"$8,462.85 ",$68.85 ,"$8,020.00 ","$7,448.00 ","$2,521.25 ","$5,077.71 ","$7,193.42 ","$5,924.00 ",$68.85 ,$68.85 ,"$8,039.71 ","$6,431.77 ","$6,347.14 ","$2,929.00 ","$7,193.42 ","$2,521.25 ","$2,929.00 ","$2,929.00 ","$5,924.00 ","$5,153.88 ",$68.85 ,"$2,521.25 ","$2,470.82 ","$5,042.50 ",$72.98 ,"$7,193.42 ","$5,672.82 ","$7,785.82 ","$5,924.00 ","$2,747.95 ","$3,435.21 ","$5,153.88 ","$3,435.21 ","$5,847.83 ","$7,616.57 ","$5,781.82 ","$2,495.53 ","$6,685.65 ",$72.98 ,"$5,171.00 ","$5,171.00 ","$2,470.82 ","$5,171.00 ","$6,093.25 ","$5,246.97 ","$6,093.25 ","$6,093.25 ","$6,770.28 "
ST NICHOLAS HOSPITAL - ACUTE,36010135,N/A,HC MINOR TREATMENT ROOM LEVEL 1,360,1 ,"$1,068.48 ",$705.20 ,$541.93 ,"$1,068.48 ", N/A , N/A , N/A , N/A ,$641.09 ,$908.21 ,$747.94 , N/A , N/A ,"$1,015.06 ",$812.04 ,$801.36 , N/A ,$908.21 , N/A , N/A , N/A ,$747.94 ,$650.70 , N/A , N/A , N/A , N/A , N/A ,$908.21 , N/A ,$983.00 ,$747.94 ,$541.93 ,$650.38 ,$650.70 ,$650.38 ,$738.32 ,$961.63 ,$729.99 , N/A ,$844.10 , N/A , N/A , N/A , N/A , N/A ,$769.31 ,$662.46 ,$769.31 ,$769.31 ,$854.78 
ST NICHOLAS HOSPITAL - ACUTE,36030001,N/A,HC ABDOMINOPLASTY MINI,360,1 ,"$2,946.80 ","$1,944.89 ","$1,494.62 ","$2,946.80 ", N/A , N/A , N/A , N/A ,"$1,768.08 ","$2,504.78 ","$2,062.76 ", N/A , N/A ,"$2,799.46 ","$2,239.57 ","$2,210.10 ", N/A ,"$2,504.78 ", N/A , N/A , N/A ,"$2,062.76 ","$1,794.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,504.78 ", N/A ,"$2,711.06 ","$2,062.76 ","$1,494.62 ","$1,793.72 ","$1,794.60 ","$1,793.72 ","$2,036.24 ","$2,652.12 ","$2,013.25 ", N/A ,"$2,327.97 ", N/A , N/A , N/A , N/A , N/A ,"$2,121.70 ","$1,827.02 ","$2,121.70 ","$2,121.70 ","$2,357.44 "
ST NICHOLAS HOSPITAL - ACUTE,36030002,N/A,HC ABDOMINOPLASTY OPEN/ENDOSCOPIC,360,1 ,"$3,592.34 ","$2,370.94 ","$1,822.03 ","$3,592.34 ", N/A , N/A , N/A , N/A ,"$2,155.40 ","$3,053.49 ","$2,514.64 ", N/A , N/A ,"$3,412.72 ","$2,730.18 ","$2,694.26 ", N/A ,"$3,053.49 ", N/A , N/A , N/A ,"$2,514.64 ","$2,187.74 ", N/A , N/A , N/A , N/A , N/A ,"$3,053.49 ", N/A ,"$3,304.95 ","$2,514.64 ","$1,822.03 ","$2,186.66 ","$2,187.74 ","$2,186.66 ","$2,482.31 ","$3,233.11 ","$2,454.29 ", N/A ,"$2,837.95 ", N/A , N/A , N/A , N/A , N/A ,"$2,586.48 ","$2,227.25 ","$2,586.48 ","$2,586.48 ","$2,873.87 "
ST NICHOLAS HOSPITAL - ACUTE,36030003,N/A,HC BLEPHAROPLASTY LOWER,360,1 ,"$1,651.48 ","$1,089.98 ",$837.63 ,"$1,651.48 ", N/A , N/A , N/A , N/A ,$990.89 ,"$1,403.76 ","$1,156.04 ", N/A , N/A ,"$1,568.91 ","$1,255.12 ","$1,238.61 ", N/A ,"$1,403.76 ", N/A , N/A , N/A ,"$1,156.04 ","$1,005.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,403.76 ", N/A ,"$1,519.36 ","$1,156.04 ",$837.63 ,"$1,005.26 ","$1,005.75 ","$1,005.26 ","$1,141.17 ","$1,486.33 ","$1,128.29 ", N/A ,"$1,304.67 ", N/A , N/A , N/A , N/A , N/A ,"$1,189.07 ","$1,023.92 ","$1,189.07 ","$1,189.07 ","$1,321.18 "
ST NICHOLAS HOSPITAL - ACUTE,36030004,N/A,HC BLEPHAROPLASTY UPPER,360,1 ,"$1,004.88 ",$663.22 ,$509.68 ,"$1,004.88 ", N/A , N/A , N/A , N/A ,$602.93 ,$854.15 ,$703.42 , N/A , N/A ,$954.64 ,$763.71 ,$753.66 , N/A ,$854.15 , N/A , N/A , N/A ,$703.42 ,$611.97 , N/A , N/A , N/A , N/A , N/A ,$854.15 , N/A ,$924.49 ,$703.42 ,$509.68 ,$611.67 ,$611.97 ,$611.67 ,$694.37 ,$904.39 ,$686.53 , N/A ,$793.86 , N/A , N/A , N/A , N/A , N/A ,$723.51 ,$623.03 ,$723.51 ,$723.51 ,$803.90 
ST NICHOLAS HOSPITAL - ACUTE,36030005,N/A,HC BLEPHAROPLASTY UPPER/LOWER,360,1 ,"$2,300.20 ","$1,518.13 ","$1,166.66 ","$2,300.20 ", N/A , N/A , N/A , N/A ,"$1,380.12 ","$1,955.17 ","$1,610.14 ", N/A , N/A ,"$2,185.19 ","$1,748.15 ","$1,725.15 ", N/A ,"$1,955.17 ", N/A , N/A , N/A ,"$1,610.14 ","$1,400.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,955.17 ", N/A ,"$2,116.18 ","$1,610.14 ","$1,166.66 ","$1,400.13 ","$1,400.82 ","$1,400.13 ","$1,589.44 ","$2,070.18 ","$1,571.50 ", N/A ,"$1,817.16 ", N/A , N/A , N/A , N/A , N/A ,"$1,656.14 ","$1,426.12 ","$1,656.14 ","$1,656.14 ","$1,840.16 "
ST NICHOLAS HOSPITAL - ACUTE,36030006,N/A,HC BRACHIOPLASTY (ARM LIFT),360,1 ,"$2,946.80 ","$1,944.89 ","$1,494.62 ","$2,946.80 ", N/A , N/A , N/A , N/A ,"$1,768.08 ","$2,504.78 ","$2,062.76 ", N/A , N/A ,"$2,799.46 ","$2,239.57 ","$2,210.10 ", N/A ,"$2,504.78 ", N/A , N/A , N/A ,"$2,062.76 ","$1,794.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,504.78 ", N/A ,"$2,711.06 ","$2,062.76 ","$1,494.62 ","$1,793.72 ","$1,794.60 ","$1,793.72 ","$2,036.24 ","$2,652.12 ","$2,013.25 ", N/A ,"$2,327.97 ", N/A , N/A , N/A , N/A , N/A ,"$2,121.70 ","$1,827.02 ","$2,121.70 ","$2,121.70 ","$2,357.44 "
ST NICHOLAS HOSPITAL - ACUTE,36030008,N/A,HC BREAST AUGMENTATION (BILAT),360,1 ,"$2,300.20 ","$1,518.13 ","$1,166.66 ","$2,300.20 ", N/A , N/A , N/A , N/A ,"$1,380.12 ","$1,955.17 ","$1,610.14 ", N/A , N/A ,"$2,185.19 ","$1,748.15 ","$1,725.15 ", N/A ,"$1,955.17 ", N/A , N/A , N/A ,"$1,610.14 ","$1,400.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,955.17 ", N/A ,"$2,116.18 ","$1,610.14 ","$1,166.66 ","$1,400.13 ","$1,400.82 ","$1,400.13 ","$1,589.44 ","$2,070.18 ","$1,571.50 ", N/A ,"$1,817.16 ", N/A , N/A , N/A , N/A , N/A ,"$1,656.14 ","$1,426.12 ","$1,656.14 ","$1,656.14 ","$1,840.16 "
ST NICHOLAS HOSPITAL - ACUTE,36030009,N/A,HC BREAST LIFT W/IMPLANTS (MASTOP,360,1 ,"$4,888.72 ","$3,226.56 ","$2,479.56 ","$4,888.72 ", N/A , N/A , N/A , N/A ,"$2,933.23 ","$4,155.41 ","$3,422.10 ", N/A , N/A ,"$4,644.28 ","$3,715.43 ","$3,666.54 ", N/A ,"$4,155.41 ", N/A , N/A , N/A ,"$3,422.10 ","$2,977.23 ", N/A , N/A , N/A , N/A , N/A ,"$4,155.41 ", N/A ,"$4,497.62 ","$3,422.10 ","$2,479.56 ","$2,975.76 ","$2,977.23 ","$2,975.76 ","$3,378.11 ","$4,399.85 ","$3,339.97 ", N/A ,"$3,862.09 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.88 ","$3,031.01 ","$3,519.88 ","$3,519.88 ","$3,910.98 "
ST NICHOLAS HOSPITAL - ACUTE,36030010,N/A,HC BREAST LIFT(MASTOPEXY),360,1 ,"$2,946.80 ","$1,944.89 ","$1,494.62 ","$2,946.80 ", N/A , N/A , N/A , N/A ,"$1,768.08 ","$2,504.78 ","$2,062.76 ", N/A , N/A ,"$2,799.46 ","$2,239.57 ","$2,210.10 ", N/A ,"$2,504.78 ", N/A , N/A , N/A ,"$2,062.76 ","$1,794.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,504.78 ", N/A ,"$2,711.06 ","$2,062.76 ","$1,494.62 ","$1,793.72 ","$1,794.60 ","$1,793.72 ","$2,036.24 ","$2,652.12 ","$2,013.25 ", N/A ,"$2,327.97 ", N/A , N/A , N/A , N/A , N/A ,"$2,121.70 ","$1,827.02 ","$2,121.70 ","$2,121.70 ","$2,357.44 "
ST NICHOLAS HOSPITAL - ACUTE,36030011,N/A,HC BREAST REDUCTION BILATERAL,360,1 ,"$4,241.06 ","$2,799.10 ","$2,151.07 ","$4,241.06 ", N/A , N/A , N/A , N/A ,"$2,544.64 ","$3,604.90 ","$2,968.74 ", N/A , N/A ,"$4,029.01 ","$3,223.21 ","$3,180.80 ", N/A ,"$3,604.90 ", N/A , N/A , N/A ,"$2,968.74 ","$2,582.81 ", N/A , N/A , N/A , N/A , N/A ,"$3,604.90 ", N/A ,"$3,901.78 ","$2,968.74 ","$2,151.07 ","$2,581.53 ","$2,582.81 ","$2,581.53 ","$2,930.57 ","$3,816.95 ","$2,897.49 ", N/A ,"$3,350.44 ", N/A , N/A , N/A , N/A , N/A ,"$3,053.56 ","$2,629.46 ","$3,053.56 ","$3,053.56 ","$3,392.85 "
ST NICHOLAS HOSPITAL - ACUTE,36030014,N/A,HC BROW LIFT ENDOSCOPIC,360,1 ,"$3,592.34 ","$2,370.94 ","$1,822.03 ","$3,592.34 ", N/A , N/A , N/A , N/A ,"$2,155.40 ","$3,053.49 ","$2,514.64 ", N/A , N/A ,"$3,412.72 ","$2,730.18 ","$2,694.26 ", N/A ,"$3,053.49 ", N/A , N/A , N/A ,"$2,514.64 ","$2,187.74 ", N/A , N/A , N/A , N/A , N/A ,"$3,053.49 ", N/A ,"$3,304.95 ","$2,514.64 ","$1,822.03 ","$2,186.66 ","$2,187.74 ","$2,186.66 ","$2,482.31 ","$3,233.11 ","$2,454.29 ", N/A ,"$2,837.95 ", N/A , N/A , N/A , N/A , N/A ,"$2,586.48 ","$2,227.25 ","$2,586.48 ","$2,586.48 ","$2,873.87 "
ST NICHOLAS HOSPITAL - ACUTE,36030015,N/A,HC BROW LIFT OPEN,360,1 ,"$2,300.20 ","$1,518.13 ","$1,166.66 ","$2,300.20 ", N/A , N/A , N/A , N/A ,"$1,380.12 ","$1,955.17 ","$1,610.14 ", N/A , N/A ,"$2,185.19 ","$1,748.15 ","$1,725.15 ", N/A ,"$1,955.17 ", N/A , N/A , N/A ,"$1,610.14 ","$1,400.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,955.17 ", N/A ,"$2,116.18 ","$1,610.14 ","$1,166.66 ","$1,400.13 ","$1,400.82 ","$1,400.13 ","$1,589.44 ","$2,070.18 ","$1,571.50 ", N/A ,"$1,817.16 ", N/A , N/A , N/A , N/A , N/A ,"$1,656.14 ","$1,426.12 ","$1,656.14 ","$1,656.14 ","$1,840.16 "
ST NICHOLAS HOSPITAL - ACUTE,36030017,N/A,HC FACELIFT (RHYTIDECTOMY),360,1 ,"$4,888.72 ","$3,226.56 ","$2,479.56 ","$4,888.72 ", N/A , N/A , N/A , N/A ,"$2,933.23 ","$4,155.41 ","$3,422.10 ", N/A , N/A ,"$4,644.28 ","$3,715.43 ","$3,666.54 ", N/A ,"$4,155.41 ", N/A , N/A , N/A ,"$3,422.10 ","$2,977.23 ", N/A , N/A , N/A , N/A , N/A ,"$4,155.41 ", N/A ,"$4,497.62 ","$3,422.10 ","$2,479.56 ","$2,975.76 ","$2,977.23 ","$2,975.76 ","$3,378.11 ","$4,399.85 ","$3,339.97 ", N/A ,"$3,862.09 ", N/A , N/A , N/A , N/A , N/A ,"$3,519.88 ","$3,031.01 ","$3,519.88 ","$3,519.88 ","$3,910.98 "
ST NICHOLAS HOSPITAL - ACUTE,36030055,N/A,HC NECKLIFT (PLATSYMAPLASTY),360,1 ,"$2,946.80 ","$1,944.89 ","$1,494.62 ","$2,946.80 ", N/A , N/A , N/A , N/A ,"$1,768.08 ","$2,504.78 ","$2,062.76 ", N/A , N/A ,"$2,799.46 ","$2,239.57 ","$2,210.10 ", N/A ,"$2,504.78 ", N/A , N/A , N/A ,"$2,062.76 ","$1,794.60 ", N/A , N/A , N/A , N/A , N/A ,"$2,504.78 ", N/A ,"$2,711.06 ","$2,062.76 ","$1,494.62 ","$1,793.72 ","$1,794.60 ","$1,793.72 ","$2,036.24 ","$2,652.12 ","$2,013.25 ", N/A ,"$2,327.97 ", N/A , N/A , N/A , N/A , N/A ,"$2,121.70 ","$1,827.02 ","$2,121.70 ","$2,121.70 ","$2,357.44 "
ST NICHOLAS HOSPITAL - ACUTE,36030056,N/A,HC RHINOPLASTY (2 HR),360,1 ,"$3,592.34 ","$2,370.94 ","$1,822.03 ","$3,592.34 ", N/A , N/A , N/A , N/A ,"$2,155.40 ","$3,053.49 ","$2,514.64 ", N/A , N/A ,"$3,412.72 ","$2,730.18 ","$2,694.26 ", N/A ,"$3,053.49 ", N/A , N/A , N/A ,"$2,514.64 ","$2,187.74 ", N/A , N/A , N/A , N/A , N/A ,"$3,053.49 ", N/A ,"$3,304.95 ","$2,514.64 ","$1,822.03 ","$2,186.66 ","$2,187.74 ","$2,186.66 ","$2,482.31 ","$3,233.11 ","$2,454.29 ", N/A ,"$2,837.95 ", N/A , N/A , N/A , N/A , N/A ,"$2,586.48 ","$2,227.25 ","$2,586.48 ","$2,586.48 ","$2,873.87 "
ST NICHOLAS HOSPITAL - ACUTE,36030112,N/A,HC DENTAL 0-90 MIN ASC,360,1 ,"$7,011.90 ","$4,627.85 ","$3,556.44 ","$7,011.90 ", N/A , N/A , N/A , N/A ,"$4,207.14 ","$5,960.12 ","$4,908.33 ", N/A , N/A ,"$6,661.31 ","$5,329.04 ","$5,258.93 ", N/A ,"$5,960.12 ", N/A , N/A , N/A ,"$4,908.33 ","$4,270.25 ", N/A , N/A , N/A , N/A , N/A ,"$5,960.12 ", N/A ,"$6,450.95 ","$4,908.33 ","$3,556.44 ","$4,268.14 ","$4,270.25 ","$4,268.14 ","$4,845.22 ","$6,310.71 ","$4,790.53 ", N/A ,"$5,539.40 ", N/A , N/A , N/A , N/A , N/A ,"$5,048.57 ","$4,347.38 ","$5,048.57 ","$5,048.57 ","$5,609.52 "
ST NICHOLAS HOSPITAL - ACUTE,36030113,N/A,HC DENTAL 91-150 MIN ASC,360,1 ,"$1,335.60 ",$881.50 ,$677.42 ,"$1,335.60 ", N/A , N/A , N/A , N/A ,$801.36 ,"$1,135.26 ",$934.92 , N/A , N/A ,"$1,268.82 ","$1,015.06 ","$1,001.70 ", N/A ,"$1,135.26 ", N/A , N/A , N/A ,$934.92 ,$813.38 , N/A , N/A , N/A , N/A , N/A ,"$1,135.26 ", N/A ,"$1,228.75 ",$934.92 ,$677.42 ,$812.98 ,$813.38 ,$812.98 ,$922.90 ,"$1,202.04 ",$912.48 , N/A ,"$1,055.12 ", N/A , N/A , N/A , N/A , N/A ,$961.63 ,$828.07 ,$961.63 ,$961.63 ,"$1,068.48 "
ST NICHOLAS HOSPITAL - ACUTE,36030114,N/A,HC DENTAL 151 AND GREATER ASC,360,1 ,"$2,003.40 ","$1,322.24 ","$1,016.12 ","$2,003.40 ", N/A , N/A , N/A , N/A ,"$1,202.04 ","$1,702.89 ","$1,402.38 ", N/A , N/A ,"$1,903.23 ","$1,522.58 ","$1,502.55 ", N/A ,"$1,702.89 ", N/A , N/A , N/A ,"$1,402.38 ","$1,220.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,702.89 ", N/A ,"$1,843.13 ","$1,402.38 ","$1,016.12 ","$1,219.47 ","$1,220.07 ","$1,219.47 ","$1,384.35 ","$1,803.06 ","$1,368.72 ", N/A ,"$1,582.69 ", N/A , N/A , N/A , N/A , N/A ,"$1,442.45 ","$1,242.11 ","$1,442.45 ","$1,442.45 ","$1,602.72 "
ST NICHOLAS HOSPITAL - ACUTE,36030120,N/A,HC LIPOSUCTION MINI,360,1 ,"$1,441.60 ",$951.46 ,$731.18 ,"$1,441.60 ", N/A , N/A , N/A , N/A ,$864.96 ,"$1,225.36 ","$1,009.12 ", N/A , N/A ,"$1,369.52 ","$1,095.62 ","$1,081.20 ", N/A ,"$1,225.36 ", N/A , N/A , N/A ,"$1,009.12 ",$877.93 , N/A , N/A , N/A , N/A , N/A ,"$1,225.36 ", N/A ,"$1,326.27 ","$1,009.12 ",$731.18 ,$877.50 ,$877.93 ,$877.50 ,$996.15 ,"$1,297.44 ",$984.90 , N/A ,"$1,138.86 ", N/A , N/A , N/A , N/A , N/A ,"$1,037.95 ",$893.79 ,"$1,037.95 ","$1,037.95 ","$1,153.28 "
ST NICHOLAS HOSPITAL - ACUTE,36030121,N/A,HC LIPOSUCTION MEDIUM,360,1 ,"$2,160.28 ","$1,425.78 ","$1,095.69 ","$2,160.28 ", N/A , N/A , N/A , N/A ,"$1,296.17 ","$1,836.24 ","$1,512.20 ", N/A , N/A ,"$2,052.27 ","$1,641.81 ","$1,620.21 ", N/A ,"$1,836.24 ", N/A , N/A , N/A ,"$1,512.20 ","$1,315.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,836.24 ", N/A ,"$1,987.46 ","$1,512.20 ","$1,095.69 ","$1,314.96 ","$1,315.61 ","$1,314.96 ","$1,492.75 ","$1,944.25 ","$1,475.90 ", N/A ,"$1,706.62 ", N/A , N/A , N/A , N/A , N/A ,"$1,555.40 ","$1,339.37 ","$1,555.40 ","$1,555.40 ","$1,728.22 "
ST NICHOLAS HOSPITAL - ACUTE,36030122,N/A,HC LIPOSUCTION FULL,360,1 ,"$2,880.02 ","$1,900.81 ","$1,460.75 ","$2,880.02 ", N/A , N/A , N/A , N/A ,"$1,728.01 ","$2,448.02 ","$2,016.01 ", N/A , N/A ,"$2,736.02 ","$2,188.82 ","$2,160.02 ", N/A ,"$2,448.02 ", N/A , N/A , N/A ,"$2,016.01 ","$1,753.93 ", N/A , N/A , N/A , N/A , N/A ,"$2,448.02 ", N/A ,"$2,649.62 ","$2,016.01 ","$1,460.75 ","$1,753.07 ","$1,753.93 ","$1,753.07 ","$1,990.09 ","$2,592.02 ","$1,967.63 ", N/A ,"$2,275.22 ", N/A , N/A , N/A , N/A , N/A ,"$2,073.61 ","$1,785.61 ","$2,073.61 ","$2,073.61 ","$2,304.02 "
ST NICHOLAS HOSPITAL - ACUTE,36030123,N/A,HC SLIM LIPO PRO MINI,360,1 ,"$1,765.96 ","$1,165.53 ",$895.69 ,"$1,765.96 ", N/A , N/A , N/A , N/A ,"$1,059.58 ","$1,501.07 ","$1,236.17 ", N/A , N/A ,"$1,677.66 ","$1,342.13 ","$1,324.47 ", N/A ,"$1,501.07 ", N/A , N/A , N/A ,"$1,236.17 ","$1,075.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,501.07 ", N/A ,"$1,624.68 ","$1,236.17 ",$895.69 ,"$1,074.94 ","$1,075.47 ","$1,074.94 ","$1,220.28 ","$1,589.36 ","$1,206.50 ", N/A ,"$1,395.11 ", N/A , N/A , N/A , N/A , N/A ,"$1,271.49 ","$1,094.90 ","$1,271.49 ","$1,271.49 ","$1,412.77 "
ST NICHOLAS HOSPITAL - ACUTE,36030124,N/A,HC SLIM LIPO PRO MEDIUM,360,1 ,"$2,485.70 ","$1,640.56 ","$1,260.75 ","$2,485.70 ", N/A , N/A , N/A , N/A ,"$1,491.42 ","$2,112.85 ","$1,739.99 ", N/A , N/A ,"$2,361.42 ","$1,889.13 ","$1,864.28 ", N/A ,"$2,112.85 ", N/A , N/A , N/A ,"$1,739.99 ","$1,513.79 ", N/A , N/A , N/A , N/A , N/A ,"$2,112.85 ", N/A ,"$2,286.84 ","$1,739.99 ","$1,260.75 ","$1,513.05 ","$1,513.79 ","$1,513.05 ","$1,717.62 ","$2,237.13 ","$1,698.23 ", N/A ,"$1,963.70 ", N/A , N/A , N/A , N/A , N/A ,"$1,789.70 ","$1,541.13 ","$1,789.70 ","$1,789.70 ","$1,988.56 "
ST NICHOLAS HOSPITAL - ACUTE,36030125,N/A,HC SLIM LIPO PRO FULL,360,1 ,"$3,205.44 ","$2,115.59 ","$1,625.80 ","$3,205.44 ", N/A , N/A , N/A , N/A ,"$1,923.26 ","$2,724.62 ","$2,243.81 ", N/A , N/A ,"$3,045.17 ","$2,436.13 ","$2,404.08 ", N/A ,"$2,724.62 ", N/A , N/A , N/A ,"$2,243.81 ","$1,952.11 ", N/A , N/A , N/A , N/A , N/A ,"$2,724.62 ", N/A ,"$2,949.00 ","$2,243.81 ","$1,625.80 ","$1,951.15 ","$1,952.11 ","$1,951.15 ","$2,214.96 ","$2,884.90 ","$2,189.96 ", N/A ,"$2,532.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,307.92 ","$1,987.37 ","$2,307.92 ","$2,307.92 ","$2,564.35 "
ST NICHOLAS HOSPITAL - ACUTE,36030200,N/A,HC HEROLD COSMETIC 0-60 MIN,360,1 ,$848.00 ,$559.68 ,$430.11 ,$848.00 , N/A , N/A , N/A , N/A ,$508.80 ,$720.80 ,$593.60 , N/A , N/A ,$805.60 ,$644.48 ,$636.00 , N/A ,$720.80 , N/A , N/A , N/A ,$593.60 ,$516.43 , N/A , N/A , N/A , N/A , N/A ,$720.80 , N/A ,$780.16 ,$593.60 ,$430.11 ,$516.18 ,$516.43 ,$516.18 ,$585.97 ,$763.20 ,$579.35 , N/A ,$669.92 , N/A , N/A , N/A , N/A , N/A ,$610.56 ,$525.76 ,$610.56 ,$610.56 ,$678.40 
ST NICHOLAS HOSPITAL - ACUTE,36030201,N/A,HC HEROLD COSMETIC 61-90 MIN,360,1 ,"$1,219.00 ",$804.54 ,$618.28 ,"$1,219.00 ", N/A , N/A , N/A , N/A ,$731.40 ,"$1,036.15 ",$853.30 , N/A , N/A ,"$1,158.05 ",$926.44 ,$914.25 , N/A ,"$1,036.15 ", N/A , N/A , N/A ,$853.30 ,$742.37 , N/A , N/A , N/A , N/A , N/A ,"$1,036.15 ", N/A ,"$1,121.48 ",$853.30 ,$618.28 ,$742.01 ,$742.37 ,$742.01 ,$842.33 ,"$1,097.10 ",$832.82 , N/A ,$963.01 , N/A , N/A , N/A , N/A , N/A ,$877.68 ,$755.78 ,$877.68 ,$877.68 ,$975.20 
ST NICHOLAS HOSPITAL - ACUTE,36030202,N/A,HC HEROLD COSMETIC  91-120 MIN,360,1 ,"$1,378.00 ",$909.48 ,$698.92 ,"$1,378.00 ", N/A , N/A , N/A , N/A ,$826.80 ,"$1,171.30 ",$964.60 , N/A , N/A ,"$1,309.10 ","$1,047.28 ","$1,033.50 ", N/A ,"$1,171.30 ", N/A , N/A , N/A ,$964.60 ,$839.20 , N/A , N/A , N/A , N/A , N/A ,"$1,171.30 ", N/A ,"$1,267.76 ",$964.60 ,$698.92 ,$838.79 ,$839.20 ,$838.79 ,$952.20 ,"$1,240.20 ",$941.45 , N/A ,"$1,088.62 ", N/A , N/A , N/A , N/A , N/A ,$992.16 ,$854.36 ,$992.16 ,$992.16 ,"$1,102.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030203,N/A,HC HEROLD COSMETIC 121-150 MIN,360,1 ,"$1,590.00 ","$1,049.40 ",$806.45 ,"$1,590.00 ", N/A , N/A , N/A , N/A ,$954.00 ,"$1,351.50 ","$1,113.00 ", N/A , N/A ,"$1,510.50 ","$1,208.40 ","$1,192.50 ", N/A ,"$1,351.50 ", N/A , N/A , N/A ,"$1,113.00 ",$968.31 , N/A , N/A , N/A , N/A , N/A ,"$1,351.50 ", N/A ,"$1,462.80 ","$1,113.00 ",$806.45 ,$967.83 ,$968.31 ,$967.83 ,"$1,098.69 ","$1,431.00 ","$1,086.29 ", N/A ,"$1,256.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,144.80 ",$985.80 ,"$1,144.80 ","$1,144.80 ","$1,272.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030204,N/A,HC HEROLD COSMETIC 151-180 MIN,360,1 ,"$1,749.00 ","$1,154.34 ",$887.09 ,"$1,749.00 ", N/A , N/A , N/A , N/A ,"$1,049.40 ","$1,486.65 ","$1,224.30 ", N/A , N/A ,"$1,661.55 ","$1,329.24 ","$1,311.75 ", N/A ,"$1,486.65 ", N/A , N/A , N/A ,"$1,224.30 ","$1,065.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,486.65 ", N/A ,"$1,609.08 ","$1,224.30 ",$887.09 ,"$1,064.62 ","$1,065.14 ","$1,064.62 ","$1,208.56 ","$1,574.10 ","$1,194.92 ", N/A ,"$1,381.71 ", N/A , N/A , N/A , N/A , N/A ,"$1,259.28 ","$1,084.38 ","$1,259.28 ","$1,259.28 ","$1,399.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030205,N/A,HC HEROLD COSMETIC 181-210 MIN,360,1 ,"$1,908.00 ","$1,259.28 ",$967.74 ,"$1,908.00 ", N/A , N/A , N/A , N/A ,"$1,144.80 ","$1,621.80 ","$1,335.60 ", N/A , N/A ,"$1,812.60 ","$1,450.08 ","$1,431.00 ", N/A ,"$1,621.80 ", N/A , N/A , N/A ,"$1,335.60 ","$1,161.97 ", N/A , N/A , N/A , N/A , N/A ,"$1,621.80 ", N/A ,"$1,755.36 ","$1,335.60 ",$967.74 ,"$1,161.40 ","$1,161.97 ","$1,161.40 ","$1,318.43 ","$1,717.20 ","$1,303.55 ", N/A ,"$1,507.32 ", N/A , N/A , N/A , N/A , N/A ,"$1,373.76 ","$1,182.96 ","$1,373.76 ","$1,373.76 ","$1,526.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030206,N/A,HC HEROLD COSMETIC 211-240 MIN,360,1 ,"$2,120.00 ","$1,399.20 ","$1,075.26 ","$2,120.00 ", N/A , N/A , N/A , N/A ,"$1,272.00 ","$1,802.00 ","$1,484.00 ", N/A , N/A ,"$2,014.00 ","$1,611.20 ","$1,590.00 ", N/A ,"$1,802.00 ", N/A , N/A , N/A ,"$1,484.00 ","$1,291.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,802.00 ", N/A ,"$1,950.40 ","$1,484.00 ","$1,075.26 ","$1,290.44 ","$1,291.08 ","$1,290.44 ","$1,464.92 ","$1,908.00 ","$1,448.38 ", N/A ,"$1,674.80 ", N/A , N/A , N/A , N/A , N/A ,"$1,526.40 ","$1,314.40 ","$1,526.40 ","$1,526.40 ","$1,696.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030207,N/A,HC HEROLD COSMETIC 241-270 MIN,360,1 ,"$2,279.00 ","$1,504.14 ","$1,155.91 ","$2,279.00 ", N/A , N/A , N/A , N/A ,"$1,367.40 ","$1,937.15 ","$1,595.30 ", N/A , N/A ,"$2,165.05 ","$1,732.04 ","$1,709.25 ", N/A ,"$1,937.15 ", N/A , N/A , N/A ,"$1,595.30 ","$1,387.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,937.15 ", N/A ,"$2,096.68 ","$1,595.30 ","$1,155.91 ","$1,387.23 ","$1,387.91 ","$1,387.23 ","$1,574.79 ","$2,051.10 ","$1,557.01 ", N/A ,"$1,800.41 ", N/A , N/A , N/A , N/A , N/A ,"$1,640.88 ","$1,412.98 ","$1,640.88 ","$1,640.88 ","$1,823.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030208,N/A,HC HEROLD COSMETIC 271-300 MIN,360,1 ,"$2,438.00 ","$1,609.08 ","$1,236.55 ","$2,438.00 ", N/A , N/A , N/A , N/A ,"$1,462.80 ","$2,072.30 ","$1,706.60 ", N/A , N/A ,"$2,316.10 ","$1,852.88 ","$1,828.50 ", N/A ,"$2,072.30 ", N/A , N/A , N/A ,"$1,706.60 ","$1,484.74 ", N/A , N/A , N/A , N/A , N/A ,"$2,072.30 ", N/A ,"$2,242.96 ","$1,706.60 ","$1,236.55 ","$1,484.01 ","$1,484.74 ","$1,484.01 ","$1,684.66 ","$2,194.20 ","$1,665.64 ", N/A ,"$1,926.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,755.36 ","$1,511.56 ","$1,755.36 ","$1,755.36 ","$1,950.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030209,N/A,HC HEROLD COSMETIC 301-330 MIN,360,1 ,"$2,597.00 ","$1,714.02 ","$1,317.20 ","$2,597.00 ", N/A , N/A , N/A , N/A ,"$1,558.20 ","$2,207.45 ","$1,817.90 ", N/A , N/A ,"$2,467.15 ","$1,973.72 ","$1,947.75 ", N/A ,"$2,207.45 ", N/A , N/A , N/A ,"$1,817.90 ","$1,581.57 ", N/A , N/A , N/A , N/A , N/A ,"$2,207.45 ", N/A ,"$2,389.24 ","$1,817.90 ","$1,317.20 ","$1,580.79 ","$1,581.57 ","$1,580.79 ","$1,794.53 ","$2,337.30 ","$1,774.27 ", N/A ,"$2,051.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,869.84 ","$1,610.14 ","$1,869.84 ","$1,869.84 ","$2,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,36030210,N/A,HC HEROLD COSMETIC 331+ MIN,360,1 ,"$2,809.00 ","$1,853.94 ","$1,424.72 ","$2,809.00 ", N/A , N/A , N/A , N/A ,"$1,685.40 ","$2,387.65 ","$1,966.30 ", N/A , N/A ,"$2,668.55 ","$2,134.84 ","$2,106.75 ", N/A ,"$2,387.65 ", N/A , N/A , N/A ,"$1,966.30 ","$1,710.68 ", N/A , N/A , N/A , N/A , N/A ,"$2,387.65 ", N/A ,"$2,584.28 ","$1,966.30 ","$1,424.72 ","$1,709.84 ","$1,710.68 ","$1,709.84 ","$1,941.02 ","$2,528.10 ","$1,919.11 ", N/A ,"$2,219.11 ", N/A , N/A , N/A , N/A , N/A ,"$2,022.48 ","$1,741.58 ","$2,022.48 ","$2,022.48 ","$2,247.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030211,N/A,HC HEROLD COSMETIC BREAST AUGMENTATION,360,1 ,$901.00 ,$594.66 ,$456.99 ,$901.00 , N/A , N/A , N/A , N/A ,$540.60 ,$765.85 ,$630.70 , N/A , N/A ,$855.95 ,$684.76 ,$675.75 , N/A ,$765.85 , N/A , N/A , N/A ,$630.70 ,$548.71 , N/A , N/A , N/A , N/A , N/A ,$765.85 , N/A ,$828.92 ,$630.70 ,$456.99 ,$548.44 ,$548.71 ,$548.44 ,$622.59 ,$810.90 ,$615.56 , N/A ,$711.79 , N/A , N/A , N/A , N/A , N/A ,$648.72 ,$558.62 ,$648.72 ,$648.72 ,$720.80 
ST NICHOLAS HOSPITAL - ACUTE,36030300,N/A,HC CAMPBELL BROW LIFT,360,1 ,"$1,335.60 ",$881.50 ,$677.42 ,"$1,335.60 ", N/A , N/A , N/A , N/A ,$801.36 ,"$1,135.26 ",$934.92 , N/A , N/A ,"$1,268.82 ","$1,015.06 ","$1,001.70 ", N/A ,"$1,135.26 ", N/A , N/A , N/A ,$934.92 ,$813.38 , N/A , N/A , N/A , N/A , N/A ,"$1,135.26 ", N/A ,"$1,228.75 ",$934.92 ,$677.42 ,$812.98 ,$813.38 ,$812.98 ,$922.90 ,"$1,202.04 ",$912.48 , N/A ,"$1,055.12 ", N/A , N/A , N/A , N/A , N/A ,$961.63 ,$828.07 ,$961.63 ,$961.63 ,"$1,068.48 "
ST NICHOLAS HOSPITAL - ACUTE,36030301,N/A,HC CAMPBELL BLEPHAROPLASTY LOWER,360,1 ,"$1,029.26 ",$679.31 ,$522.04 ,"$1,029.26 ", N/A , N/A , N/A , N/A ,$617.56 ,$874.87 ,$720.48 , N/A , N/A ,$977.80 ,$782.24 ,$771.95 , N/A ,$874.87 , N/A , N/A , N/A ,$720.48 ,$626.82 , N/A , N/A , N/A , N/A , N/A ,$874.87 , N/A ,$946.92 ,$720.48 ,$522.04 ,$626.51 ,$626.82 ,$626.51 ,$711.22 ,$926.33 ,$703.19 , N/A ,$813.12 , N/A , N/A , N/A , N/A , N/A ,$741.07 ,$638.14 ,$741.07 ,$741.07 ,$823.41 
ST NICHOLAS HOSPITAL - ACUTE,36030302,N/A,HC CAMPBELL BLEPHAROPLASTY UPPER,360,1 ,$751.54 ,$496.02 ,$381.18 ,$751.54 , N/A , N/A , N/A , N/A ,$450.92 ,$638.81 ,$526.08 , N/A , N/A ,$713.96 ,$571.17 ,$563.66 , N/A ,$638.81 , N/A , N/A , N/A ,$526.08 ,$457.69 , N/A , N/A , N/A , N/A , N/A ,$638.81 , N/A ,$691.42 ,$526.08 ,$381.18 ,$457.46 ,$457.69 ,$457.46 ,$519.31 ,$676.39 ,$513.45 , N/A ,$593.72 , N/A , N/A , N/A , N/A , N/A ,$541.11 ,$465.95 ,$541.11 ,$541.11 ,$601.23 
ST NICHOLAS HOSPITAL - ACUTE,36030303,N/A,HC CAMPBELL BLEPHAROPLASTY UPPER/LOWER,360,1 ,"$1,503.08 ",$992.03 ,$762.36 ,"$1,503.08 ", N/A , N/A , N/A , N/A ,$901.85 ,"$1,277.62 ","$1,052.16 ", N/A , N/A ,"$1,427.93 ","$1,142.34 ","$1,127.31 ", N/A ,"$1,277.62 ", N/A , N/A , N/A ,"$1,052.16 ",$915.38 , N/A , N/A , N/A , N/A , N/A ,"$1,277.62 ", N/A ,"$1,382.83 ","$1,052.16 ",$762.36 ,$914.92 ,$915.38 ,$914.92 ,"$1,038.63 ","$1,352.77 ","$1,026.90 ", N/A ,"$1,187.43 ", N/A , N/A , N/A , N/A , N/A ,"$1,082.22 ",$931.91 ,"$1,082.22 ","$1,082.22 ","$1,202.46 "
ST NICHOLAS HOSPITAL - ACUTE,36030304,N/A,HC CAMPBELL MINI-FACELIFT,360,1 ,$779.10 ,$514.21 ,$395.16 ,$779.10 , N/A , N/A , N/A , N/A ,$467.46 ,$662.24 ,$545.37 , N/A , N/A ,$740.15 ,$592.12 ,$584.33 , N/A ,$662.24 , N/A , N/A , N/A ,$545.37 ,$474.47 , N/A , N/A , N/A , N/A , N/A ,$662.24 , N/A ,$716.77 ,$545.37 ,$395.16 ,$474.24 ,$474.47 ,$474.24 ,$538.36 ,$701.19 ,$532.28 , N/A ,$615.49 , N/A , N/A , N/A , N/A , N/A ,$560.95 ,$483.04 ,$560.95 ,$560.95 ,$623.28 
ST NICHOLAS HOSPITAL - ACUTE,36030305,N/A,HC CAMPBELL DEEP PLANE FACELIFT,360,1 ,"$1,558.20 ","$1,028.41 ",$790.32 ,"$1,558.20 ", N/A , N/A , N/A , N/A ,$934.92 ,"$1,324.47 ","$1,090.74 ", N/A , N/A ,"$1,480.29 ","$1,184.23 ","$1,168.65 ", N/A ,"$1,324.47 ", N/A , N/A , N/A ,"$1,090.74 ",$948.94 , N/A , N/A , N/A , N/A , N/A ,"$1,324.47 ", N/A ,"$1,433.54 ","$1,090.74 ",$790.32 ,$948.48 ,$948.94 ,$948.48 ,"$1,076.72 ","$1,402.38 ","$1,064.56 ", N/A ,"$1,230.98 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.90 ",$966.08 ,"$1,121.90 ","$1,121.90 ","$1,246.56 "
ST NICHOLAS HOSPITAL - ACUTE,36030306,N/A,HC CAMPBELL FACIAL IMPLANTS,360,1 ,$445.20 ,$293.83 ,$225.81 ,$445.20 , N/A , N/A , N/A , N/A ,$267.12 ,$378.42 ,$311.64 , N/A , N/A ,$422.94 ,$338.35 ,$333.90 , N/A ,$378.42 , N/A , N/A , N/A ,$311.64 ,$271.13 , N/A , N/A , N/A , N/A , N/A ,$378.42 , N/A ,$409.58 ,$311.64 ,$225.81 ,$270.99 ,$271.13 ,$270.99 ,$307.63 ,$400.68 ,$304.16 , N/A ,$351.71 , N/A , N/A , N/A , N/A , N/A ,$320.54 ,$276.02 ,$320.54 ,$320.54 ,$356.16 
ST NICHOLAS HOSPITAL - ACUTE,36030307,N/A,HC CAMPBELL OTOPLASTY,360,1 ,"$1,558.20 ","$1,028.41 ",$790.32 ,"$1,558.20 ", N/A , N/A , N/A , N/A ,$934.92 ,"$1,324.47 ","$1,090.74 ", N/A , N/A ,"$1,480.29 ","$1,184.23 ","$1,168.65 ", N/A ,"$1,324.47 ", N/A , N/A , N/A ,"$1,090.74 ",$948.94 , N/A , N/A , N/A , N/A , N/A ,"$1,324.47 ", N/A ,"$1,433.54 ","$1,090.74 ",$790.32 ,$948.48 ,$948.94 ,$948.48 ,"$1,076.72 ","$1,402.38 ","$1,064.56 ", N/A ,"$1,230.98 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.90 ",$966.08 ,"$1,121.90 ","$1,121.90 ","$1,246.56 "
ST NICHOLAS HOSPITAL - ACUTE,36030308,N/A,HC CAMPBELL RHINOPLASTY,360,1 ,"$1,474.46 ",$973.14 ,$747.85 ,"$1,474.46 ", N/A , N/A , N/A , N/A ,$884.68 ,"$1,253.29 ","$1,032.12 ", N/A , N/A ,"$1,400.74 ","$1,120.59 ","$1,105.85 ", N/A ,"$1,253.29 ", N/A , N/A , N/A ,"$1,032.12 ",$897.95 , N/A , N/A , N/A , N/A , N/A ,"$1,253.29 ", N/A ,"$1,356.50 ","$1,032.12 ",$747.85 ,$897.50 ,$897.95 ,$897.50 ,"$1,018.85 ","$1,327.01 ","$1,007.35 ", N/A ,"$1,164.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,061.61 ",$914.17 ,"$1,061.61 ","$1,061.61 ","$1,179.57 "
ST NICHOLAS HOSPITAL - ACUTE,36030309,N/A,HC CAMPBELL ERBIUM LASER,360,1 ,$667.80 ,$440.75 ,$338.71 ,$667.80 , N/A , N/A , N/A , N/A ,$400.68 ,$567.63 ,$467.46 , N/A , N/A ,$634.41 ,$507.53 ,$500.85 , N/A ,$567.63 , N/A , N/A , N/A ,$467.46 ,$406.69 , N/A , N/A , N/A , N/A , N/A ,$567.63 , N/A ,$614.38 ,$467.46 ,$338.71 ,$406.49 ,$406.69 ,$406.49 ,$461.45 ,$601.02 ,$456.24 , N/A ,$527.56 , N/A , N/A , N/A , N/A , N/A ,$480.82 ,$414.04 ,$480.82 ,$480.82 ,$534.24 
ST NICHOLAS HOSPITAL - ACUTE,36030310,N/A,HC CAMPBELL COMPREHENSIVE REJUVENATION,360,1 ,"$3,339.00 ","$2,203.74 ","$1,693.54 ","$3,339.00 ", N/A , N/A , N/A , N/A ,"$2,003.40 ","$2,838.15 ","$2,337.30 ", N/A , N/A ,"$3,172.05 ","$2,537.64 ","$2,504.25 ", N/A ,"$2,838.15 ", N/A , N/A , N/A ,"$2,337.30 ","$2,033.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,838.15 ", N/A ,"$3,071.88 ","$2,337.30 ","$1,693.54 ","$2,032.45 ","$2,033.45 ","$2,032.45 ","$2,307.25 ","$3,005.10 ","$2,281.20 ", N/A ,"$2,637.81 ", N/A , N/A , N/A , N/A , N/A ,"$2,404.08 ","$2,070.18 ","$2,404.08 ","$2,404.08 ","$2,671.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030311,N/A,HC CAMPBELL LIPO HEAD AND NECK,360,1 ,$333.90 ,$220.37 ,$169.35 ,$333.90 , N/A , N/A , N/A , N/A ,$200.34 ,$283.82 ,$233.73 , N/A , N/A ,$317.21 ,$253.76 ,$250.43 , N/A ,$283.82 , N/A , N/A , N/A ,$233.73 ,$203.35 , N/A , N/A , N/A , N/A , N/A ,$283.82 , N/A ,$307.19 ,$233.73 ,$169.35 ,$203.24 ,$203.35 ,$203.24 ,$230.72 ,$300.51 ,$228.12 , N/A ,$263.78 , N/A , N/A , N/A , N/A , N/A ,$240.41 ,$207.02 ,$240.41 ,$240.41 ,$267.12 
ST NICHOLAS HOSPITAL - ACUTE,36030312,N/A,HC CAMPBELL COLLAGEN BOTOX INJECTION,360,1 ,$445.20 ,$293.83 ,$225.81 ,$445.20 , N/A , N/A , N/A , N/A ,$267.12 ,$378.42 ,$311.64 , N/A , N/A ,$422.94 ,$338.35 ,$333.90 , N/A ,$378.42 , N/A , N/A , N/A ,$311.64 ,$271.13 , N/A , N/A , N/A , N/A , N/A ,$378.42 , N/A ,$409.58 ,$311.64 ,$225.81 ,$270.99 ,$271.13 ,$270.99 ,$307.63 ,$400.68 ,$304.16 , N/A ,$351.71 , N/A , N/A , N/A , N/A , N/A ,$320.54 ,$276.02 ,$320.54 ,$320.54 ,$356.16 
ST NICHOLAS HOSPITAL - ACUTE,36030313,N/A,HC CAMPBELL CHIN IMPLANT,360,1 ,$974.14 ,$642.93 ,$494.08 ,$974.14 , N/A , N/A , N/A , N/A ,$584.48 ,$828.02 ,$681.90 , N/A , N/A ,$925.43 ,$740.35 ,$730.61 , N/A ,$828.02 , N/A , N/A , N/A ,$681.90 ,$593.25 , N/A , N/A , N/A , N/A , N/A ,$828.02 , N/A ,$896.21 ,$681.90 ,$494.08 ,$592.96 ,$593.25 ,$592.96 ,$673.13 ,$876.73 ,$665.53 , N/A ,$769.57 , N/A , N/A , N/A , N/A , N/A ,$701.38 ,$603.97 ,$701.38 ,$701.38 ,$779.31 
ST NICHOLAS HOSPITAL - ACUTE,36030314,N/A,HC CAMPBELL SKIN TISSUE PROCEDURE,360,1 ,"$1,140.56 ",$752.77 ,$578.49 ,"$1,140.56 ", N/A , N/A , N/A , N/A ,$684.34 ,$969.48 ,$798.39 , N/A , N/A ,"$1,083.53 ",$866.83 ,$855.42 , N/A ,$969.48 , N/A , N/A , N/A ,$798.39 ,$694.60 , N/A , N/A , N/A , N/A , N/A ,$969.48 , N/A ,"$1,049.32 ",$798.39 ,$578.49 ,$694.26 ,$694.60 ,$694.26 ,$788.13 ,"$1,026.50 ",$779.23 , N/A ,$901.04 , N/A , N/A , N/A , N/A , N/A ,$821.20 ,$707.15 ,$821.20 ,$821.20 ,$912.45 
ST NICHOLAS HOSPITAL - ACUTE,36030315,N/A,HC CAMPBELL RHYTIDECTOMY,360,1 ,"$2,030.96 ","$1,340.43 ","$1,030.10 ","$2,030.96 ", N/A , N/A , N/A , N/A ,"$1,218.58 ","$1,726.32 ","$1,421.67 ", N/A , N/A ,"$1,929.41 ","$1,543.53 ","$1,523.22 ", N/A ,"$1,726.32 ", N/A , N/A , N/A ,"$1,421.67 ","$1,236.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,726.32 ", N/A ,"$1,868.48 ","$1,421.67 ","$1,030.10 ","$1,236.25 ","$1,236.85 ","$1,236.25 ","$1,403.39 ","$1,827.86 ","$1,387.55 ", N/A ,"$1,604.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,462.29 ","$1,259.20 ","$1,462.29 ","$1,462.29 ","$1,624.77 "
ST NICHOLAS HOSPITAL - ACUTE,36030316,N/A,HC CAMPBELL FAT GRAFTING,360,1 ,$556.50 ,$367.29 ,$282.26 ,$556.50 , N/A , N/A , N/A , N/A ,$333.90 ,$473.03 ,$389.55 , N/A , N/A ,$528.68 ,$422.94 ,$417.38 , N/A ,$473.03 , N/A , N/A , N/A ,$389.55 ,$338.91 , N/A , N/A , N/A , N/A , N/A ,$473.03 , N/A ,$511.98 ,$389.55 ,$282.26 ,$338.74 ,$338.91 ,$338.74 ,$384.54 ,$500.85 ,$380.20 , N/A ,$439.64 , N/A , N/A , N/A , N/A , N/A ,$400.68 ,$345.03 ,$400.68 ,$400.68 ,$445.20 
ST NICHOLAS HOSPITAL - ACUTE,36030317,N/A,HC CAMPBELL MINI W/PLATYSMA PLICATION,360,1 ,"$1,001.70 ",$661.12 ,$508.06 ,"$1,001.70 ", N/A , N/A , N/A , N/A ,$601.02 ,$851.45 ,$701.19 , N/A , N/A ,$951.62 ,$761.29 ,$751.28 , N/A ,$851.45 , N/A , N/A , N/A ,$701.19 ,$610.04 , N/A , N/A , N/A , N/A , N/A ,$851.45 , N/A ,$921.56 ,$701.19 ,$508.06 ,$609.73 ,$610.04 ,$609.73 ,$692.17 ,$901.53 ,$684.36 , N/A ,$791.34 , N/A , N/A , N/A , N/A , N/A ,$721.22 ,$621.05 ,$721.22 ,$721.22 ,$801.36 
ST NICHOLAS HOSPITAL - ACUTE,36030318,N/A,HC CAMPBELL MINOR DORSUM RHINOPLASTY,360,1 ,$556.50 ,$367.29 ,$282.26 ,$556.50 , N/A , N/A , N/A , N/A ,$333.90 ,$473.03 ,$389.55 , N/A , N/A ,$528.68 ,$422.94 ,$417.38 , N/A ,$473.03 , N/A , N/A , N/A ,$389.55 ,$338.91 , N/A , N/A , N/A , N/A , N/A ,$473.03 , N/A ,$511.98 ,$389.55 ,$282.26 ,$338.74 ,$338.91 ,$338.74 ,$384.54 ,$500.85 ,$380.20 , N/A ,$439.64 , N/A , N/A , N/A , N/A , N/A ,$400.68 ,$345.03 ,$400.68 ,$400.68 ,$445.20 
ST NICHOLAS HOSPITAL - ACUTE,36030325,N/A,HC BUTZ ABDOMINOPLASTY,360,1 ,"$2,226.00 ","$1,469.16 ","$1,129.03 ","$2,226.00 ", N/A , N/A , N/A , N/A ,"$1,335.60 ","$1,892.10 ","$1,558.20 ", N/A , N/A ,"$2,114.70 ","$1,691.76 ","$1,669.50 ", N/A ,"$1,892.10 ", N/A , N/A , N/A ,"$1,558.20 ","$1,355.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,892.10 ", N/A ,"$2,047.92 ","$1,558.20 ","$1,129.03 ","$1,354.97 ","$1,355.63 ","$1,354.97 ","$1,538.17 ","$2,003.40 ","$1,520.80 ", N/A ,"$1,758.54 ", N/A , N/A , N/A , N/A , N/A ,"$1,602.72 ","$1,380.12 ","$1,602.72 ","$1,602.72 ","$1,780.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030326,N/A,HC BUTZ BLEPHAROPLASTY UPPER/LOWER,360,1 ,"$1,503.08 ",$992.03 ,$762.36 ,"$1,503.08 ", N/A , N/A , N/A , N/A ,$901.85 ,"$1,277.62 ","$1,052.16 ", N/A , N/A ,"$1,427.93 ","$1,142.34 ","$1,127.31 ", N/A ,"$1,277.62 ", N/A , N/A , N/A ,"$1,052.16 ",$915.38 , N/A , N/A , N/A , N/A , N/A ,"$1,277.62 ", N/A ,"$1,382.83 ","$1,052.16 ",$762.36 ,$914.92 ,$915.38 ,$914.92 ,"$1,038.63 ","$1,352.77 ","$1,026.90 ", N/A ,"$1,187.43 ", N/A , N/A , N/A , N/A , N/A ,"$1,082.22 ",$931.91 ,"$1,082.22 ","$1,082.22 ","$1,202.46 "
ST NICHOLAS HOSPITAL - ACUTE,36030327,N/A,HC BUTZ BLEPHAROPLASTY LOWER,360,1 ,"$1,029.26 ",$679.31 ,$522.04 ,"$1,029.26 ", N/A , N/A , N/A , N/A ,$617.56 ,$874.87 ,$720.48 , N/A , N/A ,$977.80 ,$782.24 ,$771.95 , N/A ,$874.87 , N/A , N/A , N/A ,$720.48 ,$626.82 , N/A , N/A , N/A , N/A , N/A ,$874.87 , N/A ,$946.92 ,$720.48 ,$522.04 ,$626.51 ,$626.82 ,$626.51 ,$711.22 ,$926.33 ,$703.19 , N/A ,$813.12 , N/A , N/A , N/A , N/A , N/A ,$741.07 ,$638.14 ,$741.07 ,$741.07 ,$823.41 
ST NICHOLAS HOSPITAL - ACUTE,36030328,N/A,HC BUTZ BLEPHAROPLASTY UPPER,360,1 ,$751.54 ,$496.02 ,$381.18 ,$751.54 , N/A , N/A , N/A , N/A ,$450.92 ,$638.81 ,$526.08 , N/A , N/A ,$713.96 ,$571.17 ,$563.66 , N/A ,$638.81 , N/A , N/A , N/A ,$526.08 ,$457.69 , N/A , N/A , N/A , N/A , N/A ,$638.81 , N/A ,$691.42 ,$526.08 ,$381.18 ,$457.46 ,$457.69 ,$457.46 ,$519.31 ,$676.39 ,$513.45 , N/A ,$593.72 , N/A , N/A , N/A , N/A , N/A ,$541.11 ,$465.95 ,$541.11 ,$541.11 ,$601.23 
ST NICHOLAS HOSPITAL - ACUTE,36030329,N/A,HC BUTZ BRACHIOPLASTY(BILATERAL),360,1 ,"$1,725.68 ","$1,138.95 ",$875.26 ,"$1,725.68 ", N/A , N/A , N/A , N/A ,"$1,035.41 ","$1,466.83 ","$1,207.98 ", N/A , N/A ,"$1,639.40 ","$1,311.52 ","$1,294.26 ", N/A ,"$1,466.83 ", N/A , N/A , N/A ,"$1,207.98 ","$1,050.94 ", N/A , N/A , N/A , N/A , N/A ,"$1,466.83 ", N/A ,"$1,587.63 ","$1,207.98 ",$875.26 ,"$1,050.42 ","$1,050.94 ","$1,050.42 ","$1,192.44 ","$1,553.11 ","$1,178.98 ", N/A ,"$1,363.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,242.49 ","$1,069.92 ","$1,242.49 ","$1,242.49 ","$1,380.54 "
ST NICHOLAS HOSPITAL - ACUTE,36030330,N/A,HC BUTZ BREAST AUGMENTATION (BILATERAL),360,1 ,"$1,363.16 ",$899.69 ,$691.39 ,"$1,363.16 ", N/A , N/A , N/A , N/A ,$817.90 ,"$1,158.69 ",$954.21 , N/A , N/A ,"$1,295.00 ","$1,036.00 ","$1,022.37 ", N/A ,"$1,158.69 ", N/A , N/A , N/A ,$954.21 ,$830.16 , N/A , N/A , N/A , N/A , N/A ,"$1,158.69 ", N/A ,"$1,254.11 ",$954.21 ,$691.39 ,$829.76 ,$830.16 ,$829.76 ,$941.94 ,"$1,226.84 ",$931.31 , N/A ,"$1,076.90 ", N/A , N/A , N/A , N/A , N/A ,$981.48 ,$845.16 ,$981.48 ,$981.48 ,"$1,090.53 "
ST NICHOLAS HOSPITAL - ACUTE,36030331,N/A,HC BUTZ BREAST IMPLANT UNILATERAL,360,1 ,$862.84 ,$569.47 ,$437.63 ,$862.84 , N/A , N/A , N/A , N/A ,$517.70 ,$733.41 ,$603.99 , N/A , N/A ,$819.70 ,$655.76 ,$647.13 , N/A ,$733.41 , N/A , N/A , N/A ,$603.99 ,$525.47 , N/A , N/A , N/A , N/A , N/A ,$733.41 , N/A ,$793.81 ,$603.99 ,$437.63 ,$525.21 ,$525.47 ,$525.21 ,$596.22 ,$776.56 ,$589.49 , N/A ,$681.64 , N/A , N/A , N/A , N/A , N/A ,$621.24 ,$534.96 ,$621.24 ,$621.24 ,$690.27 
ST NICHOLAS HOSPITAL - ACUTE,36030332,N/A,HC BUTZ BREAST REDUCTION (BILATERAL),360,1 ,"$2,142.26 ","$1,413.89 ","$1,086.55 ","$2,142.26 ", N/A , N/A , N/A , N/A ,"$1,285.36 ","$1,820.92 ","$1,499.58 ", N/A , N/A ,"$2,035.15 ","$1,628.12 ","$1,606.70 ", N/A ,"$1,820.92 ", N/A , N/A , N/A ,"$1,499.58 ","$1,304.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,820.92 ", N/A ,"$1,970.88 ","$1,499.58 ","$1,086.55 ","$1,303.99 ","$1,304.64 ","$1,303.99 ","$1,480.30 ","$1,928.03 ","$1,463.59 ", N/A ,"$1,692.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,542.43 ","$1,328.20 ","$1,542.43 ","$1,542.43 ","$1,713.81 "
ST NICHOLAS HOSPITAL - ACUTE,36030333,N/A,HC BUTZ BROW LIFT,360,1 ,"$1,335.60 ",$881.50 ,$677.42 ,"$1,335.60 ", N/A , N/A , N/A , N/A ,$801.36 ,"$1,135.26 ",$934.92 , N/A , N/A ,"$1,268.82 ","$1,015.06 ","$1,001.70 ", N/A ,"$1,135.26 ", N/A , N/A , N/A ,$934.92 ,$813.38 , N/A , N/A , N/A , N/A , N/A ,"$1,135.26 ", N/A ,"$1,228.75 ",$934.92 ,$677.42 ,$812.98 ,$813.38 ,$812.98 ,$922.90 ,"$1,202.04 ",$912.48 , N/A ,"$1,055.12 ", N/A , N/A , N/A , N/A , N/A ,$961.63 ,$828.07 ,$961.63 ,$961.63 ,"$1,068.48 "
ST NICHOLAS HOSPITAL - ACUTE,36030334,N/A,HC BUTZ CANTHOPLASTY(BILATERAL),360,1 ,$890.40 ,$587.66 ,$451.61 ,$890.40 , N/A , N/A , N/A , N/A ,$534.24 ,$756.84 ,$623.28 , N/A , N/A ,$845.88 ,$676.70 ,$667.80 , N/A ,$756.84 , N/A , N/A , N/A ,$623.28 ,$542.25 , N/A , N/A , N/A , N/A , N/A ,$756.84 , N/A ,$819.17 ,$623.28 ,$451.61 ,$541.99 ,$542.25 ,$541.99 ,$615.27 ,$801.36 ,$608.32 , N/A ,$703.42 , N/A , N/A , N/A , N/A , N/A ,$641.09 ,$552.05 ,$641.09 ,$641.09 ,$712.32 
ST NICHOLAS HOSPITAL - ACUTE,36030335,N/A,HC BUTZ CHIN IMPLANT,360,1 ,$974.14 ,$642.93 ,$494.08 ,$974.14 , N/A , N/A , N/A , N/A ,$584.48 ,$828.02 ,$681.90 , N/A , N/A ,$925.43 ,$740.35 ,$730.61 , N/A ,$828.02 , N/A , N/A , N/A ,$681.90 ,$593.25 , N/A , N/A , N/A , N/A , N/A ,$828.02 , N/A ,$896.21 ,$681.90 ,$494.08 ,$592.96 ,$593.25 ,$592.96 ,$673.13 ,$876.73 ,$665.53 , N/A ,$769.57 , N/A , N/A , N/A , N/A , N/A ,$701.38 ,$603.97 ,$701.38 ,$701.38 ,$779.31 
ST NICHOLAS HOSPITAL - ACUTE,36030336,N/A,HC BUTZ FAT TRANSFER,360,1 ,"$2,142.26 ","$1,413.89 ","$1,086.55 ","$2,142.26 ", N/A , N/A , N/A , N/A ,"$1,285.36 ","$1,820.92 ","$1,499.58 ", N/A , N/A ,"$2,035.15 ","$1,628.12 ","$1,606.70 ", N/A ,"$1,820.92 ", N/A , N/A , N/A ,"$1,499.58 ","$1,304.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,820.92 ", N/A ,"$1,970.88 ","$1,499.58 ","$1,086.55 ","$1,303.99 ","$1,304.64 ","$1,303.99 ","$1,480.30 ","$1,928.03 ","$1,463.59 ", N/A ,"$1,692.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,542.43 ","$1,328.20 ","$1,542.43 ","$1,542.43 ","$1,713.81 "
ST NICHOLAS HOSPITAL - ACUTE,36030337,N/A,HC BUTZ GYNECOMASTY(BILATERAL),360,1 ,"$1,391.78 ",$918.57 ,$705.91 ,"$1,391.78 ", N/A , N/A , N/A , N/A ,$835.07 ,"$1,183.01 ",$974.25 , N/A , N/A ,"$1,322.19 ","$1,057.75 ","$1,043.84 ", N/A ,"$1,183.01 ", N/A , N/A , N/A ,$974.25 ,$847.59 , N/A , N/A , N/A , N/A , N/A ,"$1,183.01 ", N/A ,"$1,280.44 ",$974.25 ,$705.91 ,$847.18 ,$847.59 ,$847.18 ,$961.72 ,"$1,252.60 ",$950.86 , N/A ,"$1,099.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,002.08 ",$862.90 ,"$1,002.08 ","$1,002.08 ","$1,113.42 "
ST NICHOLAS HOSPITAL - ACUTE,36030338,N/A,HC BUTZ LESION REMOVAL,360,1 ,$751.54 ,$496.02 ,$381.18 ,$751.54 , N/A , N/A , N/A , N/A ,$450.92 ,$638.81 ,$526.08 , N/A , N/A ,$713.96 ,$571.17 ,$563.66 , N/A ,$638.81 , N/A , N/A , N/A ,$526.08 ,$457.69 , N/A , N/A , N/A , N/A , N/A ,$638.81 , N/A ,$691.42 ,$526.08 ,$381.18 ,$457.46 ,$457.69 ,$457.46 ,$519.31 ,$676.39 ,$513.45 , N/A ,$593.72 , N/A , N/A , N/A , N/A , N/A ,$541.11 ,$465.95 ,$541.11 ,$541.11 ,$601.23 
ST NICHOLAS HOSPITAL - ACUTE,36030339,N/A,HC BUTZ LIPO CHIN/NECK,360,1 ,$779.10 ,$514.21 ,$395.16 ,$779.10 , N/A , N/A , N/A , N/A ,$467.46 ,$662.24 ,$545.37 , N/A , N/A ,$740.15 ,$592.12 ,$584.33 , N/A ,$662.24 , N/A , N/A , N/A ,$545.37 ,$474.47 , N/A , N/A , N/A , N/A , N/A ,$662.24 , N/A ,$716.77 ,$545.37 ,$395.16 ,$474.24 ,$474.47 ,$474.24 ,$538.36 ,$701.19 ,$532.28 , N/A ,$615.49 , N/A , N/A , N/A , N/A , N/A ,$560.95 ,$483.04 ,$560.95 ,$560.95 ,$623.28 
ST NICHOLAS HOSPITAL - ACUTE,36030340,N/A,HC BUTZ LIPO TORSO HIPS BUTTOCKS,360,1 ,"$1,503.08 ",$992.03 ,$762.36 ,"$1,503.08 ", N/A , N/A , N/A , N/A ,$901.85 ,"$1,277.62 ","$1,052.16 ", N/A , N/A ,"$1,427.93 ","$1,142.34 ","$1,127.31 ", N/A ,"$1,277.62 ", N/A , N/A , N/A ,"$1,052.16 ",$915.38 , N/A , N/A , N/A , N/A , N/A ,"$1,277.62 ", N/A ,"$1,382.83 ","$1,052.16 ",$762.36 ,$914.92 ,$915.38 ,$914.92 ,"$1,038.63 ","$1,352.77 ","$1,026.90 ", N/A ,"$1,187.43 ", N/A , N/A , N/A , N/A , N/A ,"$1,082.22 ",$931.91 ,"$1,082.22 ","$1,082.22 ","$1,202.46 "
ST NICHOLAS HOSPITAL - ACUTE,36030341,N/A,HC BUTZ MATOPEXY,360,1 ,"$1,614.38 ","$1,065.49 ",$818.81 ,"$1,614.38 ", N/A , N/A , N/A , N/A ,$968.63 ,"$1,372.22 ","$1,130.07 ", N/A , N/A ,"$1,533.66 ","$1,226.93 ","$1,210.79 ", N/A ,"$1,372.22 ", N/A , N/A , N/A ,"$1,130.07 ",$983.16 , N/A , N/A , N/A , N/A , N/A ,"$1,372.22 ", N/A ,"$1,485.23 ","$1,130.07 ",$818.81 ,$982.67 ,$983.16 ,$982.67 ,"$1,115.54 ","$1,452.94 ","$1,102.94 ", N/A ,"$1,275.36 ", N/A , N/A , N/A , N/A , N/A ,"$1,162.35 ","$1,000.92 ","$1,162.35 ","$1,162.35 ","$1,291.50 "
ST NICHOLAS HOSPITAL - ACUTE,36030342,N/A,HC BUTZ OTOPLASTY,360,1 ,"$1,558.20 ","$1,028.41 ",$790.32 ,"$1,558.20 ", N/A , N/A , N/A , N/A ,$934.92 ,"$1,324.47 ","$1,090.74 ", N/A , N/A ,"$1,480.29 ","$1,184.23 ","$1,168.65 ", N/A ,"$1,324.47 ", N/A , N/A , N/A ,"$1,090.74 ",$948.94 , N/A , N/A , N/A , N/A , N/A ,"$1,324.47 ", N/A ,"$1,433.54 ","$1,090.74 ",$790.32 ,$948.48 ,$948.94 ,$948.48 ,"$1,076.72 ","$1,402.38 ","$1,064.56 ", N/A ,"$1,230.98 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.90 ",$966.08 ,"$1,121.90 ","$1,121.90 ","$1,246.56 "
ST NICHOLAS HOSPITAL - ACUTE,36030343,N/A,HC BUTZ RHINOPLASTY,360,1 ,"$1,474.46 ",$973.14 ,$747.85 ,"$1,474.46 ", N/A , N/A , N/A , N/A ,$884.68 ,"$1,253.29 ","$1,032.12 ", N/A , N/A ,"$1,400.74 ","$1,120.59 ","$1,105.85 ", N/A ,"$1,253.29 ", N/A , N/A , N/A ,"$1,032.12 ",$897.95 , N/A , N/A , N/A , N/A , N/A ,"$1,253.29 ", N/A ,"$1,356.50 ","$1,032.12 ",$747.85 ,$897.50 ,$897.95 ,$897.50 ,"$1,018.85 ","$1,327.01 ","$1,007.35 ", N/A ,"$1,164.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,061.61 ",$914.17 ,"$1,061.61 ","$1,061.61 ","$1,179.57 "
ST NICHOLAS HOSPITAL - ACUTE,36030344,N/A,HC BUTZ RHINOPLASTY TIP,360,1 ,"$1,029.26 ",$679.31 ,$522.04 ,"$1,029.26 ", N/A , N/A , N/A , N/A ,$617.56 ,$874.87 ,$720.48 , N/A , N/A ,$977.80 ,$782.24 ,$771.95 , N/A ,$874.87 , N/A , N/A , N/A ,$720.48 ,$626.82 , N/A , N/A , N/A , N/A , N/A ,$874.87 , N/A ,$946.92 ,$720.48 ,$522.04 ,$626.51 ,$626.82 ,$626.51 ,$711.22 ,$926.33 ,$703.19 , N/A ,$813.12 , N/A , N/A , N/A , N/A , N/A ,$741.07 ,$638.14 ,$741.07 ,$741.07 ,$823.41 
ST NICHOLAS HOSPITAL - ACUTE,36030345,N/A,HC BUTZ RHYTIDECTOMY,360,1 ,"$2,030.96 ","$1,340.43 ","$1,030.10 ","$2,030.96 ", N/A , N/A , N/A , N/A ,"$1,218.58 ","$1,726.32 ","$1,421.67 ", N/A , N/A ,"$1,929.41 ","$1,543.53 ","$1,523.22 ", N/A ,"$1,726.32 ", N/A , N/A , N/A ,"$1,421.67 ","$1,236.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,726.32 ", N/A ,"$1,868.48 ","$1,421.67 ","$1,030.10 ","$1,236.25 ","$1,236.85 ","$1,236.25 ","$1,403.39 ","$1,827.86 ","$1,387.55 ", N/A ,"$1,604.46 ", N/A , N/A , N/A , N/A , N/A ,"$1,462.29 ","$1,259.20 ","$1,462.29 ","$1,462.29 ","$1,624.77 "
ST NICHOLAS HOSPITAL - ACUTE,36030346,N/A,HC BUTZ SCAR REVISION,360,1 ,$806.66 ,$532.40 ,$409.14 ,$806.66 , N/A , N/A , N/A , N/A ,$484.00 ,$685.66 ,$564.66 , N/A , N/A ,$766.33 ,$613.06 ,$605.00 , N/A ,$685.66 , N/A , N/A , N/A ,$564.66 ,$491.26 , N/A , N/A , N/A , N/A , N/A ,$685.66 , N/A ,$742.13 ,$564.66 ,$409.14 ,$491.01 ,$491.26 ,$491.01 ,$557.40 ,$725.99 ,$551.11 , N/A ,$637.26 , N/A , N/A , N/A , N/A , N/A ,$580.80 ,$500.13 ,$580.80 ,$580.80 ,$645.33 
ST NICHOLAS HOSPITAL - ACUTE,36030347,N/A,HC BUTZ SEPTOPLASTY,360,1 ,"$1,085.44 ",$716.39 ,$550.54 ,"$1,085.44 ", N/A , N/A , N/A , N/A ,$651.26 ,$922.62 ,$759.81 , N/A , N/A ,"$1,031.17 ",$824.93 ,$814.08 , N/A ,$922.62 , N/A , N/A , N/A ,$759.81 ,$661.03 , N/A , N/A , N/A , N/A , N/A ,$922.62 , N/A ,$998.60 ,$759.81 ,$550.54 ,$660.71 ,$661.03 ,$660.71 ,$750.04 ,$976.90 ,$741.57 , N/A ,$857.50 , N/A , N/A , N/A , N/A , N/A ,$781.52 ,$672.97 ,$781.52 ,$781.52 ,$868.35 
ST NICHOLAS HOSPITAL - ACUTE,36030348,N/A,HC BUTZ THIGH LIFT (BILATERAL),360,1 ,"$1,753.24 ","$1,157.14 ",$889.24 ,"$1,753.24 ", N/A , N/A , N/A , N/A ,"$1,051.94 ","$1,490.25 ","$1,227.27 ", N/A , N/A ,"$1,665.58 ","$1,332.46 ","$1,314.93 ", N/A ,"$1,490.25 ", N/A , N/A , N/A ,"$1,227.27 ","$1,067.72 ", N/A , N/A , N/A , N/A , N/A ,"$1,490.25 ", N/A ,"$1,612.98 ","$1,227.27 ",$889.24 ,"$1,067.20 ","$1,067.72 ","$1,067.20 ","$1,211.49 ","$1,577.92 ","$1,197.81 ", N/A ,"$1,385.06 ", N/A , N/A , N/A , N/A , N/A ,"$1,262.33 ","$1,087.01 ","$1,262.33 ","$1,262.33 ","$1,402.59 "
ST NICHOLAS HOSPITAL - ACUTE,36030349,N/A,HC BUTZ TORSOPLASTY FULL,360,1 ,"$2,421.04 ","$1,597.89 ","$1,227.95 ","$2,421.04 ", N/A , N/A , N/A , N/A ,"$1,452.62 ","$2,057.88 ","$1,694.73 ", N/A , N/A ,"$2,299.99 ","$1,839.99 ","$1,815.78 ", N/A ,"$2,057.88 ", N/A , N/A , N/A ,"$1,694.73 ","$1,474.41 ", N/A , N/A , N/A , N/A , N/A ,"$2,057.88 ", N/A ,"$2,227.36 ","$1,694.73 ","$1,227.95 ","$1,473.69 ","$1,474.41 ","$1,473.69 ","$1,672.94 ","$2,178.94 ","$1,654.05 ", N/A ,"$1,912.62 ", N/A , N/A , N/A , N/A , N/A ,"$1,743.15 ","$1,501.04 ","$1,743.15 ","$1,743.15 ","$1,936.83 "
ST NICHOLAS HOSPITAL - ACUTE,36030350,N/A,HC BUTZ TORSOPLASTY PARTIAL,360,1 ,"$1,669.50 ","$1,101.87 ",$846.77 ,"$1,669.50 ", N/A , N/A , N/A , N/A ,"$1,001.70 ","$1,419.08 ","$1,168.65 ", N/A , N/A ,"$1,586.03 ","$1,268.82 ","$1,252.13 ", N/A ,"$1,419.08 ", N/A , N/A , N/A ,"$1,168.65 ","$1,016.73 ", N/A , N/A , N/A , N/A , N/A ,"$1,419.08 ", N/A ,"$1,535.94 ","$1,168.65 ",$846.77 ,"$1,016.22 ","$1,016.73 ","$1,016.22 ","$1,153.62 ","$1,502.55 ","$1,140.60 ", N/A ,"$1,318.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,202.04 ","$1,035.09 ","$1,202.04 ","$1,202.04 ","$1,335.60 "
ST NICHOLAS HOSPITAL - ACUTE,36030351,N/A,HC BUTZ COSMETIC ADDL 30MIN,360,1 ,$167.48 ,$110.54 ,$84.95 ,$167.48 , N/A , N/A , N/A , N/A ,$100.49 ,$142.36 ,$117.24 , N/A , N/A ,$159.11 ,$127.28 ,$125.61 , N/A ,$142.36 , N/A , N/A , N/A ,$117.24 ,$102.00 , N/A , N/A , N/A , N/A , N/A ,$142.36 , N/A ,$154.08 ,$117.24 ,$84.95 ,$101.95 ,$102.00 ,$101.95 ,$115.73 ,$150.73 ,$114.42 , N/A ,$132.31 , N/A , N/A , N/A , N/A , N/A ,$120.59 ,$103.84 ,$120.59 ,$120.59 ,$133.98 
ST NICHOLAS HOSPITAL - ACUTE,36030400,N/A,HC REFRACTIVE LENS STANDARD,360,1 ,"$1,335.60 ",$881.50 ,$677.42 ,"$1,335.60 ", N/A , N/A , N/A , N/A ,$801.36 ,"$1,135.26 ",$934.92 , N/A , N/A ,"$1,268.82 ","$1,015.06 ","$1,001.70 ", N/A ,"$1,135.26 ", N/A , N/A , N/A ,$934.92 ,$813.38 , N/A , N/A , N/A , N/A , N/A ,"$1,135.26 ", N/A ,"$1,228.75 ",$934.92 ,$677.42 ,$812.98 ,$813.38 ,$812.98 ,$922.90 ,"$1,202.04 ",$912.48 , N/A ,"$1,055.12 ", N/A , N/A , N/A , N/A , N/A ,$961.63 ,$828.07 ,$961.63 ,$961.63 ,"$1,068.48 "
ST NICHOLAS HOSPITAL - ACUTE,36030401,N/A,HC REFRACTIVE LENS TORIC,360,1 ,"$1,335.60 ",$881.50 ,$677.42 ,"$1,335.60 ", N/A , N/A , N/A , N/A ,$801.36 ,"$1,135.26 ",$934.92 , N/A , N/A ,"$1,268.82 ","$1,015.06 ","$1,001.70 ", N/A ,"$1,135.26 ", N/A , N/A , N/A ,$934.92 ,$813.38 , N/A , N/A , N/A , N/A , N/A ,"$1,135.26 ", N/A ,"$1,228.75 ",$934.92 ,$677.42 ,$812.98 ,$813.38 ,$812.98 ,$922.90 ,"$1,202.04 ",$912.48 , N/A ,"$1,055.12 ", N/A , N/A , N/A , N/A , N/A ,$961.63 ,$828.07 ,$961.63 ,$961.63 ,"$1,068.48 "
ST NICHOLAS HOSPITAL - ACUTE,36030402,N/A,HC REFRACTIVE LENS MULTIFOCAL,360,1 ,"$1,335.60 ",$881.50 ,$677.42 ,"$1,335.60 ", N/A , N/A , N/A , N/A ,$801.36 ,"$1,135.26 ",$934.92 , N/A , N/A ,"$1,268.82 ","$1,015.06 ","$1,001.70 ", N/A ,"$1,135.26 ", N/A , N/A , N/A ,$934.92 ,$813.38 , N/A , N/A , N/A , N/A , N/A ,"$1,135.26 ", N/A ,"$1,228.75 ",$934.92 ,$677.42 ,$812.98 ,$813.38 ,$812.98 ,$922.90 ,"$1,202.04 ",$912.48 , N/A ,"$1,055.12 ", N/A , N/A , N/A , N/A , N/A ,$961.63 ,$828.07 ,$961.63 ,$961.63 ,"$1,068.48 "
ST NICHOLAS HOSPITAL - ACUTE,36030403,N/A,HC DENTAL CASE PACKAGE SSC CASH ONLY,360,1 ,"$1,391.78 ",$918.57 ,$705.91 ,"$1,391.78 ", N/A , N/A , N/A , N/A ,$835.07 ,"$1,183.01 ",$974.25 , N/A , N/A ,"$1,322.19 ","$1,057.75 ","$1,043.84 ", N/A ,"$1,183.01 ", N/A , N/A , N/A ,$974.25 ,$847.59 , N/A , N/A , N/A , N/A , N/A ,"$1,183.01 ", N/A ,"$1,280.44 ",$974.25 ,$705.91 ,$847.18 ,$847.59 ,$847.18 ,$961.72 ,"$1,252.60 ",$950.86 , N/A ,"$1,099.51 ", N/A , N/A , N/A , N/A , N/A ,"$1,002.08 ",$862.90 ,"$1,002.08 ","$1,002.08 ","$1,113.42 "
ST NICHOLAS HOSPITAL - ACUTE,36030404,N/A,HC PIGGYBACK LENS PACKAGE SSC,360,1 ,"$1,335.60 ",$881.50 ,$677.42 ,"$1,335.60 ", N/A , N/A , N/A , N/A ,$801.36 ,"$1,135.26 ",$934.92 , N/A , N/A ,"$1,268.82 ","$1,015.06 ","$1,001.70 ", N/A ,"$1,135.26 ", N/A , N/A , N/A ,$934.92 ,$813.38 , N/A , N/A , N/A , N/A , N/A ,"$1,135.26 ", N/A ,"$1,228.75 ",$934.92 ,$677.42 ,$812.98 ,$813.38 ,$812.98 ,$922.90 ,"$1,202.04 ",$912.48 , N/A ,"$1,055.12 ", N/A , N/A , N/A , N/A , N/A ,$961.63 ,$828.07 ,$961.63 ,$961.63 ,"$1,068.48 "
ST NICHOLAS HOSPITAL - ACUTE,36030405,0232T,HC INJECTION PALTELET RICH PLASMA,360,1 ,$433.55 ,$286.14 ,$14.62 ,$829.14 ,$14.62 ,$433.55 ,$433.55 ,$368.51 ,$260.13 ,$368.52 ,$303.49 ,$14.62 ,$14.62 ,$411.87 ,$329.50 ,$325.16 ,$433.55 ,$368.52 ,$368.51 ,$433.55 ,$433.55 ,$303.49 ,$264.03 ,$14.62 ,$368.51 ,$361.14 ,$433.55 ,$15.50 ,$368.52 ,$829.14 ,$398.87 ,$303.49 ,$219.90 ,$263.90 ,$264.03 ,$263.90 ,$299.58 ,$390.20 ,$296.20 ,$364.76 ,$342.50 ,$15.50 ,$433.55 ,$433.55 ,$361.14 ,$433.55 ,$312.16 ,$268.80 ,$312.16 ,$312.16 ,$346.84 
ST NICHOLAS HOSPITAL - ACUTE,36030405,0232T,HC INJECTION PLATELET RICH PLASMA,360,1 ,$433.55 ,$286.14 ,$14.62 ,$829.14 ,$14.62 ,$433.55 ,$433.55 ,$368.51 ,$260.13 ,$368.52 ,$303.49 ,$14.62 ,$14.62 ,$411.87 ,$329.50 ,$325.16 ,$433.55 ,$368.52 ,$368.51 ,$433.55 ,$433.55 ,$303.49 ,$264.03 ,$14.62 ,$368.51 ,$361.14 ,$433.55 ,$15.50 ,$368.52 ,$829.14 ,$398.87 ,$303.49 ,$219.90 ,$263.90 ,$264.03 ,$263.90 ,$299.58 ,$390.20 ,$296.20 ,$364.76 ,$342.50 ,$15.50 ,$433.55 ,$433.55 ,$361.14 ,$433.55 ,$312.16 ,$268.80 ,$312.16 ,$312.16 ,$346.84 
ST NICHOLAS HOSPITAL - ACUTE,36030406,0232T,HC INJECTION BONE MARROW,360,1 ,"$1,362.75 ",$899.42 ,$14.62 ,"$1,362.75 ",$14.62 ,"$1,362.75 ","$1,362.75 ",$368.51 ,$817.65 ,"$1,158.34 ",$953.93 ,$14.62 ,$14.62 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ","$1,362.75 ","$1,158.34 ",$368.51 ,"$1,362.75 ","$1,362.75 ",$953.93 ,$829.91 ,$14.62 ,$368.51 ,$361.14 ,$737.02 ,$15.50 ,"$1,158.34 ",$829.14 ,"$1,253.73 ",$953.93 ,$691.19 ,$829.51 ,$829.91 ,$829.51 ,$941.66 ,"$1,226.48 ",$931.03 ,$364.76 ,"$1,076.57 ",$15.50 ,"$1,362.75 ","$1,362.75 ",$361.14 ,"$1,362.75 ",$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030406,0232T,HC INJECTION BONE MARROW,360,1 ,"$1,362.75 ",$899.42 ,$14.62 ,"$1,362.75 ",$14.62 ,"$1,362.75 ","$1,362.75 ",$368.51 ,$817.65 ,"$1,158.34 ",$953.93 ,$14.62 ,$14.62 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ","$1,362.75 ","$1,158.34 ",$368.51 ,"$1,362.75 ","$1,362.75 ",$953.93 ,$829.91 ,$14.62 ,$368.51 ,$361.14 ,$737.02 ,$15.50 ,"$1,158.34 ",$829.14 ,"$1,253.73 ",$953.93 ,$691.19 ,$829.51 ,$829.91 ,$829.51 ,$941.66 ,"$1,226.48 ",$931.03 ,$364.76 ,"$1,076.57 ",$15.50 ,"$1,362.75 ","$1,362.75 ",$361.14 ,"$1,362.75 ",$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,36040025,N/A,HC SURGICAL SUITE PER 15 MINS,360,1 ,"$1,102.50 ",$727.65 ,$559.19 ,"$1,102.50 ", N/A , N/A , N/A , N/A ,$661.50 ,$937.13 ,$771.75 , N/A , N/A ,"$1,047.38 ",$837.90 ,$826.88 , N/A ,$937.13 , N/A , N/A , N/A ,$771.75 ,$671.42 , N/A , N/A , N/A , N/A , N/A ,$937.13 , N/A ,"$1,014.30 ",$771.75 ,$559.19 ,$671.09 ,$671.42 ,$671.09 ,$761.83 ,$992.25 ,$753.23 , N/A ,$870.98 , N/A , N/A , N/A , N/A , N/A ,$793.80 ,$683.55 ,$793.80 ,$793.80 ,$882.00 
ST NICHOLAS HOSPITAL - ACUTE,36040027,N/A,HC SURGICAL PROCEDURE PER 15 MINS CATH/RAD ONC,360,1 ,"$1,102.50 ",$727.65 ,$559.19 ,"$1,102.50 ", N/A , N/A , N/A , N/A ,$661.50 ,$937.13 ,$771.75 , N/A , N/A ,"$1,047.38 ",$837.90 ,$826.88 , N/A ,$937.13 , N/A , N/A , N/A ,$771.75 ,$671.42 , N/A , N/A , N/A , N/A , N/A ,$937.13 , N/A ,"$1,014.30 ",$771.75 ,$559.19 ,$671.09 ,$671.42 ,$671.09 ,$761.83 ,$992.25 ,$753.23 , N/A ,$870.98 , N/A , N/A , N/A , N/A , N/A ,$793.80 ,$683.55 ,$793.80 ,$793.80 ,$882.00 
ST NICHOLAS HOSPITAL - ACUTE,36050178,N/A,HC LITHOTRIPSY SHOCKWAVE,360,1 ,"$4,770.00 ","$3,148.20 ","$2,419.34 ","$4,770.00 ", N/A , N/A , N/A , N/A ,"$2,862.00 ","$4,054.50 ","$3,339.00 ", N/A , N/A ,"$4,531.50 ","$3,625.20 ","$3,577.50 ", N/A ,"$4,054.50 ", N/A , N/A , N/A ,"$3,339.00 ","$2,904.93 ", N/A , N/A , N/A , N/A , N/A ,"$4,054.50 ", N/A ,"$4,388.40 ","$3,339.00 ","$2,419.34 ","$2,903.50 ","$2,904.93 ","$2,903.50 ","$3,296.07 ","$4,293.00 ","$3,258.86 ", N/A ,"$3,768.30 ", N/A , N/A , N/A , N/A , N/A ,"$3,434.40 ","$2,957.40 ","$3,434.40 ","$3,434.40 ","$3,816.00 "
ST NICHOLAS HOSPITAL - ACUTE,36050640,N/A,HC LASER FOR CATARACT SURGERY,360,1 ,$647.66 ,$427.46 ,$328.49 ,$647.66 , N/A , N/A , N/A , N/A ,$388.60 ,$550.51 ,$453.36 , N/A , N/A ,$615.28 ,$492.22 ,$485.75 , N/A ,$550.51 , N/A , N/A , N/A ,$453.36 ,$394.42 , N/A , N/A , N/A , N/A , N/A ,$550.51 , N/A ,$595.85 ,$453.36 ,$328.49 ,$394.23 ,$394.42 ,$394.23 ,$447.53 ,$582.89 ,$442.48 , N/A ,$511.65 , N/A , N/A , N/A , N/A , N/A ,$466.32 ,$401.55 ,$466.32 ,$466.32 ,$518.13 
ST NICHOLAS HOSPITAL - ACUTE,36060001,N/A,HC OR LEVEL 1 BASE,360,1 ,"$4,006.80 ","$2,644.49 ","$2,032.25 ","$4,006.80 ", N/A , N/A , N/A , N/A ,"$2,404.08 ","$3,405.78 ","$2,804.76 ", N/A , N/A ,"$3,806.46 ","$3,045.17 ","$3,005.10 ", N/A ,"$3,405.78 ", N/A , N/A , N/A ,"$2,804.76 ","$2,440.14 ", N/A , N/A , N/A , N/A , N/A ,"$3,405.78 ", N/A ,"$3,686.26 ","$2,804.76 ","$2,032.25 ","$2,438.94 ","$2,440.14 ","$2,438.94 ","$2,768.70 ","$3,606.12 ","$2,737.45 ", N/A ,"$3,165.37 ", N/A , N/A , N/A , N/A , N/A ,"$2,884.90 ","$2,484.22 ","$2,884.90 ","$2,884.90 ","$3,205.44 "
ST NICHOLAS HOSPITAL - ACUTE,36060002,N/A,HC OR LEVEL 2 BASE,360,1 ,"$5,787.60 ","$3,819.82 ","$2,935.47 ","$5,787.60 ", N/A , N/A , N/A , N/A ,"$3,472.56 ","$4,919.46 ","$4,051.32 ", N/A , N/A ,"$5,498.22 ","$4,398.58 ","$4,340.70 ", N/A ,"$4,919.46 ", N/A , N/A , N/A ,"$4,051.32 ","$3,524.65 ", N/A , N/A , N/A , N/A , N/A ,"$4,919.46 ", N/A ,"$5,324.59 ","$4,051.32 ","$2,935.47 ","$3,522.91 ","$3,524.65 ","$3,522.91 ","$3,999.23 ","$5,208.84 ","$3,954.09 ", N/A ,"$4,572.20 ", N/A , N/A , N/A , N/A , N/A ,"$4,167.07 ","$3,588.31 ","$4,167.07 ","$4,167.07 ","$4,630.08 "
ST NICHOLAS HOSPITAL - ACUTE,36060003,N/A,HC OR LEVEL 3 BASE,360,1 ,"$7,457.10 ","$4,921.69 ","$3,782.24 ","$7,457.10 ", N/A , N/A , N/A , N/A ,"$4,474.26 ","$6,338.54 ","$5,219.97 ", N/A , N/A ,"$7,084.25 ","$5,667.40 ","$5,592.83 ", N/A ,"$6,338.54 ", N/A , N/A , N/A ,"$5,219.97 ","$4,541.37 ", N/A , N/A , N/A , N/A , N/A ,"$6,338.54 ", N/A ,"$6,860.53 ","$5,219.97 ","$3,782.24 ","$4,539.14 ","$4,541.37 ","$4,539.14 ","$5,152.86 ","$6,711.39 ","$5,094.69 ", N/A ,"$5,891.11 ", N/A , N/A , N/A , N/A , N/A ,"$5,369.11 ","$4,623.40 ","$5,369.11 ","$5,369.11 ","$5,965.68 "
ST NICHOLAS HOSPITAL - ACUTE,36060004,N/A,HC OR LEVEL 4 BASE,360,1 ,"$10,350.90 ","$6,831.59 ","$5,249.98 ","$10,350.90 ", N/A , N/A , N/A , N/A ,"$6,210.54 ","$8,798.27 ","$7,245.63 ", N/A , N/A ,"$9,833.36 ","$7,866.68 ","$7,763.18 ", N/A ,"$8,798.27 ", N/A , N/A , N/A ,"$7,245.63 ","$6,303.70 ", N/A , N/A , N/A , N/A , N/A ,"$8,798.27 ", N/A ,"$9,522.83 ","$7,245.63 ","$5,249.98 ","$6,300.59 ","$6,303.70 ","$6,300.59 ","$7,152.47 ","$9,315.81 ","$7,071.73 ", N/A ,"$8,177.21 ", N/A , N/A , N/A , N/A , N/A ,"$7,452.65 ","$6,417.56 ","$7,452.65 ","$7,452.65 ","$8,280.72 "
ST NICHOLAS HOSPITAL - ACUTE,36060005,N/A,HC OR LEVEL 5 BASE,360,1 ,"$12,243.00 ","$8,080.38 ","$6,209.65 ","$12,243.00 ", N/A , N/A , N/A , N/A ,"$7,345.80 ","$10,406.55 ","$8,570.10 ", N/A , N/A ,"$11,630.85 ","$9,304.68 ","$9,182.25 ", N/A ,"$10,406.55 ", N/A , N/A , N/A ,"$8,570.10 ","$7,455.99 ", N/A , N/A , N/A , N/A , N/A ,"$10,406.55 ", N/A ,"$11,263.56 ","$8,570.10 ","$6,209.65 ","$7,452.31 ","$7,455.99 ","$7,452.31 ","$8,459.91 ","$11,018.70 ","$8,364.42 ", N/A ,"$9,671.97 ", N/A , N/A , N/A , N/A , N/A ,"$8,814.96 ","$7,590.66 ","$8,814.96 ","$8,814.96 ","$9,794.40 "
ST NICHOLAS HOSPITAL - ACUTE,36060006,N/A,HC OR LEVEL 6 BASE,360,1 ,"$15,582.00 ","$10,284.12 ","$7,903.19 ","$15,582.00 ", N/A , N/A , N/A , N/A ,"$9,349.20 ","$13,244.70 ","$10,907.40 ", N/A , N/A ,"$14,802.90 ","$11,842.32 ","$11,686.50 ", N/A ,"$13,244.70 ", N/A , N/A , N/A ,"$10,907.40 ","$9,489.44 ", N/A , N/A , N/A , N/A , N/A ,"$13,244.70 ", N/A ,"$14,335.44 ","$10,907.40 ","$7,903.19 ","$9,484.76 ","$9,489.44 ","$9,484.76 ","$10,767.16 ","$14,023.80 ","$10,645.62 ", N/A ,"$12,309.78 ", N/A , N/A , N/A , N/A , N/A ,"$11,219.04 ","$9,660.84 ","$11,219.04 ","$11,219.04 ","$12,465.60 "
ST NICHOLAS HOSPITAL - ACUTE,36060007,N/A,HC OR LEVEL 1 PER MIN,360,1 ,$16.70 ,$11.02 ,$8.47 ,$16.70 , N/A , N/A , N/A , N/A ,$10.02 ,$14.20 ,$11.69 , N/A , N/A ,$15.87 ,$12.69 ,$12.53 , N/A ,$14.20 , N/A , N/A , N/A ,$11.69 ,$10.17 , N/A , N/A , N/A , N/A , N/A ,$14.20 , N/A ,$15.36 ,$11.69 ,$8.47 ,$10.17 ,$10.17 ,$10.17 ,$11.54 ,$15.03 ,$11.41 , N/A ,$13.19 , N/A , N/A , N/A , N/A , N/A ,$12.02 ,$10.35 ,$12.02 ,$12.02 ,$13.36 
ST NICHOLAS HOSPITAL - ACUTE,36060008,N/A,HC OR LEVEL 2 PER MIN,360,1 ,$40.28 ,$26.58 ,$20.43 ,$40.28 , N/A , N/A , N/A , N/A ,$24.17 ,$34.24 ,$28.20 , N/A , N/A ,$38.27 ,$30.61 ,$30.21 , N/A ,$34.24 , N/A , N/A , N/A ,$28.20 ,$24.53 , N/A , N/A , N/A , N/A , N/A ,$34.24 , N/A ,$37.06 ,$28.20 ,$20.43 ,$24.52 ,$24.53 ,$24.52 ,$27.83 ,$36.25 ,$27.52 , N/A ,$31.82 , N/A , N/A , N/A , N/A , N/A ,$29.00 ,$24.97 ,$29.00 ,$29.00 ,$32.22 
ST NICHOLAS HOSPITAL - ACUTE,36060009,N/A,HC OR LEVEL 3 PER MIN,360,1 ,$56.18 ,$37.08 ,$28.49 ,$56.18 , N/A , N/A , N/A , N/A ,$33.71 ,$47.75 ,$39.33 , N/A , N/A ,$53.37 ,$42.70 ,$42.14 , N/A ,$47.75 , N/A , N/A , N/A ,$39.33 ,$34.21 , N/A , N/A , N/A , N/A , N/A ,$47.75 , N/A ,$51.69 ,$39.33 ,$28.49 ,$34.20 ,$34.21 ,$34.20 ,$38.82 ,$50.56 ,$38.38 , N/A ,$44.38 , N/A , N/A , N/A , N/A , N/A ,$40.45 ,$34.83 ,$40.45 ,$40.45 ,$44.94 
ST NICHOLAS HOSPITAL - ACUTE,36060010,N/A,HC OR LEVEL 4 PER MIN,360,1 ,$89.04 ,$58.77 ,$45.16 ,$89.04 , N/A , N/A , N/A , N/A ,$53.42 ,$75.68 ,$62.33 , N/A , N/A ,$84.59 ,$67.67 ,$66.78 , N/A ,$75.68 , N/A , N/A , N/A ,$62.33 ,$54.23 , N/A , N/A , N/A , N/A , N/A ,$75.68 , N/A ,$81.92 ,$62.33 ,$45.16 ,$54.20 ,$54.23 ,$54.20 ,$61.53 ,$80.14 ,$60.83 , N/A ,$70.34 , N/A , N/A , N/A , N/A , N/A ,$64.11 ,$55.20 ,$64.11 ,$64.11 ,$71.23 
ST NICHOLAS HOSPITAL - ACUTE,36060011,N/A,HC OR LEVEL 5 PER MIN,360,1 ,$100.70 ,$66.46 ,$51.08 ,$100.70 , N/A , N/A , N/A , N/A ,$60.42 ,$85.60 ,$70.49 , N/A , N/A ,$95.67 ,$76.53 ,$75.53 , N/A ,$85.60 , N/A , N/A , N/A ,$70.49 ,$61.33 , N/A , N/A , N/A , N/A , N/A ,$85.60 , N/A ,$92.64 ,$70.49 ,$51.08 ,$61.30 ,$61.33 ,$61.30 ,$69.58 ,$90.63 ,$68.80 , N/A ,$79.55 , N/A , N/A , N/A , N/A , N/A ,$72.50 ,$62.43 ,$72.50 ,$72.50 ,$80.56 
ST NICHOLAS HOSPITAL - ACUTE,36060012,N/A,HC OR LEVEL 6 PER MIN,360,1 ,$111.30 ,$73.46 ,$56.45 ,$111.30 , N/A , N/A , N/A , N/A ,$66.78 ,$94.61 ,$77.91 , N/A , N/A ,$105.74 ,$84.59 ,$83.48 , N/A ,$94.61 , N/A , N/A , N/A ,$77.91 ,$67.78 , N/A , N/A , N/A , N/A , N/A ,$94.61 , N/A ,$102.40 ,$77.91 ,$56.45 ,$67.75 ,$67.78 ,$67.75 ,$76.91 ,$100.17 ,$76.04 , N/A ,$87.93 , N/A , N/A , N/A , N/A , N/A ,$80.14 ,$69.01 ,$80.14 ,$80.14 ,$89.04 
ST NICHOLAS HOSPITAL - ACUTE,36080006,64400,HC NERVE BLOCK TRIGEMINAL,360,1 ,$930.35 ,$614.03 ,$13.98 ,$930.35 ,$13.98 ,$930.35 ,$930.35 ,$265.36 ,$558.21 ,$790.80 ,$651.25 ,$13.98 ,$13.98 ,$883.83 ,$707.07 ,$697.76 ,$930.35 ,$790.80 ,$265.36 ,$930.35 ,$930.35 ,$651.25 ,$566.58 ,$13.98 ,$265.36 ,$260.05 ,$530.72 ,$14.82 ,$790.80 ,$597.07 ,$855.92 ,$651.25 ,$471.87 ,$566.30 ,$566.58 ,$566.30 ,$642.87 ,$837.32 ,$635.62 ,$262.65 ,$734.98 ,$14.82 ,$930.35 ,$930.35 ,$260.05 ,$930.35 ,$669.85 ,$576.82 ,$669.85 ,$669.85 ,$744.28 
ST NICHOLAS HOSPITAL - ACUTE,36100001,47537,HC REM BIL CATH W G SI CHOLANG,361,1 ,"$1,725.00 ","$1,138.50 ",$16.75 ,"$1,812.82 ",$16.75 ,"$1,725.00 ","$1,725.00 ",$805.70 ,"$1,035.00 ","$1,466.25 ","$1,207.50 ",$16.75 ,$16.75 ,"$1,638.75 ","$1,311.00 ","$1,293.75 ","$1,725.00 ","$1,466.25 ",$805.70 ,"$1,725.00 ","$1,725.00 ","$1,207.50 ","$1,050.53 ",$16.75 ,$805.70 ,$789.59 ,"$1,611.40 ",$17.76 ,"$1,466.25 ","$1,812.82 ","$1,587.00 ","$1,207.50 ","$1,725.00 ","$1,725.00 ","$1,050.53 ","$1,725.00 ","$1,191.98 ","$1,552.50 ","$1,178.52 ",$797.48 ,"$1,362.75 ",$17.76 ,"$1,725.00 ","$1,725.00 ",$789.59 ,"$1,725.00 ","$1,242.00 ","$1,069.50 ","$1,242.00 ","$1,242.00 ","$1,380.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100002,47538,HC PLC BILE SNT W G SI EX/REMOVAL CHOLANG,361,1 ,"$9,539.25 ","$6,295.91 ",$82.11 ,"$11,445.88 ",$82.11 ,"$9,539.25 ","$9,539.25 ","$5,087.06 ","$5,723.55 ","$8,108.36 ","$6,677.48 ",$82.11 ,$82.11 ,"$9,062.29 ","$7,249.83 ","$7,154.44 ","$7,276.00 ","$8,108.36 ","$5,087.06 ","$7,276.00 ","$7,276.00 ","$6,677.48 ","$5,809.40 ",$82.11 ,"$5,087.06 ","$4,985.32 ","$9,539.25 ",$87.04 ,"$8,108.36 ","$11,445.88 ","$8,776.11 ","$6,677.48 ","$4,535.48 ","$5,669.62 ","$5,809.40 ","$5,669.62 ","$6,591.62 ","$8,585.33 ","$6,517.22 ","$5,035.17 ","$7,536.01 ",$87.04 ,"$9,030.00 ","$9,030.00 ","$4,985.32 ","$9,030.00 ","$6,868.26 ","$5,914.34 ","$6,868.26 ","$6,868.26 ","$7,631.40 "
ST NICHOLAS HOSPITAL - ACUTE,36100003,47540,HC PLC BILE SNT W GD SI  NEW ACCESS,361,1 ,"$11,500.00 ","$7,590.00 ",$202.70 ,"$11,500.00 ",$202.70 ,"$11,500.00 ","$10,426.00 ","$5,087.06 ","$6,900.00 ","$9,775.00 ","$8,050.00 ",$202.70 ,$202.70 ,"$10,925.00 ","$8,740.00 ","$8,625.00 ","$7,276.00 ","$9,775.00 ","$5,087.06 ","$7,276.00 ","$7,276.00 ","$8,050.00 ","$7,003.50 ",$202.70 ,"$5,087.06 ","$4,985.32 ","$10,174.12 ",$214.86 ,"$9,775.00 ","$11,445.88 ","$10,580.00 ","$8,050.00 ","$4,535.48 ","$5,669.62 ","$7,003.50 ","$5,669.62 ","$7,946.50 ","$10,350.00 ","$7,856.80 ","$5,035.17 ","$9,085.00 ",$214.86 ,"$9,030.00 ","$9,030.00 ","$4,985.32 ","$9,030.00 ","$8,280.00 ","$7,130.00 ","$8,280.00 ","$8,280.00 ","$9,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100004,50430,HC INJ NEPH URET W G SI NEW ACCESS,361,1 ,"$2,318.40 ","$1,530.14 ",$13.57 ,"$2,318.40 ",$13.57 ,"$2,318.40 ","$2,292.00 ",$610.33 ,"$1,391.04 ","$1,970.64 ","$1,622.88 ",$13.57 ,$13.57 ,"$2,202.48 ","$1,761.98 ","$1,738.80 ","$2,318.40 ","$1,970.64 ",$610.33 ,"$2,318.40 ","$2,318.40 ","$1,622.88 ","$1,411.91 ",$13.57 ,$610.33 ,$598.12 ,"$1,220.66 ",$14.38 ,"$1,970.64 ","$1,373.25 ","$2,132.93 ","$1,622.88 ","$1,771.14 ","$2,213.66 ","$1,411.91 ","$2,213.66 ","$1,602.01 ","$2,086.56 ","$1,583.93 ",$604.10 ,"$1,831.54 ",$14.38 ,"$2,318.40 ","$2,318.40 ",$598.12 ,"$2,318.40 ","$1,669.25 ","$1,437.41 ","$1,669.25 ","$1,669.25 ","$1,854.72 "
ST NICHOLAS HOSPITAL - ACUTE,36100005,50433,HC PL NEPH CAT W GD S AND I NEW ACCESS,361,1 ,"$7,360.00 ","$4,857.60 ",$101.96 ,"$7,360.00 ",$101.96 ,"$4,469.00 ","$4,010.00 ","$3,128.20 ","$4,416.00 ","$6,256.00 ","$5,152.00 ",$101.96 ,$101.96 ,"$6,992.00 ","$5,593.60 ","$5,520.00 ","$7,276.00 ","$6,256.00 ","$3,128.20 ","$7,276.00 ","$7,276.00 ","$5,152.00 ","$4,482.24 ",$101.96 ,"$3,128.20 ","$3,065.64 ","$6,256.40 ",$108.08 ,"$6,256.00 ","$7,038.44 ","$6,771.20 ","$5,152.00 ","$2,747.95 ","$3,435.21 ","$4,482.24 ","$3,435.21 ","$5,085.76 ","$6,624.00 ","$5,028.35 ","$3,096.29 ","$5,814.40 ",$108.08 ,"$5,171.00 ","$5,171.00 ","$3,065.64 ","$5,171.00 ","$5,299.20 ","$4,563.20 ","$5,299.20 ","$5,299.20 ","$5,888.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100006,50434,HC CONVERT NEPH CTH NEPHUR CTH WG S AND I EXST TRACT,361,1 ,"$7,590.00 ","$5,009.40 ",$52.09 ,"$7,590.00 ",$52.09 ,"$4,469.00 ","$4,010.00 ","$1,810.36 ","$4,554.00 ","$6,451.50 ","$5,313.00 ",$52.09 ,$52.09 ,"$7,210.50 ","$5,768.40 ","$5,692.50 ","$7,276.00 ","$6,451.50 ","$1,810.36 ","$7,276.00 ","$7,276.00 ","$5,313.00 ","$4,622.31 ",$52.09 ,"$1,810.36 ","$1,774.15 ","$3,620.72 ",$55.22 ,"$6,451.50 ","$4,073.32 ","$6,982.80 ","$5,313.00 ","$1,771.14 ","$2,213.66 ","$4,622.31 ","$2,213.66 ","$5,244.69 ","$6,831.00 ","$5,185.49 ","$1,791.89 ","$5,996.10 ",$55.22 ,"$2,747.00 ","$2,747.00 ","$1,774.15 ","$2,747.00 ","$5,464.80 ","$4,705.80 ","$5,464.80 ","$5,464.80 ","$6,072.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100007,50606,HC ENDO BX URETER/RENAL PELVIS W/G SI,361,1 ,$540.50 ,$356.73 ,$237.90 ,"$2,213.66 ",$237.90 ,$540.50 ,$540.50 , N/A ,$324.30 ,$459.43 ,$378.35 ,$237.90 ,$237.90 ,$513.48 ,$410.78 ,$405.38 ,$540.50 ,$459.43 , N/A ,$540.50 ,$540.50 ,$378.35 ,$329.16 ,$237.90 , N/A , N/A , N/A ,$252.17 ,$459.43 , N/A ,$497.26 ,$378.35 ,"$1,771.14 ","$2,213.66 ",$329.16 ,"$2,213.66 ",$373.49 ,$486.45 ,$369.27 , N/A ,$427.00 ,$252.17 ,$540.50 ,$540.50 , N/A ,$540.50 ,$389.16 ,$335.11 ,$389.16 ,$389.16 ,$432.40 
ST NICHOLAS HOSPITAL - ACUTE,36100008,50694,HC PL URT STNT W G SI NEW ACCESS WO NEPH CATH,361,1 ,"$6,937.95 ","$4,579.05 ",$101.96 ,"$7,038.44 ",$101.96 ,"$6,937.95 ","$6,937.95 ","$3,128.20 ","$4,162.77 ","$5,897.26 ","$4,856.57 ",$101.96 ,$101.96 ,"$6,591.05 ","$5,272.84 ","$5,203.46 ","$6,937.95 ","$5,897.26 ","$3,128.20 ","$6,937.95 ","$6,937.95 ","$4,856.57 ","$4,225.21 ",$101.96 ,"$3,128.20 ","$3,065.64 ","$6,256.40 ",$108.08 ,"$5,897.26 ","$7,038.44 ","$6,382.91 ","$4,856.57 ","$3,273.50 ","$4,091.88 ","$4,225.21 ","$4,091.88 ","$4,794.12 ","$6,244.16 ","$4,740.01 ","$3,096.29 ","$5,480.98 ",$108.08 ,"$6,800.00 ","$6,800.00 ","$3,065.64 ","$6,800.00 ","$4,995.32 ","$4,301.53 ","$4,995.32 ","$4,995.32 ","$5,550.36 "
ST NICHOLAS HOSPITAL - ACUTE,36100009,50695,HC PL URT STNT W G SI NEW ACCESS WITH NEPH CATH,361,1 ,"$22,300.80 ","$14,718.53 ",$101.96 ,"$22,300.80 ",$101.96 ,"$8,020.00 ","$7,448.00 ","$3,128.20 ","$13,380.48 ","$18,955.68 ","$15,610.56 ",$101.96 ,$101.96 ,"$21,185.76 ","$16,948.61 ","$16,725.60 ","$7,276.00 ","$18,955.68 ","$3,128.20 ","$7,276.00 ","$7,276.00 ","$15,610.56 ","$13,581.19 ",$101.96 ,"$3,128.20 ","$3,065.64 ","$6,256.40 ",$108.08 ,"$18,955.68 ","$7,038.44 ","$20,516.74 ","$15,610.56 ","$3,273.50 ","$4,091.88 ","$13,581.19 ","$4,091.88 ","$15,409.85 ","$20,070.72 ","$15,235.91 ","$3,096.29 ","$17,617.63 ",$108.08 ,"$6,800.00 ","$6,800.00 ","$3,065.64 ","$6,800.00 ","$16,056.58 ","$13,826.50 ","$16,056.58 ","$16,056.58 ","$17,840.64 "
ST NICHOLAS HOSPITAL - ACUTE,36100010,50705,HC URETERAL EMBOL OR OCCLUSION W/G SI,361,1 ,$460.00 ,$303.60 ,$237.90 ,"$2,213.66 ",$237.90 ,$460.00 ,$460.00 , N/A ,$276.00 ,$391.00 ,$322.00 ,$237.90 ,$237.90 ,$437.00 ,$349.60 ,$345.00 ,$460.00 ,$391.00 , N/A ,$460.00 ,$460.00 ,$322.00 ,$280.14 ,$237.90 , N/A , N/A , N/A ,$252.17 ,$391.00 , N/A ,$423.20 ,$322.00 ,"$1,771.14 ","$2,213.66 ",$280.14 ,"$2,213.66 ",$317.86 ,$414.00 ,$314.27 , N/A ,$363.40 ,$252.17 ,$460.00 ,$460.00 , N/A ,$460.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,36100011,49185,HC SCLEROTHERAPY FLUID COLLECTION PERC INJECT IG SI,361,1 ,"$2,973.90 ","$1,962.77 ",$25.31 ,"$3,293.01 ",$25.31 ,"$2,864.00 ","$2,292.00 ","$1,463.56 ","$1,784.34 ","$2,527.82 ","$2,081.73 ",$25.31 ,$25.31 ,"$2,825.21 ","$2,260.16 ","$2,230.43 ","$2,973.90 ","$2,527.82 ","$1,463.56 ","$2,973.90 ","$2,973.90 ","$2,081.73 ","$1,811.11 ",$25.31 ,"$1,463.56 ","$1,434.29 ","$2,927.12 ",$26.83 ,"$2,527.82 ","$3,293.01 ","$2,735.99 ","$2,081.73 ","$1,771.14 ","$2,213.66 ","$1,811.11 ","$2,213.66 ","$2,054.96 ","$2,676.51 ","$2,031.77 ","$1,448.64 ","$2,349.38 ",$26.83 ,"$2,747.00 ","$2,747.00 ","$1,434.29 ","$2,747.00 ","$2,141.21 ","$1,843.82 ","$2,141.21 ","$2,141.21 ","$2,379.12 "
ST NICHOLAS HOSPITAL - ACUTE,36100012,50706,HC BALLOON DILATION URETERAL IG SI,361,1 ,$667.00 ,$440.22 ,$237.90 ,"$2,497.74 ",$237.90 ,$667.00 ,$667.00 , N/A ,$400.20 ,$566.95 ,$466.90 ,$237.90 ,$237.90 ,$633.65 ,$506.92 ,$500.25 ,$667.00 ,$566.95 , N/A ,$667.00 ,$667.00 ,$466.90 ,$406.20 ,$237.90 , N/A , N/A , N/A ,$252.17 ,$566.95 , N/A ,$613.64 ,$466.90 ,"$1,998.41 ","$2,497.74 ",$406.20 ,"$2,497.74 ",$460.90 ,$600.30 ,$455.69 , N/A ,$526.93 ,$252.17 ,$667.00 ,$667.00 , N/A ,$667.00 ,$480.24 ,$413.54 ,$480.24 ,$480.24 ,$533.60 
ST NICHOLAS HOSPITAL - ACUTE,36100013,47541,HC PLCMENT ACCESS BILIARY TREE BOWEL PERC IG SI,361,1 ,"$5,060.00 ","$3,339.60 ",$202.70 ,"$7,778.08 ",$202.70 ,"$5,060.00 ","$5,060.00 ","$3,456.92 ","$3,036.00 ","$4,301.00 ","$3,542.00 ",$202.70 ,$202.70 ,"$4,807.00 ","$3,845.60 ","$3,795.00 ","$5,060.00 ","$4,301.00 ","$3,456.92 ","$5,060.00 ","$5,060.00 ","$3,542.00 ","$3,081.54 ",$202.70 ,"$3,456.92 ","$3,387.78 ","$5,060.00 ",$214.86 ,"$4,301.00 ","$7,778.08 ","$4,655.20 ","$3,542.00 ","$3,273.50 ","$4,091.88 ","$3,081.54 ","$4,091.88 ","$3,496.46 ","$4,554.00 ","$3,456.99 ","$3,421.66 ","$3,997.40 ",$214.86 ,"$5,060.00 ","$5,060.00 ","$3,387.78 ","$5,060.00 ","$3,643.20 ","$3,137.20 ","$3,643.20 ","$3,643.20 ","$4,048.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100024,G0259,HC INJ ARTHROGRAM SACROILIAC JNT,361,1 ,"$1,858.40 ","$1,226.54 ",$16.55 ,"$1,858.40 ",$16.55 , N/A , N/A , N/A ,"$1,115.04 ","$1,579.64 ","$1,300.88 ",$16.55 ,$16.55 ,"$1,765.48 ","$1,412.38 ","$1,393.80 ","$1,858.40 ","$1,579.64 ", N/A ,"$1,858.40 ","$1,858.40 ","$1,300.88 ","$1,131.77 ",$16.55 , N/A , N/A , N/A ,$17.54 ,"$1,579.64 ", N/A ,"$1,709.73 ","$1,300.88 ",$942.58 ,"$1,131.21 ","$1,131.77 ","$1,131.21 ","$1,284.15 ","$1,672.56 ","$1,269.66 ", N/A ,"$1,468.14 ",$17.54 ,"$1,858.40 ","$1,858.40 ", N/A ,"$1,858.40 ","$1,338.05 ","$1,152.21 ","$1,338.05 ","$1,338.05 ","$1,486.72 "
ST NICHOLAS HOSPITAL - ACUTE,36100100,62320,HC INJ INTRLAMNR CERV/THOR W/O GUIDE,361,1 ,"$1,486.95 ",$981.39 ,$30.03 ,"$1,486.95 ",$30.03 ,"$1,486.95 ","$1,486.95 ",$628.88 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$30.03 ,$30.03 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ","$1,486.95 ","$1,263.91 ",$628.88 ,"$1,486.95 ","$1,486.95 ","$1,040.87 ",$905.55 ,$30.03 ,$628.88 ,$616.30 ,"$1,257.76 ",$31.83 ,"$1,263.91 ","$1,414.97 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ",$622.47 ,"$1,174.69 ",$31.83 ,"$1,486.95 ","$1,486.95 ",$616.30 ,"$1,486.95 ","$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,36100101,62321,HC INJ INTRLAMNR CERV/THOR W/GUIDE,361,1 ,"$2,354.05 ","$1,553.67 ",$30.03 ,"$2,354.05 ",$30.03 ,"$2,354.05 ","$2,292.00 ",$628.88 ,"$1,412.43 ","$2,000.94 ","$1,647.84 ",$30.03 ,$30.03 ,"$2,236.35 ","$1,789.08 ","$1,765.54 ","$2,354.05 ","$2,000.94 ",$628.88 ,"$2,354.05 ","$2,354.05 ","$1,647.84 ","$1,433.62 ",$30.03 ,$628.88 ,$616.30 ,"$1,257.76 ",$31.83 ,"$2,000.94 ","$1,414.97 ","$2,165.73 ","$1,647.84 ","$1,771.14 ","$2,213.66 ","$1,433.62 ","$2,213.66 ","$1,626.65 ","$2,118.65 ","$1,608.29 ",$622.47 ,"$1,859.70 ",$31.83 ,"$2,354.05 ","$2,354.05 ",$616.30 ,"$2,354.05 ","$1,694.92 ","$1,459.51 ","$1,694.92 ","$1,694.92 ","$1,883.24 "
ST NICHOLAS HOSPITAL - ACUTE,36100102,62322,HC INJ INTRLAMNR LUM/SAC W/O GUIDE,361,1 ,"$1,486.95 ",$981.39 ,$30.03 ,"$1,871.39 ",$30.03 ,"$1,486.95 ","$1,486.95 ",$831.73 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$30.03 ,$30.03 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ","$1,486.95 ","$1,263.91 ",$831.73 ,"$1,486.95 ","$1,486.95 ","$1,040.87 ",$905.55 ,$30.03 ,$831.73 ,$815.10 ,"$1,486.95 ",$31.83 ,"$1,263.91 ","$1,871.39 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ",$823.25 ,"$1,174.69 ",$31.83 ,"$1,486.95 ","$1,486.95 ",$815.10 ,"$1,486.95 ","$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,36100103,62323,HC INJ INTRLAMNR LUM/SAC W/GUIDE,361,1 ,"$1,858.40 ","$1,226.54 ",$30.03 ,"$1,858.40 ",$30.03 ,"$1,858.40 ","$1,858.40 ",$628.88 ,"$1,115.04 ","$1,579.64 ","$1,300.88 ",$30.03 ,$30.03 ,"$1,765.48 ","$1,412.38 ","$1,393.80 ","$1,858.40 ","$1,579.64 ",$628.88 ,"$1,858.40 ","$1,858.40 ","$1,300.88 ","$1,131.77 ",$30.03 ,$628.88 ,$616.30 ,"$1,257.76 ",$31.83 ,"$1,579.64 ","$1,414.97 ","$1,709.73 ","$1,300.88 ","$1,771.14 ","$1,858.40 ","$1,131.77 ","$1,858.40 ","$1,284.15 ","$1,672.56 ","$1,269.66 ",$622.47 ,"$1,468.14 ",$31.83 ,"$1,858.40 ","$1,858.40 ",$616.30 ,"$1,858.40 ","$1,338.05 ","$1,152.21 ","$1,338.05 ","$1,338.05 ","$1,486.72 "
ST NICHOLAS HOSPITAL - ACUTE,36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$1,486.95 ",$981.39 ,$30.03 ,"$1,871.39 ",$30.03 ,"$1,486.95 ","$1,486.95 ",$831.73 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$30.03 ,$30.03 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ","$1,486.95 ","$1,263.91 ",$831.73 ,"$1,486.95 ","$1,486.95 ","$1,040.87 ",$905.55 ,$30.03 ,$831.73 ,$815.10 ,"$1,486.95 ",$31.83 ,"$1,263.91 ","$1,871.39 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ",$823.25 ,"$1,174.69 ",$31.83 ,"$1,486.95 ","$1,486.95 ",$815.10 ,"$1,486.95 ","$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,36100107,62327,HC INJ W/CATH LUM/SAC W/GUIDE,361,1 ,"$1,858.40 ","$1,226.54 ",$30.03 ,"$1,871.39 ",$30.03 ,"$1,858.40 ","$1,858.40 ",$831.73 ,"$1,115.04 ","$1,579.64 ","$1,300.88 ",$30.03 ,$30.03 ,"$1,765.48 ","$1,412.38 ","$1,393.80 ","$1,858.40 ","$1,579.64 ",$831.73 ,"$1,858.40 ","$1,858.40 ","$1,300.88 ","$1,131.77 ",$30.03 ,$831.73 ,$815.10 ,"$1,663.46 ",$31.83 ,"$1,579.64 ","$1,871.39 ","$1,709.73 ","$1,300.88 ","$1,771.14 ","$1,858.40 ","$1,131.77 ","$1,858.40 ","$1,284.15 ","$1,672.56 ","$1,269.66 ",$823.25 ,"$1,468.14 ",$31.83 ,"$1,858.40 ","$1,858.40 ",$815.10 ,"$1,858.40 ","$1,338.05 ","$1,152.21 ","$1,338.05 ","$1,338.05 ","$1,486.72 "
ST NICHOLAS HOSPITAL - ACUTE,36100108,29445,HC APPL CAST LEG RIGID CONTACT -BIL,361,1 ,"$1,152.30 ",$760.52 ,$9.25 ,"$1,152.30 ",$9.25 ,"$1,152.30 ","$1,152.30 ",$351.23 ,$691.38 ,$979.46 ,$806.61 ,$9.25 ,$9.25 ,"$1,094.69 ",$875.75 ,$864.23 ,"$1,152.30 ",$979.46 ,$351.23 ,"$1,152.30 ","$1,152.30 ",$806.61 ,$701.75 ,$9.25 ,$351.23 ,$344.21 ,$702.46 ,$9.81 ,$979.46 ,$790.26 ,"$1,060.12 ",$806.61 ,$584.45 ,$701.41 ,$701.75 ,$701.41 ,$796.24 ,"$1,037.07 ",$787.25 ,$347.65 ,$910.32 ,$9.81 ,"$1,152.30 ","$1,152.30 ",$344.21 ,"$1,152.30 ",$829.66 ,$714.43 ,$829.66 ,$829.66 ,$921.84 
ST NICHOLAS HOSPITAL - ACUTE,36100135,31625,HC BRONCHOSCOPY BX SGL/MULT SITES,361,1 ,"$2,900.00 ","$1,914.00 ",$59.62 ,"$3,510.44 ",$59.62 ,"$2,900.00 ","$2,900.00 ","$1,560.19 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$59.62 ,$59.62 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ","$1,560.19 ","$2,900.00 ","$2,900.00 ","$2,030.00 ","$1,766.10 ",$59.62 ,"$1,560.19 ","$1,528.99 ","$2,900.00 ",$63.20 ,"$2,465.00 ","$3,510.44 ","$2,668.00 ","$2,030.00 ","$1,998.41 ","$2,497.74 ","$1,766.10 ","$2,497.74 ","$2,003.90 ","$2,610.00 ","$1,981.28 ","$1,544.27 ","$2,291.00 ",$63.20 ,"$2,900.00 ","$2,900.00 ","$1,528.99 ","$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100136,31627,HC BRONCHOSCOPY NAVAGATIONAL,361,1 ,"$2,900.00 ","$1,914.00 ",$6.83 ,"$2,900.00 ",$6.83 ,"$2,900.00 ","$2,900.00 ", N/A ,"$1,740.00 ","$2,465.00 ","$2,030.00 ",$6.83 ,$6.83 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ", N/A ,"$2,900.00 ","$2,900.00 ","$2,030.00 ","$1,766.10 ",$6.83 , N/A , N/A , N/A ,$7.24 ,"$2,465.00 ", N/A ,"$2,668.00 ","$2,030.00 ","$1,998.41 ","$2,497.74 ","$1,766.10 ","$2,497.74 ","$2,003.90 ","$2,610.00 ","$1,981.28 ", N/A ,"$2,291.00 ",$7.24 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100137,31629,HC BRONCHOSCOPY W/ASP BX TRANSHC BRONCH,361,1 ,"$3,200.00 ","$2,112.00 ",$59.62 ,"$7,320.70 ",$59.62 ,"$3,200.00 ","$3,200.00 ","$3,253.64 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$59.62 ,$59.62 ,"$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$3,253.64 ","$3,200.00 ","$3,200.00 ","$2,240.00 ","$1,948.80 ",$59.62 ,"$3,253.64 ","$3,188.57 ","$3,200.00 ",$63.20 ,"$2,720.00 ","$7,320.70 ","$2,944.00 ","$2,240.00 ","$3,273.50 ","$4,091.88 ","$1,948.80 ","$4,091.88 ","$2,211.20 ","$2,880.00 ","$2,186.24 ","$3,220.46 ","$2,528.00 ",$63.20 ,"$3,200.00 ","$3,200.00 ","$3,188.57 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100140,31623,HC BRONCHOSCOPY W/BRUSHING,361,1 ,"$2,900.00 ","$1,914.00 ",$59.62 ,"$3,510.44 ",$59.62 ,"$2,900.00 ","$2,900.00 ","$1,560.19 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$59.62 ,$59.62 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ","$1,560.19 ","$2,900.00 ","$2,900.00 ","$2,030.00 ","$1,766.10 ",$59.62 ,"$1,560.19 ","$1,528.99 ","$2,900.00 ",$63.20 ,"$2,465.00 ","$3,510.44 ","$2,668.00 ","$2,030.00 ","$1,998.41 ","$2,497.74 ","$1,766.10 ","$2,497.74 ","$2,003.90 ","$2,610.00 ","$1,981.28 ","$1,544.27 ","$2,291.00 ",$63.20 ,"$2,900.00 ","$2,900.00 ","$1,528.99 ","$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100141,31628,HC BRONCHOSCOPY W/BX TRANSHC BRONCH SGL,361,1 ,"$3,200.00 ","$2,112.00 ",$59.62 ,"$7,320.70 ",$59.62 ,"$3,200.00 ","$3,200.00 ","$3,253.64 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$59.62 ,$59.62 ,"$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$3,253.64 ","$3,200.00 ","$3,200.00 ","$2,240.00 ","$1,948.80 ",$59.62 ,"$3,253.64 ","$3,188.57 ","$3,200.00 ",$63.20 ,"$2,720.00 ","$7,320.70 ","$2,944.00 ","$2,240.00 ","$1,998.41 ","$2,497.74 ","$1,948.80 ","$2,497.74 ","$2,211.20 ","$2,880.00 ","$2,186.24 ","$3,220.46 ","$2,528.00 ",$63.20 ,"$3,200.00 ","$3,200.00 ","$3,188.57 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100143,31624,HC BRONCHOSCOPY W/LAVAGE ALVEOLAR,361,1 ,"$2,900.00 ","$1,914.00 ",$59.62 ,"$3,510.44 ",$59.62 ,"$2,900.00 ","$2,900.00 ","$1,560.19 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$59.62 ,$59.62 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ","$1,560.19 ","$2,900.00 ","$2,900.00 ","$2,030.00 ","$1,766.10 ",$59.62 ,"$1,560.19 ","$1,528.99 ","$2,900.00 ",$63.20 ,"$2,465.00 ","$3,510.44 ","$2,668.00 ","$2,030.00 ","$1,998.41 ","$2,497.74 ","$1,766.10 ","$2,497.74 ","$2,003.90 ","$2,610.00 ","$1,981.28 ","$1,544.27 ","$2,291.00 ",$63.20 ,"$2,900.00 ","$2,900.00 ","$1,528.99 ","$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100158,20983,HC ABLATION TUMOR BONE PERC W/GUIDANCE CRYO,361,1 ,"$6,070.85 ","$4,006.76 ",$62.90 ,"$14,525.73 ",$62.90 ,"$6,070.85 ","$6,070.85 ","$6,455.88 ","$3,642.51 ","$5,160.22 ","$4,249.60 ",$62.90 ,$62.90 ,"$5,767.31 ","$4,613.85 ","$4,553.14 ","$6,070.85 ","$5,160.22 ","$6,455.88 ","$6,070.85 ","$6,070.85 ","$4,249.60 ","$3,697.15 ",$62.90 ,"$6,455.88 ","$6,326.76 ","$6,070.85 ",$66.67 ,"$5,160.22 ","$14,525.73 ","$5,585.18 ","$4,249.60 ","$4,535.48 ","$5,669.62 ","$3,697.15 ","$5,669.62 ","$4,194.96 ","$5,463.77 ","$4,147.60 ","$6,390.03 ","$4,795.97 ",$66.67 ,"$6,070.85 ","$6,070.85 ","$6,326.76 ","$6,070.85 ","$4,371.01 ","$3,763.93 ","$4,371.01 ","$4,371.01 ","$4,856.68 "
ST NICHOLAS HOSPITAL - ACUTE,36100178,62264,HC INJ LYSIS EPID ADHESIONS W/RAD LOCAL 1 DAY,361,1 ,"$1,933.15 ","$1,275.88 ",$30.03 ,"$1,933.15 ",$30.03 ,"$1,933.15 ","$1,933.15 ",$831.73 ,"$1,159.89 ","$1,643.18 ","$1,353.21 ",$30.03 ,$30.03 ,"$1,836.49 ","$1,469.19 ","$1,449.86 ","$1,933.15 ","$1,643.18 ",$831.73 ,"$1,933.15 ","$1,933.15 ","$1,353.21 ","$1,177.29 ",$30.03 ,$831.73 ,$815.10 ,"$1,663.46 ",$31.83 ,"$1,643.18 ","$1,871.39 ","$1,778.50 ","$1,353.21 ","$1,771.14 ","$1,933.15 ","$1,177.29 ","$1,933.15 ","$1,335.81 ","$1,739.84 ","$1,320.73 ",$823.25 ,"$1,527.19 ",$31.83 ,"$1,933.15 ","$1,933.15 ",$815.10 ,"$1,933.15 ","$1,391.87 ","$1,198.55 ","$1,391.87 ","$1,391.87 ","$1,546.52 "
ST NICHOLAS HOSPITAL - ACUTE,36100196,64447,HC FEMORAL NERVE BLOCK SINGLE,361,1 ,$768.20 ,$507.01 ,$13.98 ,"$1,414.97 ",$13.98 ,$768.20 ,$768.20 ,$628.88 ,$460.92 ,$652.97 ,$537.74 ,$13.98 ,$13.98 ,$729.79 ,$583.83 ,$576.15 ,$768.20 ,$652.97 ,$628.88 ,$768.20 ,$768.20 ,$537.74 ,$467.83 ,$13.98 ,$628.88 ,$616.30 ,$768.20 ,$14.82 ,$652.97 ,"$1,414.97 ",$706.74 ,$537.74 ,$768.20 ,$768.20 ,$467.83 ,$768.20 ,$530.83 ,$691.38 ,$524.83 ,$622.47 ,$606.88 ,$14.82 ,$768.20 ,$768.20 ,$616.30 ,$768.20 ,$553.10 ,$476.28 ,$553.10 ,$553.10 ,$614.56 
ST NICHOLAS HOSPITAL - ACUTE,36100227,31635,HC BRONCHOSCOPY W/REM FOREIGN BODY,361,1 ,"$3,200.00 ","$2,112.00 ",$59.62 ,"$3,510.44 ",$59.62 ,"$3,200.00 ","$3,200.00 ","$1,560.19 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$59.62 ,$59.62 ,"$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$1,560.19 ","$3,200.00 ","$3,200.00 ","$2,240.00 ","$1,948.80 ",$59.62 ,"$1,560.19 ","$1,528.99 ","$3,120.38 ",$63.20 ,"$2,720.00 ","$3,510.44 ","$2,944.00 ","$2,240.00 ","$1,998.41 ","$2,497.74 ","$1,948.80 ","$2,497.74 ","$2,211.20 ","$2,880.00 ","$2,186.24 ","$1,544.27 ","$2,528.00 ",$63.20 ,"$3,200.00 ","$3,200.00 ","$1,528.99 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100228,31641,HC BRONCHOSCOPY W/TUMOR DESTRUCTION,361,1 ,"$3,200.00 ","$2,112.00 ",$120.77 ,"$7,320.70 ",$120.77 ,"$3,200.00 ","$3,200.00 ","$3,253.64 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$120.77 ,$120.77 ,"$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$3,253.64 ","$3,200.00 ","$3,200.00 ","$2,240.00 ","$1,948.80 ",$120.77 ,"$3,253.64 ","$3,188.57 ","$3,200.00 ",$128.02 ,"$2,720.00 ","$7,320.70 ","$2,944.00 ","$2,240.00 ","$3,273.50 ","$4,091.88 ","$1,948.80 ","$4,091.88 ","$2,211.20 ","$2,880.00 ","$2,186.24 ","$3,220.46 ","$2,528.00 ",$128.02 ,"$3,200.00 ","$3,200.00 ","$3,188.57 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100230,50436,HC DILATION EXIST TRACT ENDOURAL W/GUIDE,361,1 ,"$10,613.35 ","$7,004.81 ",$52.09 ,"$10,613.35 ",$52.09 ,"$4,469.00 ","$4,010.00 ","$3,128.20 ","$6,368.01 ","$9,021.35 ","$7,429.35 ",$52.09 ,$52.09 ,"$10,082.68 ","$8,066.15 ","$7,960.01 ","$7,276.00 ","$9,021.35 ","$3,128.20 ","$7,276.00 ","$7,276.00 ","$7,429.35 ","$6,463.53 ",$52.09 ,"$3,128.20 ","$3,065.64 ","$6,256.40 ",$55.22 ,"$9,021.35 ","$7,038.44 ","$9,764.28 ","$7,429.35 ","$2,747.95 ","$3,435.21 ","$6,463.53 ","$3,435.21 ","$7,333.82 ","$9,552.02 ","$7,251.04 ","$3,096.29 ","$8,384.55 ",$55.22 ,"$5,171.00 ","$5,171.00 ","$3,065.64 ","$5,171.00 ","$7,641.61 ","$6,580.28 ","$7,641.61 ","$7,641.61 ","$8,490.68 "
ST NICHOLAS HOSPITAL - ACUTE,36100232,11103,HC BIOPSY SKIN TANGENTIAL ADDL LESN,361,1 ,$186.30 ,$122.96 ,$15.19 ,"$2,213.66 ",$15.19 , N/A , N/A , N/A ,$111.78 ,$158.36 ,$130.41 ,$15.19 ,$15.19 ,$176.99 ,$141.59 ,$139.73 ,$186.30 ,$158.36 , N/A ,$186.30 ,$186.30 ,$130.41 ,$113.46 ,$15.19 , N/A , N/A , N/A ,$16.10 ,$158.36 , N/A ,$171.40 ,$130.41 ,"$1,771.14 ","$2,213.66 ",$113.46 ,"$2,213.66 ",$128.73 ,$167.67 ,$127.28 , N/A ,$147.18 ,$16.10 ,$186.30 ,$186.30 , N/A ,$186.30 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,36100233,11105,HC BIOPSY SKIN PUNCH ADDL LESN,361,1 ,$186.30 ,$122.96 ,$15.19 ,"$2,213.66 ",$15.19 , N/A , N/A , N/A ,$111.78 ,$158.36 ,$130.41 ,$15.19 ,$15.19 ,$176.99 ,$141.59 ,$139.73 ,$186.30 ,$158.36 , N/A ,$186.30 ,$186.30 ,$130.41 ,$113.46 ,$15.19 , N/A , N/A , N/A ,$16.10 ,$158.36 , N/A ,$171.40 ,$130.41 ,"$1,771.14 ","$2,213.66 ",$113.46 ,"$2,213.66 ",$128.73 ,$167.67 ,$127.28 , N/A ,$147.18 ,$16.10 ,$186.30 ,$186.30 , N/A ,$186.30 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,36100234,11107,HC BIOPSY SKIN INCISIONAL ADDL LESN,361,1 ,$186.30 ,$122.96 ,$15.19 ,"$2,213.66 ",$15.19 , N/A , N/A , N/A ,$111.78 ,$158.36 ,$130.41 ,$15.19 ,$15.19 ,$176.99 ,$141.59 ,$139.73 ,$186.30 ,$158.36 , N/A ,$186.30 ,$186.30 ,$130.41 ,$113.46 ,$15.19 , N/A , N/A , N/A ,$16.10 ,$158.36 , N/A ,$171.40 ,$130.41 ,"$1,771.14 ","$2,213.66 ",$113.46 ,"$2,213.66 ",$128.73 ,$167.67 ,$127.28 , N/A ,$147.18 ,$16.10 ,$186.30 ,$186.30 , N/A ,$186.30 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,36100235,11102,HC BIOPSY SKIN TANGENTIAL INIT LESN,361,1 ,$384.10 ,$253.51 ,$15.19 ,$396.55 ,$15.19 ,$384.10 ,$384.10 ,$176.25 ,$230.46 ,$326.49 ,$268.87 ,$15.19 ,$15.19 ,$364.90 ,$291.92 ,$288.08 ,$384.10 ,$326.49 ,$176.25 ,$384.10 ,$384.10 ,$268.87 ,$233.92 ,$15.19 ,$176.25 ,$172.72 ,$352.50 ,$16.10 ,$326.49 ,$396.55 ,$353.37 ,$268.87 ,$194.82 ,$233.80 ,$233.92 ,$233.80 ,$265.41 ,$345.69 ,$262.42 ,$174.45 ,$303.44 ,$16.10 ,$384.10 ,$384.10 ,$172.72 ,$384.10 ,$276.55 ,$238.14 ,$276.55 ,$276.55 ,$307.28 
ST NICHOLAS HOSPITAL - ACUTE,36100236,11104,HC BIOPSY SKIN PUNCH INIT LESN,361,1 ,$384.10 ,$253.51 ,$15.19 ,$819.26 ,$15.19 ,$384.10 ,$384.10 ,$364.12 ,$230.46 ,$326.49 ,$268.87 ,$15.19 ,$15.19 ,$364.90 ,$291.92 ,$288.08 ,$384.10 ,$326.49 ,$364.12 ,$384.10 ,$384.10 ,$268.87 ,$233.92 ,$15.19 ,$364.12 ,$356.84 ,$384.10 ,$16.10 ,$326.49 ,$819.26 ,$353.37 ,$268.87 ,$194.82 ,$233.80 ,$233.92 ,$233.80 ,$265.41 ,$345.69 ,$262.42 ,$360.40 ,$303.44 ,$16.10 ,$384.10 ,$384.10 ,$356.84 ,$384.10 ,$276.55 ,$238.14 ,$276.55 ,$276.55 ,$307.28 
ST NICHOLAS HOSPITAL - ACUTE,36100237,11106,HC BIOPSY SKIN INCISIONAL INIT LESN,361,1 ,$384.10 ,$253.51 ,$15.19 ,"$1,275.77 ",$15.19 ,$384.10 ,$384.10 ,$567.01 ,$230.46 ,$326.49 ,$268.87 ,$15.19 ,$15.19 ,$364.90 ,$291.92 ,$288.08 ,$384.10 ,$326.49 ,$567.01 ,$384.10 ,$384.10 ,$268.87 ,$233.92 ,$15.19 ,$567.01 ,$555.67 ,$384.10 ,$16.10 ,$326.49 ,"$1,275.77 ",$353.37 ,$268.87 ,$384.10 ,$384.10 ,$233.92 ,$384.10 ,$265.41 ,$345.69 ,$262.42 ,$561.23 ,$303.44 ,$16.10 ,$384.10 ,$384.10 ,$555.67 ,$384.10 ,$276.55 ,$238.14 ,$276.55 ,$276.55 ,$307.28 
ST NICHOLAS HOSPITAL - ACUTE,36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,"$1,362.75 ",$899.42 ,$23.54 ,"$1,425.14 ",$23.54 ,"$1,362.75 ","$1,362.75 ",$633.39 ,$817.65 ,"$1,158.34 ",$953.93 ,$23.54 ,$23.54 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ","$1,362.75 ","$1,158.34 ",$633.39 ,"$1,362.75 ","$1,362.75 ",$953.93 ,$829.91 ,$23.54 ,$633.39 ,$620.72 ,"$1,266.78 ",$24.95 ,"$1,158.34 ","$1,425.14 ","$1,253.73 ",$953.93 ,"$1,362.75 ","$1,362.75 ",$829.91 ,"$1,362.75 ",$941.66 ,"$1,226.48 ",$931.03 ,$626.93 ,"$1,076.57 ",$24.95 ,"$1,362.75 ","$1,362.75 ",$620.72 ,"$1,362.75 ",$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,36100239,10006,HC ASP FINE NDL W/US GUIDE EA ADDL LESN,361,1 ,$681.95 ,$450.09 ,$23.54 ,"$2,497.74 ",$23.54 ,$681.95 ,$681.95 , N/A ,$409.17 ,$579.66 ,$477.37 ,$23.54 ,$23.54 ,$647.85 ,$518.28 ,$511.46 ,$681.95 ,$579.66 , N/A ,$681.95 ,$681.95 ,$477.37 ,$415.31 ,$23.54 , N/A , N/A , N/A ,$24.95 ,$579.66 , N/A ,$627.39 ,$477.37 ,"$1,998.41 ","$2,497.74 ",$415.31 ,"$2,497.74 ",$471.23 ,$613.76 ,$465.91 , N/A ,$538.74 ,$24.95 ,$681.95 ,$681.95 , N/A ,$681.95 ,$491.00 ,$422.81 ,$491.00 ,$491.00 ,$545.56 
ST NICHOLAS HOSPITAL - ACUTE,36100240,10007,HC ASP FINE NDL W/FLUORO GUIDE INIT LESN,361,1 ,"$1,362.75 ",$899.42 ,$23.54 ,"$1,425.14 ",$23.54 ,"$1,362.75 ","$1,362.75 ",$633.39 ,$817.65 ,"$1,158.34 ",$953.93 ,$23.54 ,$23.54 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ","$1,362.75 ","$1,158.34 ",$633.39 ,"$1,362.75 ","$1,362.75 ",$953.93 ,$829.91 ,$23.54 ,$633.39 ,$620.72 ,"$1,266.78 ",$24.95 ,"$1,158.34 ","$1,425.14 ","$1,253.73 ",$953.93 ,"$1,362.75 ","$1,362.75 ",$829.91 ,"$1,362.75 ",$941.66 ,"$1,226.48 ",$931.03 ,$626.93 ,"$1,076.57 ",$24.95 ,"$1,362.75 ","$1,362.75 ",$620.72 ,"$1,362.75 ",$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,36100241,10008,HC ASP FINE NDL W/FLUORO GUIDE EA ADDL LESN,361,1 ,$681.95 ,$450.09 ,$23.54 ,"$2,497.74 ",$23.54 , N/A , N/A , N/A ,$409.17 ,$579.66 ,$477.37 ,$23.54 ,$23.54 ,$647.85 ,$518.28 ,$511.46 ,$681.95 ,$579.66 , N/A ,$681.95 ,$681.95 ,$477.37 ,$415.31 ,$23.54 , N/A , N/A , N/A ,$24.95 ,$579.66 , N/A ,$627.39 ,$477.37 ,"$1,998.41 ","$2,497.74 ",$415.31 ,"$2,497.74 ",$471.23 ,$613.76 ,$465.91 , N/A ,$538.74 ,$24.95 ,$681.95 ,$681.95 , N/A ,$681.95 ,$491.00 ,$422.81 ,$491.00 ,$491.00 ,$545.56 
ST NICHOLAS HOSPITAL - ACUTE,36100242,10009,HC ASP FINE NDL W/CT GUIDE INIT LESN,361,1 ,"$1,362.75 ",$899.42 ,$23.54 ,"$1,425.14 ",$23.54 ,"$1,362.75 ","$1,362.75 ",$633.39 ,$817.65 ,"$1,158.34 ",$953.93 ,$23.54 ,$23.54 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ","$1,362.75 ","$1,158.34 ",$633.39 ,"$1,362.75 ","$1,362.75 ",$953.93 ,$829.91 ,$23.54 ,$633.39 ,$620.72 ,"$1,266.78 ",$24.95 ,"$1,158.34 ","$1,425.14 ","$1,253.73 ",$953.93 ,"$1,362.75 ","$1,362.75 ",$829.91 ,"$1,362.75 ",$941.66 ,"$1,226.48 ",$931.03 ,$626.93 ,"$1,076.57 ",$24.95 ,"$1,362.75 ","$1,362.75 ",$620.72 ,"$1,362.75 ",$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,36100243,10010,HC ASP FINE NDL W/CT GUIDE EA ADDL LESN,361,1 ,$681.95 ,$450.09 ,$23.54 ,"$2,497.74 ",$23.54 , N/A , N/A , N/A ,$409.17 ,$579.66 ,$477.37 ,$23.54 ,$23.54 ,$647.85 ,$518.28 ,$511.46 ,$681.95 ,$579.66 , N/A ,$681.95 ,$681.95 ,$477.37 ,$415.31 ,$23.54 , N/A , N/A , N/A ,$24.95 ,$579.66 , N/A ,$627.39 ,$477.37 ,"$1,998.41 ","$2,497.74 ",$415.31 ,"$2,497.74 ",$471.23 ,$613.76 ,$465.91 , N/A ,$538.74 ,$24.95 ,$681.95 ,$681.95 , N/A ,$681.95 ,$491.00 ,$422.81 ,$491.00 ,$491.00 ,$545.56 
ST NICHOLAS HOSPITAL - ACUTE,36100246,36572,HC INS CATH PERIPH CV W/O PORT W/GUIDANCE <5,361,1 ,"$3,284.40 ","$2,167.70 ",$38.41 ,"$3,284.40 ",$38.41 ,"$2,864.00 ","$2,292.00 ",$564.62 ,"$1,970.64 ","$2,791.74 ","$2,299.08 ",$38.41 ,$38.41 ,"$3,120.18 ","$2,496.14 ","$2,463.30 ","$3,284.40 ","$2,791.74 ",$564.62 ,"$3,284.40 ","$3,284.40 ","$2,299.08 ","$2,000.20 ",$38.41 ,$564.62 ,$553.33 ,"$1,129.24 ",$40.71 ,"$2,791.74 ","$1,270.39 ","$3,021.65 ","$2,299.08 ","$1,771.14 ","$2,213.66 ","$2,000.20 ","$2,213.66 ","$2,269.52 ","$2,955.96 ","$2,243.90 ",$558.86 ,"$2,594.68 ",$40.71 ,"$2,747.00 ","$2,747.00 ",$553.33 ,"$2,747.00 ","$2,364.77 ","$2,036.33 ","$2,364.77 ","$2,364.77 ","$2,627.52 "
ST NICHOLAS HOSPITAL - ACUTE,36100247,36573,HC INS PER CV CATH W/O PORT W/GUIDANCE 5>,361,1 ,"$3,592.60 ","$2,371.12 ",$38.41 ,"$3,592.60 ",$38.41 ,"$3,592.60 ","$3,592.60 ","$1,452.14 ","$2,155.56 ","$3,053.71 ","$2,514.82 ",$38.41 ,$38.41 ,"$3,412.97 ","$2,730.38 ","$2,694.45 ","$3,592.60 ","$3,053.71 ","$1,452.14 ","$3,592.60 ","$3,592.60 ","$2,514.82 ","$2,187.89 ",$38.41 ,"$1,452.14 ","$1,423.10 ","$2,904.28 ",$40.71 ,"$3,053.71 ","$3,267.32 ","$3,305.19 ","$2,514.82 ","$1,998.41 ","$2,497.74 ","$2,187.89 ","$2,497.74 ","$2,482.49 ","$3,233.34 ","$2,454.46 ","$1,437.33 ","$2,838.15 ",$40.71 ,"$3,592.60 ","$3,592.60 ","$1,423.10 ","$3,592.60 ","$2,586.67 ","$2,227.41 ","$2,586.67 ","$2,586.67 ","$2,874.08 "
ST NICHOLAS HOSPITAL - ACUTE,36100264,33016,HC PERICARDIOCENTESIS W/ OR W/O IMAGING,361,1 ,"$1,819.00 ","$1,200.54 ",$33.66 ,"$3,267.32 ",$33.66 ,"$1,819.00 ","$1,819.00 ","$1,452.14 ","$1,091.40 ","$1,546.15 ","$1,273.30 ",$33.66 ,$33.66 ,"$1,728.05 ","$1,382.44 ","$1,364.25 ","$1,819.00 ","$1,546.15 ","$1,452.14 ","$1,819.00 ","$1,819.00 ","$1,273.30 ","$1,107.77 ",$33.66 ,"$1,452.14 ","$1,423.10 ","$1,819.00 ",$35.68 ,"$1,546.15 ","$3,267.32 ","$1,673.48 ","$1,273.30 ","$1,771.14 ","$1,819.00 ","$1,107.77 ","$1,819.00 ","$1,256.93 ","$1,637.10 ","$1,242.74 ","$1,437.33 ","$1,437.01 ",$35.68 ,"$1,819.00 ","$1,819.00 ","$1,423.10 ","$1,819.00 ","$1,309.68 ","$1,127.78 ","$1,309.68 ","$1,309.68 ","$1,455.20 "
ST NICHOLAS HOSPITAL - ACUTE,36100265,33017,HC PERICARDIAL DRAINAGE =>6 YRS W/O CONGENITAL CARDIAC ANOMALY,361,1 ,"$2,247.00 ","$1,483.02 ",$33.66 ,"$2,247.00 ",$33.66 ,"$2,247.00 ","$2,247.00 ", N/A ,"$1,348.20 ","$1,909.95 ","$1,572.90 ",$33.66 ,$33.66 ,"$2,134.65 ","$1,707.72 ","$1,685.25 ","$2,247.00 ","$1,909.95 ", N/A ,"$2,247.00 ","$2,247.00 ","$1,572.90 ","$1,368.42 ",$33.66 , N/A , N/A , N/A ,$35.68 ,"$1,909.95 ", N/A ,"$2,067.24 ","$1,572.90 ", N/A , N/A ,"$1,368.42 ", N/A ,"$1,552.68 ","$2,022.30 ","$1,535.15 ", N/A ,"$1,775.13 ",$35.68 ,"$2,247.00 ","$2,247.00 ", N/A ,"$2,247.00 ","$1,617.84 ","$1,393.14 ","$1,617.84 ","$1,617.84 ","$1,797.60 "
ST NICHOLAS HOSPITAL - ACUTE,36100270,62328,HC LUMBAR PUNCTURE DIAGNOSTIC W/FLUORO OR CT GUID,361,1 ,"$1,486.95 ",$981.39 ,$30.03 ,"$1,486.95 ",$30.03 ,"$1,486.95 ","$1,486.95 ",$628.88 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$30.03 ,$30.03 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ","$1,486.95 ","$1,263.91 ",$628.88 ,"$1,486.95 ","$1,486.95 ","$1,040.87 ",$905.55 ,$30.03 ,$628.88 ,$616.30 ,"$1,257.76 ",$31.83 ,"$1,263.91 ","$1,414.97 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ",$622.47 ,"$1,174.69 ",$31.83 ,"$1,486.95 ","$1,486.95 ",$616.30 ,"$1,486.95 ","$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,36100271,62329,HC LUMBAR PUNCTURE THERAPEUTIC/DRAINAGE W//FLUORO OR CT GUID,361,1 ,"$1,486.95 ",$981.39 ,$30.03 ,"$1,486.95 ",$30.03 ,"$1,486.95 ","$1,486.95 ",$628.88 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$30.03 ,$30.03 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ","$1,486.95 ","$1,263.91 ",$628.88 ,"$1,486.95 ","$1,486.95 ","$1,040.87 ",$905.55 ,$30.03 ,$628.88 ,$616.30 ,"$1,257.76 ",$31.83 ,"$1,263.91 ","$1,414.97 ","$1,367.99 ","$1,040.87 ","$1,486.95 ","$1,486.95 ",$905.55 ,"$1,486.95 ","$1,027.48 ","$1,338.26 ","$1,015.88 ",$622.47 ,"$1,174.69 ",$31.83 ,"$1,486.95 ","$1,486.95 ",$616.30 ,"$1,486.95 ","$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,36100275,64625,HC ABLATION RF NERVES SI JOINT W/FLUORO OR CT GUID,361,1 ,"$4,088.25 ","$2,698.25 ",$47.82 ,"$4,088.25 ",$47.82 ,"$4,088.25 ","$4,010.00 ","$1,754.38 ","$2,452.95 ","$3,475.01 ","$2,861.78 ",$47.82 ,$47.82 ,"$3,883.84 ","$3,107.07 ","$3,066.19 ","$4,088.25 ","$3,475.01 ","$1,754.38 ","$4,088.25 ","$4,088.25 ","$2,861.78 ","$2,489.74 ",$47.82 ,"$1,754.38 ","$1,719.29 ","$3,508.76 ",$50.69 ,"$3,475.01 ","$3,947.35 ","$3,761.19 ","$2,861.78 ","$2,747.95 ","$3,435.21 ","$2,489.74 ","$3,435.21 ","$2,824.98 ","$3,679.43 ","$2,793.09 ","$1,736.48 ","$3,229.72 ",$50.69 ,"$4,088.25 ","$4,088.25 ","$1,719.29 ","$4,088.25 ","$2,943.54 ","$2,534.72 ","$2,943.54 ","$2,943.54 ","$3,270.60 "
ST NICHOLAS HOSPITAL - ACUTE,36100281,32408,HC CORE NDL BX LUNG/MEDIASTINUM PERQ W IMG,361,1 ,"$5,064.60 ","$3,342.64 ",$33.66 ,"$5,064.60 ",$33.66 ,"$4,469.00 ","$4,010.00 ","$1,463.56 ","$3,038.76 ","$4,304.91 ","$3,545.22 ",$33.66 ,$33.66 ,"$4,811.37 ","$3,849.10 ","$3,798.45 ","$5,064.60 ","$4,304.91 ","$1,463.56 ","$5,064.60 ","$5,064.60 ","$3,545.22 ","$3,084.34 ",$33.66 ,"$1,463.56 ","$1,434.29 ","$2,927.12 ",$35.68 ,"$4,304.91 ","$3,293.01 ","$4,659.43 ","$3,545.22 ","$1,998.41 ","$2,497.74 ","$3,084.34 ","$2,497.74 ","$3,499.64 ","$4,558.14 ","$3,460.13 ","$1,448.64 ","$4,001.03 ",$35.68 ,"$4,106.00 ","$4,106.00 ","$1,434.29 ","$4,106.00 ","$3,646.51 ","$3,140.05 ","$3,646.51 ","$3,646.51 ","$4,051.68 "
ST NICHOLAS HOSPITAL - ACUTE,36100284,53060,HC DRAIN OF SKENE GLAND ABS OR CYST,450,1 ,$287.50 ,$189.75 ,$100.60 ,"$4,073.32 ",$100.60 ,$197.05 ,$197.05 ,"$1,810.36 ",$172.50 ,$244.38 ,$201.25 ,$100.60 ,$100.60 ,$273.13 ,$218.50 ,$215.63 ,$186.88 ,$244.38 ,"$1,810.36 ",$186.88 ,$186.88 ,$201.25 ,$175.09 ,$100.60 ,"$1,810.36 ","$1,774.15 ",$287.50 ,$106.64 ,$244.38 ,"$4,073.32 ",$264.50 ,$201.25 ,$145.82 ,$175.00 ,$175.09 ,$175.00 ,$198.66 ,$258.75 ,$196.42 ,"$1,791.89 ",$227.13 ,$106.64 ,$287.50 ,$287.50 ,"$1,774.15 ",$287.50 ,$207.00 ,$178.25 ,$207.00 ,$207.00 ,$230.00 
ST NICHOLAS HOSPITAL - ACUTE,36100513,28899,HC ARTHROGRAM FOOT/TOE,361,1 ,$678.50 ,$447.81 ,$15.68 ,$678.50 ,$15.68 ,$678.50 ,$678.50 ,$202.04 ,$407.10 ,$576.73 ,$474.95 ,$15.68 ,$15.68 ,$644.58 ,$515.66 ,$508.88 ,$678.50 ,$576.73 ,$202.04 ,$678.50 ,$678.50 ,$474.95 ,$413.21 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$576.73 ,$454.59 ,$624.22 ,$474.95 ,$344.14 ,$413.00 ,$413.21 ,$413.00 ,$468.84 ,$610.65 ,$463.55 ,$199.98 ,$536.02 ,$16.62 ,$678.50 ,$678.50 ,$198.00 ,$678.50 ,$488.52 ,$420.67 ,$488.52 ,$488.52 ,$542.80 
ST NICHOLAS HOSPITAL - ACUTE,37000002,N/A,HC DIFFICULT AIRWAY CHARGE,370,1 ,$979.44 ,$646.43 ,$496.77 ,$979.44 , N/A ,$671.31 ,$671.31 , N/A ,$587.66 ,$832.52 ,$685.61 , N/A , N/A ,$930.47 ,$744.37 ,$734.58 ,$636.64 ,$832.52 , N/A ,$636.64 ,$636.64 ,$685.61 ,$596.48 , N/A , N/A , N/A , N/A , N/A ,$832.52 , N/A ,$901.08 ,$685.61 ,$496.77 ,$596.19 ,$596.48 ,$596.19 ,$676.79 ,$881.50 ,$669.15 , N/A ,$773.76 , N/A ,$577.87 ,$577.87 , N/A ,$577.87 ,$705.20 ,$607.25 ,$705.20 ,$705.20 ,$783.55 
ST NICHOLAS HOSPITAL - ACUTE,37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,"$1,265.00 ",$834.90 ,$25.07 ,"$1,265.00 ",$25.07 ,"$1,265.00 ","$1,265.00 ",$202.84 ,$759.00 ,"$1,075.25 ",$885.50 ,$25.07 ,$25.07 ,"$1,201.75 ",$961.40 ,$948.75 ,"$1,265.00 ","$1,075.25 ",$202.84 ,"$1,265.00 ","$1,265.00 ",$885.50 ,$770.39 ,$25.07 ,$202.84 ,$198.78 ,$405.68 ,$26.57 ,"$1,075.25 ",$456.39 ,"$1,163.80 ",$885.50 ,$641.61 ,$770.01 ,$770.39 ,$770.01 ,$874.12 ,"$1,138.50 ",$864.25 ,$200.77 ,$999.35 ,$26.57 ,"$1,265.00 ","$1,265.00 ",$198.78 ,"$1,265.00 ",$910.80 ,$784.30 ,$910.80 ,$910.80 ,"$1,012.00 "
ST NICHOLAS HOSPITAL - ACUTE,37000014,64448,HC FEMORAL NERVE BLOCK CONTINUOUS,370,1 ,$941.85 ,$621.62 ,$37.48 ,"$1,871.39 ",$37.48 ,$645.54 ,$645.54 ,$831.73 ,$565.11 ,$800.57 ,$659.30 ,$37.48 ,$37.48 ,$894.76 ,$715.81 ,$706.39 ,$612.20 ,$800.57 ,$831.73 ,$612.20 ,$612.20 ,$659.30 ,$573.59 ,$37.48 ,$831.73 ,$815.10 ,$941.85 ,$39.73 ,$800.57 ,"$1,871.39 ",$866.50 ,$659.30 ,$941.85 ,$941.85 ,$573.59 ,$941.85 ,$650.82 ,$847.67 ,$643.47 ,$823.25 ,$744.06 ,$39.73 ,$555.69 ,$555.69 ,$815.10 ,$555.69 ,$678.13 ,$583.95 ,$678.13 ,$678.13 ,$753.48 
ST NICHOLAS HOSPITAL - ACUTE,37000017,99153,HC MODERATE SEDATION SAME PHY EA ADDL 15MIN,370,1 ,$92.00 ,$60.72 ,$0.76 ,$92.00 ,$0.76 ,$63.06 ,$63.06 , N/A ,$55.20 ,$78.20 ,$64.40 ,$0.76 ,$0.76 ,$87.40 ,$69.92 ,$69.00 ,$59.80 ,$78.20 , N/A ,$59.80 ,$59.80 ,$64.40 ,$56.03 ,$0.76 , N/A , N/A , N/A ,$0.81 ,$78.20 , N/A ,$84.64 ,$64.40 ,$46.66 ,$56.00 ,$56.03 ,$56.00 ,$63.57 ,$82.80 ,$62.85 , N/A ,$72.68 ,$0.81 ,$54.28 ,$54.28 , N/A ,$54.28 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,37000020,99157,HC MODERATE SEDATION DIFF PHY EA ADDL 15MIN,370,1 ,$92.00 ,$60.72 ,$0.76 ,$92.00 ,$0.76 ,$63.06 ,$63.06 , N/A ,$55.20 ,$78.20 ,$64.40 ,$0.76 ,$0.76 ,$87.40 ,$69.92 ,$69.00 ,$59.80 ,$78.20 , N/A ,$59.80 ,$59.80 ,$64.40 ,$56.03 ,$0.76 , N/A , N/A , N/A ,$0.81 ,$78.20 , N/A ,$84.64 ,$64.40 ,$46.66 ,$56.00 ,$56.03 ,$56.00 ,$63.57 ,$82.80 ,$62.85 , N/A ,$72.68 ,$0.81 ,$54.28 ,$54.28 , N/A ,$54.28 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,37000021,64447,HC FEMORAL NERVE BLOCK SINGLE,370,1 ,$768.20 ,$507.01 ,$13.98 ,"$1,414.97 ",$13.98 ,$526.52 ,$526.52 ,$628.88 ,$460.92 ,$652.97 ,$537.74 ,$13.98 ,$13.98 ,$729.79 ,$583.83 ,$576.15 ,$499.33 ,$652.97 ,$628.88 ,$499.33 ,$499.33 ,$537.74 ,$467.83 ,$13.98 ,$628.88 ,$616.30 ,$768.20 ,$14.82 ,$652.97 ,"$1,414.97 ",$706.74 ,$537.74 ,$768.20 ,$768.20 ,$467.83 ,$768.20 ,$530.83 ,$691.38 ,$524.83 ,$622.47 ,$606.88 ,$14.82 ,$453.24 ,$453.24 ,$616.30 ,$453.24 ,$553.10 ,$476.28 ,$553.10 ,$553.10 ,$614.56 
ST NICHOLAS HOSPITAL - ACUTE,37000022,64415,HC INTRASCALENE BLOCK SINGLE,370,1 ,$768.20 ,$507.01 ,$37.48 ,"$1,871.39 ",$37.48 ,$526.52 ,$526.52 ,$831.73 ,$460.92 ,$652.97 ,$537.74 ,$37.48 ,$37.48 ,$729.79 ,$583.83 ,$576.15 ,$499.33 ,$652.97 ,$831.73 ,$499.33 ,$499.33 ,$537.74 ,$467.83 ,$37.48 ,$831.73 ,$815.10 ,$768.20 ,$39.73 ,$652.97 ,"$1,871.39 ",$706.74 ,$537.74 ,$768.20 ,$768.20 ,$467.83 ,$768.20 ,$530.83 ,$691.38 ,$524.83 ,$823.25 ,$606.88 ,$39.73 ,$453.24 ,$453.24 ,$815.10 ,$453.24 ,$553.10 ,$476.28 ,$553.10 ,$553.10 ,$614.56 
ST NICHOLAS HOSPITAL - ACUTE,37000023,64416,HC INTRASCALENE BLOCK CONTINUOUS,370,1 ,"$2,843.95 ","$1,877.01 ",$37.48 ,"$2,843.95 ",$37.48 ,"$1,949.24 ","$1,949.24 ",$831.73 ,"$1,706.37 ","$2,417.36 ","$1,990.77 ",$37.48 ,$37.48 ,"$2,701.75 ","$2,161.40 ","$2,132.96 ","$1,848.57 ","$2,417.36 ",$831.73 ,"$1,848.57 ","$1,848.57 ","$1,990.77 ","$1,731.97 ",$37.48 ,$831.73 ,$815.10 ,"$1,663.46 ",$39.73 ,"$2,417.36 ","$1,871.39 ","$2,616.43 ","$1,990.77 ","$1,771.14 ","$2,213.66 ","$1,731.97 ","$2,213.66 ","$1,965.17 ","$2,559.56 ","$1,942.99 ",$823.25 ,"$2,246.72 ",$39.73 ,"$1,677.93 ","$1,677.93 ",$815.10 ,"$1,677.93 ","$2,047.64 ","$1,763.25 ","$2,047.64 ","$2,047.64 ","$2,275.16 "
ST NICHOLAS HOSPITAL - ACUTE,37000024,N/A,HC EPIDURAL NERVE BLOCK,370,1 ,$690.06 ,$455.44 ,$350.00 ,$690.06 , N/A ,$472.97 ,$472.97 , N/A ,$414.04 ,$586.55 ,$483.04 , N/A , N/A ,$655.56 ,$524.45 ,$517.55 ,$448.54 ,$586.55 , N/A ,$448.54 ,$448.54 ,$483.04 ,$420.25 , N/A , N/A , N/A , N/A , N/A ,$586.55 , N/A ,$634.86 ,$483.04 ,$350.00 ,$420.04 ,$420.25 ,$420.04 ,$476.83 ,$621.05 ,$471.45 , N/A ,$545.15 , N/A ,$407.14 ,$407.14 , N/A ,$407.14 ,$496.84 ,$427.84 ,$496.84 ,$496.84 ,$552.05 
ST NICHOLAS HOSPITAL - ACUTE,37000026,N/A,HC ANES BLOCK PERIPHERAL,370,1 ,$690.06 ,$455.44 ,$350.00 ,$690.06 , N/A ,$472.97 ,$472.97 , N/A ,$414.04 ,$586.55 ,$483.04 , N/A , N/A ,$655.56 ,$524.45 ,$517.55 ,$448.54 ,$586.55 , N/A ,$448.54 ,$448.54 ,$483.04 ,$420.25 , N/A , N/A , N/A , N/A , N/A ,$586.55 , N/A ,$634.86 ,$483.04 ,$350.00 ,$420.04 ,$420.25 ,$420.04 ,$476.83 ,$621.05 ,$471.45 , N/A ,$545.15 , N/A ,$407.14 ,$407.14 , N/A ,$407.14 ,$496.84 ,$427.84 ,$496.84 ,$496.84 ,$552.05 
ST NICHOLAS HOSPITAL - ACUTE,37000027,N/A,HC ANES SPINAL,370,1 ,$690.06 ,$455.44 ,$350.00 ,$690.06 , N/A ,$472.97 ,$472.97 , N/A ,$414.04 ,$586.55 ,$483.04 , N/A , N/A ,$655.56 ,$524.45 ,$517.55 ,$448.54 ,$586.55 , N/A ,$448.54 ,$448.54 ,$483.04 ,$420.25 , N/A , N/A , N/A , N/A , N/A ,$586.55 , N/A ,$634.86 ,$483.04 ,$350.00 ,$420.04 ,$420.25 ,$420.04 ,$476.83 ,$621.05 ,$471.45 , N/A ,$545.15 , N/A ,$407.14 ,$407.14 , N/A ,$407.14 ,$496.84 ,$427.84 ,$496.84 ,$496.84 ,$552.05 
ST NICHOLAS HOSPITAL - ACUTE,37000028,N/A,HC ANES CENTRAL LINE,370,1 ,$690.06 ,$455.44 ,$350.00 ,$690.06 , N/A ,$472.97 ,$472.97 , N/A ,$414.04 ,$586.55 ,$483.04 , N/A , N/A ,$655.56 ,$524.45 ,$517.55 ,$448.54 ,$586.55 , N/A ,$448.54 ,$448.54 ,$483.04 ,$420.25 , N/A , N/A , N/A , N/A , N/A ,$586.55 , N/A ,$634.86 ,$483.04 ,$350.00 ,$420.04 ,$420.25 ,$420.04 ,$476.83 ,$621.05 ,$471.45 , N/A ,$545.15 , N/A ,$407.14 ,$407.14 , N/A ,$407.14 ,$496.84 ,$427.84 ,$496.84 ,$496.84 ,$552.05 
ST NICHOLAS HOSPITAL - ACUTE,37000050,N/A,HC BIER BLOCK ANES INIT,370,1 ,$868.14 ,$572.97 ,$440.32 ,$868.14 , N/A ,$595.02 ,$595.02 , N/A ,$520.88 ,$737.92 ,$607.70 , N/A , N/A ,$824.73 ,$659.79 ,$651.11 ,$564.29 ,$737.92 , N/A ,$564.29 ,$564.29 ,$607.70 ,$528.70 , N/A , N/A , N/A , N/A , N/A ,$737.92 , N/A ,$798.69 ,$607.70 ,$440.32 ,$528.44 ,$528.70 ,$528.44 ,$599.88 ,$781.33 ,$593.11 , N/A ,$685.83 , N/A ,$512.20 ,$512.20 , N/A ,$512.20 ,$625.06 ,$538.25 ,$625.06 ,$625.06 ,$694.51 
ST NICHOLAS HOSPITAL - ACUTE,37000051,N/A,HC BIER BLOCK ANES ADDL,370,1 ,$178.08 ,$117.53 ,$90.32 ,$178.08 , N/A ,$122.06 ,$122.06 , N/A ,$106.85 ,$151.37 ,$124.66 , N/A , N/A ,$169.18 ,$135.34 ,$133.56 ,$115.75 ,$151.37 , N/A ,$115.75 ,$115.75 ,$124.66 ,$108.45 , N/A , N/A , N/A , N/A , N/A ,$151.37 , N/A ,$163.83 ,$124.66 ,$90.32 ,$108.40 ,$108.45 ,$108.40 ,$123.05 ,$160.27 ,$121.66 , N/A ,$140.68 , N/A ,$105.07 ,$105.07 , N/A ,$105.07 ,$128.22 ,$110.41 ,$128.22 ,$128.22 ,$142.46 
ST NICHOLAS HOSPITAL - ACUTE,37000052,N/A,HC GENERAL ANES INIT,370,1 ,"$1,558.20 ","$1,028.41 ",$790.32 ,"$1,558.20 ", N/A ,"$1,067.99 ","$1,067.99 ", N/A ,$934.92 ,"$1,324.47 ","$1,090.74 ", N/A , N/A ,"$1,480.29 ","$1,184.23 ","$1,168.65 ","$1,012.83 ","$1,324.47 ", N/A ,"$1,012.83 ","$1,012.83 ","$1,090.74 ",$948.94 , N/A , N/A , N/A , N/A , N/A ,"$1,324.47 ", N/A ,"$1,433.54 ","$1,090.74 ",$790.32 ,$948.48 ,$948.94 ,$948.48 ,"$1,076.72 ","$1,402.38 ","$1,064.56 ", N/A ,"$1,230.98 ", N/A ,$919.34 ,$919.34 , N/A ,$919.34 ,"$1,121.90 ",$966.08 ,"$1,121.90 ","$1,121.90 ","$1,246.56 "
ST NICHOLAS HOSPITAL - ACUTE,37000053,N/A,HC GENERAL ANES ADDL,370,1 ,$212.00 ,$139.92 ,$107.53 ,$212.00 , N/A ,$145.30 ,$145.30 , N/A ,$127.20 ,$180.20 ,$148.40 , N/A , N/A ,$201.40 ,$161.12 ,$159.00 ,$137.80 ,$180.20 , N/A ,$137.80 ,$137.80 ,$148.40 ,$129.11 , N/A , N/A , N/A , N/A , N/A ,$180.20 , N/A ,$195.04 ,$148.40 ,$107.53 ,$129.04 ,$129.11 ,$129.04 ,$146.49 ,$190.80 ,$144.84 , N/A ,$167.48 , N/A ,$125.08 ,$125.08 , N/A ,$125.08 ,$152.64 ,$131.44 ,$152.64 ,$152.64 ,$169.60 
ST NICHOLAS HOSPITAL - ACUTE,37000054,N/A,HC MONITORED ANES INIT,370,1 ,$690.06 ,$455.44 ,$350.00 ,$690.06 , N/A ,$472.97 ,$472.97 , N/A ,$414.04 ,$586.55 ,$483.04 , N/A , N/A ,$655.56 ,$524.45 ,$517.55 ,$448.54 ,$586.55 , N/A ,$448.54 ,$448.54 ,$483.04 ,$420.25 , N/A , N/A , N/A , N/A , N/A ,$586.55 , N/A ,$634.86 ,$483.04 ,$350.00 ,$420.04 ,$420.25 ,$420.04 ,$476.83 ,$621.05 ,$471.45 , N/A ,$545.15 , N/A ,$407.14 ,$407.14 , N/A ,$407.14 ,$496.84 ,$427.84 ,$496.84 ,$496.84 ,$552.05 
ST NICHOLAS HOSPITAL - ACUTE,37000055,N/A,HC MONITORED ANES ADDL,370,1 ,$178.08 ,$117.53 ,$90.32 ,$178.08 , N/A ,$122.06 ,$122.06 , N/A ,$106.85 ,$151.37 ,$124.66 , N/A , N/A ,$169.18 ,$135.34 ,$133.56 ,$115.75 ,$151.37 , N/A ,$115.75 ,$115.75 ,$124.66 ,$108.45 , N/A , N/A , N/A , N/A , N/A ,$151.37 , N/A ,$163.83 ,$124.66 ,$90.32 ,$108.40 ,$108.45 ,$108.40 ,$123.05 ,$160.27 ,$121.66 , N/A ,$140.68 , N/A ,$105.07 ,$105.07 , N/A ,$105.07 ,$128.22 ,$110.41 ,$128.22 ,$128.22 ,$142.46 
ST NICHOLAS HOSPITAL - ACUTE,37000056,N/A,HC SPINAL ANES INIT,370,1 ,"$1,558.20 ","$1,028.41 ",$790.32 ,"$1,558.20 ", N/A ,"$1,067.99 ","$1,067.99 ", N/A ,$934.92 ,"$1,324.47 ","$1,090.74 ", N/A , N/A ,"$1,480.29 ","$1,184.23 ","$1,168.65 ","$1,012.83 ","$1,324.47 ", N/A ,"$1,012.83 ","$1,012.83 ","$1,090.74 ",$948.94 , N/A , N/A , N/A , N/A , N/A ,"$1,324.47 ", N/A ,"$1,433.54 ","$1,090.74 ",$790.32 ,$948.48 ,$948.94 ,$948.48 ,"$1,076.72 ","$1,402.38 ","$1,064.56 ", N/A ,"$1,230.98 ", N/A ,$919.34 ,$919.34 , N/A ,$919.34 ,"$1,121.90 ",$966.08 ,"$1,121.90 ","$1,121.90 ","$1,246.56 "
ST NICHOLAS HOSPITAL - ACUTE,37000057,N/A,HC SPINAL ANES ADDL,370,1 ,$178.08 ,$117.53 ,$90.32 ,$178.08 , N/A ,$122.06 ,$122.06 , N/A ,$106.85 ,$151.37 ,$124.66 , N/A , N/A ,$169.18 ,$135.34 ,$133.56 ,$115.75 ,$151.37 , N/A ,$115.75 ,$115.75 ,$124.66 ,$108.45 , N/A , N/A , N/A , N/A , N/A ,$151.37 , N/A ,$163.83 ,$124.66 ,$90.32 ,$108.40 ,$108.45 ,$108.40 ,$123.05 ,$160.27 ,$121.66 , N/A ,$140.68 , N/A ,$105.07 ,$105.07 , N/A ,$105.07 ,$128.22 ,$110.41 ,$128.22 ,$128.22 ,$142.46 
ST NICHOLAS HOSPITAL - ACUTE,37000058,N/A,HC CARDIAC ANES INIT,370,1 ,"$4,563.30 ","$3,011.78 ","$2,314.51 ","$4,563.30 ", N/A ,"$3,127.69 ","$3,127.69 ", N/A ,"$2,737.98 ","$3,878.81 ","$3,194.31 ", N/A , N/A ,"$4,335.14 ","$3,468.11 ","$3,422.48 ","$2,966.15 ","$3,878.81 ", N/A ,"$2,966.15 ","$2,966.15 ","$3,194.31 ","$2,779.05 ", N/A , N/A , N/A , N/A , N/A ,"$3,878.81 ", N/A ,"$4,198.24 ","$3,194.31 ","$2,314.51 ","$2,777.68 ","$2,779.05 ","$2,777.68 ","$3,153.24 ","$4,106.97 ","$3,117.65 ", N/A ,"$3,605.01 ", N/A ,"$2,692.35 ","$2,692.35 ", N/A ,"$2,692.35 ","$3,285.58 ","$2,829.25 ","$3,285.58 ","$3,285.58 ","$3,650.64 "
ST NICHOLAS HOSPITAL - ACUTE,37000059,N/A,HC CARDIAC ANES ADDL,370,1 ,$345.56 ,$228.07 ,$175.27 ,$345.56 , N/A ,$236.85 ,$236.85 , N/A ,$207.34 ,$293.73 ,$241.89 , N/A , N/A ,$328.28 ,$262.63 ,$259.17 ,$224.61 ,$293.73 , N/A ,$224.61 ,$224.61 ,$241.89 ,$210.45 , N/A , N/A , N/A , N/A , N/A ,$293.73 , N/A ,$317.92 ,$241.89 ,$175.27 ,$210.34 ,$210.45 ,$210.34 ,$238.78 ,$311.00 ,$236.09 , N/A ,$272.99 , N/A ,$203.88 ,$203.88 , N/A ,$203.88 ,$248.80 ,$214.25 ,$248.80 ,$248.80 ,$276.45 
ST NICHOLAS HOSPITAL - ACUTE,37000072,99151,HC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,370,1 ,$437.00 ,$288.42 ,$0.76 ,$437.00 ,$0.76 ,$299.52 ,$299.52 , N/A ,$262.20 ,$371.45 ,$305.90 ,$0.76 ,$0.76 ,$415.15 ,$332.12 ,$327.75 ,$284.05 ,$371.45 , N/A ,$284.05 ,$284.05 ,$305.90 ,$266.13 ,$0.76 , N/A , N/A , N/A ,$0.81 ,$371.45 , N/A ,$402.04 ,$305.90 ,$221.65 ,$266.00 ,$266.13 ,$266.00 ,$301.97 ,$393.30 ,$298.56 , N/A ,$345.23 ,$0.81 ,$257.83 ,$257.83 , N/A ,$257.83 ,$314.64 ,$270.94 ,$314.64 ,$314.64 ,$349.60 
ST NICHOLAS HOSPITAL - ACUTE,37000073,99152,HC MODERATE SEDATION SAME PHY >5YR 1ST 15MIN,370,1 ,$437.00 ,$288.42 ,$0.76 ,$437.00 ,$0.76 ,$299.52 ,$299.52 , N/A ,$262.20 ,$371.45 ,$305.90 ,$0.76 ,$0.76 ,$415.15 ,$332.12 ,$327.75 ,$284.05 ,$371.45 , N/A ,$284.05 ,$284.05 ,$305.90 ,$266.13 ,$0.76 , N/A , N/A , N/A ,$0.81 ,$371.45 , N/A ,$402.04 ,$305.90 ,$221.65 ,$266.00 ,$266.13 ,$266.00 ,$301.97 ,$393.30 ,$298.56 , N/A ,$345.23 ,$0.81 ,$257.83 ,$257.83 , N/A ,$257.83 ,$314.64 ,$270.94 ,$314.64 ,$314.64 ,$349.60 
ST NICHOLAS HOSPITAL - ACUTE,37000074,99155,HC MODERATE SEDATION DIFF PHY <5YR 1ST 15MIN,370,1 ,$437.00 ,$288.42 ,$0.76 ,$437.00 ,$0.76 ,$299.52 ,$299.52 , N/A ,$262.20 ,$371.45 ,$305.90 ,$0.76 ,$0.76 ,$415.15 ,$332.12 ,$327.75 ,$284.05 ,$371.45 , N/A ,$284.05 ,$284.05 ,$305.90 ,$266.13 ,$0.76 , N/A , N/A , N/A ,$0.81 ,$371.45 , N/A ,$402.04 ,$305.90 ,$221.65 ,$266.00 ,$266.13 ,$266.00 ,$301.97 ,$393.30 ,$298.56 , N/A ,$345.23 ,$0.81 ,$257.83 ,$257.83 , N/A ,$257.83 ,$314.64 ,$270.94 ,$314.64 ,$314.64 ,$349.60 
ST NICHOLAS HOSPITAL - ACUTE,37000075,99156,HC MODERATE SEDATION DIFF PHY >5YR 1ST 15MIN,370,1 ,$437.00 ,$288.42 ,$0.76 ,$437.00 ,$0.76 ,$299.52 ,$299.52 , N/A ,$262.20 ,$371.45 ,$305.90 ,$0.76 ,$0.76 ,$415.15 ,$332.12 ,$327.75 ,$284.05 ,$371.45 , N/A ,$284.05 ,$284.05 ,$305.90 ,$266.13 ,$0.76 , N/A , N/A , N/A ,$0.81 ,$371.45 , N/A ,$402.04 ,$305.90 ,$221.65 ,$266.00 ,$266.13 ,$266.00 ,$301.97 ,$393.30 ,$298.56 , N/A ,$345.23 ,$0.81 ,$257.83 ,$257.83 , N/A ,$257.83 ,$314.64 ,$270.94 ,$314.64 ,$314.64 ,$349.60 
ST NICHOLAS HOSPITAL - ACUTE,37001000,1967,HC EPIDURAL/SPINAL FOR LABOR,370,1 ,$984.40 ,$649.70 ,$0.76 ,$984.40 ,$0.76 ,$674.71 ,$674.71 , N/A ,$590.64 ,$836.74 ,$689.08 ,$0.76 ,$0.76 ,$935.18 ,$748.14 ,$738.30 ,$639.86 ,$836.74 , N/A ,$639.86 ,$639.86 ,$689.08 ,$599.50 ,$0.76 , N/A , N/A , N/A ,$0.81 ,$836.74 , N/A ,$905.65 ,$689.08 ,$499.29 ,$599.20 ,$599.50 ,$599.20 ,$680.22 ,$885.96 ,$672.54 , N/A ,$777.68 ,$0.81 ,$580.80 ,$580.80 , N/A ,$580.80 ,$708.77 ,$610.33 ,$708.77 ,$708.77 ,$787.52 
ST NICHOLAS HOSPITAL - ACUTE,39000103,P9012,HC CRYOPRECIPITATE EA UNIT,390,1 ,$202.00 ,$133.32 ,$11.37 ,$202.00 ,$11.37 ,$138.45 ,$138.45 ,$74.39 ,$121.20 ,$171.70 ,$141.40 ,$11.37 ,$11.37 ,$191.90 ,$153.52 ,$151.50 ,$131.30 ,$171.70 ,$74.39 ,$131.30 ,$131.30 ,$141.40 ,$123.02 ,$11.37 ,$74.39 ,$72.90 ,$148.78 ,$12.05 ,$171.70 ,$167.38 ,$185.84 ,$141.40 ,$102.45 ,$122.96 ,$123.02 ,$122.96 ,$139.58 ,$181.80 ,$138.01 ,$73.63 ,$159.58 ,$12.05 ,$202.00 ,$202.00 ,$72.90 ,$202.00 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,39000105,P9012,HC CRYOPRECIPITATE EA UNIT (RC),390,1 ,$202.00 ,$133.32 ,$11.37 ,$202.00 ,$11.37 ,$138.45 ,$138.45 ,$74.39 ,$121.20 ,$171.70 ,$141.40 ,$11.37 ,$11.37 ,$191.90 ,$153.52 ,$151.50 ,$131.30 ,$171.70 ,$74.39 ,$131.30 ,$131.30 ,$141.40 ,$123.02 ,$11.37 ,$74.39 ,$72.90 ,$148.78 ,$12.05 ,$171.70 ,$167.38 ,$185.84 ,$141.40 ,$102.45 ,$122.96 ,$123.02 ,$122.96 ,$139.58 ,$181.80 ,$138.01 ,$73.63 ,$159.58 ,$12.05 ,$202.00 ,$202.00 ,$72.90 ,$202.00 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,39000107,P9016,HC RED CELLS L/R EA,390,1 ,$392.00 ,$258.72 ,$185.43 ,$425.72 ,$392.00 ,$268.68 ,$268.68 ,$189.21 ,$235.20 ,$333.20 ,$274.40 ,$392.00 ,$392.00 ,$372.40 ,$297.92 ,$294.00 ,$254.80 ,$333.20 ,$189.21 ,$254.80 ,$254.80 ,$274.40 ,$238.73 ,$392.00 ,$189.21 ,$185.43 ,$378.42 ,$415.52 ,$333.20 ,$425.72 ,$360.64 ,$274.40 ,$198.82 ,$238.61 ,$238.73 ,$238.61 ,$270.87 ,$352.80 ,$267.81 ,$187.28 ,$309.68 ,$415.52 ,$392.00 ,$392.00 ,$185.43 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,39000110,P9017,HC FRESH FROZEN PLASMA EA,390,1 ,$246.00 ,$162.36 ,$38.65 ,$246.00 ,$38.65 ,$168.61 ,$168.61 ,$85.47 ,$147.60 ,$209.10 ,$172.20 ,$38.65 ,$38.65 ,$233.70 ,$186.96 ,$184.50 ,$159.90 ,$209.10 ,$85.47 ,$159.90 ,$159.90 ,$172.20 ,$149.81 ,$38.65 ,$85.47 ,$83.76 ,$170.94 ,$40.97 ,$209.10 ,$192.31 ,$226.32 ,$172.20 ,$124.77 ,$149.74 ,$149.81 ,$149.74 ,$169.99 ,$221.40 ,$168.07 ,$84.59 ,$194.34 ,$40.97 ,$246.00 ,$246.00 ,$83.76 ,$246.00 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,39000112,P9017,HC FRESH FROZEN PLASMA EA (AD-RC),390,1 ,$246.00 ,$162.36 ,$38.65 ,$246.00 ,$38.65 ,$168.61 ,$168.61 ,$85.47 ,$147.60 ,$209.10 ,$172.20 ,$38.65 ,$38.65 ,$233.70 ,$186.96 ,$184.50 ,$159.90 ,$209.10 ,$85.47 ,$159.90 ,$159.90 ,$172.20 ,$149.81 ,$38.65 ,$85.47 ,$83.76 ,$170.94 ,$40.97 ,$209.10 ,$192.31 ,$226.32 ,$172.20 ,$124.77 ,$149.74 ,$149.81 ,$149.74 ,$169.99 ,$221.40 ,$168.07 ,$84.59 ,$194.34 ,$40.97 ,$246.00 ,$246.00 ,$83.76 ,$246.00 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,39000116,P9021,HC RED CELLS PACKED EA,390,1 ,$448.00 ,$295.68 ,$5.01 ,$448.00 ,$5.01 ,$307.06 ,$307.06 ,$135.52 ,$268.80 ,$380.80 ,$313.60 ,$5.01 ,$5.01 ,$425.60 ,$340.48 ,$336.00 ,$291.20 ,$380.80 ,$135.52 ,$291.20 ,$291.20 ,$313.60 ,$272.83 ,$5.01 ,$135.52 ,$132.81 ,$271.04 ,$5.31 ,$380.80 ,$304.92 ,$412.16 ,$313.60 ,$227.23 ,$272.70 ,$272.83 ,$272.70 ,$309.57 ,$403.20 ,$306.07 ,$134.14 ,$353.92 ,$5.31 ,$448.00 ,$448.00 ,$132.81 ,$448.00 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$358.40 
ST NICHOLAS HOSPITAL - ACUTE,39000120,P9035,HC PLATELETS PHER L/R EA,390,1 ,"$1,568.00 ","$1,034.88 ",$11.37 ,"$1,568.00 ",$11.37 ,"$1,074.71 ","$1,074.71 ",$485.66 ,$940.80 ,"$1,332.80 ","$1,097.60 ",$11.37 ,$11.37 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ","$1,019.20 ","$1,332.80 ",$485.66 ,"$1,019.20 ","$1,019.20 ","$1,097.60 ",$954.91 ,$11.37 ,$485.66 ,$475.95 ,$971.32 ,$12.05 ,"$1,332.80 ","$1,092.74 ","$1,442.56 ","$1,097.60 ",$795.29 ,$954.44 ,$954.91 ,$954.44 ,"$1,083.49 ","$1,411.20 ","$1,071.26 ",$480.71 ,"$1,238.72 ",$12.05 ,$470.00 ,$470.00 ,$475.95 ,$470.00 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,39000122,P9037,HC PLATELETS PHER L/R IRR EA,390,1 ,"$1,568.00 ","$1,034.88 ",$11.37 ,"$1,568.00 ",$11.37 ,"$1,074.71 ","$1,074.71 ",$638.19 ,$940.80 ,"$1,332.80 ","$1,097.60 ",$11.37 ,$11.37 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ","$1,019.20 ","$1,332.80 ",$638.19 ,"$1,019.20 ","$1,019.20 ","$1,097.60 ",$954.91 ,$11.37 ,$638.19 ,$625.43 ,"$1,276.38 ",$12.05 ,"$1,332.80 ","$1,435.93 ","$1,442.56 ","$1,097.60 ",$795.29 ,$954.44 ,$954.91 ,$954.44 ,"$1,083.49 ","$1,411.20 ","$1,071.26 ",$631.68 ,"$1,238.72 ",$12.05 ,$470.00 ,$470.00 ,$625.43 ,$470.00 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,39000124,P9040,HC RED CELLS L/R IRR EA,390,1 ,$862.00 ,$568.92 ,$5.01 ,$862.00 ,$5.01 ,$590.81 ,$590.81 ,$259.12 ,$517.20 ,$732.70 ,$603.40 ,$5.01 ,$5.01 ,$818.90 ,$655.12 ,$646.50 ,$560.30 ,$732.70 ,$259.12 ,$560.30 ,$560.30 ,$603.40 ,$524.96 ,$5.01 ,$259.12 ,$253.94 ,$518.24 ,$5.31 ,$732.70 ,$583.02 ,$793.04 ,$603.40 ,$437.21 ,$524.70 ,$524.96 ,$524.70 ,$595.64 ,$775.80 ,$588.92 ,$256.48 ,$680.98 ,$5.31 ,$470.00 ,$470.00 ,$253.94 ,$470.00 ,$620.64 ,$534.44 ,$620.64 ,$620.64 ,$689.60 
ST NICHOLAS HOSPITAL - ACUTE,39000126,P9040,HC RED CELLS L/R IRR EA (DIRECTED),390,1 ,$862.00 ,$568.92 ,$5.01 ,$862.00 ,$5.01 ,$590.81 ,$590.81 ,$259.12 ,$517.20 ,$732.70 ,$603.40 ,$5.01 ,$5.01 ,$818.90 ,$655.12 ,$646.50 ,$560.30 ,$732.70 ,$259.12 ,$560.30 ,$560.30 ,$603.40 ,$524.96 ,$5.01 ,$259.12 ,$253.94 ,$518.24 ,$5.31 ,$732.70 ,$583.02 ,$793.04 ,$603.40 ,$437.21 ,$524.70 ,$524.96 ,$524.70 ,$595.64 ,$775.80 ,$588.92 ,$256.48 ,$680.98 ,$5.31 ,$470.00 ,$470.00 ,$253.94 ,$470.00 ,$620.64 ,$534.44 ,$620.64 ,$620.64 ,$689.60 
ST NICHOLAS HOSPITAL - ACUTE,39000132,P9052,HC PLT APHER/PHER L/R HLA EA,390,1 ,"$2,352.00 ","$1,552.32 ",$11.37 ,"$2,352.00 ",$11.37 ,"$1,612.06 ","$1,612.06 ",$828.56 ,"$1,411.20 ","$1,999.20 ","$1,646.40 ",$11.37 ,$11.37 ,"$2,234.40 ","$1,787.52 ","$1,764.00 ","$1,528.80 ","$1,999.20 ",$828.56 ,"$1,528.80 ","$1,528.80 ","$1,646.40 ","$1,432.37 ",$11.37 ,$828.56 ,$811.99 ,"$1,657.12 ",$12.05 ,"$1,999.20 ","$1,864.26 ","$2,163.84 ","$1,646.40 ","$1,192.93 ","$1,431.66 ","$1,432.37 ","$1,431.66 ","$1,625.23 ","$2,116.80 ","$1,606.89 ",$820.11 ,"$1,858.08 ",$12.05 ,$470.00 ,$470.00 ,$811.99 ,$470.00 ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,881.60 "
ST NICHOLAS HOSPITAL - ACUTE,39000133,P9052,HC PLT APHER/PHER L/R HLA EA (IRRAD),390,1 ,"$2,352.00 ","$1,552.32 ",$11.37 ,"$2,352.00 ",$11.37 ,"$1,612.06 ","$1,612.06 ",$828.56 ,"$1,411.20 ","$1,999.20 ","$1,646.40 ",$11.37 ,$11.37 ,"$2,234.40 ","$1,787.52 ","$1,764.00 ","$1,528.80 ","$1,999.20 ",$828.56 ,"$1,528.80 ","$1,528.80 ","$1,646.40 ","$1,432.37 ",$11.37 ,$828.56 ,$811.99 ,"$1,657.12 ",$12.05 ,"$1,999.20 ","$1,864.26 ","$2,163.84 ","$1,646.40 ","$1,192.93 ","$1,431.66 ","$1,432.37 ","$1,431.66 ","$1,625.23 ","$2,116.80 ","$1,606.89 ",$820.11 ,"$1,858.08 ",$12.05 ,$470.00 ,$470.00 ,$811.99 ,$470.00 ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,881.60 "
ST NICHOLAS HOSPITAL - ACUTE,39000140,P9058,HC RBC LEUKORED CMV NEG IRRAD,390,1 ,$806.00 ,$531.96 ,$5.01 ,$806.00 ,$5.01 ,$552.43 ,$552.43 ,$250.99 ,$483.60 ,$685.10 ,$564.20 ,$5.01 ,$5.01 ,$765.70 ,$612.56 ,$604.50 ,$523.90 ,$685.10 ,$250.99 ,$523.90 ,$523.90 ,$564.20 ,$490.85 ,$5.01 ,$250.99 ,$245.97 ,$501.98 ,$5.31 ,$685.10 ,$564.73 ,$741.52 ,$564.20 ,$408.80 ,$490.61 ,$490.85 ,$490.61 ,$556.95 ,$725.40 ,$550.66 ,$248.43 ,$636.74 ,$5.31 ,$470.00 ,$470.00 ,$245.97 ,$470.00 ,$580.32 ,$499.72 ,$580.32 ,$580.32 ,$644.80 
ST NICHOLAS HOSPITAL - ACUTE,39000204,P9073,HC PLATELETS PHERESIS PATH REDUCED EA UN,390,1 ,"$1,139.00 ",$751.74 ,$11.37 ,"$1,300.25 ",$11.37 ,$780.67 ,$780.67 ,$577.89 ,$683.40 ,$968.15 ,$797.30 ,$11.37 ,$11.37 ,"$1,082.05 ",$865.64 ,$854.25 ,$740.35 ,$968.15 ,$577.89 ,$740.35 ,$740.35 ,$797.30 ,$693.65 ,$11.37 ,$577.89 ,$566.33 ,"$1,139.00 ",$12.05 ,$968.15 ,"$1,300.25 ","$1,047.88 ",$797.30 ,$577.70 ,$693.31 ,$693.65 ,$693.31 ,$787.05 ,"$1,025.10 ",$778.16 ,$572.00 ,$899.81 ,$12.05 ,$470.00 ,$470.00 ,$566.33 ,$470.00 ,$820.08 ,$706.18 ,$820.08 ,$820.08 ,$911.20 
ST NICHOLAS HOSPITAL - ACUTE,39000209,P9040,HC RED CELLS L/R IRR EA SALINE WASH (RC),390,1 ,$946.00 ,$624.36 ,$5.01 ,$946.00 ,$5.01 ,$648.39 ,$648.39 ,$259.12 ,$567.60 ,$804.10 ,$662.20 ,$5.01 ,$5.01 ,$898.70 ,$718.96 ,$709.50 ,$614.90 ,$804.10 ,$259.12 ,$614.90 ,$614.90 ,$662.20 ,$576.11 ,$5.01 ,$259.12 ,$253.94 ,$518.24 ,$5.31 ,$804.10 ,$583.02 ,$870.32 ,$662.20 ,$479.81 ,$575.83 ,$576.11 ,$575.83 ,$653.69 ,$851.40 ,$646.31 ,$256.48 ,$747.34 ,$5.31 ,$470.00 ,$470.00 ,$253.94 ,$470.00 ,$681.12 ,$586.52 ,$681.12 ,$681.12 ,$756.80 
ST NICHOLAS HOSPITAL - ACUTE,39000211,P9059,HC COVID CONVALESCENT PLASMA,390,1 ,"$1,594.00 ","$1,052.04 ",$5.01 ,"$1,594.00 ",$5.01 ,"$1,092.53 ","$1,092.53 ",$76.20 ,$956.40 ,"$1,354.90 ","$1,115.80 ",$5.01 ,$5.01 ,"$1,514.30 ","$1,211.44 ","$1,195.50 ","$1,036.10 ","$1,354.90 ",$76.20 ,"$1,036.10 ","$1,036.10 ","$1,115.80 ",$970.75 ,$5.01 ,$76.20 ,$74.68 ,$152.40 ,$5.31 ,"$1,354.90 ",$171.45 ,"$1,466.48 ","$1,115.80 ",$808.48 ,$970.27 ,$970.75 ,$970.27 ,"$1,101.45 ","$1,434.60 ","$1,089.02 ",$75.42 ,"$1,259.26 ",$5.31 ,$470.00 ,$470.00 ,$74.68 ,$470.00 ,"$1,147.68 ",$988.28 ,"$1,147.68 ","$1,147.68 ","$1,275.20 "
ST NICHOLAS HOSPITAL - ACUTE,39100001,36430,HC BLOOD PROD ADMIN,391,1 ,"$1,077.55 ",$711.18 ,$14.62 ,"$1,077.55 ",$14.62 ,$738.55 ,$738.55 ,$397.96 ,$646.53 ,$915.92 ,$754.29 ,$14.62 ,$14.62 ,"$1,023.67 ",$818.94 ,$808.16 ,$700.41 ,$915.92 ,$397.96 ,$700.41 ,$700.41 ,$754.29 ,$656.23 ,$14.62 ,$397.96 ,$390.00 ,$795.92 ,$15.50 ,$915.92 ,$895.42 ,$991.35 ,$754.29 ,$546.53 ,$655.90 ,$656.23 ,$655.90 ,$744.59 ,$969.80 ,$736.18 ,$393.90 ,$851.26 ,$15.50 ,$470.00 ,$470.00 ,$390.00 ,$470.00 ,$775.84 ,$668.08 ,$775.84 ,$775.84 ,$862.04 
ST NICHOLAS HOSPITAL - ACUTE,39100002,36430,HC MASSIVE TRANSFUSION,391,1 ,"$1,077.55 ",$711.18 ,$14.62 ,"$1,077.55 ",$14.62 ,$738.55 ,$738.55 ,$397.96 ,$646.53 ,$915.92 ,$754.29 ,$14.62 ,$14.62 ,"$1,023.67 ",$818.94 ,$808.16 ,$700.41 ,$915.92 ,$397.96 ,$700.41 ,$700.41 ,$754.29 ,$656.23 ,$14.62 ,$397.96 ,$390.00 ,$795.92 ,$15.50 ,$915.92 ,$895.42 ,$991.35 ,$754.29 ,$546.53 ,$655.90 ,$656.23 ,$655.90 ,$744.59 ,$969.80 ,$736.18 ,$393.90 ,$851.26 ,$15.50 ,$470.00 ,$470.00 ,$390.00 ,$470.00 ,$775.84 ,$668.08 ,$775.84 ,$775.84 ,$862.04 
ST NICHOLAS HOSPITAL - ACUTE,40100001,77067,HC MAMM SCREEN BI W/CAD SELF REFERRAL,401,1 ,$296.00 ,$195.36 ,$1.69 ,$296.00 ,$1.69 ,$296.00 ,$229.00 ,$88.96 ,$177.60 ,$251.60 ,$207.20 ,$1.69 ,$1.69 ,$281.20 ,$224.96 ,$222.00 ,$182.37 ,$251.60 ,$88.96 ,$182.37 ,$182.37 ,$207.20 ,$180.26 ,$1.69 ,$88.96 ,$87.18 ,$177.92 ,$1.79 ,$251.60 ,$200.16 ,$272.32 ,$207.20 ,$150.13 ,$180.18 ,$180.26 ,$180.18 ,$204.54 ,$266.40 ,$202.23 ,$88.05 ,$233.84 ,$1.79 ,$167.00 ,$167.00 ,$87.18 ,$167.00 ,$213.12 ,$183.52 ,$213.12 ,$213.12 ,$236.80 
ST NICHOLAS HOSPITAL - ACUTE,40100002,77067,HC MAMM SCREEN BI W/CAD CORPORATE,403,1 ,$134.30 ,$88.64 ,$1.69 ,$200.16 ,$1.69 ,$134.30 ,$134.30 ,$88.96 ,$80.58 ,$114.16 ,$94.01 ,$1.69 ,$1.69 ,$127.59 ,$102.07 ,$100.73 ,$134.30 ,$114.16 ,$88.96 ,$134.30 ,$134.30 ,$94.01 ,$81.79 ,$1.69 ,$88.96 ,$87.18 ,$134.30 ,$1.79 ,$114.16 ,$200.16 ,$123.56 ,$94.01 ,$68.12 ,$81.75 ,$81.79 ,$81.75 ,$92.80 ,$120.87 ,$91.75 ,$88.05 ,$106.10 ,$1.79 ,$134.30 ,$134.30 ,$87.18 ,$134.30 ,$96.70 ,$83.27 ,$96.70 ,$96.70 ,$107.44 
ST NICHOLAS HOSPITAL - ACUTE,40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$460.00 ,$303.60 ,$1.69 ,$460.00 ,$1.69 ,$343.00 ,$229.00 ,$107.31 ,$276.00 ,$391.00 ,$322.00 ,$1.69 ,$1.69 ,$437.00 ,$349.60 ,$345.00 ,$219.99 ,$391.00 ,$107.31 ,$219.99 ,$219.99 ,$322.00 ,$280.14 ,$1.69 ,$107.31 ,$105.16 ,$214.62 ,$1.79 ,$391.00 ,$241.45 ,$423.20 ,$322.00 ,$233.31 ,$280.00 ,$280.14 ,$280.00 ,$317.86 ,$414.00 ,$314.27 ,$106.21 ,$363.40 ,$1.79 ,$167.00 ,$167.00 ,$105.16 ,$167.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$460.00 ,$303.60 ,$1.69 ,$460.00 ,$1.69 ,$343.00 ,$229.00 ,$107.31 ,$276.00 ,$391.00 ,$322.00 ,$1.69 ,$1.69 ,$437.00 ,$349.60 ,$345.00 ,$219.99 ,$391.00 ,$107.31 ,$219.99 ,$219.99 ,$322.00 ,$280.14 ,$1.69 ,$107.31 ,$105.16 ,$214.62 ,$1.79 ,$391.00 ,$241.45 ,$423.20 ,$322.00 ,$233.31 ,$280.00 ,$280.14 ,$280.00 ,$317.86 ,$414.00 ,$314.27 ,$106.21 ,$363.40 ,$1.79 ,$167.00 ,$167.00 ,$105.16 ,$167.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40100005,77066,HC MAMMOGRAM DIAG BILAT W/CAD IMPLANT,401,1 ,$460.00 ,$303.60 ,$1.69 ,$460.00 ,$1.69 ,$343.00 ,$229.00 ,$107.31 ,$276.00 ,$391.00 ,$322.00 ,$1.69 ,$1.69 ,$437.00 ,$349.60 ,$345.00 ,$219.99 ,$391.00 ,$107.31 ,$219.99 ,$219.99 ,$322.00 ,$280.14 ,$1.69 ,$107.31 ,$105.16 ,$214.62 ,$1.79 ,$391.00 ,$241.45 ,$423.20 ,$322.00 ,$233.31 ,$280.00 ,$280.14 ,$280.00 ,$317.86 ,$414.00 ,$314.27 ,$106.21 ,$363.40 ,$1.79 ,$167.00 ,$167.00 ,$105.16 ,$167.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40100006,77066,HC MAMMOGRAM DIAG W/CAD UPGRADE BIL,401,1 ,$460.00 ,$303.60 ,$1.69 ,$460.00 ,$1.69 ,$343.00 ,$229.00 ,$107.31 ,$276.00 ,$391.00 ,$322.00 ,$1.69 ,$1.69 ,$437.00 ,$349.60 ,$345.00 ,$219.99 ,$391.00 ,$107.31 ,$219.99 ,$219.99 ,$322.00 ,$280.14 ,$1.69 ,$107.31 ,$105.16 ,$214.62 ,$1.79 ,$391.00 ,$241.45 ,$423.20 ,$322.00 ,$233.31 ,$280.00 ,$280.14 ,$280.00 ,$317.86 ,$414.00 ,$314.27 ,$106.21 ,$363.40 ,$1.79 ,$167.00 ,$167.00 ,$105.16 ,$167.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$350.00 ,$231.00 ,$1.69 ,$350.00 ,$1.69 ,$343.00 ,$229.00 ,$84.13 ,$210.00 ,$297.50 ,$245.00 ,$1.69 ,$1.69 ,$332.50 ,$266.00 ,$262.50 ,$172.47 ,$297.50 ,$84.13 ,$172.47 ,$172.47 ,$245.00 ,$213.15 ,$1.69 ,$84.13 ,$82.45 ,$168.26 ,$1.79 ,$297.50 ,$189.29 ,$322.00 ,$245.00 ,$177.52 ,$213.05 ,$213.15 ,$213.05 ,$241.85 ,$315.00 ,$239.12 ,$83.27 ,$276.50 ,$1.79 ,$167.00 ,$167.00 ,$82.45 ,$167.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD  ADDNT VIEW,401,1 ,$350.00 ,$231.00 ,$1.69 ,$350.00 ,$1.69 ,$343.00 ,$229.00 ,$84.13 ,$210.00 ,$297.50 ,$245.00 ,$1.69 ,$1.69 ,$332.50 ,$266.00 ,$262.50 ,$172.47 ,$297.50 ,$84.13 ,$172.47 ,$172.47 ,$245.00 ,$213.15 ,$1.69 ,$84.13 ,$82.45 ,$168.26 ,$1.79 ,$297.50 ,$189.29 ,$322.00 ,$245.00 ,$177.52 ,$213.05 ,$213.15 ,$213.05 ,$241.85 ,$315.00 ,$239.12 ,$83.27 ,$276.50 ,$1.79 ,$167.00 ,$167.00 ,$82.45 ,$167.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$350.00 ,$231.00 ,$1.69 ,$350.00 ,$1.69 ,$343.00 ,$229.00 ,$84.13 ,$210.00 ,$297.50 ,$245.00 ,$1.69 ,$1.69 ,$332.50 ,$266.00 ,$262.50 ,$172.47 ,$297.50 ,$84.13 ,$172.47 ,$172.47 ,$245.00 ,$213.15 ,$1.69 ,$84.13 ,$82.45 ,$168.26 ,$1.79 ,$297.50 ,$189.29 ,$322.00 ,$245.00 ,$177.52 ,$213.05 ,$213.15 ,$213.05 ,$241.85 ,$315.00 ,$239.12 ,$83.27 ,$276.50 ,$1.79 ,$167.00 ,$167.00 ,$82.45 ,$167.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40100010,77065,HC MAMMOGRAM DIAG UNIL W/CAD UPGRADE,401,1 ,$350.00 ,$231.00 ,$1.69 ,$350.00 ,$1.69 ,$343.00 ,$229.00 ,$84.13 ,$210.00 ,$297.50 ,$245.00 ,$1.69 ,$1.69 ,$332.50 ,$266.00 ,$262.50 ,$172.47 ,$297.50 ,$84.13 ,$172.47 ,$172.47 ,$245.00 ,$213.15 ,$1.69 ,$84.13 ,$82.45 ,$168.26 ,$1.79 ,$297.50 ,$189.29 ,$322.00 ,$245.00 ,$177.52 ,$213.05 ,$213.15 ,$213.05 ,$241.85 ,$315.00 ,$239.12 ,$83.27 ,$276.50 ,$1.79 ,$167.00 ,$167.00 ,$82.45 ,$167.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40100014,G0279,HC DIAGNOSTIC DIGITAL BREAST TOMOSYTH UNI/BIL,401,1 ,$130.00 ,$85.80 ,$1.69 ,$130.00 ,$1.69 ,$89.10 ,$89.10 ,$23.18 ,$78.00 ,$110.50 ,$91.00 ,$1.69 ,$1.69 ,$123.50 ,$98.80 ,$97.50 ,$47.52 ,$110.50 ,$23.18 ,$47.52 ,$47.52 ,$91.00 ,$79.17 ,$1.69 ,$23.18 ,$22.72 ,$46.36 ,$1.79 ,$110.50 ,$52.16 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$88.82 ,$22.94 ,$102.70 ,$1.79 ,$130.00 ,$130.00 ,$22.72 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,40200001,93880,HC CAROTID BI US SELF SCREEN,402,1 ,$90.42 ,$59.68 ,$5.75 ,$512.81 ,$5.75 ,$90.42 ,$90.42 ,$227.92 ,$54.25 ,$76.86 ,$63.29 ,$5.75 ,$5.75 ,$85.90 ,$68.72 ,$67.82 ,$90.42 ,$76.86 ,$227.92 ,$90.42 ,$90.42 ,$63.29 ,$55.07 ,$5.75 ,$227.92 ,$223.36 ,$90.42 ,$6.10 ,$76.86 ,$512.81 ,$83.19 ,$63.29 ,$45.86 ,$55.04 ,$55.07 ,$55.04 ,$62.48 ,$81.38 ,$61.77 ,$225.60 ,$71.43 ,$6.10 ,$90.42 ,$90.42 ,$223.36 ,$90.42 ,$65.10 ,$56.06 ,$65.10 ,$65.10 ,$72.34 
ST NICHOLAS HOSPITAL - ACUTE,40200005,21925,HC BX SOFT TISSUE BACK/FLANK DEEP,402,1 ,"$4,459.70 ","$2,943.40 ",$62.90 ,"$4,459.70 ",$62.90 ,$631.00 ,$590.00 ,"$1,463.56 ","$2,675.82 ","$3,790.75 ","$3,121.79 ",$62.90 ,$62.90 ,"$4,236.72 ","$3,389.37 ","$3,344.78 ",$722.48 ,"$3,790.75 ","$1,463.56 ",$722.48 ,$722.48 ,"$3,121.79 ","$2,715.96 ",$62.90 ,"$1,463.56 ","$1,434.29 ","$2,927.12 ",$66.67 ,"$3,790.75 ","$3,293.01 ","$4,102.92 ","$3,121.79 ","$2,747.95 ","$3,435.21 ","$2,715.96 ","$3,435.21 ","$3,081.65 ","$4,013.73 ","$3,046.87 ","$1,448.64 ","$3,523.16 ",$66.67 ,$523.00 ,$523.00 ,"$1,434.29 ",$523.00 ,"$3,210.98 ","$2,765.01 ","$3,210.98 ","$3,210.98 ","$3,567.76 "
ST NICHOLAS HOSPITAL - ACUTE,40200007,51798,HC US BLADDER SCAN,402,1 ,$210.45 ,$138.90 ,$2.75 ,$210.45 ,$2.75 ,$210.45 ,$210.45 ,$56.10 ,$126.27 ,$178.88 ,$147.32 ,$2.75 ,$2.75 ,$199.93 ,$159.94 ,$157.84 ,$20.68 ,$178.88 ,$56.10 ,$20.68 ,$20.68 ,$147.32 ,$128.16 ,$2.75 ,$56.10 ,$54.98 ,$112.20 ,$2.92 ,$178.88 ,$126.23 ,$193.61 ,$147.32 ,$106.74 ,$128.10 ,$128.16 ,$128.10 ,$145.42 ,$189.41 ,$143.78 ,$55.53 ,$166.26 ,$2.92 ,$210.45 ,$210.45 ,$54.98 ,$210.45 ,$151.52 ,$130.48 ,$151.52 ,$151.52 ,$168.36 
ST NICHOLAS HOSPITAL - ACUTE,40200009,49407,HC DRAIN ABSC PELVIC TRNSVAG PERC,402,1 ,"$2,760.00 ","$1,821.60 ",$25.31 ,"$3,293.01 ",$25.31 ,$631.00 ,$590.00 ,"$1,463.56 ","$1,656.00 ","$2,346.00 ","$1,932.00 ",$25.31 ,$25.31 ,"$2,622.00 ","$2,097.60 ","$2,070.00 ",$392.62 ,"$2,346.00 ","$1,463.56 ",$392.62 ,$392.62 ,"$1,932.00 ","$1,680.84 ",$25.31 ,"$1,463.56 ","$1,434.29 ","$2,760.00 ",$26.83 ,"$2,346.00 ","$3,293.01 ","$2,539.20 ","$1,932.00 ","$1,998.41 ","$2,497.74 ","$1,680.84 ","$2,497.74 ","$1,907.16 ","$2,484.00 ","$1,885.63 ","$1,448.64 ","$2,180.40 ",$26.83 ,$523.00 ,$523.00 ,"$1,434.29 ",$523.00 ,"$1,987.20 ","$1,711.20 ","$1,987.20 ","$1,987.20 ","$2,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,40200011,60300,HC ASP/INJ CYST THYROID,402,1 ,$786.60 ,$519.16 ,$23.54 ,"$1,425.14 ",$23.54 ,$631.00 ,$590.00 ,$633.39 ,$471.96 ,$668.61 ,$550.62 ,$23.54 ,$23.54 ,$747.27 ,$597.82 ,$589.95 ,$93.32 ,$668.61 ,$633.39 ,$93.32 ,$93.32 ,$550.62 ,$479.04 ,$23.54 ,$633.39 ,$620.72 ,$786.60 ,$24.95 ,$668.61 ,"$1,425.14 ",$723.67 ,$550.62 ,$786.60 ,$786.60 ,$479.04 ,$786.60 ,$543.54 ,$707.94 ,$537.41 ,$626.93 ,$621.41 ,$24.95 ,$523.00 ,$523.00 ,$620.72 ,$523.00 ,$566.35 ,$487.69 ,$566.35 ,$566.35 ,$629.28 
ST NICHOLAS HOSPITAL - ACUTE,40200012,76506,HC US ENCEPHALOGRAM,402,1 ,$900.00 ,$594.00 ,$3.71 ,$900.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$540.00 ,$765.00 ,$630.00 ,$3.71 ,$3.71 ,$855.00 ,$684.00 ,$675.00 ,$165.21 ,$765.00 ,$104.31 ,$165.21 ,$165.21 ,$630.00 ,$548.10 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$765.00 ,$234.71 ,$828.00 ,$630.00 ,$506.63 ,$506.63 ,$548.10 ,$506.63 ,$621.90 ,$810.00 ,$614.88 ,$103.24 ,$711.00 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$648.00 ,$558.00 ,$648.00 ,$648.00 ,$720.00 
ST NICHOLAS HOSPITAL - ACUTE,40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,$790.00 ,$521.40 ,$3.71 ,$790.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$474.00 ,$671.50 ,$553.00 ,$3.71 ,$3.71 ,$750.50 ,$600.40 ,$592.50 ,$167.20 ,$671.50 ,$104.31 ,$167.20 ,$167.20 ,$553.00 ,$481.11 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$671.50 ,$234.71 ,$726.80 ,$553.00 ,$506.63 ,$506.63 ,$481.11 ,$506.63 ,$545.89 ,$711.00 ,$539.73 ,$103.24 ,$624.10 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$568.80 ,$489.80 ,$568.80 ,$568.80 ,$632.00 
ST NICHOLAS HOSPITAL - ACUTE,40200014,76604,HC US CHEST,402,1 ,$580.00 ,$382.80 ,$3.71 ,$580.00 ,$3.71 ,$580.00 ,$580.00 ,$104.31 ,$348.00 ,$493.00 ,$406.00 ,$3.71 ,$3.71 ,$551.00 ,$440.80 ,$435.00 ,$57.63 ,$493.00 ,$104.31 ,$57.63 ,$57.63 ,$406.00 ,$353.22 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$493.00 ,$234.71 ,$533.60 ,$406.00 ,$506.63 ,$506.63 ,$353.22 ,$506.63 ,$400.78 ,$522.00 ,$396.26 ,$103.24 ,$458.20 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$417.60 ,$359.60 ,$417.60 ,$417.60 ,$464.00 
ST NICHOLAS HOSPITAL - ACUTE,40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$448.80 ,$5.56 ,$680.00 ,$5.56 ,$631.00 ,$590.00 ,$104.31 ,$408.00 ,$578.00 ,$476.00 ,$5.56 ,$5.56 ,$646.00 ,$516.80 ,$510.00 ,$136.16 ,$578.00 ,$104.31 ,$136.16 ,$136.16 ,$476.00 ,$414.12 ,$5.56 ,$104.31 ,$102.22 ,$208.62 ,$5.89 ,$578.00 ,$234.71 ,$625.60 ,$476.00 ,$509.57 ,$509.57 ,$414.12 ,$509.57 ,$469.88 ,$612.00 ,$464.58 ,$103.24 ,$537.20 ,$5.89 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$489.60 ,$421.60 ,$489.60 ,$489.60 ,$544.00 
ST NICHOLAS HOSPITAL - ACUTE,40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$448.80 ,$5.56 ,$680.00 ,$5.56 ,$631.00 ,$590.00 ,$104.31 ,$408.00 ,$578.00 ,$476.00 ,$5.56 ,$5.56 ,$646.00 ,$516.80 ,$510.00 ,$136.16 ,$578.00 ,$104.31 ,$136.16 ,$136.16 ,$476.00 ,$414.12 ,$5.56 ,$104.31 ,$102.22 ,$208.62 ,$5.89 ,$578.00 ,$234.71 ,$625.60 ,$476.00 ,$509.57 ,$509.57 ,$414.12 ,$509.57 ,$469.88 ,$612.00 ,$464.58 ,$103.24 ,$537.20 ,$5.89 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$489.60 ,$421.60 ,$489.60 ,$489.60 ,$544.00 
ST NICHOLAS HOSPITAL - ACUTE,40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$363.00 ,$5.56 ,$550.00 ,$5.56 ,$550.00 ,$550.00 ,$84.79 ,$330.00 ,$467.50 ,$385.00 ,$5.56 ,$5.56 ,$522.50 ,$418.00 ,$412.50 ,$104.49 ,$467.50 ,$84.79 ,$104.49 ,$104.49 ,$385.00 ,$334.95 ,$5.56 ,$84.79 ,$83.09 ,$169.58 ,$5.89 ,$467.50 ,$190.79 ,$506.00 ,$385.00 ,$509.57 ,$509.57 ,$334.95 ,$509.57 ,$380.05 ,$495.00 ,$375.76 ,$83.93 ,$434.50 ,$5.89 ,$523.00 ,$523.00 ,$83.09 ,$523.00 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$440.00 
ST NICHOLAS HOSPITAL - ACUTE,40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$363.00 ,$5.56 ,$550.00 ,$5.56 ,$550.00 ,$550.00 ,$84.79 ,$330.00 ,$467.50 ,$385.00 ,$5.56 ,$5.56 ,$522.50 ,$418.00 ,$412.50 ,$104.49 ,$467.50 ,$84.79 ,$104.49 ,$104.49 ,$385.00 ,$334.95 ,$5.56 ,$84.79 ,$83.09 ,$169.58 ,$5.89 ,$467.50 ,$190.79 ,$506.00 ,$385.00 ,$509.57 ,$509.57 ,$334.95 ,$509.57 ,$380.05 ,$495.00 ,$375.76 ,$83.93 ,$434.50 ,$5.89 ,$523.00 ,$523.00 ,$83.09 ,$523.00 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$440.00 
ST NICHOLAS HOSPITAL - ACUTE,40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,100.00 ",$726.00 ,$5.75 ,"$1,100.00 ",$5.75 ,$631.00 ,$590.00 ,$104.31 ,$660.00 ,$935.00 ,$770.00 ,$5.75 ,$5.75 ,"$1,045.00 ",$836.00 ,$825.00 ,$155.96 ,$935.00 ,$104.31 ,$155.96 ,$155.96 ,$770.00 ,$669.90 ,$5.75 ,$104.31 ,$102.22 ,$208.62 ,$6.10 ,$935.00 ,$234.71 ,"$1,012.00 ",$770.00 ,$506.63 ,$506.63 ,$669.90 ,$506.63 ,$760.10 ,$990.00 ,$751.52 ,$103.24 ,$869.00 ,$6.10 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,40200018,76705,HC US ABDOMEN LTD,402,1 ,$820.00 ,$541.20 ,$3.71 ,$820.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$492.00 ,$697.00 ,$574.00 ,$3.71 ,$3.71 ,$779.00 ,$623.20 ,$615.00 ,$119.00 ,$697.00 ,$104.31 ,$119.00 ,$119.00 ,$574.00 ,$499.38 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$697.00 ,$234.71 ,$754.40 ,$574.00 ,$506.63 ,$506.63 ,$499.38 ,$506.63 ,$566.62 ,$738.00 ,$560.22 ,$103.24 ,$647.80 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$656.00 
ST NICHOLAS HOSPITAL - ACUTE,40200019,76770,HC US RETROPERITIONEAL,402,1 ,$810.00 ,$534.60 ,$5.75 ,$810.00 ,$5.75 ,$631.00 ,$590.00 ,$104.31 ,$486.00 ,$688.50 ,$567.00 ,$5.75 ,$5.75 ,$769.50 ,$615.60 ,$607.50 ,$146.74 ,$688.50 ,$104.31 ,$146.74 ,$146.74 ,$567.00 ,$493.29 ,$5.75 ,$104.31 ,$102.22 ,$208.62 ,$6.10 ,$688.50 ,$234.71 ,$745.20 ,$567.00 ,$506.63 ,$506.63 ,$493.29 ,$506.63 ,$559.71 ,$729.00 ,$553.39 ,$103.24 ,$639.90 ,$6.10 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$648.00 
ST NICHOLAS HOSPITAL - ACUTE,40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,$740.00 ,$488.40 ,$3.71 ,$740.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$444.00 ,$629.00 ,$518.00 ,$3.71 ,$3.71 ,$703.00 ,$562.40 ,$555.00 ,$62.26 ,$629.00 ,$104.31 ,$62.26 ,$62.26 ,$518.00 ,$450.66 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$629.00 ,$234.71 ,$680.80 ,$518.00 ,$506.63 ,$506.63 ,$450.66 ,$506.63 ,$511.34 ,$666.00 ,$505.57 ,$103.24 ,$584.60 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$532.80 ,$458.80 ,$532.80 ,$532.80 ,$592.00 
ST NICHOLAS HOSPITAL - ACUTE,40200021,76776,HC US KIDNEY TRANSPLANT W/DOPPLER,402,1 ,$820.00 ,$541.20 ,$3.71 ,$820.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$492.00 ,$697.00 ,$574.00 ,$3.71 ,$3.71 ,$779.00 ,$623.20 ,$615.00 ,$222.84 ,$697.00 ,$104.31 ,$222.84 ,$222.84 ,$574.00 ,$499.38 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$697.00 ,$234.71 ,$754.40 ,$574.00 ,$506.63 ,$506.63 ,$499.38 ,$506.63 ,$566.62 ,$738.00 ,$560.22 ,$103.24 ,$647.80 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$656.00 
ST NICHOLAS HOSPITAL - ACUTE,40200022,76800,HC US SPINAL CANAL  AND  CONTENTS,402,1 ,$500.00 ,$330.00 ,$3.71 ,$500.00 ,$3.71 ,$500.00 ,$500.00 ,$104.31 ,$300.00 ,$425.00 ,$350.00 ,$3.71 ,$3.71 ,$475.00 ,$380.00 ,$375.00 ,$190.96 ,$425.00 ,$104.31 ,$190.96 ,$190.96 ,$350.00 ,$304.50 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$425.00 ,$234.71 ,$460.00 ,$350.00 ,$339.01 ,$339.01 ,$304.50 ,$339.01 ,$345.50 ,$450.00 ,$341.60 ,$103.24 ,$395.00 ,$3.93 ,$500.00 ,$500.00 ,$102.22 ,$500.00 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,$650.00 ,$429.00 ,$3.48 ,$650.00 ,$3.48 ,$631.00 ,$590.00 ,$104.31 ,$390.00 ,$552.50 ,$455.00 ,$3.48 ,$3.48 ,$617.50 ,$494.00 ,$487.50 ,$140.77 ,$552.50 ,$104.31 ,$140.77 ,$140.77 ,$455.00 ,$395.85 ,$3.48 ,$104.31 ,$102.22 ,$208.62 ,$3.69 ,$552.50 ,$234.71 ,$598.00 ,$455.00 ,$506.63 ,$506.63 ,$395.85 ,$506.63 ,$449.15 ,$585.00 ,$444.08 ,$103.24 ,$513.50 ,$3.69 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$468.00 ,$403.00 ,$468.00 ,$468.00 ,$520.00 
ST NICHOLAS HOSPITAL - ACUTE,40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$360.00 ,$237.60 ,$3.48 ,$360.00 ,$3.48 ,$360.00 ,$360.00 , N/A ,$216.00 ,$306.00 ,$252.00 ,$3.48 ,$3.48 ,$342.00 ,$273.60 ,$270.00 ,$42.25 ,$306.00 , N/A ,$42.25 ,$42.25 ,$252.00 ,$219.24 ,$3.48 , N/A , N/A , N/A ,$3.69 ,$306.00 , N/A ,$331.20 ,$252.00 ,$182.59 ,$219.13 ,$219.24 ,$219.13 ,$248.76 ,$324.00 ,$245.95 , N/A ,$284.40 ,$3.69 ,$360.00 ,$360.00 , N/A ,$360.00 ,$259.20 ,$223.20 ,$259.20 ,$259.20 ,$288.00 
ST NICHOLAS HOSPITAL - ACUTE,40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,$820.00 ,$541.20 ,$3.48 ,$820.00 ,$3.48 ,$631.00 ,$590.00 ,$104.31 ,$492.00 ,$697.00 ,$574.00 ,$3.48 ,$3.48 ,$779.00 ,$623.20 ,$615.00 ,$175.32 ,$697.00 ,$104.31 ,$175.32 ,$175.32 ,$574.00 ,$499.38 ,$3.48 ,$104.31 ,$102.22 ,$208.62 ,$3.69 ,$697.00 ,$234.71 ,$754.40 ,$574.00 ,$506.63 ,$506.63 ,$499.38 ,$506.63 ,$566.62 ,$738.00 ,$560.22 ,$103.24 ,$647.80 ,$3.69 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$656.00 
ST NICHOLAS HOSPITAL - ACUTE,40200027,76810,HC US PREGNANCY >14 WEEKS ADDL,402,1 ,$440.00 ,$290.40 ,$3.48 ,$440.00 ,$3.48 ,$440.00 ,$440.00 , N/A ,$264.00 ,$374.00 ,$308.00 ,$3.48 ,$3.48 ,$418.00 ,$334.40 ,$330.00 ,$82.04 ,$374.00 , N/A ,$82.04 ,$82.04 ,$308.00 ,$267.96 ,$3.48 , N/A , N/A , N/A ,$3.69 ,$374.00 , N/A ,$404.80 ,$308.00 ,$223.17 ,$267.83 ,$267.96 ,$267.83 ,$304.04 ,$396.00 ,$300.61 , N/A ,$347.60 ,$3.69 ,$440.00 ,$440.00 , N/A ,$440.00 ,$316.80 ,$272.80 ,$316.80 ,$316.80 ,$352.00 
ST NICHOLAS HOSPITAL - ACUTE,40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,$930.00 ,$613.80 ,$3.48 ,$930.00 ,$3.48 ,$631.00 ,$590.00 ,$227.92 ,$558.00 ,$790.50 ,$651.00 ,$3.48 ,$3.48 ,$883.50 ,$706.80 ,$697.50 ,$169.17 ,$790.50 ,$227.92 ,$169.17 ,$169.17 ,$651.00 ,$566.37 ,$3.48 ,$227.92 ,$223.36 ,$455.84 ,$3.69 ,$790.50 ,$512.81 ,$855.60 ,$651.00 ,$718.50 ,$718.50 ,$566.37 ,$718.50 ,$642.63 ,$837.00 ,$635.38 ,$225.60 ,$734.70 ,$3.69 ,$523.00 ,$523.00 ,$223.36 ,$523.00 ,$669.60 ,$576.60 ,$669.60 ,$669.60 ,$744.00 
ST NICHOLAS HOSPITAL - ACUTE,40200029,76812,HC US PREGNANCY DETAILED ADDL,402,1 ,$425.00 ,$280.50 ,$3.48 ,$425.00 ,$3.48 ,$425.00 ,$425.00 , N/A ,$255.00 ,$361.25 ,$297.50 ,$3.48 ,$3.48 ,$403.75 ,$323.00 ,$318.75 ,$212.93 ,$361.25 , N/A ,$212.93 ,$212.93 ,$297.50 ,$258.83 ,$3.48 , N/A , N/A , N/A ,$3.69 ,$361.25 , N/A ,$391.00 ,$297.50 ,$215.56 ,$258.70 ,$258.83 ,$258.70 ,$293.68 ,$382.50 ,$290.36 , N/A ,$335.75 ,$3.69 ,$425.00 ,$425.00 , N/A ,$425.00 ,$306.00 ,$263.50 ,$306.00 ,$306.00 ,$340.00 
ST NICHOLAS HOSPITAL - ACUTE,40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,$460.00 ,$303.60 ,$3.48 ,$460.00 ,$3.48 ,$460.00 ,$460.00 ,$104.31 ,$276.00 ,$391.00 ,$322.00 ,$3.48 ,$3.48 ,$437.00 ,$349.60 ,$345.00 ,$137.49 ,$391.00 ,$104.31 ,$137.49 ,$137.49 ,$322.00 ,$280.14 ,$3.48 ,$104.31 ,$102.22 ,$208.62 ,$3.69 ,$391.00 ,$234.71 ,$423.20 ,$322.00 ,$339.01 ,$339.01 ,$280.14 ,$339.01 ,$317.86 ,$414.00 ,$314.27 ,$103.24 ,$363.40 ,$3.69 ,$460.00 ,$460.00 ,$102.22 ,$460.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40200031,76815,HC US FETAL HEART BEAT,402,1 ,$480.00 ,$316.80 ,$3.48 ,$480.00 ,$3.48 ,$480.00 ,$480.00 ,$104.31 ,$288.00 ,$408.00 ,$336.00 ,$3.48 ,$3.48 ,$456.00 ,$364.80 ,$360.00 ,$99.88 ,$408.00 ,$104.31 ,$99.88 ,$99.88 ,$336.00 ,$292.32 ,$3.48 ,$104.31 ,$102.22 ,$208.62 ,$3.69 ,$408.00 ,$234.71 ,$441.60 ,$336.00 ,$480.00 ,$480.00 ,$292.32 ,$480.00 ,$331.68 ,$432.00 ,$327.94 ,$103.24 ,$379.20 ,$3.69 ,$480.00 ,$480.00 ,$102.22 ,$480.00 ,$345.60 ,$297.60 ,$345.60 ,$345.60 ,$384.00 
ST NICHOLAS HOSPITAL - ACUTE,40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,$630.00 ,$415.80 ,$3.48 ,$630.00 ,$3.48 ,$630.00 ,$590.00 ,$104.31 ,$378.00 ,$535.50 ,$441.00 ,$3.48 ,$3.48 ,$598.50 ,$478.80 ,$472.50 ,$113.06 ,$535.50 ,$104.31 ,$113.06 ,$113.06 ,$441.00 ,$383.67 ,$3.48 ,$104.31 ,$102.22 ,$208.62 ,$3.69 ,$535.50 ,$234.71 ,$579.60 ,$441.00 ,$506.63 ,$506.63 ,$383.67 ,$506.63 ,$435.33 ,$567.00 ,$430.42 ,$103.24 ,$497.70 ,$3.69 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$453.60 ,$390.60 ,$453.60 ,$453.60 ,$504.00 
ST NICHOLAS HOSPITAL - ACUTE,40200033,76818,HC US FETAL BIO PROFILE W/NST,402,1 ,$700.00 ,$462.00 ,$3.48 ,$700.00 ,$3.48 ,$631.00 ,$590.00 ,$104.31 ,$420.00 ,$595.00 ,$490.00 ,$3.48 ,$3.48 ,$665.00 ,$532.00 ,$525.00 ,$131.10 ,$595.00 ,$104.31 ,$131.10 ,$131.10 ,$490.00 ,$426.30 ,$3.48 ,$104.31 ,$102.22 ,$208.62 ,$3.69 ,$595.00 ,$234.71 ,$644.00 ,$490.00 ,$506.63 ,$506.63 ,$426.30 ,$506.63 ,$483.70 ,$630.00 ,$478.24 ,$103.24 ,$553.00 ,$3.69 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,40200034,76819,HC US FETAL BIO PROFILE W/O NST,402,1 ,$570.00 ,$376.20 ,$3.48 ,$570.00 ,$3.48 ,$570.00 ,$570.00 ,$104.31 ,$342.00 ,$484.50 ,$399.00 ,$3.48 ,$3.48 ,$541.50 ,$433.20 ,$427.50 ,$94.59 ,$484.50 ,$104.31 ,$94.59 ,$94.59 ,$399.00 ,$347.13 ,$3.48 ,$104.31 ,$102.22 ,$208.62 ,$3.69 ,$484.50 ,$234.71 ,$524.40 ,$399.00 ,$506.63 ,$506.63 ,$347.13 ,$506.63 ,$393.87 ,$513.00 ,$389.42 ,$103.24 ,$450.30 ,$3.69 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$410.40 ,$353.40 ,$410.40 ,$410.40 ,$456.00 
ST NICHOLAS HOSPITAL - ACUTE,40200038,76830,HC US TRANSVAGINAL,402,1 ,$760.00 ,$501.60 ,$3.71 ,$760.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$456.00 ,$646.00 ,$532.00 ,$3.71 ,$3.71 ,$722.00 ,$577.60 ,$570.00 ,$172.47 ,$646.00 ,$104.31 ,$172.47 ,$172.47 ,$532.00 ,$462.84 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$646.00 ,$234.71 ,$699.20 ,$532.00 ,$506.63 ,$506.63 ,$462.84 ,$506.63 ,$525.16 ,$684.00 ,$519.23 ,$103.24 ,$600.40 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,40200040,76856,HC US PELVIS NON OB,402,1 ,$880.00 ,$580.80 ,$5.75 ,$880.00 ,$5.75 ,$631.00 ,$590.00 ,$104.31 ,$528.00 ,$748.00 ,$616.00 ,$5.75 ,$5.75 ,$836.00 ,$668.80 ,$660.00 ,$144.73 ,$748.00 ,$104.31 ,$144.73 ,$144.73 ,$616.00 ,$535.92 ,$5.75 ,$104.31 ,$102.22 ,$208.62 ,$6.10 ,$748.00 ,$234.71 ,$809.60 ,$616.00 ,$506.63 ,$506.63 ,$535.92 ,$506.63 ,$608.08 ,$792.00 ,$601.22 ,$103.24 ,$695.20 ,$6.10 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$633.60 ,$545.60 ,$633.60 ,$633.60 ,$704.00 
ST NICHOLAS HOSPITAL - ACUTE,40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,$690.00 ,$455.40 ,$3.71 ,$690.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$414.00 ,$586.50 ,$483.00 ,$3.71 ,$3.71 ,$655.50 ,$524.40 ,$517.50 ,$49.71 ,$586.50 ,$104.31 ,$49.71 ,$49.71 ,$483.00 ,$420.21 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$586.50 ,$234.71 ,$634.80 ,$483.00 ,$339.01 ,$339.01 ,$420.21 ,$339.01 ,$476.79 ,$621.00 ,$471.41 ,$103.24 ,$545.10 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$496.80 ,$427.80 ,$496.80 ,$496.80 ,$552.00 
ST NICHOLAS HOSPITAL - ACUTE,40200042,76870,HC US SCROTUM,402,1 ,$740.00 ,$488.40 ,$3.71 ,$740.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$444.00 ,$629.00 ,$518.00 ,$3.71 ,$3.71 ,$703.00 ,$562.40 ,$555.00 ,$140.12 ,$629.00 ,$104.31 ,$140.12 ,$140.12 ,$518.00 ,$450.66 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$629.00 ,$234.71 ,$680.80 ,$518.00 ,$506.63 ,$506.63 ,$450.66 ,$506.63 ,$511.34 ,$666.00 ,$505.57 ,$103.24 ,$584.60 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$532.80 ,$458.80 ,$532.80 ,$532.80 ,$592.00 
ST NICHOLAS HOSPITAL - ACUTE,40200043,76872,HC ULTRA BX PROS,402,1 ,$327.00 ,$215.82 ,$3.71 ,$327.00 ,$3.71 ,$327.00 ,$327.00 ,$104.31 ,$196.20 ,$277.95 ,$228.90 ,$3.71 ,$3.71 ,$310.65 ,$248.52 ,$245.25 ,$327.00 ,$277.95 ,$104.31 ,$327.00 ,$327.00 ,$228.90 ,$199.14 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$277.95 ,$234.71 ,$300.84 ,$228.90 ,$327.00 ,$327.00 ,$199.14 ,$327.00 ,$225.96 ,$294.30 ,$223.41 ,$103.24 ,$258.33 ,$3.93 ,$327.00 ,$327.00 ,$102.22 ,$327.00 ,$235.44 ,$202.74 ,$235.44 ,$235.44 ,$261.60 
ST NICHOLAS HOSPITAL - ACUTE,40200044,76873,HC US TRANSRECTAL PROSTATE VOLUME,402,1 ,$690.00 ,$455.40 ,$5.75 ,$690.00 ,$5.75 ,$631.00 ,$590.00 ,$104.31 ,$414.00 ,$586.50 ,$483.00 ,$5.75 ,$5.75 ,$655.50 ,$524.40 ,$517.50 ,$195.12 ,$586.50 ,$104.31 ,$195.12 ,$195.12 ,$483.00 ,$420.21 ,$5.75 ,$104.31 ,$102.22 ,$208.62 ,$6.10 ,$586.50 ,$234.71 ,$634.80 ,$483.00 ,$690.00 ,$690.00 ,$420.21 ,$690.00 ,$476.79 ,$621.00 ,$471.41 ,$103.24 ,$545.10 ,$6.10 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$496.80 ,$427.80 ,$496.80 ,$496.80 ,$552.00 
ST NICHOLAS HOSPITAL - ACUTE,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$810.00 ,$534.60 ,$3.71 ,$810.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$486.00 ,$688.50 ,$567.00 ,$3.71 ,$3.71 ,$769.50 ,$615.60 ,$607.50 ,$21.34 ,$688.50 ,$104.31 ,$21.34 ,$21.34 ,$567.00 ,$493.29 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$688.50 ,$234.71 ,$745.20 ,$567.00 ,$759.95 ,$759.95 ,$493.29 ,$759.95 ,$559.71 ,$729.00 ,$553.39 ,$103.24 ,$639.90 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$648.00 
ST NICHOLAS HOSPITAL - ACUTE,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$810.00 ,$534.60 ,$3.71 ,$810.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$486.00 ,$688.50 ,$567.00 ,$3.71 ,$3.71 ,$769.50 ,$615.60 ,$607.50 ,$21.34 ,$688.50 ,$104.31 ,$21.34 ,$21.34 ,$567.00 ,$493.29 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$688.50 ,$234.71 ,$745.20 ,$567.00 ,$759.95 ,$759.95 ,$493.29 ,$759.95 ,$559.71 ,$729.00 ,$553.39 ,$103.24 ,$639.90 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$648.00 
ST NICHOLAS HOSPITAL - ACUTE,40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$550.00 ,$363.00 ,$3.71 ,$550.00 ,$3.71 ,$550.00 ,$550.00 ,$104.31 ,$330.00 ,$467.50 ,$385.00 ,$3.71 ,$3.71 ,$522.50 ,$418.00 ,$412.50 ,$18.02 ,$467.50 ,$104.31 ,$18.02 ,$18.02 ,$385.00 ,$334.95 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$467.50 ,$234.71 ,$506.00 ,$385.00 ,$339.01 ,$339.01 ,$334.95 ,$339.01 ,$380.05 ,$495.00 ,$375.76 ,$103.24 ,$434.50 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$440.00 
ST NICHOLAS HOSPITAL - ACUTE,40200048,76885,HC US HIPS INFANT DYNAMIC,402,1 ,$540.00 ,$356.40 ,$3.71 ,$540.00 ,$3.71 ,$540.00 ,$540.00 ,$84.79 ,$324.00 ,$459.00 ,$378.00 ,$3.71 ,$3.71 ,$513.00 ,$410.40 ,$405.00 ,$201.74 ,$459.00 ,$84.79 ,$201.74 ,$201.74 ,$378.00 ,$328.86 ,$3.71 ,$84.79 ,$83.09 ,$169.58 ,$3.93 ,$459.00 ,$190.79 ,$496.80 ,$378.00 ,$339.01 ,$339.01 ,$328.86 ,$339.01 ,$373.14 ,$486.00 ,$368.93 ,$83.93 ,$426.60 ,$3.93 ,$523.00 ,$523.00 ,$83.09 ,$523.00 ,$388.80 ,$334.80 ,$388.80 ,$388.80 ,$432.00 
ST NICHOLAS HOSPITAL - ACUTE,40200050,76936,HC US GUIDED COMPRESSION RPR,402,1 ,"$1,094.80 ",$722.57 ,$6.83 ,"$1,094.80 ",$6.83 ,$631.00 ,$590.00 ,$273.34 ,$656.88 ,$930.58 ,$766.36 ,$6.83 ,$6.83 ,"$1,040.06 ",$832.05 ,$821.10 ,$328.21 ,$930.58 ,$273.34 ,$328.21 ,$328.21 ,$766.36 ,$666.73 ,$6.83 ,$273.34 ,$267.87 ,$546.68 ,$7.24 ,$930.58 ,$615.01 ,"$1,007.22 ",$766.36 ,$493.43 ,$493.43 ,$666.73 ,$493.43 ,$756.51 ,$985.32 ,$747.97 ,$270.55 ,$864.89 ,$7.24 ,$523.00 ,$523.00 ,$267.87 ,$523.00 ,$788.26 ,$678.78 ,$788.26 ,$788.26 ,$875.84 
ST NICHOLAS HOSPITAL - ACUTE,40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,$530.00 ,$349.80 ,$3.89 ,$530.00 ,$3.89 ,$530.00 ,$530.00 , N/A ,$318.00 ,$450.50 ,$371.00 ,$3.89 ,$3.89 ,$503.50 ,$402.80 ,$397.50 ,$50.14 ,$450.50 , N/A ,$50.14 ,$50.14 ,$371.00 ,$322.77 ,$3.89 , N/A , N/A , N/A ,$4.12 ,$450.50 , N/A ,$487.60 ,$371.00 ,$268.82 ,$322.61 ,$322.77 ,$322.61 ,$366.23 ,$477.00 ,$362.10 , N/A ,$418.70 ,$4.12 ,$523.00 ,$523.00 , N/A ,$523.00 ,$381.60 ,$328.60 ,$381.60 ,$381.60 ,$424.00 
ST NICHOLAS HOSPITAL - ACUTE,40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,"$1,000.00 ",$660.00 ,$3.89 ,"$1,000.00 ",$3.89 ,$631.00 ,$590.00 , N/A ,$600.00 ,$850.00 ,$700.00 ,$3.89 ,$3.89 ,$950.00 ,$760.00 ,$750.00 ,$54.98 ,$850.00 , N/A ,$54.98 ,$54.98 ,$700.00 ,$609.00 ,$3.89 , N/A , N/A , N/A ,$4.12 ,$850.00 , N/A ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$608.70 ,$691.00 ,$900.00 ,$683.20 , N/A ,$790.00 ,$4.12 ,$523.00 ,$523.00 , N/A ,$523.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,40200057,76942,HC US GUIDED NEEDLE BX THORA,402,1 ,"$1,000.00 ",$660.00 ,$3.89 ,"$1,000.00 ",$3.89 ,$631.00 ,$590.00 , N/A ,$600.00 ,$850.00 ,$700.00 ,$3.89 ,$3.89 ,$950.00 ,$760.00 ,$750.00 ,$54.98 ,$850.00 , N/A ,$54.98 ,$54.98 ,$700.00 ,$609.00 ,$3.89 , N/A , N/A , N/A ,$4.12 ,$850.00 , N/A ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$608.70 ,$691.00 ,$900.00 ,$683.20 , N/A ,$790.00 ,$4.12 ,$523.00 ,$523.00 , N/A ,$523.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,40200061,76965,HC US GUIDED INTERSTITIAL THRPY,402,1 ,$120.00 ,$79.20 ,$3.89 ,$120.00 ,$3.89 ,$120.00 ,$120.00 , N/A ,$72.00 ,$102.00 ,$84.00 ,$3.89 ,$3.89 ,$114.00 ,$91.20 ,$90.00 ,$53.01 ,$102.00 , N/A ,$53.01 ,$53.01 ,$84.00 ,$73.08 ,$3.89 , N/A , N/A , N/A ,$4.12 ,$102.00 , N/A ,$110.40 ,$84.00 ,$60.86 ,$73.04 ,$73.08 ,$73.04 ,$82.92 ,$108.00 ,$81.98 , N/A ,$94.80 ,$4.12 ,$120.00 ,$120.00 , N/A ,$120.00 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,40200062,76998,HC US INTRAOPERATIVE,402,1 ,"$1,200.00 ",$792.00 ,$3.89 ,"$1,200.00 ",$3.89 ,$631.00 ,$590.00 , N/A ,$720.00 ,"$1,020.00 ",$840.00 ,$3.89 ,$3.89 ,"$1,140.00 ",$912.00 ,$900.00 ,$103.16 ,"$1,020.00 ", N/A ,$103.16 ,$103.16 ,$840.00 ,$730.80 ,$3.89 , N/A , N/A , N/A ,$4.12 ,"$1,020.00 ", N/A ,"$1,104.00 ",$840.00 ,$608.64 ,$730.44 ,$730.80 ,$730.44 ,$829.20 ,"$1,080.00 ",$819.84 , N/A ,$948.00 ,$4.12 ,$523.00 ,$523.00 , N/A ,$523.00 ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$960.00 
ST NICHOLAS HOSPITAL - ACUTE,40200063,76999,HC UNLISTED PROCEDURE ULTRASOUND,402,1 ,$420.00 ,$277.20 ,$3.71 ,$420.00 ,$3.71 ,$420.00 ,$420.00 ,$84.79 ,$252.00 ,$357.00 ,$294.00 ,$3.71 ,$3.71 ,$399.00 ,$319.20 ,$315.00 , N/A ,$357.00 ,$84.79 , N/A , N/A ,$294.00 ,$255.78 ,$3.71 ,$84.79 ,$83.09 ,$169.58 ,$3.93 ,$357.00 ,$190.79 ,$386.40 ,$294.00 ,$339.01 ,$339.01 ,$255.78 ,$339.01 ,$290.22 ,$378.00 ,$286.94 ,$83.93 ,$331.80 ,$3.93 ,$420.00 ,$420.00 ,$83.09 ,$420.00 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,"$1,100.00 ",$726.00 ,$5.75 ,"$1,100.00 ",$5.75 ,$631.00 ,$590.00 ,$227.92 ,$660.00 ,$935.00 ,$770.00 ,$5.75 ,$5.75 ,"$1,045.00 ",$836.00 ,$825.00 ,$416.64 ,$935.00 ,$227.92 ,$416.64 ,$416.64 ,$770.00 ,$669.90 ,$5.75 ,$227.92 ,$223.36 ,$455.84 ,$6.10 ,$935.00 ,$512.81 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$669.57 ,$760.10 ,$990.00 ,$751.52 ,$225.60 ,$869.00 ,$6.10 ,$523.00 ,$523.00 ,$223.36 ,$523.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,40200066,93975,HC DUPLEX ABD/PEL/RETRO CMPL RENAL,402,1 ,"$1,100.00 ",$726.00 ,$5.75 ,"$1,100.00 ",$5.75 ,$631.00 ,$590.00 ,$227.92 ,$660.00 ,$935.00 ,$770.00 ,$5.75 ,$5.75 ,"$1,045.00 ",$836.00 ,$825.00 ,$416.64 ,$935.00 ,$227.92 ,$416.64 ,$416.64 ,$770.00 ,$669.90 ,$5.75 ,$227.92 ,$223.36 ,$455.84 ,$6.10 ,$935.00 ,$512.81 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$669.57 ,$760.10 ,$990.00 ,$751.52 ,$225.60 ,$869.00 ,$6.10 ,$523.00 ,$523.00 ,$223.36 ,$523.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,40200067,93975,HC DUPLEX ABD/PEL/RETRO CMPL AORTA,402,1 ,"$1,100.00 ",$726.00 ,$5.75 ,"$1,100.00 ",$5.75 ,$631.00 ,$590.00 ,$227.92 ,$660.00 ,$935.00 ,$770.00 ,$5.75 ,$5.75 ,"$1,045.00 ",$836.00 ,$825.00 ,$416.64 ,$935.00 ,$227.92 ,$416.64 ,$416.64 ,$770.00 ,$669.90 ,$5.75 ,$227.92 ,$223.36 ,$455.84 ,$6.10 ,$935.00 ,$512.81 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$669.57 ,$760.10 ,$990.00 ,$751.52 ,$225.60 ,$869.00 ,$6.10 ,$523.00 ,$523.00 ,$223.36 ,$523.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,40200068,93976,HC DUPLEX ABD/PEL/RETRO LTD,402,1 ,"$1,000.00 ",$660.00 ,$5.75 ,"$1,000.00 ",$5.75 ,$631.00 ,$590.00 ,$104.31 ,$600.00 ,$850.00 ,$700.00 ,$5.75 ,$5.75 ,$950.00 ,$760.00 ,$750.00 ,$238.68 ,$850.00 ,$104.31 ,$238.68 ,$238.68 ,$700.00 ,$609.00 ,$5.75 ,$104.31 ,$102.22 ,$208.62 ,$6.10 ,$850.00 ,$234.71 ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$608.70 ,$691.00 ,$900.00 ,$683.20 ,$103.24 ,$790.00 ,$6.10 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,"$1,000.00 ",$660.00 ,$5.75 ,"$1,000.00 ",$5.75 ,$631.00 ,$590.00 ,$104.31 ,$600.00 ,$850.00 ,$700.00 ,$5.75 ,$5.75 ,$950.00 ,$760.00 ,$750.00 ,$238.68 ,$850.00 ,$104.31 ,$238.68 ,$238.68 ,$700.00 ,$609.00 ,$5.75 ,$104.31 ,$102.22 ,$208.62 ,$6.10 ,$850.00 ,$234.71 ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$608.70 ,$691.00 ,$900.00 ,$683.20 ,$103.24 ,$790.00 ,$6.10 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,40200073,93978,HC DUPLEX AORTA/IVC/GRAFT CMPL,921,1 ,$860.00 ,$567.60 ,$5.75 ,$860.00 ,$5.75 ,$589.44 ,$589.44 ,$227.92 ,$516.00 ,$731.00 ,$602.00 ,$5.75 ,$5.75 ,$817.00 ,$653.60 ,$645.00 ,$559.00 ,$731.00 ,$227.92 ,$559.00 ,$559.00 ,$602.00 ,$523.74 ,$5.75 ,$227.92 ,$223.36 ,$455.84 ,$6.10 ,$731.00 ,$512.81 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 ,$225.60 ,$679.40 ,$6.10 ,$475.00 ,$475.00 ,$223.36 ,$475.00 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,40200074,93979,HC DUPLEX AORTA/IVC/GRAFT LTD,402,1 ,$660.00 ,$435.60 ,$3.71 ,$660.00 ,$3.71 ,$631.00 ,$590.00 ,$104.31 ,$396.00 ,$561.00 ,$462.00 ,$3.71 ,$3.71 ,$627.00 ,$501.60 ,$495.00 ,$185.87 ,$561.00 ,$104.31 ,$185.87 ,$185.87 ,$462.00 ,$401.94 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$561.00 ,$234.71 ,$607.20 ,$462.00 ,$334.75 ,$401.74 ,$401.94 ,$401.74 ,$456.06 ,$594.00 ,$450.91 ,$103.24 ,$521.40 ,$3.93 ,$523.00 ,$523.00 ,$102.22 ,$523.00 ,$475.20 ,$409.20 ,$475.20 ,$475.20 ,$528.00 
ST NICHOLAS HOSPITAL - ACUTE,40200075,76706,HC US AORTA (SCREENING),402,1 ,$500.00 ,$330.00 ,$3.71 ,$500.00 ,$3.71 ,$500.00 ,$500.00 ,$104.31 ,$300.00 ,$425.00 ,$350.00 ,$3.71 ,$3.71 ,$475.00 ,$380.00 ,$375.00 ,$159.92 ,$425.00 ,$104.31 ,$159.92 ,$159.92 ,$350.00 ,$304.50 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$425.00 ,$234.71 ,$460.00 ,$350.00 ,$413.50 ,$413.50 ,$304.50 ,$413.50 ,$345.50 ,$450.00 ,$341.60 ,$103.24 ,$395.00 ,$3.93 ,$500.00 ,$500.00 ,$102.22 ,$500.00 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,40200077,76706,HC ABD AORTA US SELF SCREEN CORP,402,1 ,$57.00 ,$37.62 ,$3.71 ,$234.71 ,$3.71 ,$57.00 ,$57.00 ,$104.31 ,$34.20 ,$48.45 ,$39.90 ,$3.71 ,$3.71 ,$54.15 ,$43.32 ,$42.75 ,$57.00 ,$48.45 ,$104.31 ,$57.00 ,$57.00 ,$39.90 ,$34.71 ,$3.71 ,$104.31 ,$102.22 ,$57.00 ,$3.93 ,$48.45 ,$234.71 ,$52.44 ,$39.90 ,$57.00 ,$57.00 ,$34.71 ,$57.00 ,$39.39 ,$51.30 ,$38.94 ,$103.24 ,$45.03 ,$3.93 ,$57.00 ,$57.00 ,$102.22 ,$57.00 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$45.60 
ST NICHOLAS HOSPITAL - ACUTE,40200096,76512,HC OPHTHALMIC US DIAG B-SCAN,402,1 ,$318.00 ,$209.88 ,$3.71 ,$318.00 ,$3.71 ,$318.00 ,$318.00 ,$104.31 ,$190.80 ,$270.30 ,$222.60 ,$3.71 ,$3.71 ,$302.10 ,$241.68 ,$238.50 ,$34.52 ,$270.30 ,$104.31 ,$34.52 ,$34.52 ,$222.60 ,$193.66 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$270.30 ,$234.71 ,$292.56 ,$222.60 ,$318.00 ,$318.00 ,$193.66 ,$318.00 ,$219.74 ,$286.20 ,$217.26 ,$103.24 ,$251.22 ,$3.93 ,$318.00 ,$318.00 ,$102.22 ,$318.00 ,$228.96 ,$197.16 ,$228.96 ,$228.96 ,$254.40 
ST NICHOLAS HOSPITAL - ACUTE,40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$350.00 ,$231.00 ,$1.69 ,$350.00 ,$1.69 ,$343.00 ,$229.00 ,$88.96 ,$210.00 ,$297.50 ,$245.00 ,$1.69 ,$1.69 ,$332.50 ,$266.00 ,$262.50 ,$182.37 ,$297.50 ,$88.96 ,$182.37 ,$182.37 ,$245.00 ,$213.15 ,$1.69 ,$88.96 ,$87.18 ,$177.92 ,$1.79 ,$297.50 ,$200.16 ,$322.00 ,$245.00 ,$177.52 ,$213.05 ,$213.15 ,$213.05 ,$241.85 ,$315.00 ,$239.12 ,$88.05 ,$276.50 ,$1.79 ,$167.00 ,$167.00 ,$87.18 ,$167.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$350.00 ,$231.00 ,$1.69 ,$350.00 ,$1.69 ,$343.00 ,$229.00 ,$88.96 ,$210.00 ,$297.50 ,$245.00 ,$1.69 ,$1.69 ,$332.50 ,$266.00 ,$262.50 ,$182.37 ,$297.50 ,$88.96 ,$182.37 ,$182.37 ,$245.00 ,$213.15 ,$1.69 ,$88.96 ,$87.18 ,$177.92 ,$1.79 ,$297.50 ,$200.16 ,$322.00 ,$245.00 ,$177.52 ,$213.05 ,$213.15 ,$213.05 ,$241.85 ,$315.00 ,$239.12 ,$88.05 ,$276.50 ,$1.79 ,$167.00 ,$167.00 ,$87.18 ,$167.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40300006,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL,403,1 ,$130.00 ,$85.80 ,$1.69 ,$130.00 ,$1.69 ,$89.10 ,$89.10 ,$23.18 ,$78.00 ,$110.50 ,$91.00 ,$1.69 ,$1.69 ,$123.50 ,$98.80 ,$97.50 ,$47.52 ,$110.50 ,$23.18 ,$47.52 ,$47.52 ,$91.00 ,$79.17 ,$1.69 ,$23.18 ,$22.72 ,$46.36 ,$1.79 ,$110.50 ,$52.16 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$88.82 ,$22.94 ,$102.70 ,$1.79 ,$130.00 ,$130.00 ,$22.72 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,40300008,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL CORPORATE,403,1 ,$40.00 ,$26.40 ,$1.69 ,$52.16 ,$1.69 ,$27.42 ,$27.42 ,$23.18 ,$24.00 ,$34.00 ,$28.00 ,$1.69 ,$1.69 ,$38.00 ,$30.40 ,$30.00 ,$40.00 ,$34.00 ,$23.18 ,$40.00 ,$40.00 ,$28.00 ,$24.36 ,$1.69 ,$23.18 ,$22.72 ,$40.00 ,$1.79 ,$34.00 ,$52.16 ,$36.80 ,$28.00 ,$20.29 ,$24.35 ,$24.36 ,$24.35 ,$27.64 ,$36.00 ,$27.33 ,$22.94 ,$31.60 ,$1.79 ,$40.00 ,$40.00 ,$22.72 ,$40.00 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,40400003,78814,HC PET W/CT TUMR LIMITED AREA,404,1 ,"$7,007.00 ","$4,624.62 ",$45.33 ,"$7,007.00 ",$45.33 ,"$4,927.00 ","$4,698.00 ","$1,453.61 ","$4,204.20 ","$5,955.95 ","$4,904.90 ",$45.33 ,$45.33 ,"$6,656.65 ","$5,325.32 ","$5,255.25 ","$5,794.84 ","$5,955.95 ","$1,453.61 ","$5,794.84 ","$5,794.84 ","$4,904.90 ","$4,267.26 ",$45.33 ,"$1,453.61 ","$1,424.54 ","$2,907.22 ",$48.05 ,"$5,955.95 ","$3,270.61 ","$6,446.44 ","$4,904.90 ","$4,934.34 ","$4,934.34 ","$4,267.26 ","$4,934.34 ","$4,841.84 ","$6,306.30 ","$4,787.18 ","$1,438.79 ","$5,535.53 ",$48.05 ,"$3,966.00 ","$3,966.00 ","$1,424.54 ","$3,966.00 ","$5,045.04 ","$4,344.34 ","$5,045.04 ","$5,045.04 ","$5,605.60 "
ST NICHOLAS HOSPITAL - ACUTE,40400004,78815,HC PET W/CT TUMR SKULL MID-THIGH,404,1 ,"$7,321.00 ","$4,831.86 ",$45.33 ,"$7,321.00 ",$45.33 ,"$4,927.00 ","$4,698.00 ","$1,453.61 ","$4,392.60 ","$6,222.85 ","$5,124.70 ",$45.33 ,$45.33 ,"$6,954.95 ","$5,563.96 ","$5,490.75 ","$5,794.84 ","$6,222.85 ","$1,453.61 ","$5,794.84 ","$5,794.84 ","$5,124.70 ","$4,458.49 ",$45.33 ,"$1,453.61 ","$1,424.54 ","$2,907.22 ",$48.05 ,"$6,222.85 ","$3,270.61 ","$6,735.32 ","$5,124.70 ","$4,934.34 ","$4,934.34 ","$4,458.49 ","$4,934.34 ","$5,058.81 ","$6,588.90 ","$5,001.71 ","$1,438.79 ","$5,783.59 ",$48.05 ,"$3,966.00 ","$3,966.00 ","$1,424.54 ","$3,966.00 ","$5,271.12 ","$4,539.02 ","$5,271.12 ","$5,271.12 ","$5,856.80 "
ST NICHOLAS HOSPITAL - ACUTE,40400005,78816,HC PET W/CT MELAN IMAG WHOLE BODY,404,1 ,"$7,321.00 ","$4,831.86 ",$45.33 ,"$7,321.00 ",$45.33 ,"$4,927.00 ","$4,698.00 ","$1,453.61 ","$4,392.60 ","$6,222.85 ","$5,124.70 ",$45.33 ,$45.33 ,"$6,954.95 ","$5,563.96 ","$5,490.75 ","$5,794.84 ","$6,222.85 ","$1,453.61 ","$5,794.84 ","$5,794.84 ","$5,124.70 ","$4,458.49 ",$45.33 ,"$1,453.61 ","$1,424.54 ","$2,907.22 ",$48.05 ,"$6,222.85 ","$3,270.61 ","$6,735.32 ","$5,124.70 ","$4,934.34 ","$4,934.34 ","$4,458.49 ","$4,934.34 ","$5,058.81 ","$6,588.90 ","$5,001.71 ","$1,438.79 ","$5,783.59 ",$48.05 ,"$3,966.00 ","$3,966.00 ","$1,424.54 ","$3,966.00 ","$5,271.12 ","$4,539.02 ","$5,271.12 ","$5,271.12 ","$5,856.80 "
ST NICHOLAS HOSPITAL - ACUTE,40400006,78608,HC PET BRAIN LIMITED ALZHEIMERS,404,1 ,"$7,007.00 ","$4,624.62 ",$45.33 ,"$7,007.00 ",$45.33 ,"$4,927.00 ","$4,698.00 ","$1,453.61 ","$4,204.20 ","$5,955.95 ","$4,904.90 ",$45.33 ,$45.33 ,"$6,656.65 ","$5,325.32 ","$5,255.25 ","$2,900.05 ","$5,955.95 ","$1,453.61 ","$2,900.05 ","$2,900.05 ","$4,904.90 ","$4,267.26 ",$45.33 ,"$1,453.61 ","$1,424.54 ","$2,907.22 ",$48.05 ,"$5,955.95 ","$3,270.61 ","$6,446.44 ","$4,904.90 ","$4,934.34 ","$4,934.34 ","$4,267.26 ","$4,934.34 ","$4,841.84 ","$6,306.30 ","$4,787.18 ","$1,438.79 ","$5,535.53 ",$48.05 ,"$3,966.00 ","$3,966.00 ","$1,424.54 ","$3,966.00 ","$5,045.04 ","$4,344.34 ","$5,045.04 ","$5,045.04 ","$5,605.60 "
ST NICHOLAS HOSPITAL - ACUTE,41000002,31502,HC CHG TUBE TRACHEOTOMY,410,1 ,$557.75 ,$368.12 ,$5.60 ,$557.75 ,$5.60 ,$382.28 ,$382.28 ,$202.84 ,$334.65 ,$474.09 ,$390.43 ,$5.60 ,$5.60 ,$529.86 ,$423.89 ,$418.31 ,$362.54 ,$474.09 ,$202.84 ,$362.54 ,$362.54 ,$390.43 ,$339.67 ,$5.60 ,$202.84 ,$198.78 ,$405.68 ,$5.94 ,$474.09 ,$456.39 ,$513.13 ,$390.43 ,$282.89 ,$339.50 ,$339.67 ,$339.50 ,$385.41 ,$501.98 ,$381.05 ,$200.77 ,$440.62 ,$5.94 ,$93.00 ,$93.00 ,$198.78 ,$93.00 ,$401.58 ,$345.81 ,$401.58 ,$401.58 ,$446.20 
ST NICHOLAS HOSPITAL - ACUTE,41000005,92950,HC CPR,480,1 ,$749.00 ,$494.34 ,$25.07 ,$749.00 ,$25.07 ,$513.36 ,$513.36 ,$273.34 ,$449.40 ,$636.65 ,$524.30 ,$25.07 ,$25.07 ,$711.55 ,$569.24 ,$561.75 ,$486.85 ,$636.65 ,$273.34 ,$486.85 ,$486.85 ,$524.30 ,$456.14 ,$25.07 ,$273.34 ,$267.87 ,$546.68 ,$26.57 ,$636.65 ,$615.01 ,$689.08 ,$524.30 ,$379.89 ,$455.92 ,$456.14 ,$455.92 ,$517.56 ,$674.10 ,$511.72 ,$270.55 ,$591.71 ,$26.57 ,$749.00 ,$749.00 ,$267.87 ,$749.00 ,$539.28 ,$464.38 ,$539.28 ,$539.28 ,$599.20 
ST NICHOLAS HOSPITAL - ACUTE,41000008,N/A,HC HIGH FLOW OXYGEN CANNULA,410,1 ,$89.04 ,$58.77 ,$45.16 ,$89.04 , N/A ,$61.03 ,$61.03 , N/A ,$53.42 ,$75.68 ,$62.33 , N/A , N/A ,$84.59 ,$67.67 ,$66.78 ,$57.88 ,$75.68 , N/A ,$57.88 ,$57.88 ,$62.33 ,$54.23 , N/A , N/A , N/A , N/A , N/A ,$75.68 , N/A ,$81.92 ,$62.33 ,$45.16 ,$54.20 ,$54.23 ,$54.20 ,$61.53 ,$80.14 ,$60.83 , N/A ,$70.34 , N/A ,$89.04 ,$89.04 , N/A ,$89.04 ,$64.11 ,$55.20 ,$64.11 ,$64.11 ,$71.23 
ST NICHOLAS HOSPITAL - ACUTE,41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,"$1,138.50 ",$751.41 ,$38.73 ,"$1,222.56 ",$38.73 ,$780.33 ,$780.33 ,$543.36 ,$683.10 ,$967.73 ,$796.95 ,$38.73 ,$38.73 ,"$1,081.58 ",$865.26 ,$853.88 ,$740.03 ,$967.73 ,$543.36 ,$740.03 ,$740.03 ,$796.95 ,$693.35 ,$38.73 ,$543.36 ,$532.49 ,"$1,086.72 ",$41.05 ,$967.73 ,"$1,222.56 ","$1,047.42 ",$796.95 ,$577.45 ,$693.01 ,$693.35 ,$693.01 ,$786.70 ,"$1,024.65 ",$777.82 ,$537.81 ,$899.42 ,$41.05 ,$93.00 ,$93.00 ,$532.49 ,$93.00 ,$819.72 ,$705.87 ,$819.72 ,$819.72 ,$910.80 
ST NICHOLAS HOSPITAL - ACUTE,41000010,94002,HC VENTIL HI FREQ INTL DAY,410,1 ,"$1,138.50 ",$751.41 ,$38.73 ,"$1,222.56 ",$38.73 ,$780.33 ,$780.33 ,$543.36 ,$683.10 ,$967.73 ,$796.95 ,$38.73 ,$38.73 ,"$1,081.58 ",$865.26 ,$853.88 ,$740.03 ,$967.73 ,$543.36 ,$740.03 ,$740.03 ,$796.95 ,$693.35 ,$38.73 ,$543.36 ,$532.49 ,"$1,086.72 ",$41.05 ,$967.73 ,"$1,222.56 ","$1,047.42 ",$796.95 ,$577.45 ,$693.01 ,$693.35 ,$693.01 ,$786.70 ,"$1,024.65 ",$777.82 ,$537.81 ,$899.42 ,$41.05 ,$93.00 ,$93.00 ,$532.49 ,$93.00 ,$819.72 ,$705.87 ,$819.72 ,$819.72 ,$910.80 
ST NICHOLAS HOSPITAL - ACUTE,41000012,94002,HC VENT SEDATED INTL DAY,410,1 ,"$1,138.50 ",$751.41 ,$38.73 ,"$1,222.56 ",$38.73 ,$780.33 ,$780.33 ,$543.36 ,$683.10 ,$967.73 ,$796.95 ,$38.73 ,$38.73 ,"$1,081.58 ",$865.26 ,$853.88 ,$740.03 ,$967.73 ,$543.36 ,$740.03 ,$740.03 ,$796.95 ,$693.35 ,$38.73 ,$543.36 ,$532.49 ,"$1,086.72 ",$41.05 ,$967.73 ,"$1,222.56 ","$1,047.42 ",$796.95 ,$577.45 ,$693.01 ,$693.35 ,$693.01 ,$786.70 ,"$1,024.65 ",$777.82 ,$537.81 ,$899.42 ,$41.05 ,$93.00 ,$93.00 ,$532.49 ,$93.00 ,$819.72 ,$705.87 ,$819.72 ,$819.72 ,$910.80 
ST NICHOLAS HOSPITAL - ACUTE,41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$322.00 ,$212.52 ,$4.38 ,$420.53 ,$4.38 ,$220.70 ,$220.70 ,$186.90 ,$193.20 ,$273.70 ,$225.40 ,$4.38 ,$4.38 ,$305.90 ,$244.72 ,$241.50 ,$209.30 ,$273.70 ,$186.90 ,$209.30 ,$209.30 ,$225.40 ,$196.10 ,$4.38 ,$186.90 ,$183.16 ,$322.00 ,$4.64 ,$273.70 ,$420.53 ,$296.24 ,$225.40 ,$163.32 ,$196.00 ,$196.10 ,$196.00 ,$222.50 ,$289.80 ,$219.99 ,$184.99 ,$254.38 ,$4.64 ,$93.00 ,$93.00 ,$183.16 ,$93.00 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,41000014,94002,HC VENT WEANING FIRST DAY,410,1 ,"$1,138.50 ",$751.41 ,$38.73 ,"$1,222.56 ",$38.73 ,$780.33 ,$780.33 ,$543.36 ,$683.10 ,$967.73 ,$796.95 ,$38.73 ,$38.73 ,"$1,081.58 ",$865.26 ,$853.88 ,$740.03 ,$967.73 ,$543.36 ,$740.03 ,$740.03 ,$796.95 ,$693.35 ,$38.73 ,$543.36 ,$532.49 ,"$1,086.72 ",$41.05 ,$967.73 ,"$1,222.56 ","$1,047.42 ",$796.95 ,$577.45 ,$693.01 ,$693.35 ,$693.01 ,$786.70 ,"$1,024.65 ",$777.82 ,$537.81 ,$899.42 ,$41.05 ,$93.00 ,$93.00 ,$532.49 ,$93.00 ,$819.72 ,$705.87 ,$819.72 ,$819.72 ,$910.80 
ST NICHOLAS HOSPITAL - ACUTE,41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,$874.00 ,$576.84 ,$38.73 ,"$1,222.56 ",$38.73 ,$599.04 ,$599.04 ,$543.36 ,$524.40 ,$742.90 ,$611.80 ,$38.73 ,$38.73 ,$830.30 ,$664.24 ,$655.50 ,$568.10 ,$742.90 ,$543.36 ,$568.10 ,$568.10 ,$611.80 ,$532.27 ,$38.73 ,$543.36 ,$532.49 ,$874.00 ,$41.05 ,$742.90 ,"$1,222.56 ",$804.08 ,$611.80 ,$443.29 ,$532.00 ,$532.27 ,$532.00 ,$603.93 ,$786.60 ,$597.12 ,$537.81 ,$690.46 ,$41.05 ,$93.00 ,$93.00 ,$532.49 ,$93.00 ,$629.28 ,$541.88 ,$629.28 ,$629.28 ,$699.20 
ST NICHOLAS HOSPITAL - ACUTE,41000028,94003,HC VENT HI FREQ SUBQ DAY,410,1 ,$874.00 ,$576.84 ,$38.73 ,"$1,222.56 ",$38.73 ,$599.04 ,$599.04 ,$543.36 ,$524.40 ,$742.90 ,$611.80 ,$38.73 ,$38.73 ,$830.30 ,$664.24 ,$655.50 ,$568.10 ,$742.90 ,$543.36 ,$568.10 ,$568.10 ,$611.80 ,$532.27 ,$38.73 ,$543.36 ,$532.49 ,$874.00 ,$41.05 ,$742.90 ,"$1,222.56 ",$804.08 ,$611.80 ,$443.29 ,$532.00 ,$532.27 ,$532.00 ,$603.93 ,$786.60 ,$597.12 ,$537.81 ,$690.46 ,$41.05 ,$93.00 ,$93.00 ,$532.49 ,$93.00 ,$629.28 ,$541.88 ,$629.28 ,$629.28 ,$699.20 
ST NICHOLAS HOSPITAL - ACUTE,41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$322.00 ,$212.52 ,$4.38 ,$420.53 ,$4.38 ,$220.70 ,$220.70 ,$186.90 ,$193.20 ,$273.70 ,$225.40 ,$4.38 ,$4.38 ,$305.90 ,$244.72 ,$241.50 ,$209.30 ,$273.70 ,$186.90 ,$209.30 ,$209.30 ,$225.40 ,$196.10 ,$4.38 ,$186.90 ,$183.16 ,$322.00 ,$4.64 ,$273.70 ,$420.53 ,$296.24 ,$225.40 ,$163.32 ,$196.00 ,$196.10 ,$196.00 ,$222.50 ,$289.80 ,$219.99 ,$184.99 ,$254.38 ,$4.64 ,$93.00 ,$93.00 ,$183.16 ,$93.00 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,41000030,94003,HC VENT WEANING SUBQ DAY,410,1 ,$874.00 ,$576.84 ,$38.73 ,"$1,222.56 ",$38.73 ,$599.04 ,$599.04 ,$543.36 ,$524.40 ,$742.90 ,$611.80 ,$38.73 ,$38.73 ,$830.30 ,$664.24 ,$655.50 ,$568.10 ,$742.90 ,$543.36 ,$568.10 ,$568.10 ,$611.80 ,$532.27 ,$38.73 ,$543.36 ,$532.49 ,$874.00 ,$41.05 ,$742.90 ,"$1,222.56 ",$804.08 ,$611.80 ,$443.29 ,$532.00 ,$532.27 ,$532.00 ,$603.93 ,$786.60 ,$597.12 ,$537.81 ,$690.46 ,$41.05 ,$93.00 ,$93.00 ,$532.49 ,$93.00 ,$629.28 ,$541.88 ,$629.28 ,$629.28 ,$699.20 
ST NICHOLAS HOSPITAL - ACUTE,41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$334.65 ,$220.87 ,$1.89 ,$420.53 ,$1.89 ,$229.37 ,$229.37 ,$186.90 ,$200.79 ,$284.45 ,$234.26 ,$1.89 ,$1.89 ,$317.92 ,$254.33 ,$250.99 ,$217.52 ,$284.45 ,$186.90 ,$217.52 ,$217.52 ,$234.26 ,$203.80 ,$1.89 ,$186.90 ,$183.16 ,$334.65 ,$2.00 ,$284.45 ,$420.53 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$184.99 ,$264.37 ,$2.00 ,$93.00 ,$93.00 ,$183.16 ,$93.00 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,41000036,94640,HC HELI OX PROCEDURE,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000038,94640,HC AEROSOL GENTR SHORT-TERM,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000040,94640,HC EZ PAP TREATMENT,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000042,94640,HC SPUTUM SPECIMEN INDUCTION,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000043,94640,HC PERI NEB WITH INSTRUCTION,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000044,94640,HC UPDRAFT W/INSTRUCT AND EVAL,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000045,94640,HC AEROSOL GENERATOR CONT,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000046,94640,HC HIGH EFF NEB AERO EACH,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000047,94640,HC HIGH EFF NEB AERO W/INSTR/TEACH DEVICE,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000049,94642,HC AEROSOL INHALATION PENTAMIDINE,410,1 ,$210.45 ,$138.90 ,$1.89 ,$420.53 ,$1.89 ,$144.24 ,$144.24 ,$186.90 ,$126.27 ,$178.88 ,$147.32 ,$1.89 ,$1.89 ,$199.93 ,$159.94 ,$157.84 ,$136.79 ,$178.88 ,$186.90 ,$136.79 ,$136.79 ,$147.32 ,$128.16 ,$1.89 ,$186.90 ,$183.16 ,$210.45 ,$2.00 ,$178.88 ,$420.53 ,$193.61 ,$147.32 ,$106.74 ,$128.10 ,$128.16 ,$128.10 ,$145.42 ,$189.41 ,$143.78 ,$184.99 ,$166.26 ,$2.00 ,$93.00 ,$93.00 ,$183.16 ,$93.00 ,$151.52 ,$130.48 ,$151.52 ,$151.52 ,$168.36 
ST NICHOLAS HOSPITAL - ACUTE,41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$260.63 ,$172.02 ,$1.89 ,$260.63 ,$1.89 ,$178.64 ,$178.64 ,$113.32 ,$156.38 ,$221.54 ,$182.44 ,$1.89 ,$1.89 ,$247.60 ,$198.08 ,$195.47 ,$169.41 ,$221.54 ,$113.32 ,$169.41 ,$169.41 ,$182.44 ,$158.72 ,$1.89 ,$113.32 ,$111.05 ,$226.64 ,$2.00 ,$221.54 ,$254.98 ,$239.78 ,$182.44 ,$132.19 ,$158.65 ,$158.72 ,$158.65 ,$180.10 ,$234.57 ,$178.06 ,$112.16 ,$205.90 ,$2.00 ,$93.00 ,$93.00 ,$111.05 ,$93.00 ,$187.65 ,$161.59 ,$187.65 ,$187.65 ,$208.50 
ST NICHOLAS HOSPITAL - ACUTE,41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$48.73 ,$32.16 ,$1.89 ,$48.73 ,$1.89 ,$33.40 ,$33.40 , N/A ,$29.24 ,$41.42 ,$34.11 ,$1.89 ,$1.89 ,$46.29 ,$37.03 ,$36.55 ,$31.67 ,$41.42 , N/A ,$31.67 ,$31.67 ,$34.11 ,$29.68 ,$1.89 , N/A , N/A , N/A ,$2.00 ,$41.42 , N/A ,$44.83 ,$34.11 ,$24.72 ,$29.66 ,$29.68 ,$29.66 ,$33.67 ,$43.86 ,$33.29 , N/A ,$38.50 ,$2.00 ,$48.73 ,$48.73 , N/A ,$48.73 ,$35.09 ,$30.21 ,$35.09 ,$35.09 ,$38.98 
ST NICHOLAS HOSPITAL - ACUTE,41000052,94660,HC CPAP,410,1 ,$356.50 ,$235.29 ,$4.38 ,$420.53 ,$4.38 ,$244.35 ,$244.35 ,$186.90 ,$213.90 ,$303.03 ,$249.55 ,$4.38 ,$4.38 ,$338.68 ,$270.94 ,$267.38 ,$231.73 ,$303.03 ,$186.90 ,$231.73 ,$231.73 ,$249.55 ,$217.11 ,$4.38 ,$186.90 ,$183.16 ,$356.50 ,$4.64 ,$303.03 ,$420.53 ,$327.98 ,$249.55 ,$180.82 ,$217.00 ,$217.11 ,$217.00 ,$246.34 ,$320.85 ,$243.56 ,$184.99 ,$281.64 ,$4.64 ,$93.00 ,$93.00 ,$183.16 ,$93.00 ,$256.68 ,$221.03 ,$256.68 ,$256.68 ,$285.20 
ST NICHOLAS HOSPITAL - ACUTE,41000053,94660,HC CPAP DAILY EST PT,410,1 ,$161.00 ,$106.26 ,$4.38 ,$420.53 ,$4.38 ,$110.35 ,$110.35 ,$186.90 ,$96.60 ,$136.85 ,$112.70 ,$4.38 ,$4.38 ,$152.95 ,$122.36 ,$120.75 ,$104.65 ,$136.85 ,$186.90 ,$104.65 ,$104.65 ,$112.70 ,$98.05 ,$4.38 ,$186.90 ,$183.16 ,$161.00 ,$4.64 ,$136.85 ,$420.53 ,$148.12 ,$112.70 ,$81.66 ,$98.00 ,$98.05 ,$98.00 ,$111.25 ,$144.90 ,$110.00 ,$184.99 ,$127.19 ,$4.64 ,$93.00 ,$93.00 ,$183.16 ,$93.00 ,$115.92 ,$99.82 ,$115.92 ,$115.92 ,$128.80 
ST NICHOLAS HOSPITAL - ACUTE,41000055,99211,HC CPAP THERAPY CONSULT INITIAL,510,1 ,$438.15 ,$289.18 ,$4.33 ,$438.15 ,$4.33 ,$144.00 ,$114.00 , N/A ,$262.89 ,$372.43 ,$306.71 ,$4.33 ,$4.33 ,$416.24 ,$332.99 ,$328.61 ,$108.00 ,$372.43 , N/A ,$108.00 ,$108.00 ,$306.71 ,$266.83 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$372.43 , N/A ,$403.10 ,$306.71 ,$222.23 ,$266.70 ,$266.83 ,$266.70 ,$302.76 ,$394.34 ,$299.34 , N/A ,$346.14 ,$4.59 ,$258.51 ,$258.51 , N/A ,$258.51 ,$315.47 ,$271.65 ,$315.47 ,$315.47 ,$350.52 
ST NICHOLAS HOSPITAL - ACUTE,41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$210.45 ,$138.90 ,$1.89 ,$420.53 ,$1.89 ,$144.24 ,$144.24 ,$186.90 ,$126.27 ,$178.88 ,$147.32 ,$1.89 ,$1.89 ,$199.93 ,$159.94 ,$157.84 ,$136.79 ,$178.88 ,$186.90 ,$136.79 ,$136.79 ,$147.32 ,$128.16 ,$1.89 ,$186.90 ,$183.16 ,$210.45 ,$2.00 ,$178.88 ,$420.53 ,$193.61 ,$147.32 ,$106.74 ,$128.10 ,$128.16 ,$128.10 ,$145.42 ,$189.41 ,$143.78 ,$184.99 ,$166.26 ,$2.00 ,$93.00 ,$93.00 ,$183.16 ,$93.00 ,$151.52 ,$130.48 ,$151.52 ,$151.52 ,$168.36 
ST NICHOLAS HOSPITAL - ACUTE,41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$111.55 ,$73.62 ,$1.89 ,$254.98 ,$1.89 ,$76.46 ,$76.46 ,$113.32 ,$66.93 ,$94.82 ,$78.09 ,$1.89 ,$1.89 ,$105.97 ,$84.78 ,$83.66 ,$72.51 ,$94.82 ,$113.32 ,$72.51 ,$72.51 ,$78.09 ,$67.93 ,$1.89 ,$113.32 ,$111.05 ,$111.55 ,$2.00 ,$94.82 ,$254.98 ,$102.63 ,$78.09 ,$56.58 ,$67.90 ,$67.93 ,$67.90 ,$77.08 ,$100.40 ,$76.21 ,$112.16 ,$88.12 ,$2.00 ,$93.00 ,$93.00 ,$111.05 ,$93.00 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$111.55 ,$73.62 ,$1.89 ,$254.98 ,$1.89 ,$76.46 ,$76.46 ,$113.32 ,$66.93 ,$94.82 ,$78.09 ,$1.89 ,$1.89 ,$105.97 ,$84.78 ,$83.66 ,$72.51 ,$94.82 ,$113.32 ,$72.51 ,$72.51 ,$78.09 ,$67.93 ,$1.89 ,$113.32 ,$111.05 ,$111.55 ,$2.00 ,$94.82 ,$254.98 ,$102.63 ,$78.09 ,$56.58 ,$67.90 ,$67.93 ,$67.90 ,$77.08 ,$100.40 ,$76.21 ,$112.16 ,$88.12 ,$2.00 ,$93.00 ,$93.00 ,$111.05 ,$93.00 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$86.25 ,$56.93 ,$1.89 ,$254.98 ,$1.89 ,$59.12 ,$59.12 ,$113.32 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$113.32 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$113.32 ,$111.05 ,$86.25 ,$2.00 ,$73.31 ,$254.98 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$112.16 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$111.05 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$86.25 ,$56.93 ,$1.89 ,$254.98 ,$1.89 ,$59.12 ,$59.12 ,$113.32 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$113.32 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$113.32 ,$111.05 ,$86.25 ,$2.00 ,$73.31 ,$254.98 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$112.16 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$111.05 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000065,94799,HC CARBON MONOXIDE TEST,410,1 ,$130.31 ,$86.00 ,$1.89 ,$319.36 ,$1.89 ,$89.31 ,$89.31 ,$141.94 ,$78.19 ,$110.76 ,$91.22 ,$1.89 ,$1.89 ,$123.79 ,$99.04 ,$97.73 ,$84.70 ,$110.76 ,$141.94 ,$84.70 ,$84.70 ,$91.22 ,$79.36 ,$1.89 ,$141.94 ,$139.10 ,$130.31 ,$2.00 ,$110.76 ,$319.36 ,$119.89 ,$91.22 ,$66.09 ,$79.32 ,$79.36 ,$79.32 ,$90.04 ,$117.28 ,$89.03 ,$140.49 ,$102.94 ,$2.00 ,$93.00 ,$93.00 ,$139.10 ,$93.00 ,$93.82 ,$80.79 ,$93.82 ,$93.82 ,$104.25 
ST NICHOLAS HOSPITAL - ACUTE,41000066,94799,HC SEDATION BAGGING,410,1 ,$130.31 ,$86.00 ,$1.89 ,$319.36 ,$1.89 ,$89.31 ,$89.31 ,$141.94 ,$78.19 ,$110.76 ,$91.22 ,$1.89 ,$1.89 ,$123.79 ,$99.04 ,$97.73 ,$84.70 ,$110.76 ,$141.94 ,$84.70 ,$84.70 ,$91.22 ,$79.36 ,$1.89 ,$141.94 ,$139.10 ,$130.31 ,$2.00 ,$110.76 ,$319.36 ,$119.89 ,$91.22 ,$66.09 ,$79.32 ,$79.36 ,$79.32 ,$90.04 ,$117.28 ,$89.03 ,$140.49 ,$102.94 ,$2.00 ,$93.00 ,$93.00 ,$139.10 ,$93.00 ,$93.82 ,$80.79 ,$93.82 ,$93.82 ,$104.25 
ST NICHOLAS HOSPITAL - ACUTE,41000067,94799,HC PEP THERAPY FLUTTER,410,1 ,$444.97 ,$293.68 ,$1.89 ,$444.97 ,$1.89 ,$304.98 ,$304.98 ,$141.94 ,$266.98 ,$378.22 ,$311.48 ,$1.89 ,$1.89 ,$422.72 ,$338.18 ,$333.73 ,$289.23 ,$378.22 ,$141.94 ,$289.23 ,$289.23 ,$311.48 ,$270.99 ,$1.89 ,$141.94 ,$139.10 ,$283.88 ,$2.00 ,$378.22 ,$319.36 ,$409.37 ,$311.48 ,$225.69 ,$270.85 ,$270.99 ,$270.85 ,$307.47 ,$400.47 ,$304.00 ,$140.49 ,$351.53 ,$2.00 ,$93.00 ,$93.00 ,$139.10 ,$93.00 ,$320.38 ,$275.88 ,$320.38 ,$320.38 ,$355.98 
ST NICHOLAS HOSPITAL - ACUTE,41000068,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$98.90 ,$65.27 ,$1.19 ,$98.90 ,$1.19 ,$67.79 ,$67.79 ,$24.36 ,$59.34 ,$84.07 ,$69.23 ,$1.19 ,$1.19 ,$93.96 ,$75.16 ,$74.18 ,$64.29 ,$84.07 ,$24.36 ,$64.29 ,$64.29 ,$69.23 ,$60.23 ,$1.19 ,$24.36 ,$23.87 ,$48.72 ,$1.26 ,$84.07 ,$54.81 ,$90.99 ,$69.23 ,$50.16 ,$60.20 ,$60.23 ,$60.20 ,$68.34 ,$89.01 ,$67.57 ,$24.11 ,$78.13 ,$1.26 ,$93.00 ,$93.00 ,$23.87 ,$93.00 ,$71.21 ,$61.32 ,$71.21 ,$71.21 ,$79.12 
ST NICHOLAS HOSPITAL - ACUTE,41000069,G0238,HC RESP THRP FUNCTION,410,1 ,$105.80 ,$69.83 ,$1.19 ,$105.80 ,$1.19 ,$72.52 ,$72.52 ,$24.36 ,$63.48 ,$89.93 ,$74.06 ,$1.19 ,$1.19 ,$100.51 ,$80.41 ,$79.35 ,$68.77 ,$89.93 ,$24.36 ,$68.77 ,$68.77 ,$74.06 ,$64.43 ,$1.19 ,$24.36 ,$23.87 ,$48.72 ,$1.26 ,$89.93 ,$54.81 ,$97.34 ,$74.06 ,$53.66 ,$64.40 ,$64.43 ,$64.40 ,$73.11 ,$95.22 ,$72.28 ,$24.11 ,$83.58 ,$1.26 ,$93.00 ,$93.00 ,$23.87 ,$93.00 ,$76.18 ,$65.60 ,$76.18 ,$76.18 ,$84.64 
ST NICHOLAS HOSPITAL - ACUTE,41000070,G0239,HC THERAPEUTIC RT EXERCISE GROUP,410,1 ,$210.45 ,$138.90 ,$1.19 ,$210.45 ,$1.19 ,$144.24 ,$144.24 ,$33.15 ,$126.27 ,$178.88 ,$147.32 ,$1.19 ,$1.19 ,$199.93 ,$159.94 ,$157.84 ,$136.79 ,$178.88 ,$33.15 ,$136.79 ,$136.79 ,$147.32 ,$128.16 ,$1.19 ,$33.15 ,$32.49 ,$66.30 ,$1.26 ,$178.88 ,$74.58 ,$193.61 ,$147.32 ,$106.74 ,$128.10 ,$128.16 ,$128.10 ,$145.42 ,$189.41 ,$143.78 ,$32.81 ,$166.26 ,$1.26 ,$93.00 ,$93.00 ,$32.49 ,$93.00 ,$151.52 ,$130.48 ,$151.52 ,$151.52 ,$168.36 
ST NICHOLAS HOSPITAL - ACUTE,41000071,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$86.25 ,$56.93 ,$1.19 ,$86.25 ,$1.19 ,$59.12 ,$59.12 ,$24.36 ,$51.75 ,$73.31 ,$60.38 ,$1.19 ,$1.19 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$24.36 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.19 ,$24.36 ,$23.87 ,$48.72 ,$1.26 ,$73.31 ,$54.81 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$24.11 ,$68.14 ,$1.26 ,$86.25 ,$86.25 ,$23.87 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41000072,G0238,HC RESP THRP FUNC-59,410,1 ,$105.80 ,$69.83 ,$1.19 ,$105.80 ,$1.19 ,$72.52 ,$72.52 ,$24.36 ,$63.48 ,$89.93 ,$74.06 ,$1.19 ,$1.19 ,$100.51 ,$80.41 ,$79.35 ,$68.77 ,$89.93 ,$24.36 ,$68.77 ,$68.77 ,$74.06 ,$64.43 ,$1.19 ,$24.36 ,$23.87 ,$48.72 ,$1.26 ,$89.93 ,$54.81 ,$97.34 ,$74.06 ,$53.66 ,$64.40 ,$64.43 ,$64.40 ,$73.11 ,$95.22 ,$72.28 ,$24.11 ,$83.58 ,$1.26 ,$93.00 ,$93.00 ,$23.87 ,$93.00 ,$76.18 ,$65.60 ,$76.18 ,$76.18 ,$84.64 
ST NICHOLAS HOSPITAL - ACUTE,41000083,94660,HC CPAP/BIPAP SUBSQ,410,1 ,$612.95 ,$404.55 ,$4.38 ,$612.95 ,$4.38 ,$420.12 ,$420.12 ,$186.90 ,$367.77 ,$521.01 ,$429.07 ,$4.38 ,$4.38 ,$582.30 ,$465.84 ,$459.71 ,$398.42 ,$521.01 ,$186.90 ,$398.42 ,$398.42 ,$429.07 ,$373.29 ,$4.38 ,$186.90 ,$183.16 ,$373.80 ,$4.64 ,$521.01 ,$420.53 ,$563.91 ,$429.07 ,$310.89 ,$373.10 ,$373.29 ,$373.10 ,$423.55 ,$551.66 ,$418.77 ,$184.99 ,$484.23 ,$4.64 ,$93.00 ,$93.00 ,$183.16 ,$93.00 ,$441.32 ,$380.03 ,$441.32 ,$441.32 ,$490.36 
ST NICHOLAS HOSPITAL - ACUTE,41000087,94669,HC MECHANICAL CHEST WALL OSCILLATION INITIAL,410,1 ,$652.05 ,$430.35 ,$1.89 ,$652.05 ,$1.89 ,$446.92 ,$446.92 ,$186.90 ,$391.23 ,$554.24 ,$456.44 ,$1.89 ,$1.89 ,$619.45 ,$495.56 ,$489.04 ,$423.83 ,$554.24 ,$186.90 ,$423.83 ,$423.83 ,$456.44 ,$397.10 ,$1.89 ,$186.90 ,$183.16 ,$373.80 ,$2.00 ,$554.24 ,$420.53 ,$599.89 ,$456.44 ,$330.72 ,$396.90 ,$397.10 ,$396.90 ,$450.57 ,$586.85 ,$445.48 ,$184.99 ,$515.12 ,$2.00 ,$93.00 ,$93.00 ,$183.16 ,$93.00 ,$469.48 ,$404.27 ,$469.48 ,$469.48 ,$521.64 
ST NICHOLAS HOSPITAL - ACUTE,41000090,94640,HC MDI/DPI INHAL TX SUBSQ,410,1 ,$86.25 ,$56.93 ,$1.89 ,$420.53 ,$1.89 ,$59.12 ,$59.12 ,$186.90 ,$51.75 ,$73.31 ,$60.38 ,$1.89 ,$1.89 ,$81.94 ,$65.55 ,$64.69 ,$56.06 ,$73.31 ,$186.90 ,$56.06 ,$56.06 ,$60.38 ,$52.53 ,$1.89 ,$186.90 ,$183.16 ,$86.25 ,$2.00 ,$73.31 ,$420.53 ,$79.35 ,$60.38 ,$43.75 ,$52.50 ,$52.53 ,$52.50 ,$59.60 ,$77.63 ,$58.93 ,$184.99 ,$68.14 ,$2.00 ,$86.25 ,$86.25 ,$183.16 ,$86.25 ,$62.10 ,$53.48 ,$62.10 ,$62.10 ,$69.00 
ST NICHOLAS HOSPITAL - ACUTE,41300000,99183,HC HYPERBARIC O2 PER SESSION,413,1 ,"$3,964.05 ","$2,616.27 ","$2,010.57 ","$3,964.05 ", N/A ,"$2,716.96 ","$2,716.96 ", N/A ,"$2,378.43 ","$3,369.44 ","$2,774.84 ", N/A , N/A ,"$3,765.85 ","$3,012.68 ","$2,973.04 ","$2,576.63 ","$3,369.44 ", N/A ,"$2,576.63 ","$2,576.63 ","$2,774.84 ","$2,414.11 ", N/A , N/A , N/A , N/A , N/A ,"$3,369.44 ", N/A ,"$3,646.93 ","$2,774.84 ","$2,010.57 ","$2,412.92 ","$2,414.11 ","$2,412.92 ","$2,739.16 ","$3,567.65 ","$2,708.24 ", N/A ,"$3,131.60 ", N/A ,"$2,716.00 ","$2,716.00 ", N/A ,"$2,716.00 ","$2,854.12 ","$2,457.71 ","$2,854.12 ","$2,854.12 ","$3,171.24 "
ST NICHOLAS HOSPITAL - ACUTE,41300002,G0277,HC HYPERBARIC O2 PER 30 MIN,413,1 ,$681.95 ,$450.09 ,$13.09 ,$681.95 ,$13.09 ,$467.41 ,$467.41 ,$122.07 ,$409.17 ,$579.66 ,$477.37 ,$13.09 ,$13.09 ,$647.85 ,$518.28 ,$511.46 ,$443.27 ,$579.66 ,$122.07 ,$443.27 ,$443.27 ,$477.37 ,$415.31 ,$13.09 ,$122.07 ,$119.63 ,$244.14 ,$13.88 ,$579.66 ,$274.65 ,$627.39 ,$477.37 ,$345.89 ,$415.10 ,$415.31 ,$415.10 ,$471.23 ,$613.76 ,$465.91 ,$120.82 ,$538.74 ,$13.88 ,$681.95 ,$681.95 ,$119.63 ,$681.95 ,$491.00 ,$422.81 ,$491.00 ,$491.00 ,$545.56 
ST NICHOLAS HOSPITAL - ACUTE,41300003,G0277,HC HYPERBARIC O2 PER 30 MIN,413,1 ,$681.95 ,$450.09 ,$13.09 ,$681.95 ,$13.09 ,$467.41 ,$467.41 ,$122.07 ,$409.17 ,$579.66 ,$477.37 ,$13.09 ,$13.09 ,$647.85 ,$518.28 ,$511.46 ,$443.27 ,$579.66 ,$122.07 ,$443.27 ,$443.27 ,$477.37 ,$415.31 ,$13.09 ,$122.07 ,$119.63 ,$244.14 ,$13.88 ,$579.66 ,$274.65 ,$627.39 ,$477.37 ,$345.89 ,$415.10 ,$415.31 ,$415.10 ,$471.23 ,$613.76 ,$465.91 ,$120.82 ,$538.74 ,$13.88 ,$681.95 ,$681.95 ,$119.63 ,$681.95 ,$491.00 ,$422.81 ,$491.00 ,$491.00 ,$545.56 
ST NICHOLAS HOSPITAL - ACUTE,41300004,99183,HC HYPERBARIC O2 PER SESSION,413,1 ,"$3,964.05 ","$2,616.27 ","$2,010.57 ","$3,964.05 ", N/A ,"$2,716.96 ","$2,716.96 ", N/A ,"$2,378.43 ","$3,369.44 ","$2,774.84 ", N/A , N/A ,"$3,765.85 ","$3,012.68 ","$2,973.04 ","$2,576.63 ","$3,369.44 ", N/A ,"$2,576.63 ","$2,576.63 ","$2,774.84 ","$2,414.11 ", N/A , N/A , N/A , N/A , N/A ,"$3,369.44 ", N/A ,"$3,646.93 ","$2,774.84 ","$2,010.57 ","$2,412.92 ","$2,414.11 ","$2,412.92 ","$2,739.16 ","$3,567.65 ","$2,708.24 ", N/A ,"$3,131.60 ", N/A ,"$2,716.00 ","$2,716.00 ", N/A ,"$2,716.00 ","$2,854.12 ","$2,457.71 ","$2,854.12 ","$2,854.12 ","$3,171.24 "
ST NICHOLAS HOSPITAL - ACUTE,42000008,95992,HC CANALITH REPOSITIONING,420,1 ,$154.10 ,$101.71 ,$1.39 ,$154.10 , N/A ,$154.10 ,$154.10 ,$41.94 ,$92.46 ,$130.99 ,$107.87 , N/A , N/A ,$146.40 ,$117.12 ,$115.58 ,$100.17 ,$130.99 ,$41.94 ,$100.17 ,$100.17 ,$107.87 ,$93.85 , N/A ,$41.94 ,$41.10 ,$83.88 , N/A ,$130.99 ,$94.37 ,$141.77 ,$107.87 ,$78.16 ,$93.80 ,$93.85 ,$93.80 ,$106.48 ,$138.69 ,$105.28 ,$41.51 ,$121.74 ,$1.39 ,$154.10 ,$154.10 ,$41.10 ,$154.10 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,42000009,97012,HC TRACTION MECH APP,420,1 ,$100.00 ,$66.00 ,$1.19 ,$100.00 ,$25.78 ,$100.00 ,$100.00 ,$14.05 ,$60.00 ,$85.00 ,$70.00 ,$25.78 ,$25.78 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$14.05 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$25.78 ,$14.05 ,$13.77 ,$28.10 ,$27.33 ,$85.00 ,$31.61 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$13.91 ,$79.00 ,$1.19 ,$100.00 ,$100.00 ,$13.77 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000010,97016,HC APPLY VASOPNEUMATIC DEVICE,420,1 ,$90.00 ,$59.40 ,$1.19 ,$90.00 ,$25.19 ,$90.00 ,$90.00 ,$11.36 ,$54.00 ,$76.50 ,$63.00 ,$25.19 ,$25.19 ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$11.36 ,$58.50 ,$58.50 ,$63.00 ,$54.81 ,$25.19 ,$11.36 ,$11.13 ,$22.72 ,$26.70 ,$76.50 ,$25.56 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$61.49 ,$11.24 ,$71.10 ,$1.19 ,$90.00 ,$90.00 ,$11.13 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,42000020,97022,HC FLUIDOTHERAPY,420,1 ,$110.00 ,$72.60 ,$1.19 ,$110.00 ,$25.78 ,$110.00 ,$110.00 ,$16.49 ,$66.00 ,$93.50 ,$77.00 ,$25.78 ,$25.78 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$16.49 ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$25.78 ,$16.49 ,$16.16 ,$32.98 ,$27.33 ,$93.50 ,$37.10 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 ,$16.32 ,$86.90 ,$1.19 ,$110.00 ,$110.00 ,$16.16 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42000025,97032,HC ELECTRIC STIM EACH 15 MIN,420,1 ,$90.00 ,$59.40 ,$1.19 ,$90.00 ,$22.38 ,$90.00 ,$90.00 ,$14.05 ,$54.00 ,$76.50 ,$63.00 ,$22.38 ,$22.38 ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$14.05 ,$58.50 ,$58.50 ,$63.00 ,$54.81 ,$22.38 ,$14.05 ,$13.77 ,$28.10 ,$23.72 ,$76.50 ,$31.61 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$61.49 ,$13.91 ,$71.10 ,$1.19 ,$90.00 ,$90.00 ,$13.77 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,42000026,97032,HC TENS; EA 15 MIN,420,1 ,$90.00 ,$59.40 ,$1.19 ,$90.00 ,$22.38 ,$90.00 ,$90.00 ,$14.05 ,$54.00 ,$76.50 ,$63.00 ,$22.38 ,$22.38 ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$14.05 ,$58.50 ,$58.50 ,$63.00 ,$54.81 ,$22.38 ,$14.05 ,$13.77 ,$28.10 ,$23.72 ,$76.50 ,$31.61 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$61.49 ,$13.91 ,$71.10 ,$1.19 ,$90.00 ,$90.00 ,$13.77 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$110.00 ,$72.60 ,$1.19 ,$110.00 ,$23.51 ,$110.00 ,$110.00 ,$19.22 ,$66.00 ,$93.50 ,$77.00 ,$23.51 ,$23.51 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$19.22 ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$23.51 ,$19.22 ,$18.84 ,$38.44 ,$24.92 ,$93.50 ,$43.25 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 ,$19.02 ,$86.90 ,$1.19 ,$110.00 ,$110.00 ,$18.84 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$90.00 ,$59.40 ,$1.19 ,$90.00 ,$18.49 ,$90.00 ,$90.00 ,$13.98 ,$54.00 ,$76.50 ,$63.00 ,$18.49 ,$18.49 ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$13.98 ,$58.50 ,$58.50 ,$63.00 ,$54.81 ,$18.49 ,$13.98 ,$13.70 ,$27.96 ,$19.60 ,$76.50 ,$31.46 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$61.49 ,$13.84 ,$71.10 ,$1.19 ,$90.00 ,$90.00 ,$13.70 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,42000037,97110,HC THERA EXER; EA 15 MIN,420,1 ,$100.00 ,$66.00 ,$1.39 ,$100.00 ,$19.63 ,$100.00 ,$100.00 ,$28.88 ,$60.00 ,$85.00 ,$70.00 ,$19.63 ,$19.63 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$28.88 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$19.63 ,$28.88 ,$28.30 ,$57.76 ,$20.81 ,$85.00 ,$64.98 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$28.59 ,$79.00 ,$1.39 ,$100.00 ,$100.00 ,$28.30 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000045,97112,HC NEUROMUSCULAR RE ED EA 15 MIN,420,1 ,$130.00 ,$85.80 ,$1.39 ,$130.00 ,$19.32 ,$130.00 ,$130.00 ,$33.15 ,$78.00 ,$110.50 ,$91.00 ,$19.32 ,$19.32 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$33.15 ,$84.50 ,$84.50 ,$91.00 ,$79.17 ,$19.32 ,$33.15 ,$32.49 ,$66.30 ,$20.48 ,$110.50 ,$74.59 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$88.82 ,$32.81 ,$102.70 ,$1.39 ,$130.00 ,$130.00 ,$32.49 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,42000049,97116,HC AMBULATION GAIT TRAIN EA 15 MIN,420,1 ,$100.00 ,$66.00 ,$1.19 ,$100.00 ,$16.47 ,$100.00 ,$100.00 ,$28.88 ,$60.00 ,$85.00 ,$70.00 ,$16.47 ,$16.47 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$28.88 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$16.47 ,$28.88 ,$28.30 ,$57.76 ,$17.46 ,$85.00 ,$64.98 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$28.59 ,$79.00 ,$1.19 ,$100.00 ,$100.00 ,$28.30 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000053,97124,HC THERAPEUTIC MASSAGE EA 15 MIN,420,1 ,$100.00 ,$66.00 ,$1.19 ,$100.00 ,$23.41 ,$100.00 ,$100.00 ,$29.35 ,$60.00 ,$85.00 ,$70.00 ,$23.41 ,$23.41 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$29.35 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$23.41 ,$29.35 ,$28.76 ,$58.70 ,$24.81 ,$85.00 ,$66.04 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$29.05 ,$79.00 ,$1.19 ,$100.00 ,$100.00 ,$28.76 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000056,97140,HC MANUAL THERAPY EA 15 MIN,420,1 ,$100.00 ,$66.00 ,$1.39 ,$100.00 ,$25.53 ,$100.00 ,$100.00 ,$26.59 ,$60.00 ,$85.00 ,$70.00 ,$25.53 ,$25.53 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$26.59 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$25.53 ,$26.59 ,$26.06 ,$53.18 ,$27.06 ,$85.00 ,$59.83 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$26.32 ,$79.00 ,$1.39 ,$100.00 ,$100.00 ,$26.06 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000065,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN,420,1 ,$120.00 ,$79.20 ,$1.39 ,$120.00 ,$18.05 ,$120.00 ,$120.00 ,$36.26 ,$72.00 ,$102.00 ,$84.00 ,$18.05 ,$18.05 ,$114.00 ,$91.20 ,$90.00 ,$78.00 ,$102.00 ,$36.26 ,$78.00 ,$78.00 ,$84.00 ,$73.08 ,$18.05 ,$36.26 ,$35.53 ,$72.52 ,$19.13 ,$102.00 ,$81.59 ,$110.40 ,$84.00 ,$60.86 ,$73.04 ,$73.08 ,$73.04 ,$82.92 ,$108.00 ,$81.98 ,$35.89 ,$94.80 ,$1.39 ,$120.00 ,$120.00 ,$35.53 ,$120.00 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,42000068,97597,HC DEBR SKIN PART THICKNESS <20CM,420,1 ,$446.20 ,$294.49 ,$6.79 ,$446.20 ,$42.35 ,$298.00 ,$240.00 ,$96.91 ,$267.72 ,$379.27 ,$312.34 ,$42.35 ,$42.35 ,$423.89 ,$339.11 ,$334.65 ,$290.03 ,$379.27 ,$96.91 ,$290.03 ,$290.03 ,$312.34 ,$271.74 ,$42.35 ,$96.91 ,$94.97 ,$193.82 ,$44.89 ,$379.27 ,$218.05 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$95.92 ,$352.50 ,$6.79 ,$264.00 ,$264.00 ,$94.97 ,$264.00 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,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 , N/A ,$118.68 ,$168.13 ,$138.46 ,$35.14 ,$35.14 ,$187.91 ,$150.33 ,$148.35 ,$128.57 ,$168.13 , N/A ,$128.57 ,$128.57 ,$138.46 ,$120.46 ,$35.14 , N/A , N/A , N/A ,$37.25 ,$168.13 , N/A ,$181.98 ,$138.46 ,$100.32 ,$120.40 ,$120.46 ,$120.40 ,$136.68 ,$178.02 ,$135.14 , N/A ,$156.26 ,$37.06 ,$197.80 ,$197.80 , N/A ,$197.80 ,$142.42 ,$122.64 ,$142.42 ,$142.42 ,$158.24 
ST NICHOLAS HOSPITAL - ACUTE,42000084,97602,HC DEBRIDEMENT NONSELECTIVE,420,1 ,$173.65 ,$114.61 ,$13.88 ,$173.65 , N/A ,$173.65 ,$173.65 , N/A ,$104.19 ,$147.60 ,$121.56 , N/A , N/A ,$164.97 ,$131.97 ,$130.24 ,$112.87 ,$147.60 , N/A ,$112.87 ,$112.87 ,$121.56 ,$105.75 , N/A , N/A , N/A , N/A , N/A ,$147.60 , N/A ,$159.76 ,$121.56 ,$88.08 ,$105.70 ,$105.75 ,$105.70 ,$119.99 ,$156.29 ,$118.64 , N/A ,$137.18 ,$13.88 ,$173.65 ,$173.65 , N/A ,$173.65 ,$125.03 ,$107.66 ,$125.03 ,$125.03 ,$138.92 
ST NICHOLAS HOSPITAL - ACUTE,42000085,97605,HC NWPT <50 SQ CM FAC,420,1 ,$247.25 ,$163.19 ,$6.79 ,$247.25 , N/A ,$247.25 ,$240.00 ,$41.60 ,$148.35 ,$210.16 ,$173.08 , N/A , N/A ,$234.89 ,$187.91 ,$185.44 ,$160.71 ,$210.16 ,$41.60 ,$160.71 ,$160.71 ,$173.08 ,$150.58 , N/A ,$41.60 ,$40.77 ,$83.20 , N/A ,$210.16 ,$93.60 ,$227.47 ,$173.08 ,$125.41 ,$150.50 ,$150.58 ,$150.50 ,$170.85 ,$222.53 ,$168.92 ,$41.18 ,$195.33 ,$6.79 ,$247.25 ,$247.25 ,$40.77 ,$247.25 ,$178.02 ,$153.30 ,$178.02 ,$178.02 ,$197.80 
ST NICHOLAS HOSPITAL - ACUTE,42000089,97606,HC NWPT >50 SQ CM FAC,420,1 ,$322.00 ,$212.52 ,$13.88 ,$322.00 , N/A ,$298.00 ,$240.00 ,$49.73 ,$193.20 ,$273.70 ,$225.40 , N/A , N/A ,$305.90 ,$244.72 ,$241.50 ,$209.30 ,$273.70 ,$49.73 ,$209.30 ,$209.30 ,$225.40 ,$196.10 , N/A ,$49.73 ,$48.74 ,$99.46 , N/A ,$273.70 ,$111.89 ,$296.24 ,$225.40 ,$163.32 ,$196.00 ,$196.10 ,$196.00 ,$222.50 ,$289.80 ,$219.99 ,$49.23 ,$254.38 ,$13.88 ,$264.00 ,$264.00 ,$48.74 ,$264.00 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$100.00 ,$66.00 ,$1.39 ,$100.00 , N/A ,$100.00 ,$100.00 ,$33.06 ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$33.06 ,$65.00 ,$65.00 ,$70.00 ,$60.90 , N/A ,$33.06 ,$32.40 ,$66.12 , N/A ,$85.00 ,$74.39 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$32.72 ,$79.00 ,$1.39 ,$100.00 ,$100.00 ,$32.40 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000094,97761,HC PROSTHETIC TRAINING EA 15 MIN,420,1 ,$100.00 ,$66.00 ,$1.39 ,$100.00 ,$21.40 ,$100.00 ,$100.00 ,$40.87 ,$60.00 ,$85.00 ,$70.00 ,$21.40 ,$21.40 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.87 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$21.40 ,$40.87 ,$40.05 ,$81.74 ,$22.68 ,$85.00 ,$91.96 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$40.45 ,$79.00 ,$1.39 ,$100.00 ,$100.00 ,$40.05 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000110,G0283,HC ELECT STIM(UNATTEND) OTHER,420,1 ,$136.85 ,$90.32 ,$1.19 ,$136.85 ,$22.38 ,$136.85 ,$136.85 ,$11.68 ,$82.11 ,$116.32 ,$95.80 ,$22.38 ,$22.38 ,$130.01 ,$104.01 ,$102.64 ,$88.95 ,$116.32 ,$11.68 ,$88.95 ,$88.95 ,$95.80 ,$83.34 ,$22.38 ,$11.68 ,$11.45 ,$23.36 ,$23.72 ,$116.32 ,$26.28 ,$125.90 ,$95.80 ,$69.41 ,$83.30 ,$83.34 ,$83.30 ,$94.56 ,$123.17 ,$93.50 ,$11.56 ,$108.11 ,$1.19 ,$136.85 ,$136.85 ,$11.45 ,$136.85 ,$98.53 ,$84.85 ,$98.53 ,$98.53 ,$109.48 
ST NICHOLAS HOSPITAL - ACUTE,42000122,97150,HC GROUP TREATMENT 60MIN,420,1 ,$100.00 ,$66.00 ,$1.39 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$17.34 ,$60.00 ,$85.00 ,$70.00 ,$6.08 ,$6.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$17.34 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$6.08 ,$17.34 ,$16.99 ,$34.68 ,$6.44 ,$85.00 ,$39.02 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$17.16 ,$79.00 ,$1.39 ,$100.00 ,$100.00 ,$16.99 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000145,97597,HC DEBR SKIN INIT 20CM/NWPT/WRAP,420,1 ,$446.20 ,$294.49 ,$6.79 ,$446.20 ,$42.35 ,$298.00 ,$240.00 ,$96.91 ,$267.72 ,$379.27 ,$312.34 ,$42.35 ,$42.35 ,$423.89 ,$339.11 ,$334.65 ,$290.03 ,$379.27 ,$96.91 ,$290.03 ,$290.03 ,$312.34 ,$271.74 ,$42.35 ,$96.91 ,$94.97 ,$193.82 ,$44.89 ,$379.27 ,$218.05 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$95.92 ,$352.50 ,$6.79 ,$264.00 ,$264.00 ,$94.97 ,$264.00 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,42000146,97597,HC DEBR SKIN INIT 20CM/NWPT/BILWRAP,420,1 ,$446.20 ,$294.49 ,$6.79 ,$446.20 ,$42.35 ,$298.00 ,$240.00 ,$96.91 ,$267.72 ,$379.27 ,$312.34 ,$42.35 ,$42.35 ,$423.89 ,$339.11 ,$334.65 ,$290.03 ,$379.27 ,$96.91 ,$290.03 ,$290.03 ,$312.34 ,$271.74 ,$42.35 ,$96.91 ,$94.97 ,$193.82 ,$44.89 ,$379.27 ,$218.05 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$95.92 ,$352.50 ,$6.79 ,$264.00 ,$264.00 ,$94.97 ,$264.00 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,42000216,99366,HC MEDICAL TEAM CONFERENCE W/PATIENT NON-PHYSICIAN,420,1 ,$154.10 ,$101.71 ,$3.25 ,$154.10 , N/A ,$154.10 ,$154.10 , N/A ,$92.46 ,$130.99 ,$107.87 , N/A , N/A ,$146.40 ,$117.12 ,$115.58 ,$100.17 ,$130.99 , N/A ,$100.17 ,$100.17 ,$107.87 ,$93.85 , N/A , N/A , N/A , N/A , N/A ,$130.99 , N/A ,$141.77 ,$107.87 ,$78.16 ,$93.80 ,$93.85 ,$93.80 ,$106.48 ,$138.69 ,$105.28 , N/A ,$121.74 ,$3.25 ,$154.10 ,$154.10 , N/A ,$154.10 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400044,97161,HC PT EVAL LOW COMPLEXITY 30MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400045,97161,HC PT EVAL LOW COMPLEXITY 45MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400046,97161,HC PT EVAL LOW COMPLEXITY 60MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400055,97162,HC PT EVAL MOD COMPLEXITY 15MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400056,97162,HC PT EVAL MOD COMPLEXITY 30MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400057,97162,HC PT EVAL MOD COMPLEXITY 45MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400058,97162,HC PT EVAL MOD COMPLEXITY 60MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400067,97163,HC PT EVAL HIGH COMPLEXITY 15MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400068,97163,HC PT EVAL HIGH COMPLEXITY 30MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400069,97163,HC PT EVAL HIGH COMPLEXITY 45MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400070,97163,HC PT EVAL HIGH COMPLEXITY 60MIN,424,1 ,$210.00 ,$138.60 ,$8.81 ,$221.24 ,$62.66 ,$210.00 ,$210.00 ,$98.33 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.33 ,$136.50 ,$136.50 ,$147.00 ,$127.89 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$178.50 ,$221.24 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$143.47 ,$97.32 ,$165.90 ,$8.81 ,$210.00 ,$210.00 ,$96.36 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$110.00 ,$72.60 ,$8.81 ,$152.39 ,$62.66 ,$110.00 ,$110.00 ,$67.73 ,$66.00 ,$93.50 ,$77.00 ,$62.66 ,$62.66 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$67.73 ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$62.66 ,$67.73 ,$66.38 ,$110.00 ,$66.42 ,$93.50 ,$152.39 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 ,$67.04 ,$86.90 ,$8.81 ,$110.00 ,$110.00 ,$66.38 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$110.00 ,$72.60 ,$8.81 ,$152.39 ,$62.66 ,$110.00 ,$110.00 ,$67.73 ,$66.00 ,$93.50 ,$77.00 ,$62.66 ,$62.66 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$67.73 ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$62.66 ,$67.73 ,$66.38 ,$110.00 ,$66.42 ,$93.50 ,$152.39 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 ,$67.04 ,$86.90 ,$8.81 ,$110.00 ,$110.00 ,$66.38 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$110.00 ,$72.60 ,$8.81 ,$152.39 ,$62.66 ,$110.00 ,$110.00 ,$67.73 ,$66.00 ,$93.50 ,$77.00 ,$62.66 ,$62.66 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$67.73 ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$62.66 ,$67.73 ,$66.38 ,$110.00 ,$66.42 ,$93.50 ,$152.39 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 ,$67.04 ,$86.90 ,$8.81 ,$110.00 ,$110.00 ,$66.38 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42400082,97164,HC PT RE-EVAL 60MIN,424,1 ,$110.00 ,$72.60 ,$8.81 ,$152.39 ,$62.66 ,$110.00 ,$110.00 ,$67.73 ,$66.00 ,$93.50 ,$77.00 ,$62.66 ,$62.66 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$67.73 ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$62.66 ,$67.73 ,$66.38 ,$110.00 ,$66.42 ,$93.50 ,$152.39 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 ,$67.04 ,$86.90 ,$8.81 ,$110.00 ,$110.00 ,$66.38 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,43000016,97535,HC SELF CARE ADL TRAINING EA 15MIN,430,1 ,$110.00 ,$72.60 ,$1.19 ,$110.00 ,$20.93 ,$110.00 ,$110.00 ,$32.10 ,$66.00 ,$93.50 ,$77.00 ,$20.93 ,$20.93 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$32.10 ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$20.93 ,$32.10 ,$31.46 ,$64.20 ,$22.19 ,$93.50 ,$72.23 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 ,$31.77 ,$86.90 ,$1.19 ,$110.00 ,$110.00 ,$31.46 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,43000024,97542,HC SEATING CLINIC EA 15 MIN,430,1 ,$80.00 ,$52.80 ,$1.39 ,$80.00 ,$18.94 ,$80.00 ,$80.00 ,$31.18 ,$48.00 ,$68.00 ,$56.00 ,$18.94 ,$18.94 ,$76.00 ,$60.80 ,$60.00 ,$52.00 ,$68.00 ,$31.18 ,$52.00 ,$52.00 ,$56.00 ,$48.72 ,$18.94 ,$31.18 ,$30.56 ,$62.36 ,$20.08 ,$68.00 ,$70.16 ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$48.70 ,$55.28 ,$72.00 ,$54.66 ,$30.86 ,$63.20 ,$1.39 ,$80.00 ,$80.00 ,$30.56 ,$80.00 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,43000027,97760,HC ORTHOTICS FABRICATION EA 15 MIN,430,1 ,$110.00 ,$72.60 ,$1.39 ,$110.00 , N/A ,$110.00 ,$110.00 ,$47.31 ,$66.00 ,$93.50 ,$77.00 , N/A , N/A ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$47.31 ,$71.50 ,$71.50 ,$77.00 ,$66.99 , N/A ,$47.31 ,$46.36 ,$94.62 , N/A ,$93.50 ,$106.45 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 ,$46.82 ,$86.90 ,$1.39 ,$110.00 ,$110.00 ,$46.36 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,43000061,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN,430,1 ,$90.00 ,$59.40 ,$21.76 ,$90.00 , N/A ,$90.00 ,$90.00 ,$22.20 ,$54.00 ,$76.50 ,$63.00 , N/A , N/A ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$22.20 ,$58.50 ,$58.50 ,$63.00 ,$54.81 , N/A ,$22.20 ,$21.76 ,$44.40 , N/A ,$76.50 ,$49.95 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$61.49 ,$21.97 ,$71.10 , N/A ,$90.00 ,$90.00 ,$21.76 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,43000062,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN,430,1 ,$90.00 ,$59.40 ,$20.78 ,$90.00 , N/A ,$90.00 ,$90.00 ,$21.20 ,$54.00 ,$76.50 ,$63.00 , N/A , N/A ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$21.20 ,$58.50 ,$58.50 ,$63.00 ,$54.81 , N/A ,$21.20 ,$20.78 ,$42.40 , N/A ,$76.50 ,$47.70 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$61.49 ,$20.98 ,$71.10 , N/A ,$90.00 ,$90.00 ,$20.78 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,43400034,97165,HC OT EVAL LOW COMPLEXITY 15MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400035,97165,HC OT EVAL LOW COMPLEXITY 30MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400036,97165,HC OT EVAL LOW COMPLEXITY 45MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400037,97165,HC OT EVAL LOW COMPLEXITY 60MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400046,97166,HC OT EVAL MOD COMPLEXITY 15MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400047,97166,HC OT EVAL MOD COMPLEXITY 30MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400048,97166,HC OT EVAL MOD COMPLEXITY 45MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400049,97166,HC OT EVAL MOD COMPLEXITY 60MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400058,97167,HC OT EVAL HIGH COMPLEXITY 15MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400059,97167,HC OT EVAL HIGH COMPLEXITY 30MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400060,97167,HC OT EVAL HIGH COMPLEXITY 45MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400061,97167,HC OT EVAL HIGH COMPLEXITY 60MIN,434,1 ,$220.00 ,$145.20 ,$6.79 ,$221.24 ,$62.66 ,$220.00 ,$220.00 ,$98.33 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.33 ,$143.00 ,$143.00 ,$154.00 ,$133.98 ,$62.66 ,$98.33 ,$96.36 ,$196.66 ,$66.42 ,$187.00 ,$221.24 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$150.30 ,$97.32 ,$173.80 ,$6.79 ,$220.00 ,$220.00 ,$96.36 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$130.00 ,$85.80 ,$6.79 ,$151.65 ,$62.66 ,$130.00 ,$130.00 ,$67.40 ,$78.00 ,$110.50 ,$91.00 ,$62.66 ,$62.66 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$67.40 ,$84.50 ,$84.50 ,$91.00 ,$79.17 ,$62.66 ,$67.40 ,$66.05 ,$130.00 ,$66.42 ,$110.50 ,$151.65 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$88.82 ,$66.71 ,$102.70 ,$6.79 ,$130.00 ,$130.00 ,$66.05 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$130.00 ,$85.80 ,$6.79 ,$151.65 ,$62.66 ,$130.00 ,$130.00 ,$67.40 ,$78.00 ,$110.50 ,$91.00 ,$62.66 ,$62.66 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$67.40 ,$84.50 ,$84.50 ,$91.00 ,$79.17 ,$62.66 ,$67.40 ,$66.05 ,$130.00 ,$66.42 ,$110.50 ,$151.65 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$88.82 ,$66.71 ,$102.70 ,$6.79 ,$130.00 ,$130.00 ,$66.05 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$130.00 ,$85.80 ,$6.79 ,$151.65 ,$62.66 ,$130.00 ,$130.00 ,$67.40 ,$78.00 ,$110.50 ,$91.00 ,$62.66 ,$62.66 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$67.40 ,$84.50 ,$84.50 ,$91.00 ,$79.17 ,$62.66 ,$67.40 ,$66.05 ,$130.00 ,$66.42 ,$110.50 ,$151.65 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$88.82 ,$66.71 ,$102.70 ,$6.79 ,$130.00 ,$130.00 ,$66.05 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,43400073,97168,HC OT RE-EVAL 60MIN,434,1 ,$130.00 ,$85.80 ,$6.79 ,$151.65 ,$62.66 ,$130.00 ,$130.00 ,$67.40 ,$78.00 ,$110.50 ,$91.00 ,$62.66 ,$62.66 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$67.40 ,$84.50 ,$84.50 ,$91.00 ,$79.17 ,$62.66 ,$67.40 ,$66.05 ,$130.00 ,$66.42 ,$110.50 ,$151.65 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$88.82 ,$66.71 ,$102.70 ,$6.79 ,$130.00 ,$130.00 ,$66.05 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$280.00 ,$184.80 ,$8.50 ,$280.00 ,$47.91 ,$280.00 ,$240.00 ,$74.74 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$47.91 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$74.74 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$47.91 ,$74.74 ,$73.25 ,$149.48 ,$50.78 ,$238.00 ,$168.17 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$73.98 ,$221.20 ,$8.50 ,$264.00 ,$264.00 ,$73.25 ,$264.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$280.00 ,$184.80 ,$8.50 ,$280.00 ,$47.91 ,$280.00 ,$240.00 ,$74.74 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$47.91 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$74.74 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$47.91 ,$74.74 ,$73.25 ,$149.48 ,$50.78 ,$238.00 ,$168.17 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$73.98 ,$221.20 ,$8.50 ,$264.00 ,$264.00 ,$73.25 ,$264.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$280.00 ,$184.80 ,$8.50 ,$280.00 ,$47.91 ,$280.00 ,$240.00 ,$74.74 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$47.91 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$74.74 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$47.91 ,$74.74 ,$73.25 ,$149.48 ,$50.78 ,$238.00 ,$168.17 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$73.98 ,$221.20 ,$8.50 ,$264.00 ,$264.00 ,$73.25 ,$264.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$280.00 ,$184.80 ,$8.50 ,$280.00 ,$47.91 ,$280.00 ,$240.00 ,$74.74 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$47.91 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$74.74 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$47.91 ,$74.74 ,$73.25 ,$149.48 ,$50.78 ,$238.00 ,$168.17 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$73.98 ,$221.20 ,$8.50 ,$264.00 ,$264.00 ,$73.25 ,$264.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$280.00 ,$184.80 ,$1.39 ,$280.00 ,$48.82 ,$280.00 ,$240.00 ,$82.86 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$48.82 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$82.86 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$48.82 ,$82.86 ,$81.20 ,$165.72 ,$51.75 ,$238.00 ,$186.44 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$82.02 ,$221.20 ,$1.39 ,$264.00 ,$264.00 ,$81.20 ,$264.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$280.00 ,$184.80 ,$1.39 ,$280.00 ,$48.82 ,$280.00 ,$240.00 ,$82.86 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$48.82 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$82.86 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$48.82 ,$82.86 ,$81.20 ,$165.72 ,$51.75 ,$238.00 ,$186.44 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$82.02 ,$221.20 ,$1.39 ,$264.00 ,$264.00 ,$81.20 ,$264.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$280.00 ,$184.80 ,$1.39 ,$280.00 ,$48.82 ,$280.00 ,$240.00 ,$82.86 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$48.82 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$82.86 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$48.82 ,$82.86 ,$81.20 ,$165.72 ,$51.75 ,$238.00 ,$186.44 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$82.02 ,$221.20 ,$1.39 ,$264.00 ,$264.00 ,$81.20 ,$264.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$280.00 ,$184.80 ,$1.39 ,$280.00 ,$48.82 ,$280.00 ,$240.00 ,$82.86 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$48.82 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$82.86 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$48.82 ,$82.86 ,$81.20 ,$165.72 ,$51.75 ,$238.00 ,$186.44 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$82.02 ,$221.20 ,$1.39 ,$264.00 ,$264.00 ,$81.20 ,$264.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44400016,92610,HC DYSHPAGIA THERAPY,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400021,92610,HC DYSPHAGIA REEVALUATION 15MIN,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400022,92610,HC DYSPHAGIA REEVALUATION 30MIN,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400023,92610,HC DYSPHAGIA REEVALUATION 45MIN,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400024,92610,HC EVAL SWALLOW-ORAL FEED,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400025,92610,HC DYSPHAGIA EVALUATION,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400029,92611,HC DYSPHAGIA EVAL-VIDEO 15MIN,444,1 ,$390.00 ,$257.40 ,$4.40 ,$390.00 ,$116.92 ,$298.00 ,$240.00 ,$88.43 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$88.43 ,$253.50 ,$253.50 ,$273.00 ,$237.51 ,$116.92 ,$88.43 ,$86.66 ,$176.86 ,$123.94 ,$331.50 ,$198.97 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$266.45 ,$87.52 ,$308.10 ,$4.40 ,$264.00 ,$264.00 ,$86.66 ,$264.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400030,92611,HC DYSPHAGIA EVAL-VIDEO 30MIN,444,1 ,$390.00 ,$257.40 ,$4.40 ,$390.00 ,$116.92 ,$298.00 ,$240.00 ,$88.43 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$88.43 ,$253.50 ,$253.50 ,$273.00 ,$237.51 ,$116.92 ,$88.43 ,$86.66 ,$176.86 ,$123.94 ,$331.50 ,$198.97 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$266.45 ,$87.52 ,$308.10 ,$4.40 ,$264.00 ,$264.00 ,$86.66 ,$264.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400031,92611,HC DYSPHAGIA EVAL-VIDEO 45MIN,444,1 ,$390.00 ,$257.40 ,$4.40 ,$390.00 ,$116.92 ,$298.00 ,$240.00 ,$88.43 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$88.43 ,$253.50 ,$253.50 ,$273.00 ,$237.51 ,$116.92 ,$88.43 ,$86.66 ,$176.86 ,$123.94 ,$331.50 ,$198.97 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$266.45 ,$87.52 ,$308.10 ,$4.40 ,$264.00 ,$264.00 ,$86.66 ,$264.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400032,92611,HC DYSPHAGIA EVAL-VIDEO 60MIN,444,1 ,$390.00 ,$257.40 ,$4.40 ,$390.00 ,$116.92 ,$298.00 ,$240.00 ,$88.43 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$88.43 ,$253.50 ,$253.50 ,$273.00 ,$237.51 ,$116.92 ,$88.43 ,$86.66 ,$176.86 ,$123.94 ,$331.50 ,$198.97 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$266.45 ,$87.52 ,$308.10 ,$4.40 ,$264.00 ,$264.00 ,$86.66 ,$264.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400033,92611,HC DYSPHAGIA EVAL-VIDEO,444,1 ,$390.00 ,$257.40 ,$4.40 ,$390.00 ,$116.92 ,$298.00 ,$240.00 ,$88.43 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$88.43 ,$253.50 ,$253.50 ,$273.00 ,$237.51 ,$116.92 ,$88.43 ,$86.66 ,$176.86 ,$123.94 ,$331.50 ,$198.97 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$266.45 ,$87.52 ,$308.10 ,$4.40 ,$264.00 ,$264.00 ,$86.66 ,$264.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400034,92611,HC DYSPHAGIA RE-EVAL VIDEO 15MIN,444,1 ,$390.00 ,$257.40 ,$4.40 ,$390.00 ,$116.92 ,$298.00 ,$240.00 ,$88.43 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$88.43 ,$253.50 ,$253.50 ,$273.00 ,$237.51 ,$116.92 ,$88.43 ,$86.66 ,$176.86 ,$123.94 ,$331.50 ,$198.97 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$266.45 ,$87.52 ,$308.10 ,$4.40 ,$264.00 ,$264.00 ,$86.66 ,$264.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400040,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN,444,1 ,$260.00 ,$171.60 ,$8.50 ,$292.48 ,$30.27 ,$260.00 ,$240.00 ,$129.99 ,$156.00 ,$221.00 ,$182.00 ,$30.27 ,$30.27 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$129.99 ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$30.27 ,$129.99 ,$127.39 ,$259.98 ,$32.09 ,$221.00 ,$292.48 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 ,$128.66 ,$205.40 ,$8.50 ,$260.00 ,$260.00 ,$127.39 ,$260.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400041,92522,HC EVALUATE SPEECH PRODUCTION 15MIN,444,1 ,$260.00 ,$171.60 ,$8.50 ,$260.00 ,$24.58 ,$260.00 ,$240.00 ,$108.30 ,$156.00 ,$221.00 ,$182.00 ,$24.58 ,$24.58 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$108.30 ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$24.58 ,$108.30 ,$106.13 ,$216.60 ,$26.05 ,$221.00 ,$243.68 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 ,$107.19 ,$205.40 ,$8.50 ,$260.00 ,$260.00 ,$106.13 ,$260.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400042,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 15MIN,444,1 ,$430.00 ,$283.80 ,$8.50 ,$501.62 ,$48.63 ,$298.00 ,$240.00 ,$222.94 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$48.63 ,$408.50 ,$326.80 ,$322.50 ,$279.50 ,$365.50 ,$222.94 ,$279.50 ,$279.50 ,$301.00 ,$261.87 ,$48.63 ,$222.94 ,$218.48 ,$430.00 ,$51.55 ,$365.50 ,$501.62 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 ,$220.67 ,$339.70 ,$8.50 ,$264.00 ,$264.00 ,$218.48 ,$264.00 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,44400043,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 15MIN,444,1 ,$230.00 ,$151.80 ,$8.50 ,$240.80 ,$25.62 ,$230.00 ,$230.00 ,$107.02 ,$138.00 ,$195.50 ,$161.00 ,$25.62 ,$25.62 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$107.02 ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$25.62 ,$107.02 ,$104.88 ,$214.04 ,$27.16 ,$195.50 ,$240.80 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 ,$105.93 ,$181.70 ,$8.50 ,$230.00 ,$230.00 ,$104.88 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,44400048,92610,HC DYSPHAGIA REEVALUATION 60MIN,444,1 ,$340.00 ,$224.40 ,$8.50 ,$340.00 ,$72.23 ,$298.00 ,$240.00 ,$82.79 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$82.79 ,$221.00 ,$221.00 ,$238.00 ,$207.06 ,$72.23 ,$82.79 ,$81.13 ,$165.58 ,$76.56 ,$289.00 ,$186.28 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$81.95 ,$268.60 ,$8.50 ,$264.00 ,$264.00 ,$81.13 ,$264.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400049,92611,HC DYSPHAGIA RE-EVAL VIDEO 30MIN,444,1 ,$390.00 ,$257.40 ,$4.40 ,$390.00 ,$116.92 ,$298.00 ,$240.00 ,$88.43 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$88.43 ,$253.50 ,$253.50 ,$273.00 ,$237.51 ,$116.92 ,$88.43 ,$86.66 ,$176.86 ,$123.94 ,$331.50 ,$198.97 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$266.45 ,$87.52 ,$308.10 ,$4.40 ,$264.00 ,$264.00 ,$86.66 ,$264.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400050,92611,HC DYSPHAGIA RE-EVAL VIDEO 45MIN,444,1 ,$390.00 ,$257.40 ,$4.40 ,$390.00 ,$116.92 ,$298.00 ,$240.00 ,$88.43 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$88.43 ,$253.50 ,$253.50 ,$273.00 ,$237.51 ,$116.92 ,$88.43 ,$86.66 ,$176.86 ,$123.94 ,$331.50 ,$198.97 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$266.45 ,$87.52 ,$308.10 ,$4.40 ,$264.00 ,$264.00 ,$86.66 ,$264.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400051,92611,HC DYSPHAGIA RE-EVAL VIDEO 60MIN,444,1 ,$390.00 ,$257.40 ,$4.40 ,$390.00 ,$116.92 ,$298.00 ,$240.00 ,$88.43 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$88.43 ,$253.50 ,$253.50 ,$273.00 ,$237.51 ,$116.92 ,$88.43 ,$86.66 ,$176.86 ,$123.94 ,$331.50 ,$198.97 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$266.45 ,$87.52 ,$308.10 ,$4.40 ,$264.00 ,$264.00 ,$86.66 ,$264.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400052,92521,HC EVALUATION OF SPEECH FLUENCY 30MIN,444,1 ,$260.00 ,$171.60 ,$8.50 ,$292.48 ,$30.27 ,$260.00 ,$240.00 ,$129.99 ,$156.00 ,$221.00 ,$182.00 ,$30.27 ,$30.27 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$129.99 ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$30.27 ,$129.99 ,$127.39 ,$259.98 ,$32.09 ,$221.00 ,$292.48 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 ,$128.66 ,$205.40 ,$8.50 ,$260.00 ,$260.00 ,$127.39 ,$260.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400053,92521,HC EVALUATION OF SPEECH FLUENCY 45MIN,444,1 ,$260.00 ,$171.60 ,$8.50 ,$292.48 ,$30.27 ,$260.00 ,$240.00 ,$129.99 ,$156.00 ,$221.00 ,$182.00 ,$30.27 ,$30.27 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$129.99 ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$30.27 ,$129.99 ,$127.39 ,$259.98 ,$32.09 ,$221.00 ,$292.48 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 ,$128.66 ,$205.40 ,$8.50 ,$260.00 ,$260.00 ,$127.39 ,$260.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400054,92521,HC EVALUATION OF SPEECH FLUENCY 60MIN,444,1 ,$260.00 ,$171.60 ,$8.50 ,$292.48 ,$30.27 ,$260.00 ,$240.00 ,$129.99 ,$156.00 ,$221.00 ,$182.00 ,$30.27 ,$30.27 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$129.99 ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$30.27 ,$129.99 ,$127.39 ,$259.98 ,$32.09 ,$221.00 ,$292.48 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 ,$128.66 ,$205.40 ,$8.50 ,$260.00 ,$260.00 ,$127.39 ,$260.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400055,92522,HC EVALUATE SPEECH PRODUCTION 30MIN,444,1 ,$260.00 ,$171.60 ,$8.50 ,$260.00 ,$24.58 ,$260.00 ,$240.00 ,$108.30 ,$156.00 ,$221.00 ,$182.00 ,$24.58 ,$24.58 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$108.30 ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$24.58 ,$108.30 ,$106.13 ,$216.60 ,$26.05 ,$221.00 ,$243.68 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 ,$107.19 ,$205.40 ,$8.50 ,$260.00 ,$260.00 ,$106.13 ,$260.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400056,92522,HC EVALUATE SPEECH PRODUCTION 45MIN,444,1 ,$260.00 ,$171.60 ,$8.50 ,$260.00 ,$24.58 ,$260.00 ,$240.00 ,$108.30 ,$156.00 ,$221.00 ,$182.00 ,$24.58 ,$24.58 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$108.30 ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$24.58 ,$108.30 ,$106.13 ,$216.60 ,$26.05 ,$221.00 ,$243.68 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 ,$107.19 ,$205.40 ,$8.50 ,$260.00 ,$260.00 ,$106.13 ,$260.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400057,92522,HC EVALUATE SPEECH PRODUCTION 60MIN,444,1 ,$260.00 ,$171.60 ,$8.50 ,$260.00 ,$24.58 ,$260.00 ,$240.00 ,$108.30 ,$156.00 ,$221.00 ,$182.00 ,$24.58 ,$24.58 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$108.30 ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$24.58 ,$108.30 ,$106.13 ,$216.60 ,$26.05 ,$221.00 ,$243.68 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 ,$107.19 ,$205.40 ,$8.50 ,$260.00 ,$260.00 ,$106.13 ,$260.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$430.00 ,$283.80 ,$8.50 ,$501.62 ,$48.63 ,$298.00 ,$240.00 ,$222.94 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$48.63 ,$408.50 ,$326.80 ,$322.50 ,$279.50 ,$365.50 ,$222.94 ,$279.50 ,$279.50 ,$301.00 ,$261.87 ,$48.63 ,$222.94 ,$218.48 ,$430.00 ,$51.55 ,$365.50 ,$501.62 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 ,$220.67 ,$339.70 ,$8.50 ,$264.00 ,$264.00 ,$218.48 ,$264.00 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,44400059,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 45MIN,444,1 ,$430.00 ,$283.80 ,$8.50 ,$501.62 ,$48.63 ,$298.00 ,$240.00 ,$222.94 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$48.63 ,$408.50 ,$326.80 ,$322.50 ,$279.50 ,$365.50 ,$222.94 ,$279.50 ,$279.50 ,$301.00 ,$261.87 ,$48.63 ,$222.94 ,$218.48 ,$430.00 ,$51.55 ,$365.50 ,$501.62 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 ,$220.67 ,$339.70 ,$8.50 ,$264.00 ,$264.00 ,$218.48 ,$264.00 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$430.00 ,$283.80 ,$8.50 ,$501.62 ,$48.63 ,$298.00 ,$240.00 ,$222.94 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$48.63 ,$408.50 ,$326.80 ,$322.50 ,$279.50 ,$365.50 ,$222.94 ,$279.50 ,$279.50 ,$301.00 ,$261.87 ,$48.63 ,$222.94 ,$218.48 ,$430.00 ,$51.55 ,$365.50 ,$501.62 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$293.78 ,$220.67 ,$339.70 ,$8.50 ,$264.00 ,$264.00 ,$218.48 ,$264.00 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,44400061,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 30MIN,444,1 ,$230.00 ,$151.80 ,$8.50 ,$240.80 ,$25.62 ,$230.00 ,$230.00 ,$107.02 ,$138.00 ,$195.50 ,$161.00 ,$25.62 ,$25.62 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$107.02 ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$25.62 ,$107.02 ,$104.88 ,$214.04 ,$27.16 ,$195.50 ,$240.80 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 ,$105.93 ,$181.70 ,$8.50 ,$230.00 ,$230.00 ,$104.88 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,44400062,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 45MIN,444,1 ,$230.00 ,$151.80 ,$8.50 ,$240.80 ,$25.62 ,$230.00 ,$230.00 ,$107.02 ,$138.00 ,$195.50 ,$161.00 ,$25.62 ,$25.62 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$107.02 ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$25.62 ,$107.02 ,$104.88 ,$214.04 ,$27.16 ,$195.50 ,$240.80 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 ,$105.93 ,$181.70 ,$8.50 ,$230.00 ,$230.00 ,$104.88 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,44400063,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 60MIN,444,1 ,$230.00 ,$151.80 ,$8.50 ,$240.80 ,$25.62 ,$230.00 ,$230.00 ,$107.02 ,$138.00 ,$195.50 ,$161.00 ,$25.62 ,$25.62 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$107.02 ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$25.62 ,$107.02 ,$104.88 ,$214.04 ,$27.16 ,$195.50 ,$240.80 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 ,$105.93 ,$181.70 ,$8.50 ,$230.00 ,$230.00 ,$104.88 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$966.00 ,$637.56 ,$5.80 ,$966.00 ,$5.80 ,$662.10 ,$662.10 ,$364.12 ,$579.60 ,$821.10 ,$676.20 ,$5.80 ,$5.80 ,$917.70 ,$734.16 ,$724.50 ,$627.90 ,$821.10 ,$364.12 ,$627.90 ,$627.90 ,$676.20 ,$588.29 ,$5.80 ,$364.12 ,$356.84 ,$728.24 ,$6.15 ,$821.10 ,$819.26 ,$888.72 ,$676.20 ,$489.96 ,$588.00 ,$588.29 ,$588.00 ,$667.51 ,$869.40 ,$659.97 ,$360.40 ,$763.14 ,$6.15 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$695.52 ,$598.92 ,$695.52 ,$695.52 ,$772.80 
ST NICHOLAS HOSPITAL - ACUTE,45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$545.10 ,$359.77 ,$5.80 ,"$1,425.14 ",$5.80 ,$373.61 ,$373.61 ,$633.39 ,$327.06 ,$463.34 ,$381.57 ,$5.80 ,$5.80 ,$517.85 ,$414.28 ,$408.83 ,$354.32 ,$463.34 ,$633.39 ,$354.32 ,$354.32 ,$381.57 ,$331.97 ,$5.80 ,$633.39 ,$620.72 ,$545.10 ,$6.15 ,$463.34 ,"$1,425.14 ",$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 ,$626.93 ,$430.63 ,$6.15 ,$545.10 ,$545.10 ,$620.72 ,$545.10 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,45000004,10081,HC I AND D CYST PILONIDAL CPLX,450,1 ,"$2,973.90 ","$1,962.77 ",$38.33 ,"$2,973.90 ",$38.33 ,"$2,038.31 ","$2,038.31 ",$633.39 ,"$1,784.34 ","$2,527.82 ","$2,081.73 ",$38.33 ,$38.33 ,"$2,825.21 ","$2,260.16 ","$2,230.43 ","$1,933.04 ","$2,527.82 ",$633.39 ,"$1,933.04 ","$1,933.04 ","$2,081.73 ","$1,811.11 ",$38.33 ,$633.39 ,$620.72 ,"$1,266.78 ",$40.63 ,"$2,527.82 ","$1,425.14 ","$2,735.99 ","$2,081.73 ","$1,508.36 ","$1,810.21 ","$1,811.11 ","$1,810.21 ","$2,054.96 ","$2,676.51 ","$2,031.77 ",$626.93 ,"$2,349.38 ",$40.63 ,$700.00 ,$700.00 ,$620.72 ,$700.00 ,"$2,141.21 ","$1,843.82 ","$2,141.21 ","$2,141.21 ","$2,379.12 "
ST NICHOLAS HOSPITAL - ACUTE,45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$446.20 ,$294.49 ,$5.80 ,$819.26 ,$5.80 ,$305.83 ,$305.83 ,$364.12 ,$267.72 ,$379.27 ,$312.34 ,$5.80 ,$5.80 ,$423.89 ,$339.11 ,$334.65 ,$290.03 ,$379.27 ,$364.12 ,$290.03 ,$290.03 ,$312.34 ,$271.74 ,$5.80 ,$364.12 ,$356.84 ,$446.20 ,$6.15 ,$379.27 ,$819.26 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$360.40 ,$352.50 ,$6.15 ,$446.20 ,$446.20 ,$356.84 ,$446.20 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$334.65 ,$220.87 ,$2.25 ,$396.55 ,$2.25 ,$229.37 ,$229.37 ,$176.25 ,$200.79 ,$284.45 ,$234.26 ,$2.25 ,$2.25 ,$317.92 ,$254.33 ,$250.99 ,$217.52 ,$284.45 ,$176.25 ,$217.52 ,$217.52 ,$234.26 ,$203.80 ,$2.25 ,$176.25 ,$172.72 ,$334.65 ,$2.39 ,$284.45 ,$396.55 ,$307.88 ,$234.26 ,$169.73 ,$203.70 ,$203.80 ,$203.70 ,$231.24 ,$301.19 ,$228.63 ,$174.45 ,$264.37 ,$2.39 ,$334.65 ,$334.65 ,$172.72 ,$334.65 ,$240.95 ,$207.48 ,$240.95 ,$240.95 ,$267.72 
ST NICHOLAS HOSPITAL - ACUTE,45000010,11732,HC AVULSION NAIL PL PT/CO EA ADDL FAC,450,1 ,$266.80 ,$176.09 ,$2.25 ,$266.80 ,$2.25 ,$182.86 ,$182.86 , N/A ,$160.08 ,$226.78 ,$186.76 ,$2.25 ,$2.25 ,$253.46 ,$202.77 ,$200.10 ,$173.42 ,$226.78 , N/A ,$173.42 ,$173.42 ,$186.76 ,$162.48 ,$2.25 , N/A , N/A , N/A ,$2.39 ,$226.78 , N/A ,$245.46 ,$186.76 ,$135.32 ,$162.40 ,$162.48 ,$162.40 ,$184.36 ,$240.12 ,$182.28 , N/A ,$210.77 ,$2.39 ,$266.80 ,$266.80 , N/A ,$266.80 ,$192.10 ,$165.42 ,$192.10 ,$192.10 ,$213.44 
ST NICHOLAS HOSPITAL - ACUTE,45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$173.65 ,$114.61 ,$2.25 ,$254.98 ,$2.25 ,$119.02 ,$119.02 ,$113.32 ,$104.19 ,$147.60 ,$121.56 ,$2.25 ,$2.25 ,$164.97 ,$131.97 ,$130.24 ,$112.87 ,$147.60 ,$113.32 ,$112.87 ,$112.87 ,$121.56 ,$105.75 ,$2.25 ,$113.32 ,$111.05 ,$173.65 ,$2.39 ,$147.60 ,$254.98 ,$159.76 ,$121.56 ,$88.08 ,$105.70 ,$105.75 ,$105.70 ,$119.99 ,$156.29 ,$118.64 ,$112.16 ,$137.18 ,$2.39 ,$173.65 ,$173.65 ,$111.05 ,$173.65 ,$125.03 ,$107.66 ,$125.03 ,$125.03 ,$138.92 
ST NICHOLAS HOSPITAL - ACUTE,45000012,11760,HC REPAIR NAIL BED,450,1 ,$532.45 ,$351.42 ,$2.25 ,"$1,275.77 ",$2.25 ,$364.94 ,$364.94 ,$567.01 ,$319.47 ,$452.58 ,$372.72 ,$2.25 ,$2.25 ,$505.83 ,$404.66 ,$399.34 ,$346.09 ,$452.58 ,$567.01 ,$346.09 ,$346.09 ,$372.72 ,$324.26 ,$2.25 ,$567.01 ,$555.67 ,$532.45 ,$2.39 ,$452.58 ,"$1,275.77 ",$489.85 ,$372.72 ,$270.06 ,$324.10 ,$324.26 ,$324.10 ,$367.92 ,$479.21 ,$363.77 ,$561.23 ,$420.64 ,$2.39 ,$532.45 ,$532.45 ,$555.67 ,$532.45 ,$383.36 ,$330.12 ,$383.36 ,$383.36 ,$425.96 
ST NICHOLAS HOSPITAL - ACUTE,45000013,11765,HC EXC WEDGE SKIN NAIL FOLD,450,1 ,$458.85 ,$302.84 ,$2.25 ,$819.26 ,$2.25 ,$314.50 ,$314.50 ,$364.12 ,$275.31 ,$390.02 ,$321.20 ,$2.25 ,$2.25 ,$435.91 ,$348.73 ,$344.14 ,$298.25 ,$390.02 ,$364.12 ,$298.25 ,$298.25 ,$321.20 ,$279.44 ,$2.25 ,$364.12 ,$356.84 ,$458.85 ,$2.39 ,$390.02 ,$819.26 ,$422.14 ,$321.20 ,$232.73 ,$279.30 ,$279.44 ,$279.30 ,$317.07 ,$412.97 ,$313.49 ,$360.40 ,$362.49 ,$2.39 ,$458.85 ,$458.85 ,$356.84 ,$458.85 ,$330.37 ,$284.49 ,$330.37 ,$330.37 ,$367.08 
ST NICHOLAS HOSPITAL - ACUTE,45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$631.35 ,$416.69 ,$6.41 ,$631.35 ,$6.41 ,$432.73 ,$432.73 ,$176.25 ,$378.81 ,$536.65 ,$441.95 ,$6.41 ,$6.41 ,$599.78 ,$479.83 ,$473.51 ,$410.38 ,$536.65 ,$176.25 ,$410.38 ,$410.38 ,$441.95 ,$384.49 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$536.65 ,$396.55 ,$580.84 ,$441.95 ,$320.22 ,$384.30 ,$384.49 ,$384.30 ,$436.26 ,$568.22 ,$431.34 ,$174.45 ,$498.77 ,$6.79 ,$631.35 ,$631.35 ,$172.72 ,$631.35 ,$454.57 ,$391.44 ,$454.57 ,$454.57 ,$505.08 
ST NICHOLAS HOSPITAL - ACUTE,45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$693.45 ,$457.68 ,$6.41 ,$693.45 ,$6.41 ,$475.29 ,$475.29 ,$176.25 ,$416.07 ,$589.43 ,$485.42 ,$6.41 ,$6.41 ,$658.78 ,$527.02 ,$520.09 ,$450.74 ,$589.43 ,$176.25 ,$450.74 ,$450.74 ,$485.42 ,$422.31 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$589.43 ,$396.55 ,$637.97 ,$485.42 ,$351.72 ,$422.10 ,$422.31 ,$422.10 ,$479.17 ,$624.11 ,$473.77 ,$174.45 ,$547.83 ,$6.79 ,$693.45 ,$693.45 ,$172.72 ,$693.45 ,$499.28 ,$429.94 ,$499.28 ,$499.28 ,$554.76 
ST NICHOLAS HOSPITAL - ACUTE,45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$755.55 ,$498.66 ,$6.41 ,$755.55 ,$6.41 ,$517.85 ,$517.85 ,$176.25 ,$453.33 ,$642.22 ,$528.89 ,$6.41 ,$6.41 ,$717.77 ,$574.22 ,$566.66 ,$491.11 ,$642.22 ,$176.25 ,$491.11 ,$491.11 ,$528.89 ,$460.13 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$642.22 ,$396.55 ,$695.11 ,$528.89 ,$383.22 ,$459.90 ,$460.13 ,$459.90 ,$522.09 ,$680.00 ,$516.19 ,$174.45 ,$596.88 ,$6.79 ,$700.00 ,$700.00 ,$172.72 ,$700.00 ,$544.00 ,$468.44 ,$544.00 ,$544.00 ,$604.44 
ST NICHOLAS HOSPITAL - ACUTE,45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$817.65 ,$539.65 ,$6.41 ,$819.26 ,$6.41 ,$560.42 ,$560.42 ,$364.12 ,$490.59 ,$695.00 ,$572.36 ,$6.41 ,$6.41 ,$776.77 ,$621.41 ,$613.24 ,$531.47 ,$695.00 ,$364.12 ,$531.47 ,$531.47 ,$572.36 ,$497.95 ,$6.41 ,$364.12 ,$356.84 ,$728.24 ,$6.79 ,$695.00 ,$819.26 ,$752.24 ,$572.36 ,$414.71 ,$497.70 ,$497.95 ,$497.70 ,$565.00 ,$735.89 ,$558.62 ,$360.40 ,$645.94 ,$6.79 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$588.71 ,$506.94 ,$588.71 ,$588.71 ,$654.12 
ST NICHOLAS HOSPITAL - ACUTE,45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$879.75 ,$580.64 ,$6.41 ,$879.75 ,$6.41 ,$602.98 ,$602.98 ,$364.12 ,$527.85 ,$747.79 ,$615.83 ,$6.41 ,$6.41 ,$835.76 ,$668.61 ,$659.81 ,$571.84 ,$747.79 ,$364.12 ,$571.84 ,$571.84 ,$615.83 ,$535.77 ,$6.41 ,$364.12 ,$356.84 ,$728.24 ,$6.79 ,$747.79 ,$819.26 ,$809.37 ,$615.83 ,$446.21 ,$535.50 ,$535.77 ,$535.50 ,$607.91 ,$791.78 ,$601.05 ,$360.40 ,$695.00 ,$6.79 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$633.42 ,$545.45 ,$633.42 ,$633.42 ,$703.80 
ST NICHOLAS HOSPITAL - ACUTE,45000019,12007,HC SIMP S/N/AX/GN/TRK/EXT > 30CM,450,1 ,$903.90 ,$596.57 ,$6.41 ,$903.90 ,$6.41 ,$619.53 ,$619.53 ,$176.25 ,$542.34 ,$768.32 ,$632.73 ,$6.41 ,$6.41 ,$858.71 ,$686.96 ,$677.93 ,$587.54 ,$768.32 ,$176.25 ,$587.54 ,$587.54 ,$632.73 ,$550.48 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$768.32 ,$396.55 ,$831.59 ,$632.73 ,$458.46 ,$550.20 ,$550.48 ,$550.20 ,$624.59 ,$813.51 ,$617.54 ,$174.45 ,$714.08 ,$6.79 ,$700.00 ,$700.00 ,$172.72 ,$700.00 ,$650.81 ,$560.42 ,$650.81 ,$650.81 ,$723.12 
ST NICHOLAS HOSPITAL - ACUTE,45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$780.85 ,$515.36 ,$6.41 ,$780.85 ,$6.41 ,$535.19 ,$535.19 ,$176.25 ,$468.51 ,$663.72 ,$546.60 ,$6.41 ,$6.41 ,$741.81 ,$593.45 ,$585.64 ,$507.55 ,$663.72 ,$176.25 ,$507.55 ,$507.55 ,$546.60 ,$475.54 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$663.72 ,$396.55 ,$718.38 ,$546.60 ,$396.05 ,$475.30 ,$475.54 ,$475.30 ,$539.57 ,$702.77 ,$533.48 ,$174.45 ,$616.87 ,$6.79 ,$700.00 ,$700.00 ,$172.72 ,$700.00 ,$562.21 ,$484.13 ,$562.21 ,$562.21 ,$624.68 
ST NICHOLAS HOSPITAL - ACUTE,45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$854.45 ,$563.94 ,$6.41 ,$854.45 ,$6.41 ,$585.64 ,$585.64 ,$176.25 ,$512.67 ,$726.28 ,$598.12 ,$6.41 ,$6.41 ,$811.73 ,$649.38 ,$640.84 ,$555.39 ,$726.28 ,$176.25 ,$555.39 ,$555.39 ,$598.12 ,$520.36 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$726.28 ,$396.55 ,$786.09 ,$598.12 ,$433.38 ,$520.10 ,$520.36 ,$520.10 ,$590.43 ,$769.01 ,$583.76 ,$174.45 ,$675.02 ,$6.79 ,$700.00 ,$700.00 ,$172.72 ,$700.00 ,$615.20 ,$529.76 ,$615.20 ,$615.20 ,$683.56 
ST NICHOLAS HOSPITAL - ACUTE,45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$879.75 ,$580.64 ,$6.41 ,$879.75 ,$6.41 ,$602.98 ,$602.98 ,$176.25 ,$527.85 ,$747.79 ,$615.83 ,$6.41 ,$6.41 ,$835.76 ,$668.61 ,$659.81 ,$571.84 ,$747.79 ,$176.25 ,$571.84 ,$571.84 ,$615.83 ,$535.77 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$747.79 ,$396.55 ,$809.37 ,$615.83 ,$446.21 ,$535.50 ,$535.77 ,$535.50 ,$607.91 ,$791.78 ,$601.05 ,$174.45 ,$695.00 ,$6.79 ,$700.00 ,$700.00 ,$172.72 ,$700.00 ,$633.42 ,$545.45 ,$633.42 ,$633.42 ,$703.80 
ST NICHOLAS HOSPITAL - ACUTE,45000023,12015,HC SIMP F/E/E/N/L/MM 7.6 -12.5CM,450,1 ,$903.90 ,$596.57 ,$6.41 ,$903.90 ,$6.41 ,$619.53 ,$619.53 ,$176.25 ,$542.34 ,$768.32 ,$632.73 ,$6.41 ,$6.41 ,$858.71 ,$686.96 ,$677.93 ,$587.54 ,$768.32 ,$176.25 ,$587.54 ,$587.54 ,$632.73 ,$550.48 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$768.32 ,$396.55 ,$831.59 ,$632.73 ,$458.46 ,$550.20 ,$550.48 ,$550.20 ,$624.59 ,$813.51 ,$617.54 ,$174.45 ,$714.08 ,$6.79 ,$700.00 ,$700.00 ,$172.72 ,$700.00 ,$650.81 ,$560.42 ,$650.81 ,$650.81 ,$723.12 
ST NICHOLAS HOSPITAL - ACUTE,45000024,12016,HC SIMP F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$916.55 ,$604.92 ,$6.41 ,$916.55 ,$6.41 ,$628.20 ,$628.20 ,$364.12 ,$549.93 ,$779.07 ,$641.59 ,$6.41 ,$6.41 ,$870.72 ,$696.58 ,$687.41 ,$595.76 ,$779.07 ,$364.12 ,$595.76 ,$595.76 ,$641.59 ,$558.18 ,$6.41 ,$364.12 ,$356.84 ,$728.24 ,$6.79 ,$779.07 ,$819.26 ,$843.23 ,$641.59 ,$464.87 ,$557.90 ,$558.18 ,$557.90 ,$633.34 ,$824.90 ,$626.19 ,$360.40 ,$724.07 ,$6.79 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$659.92 ,$568.26 ,$659.92 ,$659.92 ,$733.24 
ST NICHOLAS HOSPITAL - ACUTE,45000025,12017,HC SIMP F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$941.85 ,$621.62 ,$6.41 ,$941.85 ,$6.41 ,$645.54 ,$645.54 ,$364.12 ,$565.11 ,$800.57 ,$659.30 ,$6.41 ,$6.41 ,$894.76 ,$715.81 ,$706.39 ,$612.20 ,$800.57 ,$364.12 ,$612.20 ,$612.20 ,$659.30 ,$573.59 ,$6.41 ,$364.12 ,$356.84 ,$728.24 ,$6.79 ,$800.57 ,$819.26 ,$866.50 ,$659.30 ,$477.71 ,$573.30 ,$573.59 ,$573.30 ,$650.82 ,$847.67 ,$643.47 ,$360.40 ,$744.06 ,$6.79 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$678.13 ,$583.95 ,$678.13 ,$678.13 ,$753.48 
ST NICHOLAS HOSPITAL - ACUTE,45000026,12018,HC SIMP F/E/E/N/L/MM OVER 30CM,450,1 ,$966.00 ,$637.56 ,$6.41 ,$966.00 ,$6.41 ,$662.10 ,$662.10 ,$176.25 ,$579.60 ,$821.10 ,$676.20 ,$6.41 ,$6.41 ,$917.70 ,$734.16 ,$724.50 ,$627.90 ,$821.10 ,$176.25 ,$627.90 ,$627.90 ,$676.20 ,$588.29 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$821.10 ,$396.55 ,$888.72 ,$676.20 ,$489.96 ,$588.00 ,$588.29 ,$588.00 ,$667.51 ,$869.40 ,$659.97 ,$174.45 ,$763.14 ,$6.79 ,$700.00 ,$700.00 ,$172.72 ,$700.00 ,$695.52 ,$598.92 ,$695.52 ,$695.52 ,$772.80 
ST NICHOLAS HOSPITAL - ACUTE,45000027,12020,HC SIMP SUPERFICIAL DEHISCENCE,450,1 ,"$1,486.95 ",$981.39 ,$13.09 ,"$1,486.95 ",$13.09 ,"$1,019.16 ","$1,019.16 ",$567.01 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$13.09 ,$13.09 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$966.52 ,"$1,263.91 ",$567.01 ,$966.52 ,$966.52 ,"$1,040.87 ",$905.55 ,$13.09 ,$567.01 ,$555.67 ,"$1,134.02 ",$13.88 ,"$1,263.91 ","$1,275.77 ","$1,367.99 ","$1,040.87 ",$754.18 ,$905.11 ,$905.55 ,$905.11 ,"$1,027.48 ","$1,338.26 ","$1,015.88 ",$561.23 ,"$1,174.69 ",$13.88 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,45000028,12021,HC SIMP SUPERFICIAL DEHISCENC/PAK,450,1 ,$584.20 ,$385.57 ,$13.09 ,$819.26 ,$13.09 ,$400.41 ,$400.41 ,$364.12 ,$350.52 ,$496.57 ,$408.94 ,$13.09 ,$13.09 ,$554.99 ,$443.99 ,$438.15 ,$379.73 ,$496.57 ,$364.12 ,$379.73 ,$379.73 ,$408.94 ,$355.78 ,$13.09 ,$364.12 ,$356.84 ,$584.20 ,$13.88 ,$496.57 ,$819.26 ,$537.46 ,$408.94 ,$296.31 ,$355.60 ,$355.78 ,$355.60 ,$403.68 ,$525.78 ,$399.13 ,$360.40 ,$461.52 ,$13.88 ,$584.20 ,$584.20 ,$356.84 ,$584.20 ,$420.62 ,$362.20 ,$420.62 ,$420.62 ,$467.36 
ST NICHOLAS HOSPITAL - ACUTE,45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,$805.00 ,$531.30 ,$13.09 ,$819.26 ,$13.09 ,$551.75 ,$551.75 ,$364.12 ,$483.00 ,$684.25 ,$563.50 ,$13.09 ,$13.09 ,$764.75 ,$611.80 ,$603.75 ,$523.25 ,$684.25 ,$364.12 ,$523.25 ,$523.25 ,$563.50 ,$490.25 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$684.25 ,$819.26 ,$740.60 ,$563.50 ,$408.30 ,$490.00 ,$490.25 ,$490.00 ,$556.26 ,$724.50 ,$549.98 ,$360.40 ,$635.95 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$579.60 ,$499.10 ,$579.60 ,$579.60 ,$644.00 
ST NICHOLAS HOSPITAL - ACUTE,45000030,12032,HC INTRM S/A/T/EXT 2.6-7.5CM,450,1 ,$892.40 ,$588.98 ,$13.09 ,$892.40 ,$13.09 ,$611.65 ,$611.65 ,$364.12 ,$535.44 ,$758.54 ,$624.68 ,$13.09 ,$13.09 ,$847.78 ,$678.22 ,$669.30 ,$580.06 ,$758.54 ,$364.12 ,$580.06 ,$580.06 ,$624.68 ,$543.47 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$758.54 ,$819.26 ,$821.01 ,$624.68 ,$452.63 ,$543.20 ,$543.47 ,$543.20 ,$616.65 ,$803.16 ,$609.69 ,$360.40 ,$705.00 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$642.53 ,$553.29 ,$642.53 ,$642.53 ,$713.92 
ST NICHOLAS HOSPITAL - ACUTE,45000031,12034,HC INTRM S/A/T/EXT 7.6-12.5CM,450,1 ,$966.00 ,$637.56 ,$13.09 ,$966.00 ,$13.09 ,$662.10 ,$662.10 ,$364.12 ,$579.60 ,$821.10 ,$676.20 ,$13.09 ,$13.09 ,$917.70 ,$734.16 ,$724.50 ,$627.90 ,$821.10 ,$364.12 ,$627.90 ,$627.90 ,$676.20 ,$588.29 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$821.10 ,$819.26 ,$888.72 ,$676.20 ,$489.96 ,$588.00 ,$588.29 ,$588.00 ,$667.51 ,$869.40 ,$659.97 ,$360.40 ,$763.14 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$695.52 ,$598.92 ,$695.52 ,$695.52 ,$772.80 
ST NICHOLAS HOSPITAL - ACUTE,45000032,12035,HC INTRM S/A/T/EXT 12.6-20.0CM,450,1 ,"$1,053.40 ",$695.24 ,$13.09 ,"$1,053.40 ",$13.09 ,$722.00 ,$722.00 ,$364.12 ,$632.04 ,$895.39 ,$737.38 ,$13.09 ,$13.09 ,"$1,000.73 ",$800.58 ,$790.05 ,$684.71 ,$895.39 ,$364.12 ,$684.71 ,$684.71 ,$737.38 ,$641.52 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$895.39 ,$819.26 ,$969.13 ,$737.38 ,$534.28 ,$641.20 ,$641.52 ,$641.20 ,$727.90 ,$948.06 ,$719.68 ,$360.40 ,$832.19 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$758.45 ,$653.11 ,$758.45 ,$758.45 ,$842.72 
ST NICHOLAS HOSPITAL - ACUTE,45000033,12036,HC INTRM S/A/T/EXT 20.1-30.0CM,450,1 ,"$1,127.00 ",$743.82 ,$13.09 ,"$1,275.77 ",$13.09 ,$772.45 ,$772.45 ,$567.01 ,$676.20 ,$957.95 ,$788.90 ,$13.09 ,$13.09 ,"$1,070.65 ",$856.52 ,$845.25 ,$732.55 ,$957.95 ,$567.01 ,$732.55 ,$732.55 ,$788.90 ,$686.34 ,$13.09 ,$567.01 ,$555.67 ,"$1,127.00 ",$13.88 ,$957.95 ,"$1,275.77 ","$1,036.84 ",$788.90 ,$571.61 ,$686.00 ,$686.34 ,$686.00 ,$778.76 ,"$1,014.30 ",$769.97 ,$561.23 ,$890.33 ,$13.88 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,$811.44 ,$698.74 ,$811.44 ,$811.44 ,$901.60 
ST NICHOLAS HOSPITAL - ACUTE,45000034,12037,HC INTRM S/A/T/EXT OVER 30CM,450,1 ,"$1,486.95 ",$981.39 ,$13.09 ,"$3,789.99 ",$13.09 ,"$1,019.16 ","$1,019.16 ","$1,684.44 ",$892.17 ,"$1,263.91 ","$1,040.87 ",$13.09 ,$13.09 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$966.52 ,"$1,263.91 ","$1,684.44 ",$966.52 ,$966.52 ,"$1,040.87 ",$905.55 ,$13.09 ,"$1,684.44 ","$1,650.75 ","$1,486.95 ",$13.88 ,"$1,263.91 ","$3,789.99 ","$1,367.99 ","$1,040.87 ",$754.18 ,$905.11 ,$905.55 ,$905.11 ,"$1,027.48 ","$1,338.26 ","$1,015.88 ","$1,667.25 ","$1,174.69 ",$13.88 ,$700.00 ,$700.00 ,"$1,650.75 ",$700.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,$731.40 ,$482.72 ,$13.09 ,$819.26 ,$13.09 ,$501.30 ,$501.30 ,$364.12 ,$438.84 ,$621.69 ,$511.98 ,$13.09 ,$13.09 ,$694.83 ,$555.86 ,$548.55 ,$475.41 ,$621.69 ,$364.12 ,$475.41 ,$475.41 ,$511.98 ,$445.42 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$621.69 ,$819.26 ,$672.89 ,$511.98 ,$370.97 ,$445.20 ,$445.42 ,$445.20 ,$505.40 ,$658.26 ,$499.69 ,$360.40 ,$577.81 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$526.61 ,$453.47 ,$526.61 ,$526.61 ,$585.12 
ST NICHOLAS HOSPITAL - ACUTE,45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$805.00 ,$531.30 ,$13.09 ,$819.26 ,$13.09 ,$551.75 ,$551.75 ,$364.12 ,$483.00 ,$684.25 ,$563.50 ,$13.09 ,$13.09 ,$764.75 ,$611.80 ,$603.75 ,$523.25 ,$684.25 ,$364.12 ,$523.25 ,$523.25 ,$563.50 ,$490.25 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$684.25 ,$819.26 ,$740.60 ,$563.50 ,$408.30 ,$490.00 ,$490.25 ,$490.00 ,$556.26 ,$724.50 ,$549.98 ,$360.40 ,$635.95 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$579.60 ,$499.10 ,$579.60 ,$579.60 ,$644.00 
ST NICHOLAS HOSPITAL - ACUTE,45000037,12044,HC INTRM N/H/F/GEN 7.6-12.5CM,450,1 ,$892.40 ,$588.98 ,$13.09 ,"$1,275.77 ",$13.09 ,$611.65 ,$611.65 ,$567.01 ,$535.44 ,$758.54 ,$624.68 ,$13.09 ,$13.09 ,$847.78 ,$678.22 ,$669.30 ,$580.06 ,$758.54 ,$567.01 ,$580.06 ,$580.06 ,$624.68 ,$543.47 ,$13.09 ,$567.01 ,$555.67 ,$892.40 ,$13.88 ,$758.54 ,"$1,275.77 ",$821.01 ,$624.68 ,$452.63 ,$543.20 ,$543.47 ,$543.20 ,$616.65 ,$803.16 ,$609.69 ,$561.23 ,$705.00 ,$13.88 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,$642.53 ,$553.29 ,$642.53 ,$642.53 ,$713.92 
ST NICHOLAS HOSPITAL - ACUTE,45000038,12045,HC INTRM N/H/F/GEN 12.6-20.0CM,450,1 ,"$1,053.40 ",$695.24 ,$13.09 ,"$1,275.77 ",$13.09 ,$722.00 ,$722.00 ,$567.01 ,$632.04 ,$895.39 ,$737.38 ,$13.09 ,$13.09 ,"$1,000.73 ",$800.58 ,$790.05 ,$684.71 ,$895.39 ,$567.01 ,$684.71 ,$684.71 ,$737.38 ,$641.52 ,$13.09 ,$567.01 ,$555.67 ,"$1,053.40 ",$13.88 ,$895.39 ,"$1,275.77 ",$969.13 ,$737.38 ,$534.28 ,$641.20 ,$641.52 ,$641.20 ,$727.90 ,$948.06 ,$719.68 ,$561.23 ,$832.19 ,$13.88 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,$758.45 ,$653.11 ,$758.45 ,$758.45 ,$842.72 
ST NICHOLAS HOSPITAL - ACUTE,45000039,12046,HC INTRM N/H/F/GEN 20.1-30CM,450,1 ,"$1,127.00 ",$743.82 ,$13.09 ,"$1,275.77 ",$13.09 ,$772.45 ,$772.45 ,$567.01 ,$676.20 ,$957.95 ,$788.90 ,$13.09 ,$13.09 ,"$1,070.65 ",$856.52 ,$845.25 ,$732.55 ,$957.95 ,$567.01 ,$732.55 ,$732.55 ,$788.90 ,$686.34 ,$13.09 ,$567.01 ,$555.67 ,"$1,127.00 ",$13.88 ,$957.95 ,"$1,275.77 ","$1,036.84 ",$788.90 ,$571.61 ,$686.00 ,$686.34 ,$686.00 ,$778.76 ,"$1,014.30 ",$769.97 ,$561.23 ,$890.33 ,$13.88 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,$811.44 ,$698.74 ,$811.44 ,$811.44 ,$901.60 
ST NICHOLAS HOSPITAL - ACUTE,45000040,12047,HC INTRM N/H/F/GEN OVER 30CM,450,1 ,"$1,486.95 ",$981.39 ,$13.09 ,"$3,789.99 ",$13.09 ,"$1,019.16 ","$1,019.16 ","$1,684.44 ",$892.17 ,"$1,263.91 ","$1,040.87 ",$13.09 ,$13.09 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$966.52 ,"$1,263.91 ","$1,684.44 ",$966.52 ,$966.52 ,"$1,040.87 ",$905.55 ,$13.09 ,"$1,684.44 ","$1,650.75 ","$1,486.95 ",$13.88 ,"$1,263.91 ","$3,789.99 ","$1,367.99 ","$1,040.87 ",$754.18 ,$905.11 ,$905.55 ,$905.11 ,"$1,027.48 ","$1,338.26 ","$1,015.88 ","$1,667.25 ","$1,174.69 ",$13.88 ,$700.00 ,$700.00 ,"$1,650.75 ",$700.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$780.85 ,$515.36 ,$13.09 ,$819.26 ,$13.09 ,$535.19 ,$535.19 ,$364.12 ,$468.51 ,$663.72 ,$546.60 ,$13.09 ,$13.09 ,$741.81 ,$593.45 ,$585.64 ,$507.55 ,$663.72 ,$364.12 ,$507.55 ,$507.55 ,$546.60 ,$475.54 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$663.72 ,$819.26 ,$718.38 ,$546.60 ,$396.05 ,$475.30 ,$475.54 ,$475.30 ,$539.57 ,$702.77 ,$533.48 ,$360.40 ,$616.87 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$562.21 ,$484.13 ,$562.21 ,$562.21 ,$624.68 
ST NICHOLAS HOSPITAL - ACUTE,45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$854.45 ,$563.94 ,$13.09 ,$854.45 ,$13.09 ,$585.64 ,$585.64 ,$364.12 ,$512.67 ,$726.28 ,$598.12 ,$13.09 ,$13.09 ,$811.73 ,$649.38 ,$640.84 ,$555.39 ,$726.28 ,$364.12 ,$555.39 ,$555.39 ,$598.12 ,$520.36 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$726.28 ,$819.26 ,$786.09 ,$598.12 ,$433.38 ,$520.10 ,$520.36 ,$520.10 ,$590.43 ,$769.01 ,$583.76 ,$360.40 ,$675.02 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$615.20 ,$529.76 ,$615.20 ,$615.20 ,$683.56 
ST NICHOLAS HOSPITAL - ACUTE,45000043,12053,HC INTRM F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$929.20 ,$613.27 ,$13.09 ,$929.20 ,$13.09 ,$636.87 ,$636.87 ,$364.12 ,$557.52 ,$789.82 ,$650.44 ,$13.09 ,$13.09 ,$882.74 ,$706.19 ,$696.90 ,$603.98 ,$789.82 ,$364.12 ,$603.98 ,$603.98 ,$650.44 ,$565.88 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$789.82 ,$819.26 ,$854.86 ,$650.44 ,$471.29 ,$565.60 ,$565.88 ,$565.60 ,$642.08 ,$836.28 ,$634.83 ,$360.40 ,$734.07 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$669.02 ,$576.10 ,$669.02 ,$669.02 ,$743.36 
ST NICHOLAS HOSPITAL - ACUTE,45000044,12054,HC INTRM F/E/E/N/L/MM 7.6-12.5CM,450,1 ,"$1,015.45 ",$670.20 ,$13.09 ,"$1,015.45 ",$13.09 ,$695.99 ,$695.99 ,$364.12 ,$609.27 ,$863.13 ,$710.82 ,$13.09 ,$13.09 ,$964.68 ,$771.74 ,$761.59 ,$660.04 ,$863.13 ,$364.12 ,$660.04 ,$660.04 ,$710.82 ,$618.41 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$863.13 ,$819.26 ,$934.21 ,$710.82 ,$515.04 ,$618.10 ,$618.41 ,$618.10 ,$701.68 ,$913.91 ,$693.76 ,$360.40 ,$802.21 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$731.12 ,$629.58 ,$731.12 ,$731.12 ,$812.36 
ST NICHOLAS HOSPITAL - ACUTE,45000045,12055,HC INTRM F/E/E/N/L/MM 12.6-20.0CM,450,1 ,"$1,084.45 ",$715.74 ,$13.09 ,"$1,084.45 ",$13.09 ,$743.28 ,$743.28 ,$364.12 ,$650.67 ,$921.78 ,$759.12 ,$13.09 ,$13.09 ,"$1,030.23 ",$824.18 ,$813.34 ,$704.89 ,$921.78 ,$364.12 ,$704.89 ,$704.89 ,$759.12 ,$660.43 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$921.78 ,$819.26 ,$997.69 ,$759.12 ,$550.03 ,$660.10 ,$660.43 ,$660.10 ,$749.36 ,$976.01 ,$740.90 ,$360.40 ,$856.72 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$780.80 ,$672.36 ,$780.80 ,$780.80 ,$867.56 
ST NICHOLAS HOSPITAL - ACUTE,45000046,12056,HC INTRM F/E/E/N/L/MM 20.1-30.0CM,450,1 ,"$1,127.00 ",$743.82 ,$13.09 ,"$1,127.00 ",$13.09 ,$772.45 ,$772.45 ,$364.12 ,$676.20 ,$957.95 ,$788.90 ,$13.09 ,$13.09 ,"$1,070.65 ",$856.52 ,$845.25 ,$732.55 ,$957.95 ,$364.12 ,$732.55 ,$732.55 ,$788.90 ,$686.34 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,$957.95 ,$819.26 ,"$1,036.84 ",$788.90 ,$571.61 ,$686.00 ,$686.34 ,$686.00 ,$778.76 ,"$1,014.30 ",$769.97 ,$360.40 ,$890.33 ,$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,$811.44 ,$698.74 ,$811.44 ,$811.44 ,$901.60 
ST NICHOLAS HOSPITAL - ACUTE,45000047,12057,HC INTRM F/E/E/N/L/MM OVER 30.0CM,450,1 ,"$1,486.95 ",$981.39 ,$13.09 ,"$1,486.95 ",$13.09 ,"$1,019.16 ","$1,019.16 ",$364.12 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$13.09 ,$13.09 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$966.52 ,"$1,263.91 ",$364.12 ,$966.52 ,$966.52 ,"$1,040.87 ",$905.55 ,$13.09 ,$364.12 ,$356.84 ,$728.24 ,$13.88 ,"$1,263.91 ",$819.26 ,"$1,367.99 ","$1,040.87 ",$754.18 ,$905.11 ,$905.55 ,$905.11 ,"$1,027.48 ","$1,338.26 ","$1,015.88 ",$360.40 ,"$1,174.69 ",$13.88 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,45000048,13100,HC CMPLX TRUNK 1.1-2.5 CM,450,1 ,"$1,127.00 ",$743.82 ,$15.19 ,"$1,275.77 ",$15.19 ,$772.45 ,$772.45 ,$567.01 ,$676.20 ,$957.95 ,$788.90 ,$15.19 ,$15.19 ,"$1,070.65 ",$856.52 ,$845.25 ,$732.55 ,$957.95 ,$567.01 ,$732.55 ,$732.55 ,$788.90 ,$686.34 ,$15.19 ,$567.01 ,$555.67 ,"$1,127.00 ",$16.10 ,$957.95 ,"$1,275.77 ","$1,036.84 ",$788.90 ,$571.61 ,$686.00 ,$686.34 ,$686.00 ,$778.76 ,"$1,014.30 ",$769.97 ,$561.23 ,$890.33 ,$16.10 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,$811.44 ,$698.74 ,$811.44 ,$811.44 ,$901.60 
ST NICHOLAS HOSPITAL - ACUTE,45000049,13101,HC CMPLX TRUNK 2.6-7.5 CM,450,1 ,"$1,127.00 ",$743.82 ,$15.19 ,"$1,275.77 ",$15.19 ,$772.45 ,$772.45 ,$567.01 ,$676.20 ,$957.95 ,$788.90 ,$15.19 ,$15.19 ,"$1,070.65 ",$856.52 ,$845.25 ,$732.55 ,$957.95 ,$567.01 ,$732.55 ,$732.55 ,$788.90 ,$686.34 ,$15.19 ,$567.01 ,$555.67 ,"$1,127.00 ",$16.10 ,$957.95 ,"$1,275.77 ","$1,036.84 ",$788.90 ,$571.61 ,$686.00 ,$686.34 ,$686.00 ,$778.76 ,"$1,014.30 ",$769.97 ,$561.23 ,$890.33 ,$16.10 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,$811.44 ,$698.74 ,$811.44 ,$811.44 ,$901.60 
ST NICHOLAS HOSPITAL - ACUTE,45000050,13102,HC CMPLX TRUNK EA ADDL 5 CM OR LESS,450,1 ,$619.85 ,$409.10 ,$15.19 ,$619.85 ,$15.19 ,$424.85 ,$424.85 , N/A ,$371.91 ,$526.87 ,$433.90 ,$15.19 ,$15.19 ,$588.86 ,$471.09 ,$464.89 ,$402.90 ,$526.87 , N/A ,$402.90 ,$402.90 ,$433.90 ,$377.49 ,$15.19 , N/A , N/A , N/A ,$16.10 ,$526.87 , N/A ,$570.26 ,$433.90 ,$314.39 ,$377.30 ,$377.49 ,$377.30 ,$428.32 ,$557.87 ,$423.48 , N/A ,$489.68 ,$16.10 ,$619.85 ,$619.85 , N/A ,$619.85 ,$446.29 ,$384.31 ,$446.29 ,$446.29 ,$495.88 
ST NICHOLAS HOSPITAL - ACUTE,45000051,13120,HC CMPLX S/A/L 1.1-2.5 CM,450,1 ,"$1,127.00 ",$743.82 ,$15.19 ,"$1,275.77 ",$15.19 ,$772.45 ,$772.45 ,$567.01 ,$676.20 ,$957.95 ,$788.90 ,$15.19 ,$15.19 ,"$1,070.65 ",$856.52 ,$845.25 ,$732.55 ,$957.95 ,$567.01 ,$732.55 ,$732.55 ,$788.90 ,$686.34 ,$15.19 ,$567.01 ,$555.67 ,"$1,127.00 ",$16.10 ,$957.95 ,"$1,275.77 ","$1,036.84 ",$788.90 ,$571.61 ,$686.00 ,$686.34 ,$686.00 ,$778.76 ,"$1,014.30 ",$769.97 ,$561.23 ,$890.33 ,$16.10 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,$811.44 ,$698.74 ,$811.44 ,$811.44 ,$901.60 
ST NICHOLAS HOSPITAL - ACUTE,45000052,13121,HC CMPLX S/A/L 2.6-7.5 CM,450,1 ,"$1,486.95 ",$981.39 ,$15.19 ,"$1,486.95 ",$15.19 ,"$1,019.16 ","$1,019.16 ",$567.01 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$15.19 ,$15.19 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$966.52 ,"$1,263.91 ",$567.01 ,$966.52 ,$966.52 ,"$1,040.87 ",$905.55 ,$15.19 ,$567.01 ,$555.67 ,"$1,134.02 ",$16.10 ,"$1,263.91 ","$1,275.77 ","$1,367.99 ","$1,040.87 ",$754.18 ,$905.11 ,$905.55 ,$905.11 ,"$1,027.48 ","$1,338.26 ","$1,015.88 ",$561.23 ,"$1,174.69 ",$16.10 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,45000053,13122,HC CMPLX S/A/L EA ADDL 5 CM OR LESS,450,1 ,$619.85 ,$409.10 ,$15.19 ,$619.85 ,$15.19 ,$424.85 ,$424.85 , N/A ,$371.91 ,$526.87 ,$433.90 ,$15.19 ,$15.19 ,$588.86 ,$471.09 ,$464.89 ,$402.90 ,$526.87 , N/A ,$402.90 ,$402.90 ,$433.90 ,$377.49 ,$15.19 , N/A , N/A , N/A ,$16.10 ,$526.87 , N/A ,$570.26 ,$433.90 ,$314.39 ,$377.30 ,$377.49 ,$377.30 ,$428.32 ,$557.87 ,$423.48 , N/A ,$489.68 ,$16.10 ,$619.85 ,$619.85 , N/A ,$619.85 ,$446.29 ,$384.31 ,$446.29 ,$446.29 ,$495.88 
ST NICHOLAS HOSPITAL - ACUTE,45000054,13131,HC CMPLX F/C/C/M/N/A/G/H/F 1.1-2.5 CM,450,1 ,"$1,486.95 ",$981.39 ,$15.19 ,"$1,486.95 ",$15.19 ,"$1,019.16 ","$1,019.16 ",$364.12 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$15.19 ,$15.19 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$966.52 ,"$1,263.91 ",$364.12 ,$966.52 ,$966.52 ,"$1,040.87 ",$905.55 ,$15.19 ,$364.12 ,$356.84 ,$728.24 ,$16.10 ,"$1,263.91 ",$819.26 ,"$1,367.99 ","$1,040.87 ",$754.18 ,$905.11 ,$905.55 ,$905.11 ,"$1,027.48 ","$1,338.26 ","$1,015.88 ",$360.40 ,"$1,174.69 ",$16.10 ,$700.00 ,$700.00 ,$356.84 ,$700.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,45000055,13132,HC CMPLX F/C/C/M/N/A/G/H/F 2.6-7.5 CM,450,1 ,"$1,611.15 ","$1,063.36 ",$15.19 ,"$1,611.15 ",$15.19 ,"$1,104.28 ","$1,104.28 ",$567.01 ,$966.69 ,"$1,369.48 ","$1,127.81 ",$15.19 ,$15.19 ,"$1,530.59 ","$1,224.47 ","$1,208.36 ","$1,047.25 ","$1,369.48 ",$567.01 ,"$1,047.25 ","$1,047.25 ","$1,127.81 ",$981.19 ,$15.19 ,$567.01 ,$555.67 ,"$1,134.02 ",$16.10 ,"$1,369.48 ","$1,275.77 ","$1,482.26 ","$1,127.81 ",$817.18 ,$980.71 ,$981.19 ,$980.71 ,"$1,113.30 ","$1,450.04 ","$1,100.74 ",$561.23 ,"$1,272.81 ",$16.10 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,"$1,160.03 ",$998.91 ,"$1,160.03 ","$1,160.03 ","$1,288.92 "
ST NICHOLAS HOSPITAL - ACUTE,45000056,13133,HC CMPLX F/C/C/M/N/A/G/H/F EA ADDL 5 CM OR LESS,450,1 ,$619.85 ,$409.10 ,$15.19 ,$619.85 ,$15.19 ,$424.85 ,$424.85 , N/A ,$371.91 ,$526.87 ,$433.90 ,$15.19 ,$15.19 ,$588.86 ,$471.09 ,$464.89 ,$402.90 ,$526.87 , N/A ,$402.90 ,$402.90 ,$433.90 ,$377.49 ,$15.19 , N/A , N/A , N/A ,$16.10 ,$526.87 , N/A ,$570.26 ,$433.90 ,$314.39 ,$377.30 ,$377.49 ,$377.30 ,$428.32 ,$557.87 ,$423.48 , N/A ,$489.68 ,$16.10 ,$619.85 ,$619.85 , N/A ,$619.85 ,$446.29 ,$384.31 ,$446.29 ,$446.29 ,$495.88 
ST NICHOLAS HOSPITAL - ACUTE,45000058,13151,HC CMPLX E/N/E/L 1.1-2.5 CM,450,1 ,"$1,486.95 ",$981.39 ,$15.19 ,"$1,486.95 ",$15.19 ,"$1,019.16 ","$1,019.16 ",$567.01 ,$892.17 ,"$1,263.91 ","$1,040.87 ",$15.19 ,$15.19 ,"$1,412.60 ","$1,130.08 ","$1,115.21 ",$966.52 ,"$1,263.91 ",$567.01 ,$966.52 ,$966.52 ,"$1,040.87 ",$905.55 ,$15.19 ,$567.01 ,$555.67 ,"$1,134.02 ",$16.10 ,"$1,263.91 ","$1,275.77 ","$1,367.99 ","$1,040.87 ",$754.18 ,$905.11 ,$905.55 ,$905.11 ,"$1,027.48 ","$1,338.26 ","$1,015.88 ",$561.23 ,"$1,174.69 ",$16.10 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,"$1,070.60 ",$921.91 ,"$1,070.60 ","$1,070.60 ","$1,189.56 "
ST NICHOLAS HOSPITAL - ACUTE,45000059,13152,HC CMPLX E/N/E/L 2.6-7.5 CM,450,1 ,"$1,611.15 ","$1,063.36 ",$15.19 ,"$1,611.15 ",$15.19 ,"$1,104.28 ","$1,104.28 ",$567.01 ,$966.69 ,"$1,369.48 ","$1,127.81 ",$15.19 ,$15.19 ,"$1,530.59 ","$1,224.47 ","$1,208.36 ","$1,047.25 ","$1,369.48 ",$567.01 ,"$1,047.25 ","$1,047.25 ","$1,127.81 ",$981.19 ,$15.19 ,$567.01 ,$555.67 ,"$1,134.02 ",$16.10 ,"$1,369.48 ","$1,275.77 ","$1,482.26 ","$1,127.81 ",$817.18 ,$980.71 ,$981.19 ,$980.71 ,"$1,113.30 ","$1,450.04 ","$1,100.74 ",$561.23 ,"$1,272.81 ",$16.10 ,$700.00 ,$700.00 ,$555.67 ,$700.00 ,"$1,160.03 ",$998.91 ,"$1,160.03 ","$1,160.03 ","$1,288.92 "
ST NICHOLAS HOSPITAL - ACUTE,45000060,13153,HC CMPLX E/N/E/L EA ADDL 5 CM OR LESS,450,1 ,$854.45 ,$563.94 ,$41.96 ,$854.45 ,$41.96 ,$585.64 ,$585.64 , N/A ,$512.67 ,$726.28 ,$598.12 ,$41.96 ,$41.96 ,$811.73 ,$649.38 ,$640.84 ,$555.39 ,$726.28 , N/A ,$555.39 ,$555.39 ,$598.12 ,$520.36 ,$41.96 , N/A , N/A , N/A ,$44.48 ,$726.28 , N/A ,$786.09 ,$598.12 ,$433.38 ,$520.10 ,$520.36 ,$520.10 ,$590.43 ,$769.01 ,$583.76 , N/A ,$675.02 ,$44.48 ,$700.00 ,$700.00 , N/A ,$700.00 ,$615.20 ,$529.76 ,$615.20 ,$615.20 ,$683.56 
ST NICHOLAS HOSPITAL - ACUTE,45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$210.45 ,$138.90 ,$6.41 ,$396.55 ,$6.41 ,$144.24 ,$144.24 ,$176.25 ,$126.27 ,$178.88 ,$147.32 ,$6.41 ,$6.41 ,$199.93 ,$159.94 ,$157.84 ,$136.79 ,$178.88 ,$176.25 ,$136.79 ,$136.79 ,$147.32 ,$128.16 ,$6.41 ,$176.25 ,$172.72 ,$210.45 ,$6.79 ,$178.88 ,$396.55 ,$193.61 ,$147.32 ,$106.74 ,$128.10 ,$128.16 ,$128.10 ,$145.42 ,$189.41 ,$143.78 ,$174.45 ,$166.26 ,$6.79 ,$210.45 ,$210.45 ,$172.72 ,$210.45 ,$151.52 ,$130.48 ,$151.52 ,$151.52 ,$168.36 
ST NICHOLAS HOSPITAL - ACUTE,45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$470.35 ,$310.43 ,$6.41 ,$470.35 ,$6.41 ,$322.38 ,$322.38 ,$176.25 ,$282.21 ,$399.80 ,$329.25 ,$6.41 ,$6.41 ,$446.83 ,$357.47 ,$352.76 ,$305.73 ,$399.80 ,$176.25 ,$305.73 ,$305.73 ,$329.25 ,$286.44 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$399.80 ,$396.55 ,$432.72 ,$329.25 ,$238.56 ,$286.30 ,$286.44 ,$286.30 ,$325.01 ,$423.32 ,$321.34 ,$174.45 ,$371.58 ,$6.79 ,$470.35 ,$470.35 ,$172.72 ,$470.35 ,$338.65 ,$291.62 ,$338.65 ,$338.65 ,$376.28 
ST NICHOLAS HOSPITAL - ACUTE,45000063,16025,HC DRESS/DEB BURN 5-10% TOTAL MED,450,1 ,$545.10 ,$359.77 ,$6.41 ,$545.10 ,$6.41 ,$373.61 ,$373.61 ,$176.25 ,$327.06 ,$463.34 ,$381.57 ,$6.41 ,$6.41 ,$517.85 ,$414.28 ,$408.83 ,$354.32 ,$463.34 ,$176.25 ,$354.32 ,$354.32 ,$381.57 ,$331.97 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$463.34 ,$396.55 ,$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 ,$174.45 ,$430.63 ,$6.79 ,$545.10 ,$545.10 ,$172.72 ,$545.10 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,$656.65 ,$433.39 ,$13.09 ,$819.26 ,$13.09 ,$450.07 ,$450.07 ,$364.12 ,$393.99 ,$558.15 ,$459.66 ,$13.09 ,$13.09 ,$623.82 ,$499.05 ,$492.49 ,$426.82 ,$558.15 ,$364.12 ,$426.82 ,$426.82 ,$459.66 ,$399.90 ,$13.09 ,$364.12 ,$356.84 ,$656.65 ,$13.88 ,$558.15 ,$819.26 ,$604.12 ,$459.66 ,$333.05 ,$399.70 ,$399.90 ,$399.70 ,$453.75 ,$590.99 ,$448.62 ,$360.40 ,$518.75 ,$13.88 ,$656.65 ,$656.65 ,$356.84 ,$656.65 ,$472.79 ,$407.12 ,$472.79 ,$472.79 ,$525.32 
ST NICHOLAS HOSPITAL - ACUTE,45000065,16035,HC ESCHARATOMY; INITIAL,450,1 ,$545.10 ,$359.77 ,$13.09 ,$819.26 ,$13.09 ,$373.61 ,$373.61 ,$364.12 ,$327.06 ,$463.34 ,$381.57 ,$13.09 ,$13.09 ,$517.85 ,$414.28 ,$408.83 ,$354.32 ,$463.34 ,$364.12 ,$354.32 ,$354.32 ,$381.57 ,$331.97 ,$13.09 ,$364.12 ,$356.84 ,$545.10 ,$13.88 ,$463.34 ,$819.26 ,$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 ,$360.40 ,$430.63 ,$13.88 ,$545.10 ,$545.10 ,$356.84 ,$545.10 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,45000066,16036,HC ESCHARATOMY; EACH ADDL,450,1 ,$259.90 ,$171.53 ,$13.09 ,$259.90 ,$13.09 ,$178.14 ,$178.14 , N/A ,$155.94 ,$220.92 ,$181.93 ,$13.09 ,$13.09 ,$246.91 ,$197.52 ,$194.93 ,$168.94 ,$220.92 , N/A ,$168.94 ,$168.94 ,$181.93 ,$158.28 ,$13.09 , N/A , N/A , N/A ,$13.88 ,$220.92 , N/A ,$239.11 ,$181.93 ,$131.82 ,$158.20 ,$158.28 ,$158.20 ,$179.59 ,$233.91 ,$177.56 , N/A ,$205.32 ,$13.88 ,$259.90 ,$259.90 , N/A ,$259.90 ,$187.13 ,$161.14 ,$187.13 ,$187.13 ,$207.92 
ST NICHOLAS HOSPITAL - ACUTE,45000067,17250,HC CAUT CHEM TISSUE GRANULATION,450,1 ,$446.20 ,$294.49 ,$5.80 ,$446.20 ,$5.80 ,$305.83 ,$305.83 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$5.80 ,$5.80 ,$423.89 ,$339.11 ,$334.65 ,$290.03 ,$379.27 ,$176.25 ,$290.03 ,$290.03 ,$312.34 ,$271.74 ,$5.80 ,$176.25 ,$172.72 ,$352.50 ,$6.15 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.15 ,$446.20 ,$446.20 ,$172.72 ,$446.20 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,45000068,20103,HC EXPL PENTR WOUND EXTREMITY,450,1 ,"$1,362.75 ",$899.42 ,$13.09 ,"$3,293.01 ",$13.09 ,$934.03 ,$934.03 ,"$1,463.56 ",$817.65 ,"$1,158.34 ",$953.93 ,$13.09 ,$13.09 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$885.79 ,"$1,158.34 ","$1,463.56 ",$885.79 ,$885.79 ,$953.93 ,$829.91 ,$13.09 ,"$1,463.56 ","$1,434.29 ","$1,362.75 ",$13.88 ,"$1,158.34 ","$3,293.01 ","$1,253.73 ",$953.93 ,$691.19 ,$829.51 ,$829.91 ,$829.51 ,$941.66 ,"$1,226.48 ",$931.03 ,"$1,448.64 ","$1,076.57 ",$13.88 ,$700.00 ,$700.00 ,"$1,434.29 ",$700.00 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$545.10 ,$359.77 ,$8.46 ,$597.07 ,$8.46 ,$373.61 ,$373.61 ,$265.36 ,$327.06 ,$463.34 ,$381.57 ,$8.46 ,$8.46 ,$517.85 ,$414.28 ,$408.83 ,$354.32 ,$463.34 ,$265.36 ,$354.32 ,$354.32 ,$381.57 ,$331.97 ,$8.46 ,$265.36 ,$260.05 ,$530.72 ,$8.97 ,$463.34 ,$597.07 ,$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 ,$262.65 ,$430.63 ,$8.97 ,$545.10 ,$545.10 ,$260.05 ,$545.10 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$805.00 ,$531.30 ,$8.46 ,$805.00 ,$8.46 ,$551.75 ,$551.75 ,$265.36 ,$483.00 ,$684.25 ,$563.50 ,$8.46 ,$8.46 ,$764.75 ,$611.80 ,$603.75 ,$523.25 ,$684.25 ,$265.36 ,$523.25 ,$523.25 ,$563.50 ,$490.25 ,$8.46 ,$265.36 ,$260.05 ,$530.72 ,$8.97 ,$684.25 ,$597.07 ,$740.60 ,$563.50 ,$408.30 ,$490.00 ,$490.25 ,$490.00 ,$556.26 ,$724.50 ,$549.98 ,$262.65 ,$635.95 ,$8.97 ,$700.00 ,$700.00 ,$260.05 ,$700.00 ,$579.60 ,$499.10 ,$579.60 ,$579.60 ,$644.00 
ST NICHOLAS HOSPITAL - ACUTE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$805.00 ,$531.30 ,$12.69 ,$895.61 ,$12.69 ,$551.75 ,$551.75 ,$398.05 ,$483.00 ,$684.25 ,$563.50 ,$12.69 ,$12.69 ,$764.75 ,$611.80 ,$603.75 ,$523.25 ,$684.25 ,$398.05 ,$523.25 ,$523.25 ,$563.50 ,$490.25 ,$12.69 ,$398.05 ,$390.09 ,$796.10 ,$13.45 ,$684.25 ,$895.61 ,$740.60 ,$563.50 ,$408.30 ,$490.00 ,$490.25 ,$490.00 ,$556.26 ,$724.50 ,$549.98 ,$393.99 ,$635.95 ,$13.45 ,$700.00 ,$700.00 ,$390.09 ,$700.00 ,$579.60 ,$499.10 ,$579.60 ,$579.60 ,$644.00 
ST NICHOLAS HOSPITAL - ACUTE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$805.00 ,$531.30 ,$12.69 ,$895.61 ,$12.69 ,$551.75 ,$551.75 ,$398.05 ,$483.00 ,$684.25 ,$563.50 ,$12.69 ,$12.69 ,$764.75 ,$611.80 ,$603.75 ,$523.25 ,$684.25 ,$398.05 ,$523.25 ,$523.25 ,$563.50 ,$490.25 ,$12.69 ,$398.05 ,$390.09 ,$796.10 ,$13.45 ,$684.25 ,$895.61 ,$740.60 ,$563.50 ,$408.30 ,$490.00 ,$490.25 ,$490.00 ,$556.26 ,$724.50 ,$549.98 ,$393.99 ,$635.95 ,$13.45 ,$700.00 ,$700.00 ,$390.09 ,$700.00 ,$579.60 ,$499.10 ,$579.60 ,$579.60 ,$644.00 
ST NICHOLAS HOSPITAL - ACUTE,45000072,20612,HC INJ GANGLION CYST,450,1 ,$607.20 ,$400.75 ,$8.46 ,$607.20 ,$8.46 ,$416.17 ,$416.17 ,$265.36 ,$364.32 ,$516.12 ,$425.04 ,$8.46 ,$8.46 ,$576.84 ,$461.47 ,$455.40 ,$394.68 ,$516.12 ,$265.36 ,$394.68 ,$394.68 ,$425.04 ,$369.78 ,$8.46 ,$265.36 ,$260.05 ,$530.72 ,$8.97 ,$516.12 ,$597.07 ,$558.62 ,$425.04 ,$307.97 ,$369.60 ,$369.78 ,$369.60 ,$419.58 ,$546.48 ,$414.84 ,$262.65 ,$479.69 ,$8.97 ,$607.20 ,$607.20 ,$260.05 ,$607.20 ,$437.18 ,$376.46 ,$437.18 ,$437.18 ,$485.76 
ST NICHOLAS HOSPITAL - ACUTE,45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,"$1,028.10 ",$678.55 ,$15.68 ,"$1,028.10 ",$15.68 ,$704.66 ,$704.66 ,$202.04 ,$616.86 ,$873.89 ,$719.67 ,$15.68 ,$15.68 ,$976.70 ,$781.36 ,$771.08 ,$668.27 ,$873.89 ,$202.04 ,$668.27 ,$668.27 ,$719.67 ,$626.11 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$873.89 ,$454.59 ,$945.85 ,$719.67 ,$521.45 ,$625.80 ,$626.11 ,$625.80 ,$710.42 ,$925.29 ,$702.40 ,$199.98 ,$812.20 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$740.23 ,$637.42 ,$740.23 ,$740.23 ,$822.48 
ST NICHOLAS HOSPITAL - ACUTE,45000075,23655,HC TX DISL SHLDR W/MAN/ANES CLS,450,1 ,"$1,734.20 ","$1,144.57 ",$34.94 ,"$3,150.21 ",$34.94 ,"$1,188.62 ","$1,188.62 ","$1,400.09 ","$1,040.52 ","$1,474.07 ","$1,213.94 ",$34.94 ,$34.94 ,"$1,647.49 ","$1,317.99 ","$1,300.65 ","$1,127.23 ","$1,474.07 ","$1,400.09 ","$1,127.23 ","$1,127.23 ","$1,213.94 ","$1,056.13 ",$34.94 ,"$1,400.09 ","$1,372.09 ","$1,734.20 ",$37.04 ,"$1,474.07 ","$3,150.21 ","$1,595.46 ","$1,213.94 ",$879.59 ,"$1,055.61 ","$1,056.13 ","$1,055.61 ","$1,198.33 ","$1,560.78 ","$1,184.81 ","$1,385.81 ","$1,370.02 ",$37.04 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$1,248.62 ","$1,075.20 ","$1,248.62 ","$1,248.62 ","$1,387.36 "
ST NICHOLAS HOSPITAL - ACUTE,45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$656.65 ,$433.39 ,$15.68 ,$656.65 ,$15.68 ,$450.07 ,$450.07 ,$202.04 ,$393.99 ,$558.15 ,$459.66 ,$15.68 ,$15.68 ,$623.82 ,$499.05 ,$492.49 ,$426.82 ,$558.15 ,$202.04 ,$426.82 ,$426.82 ,$459.66 ,$399.90 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$558.15 ,$454.59 ,$604.12 ,$459.66 ,$333.05 ,$399.70 ,$399.90 ,$399.70 ,$453.75 ,$590.99 ,$448.62 ,$199.98 ,$518.75 ,$16.62 ,$656.65 ,$656.65 ,$198.00 ,$656.65 ,$472.79 ,$407.12 ,$472.79 ,$472.79 ,$525.32 
ST NICHOLAS HOSPITAL - ACUTE,45000077,24605,HC CL TX ELBOW DISLOCATION W ANESTH,450,1 ,"$1,641.05 ","$1,083.09 ",$34.94 ,"$3,150.21 ",$34.94 ,"$1,124.78 ","$1,124.78 ","$1,400.09 ",$984.63 ,"$1,394.89 ","$1,148.74 ",$34.94 ,$34.94 ,"$1,559.00 ","$1,247.20 ","$1,230.79 ","$1,066.68 ","$1,394.89 ","$1,400.09 ","$1,066.68 ","$1,066.68 ","$1,148.74 ",$999.40 ,$34.94 ,"$1,400.09 ","$1,372.09 ","$1,641.05 ",$37.04 ,"$1,394.89 ","$3,150.21 ","$1,509.77 ","$1,148.74 ",$832.34 ,$998.91 ,$999.40 ,$998.91 ,"$1,133.97 ","$1,476.95 ","$1,121.17 ","$1,385.81 ","$1,296.43 ",$37.04 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$1,181.56 ","$1,017.45 ","$1,181.56 ","$1,181.56 ","$1,312.84 "
ST NICHOLAS HOSPITAL - ACUTE,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$607.20 ,$400.75 ,$15.68 ,$607.20 ,$15.68 ,$416.17 ,$416.17 ,$202.04 ,$364.32 ,$516.12 ,$425.04 ,$15.68 ,$15.68 ,$576.84 ,$461.47 ,$455.40 ,$394.68 ,$516.12 ,$202.04 ,$394.68 ,$394.68 ,$425.04 ,$369.78 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$516.12 ,$454.59 ,$558.62 ,$425.04 ,$307.97 ,$369.60 ,$369.78 ,$369.60 ,$419.58 ,$546.48 ,$414.84 ,$199.98 ,$479.69 ,$16.62 ,$607.20 ,$607.20 ,$198.00 ,$607.20 ,$437.18 ,$376.46 ,$437.18 ,$437.18 ,$485.76 
ST NICHOLAS HOSPITAL - ACUTE,45000081,25565,HC CL TX RADIAL/ULNAR SHAFT FX W MANIP,450,1 ,$954.50 ,$629.97 ,$15.68 ,"$3,150.21 ",$15.68 ,$654.21 ,$654.21 ,"$1,400.09 ",$572.70 ,$811.33 ,$668.15 ,$15.68 ,$15.68 ,$906.78 ,$725.42 ,$715.88 ,$620.43 ,$811.33 ,"$1,400.09 ",$620.43 ,$620.43 ,$668.15 ,$581.29 ,$15.68 ,"$1,400.09 ","$1,372.09 ",$954.50 ,$16.62 ,$811.33 ,"$3,150.21 ",$878.14 ,$668.15 ,$484.12 ,$581.00 ,$581.29 ,$581.00 ,$659.56 ,$859.05 ,$652.11 ,"$1,385.81 ",$754.06 ,$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,$687.24 ,$591.79 ,$687.24 ,$687.24 ,$763.60 
ST NICHOLAS HOSPITAL - ACUTE,45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,$954.50 ,$629.97 ,$15.68 ,"$3,150.21 ",$15.68 ,$654.21 ,$654.21 ,"$1,400.09 ",$572.70 ,$811.33 ,$668.15 ,$15.68 ,$15.68 ,$906.78 ,$725.42 ,$715.88 ,$620.43 ,$811.33 ,"$1,400.09 ",$620.43 ,$620.43 ,$668.15 ,$581.29 ,$15.68 ,"$1,400.09 ","$1,372.09 ",$954.50 ,$16.62 ,$811.33 ,"$3,150.21 ",$878.14 ,$668.15 ,$484.12 ,$581.00 ,$581.29 ,$581.00 ,$659.56 ,$859.05 ,$652.11 ,"$1,385.81 ",$754.06 ,$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,$687.24 ,$591.79 ,$687.24 ,$687.24 ,$763.60 
ST NICHOLAS HOSPITAL - ACUTE,45000083,26010,HC DRAIN ABSC FINGER SIMPLE,450,1 ,$495.65 ,$327.13 ,$5.80 ,$495.65 ,$5.80 ,$339.72 ,$339.72 ,$176.25 ,$297.39 ,$421.30 ,$346.96 ,$5.80 ,$5.80 ,$470.87 ,$376.69 ,$371.74 ,$322.17 ,$421.30 ,$176.25 ,$322.17 ,$322.17 ,$346.96 ,$301.85 ,$5.80 ,$176.25 ,$172.72 ,$352.50 ,$6.15 ,$421.30 ,$396.55 ,$456.00 ,$346.96 ,$251.39 ,$301.70 ,$301.85 ,$301.70 ,$342.49 ,$446.09 ,$338.63 ,$174.45 ,$391.56 ,$6.15 ,$495.65 ,$495.65 ,$172.72 ,$495.65 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,45000084,26011,HC DRAIN ABSC FINGER COMPLCD,450,1 ,"$4,854.15 ","$3,203.74 ",$38.33 ,"$4,854.15 ",$38.33 ,"$3,327.03 ","$3,327.03 ","$1,463.56 ","$2,912.49 ","$4,126.03 ","$3,397.91 ",$38.33 ,$38.33 ,"$4,611.44 ","$3,689.15 ","$3,640.61 ","$3,155.20 ","$4,126.03 ","$1,463.56 ","$3,155.20 ","$3,155.20 ","$3,397.91 ","$2,956.18 ",$38.33 ,"$1,463.56 ","$1,434.29 ","$2,927.12 ",$40.63 ,"$4,126.03 ","$3,293.01 ","$4,465.82 ","$3,397.91 ","$2,462.02 ","$2,954.72 ","$2,956.18 ","$2,954.72 ","$3,354.22 ","$4,368.74 ","$3,316.36 ","$1,448.64 ","$3,834.78 ",$40.63 ,$700.00 ,$700.00 ,"$1,434.29 ",$700.00 ,"$3,494.99 ","$3,009.57 ","$3,494.99 ","$3,494.99 ","$3,883.32 "
ST NICHOLAS HOSPITAL - ACUTE,45000085,26410,HC RPR TENDON HAND EXTEN W/O,450,1 ,"$2,354.05 ","$1,553.67 ",$46.19 ,"$3,150.21 ",$46.19 ,"$1,613.47 ","$1,613.47 ","$1,400.09 ","$1,412.43 ","$2,000.94 ","$1,647.84 ",$46.19 ,$46.19 ,"$2,236.35 ","$1,789.08 ","$1,765.54 ","$1,530.13 ","$2,000.94 ","$1,400.09 ","$1,530.13 ","$1,530.13 ","$1,647.84 ","$1,433.62 ",$46.19 ,"$1,400.09 ","$1,372.09 ","$2,354.05 ",$48.96 ,"$2,000.94 ","$3,150.21 ","$2,165.73 ","$1,647.84 ","$1,193.97 ","$1,432.91 ","$1,433.62 ","$1,432.91 ","$1,626.65 ","$2,118.65 ","$1,608.29 ","$1,385.81 ","$1,859.70 ",$48.96 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$1,694.92 ","$1,459.51 ","$1,694.92 ","$1,694.92 ","$1,883.24 "
ST NICHOLAS HOSPITAL - ACUTE,45000086,26418,HC RPR EXTEN TENDON FNGR W/O FREE,450,1 ,"$2,354.05 ","$1,553.67 ",$46.19 ,"$3,150.21 ",$46.19 ,"$1,613.47 ","$1,613.47 ","$1,400.09 ","$1,412.43 ","$2,000.94 ","$1,647.84 ",$46.19 ,$46.19 ,"$2,236.35 ","$1,789.08 ","$1,765.54 ","$1,530.13 ","$2,000.94 ","$1,400.09 ","$1,530.13 ","$1,530.13 ","$1,647.84 ","$1,433.62 ",$46.19 ,"$1,400.09 ","$1,372.09 ","$2,354.05 ",$48.96 ,"$2,000.94 ","$3,150.21 ","$2,165.73 ","$1,647.84 ","$1,193.97 ","$1,432.91 ","$1,433.62 ","$1,432.91 ","$1,626.65 ","$2,118.65 ","$1,608.29 ","$1,385.81 ","$1,859.70 ",$48.96 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$1,694.92 ","$1,459.51 ","$1,694.92 ","$1,694.92 ","$1,883.24 "
ST NICHOLAS HOSPITAL - ACUTE,45000087,26725,HC TX FX PHALANX PROX W/MAN CLS,450,1 ,$879.75 ,$580.64 ,$15.68 ,$879.75 ,$15.68 ,$602.98 ,$602.98 ,$202.04 ,$527.85 ,$747.79 ,$615.83 ,$15.68 ,$15.68 ,$835.76 ,$668.61 ,$659.81 ,$571.84 ,$747.79 ,$202.04 ,$571.84 ,$571.84 ,$615.83 ,$535.77 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$747.79 ,$454.59 ,$809.37 ,$615.83 ,$446.21 ,$535.50 ,$535.77 ,$535.50 ,$607.91 ,$791.78 ,$601.05 ,$199.98 ,$695.00 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$633.42 ,$545.45 ,$633.42 ,$633.42 ,$703.80 
ST NICHOLAS HOSPITAL - ACUTE,45000088,26742,HC TX FX (M-P)(I-P) JT W/MAN,450,1 ,$929.20 ,$613.27 ,$15.68 ,"$3,150.21 ",$15.68 ,$636.87 ,$636.87 ,"$1,400.09 ",$557.52 ,$789.82 ,$650.44 ,$15.68 ,$15.68 ,$882.74 ,$706.19 ,$696.90 ,$603.98 ,$789.82 ,"$1,400.09 ",$603.98 ,$603.98 ,$650.44 ,$565.88 ,$15.68 ,"$1,400.09 ","$1,372.09 ",$929.20 ,$16.62 ,$789.82 ,"$3,150.21 ",$854.86 ,$650.44 ,$471.29 ,$565.60 ,$565.88 ,$565.60 ,$642.08 ,$836.28 ,$634.83 ,"$1,385.81 ",$734.07 ,$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,$669.02 ,$576.10 ,$669.02 ,$669.02 ,$743.36 
ST NICHOLAS HOSPITAL - ACUTE,45000089,26755,HC TX FX PHALANX DIST W/MAN CLS,450,1 ,$879.75 ,$580.64 ,$15.68 ,$879.75 ,$15.68 ,$602.98 ,$602.98 ,$202.04 ,$527.85 ,$747.79 ,$615.83 ,$15.68 ,$15.68 ,$835.76 ,$668.61 ,$659.81 ,$571.84 ,$747.79 ,$202.04 ,$571.84 ,$571.84 ,$615.83 ,$535.77 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$747.79 ,$454.59 ,$809.37 ,$615.83 ,$446.21 ,$535.50 ,$535.77 ,$535.50 ,$607.91 ,$791.78 ,$601.05 ,$199.98 ,$695.00 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$633.42 ,$545.45 ,$633.42 ,$633.42 ,$703.80 
ST NICHOLAS HOSPITAL - ACUTE,45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$978.65 ,$645.91 ,$15.68 ,$978.65 ,$15.68 ,$670.77 ,$670.77 ,$202.04 ,$587.19 ,$831.85 ,$685.06 ,$15.68 ,$15.68 ,$929.72 ,$743.77 ,$733.99 ,$636.12 ,$831.85 ,$202.04 ,$636.12 ,$636.12 ,$685.06 ,$596.00 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$831.85 ,$454.59 ,$900.36 ,$685.06 ,$496.37 ,$595.70 ,$596.00 ,$595.70 ,$676.25 ,$880.79 ,$668.61 ,$199.98 ,$773.13 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$704.63 ,$606.76 ,$704.63 ,$704.63 ,$782.92 
ST NICHOLAS HOSPITAL - ACUTE,45000091,26951,HC AMPUT FINGER/THUMB SGL CLSR,450,1 ,"$3,221.15 ","$2,125.96 ",$46.19 ,"$6,536.75 ",$46.19 ,"$2,207.78 ","$2,207.78 ","$2,905.22 ","$1,932.69 ","$2,737.98 ","$2,254.81 ",$46.19 ,$46.19 ,"$3,060.09 ","$2,448.07 ","$2,415.86 ","$2,093.75 ","$2,737.98 ","$2,905.22 ","$2,093.75 ","$2,093.75 ","$2,254.81 ","$1,961.68 ",$46.19 ,"$2,905.22 ","$2,847.12 ","$3,221.15 ",$48.96 ,"$2,737.98 ","$6,536.75 ","$2,963.46 ","$2,254.81 ","$1,633.77 ","$1,960.71 ","$1,961.68 ","$1,960.71 ","$2,225.81 ","$2,899.04 ","$2,200.69 ","$2,875.58 ","$2,544.71 ",$48.96 ,$700.00 ,$700.00 ,"$2,847.12 ",$700.00 ,"$2,319.23 ","$1,997.11 ","$2,319.23 ","$2,319.23 ","$2,576.92 "
ST NICHOLAS HOSPITAL - ACUTE,45000092,27250,HC TX DISCL HIP CLOSED W/O ANES,450,1 ,$830.30 ,$548.00 ,$15.68 ,$830.30 ,$15.68 ,$569.09 ,$569.09 ,$202.04 ,$498.18 ,$705.76 ,$581.21 ,$15.68 ,$15.68 ,$788.79 ,$631.03 ,$622.73 ,$539.70 ,$705.76 ,$202.04 ,$539.70 ,$539.70 ,$581.21 ,$505.65 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$705.76 ,$454.59 ,$763.88 ,$581.21 ,$421.13 ,$505.40 ,$505.65 ,$505.40 ,$573.74 ,$747.27 ,$567.26 ,$199.98 ,$655.94 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$597.82 ,$514.79 ,$597.82 ,$597.82 ,$664.24 
ST NICHOLAS HOSPITAL - ACUTE,45000093,27252,HC CL TX HIP DISLOCATION; TRAUMATIC W ANESTH,450,1 ,"$1,334.00 ",$880.44 ,$34.94 ,"$3,150.21 ",$34.94 ,$914.32 ,$914.32 ,"$1,400.09 ",$800.40 ,"$1,133.90 ",$933.80 ,$34.94 ,$34.94 ,"$1,267.30 ","$1,013.84 ","$1,000.50 ",$867.10 ,"$1,133.90 ","$1,400.09 ",$867.10 ,$867.10 ,$933.80 ,$812.41 ,$34.94 ,"$1,400.09 ","$1,372.09 ","$1,334.00 ",$37.04 ,"$1,133.90 ","$3,150.21 ","$1,227.28 ",$933.80 ,$676.60 ,$812.01 ,$812.41 ,$812.01 ,$921.79 ,"$1,200.60 ",$911.39 ,"$1,385.81 ","$1,053.86 ",$37.04 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,$960.48 ,$827.08 ,$960.48 ,$960.48 ,"$1,067.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$978.65 ,$645.91 ,$15.68 ,$978.65 ,$15.68 ,$670.77 ,$670.77 ,$202.04 ,$587.19 ,$831.85 ,$685.06 ,$15.68 ,$15.68 ,$929.72 ,$743.77 ,$733.99 ,$636.12 ,$831.85 ,$202.04 ,$636.12 ,$636.12 ,$685.06 ,$596.00 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$831.85 ,$454.59 ,$900.36 ,$685.06 ,$496.37 ,$595.70 ,$596.00 ,$595.70 ,$676.25 ,$880.79 ,$668.61 ,$199.98 ,$773.13 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$704.63 ,$606.76 ,$704.63 ,$704.63 ,$782.92 
ST NICHOLAS HOSPITAL - ACUTE,45000095,27266,HC CL TX POST HIP ARTHROPLASTY DISLOCAT W ANESTH,450,1 ,"$2,105.65 ","$1,389.73 ",$34.94 ,"$3,150.21 ",$34.94 ,"$1,443.21 ","$1,443.21 ","$1,400.09 ","$1,263.39 ","$1,789.80 ","$1,473.96 ",$34.94 ,$34.94 ,"$2,000.37 ","$1,600.29 ","$1,579.24 ","$1,368.67 ","$1,789.80 ","$1,400.09 ","$1,368.67 ","$1,368.67 ","$1,473.96 ","$1,282.34 ",$34.94 ,"$1,400.09 ","$1,372.09 ","$2,105.65 ",$37.04 ,"$1,789.80 ","$3,150.21 ","$1,937.20 ","$1,473.96 ","$1,067.99 ","$1,281.71 ","$1,282.34 ","$1,281.71 ","$1,455.00 ","$1,895.09 ","$1,438.58 ","$1,385.81 ","$1,663.46 ",$37.04 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$1,516.07 ","$1,305.50 ","$1,516.07 ","$1,516.07 ","$1,684.52 "
ST NICHOLAS HOSPITAL - ACUTE,45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$830.30 ,$548.00 ,$15.68 ,$830.30 ,$15.68 ,$569.09 ,$569.09 ,$202.04 ,$498.18 ,$705.76 ,$581.21 ,$15.68 ,$15.68 ,$788.79 ,$631.03 ,$622.73 ,$539.70 ,$705.76 ,$202.04 ,$539.70 ,$539.70 ,$581.21 ,$505.65 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$705.76 ,$454.59 ,$763.88 ,$581.21 ,$421.13 ,$505.40 ,$505.65 ,$505.40 ,$573.74 ,$747.27 ,$567.26 ,$199.98 ,$655.94 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$597.82 ,$514.79 ,$597.82 ,$597.82 ,$664.24 
ST NICHOLAS HOSPITAL - ACUTE,45000097,28190,HC REM FB FOOT SUBQ,450,1 ,"$1,040.75 ",$686.90 ,$15.19 ,"$1,425.14 ",$15.19 ,$713.33 ,$713.33 ,$633.39 ,$624.45 ,$884.64 ,$728.53 ,$15.19 ,$15.19 ,$988.71 ,$790.97 ,$780.56 ,$676.49 ,$884.64 ,$633.39 ,$676.49 ,$676.49 ,$728.53 ,$633.82 ,$15.19 ,$633.39 ,$620.72 ,"$1,040.75 ",$16.10 ,$884.64 ,"$1,425.14 ",$957.49 ,$728.53 ,$527.87 ,$633.50 ,$633.82 ,$633.50 ,$719.16 ,$936.68 ,$711.04 ,$626.93 ,$822.19 ,$16.10 ,$700.00 ,$700.00 ,$620.72 ,$700.00 ,$749.34 ,$645.27 ,$749.34 ,$749.34 ,$832.60 
ST NICHOLAS HOSPITAL - ACUTE,45000098,29065,HC APPL CAST ARM LONG,450,1 ,$347.30 ,$229.22 ,$6.17 ,$526.84 ,$6.17 ,$238.04 ,$238.04 ,$234.15 ,$208.38 ,$295.21 ,$243.11 ,$6.17 ,$6.17 ,$329.94 ,$263.95 ,$260.48 ,$225.75 ,$295.21 ,$234.15 ,$225.75 ,$225.75 ,$243.11 ,$211.51 ,$6.17 ,$234.15 ,$229.47 ,$347.30 ,$6.54 ,$295.21 ,$526.84 ,$319.52 ,$243.11 ,$176.15 ,$211.40 ,$211.51 ,$211.40 ,$239.98 ,$312.57 ,$237.28 ,$231.76 ,$274.37 ,$6.54 ,$347.30 ,$347.30 ,$229.47 ,$347.30 ,$250.06 ,$215.33 ,$250.06 ,$250.06 ,$277.84 
ST NICHOLAS HOSPITAL - ACUTE,45000099,29075,HC CAST APPL; ELBOW TO FINGERS,450,1 ,$347.30 ,$229.22 ,$6.17 ,$526.84 ,$6.17 ,$238.04 ,$238.04 ,$234.15 ,$208.38 ,$295.21 ,$243.11 ,$6.17 ,$6.17 ,$329.94 ,$263.95 ,$260.48 ,$225.75 ,$295.21 ,$234.15 ,$225.75 ,$225.75 ,$243.11 ,$211.51 ,$6.17 ,$234.15 ,$229.47 ,$347.30 ,$6.54 ,$295.21 ,$526.84 ,$319.52 ,$243.11 ,$176.15 ,$211.40 ,$211.51 ,$211.40 ,$239.98 ,$312.57 ,$237.28 ,$231.76 ,$274.37 ,$6.54 ,$347.30 ,$347.30 ,$229.47 ,$347.30 ,$250.06 ,$215.33 ,$250.06 ,$250.06 ,$277.84 
ST NICHOLAS HOSPITAL - ACUTE,45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$483.00 ,$318.78 ,$2.42 ,$483.00 ,$2.42 ,$331.05 ,$331.05 ,$142.26 ,$289.80 ,$410.55 ,$338.10 ,$2.42 ,$2.42 ,$458.85 ,$367.08 ,$362.25 ,$313.95 ,$410.55 ,$142.26 ,$313.95 ,$313.95 ,$338.10 ,$294.15 ,$2.42 ,$142.26 ,$139.41 ,$284.52 ,$2.57 ,$410.55 ,$320.09 ,$444.36 ,$338.10 ,$244.98 ,$294.00 ,$294.15 ,$294.00 ,$333.75 ,$434.70 ,$329.99 ,$140.81 ,$381.57 ,$2.57 ,$483.00 ,$483.00 ,$139.41 ,$483.00 ,$347.76 ,$299.46 ,$347.76 ,$347.76 ,$386.40 
ST NICHOLAS HOSPITAL - ACUTE,45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$347.30 ,$229.22 ,$2.42 ,$347.30 ,$2.42 ,$238.04 ,$238.04 ,$113.32 ,$208.38 ,$295.21 ,$243.11 ,$2.42 ,$2.42 ,$329.94 ,$263.95 ,$260.48 ,$225.75 ,$295.21 ,$113.32 ,$225.75 ,$225.75 ,$243.11 ,$211.51 ,$2.42 ,$113.32 ,$111.05 ,$226.64 ,$2.57 ,$295.21 ,$254.98 ,$319.52 ,$243.11 ,$176.15 ,$211.40 ,$211.51 ,$211.40 ,$239.98 ,$312.57 ,$237.28 ,$112.16 ,$274.37 ,$2.57 ,$347.30 ,$347.30 ,$111.05 ,$347.30 ,$250.06 ,$215.33 ,$250.06 ,$250.06 ,$277.84 
ST NICHOLAS HOSPITAL - ACUTE,45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$309.35 ,$204.17 ,$2.42 ,$309.35 ,$2.42 ,$212.03 ,$212.03 ,$113.32 ,$185.61 ,$262.95 ,$216.55 ,$2.42 ,$2.42 ,$293.88 ,$235.11 ,$232.01 ,$201.08 ,$262.95 ,$113.32 ,$201.08 ,$201.08 ,$216.55 ,$188.39 ,$2.42 ,$113.32 ,$111.05 ,$226.64 ,$2.57 ,$262.95 ,$254.98 ,$284.60 ,$216.55 ,$156.90 ,$188.30 ,$188.39 ,$188.30 ,$213.76 ,$278.42 ,$211.35 ,$112.16 ,$244.39 ,$2.57 ,$309.35 ,$309.35 ,$111.05 ,$309.35 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$396.75 ,$261.86 ,$2.42 ,$396.75 ,$2.42 ,$271.93 ,$271.93 ,$113.32 ,$238.05 ,$337.24 ,$277.73 ,$2.42 ,$2.42 ,$376.91 ,$301.53 ,$297.56 ,$257.89 ,$337.24 ,$113.32 ,$257.89 ,$257.89 ,$277.73 ,$241.62 ,$2.42 ,$113.32 ,$111.05 ,$226.64 ,$2.57 ,$337.24 ,$254.98 ,$365.01 ,$277.73 ,$201.23 ,$241.50 ,$241.62 ,$241.50 ,$274.15 ,$357.08 ,$271.06 ,$112.16 ,$313.43 ,$2.57 ,$396.75 ,$396.75 ,$111.05 ,$396.75 ,$285.66 ,$245.99 ,$285.66 ,$285.66 ,$317.40 
ST NICHOLAS HOSPITAL - ACUTE,45000104,29131,HC APPL FINGER SPLINT DYNAMIC,450,1 ,$309.35 ,$204.17 ,$2.42 ,$309.35 ,$2.42 ,$212.03 ,$212.03 ,$56.10 ,$185.61 ,$262.95 ,$216.55 ,$2.42 ,$2.42 ,$293.88 ,$235.11 ,$232.01 ,$201.08 ,$262.95 ,$56.10 ,$201.08 ,$201.08 ,$216.55 ,$188.39 ,$2.42 ,$56.10 ,$54.98 ,$112.20 ,$2.57 ,$262.95 ,$126.23 ,$284.60 ,$216.55 ,$156.90 ,$188.30 ,$188.39 ,$188.30 ,$213.76 ,$278.42 ,$211.35 ,$55.53 ,$244.39 ,$2.57 ,$309.35 ,$309.35 ,$54.98 ,$309.35 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,45000105,29240,HC STRAPPING SHLDR,450,1 ,$309.35 ,$204.17 ,$2.42 ,$309.35 ,$2.42 ,$212.03 ,$212.03 ,$113.32 ,$185.61 ,$262.95 ,$216.55 ,$2.42 ,$2.42 ,$293.88 ,$235.11 ,$232.01 ,$201.08 ,$262.95 ,$113.32 ,$201.08 ,$201.08 ,$216.55 ,$188.39 ,$2.42 ,$113.32 ,$111.05 ,$226.64 ,$2.57 ,$262.95 ,$254.98 ,$284.60 ,$216.55 ,$156.90 ,$188.30 ,$188.39 ,$188.30 ,$213.76 ,$278.42 ,$211.35 ,$112.16 ,$244.39 ,$2.57 ,$309.35 ,$309.35 ,$111.05 ,$309.35 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$483.00 ,$318.78 ,$6.17 ,$526.84 ,$6.17 ,$331.05 ,$331.05 ,$234.15 ,$289.80 ,$410.55 ,$338.10 ,$6.17 ,$6.17 ,$458.85 ,$367.08 ,$362.25 ,$313.95 ,$410.55 ,$234.15 ,$313.95 ,$313.95 ,$338.10 ,$294.15 ,$6.17 ,$234.15 ,$229.47 ,$468.30 ,$6.54 ,$410.55 ,$526.84 ,$444.36 ,$338.10 ,$244.98 ,$294.00 ,$294.15 ,$294.00 ,$333.75 ,$434.70 ,$329.99 ,$231.76 ,$381.57 ,$6.54 ,$483.00 ,$483.00 ,$229.47 ,$483.00 ,$347.76 ,$299.46 ,$347.76 ,$347.76 ,$386.40 
ST NICHOLAS HOSPITAL - ACUTE,45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$483.00 ,$318.78 ,$2.42 ,$483.00 ,$2.42 ,$331.05 ,$331.05 ,$142.26 ,$289.80 ,$410.55 ,$338.10 ,$2.42 ,$2.42 ,$458.85 ,$367.08 ,$362.25 ,$313.95 ,$410.55 ,$142.26 ,$313.95 ,$313.95 ,$338.10 ,$294.15 ,$2.42 ,$142.26 ,$139.41 ,$284.52 ,$2.57 ,$410.55 ,$320.09 ,$444.36 ,$338.10 ,$244.98 ,$294.00 ,$294.15 ,$294.00 ,$333.75 ,$434.70 ,$329.99 ,$140.81 ,$381.57 ,$2.57 ,$483.00 ,$483.00 ,$139.41 ,$483.00 ,$347.76 ,$299.46 ,$347.76 ,$347.76 ,$386.40 
ST NICHOLAS HOSPITAL - ACUTE,45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$483.00 ,$318.78 ,$2.42 ,$483.00 ,$2.42 ,$331.05 ,$331.05 ,$142.26 ,$289.80 ,$410.55 ,$338.10 ,$2.42 ,$2.42 ,$458.85 ,$367.08 ,$362.25 ,$313.95 ,$410.55 ,$142.26 ,$313.95 ,$313.95 ,$338.10 ,$294.15 ,$2.42 ,$142.26 ,$139.41 ,$284.52 ,$2.57 ,$410.55 ,$320.09 ,$444.36 ,$338.10 ,$244.98 ,$294.00 ,$294.15 ,$294.00 ,$333.75 ,$434.70 ,$329.99 ,$140.81 ,$381.57 ,$2.57 ,$483.00 ,$483.00 ,$139.41 ,$483.00 ,$347.76 ,$299.46 ,$347.76 ,$347.76 ,$386.40 
ST NICHOLAS HOSPITAL - ACUTE,45000109,29705,HC REM/BIV CAST ARM/LEG,450,1 ,$545.10 ,$359.77 ,$6.17 ,$545.10 ,$6.17 ,$373.61 ,$373.61 ,$234.15 ,$327.06 ,$463.34 ,$381.57 ,$6.17 ,$6.17 ,$517.85 ,$414.28 ,$408.83 ,$354.32 ,$463.34 ,$234.15 ,$354.32 ,$354.32 ,$381.57 ,$331.97 ,$6.17 ,$234.15 ,$229.47 ,$468.30 ,$6.54 ,$463.34 ,$526.84 ,$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 ,$231.76 ,$430.63 ,$6.54 ,$545.10 ,$545.10 ,$229.47 ,$545.10 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,45000110,30300,HC REM FB INTRANASAL,450,1 ,$433.55 ,$286.14 ,$5.60 ,$433.55 ,$5.60 ,$297.16 ,$297.16 ,$113.32 ,$260.13 ,$368.52 ,$303.49 ,$5.60 ,$5.60 ,$411.87 ,$329.50 ,$325.16 ,$281.81 ,$368.52 ,$113.32 ,$281.81 ,$281.81 ,$303.49 ,$264.03 ,$5.60 ,$113.32 ,$111.05 ,$226.64 ,$5.94 ,$368.52 ,$254.98 ,$398.87 ,$303.49 ,$219.90 ,$263.90 ,$264.03 ,$263.90 ,$299.58 ,$390.20 ,$296.20 ,$112.16 ,$342.50 ,$5.94 ,$433.55 ,$433.55 ,$111.05 ,$433.55 ,$312.16 ,$268.80 ,$312.16 ,$312.16 ,$346.84 
ST NICHOLAS HOSPITAL - ACUTE,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$446.20 ,$294.49 ,$5.60 ,$446.20 ,$5.60 ,$305.83 ,$305.83 ,$113.32 ,$267.72 ,$379.27 ,$312.34 ,$5.60 ,$5.60 ,$423.89 ,$339.11 ,$334.65 ,$290.03 ,$379.27 ,$113.32 ,$290.03 ,$290.03 ,$312.34 ,$271.74 ,$5.60 ,$113.32 ,$111.05 ,$226.64 ,$5.94 ,$379.27 ,$254.98 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$112.16 ,$352.50 ,$5.94 ,$446.20 ,$446.20 ,$111.05 ,$446.20 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,45000112,30903,HC CNTRL NOSEBLEED ANT CPLX,450,1 ,$545.10 ,$359.77 ,$5.60 ,$545.10 ,$5.60 ,$373.61 ,$373.61 ,$113.32 ,$327.06 ,$463.34 ,$381.57 ,$5.60 ,$5.60 ,$517.85 ,$414.28 ,$408.83 ,$354.32 ,$463.34 ,$113.32 ,$354.32 ,$354.32 ,$381.57 ,$331.97 ,$5.60 ,$113.32 ,$111.05 ,$226.64 ,$5.94 ,$463.34 ,$254.98 ,$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 ,$112.16 ,$430.63 ,$5.94 ,$545.10 ,$545.10 ,$111.05 ,$545.10 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$495.65 ,$327.13 ,$5.60 ,$495.65 ,$5.60 ,$339.72 ,$339.72 ,$113.32 ,$297.39 ,$421.30 ,$346.96 ,$5.60 ,$5.60 ,$470.87 ,$376.69 ,$371.74 ,$322.17 ,$421.30 ,$113.32 ,$322.17 ,$322.17 ,$346.96 ,$301.85 ,$5.60 ,$113.32 ,$111.05 ,$226.64 ,$5.94 ,$421.30 ,$254.98 ,$456.00 ,$346.96 ,$251.39 ,$301.70 ,$301.85 ,$301.70 ,$342.49 ,$446.09 ,$338.63 ,$112.16 ,$391.56 ,$5.94 ,$495.65 ,$495.65 ,$111.05 ,$495.65 ,$356.87 ,$307.30 ,$356.87 ,$356.87 ,$396.52 
ST NICHOLAS HOSPITAL - ACUTE,45000114,31238,HC NASAL ENDO W EPISTAX CONTROL,450,1 ,"$3,100.00 ","$2,046.00 ",$66.11 ,"$3,510.44 ",$66.11 ,"$2,124.74 ","$2,124.74 ","$1,560.19 ","$1,860.00 ","$2,635.00 ","$2,170.00 ",$66.11 ,$66.11 ,"$2,945.00 ","$2,356.00 ","$2,325.00 ","$2,015.00 ","$2,635.00 ","$1,560.19 ","$2,015.00 ","$2,015.00 ","$2,170.00 ","$1,887.90 ",$66.11 ,"$1,560.19 ","$1,528.99 ","$3,100.00 ",$70.08 ,"$2,635.00 ","$3,510.44 ","$2,852.00 ","$2,170.00 ","$1,572.32 ","$1,886.97 ","$1,887.90 ","$1,886.97 ","$2,142.10 ","$2,790.00 ","$2,117.92 ","$1,544.27 ","$2,449.00 ",$70.08 ,$700.00 ,$700.00 ,"$1,528.99 ",$700.00 ,"$2,232.00 ","$1,922.00 ","$2,232.00 ","$2,232.00 ","$2,480.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000116,31720,HC ASP CATH NASOTRACHEAL,450,1 ,$285.20 ,$188.23 ,$1.89 ,$420.53 ,$1.89 ,$195.48 ,$195.48 ,$186.90 ,$171.12 ,$242.42 ,$199.64 ,$1.89 ,$1.89 ,$270.94 ,$216.75 ,$213.90 ,$185.38 ,$242.42 ,$186.90 ,$185.38 ,$185.38 ,$199.64 ,$173.69 ,$1.89 ,$186.90 ,$183.16 ,$285.20 ,$2.00 ,$242.42 ,$420.53 ,$262.38 ,$199.64 ,$144.65 ,$173.60 ,$173.69 ,$173.60 ,$197.07 ,$256.68 ,$194.85 ,$184.99 ,$225.31 ,$2.00 ,$285.20 ,$285.20 ,$183.16 ,$285.20 ,$205.34 ,$176.82 ,$205.34 ,$205.34 ,$228.16 
ST NICHOLAS HOSPITAL - ACUTE,45000123,36400,HC IV START < 3 YEARS OLD (MD),450,1 ,$197.80 ,$130.55 ,$0.08 ,$197.80 ,$0.08 ,$135.57 ,$135.57 , N/A ,$118.68 ,$168.13 , N/A ,$0.08 ,$0.08 ,$187.91 ,$150.33 ,$148.35 ,$128.57 ,$168.13 , N/A ,$128.57 ,$128.57 ,$138.46 ,$120.46 ,$0.08 , N/A , N/A , N/A ,$0.08 ,$168.13 , N/A ,$181.98 ,$138.46 ,$100.32 ,$120.40 ,$120.46 ,$120.40 ,$136.68 ,$178.02 ,$135.14 , N/A ,$156.26 ,$0.08 ,$197.80 ,$197.80 , N/A ,$197.80 ,$142.42 ,$122.64 ,$142.42 ,$142.42 ,$158.24 
ST NICHOLAS HOSPITAL - ACUTE,45000124,36406,HC VENIPUNCTURE <3YR VEIN OTHR,450,1 ,$34.50 ,$22.77 ,$0.08 ,$34.50 ,$0.08 ,$23.65 ,$23.65 , N/A ,$20.70 ,$29.33 ,$24.15 ,$0.08 ,$0.08 ,$32.78 ,$26.22 ,$25.88 ,$22.43 ,$29.33 , N/A ,$22.43 ,$22.43 ,$24.15 ,$21.01 ,$0.08 , N/A , N/A , N/A ,$0.08 ,$29.33 , N/A ,$31.74 ,$24.15 ,$17.50 ,$21.00 ,$21.01 ,$21.00 ,$23.84 ,$31.05 ,$23.57 , N/A ,$27.26 ,$0.08 ,$34.50 ,$34.50 , N/A ,$34.50 ,$24.84 ,$21.39 ,$24.84 ,$24.84 ,$27.60 
ST NICHOLAS HOSPITAL - ACUTE,45000132,36680,HC PLACE NDL INFS INTRAOSSEOUS,450,1 ,$669.30 ,$441.74 ,$8.46 ,$829.14 ,$8.46 ,$458.74 ,$458.74 ,$368.51 ,$401.58 ,$568.91 ,$468.51 ,$8.46 ,$8.46 ,$635.84 ,$508.67 ,$501.98 ,$435.05 ,$568.91 ,$368.51 ,$435.05 ,$435.05 ,$468.51 ,$407.60 ,$8.46 ,$368.51 ,$361.14 ,$669.30 ,$8.97 ,$568.91 ,$829.14 ,$615.76 ,$468.51 ,$339.47 ,$407.40 ,$407.60 ,$407.40 ,$462.49 ,$602.37 ,$457.27 ,$364.76 ,$528.75 ,$8.97 ,$669.30 ,$669.30 ,$361.14 ,$669.30 ,$481.90 ,$414.97 ,$481.90 ,$481.90 ,$535.44 
ST NICHOLAS HOSPITAL - ACUTE,45000133,40650,HC RPR LIP FULL THICK VERMILN,450,1 ,"$1,238.55 ",$817.44 ,$5.60 ,"$1,238.55 ",$5.60 ,$848.90 ,$848.90 ,$445.86 ,$743.13 ,"$1,052.77 ",$866.99 ,$5.60 ,$5.60 ,"$1,176.62 ",$941.30 ,$928.91 ,$805.06 ,"$1,052.77 ",$445.86 ,$805.06 ,$805.06 ,$866.99 ,$754.28 ,$5.60 ,$445.86 ,$436.94 ,$891.72 ,$5.94 ,"$1,052.77 ","$1,003.18 ","$1,139.47 ",$866.99 ,$628.19 ,$753.91 ,$754.28 ,$753.91 ,$855.84 ,"$1,114.70 ",$846.18 ,$441.31 ,$978.45 ,$5.94 ,$700.00 ,$700.00 ,$436.94 ,$700.00 ,$891.76 ,$767.90 ,$891.76 ,$891.76 ,$990.84 
ST NICHOLAS HOSPITAL - ACUTE,45000134,40652,HC RPR LIP UP 1/2 VERTICAL,450,1 ,"$1,238.55 ",$817.44 ,$5.60 ,"$1,238.55 ",$5.60 ,$848.90 ,$848.90 ,$445.86 ,$743.13 ,"$1,052.77 ",$866.99 ,$5.60 ,$5.60 ,"$1,176.62 ",$941.30 ,$928.91 ,$805.06 ,"$1,052.77 ",$445.86 ,$805.06 ,$805.06 ,$866.99 ,$754.28 ,$5.60 ,$445.86 ,$436.94 ,$891.72 ,$5.94 ,"$1,052.77 ","$1,003.18 ","$1,139.47 ",$866.99 ,$628.19 ,$753.91 ,$754.28 ,$753.91 ,$855.84 ,"$1,114.70 ",$846.18 ,$441.31 ,$978.45 ,$5.94 ,$700.00 ,$700.00 ,$436.94 ,$700.00 ,$891.76 ,$767.90 ,$891.76 ,$891.76 ,$990.84 
ST NICHOLAS HOSPITAL - ACUTE,45000135,40654,HC RPR LIP CPLX,450,1 ,"$1,734.20 ","$1,144.57 ",$51.06 ,"$3,048.36 ",$51.06 ,"$1,188.62 ","$1,188.62 ","$1,354.82 ","$1,040.52 ","$1,474.07 ","$1,213.94 ",$51.06 ,$51.06 ,"$1,647.49 ","$1,317.99 ","$1,300.65 ","$1,127.23 ","$1,474.07 ","$1,354.82 ","$1,127.23 ","$1,127.23 ","$1,213.94 ","$1,056.13 ",$51.06 ,"$1,354.82 ","$1,327.72 ","$1,734.20 ",$54.12 ,"$1,474.07 ","$3,048.36 ","$1,595.46 ","$1,213.94 ",$879.59 ,"$1,055.61 ","$1,056.13 ","$1,055.61 ","$1,198.33 ","$1,560.78 ","$1,184.81 ","$1,341.00 ","$1,370.02 ",$54.12 ,$700.00 ,$700.00 ,"$1,327.72 ",$700.00 ,"$1,248.62 ","$1,075.20 ","$1,248.62 ","$1,248.62 ","$1,387.36 "
ST NICHOLAS HOSPITAL - ACUTE,45000136,40800,HC DRAINAGE MOUTH LESION,450,1 ,"$2,084.95 ","$1,376.07 ",$42.01 ,"$2,084.95 ",$42.01 ,"$1,429.02 ","$1,429.02 ",$633.39 ,"$1,250.97 ","$1,772.21 ","$1,459.47 ",$42.01 ,$42.01 ,"$1,980.70 ","$1,584.56 ","$1,563.71 ","$1,355.22 ","$1,772.21 ",$633.39 ,"$1,355.22 ","$1,355.22 ","$1,459.47 ","$1,269.73 ",$42.01 ,$633.39 ,$620.72 ,"$1,266.78 ",$44.53 ,"$1,772.21 ","$1,425.14 ","$1,918.15 ","$1,459.47 ","$1,057.49 ","$1,269.11 ","$1,269.73 ","$1,269.11 ","$1,440.70 ","$1,876.46 ","$1,424.44 ",$626.93 ,"$1,647.11 ",$44.53 ,$700.00 ,$700.00 ,$620.72 ,$700.00 ,"$1,501.16 ","$1,292.67 ","$1,501.16 ","$1,501.16 ","$1,667.96 "
ST NICHOLAS HOSPITAL - ACUTE,45000137,40830,HC LAC REPAIR VESTIBULE MOUTH 2.5 CM OR LESS,450,1 ,$731.40 ,$482.72 ,$5.60 ,$731.40 ,$5.60 ,$501.30 ,$501.30 ,$202.84 ,$438.84 ,$621.69 ,$511.98 ,$5.60 ,$5.60 ,$694.83 ,$555.86 ,$548.55 ,$475.41 ,$621.69 ,$202.84 ,$475.41 ,$475.41 ,$511.98 ,$445.42 ,$5.60 ,$202.84 ,$198.78 ,$405.68 ,$5.94 ,$621.69 ,$456.39 ,$672.89 ,$511.98 ,$370.97 ,$445.20 ,$445.42 ,$445.20 ,$505.40 ,$658.26 ,$499.69 ,$200.77 ,$577.81 ,$5.94 ,$700.00 ,$700.00 ,$198.78 ,$700.00 ,$526.61 ,$453.47 ,$526.61 ,$526.61 ,$585.12 
ST NICHOLAS HOSPITAL - ACUTE,45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$644.00 ,$425.04 ,$5.60 ,$829.14 ,$5.60 ,$441.40 ,$441.40 ,$368.51 ,$386.40 ,$547.40 ,$450.80 ,$5.60 ,$5.60 ,$611.80 ,$489.44 ,$483.00 ,$418.60 ,$547.40 ,$368.51 ,$418.60 ,$418.60 ,$450.80 ,$392.20 ,$5.60 ,$368.51 ,$361.14 ,$644.00 ,$5.94 ,$547.40 ,$829.14 ,$592.48 ,$450.80 ,$326.64 ,$392.00 ,$392.20 ,$392.00 ,$445.00 ,$579.60 ,$439.98 ,$364.76 ,$508.76 ,$5.94 ,$644.00 ,$644.00 ,$361.14 ,$644.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$483.00 ,$318.78 ,$5.60 ,$483.00 ,$5.60 ,$331.05 ,$331.05 ,$113.32 ,$289.80 ,$410.55 ,$338.10 ,$5.60 ,$5.60 ,$458.85 ,$367.08 ,$362.25 ,$313.95 ,$410.55 ,$113.32 ,$313.95 ,$313.95 ,$338.10 ,$294.15 ,$5.60 ,$113.32 ,$111.05 ,$226.64 ,$5.94 ,$410.55 ,$254.98 ,$444.36 ,$338.10 ,$244.98 ,$294.00 ,$294.15 ,$294.00 ,$333.75 ,$434.70 ,$329.99 ,$112.16 ,$381.57 ,$5.94 ,$483.00 ,$483.00 ,$111.05 ,$483.00 ,$347.76 ,$299.46 ,$347.76 ,$347.76 ,$386.40 
ST NICHOLAS HOSPITAL - ACUTE,45000140,42700,HC I AND D ABSC PERITONSILLAR,450,1 ,$731.40 ,$482.72 ,$5.60 ,$731.40 ,$5.60 ,$501.30 ,$501.30 ,$202.84 ,$438.84 ,$621.69 ,$511.98 ,$5.60 ,$5.60 ,$694.83 ,$555.86 ,$548.55 ,$475.41 ,$621.69 ,$202.84 ,$475.41 ,$475.41 ,$511.98 ,$445.42 ,$5.60 ,$202.84 ,$198.78 ,$405.68 ,$5.94 ,$621.69 ,$456.39 ,$672.89 ,$511.98 ,$370.97 ,$445.20 ,$445.42 ,$445.20 ,$505.40 ,$658.26 ,$499.69 ,$200.77 ,$577.81 ,$5.94 ,$700.00 ,$700.00 ,$198.78 ,$700.00 ,$526.61 ,$453.47 ,$526.61 ,$526.61 ,$585.12 
ST NICHOLAS HOSPITAL - ACUTE,45000141,42809,HC REMOVE PHARYNX FOREIGN BODY,450,1 ,$247.25 ,$163.19 ,$5.60 ,$829.14 ,$5.60 ,$169.47 ,$169.47 ,$368.51 ,$148.35 ,$210.16 ,$173.08 ,$5.60 ,$5.60 ,$234.89 ,$187.91 ,$185.44 ,$160.71 ,$210.16 ,$368.51 ,$160.71 ,$160.71 ,$173.08 ,$150.58 ,$5.60 ,$368.51 ,$361.14 ,$247.25 ,$5.94 ,$210.16 ,$829.14 ,$227.47 ,$173.08 ,$125.41 ,$150.50 ,$150.58 ,$150.50 ,$170.85 ,$222.53 ,$168.92 ,$364.76 ,$195.33 ,$5.94 ,$247.25 ,$247.25 ,$361.14 ,$247.25 ,$178.02 ,$153.30 ,$178.02 ,$178.02 ,$197.80 
ST NICHOLAS HOSPITAL - ACUTE,45000143,43753,HC GASTRIC LAVAGE,450,1 ,$731.40 ,$482.72 ,$267.87 ,$731.40 , N/A ,$501.30 ,$501.30 ,$273.34 ,$438.84 ,$621.69 ,$511.98 , N/A , N/A ,$694.83 ,$555.86 ,$548.55 ,$475.41 ,$621.69 ,$273.34 ,$475.41 ,$475.41 ,$511.98 ,$445.42 , N/A ,$273.34 ,$267.87 ,$546.68 , N/A ,$621.69 ,$615.01 ,$672.89 ,$511.98 ,$370.97 ,$445.20 ,$445.42 ,$445.20 ,$505.40 ,$658.26 ,$499.69 ,$270.55 ,$577.81 , N/A ,$700.00 ,$700.00 ,$267.87 ,$700.00 ,$526.61 ,$453.47 ,$526.61 ,$526.61 ,$585.12 
ST NICHOLAS HOSPITAL - ACUTE,45000146,46040,HC INCISION RECTAL ABSCESS,450,1 ,"$3,096.95 ","$2,043.99 ",$51.36 ,"$3,096.95 ",$51.36 ,"$2,122.65 ","$2,122.65 ","$1,056.92 ","$1,858.17 ","$2,632.41 ","$2,167.87 ",$51.36 ,$51.36 ,"$2,942.10 ","$2,353.68 ","$2,322.71 ","$2,013.02 ","$2,632.41 ","$1,056.92 ","$2,013.02 ","$2,013.02 ","$2,167.87 ","$1,886.04 ",$51.36 ,"$1,056.92 ","$1,035.78 ","$2,113.84 ",$54.44 ,"$2,632.41 ","$2,378.07 ","$2,849.19 ","$2,167.87 ","$1,570.77 ","$1,885.11 ","$1,886.04 ","$1,885.11 ","$2,139.99 ","$2,787.26 ","$2,115.84 ","$1,046.14 ","$2,446.59 ",$54.44 ,$700.00 ,$700.00 ,"$1,035.78 ",$700.00 ,"$2,229.80 ","$1,920.11 ","$2,229.80 ","$2,229.80 ","$2,477.56 "
ST NICHOLAS HOSPITAL - ACUTE,45000147,46050,HC I AND D ABSC PERIANAL SUPFIC,450,1 ,"$1,362.75 ",$899.42 ,$51.36 ,"$1,824.96 ",$51.36 ,$934.03 ,$934.03 ,$811.10 ,$817.65 ,"$1,158.34 ",$953.93 ,$51.36 ,$51.36 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$885.79 ,"$1,158.34 ",$811.10 ,$885.79 ,$885.79 ,$953.93 ,$829.91 ,$51.36 ,$811.10 ,$794.88 ,"$1,362.75 ",$54.44 ,"$1,158.34 ","$1,824.96 ","$1,253.73 ",$953.93 ,$691.19 ,$829.51 ,$829.91 ,$829.51 ,$941.66 ,"$1,226.48 ",$931.03 ,$802.83 ,"$1,076.57 ",$54.44 ,$700.00 ,$700.00 ,$794.88 ,$700.00 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000148,46083,HC INC HEMORRHOID EXTERNAL,450,1 ,$545.10 ,$359.77 ,$51.36 ,$545.10 ,$51.36 ,$373.61 ,$373.61 ,$209.71 ,$327.06 ,$463.34 ,$381.57 ,$51.36 ,$51.36 ,$517.85 ,$414.28 ,$408.83 ,$354.32 ,$463.34 ,$209.71 ,$354.32 ,$354.32 ,$381.57 ,$331.97 ,$51.36 ,$209.71 ,$205.52 ,$419.42 ,$54.44 ,$463.34 ,$471.85 ,$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 ,$207.57 ,$430.63 ,$54.44 ,$545.10 ,$545.10 ,$205.52 ,$545.10 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,45000149,46320,HC EXCISION THROMBOSED HEMORRHOID; EXTERNAL,450,1 ,"$2,725.50 ","$1,798.83 ",$51.36 ,"$2,725.50 ",$51.36 ,"$1,868.06 ","$1,868.06 ","$1,056.92 ","$1,635.30 ","$2,316.68 ","$1,907.85 ",$51.36 ,$51.36 ,"$2,589.23 ","$2,071.38 ","$2,044.13 ","$1,771.58 ","$2,316.68 ","$1,056.92 ","$1,771.58 ","$1,771.58 ","$1,907.85 ","$1,659.83 ",$51.36 ,"$1,056.92 ","$1,035.78 ","$2,113.84 ",$54.44 ,"$2,316.68 ","$2,378.07 ","$2,507.46 ","$1,907.85 ","$1,382.37 ","$1,659.01 ","$1,659.83 ","$1,659.01 ","$1,883.32 ","$2,452.95 ","$1,862.06 ","$1,046.14 ","$2,153.15 ",$54.44 ,$700.00 ,$700.00 ,"$1,035.78 ",$700.00 ,"$1,962.36 ","$1,689.81 ","$1,962.36 ","$1,962.36 ","$2,180.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000150,46600,HC ANOSCOPY,450,1 ,$230.00 ,$151.80 ,$6.83 ,$254.98 ,$6.83 ,$157.64 ,$157.64 ,$113.32 ,$138.00 ,$195.50 ,$161.00 ,$6.83 ,$6.83 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$113.32 ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$6.83 ,$113.32 ,$111.05 ,$226.64 ,$7.24 ,$195.50 ,$254.98 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 ,$112.16 ,$181.70 ,$7.24 ,$230.00 ,$230.00 ,$111.05 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,45000151,46608,HC ANOSCOPY W FB REMOVAL,450,1 ,"$2,200.00 ","$1,452.00 ",$34.52 ,"$2,200.00 ",$34.52 ,"$1,507.88 ","$1,507.88 ",$811.10 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$34.52 ,$34.52 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,430.00 ","$1,870.00 ",$811.10 ,"$1,430.00 ","$1,430.00 ","$1,540.00 ","$1,339.80 ",$34.52 ,$811.10 ,$794.88 ,"$1,622.20 ",$36.59 ,"$1,870.00 ","$1,824.96 ","$2,024.00 ","$1,540.00 ","$1,115.84 ","$1,339.14 ","$1,339.80 ","$1,339.14 ","$1,520.20 ","$1,980.00 ","$1,503.04 ",$802.83 ,"$1,738.00 ",$36.59 ,$700.00 ,$700.00 ,$794.88 ,$700.00 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$594.55 ,$392.40 ,$2.75 ,$594.55 ,$2.75 ,$407.50 ,$407.50 ,$209.71 ,$356.73 ,$505.37 ,$416.19 ,$2.75 ,$2.75 ,$564.82 ,$451.86 ,$445.91 ,$386.46 ,$505.37 ,$209.71 ,$386.46 ,$386.46 ,$416.19 ,$362.08 ,$2.75 ,$209.71 ,$205.52 ,$419.42 ,$2.92 ,$505.37 ,$471.85 ,$546.99 ,$416.19 ,$301.56 ,$361.90 ,$362.08 ,$361.90 ,$410.83 ,$535.10 ,$406.20 ,$207.57 ,$469.69 ,$2.92 ,$594.55 ,$594.55 ,$205.52 ,$594.55 ,$428.08 ,$368.62 ,$428.08 ,$428.08 ,$475.64 
ST NICHOLAS HOSPITAL - ACUTE,45000157,51705,HC CHG TUBE CYSTOSTOMY SMP,450,1 ,$681.95 ,$450.09 ,$2.75 ,$681.95 ,$2.75 ,$467.41 ,$467.41 ,$209.71 ,$409.17 ,$579.66 ,$477.37 ,$2.75 ,$2.75 ,$647.85 ,$518.28 ,$511.46 ,$443.27 ,$579.66 ,$209.71 ,$443.27 ,$443.27 ,$477.37 ,$415.31 ,$2.75 ,$209.71 ,$205.52 ,$419.42 ,$2.92 ,$579.66 ,$471.85 ,$627.39 ,$477.37 ,$345.89 ,$415.10 ,$415.31 ,$415.10 ,$471.23 ,$613.76 ,$465.91 ,$207.57 ,$538.74 ,$2.92 ,$681.95 ,$681.95 ,$205.52 ,$681.95 ,$491.00 ,$422.81 ,$491.00 ,$491.00 ,$545.56 
ST NICHOLAS HOSPITAL - ACUTE,45000159,54220,HC IRRIG CORPORA CAVNOSA,450,1 ,$519.80 ,$343.07 ,$2.75 ,$519.80 ,$2.75 ,$356.27 ,$356.27 ,$209.71 ,$311.88 ,$441.83 ,$363.86 ,$2.75 ,$2.75 ,$493.81 ,$395.05 ,$389.85 ,$337.87 ,$441.83 ,$209.71 ,$337.87 ,$337.87 ,$363.86 ,$316.56 ,$2.75 ,$209.71 ,$205.52 ,$419.42 ,$2.92 ,$441.83 ,$471.85 ,$478.22 ,$363.86 ,$263.64 ,$316.40 ,$316.56 ,$316.40 ,$359.18 ,$467.82 ,$355.13 ,$207.57 ,$410.64 ,$2.92 ,$519.80 ,$519.80 ,$205.52 ,$519.80 ,$374.26 ,$322.28 ,$374.26 ,$374.26 ,$415.84 
ST NICHOLAS HOSPITAL - ACUTE,45000160,54450,HC MANIP FORESKIN STRETCH,450,1 ,$892.40 ,$588.98 ,$13.57 ,$892.40 ,$13.57 ,$611.65 ,$611.65 ,$209.71 ,$535.44 ,$758.54 ,$624.68 ,$13.57 ,$13.57 ,$847.78 ,$678.22 ,$669.30 ,$580.06 ,$758.54 ,$209.71 ,$580.06 ,$580.06 ,$624.68 ,$543.47 ,$13.57 ,$209.71 ,$205.52 ,$419.42 ,$14.38 ,$758.54 ,$471.85 ,$821.01 ,$624.68 ,$452.63 ,$543.20 ,$543.47 ,$543.20 ,$616.65 ,$803.16 ,$609.69 ,$207.57 ,$705.00 ,$14.38 ,$700.00 ,$700.00 ,$205.52 ,$700.00 ,$642.53 ,$553.29 ,$642.53 ,$642.53 ,$713.92 
ST NICHOLAS HOSPITAL - ACUTE,45000161,54700,HC I AND D EPIDIDYMIS TESTIS OR SCROTAL SPACE,450,1 ,"$2,354.05 ","$1,553.67 ",$71.49 ,"$4,073.32 ",$71.49 ,"$1,613.47 ","$1,613.47 ","$1,810.36 ","$1,412.43 ","$2,000.94 ","$1,647.84 ",$71.49 ,$71.49 ,"$2,236.35 ","$1,789.08 ","$1,765.54 ","$1,530.13 ","$2,000.94 ","$1,810.36 ","$1,530.13 ","$1,530.13 ","$1,647.84 ","$1,433.62 ",$71.49 ,"$1,810.36 ","$1,774.15 ","$2,354.05 ",$75.78 ,"$2,000.94 ","$4,073.32 ","$2,165.73 ","$1,647.84 ","$1,193.97 ","$1,432.91 ","$1,433.62 ","$1,432.91 ","$1,626.65 ","$2,118.65 ","$1,608.29 ","$1,791.89 ","$1,859.70 ",$75.78 ,$700.00 ,$700.00 ,"$1,774.15 ",$700.00 ,"$1,694.92 ","$1,459.51 ","$1,694.92 ","$1,694.92 ","$1,883.24 "
ST NICHOLAS HOSPITAL - ACUTE,45000162,55100,HC DRAIN ABSC SCROTAL WALL,450,1 ,"$1,077.55 ",$711.18 ,$71.49 ,"$3,293.01 ",$71.49 ,$738.55 ,$738.55 ,"$1,463.56 ",$646.53 ,$915.92 ,$754.29 ,$71.49 ,$71.49 ,"$1,023.67 ",$818.94 ,$808.16 ,$700.41 ,$915.92 ,"$1,463.56 ",$700.41 ,$700.41 ,$754.29 ,$656.23 ,$71.49 ,"$1,463.56 ","$1,434.29 ","$1,077.55 ",$75.78 ,$915.92 ,"$3,293.01 ",$991.35 ,$754.29 ,$546.53 ,$655.90 ,$656.23 ,$655.90 ,$744.59 ,$969.80 ,$736.18 ,"$1,448.64 ",$851.26 ,$75.78 ,$700.00 ,$700.00 ,"$1,434.29 ",$700.00 ,$775.84 ,$668.08 ,$775.84 ,$775.84 ,$862.04 
ST NICHOLAS HOSPITAL - ACUTE,45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$681.95 ,$450.09 ,$6.57 ,$681.95 ,$6.57 ,$467.41 ,$467.41 ,$284.95 ,$409.17 ,$579.66 ,$477.37 ,$6.57 ,$6.57 ,$647.85 ,$518.28 ,$511.46 ,$443.27 ,$579.66 ,$284.95 ,$443.27 ,$443.27 ,$477.37 ,$415.31 ,$6.57 ,$284.95 ,$279.25 ,$569.90 ,$6.96 ,$579.66 ,$641.14 ,$627.39 ,$477.37 ,$345.89 ,$415.10 ,$415.31 ,$415.10 ,$471.23 ,$613.76 ,$465.91 ,$282.04 ,$538.74 ,$6.96 ,$681.95 ,$681.95 ,$279.25 ,$681.95 ,$491.00 ,$422.81 ,$491.00 ,$491.00 ,$545.56 
ST NICHOLAS HOSPITAL - ACUTE,45000164,56420,HC I AND D ABSC GLAND BARTHOLIN'S,450,1 ,$581.90 ,$384.05 ,$6.57 ,$581.90 ,$6.57 ,$398.83 ,$398.83 ,$173.85 ,$349.14 ,$494.62 ,$407.33 ,$6.57 ,$6.57 ,$552.81 ,$442.24 ,$436.43 ,$378.24 ,$494.62 ,$173.85 ,$378.24 ,$378.24 ,$407.33 ,$354.38 ,$6.57 ,$173.85 ,$170.37 ,$347.70 ,$6.96 ,$494.62 ,$391.17 ,$535.35 ,$407.33 ,$295.14 ,$354.20 ,$354.38 ,$354.20 ,$402.09 ,$523.71 ,$397.55 ,$172.08 ,$459.70 ,$6.96 ,$581.90 ,$581.90 ,$170.37 ,$581.90 ,$418.97 ,$360.78 ,$418.97 ,$418.97 ,$465.52 
ST NICHOLAS HOSPITAL - ACUTE,45000165,58301,HC REM DVC INTRAUTERINE,450,1 ,$259.90 ,$171.53 ,$6.57 ,$641.14 ,$6.57 ,$178.14 ,$178.14 ,$284.95 ,$155.94 ,$220.92 ,$181.93 ,$6.57 ,$6.57 ,$246.91 ,$197.52 ,$194.93 ,$168.94 ,$220.92 ,$284.95 ,$168.94 ,$168.94 ,$181.93 ,$158.28 ,$6.57 ,$284.95 ,$279.25 ,$259.90 ,$6.96 ,$220.92 ,$641.14 ,$239.11 ,$181.93 ,$131.82 ,$158.20 ,$158.28 ,$158.20 ,$179.59 ,$233.91 ,$177.56 ,$282.04 ,$205.32 ,$6.96 ,$259.90 ,$259.90 ,$279.25 ,$259.90 ,$187.13 ,$161.14 ,$187.13 ,$187.13 ,$207.92 
ST NICHOLAS HOSPITAL - ACUTE,45000166,59414,HC DELIVERY OF PLACENTA,450,1 ,"$3,964.05 ","$2,616.27 ",$69.86 ,"$6,209.06 ",$69.86 ,"$2,716.96 ","$2,716.96 ","$2,759.58 ","$2,378.43 ","$3,369.44 ","$2,774.84 ",$69.86 ,$69.86 ,"$3,765.85 ","$3,012.68 ","$2,973.04 ","$2,576.63 ","$3,369.44 ","$2,759.58 ","$2,576.63 ","$2,576.63 ","$2,774.84 ","$2,414.11 ",$69.86 ,"$2,759.58 ","$2,704.39 ","$3,964.05 ",$74.05 ,"$3,369.44 ","$6,209.06 ","$3,646.93 ","$2,774.84 ","$2,010.57 ","$2,412.92 ","$2,414.11 ","$2,412.92 ","$2,739.16 ","$3,567.65 ","$2,708.24 ","$2,731.44 ","$3,131.60 ",$74.05 ,$700.00 ,$700.00 ,"$2,704.39 ",$700.00 ,"$2,854.12 ","$2,457.71 ","$2,854.12 ","$2,854.12 ","$3,171.24 "
ST NICHOLAS HOSPITAL - ACUTE,45000168,64400,HC DENTAL BLOCK,450,1 ,$879.75 ,$580.64 ,$13.98 ,$879.75 ,$13.98 ,$602.98 ,$602.98 ,$265.36 ,$527.85 ,$747.79 ,$615.83 ,$13.98 ,$13.98 ,$835.76 ,$668.61 ,$659.81 ,$571.84 ,$747.79 ,$265.36 ,$571.84 ,$571.84 ,$615.83 ,$535.77 ,$13.98 ,$265.36 ,$260.05 ,$530.72 ,$14.82 ,$747.79 ,$597.07 ,$809.37 ,$615.83 ,$446.21 ,$535.50 ,$535.77 ,$535.50 ,$607.91 ,$791.78 ,$601.05 ,$262.65 ,$695.00 ,$14.82 ,$700.00 ,$700.00 ,$260.05 ,$700.00 ,$633.42 ,$545.45 ,$633.42 ,$633.42 ,$703.80 
ST NICHOLAS HOSPITAL - ACUTE,45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$437.00 ,$288.42 ,$13.98 ,$597.07 ,$13.98 ,$299.52 ,$299.52 ,$265.36 ,$262.20 ,$371.45 ,$305.90 ,$13.98 ,$13.98 ,$415.15 ,$332.12 ,$327.75 ,$284.05 ,$371.45 ,$265.36 ,$284.05 ,$284.05 ,$305.90 ,$266.13 ,$13.98 ,$265.36 ,$260.05 ,$437.00 ,$14.82 ,$371.45 ,$597.07 ,$402.04 ,$305.90 ,$221.65 ,$266.00 ,$266.13 ,$266.00 ,$301.97 ,$393.30 ,$298.56 ,$262.65 ,$345.23 ,$14.82 ,$437.00 ,$437.00 ,$260.05 ,$437.00 ,$314.64 ,$270.94 ,$314.64 ,$314.64 ,$349.60 
ST NICHOLAS HOSPITAL - ACUTE,45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,$954.50 ,$629.97 ,$13.98 ,"$1,414.97 ",$13.98 ,$654.21 ,$654.21 ,$628.88 ,$572.70 ,$811.33 ,$668.15 ,$13.98 ,$13.98 ,$906.78 ,$725.42 ,$715.88 ,$620.43 ,$811.33 ,$628.88 ,$620.43 ,$620.43 ,$668.15 ,$581.29 ,$13.98 ,$628.88 ,$616.30 ,$954.50 ,$14.82 ,$811.33 ,"$1,414.97 ",$878.14 ,$668.15 ,$484.12 ,$581.00 ,$581.29 ,$581.00 ,$659.56 ,$859.05 ,$652.11 ,$622.47 ,$754.06 ,$14.82 ,$700.00 ,$700.00 ,$616.30 ,$700.00 ,$687.24 ,$591.79 ,$687.24 ,$687.24 ,$763.60 
ST NICHOLAS HOSPITAL - ACUTE,45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$438.15 ,$289.18 ,$2.54 ,$438.15 ,$2.54 ,$300.31 ,$300.31 ,$113.32 ,$262.89 ,$372.43 ,$306.71 ,$2.54 ,$2.54 ,$416.24 ,$332.99 ,$328.61 ,$284.80 ,$372.43 ,$113.32 ,$284.80 ,$284.80 ,$306.71 ,$266.83 ,$2.54 ,$113.32 ,$111.05 ,$226.64 ,$2.69 ,$372.43 ,$254.98 ,$403.10 ,$306.71 ,$222.23 ,$266.70 ,$266.83 ,$266.70 ,$302.76 ,$394.34 ,$299.34 ,$112.16 ,$346.14 ,$2.69 ,$438.15 ,$438.15 ,$111.05 ,$438.15 ,$315.47 ,$271.65 ,$315.47 ,$315.47 ,$350.52 
ST NICHOLAS HOSPITAL - ACUTE,45000172,65210,HC REM EYE FB CONJUCT EMBED,450,1 ,$438.15 ,$289.18 ,$2.54 ,$829.14 ,$2.54 ,$300.31 ,$300.31 ,$368.51 ,$262.89 ,$372.43 ,$306.71 ,$2.54 ,$2.54 ,$416.24 ,$332.99 ,$328.61 ,$284.80 ,$372.43 ,$368.51 ,$284.80 ,$284.80 ,$306.71 ,$266.83 ,$2.54 ,$368.51 ,$361.14 ,$438.15 ,$2.69 ,$372.43 ,$829.14 ,$403.10 ,$306.71 ,$222.23 ,$266.70 ,$266.83 ,$266.70 ,$302.76 ,$394.34 ,$299.34 ,$364.76 ,$346.14 ,$2.69 ,$438.15 ,$438.15 ,$361.14 ,$438.15 ,$315.47 ,$271.65 ,$315.47 ,$315.47 ,$350.52 
ST NICHOLAS HOSPITAL - ACUTE,45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$438.15 ,$289.18 ,$2.54 ,$829.14 ,$2.54 ,$300.31 ,$300.31 ,$368.51 ,$262.89 ,$372.43 ,$306.71 ,$2.54 ,$2.54 ,$416.24 ,$332.99 ,$328.61 ,$284.80 ,$372.43 ,$368.51 ,$284.80 ,$284.80 ,$306.71 ,$266.83 ,$2.54 ,$368.51 ,$361.14 ,$438.15 ,$2.69 ,$372.43 ,$829.14 ,$403.10 ,$306.71 ,$222.23 ,$266.70 ,$266.83 ,$266.70 ,$302.76 ,$394.34 ,$299.34 ,$364.76 ,$346.14 ,$2.69 ,$438.15 ,$438.15 ,$361.14 ,$438.15 ,$315.47 ,$271.65 ,$315.47 ,$315.47 ,$350.52 
ST NICHOLAS HOSPITAL - ACUTE,45000174,65222,HC REM FB CORNL W/ SLIT LA,450,1 ,$463.45 ,$305.88 ,$2.54 ,$463.45 ,$2.54 ,$317.65 ,$317.65 ,$113.32 ,$278.07 ,$393.93 ,$324.42 ,$2.54 ,$2.54 ,$440.28 ,$352.22 ,$347.59 ,$301.24 ,$393.93 ,$113.32 ,$301.24 ,$301.24 ,$324.42 ,$282.24 ,$2.54 ,$113.32 ,$111.05 ,$226.64 ,$2.69 ,$393.93 ,$254.98 ,$426.37 ,$324.42 ,$235.06 ,$282.10 ,$282.24 ,$282.10 ,$320.24 ,$417.11 ,$316.63 ,$112.16 ,$366.13 ,$2.69 ,$463.45 ,$463.45 ,$111.05 ,$463.45 ,$333.68 ,$287.34 ,$333.68 ,$333.68 ,$370.76 
ST NICHOLAS HOSPITAL - ACUTE,45000175,65235,HC REMOVE FB EYE; INTRAOCULAR ANTERIOR CHAMBER,450,1 ,"$2,447.20 ","$1,615.15 ",$32.35 ,"$4,742.13 ",$32.35 ,"$1,677.31 ","$1,677.31 ","$2,107.61 ","$1,468.32 ","$2,080.12 ","$1,713.04 ",$32.35 ,$32.35 ,"$2,324.84 ","$1,859.87 ","$1,835.40 ","$1,590.68 ","$2,080.12 ","$2,107.61 ","$1,590.68 ","$1,590.68 ","$1,713.04 ","$1,490.34 ",$32.35 ,"$2,107.61 ","$2,065.46 ","$2,447.20 ",$34.29 ,"$2,080.12 ","$4,742.13 ","$2,251.42 ","$1,713.04 ","$1,241.22 ","$1,489.61 ","$1,490.34 ","$1,489.61 ","$1,691.02 ","$2,202.48 ","$1,671.93 ","$2,086.12 ","$1,933.29 ",$34.29 ,$700.00 ,$700.00 ,"$2,065.46 ",$700.00 ,"$1,761.98 ","$1,517.26 ","$1,761.98 ","$1,761.98 ","$1,957.76 "
ST NICHOLAS HOSPITAL - ACUTE,45000176,65260,HC REMOVE FB EYE; INTRAOCULAR POSTERIOR SEGMENT,450,1 ,"$1,120.10 ",$739.27 ,$33.70 ,"$4,742.13 ",$33.70 ,$767.72 ,$767.72 ,"$2,107.61 ",$672.06 ,$952.09 ,$784.07 ,$33.70 ,$33.70 ,"$1,064.10 ",$851.28 ,$840.08 ,$728.07 ,$952.09 ,"$2,107.61 ",$728.07 ,$728.07 ,$784.07 ,$682.14 ,$33.70 ,"$2,107.61 ","$2,065.46 ","$1,120.10 ",$35.72 ,$952.09 ,"$4,742.13 ","$1,030.49 ",$784.07 ,$568.11 ,$681.80 ,$682.14 ,$681.80 ,$773.99 ,"$1,008.09 ",$765.25 ,"$2,086.12 ",$884.88 ,$35.72 ,$700.00 ,$700.00 ,"$2,065.46 ",$700.00 ,$806.47 ,$694.46 ,$806.47 ,$806.47 ,$896.08 
ST NICHOLAS HOSPITAL - ACUTE,45000177,67700,HC I AND D ABSCESS EYELID,450,1 ,$644.00 ,$425.04 ,$9.49 ,$644.00 ,$9.49 ,$441.40 ,$441.40 ,$258.36 ,$386.40 ,$547.40 ,$450.80 ,$9.49 ,$9.49 ,$611.80 ,$489.44 ,$483.00 ,$418.60 ,$547.40 ,$258.36 ,$418.60 ,$418.60 ,$450.80 ,$392.20 ,$9.49 ,$258.36 ,$253.19 ,$516.72 ,$10.06 ,$547.40 ,$581.30 ,$592.48 ,$450.80 ,$326.64 ,$392.00 ,$392.20 ,$392.00 ,$445.00 ,$579.60 ,$439.98 ,$255.72 ,$508.76 ,$10.06 ,$644.00 ,$644.00 ,$253.19 ,$644.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,$604.90 ,$399.23 ,$9.49 ,$604.90 ,$9.49 ,$414.60 ,$414.60 ,$258.36 ,$362.94 ,$514.17 ,$423.43 ,$9.49 ,$9.49 ,$574.66 ,$459.72 ,$453.68 ,$393.19 ,$514.17 ,$258.36 ,$393.19 ,$393.19 ,$423.43 ,$368.38 ,$9.49 ,$258.36 ,$253.19 ,$516.72 ,$10.06 ,$514.17 ,$581.30 ,$556.51 ,$423.43 ,$306.81 ,$368.20 ,$368.38 ,$368.20 ,$417.99 ,$544.41 ,$413.27 ,$255.72 ,$477.87 ,$10.06 ,$604.90 ,$604.90 ,$253.19 ,$604.90 ,$435.53 ,$375.04 ,$435.53 ,$435.53 ,$483.92 
ST NICHOLAS HOSPITAL - ACUTE,45000179,69000,HC DRAIN ABSC/HEMA EAR EXT SMP,450,1 ,$570.40 ,$376.46 ,$5.60 ,"$1,425.14 ",$5.60 ,$390.95 ,$390.95 ,$633.39 ,$342.24 ,$484.84 ,$399.28 ,$5.60 ,$5.60 ,$541.88 ,$433.50 ,$427.80 ,$370.76 ,$484.84 ,$633.39 ,$370.76 ,$370.76 ,$399.28 ,$347.37 ,$5.60 ,$633.39 ,$620.72 ,$570.40 ,$5.94 ,$484.84 ,"$1,425.14 ",$524.77 ,$399.28 ,$289.31 ,$347.20 ,$347.37 ,$347.20 ,$394.15 ,$513.36 ,$389.70 ,$626.93 ,$450.62 ,$5.94 ,$570.40 ,$570.40 ,$620.72 ,$570.40 ,$410.69 ,$353.65 ,$410.69 ,$410.69 ,$456.32 
ST NICHOLAS HOSPITAL - ACUTE,45000180,69005,HC I AND D ABSCESS EXTERNAL EAR CMPLX,450,1 ,"$1,672.10 ","$1,103.59 ",$51.06 ,"$3,293.01 ",$51.06 ,"$1,146.06 ","$1,146.06 ","$1,463.56 ","$1,003.26 ","$1,421.29 ","$1,170.47 ",$51.06 ,$51.06 ,"$1,588.50 ","$1,270.80 ","$1,254.08 ","$1,086.87 ","$1,421.29 ","$1,463.56 ","$1,086.87 ","$1,086.87 ","$1,170.47 ","$1,018.31 ",$51.06 ,"$1,463.56 ","$1,434.29 ","$1,672.10 ",$54.12 ,"$1,421.29 ","$3,293.01 ","$1,538.33 ","$1,170.47 ",$848.09 ,"$1,017.81 ","$1,018.31 ","$1,017.81 ","$1,155.42 ","$1,504.89 ","$1,142.38 ","$1,448.64 ","$1,320.96 ",$54.12 ,$700.00 ,$700.00 ,"$1,434.29 ",$700.00 ,"$1,203.91 ","$1,036.70 ","$1,203.91 ","$1,203.91 ","$1,337.68 "
ST NICHOLAS HOSPITAL - ACUTE,45000181,69200,HC FB REMOVAL EAR,450,1 ,$247.25 ,$163.19 ,$111.05 ,$254.98 , N/A ,$169.47 ,$169.47 ,$113.32 ,$148.35 ,$210.16 ,$173.08 , N/A , N/A ,$234.89 ,$187.91 ,$185.44 ,$160.71 ,$210.16 ,$113.32 ,$160.71 ,$160.71 ,$173.08 ,$150.58 , N/A ,$113.32 ,$111.05 ,$226.64 , N/A ,$210.16 ,$254.98 ,$227.47 ,$173.08 ,$125.41 ,$150.50 ,$150.58 ,$150.50 ,$170.85 ,$222.53 ,$168.92 ,$112.16 ,$195.33 , N/A ,$247.25 ,$247.25 ,$111.05 ,$247.25 ,$178.02 ,$153.30 ,$178.02 ,$178.02 ,$197.80 
ST NICHOLAS HOSPITAL - ACUTE,45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$124.20 ,$81.97 ,$54.98 ,$126.23 , N/A ,$85.13 ,$85.13 ,$56.10 ,$74.52 ,$105.57 ,$86.94 , N/A , N/A ,$117.99 ,$94.39 ,$93.15 ,$80.73 ,$105.57 ,$56.10 ,$80.73 ,$80.73 ,$86.94 ,$75.64 , N/A ,$56.10 ,$54.98 ,$112.20 , N/A ,$105.57 ,$126.23 ,$114.26 ,$86.94 ,$62.99 ,$75.60 ,$75.64 ,$75.60 ,$85.82 ,$111.78 ,$84.85 ,$55.53 ,$98.12 , N/A ,$124.20 ,$124.20 ,$54.98 ,$124.20 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,45000185,92511,HC NASOPHARYNGOSCOPY,450,1 ,$310.00 ,$204.60 ,$5.60 ,$392.54 ,$5.60 ,$212.47 ,$212.47 ,$174.46 ,$186.00 ,$263.50 ,$217.00 ,$5.60 ,$5.60 ,$294.50 ,$235.60 ,$232.50 ,$201.50 ,$263.50 ,$174.46 ,$201.50 ,$201.50 ,$217.00 ,$188.79 ,$5.60 ,$174.46 ,$170.97 ,$310.00 ,$5.94 ,$263.50 ,$392.54 ,$285.20 ,$217.00 ,$157.23 ,$188.70 ,$188.79 ,$188.70 ,$214.21 ,$279.00 ,$211.79 ,$172.68 ,$244.90 ,$5.94 ,$310.00 ,$310.00 ,$170.97 ,$310.00 ,$223.20 ,$192.20 ,$223.20 ,$223.20 ,$248.00 
ST NICHOLAS HOSPITAL - ACUTE,45000186,92953,HC TEMPORARY EXTERNAL PACING,450,1 ,"$1,362.75 ",$899.42 ,$21.86 ,"$1,362.75 ",$21.86 ,$934.03 ,$934.03 ,$574.02 ,$817.65 ,"$1,158.34 ",$953.93 ,$21.86 ,$21.86 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$885.79 ,"$1,158.34 ",$574.02 ,$885.79 ,$885.79 ,$953.93 ,$829.91 ,$21.86 ,$574.02 ,$562.54 ,"$1,148.04 ",$23.17 ,"$1,158.34 ","$1,291.56 ","$1,253.73 ",$953.93 ,$691.19 ,$829.51 ,$829.91 ,$829.51 ,$941.66 ,"$1,226.48 ",$931.03 ,$568.16 ,"$1,076.57 ",$23.17 ,$700.00 ,$700.00 ,$562.54 ,$700.00 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000187,92977,HC THROMBOLYSIS CORONARY IV INFS,450,1 ,$863.00 ,$569.58 ,$17.55 ,$863.00 ,$17.55 ,$591.50 ,$591.50 ,$324.64 ,$517.80 ,$733.55 ,$604.10 ,$17.55 ,$17.55 ,$819.85 ,$655.88 ,$647.25 ,$560.95 ,$733.55 ,$324.64 ,$560.95 ,$560.95 ,$604.10 ,$525.57 ,$17.55 ,$324.64 ,$318.15 ,$649.28 ,$18.60 ,$733.55 ,$730.43 ,$793.96 ,$604.10 ,$437.71 ,$525.31 ,$525.57 ,$525.31 ,$596.33 ,$776.70 ,$589.60 ,$321.33 ,$681.77 ,$18.60 ,$700.00 ,$700.00 ,$318.15 ,$700.00 ,$621.36 ,$535.06 ,$621.36 ,$621.36 ,$690.40 
ST NICHOLAS HOSPITAL - ACUTE,45000188,99281,HC ER LEVEL 1,450,1 ,$170.00 ,$112.20 ,$4.33 ,$170.00 ,$4.33 ,$170.00 ,$170.00 ,$73.29 ,$102.00 ,$144.50 ,$119.00 ,$4.33 ,$4.33 ,$161.50 ,$129.20 ,$127.50 ,$170.00 ,$144.50 ,$73.29 ,$170.00 ,$170.00 ,$119.00 ,$103.53 ,$4.33 ,$73.29 ,$71.82 ,$146.58 ,$4.59 ,$144.50 ,$164.90 ,$156.40 ,$119.00 ,$86.22 ,$103.48 ,$103.53 ,$103.48 ,$117.47 ,$153.00 ,$116.14 ,$72.54 ,$134.30 ,$4.59 ,$170.00 ,$170.00 ,$71.82 ,$170.00 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,45000189,99282,HC ER LEVEL 2,450,1 ,$340.00 ,$224.40 ,$4.33 ,$340.00 ,$4.33 ,$340.00 ,$340.00 ,$136.34 ,$204.00 ,$289.00 ,$238.00 ,$4.33 ,$4.33 ,$323.00 ,$258.40 ,$255.00 ,$340.00 ,$289.00 ,$136.34 ,$340.00 ,$340.00 ,$238.00 ,$207.06 ,$4.33 ,$136.34 ,$133.61 ,$272.68 ,$4.59 ,$289.00 ,$306.76 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$232.29 ,$134.95 ,$268.60 ,$4.59 ,$340.00 ,$340.00 ,$133.61 ,$340.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,45000190,99283,HC ER LEVEL 3,450,1 ,"$1,200.00 ",$792.00 ,$4.33 ,"$1,200.00 ",$4.33 ,"$1,200.00 ","$1,089.00 ",$239.15 ,$720.00 ,"$1,020.00 ",$840.00 ,$4.33 ,$4.33 ,"$1,140.00 ",$912.00 ,$900.00 ,"$1,200.00 ","$1,020.00 ",$239.15 ,"$1,200.00 ","$1,200.00 ",$840.00 ,$730.80 ,$4.33 ,$239.15 ,$234.37 ,$478.30 ,$4.59 ,"$1,020.00 ",$538.09 ,"$1,104.00 ",$840.00 ,$608.64 ,$730.44 ,$730.80 ,$730.44 ,$829.20 ,"$1,080.00 ",$819.84 ,$236.71 ,$948.00 ,$4.59 ,"$1,200.00 ","$1,200.00 ",$234.37 ,"$1,200.00 ",$864.00 ,$744.00 ,$864.00 ,$864.00 ,$960.00 
ST NICHOLAS HOSPITAL - ACUTE,45000191,99284,HC ER LEVEL 4,450,1 ,"$1,800.00 ","$1,188.00 ",$4.33 ,"$1,800.00 ",$4.33 ,"$1,800.00 ","$1,800.00 ",$372.45 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$4.33 ,$4.33 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,800.00 ","$1,530.00 ",$372.45 ,"$1,800.00 ","$1,800.00 ","$1,260.00 ","$1,096.20 ",$4.33 ,$372.45 ,$365.00 ,$744.90 ,$4.59 ,"$1,530.00 ",$838.02 ,"$1,656.00 ","$1,260.00 ",$912.96 ,"$1,095.66 ","$1,096.20 ","$1,095.66 ","$1,243.80 ","$1,620.00 ","$1,229.76 ",$368.65 ,"$1,422.00 ",$4.59 ,"$1,800.00 ","$1,800.00 ",$365.00 ,"$1,800.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000192,99285,HC ER LEVEL 5,450,1 ,"$2,400.00 ","$1,584.00 ",$4.33 ,"$2,400.00 ",$4.33 ,"$2,400.00 ","$2,400.00 ",$534.96 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$4.33 ,$4.33 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ","$2,400.00 ","$2,040.00 ",$534.96 ,"$2,400.00 ","$2,400.00 ","$1,680.00 ","$1,461.60 ",$4.33 ,$534.96 ,$524.26 ,"$1,069.92 ",$4.59 ,"$2,040.00 ","$1,203.65 ","$2,208.00 ","$1,680.00 ","$1,217.28 ","$1,460.88 ","$1,461.60 ","$1,460.88 ","$1,658.40 ","$2,160.00 ","$1,639.68 ",$529.50 ,"$1,896.00 ",$4.59 ,"$2,400.00 ","$2,400.00 ",$524.26 ,"$2,400.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000193,99291,HC CRITICAL CARE 30-74 MIN,450,1 ,"$2,900.00 ","$1,914.00 ",$4.33 ,"$2,900.00 ",$4.33 ,"$2,900.00 ","$2,900.00 ",$749.29 ,"$1,740.00 ","$2,465.00 ","$2,030.00 ",$4.33 ,$4.33 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ",$749.29 ,"$2,900.00 ","$2,900.00 ","$2,030.00 ","$1,766.10 ",$4.33 ,$749.29 ,$734.30 ,"$1,498.58 ",$4.59 ,"$2,465.00 ","$1,685.91 ","$2,668.00 ","$2,030.00 ","$1,470.88 ","$1,765.23 ","$1,766.10 ","$1,765.23 ","$2,003.90 ","$2,610.00 ","$1,981.28 ",$741.64 ,"$2,291.00 ",$4.59 ,"$2,900.00 ","$2,900.00 ",$734.30 ,"$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000194,99285,HC ER LEVEL 5 SANE,450,1 ,"$2,400.00 ","$1,584.00 ",$4.33 ,"$2,400.00 ",$4.33 ,"$2,400.00 ","$2,400.00 ",$534.96 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$4.33 ,$4.33 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ","$2,400.00 ","$2,040.00 ",$534.96 ,"$2,400.00 ","$2,400.00 ","$1,680.00 ","$1,461.60 ",$4.33 ,$534.96 ,$524.26 ,"$1,069.92 ",$4.59 ,"$2,040.00 ","$1,203.65 ","$2,208.00 ","$1,680.00 ","$1,217.28 ","$1,460.88 ","$1,461.60 ","$1,460.88 ","$1,658.40 ","$2,160.00 ","$1,639.68 ",$529.50 ,"$1,896.00 ",$4.59 ,"$2,400.00 ","$2,400.00 ",$524.26 ,"$2,400.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,$510.00 ,$336.60 ,$4.33 ,$510.00 ,$4.33 ,$349.55 ,$349.55 , N/A ,$306.00 ,$433.50 ,$357.00 ,$4.33 ,$4.33 ,$484.50 ,$387.60 ,$382.50 ,$331.50 ,$433.50 , N/A ,$331.50 ,$331.50 ,$357.00 ,$310.59 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$433.50 , N/A ,$469.20 ,$357.00 ,$258.67 ,$310.44 ,$310.59 ,$310.44 ,$352.41 ,$459.00 ,$348.43 , N/A ,$402.90 ,$4.59 ,$510.00 ,$510.00 , N/A ,$510.00 ,$367.20 ,$316.20 ,$367.20 ,$367.20 ,$408.00 
ST NICHOLAS HOSPITAL - ACUTE,45000196,27810,HC TX FX BIM ANKLE W/MAN CLS,450,1 ,$954.50 ,$629.97 ,$15.68 ,"$3,150.21 ",$15.68 ,$654.21 ,$654.21 ,"$1,400.09 ",$572.70 ,$811.33 ,$668.15 ,$15.68 ,$15.68 ,$906.78 ,$725.42 ,$715.88 ,$620.43 ,$811.33 ,"$1,400.09 ",$620.43 ,$620.43 ,$668.15 ,$581.29 ,$15.68 ,"$1,400.09 ","$1,372.09 ",$954.50 ,$16.62 ,$811.33 ,"$3,150.21 ",$878.14 ,$668.15 ,$484.12 ,$581.00 ,$581.29 ,$581.00 ,$659.56 ,$859.05 ,$652.11 ,"$1,385.81 ",$754.06 ,$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,$687.24 ,$591.79 ,$687.24 ,$687.24 ,$763.60 
ST NICHOLAS HOSPITAL - ACUTE,45000197,26700,HC TX DISL (M-P) W/O ANES CLS,450,1 ,$879.75 ,$580.64 ,$15.68 ,$879.75 ,$15.68 ,$602.98 ,$602.98 ,$202.04 ,$527.85 ,$747.79 ,$615.83 ,$15.68 ,$15.68 ,$835.76 ,$668.61 ,$659.81 ,$571.84 ,$747.79 ,$202.04 ,$571.84 ,$571.84 ,$615.83 ,$535.77 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$747.79 ,$454.59 ,$809.37 ,$615.83 ,$446.21 ,$535.50 ,$535.77 ,$535.50 ,$607.91 ,$791.78 ,$601.05 ,$199.98 ,$695.00 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$633.42 ,$545.45 ,$633.42 ,$633.42 ,$703.80 
ST NICHOLAS HOSPITAL - ACUTE,45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$532.45 ,$351.42 ,$5.60 ,$532.45 ,$5.60 ,$364.94 ,$364.94 ,$202.04 ,$319.47 ,$452.58 ,$372.72 ,$5.60 ,$5.60 ,$505.83 ,$404.66 ,$399.34 ,$346.09 ,$452.58 ,$202.04 ,$346.09 ,$346.09 ,$372.72 ,$324.26 ,$5.60 ,$202.04 ,$198.00 ,$404.08 ,$5.94 ,$452.58 ,$454.59 ,$489.85 ,$372.72 ,$270.06 ,$324.10 ,$324.26 ,$324.10 ,$367.92 ,$479.21 ,$363.77 ,$199.98 ,$420.64 ,$5.94 ,$532.45 ,$532.45 ,$198.00 ,$532.45 ,$383.36 ,$330.12 ,$383.36 ,$383.36 ,$425.96 
ST NICHOLAS HOSPITAL - ACUTE,45000199,35207,HC RPR VESSEL HAND/FINGER,450,1 ,"$3,638.00 ","$2,401.08 ",$74.78 ,"$6,541.82 ",$74.78 ,"$2,493.49 ","$2,493.49 ","$2,907.47 ","$2,182.80 ","$3,092.30 ","$2,546.60 ",$74.78 ,$74.78 ,"$3,456.10 ","$2,764.88 ","$2,728.50 ","$2,364.70 ","$3,092.30 ","$2,907.47 ","$2,364.70 ","$2,364.70 ","$2,546.60 ","$2,215.54 ",$74.78 ,"$2,907.47 ","$2,849.32 ","$3,638.00 ",$79.27 ,"$3,092.30 ","$6,541.82 ","$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,214.45 ","$2,513.86 ","$3,274.20 ","$2,485.48 ","$2,877.81 ","$2,874.02 ",$79.27 ,$700.00 ,$700.00 ,"$2,849.32 ",$700.00 ,"$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000200,35206,HC RPR VESSEL EXTREM UPR,450,1 ,"$3,638.00 ","$2,401.08 ",$74.78 ,"$6,541.82 ",$74.78 ,"$2,493.49 ","$2,493.49 ","$2,907.47 ","$2,182.80 ","$3,092.30 ","$2,546.60 ",$74.78 ,$74.78 ,"$3,456.10 ","$2,764.88 ","$2,728.50 ","$2,364.70 ","$3,092.30 ","$2,907.47 ","$2,364.70 ","$2,364.70 ","$2,546.60 ","$2,215.54 ",$74.78 ,"$2,907.47 ","$2,849.32 ","$3,638.00 ",$79.27 ,"$3,092.30 ","$6,541.82 ","$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,214.45 ","$2,513.86 ","$3,274.20 ","$2,485.48 ","$2,877.81 ","$2,874.02 ",$79.27 ,$700.00 ,$700.00 ,"$2,849.32 ",$700.00 ,"$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000202,26645,HC CL TX CARPOMETACARPAL FRAC DISLOC THUMB,450,1 ,$842.95 ,$556.35 ,$15.68 ,"$3,150.21 ",$15.68 ,$577.76 ,$577.76 ,"$1,400.09 ",$505.77 ,$716.51 ,$590.07 ,$15.68 ,$15.68 ,$800.80 ,$640.64 ,$632.21 ,$547.92 ,$716.51 ,"$1,400.09 ",$547.92 ,$547.92 ,$590.07 ,$513.36 ,$15.68 ,"$1,400.09 ","$1,372.09 ",$842.95 ,$16.62 ,$716.51 ,"$3,150.21 ",$775.51 ,$590.07 ,$427.54 ,$513.10 ,$513.36 ,$513.10 ,$582.48 ,$758.66 ,$575.90 ,"$1,385.81 ",$665.93 ,$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,$606.92 ,$522.63 ,$606.92 ,$606.92 ,$674.36 
ST NICHOLAS HOSPITAL - ACUTE,45000203,27840,HC TX DISL ANKLE W/O ANES CLS,450,1 ,$681.95 ,$450.09 ,$15.68 ,$681.95 ,$15.68 ,$467.41 ,$467.41 ,$202.04 ,$409.17 ,$579.66 ,$477.37 ,$15.68 ,$15.68 ,$647.85 ,$518.28 ,$511.46 ,$443.27 ,$579.66 ,$202.04 ,$443.27 ,$443.27 ,$477.37 ,$415.31 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$579.66 ,$454.59 ,$627.39 ,$477.37 ,$345.89 ,$415.10 ,$415.31 ,$415.10 ,$471.23 ,$613.76 ,$465.91 ,$199.98 ,$538.74 ,$16.62 ,$681.95 ,$681.95 ,$198.00 ,$681.95 ,$491.00 ,$422.81 ,$491.00 ,$491.00 ,$545.56 
ST NICHOLAS HOSPITAL - ACUTE,45000204,23931,HC I AND D BURSA ELBOW/ARM,450,1 ,"$1,610.00 ","$1,062.60 ",$62.90 ,"$3,293.01 ",$62.90 ,"$1,103.49 ","$1,103.49 ","$1,463.56 ",$966.00 ,"$1,368.50 ","$1,127.00 ",$62.90 ,$62.90 ,"$1,529.50 ","$1,223.60 ","$1,207.50 ","$1,046.50 ","$1,368.50 ","$1,463.56 ","$1,046.50 ","$1,046.50 ","$1,127.00 ",$980.49 ,$62.90 ,"$1,463.56 ","$1,434.29 ","$1,610.00 ",$66.67 ,"$1,368.50 ","$3,293.01 ","$1,481.20 ","$1,127.00 ",$816.59 ,$980.01 ,$980.49 ,$980.01 ,"$1,112.51 ","$1,449.00 ","$1,099.95 ","$1,448.64 ","$1,271.90 ",$66.67 ,$700.00 ,$700.00 ,"$1,434.29 ",$700.00 ,"$1,159.20 ",$998.20 ,"$1,159.20 ","$1,159.20 ","$1,288.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000205,31605,HC TRACHEOSTOMY,450,1 ,"$1,495.00 ",$986.70 ,$76.44 ,"$1,495.00 ",$76.44 ,"$1,024.67 ","$1,024.67 ",$202.84 ,$897.00 ,"$1,270.75 ","$1,046.50 ",$76.44 ,$76.44 ,"$1,420.25 ","$1,136.20 ","$1,121.25 ",$971.75 ,"$1,270.75 ",$202.84 ,$971.75 ,$971.75 ,"$1,046.50 ",$910.46 ,$76.44 ,$202.84 ,$198.78 ,$405.68 ,$81.03 ,"$1,270.75 ",$456.39 ,"$1,375.40 ","$1,046.50 ",$758.26 ,$910.01 ,$910.46 ,$910.01 ,"$1,033.05 ","$1,345.50 ","$1,021.38 ",$200.77 ,"$1,181.05 ",$81.03 ,$700.00 ,$700.00 ,$198.78 ,$700.00 ,"$1,076.40 ",$926.90 ,"$1,076.40 ","$1,076.40 ","$1,196.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000206,36405,HC VENIPUNCTURE SCALP VEIN <3YRS,450,1 ,$51.75 ,$34.16 ,$0.08 ,$51.75 ,$0.08 ,$35.47 ,$35.47 , N/A ,$31.05 ,$43.99 , N/A ,$0.08 ,$0.08 ,$49.16 ,$39.33 ,$38.81 ,$33.64 ,$43.99 , N/A ,$33.64 ,$33.64 ,$36.23 ,$31.52 ,$0.08 , N/A , N/A , N/A ,$0.08 ,$43.99 , N/A ,$47.61 ,$36.23 ,$26.25 ,$31.50 ,$31.52 ,$31.50 ,$35.76 ,$46.58 ,$35.36 , N/A ,$40.88 ,$0.08 ,$51.75 ,$51.75 , N/A ,$51.75 ,$37.26 ,$32.09 ,$37.26 ,$37.26 ,$41.40 
ST NICHOLAS HOSPITAL - ACUTE,45000207,49084,HC PERITONEAL LAVAGE,450,1 ,"$1,109.75 ",$732.44 ,$25.31 ,"$1,812.82 ",$25.31 ,$760.62 ,$760.62 ,$805.70 ,$665.85 ,$943.29 ,$776.83 ,$25.31 ,$25.31 ,"$1,054.26 ",$843.41 ,$832.31 ,$721.34 ,$943.29 ,$805.70 ,$721.34 ,$721.34 ,$776.83 ,$675.84 ,$25.31 ,$805.70 ,$789.59 ,"$1,109.75 ",$26.83 ,$943.29 ,"$1,812.82 ","$1,020.97 ",$776.83 ,$562.87 ,$675.50 ,$675.84 ,$675.50 ,$766.84 ,$998.78 ,$758.18 ,$797.48 ,$876.70 ,$26.83 ,$700.00 ,$700.00 ,$789.59 ,$700.00 ,$799.02 ,$688.05 ,$799.02 ,$799.02 ,$887.80 
ST NICHOLAS HOSPITAL - ACUTE,45000212,25690,HC CLSD WRIST DISLOC,450,1 ,"$4,809.96 ","$3,174.57 ",$15.68 ,"$4,809.96 ",$15.68 ,"$3,296.75 ","$3,296.75 ","$1,400.09 ","$2,885.98 ","$4,088.47 ","$3,366.97 ",$15.68 ,$15.68 ,"$4,569.46 ","$3,655.57 ","$3,607.47 ","$3,126.47 ","$4,088.47 ","$1,400.09 ","$3,126.47 ","$3,126.47 ","$3,366.97 ","$2,929.27 ",$15.68 ,"$1,400.09 ","$1,372.09 ","$2,800.18 ",$16.62 ,"$4,088.47 ","$3,150.21 ","$4,425.16 ","$3,366.97 ","$2,439.61 ","$2,927.82 ","$2,929.27 ","$2,927.82 ","$3,323.68 ","$4,328.96 ","$3,286.16 ","$1,385.81 ","$3,799.87 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$3,463.17 ","$2,982.18 ","$3,463.17 ","$3,463.17 ","$3,847.97 "
ST NICHOLAS HOSPITAL - ACUTE,45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$755.00 ,$498.30 ,$10.04 ,$755.00 ,$10.04 ,$517.48 ,$517.48 ,$324.64 ,$453.00 ,$641.75 ,$528.50 ,$10.04 ,$10.04 ,$717.25 ,$573.80 ,$566.25 ,$490.75 ,$641.75 ,$324.64 ,$490.75 ,$490.75 ,$528.50 ,$459.80 ,$10.04 ,$324.64 ,$318.15 ,$649.28 ,$10.64 ,$641.75 ,$730.43 ,$694.60 ,$528.50 ,$382.94 ,$459.57 ,$459.80 ,$459.57 ,$521.71 ,$679.50 ,$515.82 ,$321.33 ,$596.45 ,$10.64 ,$700.00 ,$700.00 ,$318.15 ,$700.00 ,$543.60 ,$468.10 ,$543.60 ,$543.60 ,$604.00 
ST NICHOLAS HOSPITAL - ACUTE,45000216,41899,HC DENTOALVEOLAR STRUCT PROC,450,1 ,$675.05 ,$445.53 ,$42.01 ,$675.05 ,$42.01 ,$462.68 ,$462.68 ,$202.84 ,$405.03 ,$573.79 ,$472.54 ,$42.01 ,$42.01 ,$641.30 ,$513.04 ,$506.29 ,$438.78 ,$573.79 ,$202.84 ,$438.78 ,$438.78 ,$472.54 ,$411.11 ,$42.01 ,$202.84 ,$198.78 ,$405.68 ,$44.53 ,$573.79 ,$456.39 ,$621.05 ,$472.54 ,$342.39 ,$410.90 ,$411.11 ,$410.90 ,$466.46 ,$607.55 ,$461.19 ,$200.77 ,$533.29 ,$44.53 ,$675.05 ,$675.05 ,$198.78 ,$675.05 ,$486.04 ,$418.53 ,$486.04 ,$486.04 ,$540.04 
ST NICHOLAS HOSPITAL - ACUTE,45000219,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP,450,1 ,"$1,603.10 ","$1,058.05 ",$15.68 ,"$3,150.21 ",$15.68 ,"$1,098.76 ","$1,098.76 ","$1,400.09 ",$961.86 ,"$1,362.64 ","$1,122.17 ",$15.68 ,$15.68 ,"$1,522.95 ","$1,218.36 ","$1,202.33 ","$1,042.02 ","$1,362.64 ","$1,400.09 ","$1,042.02 ","$1,042.02 ","$1,122.17 ",$976.29 ,$15.68 ,"$1,400.09 ","$1,372.09 ","$1,603.10 ",$16.62 ,"$1,362.64 ","$3,150.21 ","$1,474.85 ","$1,122.17 ",$813.09 ,$975.81 ,$976.29 ,$975.81 ,"$1,107.74 ","$1,442.79 ","$1,095.24 ","$1,385.81 ","$1,266.45 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$1,154.23 ",$993.92 ,"$1,154.23 ","$1,154.23 ","$1,282.48 "
ST NICHOLAS HOSPITAL - ACUTE,45000227,25600,HC CLSD DIS.RADIUS W/O MANIP,450,1 ,$691.00 ,$456.06 ,$15.68 ,$691.00 ,$15.68 ,$473.61 ,$473.61 ,$202.04 ,$414.60 ,$587.35 ,$483.70 ,$15.68 ,$15.68 ,$656.45 ,$525.16 ,$518.25 ,$449.15 ,$587.35 ,$202.04 ,$449.15 ,$449.15 ,$483.70 ,$420.82 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$587.35 ,$454.59 ,$635.72 ,$483.70 ,$350.48 ,$420.61 ,$420.82 ,$420.61 ,$477.48 ,$621.90 ,$472.09 ,$199.98 ,$545.89 ,$16.62 ,$691.00 ,$691.00 ,$198.00 ,$691.00 ,$497.52 ,$428.42 ,$497.52 ,$497.52 ,$552.80 
ST NICHOLAS HOSPITAL - ACUTE,45000228,26750,HC CLSD DIST PHALANGEAL W/O MANIP,450,1 ,$801.55 ,$529.02 ,$15.68 ,$801.55 ,$15.68 ,$549.38 ,$549.38 ,$202.04 ,$480.93 ,$681.32 ,$561.09 ,$15.68 ,$15.68 ,$761.47 ,$609.18 ,$601.16 ,$521.01 ,$681.32 ,$202.04 ,$521.01 ,$521.01 ,$561.09 ,$488.14 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$681.32 ,$454.59 ,$737.43 ,$561.09 ,$406.55 ,$487.90 ,$488.14 ,$487.90 ,$553.87 ,$721.40 ,$547.62 ,$199.98 ,$633.22 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$577.12 ,$496.96 ,$577.12 ,$577.12 ,$641.24 
ST NICHOLAS HOSPITAL - ACUTE,45000230,26605,HC CLSD METACARPAL FX W/MANIP,450,1 ,$768.20 ,$507.01 ,$15.68 ,$768.20 ,$15.68 ,$526.52 ,$526.52 ,$202.04 ,$460.92 ,$652.97 ,$537.74 ,$15.68 ,$15.68 ,$729.79 ,$583.83 ,$576.15 ,$499.33 ,$652.97 ,$202.04 ,$499.33 ,$499.33 ,$537.74 ,$467.83 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$652.97 ,$454.59 ,$706.74 ,$537.74 ,$389.63 ,$467.60 ,$467.83 ,$467.60 ,$530.83 ,$691.38 ,$524.83 ,$199.98 ,$606.88 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$553.10 ,$476.28 ,$553.10 ,$553.10 ,$614.56 
ST NICHOLAS HOSPITAL - ACUTE,45000238,26670,HC HAND DISL W/MANIP W/O ANES,450,1 ,$640.50 ,$422.73 ,$15.68 ,$640.50 ,$15.68 ,$439.00 ,$439.00 ,$202.04 ,$384.30 ,$544.43 ,$448.35 ,$15.68 ,$15.68 ,$608.48 ,$486.78 ,$480.38 ,$416.33 ,$544.43 ,$202.04 ,$416.33 ,$416.33 ,$448.35 ,$390.06 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$544.43 ,$454.59 ,$589.26 ,$448.35 ,$324.86 ,$389.87 ,$390.06 ,$389.87 ,$442.59 ,$576.45 ,$437.59 ,$199.98 ,$506.00 ,$16.62 ,$640.50 ,$640.50 ,$198.00 ,$640.50 ,$461.16 ,$397.11 ,$461.16 ,$461.16 ,$512.40 
ST NICHOLAS HOSPITAL - ACUTE,45000248,28475,HC CLSD METATARSAL W/MANIP,450,1 ,$688.85 ,$454.64 ,$15.68 ,$688.85 ,$15.68 ,$472.14 ,$472.14 ,$202.04 ,$413.31 ,$585.52 ,$482.20 ,$15.68 ,$15.68 ,$654.41 ,$523.53 ,$516.64 ,$447.75 ,$585.52 ,$202.04 ,$447.75 ,$447.75 ,$482.20 ,$419.51 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$585.52 ,$454.59 ,$633.74 ,$482.20 ,$349.38 ,$419.30 ,$419.51 ,$419.30 ,$476.00 ,$619.97 ,$470.62 ,$199.98 ,$544.19 ,$16.62 ,$688.85 ,$688.85 ,$198.00 ,$688.85 ,$495.97 ,$427.09 ,$495.97 ,$495.97 ,$551.08 
ST NICHOLAS HOSPITAL - ACUTE,45000249,28515,HC TOE FX W/MANIP,450,1 ,$713.00 ,$470.58 ,$15.68 ,$713.00 ,$15.68 ,$488.69 ,$488.69 ,$202.04 ,$427.80 ,$606.05 ,$499.10 ,$15.68 ,$15.68 ,$677.35 ,$541.88 ,$534.75 ,$463.45 ,$606.05 ,$202.04 ,$463.45 ,$463.45 ,$499.10 ,$434.22 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$606.05 ,$454.59 ,$655.96 ,$499.10 ,$361.63 ,$434.00 ,$434.22 ,$434.00 ,$492.68 ,$641.70 ,$487.12 ,$199.98 ,$563.27 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$513.36 ,$442.06 ,$513.36 ,$513.36 ,$570.40 
ST NICHOLAS HOSPITAL - ACUTE,45000252,20520,HC MUSCLE FB REM W/ INC,450,1 ,"$4,715.00 ","$3,111.90 ",$62.90 ,"$4,715.00 ",$62.90 ,"$3,231.66 ","$3,231.66 ","$1,463.56 ","$2,829.00 ","$4,007.75 ","$3,300.50 ",$62.90 ,$62.90 ,"$4,479.25 ","$3,583.40 ","$3,536.25 ","$3,064.75 ","$4,007.75 ","$1,463.56 ","$3,064.75 ","$3,064.75 ","$3,300.50 ","$2,871.44 ",$62.90 ,"$1,463.56 ","$1,434.29 ","$2,927.12 ",$66.67 ,"$4,007.75 ","$3,293.01 ","$4,337.80 ","$3,300.50 ","$2,391.45 ","$2,870.02 ","$2,871.44 ","$2,870.02 ","$3,258.07 ","$4,243.50 ","$3,221.29 ","$1,448.64 ","$3,724.85 ",$66.67 ,$700.00 ,$700.00 ,"$1,434.29 ",$700.00 ,"$3,394.80 ","$2,923.30 ","$3,394.80 ","$3,394.80 ","$3,772.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000259,28630,HC FOOT DISCL W/O ANES,450,1 ,$744.05 ,$491.07 ,$15.68 ,$744.05 ,$15.68 ,$509.97 ,$509.97 ,$202.04 ,$446.43 ,$632.44 ,$520.84 ,$15.68 ,$15.68 ,$706.85 ,$565.48 ,$558.04 ,$483.63 ,$632.44 ,$202.04 ,$483.63 ,$483.63 ,$520.84 ,$453.13 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$632.44 ,$454.59 ,$684.53 ,$520.84 ,$377.38 ,$452.90 ,$453.13 ,$452.90 ,$514.14 ,$669.65 ,$508.34 ,$199.98 ,$587.80 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$535.72 ,$461.31 ,$535.72 ,$535.72 ,$595.24 
ST NICHOLAS HOSPITAL - ACUTE,45000270,20606,HC ARTHROCNT ASP/INJ JT INTRM W/ULTRA,450,1 ,"$1,102.85 ",$727.88 ,$16.55 ,"$1,414.97 ",$16.55 ,$755.89 ,$755.89 ,$628.88 ,$661.71 ,$937.42 ,$772.00 ,$16.55 ,$16.55 ,"$1,047.71 ",$838.17 ,$827.14 ,$716.85 ,$937.42 ,$628.88 ,$716.85 ,$716.85 ,$772.00 ,$671.64 ,$16.55 ,$628.88 ,$616.30 ,"$1,102.85 ",$17.54 ,$937.42 ,"$1,414.97 ","$1,014.62 ",$772.00 ,$559.37 ,$671.30 ,$671.64 ,$671.30 ,$762.07 ,$992.57 ,$753.47 ,$622.47 ,$871.25 ,$17.54 ,$700.00 ,$700.00 ,$616.30 ,$700.00 ,$794.05 ,$683.77 ,$794.05 ,$794.05 ,$882.28 
ST NICHOLAS HOSPITAL - ACUTE,45000271,20604,HC ARTHROCNT ASP/INJ JT SMALL W/ULTRA,450,1 ,"$1,066.05 ",$703.59 ,$16.55 ,"$1,066.05 ",$16.55 ,$730.67 ,$730.67 ,$265.36 ,$639.63 ,$906.14 ,$746.24 ,$16.55 ,$16.55 ,"$1,012.75 ",$810.20 ,$799.54 ,$692.93 ,$906.14 ,$265.36 ,$692.93 ,$692.93 ,$746.24 ,$649.22 ,$16.55 ,$265.36 ,$260.05 ,$530.72 ,$17.54 ,$906.14 ,$597.07 ,$980.77 ,$746.24 ,$540.70 ,$648.90 ,$649.22 ,$648.90 ,$736.64 ,$959.45 ,$728.33 ,$262.65 ,$842.18 ,$17.54 ,$700.00 ,$700.00 ,$260.05 ,$700.00 ,$767.56 ,$660.95 ,$767.56 ,$767.56 ,$852.84 
ST NICHOLAS HOSPITAL - ACUTE,45000272,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ ULTRA,450,1 ,"$1,362.75 ",$899.42 ,$16.55 ,"$1,362.75 ",$16.55 ,$934.03 ,$934.03 ,$265.36 ,$817.65 ,"$1,158.34 ",$953.93 ,$16.55 ,$16.55 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$885.79 ,"$1,158.34 ",$265.36 ,$885.79 ,$885.79 ,$953.93 ,$829.91 ,$16.55 ,$265.36 ,$260.05 ,$530.72 ,$17.54 ,"$1,158.34 ",$597.07 ,"$1,253.73 ",$953.93 ,$691.19 ,$829.51 ,$829.91 ,$829.51 ,$941.66 ,"$1,226.48 ",$931.03 ,$262.65 ,"$1,076.57 ",$17.54 ,$700.00 ,$700.00 ,$260.05 ,$700.00 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$148.35 ,$97.91 ,$54.98 ,$148.35 , N/A ,$101.68 ,$101.68 ,$56.10 ,$89.01 ,$126.10 ,$103.85 , N/A , N/A ,$140.93 ,$112.75 ,$111.26 ,$96.43 ,$126.10 ,$56.10 ,$96.43 ,$96.43 ,$103.85 ,$90.35 , N/A ,$56.10 ,$54.98 ,$112.20 , N/A ,$126.10 ,$126.23 ,$136.48 ,$103.85 ,$75.24 ,$90.30 ,$90.35 ,$90.30 ,$102.51 ,$133.52 ,$101.35 ,$55.53 ,$117.20 , N/A ,$148.35 ,$148.35 ,$54.98 ,$148.35 ,$106.81 ,$91.98 ,$106.81 ,$106.81 ,$118.68 
ST NICHOLAS HOSPITAL - ACUTE,45000281,N/A,HC ED PROC LEVEL 1,450,1 ,$333.90 ,$220.37 ,$169.35 ,$333.90 , N/A ,$228.86 ,$228.86 , N/A ,$200.34 ,$283.82 ,$233.73 , N/A , N/A ,$317.21 ,$253.76 ,$250.43 ,$217.04 ,$283.82 , N/A ,$217.04 ,$217.04 ,$233.73 ,$203.35 , N/A , N/A , N/A , N/A , N/A ,$283.82 , N/A ,$307.19 ,$233.73 ,$169.35 ,$203.24 ,$203.35 ,$203.24 ,$230.72 ,$300.51 ,$228.12 , N/A ,$263.78 , N/A ,$333.90 ,$333.90 , N/A ,$333.90 ,$240.41 ,$207.02 ,$240.41 ,$240.41 ,$267.12 
ST NICHOLAS HOSPITAL - ACUTE,45000282,N/A,HC ED PROC LEVEL 2,450,1 ,$556.50 ,$367.29 ,$282.26 ,$556.50 , N/A ,$381.43 ,$381.43 , N/A ,$333.90 ,$473.03 ,$389.55 , N/A , N/A ,$528.68 ,$422.94 ,$417.38 ,$361.73 ,$473.03 , N/A ,$361.73 ,$361.73 ,$389.55 ,$338.91 , N/A , N/A , N/A , N/A , N/A ,$473.03 , N/A ,$511.98 ,$389.55 ,$282.26 ,$338.74 ,$338.91 ,$338.74 ,$384.54 ,$500.85 ,$380.20 , N/A ,$439.64 , N/A ,$556.50 ,$556.50 , N/A ,$556.50 ,$400.68 ,$345.03 ,$400.68 ,$400.68 ,$445.20 
ST NICHOLAS HOSPITAL - ACUTE,45000283,N/A,HC ED PROC LEVEL 3,450,1 ,"$1,113.00 ",$734.58 ,$564.51 ,"$1,113.00 ", N/A ,$762.85 ,$762.85 , N/A ,$667.80 ,$946.05 ,$779.10 , N/A , N/A ,"$1,057.35 ",$845.88 ,$834.75 ,$723.45 ,$946.05 , N/A ,$723.45 ,$723.45 ,$779.10 ,$677.82 , N/A , N/A , N/A , N/A , N/A ,$946.05 , N/A ,"$1,023.96 ",$779.10 ,$564.51 ,$677.48 ,$677.82 ,$677.48 ,$769.08 ,"$1,001.70 ",$760.40 , N/A ,$879.27 , N/A ,$700.00 ,$700.00 , N/A ,$700.00 ,$801.36 ,$690.06 ,$801.36 ,$801.36 ,$890.40 
ST NICHOLAS HOSPITAL - ACUTE,45000284,N/A,HC ED PROC LEVEL 4,450,1 ,"$2,226.00 ","$1,469.16 ",$700.00 ,"$2,226.00 ", N/A ,"$1,525.70 ","$1,525.70 ", N/A ,"$1,335.60 ","$1,892.10 ","$1,558.20 ", N/A , N/A ,"$2,114.70 ","$1,691.76 ","$1,669.50 ","$1,446.90 ","$1,892.10 ", N/A ,"$1,446.90 ","$1,446.90 ","$1,558.20 ","$1,355.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,892.10 ", N/A ,"$2,047.92 ","$1,558.20 ","$1,129.03 ","$1,354.97 ","$1,355.63 ","$1,354.97 ","$1,538.17 ","$2,003.40 ","$1,520.80 ", N/A ,"$1,758.54 ", N/A ,$700.00 ,$700.00 , N/A ,$700.00 ,"$1,602.72 ","$1,380.12 ","$1,602.72 ","$1,602.72 ","$1,780.80 "
ST NICHOLAS HOSPITAL - ACUTE,45000285,N/A,HC ED PROC LEVEL 5,450,1 ,"$3,339.00 ","$2,203.74 ",$700.00 ,"$3,339.00 ", N/A ,"$2,288.55 ","$2,288.55 ", N/A ,"$2,003.40 ","$2,838.15 ","$2,337.30 ", N/A , N/A ,"$3,172.05 ","$2,537.64 ","$2,504.25 ","$2,170.35 ","$2,838.15 ", N/A ,"$2,170.35 ","$2,170.35 ","$2,337.30 ","$2,033.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,838.15 ", N/A ,"$3,071.88 ","$2,337.30 ","$1,693.54 ","$2,032.45 ","$2,033.45 ","$2,032.45 ","$2,307.25 ","$3,005.10 ","$2,281.20 ", N/A ,"$2,637.81 ", N/A ,$700.00 ,$700.00 , N/A ,$700.00 ,"$2,404.08 ","$2,070.18 ","$2,404.08 ","$2,404.08 ","$2,671.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000287,11402,HC EXCISION LESION BENIGN TRUNK/ARM/LEG 1.1-2.0CM,450,1 ,"$1,449.00 ",$956.34 ,$15.19 ,"$1,449.00 ",$15.19 ,$993.14 ,$993.14 ,$633.39 ,$869.40 ,"$1,231.65 ","$1,014.30 ",$15.19 ,$15.19 ,"$1,376.55 ","$1,101.24 ","$1,086.75 ",$941.85 ,"$1,231.65 ",$633.39 ,$941.85 ,$941.85 ,"$1,014.30 ",$882.44 ,$15.19 ,$633.39 ,$620.72 ,"$1,266.78 ",$16.10 ,"$1,231.65 ","$1,425.14 ","$1,333.08 ","$1,014.30 ",$734.93 ,$882.01 ,$882.44 ,$882.01 ,"$1,001.26 ","$1,304.10 ",$989.96 ,$626.93 ,"$1,144.71 ",$16.10 ,$700.00 ,$700.00 ,$620.72 ,$700.00 ,"$1,043.28 ",$898.38 ,"$1,043.28 ","$1,043.28 ","$1,159.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000303,24620,HC CLOSED TX ELBOW FRACTURE W/MANIP,450,1 ,"$5,037.00 ","$3,324.42 ",$15.68 ,"$5,037.00 ",$15.68 ,"$3,452.36 ","$3,452.36 ","$1,400.09 ","$3,022.20 ","$4,281.45 ","$3,525.90 ",$15.68 ,$15.68 ,"$4,785.15 ","$3,828.12 ","$3,777.75 ","$3,274.05 ","$4,281.45 ","$1,400.09 ","$3,274.05 ","$3,274.05 ","$3,525.90 ","$3,067.53 ",$15.68 ,"$1,400.09 ","$1,372.09 ","$2,800.18 ",$16.62 ,"$4,281.45 ","$3,150.21 ","$4,634.04 ","$3,525.90 ","$2,554.77 ","$3,066.02 ","$3,067.53 ","$3,066.02 ","$3,480.57 ","$4,533.30 ","$3,441.28 ","$1,385.81 ","$3,979.23 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$3,626.64 ","$3,122.94 ","$3,626.64 ","$3,626.64 ","$4,029.60 "
ST NICHOLAS HOSPITAL - ACUTE,45000309,28660,HC CLOSED TX I-P JOINT DISLOCATION W/O ANES,450,1 ,$770.50 ,$508.53 ,$15.68 ,$770.50 ,$15.68 ,$528.10 ,$528.10 ,$202.04 ,$462.30 ,$654.93 ,$539.35 ,$15.68 ,$15.68 ,$731.98 ,$585.58 ,$577.88 ,$500.83 ,$654.93 ,$202.04 ,$500.83 ,$500.83 ,$539.35 ,$469.23 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$654.93 ,$454.59 ,$708.86 ,$539.35 ,$390.80 ,$469.00 ,$469.23 ,$469.00 ,$532.42 ,$693.45 ,$526.41 ,$199.98 ,$608.70 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$554.76 ,$477.71 ,$554.76 ,$554.76 ,$616.40 
ST NICHOLAS HOSPITAL - ACUTE,45000310,31505,HC LARYNGOSCOPY INDIRECT,450,1 ,$493.00 ,$325.38 ,$5.60 ,$493.00 ,$5.60 ,$337.90 ,$337.90 ,$174.46 ,$295.80 ,$419.05 ,$345.10 ,$5.60 ,$5.60 ,$468.35 ,$374.68 ,$369.75 ,$320.45 ,$419.05 ,$174.46 ,$320.45 ,$320.45 ,$345.10 ,$300.24 ,$5.60 ,$174.46 ,$170.97 ,$348.92 ,$5.94 ,$419.05 ,$392.54 ,$453.56 ,$345.10 ,$250.05 ,$300.09 ,$300.24 ,$300.09 ,$340.66 ,$443.70 ,$336.82 ,$172.68 ,$389.47 ,$5.94 ,$493.00 ,$493.00 ,$170.97 ,$493.00 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,45000312,40831,HC LAC REPAIR VESTIBULE MOUTH COMPLEX >2.5CM,450,1 ,"$1,404.90 ",$927.23 ,$42.01 ,"$1,404.90 ",$42.01 ,$962.92 ,$962.92 ,$445.86 ,$842.94 ,"$1,194.17 ",$983.43 ,$42.01 ,$42.01 ,"$1,334.66 ","$1,067.72 ","$1,053.68 ",$913.19 ,"$1,194.17 ",$445.86 ,$913.19 ,$913.19 ,$983.43 ,$855.58 ,$42.01 ,$445.86 ,$436.94 ,$891.72 ,$44.53 ,"$1,194.17 ","$1,003.18 ","$1,292.51 ",$983.43 ,$712.57 ,$855.16 ,$855.58 ,$855.16 ,$970.79 ,"$1,264.41 ",$959.83 ,$441.31 ,"$1,109.87 ",$44.53 ,$700.00 ,$700.00 ,$436.94 ,$700.00 ,"$1,011.53 ",$871.04 ,"$1,011.53 ","$1,011.53 ","$1,123.92 "
ST NICHOLAS HOSPITAL - ACUTE,45000313,41008,HC DRAINAGE OF MOUTH LESION,450,1 ,$210.59 ,$138.99 ,$51.06 ,"$6,247.69 ",$51.06 ,$144.34 ,$144.34 ,"$2,776.75 ",$126.35 ,$179.00 ,$147.41 ,$51.06 ,$51.06 ,$200.06 ,$160.05 ,$157.94 ,$136.88 ,$179.00 ,"$2,776.75 ",$136.88 ,$136.88 ,$147.41 ,$128.25 ,$51.06 ,"$2,776.75 ","$2,721.21 ",$210.59 ,$54.12 ,$179.00 ,"$6,247.69 ",$193.74 ,$147.41 ,$106.81 ,$128.19 ,$128.25 ,$128.19 ,$145.52 ,$189.53 ,$143.88 ,"$2,748.43 ",$166.37 ,$54.12 ,$210.59 ,$210.59 ,"$2,721.21 ",$210.59 ,$151.62 ,$130.57 ,$151.62 ,$151.62 ,$168.47 
ST NICHOLAS HOSPITAL - ACUTE,45000326,24670,HC CLOSED TX FX ULNAR PROX END W/MANIP,450,1 ,$641.70 ,$423.52 ,$15.68 ,$641.70 ,$15.68 ,$439.82 ,$439.82 ,$202.04 ,$385.02 ,$545.45 ,$449.19 ,$15.68 ,$15.68 ,$609.62 ,$487.69 ,$481.28 ,$417.11 ,$545.45 ,$202.04 ,$417.11 ,$417.11 ,$449.19 ,$390.80 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$545.45 ,$454.59 ,$590.36 ,$449.19 ,$325.47 ,$390.60 ,$390.80 ,$390.60 ,$443.41 ,$577.53 ,$438.41 ,$199.98 ,$506.94 ,$16.62 ,$641.70 ,$641.70 ,$198.00 ,$641.70 ,$462.02 ,$397.85 ,$462.02 ,$462.02 ,$513.36 
ST NICHOLAS HOSPITAL - ACUTE,45000327,26765,HC TX FX OPEN FINGER/THUMB W/INT FIX EACH,450,1 ,"$9,485.40 ","$6,260.36 ",$185.77 ,"$9,485.40 ",$185.77 ,"$6,501.29 ","$6,501.29 ","$2,905.22 ","$5,691.24 ","$8,062.59 ","$6,639.78 ",$185.77 ,$185.77 ,"$9,011.13 ","$7,208.90 ","$7,114.05 ","$6,165.51 ","$8,062.59 ","$2,905.22 ","$6,165.51 ","$6,165.51 ","$6,639.78 ","$5,776.61 ",$185.77 ,"$2,905.22 ","$2,847.12 ","$5,810.44 ",$196.92 ,"$8,062.59 ","$6,536.75 ","$8,726.57 ","$6,639.78 ","$4,810.99 ","$5,773.76 ","$5,776.61 ","$5,773.76 ","$6,554.41 ","$8,536.86 ","$6,480.43 ","$2,875.58 ","$7,493.47 ",$196.92 ,$700.00 ,$700.00 ,"$2,847.12 ",$700.00 ,"$6,829.49 ","$5,880.95 ","$6,829.49 ","$6,829.49 ","$7,588.32 "
ST NICHOLAS HOSPITAL - ACUTE,45000328,27550,HC CLSD TX KNEE DISLOC W/O ANESTH,450,1 ,$688.97 ,$454.72 ,$15.68 ,$688.97 ,$15.68 ,$472.22 ,$472.22 ,$202.04 ,$413.38 ,$585.62 ,$482.28 ,$15.68 ,$15.68 ,$654.52 ,$523.62 ,$516.73 ,$447.83 ,$585.62 ,$202.04 ,$447.83 ,$447.83 ,$482.28 ,$419.58 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$585.62 ,$454.59 ,$633.85 ,$482.28 ,$349.45 ,$419.38 ,$419.58 ,$419.38 ,$476.08 ,$620.07 ,$470.70 ,$199.98 ,$544.29 ,$16.62 ,$688.97 ,$688.97 ,$198.00 ,$688.97 ,$496.06 ,$427.16 ,$496.06 ,$496.06 ,$551.18 
ST NICHOLAS HOSPITAL - ACUTE,45000329,27752,HC CLSD TX FX TIBIAL SHAFT W/MANIP,450,1 ,"$4,838.05 ","$3,193.11 ",$15.68 ,"$4,838.05 ",$15.68 ,"$3,316.00 ","$3,316.00 ","$1,400.09 ","$2,902.83 ","$4,112.34 ","$3,386.64 ",$15.68 ,$15.68 ,"$4,596.15 ","$3,676.92 ","$3,628.54 ","$3,144.73 ","$4,112.34 ","$1,400.09 ","$3,144.73 ","$3,144.73 ","$3,386.64 ","$2,946.37 ",$15.68 ,"$1,400.09 ","$1,372.09 ","$2,800.18 ",$16.62 ,"$4,112.34 ","$3,150.21 ","$4,451.01 ","$3,386.64 ","$2,453.86 ","$2,944.92 ","$2,946.37 ","$2,944.92 ","$3,343.09 ","$4,354.25 ","$3,305.36 ","$1,385.81 ","$3,822.06 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$3,483.40 ","$2,999.59 ","$3,483.40 ","$3,483.40 ","$3,870.44 "
ST NICHOLAS HOSPITAL - ACUTE,45000331,27788,HC CLOSED TX FX DISTAL FIBULAR W/MANIP,450,1 ,$631.35 ,$416.69 ,$15.68 ,$631.35 ,$15.68 ,$432.73 ,$432.73 ,$202.04 ,$378.81 ,$536.65 ,$441.95 ,$15.68 ,$15.68 ,$599.78 ,$479.83 ,$473.51 ,$410.38 ,$536.65 ,$202.04 ,$410.38 ,$410.38 ,$441.95 ,$384.49 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$536.65 ,$454.59 ,$580.84 ,$441.95 ,$320.22 ,$384.30 ,$384.49 ,$384.30 ,$436.26 ,$568.22 ,$431.34 ,$199.98 ,$498.77 ,$16.62 ,$631.35 ,$631.35 ,$198.00 ,$631.35 ,$454.57 ,$391.44 ,$454.57 ,$454.57 ,$505.08 
ST NICHOLAS HOSPITAL - ACUTE,45000341,31603,HC TRACHEOSTOMY TRANSTRACHEAL,450,1 ,"$1,757.00 ","$1,159.62 ",$76.44 ,"$3,048.36 ",$76.44 ,"$1,204.25 ","$1,204.25 ","$1,354.82 ","$1,054.20 ","$1,493.45 ","$1,229.90 ",$76.44 ,$76.44 ,"$1,669.15 ","$1,335.32 ","$1,317.75 ","$1,142.05 ","$1,493.45 ","$1,354.82 ","$1,142.05 ","$1,142.05 ","$1,229.90 ","$1,070.01 ",$76.44 ,"$1,354.82 ","$1,327.72 ","$1,757.00 ",$81.03 ,"$1,493.45 ","$3,048.36 ","$1,616.44 ","$1,229.90 ",$891.15 ,"$1,069.49 ","$1,070.01 ","$1,069.49 ","$1,214.09 ","$1,581.30 ","$1,200.38 ","$1,341.00 ","$1,388.03 ",$81.03 ,$700.00 ,$700.00 ,"$1,327.72 ",$700.00 ,"$1,265.04 ","$1,089.34 ","$1,265.04 ","$1,265.04 ","$1,405.60 "
ST NICHOLAS HOSPITAL - ACUTE,45000500,57200,HC REPAIR SUTURE VAGINA COLPORRHAPHY,450,1 ,"$8,790.60 ","$5,801.80 ",$85.91 ,"$8,790.60 ",$85.91 ,"$6,025.08 ","$6,025.08 ","$2,759.58 ","$5,274.36 ","$7,472.01 ","$6,153.42 ",$85.91 ,$85.91 ,"$8,351.07 ","$6,680.86 ","$6,592.95 ","$5,713.89 ","$7,472.01 ","$2,759.58 ","$5,713.89 ","$5,713.89 ","$6,153.42 ","$5,353.48 ",$85.91 ,"$2,759.58 ","$2,704.39 ","$5,519.16 ",$91.06 ,"$7,472.01 ","$6,209.06 ","$8,087.35 ","$6,153.42 ","$4,458.59 ","$5,350.84 ","$5,353.48 ","$5,350.84 ","$6,074.30 ","$7,911.54 ","$6,005.74 ","$2,731.44 ","$6,944.57 ",$91.06 ,$700.00 ,$700.00 ,"$2,704.39 ",$700.00 ,"$6,329.23 ","$5,450.17 ","$6,329.23 ","$6,329.23 ","$7,032.48 "
ST NICHOLAS HOSPITAL - ACUTE,45000736,21337,HC CLOSED TX FX NASAL SEPTAL,450,1 ,"$6,043.25 ","$3,988.55 ",$15.68 ,"$6,247.69 ",$15.68 ,"$4,142.04 ","$4,142.04 ","$2,776.75 ","$3,625.95 ","$5,136.76 ","$4,230.28 ",$15.68 ,$15.68 ,"$5,741.09 ","$4,592.87 ","$4,532.44 ","$3,928.11 ","$5,136.76 ","$2,776.75 ","$3,928.11 ","$3,928.11 ","$4,230.28 ","$3,680.34 ",$15.68 ,"$2,776.75 ","$2,721.21 ","$5,553.50 ",$16.62 ,"$5,136.76 ","$6,247.69 ","$5,559.79 ","$4,230.28 ","$3,065.14 ","$3,678.53 ","$3,680.34 ","$3,678.53 ","$4,175.89 ","$5,438.93 ","$4,128.75 ","$2,748.43 ","$4,774.17 ",$16.62 ,$700.00 ,$700.00 ,"$2,721.21 ",$700.00 ,"$4,351.14 ","$3,746.82 ","$4,351.14 ","$4,351.14 ","$4,834.60 "
ST NICHOLAS HOSPITAL - ACUTE,45001159,43754,HC GASTRIC INTUBATION/ASPIRATION DIAG SINGLE,450,1 ,$805.20 ,$531.43 ,$267.87 ,$805.20 , N/A ,$551.88 ,$551.88 ,$273.34 ,$483.12 ,$684.42 ,$563.64 , N/A , N/A ,$764.94 ,$611.95 ,$603.90 ,$523.38 ,$684.42 ,$273.34 ,$523.38 ,$523.38 ,$563.64 ,$490.37 , N/A ,$273.34 ,$267.87 ,$546.68 , N/A ,$684.42 ,$615.01 ,$740.78 ,$563.64 ,$408.40 ,$490.13 ,$490.37 ,$490.13 ,$556.39 ,$724.68 ,$550.11 ,$270.55 ,$636.11 , N/A ,$700.00 ,$700.00 ,$267.87 ,$700.00 ,$579.74 ,$499.22 ,$579.74 ,$579.74 ,$644.16 
ST NICHOLAS HOSPITAL - ACUTE,45001168,52281,HC CYSTOURETHROSCOPY W/CALIBRATION/DILATION,450,1 ,"$5,205.01 ","$3,435.31 ",$54.25 ,"$5,205.01 ",$54.25 ,"$3,567.51 ","$3,567.51 ","$1,810.36 ","$3,123.01 ","$4,424.26 ","$3,643.51 ",$54.25 ,$54.25 ,"$4,944.76 ","$3,955.81 ","$3,903.76 ","$3,383.26 ","$4,424.26 ","$1,810.36 ","$3,383.26 ","$3,383.26 ","$3,643.51 ","$3,169.85 ",$54.25 ,"$1,810.36 ","$1,774.15 ","$3,620.72 ",$57.51 ,"$4,424.26 ","$4,073.32 ","$4,788.61 ","$3,643.51 ","$2,639.98 ","$3,168.29 ","$3,169.85 ","$3,168.29 ","$3,596.66 ","$4,684.51 ","$3,556.06 ","$1,791.89 ","$4,111.96 ",$57.51 ,$700.00 ,$700.00 ,"$1,774.15 ",$700.00 ,"$3,747.61 ","$3,227.11 ","$3,747.61 ","$3,747.61 ","$4,164.01 "
ST NICHOLAS HOSPITAL - ACUTE,45001272,23665,HC TX FX DISLOC SHOULDER HUMERW/MANIP,450,1 ,"$5,037.00 ","$3,324.42 ",$15.68 ,"$5,037.00 ",$15.68 ,"$3,452.36 ","$3,452.36 ","$1,400.09 ","$3,022.20 ","$4,281.45 ","$3,525.90 ",$15.68 ,$15.68 ,"$4,785.15 ","$3,828.12 ","$3,777.75 ","$3,274.05 ","$4,281.45 ","$1,400.09 ","$3,274.05 ","$3,274.05 ","$3,525.90 ","$3,067.53 ",$15.68 ,"$1,400.09 ","$1,372.09 ","$2,800.18 ",$16.62 ,"$4,281.45 ","$3,150.21 ","$4,634.04 ","$3,525.90 ","$2,554.77 ","$3,066.02 ","$3,067.53 ","$3,066.02 ","$3,480.57 ","$4,533.30 ","$3,441.28 ","$1,385.81 ","$3,979.23 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$3,626.64 ","$3,122.94 ","$3,626.64 ","$3,626.64 ","$4,029.60 "
ST NICHOLAS HOSPITAL - ACUTE,45001281,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED,450,1 ,"$4,666.13 ","$3,079.65 ",$15.68 ,"$4,666.13 ",$15.68 ,"$3,198.17 ","$3,198.17 ","$1,400.09 ","$2,799.68 ","$3,966.21 ","$3,266.29 ",$15.68 ,$15.68 ,"$4,432.82 ","$3,546.26 ","$3,499.60 ","$3,032.98 ","$3,966.21 ","$1,400.09 ","$3,032.98 ","$3,032.98 ","$3,266.29 ","$2,841.67 ",$15.68 ,"$1,400.09 ","$1,372.09 ","$2,800.18 ",$16.62 ,"$3,966.21 ","$3,150.21 ","$4,292.84 ","$3,266.29 ","$2,366.66 ","$2,840.27 ","$2,841.67 ","$2,840.27 ","$3,224.30 ","$4,199.52 ","$3,187.90 ","$1,385.81 ","$3,686.24 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$3,359.61 ","$2,893.00 ","$3,359.61 ","$3,359.61 ","$3,732.90 "
ST NICHOLAS HOSPITAL - ACUTE,45001291,27502,HC TX FX FEMUR W/MAN W/W/O TRACTION,450,1 ,"$4,635.65 ","$3,059.53 ",$15.68 ,"$4,635.65 ",$15.68 ,"$3,177.27 ","$3,177.27 ","$1,400.09 ","$2,781.39 ","$3,940.30 ","$3,244.96 ",$15.68 ,$15.68 ,"$4,403.87 ","$3,523.09 ","$3,476.74 ","$3,013.17 ","$3,940.30 ","$1,400.09 ","$3,013.17 ","$3,013.17 ","$3,244.96 ","$2,823.11 ",$15.68 ,"$1,400.09 ","$1,372.09 ","$2,800.18 ",$16.62 ,"$3,940.30 ","$3,150.21 ","$4,264.80 ","$3,244.96 ","$2,351.20 ","$2,821.72 ","$2,823.11 ","$2,821.72 ","$3,203.23 ","$4,172.09 ","$3,167.08 ","$1,385.81 ","$3,662.16 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$3,337.67 ","$2,874.10 ","$3,337.67 ","$3,337.67 ","$3,708.52 "
ST NICHOLAS HOSPITAL - ACUTE,45001296,27762,HC TX FX CLOSED MEDIAL MALLEOLUS W/MANIP,450,1 ,"$5,503.33 ","$3,632.20 ",$15.68 ,"$5,503.33 ",$15.68 ,"$3,771.98 ","$3,771.98 ","$1,400.09 ","$3,302.00 ","$4,677.83 ","$3,852.33 ",$15.68 ,$15.68 ,"$5,228.16 ","$4,182.53 ","$4,127.50 ","$3,577.16 ","$4,677.83 ","$1,400.09 ","$3,577.16 ","$3,577.16 ","$3,852.33 ","$3,351.53 ",$15.68 ,"$1,400.09 ","$1,372.09 ","$2,800.18 ",$16.62 ,"$4,677.83 ","$3,150.21 ","$5,063.06 ","$3,852.33 ","$2,791.29 ","$3,349.88 ","$3,351.53 ","$3,349.88 ","$3,802.80 ","$4,953.00 ","$3,759.88 ","$1,385.81 ","$4,347.63 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$3,962.40 ","$3,412.06 ","$3,962.40 ","$3,962.40 ","$4,402.66 "
ST NICHOLAS HOSPITAL - ACUTE,45001303,28208,HC REPAIR TENDON EXTENSOR FOOT,450,1 ,"$9,764.65 ","$6,444.67 ",$75.39 ,"$9,764.65 ",$75.39 ,"$6,692.69 ","$6,692.69 ","$2,905.22 ","$5,858.79 ","$8,299.95 ","$6,835.26 ",$75.39 ,$75.39 ,"$9,276.42 ","$7,421.13 ","$7,323.49 ","$6,347.02 ","$8,299.95 ","$2,905.22 ","$6,347.02 ","$6,347.02 ","$6,835.26 ","$5,946.67 ",$75.39 ,"$2,905.22 ","$2,847.12 ","$5,810.44 ",$79.91 ,"$8,299.95 ","$6,536.75 ","$8,983.48 ","$6,835.26 ","$4,952.63 ","$5,943.74 ","$5,946.67 ","$5,943.74 ","$6,747.37 ","$8,788.19 ","$6,671.21 ","$2,875.58 ","$7,714.07 ",$79.91 ,$700.00 ,$700.00 ,"$2,847.12 ",$700.00 ,"$7,030.55 ","$6,054.08 ","$7,030.55 ","$7,030.55 ","$7,811.72 "
ST NICHOLAS HOSPITAL - ACUTE,45001305,28435,HC TX FX CLOSED TALUS W/MANIP,450,1 ,"$4,651.75 ","$3,070.16 ",$15.68 ,"$4,651.75 ",$15.68 ,"$3,188.31 ","$3,188.31 ","$1,400.09 ","$2,791.05 ","$3,953.99 ","$3,256.23 ",$15.68 ,$15.68 ,"$4,419.16 ","$3,535.33 ","$3,488.81 ","$3,023.64 ","$3,953.99 ","$1,400.09 ","$3,023.64 ","$3,023.64 ","$3,256.23 ","$2,832.92 ",$15.68 ,"$1,400.09 ","$1,372.09 ","$2,800.18 ",$16.62 ,"$3,953.99 ","$3,150.21 ","$4,279.61 ","$3,256.23 ","$2,359.37 ","$2,831.52 ","$2,832.92 ","$2,831.52 ","$3,214.36 ","$4,186.58 ","$3,178.08 ","$1,385.81 ","$3,674.88 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$3,349.26 ","$2,884.09 ","$3,349.26 ","$3,349.26 ","$3,721.40 "
ST NICHOLAS HOSPITAL - ACUTE,45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$879.75 ,$580.64 ,$16.75 ,$879.75 ,$16.75 ,$602.98 ,$602.98 ,$209.71 ,$527.85 ,$747.79 ,$615.83 ,$16.75 ,$16.75 ,$835.76 ,$668.61 ,$659.81 ,$571.84 ,$747.79 ,$209.71 ,$571.84 ,$571.84 ,$615.83 ,$535.77 ,$16.75 ,$209.71 ,$205.52 ,$419.42 ,$17.76 ,$747.79 ,$471.85 ,$809.37 ,$615.83 ,$446.21 ,$535.50 ,$535.77 ,$535.50 ,$607.91 ,$791.78 ,$601.05 ,$207.57 ,$695.00 ,$17.76 ,$700.00 ,$700.00 ,$205.52 ,$700.00 ,$633.42 ,$545.45 ,$633.42 ,$633.42 ,$703.80 
ST NICHOLAS HOSPITAL - ACUTE,45001332,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT,450,1 ,"$1,159.20 ",$765.07 ,$16.75 ,"$1,159.20 ",$16.75 ,$794.52 ,$794.52 ,$209.71 ,$695.52 ,$985.32 ,$811.44 ,$16.75 ,$16.75 ,"$1,101.24 ",$880.99 ,$869.40 ,$753.48 ,$985.32 ,$209.71 ,$753.48 ,$753.48 ,$811.44 ,$705.95 ,$16.75 ,$209.71 ,$205.52 ,$419.42 ,$17.76 ,$985.32 ,$471.85 ,"$1,066.46 ",$811.44 ,$587.95 ,$705.61 ,$705.95 ,$705.61 ,$801.01 ,"$1,043.28 ",$791.97 ,$207.57 ,$915.77 ,$17.76 ,$700.00 ,$700.00 ,$205.52 ,$700.00 ,$834.62 ,$718.70 ,$834.62 ,$834.62 ,$927.36 
ST NICHOLAS HOSPITAL - ACUTE,45001343,37799,HC REPAIR/SUTURE MINOR VESSEL,450,1 ,"$1,628.00 ","$1,074.48 ",$74.78 ,"$1,628.00 ",$74.78 ,"$1,115.83 ","$1,115.83 ",$564.62 ,$976.80 ,"$1,383.80 ","$1,139.60 ",$74.78 ,$74.78 ,"$1,546.60 ","$1,237.28 ","$1,221.00 ","$1,058.20 ","$1,383.80 ",$564.62 ,"$1,058.20 ","$1,058.20 ","$1,139.60 ",$991.45 ,$74.78 ,$564.62 ,$553.33 ,"$1,129.24 ",$79.27 ,"$1,383.80 ","$1,270.39 ","$1,497.76 ","$1,139.60 ",$825.72 ,$990.96 ,$991.45 ,$990.96 ,"$1,124.95 ","$1,465.20 ","$1,112.25 ",$558.86 ,"$1,286.12 ",$79.27 ,$700.00 ,$700.00 ,$553.33 ,$700.00 ,"$1,172.16 ","$1,009.36 ","$1,172.16 ","$1,172.16 ","$1,302.40 "
ST NICHOLAS HOSPITAL - ACUTE,45001355,25660,HC CLTX RDCRPL/INTERCARPL DISLC 1 >BONES W MAN,450,1 ,$744.05 ,$491.07 ,$15.68 ,$744.05 ,$15.68 ,$509.97 ,$509.97 ,$202.04 ,$446.43 ,$632.44 ,$520.84 ,$15.68 ,$15.68 ,$706.85 ,$565.48 ,$558.04 ,$483.63 ,$632.44 ,$202.04 ,$483.63 ,$483.63 ,$520.84 ,$453.13 ,$15.68 ,$202.04 ,$198.00 ,$404.08 ,$16.62 ,$632.44 ,$454.59 ,$684.53 ,$520.84 ,$377.38 ,$452.90 ,$453.13 ,$452.90 ,$514.14 ,$669.65 ,$508.34 ,$199.98 ,$587.80 ,$16.62 ,$700.00 ,$700.00 ,$198.00 ,$700.00 ,$535.72 ,$461.31 ,$535.72 ,$535.72 ,$595.24 
ST NICHOLAS HOSPITAL - ACUTE,45001360,31577,HC LARYNGOSCOPY FLX RMVL FOREIGN BODY(S),450,1 ,"$1,097.00 ",$724.02 ,$23.29 ,"$1,097.00 ",$23.29 ,$751.88 ,$751.88 ,$368.09 ,$658.20 ,$932.45 ,$767.90 ,$23.29 ,$23.29 ,"$1,042.15 ",$833.72 ,$822.75 ,$713.05 ,$932.45 ,$368.09 ,$713.05 ,$713.05 ,$767.90 ,$668.07 ,$23.29 ,$368.09 ,$360.73 ,$736.18 ,$24.69 ,$932.45 ,$828.20 ,"$1,009.24 ",$767.90 ,$556.40 ,$667.74 ,$668.07 ,$667.74 ,$758.03 ,$987.30 ,$749.47 ,$364.33 ,$866.63 ,$24.69 ,$700.00 ,$700.00 ,$360.73 ,$700.00 ,$789.84 ,$680.14 ,$789.84 ,$789.84 ,$877.60 
ST NICHOLAS HOSPITAL - ACUTE,45001367,15853,HC REMOVAL SUTURES OR STAPLES NOT REQ ANESTH,450,1 ,$1.00 ,$0.66 ,$0.51 ,$1.00 , N/A ,$0.69 ,$0.69 , N/A ,$0.60 ,$0.85 ,$0.70 , N/A , N/A ,$0.95 ,$0.76 ,$0.75 ,$0.65 ,$0.85 , N/A ,$0.65 ,$0.65 ,$0.70 ,$0.61 , N/A , N/A , N/A , N/A , N/A ,$0.85 , N/A ,$0.92 ,$0.70 ,$0.51 ,$0.61 ,$0.61 ,$0.61 ,$0.69 ,$0.90 ,$0.68 , N/A ,$0.79 , N/A ,$1.00 ,$1.00 , N/A ,$1.00 ,$0.72 ,$0.62 ,$0.72 ,$0.72 ,$0.80 
ST NICHOLAS HOSPITAL - ACUTE,45001368,15854,HC REMOVAL SUTURES AND STAPLES NOT REQ ANESTH,450,1 ,$1.00 ,$0.66 ,$0.51 ,$1.00 , N/A ,$0.69 ,$0.69 , N/A ,$0.60 ,$0.85 ,$0.70 , N/A , N/A ,$0.95 ,$0.76 ,$0.75 ,$0.65 ,$0.85 , N/A ,$0.65 ,$0.65 ,$0.70 ,$0.61 , N/A , N/A , N/A , N/A , N/A ,$0.85 , N/A ,$0.92 ,$0.70 ,$0.51 ,$0.61 ,$0.61 ,$0.61 ,$0.69 ,$0.90 ,$0.68 , N/A ,$0.79 , N/A ,$1.00 ,$1.00 , N/A ,$1.00 ,$0.72 ,$0.62 ,$0.72 ,$0.72 ,$0.80 
ST NICHOLAS HOSPITAL - ACUTE,45001371,69110,HC EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR,450,1 ,"$7,563.75 ","$4,992.08 ",$90.07 ,"$7,563.75 ",$90.07 ,"$5,184.19 ","$5,184.19 ","$2,521.25 ","$4,538.25 ","$6,429.19 ","$5,294.63 ",$90.07 ,$90.07 ,"$7,185.56 ","$5,748.45 ","$5,672.81 ","$4,916.44 ","$6,429.19 ","$2,521.25 ","$4,916.44 ","$4,916.44 ","$5,294.63 ","$4,606.32 ",$90.07 ,"$2,521.25 ","$2,470.82 ","$5,042.50 ",$95.47 ,"$6,429.19 ","$5,672.82 ","$6,958.65 ","$5,294.63 ","$3,836.33 ","$4,604.05 ","$4,606.32 ","$4,604.05 ","$5,226.55 ","$6,807.38 ","$5,167.55 ","$2,495.53 ","$5,975.36 ",$95.47 ,$700.00 ,$700.00 ,"$2,470.82 ",$700.00 ,"$5,445.90 ","$4,689.53 ","$5,445.90 ","$5,445.90 ","$6,051.00 "
ST NICHOLAS HOSPITAL - ACUTE,45080004,23605,HC CLOSED RX PROX HUMERUS FX MANIP,450,1 ,"$4,481.40 ","$2,957.72 ",$15.68 ,"$4,481.40 ",$15.68 ,"$3,071.55 ","$3,071.55 ","$1,400.09 ","$2,688.84 ","$3,809.19 ","$3,136.98 ",$15.68 ,$15.68 ,"$4,257.33 ","$3,405.86 ","$3,361.05 ","$2,912.91 ","$3,809.19 ","$1,400.09 ","$2,912.91 ","$2,912.91 ","$3,136.98 ","$2,729.17 ",$15.68 ,"$1,400.09 ","$1,372.09 ","$2,800.18 ",$16.62 ,"$3,809.19 ","$3,150.21 ","$4,122.89 ","$3,136.98 ","$2,272.97 ","$2,727.83 ","$2,729.17 ","$2,727.83 ","$3,096.65 ","$4,033.26 ","$3,061.69 ","$1,385.81 ","$3,540.31 ",$16.62 ,$700.00 ,$700.00 ,"$1,372.09 ",$700.00 ,"$3,226.61 ","$2,778.47 ","$3,226.61 ","$3,226.61 ","$3,585.12 "
ST NICHOLAS HOSPITAL - ACUTE,46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$451.33 ,$297.88 ,$1.89 ,$451.33 ,$1.89 ,$309.34 ,$309.34 ,$141.94 ,$270.80 ,$383.63 ,$315.93 ,$1.89 ,$1.89 ,$428.76 ,$343.01 ,$338.50 ,$293.36 ,$383.63 ,$141.94 ,$293.36 ,$293.36 ,$315.93 ,$274.86 ,$1.89 ,$141.94 ,$139.10 ,$283.88 ,$2.00 ,$383.63 ,$319.36 ,$415.22 ,$315.93 ,$228.91 ,$274.72 ,$274.86 ,$274.72 ,$311.87 ,$406.20 ,$308.35 ,$140.49 ,$356.55 ,$2.00 ,$451.33 ,$451.33 ,$139.10 ,$451.33 ,$324.96 ,$279.82 ,$324.96 ,$324.96 ,$361.06 
ST NICHOLAS HOSPITAL - ACUTE,46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,$807.30 ,$532.82 ,$3.49 ,$807.30 ,$3.49 ,$553.32 ,$553.32 ,$273.34 ,$484.38 ,$686.21 ,$565.11 ,$3.49 ,$3.49 ,$766.94 ,$613.55 ,$605.48 ,$524.75 ,$686.21 ,$273.34 ,$524.75 ,$524.75 ,$565.11 ,$491.65 ,$3.49 ,$273.34 ,$267.87 ,$546.68 ,$3.70 ,$686.21 ,$615.01 ,$742.72 ,$565.11 ,$409.46 ,$491.40 ,$491.65 ,$491.40 ,$557.84 ,$726.57 ,$551.55 ,$270.55 ,$637.77 ,$3.70 ,$639.00 ,$639.00 ,$267.87 ,$639.00 ,$581.26 ,$500.53 ,$581.26 ,$581.26 ,$645.84 
ST NICHOLAS HOSPITAL - ACUTE,46000006,94070,HC SPIROMETRY/PFT CPLX,460,1 ,"$1,150.57 ",$759.38 ,$3.49 ,"$1,150.57 ",$3.49 ,$788.60 ,$788.60 ,$273.34 ,$690.34 ,$977.98 ,$805.40 ,$3.49 ,$3.49 ,"$1,093.04 ",$874.43 ,$862.93 ,$747.87 ,$977.98 ,$273.34 ,$747.87 ,$747.87 ,$805.40 ,$700.70 ,$3.49 ,$273.34 ,$267.87 ,$546.68 ,$3.70 ,$977.98 ,$615.01 ,"$1,058.52 ",$805.40 ,$583.57 ,$700.35 ,$700.70 ,$700.35 ,$795.04 ,"$1,035.51 ",$786.07 ,$270.55 ,$908.95 ,$3.70 ,$639.00 ,$639.00 ,$267.87 ,$639.00 ,$828.41 ,$713.35 ,$828.41 ,$828.41 ,$920.46 
ST NICHOLAS HOSPITAL - ACUTE,46000007,94150,HC VITAL CAPACITY TOTAL,460,1 ,$177.99 ,$117.47 ,$1.89 ,$319.36 ,$1.89 ,$121.99 ,$121.99 ,$141.94 ,$106.79 ,$151.29 ,$124.59 ,$1.89 ,$1.89 ,$169.09 ,$135.27 ,$133.49 ,$115.69 ,$151.29 ,$141.94 ,$115.69 ,$115.69 ,$124.59 ,$108.40 ,$1.89 ,$141.94 ,$139.10 ,$177.99 ,$2.00 ,$151.29 ,$319.36 ,$163.75 ,$124.59 ,$90.28 ,$108.34 ,$108.40 ,$108.34 ,$122.99 ,$160.19 ,$121.60 ,$140.49 ,$140.61 ,$2.00 ,$177.99 ,$177.99 ,$139.10 ,$177.99 ,$128.15 ,$110.35 ,$128.15 ,$128.15 ,$142.39 
ST NICHOLAS HOSPITAL - ACUTE,46000008,94729,HC RESIDUAL LUNG CAPACITY,460,1 ,$355.98 ,$234.95 ,$1.89 ,$355.98 ,$1.89 ,$243.99 ,$243.99 , N/A ,$213.59 ,$302.58 ,$249.19 ,$1.89 ,$1.89 ,$338.18 ,$270.54 ,$266.99 ,$231.39 ,$302.58 , N/A ,$231.39 ,$231.39 ,$249.19 ,$216.79 ,$1.89 , N/A , N/A , N/A ,$2.00 ,$302.58 , N/A ,$327.50 ,$249.19 ,$180.55 ,$216.69 ,$216.79 ,$216.69 ,$245.98 ,$320.38 ,$243.21 , N/A ,$281.22 ,$2.00 ,$355.98 ,$355.98 , N/A ,$355.98 ,$256.31 ,$220.71 ,$256.31 ,$256.31 ,$284.78 
ST NICHOLAS HOSPITAL - ACUTE,46000009,94250,HC EXPIRED GAS COLLECTION,460,1 ,$177.99 ,$117.47 ,$90.28 ,$177.99 , N/A ,$121.99 ,$121.99 , N/A ,$106.79 ,$151.29 ,$124.59 , N/A , N/A ,$169.09 ,$135.27 ,$133.49 ,$115.69 ,$151.29 , N/A ,$115.69 ,$115.69 ,$124.59 ,$108.40 , N/A , N/A , N/A , N/A , N/A ,$151.29 , N/A ,$163.75 ,$124.59 ,$90.28 ,$108.34 ,$108.40 ,$108.34 ,$122.99 ,$160.19 ,$121.60 , N/A ,$140.61 , N/A ,$177.99 ,$177.99 , N/A ,$177.99 ,$128.15 ,$110.35 ,$128.15 ,$128.15 ,$142.39 
ST NICHOLAS HOSPITAL - ACUTE,46000010,94726,HC THORACIC GAS VOLUME,460,1 ,$593.29 ,$391.57 ,$3.49 ,$615.01 ,$3.49 ,$406.64 ,$406.64 ,$273.34 ,$355.97 ,$504.30 ,$415.30 ,$3.49 ,$3.49 ,$563.63 ,$450.90 ,$444.97 ,$385.64 ,$504.30 ,$273.34 ,$385.64 ,$385.64 ,$415.30 ,$361.31 ,$3.49 ,$273.34 ,$267.87 ,$546.68 ,$3.70 ,$504.30 ,$615.01 ,$545.83 ,$415.30 ,$300.92 ,$361.14 ,$361.31 ,$361.14 ,$409.96 ,$533.96 ,$405.34 ,$270.55 ,$468.70 ,$3.70 ,$593.29 ,$593.29 ,$267.87 ,$593.29 ,$427.17 ,$367.84 ,$427.17 ,$427.17 ,$474.63 
ST NICHOLAS HOSPITAL - ACUTE,46000011,94727,HC NITROGEN WASHOUT CURVE,460,1 ,$344.32 ,$227.25 ,$1.89 ,$344.32 ,$1.89 ,$236.00 ,$236.00 ,$141.94 ,$206.59 ,$292.67 ,$241.02 ,$1.89 ,$1.89 ,$327.10 ,$261.68 ,$258.24 ,$223.81 ,$292.67 ,$141.94 ,$223.81 ,$223.81 ,$241.02 ,$209.69 ,$1.89 ,$141.94 ,$139.10 ,$283.88 ,$2.00 ,$292.67 ,$319.36 ,$316.77 ,$241.02 ,$174.64 ,$209.59 ,$209.69 ,$209.59 ,$237.93 ,$309.89 ,$235.24 ,$140.49 ,$272.01 ,$2.00 ,$344.32 ,$344.32 ,$139.10 ,$344.32 ,$247.91 ,$213.48 ,$247.91 ,$247.91 ,$275.46 
ST NICHOLAS HOSPITAL - ACUTE,46000012,94728,HC AIRFLOW RESISTANCE,460,1 ,$260.63 ,$172.02 ,$3.49 ,$615.01 ,$3.49 ,$178.64 ,$178.64 ,$273.34 ,$156.38 ,$221.54 ,$182.44 ,$3.49 ,$3.49 ,$247.60 ,$198.08 ,$195.47 ,$169.41 ,$221.54 ,$273.34 ,$169.41 ,$169.41 ,$182.44 ,$158.72 ,$3.49 ,$273.34 ,$267.87 ,$260.63 ,$3.70 ,$221.54 ,$615.01 ,$239.78 ,$182.44 ,$132.19 ,$158.65 ,$158.72 ,$158.65 ,$180.10 ,$234.57 ,$178.06 ,$270.55 ,$205.90 ,$3.70 ,$260.63 ,$260.63 ,$267.87 ,$260.63 ,$187.65 ,$161.59 ,$187.65 ,$187.65 ,$208.50 
ST NICHOLAS HOSPITAL - ACUTE,46000014,94618,HC WALK TEST 6 MIN,460,1 ,$557.27 ,$367.80 ,$1.89 ,$557.27 ,$1.89 ,$381.95 ,$381.95 ,$113.32 ,$334.36 ,$473.68 ,$390.09 ,$1.89 ,$1.89 ,$529.41 ,$423.53 ,$417.95 ,$362.23 ,$473.68 ,$113.32 ,$362.23 ,$362.23 ,$390.09 ,$339.38 ,$1.89 ,$113.32 ,$111.05 ,$226.64 ,$2.00 ,$473.68 ,$254.98 ,$512.69 ,$390.09 ,$282.65 ,$339.21 ,$339.38 ,$339.21 ,$385.07 ,$501.54 ,$380.73 ,$112.16 ,$440.24 ,$2.00 ,$557.27 ,$557.27 ,$111.05 ,$557.27 ,$401.23 ,$345.51 ,$401.23 ,$401.23 ,$445.82 
ST NICHOLAS HOSPITAL - ACUTE,46000017,94729,HC CARBON MONOXIDE DIFF (DLCO),460,1 ,$355.98 ,$234.95 ,$1.89 ,$355.98 ,$1.89 ,$243.99 ,$243.99 , N/A ,$213.59 ,$302.58 ,$249.19 ,$1.89 ,$1.89 ,$338.18 ,$270.54 ,$266.99 ,$231.39 ,$302.58 , N/A ,$231.39 ,$231.39 ,$249.19 ,$216.79 ,$1.89 , N/A , N/A , N/A ,$2.00 ,$302.58 , N/A ,$327.50 ,$249.19 ,$180.55 ,$216.69 ,$216.79 ,$216.69 ,$245.98 ,$320.38 ,$243.21 , N/A ,$281.22 ,$2.00 ,$355.98 ,$355.98 , N/A ,$355.98 ,$256.31 ,$220.71 ,$256.31 ,$256.31 ,$284.78 
ST NICHOLAS HOSPITAL - ACUTE,46000018,94762,HC OXIMETRY OVERNIGHT,460,1 ,$284.99 ,$188.09 ,$1.89 ,$319.36 ,$1.89 ,$195.33 ,$195.33 ,$141.94 ,$170.99 ,$242.24 ,$199.49 ,$1.89 ,$1.89 ,$270.74 ,$216.59 ,$213.74 ,$185.24 ,$242.24 ,$141.94 ,$185.24 ,$185.24 ,$199.49 ,$173.56 ,$1.89 ,$141.94 ,$139.10 ,$283.88 ,$2.00 ,$242.24 ,$319.36 ,$262.19 ,$199.49 ,$144.55 ,$173.47 ,$173.56 ,$173.47 ,$196.93 ,$256.49 ,$194.71 ,$140.49 ,$225.14 ,$2.00 ,$284.99 ,$284.99 ,$139.10 ,$284.99 ,$205.19 ,$176.69 ,$205.19 ,$205.19 ,$227.99 
ST NICHOLAS HOSPITAL - ACUTE,46000020,95801,HC APNEALINK STUDY/SAT,460,1 ,$374.03 ,$246.86 ,$5.00 ,$374.03 ,$5.00 ,$256.36 ,$256.36 ,$113.32 ,$224.42 ,$317.93 ,$261.82 ,$5.00 ,$5.00 ,$355.33 ,$284.26 ,$280.52 ,$243.12 ,$317.93 ,$113.32 ,$243.12 ,$243.12 ,$261.82 ,$227.78 ,$5.00 ,$113.32 ,$111.05 ,$226.64 ,$5.30 ,$317.93 ,$254.98 ,$344.11 ,$261.82 ,$189.71 ,$227.67 ,$227.78 ,$227.67 ,$258.45 ,$336.63 ,$255.54 ,$112.16 ,$295.48 ,$5.30 ,$374.03 ,$374.03 ,$111.05 ,$374.03 ,$269.30 ,$231.90 ,$269.30 ,$269.30 ,$299.22 
ST NICHOLAS HOSPITAL - ACUTE,46000022,94200,HC MAXIMAL VOL VENTILATION,942,1 ,$237.32 ,$156.63 ,$1.89 ,$237.32 ,$1.89 ,$162.66 ,$162.66 ,$56.10 ,$142.39 ,$201.72 ,$166.12 ,$1.89 ,$1.89 ,$225.45 ,$180.36 ,$177.99 ,$154.26 ,$201.72 ,$56.10 ,$154.26 ,$154.26 ,$166.12 ,$144.53 ,$1.89 ,$56.10 ,$54.98 ,$112.20 ,$2.00 ,$201.72 ,$126.23 ,$218.33 ,$166.12 ,$120.37 ,$144.46 ,$144.53 ,$144.46 ,$163.99 ,$213.59 ,$162.14 ,$55.53 ,$187.48 ,$2.00 ,$136.00 ,$136.00 ,$54.98 ,$136.00 ,$170.87 ,$147.14 ,$170.87 ,$170.87 ,$189.86 
ST NICHOLAS HOSPITAL - ACUTE,46000031,94681,HC CO2/O2 UPTAKE EXPIRED GAS,460,1 ,$842.27 ,$555.90 ,$3.49 ,$842.27 ,$3.49 ,$577.29 ,$577.29 ,$273.34 ,$505.36 ,$715.93 ,$589.59 ,$3.49 ,$3.49 ,$800.16 ,$640.13 ,$631.70 ,$547.48 ,$715.93 ,$273.34 ,$547.48 ,$547.48 ,$589.59 ,$512.94 ,$3.49 ,$273.34 ,$267.87 ,$546.68 ,$3.70 ,$715.93 ,$615.01 ,$774.89 ,$589.59 ,$427.20 ,$512.69 ,$512.94 ,$512.69 ,$582.01 ,$758.04 ,$575.44 ,$270.55 ,$665.39 ,$3.70 ,$639.00 ,$639.00 ,$267.87 ,$639.00 ,$606.43 ,$522.21 ,$606.43 ,$606.43 ,$673.82 
ST NICHOLAS HOSPITAL - ACUTE,46000032,94750,HC PULMONARY COMPLIANCE STUDY,460,1 ,$308.30 ,$203.48 ,$156.37 ,$308.30 , N/A ,$211.31 ,$211.31 , N/A ,$184.98 ,$262.06 ,$215.81 , N/A , N/A ,$292.89 ,$234.31 ,$231.23 ,$200.40 ,$262.06 , N/A ,$200.40 ,$200.40 ,$215.81 ,$187.75 , N/A , N/A , N/A , N/A , N/A ,$262.06 , N/A ,$283.64 ,$215.81 ,$156.37 ,$187.66 ,$187.75 ,$187.66 ,$213.04 ,$277.47 ,$210.63 , N/A ,$243.56 , N/A ,$308.30 ,$308.30 , N/A ,$308.30 ,$221.98 ,$191.15 ,$221.98 ,$221.98 ,$246.64 
ST NICHOLAS HOSPITAL - ACUTE,46000033,94617,HC EXERCISE TEST BRONCHOSPASM,460,1 ,$308.30 ,$203.48 ,$1.89 ,$308.30 ,$1.89 ,$211.31 ,$211.31 ,$113.32 ,$184.98 ,$262.06 ,$215.81 ,$1.89 ,$1.89 ,$292.89 ,$234.31 ,$231.23 ,$200.40 ,$262.06 ,$113.32 ,$200.40 ,$200.40 ,$215.81 ,$187.75 ,$1.89 ,$113.32 ,$111.05 ,$226.64 ,$2.00 ,$262.06 ,$254.98 ,$283.64 ,$215.81 ,$156.37 ,$187.66 ,$187.75 ,$187.66 ,$213.04 ,$277.47 ,$210.63 ,$112.16 ,$243.56 ,$2.00 ,$308.30 ,$308.30 ,$111.05 ,$308.30 ,$221.98 ,$191.15 ,$221.98 ,$221.98 ,$246.64 
ST NICHOLAS HOSPITAL - ACUTE,46000034,95070,HC INHALATION BRONCHIAL CHALLENGE TEST W/HISTAMINE/METHACHOLINE,460,1 ,$751.15 ,$495.76 ,$1.56 ,"$1,061.61 ",$1.56 ,$514.84 ,$514.84 ,$471.83 ,$450.69 ,$638.48 ,$525.81 ,$1.56 ,$1.56 ,$713.59 ,$570.87 ,$563.36 ,$488.25 ,$638.48 ,$471.83 ,$488.25 ,$488.25 ,$525.81 ,$457.45 ,$1.56 ,$471.83 ,$462.39 ,$751.15 ,$1.65 ,$638.48 ,"$1,061.61 ",$691.06 ,$525.81 ,$380.98 ,$457.23 ,$457.45 ,$457.23 ,$519.04 ,$676.04 ,$513.19 ,$467.02 ,$593.41 ,$1.65 ,$639.00 ,$639.00 ,$462.39 ,$639.00 ,$540.83 ,$465.71 ,$540.83 ,$540.83 ,$600.92 
ST NICHOLAS HOSPITAL - ACUTE,47000000,92585,HC AUDITORY EVOKED POTENT COMPR,470,1 ,$853.92 ,$563.59 ,$81.00 ,$853.92 , N/A ,$585.28 ,$585.28 , N/A ,$512.35 ,$725.83 ,$597.74 , N/A , N/A ,$811.22 ,$648.98 ,$640.44 ,$555.05 ,$725.83 , N/A ,$555.05 ,$555.05 ,$597.74 ,$520.04 , N/A , N/A , N/A , N/A , N/A ,$725.83 , N/A ,$785.61 ,$597.74 ,$433.11 ,$519.78 ,$520.04 ,$519.78 ,$590.06 ,$768.53 ,$583.40 , N/A ,$674.60 , N/A ,$81.00 ,$81.00 , N/A ,$81.00 ,$614.82 ,$529.43 ,$614.82 ,$614.82 ,$683.14 
ST NICHOLAS HOSPITAL - ACUTE,47000001,92587,HC DISTORTION EVOKED POTENT LTD,470,1 ,$201.30 ,$132.86 ,$2.79 ,$615.01 ,$2.79 ,$137.97 ,$137.97 ,$273.34 ,$120.78 ,$171.11 ,$140.91 ,$2.79 ,$2.79 ,$191.24 ,$152.99 ,$150.98 ,$130.85 ,$171.11 ,$273.34 ,$130.85 ,$130.85 ,$140.91 ,$122.59 ,$2.79 ,$273.34 ,$267.87 ,$201.30 ,$2.96 ,$171.11 ,$615.01 ,$185.20 ,$140.91 ,$102.10 ,$122.53 ,$122.59 ,$122.53 ,$139.10 ,$181.17 ,$137.53 ,$270.55 ,$159.03 ,$2.96 ,$81.00 ,$81.00 ,$267.87 ,$81.00 ,$144.94 ,$124.81 ,$144.94 ,$144.94 ,$161.04 
ST NICHOLAS HOSPITAL - ACUTE,47000003,92586,HC NEWBORN HEARING SCREENING,470,1 ,$296.65 ,$195.79 ,$81.00 ,$296.65 , N/A ,$203.32 ,$203.32 , N/A ,$177.99 ,$252.15 ,$207.66 , N/A , N/A ,$281.82 ,$225.45 ,$222.49 ,$192.82 ,$252.15 , N/A ,$192.82 ,$192.82 ,$207.66 ,$180.66 , N/A , N/A , N/A , N/A , N/A ,$252.15 , N/A ,$272.92 ,$207.66 ,$150.46 ,$180.57 ,$180.66 ,$180.57 ,$204.99 ,$266.99 ,$202.67 , N/A ,$234.35 , N/A ,$81.00 ,$81.00 , N/A ,$81.00 ,$213.59 ,$183.92 ,$213.59 ,$213.59 ,$237.32 
ST NICHOLAS HOSPITAL - ACUTE,47000090,92650,HC AEP SCR AUDITORY POT W STIMULI,470,1 ,$250.00 ,$165.00 ,$1.18 ,$250.00 ,$1.18 ,$171.35 ,$171.35 , N/A ,$150.00 ,$212.50 ,$175.00 ,$1.18 ,$1.18 ,$237.50 ,$190.00 ,$187.50 ,$162.50 ,$212.50 , N/A ,$162.50 ,$162.50 ,$175.00 ,$152.25 ,$1.18 , N/A , N/A , N/A ,$1.25 ,$212.50 , N/A ,$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$152.18 ,$172.75 ,$225.00 ,$170.80 , N/A ,$197.50 ,$1.25 ,$81.00 ,$81.00 , N/A ,$81.00 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,47000091,92651,HC AEP HEARING STATUS DETER BB STIM I AND R,470,1 ,$405.00 ,$267.30 ,$2.79 ,$405.00 ,$2.79 ,$277.59 ,$277.59 ,$141.94 ,$243.00 ,$344.25 ,$283.50 ,$2.79 ,$2.79 ,$384.75 ,$307.80 ,$303.75 ,$263.25 ,$344.25 ,$141.94 ,$263.25 ,$263.25 ,$283.50 ,$246.65 ,$2.79 ,$141.94 ,$139.10 ,$283.88 ,$2.96 ,$344.25 ,$319.36 ,$372.60 ,$283.50 ,$205.42 ,$246.52 ,$246.65 ,$246.52 ,$279.86 ,$364.50 ,$276.70 ,$140.49 ,$319.95 ,$2.96 ,$81.00 ,$81.00 ,$139.10 ,$81.00 ,$291.60 ,$251.10 ,$291.60 ,$291.60 ,$324.00 
ST NICHOLAS HOSPITAL - ACUTE,47100009,92558,HC AUD EVOKED OTOACOUS EMISSIONS SCREENING,471,1 ,$226.72 ,$149.64 ,$1.18 ,$226.72 ,$1.18 ,$155.39 ,$155.39 , N/A ,$136.03 ,$192.71 ,$158.70 ,$1.18 ,$1.18 ,$215.38 ,$172.31 ,$170.04 ,$147.37 ,$192.71 , N/A ,$147.37 ,$147.37 ,$158.70 ,$138.07 ,$1.18 , N/A , N/A , N/A ,$1.25 ,$192.71 , N/A ,$208.58 ,$158.70 ,$114.99 ,$138.00 ,$138.07 ,$138.00 ,$156.66 ,$204.05 ,$154.90 , N/A ,$179.11 ,$1.25 ,$81.00 ,$81.00 , N/A ,$81.00 ,$163.24 ,$140.57 ,$163.24 ,$163.24 ,$181.38 
ST NICHOLAS HOSPITAL - ACUTE,48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,"$1,858.40 ","$1,226.54 ",$21.86 ,"$1,858.40 ",$21.86 ,"$1,273.75 ","$1,273.75 ",$574.02 ,"$1,115.04 ","$1,579.64 ","$1,300.88 ",$21.86 ,$21.86 ,"$1,765.48 ","$1,412.38 ","$1,393.80 ","$1,207.96 ","$1,579.64 ",$574.02 ,"$1,207.96 ","$1,207.96 ","$1,300.88 ","$1,131.77 ",$21.86 ,$574.02 ,$562.54 ,"$1,148.04 ",$23.17 ,"$1,579.64 ","$1,291.56 ","$1,709.73 ","$1,300.88 ","$1,771.14 ","$1,858.40 ","$1,131.77 ","$1,858.40 ","$1,284.15 ","$1,672.56 ","$1,269.66 ",$568.16 ,"$1,468.14 ",$23.17 ,"$1,321.00 ","$1,321.00 ",$562.54 ,"$1,321.00 ","$1,338.05 ","$1,152.21 ","$1,338.05 ","$1,338.05 ","$1,486.72 "
ST NICHOLAS HOSPITAL - ACUTE,48000007,93281,HC MULTI CHAM PACEMAKER ANALYSIS,480,1 ,$180.55 ,$119.16 ,$1.27 ,$180.55 ,$1.27 ,$123.75 ,$123.75 ,$34.16 ,$108.33 ,$153.47 ,$126.39 ,$1.27 ,$1.27 ,$171.52 ,$137.22 ,$135.41 ,$117.36 ,$153.47 ,$34.16 ,$117.36 ,$117.36 ,$126.39 ,$109.96 ,$1.27 ,$34.16 ,$33.48 ,$68.32 ,$1.35 ,$153.47 ,$76.86 ,$166.11 ,$126.39 ,$91.58 ,$109.90 ,$109.96 ,$109.90 ,$124.76 ,$162.50 ,$123.35 ,$33.81 ,$142.63 ,$1.35 ,$180.55 ,$180.55 ,$33.48 ,$180.55 ,$130.00 ,$111.94 ,$130.00 ,$130.00 ,$144.44 
ST NICHOLAS HOSPITAL - ACUTE,48000008,G0269,HC PLACE OCCLUSIVE DEVICE A/VV G0269,480,1 ,$545.10 ,$359.77 ,$276.47 ,$545.10 , N/A ,$373.61 ,$373.61 , N/A ,$327.06 ,$463.34 ,$381.57 , N/A , N/A ,$517.85 ,$414.28 ,$408.83 ,$354.32 ,$463.34 , N/A ,$354.32 ,$354.32 ,$381.57 ,$331.97 , N/A , N/A , N/A , N/A , N/A ,$463.34 , N/A ,$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 , N/A ,$430.63 , N/A ,$545.10 ,$545.10 , N/A ,$545.10 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,48000011,93285,HC LOOP RECORDER PROGRAMMING,480,1 ,$135.70 ,$89.56 ,$1.27 ,$135.70 ,$1.27 ,$93.01 ,$93.01 ,$34.16 ,$81.42 ,$115.35 ,$94.99 ,$1.27 ,$1.27 ,$128.92 ,$103.13 ,$101.78 ,$88.21 ,$115.35 ,$34.16 ,$88.21 ,$88.21 ,$94.99 ,$82.64 ,$1.27 ,$34.16 ,$33.48 ,$68.32 ,$1.35 ,$115.35 ,$76.86 ,$124.84 ,$94.99 ,$68.83 ,$82.60 ,$82.64 ,$82.60 ,$93.77 ,$122.13 ,$92.71 ,$33.81 ,$107.20 ,$1.35 ,$135.70 ,$135.70 ,$33.48 ,$135.70 ,$97.70 ,$84.13 ,$97.70 ,$97.70 ,$108.56 
ST NICHOLAS HOSPITAL - ACUTE,48000012,93261,HC S-ICD INTERROGATION,480,1 ,$112.00 ,$73.92 ,$1.27 ,$112.00 ,$1.27 ,$76.76 ,$76.76 ,$34.16 ,$67.20 ,$95.20 ,$78.40 ,$1.27 ,$1.27 ,$106.40 ,$85.12 ,$84.00 ,$72.80 ,$95.20 ,$34.16 ,$72.80 ,$72.80 ,$78.40 ,$68.21 ,$1.27 ,$34.16 ,$33.48 ,$68.32 ,$1.35 ,$95.20 ,$76.86 ,$103.04 ,$78.40 ,$56.81 ,$68.17 ,$68.21 ,$68.17 ,$77.39 ,$100.80 ,$76.52 ,$33.81 ,$88.48 ,$1.35 ,$112.00 ,$112.00 ,$33.48 ,$112.00 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,48000017,93640,HC EP EVAL CARDIO/DEFIB LEADS,480,1 ,"$3,137.04 ","$2,070.45 ",$190.94 ,"$3,137.04 ",$190.94 ,"$2,150.13 ","$2,150.13 ", N/A ,"$1,882.22 ","$2,666.48 ","$2,195.93 ",$190.94 ,$190.94 ,"$2,980.19 ","$2,384.15 ","$2,352.78 ","$2,039.08 ","$2,666.48 ", N/A ,"$2,039.08 ","$2,039.08 ","$2,195.93 ","$1,910.46 ",$190.94 , N/A , N/A , N/A ,$202.40 ,"$2,666.48 ", N/A ,"$2,886.08 ","$2,195.93 ","$1,591.11 ","$1,909.52 ","$1,910.46 ","$1,909.52 ","$2,167.69 ","$2,823.34 ","$2,143.23 ", N/A ,"$2,478.26 ",$202.40 ,"$1,321.00 ","$1,321.00 ", N/A ,"$1,321.00 ","$2,258.67 ","$1,944.96 ","$2,258.67 ","$2,258.67 ","$2,509.63 "
ST NICHOLAS HOSPITAL - ACUTE,48000024,93668,HC PAD REHAB PER SESSION,480,1 ,$125.35 ,$82.73 ,$54.98 ,$126.23 , N/A ,$85.91 ,$85.91 ,$56.10 ,$75.21 ,$106.55 ,$87.75 , N/A , N/A ,$119.08 ,$95.27 ,$94.01 ,$81.48 ,$106.55 ,$56.10 ,$81.48 ,$81.48 ,$87.75 ,$76.34 , N/A ,$56.10 ,$54.98 ,$112.20 , N/A ,$106.55 ,$126.23 ,$115.32 ,$87.75 ,$63.58 ,$76.30 ,$76.34 ,$76.30 ,$86.62 ,$112.82 ,$85.64 ,$55.53 ,$99.03 , N/A ,$125.35 ,$125.35 ,$54.98 ,$125.35 ,$90.25 ,$77.72 ,$90.25 ,$90.25 ,$100.28 
ST NICHOLAS HOSPITAL - ACUTE,48100002,33206,HC INS/REPL PCMKR PERM ATRIAL 33206,481,1 ,"$7,918.00 ","$5,225.88 ",$279.90 ,"$22,681.98 ",$279.90 ,"$7,918.00 ","$7,918.00 ","$10,080.88 ","$4,750.80 ","$6,730.30 ","$5,542.60 ",$279.90 ,$279.90 ,"$7,522.10 ","$6,017.68 ","$5,938.50 ","$7,918.00 ","$6,730.30 ","$10,080.88 ","$7,918.00 ","$7,918.00 ","$5,542.60 ","$4,822.06 ",$279.90 ,"$10,080.88 ","$9,879.26 ","$7,918.00 ",$296.69 ,"$6,730.30 ","$22,681.98 ","$7,284.56 ","$5,542.60 ","$4,887.30 ","$6,108.86 ","$4,822.06 ","$6,108.86 ","$5,471.34 ","$7,126.20 ","$5,409.58 ","$9,978.06 ","$6,255.22 ",$296.69 ,"$7,918.00 ","$7,918.00 ","$9,879.26 ","$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100003,33207,HC INS/REPL PACEMKR PERM VENTRIC 33207,481,1 ,"$7,918.00 ","$5,225.88 ",$279.90 ,"$22,681.98 ",$279.90 ,"$7,918.00 ","$7,918.00 ","$10,080.88 ","$4,750.80 ","$6,730.30 ","$5,542.60 ",$279.90 ,$279.90 ,"$7,522.10 ","$6,017.68 ","$5,938.50 ","$7,918.00 ","$6,730.30 ","$10,080.88 ","$7,918.00 ","$7,918.00 ","$5,542.60 ","$4,822.06 ",$279.90 ,"$10,080.88 ","$9,879.26 ","$7,918.00 ",$296.69 ,"$6,730.30 ","$22,681.98 ","$7,284.56 ","$5,542.60 ","$4,887.30 ","$6,108.86 ","$4,822.06 ","$6,108.86 ","$5,471.34 ","$7,126.20 ","$5,409.58 ","$9,978.06 ","$6,255.22 ",$296.69 ,"$7,918.00 ","$7,918.00 ","$9,879.26 ","$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100004,33208,HC INS/REPL PACEMKR PERM A/V 33208,481,1 ,"$8,881.00 ","$5,861.46 ",$279.90 ,"$22,681.98 ",$279.90 ,"$8,881.00 ","$8,881.00 ","$10,080.88 ","$5,328.60 ","$7,548.85 ","$6,216.70 ",$279.90 ,$279.90 ,"$8,436.95 ","$6,749.56 ","$6,660.75 ","$8,881.00 ","$7,548.85 ","$10,080.88 ","$8,881.00 ","$8,881.00 ","$6,216.70 ","$5,408.53 ",$279.90 ,"$10,080.88 ","$9,879.26 ","$8,881.00 ",$296.69 ,"$7,548.85 ","$22,681.98 ","$8,170.52 ","$6,216.70 ","$4,986.74 ","$6,233.42 ","$5,408.53 ","$6,233.42 ","$6,136.77 ","$7,992.90 ","$6,067.50 ","$9,978.06 ","$7,015.99 ",$296.69 ,"$8,881.00 ","$8,881.00 ","$9,879.26 ","$8,881.00 ","$6,394.32 ","$5,506.22 ","$6,394.32 ","$6,394.32 ","$7,104.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100005,33210,HC INS/REPL TPM SGL ELEC/CATH 33210,481,1 ,"$4,280.00 ","$2,824.80 ",$61.63 ,"$17,925.44 ",$61.63 ,"$4,280.00 ","$4,280.00 ","$7,966.86 ","$2,568.00 ","$3,638.00 ","$2,996.00 ",$61.63 ,$61.63 ,"$4,066.00 ","$3,252.80 ","$3,210.00 ","$4,280.00 ","$3,638.00 ","$7,966.86 ","$4,280.00 ","$4,280.00 ","$2,996.00 ","$2,606.52 ",$61.63 ,"$7,966.86 ","$7,807.52 ","$4,280.00 ",$65.33 ,"$3,638.00 ","$17,925.44 ","$3,937.60 ","$2,996.00 ","$4,535.48 ","$5,669.62 ","$2,606.52 ","$5,669.62 ","$2,957.48 ","$3,852.00 ","$2,924.10 ","$7,885.60 ","$3,381.20 ",$65.33 ,"$4,280.00 ","$4,280.00 ","$7,807.52 ","$4,280.00 ","$3,081.60 ","$2,653.60 ","$3,081.60 ","$3,081.60 ","$3,424.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100006,33212,HC INS PULSE GEN SGL CHAMBER 33212,481,1 ,"$7,918.00 ","$5,225.88 ",$279.90 ,"$17,925.44 ",$279.90 ,"$7,918.00 ","$7,918.00 ","$7,966.86 ","$4,750.80 ","$6,730.30 ","$5,542.60 ",$279.90 ,$279.90 ,"$7,522.10 ","$6,017.68 ","$5,938.50 ","$6,938.00 ","$6,730.30 ","$7,966.86 ","$6,938.00 ","$6,938.00 ","$5,542.60 ","$4,822.06 ",$279.90 ,"$7,966.86 ","$7,807.52 ","$7,918.00 ",$296.69 ,"$6,730.30 ","$17,925.44 ","$7,284.56 ","$5,542.60 ","$4,887.30 ","$6,108.86 ","$4,822.06 ","$6,108.86 ","$5,471.34 ","$7,126.20 ","$5,409.58 ","$7,885.60 ","$6,255.22 ",$296.69 ,"$7,918.00 ","$7,918.00 ","$7,807.52 ","$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100007,33213,HC INS PULSE GEN DUAL CHAMBER 33213,481,1 ,"$10,031.00 ","$6,620.46 ",$279.90 ,"$22,681.98 ",$279.90 ,"$10,031.00 ","$10,031.00 ","$10,080.88 ","$6,018.60 ","$8,526.35 ","$7,021.70 ",$279.90 ,$279.90 ,"$9,529.45 ","$7,623.56 ","$7,523.25 ","$6,938.00 ","$8,526.35 ","$10,080.88 ","$6,938.00 ","$6,938.00 ","$7,021.70 ","$6,108.88 ",$279.90 ,"$10,080.88 ","$9,879.26 ","$10,031.00 ",$296.69 ,"$8,526.35 ","$22,681.98 ","$9,228.52 ","$7,021.70 ","$4,887.30 ","$6,108.86 ","$6,108.88 ","$6,108.86 ","$6,931.42 ","$9,027.90 ","$6,853.18 ","$9,978.06 ","$7,924.49 ",$296.69 ,"$10,031.00 ","$10,031.00 ","$9,879.26 ","$10,031.00 ","$7,222.32 ","$6,219.22 ","$7,222.32 ","$7,222.32 ","$8,024.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100008,33214,HC UPGRADE PACEMAKER SYSTEM 33214,481,1 ,"$14,156.00 ","$9,342.96 ",$279.90 ,"$22,681.98 ",$279.90 ,"$14,156.00 ","$12,891.00 ","$10,080.88 ","$8,493.60 ","$12,032.60 ","$9,909.20 ",$279.90 ,$279.90 ,"$13,448.20 ","$10,758.56 ","$10,617.00 ","$14,156.00 ","$12,032.60 ","$10,080.88 ","$14,156.00 ","$14,156.00 ","$9,909.20 ","$8,621.00 ",$279.90 ,"$10,080.88 ","$9,879.26 ","$14,156.00 ",$296.69 ,"$12,032.60 ","$22,681.98 ","$13,023.52 ","$9,909.20 ","$4,986.74 ","$6,233.42 ","$8,621.00 ","$6,233.42 ","$9,781.80 ","$12,740.40 ","$9,671.38 ","$9,978.06 ","$11,183.24 ",$296.69 ,"$14,156.00 ","$14,156.00 ","$9,879.26 ","$14,156.00 ","$10,192.32 ","$8,776.72 ","$10,192.32 ","$10,192.32 ","$11,324.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100009,33215,HC REPOSITION PACE/DEFIB LEAD 33215,481,1 ,"$3,424.00 ","$2,259.84 ",$61.63 ,"$6,541.82 ",$61.63 ,"$3,424.00 ","$3,424.00 ","$2,907.47 ","$2,054.40 ","$2,910.40 ","$2,396.80 ",$61.63 ,$61.63 ,"$3,252.80 ","$2,602.24 ","$2,568.00 ","$3,424.00 ","$2,910.40 ","$2,907.47 ","$3,424.00 ","$3,424.00 ","$2,396.80 ","$2,085.22 ",$61.63 ,"$2,907.47 ","$2,849.32 ","$3,424.00 ",$65.33 ,"$2,910.40 ","$6,541.82 ","$3,150.08 ","$2,396.80 ","$3,273.50 ","$4,091.88 ","$2,085.22 ","$4,091.88 ","$2,365.98 ","$3,081.60 ","$2,339.28 ","$2,877.81 ","$2,704.96 ",$65.33 ,"$3,424.00 ","$3,424.00 ","$2,849.32 ","$3,424.00 ","$2,465.28 ","$2,122.88 ","$2,465.28 ","$2,465.28 ","$2,739.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100010,33216,HC INS ELECTRODE SGL CHAMBER 33216,481,1 ,"$5,901.00 ","$3,894.66 ",$61.63 ,"$17,925.44 ",$61.63 ,"$5,901.00 ","$5,901.00 ","$7,966.86 ","$3,540.60 ","$5,015.85 ","$4,130.70 ",$61.63 ,$61.63 ,"$5,605.95 ","$4,484.76 ","$4,425.75 ","$5,901.00 ","$5,015.85 ","$7,966.86 ","$5,901.00 ","$5,901.00 ","$4,130.70 ","$3,593.71 ",$61.63 ,"$7,966.86 ","$7,807.52 ","$5,901.00 ",$65.33 ,"$5,015.85 ","$17,925.44 ","$5,428.92 ","$4,130.70 ","$4,535.48 ","$5,669.62 ","$3,593.71 ","$5,669.62 ","$4,077.59 ","$5,310.90 ","$4,031.56 ","$7,885.60 ","$4,661.79 ",$65.33 ,"$5,901.00 ","$5,901.00 ","$7,807.52 ","$5,901.00 ","$4,248.72 ","$3,658.62 ","$4,248.72 ","$4,248.72 ","$4,720.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100011,33217,HC INS ELECTRODE DUAL CHAMBER 33217,481,1 ,"$5,778.00 ","$3,813.48 ",$61.63 ,"$17,925.44 ",$61.63 ,"$5,778.00 ","$5,778.00 ","$7,966.86 ","$3,466.80 ","$4,911.30 ","$4,044.60 ",$61.63 ,$61.63 ,"$5,489.10 ","$4,391.28 ","$4,333.50 ","$5,778.00 ","$4,911.30 ","$7,966.86 ","$5,778.00 ","$5,778.00 ","$4,044.60 ","$3,518.80 ",$61.63 ,"$7,966.86 ","$7,807.52 ","$5,778.00 ",$65.33 ,"$4,911.30 ","$17,925.44 ","$5,315.76 ","$4,044.60 ","$4,535.48 ","$5,669.62 ","$3,518.80 ","$5,669.62 ","$3,992.60 ","$5,200.20 ","$3,947.53 ","$7,885.60 ","$4,564.62 ",$65.33 ,"$5,778.00 ","$5,778.00 ","$7,807.52 ","$5,778.00 ","$4,160.16 ","$3,582.36 ","$4,160.16 ","$4,160.16 ","$4,622.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100012,33222,HC REVISE PACEMAKER POCKET 33222,481,1 ,"$3,424.00 ","$2,259.84 ",$61.63 ,"$3,789.99 ",$61.63 ,"$3,424.00 ","$3,424.00 ","$1,684.44 ","$2,054.40 ","$2,910.40 ","$2,396.80 ",$61.63 ,$61.63 ,"$3,252.80 ","$2,602.24 ","$2,568.00 ","$3,424.00 ","$2,910.40 ","$1,684.44 ","$3,424.00 ","$3,424.00 ","$2,396.80 ","$2,085.22 ",$61.63 ,"$1,684.44 ","$1,650.75 ","$3,368.88 ",$65.33 ,"$2,910.40 ","$3,789.99 ","$3,150.08 ","$2,396.80 ","$1,998.41 ","$2,497.74 ","$2,085.22 ","$2,497.74 ","$2,365.98 ","$3,081.60 ","$2,339.28 ","$1,667.25 ","$2,704.96 ",$65.33 ,"$3,424.00 ","$3,424.00 ","$1,650.75 ","$3,424.00 ","$2,465.28 ","$2,122.88 ","$2,465.28 ","$2,465.28 ","$2,739.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100013,33223,HC REVISE C-D POCKET 33223,481,1 ,"$3,007.00 ","$1,984.62 ",$61.63 ,"$3,789.99 ",$61.63 ,"$3,007.00 ","$3,007.00 ","$1,684.44 ","$1,804.20 ","$2,555.95 ","$2,104.90 ",$61.63 ,$61.63 ,"$2,856.65 ","$2,285.32 ","$2,255.25 ","$3,007.00 ","$2,555.95 ","$1,684.44 ","$3,007.00 ","$3,007.00 ","$2,104.90 ","$1,831.26 ",$61.63 ,"$1,684.44 ","$1,650.75 ","$3,007.00 ",$65.33 ,"$2,555.95 ","$3,789.99 ","$2,766.44 ","$2,104.90 ","$1,998.41 ","$2,497.74 ","$1,831.26 ","$2,497.74 ","$2,077.84 ","$2,706.30 ","$2,054.38 ","$1,667.25 ","$2,375.53 ",$65.33 ,"$3,007.00 ","$3,007.00 ","$1,650.75 ","$3,007.00 ","$2,165.04 ","$1,864.34 ","$2,165.04 ","$2,165.04 ","$2,405.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100014,33224,HC INSERT LV PACING ELECTRODE 33224,481,1 ,"$8,507.00 ","$5,614.62 ",$279.90 ,"$22,681.98 ",$279.90 ,"$8,507.00 ","$8,507.00 ","$10,080.88 ","$5,104.20 ","$7,230.95 ","$5,954.90 ",$279.90 ,$279.90 ,"$8,081.65 ","$6,465.32 ","$6,380.25 ","$7,276.00 ","$7,230.95 ","$10,080.88 ","$7,276.00 ","$7,276.00 ","$5,954.90 ","$5,180.76 ",$279.90 ,"$10,080.88 ","$9,879.26 ","$8,507.00 ",$296.69 ,"$7,230.95 ","$22,681.98 ","$7,826.44 ","$5,954.90 ","$4,986.74 ","$6,233.42 ","$5,180.76 ","$6,233.42 ","$5,878.34 ","$7,656.30 ","$5,811.98 ","$9,978.06 ","$6,720.53 ",$296.69 ,"$8,507.00 ","$8,507.00 ","$9,879.26 ","$8,507.00 ","$6,125.04 ","$5,274.34 ","$6,125.04 ","$6,125.04 ","$6,805.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100015,33225,HC INS LV PACING ELCT W/C-D/PACE 33225,481,1 ,"$8,346.00 ","$5,508.36 ",$279.90 ,"$8,346.00 ",$279.90 ,"$8,346.00 ","$5,421.00 ", N/A ,"$5,007.60 ","$7,094.10 ","$5,842.20 ",$279.90 ,$279.90 ,"$7,928.70 ","$6,342.96 ","$6,259.50 ","$7,276.00 ","$7,094.10 ", N/A ,"$7,276.00 ","$7,276.00 ","$5,842.20 ","$5,082.71 ",$279.90 , N/A , N/A , N/A ,$296.69 ,"$7,094.10 ", N/A ,"$7,678.32 ","$5,842.20 ","$4,986.74 ","$6,233.42 ","$5,082.71 ","$6,233.42 ","$5,767.09 ","$7,511.40 ","$5,701.99 ", N/A ,"$6,593.34 ",$296.69 ,"$8,346.00 ","$8,346.00 ", N/A ,"$8,346.00 ","$6,009.12 ","$5,174.52 ","$6,009.12 ","$6,009.12 ","$6,676.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100016,33226,HC REPOSITION LV ELECTRODE 33226,481,1 ,"$3,852.00 ","$2,542.32 ",$240.00 ,"$6,541.82 ",$240.00 ,"$3,852.00 ","$3,852.00 ","$2,907.47 ","$2,311.20 ","$3,274.20 ","$2,696.40 ",$240.00 ,$240.00 ,"$3,659.40 ","$2,927.52 ","$2,889.00 ","$3,852.00 ","$3,274.20 ","$2,907.47 ","$3,852.00 ","$3,852.00 ","$2,696.40 ","$2,345.87 ",$240.00 ,"$2,907.47 ","$2,849.32 ","$3,852.00 ",$254.40 ,"$3,274.20 ","$6,541.82 ","$3,543.84 ","$2,696.40 ","$3,273.50 ","$4,091.88 ","$2,345.87 ","$4,091.88 ","$2,661.73 ","$3,466.80 ","$2,631.69 ","$2,877.81 ","$3,043.08 ",$254.40 ,"$3,852.00 ","$3,852.00 ","$2,849.32 ","$3,852.00 ","$2,773.44 ","$2,388.24 ","$2,773.44 ","$2,773.44 ","$3,081.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100017,33233,HC REMOVE PPM 33233,481,1 ,"$3,638.00 ","$2,401.08 ",$240.00 ,"$17,925.44 ",$240.00 ,"$3,638.00 ","$3,638.00 ","$7,966.86 ","$2,182.80 ","$3,092.30 ","$2,546.60 ",$240.00 ,$240.00 ,"$3,456.10 ","$2,764.88 ","$2,728.50 ","$3,638.00 ","$3,092.30 ","$7,966.86 ","$3,638.00 ","$3,638.00 ","$2,546.60 ","$2,215.54 ",$240.00 ,"$7,966.86 ","$7,807.52 ","$3,638.00 ",$254.40 ,"$3,092.30 ","$17,925.44 ","$3,346.96 ","$2,546.60 ","$3,273.50 ","$4,091.88 ","$2,215.54 ","$4,091.88 ","$2,513.86 ","$3,274.20 ","$2,485.48 ","$7,885.60 ","$2,874.02 ",$254.40 ,"$3,638.00 ","$3,638.00 ","$7,807.52 ","$3,638.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100018,33234,HC REMOVE ELECTRODE SGL 33234,481,1 ,"$3,092.00 ","$2,040.72 ",$61.63 ,"$7,358.64 ",$61.63 ,"$3,092.00 ","$3,092.00 ","$3,270.51 ","$1,855.20 ","$2,628.20 ","$2,164.40 ",$61.63 ,$61.63 ,"$2,937.40 ","$2,349.92 ","$2,319.00 ","$2,929.00 ","$2,628.20 ","$3,270.51 ","$2,929.00 ","$2,929.00 ","$2,164.40 ","$1,883.03 ",$61.63 ,"$3,270.51 ","$3,205.10 ","$3,092.00 ",$65.33 ,"$2,628.20 ","$7,358.64 ","$2,844.64 ","$2,164.40 ","$3,273.50 ","$4,091.88 ","$1,883.03 ","$4,091.88 ","$2,136.57 ","$2,782.80 ","$2,112.45 ","$3,237.16 ","$2,442.68 ",$65.33 ,"$3,092.00 ","$3,092.00 ","$3,205.10 ","$3,092.00 ","$2,226.24 ","$1,917.04 ","$2,226.24 ","$2,226.24 ","$2,473.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100019,33235,HC REMOVE ELECTRODE DUAL 33235,481,1 ,"$2,461.00 ","$1,624.26 ",$61.63 ,"$7,358.64 ",$61.63 ,"$2,461.00 ","$2,461.00 ","$3,270.51 ","$1,476.60 ","$2,091.85 ","$1,722.70 ",$61.63 ,$61.63 ,"$2,337.95 ","$1,870.36 ","$1,845.75 ","$2,461.00 ","$2,091.85 ","$3,270.51 ","$2,461.00 ","$2,461.00 ","$1,722.70 ","$1,498.75 ",$61.63 ,"$3,270.51 ","$3,205.10 ","$2,461.00 ",$65.33 ,"$2,091.85 ","$7,358.64 ","$2,264.12 ","$1,722.70 ","$3,273.50 ","$4,091.88 ","$1,498.75 ","$4,091.88 ","$1,700.55 ","$2,214.90 ","$1,681.36 ","$3,237.16 ","$1,944.19 ",$65.33 ,"$2,461.00 ","$2,461.00 ","$3,205.10 ","$2,461.00 ","$1,771.92 ","$1,525.82 ","$1,771.92 ","$1,771.92 ","$1,968.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100020,33240,HC INSERT SGL/DUAL CHAMBER C-D 33240,481,1 ,"$12,498.00 ","$8,248.68 ",$821.65 ,"$50,109.03 ",$821.65 ,"$12,498.00 ","$12,498.00 ","$22,270.68 ","$7,498.80 ","$10,623.30 ","$8,748.60 ",$821.65 ,$821.65 ,"$11,873.10 ","$9,498.48 ","$9,373.50 ","$12,498.00 ","$10,623.30 ","$22,270.68 ","$12,498.00 ","$12,498.00 ","$8,748.60 ","$7,611.28 ",$821.65 ,"$22,270.68 ","$21,825.27 ","$12,498.00 ",$870.95 ,"$10,623.30 ","$50,109.03 ","$11,498.16 ","$8,748.60 ","$4,149.79 ","$5,187.78 ","$7,611.28 ","$5,187.78 ","$8,636.12 ","$11,248.20 ","$8,538.63 ","$22,043.52 ","$9,873.42 ",$870.95 ,"$12,498.00 ","$12,498.00 ","$21,825.27 ","$12,498.00 ","$8,998.56 ","$7,748.76 ","$8,998.56 ","$8,998.56 ","$9,998.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100022,33241,HC REMOVE C-D PULSE GENERATOR 33241,481,1 ,"$3,103.00 ","$2,047.98 ",$240.00 ,"$7,358.64 ",$240.00 ,"$3,103.00 ","$3,103.00 ","$3,270.51 ","$1,861.80 ","$2,637.55 ","$2,172.10 ",$240.00 ,$240.00 ,"$2,947.85 ","$2,358.28 ","$2,327.25 ","$2,929.00 ","$2,637.55 ","$3,270.51 ","$2,929.00 ","$2,929.00 ","$2,172.10 ","$1,889.73 ",$240.00 ,"$3,270.51 ","$3,205.10 ","$3,103.00 ",$254.40 ,"$2,637.55 ","$7,358.64 ","$2,854.76 ","$2,172.10 ","$3,273.50 ","$4,091.88 ","$1,889.73 ","$4,091.88 ","$2,144.17 ","$2,792.70 ","$2,119.97 ","$3,237.16 ","$2,451.37 ",$254.40 ,"$3,103.00 ","$3,103.00 ","$3,205.10 ","$3,103.00 ","$2,234.16 ","$1,923.86 ","$2,234.16 ","$2,234.16 ","$2,482.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100023,33244,HC REMOVE C-D ELECTRODES 33244,481,1 ,"$2,782.00 ","$1,836.12 ",$61.63 ,"$7,358.64 ",$61.63 ,"$2,782.00 ","$2,782.00 ","$3,270.51 ","$1,669.20 ","$2,364.70 ","$1,947.40 ",$61.63 ,$61.63 ,"$2,642.90 ","$2,114.32 ","$2,086.50 ","$2,782.00 ","$2,364.70 ","$3,270.51 ","$2,782.00 ","$2,782.00 ","$1,947.40 ","$1,694.24 ",$61.63 ,"$3,270.51 ","$3,205.10 ","$2,782.00 ",$65.33 ,"$2,364.70 ","$7,358.64 ","$2,559.44 ","$1,947.40 ","$3,273.50 ","$4,091.88 ","$1,694.24 ","$4,091.88 ","$1,922.36 ","$2,503.80 ","$1,900.66 ","$3,237.16 ","$2,197.78 ",$65.33 ,"$2,782.00 ","$2,782.00 ","$3,205.10 ","$2,782.00 ","$2,003.04 ","$1,724.84 ","$2,003.04 ","$2,003.04 ","$2,225.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100024,33249,HC INS/REPOS DEFIB LEAD/GEN 33249,481,1 ,"$19,260.00 ","$12,711.60 ",$821.65 ,"$70,439.62 ",$821.65 ,"$19,260.00 ","$14,895.00 ","$31,306.50 ","$11,556.00 ","$16,371.00 ","$13,482.00 ",$821.65 ,$821.65 ,"$18,297.00 ","$14,637.60 ","$14,445.00 ","$19,260.00 ","$16,371.00 ","$31,306.50 ","$19,260.00 ","$19,260.00 ","$13,482.00 ","$11,729.34 ",$821.65 ,"$31,306.50 ","$30,680.37 ","$19,260.00 ",$870.95 ,"$16,371.00 ","$70,439.62 ","$17,719.20 ","$13,482.00 ","$4,149.79 ","$5,187.78 ","$11,729.34 ","$5,187.78 ","$13,308.66 ","$17,334.00 ","$13,158.43 ","$30,987.18 ","$15,215.40 ",$870.95 ,"$19,260.00 ","$19,260.00 ","$30,680.37 ","$19,260.00 ","$13,867.20 ","$11,941.20 ","$13,867.20 ","$13,867.20 ","$15,408.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100028,33285,HC IMPLANT CARDIAC EVENT RECORDER,481,1 ,"$6,099.00 ","$4,025.34 ","$3,659.40 ","$17,925.44 ", N/A ,"$6,099.00 ","$6,099.00 ","$7,966.86 ","$3,659.40 ","$5,184.15 ","$4,269.30 ", N/A , N/A ,"$5,794.05 ","$4,635.24 ","$4,574.25 ","$6,099.00 ","$5,184.15 ","$7,966.86 ","$6,099.00 ","$6,099.00 ","$4,269.30 ","$3,714.29 ", N/A ,"$7,966.86 ","$7,807.52 ","$6,099.00 ", N/A ,"$5,184.15 ","$17,925.44 ","$5,611.08 ","$4,269.30 ","$4,887.30 ","$6,108.86 ","$3,714.29 ","$6,108.86 ","$4,214.41 ","$5,489.10 ","$4,166.84 ","$7,885.60 ","$4,818.21 ", N/A ,"$6,099.00 ","$6,099.00 ","$7,807.52 ","$6,099.00 ","$4,391.28 ","$3,781.38 ","$4,391.28 ","$4,391.28 ","$4,879.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100029,33286,HC REMOVE CARDIAC EVENT RECORDER,481,1 ,"$1,712.00 ","$1,129.92 ",$61.63 ,"$1,712.00 ",$61.63 ,"$1,712.00 ","$1,712.00 ",$633.39 ,"$1,027.20 ","$1,455.20 ","$1,198.40 ",$61.63 ,$61.63 ,"$1,626.40 ","$1,301.12 ","$1,284.00 ","$1,712.00 ","$1,455.20 ",$633.39 ,"$1,712.00 ","$1,712.00 ","$1,198.40 ","$1,042.61 ",$61.63 ,$633.39 ,$620.72 ,"$1,266.78 ",$65.33 ,"$1,455.20 ","$1,425.14 ","$1,575.04 ","$1,198.40 ","$1,712.00 ","$1,712.00 ","$1,042.61 ","$1,712.00 ","$1,182.99 ","$1,540.80 ","$1,169.64 ",$626.93 ,"$1,352.48 ",$65.33 ,"$1,712.00 ","$1,712.00 ",$620.72 ,"$1,712.00 ","$1,232.64 ","$1,061.44 ","$1,232.64 ","$1,232.64 ","$1,369.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100030,33967,HC IABP INSERTION 33967,481,1 ,"$2,247.00 ","$1,483.02 ",$279.90 ,"$6,302.25 ",$279.90 ,"$2,247.00 ","$2,247.00 ", N/A ,"$1,348.20 ","$1,909.95 ","$1,572.90 ",$279.90 ,$279.90 ,"$2,134.65 ","$1,707.72 ","$1,685.25 ","$2,247.00 ","$1,909.95 ", N/A ,"$2,247.00 ","$2,247.00 ","$1,572.90 ","$1,368.42 ",$279.90 , N/A , N/A , N/A ,$296.69 ,"$1,909.95 ", N/A ,"$2,067.24 ","$1,572.90 ","$5,041.37 ","$6,302.25 ","$1,368.42 ","$6,302.25 ","$1,552.68 ","$2,022.30 ","$1,535.15 ", N/A ,"$1,775.13 ",$296.69 ,"$2,247.00 ","$2,247.00 ", N/A ,"$2,247.00 ","$1,617.84 ","$1,393.14 ","$1,617.84 ","$1,617.84 ","$1,797.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100032,33968,HC REMV BALLN INTRA-AORTIC PERC,481,1 ,"$2,601.30 ","$1,716.86 ",$240.00 ,"$6,302.25 ",$240.00 ,"$2,601.30 ","$2,601.30 ", N/A ,"$1,560.78 ","$2,211.11 ","$1,820.91 ",$240.00 ,$240.00 ,"$2,471.24 ","$1,976.99 ","$1,950.98 ","$2,601.30 ","$2,211.11 ", N/A ,"$2,601.30 ","$2,601.30 ","$1,820.91 ","$1,584.19 ",$240.00 , N/A , N/A , N/A ,$254.40 ,"$2,211.11 ", N/A ,"$2,393.20 ","$1,820.91 ","$5,041.37 ","$6,302.25 ","$1,584.19 ","$6,302.25 ","$1,797.50 ","$2,341.17 ","$1,777.21 ", N/A ,"$2,055.03 ",$254.40 ,"$2,601.30 ","$2,601.30 ", N/A ,"$2,601.30 ","$1,872.94 ","$1,612.81 ","$1,872.94 ","$1,872.94 ","$2,081.04 "
ST NICHOLAS HOSPITAL - ACUTE,48100034,35226,HC REPAIR BLOOD VESSEL,481,1 ,"$1,876.00 ","$1,238.16 ",$74.78 ,"$1,876.00 ",$74.78 ,"$1,876.00 ","$1,876.00 ",$633.39 ,"$1,125.60 ","$1,594.60 ","$1,313.20 ",$74.78 ,$74.78 ,"$1,782.20 ","$1,425.76 ","$1,407.00 ","$1,876.00 ","$1,594.60 ",$633.39 ,"$1,876.00 ","$1,876.00 ","$1,313.20 ","$1,142.48 ",$74.78 ,$633.39 ,$620.72 ,"$1,266.78 ",$79.27 ,"$1,594.60 ","$1,425.14 ","$1,725.92 ","$1,313.20 ","$1,771.14 ","$1,876.00 ","$1,142.48 ","$1,876.00 ","$1,296.32 ","$1,688.40 ","$1,281.68 ",$626.93 ,"$1,482.04 ",$79.27 ,"$1,876.00 ","$1,876.00 ",$620.72 ,"$1,876.00 ","$1,350.72 ","$1,163.12 ","$1,350.72 ","$1,350.72 ","$1,500.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100039,36010,HC INTRO CATH VENA CAVA SUP/IN,481,1 ,"$1,416.80 ",$935.09 ,$23.19 ,"$1,416.80 ",$23.19 ,"$1,416.80 ","$1,416.80 ", N/A ,$850.08 ,"$1,204.28 ",$991.76 ,$23.19 ,$23.19 ,"$1,345.96 ","$1,076.77 ","$1,062.60 ","$1,416.80 ","$1,204.28 ", N/A ,"$1,416.80 ","$1,416.80 ",$991.76 ,$862.83 ,$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,204.28 ", N/A ,"$1,303.46 ",$991.76 ,$718.60 ,$862.41 ,$862.83 ,$862.41 ,$979.01 ,"$1,275.12 ",$967.96 , N/A ,"$1,119.27 ",$24.58 ,"$1,416.80 ","$1,416.80 ", N/A ,"$1,416.80 ","$1,020.10 ",$878.42 ,"$1,020.10 ","$1,020.10 ","$1,133.44 "
ST NICHOLAS HOSPITAL - ACUTE,48100040,36011,"HC CATH PLCMT VENOUS, 1ST ORDER",481,1 ,"$1,017.00 ",$671.22 ,$23.19 ,"$1,017.00 ",$23.19 ,"$1,017.00 ","$1,017.00 ", N/A ,$610.20 ,$864.45 ,$711.90 ,$23.19 ,$23.19 ,$966.15 ,$772.92 ,$762.75 ,"$1,017.00 ",$864.45 , N/A ,"$1,017.00 ","$1,017.00 ",$711.90 ,$619.35 ,$23.19 , N/A , N/A , N/A ,$24.58 ,$864.45 , N/A ,$935.64 ,$711.90 ,$515.82 ,$619.05 ,$619.35 ,$619.05 ,$702.75 ,$915.30 ,$694.81 , N/A ,$803.43 ,$24.58 ,"$1,017.00 ","$1,017.00 ", N/A ,"$1,017.00 ",$732.24 ,$630.54 ,$732.24 ,$732.24 ,$813.60 
ST NICHOLAS HOSPITAL - ACUTE,48100041,36012,"HC CATH PLCMT VENOUS, 2ND ORDER",481,1 ,"$1,177.00 ",$776.82 ,$23.19 ,"$1,177.00 ",$23.19 ,"$1,177.00 ","$1,177.00 ", N/A ,$706.20 ,"$1,000.45 ",$823.90 ,$23.19 ,$23.19 ,"$1,118.15 ",$894.52 ,$882.75 ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,177.00 ","$1,177.00 ",$823.90 ,$716.79 ,$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,000.45 ", N/A ,"$1,082.84 ",$823.90 ,$596.97 ,$716.44 ,$716.79 ,$716.44 ,$813.31 ,"$1,059.30 ",$804.13 , N/A ,$929.83 ,$24.58 ,"$1,177.00 ","$1,177.00 ", N/A ,"$1,177.00 ",$847.44 ,$729.74 ,$847.44 ,$847.44 ,$941.60 
ST NICHOLAS HOSPITAL - ACUTE,48100042,36013,HC INTRO CATH ARTERY HEART/PULM,481,1 ,$803.00 ,$529.98 ,$23.19 ,$803.00 ,$23.19 ,$803.00 ,$803.00 , N/A ,$481.80 ,$682.55 ,$562.10 ,$23.19 ,$23.19 ,$762.85 ,$610.28 ,$602.25 ,$803.00 ,$682.55 , N/A ,$803.00 ,$803.00 ,$562.10 ,$489.03 ,$23.19 , N/A , N/A , N/A ,$24.58 ,$682.55 , N/A ,$738.76 ,$562.10 ,$407.28 ,$488.79 ,$489.03 ,$488.79 ,$554.87 ,$722.70 ,$548.61 , N/A ,$634.37 ,$24.58 ,$803.00 ,$803.00 , N/A ,$803.00 ,$578.16 ,$497.86 ,$578.16 ,$578.16 ,$642.40 
ST NICHOLAS HOSPITAL - ACUTE,48100043,36014,HC SELECT CATH L/R PULM ART,481,1 ,"$1,177.00 ",$776.82 ,$23.19 ,"$1,177.00 ",$23.19 ,"$1,177.00 ","$1,177.00 ", N/A ,$706.20 ,"$1,000.45 ",$823.90 ,$23.19 ,$23.19 ,"$1,118.15 ",$894.52 ,$882.75 ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,177.00 ","$1,177.00 ",$823.90 ,$716.79 ,$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,000.45 ", N/A ,"$1,082.84 ",$823.90 ,$596.97 ,$716.44 ,$716.79 ,$716.44 ,$813.31 ,"$1,059.30 ",$804.13 , N/A ,$929.83 ,$24.58 ,"$1,177.00 ","$1,177.00 ", N/A ,"$1,177.00 ",$847.44 ,$729.74 ,$847.44 ,$847.44 ,$941.60 
ST NICHOLAS HOSPITAL - ACUTE,48100044,36015,HC PLACE CATH ARTERY PULM SEG,481,1 ,$770.00 ,$508.20 ,$23.19 ,$770.00 ,$23.19 ,$770.00 ,$770.00 , N/A ,$462.00 ,$654.50 ,$539.00 ,$23.19 ,$23.19 ,$731.50 ,$585.20 ,$577.50 ,$770.00 ,$654.50 , N/A ,$770.00 ,$770.00 ,$539.00 ,$468.93 ,$23.19 , N/A , N/A , N/A ,$24.58 ,$654.50 , N/A ,$708.40 ,$539.00 ,$390.54 ,$468.70 ,$468.93 ,$468.70 ,$532.07 ,$693.00 ,$526.06 , N/A ,$608.30 ,$24.58 ,$770.00 ,$770.00 , N/A ,$770.00 ,$554.40 ,$477.40 ,$554.40 ,$554.40 ,$616.00 
ST NICHOLAS HOSPITAL - ACUTE,48100045,36100,HC INTRO CATH/NDLE CAROTID/VERTB,481,1 ,"$1,803.20 ","$1,190.11 ",$23.19 ,"$1,803.20 ",$23.19 ,"$1,803.20 ","$1,803.20 ", N/A ,"$1,081.92 ","$1,532.72 ","$1,262.24 ",$23.19 ,$23.19 ,"$1,713.04 ","$1,370.43 ","$1,352.40 ","$1,803.20 ","$1,532.72 ", N/A ,"$1,803.20 ","$1,803.20 ","$1,262.24 ","$1,098.15 ",$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,532.72 ", N/A ,"$1,658.94 ","$1,262.24 ",$914.58 ,"$1,097.61 ","$1,098.15 ","$1,097.61 ","$1,246.01 ","$1,622.88 ","$1,231.95 ", N/A ,"$1,424.53 ",$24.58 ,"$1,803.20 ","$1,803.20 ", N/A ,"$1,803.20 ","$1,298.30 ","$1,117.98 ","$1,298.30 ","$1,298.30 ","$1,442.56 "
ST NICHOLAS HOSPITAL - ACUTE,48100047,36140,HC INTRO NDL/CATH ARTERY EXTREM 36140,481,1 ,"$1,416.80 ",$935.09 ,$23.19 ,"$1,416.80 ",$23.19 ,"$1,416.80 ","$1,416.80 ", N/A ,$850.08 ,"$1,204.28 ",$991.76 ,$23.19 ,$23.19 ,"$1,345.96 ","$1,076.77 ","$1,062.60 ","$1,416.80 ","$1,204.28 ", N/A ,"$1,416.80 ","$1,416.80 ",$991.76 ,$862.83 ,$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,204.28 ", N/A ,"$1,303.46 ",$991.76 ,$718.60 ,$862.41 ,$862.83 ,$862.41 ,$979.01 ,"$1,275.12 ",$967.96 , N/A ,"$1,119.27 ",$24.58 ,"$1,416.80 ","$1,416.80 ", N/A ,"$1,416.80 ","$1,020.10 ",$878.42 ,"$1,020.10 ","$1,020.10 ","$1,133.44 "
ST NICHOLAS HOSPITAL - ACUTE,48100050,36160,HC INTRO AORTIC TRANSLUMBR,481,1 ,$535.00 ,$353.10 ,$23.19 ,$535.00 ,$23.19 ,$535.00 ,$535.00 , N/A ,$321.00 ,$454.75 ,$374.50 ,$23.19 ,$23.19 ,$508.25 ,$406.60 ,$401.25 ,$535.00 ,$454.75 , N/A ,$535.00 ,$535.00 ,$374.50 ,$325.82 ,$23.19 , N/A , N/A , N/A ,$24.58 ,$454.75 , N/A ,$492.20 ,$374.50 ,$271.35 ,$325.65 ,$325.82 ,$325.65 ,$369.69 ,$481.50 ,$365.51 , N/A ,$422.65 ,$24.58 ,$535.00 ,$535.00 , N/A ,$535.00 ,$385.20 ,$331.70 ,$385.20 ,$385.20 ,$428.00 
ST NICHOLAS HOSPITAL - ACUTE,48100051,36200,HC INTRO CATH AORTA 36200,481,1 ,"$1,803.20 ","$1,190.11 ",$23.19 ,"$1,803.20 ",$23.19 ,"$1,803.20 ","$1,803.20 ", N/A ,"$1,081.92 ","$1,532.72 ","$1,262.24 ",$23.19 ,$23.19 ,"$1,713.04 ","$1,370.43 ","$1,352.40 ","$1,803.20 ","$1,532.72 ", N/A ,"$1,803.20 ","$1,803.20 ","$1,262.24 ","$1,098.15 ",$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,532.72 ", N/A ,"$1,658.94 ","$1,262.24 ",$914.58 ,"$1,097.61 ","$1,098.15 ","$1,097.61 ","$1,246.01 ","$1,622.88 ","$1,231.95 ", N/A ,"$1,424.53 ",$24.58 ,"$1,803.20 ","$1,803.20 ", N/A ,"$1,803.20 ","$1,298.30 ","$1,117.98 ","$1,298.30 ","$1,298.30 ","$1,442.56 "
ST NICHOLAS HOSPITAL - ACUTE,48100052,36215,HC PLACE CATH THOR/BRAC 1ST ORDER 36215,481,1 ,$888.95 ,$586.71 ,$23.19 ,$888.95 ,$23.19 ,$888.95 ,$888.95 , N/A ,$533.37 ,$755.61 ,$622.27 ,$23.19 ,$23.19 ,$844.50 ,$675.60 ,$666.71 ,$888.95 ,$755.61 , N/A ,$888.95 ,$888.95 ,$622.27 ,$541.37 ,$23.19 , N/A , N/A , N/A ,$24.58 ,$755.61 , N/A ,$817.83 ,$622.27 ,$450.88 ,$541.10 ,$541.37 ,$541.10 ,$614.26 ,$800.06 ,$607.33 , N/A ,$702.27 ,$24.58 ,$888.95 ,$888.95 , N/A ,$888.95 ,$640.04 ,$551.15 ,$640.04 ,$640.04 ,$711.16 
ST NICHOLAS HOSPITAL - ACUTE,48100053,36216,HC PL CATH THOR/BRAC 2ND ORDER 36216,481,1 ,"$1,803.20 ","$1,190.11 ",$23.19 ,"$1,803.20 ",$23.19 ,"$1,803.20 ","$1,803.20 ", N/A ,"$1,081.92 ","$1,532.72 ","$1,262.24 ",$23.19 ,$23.19 ,"$1,713.04 ","$1,370.43 ","$1,352.40 ","$1,803.20 ","$1,532.72 ", N/A ,"$1,803.20 ","$1,803.20 ","$1,262.24 ","$1,098.15 ",$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,532.72 ", N/A ,"$1,658.94 ","$1,262.24 ",$914.58 ,"$1,097.61 ","$1,098.15 ","$1,097.61 ","$1,246.01 ","$1,622.88 ","$1,231.95 ", N/A ,"$1,424.53 ",$24.58 ,"$1,803.20 ","$1,803.20 ", N/A ,"$1,803.20 ","$1,298.30 ","$1,117.98 ","$1,298.30 ","$1,298.30 ","$1,442.56 "
ST NICHOLAS HOSPITAL - ACUTE,48100054,36217,HC PL CATH THOR/BRAC 3RD ORDER 36217,481,1 ,"$1,932.00 ","$1,275.12 ",$23.19 ,"$1,932.00 ",$23.19 ,"$1,932.00 ","$1,932.00 ", N/A ,"$1,159.20 ","$1,642.20 ","$1,352.40 ",$23.19 ,$23.19 ,"$1,835.40 ","$1,468.32 ","$1,449.00 ","$1,932.00 ","$1,642.20 ", N/A ,"$1,932.00 ","$1,932.00 ","$1,352.40 ","$1,176.59 ",$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,642.20 ", N/A ,"$1,777.44 ","$1,352.40 ",$979.91 ,"$1,176.01 ","$1,176.59 ","$1,176.01 ","$1,335.01 ","$1,738.80 ","$1,319.94 ", N/A ,"$1,526.28 ",$24.58 ,"$1,932.00 ","$1,932.00 ", N/A ,"$1,932.00 ","$1,391.04 ","$1,197.84 ","$1,391.04 ","$1,391.04 ","$1,545.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100055,36218,HC PL CATH THOR/BRAC ADDL 36218,481,1 ,$862.50 ,$569.25 ,$23.19 ,"$2,213.66 ",$23.19 ,$862.50 ,$862.50 , N/A ,$517.50 ,$733.13 ,$603.75 ,$23.19 ,$23.19 ,$819.38 ,$655.50 ,$646.88 ,$862.50 ,$733.13 , N/A ,$862.50 ,$862.50 ,$603.75 ,$525.26 ,$23.19 , N/A , N/A , N/A ,$24.58 ,$733.13 , N/A ,$793.50 ,$603.75 ,"$1,771.14 ","$2,213.66 ",$525.26 ,"$2,213.66 ",$595.99 ,$776.25 ,$589.26 , N/A ,$681.38 ,$24.58 ,$862.50 ,$862.50 , N/A ,$862.50 ,$621.00 ,$534.75 ,$621.00 ,$621.00 ,$690.00 
ST NICHOLAS HOSPITAL - ACUTE,48100056,36245,HC ABD 1ST ORDER 36245,481,1 ,"$2,060.80 ","$1,360.13 ",$23.19 ,"$2,060.80 ",$23.19 ,"$2,060.80 ","$2,060.80 ", N/A ,"$1,236.48 ","$1,751.68 ","$1,442.56 ",$23.19 ,$23.19 ,"$1,957.76 ","$1,566.21 ","$1,545.60 ","$2,060.80 ","$1,751.68 ", N/A ,"$2,060.80 ","$2,060.80 ","$1,442.56 ","$1,255.03 ",$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,751.68 ", N/A ,"$1,895.94 ","$1,442.56 ","$1,045.24 ","$1,254.41 ","$1,255.03 ","$1,254.41 ","$1,424.01 ","$1,854.72 ","$1,407.94 ", N/A ,"$1,628.03 ",$24.58 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$1,483.78 ","$1,277.70 ","$1,483.78 ","$1,483.78 ","$1,648.64 "
ST NICHOLAS HOSPITAL - ACUTE,48100057,36246,HC ABD INITIAL 2ND ORDER 36246,481,1 ,"$1,674.40 ","$1,105.10 ",$23.19 ,"$1,674.40 ",$23.19 ,"$1,674.40 ","$1,674.40 ", N/A ,"$1,004.64 ","$1,423.24 ","$1,172.08 ",$23.19 ,$23.19 ,"$1,590.68 ","$1,272.54 ","$1,255.80 ","$1,674.40 ","$1,423.24 ", N/A ,"$1,674.40 ","$1,674.40 ","$1,172.08 ","$1,019.71 ",$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,423.24 ", N/A ,"$1,540.45 ","$1,172.08 ",$849.26 ,"$1,019.21 ","$1,019.71 ","$1,019.21 ","$1,157.01 ","$1,506.96 ","$1,143.95 ", N/A ,"$1,322.78 ",$24.58 ,"$1,674.40 ","$1,674.40 ", N/A ,"$1,674.40 ","$1,205.57 ","$1,038.13 ","$1,205.57 ","$1,205.57 ","$1,339.52 "
ST NICHOLAS HOSPITAL - ACUTE,48100058,36247,HC ABD INT 3RD/PLUS ORDER 36247,481,1 ,"$1,932.00 ","$1,275.12 ",$23.19 ,"$1,932.00 ",$23.19 ,"$1,932.00 ","$1,932.00 ", N/A ,"$1,159.20 ","$1,642.20 ","$1,352.40 ",$23.19 ,$23.19 ,"$1,835.40 ","$1,468.32 ","$1,449.00 ","$1,932.00 ","$1,642.20 ", N/A ,"$1,932.00 ","$1,932.00 ","$1,352.40 ","$1,176.59 ",$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,642.20 ", N/A ,"$1,777.44 ","$1,352.40 ",$979.91 ,"$1,176.01 ","$1,176.59 ","$1,176.01 ","$1,335.01 ","$1,738.80 ","$1,319.94 ", N/A ,"$1,526.28 ",$24.58 ,"$1,932.00 ","$1,932.00 ", N/A ,"$1,932.00 ","$1,391.04 ","$1,197.84 ","$1,391.04 ","$1,391.04 ","$1,545.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100059,36248,HC ABD ADDL 2ND/PLUS ORDER 36248,481,1 ,"$1,416.80 ",$935.09 ,$23.19 ,"$2,213.66 ",$23.19 ,"$1,416.80 ","$1,416.80 ", N/A ,$850.08 ,"$1,204.28 ",$991.76 ,$23.19 ,$23.19 ,"$1,345.96 ","$1,076.77 ","$1,062.60 ","$1,416.80 ","$1,204.28 ", N/A ,"$1,416.80 ","$1,416.80 ",$991.76 ,$862.83 ,$23.19 , N/A , N/A , N/A ,$24.58 ,"$1,204.28 ", N/A ,"$1,303.46 ",$991.76 ,"$1,771.14 ","$2,213.66 ",$862.83 ,"$2,213.66 ",$979.01 ,"$1,275.12 ",$967.96 , N/A ,"$1,119.27 ",$24.58 ,"$1,416.80 ","$1,416.80 ", N/A ,"$1,416.80 ","$1,020.10 ",$878.42 ,"$1,020.10 ","$1,020.10 ","$1,133.44 "
ST NICHOLAS HOSPITAL - ACUTE,48100060,37184,HC PERIPH THROMBECK ONLY W/TPA 37184,481,1 ,"$5,290.00 ","$3,491.40 ",$205.34 ,"$23,311.22 ",$205.34 ,"$5,290.00 ","$5,290.00 ","$10,360.54 ","$3,174.00 ","$4,496.50 ","$3,703.00 ",$205.34 ,$205.34 ,"$5,025.50 ","$4,020.40 ","$3,967.50 ","$5,290.00 ","$4,496.50 ","$10,360.54 ","$5,290.00 ","$5,290.00 ","$3,703.00 ","$3,221.61 ",$205.34 ,"$10,360.54 ","$10,153.33 ","$5,290.00 ",$217.66 ,"$4,496.50 ","$23,311.22 ","$4,866.80 ","$3,703.00 ","$4,535.48 ","$5,669.62 ","$3,221.61 ","$5,669.62 ","$3,655.39 ","$4,761.00 ","$3,614.13 ","$10,254.87 ","$4,179.10 ",$217.66 ,"$5,290.00 ","$5,290.00 ","$10,153.33 ","$5,290.00 ","$3,808.80 ","$3,279.80 ","$3,808.80 ","$3,808.80 ","$4,232.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100061,37185,HC PRIM PERC THROMB EA ADDL 37185,481,1 ,"$4,025.00 ","$2,656.50 ",$205.34 ,"$6,233.42 ",$205.34 ,"$4,025.00 ","$4,025.00 ", N/A ,"$2,415.00 ","$3,421.25 ","$2,817.50 ",$205.34 ,$205.34 ,"$3,823.75 ","$3,059.00 ","$3,018.75 ","$4,025.00 ","$3,421.25 ", N/A ,"$4,025.00 ","$4,025.00 ","$2,817.50 ","$2,451.23 ",$205.34 , N/A , N/A , N/A ,$217.66 ,"$3,421.25 ", N/A ,"$3,703.00 ","$2,817.50 ","$4,986.74 ","$6,233.42 ","$2,451.23 ","$6,233.42 ","$2,781.28 ","$3,622.50 ","$2,749.88 ", N/A ,"$3,179.75 ",$217.66 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$2,898.00 ","$2,495.50 ","$2,898.00 ","$2,898.00 ","$3,220.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100062,37186,HC SEC PERC THROMB EA VESSEL ADDL 37186,481,1 ,"$4,025.00 ","$2,656.50 ",$376.97 ,"$6,233.42 ",$376.97 ,"$4,025.00 ","$4,025.00 ", N/A ,"$2,415.00 ","$3,421.25 ","$2,817.50 ",$376.97 ,$376.97 ,"$3,823.75 ","$3,059.00 ","$3,018.75 ","$4,025.00 ","$3,421.25 ", N/A ,"$4,025.00 ","$4,025.00 ","$2,817.50 ","$2,451.23 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$3,421.25 ", N/A ,"$3,703.00 ","$2,817.50 ","$4,986.74 ","$6,233.42 ","$2,451.23 ","$6,233.42 ","$2,781.28 ","$3,622.50 ","$2,749.88 ", N/A ,"$3,179.75 ",$399.59 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$2,898.00 ","$2,495.50 ","$2,898.00 ","$2,898.00 ","$3,220.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100065,37200,HC BIOPSY TRANSCATHETER,481,1 ,"$2,645.00 ","$1,745.70 ",$124.43 ,"$11,286.91 ",$124.43 ,"$2,645.00 ","$2,645.00 ","$5,016.41 ","$1,587.00 ","$2,248.25 ","$1,851.50 ",$124.43 ,$124.43 ,"$2,512.75 ","$2,010.20 ","$1,983.75 ","$2,645.00 ","$2,248.25 ","$5,016.41 ","$2,645.00 ","$2,645.00 ","$1,851.50 ","$1,610.81 ",$124.43 ,"$5,016.41 ","$4,916.08 ","$2,645.00 ",$131.90 ,"$2,248.25 ","$11,286.91 ","$2,433.40 ","$1,851.50 ","$4,535.48 ","$5,669.62 ","$1,610.81 ","$5,669.62 ","$1,827.70 ","$2,380.50 ","$1,807.06 ","$4,965.24 ","$2,089.55 ",$131.90 ,"$2,645.00 ","$2,645.00 ","$4,916.08 ","$2,645.00 ","$1,904.40 ","$1,639.90 ","$1,904.40 ","$1,904.40 ","$2,116.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100067,61650,HC THPY INFS NON-THROMBO INTITIAL,481,1 ,"$1,840.00 ","$1,214.40 ",$397.02 ,"$1,840.00 ",$397.02 ,"$1,840.00 ","$1,840.00 ", N/A ,"$1,104.00 ","$1,564.00 ","$1,288.00 ",$397.02 ,$397.02 ,"$1,748.00 ","$1,398.40 ","$1,380.00 ","$1,840.00 ","$1,564.00 ", N/A ,"$1,840.00 ","$1,840.00 ","$1,288.00 ","$1,120.56 ",$397.02 , N/A , N/A , N/A ,$420.84 ,"$1,564.00 ", N/A ,"$1,692.80 ","$1,288.00 ", N/A , N/A ,"$1,120.56 ", N/A ,"$1,271.44 ","$1,656.00 ","$1,257.09 ", N/A ,"$1,453.60 ",$420.84 ,"$1,840.00 ","$1,840.00 ", N/A ,"$1,840.00 ","$1,324.80 ","$1,140.80 ","$1,324.80 ","$1,324.80 ","$1,472.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100069,37241,HC OCCL/EMBOL TRANSCATH PERC 37241,481,1 ,"$7,705.00 ","$5,085.30 ",$376.97 ,"$23,311.22 ",$376.97 ,"$7,705.00 ","$7,705.00 ","$10,360.54 ","$4,623.00 ","$6,549.25 ","$5,393.50 ",$376.97 ,$376.97 ,"$7,319.75 ","$5,855.80 ","$5,778.75 ","$7,276.00 ","$6,549.25 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$5,393.50 ","$4,692.35 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$7,705.00 ",$399.59 ,"$6,549.25 ","$23,311.22 ","$7,088.60 ","$5,393.50 ","$4,887.30 ","$6,108.86 ","$4,692.35 ","$6,108.86 ","$5,324.16 ","$6,934.50 ","$5,264.06 ","$10,254.87 ","$6,086.95 ",$399.59 ,"$7,705.00 ","$7,705.00 ","$10,153.33 ","$7,705.00 ","$5,547.60 ","$4,777.10 ","$5,547.60 ","$5,547.60 ","$6,164.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100070,37236,HC PL STENT INTRAVAS PERC INIT 37236,481,1 ,"$8,132.00 ","$5,367.12 ",$376.97 ,"$23,311.22 ",$376.97 ,"$8,132.00 ","$8,132.00 ","$10,360.54 ","$4,879.20 ","$6,912.20 ","$5,692.40 ",$376.97 ,$376.97 ,"$7,725.40 ","$6,180.32 ","$6,099.00 ","$7,276.00 ","$6,912.20 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$5,692.40 ","$4,952.39 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$8,132.00 ",$399.59 ,"$6,912.20 ","$23,311.22 ","$7,481.44 ","$5,692.40 ","$4,887.30 ","$6,108.86 ","$4,952.39 ","$6,108.86 ","$5,619.21 ","$7,318.80 ","$5,555.78 ","$10,254.87 ","$6,424.28 ",$399.59 ,"$8,132.00 ","$8,132.00 ","$10,153.33 ","$8,132.00 ","$5,855.04 ","$5,041.84 ","$5,855.04 ","$5,855.04 ","$6,505.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100071,37237,HC PLACE STENT PERC ADDL 37237,481,1 ,"$6,992.00 ","$4,614.72 ",$376.97 ,"$6,992.00 ",$376.97 ,"$6,992.00 ","$5,421.00 ", N/A ,"$4,195.20 ","$5,943.20 ","$4,894.40 ",$376.97 ,$376.97 ,"$6,642.40 ","$5,313.92 ","$5,244.00 ","$6,992.00 ","$5,943.20 ", N/A ,"$6,992.00 ","$6,992.00 ","$4,894.40 ","$4,258.13 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$5,943.20 ", N/A ,"$6,432.64 ","$4,894.40 ","$4,986.74 ","$6,233.42 ","$4,258.13 ","$6,233.42 ","$4,831.47 ","$6,292.80 ","$4,776.93 ", N/A ,"$5,523.68 ",$399.59 ,"$6,992.00 ","$6,992.00 ", N/A ,"$6,992.00 ","$5,034.24 ","$4,335.04 ","$5,034.24 ","$5,034.24 ","$5,593.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100075,37243,HC EMBOLIZATION UTERINE FIBROID,481,1 ,"$10,235.00 ","$6,755.10 ",$376.97 ,"$23,311.22 ",$376.97 ,"$10,235.00 ","$10,235.00 ","$10,360.54 ","$6,141.00 ","$8,699.75 ","$7,164.50 ",$376.97 ,$376.97 ,"$9,723.25 ","$7,778.60 ","$7,676.25 ","$7,276.00 ","$8,699.75 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$7,164.50 ","$6,233.12 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$10,235.00 ",$399.59 ,"$8,699.75 ","$23,311.22 ","$9,416.20 ","$7,164.50 ","$4,887.30 ","$6,108.86 ","$6,233.12 ","$6,108.86 ","$7,072.39 ","$9,211.50 ","$6,992.55 ","$10,254.87 ","$8,085.65 ",$399.59 ,"$10,235.00 ","$10,235.00 ","$10,153.33 ","$10,235.00 ","$7,369.20 ","$6,345.70 ","$7,369.20 ","$7,369.20 ","$8,188.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100076,37215,HC PL STENT TRNSCATH CAROT ART W/ 37215,481,1 ,"$7,705.00 ","$5,085.30 ",$397.02 ,"$7,705.00 ",$397.02 ,"$7,705.00 ","$7,448.00 ", N/A ,"$4,623.00 ","$6,549.25 ","$5,393.50 ",$397.02 ,$397.02 ,"$7,319.75 ","$5,855.80 ","$5,778.75 ","$7,276.00 ","$6,549.25 ", N/A ,"$7,276.00 ","$7,276.00 ","$5,393.50 ","$4,692.35 ",$397.02 , N/A , N/A , N/A ,$420.84 ,"$6,549.25 ", N/A ,"$7,088.60 ","$5,393.50 ", N/A , N/A ,"$4,692.35 ", N/A ,"$5,324.16 ","$6,934.50 ","$5,264.06 ", N/A ,"$6,086.95 ",$420.84 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$5,547.60 ","$4,777.10 ","$5,547.60 ","$5,547.60 ","$6,164.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100077,37220,HC RVC EN PRC ICA W/ANG INT VSL 37220,481,1 ,"$7,597.00 ","$5,014.02 ",$308.00 ,"$11,453.02 ",$308.00 ,"$7,597.00 ","$7,597.00 ","$5,090.23 ","$4,558.20 ","$6,457.45 ","$5,317.90 ",$308.00 ,$308.00 ,"$7,217.15 ","$5,773.72 ","$5,697.75 ","$7,597.00 ","$6,457.45 ","$5,090.23 ","$7,597.00 ","$7,597.00 ","$5,317.90 ","$4,626.57 ",$308.00 ,"$5,090.23 ","$4,988.43 ","$7,597.00 ",$326.48 ,"$6,457.45 ","$11,453.02 ","$6,989.24 ","$5,317.90 ","$6,803.22 ","$8,504.43 ","$4,626.57 ","$8,504.43 ","$5,249.53 ","$6,837.30 ","$5,190.27 ","$5,038.31 ","$6,001.63 ",$326.48 ,"$7,597.00 ","$7,597.00 ","$4,988.43 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100077,37220,HC RVC EN PRC ICA W/ANG INT VSL 37220,481,1 ,"$7,597.00 ","$5,014.02 ",$308.00 ,"$11,453.02 ",$308.00 ,"$7,597.00 ","$7,597.00 ","$5,090.23 ","$4,558.20 ","$6,457.45 ","$5,317.90 ",$308.00 ,$308.00 ,"$7,217.15 ","$5,773.72 ","$5,697.75 ","$7,597.00 ","$6,457.45 ","$5,090.23 ","$7,597.00 ","$7,597.00 ","$5,317.90 ","$4,626.57 ",$308.00 ,"$5,090.23 ","$4,988.43 ","$7,597.00 ",$326.48 ,"$6,457.45 ","$11,453.02 ","$6,989.24 ","$5,317.90 ","$6,803.22 ","$8,504.43 ","$4,626.57 ","$8,504.43 ","$5,249.53 ","$6,837.30 ","$5,190.27 ","$5,038.31 ","$6,001.63 ",$326.48 ,"$7,597.00 ","$7,597.00 ","$4,988.43 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100078,37221,HC RVC EN PRC ICA W/TRN SNT INT V 37221,481,1 ,"$18,190.00 ","$12,005.40 ",$376.97 ,"$23,311.22 ",$376.97 ,"$18,190.00 ","$12,891.00 ","$10,360.54 ","$10,914.00 ","$15,461.50 ","$12,733.00 ",$376.97 ,$376.97 ,"$17,280.50 ","$13,824.40 ","$13,642.50 ","$7,276.00 ","$15,461.50 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$12,733.00 ","$11,077.71 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$18,190.00 ",$399.59 ,"$15,461.50 ","$23,311.22 ","$16,734.80 ","$12,733.00 ","$4,887.30 ","$6,108.86 ","$11,077.71 ","$6,108.86 ","$12,569.29 ","$16,371.00 ","$12,427.41 ","$10,254.87 ","$14,370.10 ",$399.59 ,"$10,341.00 ","$10,341.00 ","$10,153.33 ","$10,341.00 ","$13,096.80 ","$11,277.80 ","$13,096.80 ","$13,096.80 ","$14,552.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100078,37221,HC RVC EN PRC ICA W/TRN SNT INT V 37221,481,1 ,"$18,190.00 ","$12,005.40 ",$376.97 ,"$23,311.22 ",$376.97 ,"$18,190.00 ","$12,891.00 ","$10,360.54 ","$10,914.00 ","$15,461.50 ","$12,733.00 ",$376.97 ,$376.97 ,"$17,280.50 ","$13,824.40 ","$13,642.50 ","$7,276.00 ","$15,461.50 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$12,733.00 ","$11,077.71 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$18,190.00 ",$399.59 ,"$15,461.50 ","$23,311.22 ","$16,734.80 ","$12,733.00 ","$4,887.30 ","$6,108.86 ","$11,077.71 ","$6,108.86 ","$12,569.29 ","$16,371.00 ","$12,427.41 ","$10,254.87 ","$14,370.10 ",$399.59 ,"$10,341.00 ","$10,341.00 ","$10,153.33 ","$10,341.00 ","$13,096.80 ","$11,277.80 ","$13,096.80 ","$13,096.80 ","$14,552.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100079,37222,HC RVC EN PRC ICA W/ANG EA AD VS 37222,481,1 ,"$6,206.00 ","$4,095.96 ",$376.97 ,"$6,233.42 ",$376.97 ,"$6,206.00 ","$5,421.00 ", N/A ,"$3,723.60 ","$5,275.10 ","$4,344.20 ",$376.97 ,$376.97 ,"$5,895.70 ","$4,716.56 ","$4,654.50 ","$6,206.00 ","$5,275.10 ", N/A ,"$6,206.00 ","$6,206.00 ","$4,344.20 ","$3,779.45 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$5,275.10 ", N/A ,"$5,709.52 ","$4,344.20 ","$4,986.74 ","$6,233.42 ","$3,779.45 ","$6,233.42 ","$4,288.35 ","$5,585.40 ","$4,239.94 ", N/A ,"$4,902.74 ",$399.59 ,"$6,206.00 ","$6,206.00 ", N/A ,"$6,206.00 ","$4,468.32 ","$3,847.72 ","$4,468.32 ","$4,468.32 ","$4,964.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100080,37223,HC RVC EN PRC ICA W/TRN ST AD VS 37223,481,1 ,"$7,918.00 ","$5,225.88 ",$376.97 ,"$7,918.00 ",$376.97 ,"$7,918.00 ","$5,421.00 ", N/A ,"$4,750.80 ","$6,730.30 ","$5,542.60 ",$376.97 ,$376.97 ,"$7,522.10 ","$6,017.68 ","$5,938.50 ","$7,276.00 ","$6,730.30 ", N/A ,"$7,276.00 ","$7,276.00 ","$5,542.60 ","$4,822.06 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$6,730.30 ", N/A ,"$7,284.56 ","$5,542.60 ","$4,986.74 ","$6,233.42 ","$4,822.06 ","$6,233.42 ","$5,471.34 ","$7,126.20 ","$5,409.58 ", N/A ,"$6,255.22 ",$399.59 ,"$7,918.00 ","$7,918.00 ", N/A ,"$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100081,37224,HC RVC EN PRC R/P W/ANG INT VSL 37224,481,1 ,"$6,955.00 ","$4,590.30 ",$308.00 ,"$23,311.22 ",$308.00 ,"$6,955.00 ","$6,955.00 ","$10,360.54 ","$4,173.00 ","$5,911.75 ","$4,868.50 ",$308.00 ,$308.00 ,"$6,607.25 ","$5,285.80 ","$5,216.25 ","$6,955.00 ","$5,911.75 ","$10,360.54 ","$6,955.00 ","$6,955.00 ","$4,868.50 ","$4,235.60 ",$308.00 ,"$10,360.54 ","$10,153.33 ","$6,955.00 ",$326.48 ,"$5,911.75 ","$23,311.22 ","$6,398.60 ","$4,868.50 ","$6,803.22 ","$8,504.43 ","$4,235.60 ","$8,504.43 ","$4,805.91 ","$6,259.50 ","$4,751.66 ","$10,254.87 ","$5,494.45 ",$326.48 ,"$6,955.00 ","$6,955.00 ","$10,153.33 ","$6,955.00 ","$5,007.60 ","$4,312.10 ","$5,007.60 ","$5,007.60 ","$5,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100081,37224,HC RVC EN PRC R/P W/ANG INT VSL 37224,481,1 ,"$6,955.00 ","$4,590.30 ",$308.00 ,"$23,311.22 ",$308.00 ,"$6,955.00 ","$6,955.00 ","$10,360.54 ","$4,173.00 ","$5,911.75 ","$4,868.50 ",$308.00 ,$308.00 ,"$6,607.25 ","$5,285.80 ","$5,216.25 ","$6,955.00 ","$5,911.75 ","$10,360.54 ","$6,955.00 ","$6,955.00 ","$4,868.50 ","$4,235.60 ",$308.00 ,"$10,360.54 ","$10,153.33 ","$6,955.00 ",$326.48 ,"$5,911.75 ","$23,311.22 ","$6,398.60 ","$4,868.50 ","$6,803.22 ","$8,504.43 ","$4,235.60 ","$8,504.43 ","$4,805.91 ","$6,259.50 ","$4,751.66 ","$10,254.87 ","$5,494.45 ",$326.48 ,"$6,955.00 ","$6,955.00 ","$10,153.33 ","$6,955.00 ","$5,007.60 ","$4,312.10 ","$5,007.60 ","$5,007.60 ","$5,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100082,37225,HC RVC EN PRC F/P W/ANT INT VSL 37225,481,1 ,"$20,330.00 ","$13,417.80 ",$376.97 ,"$23,311.22 ",$376.97 ,"$20,330.00 ","$12,891.00 ","$10,360.54 ","$12,198.00 ","$17,280.50 ","$14,231.00 ",$376.97 ,$376.97 ,"$19,313.50 ","$15,450.80 ","$15,247.50 ","$7,276.00 ","$17,280.50 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$14,231.00 ","$12,380.97 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$20,330.00 ",$399.59 ,"$17,280.50 ","$23,311.22 ","$18,703.60 ","$14,231.00 ","$4,887.30 ","$6,108.86 ","$12,380.97 ","$6,108.86 ","$14,048.03 ","$18,297.00 ","$13,889.46 ","$10,254.87 ","$16,060.70 ",$399.59 ,"$10,341.00 ","$10,341.00 ","$10,153.33 ","$10,341.00 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$16,264.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100083,37226,HC RVC EN PRC F/P W/TRN SNT IN VS 37226,481,1 ,"$20,330.00 ","$13,417.80 ",$565.45 ,"$23,311.22 ",$565.45 ,"$20,330.00 ","$12,891.00 ","$10,360.54 ","$12,198.00 ","$17,280.50 ","$14,231.00 ",$565.45 ,$565.45 ,"$19,313.50 ","$15,450.80 ","$15,247.50 ","$10,914.00 ","$17,280.50 ","$10,360.54 ","$10,914.00 ","$10,914.00 ","$14,231.00 ","$12,380.97 ",$565.45 ,"$10,360.54 ","$10,153.33 ","$20,330.00 ",$599.38 ,"$17,280.50 ","$23,311.22 ","$18,703.60 ","$14,231.00 ","$7,330.95 ","$9,163.29 ","$12,380.97 ","$9,163.29 ","$14,048.03 ","$18,297.00 ","$13,889.46 ","$10,254.87 ","$16,060.70 ",$599.38 ,"$15,511.50 ","$15,511.50 ","$10,153.33 ","$15,511.50 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$16,264.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100083,37226,HC RVC EN PRC F/P W/TRN SNT IN VS 37226,481,1 ,"$20,330.00 ","$13,417.80 ",$565.45 ,"$23,311.22 ",$565.45 ,"$20,330.00 ","$12,891.00 ","$10,360.54 ","$12,198.00 ","$17,280.50 ","$14,231.00 ",$565.45 ,$565.45 ,"$19,313.50 ","$15,450.80 ","$15,247.50 ","$10,914.00 ","$17,280.50 ","$10,360.54 ","$10,914.00 ","$10,914.00 ","$14,231.00 ","$12,380.97 ",$565.45 ,"$10,360.54 ","$10,153.33 ","$20,330.00 ",$599.38 ,"$17,280.50 ","$23,311.22 ","$18,703.60 ","$14,231.00 ","$7,330.95 ","$9,163.29 ","$12,380.97 ","$9,163.29 ","$14,048.03 ","$18,297.00 ","$13,889.46 ","$10,254.87 ","$16,060.70 ",$599.38 ,"$15,511.50 ","$15,511.50 ","$10,153.33 ","$15,511.50 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$16,264.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100084,37227,HC RVC EN PRC F/P W/AN/TR ST INT 37227,481,1 ,"$22,470.00 ","$14,830.20 ",$376.97 ,"$37,722.01 ",$376.97 ,"$21,770.00 ","$14,895.00 ","$16,765.34 ","$13,482.00 ","$19,099.50 ","$15,729.00 ",$376.97 ,$376.97 ,"$21,346.50 ","$17,077.20 ","$16,852.50 ","$7,276.00 ","$19,099.50 ","$16,765.34 ","$7,276.00 ","$7,276.00 ","$15,729.00 ","$13,684.23 ",$376.97 ,"$16,765.34 ","$16,430.03 ","$22,470.00 ",$399.59 ,"$19,099.50 ","$37,722.01 ","$20,672.40 ","$15,729.00 ","$5,041.37 ","$6,302.25 ","$13,684.23 ","$6,302.25 ","$15,526.77 ","$20,223.00 ","$15,351.50 ","$16,594.33 ","$17,751.30 ",$399.59 ,"$14,623.00 ","$14,623.00 ","$16,430.03 ","$14,623.00 ","$16,178.40 ","$13,931.40 ","$16,178.40 ","$16,178.40 ","$17,976.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100085,37228,HC RVC EN PRC T/P W/ANG INT VSL 37228,481,1 ,"$7,276.00 ","$4,802.16 ",$308.00 ,"$23,311.22 ",$308.00 ,"$7,276.00 ","$7,276.00 ","$10,360.54 ","$4,365.60 ","$6,184.60 ","$5,093.20 ",$308.00 ,$308.00 ,"$6,912.20 ","$5,529.76 ","$5,457.00 ","$7,276.00 ","$6,184.60 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$5,093.20 ","$4,431.08 ",$308.00 ,"$10,360.54 ","$10,153.33 ","$7,276.00 ",$326.48 ,"$6,184.60 ","$23,311.22 ","$6,693.92 ","$5,093.20 ","$6,803.22 ","$8,504.43 ","$4,431.08 ","$8,504.43 ","$5,027.72 ","$6,548.40 ","$4,970.96 ","$10,254.87 ","$5,748.04 ",$326.48 ,"$7,276.00 ","$7,276.00 ","$10,153.33 ","$7,276.00 ","$5,238.72 ","$4,511.12 ","$5,238.72 ","$5,238.72 ","$5,820.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100085,37228,HC RVC EN PRC T/P W/ANG INT VSL 37228,481,1 ,"$7,276.00 ","$4,802.16 ",$308.00 ,"$23,311.22 ",$308.00 ,"$7,276.00 ","$7,276.00 ","$10,360.54 ","$4,365.60 ","$6,184.60 ","$5,093.20 ",$308.00 ,$308.00 ,"$6,912.20 ","$5,529.76 ","$5,457.00 ","$7,276.00 ","$6,184.60 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$5,093.20 ","$4,431.08 ",$308.00 ,"$10,360.54 ","$10,153.33 ","$7,276.00 ",$326.48 ,"$6,184.60 ","$23,311.22 ","$6,693.92 ","$5,093.20 ","$6,803.22 ","$8,504.43 ","$4,431.08 ","$8,504.43 ","$5,027.72 ","$6,548.40 ","$4,970.96 ","$10,254.87 ","$5,748.04 ",$326.48 ,"$7,276.00 ","$7,276.00 ","$10,153.33 ","$7,276.00 ","$5,238.72 ","$4,511.12 ","$5,238.72 ","$5,238.72 ","$5,820.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100086,37229,HC RVC EN PRC T/P W/ANT INT VSL 37229,481,1 ,"$19,260.00 ","$12,711.60 ",$376.97 ,"$37,722.01 ",$376.97 ,"$19,260.00 ","$14,895.00 ","$16,765.34 ","$11,556.00 ","$16,371.00 ","$13,482.00 ",$376.97 ,$376.97 ,"$18,297.00 ","$14,637.60 ","$14,445.00 ","$7,276.00 ","$16,371.00 ","$16,765.34 ","$7,276.00 ","$7,276.00 ","$13,482.00 ","$11,729.34 ",$376.97 ,"$16,765.34 ","$16,430.03 ","$19,260.00 ",$399.59 ,"$16,371.00 ","$37,722.01 ","$17,719.20 ","$13,482.00 ","$4,887.30 ","$6,108.86 ","$11,729.34 ","$6,108.86 ","$13,308.66 ","$17,334.00 ","$13,158.43 ","$16,594.33 ","$15,215.40 ",$399.59 ,"$10,341.00 ","$10,341.00 ","$16,430.03 ","$10,341.00 ","$13,867.20 ","$11,941.20 ","$13,867.20 ","$13,867.20 ","$15,408.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100087,37230,HC RVC EN PRC T/P W/TRN SNT IN VS 37230,481,1 ,"$19,260.00 ","$12,711.60 ",$376.97 ,"$37,722.01 ",$376.97 ,"$19,260.00 ","$14,895.00 ","$16,765.34 ","$11,556.00 ","$16,371.00 ","$13,482.00 ",$376.97 ,$376.97 ,"$18,297.00 ","$14,637.60 ","$14,445.00 ","$7,276.00 ","$16,371.00 ","$16,765.34 ","$7,276.00 ","$7,276.00 ","$13,482.00 ","$11,729.34 ",$376.97 ,"$16,765.34 ","$16,430.03 ","$19,260.00 ",$399.59 ,"$16,371.00 ","$37,722.01 ","$17,719.20 ","$13,482.00 ","$4,887.30 ","$6,108.86 ","$11,729.34 ","$6,108.86 ","$13,308.66 ","$17,334.00 ","$13,158.43 ","$16,594.33 ","$15,215.40 ",$399.59 ,"$10,341.00 ","$10,341.00 ","$16,430.03 ","$10,341.00 ","$13,867.20 ","$11,941.20 ","$13,867.20 ","$13,867.20 ","$15,408.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100088,37231,HC RVC EN PRC T/P W/AN/TR ST IN V 37231,481,1 ,"$24,610.00 ","$16,242.60 ",$376.97 ,"$37,722.01 ",$376.97 ,"$21,770.00 ","$14,895.00 ","$16,765.34 ","$14,766.00 ","$20,918.50 ","$17,227.00 ",$376.97 ,$376.97 ,"$23,379.50 ","$18,703.60 ","$18,457.50 ","$7,276.00 ","$20,918.50 ","$16,765.34 ","$7,276.00 ","$7,276.00 ","$17,227.00 ","$14,987.49 ",$376.97 ,"$16,765.34 ","$16,430.03 ","$24,610.00 ",$399.59 ,"$20,918.50 ","$37,722.01 ","$22,641.20 ","$17,227.00 ","$5,041.37 ","$6,302.25 ","$14,987.49 ","$6,302.25 ","$17,005.51 ","$22,149.00 ","$16,813.55 ","$16,594.33 ","$19,441.90 ",$399.59 ,"$14,623.00 ","$14,623.00 ","$16,430.03 ","$14,623.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100089,37232,HC RVC EN PRC T/P W/ANG EA AD VS 37232,481,1 ,"$6,099.00 ","$4,025.34 ",$376.97 ,"$6,233.42 ",$376.97 ,"$6,099.00 ","$5,421.00 ", N/A ,"$3,659.40 ","$5,184.15 ","$4,269.30 ",$376.97 ,$376.97 ,"$5,794.05 ","$4,635.24 ","$4,574.25 ","$6,099.00 ","$5,184.15 ", N/A ,"$6,099.00 ","$6,099.00 ","$4,269.30 ","$3,714.29 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$5,184.15 ", N/A ,"$5,611.08 ","$4,269.30 ","$4,986.74 ","$6,233.42 ","$3,714.29 ","$6,233.42 ","$4,214.41 ","$5,489.10 ","$4,166.84 ", N/A ,"$4,818.21 ",$399.59 ,"$6,099.00 ","$6,099.00 ", N/A ,"$6,099.00 ","$4,391.28 ","$3,781.38 ","$4,391.28 ","$4,391.28 ","$4,879.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100090,37233,HC RVC EN PRC T/P W/ANT EA AD VS 37233,481,1 ,"$14,215.00 ","$9,381.90 ",$376.97 ,"$14,215.00 ",$376.97 ,"$9,625.00 ","$5,421.00 ", N/A ,"$8,529.00 ","$12,082.75 ","$9,950.50 ",$376.97 ,$376.97 ,"$13,504.25 ","$10,803.40 ","$10,661.25 ","$7,276.00 ","$12,082.75 ", N/A ,"$7,276.00 ","$7,276.00 ","$9,950.50 ","$8,656.94 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$12,082.75 ", N/A ,"$13,077.80 ","$9,950.50 ","$4,986.74 ","$6,233.42 ","$8,656.94 ","$6,233.42 ","$9,822.57 ","$12,793.50 ","$9,711.69 ", N/A ,"$11,229.85 ",$399.59 ,"$10,341.00 ","$10,341.00 ", N/A ,"$10,341.00 ","$10,234.80 ","$8,813.30 ","$10,234.80 ","$10,234.80 ","$11,372.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100091,37234,HC RVC EN PRC T/P W/TRN SNT EA VS 37234,481,1 ,"$9,202.00 ","$6,073.32 ",$376.97 ,"$9,202.00 ",$376.97 ,"$9,202.00 ","$5,421.00 ", N/A ,"$5,521.20 ","$7,821.70 ","$6,441.40 ",$376.97 ,$376.97 ,"$8,741.90 ","$6,993.52 ","$6,901.50 ","$7,276.00 ","$7,821.70 ", N/A ,"$7,276.00 ","$7,276.00 ","$6,441.40 ","$5,604.02 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$7,821.70 ", N/A ,"$8,465.84 ","$6,441.40 ","$4,986.74 ","$6,233.42 ","$5,604.02 ","$6,233.42 ","$6,358.58 ","$8,281.80 ","$6,286.81 ", N/A ,"$7,269.58 ",$399.59 ,"$9,030.00 ","$9,030.00 ", N/A ,"$9,030.00 ","$6,625.44 ","$5,705.24 ","$6,625.44 ","$6,625.44 ","$7,361.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100092,37235,HC RVC EN PRC T/P W/AN/TR ST AD V 37235,481,1 ,"$8,881.00 ","$5,861.46 ",$376.97 ,"$8,881.00 ",$376.97 ,"$8,881.00 ","$5,421.00 ", N/A ,"$5,328.60 ","$7,548.85 ","$6,216.70 ",$376.97 ,$376.97 ,"$8,436.95 ","$6,749.56 ","$6,660.75 ","$7,276.00 ","$7,548.85 ", N/A ,"$7,276.00 ","$7,276.00 ","$6,216.70 ","$5,408.53 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$7,548.85 ", N/A ,"$8,170.52 ","$6,216.70 ","$4,986.74 ","$6,233.42 ","$5,408.53 ","$6,233.42 ","$6,136.77 ","$7,992.90 ","$6,067.50 ", N/A ,"$7,015.99 ",$399.59 ,"$8,881.00 ","$8,881.00 ", N/A ,"$8,881.00 ","$6,394.32 ","$5,506.22 ","$6,394.32 ","$6,394.32 ","$7,104.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100093,37252,HC US VASCULAR NON-CORONARY INIT 37252,481,1 ,"$2,200.00 ","$1,452.00 ","$1,320.00 ","$2,213.66 ", N/A ,"$2,200.00 ","$2,200.00 ", N/A ,"$1,320.00 ","$1,870.00 ","$1,540.00 ", N/A , N/A ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$2,200.00 ","$1,870.00 ", N/A ,"$2,200.00 ","$2,200.00 ","$1,540.00 ","$1,339.80 ", N/A , N/A , N/A , N/A , N/A ,"$1,870.00 ", N/A ,"$2,024.00 ","$1,540.00 ","$1,771.14 ","$2,213.66 ","$1,339.80 ","$2,213.66 ","$1,520.20 ","$1,980.00 ","$1,503.04 ", N/A ,"$1,738.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100094,37253,HC US VASCULAR NON-CORON ADDL EA 37253,481,1 ,"$2,000.00 ","$1,320.00 ","$1,200.00 ","$2,213.66 ", N/A ,"$2,000.00 ","$2,000.00 ", N/A ,"$1,200.00 ","$1,700.00 ","$1,400.00 ", N/A , N/A ,"$1,900.00 ","$1,520.00 ","$1,500.00 ","$2,000.00 ","$1,700.00 ", N/A ,"$2,000.00 ","$2,000.00 ","$1,400.00 ","$1,218.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,700.00 ", N/A ,"$1,840.00 ","$1,400.00 ","$1,771.14 ","$2,213.66 ","$1,218.00 ","$2,213.66 ","$1,382.00 ","$1,800.00 ","$1,366.40 ", N/A ,"$1,580.00 ", N/A ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$1,440.00 ","$1,240.00 ","$1,440.00 ","$1,440.00 ","$1,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100096,92973,HC PTC TRANSLUM CORONARY THROMB 92973,481,1 ,"$4,601.00 ","$3,036.66 ",$291.35 ,"$4,601.00 ",$291.35 , N/A , N/A , N/A ,"$2,760.60 ","$3,910.85 ","$3,220.70 ",$291.35 ,$291.35 ,"$4,370.95 ","$3,496.76 ","$3,450.75 ","$4,601.00 ","$3,910.85 ", N/A ,"$4,601.00 ","$4,601.00 ","$3,220.70 ","$2,802.01 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$3,910.85 ", N/A ,"$4,232.92 ","$3,220.70 ","$2,333.63 ","$2,800.63 ","$2,802.01 ","$2,800.63 ","$3,179.29 ","$4,140.90 ","$3,143.40 ", N/A ,"$3,634.79 ",$308.83 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$3,312.72 ","$2,852.62 ","$3,312.72 ","$3,312.72 ","$3,680.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100097,92978,HC INTRAVASCULAR ULTRSOUND INTIAL 92978,481,1 ,"$2,486.64 ","$1,641.18 ",$6.83 ,"$2,486.64 ",$6.83 ,"$2,486.64 ","$2,486.64 ", N/A ,"$1,491.98 ","$2,113.64 ","$1,740.65 ",$6.83 ,$6.83 ,"$2,362.31 ","$1,889.85 ","$1,864.98 ","$2,486.64 ","$2,113.64 ", N/A ,"$2,486.64 ","$2,486.64 ","$1,740.65 ","$1,514.36 ",$6.83 , N/A , N/A , N/A ,$7.24 ,"$2,113.64 ", N/A ,"$2,287.71 ","$1,740.65 ","$1,261.22 ","$1,513.62 ","$1,514.36 ","$1,513.62 ","$1,718.27 ","$2,237.98 ","$1,698.87 ", N/A ,"$1,964.45 ",$7.24 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$1,790.38 ","$1,541.72 ","$1,790.38 ","$1,790.38 ","$1,989.31 "
ST NICHOLAS HOSPITAL - ACUTE,48100098,92979,HC INTRAVASCULAR ULTRSOUND EA ADD 92979,481,1 ,"$1,921.50 ","$1,268.19 ",$6.83 ,"$1,921.50 ",$6.83 , N/A , N/A , N/A ,"$1,152.90 ","$1,633.28 ","$1,345.05 ",$6.83 ,$6.83 ,"$1,825.43 ","$1,460.34 ","$1,441.13 ","$1,921.50 ","$1,633.28 ", N/A ,"$1,921.50 ","$1,921.50 ","$1,345.05 ","$1,170.19 ",$6.83 , N/A , N/A , N/A ,$7.24 ,"$1,633.28 ", N/A ,"$1,767.78 ","$1,345.05 ",$974.58 ,"$1,169.62 ","$1,170.19 ","$1,169.62 ","$1,327.76 ","$1,729.35 ","$1,312.77 ", N/A ,"$1,517.99 ",$7.24 ,"$1,921.50 ","$1,921.50 ", N/A ,"$1,921.50 ","$1,383.48 ","$1,191.33 ","$1,383.48 ","$1,383.48 ","$1,537.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100103,92986,HC VALVULOPLASTY AORTIC VALVE 92986,481,1 ,"$8,025.00 ","$5,296.50 ",$291.35 ,"$11,453.02 ",$291.35 ,"$8,025.00 ","$8,025.00 ","$5,090.23 ","$4,815.00 ","$6,821.25 ","$5,617.50 ",$291.35 ,$291.35 ,"$7,623.75 ","$6,099.00 ","$6,018.75 ","$2,929.00 ","$6,821.25 ","$5,090.23 ","$2,929.00 ","$2,929.00 ","$5,617.50 ","$4,887.23 ",$291.35 ,"$5,090.23 ","$4,988.43 ","$8,025.00 ",$308.83 ,"$6,821.25 ","$11,453.02 ","$7,383.00 ","$5,617.50 ","$4,535.48 ","$5,669.62 ","$4,887.23 ","$5,669.62 ","$5,545.28 ","$7,222.50 ","$5,482.68 ","$5,038.31 ","$6,339.75 ",$308.83 ,"$8,025.00 ","$8,025.00 ","$4,988.43 ","$8,025.00 ","$5,778.00 ","$4,975.50 ","$5,778.00 ","$5,778.00 ","$6,420.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100104,92987,HC VALVULOPLASTY MITRAL VALVE 92987,481,1 ,"$9,630.00 ","$6,355.80 ",$291.35 ,"$23,311.22 ",$291.35 ,"$9,630.00 ","$9,630.00 ","$10,360.54 ","$5,778.00 ","$8,185.50 ","$6,741.00 ",$291.35 ,$291.35 ,"$9,148.50 ","$7,318.80 ","$7,222.50 ","$2,929.00 ","$8,185.50 ","$10,360.54 ","$2,929.00 ","$2,929.00 ","$6,741.00 ","$5,864.67 ",$291.35 ,"$10,360.54 ","$10,153.33 ","$9,630.00 ",$308.83 ,"$8,185.50 ","$23,311.22 ","$8,859.60 ","$6,741.00 ","$4,535.48 ","$5,669.62 ","$5,864.67 ","$5,669.62 ","$6,654.33 ","$8,667.00 ","$6,579.22 ","$10,254.87 ","$7,607.70 ",$308.83 ,"$9,030.00 ","$9,030.00 ","$10,153.33 ","$9,030.00 ","$6,933.60 ","$5,970.60 ","$6,933.60 ","$6,933.60 ","$7,704.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100107,93451,HC CATH RIGHT HEART 93451,481,1 ,"$5,778.00 ","$3,813.48 ",$84.66 ,"$6,496.78 ",$84.66 ,"$5,778.00 ","$5,778.00 ","$2,887.46 ","$3,466.80 ","$4,911.30 ","$4,044.60 ",$84.66 ,$84.66 ,"$5,489.10 ","$4,391.28 ","$4,333.50 ","$5,778.00 ","$4,911.30 ","$2,887.46 ","$5,778.00 ","$5,778.00 ","$4,044.60 ","$3,518.80 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$4,911.30 ","$6,496.78 ","$5,315.76 ","$4,044.60 ","$3,501.86 ","$4,377.05 ","$3,518.80 ","$4,377.05 ","$3,992.60 ","$5,200.20 ","$3,947.53 ","$2,858.00 ","$4,564.62 ",$89.74 ,"$5,778.00 ","$5,778.00 ","$2,829.71 ","$5,778.00 ","$4,160.16 ","$3,582.36 ","$4,160.16 ","$4,160.16 ","$4,622.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100108,93452,HC LHC ONLY NO COROS 93452,481,1 ,"$7,490.00 ","$4,943.40 ",$84.66 ,"$7,490.00 ",$84.66 ,"$7,490.00 ","$7,490.00 ","$2,887.46 ","$4,494.00 ","$6,366.50 ","$5,243.00 ",$84.66 ,$84.66 ,"$7,115.50 ","$5,692.40 ","$5,617.50 ","$7,276.00 ","$6,366.50 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$5,243.00 ","$4,561.41 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$6,366.50 ","$6,496.78 ","$6,890.80 ","$5,243.00 ","$3,501.86 ","$4,377.05 ","$4,561.41 ","$4,377.05 ","$5,175.59 ","$6,741.00 ","$5,117.17 ","$2,858.00 ","$5,917.10 ",$89.74 ,"$7,490.00 ","$7,490.00 ","$2,829.71 ","$7,490.00 ","$5,392.80 ","$4,643.80 ","$5,392.80 ","$5,392.80 ","$5,992.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100109,93453,HC RHC/LHC ONLY/NO CORS 93453,481,1 ,"$8,346.00 ","$5,508.36 ",$84.66 ,"$8,346.00 ",$84.66 ,"$8,346.00 ","$8,346.00 ","$2,887.46 ","$5,007.60 ","$7,094.10 ","$5,842.20 ",$84.66 ,$84.66 ,"$7,928.70 ","$6,342.96 ","$6,259.50 ","$7,276.00 ","$7,094.10 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$5,842.20 ","$5,082.71 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$7,094.10 ","$6,496.78 ","$7,678.32 ","$5,842.20 ","$3,501.86 ","$4,377.05 ","$5,082.71 ","$4,377.05 ","$5,767.09 ","$7,511.40 ","$5,701.99 ","$2,858.00 ","$6,593.34 ",$89.74 ,"$7,712.00 ","$7,712.00 ","$2,829.71 ","$7,712.00 ","$6,009.12 ","$5,174.52 ","$6,009.12 ","$6,009.12 ","$6,676.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100110,93454,HC CORONARY ANGIO ONLY/NO LV 93454,481,1 ,"$11,770.00 ","$7,768.20 ",$84.66 ,"$11,770.00 ",$84.66 ,"$11,770.00 ","$11,770.00 ","$2,887.46 ","$7,062.00 ","$10,004.50 ","$8,239.00 ",$84.66 ,$84.66 ,"$11,181.50 ","$8,945.20 ","$8,827.50 ","$7,276.00 ","$10,004.50 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$8,239.00 ","$7,167.93 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$10,004.50 ","$6,496.78 ","$10,828.40 ","$8,239.00 ","$3,501.86 ","$4,377.05 ","$7,167.93 ","$4,377.05 ","$8,133.07 ","$10,593.00 ","$8,041.26 ","$2,858.00 ","$9,298.30 ",$89.74 ,"$7,712.00 ","$7,712.00 ","$2,829.71 ","$7,712.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100111,93455,HC CORO ANGIO  AND  GRAFTS ONLY NO LV 93455,481,1 ,"$10,700.00 ","$7,062.00 ",$84.66 ,"$10,700.00 ",$84.66 ,"$10,700.00 ","$10,700.00 ","$2,887.46 ","$6,420.00 ","$9,095.00 ","$7,490.00 ",$84.66 ,$84.66 ,"$10,165.00 ","$8,132.00 ","$8,025.00 ","$7,276.00 ","$9,095.00 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$7,490.00 ","$6,516.30 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$9,095.00 ","$6,496.78 ","$9,844.00 ","$7,490.00 ","$3,501.86 ","$4,377.05 ","$6,516.30 ","$4,377.05 ","$7,393.70 ","$9,630.00 ","$7,310.24 ","$2,858.00 ","$8,453.00 ",$89.74 ,"$7,712.00 ","$7,712.00 ","$2,829.71 ","$7,712.00 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$8,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100112,93456,HC RHC CORONARY ANGIO/NO LV 93456,481,1 ,"$9,416.00 ","$6,214.56 ",$84.66 ,"$9,416.00 ",$84.66 ,"$9,416.00 ","$9,416.00 ","$2,887.46 ","$5,649.60 ","$8,003.60 ","$6,591.20 ",$84.66 ,$84.66 ,"$8,945.20 ","$7,156.16 ","$7,062.00 ","$7,276.00 ","$8,003.60 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$6,591.20 ","$5,734.34 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$8,003.60 ","$6,496.78 ","$8,662.72 ","$6,591.20 ","$3,501.86 ","$4,377.05 ","$5,734.34 ","$4,377.05 ","$6,506.46 ","$8,474.40 ","$6,433.01 ","$2,858.00 ","$7,438.64 ",$89.74 ,"$7,712.00 ","$7,712.00 ","$2,829.71 ","$7,712.00 ","$6,779.52 ","$5,837.92 ","$6,779.52 ","$6,779.52 ","$7,532.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100113,93457,HC RHC CORO ANGIO  AND  GRAFTS/NO LV 93457,481,1 ,"$10,379.00 ","$6,850.14 ",$84.66 ,"$10,379.00 ",$84.66 ,"$10,379.00 ","$10,379.00 ","$2,887.46 ","$6,227.40 ","$8,822.15 ","$7,265.30 ",$84.66 ,$84.66 ,"$9,860.05 ","$7,888.04 ","$7,784.25 ","$7,276.00 ","$8,822.15 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$7,265.30 ","$6,320.81 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$8,822.15 ","$6,496.78 ","$9,548.68 ","$7,265.30 ","$3,501.86 ","$4,377.05 ","$6,320.81 ","$4,377.05 ","$7,171.89 ","$9,341.10 ","$7,090.93 ","$2,858.00 ","$8,199.41 ",$89.74 ,"$7,712.00 ","$7,712.00 ","$2,829.71 ","$7,712.00 ","$7,472.88 ","$6,434.98 ","$7,472.88 ","$7,472.88 ","$8,303.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100114,93458,HC CORONARY ANGIO WITH LV 93458,481,1 ,"$10,700.00 ","$7,062.00 ",$84.66 ,"$10,700.00 ",$84.66 ,"$10,700.00 ","$10,700.00 ","$2,887.46 ","$6,420.00 ","$9,095.00 ","$7,490.00 ",$84.66 ,$84.66 ,"$10,165.00 ","$8,132.00 ","$8,025.00 ","$7,276.00 ","$9,095.00 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$7,490.00 ","$6,516.30 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$9,095.00 ","$6,496.78 ","$9,844.00 ","$7,490.00 ","$3,501.86 ","$4,377.05 ","$6,516.30 ","$4,377.05 ","$7,393.70 ","$9,630.00 ","$7,310.24 ","$2,858.00 ","$8,453.00 ",$89.74 ,"$7,712.00 ","$7,712.00 ","$2,829.71 ","$7,712.00 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$8,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100115,93459,HC CORONARY ANGIO W GRAFTS AND LV 93459,481,1 ,"$8,774.00 ","$5,790.84 ",$84.66 ,"$8,774.00 ",$84.66 ,"$8,774.00 ","$8,774.00 ","$2,887.46 ","$5,264.40 ","$7,457.90 ","$6,141.80 ",$84.66 ,$84.66 ,"$8,335.30 ","$6,668.24 ","$6,580.50 ","$7,276.00 ","$7,457.90 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$6,141.80 ","$5,343.37 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$7,457.90 ","$6,496.78 ","$8,072.08 ","$6,141.80 ","$3,501.86 ","$4,377.05 ","$5,343.37 ","$4,377.05 ","$6,062.83 ","$7,896.60 ","$5,994.40 ","$2,858.00 ","$6,931.46 ",$89.74 ,"$7,712.00 ","$7,712.00 ","$2,829.71 ","$7,712.00 ","$6,317.28 ","$5,439.88 ","$6,317.28 ","$6,317.28 ","$7,019.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100116,93460,HC RHC/LHC/CORONAY ANGIO AND LV 93460,481,1 ,"$9,309.00 ","$6,143.94 ",$84.66 ,"$9,309.00 ",$84.66 ,"$9,309.00 ","$9,309.00 ","$2,887.46 ","$5,585.40 ","$7,912.65 ","$6,516.30 ",$84.66 ,$84.66 ,"$8,843.55 ","$7,074.84 ","$6,981.75 ","$7,276.00 ","$7,912.65 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$6,516.30 ","$5,669.18 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$7,912.65 ","$6,496.78 ","$8,564.28 ","$6,516.30 ","$3,501.86 ","$4,377.05 ","$5,669.18 ","$4,377.05 ","$6,432.52 ","$8,378.10 ","$6,359.91 ","$2,858.00 ","$7,354.11 ",$89.74 ,"$7,712.00 ","$7,712.00 ","$2,829.71 ","$7,712.00 ","$6,702.48 ","$5,771.58 ","$6,702.48 ","$6,702.48 ","$7,447.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100117,93461,HC RHC/LHC/CORON ANGIO GRAFTS  AND LV 93461,481,1 ,"$11,770.00 ","$7,768.20 ",$84.66 ,"$11,770.00 ",$84.66 ,"$11,770.00 ","$11,770.00 ","$2,887.46 ","$7,062.00 ","$10,004.50 ","$8,239.00 ",$84.66 ,$84.66 ,"$11,181.50 ","$8,945.20 ","$8,827.50 ","$7,276.00 ","$10,004.50 ","$2,887.46 ","$7,276.00 ","$7,276.00 ","$8,239.00 ","$7,167.93 ",$84.66 ,"$2,887.46 ","$2,829.71 ","$5,774.92 ",$89.74 ,"$10,004.50 ","$6,496.78 ","$10,828.40 ","$8,239.00 ","$3,501.86 ","$4,377.05 ","$7,167.93 ","$4,377.05 ","$8,133.07 ","$10,593.00 ","$8,041.26 ","$2,858.00 ","$9,298.30 ",$89.74 ,"$7,712.00 ","$7,712.00 ","$2,829.71 ","$7,712.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100118,93463,HC NITRIC OXIDE STUDY 93463,481,1 ,$482.00 ,$318.12 ,$1.59 ,$482.00 ,$1.59 ,$482.00 ,$482.00 , N/A ,$289.20 ,$409.70 ,$337.40 ,$1.59 ,$1.59 ,$457.90 ,$366.32 ,$361.50 ,$482.00 ,$409.70 , N/A ,$482.00 ,$482.00 ,$337.40 ,$293.54 ,$1.59 , N/A , N/A , N/A ,$1.69 ,$409.70 , N/A ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$293.39 ,$333.06 ,$433.80 ,$329.30 , N/A ,$380.78 ,$1.69 ,$482.00 ,$482.00 , N/A ,$482.00 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,48100119,93567,HC AORTAGRAM 93567,481,1 ,$845.00 ,$557.70 ,$10.77 ,$845.00 ,$10.77 ,$845.00 ,$845.00 , N/A ,$507.00 ,$718.25 ,$591.50 ,$10.77 ,$10.77 ,$802.75 ,$642.20 ,$633.75 ,$845.00 ,$718.25 , N/A ,$845.00 ,$845.00 ,$591.50 ,$514.61 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$718.25 , N/A ,$777.40 ,$591.50 ,$428.58 ,$514.35 ,$514.61 ,$514.35 ,$583.90 ,$760.50 ,$577.30 , N/A ,$667.55 ,$11.42 ,$845.00 ,$845.00 , N/A ,$845.00 ,$608.40 ,$523.90 ,$608.40 ,$608.40 ,$676.00 
ST NICHOLAS HOSPITAL - ACUTE,48100120,93571,HC INTRAVASC DOPP COLOR FLOW INIT 93571,481,1 ,"$1,695.44 ","$1,118.99 ",$57.71 ,"$1,695.44 ",$57.71 ,"$1,695.44 ","$1,695.44 ", N/A ,"$1,017.26 ","$1,441.12 ","$1,186.81 ",$57.71 ,$57.71 ,"$1,610.67 ","$1,288.53 ","$1,271.58 ","$1,695.44 ","$1,441.12 ", N/A ,"$1,695.44 ","$1,695.44 ","$1,186.81 ","$1,032.52 ",$57.71 , N/A , N/A , N/A ,$61.17 ,"$1,441.12 ", N/A ,"$1,559.80 ","$1,186.81 ",$859.93 ,"$1,032.01 ","$1,032.52 ","$1,032.01 ","$1,171.55 ","$1,525.90 ","$1,158.32 ", N/A ,"$1,339.40 ",$61.17 ,"$1,695.44 ","$1,695.44 ", N/A ,"$1,695.44 ","$1,220.72 ","$1,051.17 ","$1,220.72 ","$1,220.72 ","$1,356.35 "
ST NICHOLAS HOSPITAL - ACUTE,48100121,93572,HC INTRAVASC DOPP COLOR FLOW ADDL 93572,481,1 ,$881.63 ,$581.88 ,$57.71 ,$881.63 ,$57.71 ,$881.63 ,$881.63 , N/A ,$528.98 ,$749.39 ,$617.14 ,$57.71 ,$57.71 ,$837.55 ,$670.04 ,$661.22 ,$881.63 ,$749.39 , N/A ,$881.63 ,$881.63 ,$617.14 ,$536.91 ,$57.71 , N/A , N/A , N/A ,$61.17 ,$749.39 , N/A ,$811.10 ,$617.14 ,$447.16 ,$536.65 ,$536.91 ,$536.65 ,$609.21 ,$793.47 ,$602.33 , N/A ,$696.49 ,$61.17 ,$881.63 ,$881.63 , N/A ,$881.63 ,$634.77 ,$546.61 ,$634.77 ,$634.77 ,$705.30 
ST NICHOLAS HOSPITAL - ACUTE,48100122,93580,HC PTC W/IMPLNT ATRIAL 93580,481,1 ,"$11,770.00 ","$7,768.20 ",$512.66 ,"$37,722.01 ",$512.66 ,"$11,770.00 ","$11,770.00 ","$16,765.34 ","$7,062.00 ","$10,004.50 ","$8,239.00 ",$512.66 ,$512.66 ,"$11,181.50 ","$8,945.20 ","$8,827.50 ","$7,276.00 ","$10,004.50 ","$16,765.34 ","$7,276.00 ","$7,276.00 ","$8,239.00 ","$7,167.93 ",$512.66 ,"$16,765.34 ","$16,430.03 ","$11,770.00 ",$543.42 ,"$10,004.50 ","$37,722.01 ","$10,828.40 ","$8,239.00 ","$4,986.74 ","$6,233.42 ","$7,167.93 ","$6,233.42 ","$8,133.07 ","$10,593.00 ","$8,041.26 ","$16,594.33 ","$9,298.30 ",$543.42 ,"$11,770.00 ","$11,770.00 ","$16,430.03 ","$11,770.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100123,93600,HC HIS BUNDLE RECORDING,481,1 ,"$3,638.00 ","$2,401.08 ",$190.94 ,"$14,785.12 ",$190.94 ,"$3,638.00 ","$3,638.00 ","$6,571.16 ","$2,182.80 ","$3,092.30 ","$2,546.60 ",$190.94 ,$190.94 ,"$3,456.10 ","$2,764.88 ","$2,728.50 ","$3,638.00 ","$3,092.30 ","$6,571.16 ","$3,638.00 ","$3,638.00 ","$2,546.60 ","$2,215.54 ",$190.94 ,"$6,571.16 ","$6,439.74 ","$3,638.00 ",$202.40 ,"$3,092.30 ","$14,785.12 ","$3,346.96 ","$2,546.60 ","$1,998.41 ","$2,497.74 ","$2,215.54 ","$2,497.74 ","$2,513.86 ","$3,274.20 ","$2,485.48 ","$6,504.13 ","$2,874.02 ",$202.40 ,"$3,638.00 ","$3,638.00 ","$6,439.74 ","$3,638.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100124,93602,HC INTRA-ATRIAL RECORDING,481,1 ,"$3,782.00 ","$2,496.12 ",$190.94 ,"$14,785.12 ",$190.94 ,"$3,782.00 ","$3,782.00 ","$6,571.16 ","$2,269.20 ","$3,214.70 ","$2,647.40 ",$190.94 ,$190.94 ,"$3,592.90 ","$2,874.32 ","$2,836.50 ","$3,782.00 ","$3,214.70 ","$6,571.16 ","$3,782.00 ","$3,782.00 ","$2,647.40 ","$2,303.24 ",$190.94 ,"$6,571.16 ","$6,439.74 ","$3,782.00 ",$202.40 ,"$3,214.70 ","$14,785.12 ","$3,479.44 ","$2,647.40 ","$1,998.41 ","$2,497.74 ","$2,303.24 ","$2,497.74 ","$2,613.36 ","$3,403.80 ","$2,583.86 ","$6,504.13 ","$2,987.78 ",$202.40 ,"$3,782.00 ","$3,782.00 ","$6,439.74 ","$3,782.00 ","$2,723.04 ","$2,344.84 ","$2,723.04 ","$2,723.04 ","$3,025.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100125,93609,HC TACHYCARDIA SITE MAPPING 93609,481,1 ,"$3,777.00 ","$2,492.82 ",$578.16 ,"$3,777.00 ",$578.16 ,"$3,777.00 ","$3,777.00 ", N/A ,"$2,266.20 ","$3,210.45 ","$2,643.90 ",$578.16 ,$578.16 ,"$3,588.15 ","$2,870.52 ","$2,832.75 ","$3,777.00 ","$3,210.45 ", N/A ,"$3,777.00 ","$3,777.00 ","$2,643.90 ","$2,300.19 ",$578.16 , N/A , N/A , N/A ,$612.85 ,"$3,210.45 ", N/A ,"$3,474.84 ","$2,643.90 ","$1,915.69 ","$2,299.06 ","$2,300.19 ","$2,299.06 ","$2,609.91 ","$3,399.30 ","$2,580.45 ", N/A ,"$2,983.83 ",$612.85 ,"$3,777.00 ","$3,777.00 ", N/A ,"$3,777.00 ","$2,719.44 ","$2,341.74 ","$2,719.44 ","$2,719.44 ","$3,021.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100126,93612,HC EP INTRAVENTRIC PACING,481,1 ,"$5,152.00 ","$3,400.32 ",$190.94 ,"$14,785.12 ",$190.94 ,"$5,152.00 ","$5,152.00 ","$6,571.16 ","$3,091.20 ","$4,379.20 ","$3,606.40 ",$190.94 ,$190.94 ,"$4,894.40 ","$3,915.52 ","$3,864.00 ","$5,152.00 ","$4,379.20 ","$6,571.16 ","$5,152.00 ","$5,152.00 ","$3,606.40 ","$3,137.57 ",$190.94 ,"$6,571.16 ","$6,439.74 ","$5,152.00 ",$202.40 ,"$4,379.20 ","$14,785.12 ","$4,739.84 ","$3,606.40 ","$1,998.41 ","$2,497.74 ","$3,137.57 ","$2,497.74 ","$3,560.03 ","$4,636.80 ","$3,519.85 ","$6,504.13 ","$4,070.08 ",$202.40 ,"$5,152.00 ","$5,152.00 ","$6,439.74 ","$5,152.00 ","$3,709.44 ","$3,194.24 ","$3,709.44 ","$3,709.44 ","$4,121.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100127,93613,HC EP INTRACARDIAC 3-D MAPPING 93613,481,1 ,"$10,700.00 ","$7,062.00 ",$578.16 ,"$10,700.00 ",$578.16 ,"$10,700.00 ","$10,700.00 ", N/A ,"$6,420.00 ","$9,095.00 ","$7,490.00 ",$578.16 ,$578.16 ,"$10,165.00 ","$8,132.00 ","$8,025.00 ","$10,700.00 ","$9,095.00 ", N/A ,"$10,700.00 ","$10,700.00 ","$7,490.00 ","$6,516.30 ",$578.16 , N/A , N/A , N/A ,$612.85 ,"$9,095.00 ", N/A ,"$9,844.00 ","$7,490.00 ","$5,427.04 ","$6,513.09 ","$6,516.30 ","$6,513.09 ","$7,393.70 ","$9,630.00 ","$7,310.24 ", N/A ,"$8,453.00 ",$612.85 ,"$6,953.00 ","$6,953.00 ", N/A ,"$6,953.00 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$8,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100128,93619,HC EP COMPREHENSIVE W/O ARRHYTHMI 93619,480,1 ,"$9,660.00 ","$6,375.60 ",$578.16 ,"$14,785.12 ",$578.16 ,"$6,620.96 ","$6,620.96 ","$6,571.16 ","$5,796.00 ","$8,211.00 ","$6,762.00 ",$578.16 ,$578.16 ,"$9,177.00 ","$7,341.60 ","$7,245.00 ","$6,279.00 ","$8,211.00 ","$6,571.16 ","$6,279.00 ","$6,279.00 ","$6,762.00 ","$5,882.94 ",$578.16 ,"$6,571.16 ","$6,439.74 ","$9,660.00 ",$612.85 ,"$8,211.00 ","$14,785.12 ","$8,887.20 ","$6,762.00 ","$4,535.48 ","$5,669.62 ","$5,882.94 ","$5,669.62 ","$6,675.06 ","$8,694.00 ","$6,599.71 ","$6,504.13 ","$7,631.40 ",$612.85 ,"$1,321.00 ","$1,321.00 ","$6,439.74 ","$1,321.00 ","$6,955.20 ","$5,989.20 ","$6,955.20 ","$6,955.20 ","$7,728.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100129,93620,HC EP COMPREHENSIVE W/ ARRHYTHMIA 93620,481,1 ,"$9,144.80 ","$6,035.57 ",$578.16 ,"$14,785.12 ",$578.16 ,"$9,144.80 ","$9,144.80 ","$6,571.16 ","$5,486.88 ","$7,773.08 ","$6,401.36 ",$578.16 ,$578.16 ,"$8,687.56 ","$6,950.05 ","$6,858.60 ","$9,144.80 ","$7,773.08 ","$6,571.16 ","$9,144.80 ","$9,144.80 ","$6,401.36 ","$5,569.18 ",$578.16 ,"$6,571.16 ","$6,439.74 ","$9,144.80 ",$612.85 ,"$7,773.08 ","$14,785.12 ","$8,413.22 ","$6,401.36 ","$4,535.48 ","$5,669.62 ","$5,569.18 ","$5,669.62 ","$6,319.06 ","$8,230.32 ","$6,247.73 ","$6,504.13 ","$7,224.39 ",$612.85 ,"$9,030.00 ","$9,030.00 ","$6,439.74 ","$9,030.00 ","$6,584.26 ","$5,669.78 ","$6,584.26 ","$6,584.26 ","$7,315.84 "
ST NICHOLAS HOSPITAL - ACUTE,48100130,93621,HC EP COMPREHENSIVE W/LT ATRIUM 93621,481,1 ,"$9,016.00 ","$5,950.56 ",$578.16 ,"$9,016.00 ",$578.16 ,"$9,016.00 ","$9,016.00 ", N/A ,"$5,409.60 ","$7,663.60 ","$6,311.20 ",$578.16 ,$578.16 ,"$8,565.20 ","$6,852.16 ","$6,762.00 ","$9,016.00 ","$7,663.60 ", N/A ,"$9,016.00 ","$9,016.00 ","$6,311.20 ","$5,490.74 ",$578.16 , N/A , N/A , N/A ,$612.85 ,"$7,663.60 ", N/A ,"$8,294.72 ","$6,311.20 ","$4,572.92 ","$5,488.04 ","$5,490.74 ","$5,488.04 ","$6,230.06 ","$8,114.40 ","$6,159.73 ", N/A ,"$7,122.64 ",$612.85 ,"$6,953.00 ","$6,953.00 ", N/A ,"$6,953.00 ","$6,491.52 ","$5,589.92 ","$6,491.52 ","$6,491.52 ","$7,212.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100131,93622,HC EP COMPREHENSIVE W/LT VENTRIC 93622,481,1 ,"$6,182.40 ","$4,080.38 ",$578.16 ,"$6,182.40 ",$578.16 ,"$6,182.40 ","$6,182.40 ", N/A ,"$3,709.44 ","$5,255.04 ","$4,327.68 ",$578.16 ,$578.16 ,"$5,873.28 ","$4,698.62 ","$4,636.80 ","$6,182.40 ","$5,255.04 ", N/A ,"$6,182.40 ","$6,182.40 ","$4,327.68 ","$3,765.08 ",$578.16 , N/A , N/A , N/A ,$612.85 ,"$5,255.04 ", N/A ,"$5,687.81 ","$4,327.68 ","$3,135.71 ","$3,763.23 ","$3,765.08 ","$3,763.23 ","$4,272.04 ","$5,564.16 ","$4,223.82 ", N/A ,"$4,884.10 ",$612.85 ,"$6,182.40 ","$6,182.40 ", N/A ,"$6,182.40 ","$4,451.33 ","$3,833.09 ","$4,451.33 ","$4,451.33 ","$4,945.92 "
ST NICHOLAS HOSPITAL - ACUTE,48100132,93623,HC EP IV DRUG INFUSION PACING 93623,481,1 ,"$2,782.00 ","$1,836.12 ",$578.16 ,"$2,782.00 ",$578.16 ,"$2,782.00 ","$2,782.00 ", N/A ,"$1,669.20 ","$2,364.70 ","$1,947.40 ",$578.16 ,$578.16 ,"$2,642.90 ","$2,114.32 ","$2,086.50 ","$2,782.00 ","$2,364.70 ", N/A ,"$2,782.00 ","$2,782.00 ","$1,947.40 ","$1,694.24 ",$578.16 , N/A , N/A , N/A ,$612.85 ,"$2,364.70 ", N/A ,"$2,559.44 ","$1,947.40 ","$1,411.03 ","$1,693.40 ","$1,694.24 ","$1,693.40 ","$1,922.36 ","$2,503.80 ","$1,900.66 ", N/A ,"$2,197.78 ",$612.85 ,"$2,782.00 ","$2,782.00 ", N/A ,"$2,782.00 ","$2,003.04 ","$1,724.84 ","$2,003.04 ","$2,003.04 ","$2,225.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100133,93641,HC EP EVAL CARDIO/DEFIB GENERATOR 93641,481,1 ,"$2,833.60 ","$1,870.18 ",$190.94 ,"$2,833.60 ",$190.94 , N/A , N/A , N/A ,"$1,700.16 ","$2,408.56 ","$1,983.52 ",$190.94 ,$190.94 ,"$2,691.92 ","$2,153.54 ","$2,125.20 ","$2,833.60 ","$2,408.56 ", N/A ,"$2,833.60 ","$2,833.60 ","$1,983.52 ","$1,725.66 ",$190.94 , N/A , N/A , N/A ,$202.40 ,"$2,408.56 ", N/A ,"$2,606.91 ","$1,983.52 ","$1,437.20 ","$1,724.81 ","$1,725.66 ","$1,724.81 ","$1,958.02 ","$2,550.24 ","$1,935.92 ", N/A ,"$2,238.54 ",$202.40 ,"$2,833.60 ","$2,833.60 ", N/A ,"$2,833.60 ","$2,040.19 ","$1,756.83 ","$2,040.19 ","$2,040.19 ","$2,266.88 "
ST NICHOLAS HOSPITAL - ACUTE,48100134,93641,HC ICD TESTING 93641,481,1 ,"$2,833.60 ","$1,870.18 ",$190.94 ,"$2,833.60 ",$190.94 , N/A , N/A , N/A ,"$1,700.16 ","$2,408.56 ","$1,983.52 ",$190.94 ,$190.94 ,"$2,691.92 ","$2,153.54 ","$2,125.20 ","$2,833.60 ","$2,408.56 ", N/A ,"$2,833.60 ","$2,833.60 ","$1,983.52 ","$1,725.66 ",$190.94 , N/A , N/A , N/A ,$202.40 ,"$2,408.56 ", N/A ,"$2,606.91 ","$1,983.52 ","$1,437.20 ","$1,724.81 ","$1,725.66 ","$1,724.81 ","$1,958.02 ","$2,550.24 ","$1,935.92 ", N/A ,"$2,238.54 ",$202.40 ,"$2,833.60 ","$2,833.60 ", N/A ,"$2,833.60 ","$2,040.19 ","$1,756.83 ","$2,040.19 ","$2,040.19 ","$2,266.88 "
ST NICHOLAS HOSPITAL - ACUTE,48100135,93642,HC EP EVAL CARDIO/DEFIB SGL/DUAL 93642,481,1 ,"$2,833.60 ","$1,870.18 ",$190.94 ,"$2,833.60 ",$190.94 , N/A , N/A ,"$1,090.25 ","$1,700.16 ","$2,408.56 ","$1,983.52 ",$190.94 ,$190.94 ,"$2,691.92 ","$2,153.54 ","$2,125.20 ","$2,833.60 ","$2,408.56 ","$1,090.25 ","$2,833.60 ","$2,833.60 ","$1,983.52 ","$1,725.66 ",$190.94 ,"$1,090.25 ","$1,068.44 ","$2,180.50 ",$202.40 ,"$2,408.56 ","$2,453.06 ","$2,606.91 ","$1,983.52 ","$1,998.41 ","$2,497.74 ","$1,725.66 ","$2,497.74 ","$1,958.02 ","$2,550.24 ","$1,935.92 ","$1,079.13 ","$2,238.54 ",$202.40 ,"$2,833.60 ","$2,833.60 ","$1,068.44 ","$2,833.60 ","$2,040.19 ","$1,756.83 ","$2,040.19 ","$2,040.19 ","$2,266.88 "
ST NICHOLAS HOSPITAL - ACUTE,48100136,93650,HC ABLATION ATRIOVENTRICULAR FNCT 93650,481,1 ,"$5,671.00 ","$3,742.86 ",$578.16 ,"$14,785.12 ",$578.16 ,"$5,671.00 ","$5,671.00 ","$6,571.16 ","$3,402.60 ","$4,820.35 ","$3,969.70 ",$578.16 ,$578.16 ,"$5,387.45 ","$4,309.96 ","$4,253.25 ","$5,671.00 ","$4,820.35 ","$6,571.16 ","$5,671.00 ","$5,671.00 ","$3,969.70 ","$3,453.64 ",$578.16 ,"$6,571.16 ","$6,439.74 ","$5,671.00 ",$612.85 ,"$4,820.35 ","$14,785.12 ","$5,217.32 ","$3,969.70 ","$4,535.48 ","$5,669.62 ","$3,453.64 ","$5,669.62 ","$3,918.66 ","$5,103.90 ","$3,874.43 ","$6,504.13 ","$4,480.09 ",$612.85 ,"$5,671.00 ","$5,671.00 ","$6,439.74 ","$5,671.00 ","$4,083.12 ","$3,516.02 ","$4,083.12 ","$4,083.12 ","$4,536.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100139,93660,HC TILT TABLE EVALUATION 93660,481,1 ,"$2,013.65 ","$1,329.01 ",$5.78 ,"$2,013.65 ",$5.78 ,"$2,013.65 ","$2,013.65 ",$471.83 ,"$1,208.19 ","$1,711.60 ","$1,409.56 ",$5.78 ,$5.78 ,"$1,912.97 ","$1,530.37 ","$1,510.24 ","$2,013.65 ","$1,711.60 ",$471.83 ,"$2,013.65 ","$2,013.65 ","$1,409.56 ","$1,226.31 ",$5.78 ,$471.83 ,$462.39 ,$943.66 ,$6.13 ,"$1,711.60 ","$1,061.61 ","$1,852.56 ","$1,409.56 ","$1,021.32 ","$1,225.71 ","$1,226.31 ","$1,225.71 ","$1,391.43 ","$1,812.29 ","$1,375.73 ",$467.02 ,"$1,590.78 ",$6.13 ,"$1,945.00 ","$1,945.00 ",$462.39 ,"$1,945.00 ","$1,449.83 ","$1,248.46 ","$1,449.83 ","$1,449.83 ","$1,610.92 "
ST NICHOLAS HOSPITAL - ACUTE,48100140,93662,HC EP INTRACARDIAC ECHO INTERVENT 93662,481,1 ,"$4,382.65 ","$2,892.55 ",$15.95 ,"$4,382.65 ",$15.95 ,"$4,382.65 ","$4,382.65 ", N/A ,"$2,629.59 ","$3,725.25 ","$3,067.86 ",$15.95 ,$15.95 ,"$4,163.52 ","$3,330.81 ","$3,286.99 ","$4,382.65 ","$3,725.25 ", N/A ,"$4,382.65 ","$4,382.65 ","$3,067.86 ","$2,669.03 ",$15.95 , N/A , N/A , N/A ,$16.91 ,"$3,725.25 ", N/A ,"$4,032.04 ","$3,067.86 ","$2,222.88 ","$2,667.72 ","$2,669.03 ","$2,667.72 ","$3,028.41 ","$3,944.39 ","$2,994.23 ", N/A ,"$3,462.29 ",$16.91 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$3,155.51 ","$2,717.24 ","$3,155.51 ","$3,155.51 ","$3,506.12 "
ST NICHOLAS HOSPITAL - ACUTE,48100150,93503,HC PLACEMENT SWANZ GAN CATH MONIT 93503,481,1 ,"$2,675.00 ","$1,765.50 ",$38.41 ,"$3,267.32 ",$38.41 ,"$2,675.00 ","$2,675.00 ","$1,452.14 ","$1,605.00 ","$2,273.75 ","$1,872.50 ",$38.41 ,$38.41 ,"$2,541.25 ","$2,033.00 ","$2,006.25 ","$2,675.00 ","$2,273.75 ","$1,452.14 ","$2,675.00 ","$2,675.00 ","$1,872.50 ","$1,629.08 ",$38.41 ,"$1,452.14 ","$1,423.10 ","$2,675.00 ",$40.71 ,"$2,273.75 ","$3,267.32 ","$2,461.00 ","$1,872.50 ","$1,771.14 ","$2,213.66 ","$1,629.08 ","$2,213.66 ","$1,848.43 ","$2,407.50 ","$1,827.56 ","$1,437.33 ","$2,113.25 ",$40.71 ,"$2,675.00 ","$2,675.00 ","$1,423.10 ","$2,675.00 ","$1,926.00 ","$1,658.50 ","$1,926.00 ","$1,926.00 ","$2,140.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100151,33227,HC REM/REPL PCMKR PUL GEN SGL 33227,481,1 ,"$5,564.00 ","$3,672.24 ",$279.90 ,"$17,925.44 ",$279.90 ,"$5,564.00 ","$5,564.00 ","$7,966.86 ","$3,338.40 ","$4,729.40 ","$3,894.80 ",$279.90 ,$279.90 ,"$5,285.80 ","$4,228.64 ","$4,173.00 ","$5,564.00 ","$4,729.40 ","$7,966.86 ","$5,564.00 ","$5,564.00 ","$3,894.80 ","$3,388.48 ",$279.90 ,"$7,966.86 ","$7,807.52 ","$5,564.00 ",$296.69 ,"$4,729.40 ","$17,925.44 ","$5,118.88 ","$3,894.80 ","$4,887.30 ","$6,108.86 ","$3,388.48 ","$6,108.86 ","$3,844.72 ","$5,007.60 ","$3,801.32 ","$7,885.60 ","$4,395.56 ",$296.69 ,"$5,564.00 ","$5,564.00 ","$7,807.52 ","$5,564.00 ","$4,006.08 ","$3,449.68 ","$4,006.08 ","$4,006.08 ","$4,451.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100152,33228,HC REM/REPL PCMKR PUL GEN DUAL 33228,481,1 ,"$6,313.00 ","$4,166.58 ",$279.90 ,"$22,681.98 ",$279.90 ,"$6,313.00 ","$6,313.00 ","$10,080.88 ","$3,787.80 ","$5,366.05 ","$4,419.10 ",$279.90 ,$279.90 ,"$5,997.35 ","$4,797.88 ","$4,734.75 ","$6,313.00 ","$5,366.05 ","$10,080.88 ","$6,313.00 ","$6,313.00 ","$4,419.10 ","$3,844.62 ",$279.90 ,"$10,080.88 ","$9,879.26 ","$6,313.00 ",$296.69 ,"$5,366.05 ","$22,681.98 ","$5,807.96 ","$4,419.10 ","$4,887.30 ","$6,108.86 ","$3,844.62 ","$6,108.86 ","$4,362.28 ","$5,681.70 ","$4,313.04 ","$9,978.06 ","$4,987.27 ",$296.69 ,"$6,313.00 ","$6,313.00 ","$9,879.26 ","$6,313.00 ","$4,545.36 ","$3,914.06 ","$4,545.36 ","$4,545.36 ","$5,050.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100153,33229,HC REM/REPL PCMKR PUL GEN MULT 33229,481,1 ,"$8,667.00 ","$5,720.22 ",$279.90 ,"$41,003.73 ",$279.90 ,"$8,667.00 ","$8,667.00 ","$18,223.88 ","$5,200.20 ","$7,366.95 ","$6,066.90 ",$279.90 ,$279.90 ,"$8,233.65 ","$6,586.92 ","$6,500.25 ","$8,667.00 ","$7,366.95 ","$18,223.88 ","$8,667.00 ","$8,667.00 ","$6,066.90 ","$5,278.20 ",$279.90 ,"$18,223.88 ","$17,859.40 ","$8,667.00 ",$296.69 ,"$7,366.95 ","$41,003.73 ","$7,973.64 ","$6,066.90 ","$4,887.30 ","$6,108.86 ","$5,278.20 ","$6,108.86 ","$5,988.90 ","$7,800.30 ","$5,921.29 ","$18,038.00 ","$6,846.93 ",$296.69 ,"$8,667.00 ","$8,667.00 ","$17,859.40 ","$8,667.00 ","$6,240.24 ","$5,373.54 ","$6,240.24 ","$6,240.24 ","$6,933.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100154,33262,HC REM/REPL DEFIB PUL GEN SGL 33262,481,1 ,"$13,910.00 ","$9,180.60 ",$821.65 ,"$50,109.03 ",$821.65 ,"$13,910.00 ","$13,910.00 ","$22,270.68 ","$8,346.00 ","$11,823.50 ","$9,737.00 ",$821.65 ,$821.65 ,"$13,214.50 ","$10,571.60 ","$10,432.50 ","$13,910.00 ","$11,823.50 ","$22,270.68 ","$13,910.00 ","$13,910.00 ","$9,737.00 ","$8,471.19 ",$821.65 ,"$22,270.68 ","$21,825.27 ","$13,910.00 ",$870.95 ,"$11,823.50 ","$50,109.03 ","$12,797.20 ","$9,737.00 ","$4,149.79 ","$5,187.78 ","$8,471.19 ","$5,187.78 ","$9,611.81 ","$12,519.00 ","$9,503.31 ","$22,043.52 ","$10,988.90 ",$870.95 ,"$13,910.00 ","$13,910.00 ","$21,825.27 ","$13,910.00 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$11,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100155,33263,HC REM/REPL DEFIB PUL GEN DUAL 33263,481,1 ,"$13,910.00 ","$9,180.60 ",$821.65 ,"$50,109.03 ",$821.65 ,"$13,910.00 ","$13,910.00 ","$22,270.68 ","$8,346.00 ","$11,823.50 ","$9,737.00 ",$821.65 ,$821.65 ,"$13,214.50 ","$10,571.60 ","$10,432.50 ","$13,910.00 ","$11,823.50 ","$22,270.68 ","$13,910.00 ","$13,910.00 ","$9,737.00 ","$8,471.19 ",$821.65 ,"$22,270.68 ","$21,825.27 ","$13,910.00 ",$870.95 ,"$11,823.50 ","$50,109.03 ","$12,797.20 ","$9,737.00 ","$4,149.79 ","$5,187.78 ","$8,471.19 ","$5,187.78 ","$9,611.81 ","$12,519.00 ","$9,503.31 ","$22,043.52 ","$10,988.90 ",$870.95 ,"$13,910.00 ","$13,910.00 ","$21,825.27 ","$13,910.00 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$11,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100156,33264,HC REM/REPL DEFIB PUL GEN MULT 33264,481,1 ,"$18,190.00 ","$12,005.40 ",$821.65 ,"$70,439.62 ",$821.65 ,"$18,190.00 ","$14,895.00 ","$31,306.50 ","$10,914.00 ","$15,461.50 ","$12,733.00 ",$821.65 ,$821.65 ,"$17,280.50 ","$13,824.40 ","$13,642.50 ","$18,190.00 ","$15,461.50 ","$31,306.50 ","$18,190.00 ","$18,190.00 ","$12,733.00 ","$11,077.71 ",$821.65 ,"$31,306.50 ","$30,680.37 ","$18,190.00 ",$870.95 ,"$15,461.50 ","$70,439.62 ","$16,734.80 ","$12,733.00 ","$4,149.79 ","$5,187.78 ","$11,077.71 ","$5,187.78 ","$12,569.29 ","$16,371.00 ","$12,427.41 ","$30,987.18 ","$14,370.10 ",$870.95 ,"$18,190.00 ","$18,190.00 ","$30,680.37 ","$18,190.00 ","$13,096.80 ","$11,277.80 ","$13,096.80 ","$13,096.80 ","$14,552.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100157,0075T,HC TRANSCATH XCRAN STENT PLCMT,481,1 ,"$9,539.25 ","$6,295.91 ",$205.34 ,"$9,539.25 ",$205.34 ,"$8,020.00 ","$7,448.00 ", N/A ,"$5,723.55 ","$8,108.36 ","$6,677.48 ",$205.34 ,$205.34 ,"$9,062.29 ","$7,249.83 ","$7,154.44 ","$7,276.00 ","$8,108.36 ", N/A ,"$7,276.00 ","$7,276.00 ","$6,677.48 ","$5,809.40 ",$205.34 , N/A , N/A , N/A ,$217.66 ,"$8,108.36 ", N/A ,"$8,776.11 ","$6,677.48 ", N/A , N/A ,"$5,809.40 ", N/A ,"$6,591.62 ","$8,585.33 ","$6,517.22 ", N/A ,"$7,536.01 ",$217.66 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$6,868.26 ","$5,914.34 ","$6,868.26 ","$6,868.26 ","$7,631.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100158,0237T,HC ARTHERECTOMY BRACHIOCEPHA PERC 0237T,481,1 ,"$12,476.35 ","$8,234.39 ",$376.97 ,"$23,311.22 ",$376.97 ,"$12,476.35 ","$12,476.35 ","$10,360.54 ","$7,485.81 ","$10,604.90 ","$8,733.45 ",$376.97 ,$376.97 ,"$11,852.53 ","$9,482.03 ","$9,357.26 ","$7,276.00 ","$10,604.90 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$8,733.45 ","$7,598.10 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$12,476.35 ",$399.59 ,"$10,604.90 ","$23,311.22 ","$11,478.24 ","$8,733.45 ","$4,887.30 ","$6,108.86 ","$7,598.10 ","$6,108.86 ","$8,621.16 ","$11,228.72 ","$8,523.84 ","$10,254.87 ","$9,856.32 ",$399.59 ,"$10,341.00 ","$10,341.00 ","$10,153.33 ","$10,341.00 ","$8,982.97 ","$7,735.34 ","$8,982.97 ","$8,982.97 ","$9,981.08 "
ST NICHOLAS HOSPITAL - ACUTE,48100160,33270,HC INS/REP SUBQ DEFIBRILLATOR 33270,481,1 ,"$25,129.00 ","$16,585.14 ",$821.65 ,"$70,439.62 ",$821.65 ,"$21,770.00 ","$14,895.00 ","$31,306.50 ","$15,077.40 ","$21,359.65 ","$17,590.30 ",$821.65 ,$821.65 ,"$23,872.55 ","$19,098.04 ","$18,846.75 ","$7,276.00 ","$21,359.65 ","$31,306.50 ","$7,276.00 ","$7,276.00 ","$17,590.30 ","$15,303.56 ",$821.65 ,"$31,306.50 ","$30,680.37 ","$25,129.00 ",$870.95 ,"$21,359.65 ","$70,439.62 ","$23,118.68 ","$17,590.30 ","$4,149.79 ","$5,187.78 ","$15,303.56 ","$5,187.78 ","$17,364.14 ","$22,616.10 ","$17,168.13 ","$30,987.18 ","$19,851.91 ",$870.95 ,"$25,129.00 ","$25,129.00 ","$30,680.37 ","$25,129.00 ","$18,092.88 ","$15,579.98 ","$18,092.88 ","$18,092.88 ","$20,103.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100165,93462,HC LHC TRANSEPTAL PUNCTURE 93462,481,1 ,"$5,671.00 ","$3,742.86 ",$84.66 ,"$6,233.42 ",$84.66 ,"$5,671.00 ","$5,671.00 ", N/A ,"$3,402.60 ","$4,820.35 ","$3,969.70 ",$84.66 ,$84.66 ,"$5,387.45 ","$4,309.96 ","$4,253.25 ","$5,671.00 ","$4,820.35 ", N/A ,"$5,671.00 ","$5,671.00 ","$3,969.70 ","$3,453.64 ",$84.66 , N/A , N/A , N/A ,$89.74 ,"$4,820.35 ", N/A ,"$5,217.32 ","$3,969.70 ","$4,986.74 ","$6,233.42 ","$3,453.64 ","$6,233.42 ","$3,918.66 ","$5,103.90 ","$3,874.43 ", N/A ,"$4,480.09 ",$89.74 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$4,083.12 ","$3,516.02 ","$4,083.12 ","$4,083.12 ","$4,536.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100170,93566,HC RT VENT OR AORTIC ANGIOGRAM,481,1 ,"$1,225.00 ",$808.50 ,$10.77 ,"$1,225.00 ",$10.77 , N/A , N/A , N/A ,$735.00 ,"$1,041.25 ",$857.50 ,$10.77 ,$10.77 ,"$1,163.75 ",$931.00 ,$918.75 ,"$1,225.00 ","$1,041.25 ", N/A ,"$1,225.00 ","$1,225.00 ",$857.50 ,$746.03 ,$10.77 , N/A , N/A , N/A ,$11.42 ,"$1,041.25 ", N/A ,"$1,127.00 ",$857.50 ,$621.32 ,$745.66 ,$746.03 ,$745.66 ,$846.48 ,"$1,102.50 ",$836.92 , N/A ,$967.75 ,$11.42 ,"$1,225.00 ","$1,225.00 ", N/A ,"$1,225.00 ",$882.00 ,$759.50 ,$882.00 ,$882.00 ,$980.00 
ST NICHOLAS HOSPITAL - ACUTE,48100171,36253,HC PLC CATH RENAL ANGIO 1< UNI,481,1 ,"$2,833.60 ","$1,870.18 ",$151.22 ,"$11,286.91 ",$151.22 ,"$2,833.60 ","$2,833.60 ","$5,016.41 ","$1,700.16 ","$2,408.56 ","$1,983.52 ",$151.22 ,$151.22 ,"$2,691.92 ","$2,153.54 ","$2,125.20 ","$2,833.60 ","$2,408.56 ","$5,016.41 ","$2,833.60 ","$2,833.60 ","$1,983.52 ","$1,725.66 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$2,833.60 ",$160.29 ,"$2,408.56 ","$11,286.91 ","$2,606.91 ","$1,983.52 ","$4,535.48 ","$5,669.62 ","$1,725.66 ","$5,669.62 ","$1,958.02 ","$2,550.24 ","$1,935.92 ","$4,965.24 ","$2,238.54 ",$160.29 ,"$2,833.60 ","$2,833.60 ","$4,916.08 ","$2,833.60 ","$2,040.19 ","$1,756.83 ","$2,040.19 ","$2,040.19 ","$2,266.88 "
ST NICHOLAS HOSPITAL - ACUTE,48100173,37193,HC FILTER REMOVAL,481,1 ,"$5,885.00 ","$3,884.10 ",$124.43 ,"$6,541.82 ",$124.43 ,"$5,885.00 ","$5,885.00 ","$2,907.47 ","$3,531.00 ","$5,002.25 ","$4,119.50 ",$124.43 ,$124.43 ,"$5,590.75 ","$4,472.60 ","$4,413.75 ","$5,885.00 ","$5,002.25 ","$2,907.47 ","$5,885.00 ","$5,885.00 ","$4,119.50 ","$3,583.97 ",$124.43 ,"$2,907.47 ","$2,849.32 ","$5,814.94 ",$131.90 ,"$5,002.25 ","$6,541.82 ","$5,414.20 ","$4,119.50 ","$3,273.50 ","$4,091.88 ","$3,583.97 ","$4,091.88 ","$4,066.54 ","$5,296.50 ","$4,020.63 ","$2,877.81 ","$4,649.15 ",$131.90 ,"$5,885.00 ","$5,885.00 ","$2,849.32 ","$5,885.00 ","$4,237.20 ","$3,648.70 ","$4,237.20 ","$4,237.20 ","$4,708.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100174,33230,HC INS DEFIB PULSE GEN W/EST DUAL,481,1 ,"$15,103.00 ","$9,967.98 ",$821.65 ,"$50,109.03 ",$821.65 ,"$15,103.00 ","$14,895.00 ","$22,270.68 ","$9,061.80 ","$12,837.55 ","$10,572.10 ",$821.65 ,$821.65 ,"$14,347.85 ","$11,478.28 ","$11,327.25 ","$15,103.00 ","$12,837.55 ","$22,270.68 ","$15,103.00 ","$15,103.00 ","$10,572.10 ","$9,197.73 ",$821.65 ,"$22,270.68 ","$21,825.27 ","$15,103.00 ",$870.95 ,"$12,837.55 ","$50,109.03 ","$13,894.76 ","$10,572.10 ","$4,149.79 ","$5,187.78 ","$9,197.73 ","$5,187.78 ","$10,436.17 ","$13,592.70 ","$10,318.37 ","$22,043.52 ","$11,931.37 ",$870.95 ,"$15,103.00 ","$15,103.00 ","$21,825.27 ","$15,103.00 ","$10,874.16 ","$9,363.86 ","$10,874.16 ","$10,874.16 ","$12,082.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100175,33231,HC INS DEFIB PULSE GEN W/EST MULT,481,1 ,"$16,280.00 ","$10,744.80 ",$821.65 ,"$70,439.62 ",$821.65 ,"$16,280.00 ","$14,895.00 ","$31,306.50 ","$9,768.00 ","$13,838.00 ","$11,396.00 ",$821.65 ,$821.65 ,"$15,466.00 ","$12,372.80 ","$12,210.00 ","$16,280.00 ","$13,838.00 ","$31,306.50 ","$16,280.00 ","$16,280.00 ","$11,396.00 ","$9,914.52 ",$821.65 ,"$31,306.50 ","$30,680.37 ","$16,280.00 ",$870.95 ,"$13,838.00 ","$70,439.62 ","$14,977.60 ","$11,396.00 ","$4,149.79 ","$5,187.78 ","$9,914.52 ","$5,187.78 ","$11,249.48 ","$14,652.00 ","$11,122.50 ","$30,987.18 ","$12,861.20 ",$870.95 ,"$16,280.00 ","$16,280.00 ","$30,680.37 ","$16,280.00 ","$11,721.60 ","$10,093.60 ","$11,721.60 ","$11,721.60 ","$13,024.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100176,37216,HC PL STENT TRNSCATH CAROT ART W/O,481,1 ,"$6,325.00 ","$4,174.50 ",$397.02 ,"$6,325.00 ",$397.02 ,"$6,325.00 ","$6,325.00 ", N/A ,"$3,795.00 ","$5,376.25 ","$4,427.50 ",$397.02 ,$397.02 ,"$6,008.75 ","$4,807.00 ","$4,743.75 ","$6,325.00 ","$5,376.25 ", N/A ,"$6,325.00 ","$6,325.00 ","$4,427.50 ","$3,851.93 ",$397.02 , N/A , N/A , N/A ,$420.84 ,"$5,376.25 ", N/A ,"$5,819.00 ","$4,427.50 ", N/A , N/A ,"$3,851.93 ", N/A ,"$4,370.58 ","$5,692.50 ","$4,321.24 ", N/A ,"$4,996.75 ",$420.84 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$4,554.00 ","$3,921.50 ","$4,554.00 ","$4,554.00 ","$5,060.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100177,93464,HC EXERCISE W/HEMODYNAMIC MEAS 93464,481,1 ,$811.90 ,$535.85 ,$5.78 ,$811.90 ,$5.78 ,$811.90 ,$811.90 , N/A ,$487.14 ,$690.12 ,$568.33 ,$5.78 ,$5.78 ,$771.31 ,$617.04 ,$608.93 ,$811.90 ,$690.12 , N/A ,$811.90 ,$811.90 ,$568.33 ,$494.45 ,$5.78 , N/A , N/A , N/A ,$6.13 ,$690.12 , N/A ,$746.95 ,$568.33 ,$411.80 ,$494.20 ,$494.45 ,$494.20 ,$561.02 ,$730.71 ,$554.69 , N/A ,$641.40 ,$6.13 ,$811.90 ,$811.90 , N/A ,$811.90 ,$584.57 ,$503.38 ,$584.57 ,$584.57 ,$649.52 
ST NICHOLAS HOSPITAL - ACUTE,48100178,93565,HC LT VENT OR AORTIC ANGIOGRAM 93565,481,1 ,"$1,134.00 ",$748.44 ,$10.77 ,"$1,134.00 ",$10.77 , N/A , N/A , N/A ,$680.40 ,$963.90 ,$793.80 ,$10.77 ,$10.77 ,"$1,077.30 ",$861.84 ,$850.50 ,"$1,134.00 ",$963.90 , N/A ,"$1,134.00 ","$1,134.00 ",$793.80 ,$690.61 ,$10.77 , N/A , N/A , N/A ,$11.42 ,$963.90 , N/A ,"$1,043.28 ",$793.80 ,$575.16 ,$690.27 ,$690.61 ,$690.27 ,$783.59 ,"$1,020.60 ",$774.75 , N/A ,$895.86 ,$11.42 ,"$1,134.00 ","$1,134.00 ", N/A ,"$1,134.00 ",$816.48 ,$703.08 ,$816.48 ,$816.48 ,$907.20 
ST NICHOLAS HOSPITAL - ACUTE,48100179,93568,HC PULMONARY ANGIOGRAM,481,1 ,"$1,471.00 ",$970.86 ,$10.77 ,"$1,471.00 ",$10.77 ,"$1,471.00 ","$1,471.00 ", N/A ,$882.60 ,"$1,250.35 ","$1,029.70 ",$10.77 ,$10.77 ,"$1,397.45 ","$1,117.96 ","$1,103.25 ","$1,471.00 ","$1,250.35 ", N/A ,"$1,471.00 ","$1,471.00 ","$1,029.70 ",$895.84 ,$10.77 , N/A , N/A , N/A ,$11.42 ,"$1,250.35 ", N/A ,"$1,353.32 ","$1,029.70 ",$746.09 ,$895.40 ,$895.84 ,$895.40 ,"$1,016.46 ","$1,323.90 ","$1,004.99 ", N/A ,"$1,162.09 ",$11.42 ,"$1,471.00 ","$1,471.00 ", N/A ,"$1,471.00 ","$1,059.12 ",$912.02 ,"$1,059.12 ","$1,059.12 ","$1,176.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100181,37212,HC VENOUS THROMBOLYSIS; INIT DAY 37212,481,1 ,"$3,565.00 ","$2,352.90 ",$124.43 ,"$6,541.82 ",$124.43 ,"$3,565.00 ","$3,565.00 ","$2,907.47 ","$2,139.00 ","$3,030.25 ","$2,495.50 ",$124.43 ,$124.43 ,"$3,386.75 ","$2,709.40 ","$2,673.75 ","$3,565.00 ","$3,030.25 ","$2,907.47 ","$3,565.00 ","$3,565.00 ","$2,495.50 ","$2,171.09 ",$124.43 ,"$2,907.47 ","$2,849.32 ","$3,565.00 ",$131.90 ,"$3,030.25 ","$6,541.82 ","$3,279.80 ","$2,495.50 ","$3,273.50 ","$4,091.88 ","$2,171.09 ","$4,091.88 ","$2,463.42 ","$3,208.50 ","$2,435.61 ","$2,877.81 ","$2,816.35 ",$131.90 ,"$3,565.00 ","$3,565.00 ","$2,849.32 ","$3,565.00 ","$2,566.80 ","$2,210.30 ","$2,566.80 ","$2,566.80 ","$2,852.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100182,37214,HC THROMBO CESS/CLOS; SUBSQ DAY 37214,481,1 ,"$4,370.00 ","$2,884.20 ",$124.43 ,"$6,541.82 ",$124.43 ,"$4,370.00 ","$4,010.00 ","$2,907.47 ","$2,622.00 ","$3,714.50 ","$3,059.00 ",$124.43 ,$124.43 ,"$4,151.50 ","$3,321.20 ","$3,277.50 ","$4,370.00 ","$3,714.50 ","$2,907.47 ","$4,370.00 ","$4,370.00 ","$3,059.00 ","$2,661.33 ",$124.43 ,"$2,907.47 ","$2,849.32 ","$4,370.00 ",$131.90 ,"$3,714.50 ","$6,541.82 ","$4,020.40 ","$3,059.00 ","$1,771.14 ","$2,213.66 ","$2,661.33 ","$2,213.66 ","$3,019.67 ","$3,933.00 ","$2,985.58 ","$2,877.81 ","$3,452.30 ",$131.90 ,"$2,747.00 ","$2,747.00 ","$2,849.32 ","$2,747.00 ","$3,146.40 ","$2,709.40 ","$3,146.40 ","$3,146.40 ","$3,496.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100183,36225,HC CATH PLCMT SEL SUBCL/INOM VERTEB UNI 36225,481,1 ,"$6,697.60 ","$4,420.42 ",$151.22 ,"$6,697.60 ",$151.22 ,"$6,697.60 ","$6,697.60 ","$2,907.47 ","$4,018.56 ","$5,692.96 ","$4,688.32 ",$151.22 ,$151.22 ,"$6,362.72 ","$5,090.18 ","$5,023.20 ","$6,697.60 ","$5,692.96 ","$2,907.47 ","$6,697.60 ","$6,697.60 ","$4,688.32 ","$4,078.84 ",$151.22 ,"$2,907.47 ","$2,849.32 ","$5,814.94 ",$160.29 ,"$5,692.96 ","$6,541.82 ","$6,161.79 ","$4,688.32 ","$3,273.50 ","$4,091.88 ","$4,078.84 ","$4,091.88 ","$4,628.04 ","$6,027.84 ","$4,575.80 ","$2,877.81 ","$5,291.10 ",$160.29 ,"$6,697.60 ","$6,697.60 ","$2,849.32 ","$6,697.60 ","$4,822.27 ","$4,152.51 ","$4,822.27 ","$4,822.27 ","$5,358.08 "
ST NICHOLAS HOSPITAL - ACUTE,48100184,36228,HC CATH PLCMT SEL EA INTRACRN BRANCH UNI 36228,481,1 ,"$3,091.20 ","$2,040.19 ",$151.22 ,"$3,091.20 ",$151.22 ,"$3,091.20 ","$3,091.20 ", N/A ,"$1,854.72 ","$2,627.52 ","$2,163.84 ",$151.22 ,$151.22 ,"$2,936.64 ","$2,349.31 ","$2,318.40 ","$3,091.20 ","$2,627.52 ", N/A ,"$3,091.20 ","$3,091.20 ","$2,163.84 ","$1,882.54 ",$151.22 , N/A , N/A , N/A ,$160.29 ,"$2,627.52 ", N/A ,"$2,843.90 ","$2,163.84 ","$1,771.14 ","$2,213.66 ","$1,882.54 ","$2,213.66 ","$2,136.02 ","$2,782.08 ","$2,111.91 ", N/A ,"$2,442.05 ",$160.29 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$2,225.66 ","$1,916.54 ","$2,225.66 ","$2,225.66 ","$2,472.96 "
ST NICHOLAS HOSPITAL - ACUTE,48100185,37211,HC ARTRL THROMBOLYSIS; INIT DAY 37211,481,1 ,"$5,290.00 ","$3,491.40 ",$124.43 ,"$11,286.91 ",$124.43 ,"$5,290.00 ","$5,290.00 ","$5,016.41 ","$3,174.00 ","$4,496.50 ","$3,703.00 ",$124.43 ,$124.43 ,"$5,025.50 ","$4,020.40 ","$3,967.50 ","$5,290.00 ","$4,496.50 ","$5,016.41 ","$5,290.00 ","$5,290.00 ","$3,703.00 ","$3,221.61 ",$124.43 ,"$5,016.41 ","$4,916.08 ","$5,290.00 ",$131.90 ,"$4,496.50 ","$11,286.91 ","$4,866.80 ","$3,703.00 ","$4,535.48 ","$5,669.62 ","$3,221.61 ","$5,669.62 ","$3,655.39 ","$4,761.00 ","$3,614.13 ","$4,965.24 ","$4,179.10 ",$131.90 ,"$5,290.00 ","$5,290.00 ","$4,916.08 ","$5,290.00 ","$3,808.80 ","$3,279.80 ","$3,808.80 ","$3,808.80 ","$4,232.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100186,37213,HC ARTRL/VENOUS THROMBOLYSIS; SUBSQ DAY 37213,481,1 ,"$4,370.00 ","$2,884.20 ",$124.43 ,"$6,541.82 ",$124.43 ,"$4,370.00 ","$4,010.00 ","$2,907.47 ","$2,622.00 ","$3,714.50 ","$3,059.00 ",$124.43 ,$124.43 ,"$4,151.50 ","$3,321.20 ","$3,277.50 ","$4,370.00 ","$3,714.50 ","$2,907.47 ","$4,370.00 ","$4,370.00 ","$3,059.00 ","$2,661.33 ",$124.43 ,"$2,907.47 ","$2,849.32 ","$4,370.00 ",$131.90 ,"$3,714.50 ","$6,541.82 ","$4,020.40 ","$3,059.00 ","$1,771.14 ","$2,213.66 ","$2,661.33 ","$2,213.66 ","$3,019.67 ","$3,933.00 ","$2,985.58 ","$2,877.81 ","$3,452.30 ",$131.90 ,"$2,747.00 ","$2,747.00 ","$2,849.32 ","$2,747.00 ","$3,146.40 ","$2,709.40 ","$3,146.40 ","$3,146.40 ","$3,496.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100187,37197,HC TRANSCATH RETRVAL FOREIGN BODY 37197,481,1 ,"$3,335.00 ","$2,201.10 ",$124.43 ,"$6,541.82 ",$124.43 ,"$3,335.00 ","$3,335.00 ","$2,907.47 ","$2,001.00 ","$2,834.75 ","$2,334.50 ",$124.43 ,$124.43 ,"$3,168.25 ","$2,534.60 ","$2,501.25 ","$3,335.00 ","$2,834.75 ","$2,907.47 ","$3,335.00 ","$3,335.00 ","$2,334.50 ","$2,031.02 ",$124.43 ,"$2,907.47 ","$2,849.32 ","$3,335.00 ",$131.90 ,"$2,834.75 ","$6,541.82 ","$3,068.20 ","$2,334.50 ","$3,273.50 ","$4,091.88 ","$2,031.02 ","$4,091.88 ","$2,304.49 ","$3,001.50 ","$2,278.47 ","$2,877.81 ","$2,634.65 ",$131.90 ,"$3,335.00 ","$3,335.00 ","$2,849.32 ","$3,335.00 ","$2,401.20 ","$2,067.70 ","$2,401.20 ","$2,401.20 ","$2,668.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100188,36221,HC CATH PLCMT NON SEL THORAC AORTA 36221,481,1 ,"$5,667.20 ","$3,740.35 ",$151.22 ,"$6,541.82 ",$151.22 ,"$5,667.20 ","$5,667.20 ","$2,907.47 ","$3,400.32 ","$4,817.12 ","$3,967.04 ",$151.22 ,$151.22 ,"$5,383.84 ","$4,307.07 ","$4,250.40 ","$5,667.20 ","$4,817.12 ","$2,907.47 ","$5,667.20 ","$5,667.20 ","$3,967.04 ","$3,451.32 ",$151.22 ,"$2,907.47 ","$2,849.32 ","$5,667.20 ",$160.29 ,"$4,817.12 ","$6,541.82 ","$5,213.82 ","$3,967.04 ","$3,273.50 ","$4,091.88 ","$3,451.32 ","$4,091.88 ","$3,916.04 ","$5,100.48 ","$3,871.83 ","$2,877.81 ","$4,477.09 ",$160.29 ,"$5,667.20 ","$5,667.20 ","$2,849.32 ","$5,667.20 ","$4,080.38 ","$3,513.66 ","$4,080.38 ","$4,080.38 ","$4,533.76 "
ST NICHOLAS HOSPITAL - ACUTE,48100189,36222,HC CATH PLCMT SEL COM CAR/INOM EXTRACRN UNI 36222,481,1 ,"$6,311.20 ","$4,165.39 ",$226.83 ,"$6,541.82 ",$226.83 ,"$6,311.20 ","$6,311.20 ","$2,907.47 ","$3,786.72 ","$5,364.52 ","$4,417.84 ",$226.83 ,$226.83 ,"$5,995.64 ","$4,796.51 ","$4,733.40 ","$6,311.20 ","$5,364.52 ","$2,907.47 ","$6,311.20 ","$6,311.20 ","$4,417.84 ","$3,843.52 ",$226.83 ,"$2,907.47 ","$2,849.32 ","$5,814.94 ",$240.44 ,"$5,364.52 ","$6,541.82 ","$5,806.30 ","$4,417.84 ","$4,910.25 ","$6,137.82 ","$3,843.52 ","$6,137.82 ","$4,361.04 ","$5,680.08 ","$4,311.81 ","$2,877.81 ","$4,985.85 ",$240.44 ,"$6,311.20 ","$6,311.20 ","$2,849.32 ","$6,311.20 ","$4,544.06 ","$3,912.94 ","$4,544.06 ","$4,544.06 ","$5,048.96 "
ST NICHOLAS HOSPITAL - ACUTE,48100189,36222,HC CATH PLCMT SEL COM CAR/INOM EXTRACRN UNI 36222,481,1 ,"$6,311.20 ","$4,165.39 ",$226.83 ,"$6,541.82 ",$226.83 ,"$6,311.20 ","$6,311.20 ","$2,907.47 ","$3,786.72 ","$5,364.52 ","$4,417.84 ",$226.83 ,$226.83 ,"$5,995.64 ","$4,796.51 ","$4,733.40 ","$6,311.20 ","$5,364.52 ","$2,907.47 ","$6,311.20 ","$6,311.20 ","$4,417.84 ","$3,843.52 ",$226.83 ,"$2,907.47 ","$2,849.32 ","$5,814.94 ",$240.44 ,"$5,364.52 ","$6,541.82 ","$5,806.30 ","$4,417.84 ","$4,910.25 ","$6,137.82 ","$3,843.52 ","$6,137.82 ","$4,361.04 ","$5,680.08 ","$4,311.81 ","$2,877.81 ","$4,985.85 ",$240.44 ,"$6,311.20 ","$6,311.20 ","$2,849.32 ","$6,311.20 ","$4,544.06 ","$3,912.94 ","$4,544.06 ","$4,544.06 ","$5,048.96 "
ST NICHOLAS HOSPITAL - ACUTE,48100190,36223,HC CATH PLCMT SEL COM CAR/INOM INTRACRN UNI 36223,481,1 ,"$11,463.20 ","$7,565.71 ",$151.22 ,"$11,463.20 ",$151.22 ,"$10,885.00 ","$8,164.00 ","$5,016.41 ","$6,877.92 ","$9,743.72 ","$8,024.24 ",$151.22 ,$151.22 ,"$10,890.04 ","$8,712.03 ","$8,597.40 ","$7,276.00 ","$9,743.72 ","$5,016.41 ","$7,276.00 ","$7,276.00 ","$8,024.24 ","$6,981.09 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$10,032.82 ",$160.29 ,"$9,743.72 ","$11,286.91 ","$10,546.14 ","$8,024.24 ","$4,535.48 ","$5,669.62 ","$6,981.09 ","$5,669.62 ","$7,921.07 ","$10,316.88 ","$7,831.66 ","$4,965.24 ","$9,055.93 ",$160.29 ,"$9,030.00 ","$9,030.00 ","$4,916.08 ","$9,030.00 ","$8,253.50 ","$7,107.18 ","$8,253.50 ","$8,253.50 ","$9,170.56 "
ST NICHOLAS HOSPITAL - ACUTE,48100191,36224,HC CATH PLCMT SEL INTERNAL CAR UNI 36224,481,1 ,"$5,924.80 ","$3,910.37 ",$151.22 ,"$11,286.91 ",$151.22 ,"$5,924.80 ","$5,924.80 ","$5,016.41 ","$3,554.88 ","$5,036.08 ","$4,147.36 ",$151.22 ,$151.22 ,"$5,628.56 ","$4,502.85 ","$4,443.60 ","$5,924.80 ","$5,036.08 ","$5,016.41 ","$5,924.80 ","$5,924.80 ","$4,147.36 ","$3,608.20 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$5,924.80 ",$160.29 ,"$5,036.08 ","$11,286.91 ","$5,450.82 ","$4,147.36 ","$4,535.48 ","$5,669.62 ","$3,608.20 ","$5,669.62 ","$4,094.04 ","$5,332.32 ","$4,047.82 ","$4,965.24 ","$4,680.59 ",$160.29 ,"$5,924.80 ","$5,924.80 ","$4,916.08 ","$5,924.80 ","$4,265.86 ","$3,673.38 ","$4,265.86 ","$4,265.86 ","$4,739.84 "
ST NICHOLAS HOSPITAL - ACUTE,48100192,36226,HC CATH PLCMT SEL VERTEBRAL UNI 36226,481,1 ,"$9,016.00 ","$5,950.56 ",$151.22 ,"$11,286.91 ",$151.22 ,"$9,016.00 ","$8,164.00 ","$5,016.41 ","$5,409.60 ","$7,663.60 ","$6,311.20 ",$151.22 ,$151.22 ,"$8,565.20 ","$6,852.16 ","$6,762.00 ","$7,276.00 ","$7,663.60 ","$5,016.41 ","$7,276.00 ","$7,276.00 ","$6,311.20 ","$5,490.74 ",$151.22 ,"$5,016.41 ","$4,916.08 ","$9,016.00 ",$160.29 ,"$7,663.60 ","$11,286.91 ","$8,294.72 ","$6,311.20 ","$4,535.48 ","$5,669.62 ","$5,490.74 ","$5,669.62 ","$6,230.06 ","$8,114.40 ","$6,159.73 ","$4,965.24 ","$7,122.64 ",$160.29 ,"$9,016.00 ","$9,016.00 ","$4,916.08 ","$9,016.00 ","$6,491.52 ","$5,589.92 ","$6,491.52 ","$6,491.52 ","$7,212.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100193,36227,HC CATH PLCMT SEL EXTERNAL CAR UNI 36227,481,1 ,"$2,576.00 ","$1,700.16 ",$151.22 ,"$2,576.00 ",$151.22 ,"$2,576.00 ","$2,576.00 ", N/A ,"$1,545.60 ","$2,189.60 ","$1,803.20 ",$151.22 ,$151.22 ,"$2,447.20 ","$1,957.76 ","$1,932.00 ","$2,576.00 ","$2,189.60 ", N/A ,"$2,576.00 ","$2,576.00 ","$1,803.20 ","$1,568.78 ",$151.22 , N/A , N/A , N/A ,$160.29 ,"$2,189.60 ", N/A ,"$2,369.92 ","$1,803.20 ","$1,771.14 ","$2,213.66 ","$1,568.78 ","$2,213.66 ","$1,780.02 ","$2,318.40 ","$1,759.92 ", N/A ,"$2,035.04 ",$160.29 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$2,060.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100200,92920,HC PTCA SINGL MAJ ART/BRANCH 92920,481,1 ,"$7,597.00 ","$5,014.02 ",$291.35 ,"$11,453.02 ",$291.35 ,"$7,597.00 ","$7,597.00 ","$5,090.23 ","$4,558.20 ","$6,457.45 ","$5,317.90 ",$291.35 ,$291.35 ,"$7,217.15 ","$5,773.72 ","$5,697.75 ","$7,597.00 ","$6,457.45 ","$5,090.23 ","$7,597.00 ","$7,597.00 ","$5,317.90 ","$4,626.57 ",$291.35 ,"$5,090.23 ","$4,988.43 ","$7,597.00 ",$308.83 ,"$6,457.45 ","$11,453.02 ","$6,989.24 ","$5,317.90 ","$4,535.48 ","$5,669.62 ","$4,626.57 ","$5,669.62 ","$5,249.53 ","$6,837.30 ","$5,190.27 ","$5,038.31 ","$6,001.63 ",$308.83 ,"$7,597.00 ","$7,597.00 ","$4,988.43 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100201,92921,HC PTCA EA ADDL BRANCH MAJ ART 92921,481,1 ,"$5,136.00 ","$3,389.76 ",$291.35 ,"$6,233.42 ",$291.35 ,"$5,136.00 ","$5,136.00 ", N/A ,"$3,081.60 ","$4,365.60 ","$3,595.20 ",$291.35 ,$291.35 ,"$4,879.20 ","$3,903.36 ","$3,852.00 ","$5,136.00 ","$4,365.60 ", N/A ,"$5,136.00 ","$5,136.00 ","$3,595.20 ","$3,127.82 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$4,365.60 ", N/A ,"$4,725.12 ","$3,595.20 ","$4,986.74 ","$6,233.42 ","$3,127.82 ","$6,233.42 ","$3,548.98 ","$4,622.40 ","$3,508.92 ", N/A ,"$4,057.44 ",$308.83 ,"$5,136.00 ","$5,136.00 ", N/A ,"$5,136.00 ","$3,697.92 ","$3,184.32 ","$3,697.92 ","$3,697.92 ","$4,108.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100202,92924,HC ROTOBLATOR SINGL MAJ ART/BRANCH 92924,481,1 ,"$14,980.00 ","$9,886.80 ",$291.35 ,"$23,311.22 ",$291.35 ,"$14,980.00 ","$14,980.00 ","$10,360.54 ","$8,988.00 ","$12,733.00 ","$10,486.00 ",$291.35 ,$291.35 ,"$14,231.00 ","$11,384.80 ","$11,235.00 ","$14,980.00 ","$12,733.00 ","$10,360.54 ","$14,980.00 ","$14,980.00 ","$10,486.00 ","$9,122.82 ",$291.35 ,"$10,360.54 ","$10,153.33 ","$14,980.00 ",$308.83 ,"$12,733.00 ","$23,311.22 ","$13,781.60 ","$10,486.00 ","$4,887.30 ","$6,108.86 ","$9,122.82 ","$6,108.86 ","$10,351.18 ","$13,482.00 ","$10,234.34 ","$10,254.87 ","$11,834.20 ",$308.83 ,"$13,905.00 ","$13,905.00 ","$10,153.33 ","$13,905.00 ","$10,785.60 ","$9,287.60 ","$10,785.60 ","$10,785.60 ","$11,984.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100203,92925,HC ROTOBLATOR EA ADDL BRANCH MAJ ART 92925,481,1 ,"$8,849.00 ","$5,840.34 ",$291.35 ,"$8,849.00 ",$291.35 ,"$8,849.00 ","$8,849.00 ", N/A ,"$5,309.40 ","$7,521.65 ","$6,194.30 ",$291.35 ,$291.35 ,"$8,406.55 ","$6,725.24 ","$6,636.75 ","$8,849.00 ","$7,521.65 ", N/A ,"$8,849.00 ","$8,849.00 ","$6,194.30 ","$5,389.04 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$7,521.65 ", N/A ,"$8,141.08 ","$6,194.30 ","$4,986.74 ","$6,233.42 ","$5,389.04 ","$6,233.42 ","$6,114.66 ","$7,964.10 ","$6,045.64 ", N/A ,"$6,990.71 ",$308.83 ,"$8,849.00 ","$8,849.00 ", N/A ,"$8,849.00 ","$6,371.28 ","$5,486.38 ","$6,371.28 ","$6,371.28 ","$7,079.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100204,92928,HC BMS SINGL MAJ ART/BRANCH 92928,481,1 ,"$10,700.00 ","$7,062.00 ",$291.35 ,"$23,311.22 ",$291.35 ,"$10,700.00 ","$10,700.00 ","$10,360.54 ","$6,420.00 ","$9,095.00 ","$7,490.00 ",$291.35 ,$291.35 ,"$10,165.00 ","$8,132.00 ","$8,025.00 ","$7,276.00 ","$9,095.00 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$7,490.00 ","$6,516.30 ",$291.35 ,"$10,360.54 ","$10,153.33 ","$10,700.00 ",$308.83 ,"$9,095.00 ","$23,311.22 ","$9,844.00 ","$7,490.00 ","$4,535.48 ","$5,669.62 ","$6,516.30 ","$5,669.62 ","$7,393.70 ","$9,630.00 ","$7,310.24 ","$10,254.87 ","$8,453.00 ",$308.83 ,"$10,700.00 ","$10,700.00 ","$10,153.33 ","$10,700.00 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$8,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100205,92929,HC BMS EA ADDL BRANCH MAJ ART 92929,481,1 ,"$11,770.00 ","$7,768.20 ",$291.35 ,"$11,770.00 ",$291.35 ,"$11,770.00 ","$11,770.00 ", N/A ,"$7,062.00 ","$10,004.50 ","$8,239.00 ",$291.35 ,$291.35 ,"$11,181.50 ","$8,945.20 ","$8,827.50 ","$7,276.00 ","$10,004.50 ", N/A ,"$7,276.00 ","$7,276.00 ","$8,239.00 ","$7,167.93 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$10,004.50 ", N/A ,"$10,828.40 ","$8,239.00 ","$4,986.74 ","$6,233.42 ","$7,167.93 ","$6,233.42 ","$8,133.07 ","$10,593.00 ","$8,041.26 ", N/A ,"$9,298.30 ",$308.83 ,"$11,770.00 ","$11,770.00 ", N/A ,"$11,770.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100206,92933,HC ROTOBLATOR/BMS SINGL MAJ ART/BRANCH 92933,481,1 ,"$20,330.00 ","$13,417.80 ",$291.35 ,"$37,722.01 ",$291.35 ,"$20,330.00 ","$20,330.00 ","$16,765.34 ","$12,198.00 ","$17,280.50 ","$14,231.00 ",$291.35 ,$291.35 ,"$19,313.50 ","$15,450.80 ","$15,247.50 ","$7,276.00 ","$17,280.50 ","$16,765.34 ","$7,276.00 ","$7,276.00 ","$14,231.00 ","$12,380.97 ",$291.35 ,"$16,765.34 ","$16,430.03 ","$20,330.00 ",$308.83 ,"$17,280.50 ","$37,722.01 ","$18,703.60 ","$14,231.00 ","$4,535.48 ","$5,669.62 ","$12,380.97 ","$5,669.62 ","$14,048.03 ","$18,297.00 ","$13,889.46 ","$16,594.33 ","$16,060.70 ",$308.83 ,"$17,066.00 ","$17,066.00 ","$16,430.03 ","$17,066.00 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$16,264.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100207,92934,HC ROTOBLATOR/BMS EA ADDL BRANCH MAJ ART 92934,481,1 ,"$15,338.00 ","$10,123.08 ",$291.35 ,"$15,338.00 ",$291.35 ,"$15,338.00 ","$15,338.00 ", N/A ,"$9,202.80 ","$13,037.30 ","$10,736.60 ",$291.35 ,$291.35 ,"$14,571.10 ","$11,656.88 ","$11,503.50 ","$7,276.00 ","$13,037.30 ", N/A ,"$7,276.00 ","$7,276.00 ","$10,736.60 ","$9,340.84 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$13,037.30 ", N/A ,"$14,110.96 ","$10,736.60 ","$4,986.74 ","$6,233.42 ","$9,340.84 ","$6,233.42 ","$10,598.56 ","$13,804.20 ","$10,478.92 ", N/A ,"$12,117.02 ",$308.83 ,"$15,338.00 ","$15,338.00 ", N/A ,"$15,338.00 ","$11,043.36 ","$9,509.56 ","$11,043.36 ","$11,043.36 ","$12,270.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100208,92937,HC BYPASS GRAFT BMS SINGL MAJ ART/BRANCH 92937,481,1 ,"$13,910.00 ","$9,180.60 ",$291.35 ,"$23,311.22 ",$291.35 ,"$13,910.00 ","$13,910.00 ","$10,360.54 ","$8,346.00 ","$11,823.50 ","$9,737.00 ",$291.35 ,$291.35 ,"$13,214.50 ","$10,571.60 ","$10,432.50 ","$7,276.00 ","$11,823.50 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$9,737.00 ","$8,471.19 ",$291.35 ,"$10,360.54 ","$10,153.33 ","$13,910.00 ",$308.83 ,"$11,823.50 ","$23,311.22 ","$12,797.20 ","$9,737.00 ","$4,535.48 ","$5,669.62 ","$8,471.19 ","$5,669.62 ","$9,611.81 ","$12,519.00 ","$9,503.31 ","$10,254.87 ","$10,988.90 ",$308.83 ,"$13,910.00 ","$13,910.00 ","$10,153.33 ","$13,910.00 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$11,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100209,92938,HC BYPASS GRAFT BMS EA ADDL BRNCH MAJ ART 92938,481,1 ,"$7,918.00 ","$5,225.88 ",$291.35 ,"$7,918.00 ",$291.35 ,"$7,918.00 ","$7,918.00 ", N/A ,"$4,750.80 ","$6,730.30 ","$5,542.60 ",$291.35 ,$291.35 ,"$7,522.10 ","$6,017.68 ","$5,938.50 ","$7,276.00 ","$6,730.30 ", N/A ,"$7,276.00 ","$7,276.00 ","$5,542.60 ","$4,822.06 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$6,730.30 ", N/A ,"$7,284.56 ","$5,542.60 ","$4,986.74 ","$6,233.42 ","$4,822.06 ","$6,233.42 ","$5,471.34 ","$7,126.20 ","$5,409.58 ", N/A ,"$6,255.22 ",$308.83 ,"$7,918.00 ","$7,918.00 ", N/A ,"$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100210,92941,HC STEMI/NSTEMI BMS SING VESS 92941,481,1 ,"$14,980.00 ","$9,886.80 ",$291.35 ,"$14,980.00 ",$291.35 ,"$14,980.00 ","$14,980.00 ", N/A ,"$8,988.00 ","$12,733.00 ","$10,486.00 ",$291.35 ,$291.35 ,"$14,231.00 ","$11,384.80 ","$11,235.00 ","$7,276.00 ","$12,733.00 ", N/A ,"$7,276.00 ","$7,276.00 ","$10,486.00 ","$9,122.82 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$12,733.00 ", N/A ,"$13,781.60 ","$10,486.00 ","$4,535.48 ","$5,669.62 ","$9,122.82 ","$5,669.62 ","$10,351.18 ","$13,482.00 ","$10,234.34 ", N/A ,"$11,834.20 ",$308.83 ,"$14,980.00 ","$14,980.00 ", N/A ,"$14,980.00 ","$10,785.60 ","$9,287.60 ","$10,785.60 ","$10,785.60 ","$11,984.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100211,92943,HC CTO BMS SING MAJ ART/BRNCH 92943,481,1 ,"$16,050.00 ","$10,593.00 ",$291.35 ,"$23,311.22 ",$291.35 ,"$16,050.00 ","$16,050.00 ","$10,360.54 ","$9,630.00 ","$13,642.50 ","$11,235.00 ",$291.35 ,$291.35 ,"$15,247.50 ","$12,198.00 ","$12,037.50 ","$7,276.00 ","$13,642.50 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$11,235.00 ","$9,774.45 ",$291.35 ,"$10,360.54 ","$10,153.33 ","$16,050.00 ",$308.83 ,"$13,642.50 ","$23,311.22 ","$14,766.00 ","$11,235.00 ","$4,535.48 ","$5,669.62 ","$9,774.45 ","$5,669.62 ","$11,090.55 ","$14,445.00 ","$10,965.36 ","$10,254.87 ","$12,679.50 ",$308.83 ,"$16,050.00 ","$16,050.00 ","$10,153.33 ","$16,050.00 ","$11,556.00 ","$9,951.00 ","$11,556.00 ","$11,556.00 ","$12,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100212,92944,HC CTO BMS EA ADD BNCH MAJ ART 92944,481,1 ,"$12,840.00 ","$8,474.40 ",$291.35 ,"$12,840.00 ",$291.35 ,"$12,840.00 ","$12,840.00 ", N/A ,"$7,704.00 ","$10,914.00 ","$8,988.00 ",$291.35 ,$291.35 ,"$12,198.00 ","$9,758.40 ","$9,630.00 ","$7,276.00 ","$10,914.00 ", N/A ,"$7,276.00 ","$7,276.00 ","$8,988.00 ","$7,819.56 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$10,914.00 ", N/A ,"$11,812.80 ","$8,988.00 ","$4,986.74 ","$6,233.42 ","$7,819.56 ","$6,233.42 ","$8,872.44 ","$11,556.00 ","$8,772.29 ", N/A ,"$10,143.60 ",$308.83 ,"$12,840.00 ","$12,840.00 ", N/A ,"$12,840.00 ","$9,244.80 ","$7,960.80 ","$9,244.80 ","$9,244.80 ","$10,272.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100213,93653,HC EP STUDY PLUS SVT ABLATION 93653,481,1 ,"$21,400.00 ","$14,124.00 ",$578.16 ,"$51,564.91 ",$578.16 ,"$21,400.00 ","$21,400.00 ","$22,917.74 ","$12,840.00 ","$18,190.00 ","$14,980.00 ",$578.16 ,$578.16 ,"$20,330.00 ","$16,264.00 ","$16,050.00 ","$16,624.00 ","$18,190.00 ","$22,917.74 ","$16,624.00 ","$16,624.00 ","$14,980.00 ","$13,032.60 ",$578.16 ,"$22,917.74 ","$22,459.39 ","$21,400.00 ",$612.85 ,"$18,190.00 ","$51,564.91 ","$19,688.00 ","$14,980.00 ","$4,986.74 ","$6,233.42 ","$13,032.60 ","$6,233.42 ","$14,787.40 ","$19,260.00 ","$14,620.48 ","$22,683.98 ","$16,906.00 ",$612.85 ,"$18,960.00 ","$18,960.00 ","$22,459.39 ","$18,960.00 ","$15,408.00 ","$13,268.00 ","$15,408.00 ","$15,408.00 ","$17,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100214,93654,HC EP STUDY PLUS VT ABLATION 93654,481,1 ,"$21,400.00 ","$14,124.00 ",$578.16 ,"$51,564.91 ",$578.16 ,"$21,400.00 ","$21,400.00 ","$22,917.74 ","$12,840.00 ","$18,190.00 ","$14,980.00 ",$578.16 ,$578.16 ,"$20,330.00 ","$16,264.00 ","$16,050.00 ","$16,624.00 ","$18,190.00 ","$22,917.74 ","$16,624.00 ","$16,624.00 ","$14,980.00 ","$13,032.60 ",$578.16 ,"$22,917.74 ","$22,459.39 ","$21,400.00 ",$612.85 ,"$18,190.00 ","$51,564.91 ","$19,688.00 ","$14,980.00 ","$4,986.74 ","$6,233.42 ","$13,032.60 ","$6,233.42 ","$14,787.40 ","$19,260.00 ","$14,620.48 ","$22,683.98 ","$16,906.00 ",$612.85 ,"$18,960.00 ","$18,960.00 ","$22,459.39 ","$18,960.00 ","$15,408.00 ","$13,268.00 ","$15,408.00 ","$15,408.00 ","$17,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100215,93655,HC ADD ON ABLAT POST ABLAT ORIG RHYTHM 93655,481,1 ,"$3,638.00 ","$2,401.08 ",$578.16 ,"$3,638.00 ",$578.16 ,"$3,638.00 ","$3,638.00 ", N/A ,"$2,182.80 ","$3,092.30 ","$2,546.60 ",$578.16 ,$578.16 ,"$3,456.10 ","$2,764.88 ","$2,728.50 ","$3,638.00 ","$3,092.30 ", N/A ,"$3,638.00 ","$3,638.00 ","$2,546.60 ","$2,215.54 ",$578.16 , N/A , N/A , N/A ,$612.85 ,"$3,092.30 ", N/A ,"$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,214.45 ","$2,513.86 ","$3,274.20 ","$2,485.48 ", N/A ,"$2,874.02 ",$612.85 ,"$3,638.00 ","$3,638.00 ", N/A ,"$3,638.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100216,93656,HC EP STUDY PLUS AFIB ABLATION 93656,481,1 ,"$21,400.00 ","$14,124.00 ",$578.16 ,"$51,564.91 ",$578.16 ,"$21,400.00 ","$21,400.00 ","$22,917.74 ","$12,840.00 ","$18,190.00 ","$14,980.00 ",$578.16 ,$578.16 ,"$20,330.00 ","$16,264.00 ","$16,050.00 ","$16,624.00 ","$18,190.00 ","$22,917.74 ","$16,624.00 ","$16,624.00 ","$14,980.00 ","$13,032.60 ",$578.16 ,"$22,917.74 ","$22,459.39 ","$21,400.00 ",$612.85 ,"$18,190.00 ","$51,564.91 ","$19,688.00 ","$14,980.00 ","$4,986.74 ","$6,233.42 ","$13,032.60 ","$6,233.42 ","$14,787.40 ","$19,260.00 ","$14,620.48 ","$22,683.98 ","$16,906.00 ",$612.85 ,"$18,960.00 ","$18,960.00 ","$22,459.39 ","$18,960.00 ","$15,408.00 ","$13,268.00 ","$15,408.00 ","$15,408.00 ","$17,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100217,93657,HC ADD ON AFIB ABLAT POST COMPL PVI 93657,481,1 ,"$3,638.00 ","$2,401.08 ",$578.16 ,"$3,638.00 ",$578.16 ,"$3,638.00 ","$3,638.00 ", N/A ,"$2,182.80 ","$3,092.30 ","$2,546.60 ",$578.16 ,$578.16 ,"$3,456.10 ","$2,764.88 ","$2,728.50 ","$3,638.00 ","$3,092.30 ", N/A ,"$3,638.00 ","$3,638.00 ","$2,546.60 ","$2,215.54 ",$578.16 , N/A , N/A , N/A ,$612.85 ,"$3,092.30 ", N/A ,"$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,214.45 ","$2,513.86 ","$3,274.20 ","$2,485.48 ", N/A ,"$2,874.02 ",$612.85 ,"$3,638.00 ","$3,638.00 ", N/A ,"$3,638.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100218,C9600,HC DES SING MAJ ART/BRNCH C9600,481,1 ,"$11,770.00 ","$7,768.20 ",$291.35 ,"$23,311.22 ",$291.35 ,"$11,770.00 ","$11,770.00 ","$10,360.54 ","$7,062.00 ","$10,004.50 ","$8,239.00 ",$291.35 ,$291.35 ,"$11,181.50 ","$8,945.20 ","$8,827.50 ","$11,770.00 ","$10,004.50 ","$10,360.54 ","$11,770.00 ","$11,770.00 ","$8,239.00 ","$7,167.93 ",$291.35 ,"$10,360.54 ","$10,153.33 ","$11,770.00 ",$308.83 ,"$10,004.50 ","$23,311.22 ","$10,828.40 ","$8,239.00 ","$4,887.30 ","$6,108.86 ","$7,167.93 ","$6,108.86 ","$8,133.07 ","$10,593.00 ","$8,041.26 ","$10,254.87 ","$9,298.30 ",$308.83 ,"$11,770.00 ","$11,770.00 ","$10,153.33 ","$11,770.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100219,C9601,HC DES EA ADD BNCH MAJ ART C9601,481,1 ,"$11,770.00 ","$7,768.20 ",$291.35 ,"$11,770.00 ",$291.35 ,"$11,770.00 ","$11,770.00 ", N/A ,"$7,062.00 ","$10,004.50 ","$8,239.00 ",$291.35 ,$291.35 ,"$11,181.50 ","$8,945.20 ","$8,827.50 ","$11,770.00 ","$10,004.50 ", N/A ,"$11,770.00 ","$11,770.00 ","$8,239.00 ","$7,167.93 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$10,004.50 ", N/A ,"$10,828.40 ","$8,239.00 ","$4,986.74 ","$6,233.42 ","$7,167.93 ","$6,233.42 ","$8,133.07 ","$10,593.00 ","$8,041.26 ", N/A ,"$9,298.30 ",$308.83 ,"$11,770.00 ","$11,770.00 ", N/A ,"$11,770.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100220,C9602,HC ROTOBLAT/DES SING MAJ ART/BRNCH C9602,481,1 ,"$16,050.00 ","$10,593.00 ",$291.35 ,"$37,722.01 ",$291.35 ,"$16,050.00 ","$16,050.00 ","$16,765.34 ","$9,630.00 ","$13,642.50 ","$11,235.00 ",$291.35 ,$291.35 ,"$15,247.50 ","$12,198.00 ","$12,037.50 ","$16,050.00 ","$13,642.50 ","$16,765.34 ","$16,050.00 ","$16,050.00 ","$11,235.00 ","$9,774.45 ",$291.35 ,"$16,765.34 ","$16,430.03 ","$16,050.00 ",$308.83 ,"$13,642.50 ","$37,722.01 ","$14,766.00 ","$11,235.00 ","$4,887.30 ","$6,108.86 ","$9,774.45 ","$6,108.86 ","$11,090.55 ","$14,445.00 ","$10,965.36 ","$16,594.33 ","$12,679.50 ",$308.83 ,"$16,050.00 ","$16,050.00 ","$16,430.03 ","$16,050.00 ","$11,556.00 ","$9,951.00 ","$11,556.00 ","$11,556.00 ","$12,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100221,C9603,HC ROTOBLAT/DES EA ADD BNCH MAJ ART C9603,481,1 ,"$15,338.00 ","$10,123.08 ",$291.35 ,"$15,338.00 ",$291.35 ,"$15,338.00 ","$15,338.00 ", N/A ,"$9,202.80 ","$13,037.30 ","$10,736.60 ",$291.35 ,$291.35 ,"$14,571.10 ","$11,656.88 ","$11,503.50 ","$15,338.00 ","$13,037.30 ", N/A ,"$15,338.00 ","$15,338.00 ","$10,736.60 ","$9,340.84 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$13,037.30 ", N/A ,"$14,110.96 ","$10,736.60 ","$7,779.43 ","$9,336.24 ","$9,340.84 ","$9,336.24 ","$10,598.56 ","$13,804.20 ","$10,478.92 ", N/A ,"$12,117.02 ",$308.83 ,"$15,338.00 ","$15,338.00 ", N/A ,"$15,338.00 ","$11,043.36 ","$9,509.56 ","$11,043.36 ","$11,043.36 ","$12,270.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100222,C9604,HC BYPASS GRAFT DES SING MAJ ART/BRNCH C9604,481,1 ,"$13,910.00 ","$9,180.60 ",$291.35 ,"$23,311.22 ",$291.35 ,"$13,910.00 ","$13,910.00 ","$10,360.54 ","$8,346.00 ","$11,823.50 ","$9,737.00 ",$291.35 ,$291.35 ,"$13,214.50 ","$10,571.60 ","$10,432.50 ","$13,910.00 ","$11,823.50 ","$10,360.54 ","$13,910.00 ","$13,910.00 ","$9,737.00 ","$8,471.19 ",$291.35 ,"$10,360.54 ","$10,153.33 ","$13,910.00 ",$308.83 ,"$11,823.50 ","$23,311.22 ","$12,797.20 ","$9,737.00 ","$4,887.30 ","$6,108.86 ","$8,471.19 ","$6,108.86 ","$9,611.81 ","$12,519.00 ","$9,503.31 ","$10,254.87 ","$10,988.90 ",$308.83 ,"$13,910.00 ","$13,910.00 ","$10,153.33 ","$13,910.00 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$11,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100223,C9605,HC BYPASS GRFT DES EA ADD BRNCH MAJ ART C9605,481,1 ,"$7,918.00 ","$5,225.88 ",$291.35 ,"$7,918.00 ",$291.35 ,"$7,918.00 ","$7,918.00 ", N/A ,"$4,750.80 ","$6,730.30 ","$5,542.60 ",$291.35 ,$291.35 ,"$7,522.10 ","$6,017.68 ","$5,938.50 ","$7,918.00 ","$6,730.30 ", N/A ,"$7,918.00 ","$7,918.00 ","$5,542.60 ","$4,822.06 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$6,730.30 ", N/A ,"$7,284.56 ","$5,542.60 ","$4,016.01 ","$4,819.69 ","$4,822.06 ","$4,819.69 ","$5,471.34 ","$7,126.20 ","$5,409.58 ", N/A ,"$6,255.22 ",$308.83 ,"$7,918.00 ","$7,918.00 ", N/A ,"$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100224,C9607,HC CTO DES SING MAJ ART/BRNCH C9607,481,1 ,"$16,050.00 ","$10,593.00 ",$291.35 ,"$37,722.01 ",$291.35 ,"$16,050.00 ","$16,050.00 ","$16,765.34 ","$9,630.00 ","$13,642.50 ","$11,235.00 ",$291.35 ,$291.35 ,"$15,247.50 ","$12,198.00 ","$12,037.50 ","$16,050.00 ","$13,642.50 ","$16,765.34 ","$16,050.00 ","$16,050.00 ","$11,235.00 ","$9,774.45 ",$291.35 ,"$16,765.34 ","$16,430.03 ","$16,050.00 ",$308.83 ,"$13,642.50 ","$37,722.01 ","$14,766.00 ","$11,235.00 ","$4,887.30 ","$6,108.86 ","$9,774.45 ","$6,108.86 ","$11,090.55 ","$14,445.00 ","$10,965.36 ","$16,594.33 ","$12,679.50 ",$308.83 ,"$16,050.00 ","$16,050.00 ","$16,430.03 ","$16,050.00 ","$11,556.00 ","$9,951.00 ","$11,556.00 ","$11,556.00 ","$12,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100225,C9608,HC CTO DES EA ADD BRNCH MAJ ART C9608,481,1 ,"$12,744.00 ","$8,411.04 ",$291.35 ,"$12,744.00 ",$291.35 ,"$12,744.00 ","$12,744.00 ", N/A ,"$7,646.40 ","$10,832.40 ","$8,920.80 ",$291.35 ,$291.35 ,"$12,106.80 ","$9,685.44 ","$9,558.00 ","$12,744.00 ","$10,832.40 ", N/A ,"$12,744.00 ","$12,744.00 ","$8,920.80 ","$7,761.10 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$10,832.40 ", N/A ,"$11,724.48 ","$8,920.80 ","$6,463.76 ","$7,757.27 ","$7,761.10 ","$7,757.27 ","$8,806.10 ","$11,469.60 ","$8,706.70 ", N/A ,"$10,067.76 ",$308.83 ,"$12,744.00 ","$12,744.00 ", N/A ,"$12,744.00 ","$9,175.68 ","$7,901.28 ","$9,175.68 ","$9,175.68 ","$10,195.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100226,C9606,HC STEMI/NSTEMI DES SINGL VESSEL C9606,481,1 ,"$14,980.00 ","$9,886.80 ",$291.35 ,"$14,980.00 ",$291.35 ,"$14,980.00 ","$14,980.00 ", N/A ,"$8,988.00 ","$12,733.00 ","$10,486.00 ",$291.35 ,$291.35 ,"$14,231.00 ","$11,384.80 ","$11,235.00 ","$14,980.00 ","$12,733.00 ", N/A ,"$14,980.00 ","$14,980.00 ","$10,486.00 ","$9,122.82 ",$291.35 , N/A , N/A , N/A ,$308.83 ,"$12,733.00 ", N/A ,"$13,781.60 ","$10,486.00 ", N/A , N/A ,"$9,122.82 ", N/A ,"$10,351.18 ","$13,482.00 ","$10,234.34 ", N/A ,"$11,834.20 ",$308.83 ,"$14,980.00 ","$14,980.00 ", N/A ,"$14,980.00 ","$10,785.60 ","$9,287.60 ","$10,785.60 ","$10,785.60 ","$11,984.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100227,93286,HC PRE OR POST PACEMAKER EVAL 93286,481,1 ,$225.66 ,$148.94 ,$1.27 ,$225.66 ,$1.27 ,$225.66 ,$225.66 , N/A ,$135.40 ,$191.81 ,$157.96 ,$1.27 ,$1.27 ,$214.38 ,$171.50 ,$169.25 ,$225.66 ,$191.81 , N/A ,$225.66 ,$225.66 ,$157.96 ,$137.43 ,$1.27 , N/A , N/A , N/A ,$1.35 ,$191.81 , N/A ,$207.61 ,$157.96 ,$114.45 ,$137.36 ,$137.43 ,$137.36 ,$155.93 ,$203.09 ,$154.17 , N/A ,$178.27 ,$1.35 , N/A , N/A , N/A , N/A ,$162.48 ,$139.91 ,$162.48 ,$162.48 ,$180.53 
ST NICHOLAS HOSPITAL - ACUTE,48100230,37241,HC VENOUS EMBO FOR VEIN MALFORMATION 37241,481,1 ,"$7,705.00 ","$5,085.30 ",$376.97 ,"$23,311.22 ",$376.97 ,"$7,705.00 ","$7,705.00 ","$10,360.54 ","$4,623.00 ","$6,549.25 ","$5,393.50 ",$376.97 ,$376.97 ,"$7,319.75 ","$5,855.80 ","$5,778.75 ","$7,276.00 ","$6,549.25 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$5,393.50 ","$4,692.35 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$7,705.00 ",$399.59 ,"$6,549.25 ","$23,311.22 ","$7,088.60 ","$5,393.50 ","$4,887.30 ","$6,108.86 ","$4,692.35 ","$6,108.86 ","$5,324.16 ","$6,934.50 ","$5,264.06 ","$10,254.87 ","$6,086.95 ",$399.59 ,"$7,705.00 ","$7,705.00 ","$10,153.33 ","$7,705.00 ","$5,547.60 ","$4,777.10 ","$5,547.60 ","$5,547.60 ","$6,164.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100231,37242,HC ARTERIAL EMBO FOR AVM ANER PRE/PST AAA 37242,481,1 ,"$10,235.00 ","$6,755.10 ",$376.97 ,"$23,311.22 ",$376.97 ,"$10,235.00 ","$10,235.00 ","$10,360.54 ","$6,141.00 ","$8,699.75 ","$7,164.50 ",$376.97 ,$376.97 ,"$9,723.25 ","$7,778.60 ","$7,676.25 ","$7,276.00 ","$8,699.75 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$7,164.50 ","$6,233.12 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$10,235.00 ",$399.59 ,"$8,699.75 ","$23,311.22 ","$9,416.20 ","$7,164.50 ","$4,887.30 ","$6,108.86 ","$6,233.12 ","$6,108.86 ","$7,072.39 ","$9,211.50 ","$6,992.55 ","$10,254.87 ","$8,085.65 ",$399.59 ,"$10,235.00 ","$10,235.00 ","$10,153.33 ","$10,235.00 ","$7,369.20 ","$6,345.70 ","$7,369.20 ","$7,369.20 ","$8,188.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100232,37243,HC EMBOLIZATION OF TUMOR UFE CHEMO 37243,481,1 ,"$10,235.00 ","$6,755.10 ",$376.97 ,"$23,311.22 ",$376.97 ,"$10,235.00 ","$10,235.00 ","$10,360.54 ","$6,141.00 ","$8,699.75 ","$7,164.50 ",$376.97 ,$376.97 ,"$9,723.25 ","$7,778.60 ","$7,676.25 ","$7,276.00 ","$8,699.75 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$7,164.50 ","$6,233.12 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$10,235.00 ",$399.59 ,"$8,699.75 ","$23,311.22 ","$9,416.20 ","$7,164.50 ","$4,887.30 ","$6,108.86 ","$6,233.12 ","$6,108.86 ","$7,072.39 ","$9,211.50 ","$6,992.55 ","$10,254.87 ","$8,085.65 ",$399.59 ,"$10,235.00 ","$10,235.00 ","$10,153.33 ","$10,235.00 ","$7,369.20 ","$6,345.70 ","$7,369.20 ","$7,369.20 ","$8,188.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100233,37244,HC EMBOLIZATION FOR HEMORRAGE ART/VEN 37244,481,1 ,"$10,235.00 ","$6,755.10 ",$376.97 ,"$23,311.22 ",$376.97 ,"$10,235.00 ","$10,235.00 ","$10,360.54 ","$6,141.00 ","$8,699.75 ","$7,164.50 ",$376.97 ,$376.97 ,"$9,723.25 ","$7,778.60 ","$7,676.25 ","$7,276.00 ","$8,699.75 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$7,164.50 ","$6,233.12 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$10,235.00 ",$399.59 ,"$8,699.75 ","$23,311.22 ","$9,416.20 ","$7,164.50 ","$4,887.30 ","$6,108.86 ","$6,233.12 ","$6,108.86 ","$7,072.39 ","$9,211.50 ","$6,992.55 ","$10,254.87 ","$8,085.65 ",$399.59 ,"$10,235.00 ","$10,235.00 ","$10,153.33 ","$10,235.00 ","$7,369.20 ","$6,345.70 ","$7,369.20 ","$7,369.20 ","$8,188.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100234,37236,HC STENT INIT ARTERY UPPER EXT VISCERAL 37236,481,1 ,"$8,132.00 ","$5,367.12 ",$376.97 ,"$23,311.22 ",$376.97 ,"$8,132.00 ","$8,132.00 ","$10,360.54 ","$4,879.20 ","$6,912.20 ","$5,692.40 ",$376.97 ,$376.97 ,"$7,725.40 ","$6,180.32 ","$6,099.00 ","$7,276.00 ","$6,912.20 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$5,692.40 ","$4,952.39 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$8,132.00 ",$399.59 ,"$6,912.20 ","$23,311.22 ","$7,481.44 ","$5,692.40 ","$4,887.30 ","$6,108.86 ","$4,952.39 ","$6,108.86 ","$5,619.21 ","$7,318.80 ","$5,555.78 ","$10,254.87 ","$6,424.28 ",$399.59 ,"$8,132.00 ","$8,132.00 ","$10,153.33 ","$8,132.00 ","$5,855.04 ","$5,041.84 ","$5,855.04 ","$5,855.04 ","$6,505.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100235,37237,HC STENT ADDN ARTERY UPPER EXT VISERAL 37237,481,1 ,"$6,992.00 ","$4,614.72 ",$376.97 ,"$6,992.00 ",$376.97 ,"$6,992.00 ","$5,421.00 ", N/A ,"$4,195.20 ","$5,943.20 ","$4,894.40 ",$376.97 ,$376.97 ,"$6,642.40 ","$5,313.92 ","$5,244.00 ","$6,992.00 ","$5,943.20 ", N/A ,"$6,992.00 ","$6,992.00 ","$4,894.40 ","$4,258.13 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$5,943.20 ", N/A ,"$6,432.64 ","$4,894.40 ","$4,986.74 ","$6,233.42 ","$4,258.13 ","$6,233.42 ","$4,831.47 ","$6,292.80 ","$4,776.93 ", N/A ,"$5,523.68 ",$399.59 ,"$6,992.00 ","$6,992.00 ", N/A ,"$6,992.00 ","$5,034.24 ","$4,335.04 ","$5,034.24 ","$5,034.24 ","$5,593.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100236,37238,HC STENT INIT VENOUS UPPER EXT VISERAL 37238,481,1 ,"$9,523.00 ","$6,285.18 ",$376.97 ,"$23,311.22 ",$376.97 ,"$9,523.00 ","$9,523.00 ","$10,360.54 ","$5,713.80 ","$8,094.55 ","$6,666.10 ",$376.97 ,$376.97 ,"$9,046.85 ","$7,237.48 ","$7,142.25 ","$7,276.00 ","$8,094.55 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$6,666.10 ","$5,799.51 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$9,523.00 ",$399.59 ,"$8,094.55 ","$23,311.22 ","$8,761.16 ","$6,666.10 ","$4,887.30 ","$6,108.86 ","$5,799.51 ","$6,108.86 ","$6,580.39 ","$8,570.70 ","$6,506.11 ","$10,254.87 ","$7,523.17 ",$399.59 ,"$9,523.00 ","$9,523.00 ","$10,153.33 ","$9,523.00 ","$6,856.56 ","$5,904.26 ","$6,856.56 ","$6,856.56 ","$7,618.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100237,37239,HC STENT ADDN VENOUS UPPER EXT VISERAL 37239,481,1 ,"$4,815.00 ","$3,177.90 ",$376.97 ,"$6,233.42 ",$376.97 ,"$4,815.00 ","$4,815.00 ", N/A ,"$2,889.00 ","$4,092.75 ","$3,370.50 ",$376.97 ,$376.97 ,"$4,574.25 ","$3,659.40 ","$3,611.25 ","$4,815.00 ","$4,092.75 ", N/A ,"$4,815.00 ","$4,815.00 ","$3,370.50 ","$2,932.34 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$4,092.75 ", N/A ,"$4,429.80 ","$3,370.50 ","$4,986.74 ","$6,233.42 ","$2,932.34 ","$6,233.42 ","$3,327.17 ","$4,333.50 ","$3,289.61 ", N/A ,"$3,803.85 ",$399.59 ,"$4,815.00 ","$4,815.00 ", N/A ,"$4,815.00 ","$3,466.80 ","$2,985.30 ","$3,466.80 ","$3,466.80 ","$3,852.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100238,37217,HC STENT CAROTID OPEN 37217,481,1 ,"$6,490.00 ","$4,283.40 ",$397.02 ,"$6,490.00 ",$397.02 ,"$6,490.00 ","$6,490.00 ", N/A ,"$3,894.00 ","$5,516.50 ","$4,543.00 ",$397.02 ,$397.02 ,"$6,165.50 ","$4,932.40 ","$4,867.50 ","$6,490.00 ","$5,516.50 ", N/A ,"$6,490.00 ","$6,490.00 ","$4,543.00 ","$3,952.41 ",$397.02 , N/A , N/A , N/A ,$420.84 ,"$5,516.50 ", N/A ,"$5,970.80 ","$4,543.00 ", N/A , N/A ,"$3,952.41 ", N/A ,"$4,484.59 ","$5,841.00 ","$4,433.97 ", N/A ,"$5,127.10 ",$420.84 ,"$3,888.00 ","$3,888.00 ", N/A ,"$3,888.00 ","$4,672.80 ","$4,023.80 ","$4,672.80 ","$4,672.80 ","$5,192.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100239,93724,HC EP EVAL PACEMAKER SYSTEM 93724,481,1 ,"$2,576.00 ","$1,700.16 ",$5.18 ,"$2,576.00 ",$5.18 , N/A , N/A ,$270.01 ,"$1,545.60 ","$2,189.60 ","$1,803.20 ",$5.18 ,$5.18 ,"$2,447.20 ","$1,957.76 ","$1,932.00 ","$2,576.00 ","$2,189.60 ",$270.01 ,"$2,576.00 ","$2,576.00 ","$1,803.20 ","$1,568.78 ",$5.18 ,$270.01 ,$264.61 ,$540.02 ,$5.49 ,"$2,189.60 ",$607.52 ,"$2,369.92 ","$1,803.20 ","$1,306.55 ","$1,568.01 ","$1,568.78 ","$1,568.01 ","$1,780.02 ","$2,318.40 ","$1,759.92 ",$267.26 ,"$2,035.04 ",$5.49 , N/A , N/A ,$264.61 , N/A ,"$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$2,060.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100255,61651,HC THPY INFS NON-THROMBO ADDNT,481,1 ,$937.25 ,$618.59 ,$397.02 ,"$2,213.66 ",$397.02 ,$937.25 ,$937.25 , N/A ,$562.35 ,$796.66 ,$656.08 ,$397.02 ,$397.02 ,$890.39 ,$712.31 ,$702.94 ,$937.25 ,$796.66 , N/A ,$937.25 ,$937.25 ,$656.08 ,$570.79 ,$397.02 , N/A , N/A , N/A ,$420.84 ,$796.66 , N/A ,$862.27 ,$656.08 ,"$1,771.14 ","$2,213.66 ",$570.79 ,"$2,213.66 ",$647.64 ,$843.53 ,$640.33 , N/A ,$740.43 ,$420.84 ,$937.25 ,$937.25 , N/A ,$937.25 ,$674.82 ,$581.10 ,$674.82 ,$674.82 ,$749.80 
ST NICHOLAS HOSPITAL - ACUTE,48100263,36902,HC INTRO CATH/CIRCUIT W/ANGIO 36902,481,1 ,"$14,402.00 ","$9,505.32 ",$124.43 ,"$14,402.00 ",$124.43 ,"$14,402.00 ","$10,885.00 ","$5,090.23 ","$8,641.20 ","$12,241.70 ","$10,081.40 ",$124.43 ,$124.43 ,"$13,681.90 ","$10,945.52 ","$10,801.50 ","$7,276.00 ","$12,241.70 ","$5,090.23 ","$7,276.00 ","$7,276.00 ","$10,081.40 ","$8,770.82 ",$124.43 ,"$5,090.23 ","$4,988.43 ","$10,180.46 ",$131.90 ,"$12,241.70 ","$11,453.02 ","$13,249.84 ","$10,081.40 ","$4,535.48 ","$5,669.62 ","$8,770.82 ","$5,669.62 ","$9,951.78 ","$12,961.80 ","$9,839.45 ","$5,038.31 ","$11,377.58 ",$131.90 ,"$9,030.00 ","$9,030.00 ","$4,988.43 ","$9,030.00 ","$10,369.44 ","$8,929.24 ","$10,369.44 ","$10,369.44 ","$11,521.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100264,36905,HC THROMBECTOMY/INFUS CIRCUIT W/ANGIO 36905,481,1 ,"$29,180.00 ","$19,258.80 ",$205.34 ,"$29,180.00 ",$205.34 ,"$20,624.00 ","$12,891.00 ","$10,360.54 ","$17,508.00 ","$24,803.00 ","$20,426.00 ",$205.34 ,$205.34 ,"$27,721.00 ","$22,176.80 ","$21,885.00 ","$7,276.00 ","$24,803.00 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$20,426.00 ","$17,770.62 ",$205.34 ,"$10,360.54 ","$10,153.33 ","$20,721.08 ",$217.66 ,"$24,803.00 ","$23,311.22 ","$26,845.60 ","$20,426.00 ","$4,887.30 ","$6,108.86 ","$17,770.62 ","$6,108.86 ","$20,163.38 ","$26,262.00 ","$19,935.78 ","$10,254.87 ","$23,052.20 ",$217.66 ,"$10,341.00 ","$10,341.00 ","$10,153.33 ","$10,341.00 ","$21,009.60 ","$18,091.60 ","$21,009.60 ","$21,009.60 ","$23,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100265,36907,HC ANGIOPLASTY CTR DIALYSIS SEGMENT 36907,481,1 ,"$9,481.00 ","$6,257.46 ",$205.34 ,"$9,481.00 ",$205.34 ,"$9,481.00 ","$5,421.00 ", N/A ,"$5,688.60 ","$8,058.85 ","$6,636.70 ",$205.34 ,$205.34 ,"$9,006.95 ","$7,205.56 ","$7,110.75 ","$7,276.00 ","$8,058.85 ", N/A ,"$7,276.00 ","$7,276.00 ","$6,636.70 ","$5,773.93 ",$205.34 , N/A , N/A , N/A ,$217.66 ,"$8,058.85 ", N/A ,"$8,722.52 ","$6,636.70 ","$4,986.74 ","$6,233.42 ","$5,773.93 ","$6,233.42 ","$6,551.37 ","$8,532.90 ","$6,477.42 ", N/A ,"$7,489.99 ",$217.66 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$6,826.32 ","$5,878.22 ","$6,826.32 ","$6,826.32 ","$7,584.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100266,37246,HC ANGIOPLASTY TRANLUM BALN INIT ARTERY 37246,481,1 ,"$7,597.00 ","$5,014.02 ",$124.43 ,"$11,453.02 ",$124.43 ,"$7,597.00 ","$7,597.00 ","$5,090.23 ","$4,558.20 ","$6,457.45 ","$5,317.90 ",$124.43 ,$124.43 ,"$7,217.15 ","$5,773.72 ","$5,697.75 ","$7,276.00 ","$6,457.45 ","$5,090.23 ","$7,276.00 ","$7,276.00 ","$5,317.90 ","$4,626.57 ",$124.43 ,"$5,090.23 ","$4,988.43 ","$7,597.00 ",$131.90 ,"$6,457.45 ","$11,453.02 ","$6,989.24 ","$5,317.90 ","$4,535.48 ","$5,669.62 ","$4,626.57 ","$5,669.62 ","$5,249.53 ","$6,837.30 ","$5,190.27 ","$5,038.31 ","$6,001.63 ",$131.90 ,"$7,597.00 ","$7,597.00 ","$4,988.43 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100267,37247,HC ANGIOPLASTY TRANLUM BALN ADDL ARTERY 37247,481,1 ,"$6,206.00 ","$4,095.96 ",$205.34 ,"$6,233.42 ",$205.34 , N/A , N/A , N/A ,"$3,723.60 ","$5,275.10 ","$4,344.20 ",$205.34 ,$205.34 ,"$5,895.70 ","$4,716.56 ","$4,654.50 ","$6,206.00 ","$5,275.10 ", N/A ,"$6,206.00 ","$6,206.00 ","$4,344.20 ","$3,779.45 ",$205.34 , N/A , N/A , N/A ,$217.66 ,"$5,275.10 ", N/A ,"$5,709.52 ","$4,344.20 ","$4,986.74 ","$6,233.42 ","$3,779.45 ","$6,233.42 ","$4,288.35 ","$5,585.40 ","$4,239.94 ", N/A ,"$4,902.74 ",$217.66 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$4,468.32 ","$3,847.72 ","$4,468.32 ","$4,468.32 ","$4,964.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100268,37248,HC ANGIOPLASTY TRANLUM BALN INIT VEIN 37248,481,1 ,"$7,597.00 ","$5,014.02 ",$124.43 ,"$11,453.02 ",$124.43 ,"$7,597.00 ","$7,597.00 ","$5,090.23 ","$4,558.20 ","$6,457.45 ","$5,317.90 ",$124.43 ,$124.43 ,"$7,217.15 ","$5,773.72 ","$5,697.75 ","$7,276.00 ","$6,457.45 ","$5,090.23 ","$7,276.00 ","$7,276.00 ","$5,317.90 ","$4,626.57 ",$124.43 ,"$5,090.23 ","$4,988.43 ","$7,597.00 ",$131.90 ,"$6,457.45 ","$11,453.02 ","$6,989.24 ","$5,317.90 ","$4,535.48 ","$5,669.62 ","$4,626.57 ","$5,669.62 ","$5,249.53 ","$6,837.30 ","$5,190.27 ","$5,038.31 ","$6,001.63 ",$131.90 ,"$7,597.00 ","$7,597.00 ","$4,988.43 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100269,37249,HC ANGIOPLASTY TRANLUM BALN ADDL VEIN 37249,481,1 ,"$6,206.00 ","$4,095.96 ",$205.34 ,"$6,233.42 ",$205.34 , N/A , N/A , N/A ,"$3,723.60 ","$5,275.10 ","$4,344.20 ",$205.34 ,$205.34 ,"$5,895.70 ","$4,716.56 ","$4,654.50 ","$6,206.00 ","$5,275.10 ", N/A ,"$6,206.00 ","$6,206.00 ","$4,344.20 ","$3,779.45 ",$205.34 , N/A , N/A , N/A ,$217.66 ,"$5,275.10 ", N/A ,"$5,709.52 ","$4,344.20 ","$4,986.74 ","$6,233.42 ","$3,779.45 ","$6,233.42 ","$4,288.35 ","$5,585.40 ","$4,239.94 ", N/A ,"$4,902.74 ",$217.66 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$4,468.32 ","$3,847.72 ","$4,468.32 ","$4,468.32 ","$4,964.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100270,36908,HC PLACE STENT CENTRAL DIAL SEGMENT 36908,481,1 ,"$11,058.00 ","$7,298.28 ",$205.34 ,"$11,058.00 ",$205.34 , N/A , N/A , N/A ,"$6,634.80 ","$9,399.30 ","$7,740.60 ",$205.34 ,$205.34 ,"$10,505.10 ","$8,404.08 ","$8,293.50 ","$7,276.00 ","$9,399.30 ", N/A ,"$7,276.00 ","$7,276.00 ","$7,740.60 ","$6,734.32 ",$205.34 , N/A , N/A , N/A ,$217.66 ,"$9,399.30 ", N/A ,"$10,173.36 ","$7,740.60 ","$4,986.74 ","$6,233.42 ","$6,734.32 ","$6,233.42 ","$7,641.08 ","$9,952.20 ","$7,554.83 ", N/A ,"$8,735.82 ",$217.66 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$7,961.76 ","$6,855.96 ","$7,961.76 ","$7,961.76 ","$8,846.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100271,36909,HC DIAL CIRCUIT VASC EMBOL/OCCUL 36909,481,1 ,"$9,523.00 ","$6,285.18 ",$376.97 ,"$9,523.00 ",$376.97 , N/A , N/A , N/A ,"$5,713.80 ","$8,094.55 ","$6,666.10 ",$376.97 ,$376.97 ,"$9,046.85 ","$7,237.48 ","$7,142.25 ","$7,276.00 ","$8,094.55 ", N/A ,"$7,276.00 ","$7,276.00 ","$6,666.10 ","$5,799.51 ",$376.97 , N/A , N/A , N/A ,$399.59 ,"$8,094.55 ", N/A ,"$8,761.16 ","$6,666.10 ","$4,986.74 ","$6,233.42 ","$5,799.51 ","$6,233.42 ","$6,580.39 ","$8,570.70 ","$6,506.11 ", N/A ,"$7,523.17 ",$399.59 ,"$1,945.00 ","$1,945.00 ", N/A ,"$1,945.00 ","$6,856.56 ","$5,904.26 ","$6,856.56 ","$6,856.56 ","$7,618.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100272,36901,HC INTRO CATH DIALYSIS CIRCUIT 36901,481,1 ,"$4,086.00 ","$2,696.76 ",$57.71 ,"$4,086.00 ",$57.71 ,"$4,086.00 ","$4,010.00 ","$1,452.14 ","$2,451.60 ","$3,473.10 ","$2,860.20 ",$57.71 ,$57.71 ,"$3,881.70 ","$3,105.36 ","$3,064.50 ","$4,086.00 ","$3,473.10 ","$1,452.14 ","$4,086.00 ","$4,086.00 ","$2,860.20 ","$2,488.37 ",$57.71 ,"$1,452.14 ","$1,423.10 ","$2,904.28 ",$61.17 ,"$3,473.10 ","$3,267.32 ","$3,759.12 ","$2,860.20 ","$1,998.41 ","$2,497.74 ","$2,488.37 ","$2,497.74 ","$2,823.43 ","$3,677.40 ","$2,791.56 ","$1,437.33 ","$3,227.94 ",$61.17 ,"$4,086.00 ","$4,086.00 ","$1,423.10 ","$4,086.00 ","$2,941.92 ","$2,533.32 ","$2,941.92 ","$2,941.92 ","$3,268.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100273,36903,HC INTRO CATH/CIRCUIT W/STENT 36903,481,1 ,"$29,180.00 ","$19,258.80 ",$376.97 ,"$29,180.00 ",$376.97 ,"$20,624.00 ","$12,891.00 ","$10,360.54 ","$17,508.00 ","$24,803.00 ","$20,426.00 ",$376.97 ,$376.97 ,"$27,721.00 ","$22,176.80 ","$21,885.00 ","$7,276.00 ","$24,803.00 ","$10,360.54 ","$7,276.00 ","$7,276.00 ","$20,426.00 ","$17,770.62 ",$376.97 ,"$10,360.54 ","$10,153.33 ","$20,721.08 ",$399.59 ,"$24,803.00 ","$23,311.22 ","$26,845.60 ","$20,426.00 ","$4,887.30 ","$6,108.86 ","$17,770.62 ","$6,108.86 ","$20,163.38 ","$26,262.00 ","$19,935.78 ","$10,254.87 ","$23,052.20 ",$399.59 ,"$10,341.00 ","$10,341.00 ","$10,153.33 ","$10,341.00 ","$21,009.60 ","$18,091.60 ","$21,009.60 ","$21,009.60 ","$23,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100274,36904,HC THROMBECTOMY/INFUS DIALYSIS CIRCUIT 36904,481,1 ,"$14,402.00 ","$9,505.32 ",$124.43 ,"$14,402.00 ",$124.43 ,"$14,402.00 ","$10,885.00 ","$5,090.23 ","$8,641.20 ","$12,241.70 ","$10,081.40 ",$124.43 ,$124.43 ,"$13,681.90 ","$10,945.52 ","$10,801.50 ","$7,276.00 ","$12,241.70 ","$5,090.23 ","$7,276.00 ","$7,276.00 ","$10,081.40 ","$8,770.82 ",$124.43 ,"$5,090.23 ","$4,988.43 ","$10,180.46 ",$131.90 ,"$12,241.70 ","$11,453.02 ","$13,249.84 ","$10,081.40 ","$4,535.48 ","$5,669.62 ","$8,770.82 ","$5,669.62 ","$9,951.78 ","$12,961.80 ","$9,839.45 ","$5,038.31 ","$11,377.58 ",$131.90 ,"$9,030.00 ","$9,030.00 ","$4,988.43 ","$9,030.00 ","$10,369.44 ","$8,929.24 ","$10,369.44 ","$10,369.44 ","$11,521.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100275,36906,HC THROMBECTOMY/INFUS CIRCUIT W/STENT 36906,481,1 ,"$46,674.00 ","$30,804.84 ",$376.97 ,"$46,674.00 ",$376.97 ,"$21,770.00 ","$14,895.00 ","$16,765.34 ","$28,004.40 ","$39,672.90 ","$32,671.80 ",$376.97 ,$376.97 ,"$44,340.30 ","$35,472.24 ","$35,005.50 ","$7,276.00 ","$39,672.90 ","$16,765.34 ","$7,276.00 ","$7,276.00 ","$32,671.80 ","$28,424.47 ",$376.97 ,"$16,765.34 ","$16,430.03 ","$33,530.68 ",$399.59 ,"$39,672.90 ","$37,722.01 ","$42,940.08 ","$32,671.80 ","$5,041.37 ","$6,302.25 ","$28,424.47 ","$6,302.25 ","$32,251.73 ","$42,006.60 ","$31,887.68 ","$16,594.33 ","$36,872.46 ",$399.59 ,"$14,623.00 ","$14,623.00 ","$16,430.03 ","$14,623.00 ","$33,605.28 ","$28,937.88 ","$33,605.28 ","$33,605.28 ","$37,339.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100277,93288,HC INTERROG DEVICE EVAL PACEMAKER SYSTEM,481,1 ,$141.97 ,$93.70 ,$1.27 ,$141.97 ,$1.27 ,$141.97 ,$141.97 ,$34.16 ,$85.18 ,$120.67 ,$99.38 ,$1.27 ,$1.27 ,$134.87 ,$107.90 ,$106.48 ,$141.97 ,$120.67 ,$34.16 ,$141.97 ,$141.97 ,$99.38 ,$86.46 ,$1.27 ,$34.16 ,$33.48 ,$68.32 ,$1.35 ,$120.67 ,$76.86 ,$130.61 ,$99.38 ,$72.01 ,$86.42 ,$86.46 ,$86.42 ,$98.10 ,$127.77 ,$96.99 ,$33.81 ,$112.16 ,$1.35 , N/A , N/A ,$33.48 , N/A ,$102.22 ,$88.02 ,$102.22 ,$102.22 ,$113.58 
ST NICHOLAS HOSPITAL - ACUTE,48100492,34712,HC TRANSCATH DELV FIX DEVICE W/S AND I,481,1 ,"$1,070.00 ",$706.20 ,$581.21 ,"$1,070.00 ",$581.21 ,"$1,070.00 ","$1,070.00 ", N/A ,$642.00 ,$909.50 ,$749.00 ,$581.21 ,$581.21 ,"$1,016.50 ",$813.20 ,$802.50 ,"$1,070.00 ",$909.50 , N/A ,"$1,070.00 ","$1,070.00 ",$749.00 ,$651.63 ,$581.21 , N/A , N/A , N/A ,$616.08 ,$909.50 , N/A ,$984.40 ,$749.00 , N/A , N/A ,$651.63 , N/A ,$739.37 ,$963.00 ,$731.02 , N/A ,$845.30 ,$616.08 ,"$1,070.00 ","$1,070.00 ", N/A ,"$1,070.00 ",$770.40 ,$663.40 ,$770.40 ,$770.40 ,$856.00 
ST NICHOLAS HOSPITAL - ACUTE,48100493,34713,HC PERQ ACCESS/CLOSURE FEM ARTY ENDOGRAFT UNI,481,1 ,$471.00 ,$310.86 ,$282.60 ,"$6,233.42 ",$581.21 , N/A , N/A , N/A ,$282.60 ,$400.35 ,$329.70 ,$581.21 ,$471.00 ,$447.45 ,$357.96 ,$353.25 ,$471.00 ,$400.35 , N/A ,$471.00 ,$471.00 ,$329.70 ,$286.84 ,$581.21 , N/A , N/A , N/A ,$499.26 ,$400.35 , N/A ,$433.32 ,$329.70 ,"$4,986.74 ","$6,233.42 ",$286.84 ,"$6,233.42 ",$325.46 ,$423.90 ,$321.79 , N/A ,$372.09 ,$616.08 ,$471.00 ,$471.00 , N/A ,$471.00 ,$339.12 ,$292.02 ,$339.12 ,$339.12 ,$376.80 
ST NICHOLAS HOSPITAL - ACUTE,48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,416.80 ",$935.09 ,$5.78 ,"$1,416.80 ",$5.78 ,$971.07 ,$971.07 ,$273.34 ,$850.08 ,"$1,204.28 ",$991.76 ,$5.78 ,$5.78 ,"$1,345.96 ","$1,076.77 ","$1,062.60 ",$920.92 ,"$1,204.28 ",$273.34 ,$920.92 ,$920.92 ,$991.76 ,$862.83 ,$5.78 ,$273.34 ,$267.87 ,$546.68 ,$6.13 ,"$1,204.28 ",$615.01 ,"$1,303.46 ",$991.76 ,$865.86 ,$865.86 ,$862.83 ,$865.86 ,$979.01 ,"$1,275.12 ",$967.96 ,$270.55 ,"$1,119.27 ",$6.13 ,$802.00 ,$802.00 ,$267.87 ,$802.00 ,"$1,020.10 ",$878.42 ,"$1,020.10 ","$1,020.10 ","$1,133.44 "
ST NICHOLAS HOSPITAL - ACUTE,48200001,93017,HC STRESS TEST TRACING ONLY CORPORATE,482,1 ,$159.85 ,$105.50 ,$5.78 ,$615.01 ,$5.78 ,$109.56 ,$109.56 ,$273.34 ,$95.91 ,$135.87 ,$111.90 ,$5.78 ,$5.78 ,$151.86 ,$121.49 ,$119.89 ,$103.90 ,$135.87 ,$273.34 ,$103.90 ,$103.90 ,$111.90 ,$97.35 ,$5.78 ,$273.34 ,$267.87 ,$159.85 ,$6.13 ,$135.87 ,$615.01 ,$147.06 ,$111.90 ,$159.85 ,$159.85 ,$97.35 ,$159.85 ,$110.46 ,$143.87 ,$109.21 ,$270.55 ,$126.28 ,$6.13 ,$159.85 ,$159.85 ,$267.87 ,$159.85 ,$115.09 ,$99.11 ,$115.09 ,$115.09 ,$127.88 
ST NICHOLAS HOSPITAL - ACUTE,48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$2,260.59 ","$1,491.99 ",$15.95 ,"$2,260.59 ",$15.95 ,"$1,549.41 ","$1,549.41 ",$491.05 ,"$1,356.35 ","$1,921.50 ","$1,582.41 ",$15.95 ,$15.95 ,"$2,147.56 ","$1,718.05 ","$1,695.44 ","$1,469.38 ","$1,921.50 ",$491.05 ,"$1,469.38 ","$1,469.38 ","$1,582.41 ","$1,376.70 ",$15.95 ,$491.05 ,$481.23 ,$982.10 ,$16.91 ,"$1,921.50 ","$1,104.87 ","$2,079.74 ","$1,582.41 ","$1,514.89 ","$1,514.89 ","$1,376.70 ","$1,514.89 ","$1,562.07 ","$2,034.53 ","$1,544.44 ",$486.04 ,"$1,785.87 ",$16.91 ,$528.00 ,$528.00 ,$481.23 ,$528.00 ,"$1,627.62 ","$1,401.57 ","$1,627.62 ","$1,627.62 ","$1,808.47 "
ST NICHOLAS HOSPITAL - ACUTE,48300001,93307,HC ECHOCARDIOGRAM 2D W/O DOP,483,1 ,"$1,944.10 ","$1,283.11 ",$15.95 ,"$1,944.10 ",$15.95 ,"$1,332.49 ","$1,332.49 ",$227.92 ,"$1,166.46 ","$1,652.49 ","$1,360.87 ",$15.95 ,$15.95 ,"$1,846.90 ","$1,477.52 ","$1,458.08 ","$1,263.67 ","$1,652.49 ",$227.92 ,"$1,263.67 ","$1,263.67 ","$1,360.87 ","$1,183.96 ",$15.95 ,$227.92 ,$223.36 ,$455.84 ,$16.91 ,"$1,652.49 ",$512.81 ,"$1,788.57 ","$1,360.87 ","$1,514.89 ","$1,514.89 ","$1,183.96 ","$1,514.89 ","$1,343.37 ","$1,749.69 ","$1,328.21 ",$225.60 ,"$1,535.84 ",$16.91 ,$528.00 ,$528.00 ,$223.36 ,$528.00 ,"$1,399.75 ","$1,205.34 ","$1,399.75 ","$1,399.75 ","$1,555.28 "
ST NICHOLAS HOSPITAL - ACUTE,48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,$994.66 ,$656.48 ,$15.95 ,$994.66 ,$15.95 ,$681.74 ,$681.74 ,$227.92 ,$596.80 ,$845.46 ,$696.26 ,$15.95 ,$15.95 ,$944.93 ,$755.94 ,$746.00 ,$646.53 ,$845.46 ,$227.92 ,$646.53 ,$646.53 ,$696.26 ,$605.75 ,$15.95 ,$227.92 ,$223.36 ,$455.84 ,$16.91 ,$845.46 ,$512.81 ,$915.09 ,$696.26 ,$888.78 ,$888.78 ,$605.75 ,$888.78 ,$687.31 ,$895.19 ,$679.55 ,$225.60 ,$785.78 ,$16.91 ,$528.00 ,$528.00 ,$223.36 ,$528.00 ,$716.16 ,$616.69 ,$716.16 ,$716.16 ,$795.73 
ST NICHOLAS HOSPITAL - ACUTE,48300003,93312,HC ECHO TEE CMPL W/PF,483,1 ,"$2,825.73 ","$1,864.98 ",$15.95 ,"$2,825.73 ",$15.95 ,"$1,936.76 ","$1,936.76 ",$491.05 ,"$1,695.44 ","$2,401.87 ","$1,978.01 ",$15.95 ,$15.95 ,"$2,684.44 ","$2,147.55 ","$2,119.30 ","$1,836.72 ","$2,401.87 ",$491.05 ,"$1,836.72 ","$1,836.72 ","$1,978.01 ","$1,720.87 ",$15.95 ,$491.05 ,$481.23 ,$982.10 ,$16.91 ,"$2,401.87 ","$1,104.87 ","$2,599.67 ","$1,978.01 ","$2,107.50 ","$2,107.50 ","$1,720.87 ","$2,107.50 ","$1,952.58 ","$2,543.16 ","$1,930.54 ",$486.04 ,"$2,232.33 ",$16.91 ,$528.00 ,$528.00 ,$481.23 ,$528.00 ,"$2,034.53 ","$1,751.95 ","$2,034.53 ","$2,034.53 ","$2,260.58 "
ST NICHOLAS HOSPITAL - ACUTE,48300004,93316,HC ECHO TEE CONGT CARDIAC ANOM PROBE,483,1 ,"$1,175.50 ",$775.83 ,$15.95 ,"$1,175.50 ",$15.95 ,$805.69 ,$805.69 ,$491.05 ,$705.30 ,$999.18 ,$822.85 ,$15.95 ,$15.95 ,"$1,116.73 ",$893.38 ,$881.63 ,$764.08 ,$999.18 ,$491.05 ,$764.08 ,$764.08 ,$822.85 ,$715.88 ,$15.95 ,$491.05 ,$481.23 ,$982.10 ,$16.91 ,$999.18 ,"$1,104.87 ","$1,081.46 ",$822.85 ,"$1,175.50 ","$1,175.50 ",$715.88 ,"$1,175.50 ",$812.27 ,"$1,057.95 ",$803.10 ,$486.04 ,$928.65 ,$16.91 ,$528.00 ,$528.00 ,$481.23 ,$528.00 ,$846.36 ,$728.81 ,$846.36 ,$846.36 ,$940.40 
ST NICHOLAS HOSPITAL - ACUTE,48300005,93320,HC ECHO DOPPLER,483,1 ,$610.36 ,$402.84 ,$15.95 ,$610.36 ,$15.95 ,$418.34 ,$418.34 , N/A ,$366.22 ,$518.81 ,$427.25 ,$15.95 ,$15.95 ,$579.84 ,$463.87 ,$457.77 ,$396.73 ,$518.81 , N/A ,$396.73 ,$396.73 ,$427.25 ,$371.71 ,$15.95 , N/A , N/A , N/A ,$16.91 ,$518.81 , N/A ,$561.53 ,$427.25 ,$309.57 ,$371.53 ,$371.71 ,$371.53 ,$421.76 ,$549.32 ,$417.00 , N/A ,$482.18 ,$16.91 ,$528.00 ,$528.00 , N/A ,$528.00 ,$439.46 ,$378.42 ,$439.46 ,$439.46 ,$488.29 
ST NICHOLAS HOSPITAL - ACUTE,48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,$565.15 ,$373.00 ,$3.71 ,$565.15 ,$3.71 ,$387.35 ,$387.35 , N/A ,$339.09 ,$480.38 ,$395.61 ,$3.71 ,$3.71 ,$536.89 ,$429.51 ,$423.86 ,$367.35 ,$480.38 , N/A ,$367.35 ,$367.35 ,$395.61 ,$344.18 ,$3.71 , N/A , N/A , N/A ,$3.93 ,$480.38 , N/A ,$519.94 ,$395.61 ,$286.64 ,$344.01 ,$344.18 ,$344.01 ,$390.52 ,$508.64 ,$386.11 , N/A ,$446.47 ,$3.93 ,$528.00 ,$528.00 , N/A ,$528.00 ,$406.91 ,$350.39 ,$406.91 ,$406.91 ,$452.12 
ST NICHOLAS HOSPITAL - ACUTE,48300007,93350,HC ECHO REST  AND  STRESS W/PF,483,1 ,"$2,147.56 ","$1,417.39 ",$15.95 ,"$2,147.56 ",$15.95 ,"$1,471.94 ","$1,471.94 ",$491.05 ,"$1,288.54 ","$1,825.43 ","$1,503.29 ",$15.95 ,$15.95 ,"$2,040.18 ","$1,632.15 ","$1,610.67 ","$1,395.91 ","$1,825.43 ",$491.05 ,"$1,395.91 ","$1,395.91 ","$1,503.29 ","$1,307.86 ",$15.95 ,$491.05 ,$481.23 ,$982.10 ,$16.91 ,"$1,825.43 ","$1,104.87 ","$1,975.76 ","$1,503.29 ","$1,514.89 ","$1,514.89 ","$1,307.86 ","$1,514.89 ","$1,483.96 ","$1,932.80 ","$1,467.21 ",$486.04 ,"$1,696.57 ",$16.91 ,$528.00 ,$528.00 ,$481.23 ,$528.00 ,"$1,546.24 ","$1,331.49 ","$1,546.24 ","$1,546.24 ","$1,718.05 "
ST NICHOLAS HOSPITAL - ACUTE,48300008,93303,HC ECHO PEDS CONGENITAL,483,1 ,"$2,740.96 ","$1,809.03 ",$15.95 ,"$2,740.96 ",$15.95 ,"$1,878.65 ","$1,878.65 ",$491.05 ,"$1,644.58 ","$2,329.82 ","$1,918.67 ",$15.95 ,$15.95 ,"$2,603.91 ","$2,083.13 ","$2,055.72 ","$1,781.62 ","$2,329.82 ",$491.05 ,"$1,781.62 ","$1,781.62 ","$1,918.67 ","$1,669.24 ",$15.95 ,$491.05 ,$481.23 ,$982.10 ,$16.91 ,"$2,329.82 ","$1,104.87 ","$2,521.68 ","$1,918.67 ","$2,107.50 ","$2,107.50 ","$1,669.24 ","$2,107.50 ","$1,894.00 ","$2,466.86 ","$1,872.62 ",$486.04 ,"$2,165.36 ",$16.91 ,$528.00 ,$528.00 ,$481.23 ,$528.00 ,"$1,973.49 ","$1,699.40 ","$1,973.49 ","$1,973.49 ","$2,192.77 "
ST NICHOLAS HOSPITAL - ACUTE,48300009,93304,HC ECHO PEDS CONGENITAL LMTD,483,1 ,"$2,045.83 ","$1,350.25 ",$15.95 ,"$2,045.83 ",$15.95 ,"$1,402.21 ","$1,402.21 ",$491.05 ,"$1,227.50 ","$1,738.96 ","$1,432.08 ",$15.95 ,$15.95 ,"$1,943.54 ","$1,554.83 ","$1,534.37 ","$1,329.79 ","$1,738.96 ",$491.05 ,"$1,329.79 ","$1,329.79 ","$1,432.08 ","$1,245.91 ",$15.95 ,$491.05 ,$481.23 ,$982.10 ,$16.91 ,"$1,738.96 ","$1,104.87 ","$1,882.16 ","$1,432.08 ","$1,514.89 ","$1,514.89 ","$1,245.91 ","$1,514.89 ","$1,413.67 ","$1,841.25 ","$1,397.71 ",$486.04 ,"$1,616.21 ",$16.91 ,$528.00 ,$528.00 ,$481.23 ,$528.00 ,"$1,473.00 ","$1,268.41 ","$1,473.00 ","$1,473.00 ","$1,636.66 "
ST NICHOLAS HOSPITAL - ACUTE,48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,$514.28 ,$339.42 ,$15.95 ,$514.28 ,$15.95 ,$352.49 ,$352.49 , N/A ,$308.57 ,$437.14 ,$360.00 ,$15.95 ,$15.95 ,$488.57 ,$390.85 ,$385.71 ,$334.28 ,$437.14 , N/A ,$334.28 ,$334.28 ,$360.00 ,$313.20 ,$15.95 , N/A , N/A , N/A ,$16.91 ,$437.14 , N/A ,$473.14 ,$360.00 ,$260.84 ,$313.04 ,$313.20 ,$313.04 ,$355.37 ,$462.85 ,$351.36 , N/A ,$406.28 ,$16.91 ,$514.28 ,$514.28 , N/A ,$514.28 ,$370.28 ,$318.85 ,$370.28 ,$370.28 ,$411.42 
ST NICHOLAS HOSPITAL - ACUTE,48300011,93351,HC ECHO 2D STRESS CONT MONITORING,483,1 ,"$2,740.96 ","$1,809.03 ",$15.95 ,"$2,740.96 ",$15.95 ,"$1,878.65 ","$1,878.65 ",$491.05 ,"$1,644.58 ","$2,329.82 ","$1,918.67 ",$15.95 ,$15.95 ,"$2,603.91 ","$2,083.13 ","$2,055.72 ","$1,781.62 ","$2,329.82 ",$491.05 ,"$1,781.62 ","$1,781.62 ","$1,918.67 ","$1,669.24 ",$15.95 ,$491.05 ,$481.23 ,$982.10 ,$16.91 ,"$2,329.82 ","$1,104.87 ","$2,521.68 ","$1,918.67 ","$2,107.50 ","$2,107.50 ","$1,669.24 ","$2,107.50 ","$1,894.00 ","$2,466.86 ","$1,872.62 ",$486.04 ,"$2,165.36 ",$16.91 ,$528.00 ,$528.00 ,$481.23 ,$528.00 ,"$1,973.49 ","$1,699.40 ","$1,973.49 ","$1,973.49 ","$2,192.77 "
ST NICHOLAS HOSPITAL - ACUTE,48300016,C8924,HC ECHO TTE W/W/O CONT  AND  W/CONT LIMIT,483,1 ,"$1,243.32 ",$820.59 ,$15.95 ,"$1,243.32 ",$15.95 ,$852.17 ,$852.17 ,$359.59 ,$745.99 ,"$1,056.82 ",$870.32 ,$15.95 ,$15.95 ,"$1,181.15 ",$944.92 ,$932.49 ,$808.16 ,"$1,056.82 ",$359.59 ,$808.16 ,$808.16 ,$870.32 ,$757.18 ,$15.95 ,$359.59 ,$352.40 ,$719.18 ,$16.91 ,"$1,056.82 ",$809.07 ,"$1,143.85 ",$870.32 ,"$1,243.32 ","$1,243.32 ",$757.18 ,"$1,243.32 ",$859.13 ,"$1,118.99 ",$849.44 ,$355.93 ,$982.22 ,$16.91 ,$528.00 ,$528.00 ,$352.40 ,$528.00 ,$895.19 ,$770.86 ,$895.19 ,$895.19 ,$994.66 
ST NICHOLAS HOSPITAL - ACUTE,48300018,C8928,HC ECHO TTE 2D STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$2,216.50 ","$1,462.89 ",$15.95 ,"$2,216.50 ",$15.95 ,"$1,519.19 ","$1,519.19 ",$722.97 ,"$1,329.90 ","$1,884.03 ","$1,551.55 ",$15.95 ,$15.95 ,"$2,105.68 ","$1,684.54 ","$1,662.38 ","$1,440.73 ","$1,884.03 ",$722.97 ,"$1,440.73 ","$1,440.73 ","$1,551.55 ","$1,349.85 ",$15.95 ,$722.97 ,$708.51 ,"$1,445.94 ",$16.91 ,"$1,884.03 ","$1,626.69 ","$2,039.18 ","$1,551.55 ","$2,216.50 ","$2,216.50 ","$1,349.85 ","$2,216.50 ","$1,531.60 ","$1,994.85 ","$1,514.31 ",$715.60 ,"$1,751.04 ",$16.91 ,$528.00 ,$528.00 ,$708.51 ,$528.00 ,"$1,595.88 ","$1,374.23 ","$1,595.88 ","$1,595.88 ","$1,773.20 "
ST NICHOLAS HOSPITAL - ACUTE,48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT  AND  W/CONT,483,1 ,"$2,216.50 ","$1,462.89 ",$15.95 ,"$2,216.50 ",$15.95 ,"$1,519.19 ","$1,519.19 ",$722.97 ,"$1,329.90 ","$1,884.03 ","$1,551.55 ",$15.95 ,$15.95 ,"$2,105.68 ","$1,684.54 ","$1,662.38 ","$1,440.73 ","$1,884.03 ",$722.97 ,"$1,440.73 ","$1,440.73 ","$1,551.55 ","$1,349.85 ",$15.95 ,$722.97 ,$708.51 ,"$1,445.94 ",$16.91 ,"$1,884.03 ","$1,626.69 ","$2,039.18 ","$1,551.55 ","$2,216.50 ","$2,216.50 ","$1,349.85 ","$2,216.50 ","$1,531.60 ","$1,994.85 ","$1,514.31 ",$715.60 ,"$1,751.04 ",$16.91 ,$528.00 ,$528.00 ,$708.51 ,$528.00 ,"$1,595.88 ","$1,374.23 ","$1,595.88 ","$1,595.88 ","$1,773.20 "
ST NICHOLAS HOSPITAL - ACUTE,51000001,N/A,HC DISCONTINUED PROCEDURE,510,1 ,"$1,113.00 ",$734.58 ,$108.00 ,"$1,113.00 ", N/A ,$144.00 ,$114.00 , N/A ,$667.80 ,$946.05 ,$779.10 , N/A , N/A ,"$1,057.35 ",$845.88 ,$834.75 ,$108.00 ,$946.05 , N/A ,$108.00 ,$108.00 ,$779.10 ,$677.82 , N/A , N/A , N/A , N/A , N/A ,$946.05 , N/A ,"$1,023.96 ",$779.10 ,$564.51 ,$677.48 ,$677.82 ,$677.48 ,$769.08 ,"$1,001.70 ",$760.40 , N/A ,$879.27 , N/A ,$656.67 ,$656.67 , N/A ,$656.67 ,$801.36 ,$690.06 ,$801.36 ,$801.36 ,$890.40 
ST NICHOLAS HOSPITAL - ACUTE,51000003,10180,HC I AND D WOUND POST OP COMPLEX,510,1 ,"$8,196.05 ","$5,409.39 ",$34.96 ,"$8,196.05 ",$34.96 ,$144.00 ,$114.00 ,"$2,521.25 ","$4,917.63 ","$6,966.64 ","$5,737.24 ",$34.96 ,$34.96 ,"$7,786.25 ","$6,229.00 ","$6,147.04 ",$108.00 ,"$6,966.64 ","$2,521.25 ",$108.00 ,$108.00 ,"$5,737.24 ","$4,991.39 ",$34.96 ,"$2,521.25 ","$2,470.82 ","$5,042.50 ",$37.06 ,"$6,966.64 ","$5,672.82 ","$7,540.37 ","$5,737.24 ","$2,747.95 ","$3,435.21 ","$4,991.39 ","$3,435.21 ","$5,663.47 ","$7,376.45 ","$5,599.54 ","$2,495.53 ","$6,474.88 ",$37.06 ,"$4,835.67 ","$4,835.67 ","$2,470.82 ","$4,835.67 ","$5,901.16 ","$5,081.55 ","$5,901.16 ","$5,901.16 ","$6,556.84 "
ST NICHOLAS HOSPITAL - ACUTE,51000005,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM FAC,510,1 ,$581.90 ,$384.05 ,$13.09 ,$819.26 ,$13.09 ,$144.00 ,$114.00 ,$364.12 ,$349.14 ,$494.62 ,$407.33 ,$13.09 ,$13.09 ,$552.81 ,$442.24 ,$436.43 ,$108.00 ,$494.62 ,$364.12 ,$108.00 ,$108.00 ,$407.33 ,$354.38 ,$13.09 ,$364.12 ,$356.84 ,$581.90 ,$13.88 ,$494.62 ,$819.26 ,$535.35 ,$407.33 ,$295.14 ,$354.20 ,$354.38 ,$354.20 ,$402.09 ,$523.71 ,$397.55 ,$360.40 ,$459.70 ,$13.88 ,$343.32 ,$343.32 ,$356.84 ,$343.32 ,$418.97 ,$360.78 ,$418.97 ,$418.97 ,$465.52 
ST NICHOLAS HOSPITAL - ACUTE,51000006,11043,HC DEBR SKIN/SUBQ TISSUE/MUSCLE FAC,510,1 ,"$1,238.55 ",$817.44 ,$13.09 ,"$1,275.77 ",$13.09 ,$144.00 ,$114.00 ,$567.01 ,$743.13 ,"$1,052.77 ",$866.99 ,$13.09 ,$13.09 ,"$1,176.62 ",$941.30 ,$928.91 ,$108.00 ,"$1,052.77 ",$567.01 ,$108.00 ,$108.00 ,$866.99 ,$754.28 ,$13.09 ,$567.01 ,$555.67 ,"$1,134.02 ",$13.88 ,"$1,052.77 ","$1,275.77 ","$1,139.47 ",$866.99 ,$628.19 ,$753.91 ,$754.28 ,$753.91 ,$855.84 ,"$1,114.70 ",$846.18 ,$561.23 ,$978.45 ,$13.88 ,$730.74 ,$730.74 ,$555.67 ,$730.74 ,$891.76 ,$767.90 ,$891.76 ,$891.76 ,$990.84 
ST NICHOLAS HOSPITAL - ACUTE,51000007,11044,HC DEBR SKIN/SUB TIS/MUS/BONE INT 20 FAC,510,1 ,"$2,725.50 ","$1,798.83 ",$34.96 ,"$3,293.01 ",$34.96 ,$144.00 ,$114.00 ,"$1,463.56 ","$1,635.30 ","$2,316.68 ","$1,907.85 ",$34.96 ,$34.96 ,"$2,589.23 ","$2,071.38 ","$2,044.13 ",$108.00 ,"$2,316.68 ","$1,463.56 ",$108.00 ,$108.00 ,"$1,907.85 ","$1,659.83 ",$34.96 ,"$1,463.56 ","$1,434.29 ","$2,725.50 ",$37.06 ,"$2,316.68 ","$3,293.01 ","$2,507.46 ","$1,907.85 ","$1,771.14 ","$2,213.66 ","$1,659.83 ","$2,213.66 ","$1,883.32 ","$2,452.95 ","$1,862.06 ","$1,448.64 ","$2,153.15 ",$37.06 ,"$1,608.05 ","$1,608.05 ","$1,434.29 ","$1,608.05 ","$1,962.36 ","$1,689.81 ","$1,962.36 ","$1,962.36 ","$2,180.40 "
ST NICHOLAS HOSPITAL - ACUTE,51000008,N/A,HC LIFETIME EX 3D/WK COUPLE,510,1 ,$133.56 ,$88.15 ,$67.74 ,$133.56 , N/A ,$133.56 ,$114.00 , N/A ,$80.14 ,$113.53 ,$93.49 , N/A , N/A ,$126.88 ,$101.51 ,$100.17 ,$108.00 ,$113.53 , N/A ,$108.00 ,$108.00 ,$93.49 ,$81.34 , N/A , N/A , N/A , N/A , N/A ,$113.53 , N/A ,$122.88 ,$93.49 ,$67.74 ,$81.30 ,$81.34 ,$81.30 ,$92.29 ,$120.20 ,$91.25 , N/A ,$105.51 , N/A ,$78.80 ,$78.80 , N/A ,$78.80 ,$96.16 ,$82.81 ,$96.16 ,$96.16 ,$106.85 
ST NICHOLAS HOSPITAL - ACUTE,51000009,11045,HC DEBR SKIN/SUBQ TIS EA ADL 20CM FAC,510,1 ,$124.20 ,$81.97 ,$34.96 ,$124.20 ,$34.96 ,$124.20 ,$114.00 , N/A ,$74.52 ,$105.57 ,$86.94 ,$34.96 ,$34.96 ,$117.99 ,$94.39 ,$93.15 ,$108.00 ,$105.57 , N/A ,$108.00 ,$108.00 ,$86.94 ,$75.64 ,$34.96 , N/A , N/A , N/A ,$37.06 ,$105.57 , N/A ,$114.26 ,$86.94 ,$62.99 ,$75.60 ,$75.64 ,$75.60 ,$85.82 ,$111.78 ,$84.85 , N/A ,$98.12 ,$37.06 ,$73.28 ,$73.28 , N/A ,$73.28 ,$89.42 ,$77.00 ,$89.42 ,$89.42 ,$99.36 
ST NICHOLAS HOSPITAL - ACUTE,51000010,11046,HC DEBR SKIN/SUBQ MUS/FAS ADL 20C FAC,510,1 ,$903.90 ,$596.57 ,$34.96 ,$903.90 ,$34.96 ,$144.00 ,$114.00 , N/A ,$542.34 ,$768.32 ,$632.73 ,$34.96 ,$34.96 ,$858.71 ,$686.96 ,$677.93 ,$108.00 ,$768.32 , N/A ,$108.00 ,$108.00 ,$632.73 ,$550.48 ,$34.96 , N/A , N/A , N/A ,$37.06 ,$768.32 , N/A ,$831.59 ,$632.73 ,$458.46 ,$550.20 ,$550.48 ,$550.20 ,$624.59 ,$813.51 ,$617.54 , N/A ,$714.08 ,$37.06 ,$533.30 ,$533.30 , N/A ,$533.30 ,$650.81 ,$560.42 ,$650.81 ,$650.81 ,$723.12 
ST NICHOLAS HOSPITAL - ACUTE,51000011,11047,HC DEBR SKIN/SUB TIS/MUS/BN ADL 20C FAC,510,1 ,"$1,721.55 ","$1,136.22 ",$34.96 ,"$1,721.55 ",$34.96 ,$144.00 ,$114.00 , N/A ,"$1,032.93 ","$1,463.32 ","$1,205.09 ",$34.96 ,$34.96 ,"$1,635.47 ","$1,308.38 ","$1,291.16 ",$108.00 ,"$1,463.32 ", N/A ,$108.00 ,$108.00 ,"$1,205.09 ","$1,048.42 ",$34.96 , N/A , N/A , N/A ,$37.06 ,"$1,463.32 ", N/A ,"$1,583.83 ","$1,205.09 ",$873.17 ,"$1,047.91 ","$1,048.42 ","$1,047.91 ","$1,189.59 ","$1,549.40 ","$1,176.16 ", N/A ,"$1,360.02 ",$37.06 ,"$1,015.71 ","$1,015.71 ", N/A ,"$1,015.71 ","$1,239.52 ","$1,067.36 ","$1,239.52 ","$1,239.52 ","$1,377.24 "
ST NICHOLAS HOSPITAL - ACUTE,51000012,11055,HC PARING LESN BENIGN 1 FAC,510,1 ,$186.30 ,$122.96 ,$5.80 ,$396.55 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$111.78 ,$158.36 ,$130.41 ,$5.80 ,$5.80 ,$176.99 ,$141.59 ,$139.73 ,$108.00 ,$158.36 ,$176.25 ,$108.00 ,$108.00 ,$130.41 ,$113.46 ,$5.80 ,$176.25 ,$172.72 ,$186.30 ,$6.15 ,$158.36 ,$396.55 ,$171.40 ,$130.41 ,$94.49 ,$113.40 ,$113.46 ,$113.40 ,$128.73 ,$167.67 ,$127.28 ,$174.45 ,$147.18 ,$6.15 ,$109.92 ,$109.92 ,$172.72 ,$109.92 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,51000014,11056,HC PARING LESN BENIGN 2-4 FAC,510,1 ,$223.10 ,$147.25 ,$5.80 ,$396.55 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$133.86 ,$189.64 ,$156.17 ,$5.80 ,$5.80 ,$211.95 ,$169.56 ,$167.33 ,$108.00 ,$189.64 ,$176.25 ,$108.00 ,$108.00 ,$156.17 ,$135.87 ,$5.80 ,$176.25 ,$172.72 ,$223.10 ,$6.15 ,$189.64 ,$396.55 ,$205.25 ,$156.17 ,$113.16 ,$135.80 ,$135.87 ,$135.80 ,$154.16 ,$200.79 ,$152.42 ,$174.45 ,$176.25 ,$6.15 ,$131.63 ,$131.63 ,$172.72 ,$131.63 ,$160.63 ,$138.32 ,$160.63 ,$160.63 ,$178.48 
ST NICHOLAS HOSPITAL - ACUTE,51000021,11719,HC TRIM NAILS NONDYSTROPHIC FAC,510,1 ,$148.35 ,$97.91 ,$2.25 ,$148.35 ,$2.25 ,$144.00 ,$114.00 ,$56.10 ,$89.01 ,$126.10 ,$103.85 ,$2.25 ,$2.25 ,$140.93 ,$112.75 ,$111.26 ,$108.00 ,$126.10 ,$56.10 ,$108.00 ,$108.00 ,$103.85 ,$90.35 ,$2.25 ,$56.10 ,$54.98 ,$112.20 ,$2.39 ,$126.10 ,$126.23 ,$136.48 ,$103.85 ,$75.24 ,$90.30 ,$90.35 ,$90.30 ,$102.51 ,$133.52 ,$101.35 ,$55.53 ,$117.20 ,$2.39 ,$87.53 ,$87.53 ,$54.98 ,$87.53 ,$106.81 ,$91.98 ,$106.81 ,$106.81 ,$118.68 
ST NICHOLAS HOSPITAL - ACUTE,51000023,11720,HC DEBR NAIL(S) UP TO 5,510,1 ,$111.55 ,$73.62 ,$2.25 ,$126.23 ,$2.25 ,$111.55 ,$111.55 ,$56.10 ,$66.93 ,$94.82 ,$78.09 ,$2.25 ,$2.25 ,$105.97 ,$84.78 ,$83.66 ,$108.00 ,$94.82 ,$56.10 ,$108.00 ,$108.00 ,$78.09 ,$67.93 ,$2.25 ,$56.10 ,$54.98 ,$111.55 ,$2.39 ,$94.82 ,$126.23 ,$102.63 ,$78.09 ,$56.58 ,$67.90 ,$67.93 ,$67.90 ,$77.08 ,$100.40 ,$76.21 ,$55.53 ,$88.12 ,$2.39 ,$65.81 ,$65.81 ,$54.98 ,$65.81 ,$80.32 ,$69.16 ,$80.32 ,$80.32 ,$89.24 
ST NICHOLAS HOSPITAL - ACUTE,51000024,11721,HC DEBR NAIL(S) 6 OR MORE,510,1 ,$148.35 ,$97.91 ,$2.25 ,$148.35 ,$2.25 ,$144.00 ,$114.00 ,$56.10 ,$89.01 ,$126.10 ,$103.85 ,$2.25 ,$2.25 ,$140.93 ,$112.75 ,$111.26 ,$108.00 ,$126.10 ,$56.10 ,$108.00 ,$108.00 ,$103.85 ,$90.35 ,$2.25 ,$56.10 ,$54.98 ,$112.20 ,$2.39 ,$126.10 ,$126.23 ,$136.48 ,$103.85 ,$75.24 ,$90.30 ,$90.35 ,$90.30 ,$102.51 ,$133.52 ,$101.35 ,$55.53 ,$117.20 ,$2.39 ,$87.53 ,$87.53 ,$54.98 ,$87.53 ,$106.81 ,$91.98 ,$106.81 ,$106.81 ,$118.68 
ST NICHOLAS HOSPITAL - ACUTE,51000025,11750,HC REMOVE NAIL BED FACIL,510,1 ,"$1,362.75 ",$899.42 ,$15.19 ,"$1,362.75 ",$15.19 ,$144.00 ,$114.00 ,$364.12 ,$817.65 ,"$1,158.34 ",$953.93 ,$15.19 ,$15.19 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$108.00 ,"$1,158.34 ",$364.12 ,$108.00 ,$108.00 ,$953.93 ,$829.91 ,$15.19 ,$364.12 ,$356.84 ,$728.24 ,$16.10 ,"$1,158.34 ",$819.26 ,"$1,253.73 ",$953.93 ,$691.19 ,$829.51 ,$829.91 ,$829.51 ,$941.66 ,"$1,226.48 ",$931.03 ,$360.40 ,"$1,076.57 ",$16.10 ,$804.02 ,$804.02 ,$356.84 ,$804.02 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,51000026,15002,HC WND PREP REC ST T/A/L<100,510,1 ,"$1,420.25 ",$937.37 ,$34.96 ,"$3,789.99 ",$34.96 ,$144.00 ,$114.00 ,"$1,684.44 ",$852.15 ,"$1,207.21 ",$994.18 ,$34.96 ,$34.96 ,"$1,349.24 ","$1,079.39 ","$1,065.19 ",$108.00 ,"$1,207.21 ","$1,684.44 ",$108.00 ,$108.00 ,$994.18 ,$864.93 ,$34.96 ,"$1,684.44 ","$1,650.75 ","$1,420.25 ",$37.06 ,"$1,207.21 ","$3,789.99 ","$1,306.63 ",$994.18 ,"$1,420.25 ","$1,420.25 ",$864.93 ,"$1,420.25 ",$981.39 ,"$1,278.23 ",$970.31 ,"$1,667.25 ","$1,122.00 ",$37.06 ,$837.95 ,$837.95 ,"$1,650.75 ",$837.95 ,"$1,022.58 ",$880.56 ,"$1,022.58 ","$1,022.58 ","$1,136.20 "
ST NICHOLAS HOSPITAL - ACUTE,51000027,15004,HC WND PREP REC ST F/N/H/F/G<100,510,1 ,"$1,219.00 ",$804.54 ,$34.96 ,"$1,275.77 ",$34.96 ,$144.00 ,$114.00 ,$567.01 ,$731.40 ,"$1,036.15 ",$853.30 ,$34.96 ,$34.96 ,"$1,158.05 ",$926.44 ,$914.25 ,$108.00 ,"$1,036.15 ",$567.01 ,$108.00 ,$108.00 ,$853.30 ,$742.37 ,$34.96 ,$567.01 ,$555.67 ,"$1,134.02 ",$37.06 ,"$1,036.15 ","$1,275.77 ","$1,121.48 ",$853.30 ,$618.28 ,$742.01 ,$742.37 ,$742.01 ,$842.33 ,"$1,097.10 ",$832.82 ,$561.23 ,$963.01 ,$37.06 ,$719.21 ,$719.21 ,$555.67 ,$719.21 ,$877.68 ,$755.78 ,$877.68 ,$877.68 ,$975.20 
ST NICHOLAS HOSPITAL - ACUTE,51000028,15100,HC AUTOGRPH T A L 100SQCM< FAC,510,1 ,"$4,596.55 ","$3,033.72 ",$68.72 ,"$4,596.55 ",$68.72 ,$144.00 ,$114.00 ,"$1,684.44 ","$2,757.93 ","$3,907.07 ","$3,217.59 ",$68.72 ,$68.72 ,"$4,366.72 ","$3,493.38 ","$3,447.41 ",$108.00 ,"$3,907.07 ","$1,684.44 ",$108.00 ,$108.00 ,"$3,217.59 ","$2,799.30 ",$68.72 ,"$1,684.44 ","$1,650.75 ","$3,368.88 ",$72.84 ,"$3,907.07 ","$3,789.99 ","$4,228.83 ","$3,217.59 ","$1,998.41 ","$2,497.74 ","$2,799.30 ","$2,497.74 ","$3,176.22 ","$4,136.90 ","$3,140.36 ","$1,667.25 ","$3,631.27 ",$72.84 ,"$2,711.96 ","$2,711.96 ","$1,650.75 ","$2,711.96 ","$3,309.52 ","$2,849.86 ","$3,309.52 ","$3,309.52 ","$3,677.24 "
ST NICHOLAS HOSPITAL - ACUTE,51000044,15786,HC ABRASION LESION SINGLE,510,1 ,$358.80 ,$236.81 ,$5.80 ,$396.55 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$215.28 ,$304.98 ,$251.16 ,$5.80 ,$5.80 ,$340.86 ,$272.69 ,$269.10 ,$108.00 ,$304.98 ,$176.25 ,$108.00 ,$108.00 ,$251.16 ,$218.51 ,$5.80 ,$176.25 ,$172.72 ,$352.50 ,$6.15 ,$304.98 ,$396.55 ,$330.10 ,$251.16 ,$181.98 ,$218.40 ,$218.51 ,$218.40 ,$247.93 ,$322.92 ,$245.13 ,$174.45 ,$283.45 ,$6.15 ,$211.69 ,$211.69 ,$172.72 ,$211.69 ,$258.34 ,$222.46 ,$258.34 ,$258.34 ,$287.04 
ST NICHOLAS HOSPITAL - ACUTE,51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$731.40 ,$482.72 ,$10.04 ,$731.40 ,$10.04 ,$144.00 ,$114.00 ,$324.64 ,$438.84 ,$621.69 ,$511.98 ,$10.04 ,$10.04 ,$694.83 ,$555.86 ,$548.55 ,$108.00 ,$621.69 ,$324.64 ,$108.00 ,$108.00 ,$511.98 ,$445.42 ,$10.04 ,$324.64 ,$318.15 ,$649.28 ,$10.64 ,$621.69 ,$730.43 ,$672.89 ,$511.98 ,$370.97 ,$445.20 ,$445.42 ,$445.20 ,$505.40 ,$658.26 ,$499.69 ,$321.33 ,$577.81 ,$10.64 ,$431.53 ,$431.53 ,$318.15 ,$431.53 ,$526.61 ,$453.47 ,$526.61 ,$526.61 ,$585.12 
ST NICHOLAS HOSPITAL - ACUTE,51000052,29445,HC APPL CAST LEG RIGID CONTACT FAC,510,1 ,$768.20 ,$507.01 ,$6.17 ,$768.20 ,$6.17 ,$144.00 ,$114.00 ,$234.15 ,$460.92 ,$652.97 ,$537.74 ,$6.17 ,$6.17 ,$729.79 ,$583.83 ,$576.15 ,$108.00 ,$652.97 ,$234.15 ,$108.00 ,$108.00 ,$537.74 ,$467.83 ,$6.17 ,$234.15 ,$229.47 ,$468.30 ,$6.54 ,$652.97 ,$526.84 ,$706.74 ,$537.74 ,$389.63 ,$467.60 ,$467.83 ,$467.60 ,$530.83 ,$691.38 ,$524.83 ,$231.76 ,$606.88 ,$6.54 ,$453.24 ,$453.24 ,$229.47 ,$453.24 ,$553.10 ,$476.28 ,$553.10 ,$553.10 ,$614.56 
ST NICHOLAS HOSPITAL - ACUTE,51000053,29580,HC APPLY UNNA BOOT,510,1 ,$384.10 ,$253.51 ,$9.25 ,$480.13 ,$9.25 ,$144.00 ,$114.00 ,$213.39 ,$230.46 ,$326.49 ,$268.87 ,$9.25 ,$9.25 ,$364.90 ,$291.92 ,$288.08 ,$108.00 ,$326.49 ,$213.39 ,$108.00 ,$108.00 ,$268.87 ,$233.92 ,$9.25 ,$213.39 ,$209.12 ,$384.10 ,$9.81 ,$326.49 ,$480.13 ,$353.37 ,$268.87 ,$194.82 ,$233.80 ,$233.92 ,$233.80 ,$265.41 ,$345.69 ,$262.42 ,$211.21 ,$303.44 ,$9.81 ,$226.62 ,$226.62 ,$209.12 ,$226.62 ,$276.55 ,$238.14 ,$276.55 ,$276.55 ,$307.28 
ST NICHOLAS HOSPITAL - ACUTE,51000053,29580,HC APPLY UNNA BOOT,510,1 ,$384.10 ,$253.51 ,$9.25 ,$480.13 ,$9.25 ,$144.00 ,$114.00 ,$213.39 ,$230.46 ,$326.49 ,$268.87 ,$9.25 ,$9.25 ,$364.90 ,$291.92 ,$288.08 ,$108.00 ,$326.49 ,$213.39 ,$108.00 ,$108.00 ,$268.87 ,$233.92 ,$9.25 ,$213.39 ,$209.12 ,$384.10 ,$9.81 ,$326.49 ,$480.13 ,$353.37 ,$268.87 ,$194.82 ,$233.80 ,$233.92 ,$233.80 ,$265.41 ,$345.69 ,$262.42 ,$211.21 ,$303.44 ,$9.81 ,$226.62 ,$226.62 ,$209.12 ,$226.62 ,$276.55 ,$238.14 ,$276.55 ,$276.55 ,$307.28 
ST NICHOLAS HOSPITAL - ACUTE,51000055,29581,HC APPLY MULTI COMP LOWER LEG FAC,510,1 ,$396.75 ,$261.86 ,$9.25 ,$480.13 ,$9.25 ,$144.00 ,$114.00 ,$213.39 ,$238.05 ,$337.24 ,$277.73 ,$9.25 ,$9.25 ,$376.91 ,$301.53 ,$297.56 ,$108.00 ,$337.24 ,$213.39 ,$108.00 ,$108.00 ,$277.73 ,$241.62 ,$9.25 ,$213.39 ,$209.12 ,$396.75 ,$9.81 ,$337.24 ,$480.13 ,$365.01 ,$277.73 ,$201.23 ,$241.50 ,$241.62 ,$241.50 ,$274.15 ,$357.08 ,$271.06 ,$211.21 ,$313.43 ,$9.81 ,$234.08 ,$234.08 ,$209.12 ,$234.08 ,$285.66 ,$245.99 ,$285.66 ,$285.66 ,$317.40 
ST NICHOLAS HOSPITAL - ACUTE,51000055,29581,HC APPLY MULTI COMP LOWER LEG FAC,510,1 ,$396.75 ,$261.86 ,$9.25 ,$480.13 ,$9.25 ,$144.00 ,$114.00 ,$213.39 ,$238.05 ,$337.24 ,$277.73 ,$9.25 ,$9.25 ,$376.91 ,$301.53 ,$297.56 ,$108.00 ,$337.24 ,$213.39 ,$108.00 ,$108.00 ,$277.73 ,$241.62 ,$9.25 ,$213.39 ,$209.12 ,$396.75 ,$9.81 ,$337.24 ,$480.13 ,$365.01 ,$277.73 ,$201.23 ,$241.50 ,$241.62 ,$241.50 ,$274.15 ,$357.08 ,$271.06 ,$211.21 ,$313.43 ,$9.81 ,$234.08 ,$234.08 ,$209.12 ,$234.08 ,$285.66 ,$245.99 ,$285.66 ,$285.66 ,$317.40 
ST NICHOLAS HOSPITAL - ACUTE,51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$128.80 ,$85.01 ,$1.59 ,$148.16 ,$1.59 ,$88.28 ,$88.28 ,$65.85 ,$77.28 ,$109.48 , N/A ,$1.59 ,$1.59 ,$122.36 ,$97.89 ,$96.60 ,$83.72 ,$109.48 ,$65.85 ,$83.72 ,$83.72 ,$90.16 ,$78.44 ,$1.59 ,$65.85 ,$64.53 ,$128.80 ,$1.69 ,$109.48 ,$148.16 ,$118.50 ,$90.16 ,$65.33 ,$78.40 ,$78.44 ,$78.40 ,$89.00 ,$115.92 ,$88.00 ,$65.18 ,$101.75 ,$1.69 ,$63.11 ,$63.11 ,$64.53 ,$63.11 ,$92.74 ,$79.86 ,$92.74 ,$92.74 ,$103.04 
ST NICHOLAS HOSPITAL - ACUTE,51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$257.60 ,$170.02 ,$1.59 ,$453.63 ,$1.59 ,$176.56 ,$176.56 ,$201.61 ,$154.56 ,$218.96 , N/A ,$1.59 ,$1.59 ,$244.72 ,$195.78 ,$193.20 ,$167.44 ,$218.96 ,$201.61 ,$167.44 ,$167.44 ,$180.32 ,$156.88 ,$1.59 ,$201.61 ,$197.58 ,$257.60 ,$1.69 ,$218.96 ,$453.63 ,$236.99 ,$180.32 ,$130.65 ,$156.80 ,$156.88 ,$156.80 ,$178.00 ,$231.84 ,$175.99 ,$199.56 ,$203.50 ,$1.69 ,$126.22 ,$126.22 ,$197.58 ,$126.22 ,$185.47 ,$159.71 ,$185.47 ,$185.47 ,$206.08 
ST NICHOLAS HOSPITAL - ACUTE,51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$205.85 ,$135.86 ,$1.59 ,$205.85 ,$1.59 ,$141.09 ,$141.09 ,$41.35 ,$123.51 ,$174.97 , N/A ,$1.59 ,$1.59 ,$195.56 ,$156.45 ,$154.39 ,$133.80 ,$174.97 ,$41.35 ,$133.80 ,$133.80 ,$144.10 ,$125.36 ,$1.59 ,$41.35 ,$40.52 ,$82.70 ,$1.69 ,$174.97 ,$93.04 ,$189.38 ,$144.10 ,$104.41 ,$125.30 ,$125.36 ,$125.30 ,$142.24 ,$185.27 ,$140.64 ,$40.92 ,$162.62 ,$1.69 ,$100.87 ,$100.87 ,$40.52 ,$100.87 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$205.85 ,$135.86 ,$1.59 ,$205.85 ,$1.59 ,$141.09 ,$141.09 , N/A ,$123.51 ,$174.97 , N/A ,$1.59 ,$1.59 ,$195.56 ,$156.45 ,$154.39 ,$133.80 ,$174.97 , N/A ,$133.80 ,$133.80 ,$144.10 ,$125.36 ,$1.59 , N/A , N/A , N/A ,$1.69 ,$174.97 , N/A ,$189.38 ,$144.10 ,$104.41 ,$125.30 ,$125.36 ,$125.30 ,$142.24 ,$185.27 ,$140.64 , N/A ,$162.62 ,$1.69 ,$100.87 ,$100.87 , N/A ,$100.87 ,$148.21 ,$127.63 ,$148.21 ,$148.21 ,$164.68 
ST NICHOLAS HOSPITAL - ACUTE,51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$146.74 ,$96.85 ,$1.59 ,$146.74 ,$1.59 ,$144.00 ,$114.00 ,$56.10 ,$88.04 ,$124.73 , N/A ,$1.59 ,$1.59 ,$139.40 ,$111.52 ,$110.06 ,$108.00 ,$124.73 ,$56.10 ,$108.00 ,$108.00 ,$102.72 ,$89.36 ,$1.59 ,$56.10 ,$54.98 ,$112.20 ,$1.69 ,$124.73 ,$126.23 ,$135.00 ,$102.72 ,$74.43 ,$89.32 ,$89.36 ,$89.32 ,$101.40 ,$132.07 ,$100.25 ,$55.53 ,$115.92 ,$1.69 ,$86.58 ,$86.58 ,$54.98 ,$86.58 ,$105.65 ,$90.98 ,$105.65 ,$105.65 ,$117.39 
ST NICHOLAS HOSPITAL - ACUTE,51000072,97597,HC DEBR SKIN PART THICKNESS <20CM FAC,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000078,97597,HC DEBR SKIN INTL CAST REMOVAL/APPLY FACIL,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000079,97597,HC DEBR SKIN INTL 20CM BIL UNNA FACIL,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000080,97597,HC DEBR SKIN INTL 20CM NWPT/UNNA FAC,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000083,97597,HC DEBR SKIN INTL 20CM WRAP BILAT FAC,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000084,97597,HC DEBR SKIN INTL 20CM WRAP FACILITY,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000086,97597,HC DEBR SKIN INTL 20CM/UNNA FACILITY,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000087,97597,HC DEBR SKIN INTL NWPT 20CM FACIL,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000088,G0296,HC CLINIC VISIT CONSULT LOW DOSE LUNG SCREEN,510,1 ,$118.45 ,$78.18 ,$4.33 ,$166.57 ,$4.33 ,$118.45 ,$114.00 ,$74.03 ,$71.07 ,$100.68 ,$82.92 ,$4.33 ,$4.33 ,$112.53 ,$90.02 ,$88.84 ,$108.00 ,$100.68 ,$74.03 ,$108.00 ,$108.00 ,$82.92 ,$72.14 ,$4.33 ,$74.03 ,$72.55 ,$118.45 ,$4.59 ,$100.68 ,$166.57 ,$108.97 ,$82.92 ,$60.08 ,$72.10 ,$72.14 ,$72.10 ,$81.85 ,$106.61 ,$80.93 ,$73.27 ,$93.58 ,$4.59 ,$69.89 ,$69.89 ,$72.55 ,$69.89 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,51000101,99202,HC CLINIC VISIT LIMITED NEW,510,1 ,$284.05 ,$187.47 ,$4.33 ,$284.05 ,$4.33 ,$144.00 ,$114.00 , N/A ,$170.43 ,$241.44 ,$198.84 ,$4.33 ,$4.33 ,$269.85 ,$215.88 ,$213.04 ,$108.00 ,$241.44 , N/A ,$108.00 ,$108.00 ,$198.84 ,$172.99 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$241.44 , N/A ,$261.33 ,$198.84 ,$144.07 ,$172.90 ,$172.99 ,$172.90 ,$196.28 ,$255.65 ,$194.06 , N/A ,$224.40 ,$4.59 ,$167.59 ,$167.59 , N/A ,$167.59 ,$204.52 ,$176.11 ,$204.52 ,$204.52 ,$227.24 
ST NICHOLAS HOSPITAL - ACUTE,51000104,99203,HC CLINIC VISIT INTERM NEW,510,1 ,$343.85 ,$226.94 ,$4.33 ,$343.85 ,$4.33 ,$144.00 ,$114.00 , N/A ,$206.31 ,$292.27 ,$240.70 ,$4.33 ,$4.33 ,$326.66 ,$261.33 ,$257.89 ,$108.00 ,$292.27 , N/A ,$108.00 ,$108.00 ,$240.70 ,$209.40 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$292.27 , N/A ,$316.34 ,$240.70 ,$174.40 ,$209.30 ,$209.40 ,$209.30 ,$237.60 ,$309.47 ,$234.92 , N/A ,$271.64 ,$4.59 ,$202.87 ,$202.87 , N/A ,$202.87 ,$247.57 ,$213.19 ,$247.57 ,$247.57 ,$275.08 
ST NICHOLAS HOSPITAL - ACUTE,51000109,99204,HC CLINIC VISIT COMPLEX NEW,510,1 ,$391.00 ,$258.06 ,$4.33 ,$391.00 ,$4.33 ,$144.00 ,$114.00 , N/A ,$234.60 ,$332.35 ,$273.70 ,$4.33 ,$4.33 ,$371.45 ,$297.16 ,$293.25 ,$108.00 ,$332.35 , N/A ,$108.00 ,$108.00 ,$273.70 ,$238.12 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$332.35 , N/A ,$359.72 ,$273.70 ,$198.32 ,$238.00 ,$238.12 ,$238.00 ,$270.18 ,$351.90 ,$267.13 , N/A ,$308.89 ,$4.59 ,$230.69 ,$230.69 , N/A ,$230.69 ,$281.52 ,$242.42 ,$281.52 ,$281.52 ,$312.80 
ST NICHOLAS HOSPITAL - ACUTE,51000113,99205,HC CLINIC VISIT COMPREH NEW,510,1 ,$473.80 ,$312.71 ,$4.33 ,$473.80 ,$4.33 ,$144.00 ,$114.00 , N/A ,$284.28 ,$402.73 ,$331.66 ,$4.33 ,$4.33 ,$450.11 ,$360.09 ,$355.35 ,$108.00 ,$402.73 , N/A ,$108.00 ,$108.00 ,$331.66 ,$288.54 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$402.73 , N/A ,$435.90 ,$331.66 ,$240.31 ,$288.40 ,$288.54 ,$288.40 ,$327.40 ,$426.42 ,$323.70 , N/A ,$374.30 ,$4.59 ,$279.54 ,$279.54 , N/A ,$279.54 ,$341.14 ,$293.76 ,$341.14 ,$341.14 ,$379.04 
ST NICHOLAS HOSPITAL - ACUTE,51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$261.05 ,$172.29 ,$4.33 ,$261.05 ,$4.33 ,$144.00 ,$114.00 , N/A ,$156.63 ,$221.89 ,$182.74 ,$4.33 ,$4.33 ,$248.00 ,$198.40 ,$195.79 ,$108.00 ,$221.89 , N/A ,$108.00 ,$108.00 ,$182.74 ,$158.98 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$221.89 , N/A ,$240.17 ,$182.74 ,$132.40 ,$158.90 ,$158.98 ,$158.90 ,$180.39 ,$234.95 ,$178.35 , N/A ,$206.23 ,$4.59 ,$154.02 ,$154.02 , N/A ,$154.02 ,$187.96 ,$161.85 ,$187.96 ,$187.96 ,$208.84 
ST NICHOLAS HOSPITAL - ACUTE,51000115,99211,HC LACTATION EST PAT-BRIEF,510,1 ,$261.05 ,$172.29 ,$4.33 ,$261.05 ,$4.33 ,$144.00 ,$114.00 , N/A ,$156.63 ,$221.89 ,$182.74 ,$4.33 ,$4.33 ,$248.00 ,$198.40 ,$195.79 ,$108.00 ,$221.89 , N/A ,$108.00 ,$108.00 ,$182.74 ,$158.98 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$221.89 , N/A ,$240.17 ,$182.74 ,$132.40 ,$158.90 ,$158.98 ,$158.90 ,$180.39 ,$234.95 ,$178.35 , N/A ,$206.23 ,$4.59 ,$154.02 ,$154.02 , N/A ,$154.02 ,$187.96 ,$161.85 ,$187.96 ,$187.96 ,$208.84 
ST NICHOLAS HOSPITAL - ACUTE,51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$272.55 ,$179.88 ,$4.33 ,$272.55 ,$4.33 ,$144.00 ,$114.00 , N/A ,$163.53 ,$231.67 ,$190.79 ,$4.33 ,$4.33 ,$258.92 ,$207.14 ,$204.41 ,$108.00 ,$231.67 , N/A ,$108.00 ,$108.00 ,$190.79 ,$165.98 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$231.67 , N/A ,$250.75 ,$190.79 ,$138.24 ,$165.90 ,$165.98 ,$165.90 ,$188.33 ,$245.30 ,$186.21 , N/A ,$215.31 ,$4.59 ,$160.80 ,$160.80 , N/A ,$160.80 ,$196.24 ,$168.98 ,$196.24 ,$196.24 ,$218.04 
ST NICHOLAS HOSPITAL - ACUTE,51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$331.20 ,$218.59 ,$4.33 ,$331.20 ,$4.33 ,$144.00 ,$114.00 , N/A ,$198.72 ,$281.52 ,$231.84 ,$4.33 ,$4.33 ,$314.64 ,$251.71 ,$248.40 ,$108.00 ,$281.52 , N/A ,$108.00 ,$108.00 ,$231.84 ,$201.70 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$281.52 , N/A ,$304.70 ,$231.84 ,$167.98 ,$201.60 ,$201.70 ,$201.60 ,$228.86 ,$298.08 ,$226.28 , N/A ,$261.65 ,$4.59 ,$195.41 ,$195.41 , N/A ,$195.41 ,$238.46 ,$205.34 ,$238.46 ,$238.46 ,$264.96 
ST NICHOLAS HOSPITAL - ACUTE,51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$366.85 ,$242.12 ,$4.33 ,$366.85 ,$4.33 ,$144.00 ,$114.00 , N/A ,$220.11 ,$311.82 ,$256.80 ,$4.33 ,$4.33 ,$348.51 ,$278.81 ,$275.14 ,$108.00 ,$311.82 , N/A ,$108.00 ,$108.00 ,$256.80 ,$223.41 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$311.82 , N/A ,$337.50 ,$256.80 ,$186.07 ,$223.30 ,$223.41 ,$223.30 ,$253.49 ,$330.17 ,$250.63 , N/A ,$289.81 ,$4.59 ,$216.44 ,$216.44 , N/A ,$216.44 ,$264.13 ,$227.45 ,$264.13 ,$264.13 ,$293.48 
ST NICHOLAS HOSPITAL - ACUTE,51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$462.30 ,$305.12 ,$4.33 ,$462.30 ,$4.33 ,$144.00 ,$114.00 , N/A ,$277.38 ,$392.96 ,$323.61 ,$4.33 ,$4.33 ,$439.19 ,$351.35 ,$346.73 ,$108.00 ,$392.96 , N/A ,$108.00 ,$108.00 ,$323.61 ,$281.54 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$392.96 , N/A ,$425.32 ,$323.61 ,$234.48 ,$281.40 ,$281.54 ,$281.40 ,$319.45 ,$416.07 ,$315.84 , N/A ,$365.22 ,$4.59 ,$272.76 ,$272.76 , N/A ,$272.76 ,$332.86 ,$286.63 ,$332.86 ,$332.86 ,$369.84 
ST NICHOLAS HOSPITAL - ACUTE,51000145,G0127,HC TRIM NAILS DYSTROPHIC FAC,510,1 ,$136.85 ,$90.32 ,$2.25 ,$136.85 ,$2.25 ,$136.85 ,$114.00 ,$56.10 ,$82.11 ,$116.32 ,$95.80 ,$2.25 ,$2.25 ,$130.01 ,$104.01 ,$102.64 ,$108.00 ,$116.32 ,$56.10 ,$108.00 ,$108.00 ,$95.80 ,$83.34 ,$2.25 ,$56.10 ,$54.98 ,$112.20 ,$2.39 ,$116.32 ,$126.23 ,$125.90 ,$95.80 ,$69.41 ,$83.30 ,$83.34 ,$83.30 ,$94.56 ,$123.17 ,$93.50 ,$55.53 ,$108.11 ,$2.39 ,$80.74 ,$80.74 ,$54.98 ,$80.74 ,$98.53 ,$84.85 ,$98.53 ,$98.53 ,$109.48 
ST NICHOLAS HOSPITAL - ACUTE,51000147,P9612,HC CATH FOR SPECIMEN COLLECTION,300,1 ,$54.05 ,$35.67 ,$0.08 ,$54.05 ,$0.08 ,$10.50 ,$10.50 ,$8.57 ,$32.43 ,$45.94 ,$37.84 ,$0.08 ,$0.08 ,$51.35 ,$41.08 ,$40.54 ,$14.57 ,$45.94 ,$8.57 ,$14.57 ,$14.57 ,$37.84 ,$32.92 ,$0.08 ,$8.57 ,$8.40 ,$17.14 ,$0.08 ,$45.94 ,$19.28 ,$49.73 ,$37.84 ,$10.99 ,$10.99 ,$32.92 ,$10.99 ,$37.35 ,$48.65 ,$36.93 ,$8.49 ,$42.70 ,$0.08 ,$3.60 ,$3.60 ,$8.40 ,$3.60 ,$38.92 ,$33.51 ,$38.92 ,$38.92 ,$43.24 
ST NICHOLAS HOSPITAL - ACUTE,51000159,16020,HC BURN DRS  AND /OR DEBRID <5% FACIL,510,1 ,$470.35 ,$310.43 ,$6.41 ,$470.35 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$282.21 ,$399.80 ,$329.25 ,$6.41 ,$6.41 ,$446.83 ,$357.47 ,$352.76 ,$108.00 ,$399.80 ,$176.25 ,$108.00 ,$108.00 ,$329.25 ,$286.44 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$399.80 ,$396.55 ,$432.72 ,$329.25 ,$238.56 ,$286.30 ,$286.44 ,$286.30 ,$325.01 ,$423.32 ,$321.34 ,$174.45 ,$371.58 ,$6.79 ,$277.51 ,$277.51 ,$172.72 ,$277.51 ,$338.65 ,$291.62 ,$338.65 ,$338.65 ,$376.28 
ST NICHOLAS HOSPITAL - ACUTE,51000160,16020,HC BURN DR AND OR DEBRD NWPT <5% FACILITY,510,1 ,$470.35 ,$310.43 ,$6.41 ,$470.35 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$282.21 ,$399.80 ,$329.25 ,$6.41 ,$6.41 ,$446.83 ,$357.47 ,$352.76 ,$108.00 ,$399.80 ,$176.25 ,$108.00 ,$108.00 ,$329.25 ,$286.44 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$399.80 ,$396.55 ,$432.72 ,$329.25 ,$238.56 ,$286.30 ,$286.44 ,$286.30 ,$325.01 ,$423.32 ,$321.34 ,$174.45 ,$371.58 ,$6.79 ,$277.51 ,$277.51 ,$172.72 ,$277.51 ,$338.65 ,$291.62 ,$338.65 ,$338.65 ,$376.28 
ST NICHOLAS HOSPITAL - ACUTE,51000161,17110,HC DESTRUCT BENIGN LESION <15 FACIL,510,1 ,$186.30 ,$122.96 ,$5.80 ,$396.55 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$111.78 ,$158.36 ,$130.41 ,$5.80 ,$5.80 ,$176.99 ,$141.59 ,$139.73 ,$108.00 ,$158.36 ,$176.25 ,$108.00 ,$108.00 ,$130.41 ,$113.46 ,$5.80 ,$176.25 ,$172.72 ,$186.30 ,$6.15 ,$158.36 ,$396.55 ,$171.40 ,$130.41 ,$94.49 ,$113.40 ,$113.46 ,$113.40 ,$128.73 ,$167.67 ,$127.28 ,$174.45 ,$147.18 ,$6.15 ,$109.92 ,$109.92 ,$172.72 ,$109.92 ,$134.14 ,$115.51 ,$134.14 ,$134.14 ,$149.04 
ST NICHOLAS HOSPITAL - ACUTE,51000162,97597,HC AWC WITH CHEM CAUTERY,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000164,17250,HC CHEM CAUTERY/NWPT FACILITY,510,1 ,$446.20 ,$294.49 ,$5.80 ,$446.20 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$5.80 ,$5.80 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$5.80 ,$176.25 ,$172.72 ,$352.50 ,$6.15 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.15 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000169,17250,HC CHEM CAUTERY FACILITY,510,1 ,$446.20 ,$294.49 ,$5.80 ,$446.20 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$5.80 ,$5.80 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$5.80 ,$176.25 ,$172.72 ,$352.50 ,$6.15 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.15 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000170,97597,HC AWC>20SQCM/CAUT/UNNA FACIL,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$235.75 ,$155.60 ,$2.75 ,$254.98 ,$2.75 ,$144.00 ,$114.00 ,$113.32 ,$141.45 ,$200.39 ,$165.03 ,$2.75 ,$2.75 ,$223.96 ,$179.17 ,$176.81 ,$108.00 ,$200.39 ,$113.32 ,$108.00 ,$108.00 ,$165.03 ,$143.57 ,$2.75 ,$113.32 ,$111.05 ,$226.64 ,$2.92 ,$200.39 ,$254.98 ,$216.89 ,$165.03 ,$119.57 ,$143.50 ,$143.57 ,$143.50 ,$162.90 ,$212.18 ,$161.06 ,$112.16 ,$186.24 ,$2.92 ,$139.09 ,$139.09 ,$111.05 ,$139.09 ,$169.74 ,$146.17 ,$169.74 ,$169.74 ,$188.60 
ST NICHOLAS HOSPITAL - ACUTE,51000172,51702,HC CATH BLADDER SMP,510,1 ,$235.75 ,$155.60 ,$2.75 ,$254.98 ,$2.75 ,$144.00 ,$114.00 ,$113.32 ,$141.45 ,$200.39 ,$165.03 ,$2.75 ,$2.75 ,$223.96 ,$179.17 ,$176.81 ,$108.00 ,$200.39 ,$113.32 ,$108.00 ,$108.00 ,$165.03 ,$143.57 ,$2.75 ,$113.32 ,$111.05 ,$226.64 ,$2.92 ,$200.39 ,$254.98 ,$216.89 ,$165.03 ,$119.57 ,$143.50 ,$143.57 ,$143.50 ,$162.90 ,$212.18 ,$161.06 ,$112.16 ,$186.24 ,$2.92 ,$139.09 ,$139.09 ,$111.05 ,$139.09 ,$169.74 ,$146.17 ,$169.74 ,$169.74 ,$188.60 
ST NICHOLAS HOSPITAL - ACUTE,51000173,51703,HC CATH BLADDER CPLX,510,1 ,$420.90 ,$277.79 ,$2.75 ,$420.90 ,$2.75 ,$144.00 ,$114.00 ,$141.94 ,$252.54 ,$357.77 ,$294.63 ,$2.75 ,$2.75 ,$399.86 ,$319.88 ,$315.68 ,$108.00 ,$357.77 ,$141.94 ,$108.00 ,$108.00 ,$294.63 ,$256.33 ,$2.75 ,$141.94 ,$139.10 ,$283.88 ,$2.92 ,$357.77 ,$319.36 ,$387.23 ,$294.63 ,$213.48 ,$256.20 ,$256.33 ,$256.20 ,$290.84 ,$378.81 ,$287.56 ,$140.49 ,$332.51 ,$2.92 ,$248.33 ,$248.33 ,$139.10 ,$248.33 ,$303.05 ,$260.96 ,$303.05 ,$303.05 ,$336.72 
ST NICHOLAS HOSPITAL - ACUTE,51000175,94780,HC CARSEAT ANALYSIS FIRST 60MIN,510,1 ,$190.00 ,$125.40 ,$1.89 ,$190.00 ,$1.89 ,$144.00 ,$114.00 ,$33.15 ,$114.00 ,$161.50 ,$133.00 ,$1.89 ,$1.89 ,$180.50 ,$144.40 ,$142.50 ,$108.00 ,$161.50 ,$33.15 ,$108.00 ,$108.00 ,$133.00 ,$115.71 ,$1.89 ,$33.15 ,$32.49 ,$66.30 ,$2.00 ,$161.50 ,$74.58 ,$174.80 ,$133.00 ,$96.37 ,$115.65 ,$115.71 ,$115.65 ,$131.29 ,$171.00 ,$129.81 ,$32.81 ,$150.10 ,$2.00 ,$112.10 ,$112.10 ,$32.49 ,$112.10 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,51000176,99213,HC CHANGE EXER ASSESS EVAL,510,1 ,$154.10 ,$101.71 ,$4.33 ,$154.10 ,$4.33 ,$144.00 ,$114.00 , N/A ,$92.46 ,$130.99 ,$107.87 ,$4.33 ,$4.33 ,$146.40 ,$117.12 ,$115.58 ,$108.00 ,$130.99 , N/A ,$108.00 ,$108.00 ,$107.87 ,$93.85 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$130.99 , N/A ,$141.77 ,$107.87 ,$78.16 ,$93.80 ,$93.85 ,$93.80 ,$106.48 ,$138.69 ,$105.28 , N/A ,$121.74 ,$4.59 ,$90.92 ,$90.92 , N/A ,$90.92 ,$110.95 ,$95.54 ,$110.95 ,$110.95 ,$123.28 
ST NICHOLAS HOSPITAL - ACUTE,51000184,99211,HC L AND D OUTPATIENT TREATMENT,510,1 ,$248.40 ,$163.94 ,$4.33 ,$248.40 ,$4.33 ,$144.00 ,$114.00 , N/A ,$149.04 ,$211.14 ,$173.88 ,$4.33 ,$4.33 ,$235.98 ,$188.78 ,$186.30 ,$108.00 ,$211.14 , N/A ,$108.00 ,$108.00 ,$173.88 ,$151.28 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$211.14 , N/A ,$228.53 ,$173.88 ,$125.99 ,$151.20 ,$151.28 ,$151.20 ,$171.64 ,$223.56 ,$169.71 , N/A ,$196.24 ,$4.59 ,$146.56 ,$146.56 , N/A ,$146.56 ,$178.85 ,$154.01 ,$178.85 ,$178.85 ,$198.72 
ST NICHOLAS HOSPITAL - ACUTE,51000187,99212,HC LACTATION EST PAT-LIMITED,510,1 ,$272.55 ,$179.88 ,$4.33 ,$272.55 ,$4.33 ,$144.00 ,$114.00 , N/A ,$163.53 ,$231.67 ,$190.79 ,$4.33 ,$4.33 ,$258.92 ,$207.14 ,$204.41 ,$108.00 ,$231.67 , N/A ,$108.00 ,$108.00 ,$190.79 ,$165.98 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$231.67 , N/A ,$250.75 ,$190.79 ,$138.24 ,$165.90 ,$165.98 ,$165.90 ,$188.33 ,$245.30 ,$186.21 , N/A ,$215.31 ,$4.59 ,$160.80 ,$160.80 , N/A ,$160.80 ,$196.24 ,$168.98 ,$196.24 ,$196.24 ,$218.04 
ST NICHOLAS HOSPITAL - ACUTE,51000188,99213,HC LACTATION EST PAT-INTERM,510,1 ,$331.20 ,$218.59 ,$4.33 ,$331.20 ,$4.33 ,$144.00 ,$114.00 , N/A ,$198.72 ,$281.52 ,$231.84 ,$4.33 ,$4.33 ,$314.64 ,$251.71 ,$248.40 ,$108.00 ,$281.52 , N/A ,$108.00 ,$108.00 ,$231.84 ,$201.70 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$281.52 , N/A ,$304.70 ,$231.84 ,$167.98 ,$201.60 ,$201.70 ,$201.60 ,$228.86 ,$298.08 ,$226.28 , N/A ,$261.65 ,$4.59 ,$195.41 ,$195.41 , N/A ,$195.41 ,$238.46 ,$205.34 ,$238.46 ,$238.46 ,$264.96 
ST NICHOLAS HOSPITAL - ACUTE,51000189,99214,HC LACTATION EST PAT-COMPLEX,510,1 ,$366.85 ,$242.12 ,$4.33 ,$366.85 ,$4.33 ,$144.00 ,$114.00 , N/A ,$220.11 ,$311.82 ,$256.80 ,$4.33 ,$4.33 ,$348.51 ,$278.81 ,$275.14 ,$108.00 ,$311.82 , N/A ,$108.00 ,$108.00 ,$256.80 ,$223.41 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$311.82 , N/A ,$337.50 ,$256.80 ,$186.07 ,$223.30 ,$223.41 ,$223.30 ,$253.49 ,$330.17 ,$250.63 , N/A ,$289.81 ,$4.59 ,$216.44 ,$216.44 , N/A ,$216.44 ,$264.13 ,$227.45 ,$264.13 ,$264.13 ,$293.48 
ST NICHOLAS HOSPITAL - ACUTE,51000190,99215,HC LACTATION EST PAT-COMPRH,510,1 ,$462.30 ,$305.12 ,$4.33 ,$462.30 ,$4.33 ,$144.00 ,$114.00 , N/A ,$277.38 ,$392.96 ,$323.61 ,$4.33 ,$4.33 ,$439.19 ,$351.35 ,$346.73 ,$108.00 ,$392.96 , N/A ,$108.00 ,$108.00 ,$323.61 ,$281.54 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$392.96 , N/A ,$425.32 ,$323.61 ,$234.48 ,$281.40 ,$281.54 ,$281.40 ,$319.45 ,$416.07 ,$315.84 , N/A ,$365.22 ,$4.59 ,$272.76 ,$272.76 , N/A ,$272.76 ,$332.86 ,$286.63 ,$332.86 ,$332.86 ,$369.84 
ST NICHOLAS HOSPITAL - ACUTE,51000191,99211,HC OP SCHED DRESSING CHANGE,510,1 ,$261.05 ,$172.29 ,$4.33 ,$261.05 ,$4.33 ,$144.00 ,$114.00 , N/A ,$156.63 ,$221.89 ,$182.74 ,$4.33 ,$4.33 ,$248.00 ,$198.40 ,$195.79 ,$108.00 ,$221.89 , N/A ,$108.00 ,$108.00 ,$182.74 ,$158.98 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$221.89 , N/A ,$240.17 ,$182.74 ,$132.40 ,$158.90 ,$158.98 ,$158.90 ,$180.39 ,$234.95 ,$178.35 , N/A ,$206.23 ,$4.59 ,$154.02 ,$154.02 , N/A ,$154.02 ,$187.96 ,$161.85 ,$187.96 ,$187.96 ,$208.84 
ST NICHOLAS HOSPITAL - ACUTE,51000192,99212,HC PEG CHECK OR REMOVAL (NON INCISIONAL),510,1 ,$272.55 ,$179.88 ,$4.33 ,$272.55 ,$4.33 ,$144.00 ,$114.00 , N/A ,$163.53 ,$231.67 ,$190.79 ,$4.33 ,$4.33 ,$258.92 ,$207.14 ,$204.41 ,$108.00 ,$231.67 , N/A ,$108.00 ,$108.00 ,$190.79 ,$165.98 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$231.67 , N/A ,$250.75 ,$190.79 ,$138.24 ,$165.90 ,$165.98 ,$165.90 ,$188.33 ,$245.30 ,$186.21 , N/A ,$215.31 ,$4.59 ,$160.80 ,$160.80 , N/A ,$160.80 ,$196.24 ,$168.98 ,$196.24 ,$196.24 ,$218.04 
ST NICHOLAS HOSPITAL - ACUTE,51000198,29445,HC APPL/REMOVE CAST FACILITY,510,1 ,$768.20 ,$507.01 ,$6.17 ,$768.20 ,$6.17 ,$144.00 ,$114.00 ,$234.15 ,$460.92 ,$652.97 ,$537.74 ,$6.17 ,$6.17 ,$729.79 ,$583.83 ,$576.15 ,$108.00 ,$652.97 ,$234.15 ,$108.00 ,$108.00 ,$537.74 ,$467.83 ,$6.17 ,$234.15 ,$229.47 ,$468.30 ,$6.54 ,$652.97 ,$526.84 ,$706.74 ,$537.74 ,$389.63 ,$467.60 ,$467.83 ,$467.60 ,$530.83 ,$691.38 ,$524.83 ,$231.76 ,$606.88 ,$6.54 ,$453.24 ,$453.24 ,$229.47 ,$453.24 ,$553.10 ,$476.28 ,$553.10 ,$553.10 ,$614.56 
ST NICHOLAS HOSPITAL - ACUTE,51000201,29799,HC REMOVAL REVISION LEGCAST FACILITY,510,1 ,$358.80 ,$236.81 ,$2.42 ,$358.80 ,$2.42 ,$144.00 ,$114.00 ,$142.26 ,$215.28 ,$304.98 ,$251.16 ,$2.42 ,$2.42 ,$340.86 ,$272.69 ,$269.10 ,$108.00 ,$304.98 ,$142.26 ,$108.00 ,$108.00 ,$251.16 ,$218.51 ,$2.42 ,$142.26 ,$139.41 ,$284.52 ,$2.57 ,$304.98 ,$320.09 ,$330.10 ,$251.16 ,$181.98 ,$218.40 ,$218.51 ,$218.40 ,$247.93 ,$322.92 ,$245.13 ,$140.81 ,$283.45 ,$2.57 ,$211.69 ,$211.69 ,$139.41 ,$211.69 ,$258.34 ,$222.46 ,$258.34 ,$258.34 ,$287.04 
ST NICHOLAS HOSPITAL - ACUTE,51000207,52000,HC CYSTOURETHROSCOPY,510,1 ,"$1,675.00 ","$1,105.50 ",$54.25 ,"$1,675.00 ",$54.25 ,$144.00 ,$114.00 ,$610.33 ,"$1,005.00 ","$1,423.75 ","$1,172.50 ",$54.25 ,$54.25 ,"$1,591.25 ","$1,273.00 ","$1,256.25 ",$108.00 ,"$1,423.75 ",$610.33 ,$108.00 ,$108.00 ,"$1,172.50 ","$1,020.08 ",$54.25 ,$610.33 ,$598.12 ,"$1,220.66 ",$57.51 ,"$1,423.75 ","$1,373.25 ","$1,541.00 ","$1,172.50 ","$1,675.00 ","$1,675.00 ","$1,020.08 ","$1,675.00 ","$1,157.43 ","$1,507.50 ","$1,144.36 ",$604.10 ,"$1,323.25 ",$57.51 ,$988.25 ,$988.25 ,$598.12 ,$988.25 ,"$1,206.00 ","$1,038.50 ","$1,206.00 ","$1,206.00 ","$1,340.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000233,57500,HC BIOPSY/EXCISE CERVICAL LESION,510,1 ,"$1,362.75 ",$899.42 ,$17.19 ,"$1,544.82 ",$17.19 ,$144.00 ,$114.00 ,$686.59 ,$817.65 ,"$1,158.34 ",$953.93 ,$17.19 ,$17.19 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$108.00 ,"$1,158.34 ",$686.59 ,$108.00 ,$108.00 ,$953.93 ,$829.91 ,$17.19 ,$686.59 ,$672.86 ,"$1,362.75 ",$18.22 ,"$1,158.34 ","$1,544.82 ","$1,253.73 ",$953.93 ,"$1,362.75 ","$1,362.75 ",$829.91 ,"$1,362.75 ",$941.66 ,"$1,226.48 ",$931.03 ,$679.59 ,"$1,076.57 ",$18.22 ,$804.02 ,$804.02 ,$672.86 ,$804.02 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,51000237,58300,HC INSERT INTRAUTERINE DEVICE,510,1 ,$335.80 ,$221.63 ,$6.57 ,$335.80 ,$6.57 ,$144.00 ,$114.00 , N/A ,$201.48 ,$285.43 ,$235.06 ,$6.57 ,$6.57 ,$319.01 ,$255.21 ,$251.85 ,$108.00 ,$285.43 , N/A ,$108.00 ,$108.00 ,$235.06 ,$204.50 ,$6.57 , N/A , N/A , N/A ,$6.96 ,$285.43 , N/A ,$308.94 ,$235.06 ,$170.32 ,$204.40 ,$204.50 ,$204.40 ,$232.04 ,$302.22 ,$229.42 , N/A ,$265.28 ,$6.96 ,$198.12 ,$198.12 , N/A ,$198.12 ,$241.78 ,$208.20 ,$241.78 ,$241.78 ,$268.64 
ST NICHOLAS HOSPITAL - ACUTE,51000315,38222,HC BM ASPIRATION (BX/ASP SAME SITE),360,1 ,"$1,611.15 ","$1,063.36 ",$51.28 ,"$5,672.82 ",$51.28 ,"$1,611.15 ","$1,611.15 ","$2,521.25 ",$966.69 ,"$1,369.48 ","$1,127.81 ",$51.28 ,$51.28 ,"$1,530.59 ","$1,224.47 ","$1,208.36 ","$1,611.15 ","$1,369.48 ","$2,521.25 ","$1,611.15 ","$1,611.15 ","$1,127.81 ",$981.19 ,$51.28 ,"$2,521.25 ","$2,470.82 ","$1,611.15 ",$54.36 ,"$1,369.48 ","$5,672.82 ","$1,482.26 ","$1,127.81 ","$1,611.15 ","$1,611.15 ",$981.19 ,"$1,611.15 ","$1,113.30 ","$1,450.04 ","$1,100.74 ","$2,495.53 ","$1,272.81 ",$54.36 ,"$1,611.15 ","$1,611.15 ","$2,470.82 ","$1,611.15 ","$1,160.03 ",$998.91 ,"$1,160.03 ","$1,160.03 ","$1,288.92 "
ST NICHOLAS HOSPITAL - ACUTE,51000320,94781,HC CARSEAT ANALYSIS  EA ADDN 30MIN,510,1 ,$130.00 ,$85.80 ,$1.89 ,$130.00 ,$1.89 ,$130.00 ,$114.00 , N/A ,$78.00 ,$110.50 ,$91.00 ,$1.89 ,$1.89 ,$123.50 ,$98.80 ,$97.50 ,$108.00 ,$110.50 , N/A ,$108.00 ,$108.00 ,$91.00 ,$79.17 ,$1.89 , N/A , N/A , N/A ,$2.00 ,$110.50 , N/A ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$88.82 , N/A ,$102.70 ,$2.00 ,$76.70 ,$76.70 , N/A ,$76.70 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,51000325,15271,HC APL SKIN SUB TAL<100 INT 25CM,761,1 ,"$1,380.00 ",$910.80 ,$68.72 ,"$3,789.99 ",$68.72 ,"$1,380.00 ","$1,380.00 ","$1,684.44 ",$828.00 ,"$1,173.00 ",$966.00 ,$68.72 ,$68.72 ,"$1,311.00 ","$1,048.80 ","$1,035.00 ","$1,380.00 ","$1,173.00 ","$1,684.44 ","$1,380.00 ","$1,380.00 ",$966.00 ,$840.42 ,$68.72 ,"$1,684.44 ","$1,650.75 ","$1,380.00 ",$72.84 ,"$1,173.00 ","$3,789.99 ","$1,269.60 ",$966.00 ,"$1,380.00 ","$1,380.00 ",$840.42 ,"$1,380.00 ",$953.58 ,"$1,242.00 ",$942.82 ,"$1,667.25 ","$1,090.20 ",$72.84 ,$814.20 ,$814.20 ,"$1,650.75 ",$814.20 ,$993.60 ,$855.60 ,$993.60 ,$993.60 ,"$1,104.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000326,15272,HC APL SKIN SUB TAL<100 ADL 25CM,761,1 ,$425.50 ,$280.83 ,$68.72 ,$425.50 ,$68.72 ,$425.50 ,$425.50 , N/A ,$255.30 ,$361.68 ,$297.85 ,$68.72 ,$68.72 ,$404.23 ,$323.38 ,$319.13 ,$425.50 ,$361.68 , N/A ,$425.50 ,$425.50 ,$297.85 ,$259.13 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$361.68 , N/A ,$391.46 ,$297.85 ,$215.81 ,$259.00 ,$259.13 ,$259.00 ,$294.02 ,$382.95 ,$290.70 , N/A ,$336.15 ,$72.84 ,$251.05 ,$251.05 , N/A ,$251.05 ,$306.36 ,$263.81 ,$306.36 ,$306.36 ,$340.40 
ST NICHOLAS HOSPITAL - ACUTE,51000327,15273,HC APL SKIN SUB TAL>100 INT 100CM,761,1 ,"$1,495.00 ",$986.70 ,$68.72 ,"$7,143.68 ",$68.72 ,"$1,495.00 ","$1,495.00 ","$3,174.97 ",$897.00 ,"$1,270.75 ","$1,046.50 ",$68.72 ,$68.72 ,"$1,420.25 ","$1,136.20 ","$1,121.25 ","$1,495.00 ","$1,270.75 ","$3,174.97 ","$1,495.00 ","$1,495.00 ","$1,046.50 ",$910.46 ,$68.72 ,"$3,174.97 ","$3,111.47 ","$1,495.00 ",$72.84 ,"$1,270.75 ","$7,143.68 ","$1,375.40 ","$1,046.50 ","$3,273.50 ","$4,091.88 ",$910.46 ,"$4,091.88 ","$1,033.05 ","$1,345.50 ","$1,021.38 ","$3,142.59 ","$1,181.05 ",$72.84 ,$882.05 ,$882.05 ,"$3,111.47 ",$882.05 ,"$1,076.40 ",$926.90 ,"$1,076.40 ","$1,076.40 ","$1,196.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000328,15274,HC APL SKIN SUB TAL>100 ADL 100CM,761,1 ,$793.50 ,$523.71 ,$68.72 ,$793.50 ,$68.72 ,$793.50 ,$793.50 , N/A ,$476.10 ,$674.48 ,$555.45 ,$68.72 ,$68.72 ,$753.83 ,$603.06 ,$595.13 ,$793.50 ,$674.48 , N/A ,$793.50 ,$793.50 ,$555.45 ,$483.24 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$674.48 , N/A ,$730.02 ,$555.45 ,$402.46 ,$483.00 ,$483.24 ,$483.00 ,$548.31 ,$714.15 ,$542.12 , N/A ,$626.87 ,$72.84 ,$468.17 ,$468.17 , N/A ,$468.17 ,$571.32 ,$491.97 ,$571.32 ,$571.32 ,$634.80 
ST NICHOLAS HOSPITAL - ACUTE,51000329,15275,HC APL SKIN SUB OTH<100 INT 25CM,761,1 ,"$1,380.00 ",$910.80 ,$68.72 ,"$3,789.99 ",$68.72 ,"$1,380.00 ","$1,380.00 ","$1,684.44 ",$828.00 ,"$1,173.00 ",$966.00 ,$68.72 ,$68.72 ,"$1,311.00 ","$1,048.80 ","$1,035.00 ","$1,380.00 ","$1,173.00 ","$1,684.44 ","$1,380.00 ","$1,380.00 ",$966.00 ,$840.42 ,$68.72 ,"$1,684.44 ","$1,650.75 ","$1,380.00 ",$72.84 ,"$1,173.00 ","$3,789.99 ","$1,269.60 ",$966.00 ,"$1,380.00 ","$1,380.00 ",$840.42 ,"$1,380.00 ",$953.58 ,"$1,242.00 ",$942.82 ,"$1,667.25 ","$1,090.20 ",$72.84 ,$814.20 ,$814.20 ,"$1,650.75 ",$814.20 ,$993.60 ,$855.60 ,$993.60 ,$993.60 ,"$1,104.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000330,15276,HC APL SKIN SUB OTH<100 ADL 25CM,761,1 ,$402.50 ,$265.65 ,$68.72 ,$402.50 ,$68.72 ,$402.50 ,$402.50 , N/A ,$241.50 ,$342.13 ,$281.75 ,$68.72 ,$68.72 ,$382.38 ,$305.90 ,$301.88 ,$402.50 ,$342.13 , N/A ,$402.50 ,$402.50 ,$281.75 ,$245.12 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$342.13 , N/A ,$370.30 ,$281.75 ,$204.15 ,$245.00 ,$245.12 ,$245.00 ,$278.13 ,$362.25 ,$274.99 , N/A ,$317.98 ,$72.84 ,$237.48 ,$237.48 , N/A ,$237.48 ,$289.80 ,$249.55 ,$289.80 ,$289.80 ,$322.00 
ST NICHOLAS HOSPITAL - ACUTE,51000331,15277,HC APL SKIN SUB OTH>100 INT 100CM,761,1 ,"$1,150.00 ",$759.00 ,$68.72 ,"$3,789.99 ",$68.72 ,"$1,150.00 ","$1,150.00 ","$1,684.44 ",$690.00 ,$977.50 ,$805.00 ,$68.72 ,$68.72 ,"$1,092.50 ",$874.00 ,$862.50 ,"$1,150.00 ",$977.50 ,"$1,684.44 ","$1,150.00 ","$1,150.00 ",$805.00 ,$700.35 ,$68.72 ,"$1,684.44 ","$1,650.75 ","$1,150.00 ",$72.84 ,$977.50 ,"$3,789.99 ","$1,058.00 ",$805.00 ,"$1,150.00 ","$1,150.00 ",$700.35 ,"$1,150.00 ",$794.65 ,"$1,035.00 ",$785.68 ,"$1,667.25 ",$908.50 ,$72.84 ,$678.50 ,$678.50 ,"$1,650.75 ",$678.50 ,$828.00 ,$713.00 ,$828.00 ,$828.00 ,$920.00 
ST NICHOLAS HOSPITAL - ACUTE,51000332,15278,HC APL SKIN SUB OTH>100 ADL 100CM,761,1 ,$977.50 ,$645.15 ,$68.72 ,$977.50 ,$68.72 ,$977.50 ,$977.50 , N/A ,$586.50 ,$830.88 ,$684.25 ,$68.72 ,$68.72 ,$928.63 ,$742.90 ,$733.13 ,$977.50 ,$830.88 , N/A ,$977.50 ,$977.50 ,$684.25 ,$595.30 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$830.88 , N/A ,$899.30 ,$684.25 ,$495.79 ,$595.00 ,$595.30 ,$595.00 ,$675.45 ,$879.75 ,$667.83 , N/A ,$772.23 ,$72.84 ,$576.73 ,$576.73 , N/A ,$576.73 ,$703.80 ,$606.05 ,$703.80 ,$703.80 ,$782.00 
ST NICHOLAS HOSPITAL - ACUTE,51000333,15271,HC APL SKIN SUB TAL<100 INT 25CM W/PROC,761,1 ,"$1,380.00 ",$910.80 ,$68.72 ,"$3,789.99 ",$68.72 ,"$1,380.00 ","$1,380.00 ","$1,684.44 ",$828.00 ,"$1,173.00 ",$966.00 ,$68.72 ,$68.72 ,"$1,311.00 ","$1,048.80 ","$1,035.00 ","$1,380.00 ","$1,173.00 ","$1,684.44 ","$1,380.00 ","$1,380.00 ",$966.00 ,$840.42 ,$68.72 ,"$1,684.44 ","$1,650.75 ","$1,380.00 ",$72.84 ,"$1,173.00 ","$3,789.99 ","$1,269.60 ",$966.00 ,"$1,380.00 ","$1,380.00 ",$840.42 ,"$1,380.00 ",$953.58 ,"$1,242.00 ",$942.82 ,"$1,667.25 ","$1,090.20 ",$72.84 ,$814.20 ,$814.20 ,"$1,650.75 ",$814.20 ,$993.60 ,$855.60 ,$993.60 ,$993.60 ,"$1,104.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000334,15273,HC APL SKIN SUB TAL>100 INT 100CM W/PROC,761,1 ,"$1,495.00 ",$986.70 ,$68.72 ,"$7,143.68 ",$68.72 ,"$1,495.00 ","$1,495.00 ","$3,174.97 ",$897.00 ,"$1,270.75 ","$1,046.50 ",$68.72 ,$68.72 ,"$1,420.25 ","$1,136.20 ","$1,121.25 ","$1,495.00 ","$1,270.75 ","$3,174.97 ","$1,495.00 ","$1,495.00 ","$1,046.50 ",$910.46 ,$68.72 ,"$3,174.97 ","$3,111.47 ","$1,495.00 ",$72.84 ,"$1,270.75 ","$7,143.68 ","$1,375.40 ","$1,046.50 ","$3,273.50 ","$4,091.88 ",$910.46 ,"$4,091.88 ","$1,033.05 ","$1,345.50 ","$1,021.38 ","$3,142.59 ","$1,181.05 ",$72.84 ,$882.05 ,$882.05 ,"$3,111.47 ",$882.05 ,"$1,076.40 ",$926.90 ,"$1,076.40 ","$1,076.40 ","$1,196.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000335,15275,HC APL SKIN SUB OTH<100 INT 25CM W/PROC,761,1 ,"$1,380.00 ",$910.80 ,$68.72 ,"$3,789.99 ",$68.72 ,"$1,380.00 ","$1,380.00 ","$1,684.44 ",$828.00 ,"$1,173.00 ",$966.00 ,$68.72 ,$68.72 ,"$1,311.00 ","$1,048.80 ","$1,035.00 ","$1,380.00 ","$1,173.00 ","$1,684.44 ","$1,380.00 ","$1,380.00 ",$966.00 ,$840.42 ,$68.72 ,"$1,684.44 ","$1,650.75 ","$1,380.00 ",$72.84 ,"$1,173.00 ","$3,789.99 ","$1,269.60 ",$966.00 ,"$1,380.00 ","$1,380.00 ",$840.42 ,"$1,380.00 ",$953.58 ,"$1,242.00 ",$942.82 ,"$1,667.25 ","$1,090.20 ",$72.84 ,$814.20 ,$814.20 ,"$1,650.75 ",$814.20 ,$993.60 ,$855.60 ,$993.60 ,$993.60 ,"$1,104.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000336,15277,HC APL SKIN SUB OTH>100 INT 100CM W/PROC,761,1 ,"$1,150.00 ",$759.00 ,$68.72 ,"$3,789.99 ",$68.72 ,"$1,150.00 ","$1,150.00 ","$1,684.44 ",$690.00 ,$977.50 ,$805.00 ,$68.72 ,$68.72 ,"$1,092.50 ",$874.00 ,$862.50 ,"$1,150.00 ",$977.50 ,"$1,684.44 ","$1,150.00 ","$1,150.00 ",$805.00 ,$700.35 ,$68.72 ,"$1,684.44 ","$1,650.75 ","$1,150.00 ",$72.84 ,$977.50 ,"$3,789.99 ","$1,058.00 ",$805.00 ,"$1,150.00 ","$1,150.00 ",$700.35 ,"$1,150.00 ",$794.65 ,"$1,035.00 ",$785.68 ,"$1,667.25 ",$908.50 ,$72.84 ,$678.50 ,$678.50 ,"$1,650.75 ",$678.50 ,$828.00 ,$713.00 ,$828.00 ,$828.00 ,$920.00 
ST NICHOLAS HOSPITAL - ACUTE,51000348,16025,HC BURN DRESS/DEB 5-10% TOTAL FACIL,761,1 ,$545.10 ,$359.77 ,$6.41 ,$545.10 ,$6.41 ,$545.10 ,$545.10 ,$176.25 ,$327.06 ,$463.34 ,$381.57 ,$6.41 ,$6.41 ,$517.85 ,$414.28 ,$408.83 ,$545.10 ,$463.34 ,$176.25 ,$545.10 ,$545.10 ,$381.57 ,$331.97 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$463.34 ,$396.55 ,$501.49 ,$381.57 ,$276.47 ,$331.80 ,$331.97 ,$331.80 ,$376.66 ,$490.59 ,$372.41 ,$174.45 ,$430.63 ,$6.79 ,$321.61 ,$321.61 ,$172.72 ,$321.61 ,$392.47 ,$337.96 ,$392.47 ,$392.47 ,$436.08 
ST NICHOLAS HOSPITAL - ACUTE,51000350,16030,HC BURN DRESS  AND /OR DEBRID >10% FACIL,761,1 ,$656.65 ,$433.39 ,$13.09 ,$819.26 ,$13.09 ,$656.65 ,$656.65 ,$364.12 ,$393.99 ,$558.15 ,$459.66 ,$13.09 ,$13.09 ,$623.82 ,$499.05 ,$492.49 ,$656.65 ,$558.15 ,$364.12 ,$656.65 ,$656.65 ,$459.66 ,$399.90 ,$13.09 ,$364.12 ,$356.84 ,$656.65 ,$13.88 ,$558.15 ,$819.26 ,$604.12 ,$459.66 ,$333.05 ,$399.70 ,$399.90 ,$399.70 ,$453.75 ,$590.99 ,$448.62 ,$360.40 ,$518.75 ,$13.88 ,$387.42 ,$387.42 ,$356.84 ,$387.42 ,$472.79 ,$407.12 ,$472.79 ,$472.79 ,$525.32 
ST NICHOLAS HOSPITAL - ACUTE,51000352,11057,HC PARING LESN BENIGN >4 FAC,510,1 ,$285.20 ,$188.23 ,$5.80 ,$396.55 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$171.12 ,$242.42 ,$199.64 ,$5.80 ,$5.80 ,$270.94 ,$216.75 ,$213.90 ,$108.00 ,$242.42 ,$176.25 ,$108.00 ,$108.00 ,$199.64 ,$173.69 ,$5.80 ,$176.25 ,$172.72 ,$285.20 ,$6.15 ,$242.42 ,$396.55 ,$262.38 ,$199.64 ,$144.65 ,$173.60 ,$173.69 ,$173.60 ,$197.07 ,$256.68 ,$194.85 ,$174.45 ,$225.31 ,$6.15 ,$168.27 ,$168.27 ,$172.72 ,$168.27 ,$205.34 ,$176.82 ,$205.34 ,$205.34 ,$228.16 
ST NICHOLAS HOSPITAL - ACUTE,51000400,29580,HC APPLY UNNA BOOT BILAT FAC,510,1 ,$570.40 ,$376.46 ,$9.25 ,$570.40 ,$9.25 ,$144.00 ,$114.00 ,$213.39 ,$342.24 ,$484.84 ,$399.28 ,$9.25 ,$9.25 ,$541.88 ,$433.50 ,$427.80 ,$108.00 ,$484.84 ,$213.39 ,$108.00 ,$108.00 ,$399.28 ,$347.37 ,$9.25 ,$213.39 ,$209.12 ,$426.78 ,$9.81 ,$484.84 ,$480.13 ,$524.77 ,$399.28 ,$289.31 ,$347.20 ,$347.37 ,$347.20 ,$394.15 ,$513.36 ,$389.70 ,$211.21 ,$450.62 ,$9.81 ,$336.54 ,$336.54 ,$209.12 ,$336.54 ,$410.69 ,$353.65 ,$410.69 ,$410.69 ,$456.32 
ST NICHOLAS HOSPITAL - ACUTE,51000401,29581,HC APPLY MULTI COMP LWR LEG BIL FAC,510,1 ,$396.75 ,$261.86 ,$9.25 ,$480.13 ,$9.25 ,$144.00 ,$114.00 ,$213.39 ,$238.05 ,$337.24 ,$277.73 ,$9.25 ,$9.25 ,$376.91 ,$301.53 ,$297.56 ,$108.00 ,$337.24 ,$213.39 ,$108.00 ,$108.00 ,$277.73 ,$241.62 ,$9.25 ,$213.39 ,$209.12 ,$396.75 ,$9.81 ,$337.24 ,$480.13 ,$365.01 ,$277.73 ,$201.23 ,$241.50 ,$241.62 ,$241.50 ,$274.15 ,$357.08 ,$271.06 ,$211.21 ,$313.43 ,$9.81 ,$234.08 ,$234.08 ,$209.12 ,$234.08 ,$285.66 ,$245.99 ,$285.66 ,$285.66 ,$317.40 
ST NICHOLAS HOSPITAL - ACUTE,51000407,11200,HC REMOVAL SKIN TAG LESIONS <=15 FAC,510,1 ,$309.35 ,$204.17 ,$5.80 ,$396.55 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$185.61 ,$262.95 ,$216.55 ,$5.80 ,$5.80 ,$293.88 ,$235.11 ,$232.01 ,$108.00 ,$262.95 ,$176.25 ,$108.00 ,$108.00 ,$216.55 ,$188.39 ,$5.80 ,$176.25 ,$172.72 ,$309.35 ,$6.15 ,$262.95 ,$396.55 ,$284.60 ,$216.55 ,$156.90 ,$188.30 ,$188.39 ,$188.30 ,$213.76 ,$278.42 ,$211.35 ,$174.45 ,$244.39 ,$6.15 ,$182.52 ,$182.52 ,$172.72 ,$182.52 ,$222.73 ,$191.80 ,$222.73 ,$222.73 ,$247.48 
ST NICHOLAS HOSPITAL - ACUTE,51000414,10140,HC I AND D HEMATOMA/SEROMA/FLUID BIL UNNA FAC,510,1 ,"$2,229.85 ","$1,471.70 ",$38.33 ,"$3,293.01 ",$38.33 ,$144.00 ,$114.00 ,"$1,463.56 ","$1,337.91 ","$1,895.37 ","$1,560.90 ",$38.33 ,$38.33 ,"$2,118.36 ","$1,694.69 ","$1,672.39 ",$108.00 ,"$1,895.37 ","$1,463.56 ",$108.00 ,$108.00 ,"$1,560.90 ","$1,357.98 ",$38.33 ,"$1,463.56 ","$1,434.29 ","$2,229.85 ",$40.63 ,"$1,895.37 ","$3,293.01 ","$2,051.46 ","$1,560.90 ","$1,998.41 ","$2,229.85 ","$1,357.98 ","$2,229.85 ","$1,540.83 ","$2,006.87 ","$1,523.43 ","$1,448.64 ","$1,761.58 ",$40.63 ,"$1,315.61 ","$1,315.61 ","$1,434.29 ","$1,315.61 ","$1,605.49 ","$1,382.51 ","$1,605.49 ","$1,605.49 ","$1,783.88 "
ST NICHOLAS HOSPITAL - ACUTE,51000419,97597,HC AWC/CHEM CAUTERY/CAST FACIL,761,1 ,$409.40 ,$270.20 ,$6.41 ,$409.40 ,$6.41 ,$409.40 ,$409.40 ,$176.25 ,$245.64 ,$347.99 ,$286.58 ,$6.41 ,$6.41 ,$388.93 ,$311.14 ,$307.05 ,$409.40 ,$347.99 ,$176.25 ,$409.40 ,$409.40 ,$286.58 ,$249.32 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$347.99 ,$396.55 ,$376.65 ,$286.58 ,$207.65 ,$249.20 ,$249.32 ,$249.20 ,$282.90 ,$368.46 ,$279.70 ,$174.45 ,$323.43 ,$6.79 ,$241.55 ,$241.55 ,$172.72 ,$241.55 ,$294.77 ,$253.83 ,$294.77 ,$294.77 ,$327.52 
ST NICHOLAS HOSPITAL - ACUTE,51000420,10140,HC I AND D HEMATOMA/SEROMA/FLUID/WRAP FACIL,761,1 ,"$2,229.85 ","$1,471.70 ",$38.33 ,"$3,293.01 ",$38.33 ,"$2,229.85 ","$2,229.85 ","$1,463.56 ","$1,337.91 ","$1,895.37 ","$1,560.90 ",$38.33 ,$38.33 ,"$2,118.36 ","$1,694.69 ","$1,672.39 ","$2,229.85 ","$1,895.37 ","$1,463.56 ","$2,229.85 ","$2,229.85 ","$1,560.90 ","$1,357.98 ",$38.33 ,"$1,463.56 ","$1,434.29 ","$2,229.85 ",$40.63 ,"$1,895.37 ","$3,293.01 ","$2,051.46 ","$1,560.90 ","$1,998.41 ","$2,229.85 ","$1,357.98 ","$2,229.85 ","$1,540.83 ","$2,006.87 ","$1,523.43 ","$1,448.64 ","$1,761.58 ",$40.63 ,"$1,315.61 ","$1,315.61 ","$1,434.29 ","$1,315.61 ","$1,605.49 ","$1,382.51 ","$1,605.49 ","$1,605.49 ","$1,783.88 "
ST NICHOLAS HOSPITAL - ACUTE,51000421,97597,HC AWC/CHEM CAUTERY/WRAP FACIL,761,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$446.20 ,$446.20 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$446.20 ,$379.27 ,$176.25 ,$446.20 ,$446.20 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000424,97597,HC DEBR SKIN INTL 20CM/BIOPSY FAC,510,1 ,$446.20 ,$294.49 ,$6.41 ,$446.20 ,$6.41 ,$144.00 ,$114.00 ,$176.25 ,$267.72 ,$379.27 ,$312.34 ,$6.41 ,$6.41 ,$423.89 ,$339.11 ,$334.65 ,$108.00 ,$379.27 ,$176.25 ,$108.00 ,$108.00 ,$312.34 ,$271.74 ,$6.41 ,$176.25 ,$172.72 ,$352.50 ,$6.79 ,$379.27 ,$396.55 ,$410.50 ,$312.34 ,$226.31 ,$271.60 ,$271.74 ,$271.60 ,$308.32 ,$401.58 ,$304.84 ,$174.45 ,$352.50 ,$6.79 ,$263.26 ,$263.26 ,$172.72 ,$263.26 ,$321.26 ,$276.64 ,$321.26 ,$321.26 ,$356.96 
ST NICHOLAS HOSPITAL - ACUTE,51000425,15110,HC EPIDRM A-GRFT TRNK/ARM/LEG CM,510,1 ,"$2,760.00 ","$1,821.60 ",$68.72 ,"$3,789.99 ",$68.72 ,$144.00 ,$114.00 ,"$1,684.44 ","$1,656.00 ","$2,346.00 ","$1,932.00 ",$68.72 ,$68.72 ,"$2,622.00 ","$2,097.60 ","$2,070.00 ",$108.00 ,"$2,346.00 ","$1,684.44 ",$108.00 ,$108.00 ,"$1,932.00 ","$1,680.84 ",$68.72 ,"$1,684.44 ","$1,650.75 ","$2,760.00 ",$72.84 ,"$2,346.00 ","$3,789.99 ","$2,539.20 ","$1,932.00 ","$1,998.41 ","$2,497.74 ","$1,680.84 ","$2,497.74 ","$1,907.16 ","$2,484.00 ","$1,885.63 ","$1,667.25 ","$2,180.40 ",$72.84 ,"$1,628.40 ","$1,628.40 ","$1,650.75 ","$1,628.40 ","$1,987.20 ","$1,711.20 ","$1,987.20 ","$1,987.20 ","$2,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000426,15115,HC EPIDRM A-GRFT FACE/NCK/HF/G,510,1 ,"$2,070.00 ","$1,366.20 ",$68.72 ,"$3,789.99 ",$68.72 ,$144.00 ,$114.00 ,"$1,684.44 ","$1,242.00 ","$1,759.50 ","$1,449.00 ",$68.72 ,$68.72 ,"$1,966.50 ","$1,573.20 ","$1,552.50 ",$108.00 ,"$1,759.50 ","$1,684.44 ",$108.00 ,$108.00 ,"$1,449.00 ","$1,260.63 ",$68.72 ,"$1,684.44 ","$1,650.75 ","$2,070.00 ",$72.84 ,"$1,759.50 ","$3,789.99 ","$1,904.40 ","$1,449.00 ","$1,998.41 ","$2,070.00 ","$1,260.63 ","$2,070.00 ","$1,430.37 ","$1,863.00 ","$1,414.22 ","$1,667.25 ","$1,635.30 ",$72.84 ,"$1,221.30 ","$1,221.30 ","$1,650.75 ","$1,221.30 ","$1,490.40 ","$1,283.40 ","$1,490.40 ","$1,490.40 ","$1,656.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000427,17999,HC UNLISTED SKIN TISSUE PROCEDURE,510,1 ,$241.50 ,$159.39 ,$5.80 ,$396.55 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$144.90 ,$205.28 ,$169.05 ,$5.80 ,$5.80 ,$229.43 ,$183.54 ,$181.13 ,$108.00 ,$205.28 ,$176.25 ,$108.00 ,$108.00 ,$169.05 ,$147.07 ,$5.80 ,$176.25 ,$172.72 ,$241.50 ,$6.15 ,$205.28 ,$396.55 ,$222.18 ,$169.05 ,$122.49 ,$147.00 ,$147.07 ,$147.00 ,$166.88 ,$217.35 ,$164.99 ,$174.45 ,$190.79 ,$6.15 ,$142.49 ,$142.49 ,$172.72 ,$142.49 ,$173.88 ,$149.73 ,$173.88 ,$173.88 ,$193.20 
ST NICHOLAS HOSPITAL - ACUTE,51000428,15111,HC EPIDRM A-GRFT TRNK/ARM/LEG CM ADDN 100,510,1 ,$224.25 ,$148.01 ,$68.72 ,$224.25 ,$68.72 ,$144.00 ,$114.00 , N/A ,$134.55 ,$190.61 ,$156.98 ,$68.72 ,$68.72 ,$213.04 ,$170.43 ,$168.19 ,$108.00 ,$190.61 , N/A ,$108.00 ,$108.00 ,$156.98 ,$136.57 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$190.61 , N/A ,$206.31 ,$156.98 ,$113.74 ,$136.50 ,$136.57 ,$136.50 ,$154.96 ,$201.83 ,$153.21 , N/A ,$177.16 ,$72.84 ,$132.31 ,$132.31 , N/A ,$132.31 ,$161.46 ,$139.04 ,$161.46 ,$161.46 ,$179.40 
ST NICHOLAS HOSPITAL - ACUTE,51000429,15116,HC EPIDRM A-GRFT FACE/NCK/HF/G CM ADDN 100,510,1 ,$224.25 ,$148.01 ,$68.72 ,$224.25 ,$68.72 ,$144.00 ,$114.00 , N/A ,$134.55 ,$190.61 ,$156.98 ,$68.72 ,$68.72 ,$213.04 ,$170.43 ,$168.19 ,$108.00 ,$190.61 , N/A ,$108.00 ,$108.00 ,$156.98 ,$136.57 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$190.61 , N/A ,$206.31 ,$156.98 ,$113.74 ,$136.50 ,$136.57 ,$136.50 ,$154.96 ,$201.83 ,$153.21 , N/A ,$177.16 ,$72.84 ,$132.31 ,$132.31 , N/A ,$132.31 ,$161.46 ,$139.04 ,$161.46 ,$161.46 ,$179.40 
ST NICHOLAS HOSPITAL - ACUTE,51000430,15110,HC EPIDRM A-GRFT TRNK ARMS LEGS FIRST 100CM W/PROC,510,1 ,"$2,760.00 ","$1,821.60 ",$68.72 ,"$3,789.99 ",$68.72 ,$144.00 ,$114.00 ,"$1,684.44 ","$1,656.00 ","$2,346.00 ","$1,932.00 ",$68.72 ,$68.72 ,"$2,622.00 ","$2,097.60 ","$2,070.00 ",$108.00 ,"$2,346.00 ","$1,684.44 ",$108.00 ,$108.00 ,"$1,932.00 ","$1,680.84 ",$68.72 ,"$1,684.44 ","$1,650.75 ","$2,760.00 ",$72.84 ,"$2,346.00 ","$3,789.99 ","$2,539.20 ","$1,932.00 ","$1,998.41 ","$2,497.74 ","$1,680.84 ","$2,497.74 ","$1,907.16 ","$2,484.00 ","$1,885.63 ","$1,667.25 ","$2,180.40 ",$72.84 ,"$1,628.40 ","$1,628.40 ","$1,650.75 ","$1,628.40 ","$1,987.20 ","$1,711.20 ","$1,987.20 ","$1,987.20 ","$2,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000431,15115,HC EPIDRM A-GRFT FACE SCLP HAND ETC FIRST 100CM W/PROC,510,1 ,"$2,070.00 ","$1,366.20 ",$68.72 ,"$3,789.99 ",$68.72 ,$144.00 ,$114.00 ,"$1,684.44 ","$1,242.00 ","$1,759.50 ","$1,449.00 ",$68.72 ,$68.72 ,"$1,966.50 ","$1,573.20 ","$1,552.50 ",$108.00 ,"$1,759.50 ","$1,684.44 ",$108.00 ,$108.00 ,"$1,449.00 ","$1,260.63 ",$68.72 ,"$1,684.44 ","$1,650.75 ","$2,070.00 ",$72.84 ,"$1,759.50 ","$3,789.99 ","$1,904.40 ","$1,449.00 ","$1,998.41 ","$2,070.00 ","$1,260.63 ","$2,070.00 ","$1,430.37 ","$1,863.00 ","$1,414.22 ","$1,667.25 ","$1,635.30 ",$72.84 ,"$1,221.30 ","$1,221.30 ","$1,650.75 ","$1,221.30 ","$1,490.40 ","$1,283.40 ","$1,490.40 ","$1,490.40 ","$1,656.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000442,95999,HC UNLISTED NEURO DIAGNOSTIC PROC,510,1 ,$490.53 ,$323.75 ,$4.77 ,$490.53 ,$4.77 ,$144.00 ,$114.00 ,$141.94 ,$294.32 ,$416.95 ,$343.37 ,$4.77 ,$4.77 ,$466.00 ,$372.80 ,$367.90 ,$108.00 ,$416.95 ,$141.94 ,$108.00 ,$108.00 ,$343.37 ,$298.73 ,$4.77 ,$141.94 ,$139.10 ,$283.88 ,$5.06 ,$416.95 ,$319.36 ,$451.29 ,$343.37 ,$248.80 ,$298.59 ,$298.73 ,$298.59 ,$338.96 ,$441.48 ,$335.13 ,$140.49 ,$387.52 ,$5.06 ,$289.41 ,$289.41 ,$139.10 ,$289.41 ,$353.18 ,$304.13 ,$353.18 ,$353.18 ,$392.42 
ST NICHOLAS HOSPITAL - ACUTE,51000444,11982,HC REMOVAL DRUG IMPLANT DEVICE,510,1 ,$933.80 ,$616.31 ,$5.80 ,$933.80 ,$5.80 ,$144.00 ,$114.00 ,$368.51 ,$560.28 ,$793.73 ,$653.66 ,$5.80 ,$5.80 ,$887.11 ,$709.69 ,$700.35 ,$108.00 ,$793.73 ,$368.51 ,$108.00 ,$108.00 ,$653.66 ,$568.68 ,$5.80 ,$368.51 ,$361.14 ,$737.02 ,$6.15 ,$793.73 ,$829.14 ,$859.10 ,$653.66 ,$473.62 ,$568.40 ,$568.68 ,$568.40 ,$645.26 ,$840.42 ,$637.97 ,$364.76 ,$737.70 ,$6.15 ,$550.94 ,$550.94 ,$361.14 ,$550.94 ,$672.34 ,$578.96 ,$672.34 ,$672.34 ,$747.04 
ST NICHOLAS HOSPITAL - ACUTE,51000450,C5271,HC APL SKIN SUB TAL<100 INT 25CM LOW,510,1 ,$972.90 ,$642.11 ,$68.72 ,"$1,275.77 ",$68.72 ,$144.00 ,$114.00 ,$567.01 ,$583.74 ,$826.97 , N/A ,$68.72 ,$68.72 ,$924.26 ,$739.40 ,$729.68 ,$108.00 ,$826.97 ,$567.01 ,$108.00 ,$108.00 ,$681.03 ,$592.50 ,$68.72 ,$567.01 ,$555.67 ,$972.90 ,$72.84 ,$826.97 ,"$1,275.77 ",$895.07 ,$681.03 ,$493.45 ,$592.20 ,$592.50 ,$592.20 ,$672.27 ,$875.61 ,$664.69 ,$561.23 ,$768.59 ,$72.84 ,$574.01 ,$574.01 ,$555.67 ,$574.01 ,$700.49 ,$603.20 ,$700.49 ,$700.49 ,$778.32 
ST NICHOLAS HOSPITAL - ACUTE,51000451,C5271,HC APL SKIN SUB TAL<100 INT 25CM W/PROC LOW,510,1 ,$972.90 ,$642.11 ,$68.72 ,"$1,275.77 ",$68.72 ,$144.00 ,$114.00 ,$567.01 ,$583.74 ,$826.97 , N/A ,$68.72 ,$68.72 ,$924.26 ,$739.40 ,$729.68 ,$108.00 ,$826.97 ,$567.01 ,$108.00 ,$108.00 ,$681.03 ,$592.50 ,$68.72 ,$567.01 ,$555.67 ,$972.90 ,$72.84 ,$826.97 ,"$1,275.77 ",$895.07 ,$681.03 ,$493.45 ,$592.20 ,$592.50 ,$592.20 ,$672.27 ,$875.61 ,$664.69 ,$561.23 ,$768.59 ,$72.84 ,$574.01 ,$574.01 ,$555.67 ,$574.01 ,$700.49 ,$603.20 ,$700.49 ,$700.49 ,$778.32 
ST NICHOLAS HOSPITAL - ACUTE,51000452,C5272,HC APL SKIN SUB TAL<100 ADL 25CM LOW,510,1 ,$427.80 ,$282.35 ,$68.72 ,$427.80 ,$68.72 ,$144.00 ,$114.00 , N/A ,$256.68 ,$363.63 , N/A ,$68.72 ,$68.72 ,$406.41 ,$325.13 ,$320.85 ,$108.00 ,$363.63 , N/A ,$108.00 ,$108.00 ,$299.46 ,$260.53 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$363.63 , N/A ,$393.58 ,$299.46 ,$216.98 ,$260.40 ,$260.53 ,$260.40 ,$295.61 ,$385.02 ,$292.27 , N/A ,$337.96 ,$72.84 ,$252.40 ,$252.40 , N/A ,$252.40 ,$308.02 ,$265.24 ,$308.02 ,$308.02 ,$342.24 
ST NICHOLAS HOSPITAL - ACUTE,51000453,C5273,HC APL SKIN SUB TAL>100 INT 100CM LOW,510,1 ,"$1,294.90 ",$854.63 ,$68.72 ,"$3,789.99 ",$68.72 ,$144.00 ,$114.00 ,"$1,684.44 ",$776.94 ,"$1,100.67 ", N/A ,$68.72 ,$68.72 ,"$1,230.16 ",$984.12 ,$971.18 ,$108.00 ,"$1,100.67 ","$1,684.44 ",$108.00 ,$108.00 ,$906.43 ,$788.59 ,$68.72 ,"$1,684.44 ","$1,650.75 ","$1,294.90 ",$72.84 ,"$1,100.67 ","$3,789.99 ","$1,191.31 ",$906.43 ,"$1,294.90 ","$1,294.90 ",$788.59 ,"$1,294.90 ",$894.78 ,"$1,165.41 ",$884.68 ,"$1,667.25 ","$1,022.97 ",$72.84 ,$763.99 ,$763.99 ,"$1,650.75 ",$763.99 ,$932.33 ,$802.84 ,$932.33 ,$932.33 ,"$1,035.92 "
ST NICHOLAS HOSPITAL - ACUTE,51000454,C5273,HC APL SKIN SUB TAL>100 INT 100CM W/PROC LOW,510,1 ,"$1,294.90 ",$854.63 ,$68.72 ,"$3,789.99 ",$68.72 ,$144.00 ,$114.00 ,"$1,684.44 ",$776.94 ,"$1,100.67 ", N/A ,$68.72 ,$68.72 ,"$1,230.16 ",$984.12 ,$971.18 ,$108.00 ,"$1,100.67 ","$1,684.44 ",$108.00 ,$108.00 ,$906.43 ,$788.59 ,$68.72 ,"$1,684.44 ","$1,650.75 ","$1,294.90 ",$72.84 ,"$1,100.67 ","$3,789.99 ","$1,191.31 ",$906.43 ,"$1,294.90 ","$1,294.90 ",$788.59 ,"$1,294.90 ",$894.78 ,"$1,165.41 ",$884.68 ,"$1,667.25 ","$1,022.97 ",$72.84 ,$763.99 ,$763.99 ,"$1,650.75 ",$763.99 ,$932.33 ,$802.84 ,$932.33 ,$932.33 ,"$1,035.92 "
ST NICHOLAS HOSPITAL - ACUTE,51000455,C5274,HC APL SKIN SUB TAL>100 ADL 100CM LOW,510,1 ,$772.80 ,$510.05 ,$68.72 ,$772.80 ,$68.72 ,$144.00 ,$114.00 , N/A ,$463.68 ,$656.88 , N/A ,$68.72 ,$68.72 ,$734.16 ,$587.33 ,$579.60 ,$108.00 ,$656.88 , N/A ,$108.00 ,$108.00 ,$540.96 ,$470.64 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$656.88 , N/A ,$710.98 ,$540.96 ,$391.96 ,$470.40 ,$470.64 ,$470.40 ,$534.00 ,$695.52 ,$527.98 , N/A ,$610.51 ,$72.84 ,$455.95 ,$455.95 , N/A ,$455.95 ,$556.42 ,$479.14 ,$556.42 ,$556.42 ,$618.24 
ST NICHOLAS HOSPITAL - ACUTE,51000456,C5275,HC APL SKIN SUB OTH<100 INT 25CM LOW,510,1 ,$978.65 ,$645.91 ,$68.72 ,"$1,275.77 ",$68.72 ,$144.00 ,$114.00 ,$567.01 ,$587.19 ,$831.85 , N/A ,$68.72 ,$68.72 ,$929.72 ,$743.77 ,$733.99 ,$108.00 ,$831.85 ,$567.01 ,$108.00 ,$108.00 ,$685.06 ,$596.00 ,$68.72 ,$567.01 ,$555.67 ,$978.65 ,$72.84 ,$831.85 ,"$1,275.77 ",$900.36 ,$685.06 ,$496.37 ,$595.70 ,$596.00 ,$595.70 ,$676.25 ,$880.79 ,$668.61 ,$561.23 ,$773.13 ,$72.84 ,$577.40 ,$577.40 ,$555.67 ,$577.40 ,$704.63 ,$606.76 ,$704.63 ,$704.63 ,$782.92 
ST NICHOLAS HOSPITAL - ACUTE,51000457,C5275,HC APL SKIN SUB OTH<100 INT 25CM W/PROC LOW,510,1 ,$978.65 ,$645.91 ,$68.72 ,"$1,275.77 ",$68.72 ,$144.00 ,$114.00 ,$567.01 ,$587.19 ,$831.85 , N/A ,$68.72 ,$68.72 ,$929.72 ,$743.77 ,$733.99 ,$108.00 ,$831.85 ,$567.01 ,$108.00 ,$108.00 ,$685.06 ,$596.00 ,$68.72 ,$567.01 ,$555.67 ,$978.65 ,$72.84 ,$831.85 ,"$1,275.77 ",$900.36 ,$685.06 ,$496.37 ,$595.70 ,$596.00 ,$595.70 ,$676.25 ,$880.79 ,$668.61 ,$561.23 ,$773.13 ,$72.84 ,$577.40 ,$577.40 ,$555.67 ,$577.40 ,$704.63 ,$606.76 ,$704.63 ,$704.63 ,$782.92 
ST NICHOLAS HOSPITAL - ACUTE,51000458,C5276,HC APL SKIN SUB OTH<100 ADL 25CM LOW,510,1 ,$384.10 ,$253.51 ,$68.72 ,$384.10 ,$68.72 ,$144.00 ,$114.00 , N/A ,$230.46 ,$326.49 , N/A ,$68.72 ,$68.72 ,$364.90 ,$291.92 ,$288.08 ,$108.00 ,$326.49 , N/A ,$108.00 ,$108.00 ,$268.87 ,$233.92 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$326.49 , N/A ,$353.37 ,$268.87 ,$194.82 ,$233.80 ,$233.92 ,$233.80 ,$265.41 ,$345.69 ,$262.42 , N/A ,$303.44 ,$72.84 ,$226.62 ,$226.62 , N/A ,$226.62 ,$276.55 ,$238.14 ,$276.55 ,$276.55 ,$307.28 
ST NICHOLAS HOSPITAL - ACUTE,51000459,C5277,HC APL SKIN SUB OTH>100 INT 100CM LOW,510,1 ,"$1,084.45 ",$715.74 ,$68.72 ,"$1,275.77 ",$68.72 ,$144.00 ,$114.00 ,$567.01 ,$650.67 ,$921.78 , N/A ,$68.72 ,$68.72 ,"$1,030.23 ",$824.18 ,$813.34 ,$108.00 ,$921.78 ,$567.01 ,$108.00 ,$108.00 ,$759.12 ,$660.43 ,$68.72 ,$567.01 ,$555.67 ,"$1,084.45 ",$72.84 ,$921.78 ,"$1,275.77 ",$997.69 ,$759.12 ,$550.03 ,$660.10 ,$660.43 ,$660.10 ,$749.36 ,$976.01 ,$740.90 ,$561.23 ,$856.72 ,$72.84 ,$639.83 ,$639.83 ,$555.67 ,$639.83 ,$780.80 ,$672.36 ,$780.80 ,$780.80 ,$867.56 
ST NICHOLAS HOSPITAL - ACUTE,51000460,C5277,HC APL SKIN SUB OTH>100 INT 100CM W/PROC LOW,510,1 ,"$1,084.45 ",$715.74 ,$68.72 ,"$1,275.77 ",$68.72 ,$144.00 ,$114.00 ,$567.01 ,$650.67 ,$921.78 , N/A ,$68.72 ,$68.72 ,"$1,030.23 ",$824.18 ,$813.34 ,$108.00 ,$921.78 ,$567.01 ,$108.00 ,$108.00 ,$759.12 ,$660.43 ,$68.72 ,$567.01 ,$555.67 ,"$1,084.45 ",$72.84 ,$921.78 ,"$1,275.77 ",$997.69 ,$759.12 ,$550.03 ,$660.10 ,$660.43 ,$660.10 ,$749.36 ,$976.01 ,$740.90 ,$561.23 ,$856.72 ,$72.84 ,$639.83 ,$639.83 ,$555.67 ,$639.83 ,$780.80 ,$672.36 ,$780.80 ,$780.80 ,$867.56 
ST NICHOLAS HOSPITAL - ACUTE,51000461,C5278,HC APL SKIN SUB OTH>100 ADL 100CM LOW,510,1 ,"$1,003.95 ",$662.61 ,$68.72 ,"$1,003.95 ",$68.72 ,$144.00 ,$114.00 , N/A ,$602.37 ,$853.36 , N/A ,$68.72 ,$68.72 ,$953.75 ,$763.00 ,$752.96 ,$108.00 ,$853.36 , N/A ,$108.00 ,$108.00 ,$702.77 ,$611.41 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$853.36 , N/A ,$923.63 ,$702.77 ,$509.20 ,$611.10 ,$611.41 ,$611.10 ,$693.73 ,$903.56 ,$685.90 , N/A ,$793.12 ,$72.84 ,$592.33 ,$592.33 , N/A ,$592.33 ,$722.84 ,$622.45 ,$722.84 ,$722.84 ,$803.16 
ST NICHOLAS HOSPITAL - ACUTE,51000462,11900,HC INJECT SKIN LESIONS </W 7 FAC,510,1 ,$204.70 ,$135.10 ,$5.80 ,$396.55 ,$5.80 ,$144.00 ,$114.00 ,$176.25 ,$122.82 ,$174.00 ,$143.29 ,$5.80 ,$5.80 ,$194.47 ,$155.57 ,$153.53 ,$108.00 ,$174.00 ,$176.25 ,$108.00 ,$108.00 ,$143.29 ,$124.66 ,$5.80 ,$176.25 ,$172.72 ,$204.70 ,$6.15 ,$174.00 ,$396.55 ,$188.32 ,$143.29 ,$103.82 ,$124.60 ,$124.66 ,$124.60 ,$141.45 ,$184.23 ,$139.85 ,$174.45 ,$161.71 ,$6.15 ,$120.77 ,$120.77 ,$172.72 ,$120.77 ,$147.38 ,$126.91 ,$147.38 ,$147.38 ,$163.76 
ST NICHOLAS HOSPITAL - ACUTE,51000478,11042,HC DEBR SKIN/SUBQ TISS INIT W/PROC 20CM,510,1 ,$581.90 ,$384.05 ,$13.09 ,$819.26 ,$13.09 ,$144.00 ,$114.00 ,$364.12 ,$349.14 ,$494.62 ,$407.33 ,$13.09 ,$13.09 ,$552.81 ,$442.24 ,$436.43 ,$108.00 ,$494.62 ,$364.12 ,$108.00 ,$108.00 ,$407.33 ,$354.38 ,$13.09 ,$364.12 ,$356.84 ,$581.90 ,$13.88 ,$494.62 ,$819.26 ,$535.35 ,$407.33 ,$295.14 ,$354.20 ,$354.38 ,$354.20 ,$402.09 ,$523.71 ,$397.55 ,$360.40 ,$459.70 ,$13.88 ,$343.32 ,$343.32 ,$356.84 ,$343.32 ,$418.97 ,$360.78 ,$418.97 ,$418.97 ,$465.52 
ST NICHOLAS HOSPITAL - ACUTE,51000481,98925,HC OSTEOPATHIC MAN 1-2 REGIONS,510,1 ,$82.95 ,$54.75 ,$1.12 ,$82.95 ,$1.12 ,$82.95 ,$82.95 ,$24.38 ,$49.77 ,$70.51 ,$58.07 ,$1.12 ,$1.12 ,$78.80 ,$63.04 ,$62.21 ,$82.95 ,$70.51 ,$24.38 ,$82.95 ,$82.95 ,$58.07 ,$50.52 ,$1.12 ,$24.38 ,$23.89 ,$48.76 ,$1.19 ,$70.51 ,$54.86 ,$76.31 ,$58.07 ,$42.07 ,$50.49 ,$50.52 ,$50.49 ,$57.32 ,$74.66 ,$56.67 ,$24.13 ,$65.53 ,$1.19 ,$48.94 ,$48.94 ,$23.89 ,$48.94 ,$59.72 ,$51.43 ,$59.72 ,$59.72 ,$66.36 
ST NICHOLAS HOSPITAL - ACUTE,51001002,N/A,HC REST EXER ASSESS EVAL,510,1 ,$61.48 ,$40.58 ,$31.18 ,$61.48 , N/A ,$61.48 ,$61.48 , N/A ,$36.89 ,$52.26 ,$43.04 , N/A , N/A ,$58.41 ,$46.72 ,$46.11 ,$61.48 ,$52.26 , N/A ,$61.48 ,$61.48 ,$43.04 ,$37.44 , N/A , N/A , N/A , N/A , N/A ,$52.26 , N/A ,$56.56 ,$43.04 ,$31.18 ,$37.42 ,$37.44 ,$37.42 ,$42.48 ,$55.33 ,$42.00 , N/A ,$48.57 , N/A ,$36.27 ,$36.27 , N/A ,$36.27 ,$44.27 ,$38.12 ,$44.27 ,$44.27 ,$49.18 
ST NICHOLAS HOSPITAL - ACUTE,51001003,N/A,HC REST EXER THER LEVEL I SESSION,510,1 ,$12.24 ,$8.08 ,$6.21 ,$12.24 , N/A ,$12.24 ,$12.24 , N/A ,$7.34 ,$10.40 ,$8.57 , N/A , N/A ,$11.63 ,$9.30 ,$9.18 ,$12.24 ,$10.40 , N/A ,$12.24 ,$12.24 ,$8.57 ,$7.45 , N/A , N/A , N/A , N/A , N/A ,$10.40 , N/A ,$11.26 ,$8.57 ,$6.21 ,$7.45 ,$7.45 ,$7.45 ,$8.46 ,$11.02 ,$8.36 , N/A ,$9.67 , N/A ,$7.22 ,$7.22 , N/A ,$7.22 ,$8.81 ,$7.59 ,$8.81 ,$8.81 ,$9.79 
ST NICHOLAS HOSPITAL - ACUTE,51001005,N/A,HC LIFETIME EX MONTH 3D/WK,510,1 ,$56.18 ,$37.08 ,$28.49 ,$56.18 , N/A ,$56.18 ,$56.18 , N/A ,$33.71 ,$47.75 ,$39.33 , N/A , N/A ,$53.37 ,$42.70 ,$42.14 ,$56.18 ,$47.75 , N/A ,$56.18 ,$56.18 ,$39.33 ,$34.21 , N/A , N/A , N/A , N/A , N/A ,$47.75 , N/A ,$51.69 ,$39.33 ,$28.49 ,$34.20 ,$34.21 ,$34.20 ,$38.82 ,$50.56 ,$38.38 , N/A ,$44.38 , N/A ,$33.15 ,$33.15 , N/A ,$33.15 ,$40.45 ,$34.83 ,$40.45 ,$40.45 ,$44.94 
ST NICHOLAS HOSPITAL - ACUTE,51001006,N/A,HC LIFETIME EX MONTHLY 2D/WK,510,1 ,$44.52 ,$29.38 ,$22.58 ,$44.52 , N/A ,$44.52 ,$44.52 , N/A ,$26.71 ,$37.84 ,$31.16 , N/A , N/A ,$42.29 ,$33.84 ,$33.39 ,$44.52 ,$37.84 , N/A ,$44.52 ,$44.52 ,$31.16 ,$27.11 , N/A , N/A , N/A , N/A , N/A ,$37.84 , N/A ,$40.96 ,$31.16 ,$22.58 ,$27.10 ,$27.11 ,$27.10 ,$30.76 ,$40.07 ,$30.42 , N/A ,$35.17 , N/A ,$26.27 ,$26.27 , N/A ,$26.27 ,$32.05 ,$27.60 ,$32.05 ,$32.05 ,$35.62 
ST NICHOLAS HOSPITAL - ACUTE,51001007,N/A,HC LIFETIME EX PER SESSION,510,1 ,$8.90 ,$5.87 ,$4.51 ,$8.90 , N/A ,$8.90 ,$8.90 , N/A ,$5.34 ,$7.57 ,$6.23 , N/A , N/A ,$8.46 ,$6.76 ,$6.68 ,$8.90 ,$7.57 , N/A ,$8.90 ,$8.90 ,$6.23 ,$5.42 , N/A , N/A , N/A , N/A , N/A ,$7.57 , N/A ,$8.19 ,$6.23 ,$4.51 ,$5.42 ,$5.42 ,$5.42 ,$6.15 ,$8.01 ,$6.08 , N/A ,$7.03 , N/A ,$5.25 ,$5.25 , N/A ,$5.25 ,$6.41 ,$5.52 ,$6.41 ,$6.41 ,$7.12 
ST NICHOLAS HOSPITAL - ACUTE,61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$3,362.80 ","$2,219.45 ",$14.78 ,"$3,362.80 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$14.78 ,$14.78 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,858.38 ",$809.07 ,"$3,093.78 ","$2,353.96 ","$1,855.81 ","$1,855.81 ","$2,047.95 ","$1,855.81 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$355.93 ,"$2,656.61 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$17.61 ,"$3,362.80 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$17.61 ,$17.61 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$17.61 ,$227.92 ,$223.36 ,$455.84 ,$18.67 ,"$2,858.38 ",$512.81 ,"$3,093.78 ","$2,353.96 ","$1,109.82 ","$1,109.82 ","$2,047.95 ","$1,109.82 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$225.60 ,"$2,656.61 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,61000002,70545,HC MRA HEAD W/CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$17.61 ,"$3,362.80 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$17.61 ,$17.61 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$2,858.38 ",$809.07 ,"$3,093.78 ","$2,353.96 ","$1,605.70 ","$1,605.70 ","$2,047.95 ","$1,605.70 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$355.93 ,"$2,656.61 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$17.61 ,"$3,362.80 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$17.61 ,$17.61 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$2,858.38 ",$809.07 ,"$3,093.78 ","$2,353.96 ","$1,855.81 ","$1,855.81 ","$2,047.95 ","$1,855.81 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$355.93 ,"$2,656.61 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$2,578.15 ","$1,701.58 ",$17.61 ,"$2,578.15 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$1,546.89 ","$2,191.43 ","$1,804.71 ",$17.61 ,$17.61 ,"$2,449.24 ","$1,959.39 ","$1,933.61 ","$2,283.00 ","$2,191.43 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$1,804.71 ","$1,570.09 ",$17.61 ,$227.92 ,$223.36 ,$455.84 ,$18.67 ,"$2,191.43 ",$512.81 ,"$2,371.90 ","$1,804.71 ","$1,109.82 ","$1,109.82 ","$1,570.09 ","$1,109.82 ","$1,781.50 ","$2,320.34 ","$1,761.39 ",$225.60 ,"$2,036.74 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$1,856.27 ","$1,598.45 ","$1,856.27 ","$1,856.27 ","$2,062.52 "
ST NICHOLAS HOSPITAL - ACUTE,61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$2,578.15 ","$1,701.58 ",$17.61 ,"$2,578.15 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,546.89 ","$2,191.43 ","$1,804.71 ",$17.61 ,$17.61 ,"$2,449.24 ","$1,959.39 ","$1,933.61 ","$2,283.00 ","$2,191.43 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,804.71 ","$1,570.09 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$2,191.43 ",$809.07 ,"$2,371.90 ","$1,804.71 ","$1,605.70 ","$1,605.70 ","$1,570.09 ","$1,605.70 ","$1,781.50 ","$2,320.34 ","$1,761.39 ",$355.93 ,"$2,036.74 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,856.27 ","$1,598.45 ","$1,856.27 ","$1,856.27 ","$2,062.52 "
ST NICHOLAS HOSPITAL - ACUTE,61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$2,578.15 ","$1,701.58 ",$17.61 ,"$2,578.15 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,546.89 ","$2,191.43 ","$1,804.71 ",$17.61 ,$17.61 ,"$2,449.24 ","$1,959.39 ","$1,933.61 ","$2,283.00 ","$2,191.43 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,804.71 ","$1,570.09 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$2,191.43 ",$809.07 ,"$2,371.90 ","$1,804.71 ","$1,855.81 ","$1,855.81 ","$1,570.09 ","$1,855.81 ","$1,781.50 ","$2,320.34 ","$1,761.39 ",$355.93 ,"$2,036.74 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,856.27 ","$1,598.45 ","$1,856.27 ","$1,856.27 ","$2,062.52 "
ST NICHOLAS HOSPITAL - ACUTE,61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$8.63 ,"$3,362.80 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$8.63 ,$8.63 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$2,858.38 ",$512.81 ,"$3,093.78 ","$2,353.96 ","$1,109.82 ","$1,109.82 ","$2,047.95 ","$1,109.82 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$225.60 ,"$2,656.61 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$3,362.80 ","$2,219.45 ",$14.78 ,"$3,362.80 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$14.78 ,$14.78 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,858.38 ",$809.07 ,"$3,093.78 ","$2,353.96 ","$1,605.70 ","$1,605.70 ","$2,047.95 ","$1,605.70 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$355.93 ,"$2,656.61 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$14.78 ,"$3,362.80 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$14.78 ,$14.78 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,858.38 ",$809.07 ,"$3,093.78 ","$2,353.96 ","$1,855.81 ","$1,855.81 ","$2,047.95 ","$1,855.81 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$355.93 ,"$2,656.61 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$2,578.15 ","$1,701.58 ",$8.63 ,"$2,578.15 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$1,546.89 ","$2,191.43 ","$1,804.71 ",$8.63 ,$8.63 ,"$2,449.24 ","$1,959.39 ","$1,933.61 ","$2,283.00 ","$2,191.43 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$1,804.71 ","$1,570.09 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$2,191.43 ",$512.81 ,"$2,371.90 ","$1,804.71 ","$1,109.82 ","$1,109.82 ","$1,570.09 ","$1,109.82 ","$1,781.50 ","$2,320.34 ","$1,761.39 ",$225.60 ,"$2,036.74 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$1,856.27 ","$1,598.45 ","$1,856.27 ","$1,856.27 ","$2,062.52 "
ST NICHOLAS HOSPITAL - ACUTE,61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$2,578.15 ","$1,701.58 ",$14.78 ,"$2,578.15 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,546.89 ","$2,191.43 ","$1,804.71 ",$14.78 ,$14.78 ,"$2,449.24 ","$1,959.39 ","$1,933.61 ","$2,283.00 ","$2,191.43 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,804.71 ","$1,570.09 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,191.43 ",$809.07 ,"$2,371.90 ","$1,804.71 ","$1,605.70 ","$1,605.70 ","$1,570.09 ","$1,605.70 ","$1,781.50 ","$2,320.34 ","$1,761.39 ",$355.93 ,"$2,036.74 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,856.27 ","$1,598.45 ","$1,856.27 ","$1,856.27 ","$2,062.52 "
ST NICHOLAS HOSPITAL - ACUTE,61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$8.63 ,"$2,777.25 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$8.63 ,$8.63 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$2,360.66 ",$512.81 ,"$2,555.07 ","$1,944.08 ","$1,109.82 ","$1,109.82 ","$1,691.35 ","$1,109.82 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$225.60 ,"$2,194.03 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,605.70 ","$1,605.70 ","$1,691.35 ","$1,605.70 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$8.63 ,"$2,777.25 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$8.63 ,$8.63 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$2,360.66 ",$512.81 ,"$2,555.07 ","$1,944.08 ","$1,109.82 ","$1,109.82 ","$1,691.35 ","$1,109.82 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$225.60 ,"$2,194.03 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,605.70 ","$1,605.70 ","$1,691.35 ","$1,605.70 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$2,578.15 ","$1,701.58 ",$14.78 ,"$2,578.15 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,546.89 ","$2,191.43 ","$1,804.71 ",$14.78 ,$14.78 ,"$2,449.24 ","$1,959.39 ","$1,933.61 ","$2,283.00 ","$2,191.43 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,804.71 ","$1,570.09 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,191.43 ",$809.07 ,"$2,371.90 ","$1,804.71 ","$1,855.81 ","$1,855.81 ","$1,570.09 ","$1,855.81 ","$1,781.50 ","$2,320.34 ","$1,761.39 ",$355.93 ,"$2,036.74 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,856.27 ","$1,598.45 ","$1,856.27 ","$1,856.27 ","$2,062.52 "
ST NICHOLAS HOSPITAL - ACUTE,61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,855.81 ","$1,855.81 ","$1,691.35 ","$1,855.81 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,855.81 ","$1,855.81 ","$1,691.35 ","$1,855.81 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$2,777.25 ","$1,832.99 ",$8.63 ,"$2,777.25 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$8.63 ,$8.63 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$2,360.66 ",$512.81 ,"$2,555.07 ","$1,944.08 ","$1,109.82 ","$1,109.82 ","$1,691.35 ","$1,109.82 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$225.60 ,"$2,194.03 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,605.70 ","$1,605.70 ","$1,691.35 ","$1,605.70 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,855.81 ","$1,855.81 ","$1,691.35 ","$1,855.81 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$12.94 ,"$2,777.25 ",$12.94 ,"$1,460.00 ","$1,460.00 ",$514.52 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$12.94 ,$12.94 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$514.52 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$12.94 ,$514.52 ,$504.23 ,"$1,029.04 ",$13.72 ,"$2,360.66 ","$1,157.67 ","$2,555.07 ","$1,944.08 ","$1,664.73 ","$1,664.73 ","$1,691.35 ","$1,664.73 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$509.28 ,"$2,194.03 ",$13.72 ,"$1,380.00 ","$1,380.00 ",$504.23 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$12.94 ,"$2,777.25 ",$12.94 ,"$1,460.00 ","$1,460.00 ",$514.52 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$12.94 ,$12.94 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$514.52 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$12.94 ,$514.52 ,$504.23 ,"$1,029.04 ",$13.72 ,"$2,360.66 ","$1,157.67 ","$2,555.07 ","$1,944.08 ","$1,664.73 ","$1,664.73 ","$1,691.35 ","$1,664.73 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$509.28 ,"$2,194.03 ",$13.72 ,"$1,380.00 ","$1,380.00 ",$504.23 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$22.17 ,"$2,777.25 ",$22.17 ,"$1,460.00 ","$1,460.00 ",$825.42 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$22.17 ,$22.17 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$825.42 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$22.17 ,$825.42 ,$808.91 ,"$1,650.84 ",$23.50 ,"$2,360.66 ","$1,857.20 ","$2,555.07 ","$1,944.08 ","$2,408.55 ","$2,408.55 ","$1,691.35 ","$2,408.55 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$817.00 ,"$2,194.03 ",$23.50 ,"$1,380.00 ","$1,380.00 ",$808.91 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$22.17 ,"$2,777.25 ",$22.17 ,"$1,460.00 ","$1,460.00 ",$825.42 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$22.17 ,$22.17 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$825.42 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$22.17 ,$825.42 ,$808.91 ,"$1,650.84 ",$23.50 ,"$2,360.66 ","$1,857.20 ","$2,555.07 ","$1,944.08 ","$2,408.55 ","$2,408.55 ","$1,691.35 ","$2,408.55 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$817.00 ,"$2,194.03 ",$23.50 ,"$1,380.00 ","$1,380.00 ",$808.91 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,855.81 ","$1,855.81 ","$1,691.35 ","$1,855.81 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$12.94 ,"$2,777.25 ",$12.94 ,"$1,460.00 ","$1,460.00 ",$514.52 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$12.94 ,$12.94 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$514.52 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$12.94 ,$514.52 ,$504.23 ,"$1,029.04 ",$13.72 ,"$2,360.66 ","$1,157.67 ","$2,555.07 ","$1,944.08 ","$1,664.73 ","$1,664.73 ","$1,691.35 ","$1,664.73 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$509.28 ,"$2,194.03 ",$13.72 ,"$1,380.00 ","$1,380.00 ",$504.23 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$12.94 ,"$2,777.25 ",$12.94 ,"$1,460.00 ","$1,460.00 ",$514.52 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$12.94 ,$12.94 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$514.52 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$12.94 ,$514.52 ,$504.23 ,"$1,029.04 ",$13.72 ,"$2,360.66 ","$1,157.67 ","$2,555.07 ","$1,944.08 ","$1,664.73 ","$1,664.73 ","$1,691.35 ","$1,664.73 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$509.28 ,"$2,194.03 ",$13.72 ,"$1,380.00 ","$1,380.00 ",$504.23 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$22.17 ,"$2,777.25 ",$22.17 ,"$1,460.00 ","$1,460.00 ",$825.42 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$22.17 ,$22.17 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$825.42 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$22.17 ,$825.42 ,$808.91 ,"$1,650.84 ",$23.50 ,"$2,360.66 ","$1,857.20 ","$2,555.07 ","$1,944.08 ","$2,408.55 ","$2,408.55 ","$1,691.35 ","$2,408.55 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$817.00 ,"$2,194.03 ",$23.50 ,"$1,380.00 ","$1,380.00 ",$808.91 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$22.17 ,"$2,777.25 ",$22.17 ,"$1,460.00 ","$1,460.00 ",$825.42 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$22.17 ,$22.17 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$825.42 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$22.17 ,$825.42 ,$808.91 ,"$1,650.84 ",$23.50 ,"$2,360.66 ","$1,857.20 ","$2,555.07 ","$1,944.08 ","$2,408.55 ","$2,408.55 ","$1,691.35 ","$2,408.55 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$817.00 ,"$2,194.03 ",$23.50 ,"$1,380.00 ","$1,380.00 ",$808.91 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,855.81 ","$1,855.81 ","$1,691.35 ","$1,855.81 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$8.63 ,"$2,777.25 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$8.63 ,$8.63 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$2,360.66 ",$512.81 ,"$2,555.07 ","$1,944.08 ","$1,109.82 ","$1,109.82 ","$1,691.35 ","$1,109.82 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$225.60 ,"$2,194.03 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,605.70 ","$1,605.70 ","$1,691.35 ","$1,605.70 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,855.81 ","$1,855.81 ","$1,691.35 ","$1,855.81 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$12.94 ,"$2,777.25 ",$12.94 ,"$1,460.00 ","$1,460.00 ",$514.52 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$12.94 ,$12.94 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$514.52 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$12.94 ,$514.52 ,$504.23 ,"$1,029.04 ",$13.72 ,"$2,360.66 ","$1,157.67 ","$2,555.07 ","$1,944.08 ","$1,664.73 ","$1,664.73 ","$1,691.35 ","$1,664.73 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$509.28 ,"$2,194.03 ",$13.72 ,"$1,380.00 ","$1,380.00 ",$504.23 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$12.94 ,"$2,777.25 ",$12.94 ,"$1,460.00 ","$1,460.00 ",$514.52 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$12.94 ,$12.94 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$514.52 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$12.94 ,$514.52 ,$504.23 ,"$1,029.04 ",$13.72 ,"$2,360.66 ","$1,157.67 ","$2,555.07 ","$1,944.08 ","$1,664.73 ","$1,664.73 ","$1,691.35 ","$1,664.73 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$509.28 ,"$2,194.03 ",$13.72 ,"$1,380.00 ","$1,380.00 ",$504.23 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$22.17 ,"$2,777.25 ",$22.17 ,"$1,460.00 ","$1,460.00 ",$825.42 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$22.17 ,$22.17 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$825.42 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$22.17 ,$825.42 ,$808.91 ,"$1,650.84 ",$23.50 ,"$2,360.66 ","$1,857.20 ","$2,555.07 ","$1,944.08 ","$2,408.55 ","$2,408.55 ","$1,691.35 ","$2,408.55 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$817.00 ,"$2,194.03 ",$23.50 ,"$1,380.00 ","$1,380.00 ",$808.91 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$22.17 ,"$2,777.25 ",$22.17 ,"$1,460.00 ","$1,460.00 ",$825.42 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$22.17 ,$22.17 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$825.42 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$22.17 ,$825.42 ,$808.91 ,"$1,650.84 ",$23.50 ,"$2,360.66 ","$1,857.20 ","$2,555.07 ","$1,944.08 ","$2,408.55 ","$2,408.55 ","$1,691.35 ","$2,408.55 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$817.00 ,"$2,194.03 ",$23.50 ,"$1,380.00 ","$1,380.00 ",$808.91 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$14.78 ,"$2,777.25 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$14.78 ,$14.78 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,855.81 ","$1,855.81 ","$1,691.35 ","$1,855.81 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$8.63 ,"$3,622.50 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$8.63 ,$8.63 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$3,079.13 ",$512.81 ,"$3,332.70 ","$2,535.75 ","$1,109.82 ","$1,109.82 ","$2,206.10 ","$1,109.82 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$225.60 ,"$2,861.78 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000039,74182,HC MRI ABDOMEN W/CON,610,1 ,"$3,622.50 ","$2,390.85 ",$14.78 ,"$3,622.50 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$14.78 ,$14.78 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$3,079.13 ",$809.07 ,"$3,332.70 ","$2,535.75 ","$1,605.70 ","$1,605.70 ","$2,206.10 ","$1,605.70 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$355.93 ,"$2,861.78 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$14.78 ,"$3,622.50 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$14.78 ,$14.78 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$3,079.13 ",$809.07 ,"$3,332.70 ","$2,535.75 ","$1,855.81 ","$1,855.81 ","$2,206.10 ","$1,855.81 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$355.93 ,"$2,861.78 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000044,76498,HC UNLISTED MRI PROC,610,1 ,"$2,777.25 ","$1,832.99 ",$8.63 ,"$2,777.25 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$84.79 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$8.63 ,$8.63 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$84.79 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$8.63 ,$84.79 ,$83.09 ,$169.58 ,$9.15 ,"$2,360.66 ",$190.79 ,"$2,555.07 ","$1,944.08 ","$1,109.82 ","$1,109.82 ","$1,691.35 ","$1,109.82 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$83.93 ,"$2,194.03 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$83.09 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000048,19085,HC BREAST BIOPSY MRI GUIDE NEEDLE PLACE,610,1 ,"$1,150.00 ",$759.00 ,$46.22 ,"$3,293.01 ",$46.22 ,"$1,150.00 ","$1,150.00 ","$1,463.56 ",$690.00 ,$977.50 ,$805.00 ,$46.22 ,$46.22 ,"$1,092.50 ",$874.00 ,$862.50 ,"$1,150.00 ",$977.50 ,"$1,463.56 ","$1,150.00 ","$1,150.00 ",$805.00 ,$700.35 ,$46.22 ,"$1,463.56 ","$1,434.29 ","$1,150.00 ",$48.99 ,$977.50 ,"$3,293.01 ","$1,058.00 ",$805.00 ,"$1,150.00 ","$1,150.00 ",$700.35 ,"$1,150.00 ",$794.65 ,"$1,035.00 ",$785.68 ,"$1,448.64 ",$908.50 ,$48.99 ,"$1,150.00 ","$1,150.00 ","$1,434.29 ","$1,150.00 ",$828.00 ,$713.00 ,$828.00 ,$828.00 ,$920.00 
ST NICHOLAS HOSPITAL - ACUTE,61000049,19287,HC MRI GUIDE NEEDLE PLACE LOC,610,1 ,"$2,530.00 ","$1,669.80 ",$46.22 ,"$2,530.00 ",$46.22 ,"$1,460.00 ","$1,460.00 ",$633.39 ,"$1,518.00 ","$2,150.50 ","$1,771.00 ",$46.22 ,$46.22 ,"$2,403.50 ","$1,922.80 ","$1,897.50 ","$2,283.00 ","$2,150.50 ",$633.39 ,"$2,283.00 ","$2,283.00 ","$1,771.00 ","$1,540.77 ",$46.22 ,$633.39 ,$620.72 ,"$1,266.78 ",$48.99 ,"$2,150.50 ","$1,425.14 ","$2,327.60 ","$1,771.00 ","$1,771.14 ","$2,213.66 ","$1,540.77 ","$2,213.66 ","$1,748.23 ","$2,277.00 ","$1,728.50 ",$626.93 ,"$1,998.70 ",$48.99 ,"$1,380.00 ","$1,380.00 ",$620.72 ,"$1,380.00 ","$1,821.60 ","$1,568.60 ","$1,821.60 ","$1,821.60 ","$2,024.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$17.61 ,"$3,622.50 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$17.61 ,$17.61 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$3,079.13 ",$809.07 ,"$3,332.70 ","$2,535.75 ","$1,605.70 ","$1,605.70 ","$2,206.10 ","$1,605.70 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$355.93 ,"$2,861.78 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000052,C8901,HC MRA ABDOMEN W/O CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$17.61 ,"$3,622.50 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$17.61 ,$17.61 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$17.61 ,$227.92 ,$223.36 ,$455.84 ,$18.67 ,"$3,079.13 ",$512.81 ,"$3,332.70 ","$2,535.75 ","$1,109.82 ","$1,109.82 ","$2,206.10 ","$1,109.82 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$225.60 ,"$2,861.78 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000053,C8902,HC MRA ABDOMEN W AND W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$17.61 ,"$3,622.50 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$17.61 ,$17.61 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$3,079.13 ",$809.07 ,"$3,332.70 ","$2,535.75 ","$1,855.81 ","$1,855.81 ","$2,206.10 ","$1,855.81 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$355.93 ,"$2,861.78 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000058,77047,HC MRI BREAST BI W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$8.63 ,"$3,622.50 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$8.63 ,$8.63 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$3,079.13 ",$512.81 ,"$3,332.70 ","$2,535.75 ",$838.28 ,$838.28 ,"$2,206.10 ",$838.28 ,"$2,503.15 ","$3,260.25 ","$2,474.89 ",$225.60 ,"$2,861.78 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000059,C8908,HC MRI BREAST BI W AND W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$14.78 ,"$3,622.50 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$14.78 ,$14.78 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$3,079.13 ",$809.07 ,"$3,332.70 ","$2,535.75 ","$1,855.81 ","$1,855.81 ","$2,206.10 ","$1,855.81 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$355.93 ,"$2,861.78 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$17.61 ,"$3,622.50 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$17.61 ,$17.61 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$3,079.13 ",$809.07 ,"$3,332.70 ","$2,535.75 ","$1,605.70 ","$1,605.70 ","$2,206.10 ","$1,605.70 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$355.93 ,"$2,861.78 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000062,C8911,HC MRA CHEST W AND W/O CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$17.61 ,"$3,622.50 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$17.61 ,$17.61 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$3,079.13 ",$809.07 ,"$3,332.70 ","$2,535.75 ","$1,855.81 ","$1,855.81 ","$2,206.10 ","$1,855.81 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$355.93 ,"$2,861.78 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000063,C8912,HC MRA LWR EXT W/CON,610,1 ,"$2,777.25 ","$1,832.99 ",$17.61 ,"$2,777.25 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$17.61 ,$17.61 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,605.70 ","$1,605.70 ","$1,691.35 ","$1,605.70 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000068,C8918,HC MRA PELVIS W/CON,610,1 ,"$3,622.50 ","$2,390.85 ",$17.61 ,"$3,622.50 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,173.50 ","$3,079.13 ","$2,535.75 ",$17.61 ,$17.61 ,"$3,441.38 ","$2,753.10 ","$2,716.88 ","$2,283.00 ","$3,079.13 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,535.75 ","$2,206.10 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$3,079.13 ",$809.07 ,"$3,332.70 ","$2,535.75 ","$1,605.70 ","$1,605.70 ","$2,206.10 ","$1,605.70 ","$2,503.15 ","$3,260.25 ","$2,474.89 ",$355.93 ,"$2,861.78 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,608.20 ","$2,245.95 ","$2,608.20 ","$2,608.20 ","$2,898.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000071,C8934,HC MRA UPPR EXT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$17.61 ,"$2,777.25 ",$17.61 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$17.61 ,$17.61 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$17.61 ,$359.59 ,$352.40 ,$719.18 ,$18.67 ,"$2,360.66 ",$809.07 ,"$2,555.07 ","$1,944.08 ","$1,605.70 ","$1,605.70 ","$1,691.35 ","$1,605.70 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$355.93 ,"$2,194.03 ",$18.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$3,362.80 ","$2,219.45 ",$14.78 ,"$3,362.80 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$14.78 ,$14.78 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,858.38 ",$809.07 ,"$3,093.78 ","$2,353.96 ","$1,855.81 ","$1,855.81 ","$2,047.95 ","$1,855.81 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$355.93 ,"$2,656.61 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,61000076,70542,HC MRI ORBIT/FACE/NECK W/CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$14.78 ,"$3,362.80 ",$14.78 ,"$1,460.00 ","$1,460.00 ",$359.59 ,"$2,017.68 ","$2,858.38 ","$2,353.96 ",$14.78 ,$14.78 ,"$3,194.66 ","$2,555.73 ","$2,522.10 ","$2,283.00 ","$2,858.38 ",$359.59 ,"$2,283.00 ","$2,283.00 ","$2,353.96 ","$2,047.95 ",$14.78 ,$359.59 ,$352.40 ,$719.18 ,$15.67 ,"$2,858.38 ",$809.07 ,"$3,093.78 ","$2,353.96 ","$1,605.70 ","$1,605.70 ","$2,047.95 ","$1,605.70 ","$2,323.69 ","$3,026.52 ","$2,297.47 ",$355.93 ,"$2,656.61 ",$15.67 ,"$1,380.00 ","$1,380.00 ",$352.40 ,"$1,380.00 ","$2,421.22 ","$2,084.94 ","$2,421.22 ","$2,421.22 ","$2,690.24 "
ST NICHOLAS HOSPITAL - ACUTE,61000077,74712,HC MRI FETAL PLACENTA/MATERN PELVIC SINGLE,610,1 ,"$2,777.25 ","$1,832.99 ",$8.63 ,"$2,777.25 ",$8.63 ,"$1,460.00 ","$1,460.00 ",$227.92 ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$8.63 ,$8.63 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ",$227.92 ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$8.63 ,$227.92 ,$223.36 ,$455.84 ,$9.15 ,"$2,360.66 ",$512.81 ,"$2,555.07 ","$1,944.08 ","$1,006.49 ","$1,006.49 ","$1,691.35 ","$1,006.49 ","$1,919.08 ","$2,499.53 ","$1,897.42 ",$225.60 ,"$2,194.03 ",$9.15 ,"$1,380.00 ","$1,380.00 ",$223.36 ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,61000078,74713,HC MRI FETAL PLACENTA/MATERN PELVIC EA ADDN,610,1 ,"$2,777.25 ","$1,832.99 ",$8.63 ,"$2,777.25 ",$8.63 ,"$1,460.00 ","$1,460.00 ", N/A ,"$1,666.35 ","$2,360.66 ","$1,944.08 ",$8.63 ,$8.63 ,"$2,638.39 ","$2,110.71 ","$2,082.94 ","$2,283.00 ","$2,360.66 ", N/A ,"$2,283.00 ","$2,283.00 ","$1,944.08 ","$1,691.35 ",$8.63 , N/A , N/A , N/A ,$9.15 ,"$2,360.66 ", N/A ,"$2,555.07 ","$1,944.08 ","$1,408.62 ","$1,690.51 ","$1,691.35 ","$1,690.51 ","$1,919.08 ","$2,499.53 ","$1,897.42 ", N/A ,"$2,194.03 ",$9.15 ,"$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ","$1,999.62 ","$1,721.90 ","$1,999.62 ","$1,999.62 ","$2,221.80 "
ST NICHOLAS HOSPITAL - ACUTE,62100008,C1750,HC PERM CATH ANGIO,621,1 ,$787.50 ,$519.75 ,$399.42 ,$787.50 , N/A ,$539.75 ,$539.75 , N/A ,$472.50 ,$669.38 ,$551.25 , N/A , N/A ,$748.13 ,$598.50 ,$590.63 ,$511.88 ,$669.38 , N/A ,$511.88 ,$511.88 ,$551.25 ,$479.59 , N/A , N/A , N/A , N/A , N/A ,$669.38 , N/A ,$724.50 ,$551.25 ,$399.42 ,$479.35 ,$479.59 ,$479.35 ,$544.16 ,$708.75 ,$538.02 , N/A ,$622.13 , N/A ,$464.63 ,$464.63 , N/A ,$464.63 ,$567.00 ,$488.25 ,$567.00 ,$567.00 ,$630.00 
ST NICHOLAS HOSPITAL - ACUTE,62100027,C2627,HC CATH SUPRAPUBIC-SYSTOSCOPIC,621,1 ,$212.10 ,$139.99 ,$107.58 ,$212.10 , N/A ,$145.37 ,$145.37 , N/A ,$127.26 ,$180.29 , N/A , N/A , N/A ,$201.50 ,$161.20 ,$159.08 ,$137.87 ,$180.29 , N/A ,$137.87 ,$137.87 ,$148.47 ,$129.17 , N/A , N/A , N/A , N/A , N/A ,$180.29 , N/A ,$195.13 ,$148.47 ,$107.58 ,$129.11 ,$129.17 ,$129.11 ,$146.56 ,$190.89 ,$144.91 , N/A ,$167.56 , N/A ,$125.14 ,$125.14 , N/A ,$125.14 ,$152.71 ,$131.50 ,$152.71 ,$152.71 ,$169.68 
ST NICHOLAS HOSPITAL - ACUTE,62100046,N/A,HC ANGIO PVA VIAL,621,1 ,$717.15 ,$473.32 ,$363.74 ,$717.15 , N/A ,$491.53 ,$491.53 , N/A ,$430.29 ,$609.58 ,$502.01 , N/A , N/A ,$681.29 ,$545.03 ,$537.86 ,$466.15 ,$609.58 , N/A ,$466.15 ,$466.15 ,$502.01 ,$436.74 , N/A , N/A , N/A , N/A , N/A ,$609.58 , N/A ,$659.78 ,$502.01 ,$363.74 ,$436.53 ,$436.74 ,$436.53 ,$495.55 ,$645.44 ,$489.96 , N/A ,$566.55 , N/A ,$423.12 ,$423.12 , N/A ,$423.12 ,$516.35 ,$444.63 ,$516.35 ,$516.35 ,$573.72 
ST NICHOLAS HOSPITAL - ACUTE,62100073,C1757,HC CATHETER INFUSION/ASPIRATION,621,1 ,"$1,239.00 ",$817.74 ,$628.42 ,"$1,239.00 ", N/A ,$849.21 ,$849.21 , N/A ,$743.40 ,"$1,053.15 ", N/A , N/A , N/A ,"$1,177.05 ",$941.64 ,$929.25 ,$805.35 ,"$1,053.15 ", N/A ,$805.35 ,$805.35 ,$867.30 ,$754.55 , N/A , N/A , N/A , N/A , N/A ,"$1,053.15 ", N/A ,"$1,139.88 ",$867.30 ,$628.42 ,$754.18 ,$754.55 ,$754.18 ,$856.15 ,"$1,115.10 ",$846.48 , N/A ,$978.81 , N/A ,$731.01 ,$731.01 , N/A ,$731.01 ,$892.08 ,$768.18 ,$892.08 ,$892.08 ,$991.20 
ST NICHOLAS HOSPITAL - ACUTE,62100113,N/A,HC TERUMO EMBOLIZATION COIL,621,1 ,"$2,808.75 ","$1,853.78 ","$1,424.60 ","$2,808.75 ", N/A ,"$1,925.12 ","$1,925.12 ", N/A ,"$1,685.25 ","$2,387.44 ","$1,966.13 ", N/A , N/A ,"$2,668.31 ","$2,134.65 ","$2,106.56 ","$1,825.69 ","$2,387.44 ", N/A ,"$1,825.69 ","$1,825.69 ","$1,966.13 ","$1,710.53 ", N/A , N/A , N/A , N/A , N/A ,"$2,387.44 ", N/A ,"$2,584.05 ","$1,966.13 ","$1,424.60 ","$1,709.69 ","$1,710.53 ","$1,709.69 ","$1,940.85 ","$2,527.88 ","$1,918.94 ", N/A ,"$2,218.91 ", N/A ,"$1,657.16 ","$1,657.16 ", N/A ,"$1,657.16 ","$2,022.30 ","$1,741.43 ","$2,022.30 ","$2,022.30 ","$2,247.00 "
ST NICHOLAS HOSPITAL - ACUTE,62100118,N/A,HSHS HC TRAY BIOPSY,621,1 ,$28.35 ,$18.71 ,$14.38 ,$28.35 , N/A ,$19.43 ,$19.43 , N/A ,$17.01 ,$24.10 ,$19.85 , N/A , N/A ,$26.93 ,$21.55 ,$21.26 ,$18.43 ,$24.10 , N/A ,$18.43 ,$18.43 ,$19.85 ,$17.27 , N/A , N/A , N/A , N/A , N/A ,$24.10 , N/A ,$26.08 ,$19.85 ,$14.38 ,$17.26 ,$17.27 ,$17.26 ,$19.59 ,$25.52 ,$19.37 , N/A ,$22.40 , N/A ,$16.73 ,$16.73 , N/A ,$16.73 ,$20.41 ,$17.58 ,$20.41 ,$20.41 ,$22.68 
ST NICHOLAS HOSPITAL - ACUTE,62200001,C1759,HC CATHETER INTRACARDIAC ECHO,622,1 ,"$6,195.00 ","$4,088.70 ","$3,142.10 ","$6,195.00 ", N/A ,"$4,246.05 ","$4,246.05 ", N/A ,"$3,717.00 ","$5,265.75 ", N/A , N/A , N/A ,"$5,885.25 ","$4,708.20 ","$4,646.25 ","$4,026.75 ","$5,265.75 ", N/A ,"$4,026.75 ","$4,026.75 ","$4,336.50 ","$3,772.76 ", N/A , N/A , N/A , N/A , N/A ,"$5,265.75 ", N/A ,"$5,699.40 ","$4,336.50 ","$3,142.10 ","$3,770.90 ","$3,772.76 ","$3,770.90 ","$4,280.75 ","$5,575.50 ","$4,232.42 ", N/A ,"$4,894.05 ", N/A ,"$3,655.05 ","$3,655.05 ", N/A ,"$3,655.05 ","$4,460.40 ","$3,840.90 ","$4,460.40 ","$4,460.40 ","$4,956.00 "
ST NICHOLAS HOSPITAL - ACUTE,62200006,C1726,HC BALLOON DILATOR,622,1 ,$477.75 ,$315.32 ,$242.31 ,$477.75 , N/A ,$327.45 ,$327.45 , N/A ,$286.65 ,$406.09 , N/A , N/A , N/A ,$453.86 ,$363.09 ,$358.31 ,$310.54 ,$406.09 , N/A ,$310.54 ,$310.54 ,$334.43 ,$290.95 , N/A , N/A , N/A , N/A , N/A ,$406.09 , N/A ,$439.53 ,$334.43 ,$242.31 ,$290.81 ,$290.95 ,$290.81 ,$330.13 ,$429.98 ,$326.40 , N/A ,$377.42 , N/A ,$281.87 ,$281.87 , N/A ,$281.87 ,$343.98 ,$296.21 ,$343.98 ,$343.98 ,$382.20 
ST NICHOLAS HOSPITAL - ACUTE,63600001,Q4101,HC APLIGRAF PER 1 SQ CM,636,1 ,$87.15 ,$57.52 ,$44.12 ,$87.15 , N/A ,$68.47 ,$45.65 , N/A ,$52.29 ,$74.08 ,$61.01 , N/A , N/A ,$82.79 ,$66.23 ,$65.36 ,$51.61 ,$74.08 , N/A ,$51.61 ,$51.61 ,$61.01 ,$53.07 , N/A , N/A , N/A , N/A , N/A ,$74.08 , N/A ,$80.18 ,$61.01 ,$44.12 ,$44.12 ,$53.07 ,$44.12 ,$60.22 ,$78.44 ,$59.54 , N/A ,$68.85 , N/A , N/A , N/A , N/A , N/A ,$62.75 ,$54.03 ,$62.75 ,$62.75 ,$69.72 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3480,0.9 % NACL WITH KCL 40 MEQ 40-0.9 MEQ/L-% SOLN per2 mEq,636,1 ,$5.30 ,$3.50 ,$0.16 ,$5.30 , N/A ,$0.25 ,$0.17 , N/A ,$3.18 ,$4.51 ,$3.71 , N/A , N/A ,$5.04 ,$4.03 ,$3.98 ,$0.24 ,$4.51 , N/A ,$0.24 ,$0.24 ,$3.71 ,$3.23 , N/A , N/A , N/A , N/A , N/A ,$4.51 , N/A ,$4.88 ,$3.71 ,$0.16 ,$0.16 ,$3.23 ,$0.16 ,$3.66 ,$4.77 ,$3.62 , N/A ,$4.19 , N/A , N/A , N/A , N/A , N/A ,$3.82 ,$3.29 ,$3.82 ,$3.82 ,$4.24 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0129,ABATACEPT 250 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$196.86 ,$129.93 ,$41.90 ,$196.86 ,$71.25 ,$96.21 ,$64.14 ,$42.76 ,$118.12 ,$167.33 ,$137.80 ,$71.25 ,$71.25 ,$187.02 ,$149.61 ,$147.65 ,$73.95 ,$167.33 ,$42.76 ,$73.95 ,$73.95 ,$137.80 ,$119.89 ,$71.25 ,$42.76 ,$41.90 ,$85.52 ,$75.53 ,$167.33 ,$96.21 ,$181.11 ,$137.80 ,$62.00 ,$62.00 ,$119.89 ,$62.00 ,$136.03 ,$177.17 ,$134.49 ,$42.33 ,$155.52 ,$75.53 ,$71.78 ,$71.78 ,$41.90 ,$71.78 ,$141.74 ,$122.05 ,$141.74 ,$141.74 ,$157.49 
ST NICHOLAS HOSPITAL - ACUTE,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 , N/A ,$1.64 ,$2.32 ,$1.91 , N/A , N/A ,$2.59 ,$2.07 ,$2.05 ,$0.17 ,$2.32 , N/A ,$0.17 ,$0.17 ,$1.91 ,$1.66 , N/A , N/A , N/A , N/A , N/A ,$2.32 , N/A ,$2.51 ,$1.91 ,$0.15 ,$0.15 ,$1.66 ,$0.15 ,$1.89 ,$2.46 ,$1.87 , N/A ,$2.16 , N/A , N/A , N/A , N/A , N/A ,$1.97 ,$1.69 ,$1.97 ,$1.97 ,$2.18 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1120,ACETAZOLAMIDE 500 MG SOLR per500 mg,636,1 ,$324.45 ,$214.14 ,$40.68 ,$324.45 , N/A ,$65.27 ,$43.52 , N/A ,$194.67 ,$275.78 ,$227.12 , N/A , N/A ,$308.23 ,$246.58 ,$243.34 ,$40.68 ,$275.78 , N/A ,$40.68 ,$40.68 ,$227.12 ,$197.59 , N/A , N/A , N/A , N/A , N/A ,$275.78 , N/A ,$298.49 ,$227.12 ,$42.06 ,$42.06 ,$197.59 ,$42.06 ,$224.20 ,$292.01 ,$221.66 , N/A ,$256.32 , N/A , N/A , N/A , N/A , N/A ,$233.60 ,$201.16 ,$233.60 ,$233.60 ,$259.56 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0132,ACETYLCYSTEINE 200 MG/ML SOLN 30 ML VIAL per100 mg,636,1 ,$23.12 ,$15.26 ,$1.10 ,$23.12 , N/A ,$1.71 ,$1.14 , N/A ,$13.87 ,$19.65 ,$16.18 , N/A , N/A ,$21.96 ,$17.57 ,$17.34 ,$1.68 ,$19.65 , N/A ,$1.68 ,$1.68 ,$16.18 ,$14.08 , N/A , N/A , N/A , N/A , N/A ,$19.65 , N/A ,$21.27 ,$16.18 ,$1.10 ,$1.10 ,$14.08 ,$1.10 ,$15.98 ,$20.81 ,$15.80 , N/A ,$18.26 , N/A , N/A , N/A , N/A , N/A ,$16.65 ,$14.33 ,$16.65 ,$16.65 ,$18.50 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0133,ACYCLOVIR 50 MG/ML SOLN 10 ML VIAL per5 mg,636,1 ,$0.98 ,$0.65 ,$0.06 ,$0.98 , N/A ,$0.09 ,$0.06 , N/A ,$0.59 ,$0.83 ,$0.69 , N/A , N/A ,$0.93 ,$0.74 ,$0.74 ,$0.09 ,$0.83 , N/A ,$0.09 ,$0.09 ,$0.69 ,$0.60 , N/A , N/A , N/A , N/A , N/A ,$0.83 , N/A ,$0.90 ,$0.69 ,$0.06 ,$0.06 ,$0.60 ,$0.06 ,$0.68 ,$0.88 ,$0.67 , N/A ,$0.77 , N/A , N/A , N/A , N/A , N/A ,$0.71 ,$0.61 ,$0.71 ,$0.71 ,$0.78 
ST NICHOLAS HOSPITAL - ACUTE,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 , N/A ,$0.55 ,$0.78 ,$0.64 , N/A , N/A ,$0.87 ,$0.70 ,$0.69 ,$0.09 ,$0.78 , N/A ,$0.09 ,$0.09 ,$0.64 ,$0.56 , N/A , N/A , N/A , N/A , N/A ,$0.78 , N/A ,$0.85 ,$0.64 ,$0.06 ,$0.06 ,$0.56 ,$0.06 ,$0.64 ,$0.83 ,$0.63 , N/A ,$0.73 , N/A , N/A , N/A , N/A , N/A ,$0.66 ,$0.57 ,$0.66 ,$0.66 ,$0.74 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0153,ADENOSINE 6 MG/2ML SOLN per1 mg,636,1 ,$13.48 ,$8.90 ,$0.73 ,$13.48 , N/A ,$1.13 ,$0.75 , N/A ,$8.09 ,$11.46 ,$9.44 , N/A , N/A ,$12.81 ,$10.24 ,$10.11 ,$0.88 ,$11.46 , N/A ,$0.88 ,$0.88 ,$9.44 ,$8.21 , N/A , N/A , N/A , N/A , N/A ,$11.46 , N/A ,$12.40 ,$9.44 ,$0.73 ,$0.73 ,$8.21 ,$0.73 ,$9.31 ,$12.13 ,$9.21 , N/A ,$10.65 , N/A , N/A , N/A , N/A , N/A ,$9.71 ,$8.36 ,$9.71 ,$9.71 ,$10.78 
ST NICHOLAS HOSPITAL - ACUTE,63600002,P9047,ALBUMIN HUMAN 25 % SOLN per50 mL,636,1 ,$664.20 ,$438.37 ,$5.01 ,$664.20 ,$5.01 ,$119.43 ,$79.62 ,$53.08 ,$398.52 ,$564.57 ,$464.94 ,$5.01 ,$5.01 ,$630.99 ,$504.79 ,$498.15 ,$89.71 ,$564.57 ,$53.08 ,$89.71 ,$89.71 ,$464.94 ,$404.50 ,$5.01 ,$53.08 ,$52.02 ,$106.16 ,$5.31 ,$564.57 ,$119.42 ,$611.06 ,$464.94 ,$76.97 ,$76.97 ,$404.50 ,$76.97 ,$458.96 ,$597.78 ,$453.78 ,$52.54 ,$524.72 ,$5.31 ,$87.07 ,$87.07 ,$52.02 ,$87.07 ,$478.22 ,$411.80 ,$478.22 ,$478.22 ,$531.36 
ST NICHOLAS HOSPITAL - ACUTE,63600002,P9045,ALBUMIN HUMAN 5 % SOLN per250 mL,636,1 ,$341.33 ,$225.28 ,$11.37 ,$341.33 ,$11.37 ,$119.43 ,$79.62 ,$53.08 ,$204.80 ,$290.13 ,$238.93 ,$11.37 ,$11.37 ,$324.26 ,$259.41 ,$256.00 ,$89.71 ,$290.13 ,$53.08 ,$89.71 ,$89.71 ,$238.93 ,$207.87 ,$11.37 ,$53.08 ,$52.02 ,$106.16 ,$12.05 ,$290.13 ,$119.42 ,$314.02 ,$238.93 ,$76.97 ,$76.97 ,$207.87 ,$76.97 ,$235.86 ,$307.20 ,$233.20 ,$52.54 ,$269.65 ,$12.05 ,$87.07 ,$87.07 ,$52.02 ,$87.07 ,$245.76 ,$211.62 ,$245.76 ,$245.76 ,$273.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2997,ALTEPLASE 100 MG SOLR per1 mg,636,1 ,$332.65 ,$219.55 ,$1.81 ,$332.65 ,$1.81 ,$197.03 ,$131.36 ,$87.57 ,$199.59 ,$282.75 ,$232.86 ,$1.81 ,$1.81 ,$316.02 ,$252.81 ,$249.49 ,$149.65 ,$282.75 ,$87.57 ,$149.65 ,$149.65 ,$232.86 ,$202.58 ,$1.81 ,$87.57 ,$85.82 ,$175.14 ,$1.92 ,$282.75 ,$197.02 ,$306.04 ,$232.86 ,$126.98 ,$126.98 ,$202.58 ,$126.98 ,$229.86 ,$299.39 ,$227.27 ,$86.68 ,$262.79 ,$1.92 ,$145.25 ,$145.25 ,$85.82 ,$145.25 ,$239.51 ,$206.24 ,$239.51 ,$239.51 ,$266.12 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2997,ALTEPLASE 2 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$400.18 ,$264.12 ,$1.81 ,$400.18 ,$1.81 ,$197.03 ,$131.36 ,$87.57 ,$240.11 ,$340.15 ,$280.13 ,$1.81 ,$1.81 ,$380.17 ,$304.14 ,$300.14 ,$149.65 ,$340.15 ,$87.57 ,$149.65 ,$149.65 ,$280.13 ,$243.71 ,$1.81 ,$87.57 ,$85.82 ,$175.14 ,$1.92 ,$340.15 ,$197.02 ,$368.17 ,$280.13 ,$126.98 ,$126.98 ,$243.71 ,$126.98 ,$276.52 ,$360.16 ,$273.40 ,$86.68 ,$316.14 ,$1.92 ,$145.25 ,$145.25 ,$85.82 ,$145.25 ,$288.13 ,$248.11 ,$288.13 ,$288.13 ,$320.14 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0280,AMINOPHYLLINE 25 MG/ML SOLN per250 mg,636,1 ,$49.00 ,$32.34 ,$12.96 ,$49.00 , N/A ,$20.12 ,$13.41 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$22.25 ,$41.65 , N/A ,$22.25 ,$22.25 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$12.96 ,$12.96 ,$29.84 ,$12.96 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0282,AMIODARONE 150 MG/3ML SOLN per30 mg,636,1 ,$9.80 ,$6.47 ,$0.65 ,$9.80 , N/A ,$6.72 ,$6.72 , N/A ,$5.88 ,$8.33 ,$6.86 , N/A , N/A ,$9.31 ,$7.45 ,$7.35 ,$0.65 ,$8.33 , N/A ,$0.65 ,$0.65 ,$6.86 ,$5.97 , N/A , N/A , N/A , N/A , N/A ,$8.33 , N/A ,$9.02 ,$6.86 ,$4.97 ,$5.97 ,$5.97 ,$5.97 ,$6.77 ,$8.82 ,$6.70 , N/A ,$7.74 , N/A , N/A , N/A , N/A , N/A ,$7.06 ,$6.08 ,$7.06 ,$7.06 ,$7.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0282,AMIODARONE 150-4.21 MG/100ML-% SOLN per30 mg,636,1 ,$57.35 ,$37.85 ,$0.65 ,$57.35 , N/A ,$39.31 ,$39.31 , N/A ,$34.41 ,$48.75 ,$40.15 , N/A , N/A ,$54.48 ,$43.59 ,$43.01 ,$0.65 ,$48.75 , N/A ,$0.65 ,$0.65 ,$40.15 ,$34.93 , N/A , N/A , N/A , N/A , N/A ,$48.75 , N/A ,$52.76 ,$40.15 ,$29.09 ,$34.91 ,$34.93 ,$34.91 ,$39.63 ,$51.62 ,$39.18 , N/A ,$45.31 , N/A , N/A , N/A , N/A , N/A ,$41.29 ,$35.56 ,$41.29 ,$41.29 ,$45.88 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0282,AMIODARONE 360-4.14 MG/200ML-% SOLN per30 mg,636,1 ,$30.97 ,$20.44 ,$0.65 ,$30.97 , N/A ,$21.23 ,$21.23 , N/A ,$18.58 ,$26.32 ,$21.68 , N/A , N/A ,$29.42 ,$23.54 ,$23.23 ,$0.65 ,$26.32 , N/A ,$0.65 ,$0.65 ,$21.68 ,$18.86 , N/A , N/A , N/A , N/A , N/A ,$26.32 , N/A ,$28.49 ,$21.68 ,$15.71 ,$18.85 ,$18.86 ,$18.85 ,$21.40 ,$27.87 ,$21.16 , N/A ,$24.47 , N/A , N/A , N/A , N/A , N/A ,$22.30 ,$19.20 ,$22.30 ,$22.30 ,$24.78 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0285,AMPHOTERICIN B 50 MG SOLR 1 EACH VIAL per50 mg,636,1 ,$168.00 ,$110.88 ,$67.16 ,$168.00 , N/A ,$104.22 ,$69.48 , N/A ,$100.80 ,$142.80 ,$117.60 , N/A , N/A ,$159.60 ,$127.68 ,$126.00 ,$71.09 ,$142.80 , N/A ,$71.09 ,$71.09 ,$117.60 ,$102.31 , N/A , N/A , N/A , N/A , N/A ,$142.80 , N/A ,$154.56 ,$117.60 ,$67.16 ,$67.16 ,$102.31 ,$67.16 ,$116.09 ,$151.20 ,$114.78 , N/A ,$132.72 , N/A , N/A , N/A , N/A , N/A ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0290,AMPICILLIN 1 G SOLR per500 mg,636,1 ,$18.45 ,$12.18 ,$1.24 ,$18.45 , N/A ,$2.07 ,$1.38 , N/A ,$11.07 ,$15.68 ,$12.92 , N/A , N/A ,$17.53 ,$14.02 ,$13.84 ,$1.24 ,$15.68 , N/A ,$1.24 ,$1.24 ,$12.92 ,$11.24 , N/A , N/A , N/A , N/A , N/A ,$15.68 , N/A ,$16.97 ,$12.92 ,$1.33 ,$1.33 ,$11.24 ,$1.33 ,$12.75 ,$16.61 ,$12.61 , N/A ,$14.58 , N/A , N/A , N/A , N/A , N/A ,$13.28 ,$11.44 ,$13.28 ,$13.28 ,$14.76 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0290,AMPICILLIN 2 G SOLR 1 EACH VIAL per500 mg,636,1 ,$25.76 ,$17.00 ,$1.24 ,$25.76 , N/A ,$2.07 ,$1.38 , N/A ,$15.46 ,$21.90 ,$18.03 , N/A , N/A ,$24.47 ,$19.58 ,$19.32 ,$1.24 ,$21.90 , N/A ,$1.24 ,$1.24 ,$18.03 ,$15.69 , N/A , N/A , N/A , N/A , N/A ,$21.90 , N/A ,$23.70 ,$18.03 ,$1.33 ,$1.33 ,$15.69 ,$1.33 ,$17.80 ,$23.18 ,$17.60 , N/A ,$20.35 , N/A , N/A , N/A , N/A , N/A ,$18.55 ,$15.97 ,$18.55 ,$18.55 ,$20.61 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0295,AMPICILLIN-SULBACTAM 1.5 (1-0.5) G SOLR 1 EACH VIAL per1.5 g,636,1 ,$58.70 ,$38.74 ,$3.15 ,$58.70 , N/A ,$4.88 ,$3.26 , N/A ,$35.22 ,$49.90 ,$41.09 , N/A , N/A ,$55.77 ,$44.61 ,$44.03 ,$3.88 ,$49.90 , N/A ,$3.88 ,$3.88 ,$41.09 ,$35.75 , N/A , N/A , N/A , N/A , N/A ,$49.90 , N/A ,$54.00 ,$41.09 ,$3.15 ,$3.15 ,$35.75 ,$3.15 ,$40.56 ,$52.83 ,$40.10 , N/A ,$46.37 , N/A , N/A , N/A , N/A , N/A ,$42.26 ,$36.39 ,$42.26 ,$42.26 ,$46.96 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0295,AMPICILLIN-SULBACTAM 3 (2-1) G SOLR 1 EACH VIAL per1.5 g,636,1 ,$58.88 ,$38.86 ,$3.15 ,$58.88 , N/A ,$4.88 ,$3.26 , N/A ,$35.33 ,$50.05 ,$41.22 , N/A , N/A ,$55.94 ,$44.75 ,$44.16 ,$3.88 ,$50.05 , N/A ,$3.88 ,$3.88 ,$41.22 ,$35.86 , N/A , N/A , N/A , N/A , N/A ,$50.05 , N/A ,$54.17 ,$41.22 ,$3.15 ,$3.15 ,$35.86 ,$3.15 ,$40.69 ,$52.99 ,$40.23 , N/A ,$46.52 , N/A , N/A , N/A , N/A , N/A ,$42.39 ,$36.51 ,$42.39 ,$42.39 ,$47.10 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0295,AMPICILLIN-SULBACTAM 30 MG(AMPICILLIN)/ML SOLN per1.5 g,636,1 ,$31.75 ,$20.96 ,$3.15 ,$31.75 , N/A ,$4.88 ,$3.26 , N/A ,$19.05 ,$26.99 ,$22.23 , N/A , N/A ,$30.16 ,$24.13 ,$23.81 ,$3.88 ,$26.99 , N/A ,$3.88 ,$3.88 ,$22.23 ,$19.34 , N/A , N/A , N/A , N/A , N/A ,$26.99 , N/A ,$29.21 ,$22.23 ,$3.15 ,$3.15 ,$19.34 ,$3.15 ,$21.94 ,$28.58 ,$21.69 , N/A ,$25.08 , N/A , N/A , N/A , N/A , N/A ,$22.86 ,$19.69 ,$22.86 ,$22.86 ,$25.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7192,ANTIHEMOPHIL FACTOR (RECOMB) 2000 UNITS SOLR per1 Int'l Units,636,1 ,$5.27 ,$3.48 ,$1.42 ,$181.19 ,$170.93 ,$3.26 ,$2.18 ,$1.45 ,$3.16 ,$4.48 ,$3.69 ,$170.93 ,$5.27 ,$5.01 ,$4.01 ,$3.95 ,$2.45 ,$4.48 ,$1.45 ,$2.45 ,$2.45 ,$3.69 ,$3.21 ,$170.93 ,$1.45 ,$1.42 ,$2.90 ,$5.59 ,$4.48 ,$3.25 ,$4.85 ,$3.69 ,$2.10 ,$2.10 ,$3.21 ,$2.10 ,$3.64 ,$4.74 ,$3.60 ,$1.43 ,$4.16 ,$181.19 ,$2.38 ,$2.38 ,$1.42 ,$2.38 ,$3.79 ,$3.27 ,$3.79 ,$3.79 ,$4.22 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7192,ANTIHEMOPHILIC FACTOR (RECOMB) 2000 UNITS KIT per1 Int'l Units,636,1 ,$5.11 ,$3.37 ,$1.42 ,$181.19 ,$170.93 ,$3.26 ,$2.18 ,$1.45 ,$3.07 ,$4.34 ,$3.58 ,$170.93 ,$5.11 ,$4.85 ,$3.88 ,$3.83 ,$2.45 ,$4.34 ,$1.45 ,$2.45 ,$2.45 ,$3.58 ,$3.11 ,$170.93 ,$1.45 ,$1.42 ,$2.90 ,$5.42 ,$4.34 ,$3.25 ,$4.70 ,$3.58 ,$2.10 ,$2.10 ,$3.11 ,$2.10 ,$3.53 ,$4.60 ,$3.49 ,$1.43 ,$4.04 ,$181.19 ,$2.38 ,$2.38 ,$1.42 ,$2.38 ,$3.68 ,$3.17 ,$3.68 ,$3.68 ,$4.09 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0461,ATROPINE 0.4 MG/ML SOLN per0.01 mg,636,1 ,$1.48 ,$0.98 ,$0.10 ,$1.48 , N/A ,$0.23 ,$0.15 , N/A ,$0.89 ,$1.26 ,$1.04 , N/A , N/A ,$1.41 ,$1.12 ,$1.11 ,$0.10 ,$1.26 , N/A ,$0.10 ,$0.10 ,$1.04 ,$0.90 , N/A , N/A , N/A , N/A , N/A ,$1.26 , N/A ,$1.36 ,$1.04 ,$0.15 ,$0.15 ,$0.90 ,$0.15 ,$1.02 ,$1.33 ,$1.01 , N/A ,$1.17 , N/A , N/A , N/A , N/A , N/A ,$1.07 ,$0.92 ,$1.07 ,$1.07 ,$1.18 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0461,ATROPINE 1 MG/10ML SOSY per0.01 mg,636,1 ,$0.77 ,$0.51 ,$0.10 ,$0.77 , N/A ,$0.23 ,$0.15 , N/A ,$0.46 ,$0.65 ,$0.54 , N/A , N/A ,$0.73 ,$0.59 ,$0.58 ,$0.10 ,$0.65 , N/A ,$0.10 ,$0.10 ,$0.54 ,$0.47 , N/A , N/A , N/A , N/A , N/A ,$0.65 , N/A ,$0.71 ,$0.54 ,$0.15 ,$0.15 ,$0.47 ,$0.15 ,$0.53 ,$0.69 ,$0.53 , N/A ,$0.61 , N/A , N/A , N/A , N/A , N/A ,$0.55 ,$0.48 ,$0.55 ,$0.55 ,$0.62 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7500,AZATHIOPRINE 50 MG TABS per50 mg,636,1 ,$7.18 ,$4.74 ,$4.31 ,$7.18 , N/A ,$7.18 ,$7.18 , N/A ,$4.31 ,$6.10 ,$5.03 , N/A , N/A ,$6.82 ,$5.46 ,$5.39 ,$7.18 ,$6.10 , N/A ,$7.18 ,$7.18 ,$5.03 ,$4.37 , N/A , N/A , N/A , N/A , N/A ,$6.10 , N/A ,$6.61 ,$5.03 ,$7.18 ,$7.18 ,$4.37 ,$7.18 ,$4.96 ,$6.46 ,$4.91 , N/A ,$5.67 , N/A , N/A , N/A , N/A , N/A ,$5.17 ,$4.45 ,$5.17 ,$5.17 ,$5.74 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0456,AZITHROMYCIN 500 MG SOLR 1 EACH VIAL per500 mg,636,1 ,$106.40 ,$70.22 ,$3.76 ,$106.40 , N/A ,$5.83 ,$3.89 , N/A ,$63.84 ,$90.44 ,$74.48 , N/A , N/A ,$101.08 ,$80.86 ,$79.80 ,$4.37 ,$90.44 , N/A ,$4.37 ,$4.37 ,$74.48 ,$64.80 , N/A , N/A , N/A , N/A , N/A ,$90.44 , N/A ,$97.89 ,$74.48 ,$3.76 ,$3.76 ,$64.80 ,$3.76 ,$73.52 ,$95.76 ,$72.69 , N/A ,$84.06 , N/A , N/A , N/A , N/A , N/A ,$76.61 ,$65.97 ,$76.61 ,$76.61 ,$85.12 
ST NICHOLAS HOSPITAL - ACUTE,63600002,C9399,BARICITINIB 2 MG TABS per2 mg,636,1 ,$339.63 ,$224.16 ,$172.26 ,$339.63 , N/A ,$232.78 ,$232.78 , N/A ,$203.78 ,$288.69 ,$237.74 , N/A , N/A ,$322.65 ,$258.12 ,$254.72 , N/A ,$288.69 , N/A , N/A , N/A ,$237.74 ,$206.83 , N/A , N/A , N/A , N/A , N/A ,$288.69 ,$203.78 ,$312.46 ,$237.74 ,$172.26 ,$206.73 ,$206.83 ,$206.73 ,$234.68 ,$305.67 ,$232.04 , N/A ,$268.31 , N/A , N/A , N/A , N/A , N/A ,$244.53 ,$210.57 ,$244.53 ,$244.53 ,$271.70 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0485,BELATACEPT 250 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$14.29 ,$9.43 ,$3.71 ,$41.86 ,$39.49 ,$8.53 ,$5.69 ,$3.79 ,$8.57 ,$12.15 ,$10.00 ,$39.49 ,$14.29 ,$13.58 ,$10.86 ,$10.72 ,$6.43 ,$12.15 ,$3.79 ,$6.43 ,$6.43 ,$10.00 ,$8.70 ,$39.49 ,$3.79 ,$3.71 ,$7.58 ,$15.15 ,$12.15 ,$8.54 ,$13.15 ,$10.00 ,$5.50 ,$5.50 ,$8.70 ,$5.50 ,$9.87 ,$12.86 ,$9.76 ,$3.75 ,$11.29 ,$41.86 ,$6.24 ,$6.24 ,$3.71 ,$6.24 ,$10.29 ,$8.86 ,$10.29 ,$10.29 ,$11.43 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0490,BELIMUMAB 120 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$177.28 ,$117.00 ,$49.21 ,$177.28 ,$71.25 ,$112.97 ,$75.32 ,$50.21 ,$106.37 ,$150.69 ,$124.10 ,$71.25 ,$71.25 ,$168.42 ,$134.73 ,$132.96 ,$85.34 ,$150.69 ,$50.21 ,$85.34 ,$85.34 ,$124.10 ,$107.96 ,$71.25 ,$50.21 ,$49.21 ,$100.42 ,$75.53 ,$150.69 ,$112.97 ,$163.10 ,$124.10 ,$72.80 ,$72.80 ,$107.96 ,$72.80 ,$122.50 ,$159.55 ,$121.12 ,$49.70 ,$140.05 ,$75.53 ,$82.83 ,$82.83 ,$49.21 ,$82.83 ,$127.64 ,$109.91 ,$127.64 ,$127.64 ,$141.82 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0490,BELIMUMAB 400 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$182.95 ,$120.75 ,$49.21 ,$182.95 ,$71.25 ,$112.97 ,$75.32 ,$50.21 ,$109.77 ,$155.51 ,$128.07 ,$71.25 ,$71.25 ,$173.80 ,$139.04 ,$137.21 ,$85.34 ,$155.51 ,$50.21 ,$85.34 ,$85.34 ,$128.07 ,$111.42 ,$71.25 ,$50.21 ,$49.21 ,$100.42 ,$75.53 ,$155.51 ,$112.97 ,$168.31 ,$128.07 ,$72.80 ,$72.80 ,$111.42 ,$72.80 ,$126.42 ,$164.66 ,$124.99 ,$49.70 ,$144.53 ,$75.53 ,$82.83 ,$82.83 ,$49.21 ,$82.83 ,$131.72 ,$113.43 ,$131.72 ,$131.72 ,$146.36 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0515,BENZTROPINE MESYLATE 1 MG/ML SOLN per1 mg,636,1 ,$230.65 ,$152.23 ,$23.01 ,$230.65 , N/A ,$35.71 ,$23.81 , N/A ,$138.39 ,$196.05 ,$161.46 , N/A , N/A ,$219.12 ,$175.29 ,$172.99 ,$29.68 ,$196.05 , N/A ,$29.68 ,$29.68 ,$161.46 ,$140.47 , N/A , N/A , N/A , N/A , N/A ,$196.05 , N/A ,$212.20 ,$161.46 ,$23.01 ,$23.01 ,$140.47 ,$23.01 ,$159.38 ,$207.59 ,$157.58 , N/A ,$182.21 , N/A , N/A , N/A , N/A , N/A ,$166.07 ,$143.00 ,$166.07 ,$166.07 ,$184.52 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0702,BETAMETHASONE ACET/SODIUM PHOSPHATE 6 (3-3) MG/ML SUSP per6 mg,636,1 ,$77.38 ,$51.07 ,$9.28 ,$77.38 , N/A ,$14.40 ,$9.60 , N/A ,$46.43 ,$65.77 ,$54.17 , N/A , N/A ,$73.51 ,$58.81 ,$58.04 ,$11.80 ,$65.77 , N/A ,$11.80 ,$11.80 ,$54.17 ,$47.12 , N/A , N/A , N/A , N/A , N/A ,$65.77 , N/A ,$71.19 ,$54.17 ,$9.28 ,$9.28 ,$47.12 ,$9.28 ,$53.47 ,$69.64 ,$52.87 , N/A ,$61.13 , N/A , N/A , N/A , N/A , N/A ,$55.71 ,$47.98 ,$55.71 ,$55.71 ,$61.90 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0565,BEZLOTOXUMAB 1000 MG/40 ML SOLN 40 ML VIAL per10 mg,636,1 ,$186.77 ,$123.27 ,$39.06 ,$186.77 ,$47.85 ,$89.69 ,$59.79 ,$39.86 ,$112.06 ,$158.75 ,$130.74 ,$47.85 ,$47.85 ,$177.43 ,$141.95 ,$140.08 ,$67.83 ,$158.75 ,$39.86 ,$67.83 ,$67.83 ,$130.74 ,$113.74 ,$47.85 ,$39.86 ,$39.06 ,$79.72 ,$50.72 ,$158.75 ,$89.69 ,$171.83 ,$130.74 ,$57.80 ,$57.80 ,$113.74 ,$57.80 ,$129.06 ,$168.09 ,$127.60 ,$39.45 ,$147.55 ,$50.72 ,$65.84 ,$65.84 ,$39.06 ,$65.84 ,$134.47 ,$115.80 ,$134.47 ,$134.47 ,$149.42 
ST NICHOLAS HOSPITAL - ACUTE,63600002,C9290,BUPIVACAINE LIPOSOME 1.3 % SUSP per1 mg,636,1 ,$9.84 ,$6.49 ,$4.99 ,$9.84 , N/A ,$6.74 ,$6.74 , N/A ,$5.90 ,$8.36 ,$6.89 , N/A , N/A ,$9.35 ,$7.48 ,$7.38 ,$6.40 ,$8.36 , N/A ,$6.40 ,$6.40 ,$6.89 ,$5.99 , N/A , N/A , N/A , N/A , N/A ,$8.36 , N/A ,$9.05 ,$6.89 ,$4.99 ,$5.99 ,$5.99 ,$5.99 ,$6.80 ,$8.86 ,$6.72 , N/A ,$7.77 , N/A , N/A , N/A , N/A , N/A ,$7.08 ,$6.10 ,$7.08 ,$7.08 ,$7.87 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0630,CALCITONIN 200 UNIT/ML SOLN per400 Units,636,1 ,"$5,919.70 ","$3,907.00 ",$47.85 ,"$5,919.70 ",$47.85 ,"$2,988.00 ","$1,992.00 ","$1,328.00 ","$3,551.82 ","$5,031.75 ","$4,143.79 ",$47.85 ,$47.85 ,"$5,623.72 ","$4,498.97 ","$4,439.78 ","$3,294.41 ","$5,031.75 ","$1,328.00 ","$3,294.41 ","$3,294.41 ","$4,143.79 ","$3,605.10 ",$47.85 ,"$1,328.00 ","$1,301.44 ","$2,656.00 ",$50.72 ,"$5,031.75 ","$2,987.99 ","$5,446.12 ","$4,143.79 ","$1,925.60 ","$1,925.60 ","$3,605.10 ","$1,925.60 ","$4,090.51 ","$5,327.73 ","$4,044.34 ","$1,314.45 ","$4,676.56 ",$50.72 ,"$3,197.52 ","$3,197.52 ","$1,301.44 ","$3,197.52 ","$4,262.18 ","$3,670.21 ","$4,262.18 ","$4,262.18 ","$4,735.76 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0610,CALCIUM GLUCONATE 1 G 1-0.675 GM/50ML-% SOLN per100 mL,636,1 ,$176.70 ,$116.62 ,$7.50 ,$176.70 , N/A ,$11.63 ,$7.76 , N/A ,$106.02 ,$150.20 ,$123.69 , N/A , N/A ,$167.87 ,$134.29 ,$132.53 ,$8.79 ,$150.20 , N/A ,$8.79 ,$8.79 ,$123.69 ,$107.61 , N/A , N/A , N/A , N/A , N/A ,$150.20 , N/A ,$162.56 ,$123.69 ,$7.50 ,$7.50 ,$107.61 ,$7.50 ,$122.10 ,$159.03 ,$120.72 , N/A ,$139.59 , N/A , N/A , N/A , N/A , N/A ,$127.22 ,$109.55 ,$127.22 ,$127.22 ,$141.36 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0610,CALCIUM GLUCONATE 10 % SOLN 10 ML VIAL per10 mL,636,1 ,$73.93 ,$48.79 ,$7.50 ,$73.93 , N/A ,$11.63 ,$7.76 , N/A ,$44.36 ,$62.84 ,$51.75 , N/A , N/A ,$70.23 ,$56.19 ,$55.45 ,$8.79 ,$62.84 , N/A ,$8.79 ,$8.79 ,$51.75 ,$45.02 , N/A , N/A , N/A , N/A , N/A ,$62.84 , N/A ,$68.02 ,$51.75 ,$7.50 ,$7.50 ,$45.02 ,$7.50 ,$51.09 ,$66.54 ,$50.51 , N/A ,$58.40 , N/A , N/A , N/A , N/A , N/A ,$53.23 ,$45.84 ,$53.23 ,$53.23 ,$59.14 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0610,CALCIUM GLUCONATE 10 % SOLN per10 mL,636,1 ,$51.80 ,$34.19 ,$7.50 ,$51.80 , N/A ,$11.63 ,$7.76 , N/A ,$31.08 ,$44.03 ,$36.26 , N/A , N/A ,$49.21 ,$39.37 ,$38.85 ,$8.79 ,$44.03 , N/A ,$8.79 ,$8.79 ,$36.26 ,$31.55 , N/A , N/A , N/A , N/A , N/A ,$44.03 , N/A ,$47.66 ,$36.26 ,$7.50 ,$7.50 ,$31.55 ,$7.50 ,$35.79 ,$46.62 ,$35.39 , N/A ,$40.92 , N/A , N/A , N/A , N/A , N/A ,$37.30 ,$32.12 ,$37.30 ,$37.30 ,$41.44 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0610,CALCIUM GLUCONATE 2 G 2-0.675 GM/100ML-% SOLN per50 mL,636,1 ,$161.23 ,$106.41 ,$7.50 ,$161.23 , N/A ,$11.63 ,$7.76 , N/A ,$96.74 ,$137.05 ,$112.86 , N/A , N/A ,$153.17 ,$122.53 ,$120.92 ,$8.79 ,$137.05 , N/A ,$8.79 ,$8.79 ,$112.86 ,$98.19 , N/A , N/A , N/A , N/A , N/A ,$137.05 , N/A ,$148.33 ,$112.86 ,$7.50 ,$7.50 ,$98.19 ,$7.50 ,$111.41 ,$145.11 ,$110.15 , N/A ,$127.37 , N/A , N/A , N/A , N/A , N/A ,$116.09 ,$99.96 ,$116.09 ,$116.09 ,$128.98 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9045,CARBOPLATIN 150 MG/15ML SOLN 15 ML VIAL per50 mg,636,1 ,$34.45 ,$22.74 ,$3.44 ,$34.45 , N/A ,$5.33 ,$3.56 , N/A ,$20.67 ,$29.28 ,$24.12 , N/A , N/A ,$32.73 ,$26.18 ,$25.84 ,$4.22 ,$29.28 , N/A ,$4.22 ,$4.22 ,$24.12 ,$20.98 , N/A , N/A , N/A , N/A , N/A ,$29.28 , N/A ,$31.69 ,$24.12 ,$3.44 ,$3.44 ,$20.98 ,$3.44 ,$23.81 ,$31.01 ,$23.54 , N/A ,$27.22 , N/A , N/A , N/A , N/A , N/A ,$24.80 ,$21.36 ,$24.80 ,$24.80 ,$27.56 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9045,CARBOPLATIN 50 MG/5ML SOLN 5 ML VIAL per50 mg,636,1 ,$102.40 ,$67.58 ,$3.44 ,$102.40 , N/A ,$5.33 ,$3.56 , N/A ,$61.44 ,$87.04 ,$71.68 , N/A , N/A ,$97.28 ,$77.82 ,$76.80 ,$4.22 ,$87.04 , N/A ,$4.22 ,$4.22 ,$71.68 ,$62.36 , N/A , N/A , N/A , N/A , N/A ,$87.04 , N/A ,$94.21 ,$71.68 ,$3.44 ,$3.44 ,$62.36 ,$3.44 ,$70.76 ,$92.16 ,$69.96 , N/A ,$80.90 , N/A , N/A , N/A , N/A , N/A ,$73.73 ,$63.49 ,$73.73 ,$73.73 ,$81.92 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9045,CARBOPLATIN 600 MG/60ML SOLN 60 ML VIAL per50 mg,636,1 ,$35.58 ,$23.48 ,$3.44 ,$35.58 , N/A ,$5.33 ,$3.56 , N/A ,$21.35 ,$30.24 ,$24.91 , N/A , N/A ,$33.80 ,$27.04 ,$26.69 ,$4.22 ,$30.24 , N/A ,$4.22 ,$4.22 ,$24.91 ,$21.67 , N/A , N/A , N/A , N/A , N/A ,$30.24 , N/A ,$32.73 ,$24.91 ,$3.44 ,$3.44 ,$21.67 ,$3.44 ,$24.59 ,$32.02 ,$24.31 , N/A ,$28.11 , N/A , N/A , N/A , N/A , N/A ,$25.62 ,$22.06 ,$25.62 ,$25.62 ,$28.46 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0690,CEFAZOLIN 2-4 GM/100ML-% SOLN per500 mg,636,1 ,$24.80 ,$16.37 ,$1.12 ,$24.80 , N/A ,$1.73 ,$1.16 , N/A ,$14.88 ,$21.08 ,$17.36 , N/A , N/A ,$23.56 ,$18.85 ,$18.60 ,$1.24 ,$21.08 , N/A ,$1.24 ,$1.24 ,$17.36 ,$15.10 , N/A , N/A , N/A , N/A , N/A ,$21.08 , N/A ,$22.82 ,$17.36 ,$1.12 ,$1.12 ,$15.10 ,$1.12 ,$17.14 ,$22.32 ,$16.94 , N/A ,$19.59 , N/A , N/A , N/A , N/A , N/A ,$17.86 ,$15.38 ,$17.86 ,$17.86 ,$19.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0690,CEFAZOLIN 3 GM/20ML SOSY per500 mg,636,1 ,$24.50 ,$16.17 ,$1.12 ,$24.50 , N/A ,$1.73 ,$1.16 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$1.24 ,$20.83 , N/A ,$1.24 ,$1.24 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$1.12 ,$1.12 ,$14.92 ,$1.12 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0690,CEFAZOLIN 1 G SOLR 1 EACH VIAL per500 mg,636,1 ,$24.50 ,$16.17 ,$1.12 ,$24.50 , N/A ,$1.73 ,$1.16 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$1.24 ,$20.83 , N/A ,$1.24 ,$1.24 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$1.12 ,$1.12 ,$14.92 ,$1.12 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0690,CEFAZOLIN 100 MG SOLN 1 EACH VIAL per500 mg,636,1 ,$24.50 ,$16.17 ,$1.12 ,$24.50 , N/A ,$1.73 ,$1.16 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$1.24 ,$20.83 , N/A ,$1.24 ,$1.24 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$1.12 ,$1.12 ,$14.92 ,$1.12 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0690,CEFAZOLIN 500 MG SOLR per500 mg,636,1 ,$49.00 ,$32.34 ,$1.12 ,$49.00 , N/A ,$1.73 ,$1.16 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.24 ,$41.65 , N/A ,$1.24 ,$1.24 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.12 ,$1.12 ,$29.84 ,$1.12 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0692,CEFEPIME 1 G SOLR 1 EACH VIAL per500 mg,636,1 ,$24.50 ,$16.17 ,$1.80 ,$24.50 , N/A ,$2.79 ,$1.86 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$2.19 ,$20.83 , N/A ,$2.19 ,$2.19 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$1.80 ,$1.80 ,$14.92 ,$1.80 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0692,CEFEPIME 2 G SOLR 1 EACH VIAL per500 mg,636,1 ,$18.09 ,$11.94 ,$1.80 ,$18.09 , N/A ,$2.79 ,$1.86 , N/A ,$10.85 ,$15.38 ,$12.66 , N/A , N/A ,$17.19 ,$13.75 ,$13.57 ,$2.19 ,$15.38 , N/A ,$2.19 ,$2.19 ,$12.66 ,$11.02 , N/A , N/A , N/A , N/A , N/A ,$15.38 , N/A ,$16.64 ,$12.66 ,$1.80 ,$1.80 ,$11.02 ,$1.80 ,$12.50 ,$16.28 ,$12.36 , N/A ,$14.29 , N/A , N/A , N/A , N/A , N/A ,$13.02 ,$11.22 ,$13.02 ,$13.02 ,$14.47 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0694,CEFOXITIN 1 G SOLR 1 EACH VIAL per1 g,636,1 ,$49.00 ,$32.34 ,$7.48 ,$49.00 , N/A ,$11.61 ,$7.74 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$8.28 ,$41.65 , N/A ,$8.28 ,$8.28 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$7.48 ,$7.48 ,$29.84 ,$7.48 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0694,CEFOXITIN 2 G SOLR 1 EACH VIAL per1 g,636,1 ,$47.05 ,$31.05 ,$7.48 ,$47.05 , N/A ,$11.61 ,$7.74 , N/A ,$28.23 ,$39.99 ,$32.94 , N/A , N/A ,$44.70 ,$35.76 ,$35.29 ,$8.28 ,$39.99 , N/A ,$8.28 ,$8.28 ,$32.94 ,$28.65 , N/A , N/A , N/A , N/A , N/A ,$39.99 , N/A ,$43.29 ,$32.94 ,$7.48 ,$7.48 ,$28.65 ,$7.48 ,$32.51 ,$42.35 ,$32.14 , N/A ,$37.17 , N/A , N/A , N/A , N/A , N/A ,$33.88 ,$29.17 ,$33.88 ,$33.88 ,$37.64 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0712,CEFTAROLINE 600 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$17.57 ,$11.60 ,$3.69 ,$17.57 ,$4.84 ,$8.48 ,$5.66 ,$3.77 ,$10.54 ,$14.93 ,$12.30 ,$4.84 ,$4.84 ,$16.69 ,$13.35 ,$13.18 ,$6.43 ,$14.93 ,$3.77 ,$6.43 ,$6.43 ,$12.30 ,$10.70 ,$4.84 ,$3.77 ,$3.69 ,$7.54 ,$5.13 ,$14.93 ,$8.47 ,$16.16 ,$12.30 ,$5.47 ,$5.47 ,$10.70 ,$5.47 ,$12.14 ,$15.81 ,$12.00 ,$3.73 ,$13.88 ,$5.13 ,$6.24 ,$6.24 ,$3.69 ,$6.24 ,$12.65 ,$10.89 ,$12.65 ,$12.65 ,$14.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0713,CEFTAZIDIME 2 G SOLR 1 EACH VIAL per500 mg,636,1 ,$20.30 ,$13.40 ,$2.70 ,$20.30 , N/A ,$4.19 ,$2.79 , N/A ,$12.18 ,$17.26 ,$14.21 , N/A , N/A ,$19.29 ,$15.43 ,$15.23 ,$3.37 ,$17.26 , N/A ,$3.37 ,$3.37 ,$14.21 ,$12.36 , N/A , N/A , N/A , N/A , N/A ,$17.26 , N/A ,$18.68 ,$14.21 ,$2.70 ,$2.70 ,$12.36 ,$2.70 ,$14.03 ,$18.27 ,$13.87 , N/A ,$16.04 , N/A , N/A , N/A , N/A , N/A ,$14.62 ,$12.59 ,$14.62 ,$14.62 ,$16.24 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0714,CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G SOLR 1 EACH VIAL per0.625 g,636,1 ,$425.20 ,$280.63 ,$9.09 ,$425.20 ,$9.09 ,$204.39 ,$136.26 ,$90.84 ,$255.12 ,$361.42 ,$297.64 ,$9.09 ,$9.09 ,$403.94 ,$323.15 ,$318.90 ,$155.33 ,$361.42 ,$90.84 ,$155.33 ,$155.33 ,$297.64 ,$258.95 ,$9.09 ,$90.84 ,$89.02 ,$181.68 ,$9.64 ,$361.42 ,$204.39 ,$391.18 ,$297.64 ,$131.72 ,$131.72 ,$258.95 ,$131.72 ,$293.81 ,$382.68 ,$290.50 ,$89.91 ,$335.91 ,$9.64 ,$150.76 ,$150.76 ,$89.02 ,$150.76 ,$306.14 ,$263.62 ,$306.14 ,$306.14 ,$340.16 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0695,CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G SOLR 1 EACH VIAL per75 mg,636,1 ,$31.18 ,$20.58 ,$4.84 ,$31.18 ,$4.84 ,$15.10 ,$10.07 ,$6.71 ,$18.71 ,$26.50 ,$21.83 ,$4.84 ,$4.84 ,$29.62 ,$23.70 ,$23.39 ,$11.15 ,$26.50 ,$6.71 ,$11.15 ,$11.15 ,$21.83 ,$18.99 ,$4.84 ,$6.71 ,$6.58 ,$13.42 ,$5.13 ,$26.50 ,$15.11 ,$28.69 ,$21.83 ,$9.73 ,$9.73 ,$18.99 ,$9.73 ,$21.55 ,$28.06 ,$21.30 ,$6.64 ,$24.63 ,$5.13 ,$10.82 ,$10.82 ,$6.58 ,$10.82 ,$22.45 ,$19.33 ,$22.45 ,$22.45 ,$24.94 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0696,CEFTRIAXONE 1 G SOLR 1 EACH VIAL per250 mg,636,1 ,$70.65 ,$46.63 ,$0.74 ,$70.65 , N/A ,$1.15 ,$0.77 , N/A ,$42.39 ,$60.05 ,$49.46 , N/A , N/A ,$67.12 ,$53.69 ,$52.99 ,$0.90 ,$60.05 , N/A ,$0.90 ,$0.90 ,$49.46 ,$43.03 , N/A , N/A , N/A , N/A , N/A ,$60.05 , N/A ,$65.00 ,$49.46 ,$0.74 ,$0.74 ,$43.03 ,$0.74 ,$48.82 ,$63.59 ,$48.27 , N/A ,$55.81 , N/A , N/A , N/A , N/A , N/A ,$50.87 ,$43.80 ,$50.87 ,$50.87 ,$56.52 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0696,CEFTRIAXONE 2 G SOLR 1 EACH VIAL per250 mg,636,1 ,$70.20 ,$46.33 ,$0.74 ,$70.20 , N/A ,$1.15 ,$0.77 , N/A ,$42.12 ,$59.67 ,$49.14 , N/A , N/A ,$66.69 ,$53.35 ,$52.65 ,$0.90 ,$59.67 , N/A ,$0.90 ,$0.90 ,$49.14 ,$42.75 , N/A , N/A , N/A , N/A , N/A ,$59.67 , N/A ,$64.58 ,$49.14 ,$0.74 ,$0.74 ,$42.75 ,$0.74 ,$48.51 ,$63.18 ,$47.96 , N/A ,$55.46 , N/A , N/A , N/A , N/A , N/A ,$50.54 ,$43.52 ,$50.54 ,$50.54 ,$56.16 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0696,CEFTRIAXONE 250 MG SOLR 1 EACH VIAL per250 mg,636,1 ,$49.00 ,$32.34 ,$0.74 ,$49.00 , N/A ,$1.15 ,$0.77 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$0.90 ,$41.65 , N/A ,$0.90 ,$0.90 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$0.74 ,$0.74 ,$29.84 ,$0.74 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0717,CERTOLIZUMAB PEGOL 2 X 200 MG/ML PSKT per1 mg,636,1 ,$37.48 ,$24.74 ,$4.87 ,$75.53 ,$71.25 ,$11.18 ,$7.46 ,$4.97 ,$22.49 ,$31.86 ,$26.24 ,$71.25 ,$37.48 ,$35.61 ,$28.48 ,$28.11 ,$8.60 ,$31.86 ,$4.97 ,$8.60 ,$8.60 ,$26.24 ,$22.83 ,$71.25 ,$4.97 ,$4.87 ,$9.94 ,$39.73 ,$31.86 ,$11.18 ,$34.48 ,$26.24 ,$7.21 ,$7.21 ,$22.83 ,$7.21 ,$25.90 ,$33.73 ,$25.61 ,$4.92 ,$29.61 ,$75.53 ,$8.35 ,$8.35 ,$4.87 ,$8.35 ,$26.99 ,$23.24 ,$26.99 ,$26.99 ,$29.98 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2400,CHLOROPROCAINE (PF) 2 % SOLN per30 mL,636,1 ,$49.00 ,$32.34 ,$29.40 ,$49.00 , N/A ,$49.00 ,$44.34 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$49.00 ,$41.65 , N/A ,$49.00 ,$49.00 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$42.86 ,$42.86 ,$29.84 ,$42.86 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1205,CHLOROTHIAZIDE 500 MG SOLR per500 mg,636,1 ,"$1,411.10 ",$931.33 ,$68.87 ,"$1,411.10 ", N/A ,$172.96 ,$115.31 , N/A ,$846.66 ,"$1,199.44 ",$987.77 , N/A , N/A ,"$1,340.55 ","$1,072.44 ","$1,058.33 ",$68.87 ,"$1,199.44 ", N/A ,$68.87 ,$68.87 ,$987.77 ,$859.36 , N/A , N/A , N/A , N/A , N/A ,"$1,199.44 ", N/A ,"$1,298.21 ",$987.77 ,$111.46 ,$111.46 ,$859.36 ,$111.46 ,$975.07 ,"$1,269.99 ",$964.06 , N/A ,"$1,114.77 ", N/A , N/A , N/A , N/A , N/A ,"$1,015.99 ",$874.88 ,"$1,015.99 ","$1,015.99 ","$1,128.88 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,N/A,CINACALCET 30 MG TABS,637,1 ,$104.25 ,$68.81 ,$52.88 ,$104.25 , N/A ,$71.45 ,$71.45 , N/A ,$62.55 ,$88.61 ,$72.98 , N/A , N/A ,$99.04 ,$79.23 ,$78.19 ,$67.76 ,$88.61 , N/A ,$67.76 ,$67.76 ,$72.98 ,$63.49 , N/A ,$104.25 , N/A , N/A , N/A ,$88.61 , N/A ,$95.91 ,$72.98 ,$52.88 ,$63.46 ,$63.49 ,$63.46 ,$72.04 ,$93.83 ,$71.22 , N/A ,$82.36 , N/A ,$61.51 ,$61.51 , N/A ,$61.51 ,$75.06 ,$64.64 ,$75.06 ,$75.06 ,$83.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,N/A,CINACALCET 60 MG TABS,636,1 ,$219.60 ,$144.94 ,$109.80 ,$219.60 , N/A ,$150.51 ,$150.51 , N/A ,$131.76 ,$186.66 ,$153.72 , N/A , N/A ,$208.62 ,$166.90 ,$164.70 ,$142.74 ,$186.66 , N/A ,$142.74 ,$142.74 ,$153.72 ,$133.74 , N/A , N/A , N/A , N/A , N/A ,$186.66 , N/A ,$202.03 ,$153.72 ,$111.38 ,$133.67 ,$133.74 ,$133.67 ,$151.74 ,$197.64 ,$150.03 , N/A ,$173.48 , N/A ,$109.80 ,$109.80 , N/A ,$109.80 ,$158.11 ,$136.15 ,$158.11 ,$158.11 ,$175.68 
ST NICHOLAS HOSPITAL - ACUTE,63600002,N/A,CINACALCET 90 MG TABS,636,1 ,$312.30 ,$206.12 ,$156.15 ,$312.30 , N/A ,$214.05 ,$214.05 , N/A ,$187.38 ,$265.46 ,$218.61 , N/A , N/A ,$296.69 ,$237.35 ,$234.23 ,$203.00 ,$265.46 , N/A ,$203.00 ,$203.00 ,$218.61 ,$190.19 , N/A , N/A , N/A , N/A , N/A ,$265.46 , N/A ,$287.32 ,$218.61 ,$158.40 ,$190.10 ,$190.19 ,$190.10 ,$215.80 ,$281.07 ,$213.36 , N/A ,$246.72 , N/A ,$156.15 ,$156.15 , N/A ,$156.15 ,$224.86 ,$193.63 ,$224.86 ,$224.86 ,$249.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0744,CIPROFLOXACIN 400 MG/200ML SOLN per200 mg,636,1 ,$28.38 ,$18.73 ,$1.85 ,$28.38 , N/A ,$3.02 ,$2.01 , N/A ,$17.03 ,$24.12 ,$19.87 , N/A , N/A ,$26.96 ,$21.57 ,$21.29 ,$1.85 ,$24.12 , N/A ,$1.85 ,$1.85 ,$19.87 ,$17.28 , N/A , N/A , N/A , N/A , N/A ,$24.12 , N/A ,$26.11 ,$19.87 ,$1.94 ,$1.94 ,$17.28 ,$1.94 ,$19.61 ,$25.54 ,$19.39 , N/A ,$22.42 , N/A , N/A , N/A , N/A , N/A ,$20.43 ,$17.60 ,$20.43 ,$20.43 ,$22.70 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0735,CLONIDINE 100 MCG/ML SOLN 10 ML VIAL per1 mg,636,1 ,$324.75 ,$214.34 ,$33.19 ,$324.75 , N/A ,$51.50 ,$34.34 , N/A ,$194.85 ,$276.04 ,$227.33 , N/A , N/A ,$308.51 ,$246.81 ,$243.56 ,$37.69 ,$276.04 , N/A ,$37.69 ,$37.69 ,$227.33 ,$197.77 , N/A , N/A , N/A , N/A , N/A ,$276.04 , N/A ,$298.77 ,$227.33 ,$33.19 ,$33.19 ,$197.77 ,$33.19 ,$224.40 ,$292.28 ,$221.87 , N/A ,$256.55 , N/A , N/A , N/A , N/A , N/A ,$233.82 ,$201.35 ,$233.82 ,$233.82 ,$259.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0735,CLONIDINE 100 MCG/ML SOLN per1 mg,636,1 ,$49.00 ,$32.34 ,$29.40 ,$49.00 , N/A ,$49.00 ,$34.34 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$37.69 ,$41.65 , N/A ,$37.69 ,$37.69 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$33.19 ,$33.19 ,$29.84 ,$33.19 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0834,COSYNTROPIN 0.25 MG SOLR per0.25 mg,636,1 ,$530.80 ,$350.33 ,$35.93 ,$530.80 , N/A ,$55.76 ,$37.17 , N/A ,$318.48 ,$451.18 ,$371.56 , N/A , N/A ,$504.26 ,$403.41 ,$398.10 ,$41.51 ,$451.18 , N/A ,$41.51 ,$41.51 ,$371.56 ,$323.26 , N/A , N/A , N/A , N/A , N/A ,$451.18 , N/A ,$488.34 ,$371.56 ,$35.93 ,$35.93 ,$323.26 ,$35.93 ,$366.78 ,$477.72 ,$362.64 , N/A ,$419.33 , N/A , N/A , N/A , N/A , N/A ,$382.18 ,$329.10 ,$382.18 ,$382.18 ,$424.64 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0791,CRIZANLIZUMAB-TMCA 100 MG/10ML SOLN 10 ML VIAL per5 mg,636,1 ,$525.62 ,$346.91 ,$39.49 ,$525.62 ,$39.49 ,$281.88 ,$187.92 ,$125.28 ,$315.37 ,$446.78 ,$367.93 ,$39.49 ,$39.49 ,$499.34 ,$399.47 ,$394.22 ,$212.72 ,$446.78 ,$125.28 ,$212.72 ,$212.72 ,$367.93 ,$320.10 ,$39.49 ,$125.28 ,$122.77 ,$250.56 ,$41.86 ,$446.78 ,$281.88 ,$483.57 ,$367.93 ,$181.66 ,$181.66 ,$320.10 ,$181.66 ,$363.20 ,$473.06 ,$359.10 ,$124.00 ,$415.24 ,$41.86 ,$206.46 ,$206.46 ,$122.77 ,$206.46 ,$378.45 ,$325.88 ,$378.45 ,$378.45 ,$420.50 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3420,CYANOCOBALAMIN 1000 MCG/ML SOLN per1000 mcg,636,1 ,$49.00 ,$32.34 ,$2.33 ,$49.00 , N/A ,$3.62 ,$2.42 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$3.49 ,$41.65 , N/A ,$3.49 ,$3.49 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$2.33 ,$2.33 ,$29.84 ,$2.33 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9070,CYCLOPHOSPHAMIDE 1 G SOLR 1 EACH VIAL per100 mg,636,1 ,$190.49 ,$125.72 ,$3.85 ,$190.49 ,$3.85 ,$48.69 ,$32.46 ,$21.64 ,$114.29 ,$161.92 ,$133.34 ,$3.85 ,$3.85 ,$180.97 ,$144.77 ,$142.87 ,$37.62 ,$161.92 ,$21.64 ,$37.62 ,$37.62 ,$133.34 ,$116.01 ,$3.85 ,$21.64 ,$21.21 ,$43.28 ,$4.08 ,$161.92 ,$48.68 ,$175.25 ,$133.34 ,$31.38 ,$31.38 ,$116.01 ,$31.38 ,$131.63 ,$171.44 ,$130.14 ,$21.42 ,$150.49 ,$4.08 ,$36.51 ,$36.51 ,$21.21 ,$36.51 ,$137.15 ,$118.10 ,$137.15 ,$137.15 ,$152.39 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9070,CYCLOPHOSPHAMIDE 500 MG SOLR 1 EACH VIAL per100 mg,636,1 ,$245.90 ,$162.29 ,$3.85 ,$245.90 ,$3.85 ,$48.69 ,$32.46 ,$21.64 ,$147.54 ,$209.02 ,$172.13 ,$3.85 ,$3.85 ,$233.61 ,$186.88 ,$184.43 ,$37.62 ,$209.02 ,$21.64 ,$37.62 ,$37.62 ,$172.13 ,$149.75 ,$3.85 ,$21.64 ,$21.21 ,$43.28 ,$4.08 ,$209.02 ,$48.68 ,$226.23 ,$172.13 ,$31.38 ,$31.38 ,$149.75 ,$31.38 ,$169.92 ,$221.31 ,$168.00 ,$21.42 ,$194.26 ,$4.08 ,$36.51 ,$36.51 ,$21.21 ,$36.51 ,$177.05 ,$152.46 ,$177.05 ,$177.05 ,$196.72 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0878,DAPTOMYCIN 500 MG SOLR per1 mg,636,1 ,$3.37 ,$2.22 ,$0.06 ,$3.37 ,$1.81 ,$0.09 ,$0.06 , N/A ,$2.02 ,$2.86 ,$2.36 ,$1.81 ,$1.81 ,$3.20 ,$2.56 ,$2.53 ,$0.09 ,$2.86 , N/A ,$0.09 ,$0.09 ,$2.36 ,$2.05 ,$1.81 , N/A , N/A , N/A ,$1.92 ,$2.86 , N/A ,$3.10 ,$2.36 ,$0.06 ,$0.06 ,$2.05 ,$0.06 ,$2.33 ,$3.03 ,$2.30 , N/A ,$2.66 ,$1.92 , N/A , N/A , N/A , N/A ,$2.43 ,$2.09 ,$2.43 ,$2.43 ,$2.70 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9145,DARATUMUMAB 100 MG/5ML SOLN per10 mg,636,1 ,$295.77 ,$195.21 ,$59.55 ,$295.77 ,$115.47 ,$136.73 ,$91.16 ,$60.77 ,$177.46 ,$251.40 ,$207.04 ,$115.47 ,$115.47 ,$280.98 ,$224.79 ,$221.83 ,$100.16 ,$251.40 ,$60.77 ,$100.16 ,$100.16 ,$207.04 ,$180.12 ,$115.47 ,$60.77 ,$59.55 ,$121.54 ,$122.40 ,$251.40 ,$136.73 ,$272.11 ,$207.04 ,$88.12 ,$88.12 ,$180.12 ,$88.12 ,$204.38 ,$266.19 ,$202.07 ,$60.15 ,$233.66 ,$122.40 ,$97.22 ,$97.22 ,$59.55 ,$97.22 ,$212.95 ,$183.38 ,$212.95 ,$212.95 ,$236.62 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9145,DARATUMUMAB 400 MG/20ML SOLN per10 mg,636,1 ,$296.28 ,$195.54 ,$59.55 ,$296.28 ,$115.47 ,$136.73 ,$91.16 ,$60.77 ,$177.77 ,$251.84 ,$207.40 ,$115.47 ,$115.47 ,$281.47 ,$225.17 ,$222.21 ,$100.16 ,$251.84 ,$60.77 ,$100.16 ,$100.16 ,$207.40 ,$180.43 ,$115.47 ,$60.77 ,$59.55 ,$121.54 ,$122.40 ,$251.84 ,$136.73 ,$272.58 ,$207.40 ,$88.12 ,$88.12 ,$180.43 ,$88.12 ,$204.73 ,$266.65 ,$202.42 ,$60.15 ,$234.06 ,$122.40 ,$97.22 ,$97.22 ,$59.55 ,$97.22 ,$213.32 ,$183.69 ,$213.32 ,$213.32 ,$237.02 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0897,DENOSUMAB 120 MG/1.7ML SOLN per1 mg,636,1 ,$66.57 ,$43.94 ,$22.56 ,$66.57 ,$31.95 ,$51.80 ,$34.53 ,$23.02 ,$39.94 ,$56.58 ,$46.60 ,$31.95 ,$31.95 ,$63.24 ,$50.59 ,$49.93 ,$39.22 ,$56.58 ,$23.02 ,$39.22 ,$39.22 ,$46.60 ,$40.54 ,$31.95 ,$23.02 ,$22.56 ,$46.04 ,$33.87 ,$56.58 ,$51.79 ,$61.24 ,$46.60 ,$33.38 ,$33.38 ,$40.54 ,$33.38 ,$46.00 ,$59.91 ,$45.48 ,$22.78 ,$52.59 ,$33.87 ,$38.07 ,$38.07 ,$22.56 ,$38.07 ,$47.93 ,$41.27 ,$47.93 ,$47.93 ,$53.26 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0897,DENOSUMAB 60 MG/ML SOSY per1 mg,636,1 ,$72.38 ,$47.77 ,$22.56 ,$72.38 ,$31.95 ,$51.80 ,$34.53 ,$23.02 ,$43.43 ,$61.52 ,$50.67 ,$31.95 ,$31.95 ,$68.76 ,$55.01 ,$54.29 ,$39.22 ,$61.52 ,$23.02 ,$39.22 ,$39.22 ,$50.67 ,$44.08 ,$31.95 ,$23.02 ,$22.56 ,$46.04 ,$33.87 ,$61.52 ,$51.79 ,$66.59 ,$50.67 ,$33.38 ,$33.38 ,$44.08 ,$33.38 ,$50.01 ,$65.14 ,$49.45 ,$22.78 ,$57.18 ,$33.87 ,$38.07 ,$38.07 ,$22.56 ,$38.07 ,$52.11 ,$44.88 ,$52.11 ,$52.11 ,$57.90 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2597,DESMOPRESSIN 4 MCG/ML SOLN 1 ML AMPULE per1 mcg,636,1 ,$148.92 ,$98.29 ,$4.84 ,$148.92 ,$4.84 ,$15.93 ,$10.62 ,$7.08 ,$89.35 ,$126.58 ,$104.24 ,$4.84 ,$4.84 ,$141.47 ,$113.18 ,$111.69 ,$12.46 ,$126.58 ,$7.08 ,$12.46 ,$12.46 ,$104.24 ,$90.69 ,$4.84 ,$7.08 ,$6.94 ,$14.16 ,$5.13 ,$126.58 ,$15.92 ,$137.01 ,$104.24 ,$10.27 ,$10.27 ,$90.69 ,$10.27 ,$102.90 ,$134.03 ,$101.74 ,$7.01 ,$117.65 ,$5.13 ,$12.09 ,$12.09 ,$6.94 ,$12.09 ,$107.22 ,$92.33 ,$107.22 ,$107.22 ,$119.14 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2597,DESMOPRESSIN 4 MCG/ML SOLN 10 ML VIAL per1 mcg,636,1 ,$151.57 ,$100.04 ,$4.84 ,$151.57 ,$4.84 ,$15.93 ,$10.62 ,$7.08 ,$90.94 ,$128.83 ,$106.10 ,$4.84 ,$4.84 ,$143.99 ,$115.19 ,$113.68 ,$12.46 ,$128.83 ,$7.08 ,$12.46 ,$12.46 ,$106.10 ,$92.31 ,$4.84 ,$7.08 ,$6.94 ,$14.16 ,$5.13 ,$128.83 ,$15.92 ,$139.44 ,$106.10 ,$10.27 ,$10.27 ,$92.31 ,$10.27 ,$104.73 ,$136.41 ,$103.55 ,$7.01 ,$119.74 ,$5.13 ,$12.09 ,$12.09 ,$6.94 ,$12.09 ,$109.13 ,$93.97 ,$109.13 ,$109.13 ,$121.26 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2597,DESMOPRESSIN 4 MCG/ML SOLN per1 mcg,636,1 ,$70.15 ,$46.30 ,$4.84 ,$70.15 ,$4.84 ,$15.93 ,$10.62 ,$7.08 ,$42.09 ,$59.63 ,$49.11 ,$4.84 ,$4.84 ,$66.64 ,$53.31 ,$52.61 ,$12.46 ,$59.63 ,$7.08 ,$12.46 ,$12.46 ,$49.11 ,$42.72 ,$4.84 ,$7.08 ,$6.94 ,$14.16 ,$5.13 ,$59.63 ,$15.92 ,$64.54 ,$49.11 ,$10.27 ,$10.27 ,$42.72 ,$10.27 ,$48.47 ,$63.14 ,$47.93 ,$7.01 ,$55.42 ,$5.13 ,$12.09 ,$12.09 ,$6.94 ,$12.09 ,$50.51 ,$43.49 ,$50.51 ,$50.51 ,$56.12 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J8540,DEXAMETHASONE 0.5 MG TABS per0.25 mg,636,1 ,$1.33 ,$0.88 ,$0.16 ,$1.33 , N/A ,$0.25 ,$0.17 , N/A ,$0.80 ,$1.13 ,$0.93 , N/A , N/A ,$1.26 ,$1.01 ,$1.00 ,$0.19 ,$1.13 , N/A ,$0.19 ,$0.19 ,$0.93 ,$0.81 , N/A , N/A , N/A , N/A , N/A ,$1.13 , N/A ,$1.22 ,$0.93 ,$0.16 ,$0.16 ,$0.81 ,$0.16 ,$0.92 ,$1.20 ,$0.91 , N/A ,$1.05 , N/A , N/A , N/A , N/A , N/A ,$0.96 ,$0.82 ,$0.96 ,$0.96 ,$1.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1100,DEXAMETHASONE 10 MG/ML SOLN per1 mg,636,1 ,$4.90 ,$3.23 ,$0.19 ,$4.90 , N/A ,$0.29 ,$0.20 , N/A ,$2.94 ,$4.17 ,$3.43 , N/A , N/A ,$4.66 ,$3.72 ,$3.68 ,$0.22 ,$4.17 , N/A ,$0.22 ,$0.22 ,$3.43 ,$2.98 , N/A , N/A , N/A , N/A , N/A ,$4.17 , N/A ,$4.51 ,$3.43 ,$0.19 ,$0.19 ,$2.98 ,$0.19 ,$3.39 ,$4.41 ,$3.35 , N/A ,$3.87 , N/A , N/A , N/A , N/A , N/A ,$3.53 ,$3.04 ,$3.53 ,$3.53 ,$3.92 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1100,DEXAMETHASONE 100 MG/10ML SOLN 10 ML VIAL per1 mg,636,1 ,$2.45 ,$1.62 ,$0.19 ,$2.45 , N/A ,$0.29 ,$0.20 , N/A ,$1.47 ,$2.08 ,$1.72 , N/A , N/A ,$2.33 ,$1.86 ,$1.84 ,$0.22 ,$2.08 , N/A ,$0.22 ,$0.22 ,$1.72 ,$1.49 , N/A , N/A , N/A , N/A , N/A ,$2.08 , N/A ,$2.25 ,$1.72 ,$0.19 ,$0.19 ,$1.49 ,$0.19 ,$1.69 ,$2.21 ,$1.67 , N/A ,$1.94 , N/A , N/A , N/A , N/A , N/A ,$1.76 ,$1.52 ,$1.76 ,$1.76 ,$1.96 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J8540,DEXAMETHASONE 2 MG TABS per0.25 mg,636,1 ,$0.50 ,$0.33 ,$0.16 ,$0.50 , N/A ,$0.25 ,$0.17 , N/A ,$0.30 ,$0.43 ,$0.35 , N/A , N/A ,$0.48 ,$0.38 ,$0.38 ,$0.19 ,$0.43 , N/A ,$0.19 ,$0.19 ,$0.35 ,$0.30 , N/A , N/A , N/A , N/A , N/A ,$0.43 , N/A ,$0.46 ,$0.35 ,$0.16 ,$0.16 ,$0.30 ,$0.16 ,$0.35 ,$0.45 ,$0.34 , N/A ,$0.40 , N/A , N/A , N/A , N/A , N/A ,$0.36 ,$0.31 ,$0.36 ,$0.36 ,$0.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1100,DEXAMETHASONE 20 MG/5ML SOLN 5 ML VIAL per1 mg,636,1 ,$6.13 ,$4.05 ,$0.19 ,$6.13 , N/A ,$0.29 ,$0.20 , N/A ,$3.68 ,$5.21 ,$4.29 , N/A , N/A ,$5.82 ,$4.66 ,$4.60 ,$0.22 ,$5.21 , N/A ,$0.22 ,$0.22 ,$4.29 ,$3.73 , N/A , N/A , N/A , N/A , N/A ,$5.21 , N/A ,$5.64 ,$4.29 ,$0.19 ,$0.19 ,$3.73 ,$0.19 ,$4.24 ,$5.52 ,$4.19 , N/A ,$4.84 , N/A , N/A , N/A , N/A , N/A ,$4.41 ,$3.80 ,$4.41 ,$4.41 ,$4.90 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1100,DEXAMETHASONE 20 MG/5ML SOLN per1 mg,636,1 ,$5.44 ,$3.59 ,$0.19 ,$5.44 , N/A ,$0.29 ,$0.20 , N/A ,$3.26 ,$4.62 ,$3.81 , N/A , N/A ,$5.17 ,$4.13 ,$4.08 ,$0.22 ,$4.62 , N/A ,$0.22 ,$0.22 ,$3.81 ,$3.31 , N/A , N/A , N/A , N/A , N/A ,$4.62 , N/A ,$5.00 ,$3.81 ,$0.19 ,$0.19 ,$3.31 ,$0.19 ,$3.76 ,$4.90 ,$3.72 , N/A ,$4.30 , N/A , N/A , N/A , N/A , N/A ,$3.92 ,$3.37 ,$3.92 ,$3.92 ,$4.35 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J8540,DEXAMETHASONE 4 MG TABS per0.25 mg,636,1 ,$0.25 ,$0.17 ,$0.15 ,$0.25 , N/A ,$0.25 ,$0.17 , N/A ,$0.15 ,$0.21 ,$0.18 , N/A , N/A ,$0.24 ,$0.19 ,$0.19 ,$0.19 ,$0.21 , N/A ,$0.19 ,$0.19 ,$0.18 ,$0.15 , N/A , N/A , N/A , N/A , N/A ,$0.21 , N/A ,$0.23 ,$0.18 ,$0.16 ,$0.16 ,$0.15 ,$0.16 ,$0.17 ,$0.23 ,$0.17 , N/A ,$0.20 , N/A , N/A , N/A , N/A , N/A ,$0.18 ,$0.16 ,$0.18 ,$0.18 ,$0.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1100,DEXAMETHASONE 4 MG/ML SOLN per1 mg,636,1 ,$12.25 ,$8.09 ,$0.19 ,$12.25 , N/A ,$0.29 ,$0.20 , N/A ,$7.35 ,$10.41 ,$8.58 , N/A , N/A ,$11.64 ,$9.31 ,$9.19 ,$0.22 ,$10.41 , N/A ,$0.22 ,$0.22 ,$8.58 ,$7.46 , N/A , N/A , N/A , N/A , N/A ,$10.41 , N/A ,$11.27 ,$8.58 ,$0.19 ,$0.19 ,$7.46 ,$0.19 ,$8.46 ,$11.03 ,$8.37 , N/A ,$9.68 , N/A , N/A , N/A , N/A , N/A ,$8.82 ,$7.60 ,$8.82 ,$8.82 ,$9.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1100,DEXAMETHASONE 4 MG/ML SOLN 1 ML VIAL per1 mg,636,1 ,$12.25 ,$8.09 ,$0.19 ,$12.25 , N/A ,$0.29 ,$0.20 , N/A ,$7.35 ,$10.41 ,$8.58 , N/A , N/A ,$11.64 ,$9.31 ,$9.19 ,$0.22 ,$10.41 , N/A ,$0.22 ,$0.22 ,$8.58 ,$7.46 , N/A , N/A , N/A , N/A , N/A ,$10.41 , N/A ,$11.27 ,$8.58 ,$0.19 ,$0.19 ,$7.46 ,$0.19 ,$8.46 ,$11.03 ,$8.37 , N/A ,$9.68 , N/A , N/A , N/A , N/A , N/A ,$8.82 ,$7.60 ,$8.82 ,$8.82 ,$9.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1100,DEXAMETHASONE PF 10 MG/ML SOLN per1 mg,636,1 ,$5.06 ,$3.34 ,$0.19 ,$5.06 , N/A ,$0.29 ,$0.20 , N/A ,$3.04 ,$4.30 ,$3.54 , N/A , N/A ,$4.81 ,$3.85 ,$3.80 ,$0.22 ,$4.30 , N/A ,$0.22 ,$0.22 ,$3.54 ,$3.08 , N/A , N/A , N/A , N/A , N/A ,$4.30 , N/A ,$4.66 ,$3.54 ,$0.19 ,$0.19 ,$3.08 ,$0.19 ,$3.50 ,$4.55 ,$3.46 , N/A ,$4.00 , N/A , N/A , N/A , N/A , N/A ,$3.64 ,$3.14 ,$3.64 ,$3.64 ,$4.05 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$0.16 ,$10.60 , N/A ,$0.25 ,$0.17 , N/A ,$6.36 ,$9.01 ,$7.42 , N/A , N/A ,$10.07 ,$8.06 ,$7.95 ,$0.24 ,$9.01 , N/A ,$0.24 ,$0.24 ,$7.42 ,$6.46 , N/A , N/A , N/A , N/A , N/A ,$9.01 , N/A ,$9.75 ,$7.42 ,$0.16 ,$0.16 ,$6.46 ,$0.16 ,$7.32 ,$9.54 ,$7.24 , N/A ,$8.37 , N/A , N/A , N/A , N/A , N/A ,$7.63 ,$6.57 ,$7.63 ,$7.63 ,$8.48 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3480,0.45 % NACL WITH KCL 20 MEQ 20-0.45 MEQ/L-% SOLN per2 mEq,636,1 ,$10.60 ,$7.00 ,$0.16 ,$10.60 , N/A ,$0.25 ,$0.17 , N/A ,$6.36 ,$9.01 ,$7.42 , N/A , N/A ,$10.07 ,$8.06 ,$7.95 ,$0.24 ,$9.01 , N/A ,$0.24 ,$0.24 ,$7.42 ,$6.46 , N/A , N/A , N/A , N/A , N/A ,$9.01 , N/A ,$9.75 ,$7.42 ,$0.16 ,$0.16 ,$6.46 ,$0.16 ,$7.32 ,$9.54 ,$7.24 , N/A ,$8.37 , N/A , N/A , N/A , N/A , N/A ,$7.63 ,$6.57 ,$7.63 ,$7.63 ,$8.48 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3480,0.9 % NACL WITH KCL 20 MEQ 20-0.9 MEQ/L-% SOLN per2 mEq,636,1 ,$10.60 ,$7.00 ,$0.16 ,$10.60 , N/A ,$0.25 ,$0.17 , N/A ,$6.36 ,$9.01 ,$7.42 , N/A , N/A ,$10.07 ,$8.06 ,$7.95 ,$0.24 ,$9.01 , N/A ,$0.24 ,$0.24 ,$7.42 ,$6.46 , N/A , N/A , N/A , N/A , N/A ,$9.01 , N/A ,$9.75 ,$7.42 ,$0.16 ,$0.16 ,$6.46 ,$0.16 ,$7.32 ,$9.54 ,$7.24 , N/A ,$8.37 , N/A , N/A , N/A , N/A , N/A ,$7.63 ,$6.57 ,$7.63 ,$7.63 ,$8.48 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$0.16 ,$10.60 , N/A ,$0.25 ,$0.17 , N/A ,$6.36 ,$9.01 ,$7.42 , N/A , N/A ,$10.07 ,$8.06 ,$7.95 ,$0.24 ,$9.01 , N/A ,$0.24 ,$0.24 ,$7.42 ,$6.46 , N/A , N/A , N/A , N/A , N/A ,$9.01 , N/A ,$9.75 ,$7.42 ,$0.16 ,$0.16 ,$6.46 ,$0.16 ,$7.32 ,$9.54 ,$7.24 , N/A ,$8.37 , N/A , N/A , N/A , N/A , N/A ,$7.63 ,$6.57 ,$7.63 ,$7.63 ,$8.48 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7042,DEXTROSE 5 %-SODIUM CHLORIDE 0.9 % 5-0.9 % SOLN per500 mL,636,1 ,$53.00 ,$34.98 ,$1.80 ,$53.00 , N/A ,$2.81 ,$1.88 , N/A ,$31.80 ,$45.05 ,$37.10 , N/A , N/A ,$50.35 ,$40.28 ,$39.75 ,$1.80 ,$45.05 , N/A ,$1.80 ,$1.80 ,$37.10 ,$32.28 , N/A , N/A , N/A , N/A , N/A ,$45.05 , N/A ,$48.76 ,$37.10 ,$1.81 ,$1.81 ,$32.28 ,$1.81 ,$36.62 ,$47.70 ,$36.21 , N/A ,$41.87 , N/A , N/A , N/A , N/A , N/A ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7121,DEXTROSE 5% LACTATED RINGERS 5 % SOLN per1000 mL,636,1 ,$106.00 ,$69.96 ,$10.03 ,$106.00 , N/A ,$72.65 ,$72.65 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$10.03 ,$90.10 , N/A ,$10.03 ,$10.03 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$64.52 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3360,DIAZEPAM 5 MG/ML SOLN per5 mg,636,1 ,$90.83 ,$59.95 ,$10.32 ,$90.83 , N/A ,$16.02 ,$10.68 , N/A ,$54.50 ,$77.21 ,$63.58 , N/A , N/A ,$86.29 ,$69.03 ,$68.12 ,$14.54 ,$77.21 , N/A ,$14.54 ,$14.54 ,$63.58 ,$55.32 , N/A , N/A , N/A , N/A , N/A ,$77.21 , N/A ,$83.56 ,$63.58 ,$10.32 ,$10.32 ,$55.32 ,$10.32 ,$62.76 ,$81.75 ,$62.06 , N/A ,$71.76 , N/A , N/A , N/A , N/A , N/A ,$65.40 ,$56.31 ,$65.40 ,$65.40 ,$72.66 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0500,DICYCLOMINE 10 MG/ML SOLN per20 mg,636,1 ,$620.40 ,$409.46 ,$33.02 ,$620.40 , N/A ,$51.23 ,$34.16 , N/A ,$372.24 ,$527.34 ,$434.28 , N/A , N/A ,$589.38 ,$471.50 ,$465.30 ,$41.12 ,$527.34 , N/A ,$41.12 ,$41.12 ,$434.28 ,$377.82 , N/A , N/A , N/A , N/A , N/A ,$527.34 , N/A ,$570.77 ,$434.28 ,$33.02 ,$33.02 ,$377.82 ,$33.02 ,$428.70 ,$558.36 ,$423.86 , N/A ,$490.12 , N/A , N/A , N/A , N/A , N/A ,$446.69 ,$384.65 ,$446.69 ,$446.69 ,$496.32 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1160,DIGOXIN 0.25 MG/ML SOLN per0.5 mg,636,1 ,$49.00 ,$32.34 ,$10.67 ,$49.00 , N/A ,$16.56 ,$11.04 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$13.80 ,$41.65 , N/A ,$13.80 ,$13.80 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$10.67 ,$10.67 ,$29.84 ,$10.67 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1110,DIHYDROERGOTAMINE 1 MG/ML SOLN per1 mg,636,1 ,$744.55 ,$491.40 ,$83.81 ,$744.55 , N/A ,$130.05 ,$86.70 , N/A ,$446.73 ,$632.87 ,$521.19 , N/A , N/A ,$707.32 ,$565.86 ,$558.41 ,$97.44 ,$632.87 , N/A ,$97.44 ,$97.44 ,$521.19 ,$453.43 , N/A , N/A , N/A , N/A , N/A ,$632.87 , N/A ,$684.99 ,$521.19 ,$83.81 ,$83.81 ,$453.43 ,$83.81 ,$514.48 ,$670.10 ,$508.68 , N/A ,$588.19 , N/A , N/A , N/A , N/A , N/A ,$536.08 ,$461.62 ,$536.08 ,$536.08 ,$595.64 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1200,DIPHENHYDRAMINE 50 MG/ML SOLN per50 mg,636,1 ,$49.00 ,$32.34 ,$1.64 ,$49.00 , N/A ,$2.54 ,$1.70 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.97 ,$41.65 , N/A ,$1.97 ,$1.97 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.64 ,$1.64 ,$29.84 ,$1.64 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90700,DIPTHERIA-ACELLULAR PERTUSSIS-TETANUS DTAP 25-58-10 LF-MCG/0.5 SUSP per0.5 mL,636,1 ,$196.75 ,$129.86 ,$0.95 ,$196.75 ,$0.95 ,$134.85 ,$134.85 , N/A ,$118.05 ,$167.24 ,$137.73 ,$0.95 ,$0.95 ,$186.91 ,$149.53 ,$147.56 ,$51.66 ,$167.24 , N/A ,$51.66 ,$51.66 ,$137.73 ,$119.82 ,$0.95 , N/A , N/A , N/A ,$1.01 ,$167.24 , N/A ,$181.01 ,$137.73 ,$99.79 ,$119.76 ,$119.82 ,$119.76 ,$135.95 ,$177.08 ,$134.42 , N/A ,$155.43 ,$1.01 , N/A , N/A , N/A , N/A ,$141.66 ,$121.99 ,$141.66 ,$141.66 ,$157.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1265,DOPAMINE 1.6-5 MG/ML-% SOLN per40 mg,636,1 ,$13.55 ,$8.94 ,$0.97 ,$13.55 , N/A ,$1.51 ,$1.01 , N/A ,$8.13 ,$11.52 ,$9.49 , N/A , N/A ,$12.87 ,$10.30 ,$10.16 ,$1.05 ,$11.52 , N/A ,$1.05 ,$1.05 ,$9.49 ,$8.25 , N/A , N/A , N/A , N/A , N/A ,$11.52 , N/A ,$12.47 ,$9.49 ,$0.97 ,$0.97 ,$8.25 ,$0.97 ,$9.36 ,$12.20 ,$9.26 , N/A ,$10.70 , N/A , N/A , N/A , N/A , N/A ,$9.76 ,$8.40 ,$9.76 ,$9.76 ,$10.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1270,DOXERCALCIFEROL 2 MCG/ML SOLN per1 mcg,636,1 ,$49.00 ,$32.34 ,$0.54 ,$49.00 , N/A ,$1.58 ,$1.05 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$0.54 ,$41.65 , N/A ,$0.54 ,$0.54 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.02 ,$1.02 ,$29.84 ,$1.02 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1270,DOXERCALCIFEROL 4 MCG/2ML SOLN per1 mcg,636,1 ,$24.50 ,$16.17 ,$0.54 ,$24.50 , N/A ,$1.58 ,$1.05 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$0.54 ,$20.83 , N/A ,$0.54 ,$0.54 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$1.02 ,$1.02 ,$14.92 ,$1.02 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9000,DOXORUBICIN 2 MG/ML SOLN per10 mg,636,1 ,$30.35 ,$20.03 ,$3.57 ,$30.35 , N/A ,$5.54 ,$3.69 , N/A ,$18.21 ,$25.80 ,$21.25 , N/A , N/A ,$28.83 ,$23.07 ,$22.76 ,$4.08 ,$25.80 , N/A ,$4.08 ,$4.08 ,$21.25 ,$18.48 , N/A , N/A , N/A , N/A , N/A ,$25.80 , N/A ,$27.92 ,$21.25 ,$3.57 ,$3.57 ,$18.48 ,$3.57 ,$20.97 ,$27.32 ,$20.74 , N/A ,$23.98 , N/A , N/A , N/A , N/A , N/A ,$21.85 ,$18.82 ,$21.85 ,$21.85 ,$24.28 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q2050,DOXORUBICIN LIPOSOMAL 2 MG/ML INJ 10 ML VIAL per10 mg,636,1 ,"$2,238.40 ","$1,477.34 ",$47.85 ,"$2,238.40 ",$47.85 ,$175.64 ,$117.09 ,$78.06 ,"$1,343.04 ","$1,902.64 ","$1,566.88 ",$47.85 ,$47.85 ,"$2,126.48 ","$1,701.18 ","$1,678.80 ",$173.81 ,"$1,902.64 ",$78.06 ,$173.81 ,$173.81 ,"$1,566.88 ","$1,363.19 ",$47.85 ,$78.06 ,$76.50 ,$156.12 ,$50.72 ,"$1,902.64 ",$175.64 ,"$2,059.33 ","$1,566.88 ",$113.19 ,$113.19 ,"$1,363.19 ",$113.19 ,"$1,546.73 ","$2,014.56 ","$1,529.27 ",$77.26 ,"$1,768.34 ",$50.72 ,$168.70 ,$168.70 ,$76.50 ,$168.70 ,"$1,611.65 ","$1,387.81 ","$1,611.65 ","$1,611.65 ","$1,790.72 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q2050,DOXORUBICIN LIPOSOMAL 2 MG/ML INJ 25 ML VIAL per10 mg,636,1 ,"$2,250.81 ","$1,485.53 ",$47.85 ,"$2,250.81 ",$47.85 ,$175.64 ,$117.09 ,$78.06 ,"$1,350.49 ","$1,913.19 ","$1,575.57 ",$47.85 ,$47.85 ,"$2,138.27 ","$1,710.62 ","$1,688.11 ",$173.81 ,"$1,913.19 ",$78.06 ,$173.81 ,$173.81 ,"$1,575.57 ","$1,370.74 ",$47.85 ,$78.06 ,$76.50 ,$156.12 ,$50.72 ,"$1,913.19 ",$175.64 ,"$2,070.75 ","$1,575.57 ",$113.19 ,$113.19 ,"$1,370.74 ",$113.19 ,"$1,555.31 ","$2,025.73 ","$1,537.75 ",$77.26 ,"$1,778.14 ",$50.72 ,$168.70 ,$168.70 ,$76.50 ,$168.70 ,"$1,620.58 ","$1,395.50 ","$1,620.58 ","$1,620.58 ","$1,800.65 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1790,DROPERIDOL 2.5 MG/ML SOLN per5 mg,636,1 ,$49.00 ,$32.34 ,$12.21 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$12.21 ,$41.65 , N/A ,$12.21 ,$12.21 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9173,DURVALUMAB 500 MG/10ML SOLN 10 ML VIAL per10 mg,636,1 ,$331.53 ,$218.81 ,$71.25 ,$331.53 ,$71.25 ,$176.78 ,$117.86 ,$78.57 ,$198.92 ,$281.80 ,$232.07 ,$71.25 ,$71.25 ,$314.95 ,$251.96 ,$248.65 ,$134.13 ,$281.80 ,$78.57 ,$134.13 ,$134.13 ,$232.07 ,$201.90 ,$71.25 ,$78.57 ,$77.00 ,$157.14 ,$75.53 ,$281.80 ,$176.79 ,$305.01 ,$232.07 ,$113.93 ,$113.93 ,$201.90 ,$113.93 ,$229.09 ,$298.38 ,$226.50 ,$77.77 ,$261.91 ,$75.53 ,$130.19 ,$130.19 ,$77.00 ,$130.19 ,$238.70 ,$205.55 ,$238.70 ,$238.70 ,$265.22 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 120 MG/0.8ML SOLN per10 mg,636,1 ,$10.57 ,$6.98 ,$1.10 ,$10.57 , N/A ,$1.71 ,$1.14 , N/A ,$6.34 ,$8.98 ,$7.40 , N/A , N/A ,$10.04 ,$8.03 ,$7.93 ,$1.38 ,$8.98 , N/A ,$1.38 ,$1.38 ,$7.40 ,$6.44 , N/A , N/A , N/A , N/A , N/A ,$8.98 , N/A ,$9.72 ,$7.40 ,$1.10 ,$1.10 ,$6.44 ,$1.10 ,$7.30 ,$9.51 ,$7.22 , N/A ,$8.35 , N/A , N/A , N/A , N/A , N/A ,$7.61 ,$6.55 ,$7.61 ,$7.61 ,$8.46 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 150 MG/ML SOLN per10 mg,636,1 ,$14.14 ,$9.33 ,$1.10 ,$14.14 , N/A ,$1.71 ,$1.14 , N/A ,$8.48 ,$12.02 ,$9.90 , N/A , N/A ,$13.43 ,$10.75 ,$10.61 ,$1.38 ,$12.02 , N/A ,$1.38 ,$1.38 ,$9.90 ,$8.61 , N/A , N/A , N/A , N/A , N/A ,$12.02 , N/A ,$13.01 ,$9.90 ,$1.10 ,$1.10 ,$8.61 ,$1.10 ,$9.77 ,$12.73 ,$9.66 , N/A ,$11.17 , N/A , N/A , N/A , N/A , N/A ,$10.18 ,$8.77 ,$10.18 ,$10.18 ,$11.31 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 150 MG/ML SOSY per10 mg,636,1 ,$11.07 ,$7.31 ,$1.10 ,$11.07 , N/A ,$1.71 ,$1.14 , N/A ,$6.64 ,$9.41 ,$7.75 , N/A , N/A ,$10.52 ,$8.41 ,$8.30 ,$1.38 ,$9.41 , N/A ,$1.38 ,$1.38 ,$7.75 ,$6.74 , N/A , N/A , N/A , N/A , N/A ,$9.41 , N/A ,$10.18 ,$7.75 ,$1.10 ,$1.10 ,$6.74 ,$1.10 ,$7.65 ,$9.96 ,$7.56 , N/A ,$8.75 , N/A , N/A , N/A , N/A , N/A ,$7.97 ,$6.86 ,$7.97 ,$7.97 ,$8.86 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 100 MG/ML SOSY per10 mg,636,1 ,$11.07 ,$7.31 ,$1.10 ,$11.07 , N/A ,$1.71 ,$1.14 , N/A ,$6.64 ,$9.41 ,$7.75 , N/A , N/A ,$10.52 ,$8.41 ,$8.30 ,$1.38 ,$9.41 , N/A ,$1.38 ,$1.38 ,$7.75 ,$6.74 , N/A , N/A , N/A , N/A , N/A ,$9.41 , N/A ,$10.18 ,$7.75 ,$1.10 ,$1.10 ,$6.74 ,$1.10 ,$7.65 ,$9.96 ,$7.56 , N/A ,$8.75 , N/A , N/A , N/A , N/A , N/A ,$7.97 ,$6.86 ,$7.97 ,$7.97 ,$8.86 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 120 MG/0.8ML SOSY per10 mg,636,1 ,$11.07 ,$7.31 ,$1.10 ,$11.07 , N/A ,$1.71 ,$1.14 , N/A ,$6.64 ,$9.41 ,$7.75 , N/A , N/A ,$10.52 ,$8.41 ,$8.30 ,$1.38 ,$9.41 , N/A ,$1.38 ,$1.38 ,$7.75 ,$6.74 , N/A , N/A , N/A , N/A , N/A ,$9.41 , N/A ,$10.18 ,$7.75 ,$1.10 ,$1.10 ,$6.74 ,$1.10 ,$7.65 ,$9.96 ,$7.56 , N/A ,$8.75 , N/A , N/A , N/A , N/A , N/A ,$7.97 ,$6.86 ,$7.97 ,$7.97 ,$8.86 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 30 MG/0.3ML SOSY per10 mg,636,1 ,$16.33 ,$10.78 ,$1.10 ,$16.33 , N/A ,$1.71 ,$1.14 , N/A ,$9.80 ,$13.88 ,$11.43 , N/A , N/A ,$15.51 ,$12.41 ,$12.25 ,$1.38 ,$13.88 , N/A ,$1.38 ,$1.38 ,$11.43 ,$9.95 , N/A , N/A , N/A , N/A , N/A ,$13.88 , N/A ,$15.02 ,$11.43 ,$1.10 ,$1.10 ,$9.95 ,$1.10 ,$11.28 ,$14.70 ,$11.16 , N/A ,$12.90 , N/A , N/A , N/A , N/A , N/A ,$11.76 ,$10.12 ,$11.76 ,$11.76 ,$13.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 30 MG/0.3ML SOLN per10 mg,636,1 ,$16.33 ,$10.78 ,$1.10 ,$16.33 , N/A ,$1.71 ,$1.14 , N/A ,$9.80 ,$13.88 ,$11.43 , N/A , N/A ,$15.51 ,$12.41 ,$12.25 ,$1.38 ,$13.88 , N/A ,$1.38 ,$1.38 ,$11.43 ,$9.95 , N/A , N/A , N/A , N/A , N/A ,$13.88 , N/A ,$15.02 ,$11.43 ,$1.10 ,$1.10 ,$9.95 ,$1.10 ,$11.28 ,$14.70 ,$11.16 , N/A ,$12.90 , N/A , N/A , N/A , N/A , N/A ,$11.76 ,$10.12 ,$11.76 ,$11.76 ,$13.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 60 MG/0.6ML SOLN per10 mg,636,1 ,$14.68 ,$9.69 ,$1.10 ,$14.68 , N/A ,$1.71 ,$1.14 , N/A ,$8.81 ,$12.48 ,$10.28 , N/A , N/A ,$13.95 ,$11.16 ,$11.01 ,$1.38 ,$12.48 , N/A ,$1.38 ,$1.38 ,$10.28 ,$8.94 , N/A , N/A , N/A , N/A , N/A ,$12.48 , N/A ,$13.51 ,$10.28 ,$1.10 ,$1.10 ,$8.94 ,$1.10 ,$10.14 ,$13.21 ,$10.03 , N/A ,$11.60 , N/A , N/A , N/A , N/A , N/A ,$10.57 ,$9.10 ,$10.57 ,$10.57 ,$11.74 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 60 MG/0.6ML SOSY per10 mg,636,1 ,$11.53 ,$7.61 ,$1.10 ,$11.53 , N/A ,$1.71 ,$1.14 , N/A ,$6.92 ,$9.80 ,$8.07 , N/A , N/A ,$10.95 ,$8.76 ,$8.65 ,$1.38 ,$9.80 , N/A ,$1.38 ,$1.38 ,$8.07 ,$7.02 , N/A , N/A , N/A , N/A , N/A ,$9.80 , N/A ,$10.61 ,$8.07 ,$1.10 ,$1.10 ,$7.02 ,$1.10 ,$7.97 ,$10.38 ,$7.88 , N/A ,$9.11 , N/A , N/A , N/A , N/A , N/A ,$8.30 ,$7.15 ,$8.30 ,$8.30 ,$9.22 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 80 MG/0.8 ML SOSY per10 mg,636,1 ,$11.08 ,$7.31 ,$1.10 ,$11.08 , N/A ,$1.71 ,$1.14 , N/A ,$6.65 ,$9.42 ,$7.76 , N/A , N/A ,$10.53 ,$8.42 ,$8.31 ,$1.38 ,$9.42 , N/A ,$1.38 ,$1.38 ,$7.76 ,$6.75 , N/A , N/A , N/A , N/A , N/A ,$9.42 , N/A ,$10.19 ,$7.76 ,$1.10 ,$1.10 ,$6.75 ,$1.10 ,$7.66 ,$9.97 ,$7.57 , N/A ,$8.75 , N/A , N/A , N/A , N/A , N/A ,$7.98 ,$6.87 ,$7.98 ,$7.98 ,$8.86 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1650,ENOXAPARIN 80 MG/0.8ML SOLN per10 mg,636,1 ,$12.25 ,$8.09 ,$1.10 ,$12.25 , N/A ,$1.71 ,$1.14 , N/A ,$7.35 ,$10.41 ,$8.58 , N/A , N/A ,$11.64 ,$9.31 ,$9.19 ,$1.38 ,$10.41 , N/A ,$1.38 ,$1.38 ,$8.58 ,$7.46 , N/A , N/A , N/A , N/A , N/A ,$10.41 , N/A ,$11.27 ,$8.58 ,$1.10 ,$1.10 ,$7.46 ,$1.10 ,$8.46 ,$11.03 ,$8.37 , N/A ,$9.68 , N/A , N/A , N/A , N/A , N/A ,$8.82 ,$7.60 ,$8.82 ,$8.82 ,$9.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3490,EPHEDRINE 50 MG/ML SOLN per50 mg,636,1 ,$349.05 ,$230.37 ,$177.04 ,$349.05 , N/A ,$239.24 ,$239.24 , N/A ,$209.43 ,$296.69 ,$244.34 , N/A , N/A ,$331.60 ,$265.28 ,$261.79 , N/A ,$296.69 , N/A , N/A , N/A ,$244.34 ,$212.57 , N/A , N/A , N/A , N/A , N/A ,$296.69 , N/A ,$321.13 ,$244.34 ,$177.04 ,$212.47 ,$212.57 ,$212.47 ,$241.19 ,$314.15 ,$238.47 , N/A ,$275.75 , N/A , N/A , N/A , N/A , N/A ,$251.32 ,$216.41 ,$251.32 ,$251.32 ,$279.24 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0171,EPINEPHRINE 1 MG/10 ML SOSY per0.1 mg,636,1 ,$3.69 ,$2.44 ,$1.07 ,$3.69 , N/A ,$1.67 ,$1.11 , N/A ,$2.21 ,$3.14 ,$2.58 , N/A , N/A ,$3.51 ,$2.80 ,$2.77 ,$1.22 ,$3.14 , N/A ,$1.22 ,$1.22 ,$2.58 ,$2.25 , N/A , N/A , N/A , N/A , N/A ,$3.14 , N/A ,$3.39 ,$2.58 ,$1.07 ,$1.07 ,$2.25 ,$1.07 ,$2.55 ,$3.32 ,$2.52 , N/A ,$2.92 , N/A , N/A , N/A , N/A , N/A ,$2.66 ,$2.29 ,$2.66 ,$2.66 ,$2.95 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0171,EPINEPHRINE 1 MG/10ML SOSY per0.1 mg,636,1 ,$7.27 ,$4.80 ,$1.07 ,$7.27 , N/A ,$1.67 ,$1.11 , N/A ,$4.36 ,$6.18 ,$5.09 , N/A , N/A ,$6.91 ,$5.53 ,$5.45 ,$1.22 ,$6.18 , N/A ,$1.22 ,$1.22 ,$5.09 ,$4.43 , N/A , N/A , N/A , N/A , N/A ,$6.18 , N/A ,$6.69 ,$5.09 ,$1.07 ,$1.07 ,$4.43 ,$1.07 ,$5.02 ,$6.54 ,$4.97 , N/A ,$5.74 , N/A , N/A , N/A , N/A , N/A ,$5.23 ,$4.51 ,$5.23 ,$5.23 ,$5.82 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0171,EPINEPHRINE 30 MG/30ML SOLN 10 ML VIAL per0.1 mg,636,1 ,$8.17 ,$5.39 ,$1.07 ,$8.17 , N/A ,$1.67 ,$1.11 , N/A ,$4.90 ,$6.94 ,$5.72 , N/A , N/A ,$7.76 ,$6.21 ,$6.13 ,$1.22 ,$6.94 , N/A ,$1.22 ,$1.22 ,$5.72 ,$4.98 , N/A , N/A , N/A , N/A , N/A ,$6.94 , N/A ,$7.52 ,$5.72 ,$1.07 ,$1.07 ,$4.98 ,$1.07 ,$5.65 ,$7.35 ,$5.58 , N/A ,$6.45 , N/A , N/A , N/A , N/A , N/A ,$5.88 ,$5.07 ,$5.88 ,$5.88 ,$6.54 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0171,EPINEPHRINE 30 MG/30ML SOLN 30 ML VIAL per0.1 mg,636,1 ,$16.33 ,$10.78 ,$1.07 ,$16.33 , N/A ,$1.67 ,$1.11 , N/A ,$9.80 ,$13.88 ,$11.43 , N/A , N/A ,$15.51 ,$12.41 ,$12.25 ,$1.22 ,$13.88 , N/A ,$1.22 ,$1.22 ,$11.43 ,$9.95 , N/A , N/A , N/A , N/A , N/A ,$13.88 , N/A ,$15.02 ,$11.43 ,$1.07 ,$1.07 ,$9.95 ,$1.07 ,$11.28 ,$14.70 ,$11.16 , N/A ,$12.90 , N/A , N/A , N/A , N/A , N/A ,$11.76 ,$10.12 ,$11.76 ,$11.76 ,$13.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0171,EPINEPHRINE 1 MG/ML SOLN per0.1 mg,636,1 ,$16.33 ,$10.78 ,$1.07 ,$16.33 , N/A ,$1.67 ,$1.11 , N/A ,$9.80 ,$13.88 ,$11.43 , N/A , N/A ,$15.51 ,$12.41 ,$12.25 ,$1.22 ,$13.88 , N/A ,$1.22 ,$1.22 ,$11.43 ,$9.95 , N/A , N/A , N/A , N/A , N/A ,$13.88 , N/A ,$15.02 ,$11.43 ,$1.07 ,$1.07 ,$9.95 ,$1.07 ,$11.28 ,$14.70 ,$11.16 , N/A ,$12.90 , N/A , N/A , N/A , N/A , N/A ,$11.76 ,$10.12 ,$11.76 ,$11.76 ,$13.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0171,EPINEPHRINE PF 1 MG/ML SOLN 1 ML AMPULE per0.1 mg,636,1 ,$10.77 ,$7.11 ,$1.07 ,$10.77 , N/A ,$1.67 ,$1.11 , N/A ,$6.46 ,$9.15 ,$7.54 , N/A , N/A ,$10.23 ,$8.19 ,$8.08 ,$1.22 ,$9.15 , N/A ,$1.22 ,$1.22 ,$7.54 ,$6.56 , N/A , N/A , N/A , N/A , N/A ,$9.15 , N/A ,$9.91 ,$7.54 ,$1.07 ,$1.07 ,$6.56 ,$1.07 ,$7.44 ,$9.69 ,$7.36 , N/A ,$8.51 , N/A , N/A , N/A , N/A , N/A ,$7.75 ,$6.68 ,$7.75 ,$7.75 ,$8.62 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0885,EPOETIN ALFA 20000 UNIT/ML SOLN per1000 Units,636,1 ,$101.02 ,$66.67 ,$4.84 ,$101.02 ,$4.84 ,$17.84 ,$11.90 ,$7.93 ,$60.61 ,$85.87 ,$70.71 ,$4.84 ,$4.84 ,$95.97 ,$76.78 ,$75.77 ,$14.03 ,$85.87 ,$7.93 ,$14.03 ,$14.03 ,$70.71 ,$61.52 ,$4.84 ,$7.93 ,$7.77 ,$15.86 ,$5.13 ,$85.87 ,$17.84 ,$92.94 ,$70.71 ,$11.50 ,$11.50 ,$61.52 ,$11.50 ,$69.80 ,$90.92 ,$69.02 ,$7.85 ,$79.81 ,$5.13 ,$13.61 ,$13.61 ,$7.77 ,$13.61 ,$72.73 ,$62.63 ,$72.73 ,$72.73 ,$80.82 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q5106,EPOETIN ALFA-EPBX 10000 UNITS/ML SOLN per1000 Units,636,1 ,$54.93 ,$36.25 ,$8.34 ,$54.93 ,$9.09 ,$19.15 ,$12.77 ,$8.51 ,$32.96 ,$46.69 ,$38.45 ,$9.09 ,$9.09 ,$52.18 ,$41.75 ,$41.20 ,$13.70 ,$46.69 ,$8.51 ,$13.70 ,$13.70 ,$38.45 ,$33.45 ,$9.09 ,$8.51 ,$8.34 ,$17.02 ,$9.64 ,$46.69 ,$19.16 ,$50.54 ,$38.45 ,$12.34 ,$12.34 ,$33.45 ,$12.34 ,$37.96 ,$49.44 ,$37.53 ,$8.43 ,$43.39 ,$9.64 ,$13.30 ,$13.30 ,$8.34 ,$13.30 ,$39.55 ,$34.06 ,$39.55 ,$39.55 ,$43.94 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3032,EPTINEZUMAB-JJMR 100 MG/ML SOLN 1 ML VIAL per1 mg,636,1 ,$47.33 ,$31.24 ,$9.09 ,$47.33 ,$9.09 ,$38.27 ,$25.52 ,$17.01 ,$28.40 ,$40.23 ,$33.13 ,$9.09 ,$9.09 ,$44.96 ,$35.97 ,$35.50 ,$28.71 ,$40.23 ,$17.01 ,$28.71 ,$28.71 ,$33.13 ,$28.82 ,$9.09 ,$17.01 ,$16.67 ,$34.02 ,$9.64 ,$40.23 ,$38.27 ,$43.54 ,$33.13 ,$24.66 ,$24.66 ,$28.82 ,$24.66 ,$32.71 ,$42.60 ,$32.34 ,$16.84 ,$37.39 ,$9.64 ,$27.87 ,$27.87 ,$16.67 ,$27.87 ,$34.08 ,$29.34 ,$34.08 ,$34.08 ,$37.86 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1335,ERTAPENEM 1 G SOLR 1 EACH VIAL per500 mg,636,1 ,$320.38 ,$211.45 ,$18.60 ,$320.38 , N/A ,$28.87 ,$19.25 , N/A ,$192.23 ,$272.32 ,$224.27 , N/A , N/A ,$304.36 ,$243.49 ,$240.29 ,$26.13 ,$272.32 , N/A ,$26.13 ,$26.13 ,$224.27 ,$195.11 , N/A , N/A , N/A , N/A , N/A ,$272.32 , N/A ,$294.75 ,$224.27 ,$18.60 ,$18.60 ,$195.11 ,$18.60 ,$221.38 ,$288.34 ,$218.88 , N/A ,$253.10 , N/A , N/A , N/A , N/A , N/A ,$230.67 ,$198.64 ,$230.67 ,$230.67 ,$256.30 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9181,ETOPOSIDE 500 MG/25ML SOLN 25 ML VIAL per10 mg,636,1 ,$8.57 ,$5.66 ,$1.25 ,$8.57 , N/A ,$1.94 ,$1.29 , N/A ,$5.14 ,$7.28 ,$6.00 , N/A , N/A ,$8.14 ,$6.51 ,$6.43 ,$1.51 ,$7.28 , N/A ,$1.51 ,$1.51 ,$6.00 ,$5.22 , N/A , N/A , N/A , N/A , N/A ,$7.28 , N/A ,$7.88 ,$6.00 ,$1.25 ,$1.25 ,$5.22 ,$1.25 ,$5.92 ,$7.71 ,$5.86 , N/A ,$6.77 , N/A , N/A , N/A , N/A , N/A ,$6.17 ,$5.31 ,$6.17 ,$6.17 ,$6.86 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3010,FENTANYL 1000 MCG/20ML SOLN per0.1 mg,636,1 ,$4.74 ,$3.13 ,$1.42 ,$4.74 , N/A ,$2.21 ,$1.47 , N/A ,$2.84 ,$4.03 ,$3.32 , N/A , N/A ,$4.50 ,$3.60 ,$3.56 ,$1.56 ,$4.03 , N/A ,$1.56 ,$1.56 ,$3.32 ,$2.89 , N/A , N/A , N/A , N/A , N/A ,$4.03 , N/A ,$4.36 ,$3.32 ,$1.42 ,$1.42 ,$2.89 ,$1.42 ,$3.28 ,$4.27 ,$3.24 , N/A ,$3.74 , N/A , N/A , N/A , N/A , N/A ,$3.41 ,$2.94 ,$3.41 ,$3.41 ,$3.79 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3010,FENTANYL 250 MCG/5ML SOLN per0.1 mg,636,1 ,$16.33 ,$10.78 ,$1.42 ,$16.33 , N/A ,$2.21 ,$1.47 , N/A ,$9.80 ,$13.88 ,$11.43 , N/A , N/A ,$15.51 ,$12.41 ,$12.25 ,$1.56 ,$13.88 , N/A ,$1.56 ,$1.56 ,$11.43 ,$9.95 , N/A , N/A , N/A , N/A , N/A ,$13.88 , N/A ,$15.02 ,$11.43 ,$1.42 ,$1.42 ,$9.95 ,$1.42 ,$11.28 ,$14.70 ,$11.16 , N/A ,$12.90 , N/A , N/A , N/A , N/A , N/A ,$11.76 ,$10.12 ,$11.76 ,$11.76 ,$13.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3010,FENTANYL 2500 MCG/50ML SOLN per0.1 mg,636,1 ,$24.50 ,$16.17 ,$1.42 ,$24.50 , N/A ,$2.21 ,$1.47 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$1.56 ,$20.83 , N/A ,$1.56 ,$1.56 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$1.42 ,$1.42 ,$14.92 ,$1.42 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3010,FENTANYL 50 MCG/ML SOLN per0.1 mg,636,1 ,$49.00 ,$32.34 ,$1.42 ,$49.00 , N/A ,$2.21 ,$1.47 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.56 ,$41.65 , N/A ,$1.56 ,$1.56 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.42 ,$1.42 ,$29.84 ,$1.42 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3010,FENTANYL 100 MCG/2ML SOLN per0.1 mg,636,1 ,$49.00 ,$32.34 ,$1.42 ,$49.00 , N/A ,$2.21 ,$1.47 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.56 ,$41.65 , N/A ,$1.56 ,$1.56 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.42 ,$1.42 ,$29.84 ,$1.42 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1439,FERRIC CARBOXYMALTOSE 750 MG/15ML SOLN 15 ML VIAL per1 mg,636,1 ,$8.52 ,$5.62 ,$1.11 ,$18.42 ,$17.38 ,$2.54 ,$1.70 ,$1.13 ,$5.11 ,$7.24 ,$5.96 ,$17.38 ,$8.52 ,$8.09 ,$6.48 ,$6.39 ,$1.87 ,$7.24 ,$1.13 ,$1.87 ,$1.87 ,$5.96 ,$5.19 ,$17.38 ,$1.13 ,$1.11 ,$2.26 ,$9.03 ,$7.24 ,$2.55 ,$7.84 ,$5.96 ,$1.64 ,$1.64 ,$5.19 ,$1.64 ,$5.89 ,$7.67 ,$5.82 ,$1.12 ,$6.73 ,$18.42 ,$1.82 ,$1.82 ,$1.11 ,$1.82 ,$6.13 ,$5.28 ,$6.13 ,$6.13 ,$6.82 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2916,FERRIC GLUCONATE 12.5 MG/ML SOLN per12.5 mg,636,1 ,$46.94 ,$30.98 ,$3.19 ,$46.94 , N/A ,$4.95 ,$3.30 , N/A ,$28.16 ,$39.90 ,$32.86 , N/A , N/A ,$44.59 ,$35.67 ,$35.21 ,$3.55 ,$39.90 , N/A ,$3.55 ,$3.55 ,$32.86 ,$28.59 , N/A , N/A , N/A , N/A , N/A ,$39.90 , N/A ,$43.18 ,$32.86 ,$3.19 ,$3.19 ,$28.59 ,$3.19 ,$32.44 ,$42.25 ,$32.07 , N/A ,$37.08 , N/A , N/A , N/A , N/A , N/A ,$33.80 ,$29.10 ,$33.80 ,$33.80 ,$37.55 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q0138,FERUMOXYTOL 510 MG/17ML SOLN 17 ML VIAL per1 mg,636,1 ,$13.10 ,$8.65 ,$0.47 ,$13.10 ,$9.09 ,$1.08 ,$0.72 ,$0.48 ,$7.86 ,$11.14 ,$9.17 ,$9.09 ,$9.09 ,$12.45 ,$9.96 ,$9.83 ,$0.95 ,$11.14 ,$0.48 ,$0.95 ,$0.95 ,$9.17 ,$7.98 ,$9.09 ,$0.48 ,$0.47 ,$0.96 ,$9.64 ,$11.14 ,$1.08 ,$12.05 ,$9.17 ,$0.70 ,$0.70 ,$7.98 ,$0.70 ,$9.05 ,$11.79 ,$8.95 ,$0.47 ,$10.35 ,$9.64 ,$0.92 ,$0.92 ,$0.47 ,$0.92 ,$9.43 ,$8.12 ,$9.43 ,$9.43 ,$10.48 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q5101,FILGRASTIM-SNDZ 480 MCG/0.8ML SOSY per1 mcg,636,1 ,$3.46 ,$2.28 ,$0.32 ,$9.64 ,$9.09 ,$0.50 ,$0.33 , N/A ,$2.08 ,$2.94 ,$2.42 ,$9.09 ,$3.46 ,$3.29 ,$2.63 ,$2.60 ,$0.41 ,$2.94 , N/A ,$0.41 ,$0.41 ,$2.42 ,$2.11 ,$9.09 , N/A , N/A , N/A ,$3.67 ,$2.94 , N/A ,$3.18 ,$2.42 ,$0.32 ,$0.32 ,$2.11 ,$0.32 ,$2.39 ,$3.11 ,$2.36 , N/A ,$2.73 ,$9.64 , N/A , N/A , N/A , N/A ,$2.49 ,$2.15 ,$2.49 ,$2.49 ,$2.77 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1450,FLUCONAZOLE 200-0.9 MG/100ML-% SOLN per200 mg,636,1 ,$75.20 ,$49.63 ,$3.55 ,$75.20 , N/A ,$5.51 ,$3.68 , N/A ,$45.12 ,$63.92 ,$52.64 , N/A , N/A ,$71.44 ,$57.15 ,$56.40 ,$3.96 ,$63.92 , N/A ,$3.96 ,$3.96 ,$52.64 ,$45.80 , N/A , N/A , N/A , N/A , N/A ,$63.92 , N/A ,$69.18 ,$52.64 ,$3.55 ,$3.55 ,$45.80 ,$3.55 ,$51.96 ,$67.68 ,$51.38 , N/A ,$59.41 , N/A , N/A , N/A , N/A , N/A ,$54.14 ,$46.62 ,$54.14 ,$54.14 ,$60.16 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1450,FLUCONAZOLE 400-0.9 MG/200ML-% SOLN per200 mg,636,1 ,$67.13 ,$44.31 ,$3.55 ,$67.13 , N/A ,$5.51 ,$3.68 , N/A ,$40.28 ,$57.06 ,$46.99 , N/A , N/A ,$63.77 ,$51.02 ,$50.35 ,$3.96 ,$57.06 , N/A ,$3.96 ,$3.96 ,$46.99 ,$40.88 , N/A , N/A , N/A , N/A , N/A ,$57.06 , N/A ,$61.76 ,$46.99 ,$3.55 ,$3.55 ,$40.88 ,$3.55 ,$46.39 ,$60.42 ,$45.86 , N/A ,$53.03 , N/A , N/A , N/A , N/A , N/A ,$48.33 ,$41.62 ,$48.33 ,$48.33 ,$53.70 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1652,FONDAPARINUX 2.5 MG/0.5ML SOLN per0.5 mg,636,1 ,$44.28 ,$29.22 ,$1.55 ,$44.28 , N/A ,$2.41 ,$1.61 , N/A ,$26.57 ,$37.64 ,$31.00 , N/A , N/A ,$42.07 ,$33.65 ,$33.21 ,$1.70 ,$37.64 , N/A ,$1.70 ,$1.70 ,$31.00 ,$26.97 , N/A , N/A , N/A , N/A , N/A ,$37.64 , N/A ,$40.74 ,$31.00 ,$1.55 ,$1.55 ,$26.97 ,$1.55 ,$30.60 ,$39.85 ,$30.25 , N/A ,$34.98 , N/A , N/A , N/A , N/A , N/A ,$31.88 ,$27.45 ,$31.88 ,$31.88 ,$35.42 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1453,FOSAPREPITANT DIMEGLUMINE 150 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$10.57 ,$6.98 ,$0.28 ,$10.57 ,$1.81 ,$0.43 ,$0.29 , N/A ,$6.34 ,$8.98 ,$7.40 ,$1.81 ,$1.81 ,$10.04 ,$8.03 ,$7.93 ,$0.31 ,$8.98 , N/A ,$0.31 ,$0.31 ,$7.40 ,$6.44 ,$1.81 , N/A , N/A , N/A ,$1.92 ,$8.98 , N/A ,$9.72 ,$7.40 ,$0.28 ,$0.28 ,$6.44 ,$0.28 ,$7.30 ,$9.51 ,$7.22 , N/A ,$8.35 ,$1.92 , N/A , N/A , N/A , N/A ,$7.61 ,$6.55 ,$7.61 ,$7.61 ,$8.46 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q2009,FOSPHENYTOIN 100 MG PE/2ML SOLN per50 mg PE,636,1 ,$55.35 ,$36.53 ,$2.33 ,$55.35 , N/A ,$3.62 ,$2.42 , N/A ,$33.21 ,$47.05 ,$38.75 , N/A , N/A ,$52.58 ,$42.07 ,$41.51 ,$7.07 ,$47.05 , N/A ,$7.07 ,$7.07 ,$38.75 ,$33.71 , N/A , N/A , N/A , N/A , N/A ,$47.05 , N/A ,$50.92 ,$38.75 ,$2.33 ,$2.33 ,$33.71 ,$2.33 ,$38.25 ,$49.82 ,$37.82 , N/A ,$43.73 , N/A , N/A , N/A , N/A , N/A ,$39.85 ,$34.32 ,$39.85 ,$39.85 ,$44.28 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q2009,FOSPHENYTOIN 100 MG PE/2ML SOLN 2 ML VIAL per50 mg PE,636,1 ,$55.35 ,$36.53 ,$2.33 ,$55.35 , N/A ,$3.62 ,$2.42 , N/A ,$33.21 ,$47.05 ,$38.75 , N/A , N/A ,$52.58 ,$42.07 ,$41.51 ,$7.07 ,$47.05 , N/A ,$7.07 ,$7.07 ,$38.75 ,$33.71 , N/A , N/A , N/A , N/A , N/A ,$47.05 , N/A ,$50.92 ,$38.75 ,$2.33 ,$2.33 ,$33.71 ,$2.33 ,$38.25 ,$49.82 ,$37.82 , N/A ,$43.73 , N/A , N/A , N/A , N/A , N/A ,$39.85 ,$34.32 ,$39.85 ,$39.85 ,$44.28 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q2009,FOSPHENYTOIN 500 MG PE/10ML SOLN per50 mg PE,636,1 ,$81.19 ,$53.59 ,$2.33 ,$81.19 , N/A ,$3.62 ,$2.42 , N/A ,$48.71 ,$69.01 ,$56.83 , N/A , N/A ,$77.13 ,$61.70 ,$60.89 ,$7.07 ,$69.01 , N/A ,$7.07 ,$7.07 ,$56.83 ,$49.44 , N/A , N/A , N/A , N/A , N/A ,$69.01 , N/A ,$74.69 ,$56.83 ,$2.33 ,$2.33 ,$49.44 ,$2.33 ,$56.10 ,$73.07 ,$55.47 , N/A ,$64.14 , N/A , N/A , N/A , N/A , N/A ,$58.46 ,$50.34 ,$58.46 ,$58.46 ,$64.95 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1940,FUROSEMIDE 10 MG/ML SOLN 10 ML VIAL per20 mg,636,1 ,$4.90 ,$3.23 ,$0.84 ,$4.90 , N/A ,$1.31 ,$0.87 , N/A ,$2.94 ,$4.17 ,$3.43 , N/A , N/A ,$4.66 ,$3.72 ,$3.68 ,$1.12 ,$4.17 , N/A ,$1.12 ,$1.12 ,$3.43 ,$2.98 , N/A , N/A , N/A , N/A , N/A ,$4.17 , N/A ,$4.51 ,$3.43 ,$0.84 ,$0.84 ,$2.98 ,$0.84 ,$3.39 ,$4.41 ,$3.35 , N/A ,$3.87 , N/A , N/A , N/A , N/A , N/A ,$3.53 ,$3.04 ,$3.53 ,$3.53 ,$3.92 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1940,FUROSEMIDE 10 MG/ML SOLN per20 mg,636,1 ,$49.00 ,$32.34 ,$0.84 ,$49.00 , N/A ,$1.31 ,$0.87 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.12 ,$41.65 , N/A ,$1.12 ,$1.12 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$0.84 ,$0.84 ,$29.84 ,$0.84 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1570,GANCICLOVIR 500 MG/10ML SOLN 1 EACH VIAL per500 mg,636,1 ,$430.45 ,$284.10 ,$68.63 ,$430.45 , N/A ,$106.49 ,$71.00 , N/A ,$258.27 ,$365.88 ,$301.32 , N/A , N/A ,$408.93 ,$327.14 ,$322.84 ,$70.40 ,$365.88 , N/A ,$70.40 ,$70.40 ,$301.32 ,$262.14 , N/A , N/A , N/A , N/A , N/A ,$365.88 , N/A ,$396.01 ,$301.32 ,$68.63 ,$68.63 ,$262.14 ,$68.63 ,$297.44 ,$387.41 ,$294.08 , N/A ,$340.06 , N/A , N/A , N/A , N/A , N/A ,$309.92 ,$266.88 ,$309.92 ,$309.92 ,$344.36 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1570,GANCICLOVIR 500 MG/10ML SOLN 10 ML VIAL per500 mg,636,1 ,$221.40 ,$146.12 ,$68.63 ,$221.40 , N/A ,$106.49 ,$71.00 , N/A ,$132.84 ,$188.19 ,$154.98 , N/A , N/A ,$210.33 ,$168.26 ,$166.05 ,$70.40 ,$188.19 , N/A ,$70.40 ,$70.40 ,$154.98 ,$134.83 , N/A , N/A , N/A , N/A , N/A ,$188.19 , N/A ,$203.69 ,$154.98 ,$68.63 ,$68.63 ,$134.83 ,$68.63 ,$152.99 ,$199.26 ,$151.26 , N/A ,$174.91 , N/A , N/A , N/A , N/A , N/A ,$159.41 ,$137.27 ,$159.41 ,$159.41 ,$177.12 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9201,GEMCITABINE 1 GM/26.3ML SOLN 26.3 ML VIAL per200 mg,636,1 ,$56.94 ,$37.58 ,$4.83 ,$56.94 , N/A ,$7.49 ,$5.00 , N/A ,$34.16 ,$48.40 ,$39.86 , N/A , N/A ,$54.09 ,$43.27 ,$42.71 ,$5.95 ,$48.40 , N/A ,$5.95 ,$5.95 ,$39.86 ,$34.68 , N/A , N/A , N/A , N/A , N/A ,$48.40 , N/A ,$52.38 ,$39.86 ,$4.83 ,$4.83 ,$34.68 ,$4.83 ,$39.35 ,$51.25 ,$38.90 , N/A ,$44.98 , N/A , N/A , N/A , N/A , N/A ,$41.00 ,$35.30 ,$41.00 ,$41.00 ,$45.55 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9201,GEMCITABINE 2 GM/52.6ML SOLN 52.6 ML VIAL per200 mg,636,1 ,$44.58 ,$29.42 ,$4.83 ,$44.58 , N/A ,$7.49 ,$5.00 , N/A ,$26.75 ,$37.89 ,$31.21 , N/A , N/A ,$42.35 ,$33.88 ,$33.44 ,$5.95 ,$37.89 , N/A ,$5.95 ,$5.95 ,$31.21 ,$27.15 , N/A , N/A , N/A , N/A , N/A ,$37.89 , N/A ,$41.01 ,$31.21 ,$4.83 ,$4.83 ,$27.15 ,$4.83 ,$30.80 ,$40.12 ,$30.46 , N/A ,$35.22 , N/A , N/A , N/A , N/A , N/A ,$32.10 ,$27.64 ,$32.10 ,$32.10 ,$35.66 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9201,GEMCITABINE HCL 1 GM/10ML SOLN 10 ML VIAL per200 mg,636,1 ,$71.13 ,$46.95 ,$4.83 ,$71.13 , N/A ,$7.49 ,$5.00 , N/A ,$42.68 ,$60.46 ,$49.79 , N/A , N/A ,$67.57 ,$54.06 ,$53.35 ,$5.95 ,$60.46 , N/A ,$5.95 ,$5.95 ,$49.79 ,$43.32 , N/A , N/A , N/A , N/A , N/A ,$60.46 , N/A ,$65.44 ,$49.79 ,$4.83 ,$4.83 ,$43.32 ,$4.83 ,$49.15 ,$64.02 ,$48.60 , N/A ,$56.19 , N/A , N/A , N/A , N/A , N/A ,$51.21 ,$44.10 ,$51.21 ,$51.21 ,$56.90 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9201,GEMCITABINE HCL 2 GM/20ML SOLN 20 ML VIAL per200 mg,636,1 ,$63.91 ,$42.18 ,$4.83 ,$63.91 , N/A ,$7.49 ,$5.00 , N/A ,$38.35 ,$54.32 ,$44.74 , N/A , N/A ,$60.71 ,$48.57 ,$47.93 ,$5.95 ,$54.32 , N/A ,$5.95 ,$5.95 ,$44.74 ,$38.92 , N/A , N/A , N/A , N/A , N/A ,$54.32 , N/A ,$58.80 ,$44.74 ,$4.83 ,$4.83 ,$38.92 ,$4.83 ,$44.16 ,$57.52 ,$43.66 , N/A ,$50.49 , N/A , N/A , N/A , N/A , N/A ,$46.02 ,$39.62 ,$46.02 ,$46.02 ,$51.13 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1580,GENTAMICIN 2-0.9 MG/ML-% SOLN per80 mg,636,1 ,$15.38 ,$10.15 ,$3.68 ,$15.38 , N/A ,$5.72 ,$3.81 , N/A ,$9.23 ,$13.07 ,$10.77 , N/A , N/A ,$14.61 ,$11.69 ,$11.54 ,$4.74 ,$13.07 , N/A ,$4.74 ,$4.74 ,$10.77 ,$9.37 , N/A , N/A , N/A , N/A , N/A ,$13.07 , N/A ,$14.15 ,$10.77 ,$3.68 ,$3.68 ,$9.37 ,$3.68 ,$10.63 ,$13.84 ,$10.51 , N/A ,$12.15 , N/A , N/A , N/A , N/A , N/A ,$11.07 ,$9.54 ,$11.07 ,$11.07 ,$12.30 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1580,GENTAMICIN 40 MG/ML SOLN 2 ML VIAL per80 mg,636,1 ,$24.03 ,$15.86 ,$3.68 ,$24.03 , N/A ,$5.72 ,$3.81 , N/A ,$14.42 ,$20.43 ,$16.82 , N/A , N/A ,$22.83 ,$18.26 ,$18.02 ,$4.74 ,$20.43 , N/A ,$4.74 ,$4.74 ,$16.82 ,$14.63 , N/A , N/A , N/A , N/A , N/A ,$20.43 , N/A ,$22.11 ,$16.82 ,$3.68 ,$3.68 ,$14.63 ,$3.68 ,$16.60 ,$21.63 ,$16.42 , N/A ,$18.98 , N/A , N/A , N/A , N/A , N/A ,$17.30 ,$14.90 ,$17.30 ,$17.30 ,$19.22 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1580,GENTAMICIN 40 MG/ML SOLN 20 ML VIAL per80 mg,636,1 ,$16.50 ,$10.89 ,$3.68 ,$16.50 , N/A ,$5.72 ,$3.81 , N/A ,$9.90 ,$14.03 ,$11.55 , N/A , N/A ,$15.68 ,$12.54 ,$12.38 ,$4.74 ,$14.03 , N/A ,$4.74 ,$4.74 ,$11.55 ,$10.05 , N/A , N/A , N/A , N/A , N/A ,$14.03 , N/A ,$15.18 ,$11.55 ,$3.68 ,$3.68 ,$10.05 ,$3.68 ,$11.40 ,$14.85 ,$11.27 , N/A ,$13.04 , N/A , N/A , N/A , N/A , N/A ,$11.88 ,$10.23 ,$11.88 ,$11.88 ,$13.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1580,GENTAMICIN 40 MG/ML SOLN per80 mg,636,1 ,$24.50 ,$16.17 ,$3.68 ,$24.50 , N/A ,$5.72 ,$3.81 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$4.74 ,$20.83 , N/A ,$4.74 ,$4.74 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$3.68 ,$3.68 ,$14.92 ,$3.68 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1610,GLUCAGON 1 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$427.30 ,$282.02 ,$4.84 ,$428.08 ,$4.84 ,$427.30 ,$285.39 ,$190.26 ,$256.38 ,$363.21 ,$299.11 ,$4.84 ,$4.84 ,$405.94 ,$324.75 ,$320.48 ,$295.43 ,$363.21 ,$190.26 ,$295.43 ,$295.43 ,$299.11 ,$260.23 ,$4.84 ,$190.26 ,$186.45 ,$380.52 ,$5.13 ,$363.21 ,$428.08 ,$393.12 ,$299.11 ,$275.88 ,$275.88 ,$260.23 ,$275.88 ,$295.26 ,$384.57 ,$291.93 ,$188.32 ,$337.57 ,$5.13 ,$286.74 ,$286.74 ,$186.45 ,$286.74 ,$307.66 ,$264.93 ,$307.66 ,$307.66 ,$341.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1610,GLUCAGON 1 MG SOLR per1 mg,636,1 ,"$1,389.10 ",$916.81 ,$4.84 ,"$1,389.10 ",$4.84 ,$428.09 ,$285.39 ,$190.26 ,$833.46 ,"$1,180.74 ",$972.37 ,$4.84 ,$4.84 ,"$1,319.65 ","$1,055.72 ","$1,041.83 ",$295.43 ,"$1,180.74 ",$190.26 ,$295.43 ,$295.43 ,$972.37 ,$845.96 ,$4.84 ,$190.26 ,$186.45 ,$380.52 ,$5.13 ,"$1,180.74 ",$428.08 ,"$1,277.97 ",$972.37 ,$275.88 ,$275.88 ,$845.96 ,$275.88 ,$959.87 ,"$1,250.19 ",$949.03 ,$188.32 ,"$1,097.39 ",$5.13 ,$286.74 ,$286.74 ,$186.45 ,$286.74 ,"$1,000.15 ",$861.24 ,"$1,000.15 ","$1,000.15 ","$1,111.28 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3490,GLYCOPYRROLATE 1 MG/5ML SOSY per1 mg,636,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 , N/A ,$41.65 , N/A , N/A , N/A ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1602,GOLIMUMAB 50 MG/4ML SOLN 4 ML VIAL per1 mg,636,1 ,$151.14 ,$99.75 ,$13.57 ,$151.14 ,$71.25 ,$31.16 ,$20.78 ,$13.85 ,$90.68 ,$128.47 ,$105.80 ,$71.25 ,$71.25 ,$143.58 ,$114.87 ,$113.36 ,$23.55 ,$128.47 ,$13.85 ,$23.55 ,$23.55 ,$105.80 ,$92.04 ,$71.25 ,$13.85 ,$13.57 ,$27.70 ,$75.53 ,$128.47 ,$31.16 ,$139.05 ,$105.80 ,$20.08 ,$20.08 ,$92.04 ,$20.08 ,$104.44 ,$136.03 ,$103.26 ,$13.71 ,$119.40 ,$75.53 ,$22.85 ,$22.85 ,$13.57 ,$22.85 ,$108.82 ,$93.71 ,$108.82 ,$108.82 ,$120.91 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1630,HALOPERIDOL LACTATE 5 MG/ML SOLN per5 mg,636,1 ,$49.00 ,$32.34 ,$1.46 ,$49.00 , N/A ,$2.59 ,$1.73 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.46 ,$41.65 , N/A ,$1.46 ,$1.46 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.67 ,$1.67 ,$29.84 ,$1.67 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1644,HEPARIN (PORCINE) 1000 UNIT/ML SOLN 10 ML VIAL per1000 Units,636,1 ,$5.60 ,$3.70 ,$0.22 ,$5.60 , N/A ,$0.59 ,$0.39 , N/A ,$3.36 ,$4.76 ,$3.92 , N/A , N/A ,$5.32 ,$4.26 ,$4.20 ,$0.22 ,$4.76 , N/A ,$0.22 ,$0.22 ,$3.92 ,$3.41 , N/A , N/A , N/A , N/A , N/A ,$4.76 , N/A ,$5.15 ,$3.92 ,$0.38 ,$0.38 ,$3.41 ,$0.38 ,$3.87 ,$5.04 ,$3.83 , N/A ,$4.42 , N/A , N/A , N/A , N/A , N/A ,$4.03 ,$3.47 ,$4.03 ,$4.03 ,$4.48 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1644,HEPARIN (PORCINE) 1000 UNIT/ML SOLN per1000 Units,636,1 ,$16.33 ,$10.78 ,$0.22 ,$16.33 , N/A ,$0.59 ,$0.39 , N/A ,$9.80 ,$13.88 ,$11.43 , N/A , N/A ,$15.51 ,$12.41 ,$12.25 ,$0.22 ,$13.88 , N/A ,$0.22 ,$0.22 ,$11.43 ,$9.95 , N/A , N/A , N/A , N/A , N/A ,$13.88 , N/A ,$15.02 ,$11.43 ,$0.38 ,$0.38 ,$9.95 ,$0.38 ,$11.28 ,$14.70 ,$11.16 , N/A ,$12.90 , N/A , N/A , N/A , N/A , N/A ,$11.76 ,$10.12 ,$11.76 ,$11.76 ,$13.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1644,HEPARIN (PORCINE) 25000-0.45 UT/250ML-% SOLN per1000 Units,636,1 ,$5.36 ,$3.54 ,$0.22 ,$5.36 , N/A ,$0.59 ,$0.39 , N/A ,$3.22 ,$4.56 ,$3.75 , N/A , N/A ,$5.09 ,$4.07 ,$4.02 ,$0.22 ,$4.56 , N/A ,$0.22 ,$0.22 ,$3.75 ,$3.26 , N/A , N/A , N/A , N/A , N/A ,$4.56 , N/A ,$4.93 ,$3.75 ,$0.38 ,$0.38 ,$3.26 ,$0.38 ,$3.70 ,$4.82 ,$3.66 , N/A ,$4.23 , N/A , N/A , N/A , N/A , N/A ,$3.86 ,$3.32 ,$3.86 ,$3.86 ,$4.29 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1644,HEPARIN (PORCINE) 5000 UNIT/ML SOLN per1000 Units,636,1 ,$9.80 ,$6.47 ,$0.22 ,$9.80 , N/A ,$0.59 ,$0.39 , N/A ,$5.88 ,$8.33 ,$6.86 , N/A , N/A ,$9.31 ,$7.45 ,$7.35 ,$0.22 ,$8.33 , N/A ,$0.22 ,$0.22 ,$6.86 ,$5.97 , N/A , N/A , N/A , N/A , N/A ,$8.33 , N/A ,$9.02 ,$6.86 ,$0.38 ,$0.38 ,$5.97 ,$0.38 ,$6.77 ,$8.82 ,$6.70 , N/A ,$7.74 , N/A , N/A , N/A , N/A , N/A ,$7.06 ,$6.08 ,$7.06 ,$7.06 ,$7.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1644,HEPARIN (PORCINE) 5000 UNIT/ML SOLN 1 ML VIAL per1000 Units,636,1 ,$9.80 ,$6.47 ,$0.22 ,$9.80 , N/A ,$0.59 ,$0.39 , N/A ,$5.88 ,$8.33 ,$6.86 , N/A , N/A ,$9.31 ,$7.45 ,$7.35 ,$0.22 ,$8.33 , N/A ,$0.22 ,$0.22 ,$6.86 ,$5.97 , N/A , N/A , N/A , N/A , N/A ,$8.33 , N/A ,$9.02 ,$6.86 ,$0.38 ,$0.38 ,$5.97 ,$0.38 ,$6.77 ,$8.82 ,$6.70 , N/A ,$7.74 , N/A , N/A , N/A , N/A , N/A ,$7.06 ,$6.08 ,$7.06 ,$7.06 ,$7.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1642,HEPARIN FLUSH 100 UNIT/ML SOLN per10 Units,636,1 ,$3.77 ,$2.49 ,$0.03 ,$3.77 , N/A ,$0.05 ,$0.03 , N/A ,$2.26 ,$3.20 , N/A , N/A , N/A ,$3.58 ,$2.87 ,$2.83 ,$0.03 ,$3.20 , N/A ,$0.03 ,$0.03 ,$2.64 ,$2.30 , N/A , N/A , N/A , N/A , N/A ,$3.20 , N/A ,$3.47 ,$2.64 ,$0.03 ,$0.03 ,$2.30 ,$0.03 ,$2.61 ,$3.39 ,$2.58 , N/A ,$2.98 , N/A , N/A , N/A , N/A , N/A ,$2.71 ,$2.34 ,$2.71 ,$2.71 ,$3.02 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90371,HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML SOSY per1 mL,636,1 ,$440.50 ,$290.73 ,$39.49 ,$440.50 ,$39.49 ,$296.46 ,$197.64 ,$131.76 ,$264.30 ,$374.43 ,$308.35 ,$39.49 ,$39.49 ,$418.48 ,$334.78 ,$330.38 ,$217.69 ,$374.43 ,$131.76 ,$217.69 ,$217.69 ,$308.35 ,$268.26 ,$39.49 ,$131.76 ,$129.12 ,$263.52 ,$41.86 ,$374.43 ,$296.46 ,$405.26 ,$308.35 ,$191.05 ,$191.05 ,$268.26 ,$191.05 ,$304.39 ,$396.45 ,$300.95 ,$130.42 ,$348.00 ,$41.86 ,$211.28 ,$211.28 ,$129.12 ,$211.28 ,$317.16 ,$273.11 ,$317.16 ,$317.16 ,$352.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90744,HEPATITIS B VACCINE 10 MCG/0.5ML SUSY per1 mL,636,1 ,$193.45 ,$127.68 ,$0.95 ,$193.45 ,$0.95 ,$69.86 ,$46.58 ,$34.82 ,$116.07 ,$164.43 ,$135.42 ,$0.95 ,$0.95 ,$183.78 ,$147.02 ,$145.09 ,$50.81 ,$164.43 ,$34.82 ,$50.81 ,$50.81 ,$135.42 ,$117.81 ,$0.95 ,$34.82 ,$34.12 ,$69.64 ,$1.01 ,$164.43 ,$78.35 ,$177.97 ,$135.42 ,$45.02 ,$45.02 ,$117.81 ,$45.02 ,$133.67 ,$174.11 ,$132.17 ,$34.47 ,$152.83 ,$1.01 ,$49.34 ,$49.34 ,$34.12 ,$49.34 ,$139.28 ,$119.94 ,$139.28 ,$139.28 ,$154.76 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3473,HYALURONIDASE HUMAN 150 UNIT/ML SOLN per1 Units,636,1 ,$2.75 ,$1.82 ,$0.52 ,$2.75 , N/A ,$0.81 ,$0.54 , N/A ,$1.65 ,$2.34 ,$1.93 , N/A , N/A ,$2.61 ,$2.09 ,$2.06 ,$0.61 ,$2.34 , N/A ,$0.61 ,$0.61 ,$1.93 ,$1.67 , N/A , N/A , N/A , N/A , N/A ,$2.34 , N/A ,$2.53 ,$1.93 ,$0.52 ,$0.52 ,$1.67 ,$0.52 ,$1.90 ,$2.48 ,$1.88 , N/A ,$2.17 , N/A , N/A , N/A , N/A , N/A ,$1.98 ,$1.71 ,$1.98 ,$1.98 ,$2.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0360,HYDRALAZINE 20 MG/ML SOLN per20 mg,636,1 ,$326.40 ,$215.42 ,$7.98 ,$326.40 , N/A ,$12.38 ,$8.25 , N/A ,$195.84 ,$277.44 ,$228.48 , N/A , N/A ,$310.08 ,$248.06 ,$244.80 ,$11.49 ,$277.44 , N/A ,$11.49 ,$11.49 ,$228.48 ,$198.78 , N/A , N/A , N/A , N/A , N/A ,$277.44 , N/A ,$300.29 ,$228.48 ,$7.98 ,$7.98 ,$198.78 ,$7.98 ,$225.54 ,$293.76 ,$223.00 , N/A ,$257.86 , N/A , N/A , N/A , N/A , N/A ,$235.01 ,$202.37 ,$235.01 ,$235.01 ,$261.12 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1720,HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLR 1 EACH VIAL per100 mg,636,1 ,$136.60 ,$90.16 ,$25.97 ,$136.60 , N/A ,$40.30 ,$26.87 , N/A ,$81.96 ,$116.11 ,$95.62 , N/A , N/A ,$129.77 ,$103.82 ,$102.45 ,$30.40 ,$116.11 , N/A ,$30.40 ,$30.40 ,$95.62 ,$83.19 , N/A , N/A , N/A , N/A , N/A ,$116.11 , N/A ,$125.67 ,$95.62 ,$25.97 ,$25.97 ,$83.19 ,$25.97 ,$94.39 ,$122.94 ,$93.33 , N/A ,$107.91 , N/A , N/A , N/A , N/A , N/A ,$98.35 ,$84.69 ,$98.35 ,$98.35 ,$109.28 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1170,HYDROMORPHONE 1 MG/ML per4 mg,636,1 ,$21.86 ,$14.43 ,$5.58 ,$21.86 , N/A ,$8.66 ,$5.78 , N/A ,$13.12 ,$18.58 ,$15.30 , N/A , N/A ,$20.77 ,$16.61 ,$16.40 ,$7.17 ,$18.58 , N/A ,$7.17 ,$7.17 ,$15.30 ,$13.31 , N/A , N/A , N/A , N/A , N/A ,$18.58 , N/A ,$20.11 ,$15.30 ,$5.58 ,$5.58 ,$13.31 ,$5.58 ,$15.11 ,$19.67 ,$14.93 , N/A ,$17.27 , N/A , N/A , N/A , N/A , N/A ,$15.74 ,$13.55 ,$15.74 ,$15.74 ,$17.49 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1170,HYDROMORPHONE 1 MG/ML SOLN per4 mg,636,1 ,$49.00 ,$32.34 ,$5.58 ,$49.00 , N/A ,$8.66 ,$5.78 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$7.17 ,$41.65 , N/A ,$7.17 ,$7.17 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$5.58 ,$5.58 ,$29.84 ,$5.58 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3410,HYDROXYZINE 50 MG/ML SOLN per25 mg,636,1 ,$94.53 ,$62.39 ,$18.16 ,$94.53 , N/A ,$29.50 ,$19.67 , N/A ,$56.72 ,$80.35 ,$66.17 , N/A , N/A ,$89.80 ,$71.84 ,$70.90 ,$18.16 ,$80.35 , N/A ,$18.16 ,$18.16 ,$66.17 ,$57.57 , N/A , N/A , N/A , N/A , N/A ,$80.35 , N/A ,$86.97 ,$66.17 ,$19.01 ,$19.01 ,$57.57 ,$19.01 ,$65.32 ,$85.08 ,$64.58 , N/A ,$74.68 , N/A , N/A , N/A , N/A , N/A ,$68.06 ,$58.61 ,$68.06 ,$68.06 ,$75.62 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1568,IMMUNE GLOBULIN 5 GM/50ML SOLN per500 mg,636,1 ,$404.10 ,$266.71 ,$40.98 ,$404.10 ,$47.85 ,$94.10 ,$62.73 ,$41.82 ,$242.46 ,$343.49 ,$282.87 ,$47.85 ,$47.85 ,$383.90 ,$307.12 ,$303.08 ,$69.82 ,$343.49 ,$41.82 ,$69.82 ,$69.82 ,$282.87 ,$246.10 ,$47.85 ,$41.82 ,$40.98 ,$83.64 ,$50.72 ,$343.49 ,$94.10 ,$371.77 ,$282.87 ,$60.64 ,$60.64 ,$246.10 ,$60.64 ,$279.23 ,$363.69 ,$276.08 ,$41.40 ,$319.24 ,$50.72 ,$67.77 ,$67.77 ,$40.98 ,$67.77 ,$290.95 ,$250.54 ,$290.95 ,$290.95 ,$323.28 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1568,IMMUNE GLOBULIN 10 GM/100ML SOLN per500 mg,636,1 ,$404.10 ,$266.71 ,$40.98 ,$404.10 ,$47.85 ,$94.10 ,$62.73 ,$41.82 ,$242.46 ,$343.49 ,$282.87 ,$47.85 ,$47.85 ,$383.90 ,$307.12 ,$303.08 ,$69.82 ,$343.49 ,$41.82 ,$69.82 ,$69.82 ,$282.87 ,$246.10 ,$47.85 ,$41.82 ,$40.98 ,$83.64 ,$50.72 ,$343.49 ,$94.10 ,$371.77 ,$282.87 ,$60.64 ,$60.64 ,$246.10 ,$60.64 ,$279.23 ,$363.69 ,$276.08 ,$41.40 ,$319.24 ,$50.72 ,$67.77 ,$67.77 ,$40.98 ,$67.77 ,$290.95 ,$250.54 ,$290.95 ,$290.95 ,$323.28 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1568,IMMUNE GLOBULIN 20 GM/200ML SOLN per500 mg,636,1 ,$404.10 ,$266.71 ,$40.98 ,$404.10 ,$47.85 ,$94.10 ,$62.73 ,$41.82 ,$242.46 ,$343.49 ,$282.87 ,$47.85 ,$47.85 ,$383.90 ,$307.12 ,$303.08 ,$69.82 ,$343.49 ,$41.82 ,$69.82 ,$69.82 ,$282.87 ,$246.10 ,$47.85 ,$41.82 ,$40.98 ,$83.64 ,$50.72 ,$343.49 ,$94.10 ,$371.77 ,$282.87 ,$60.64 ,$60.64 ,$246.10 ,$60.64 ,$279.23 ,$363.69 ,$276.08 ,$41.40 ,$319.24 ,$50.72 ,$67.77 ,$67.77 ,$40.98 ,$67.77 ,$290.95 ,$250.54 ,$290.95 ,$290.95 ,$323.28 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1745,INFLIXIMAB 100 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$343.34 ,$226.60 ,$33.36 ,$343.34 ,$47.85 ,$76.59 ,$51.06 ,$34.04 ,$206.00 ,$291.84 ,$240.34 ,$47.85 ,$47.85 ,$326.17 ,$260.94 ,$257.51 ,$59.26 ,$291.84 ,$34.04 ,$59.26 ,$59.26 ,$240.34 ,$209.09 ,$47.85 ,$34.04 ,$33.36 ,$68.08 ,$50.72 ,$291.84 ,$76.60 ,$315.87 ,$240.34 ,$49.36 ,$49.36 ,$209.09 ,$49.36 ,$237.25 ,$309.01 ,$234.57 ,$33.69 ,$271.24 ,$50.72 ,$57.52 ,$57.52 ,$33.36 ,$57.52 ,$247.20 ,$212.87 ,$247.20 ,$247.20 ,$274.67 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q5104,INFLIXIMAB-ABDA 100 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$221.50 ,$146.19 ,$35.70 ,$221.50 ,$47.85 ,$81.97 ,$54.65 ,$36.43 ,$132.90 ,$188.28 ,$155.05 ,$47.85 ,$47.85 ,$210.43 ,$168.34 ,$166.13 ,$77.30 ,$188.28 ,$36.43 ,$77.30 ,$77.30 ,$155.05 ,$134.89 ,$47.85 ,$36.43 ,$35.70 ,$72.86 ,$50.72 ,$188.28 ,$81.97 ,$203.78 ,$155.05 ,$52.82 ,$52.82 ,$134.89 ,$52.82 ,$153.06 ,$199.35 ,$151.33 ,$36.05 ,$174.99 ,$50.72 ,$75.03 ,$75.03 ,$35.70 ,$75.03 ,$159.48 ,$137.33 ,$159.48 ,$159.48 ,$177.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q5103,INFLIXIMAB-DYYB 100 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$278.21 ,$183.62 ,$20.18 ,$278.21 ,$47.85 ,$46.33 ,$30.89 ,$20.59 ,$166.93 ,$236.48 ,$194.75 ,$47.85 ,$47.85 ,$264.30 ,$211.44 ,$208.66 ,$42.16 ,$236.48 ,$20.59 ,$42.16 ,$42.16 ,$194.75 ,$169.43 ,$47.85 ,$20.59 ,$20.18 ,$41.18 ,$50.72 ,$236.48 ,$46.33 ,$255.95 ,$194.75 ,$29.86 ,$29.86 ,$169.43 ,$29.86 ,$192.24 ,$250.39 ,$190.07 ,$20.38 ,$219.79 ,$50.72 ,$40.92 ,$40.92 ,$20.18 ,$40.92 ,$200.31 ,$172.49 ,$200.31 ,$200.31 ,$222.57 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90686,INFLUENZA VIRUS VACCINE (QUAD) 0.5 ML SUSY per0.5 mL,636,1 ,$142.15 ,$93.82 ,$0.95 ,$142.15 ,$0.95 ,$42.82 ,$28.55 ,$25.59 ,$85.29 ,$120.83 ,$99.51 ,$0.95 ,$0.95 ,$135.04 ,$108.03 ,$106.61 ,$36.58 ,$120.83 ,$25.59 ,$36.58 ,$36.58 ,$99.51 ,$86.57 ,$0.95 ,$25.59 ,$25.08 ,$51.18 ,$1.01 ,$120.83 ,$57.57 ,$130.78 ,$99.51 ,$27.60 ,$27.60 ,$86.57 ,$27.60 ,$98.23 ,$127.94 ,$97.12 ,$25.33 ,$112.30 ,$1.01 ,$35.51 ,$35.51 ,$25.08 ,$35.51 ,$102.35 ,$88.13 ,$102.35 ,$102.35 ,$113.72 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1750,IRON DEXTRAN COMPLEX 50 MG/ML SOLN 2 ML VIAL per50 mg,636,1 ,$115.87 ,$76.47 ,$1.81 ,$115.87 ,$1.81 ,$37.28 ,$24.86 ,$16.57 ,$69.52 ,$98.49 ,$81.11 ,$1.81 ,$1.81 ,$110.08 ,$88.06 ,$86.90 ,$28.19 ,$98.49 ,$16.57 ,$28.19 ,$28.19 ,$81.11 ,$70.56 ,$1.81 ,$16.57 ,$16.24 ,$33.14 ,$1.92 ,$98.49 ,$37.29 ,$106.60 ,$81.11 ,$24.03 ,$24.03 ,$70.56 ,$24.03 ,$80.07 ,$104.28 ,$79.16 ,$16.41 ,$91.54 ,$1.92 ,$27.36 ,$27.36 ,$16.24 ,$27.36 ,$83.43 ,$71.84 ,$83.43 ,$83.43 ,$92.70 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1756,IRON SUCROSE 20 MG/ML SOLN 5 ML VIAL per1 mg,636,1 ,$4.26 ,$2.81 ,$0.30 ,$4.26 , N/A ,$0.47 ,$0.32 , N/A ,$2.56 ,$3.62 ,$2.98 , N/A , N/A ,$4.05 ,$3.24 ,$3.20 ,$0.37 ,$3.62 , N/A ,$0.37 ,$0.37 ,$2.98 ,$2.59 , N/A , N/A , N/A , N/A , N/A ,$3.62 , N/A ,$3.92 ,$2.98 ,$0.30 ,$0.30 ,$2.59 ,$0.30 ,$2.94 ,$3.83 ,$2.91 , N/A ,$3.37 , N/A , N/A , N/A , N/A , N/A ,$3.07 ,$2.64 ,$3.07 ,$3.07 ,$3.41 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1756,IRON SUCROSE 20 MG/ML SOLN 10 ML VIAL per1 mg,636,1 ,$4.26 ,$2.81 ,$0.30 ,$4.26 , N/A ,$0.47 ,$0.32 , N/A ,$2.56 ,$3.62 ,$2.98 , N/A , N/A ,$4.05 ,$3.24 ,$3.20 ,$0.37 ,$3.62 , N/A ,$0.37 ,$0.37 ,$2.98 ,$2.59 , N/A , N/A , N/A , N/A , N/A ,$3.62 , N/A ,$3.92 ,$2.98 ,$0.30 ,$0.30 ,$2.59 ,$0.30 ,$2.94 ,$3.83 ,$2.91 , N/A ,$3.37 , N/A , N/A , N/A , N/A , N/A ,$3.07 ,$2.64 ,$3.07 ,$3.07 ,$3.41 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q9968,ISOSULFAN BLUE 1 % SOLN per1 mg,636,1 ,$101.68 ,$67.11 ,$7.25 ,$101.68 , N/A ,$16.99 ,$11.33 ,$7.40 ,$61.01 ,$86.43 , N/A , N/A , N/A ,$96.60 ,$77.28 ,$76.26 ,$14.03 ,$86.43 ,$7.40 ,$14.03 ,$14.03 ,$71.18 ,$61.92 , N/A ,$7.40 ,$7.25 ,$14.80 , N/A ,$86.43 ,$16.65 ,$93.55 ,$71.18 ,$10.95 ,$10.95 ,$61.92 ,$10.95 ,$70.26 ,$91.51 ,$69.47 ,$7.32 ,$80.33 , N/A ,$12.79 ,$12.79 ,$7.25 ,$12.79 ,$73.21 ,$63.04 ,$73.21 ,$73.21 ,$81.34 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1885,KETOROLAC 15 MG/ML SOLN per15 mg,636,1 ,$49.00 ,$32.34 ,$0.71 ,$49.00 , N/A ,$1.10 ,$0.74 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.00 ,$41.65 , N/A ,$1.00 ,$1.00 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$0.71 ,$0.71 ,$29.84 ,$0.71 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1885,KETOROLAC 30 MG/ML SOLN per15 mg,636,1 ,$24.50 ,$16.17 ,$0.71 ,$24.50 , N/A ,$1.10 ,$0.74 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$1.00 ,$20.83 , N/A ,$1.00 ,$1.00 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$0.71 ,$0.71 ,$14.92 ,$0.71 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1885,KETOROLAC 30 MG/ML SOLN 1 ML VIAL per15 mg,636,1 ,$24.50 ,$16.17 ,$0.71 ,$24.50 , N/A ,$1.10 ,$0.74 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$1.00 ,$20.83 , N/A ,$1.00 ,$1.00 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$0.71 ,$0.71 ,$14.92 ,$0.71 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7120,LACTATED RINGERS SOLN per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.71 ,$106.00 , N/A ,$5.76 ,$3.84 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$4.25 ,$90.10 , N/A ,$4.25 ,$4.25 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$3.71 ,$3.71 ,$64.55 ,$3.71 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7120,"LACTATED RINGERS SOLN 1,000 ML FLEX CONT per1000 mL",636,1 ,$106.00 ,$69.96 ,$3.71 ,$106.00 , N/A ,$5.76 ,$3.84 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$4.25 ,$90.10 , N/A ,$4.25 ,$4.25 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$3.71 ,$3.71 ,$64.55 ,$3.71 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0640,LEUCOVORIN 100 MG SOLR per50 mg,636,1 ,$111.00 ,$73.26 ,$4.94 ,$111.00 , N/A ,$7.67 ,$5.12 , N/A ,$66.60 ,$94.35 ,$77.70 , N/A , N/A ,$105.45 ,$84.36 ,$83.25 ,$6.12 ,$94.35 , N/A ,$6.12 ,$6.12 ,$77.70 ,$67.60 , N/A , N/A , N/A , N/A , N/A ,$94.35 , N/A ,$102.12 ,$77.70 ,$4.94 ,$4.94 ,$67.60 ,$4.94 ,$76.70 ,$99.90 ,$75.84 , N/A ,$87.69 , N/A , N/A , N/A , N/A , N/A ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$88.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0640,LEUCOVORIN 200 MG SOLR per50 mg,636,1 ,$91.35 ,$60.29 ,$4.94 ,$91.35 , N/A ,$7.67 ,$5.12 , N/A ,$54.81 ,$77.65 ,$63.95 , N/A , N/A ,$86.78 ,$69.43 ,$68.51 ,$6.12 ,$77.65 , N/A ,$6.12 ,$6.12 ,$63.95 ,$55.63 , N/A , N/A , N/A , N/A , N/A ,$77.65 , N/A ,$84.04 ,$63.95 ,$4.94 ,$4.94 ,$55.63 ,$4.94 ,$63.12 ,$82.22 ,$62.41 , N/A ,$72.17 , N/A , N/A , N/A , N/A , N/A ,$65.77 ,$56.64 ,$65.77 ,$65.77 ,$73.08 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1950,LEUPROLIDE ACETATE (3 MONTH) 11.25 MG KIT per3.75 mg,636,1 ,"$4,574.30 ","$3,019.04 ",$39.49 ,"$4,574.30 ",$39.49 ,"$3,332.00 ","$2,221.34 ","$1,480.89 ","$2,744.58 ","$3,888.16 ","$3,202.01 ",$39.49 ,$39.49 ,"$4,345.59 ","$3,476.47 ","$3,430.73 ","$2,506.11 ","$3,888.16 ","$1,480.89 ","$2,506.11 ","$2,506.11 ","$3,202.01 ","$2,785.75 ",$39.49 ,"$1,480.89 ","$1,451.27 ","$2,961.78 ",$41.86 ,"$3,888.16 ","$3,331.99 ","$4,208.36 ","$3,202.01 ","$2,147.29 ","$2,147.29 ","$2,785.75 ","$2,147.29 ","$3,160.84 ","$4,116.87 ","$3,125.16 ","$1,465.79 ","$3,613.70 ",$41.86 ,"$2,432.40 ","$2,432.40 ","$1,451.27 ","$2,432.40 ","$3,293.50 ","$2,836.07 ","$3,293.50 ","$3,293.50 ","$3,659.44 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1953,LEVETIRACETAM 1000 MG/100ML SOLN per10 mg,636,1 ,$3.63 ,$2.40 ,$0.13 ,$3.63 , N/A ,$0.20 ,$0.14 , N/A ,$2.18 ,$3.09 ,$2.54 , N/A , N/A ,$3.45 ,$2.76 ,$2.72 ,$0.15 ,$3.09 , N/A ,$0.15 ,$0.15 ,$2.54 ,$2.21 , N/A , N/A , N/A , N/A , N/A ,$3.09 , N/A ,$3.34 ,$2.54 ,$0.13 ,$0.13 ,$2.21 ,$0.13 ,$2.51 ,$3.27 ,$2.48 , N/A ,$2.87 , N/A , N/A , N/A , N/A , N/A ,$2.61 ,$2.25 ,$2.61 ,$2.61 ,$2.90 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1953,LEVETIRACETAM 500 MG/100ML SOLN per10 mg,636,1 ,$4.71 ,$3.11 ,$0.13 ,$4.71 , N/A ,$0.20 ,$0.14 , N/A ,$2.83 ,$4.00 ,$3.30 , N/A , N/A ,$4.47 ,$3.58 ,$3.53 ,$0.15 ,$4.00 , N/A ,$0.15 ,$0.15 ,$3.30 ,$2.87 , N/A , N/A , N/A , N/A , N/A ,$4.00 , N/A ,$4.33 ,$3.30 ,$0.13 ,$0.13 ,$2.87 ,$0.13 ,$3.25 ,$4.24 ,$3.22 , N/A ,$3.72 , N/A , N/A , N/A , N/A , N/A ,$3.39 ,$2.92 ,$3.39 ,$3.39 ,$3.77 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1953,LEVETIRACETAM 500 MG/5ML SOLN 5 ML VIAL per10 mg,636,1 ,$1.85 ,$1.22 ,$0.13 ,$1.85 , N/A ,$0.20 ,$0.14 , N/A ,$1.11 ,$1.57 ,$1.30 , N/A , N/A ,$1.76 ,$1.41 ,$1.39 ,$0.15 ,$1.57 , N/A ,$0.15 ,$0.15 ,$1.30 ,$1.13 , N/A , N/A , N/A , N/A , N/A ,$1.57 , N/A ,$1.70 ,$1.30 ,$0.13 ,$0.13 ,$1.13 ,$0.13 ,$1.28 ,$1.67 ,$1.26 , N/A ,$1.46 , N/A , N/A , N/A , N/A , N/A ,$1.33 ,$1.15 ,$1.33 ,$1.33 ,$1.48 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1956,LEVOFLOXACIN 250 MG/50ML SOLN per250 mg,636,1 ,$75.20 ,$49.63 ,$1.22 ,$75.20 , N/A ,$1.89 ,$1.26 , N/A ,$45.12 ,$63.92 ,$52.64 , N/A , N/A ,$71.44 ,$57.15 ,$56.40 ,$1.65 ,$63.92 , N/A ,$1.65 ,$1.65 ,$52.64 ,$45.80 , N/A , N/A , N/A , N/A , N/A ,$63.92 , N/A ,$69.18 ,$52.64 ,$1.22 ,$1.22 ,$45.80 ,$1.22 ,$51.96 ,$67.68 ,$51.38 , N/A ,$59.41 , N/A , N/A , N/A , N/A , N/A ,$54.14 ,$46.62 ,$54.14 ,$54.14 ,$60.16 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1956,LEVOFLOXACIN 500 MG/100ML SOLN per250 mg,636,1 ,$53.90 ,$35.57 ,$1.22 ,$53.90 , N/A ,$1.89 ,$1.26 , N/A ,$32.34 ,$45.82 ,$37.73 , N/A , N/A ,$51.21 ,$40.96 ,$40.43 ,$1.65 ,$45.82 , N/A ,$1.65 ,$1.65 ,$37.73 ,$32.83 , N/A , N/A , N/A , N/A , N/A ,$45.82 , N/A ,$49.59 ,$37.73 ,$1.22 ,$1.22 ,$32.83 ,$1.22 ,$37.24 ,$48.51 ,$36.82 , N/A ,$42.58 , N/A , N/A , N/A , N/A , N/A ,$38.81 ,$33.42 ,$38.81 ,$38.81 ,$43.12 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1956,LEVOFLOXACIN 750 MG/150ML SOLN per250 mg,636,1 ,$26.30 ,$17.36 ,$1.22 ,$26.30 , N/A ,$1.89 ,$1.26 , N/A ,$15.78 ,$22.36 ,$18.41 , N/A , N/A ,$24.99 ,$19.99 ,$19.73 ,$1.65 ,$22.36 , N/A ,$1.65 ,$1.65 ,$18.41 ,$16.02 , N/A , N/A , N/A , N/A , N/A ,$22.36 , N/A ,$24.20 ,$18.41 ,$1.22 ,$1.22 ,$16.02 ,$1.22 ,$18.17 ,$23.67 ,$17.97 , N/A ,$20.78 , N/A , N/A , N/A , N/A , N/A ,$18.94 ,$16.31 ,$18.94 ,$18.94 ,$21.04 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2001,LIDOCAINE (CARDIAC) 20 MG/ML INJ per10 mg,636,1 ,$5.17 ,$3.41 ,$0.04 ,$5.17 , N/A ,$0.07 ,$0.05 , N/A ,$3.10 ,$4.39 ,$3.62 , N/A , N/A ,$4.91 ,$3.93 ,$3.88 ,$0.05 ,$4.39 , N/A ,$0.05 ,$0.05 ,$3.62 ,$3.15 , N/A , N/A , N/A , N/A , N/A ,$4.39 , N/A ,$4.76 ,$3.62 ,$0.04 ,$0.04 ,$3.15 ,$0.04 ,$3.57 ,$4.65 ,$3.53 , N/A ,$4.08 , N/A , N/A , N/A , N/A , N/A ,$3.72 ,$3.21 ,$3.72 ,$3.72 ,$4.14 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2020,LINEZOLID 600 MG/300ML SOLN per200 mg,636,1 ,$108.70 ,$71.74 ,$4.97 ,$108.70 , N/A ,$7.72 ,$5.15 , N/A ,$65.22 ,$92.40 ,$76.09 , N/A , N/A ,$103.27 ,$82.61 ,$81.53 ,$5.49 ,$92.40 , N/A ,$5.49 ,$5.49 ,$76.09 ,$66.20 , N/A , N/A , N/A , N/A , N/A ,$92.40 , N/A ,$100.00 ,$76.09 ,$4.97 ,$4.97 ,$66.20 ,$4.97 ,$75.11 ,$97.83 ,$74.26 , N/A ,$85.87 , N/A , N/A , N/A , N/A , N/A ,$78.26 ,$67.39 ,$78.26 ,$78.26 ,$86.96 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3490,LIOTHYRONINE 10 MCG/ML SOLN per10 mcg,636,1 ,"$1,900.95 ","$1,254.63 ",$964.16 ,"$1,900.95 ", N/A ,"$1,302.91 ","$1,302.91 ", N/A ,"$1,140.57 ","$1,615.81 ","$1,330.67 ", N/A , N/A ,"$1,805.90 ","$1,444.72 ","$1,425.71 ", N/A ,"$1,615.81 ", N/A , N/A , N/A ,"$1,330.67 ","$1,157.68 ", N/A , N/A , N/A , N/A , N/A ,"$1,615.81 ", N/A ,"$1,748.87 ","$1,330.67 ",$964.16 ,"$1,157.11 ","$1,157.68 ","$1,157.11 ","$1,313.56 ","$1,710.86 ","$1,298.73 ", N/A ,"$1,501.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,368.68 ","$1,178.59 ","$1,368.68 ","$1,368.68 ","$1,520.76 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2060,LORAZEPAM 2 MG/ML SOLN 10 ML VIAL per2 mg,636,1 ,$7.38 ,$4.87 ,$1.55 ,$7.38 , N/A ,$2.66 ,$1.77 , N/A ,$4.43 ,$6.27 ,$5.17 , N/A , N/A ,$7.01 ,$5.61 ,$5.54 ,$1.55 ,$6.27 , N/A ,$1.55 ,$1.55 ,$5.17 ,$4.49 , N/A , N/A , N/A , N/A , N/A ,$6.27 , N/A ,$6.79 ,$5.17 ,$1.71 ,$1.71 ,$4.49 ,$1.71 ,$5.10 ,$6.64 ,$5.04 , N/A ,$5.83 , N/A , N/A , N/A , N/A , N/A ,$5.31 ,$4.58 ,$5.31 ,$5.31 ,$5.90 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2060,LORAZEPAM 2 MG/ML SOLN per2 mg,636,1 ,$49.00 ,$32.34 ,$1.55 ,$49.00 , N/A ,$2.66 ,$1.77 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.55 ,$41.65 , N/A ,$1.55 ,$1.55 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.71 ,$1.71 ,$29.84 ,$1.71 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2060,LORAZEPAM 2 MG/ML SOLN 1 ML VIAL per2 mg,636,1 ,$49.00 ,$32.34 ,$1.55 ,$49.00 , N/A ,$2.66 ,$1.77 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.55 ,$41.65 , N/A ,$1.55 ,$1.55 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.71 ,$1.71 ,$29.84 ,$1.71 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3475,MAGNESIUM SULFATE 1-5 GM/100ML-% SOLN per500 mg,636,1 ,$45.60 ,$30.10 ,$1.12 ,$45.60 , N/A ,$1.78 ,$1.19 , N/A ,$27.36 ,$38.76 ,$31.92 , N/A , N/A ,$43.32 ,$34.66 ,$34.20 ,$1.12 ,$38.76 , N/A ,$1.12 ,$1.12 ,$31.92 ,$27.77 , N/A , N/A , N/A , N/A , N/A ,$38.76 , N/A ,$41.95 ,$31.92 ,$1.15 ,$1.15 ,$27.77 ,$1.15 ,$31.51 ,$41.04 ,$31.15 , N/A ,$36.02 , N/A , N/A , N/A , N/A , N/A ,$32.83 ,$28.27 ,$32.83 ,$32.83 ,$36.48 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3475,MAGNESIUM SULFATE 2 GM/50ML SOLN per500 mg,636,1 ,$37.33 ,$24.64 ,$1.12 ,$37.33 , N/A ,$1.78 ,$1.19 , N/A ,$22.40 ,$31.73 ,$26.13 , N/A , N/A ,$35.46 ,$28.37 ,$28.00 ,$1.12 ,$31.73 , N/A ,$1.12 ,$1.12 ,$26.13 ,$22.73 , N/A , N/A , N/A , N/A , N/A ,$31.73 , N/A ,$34.34 ,$26.13 ,$1.15 ,$1.15 ,$22.73 ,$1.15 ,$25.80 ,$33.60 ,$25.50 , N/A ,$29.49 , N/A , N/A , N/A , N/A , N/A ,$26.88 ,$23.14 ,$26.88 ,$26.88 ,$29.86 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3475,MAGNESIUM SULFATE 20 GM/500ML SOLN per500 mg,636,1 ,$1.93 ,$1.27 ,$1.12 ,$1.93 , N/A ,$1.78 ,$1.19 , N/A ,$1.16 ,$1.64 ,$1.35 , N/A , N/A ,$1.83 ,$1.47 ,$1.45 ,$1.12 ,$1.64 , N/A ,$1.12 ,$1.12 ,$1.35 ,$1.18 , N/A , N/A , N/A , N/A , N/A ,$1.64 , N/A ,$1.78 ,$1.35 ,$1.15 ,$1.15 ,$1.18 ,$1.15 ,$1.33 ,$1.74 ,$1.32 , N/A ,$1.52 , N/A , N/A , N/A , N/A , N/A ,$1.39 ,$1.20 ,$1.39 ,$1.39 ,$1.54 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3475,MAGNESIUM SULFATE 50 % SOLN 2 ML VIAL per500 mg,636,1 ,$49.00 ,$32.34 ,$1.12 ,$49.00 , N/A ,$1.78 ,$1.19 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.12 ,$41.65 , N/A ,$1.12 ,$1.12 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.15 ,$1.15 ,$29.84 ,$1.15 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2150,MANNITOL 25 % SOLN per50 mL,636,1 ,$31.75 ,$20.96 ,$4.39 ,$31.75 , N/A ,$6.82 ,$4.55 , N/A ,$19.05 ,$26.99 ,$22.23 , N/A , N/A ,$30.16 ,$24.13 ,$23.81 ,$8.47 ,$26.99 , N/A ,$8.47 ,$8.47 ,$22.23 ,$19.34 , N/A , N/A , N/A , N/A , N/A ,$26.99 , N/A ,$29.21 ,$22.23 ,$4.39 ,$4.39 ,$19.34 ,$4.39 ,$21.94 ,$28.58 ,$21.69 , N/A ,$25.08 , N/A , N/A , N/A , N/A , N/A ,$22.86 ,$19.69 ,$22.86 ,$22.86 ,$25.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90707,"MEASLES, MUMPS AND RUBELLA VACCINE SOLR per0.5 mL",636,1 ,$445.70 ,$294.16 ,$0.95 ,$445.70 ,$0.95 ,$305.48 ,$305.48 , N/A ,$267.42 ,$378.85 ,$311.99 ,$0.95 ,$0.95 ,$423.42 ,$338.73 ,$334.28 ,$168.49 ,$378.85 , N/A ,$168.49 ,$168.49 ,$311.99 ,$271.43 ,$0.95 , N/A , N/A , N/A ,$1.01 ,$378.85 , N/A ,$410.04 ,$311.99 ,$226.06 ,$271.30 ,$271.43 ,$271.30 ,$307.98 ,$401.13 ,$304.50 , N/A ,$352.10 ,$1.01 , N/A , N/A , N/A , N/A ,$320.90 ,$276.33 ,$320.90 ,$320.90 ,$356.56 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2175,MEPERIDINE 50 MG/ML SOLN per100 mg,636,1 ,$49.00 ,$32.34 ,$10.18 ,$49.00 , N/A ,$15.80 ,$10.53 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$16.30 ,$41.65 , N/A ,$16.30 ,$16.30 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$10.18 ,$10.18 ,$29.84 ,$10.18 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2175,MEPERIDINE 100 MG/ML SOLN per100 mg,636,1 ,$49.00 ,$32.34 ,$10.18 ,$49.00 , N/A ,$15.80 ,$10.53 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$16.30 ,$41.65 , N/A ,$16.30 ,$16.30 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$10.18 ,$10.18 ,$29.84 ,$10.18 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2175,MEPERIDINE 25 MG/ML SOLN per100 mg,636,1 ,$49.00 ,$32.34 ,$10.18 ,$49.00 , N/A ,$15.80 ,$10.53 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$16.30 ,$41.65 , N/A ,$16.30 ,$16.30 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$10.18 ,$10.18 ,$29.84 ,$10.18 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0670,MEPIVACAINE 2 % SOLN per10 mL,636,1 ,$49.00 ,$32.34 ,$4.83 ,$49.00 , N/A ,$7.81 ,$5.21 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$4.83 ,$41.65 , N/A ,$4.83 ,$4.83 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$5.03 ,$5.03 ,$29.84 ,$5.03 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2182,MEPOLIZUMAB 100 MG SOLR per1 mg,636,1 ,$123.33 ,$81.40 ,$28.78 ,$123.33 ,$71.25 ,$66.08 ,$44.06 ,$29.37 ,$74.00 ,$104.83 ,$86.33 ,$71.25 ,$71.25 ,$117.16 ,$93.73 ,$92.50 ,$50.41 ,$104.83 ,$29.37 ,$50.41 ,$50.41 ,$86.33 ,$75.11 ,$71.25 ,$29.37 ,$28.78 ,$58.74 ,$75.53 ,$104.83 ,$66.09 ,$113.46 ,$86.33 ,$42.59 ,$42.59 ,$75.11 ,$42.59 ,$85.22 ,$111.00 ,$84.26 ,$29.07 ,$97.43 ,$75.53 ,$48.92 ,$48.92 ,$28.78 ,$48.92 ,$88.80 ,$76.46 ,$88.80 ,$88.80 ,$98.66 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2185,MEROPENEM 1 G SOLR 1 EACH VIAL per100 mg,636,1 ,$22.14 ,$14.61 ,$0.73 ,$22.14 , N/A ,$1.13 ,$0.75 , N/A ,$13.28 ,$18.82 ,$15.50 , N/A , N/A ,$21.03 ,$16.83 ,$16.61 ,$1.05 ,$18.82 , N/A ,$1.05 ,$1.05 ,$15.50 ,$13.48 , N/A , N/A , N/A , N/A , N/A ,$18.82 , N/A ,$20.37 ,$15.50 ,$0.73 ,$0.73 ,$13.48 ,$0.73 ,$15.30 ,$19.93 ,$15.13 , N/A ,$17.49 , N/A , N/A , N/A , N/A , N/A ,$15.94 ,$13.73 ,$15.94 ,$15.94 ,$17.71 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2185,MEROPENEM 500 MG SOLR 1 EACH VIAL per100 mg,636,1 ,$21.48 ,$14.18 ,$0.73 ,$21.48 , N/A ,$1.13 ,$0.75 , N/A ,$12.89 ,$18.26 ,$15.04 , N/A , N/A ,$20.41 ,$16.32 ,$16.11 ,$1.05 ,$18.26 , N/A ,$1.05 ,$1.05 ,$15.04 ,$13.08 , N/A , N/A , N/A , N/A , N/A ,$18.26 , N/A ,$19.76 ,$15.04 ,$0.73 ,$0.73 ,$13.08 ,$0.73 ,$14.84 ,$19.33 ,$14.68 , N/A ,$16.97 , N/A , N/A , N/A , N/A , N/A ,$15.47 ,$13.32 ,$15.47 ,$15.47 ,$17.18 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$1.17 ,$76.50 , N/A ,$1.87 ,$1.25 , N/A ,$45.90 ,$65.03 ,$53.55 , N/A , N/A ,$72.68 ,$58.14 ,$57.38 ,$1.17 ,$65.03 , N/A ,$1.17 ,$1.17 ,$53.55 ,$46.59 , N/A , N/A , N/A , N/A , N/A ,$65.03 , N/A ,$70.38 ,$53.55 ,$1.20 ,$1.20 ,$46.59 ,$1.20 ,$52.86 ,$68.85 ,$52.26 , N/A ,$60.44 , N/A , N/A , N/A , N/A , N/A ,$55.08 ,$47.43 ,$55.08 ,$55.08 ,$61.20 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$1.17 ,$76.50 , N/A ,$1.87 ,$1.25 , N/A ,$45.90 ,$65.03 ,$53.55 , N/A , N/A ,$72.68 ,$58.14 ,$57.38 ,$1.17 ,$65.03 , N/A ,$1.17 ,$1.17 ,$53.55 ,$46.59 , N/A , N/A , N/A , N/A , N/A ,$65.03 , N/A ,$70.38 ,$53.55 ,$1.20 ,$1.20 ,$46.59 ,$1.20 ,$52.86 ,$68.85 ,$52.26 , N/A ,$60.44 , N/A , N/A , N/A , N/A , N/A ,$55.08 ,$47.43 ,$55.08 ,$55.08 ,$61.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7674,METHACHOLINE (PROVOCHOLINE) 1 MG/ML IN SODIUM CHLORIDE 0.9 % 1 MG/ML SOLR per1 mg,636,1 ,$25.50 ,$16.83 ,$1.17 ,$25.50 , N/A ,$1.87 ,$1.25 , N/A ,$15.30 ,$21.68 ,$17.85 , N/A , N/A ,$24.23 ,$19.38 ,$19.13 ,$1.17 ,$21.68 , N/A ,$1.17 ,$1.17 ,$17.85 ,$15.53 , N/A , N/A , N/A , N/A , N/A ,$21.68 , N/A ,$23.46 ,$17.85 ,$1.20 ,$1.20 ,$15.53 ,$1.20 ,$17.62 ,$22.95 ,$17.42 , N/A ,$20.15 , N/A , N/A , N/A , N/A , N/A ,$18.36 ,$15.81 ,$18.36 ,$18.36 ,$20.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7674,METHACHOLINE (PROVOCHOLINE) 16 MG/ML IN SODIUM CHLORIDE 0.9 % 16 MG/ML SOLR per1 mg,636,1 ,$1.59 ,$1.05 ,$0.95 ,$1.59 , N/A ,$1.59 ,$1.25 , N/A ,$0.95 ,$1.35 ,$1.11 , N/A , N/A ,$1.51 ,$1.21 ,$1.19 ,$1.17 ,$1.35 , N/A ,$1.17 ,$1.17 ,$1.11 ,$0.97 , N/A , N/A , N/A , N/A , N/A ,$1.35 , N/A ,$1.46 ,$1.11 ,$1.20 ,$1.20 ,$0.97 ,$1.20 ,$1.10 ,$1.43 ,$1.09 , N/A ,$1.26 , N/A , N/A , N/A , N/A , N/A ,$1.14 ,$0.99 ,$1.14 ,$1.14 ,$1.27 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7674,METHACHOLINE (PROVOCHOLINE) 4 MG/ML IN SODIUM CHLORIDE 0.9 % 4 MG/ML SOLR per1 mg,636,1 ,$6.38 ,$4.21 ,$1.17 ,$6.38 , N/A ,$1.87 ,$1.25 , N/A ,$3.83 ,$5.42 ,$4.47 , N/A , N/A ,$6.06 ,$4.85 ,$4.79 ,$1.17 ,$5.42 , N/A ,$1.17 ,$1.17 ,$4.47 ,$3.89 , N/A , N/A , N/A , N/A , N/A ,$5.42 , N/A ,$5.87 ,$4.47 ,$1.20 ,$1.20 ,$3.89 ,$1.20 ,$4.41 ,$5.74 ,$4.36 , N/A ,$5.04 , N/A , N/A , N/A , N/A , N/A ,$4.59 ,$3.96 ,$4.59 ,$4.59 ,$5.10 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9250,METHOTREXATE (PF) 50 MG/2ML SOLN per5 mg,636,1 ,$11.53 ,$7.61 ,$0.36 ,$11.53 , N/A ,$0.56 ,$0.38 , N/A ,$6.92 ,$9.80 ,$8.07 , N/A , N/A ,$10.95 ,$8.76 ,$8.65 ,$0.37 ,$9.80 , N/A ,$0.37 ,$0.37 ,$8.07 ,$7.02 , N/A , N/A , N/A , N/A , N/A ,$9.80 , N/A ,$10.61 ,$8.07 ,$0.36 ,$0.36 ,$7.02 ,$0.36 ,$7.97 ,$10.38 ,$7.88 , N/A ,$9.11 , N/A , N/A , N/A , N/A , N/A ,$8.30 ,$7.15 ,$8.30 ,$8.30 ,$9.22 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q9968,METHYLENE BLUE 1 % SOLN per1 mg,636,1 ,$12.39 ,$8.18 ,$7.25 ,$16.65 , N/A ,$12.39 ,$11.33 ,$7.40 ,$7.43 ,$10.53 , N/A , N/A , N/A ,$11.77 ,$9.42 ,$9.29 ,$12.39 ,$10.53 ,$7.40 ,$12.39 ,$12.39 ,$8.67 ,$7.55 , N/A ,$7.40 ,$7.25 ,$12.39 , N/A ,$10.53 ,$16.65 ,$11.40 ,$8.67 ,$10.95 ,$10.95 ,$7.55 ,$10.95 ,$8.56 ,$11.15 ,$8.46 ,$7.32 ,$9.79 , N/A ,$12.39 ,$12.39 ,$7.25 ,$12.39 ,$8.92 ,$7.68 ,$8.92 ,$8.92 ,$9.91 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2210,METHYLERGONOVINE 0.2 MG/ML SOLN per0.2 mg,636,1 ,$145.85 ,$96.26 ,$30.25 ,$145.85 , N/A ,$46.94 ,$31.29 , N/A ,$87.51 ,$123.97 ,$102.10 , N/A , N/A ,$138.56 ,$110.85 ,$109.39 ,$34.32 ,$123.97 , N/A ,$34.32 ,$34.32 ,$102.10 ,$88.82 , N/A , N/A , N/A , N/A , N/A ,$123.97 , N/A ,$134.18 ,$102.10 ,$30.25 ,$30.25 ,$88.82 ,$30.25 ,$100.78 ,$131.27 ,$99.64 , N/A ,$115.22 , N/A , N/A , N/A , N/A , N/A ,$105.01 ,$90.43 ,$105.01 ,$105.01 ,$116.68 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2212,METHYLNALTREXONE 12 MG/0.6ML SOLN per0.1 mg,636,1 ,$5.73 ,$3.78 ,$1.80 ,$5.73 , N/A ,$3.93 ,$3.93 , N/A ,$3.44 ,$4.87 ,$4.01 , N/A , N/A ,$5.44 ,$4.35 ,$4.30 ,$1.80 ,$4.87 , N/A ,$1.80 ,$1.80 ,$4.01 ,$3.49 , N/A , N/A , N/A , N/A , N/A ,$4.87 , N/A ,$5.27 ,$4.01 ,$2.91 ,$3.49 ,$3.49 ,$3.49 ,$3.96 ,$5.16 ,$3.91 , N/A ,$4.53 , N/A , N/A , N/A , N/A , N/A ,$4.13 ,$3.55 ,$4.13 ,$4.13 ,$4.58 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7509,METHYLPREDNISOLONE 4 MG TABS per4 mg,636,1 ,$5.65 ,$3.73 ,$0.39 ,$5.65 , N/A ,$0.61 ,$0.41 , N/A ,$3.39 ,$4.80 ,$3.96 , N/A , N/A ,$5.37 ,$4.29 ,$4.24 ,$0.43 ,$4.80 , N/A ,$0.43 ,$0.43 ,$3.96 ,$3.44 , N/A , N/A , N/A , N/A , N/A ,$4.80 , N/A ,$5.20 ,$3.96 ,$0.39 ,$0.39 ,$3.44 ,$0.39 ,$3.90 ,$5.09 ,$3.86 , N/A ,$4.46 , N/A , N/A , N/A , N/A , N/A ,$4.07 ,$3.50 ,$4.07 ,$4.07 ,$4.52 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1030,METHYLPREDNISOLONE ACETATE 40 MG/ML SUSP per40 mg,636,1 ,$83.83 ,$55.33 ,$11.72 ,$83.83 , N/A ,$18.18 ,$12.12 , N/A ,$50.30 ,$71.26 ,$58.68 , N/A , N/A ,$79.64 ,$63.71 ,$62.87 ,$13.70 ,$71.26 , N/A ,$13.70 ,$13.70 ,$58.68 ,$51.05 , N/A , N/A , N/A , N/A , N/A ,$71.26 , N/A ,$77.12 ,$58.68 ,$11.72 ,$11.72 ,$51.05 ,$11.72 ,$57.93 ,$75.45 ,$57.27 , N/A ,$66.23 , N/A , N/A , N/A , N/A , N/A ,$60.36 ,$51.97 ,$60.36 ,$60.36 ,$67.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1040,METHYLPREDNISOLONE ACETATE 80 MG/ML SUSP per80 mg,636,1 ,$145.55 ,$96.06 ,$18.49 ,$145.55 , N/A ,$28.69 ,$19.13 , N/A ,$87.33 ,$123.72 ,$101.89 , N/A , N/A ,$138.27 ,$110.62 ,$109.16 ,$20.77 ,$123.72 , N/A ,$20.77 ,$20.77 ,$101.89 ,$88.64 , N/A , N/A , N/A , N/A , N/A ,$123.72 , N/A ,$133.91 ,$101.89 ,$18.49 ,$18.49 ,$88.64 ,$18.49 ,$100.58 ,$131.00 ,$99.44 , N/A ,$114.98 , N/A , N/A , N/A , N/A , N/A ,$104.80 ,$90.24 ,$104.80 ,$104.80 ,$116.44 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2930,METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG SOLR 1 EACH VIAL per125 mg,636,1 ,$40.58 ,$26.78 ,$7.93 ,$40.58 , N/A ,$12.31 ,$8.21 , N/A ,$24.35 ,$34.49 ,$28.41 , N/A , N/A ,$38.55 ,$30.84 ,$30.44 ,$10.12 ,$34.49 , N/A ,$10.12 ,$10.12 ,$28.41 ,$24.71 , N/A , N/A , N/A , N/A , N/A ,$34.49 , N/A ,$37.33 ,$28.41 ,$7.93 ,$7.93 ,$24.71 ,$7.93 ,$28.04 ,$36.52 ,$27.72 , N/A ,$32.06 , N/A , N/A , N/A , N/A , N/A ,$29.22 ,$25.16 ,$29.22 ,$29.22 ,$32.46 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2930,METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLR per125 mg,636,1 ,$71.90 ,$47.45 ,$7.93 ,$71.90 , N/A ,$12.31 ,$8.21 , N/A ,$43.14 ,$61.12 ,$50.33 , N/A , N/A ,$68.31 ,$54.64 ,$53.93 ,$10.12 ,$61.12 , N/A ,$10.12 ,$10.12 ,$50.33 ,$43.79 , N/A , N/A , N/A , N/A , N/A ,$61.12 , N/A ,$66.15 ,$50.33 ,$7.93 ,$7.93 ,$43.79 ,$7.93 ,$49.68 ,$64.71 ,$49.12 , N/A ,$56.80 , N/A , N/A , N/A , N/A , N/A ,$51.77 ,$44.58 ,$51.77 ,$51.77 ,$57.52 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2920,METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLR per40 mg,636,1 ,$49.00 ,$32.34 ,$5.99 ,$49.00 , N/A ,$9.29 ,$6.20 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$6.94 ,$41.65 , N/A ,$6.94 ,$6.94 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$5.99 ,$5.99 ,$29.84 ,$5.99 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2765,METOCLOPRAMIDE 5 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$1.55 ,$49.00 , N/A ,$2.41 ,$1.61 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.87 ,$41.65 , N/A ,$1.87 ,$1.87 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.55 ,$1.55 ,$29.84 ,$1.55 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2248,MICAFUNGIN 100 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$9.31 ,$6.14 ,$1.20 ,$9.31 ,$1.81 ,$1.87 ,$1.25 , N/A ,$5.59 ,$7.91 ,$6.52 ,$1.81 ,$1.81 ,$8.84 ,$7.08 ,$6.98 ,$1.56 ,$7.91 , N/A ,$1.56 ,$1.56 ,$6.52 ,$5.67 ,$1.81 , N/A , N/A , N/A ,$1.92 ,$7.91 , N/A ,$8.57 ,$6.52 ,$1.20 ,$1.20 ,$5.67 ,$1.20 ,$6.43 ,$8.38 ,$6.36 , N/A ,$7.35 ,$1.92 , N/A , N/A , N/A , N/A ,$6.70 ,$5.77 ,$6.70 ,$6.70 ,$7.45 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2250,MIDAZOLAM 100 MG/100ML NS SOLN per1 mg,636,1 ,$2.52 ,$1.66 ,$0.25 ,$2.52 , N/A ,$0.38 ,$0.26 , N/A ,$1.51 ,$2.14 ,$1.76 , N/A , N/A ,$2.39 ,$1.92 ,$1.89 ,$0.27 ,$2.14 , N/A ,$0.27 ,$0.27 ,$1.76 ,$1.53 , N/A , N/A , N/A , N/A , N/A ,$2.14 , N/A ,$2.32 ,$1.76 ,$0.25 ,$0.25 ,$1.53 ,$0.25 ,$1.74 ,$2.27 ,$1.72 , N/A ,$1.99 , N/A , N/A , N/A , N/A , N/A ,$1.81 ,$1.56 ,$1.81 ,$1.81 ,$2.02 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2250,MIDAZOLAM 100 MG/100ML SOLN per1 mL,636,1 ,$2.38 ,$1.57 ,$0.25 ,$2.38 , N/A ,$0.38 ,$0.26 , N/A ,$1.43 ,$2.02 ,$1.67 , N/A , N/A ,$2.26 ,$1.81 ,$1.79 ,$0.27 ,$2.02 , N/A ,$0.27 ,$0.27 ,$1.67 ,$1.45 , N/A , N/A , N/A , N/A , N/A ,$2.02 , N/A ,$2.19 ,$1.67 ,$0.25 ,$0.25 ,$1.45 ,$0.25 ,$1.64 ,$2.14 ,$1.63 , N/A ,$1.88 , N/A , N/A , N/A , N/A , N/A ,$1.71 ,$1.48 ,$1.71 ,$1.71 ,$1.90 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2250,MIDAZOLAM 2 MG/2ML SOLN per1 mg,636,1 ,$24.50 ,$16.17 ,$0.25 ,$24.50 , N/A ,$0.38 ,$0.26 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$0.27 ,$20.83 , N/A ,$0.27 ,$0.27 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$0.25 ,$0.25 ,$14.92 ,$0.25 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2250,MIDAZOLAM 5 MG/ML SOLN per1 mg,636,1 ,$9.80 ,$6.47 ,$0.25 ,$9.80 , N/A ,$0.38 ,$0.26 , N/A ,$5.88 ,$8.33 ,$6.86 , N/A , N/A ,$9.31 ,$7.45 ,$7.35 ,$0.27 ,$8.33 , N/A ,$0.27 ,$0.27 ,$6.86 ,$5.97 , N/A , N/A , N/A , N/A , N/A ,$8.33 , N/A ,$9.02 ,$6.86 ,$0.25 ,$0.25 ,$5.97 ,$0.25 ,$6.77 ,$8.82 ,$6.70 , N/A ,$7.74 , N/A , N/A , N/A , N/A , N/A ,$7.06 ,$6.08 ,$7.06 ,$7.06 ,$7.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2250,MIDAZOLAM 5 MG/5ML SOLN per1 mg,636,1 ,$9.80 ,$6.47 ,$0.25 ,$9.80 , N/A ,$0.38 ,$0.26 , N/A ,$5.88 ,$8.33 ,$6.86 , N/A , N/A ,$9.31 ,$7.45 ,$7.35 ,$0.27 ,$8.33 , N/A ,$0.27 ,$0.27 ,$6.86 ,$5.97 , N/A , N/A , N/A , N/A , N/A ,$8.33 , N/A ,$9.02 ,$6.86 ,$0.25 ,$0.25 ,$5.97 ,$0.25 ,$6.77 ,$8.82 ,$6.70 , N/A ,$7.74 , N/A , N/A , N/A , N/A , N/A ,$7.06 ,$6.08 ,$7.06 ,$7.06 ,$7.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2270,MORPHINE 1 MG/ML SOLN per10 mg,636,1 ,$119.50 ,$78.87 ,$4.18 ,$119.50 , N/A ,$7.52 ,$5.01 , N/A ,$71.70 ,$101.58 ,$83.65 , N/A , N/A ,$113.53 ,$90.82 ,$89.63 ,$4.18 ,$101.58 , N/A ,$4.18 ,$4.18 ,$83.65 ,$72.78 , N/A , N/A , N/A , N/A , N/A ,$101.58 , N/A ,$109.94 ,$83.65 ,$4.84 ,$4.84 ,$72.78 ,$4.84 ,$82.57 ,$107.55 ,$81.64 , N/A ,$94.41 , N/A , N/A , N/A , N/A , N/A ,$86.04 ,$74.09 ,$86.04 ,$86.04 ,$95.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2270,MORPHINE 4 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$4.18 ,$49.00 , N/A ,$7.52 ,$5.01 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$4.18 ,$41.65 , N/A ,$4.18 ,$4.18 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$4.84 ,$4.84 ,$29.84 ,$4.84 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2270,MORPHINE (PF) 1 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$4.18 ,$49.00 , N/A ,$7.52 ,$5.01 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$4.18 ,$41.65 , N/A ,$4.18 ,$4.18 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$4.84 ,$4.84 ,$29.84 ,$4.84 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2270,MORPHINE (PF) 10 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$4.18 ,$49.00 , N/A ,$7.52 ,$5.01 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$4.18 ,$41.65 , N/A ,$4.18 ,$4.18 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$4.84 ,$4.84 ,$29.84 ,$4.84 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2270,MORPHINE 10 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$4.18 ,$49.00 , N/A ,$7.52 ,$5.01 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$4.18 ,$41.65 , N/A ,$4.18 ,$4.18 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$4.84 ,$4.84 ,$29.84 ,$4.84 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2270,MORPHINE 2 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$4.18 ,$49.00 , N/A ,$7.52 ,$5.01 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$4.18 ,$41.65 , N/A ,$4.18 ,$4.18 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$4.84 ,$4.84 ,$29.84 ,$4.84 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7517,MYCOPHENOLATE 250 MG CAPS per250 mg,636,1 ,$4.00 ,$2.64 ,$0.29 ,$4.00 , N/A ,$0.45 ,$0.30 , N/A ,$2.40 ,$3.40 ,$2.80 , N/A , N/A ,$3.80 ,$3.04 ,$3.00 ,$0.37 ,$3.40 , N/A ,$0.37 ,$0.37 ,$2.80 ,$2.44 , N/A , N/A , N/A , N/A , N/A ,$3.40 , N/A ,$3.68 ,$2.80 ,$0.29 ,$0.29 ,$2.44 ,$0.29 ,$2.76 ,$3.60 ,$2.73 , N/A ,$3.16 , N/A , N/A , N/A , N/A , N/A ,$2.88 ,$2.48 ,$2.88 ,$2.88 ,$3.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7518,MYCOPHENOLATE EC 180 MG TBEC per180 mg,636,1 ,$17.23 ,$11.37 ,$0.93 ,$17.23 , N/A ,$1.44 ,$0.96 , N/A ,$10.34 ,$14.65 ,$12.06 , N/A , N/A ,$16.37 ,$13.09 ,$12.92 ,$1.31 ,$14.65 , N/A ,$1.31 ,$1.31 ,$12.06 ,$10.49 , N/A , N/A , N/A , N/A , N/A ,$14.65 , N/A ,$15.85 ,$12.06 ,$0.93 ,$0.93 ,$10.49 ,$0.93 ,$11.91 ,$15.51 ,$11.77 , N/A ,$13.61 , N/A , N/A , N/A , N/A , N/A ,$12.41 ,$10.68 ,$12.41 ,$12.41 ,$13.78 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2300,NALBUPHINE SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$4.15 ,$49.00 , N/A ,$6.44 ,$4.29 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$4.73 ,$41.65 , N/A ,$4.73 ,$4.73 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$4.15 ,$4.15 ,$29.84 ,$4.15 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2310,NALOXONE 0.4 MG/ML SOLN 1 ML VIAL per1 mg,636,1 ,$91.95 ,$60.69 ,$11.70 ,$91.95 , N/A ,$18.16 ,$12.11 , N/A ,$55.17 ,$78.16 ,$64.37 , N/A , N/A ,$87.35 ,$69.88 ,$68.96 ,$17.51 ,$78.16 , N/A ,$17.51 ,$17.51 ,$64.37 ,$56.00 , N/A , N/A , N/A , N/A , N/A ,$78.16 , N/A ,$84.59 ,$64.37 ,$11.70 ,$11.70 ,$56.00 ,$11.70 ,$63.54 ,$82.76 ,$62.82 , N/A ,$72.64 , N/A , N/A , N/A , N/A , N/A ,$66.20 ,$57.01 ,$66.20 ,$66.20 ,$73.56 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2310,NALOXONE 0.4 MG/ML SOLN per1 mg,636,1 ,$145.90 ,$96.29 ,$11.70 ,$145.90 , N/A ,$18.16 ,$12.11 , N/A ,$87.54 ,$124.02 ,$102.13 , N/A , N/A ,$138.61 ,$110.88 ,$109.43 ,$17.51 ,$124.02 , N/A ,$17.51 ,$17.51 ,$102.13 ,$88.85 , N/A , N/A , N/A , N/A , N/A ,$124.02 , N/A ,$134.23 ,$102.13 ,$11.70 ,$11.70 ,$88.85 ,$11.70 ,$100.82 ,$131.31 ,$99.68 , N/A ,$115.26 , N/A , N/A , N/A , N/A , N/A ,$105.05 ,$90.46 ,$105.05 ,$105.05 ,$116.72 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2310,NALOXONE 2 MG/2ML SOSY per1 mg,636,1 ,$121.78 ,$80.37 ,$11.70 ,$121.78 , N/A ,$18.16 ,$12.11 , N/A ,$73.07 ,$103.51 ,$85.25 , N/A , N/A ,$115.69 ,$92.55 ,$91.34 ,$17.51 ,$103.51 , N/A ,$17.51 ,$17.51 ,$85.25 ,$74.16 , N/A , N/A , N/A , N/A , N/A ,$103.51 , N/A ,$112.04 ,$85.25 ,$11.70 ,$11.70 ,$74.16 ,$11.70 ,$84.15 ,$109.60 ,$83.20 , N/A ,$96.21 , N/A , N/A , N/A , N/A , N/A ,$87.68 ,$75.50 ,$87.68 ,$87.68 ,$97.42 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2315,NALTREXONE 380 MG SUSR per1 mg,636,1 ,$14.92 ,$9.85 ,$3.66 ,$41.86 ,$39.49 ,$8.39 ,$5.60 ,$3.73 ,$8.95 ,$12.68 ,$10.44 ,$39.49 ,$14.92 ,$14.17 ,$11.34 ,$11.19 ,$6.36 ,$12.68 ,$3.73 ,$6.36 ,$6.36 ,$10.44 ,$9.09 ,$39.49 ,$3.73 ,$3.66 ,$7.46 ,$15.82 ,$12.68 ,$8.39 ,$13.73 ,$10.44 ,$5.41 ,$5.41 ,$9.09 ,$5.41 ,$10.31 ,$13.43 ,$10.19 ,$3.69 ,$11.79 ,$41.86 ,$6.17 ,$6.17 ,$3.66 ,$6.17 ,$10.74 ,$9.25 ,$10.74 ,$10.74 ,$11.94 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2710,NEOSTIGMINE 5 MG/5ML SOLN per0.5 mg,636,1 ,$8.17 ,$5.39 ,$1.38 ,$8.17 , N/A ,$5.60 ,$5.60 , N/A ,$4.90 ,$6.94 ,$5.72 , N/A , N/A ,$7.76 ,$6.21 ,$6.13 ,$1.38 ,$6.94 , N/A ,$1.38 ,$1.38 ,$5.72 ,$4.98 , N/A , N/A , N/A , N/A , N/A ,$6.94 , N/A ,$7.52 ,$5.72 ,$4.14 ,$4.97 ,$4.98 ,$4.97 ,$5.65 ,$7.35 ,$5.58 , N/A ,$6.45 , N/A , N/A , N/A , N/A , N/A ,$5.88 ,$5.07 ,$5.88 ,$5.88 ,$6.54 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2710,NEOSTIGMINE 5 MG/5ML SOSY per0.5 mg,636,1 ,$15.13 ,$9.99 ,$1.38 ,$15.13 , N/A ,$10.37 ,$10.37 , N/A ,$9.08 ,$12.86 ,$10.59 , N/A , N/A ,$14.37 ,$11.50 ,$11.35 ,$1.38 ,$12.86 , N/A ,$1.38 ,$1.38 ,$10.59 ,$9.21 , N/A , N/A , N/A , N/A , N/A ,$12.86 , N/A ,$13.92 ,$10.59 ,$7.67 ,$9.21 ,$9.21 ,$9.21 ,$10.45 ,$13.62 ,$10.34 , N/A ,$11.95 , N/A , N/A , N/A , N/A , N/A ,$10.89 ,$9.38 ,$10.89 ,$10.89 ,$12.10 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9299,NIVOLUMAB 240 MG/24ML SOLN 24 ML VIAL per1 mg,636,1 ,$127.22 ,$83.97 ,$29.31 ,$181.19 ,$170.93 ,$67.30 ,$44.87 ,$29.91 ,$76.33 ,$108.14 ,$89.05 ,$170.93 ,$127.22 ,$120.86 ,$96.69 ,$95.42 ,$51.00 ,$108.14 ,$29.91 ,$51.00 ,$51.00 ,$89.05 ,$77.48 ,$170.93 ,$29.91 ,$29.31 ,$59.82 ,$134.85 ,$108.14 ,$67.30 ,$117.04 ,$89.05 ,$43.37 ,$43.37 ,$77.48 ,$43.37 ,$87.91 ,$114.50 ,$86.92 ,$29.61 ,$100.50 ,$181.19 ,$49.50 ,$49.50 ,$29.31 ,$49.50 ,$91.60 ,$78.88 ,$91.60 ,$91.60 ,$101.78 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2350,OCRELIZUMAB 300 MG/10ML SOLN 10 ML VIAL per1 mg,636,1 ,$174.41 ,$115.11 ,$57.79 ,$872.94 ,$823.53 ,$132.68 ,$88.46 ,$58.97 ,$104.65 ,$148.25 ,$122.09 ,$823.53 ,$174.41 ,$165.69 ,$132.55 ,$130.81 ,$101.41 ,$148.25 ,$58.97 ,$101.41 ,$101.41 ,$122.09 ,$106.22 ,$823.53 ,$58.97 ,$57.79 ,$117.94 ,$184.87 ,$148.25 ,$132.68 ,$160.46 ,$122.09 ,$85.51 ,$85.51 ,$106.22 ,$85.51 ,$120.52 ,$156.97 ,$119.16 ,$58.37 ,$137.78 ,$872.94 ,$98.42 ,$98.42 ,$57.79 ,$98.42 ,$125.58 ,$108.13 ,$125.58 ,$125.58 ,$139.53 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2354,OCTREOTIDE 100 MCG/ML SOLN per25 mcg,636,1 ,$24.50 ,$16.17 ,$1.68 ,$24.50 , N/A ,$2.61 ,$1.74 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$2.41 ,$20.83 , N/A ,$2.41 ,$2.41 ,$17.15 ,$14.92 , N/A , N/A , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$1.68 ,$1.68 ,$14.92 ,$1.68 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A , N/A , N/A , N/A , N/A ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2354,OCTREOTIDE 500 MCG/ML SOLN 1 ML VIAL per25 mcg,636,1 ,$18.34 ,$12.10 ,$1.68 ,$18.34 , N/A ,$2.61 ,$1.74 , N/A ,$11.00 ,$15.59 ,$12.84 , N/A , N/A ,$17.42 ,$13.94 ,$13.76 ,$2.41 ,$15.59 , N/A ,$2.41 ,$2.41 ,$12.84 ,$11.17 , N/A , N/A , N/A , N/A , N/A ,$15.59 , N/A ,$16.87 ,$12.84 ,$1.68 ,$1.68 ,$11.17 ,$1.68 ,$12.67 ,$16.51 ,$12.53 , N/A ,$14.49 , N/A , N/A , N/A , N/A , N/A ,$13.20 ,$11.37 ,$13.20 ,$13.20 ,$14.67 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2353,OCTREOTIDE ACETATE 20 MG KIT per1 mg,636,1 ,$626.92 ,$413.77 ,$170.93 ,$626.92 ,$170.93 ,$460.22 ,$306.81 ,$204.54 ,$376.15 ,$532.88 ,$438.84 ,$170.93 ,$170.93 ,$595.57 ,$476.46 ,$470.19 ,$349.61 ,$532.88 ,$204.54 ,$349.61 ,$349.61 ,$438.84 ,$381.79 ,$170.93 ,$204.54 ,$200.45 ,$409.08 ,$181.19 ,$532.88 ,$460.21 ,$576.77 ,$438.84 ,$296.58 ,$296.58 ,$381.79 ,$296.58 ,$433.20 ,$564.23 ,$428.31 ,$202.46 ,$495.27 ,$181.19 ,$339.32 ,$339.32 ,$200.45 ,$339.32 ,$451.38 ,$388.69 ,$451.38 ,$451.38 ,$501.54 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0585,ONABOTULINUMTOXINA 100 UNITS SOLR per1 Units,636,1 ,$23.97 ,$15.82 ,$6.19 ,$23.97 ,$17.38 ,$14.22 ,$9.48 ,$6.32 ,$14.38 ,$20.37 ,$16.78 ,$17.38 ,$17.38 ,$22.77 ,$18.22 ,$17.98 ,$10.74 ,$20.37 ,$6.32 ,$10.74 ,$10.74 ,$16.78 ,$14.60 ,$17.38 ,$6.32 ,$6.19 ,$12.64 ,$18.42 ,$20.37 ,$14.22 ,$22.05 ,$16.78 ,$9.16 ,$9.16 ,$14.60 ,$9.16 ,$16.56 ,$21.57 ,$16.38 ,$6.25 ,$18.94 ,$18.42 ,$10.43 ,$10.43 ,$6.19 ,$10.43 ,$17.26 ,$14.86 ,$17.26 ,$17.26 ,$19.18 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0585,ONABOTULINUMTOXINA 100 UNITS/10 ML SOLN per1 Units,636,1 ,$47.93 ,$31.63 ,$6.19 ,$47.93 ,$17.38 ,$14.22 ,$9.48 ,$6.32 ,$28.76 ,$40.74 ,$33.55 ,$17.38 ,$17.38 ,$45.53 ,$36.43 ,$35.95 ,$10.74 ,$40.74 ,$6.32 ,$10.74 ,$10.74 ,$33.55 ,$29.19 ,$17.38 ,$6.32 ,$6.19 ,$12.64 ,$18.42 ,$40.74 ,$14.22 ,$44.10 ,$33.55 ,$9.16 ,$9.16 ,$29.19 ,$9.16 ,$33.12 ,$43.14 ,$32.75 ,$6.25 ,$37.86 ,$18.42 ,$10.43 ,$10.43 ,$6.19 ,$10.43 ,$34.51 ,$29.72 ,$34.51 ,$34.51 ,$38.34 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2405,ONDANSETRON 4 MG/2ML SOLN 2 ML VIAL per1 mg,636,1 ,$4.90 ,$3.23 ,$0.13 ,$4.90 , N/A ,$0.20 ,$0.14 , N/A ,$2.94 ,$4.17 ,$3.43 , N/A , N/A ,$4.66 ,$3.72 ,$3.68 ,$0.15 ,$4.17 , N/A ,$0.15 ,$0.15 ,$3.43 ,$2.98 , N/A , N/A , N/A , N/A , N/A ,$4.17 , N/A ,$4.51 ,$3.43 ,$0.13 ,$0.13 ,$2.98 ,$0.13 ,$3.39 ,$4.41 ,$3.35 , N/A ,$3.87 , N/A , N/A , N/A , N/A , N/A ,$3.53 ,$3.04 ,$3.53 ,$3.53 ,$3.92 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2405,ONDANSETRON 4 MG/2ML SOLN per1 mg,636,1 ,$3.06 ,$2.02 ,$0.13 ,$3.06 , N/A ,$0.20 ,$0.14 , N/A ,$1.84 ,$2.60 ,$2.14 , N/A , N/A ,$2.91 ,$2.33 ,$2.30 ,$0.15 ,$2.60 , N/A ,$0.15 ,$0.15 ,$2.14 ,$1.86 , N/A , N/A , N/A , N/A , N/A ,$2.60 , N/A ,$2.82 ,$2.14 ,$0.13 ,$0.13 ,$1.86 ,$0.13 ,$2.11 ,$2.75 ,$2.09 , N/A ,$2.42 , N/A , N/A , N/A , N/A , N/A ,$2.20 ,$1.90 ,$2.20 ,$2.20 ,$2.45 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2405,ONDANSETRON 40 MG/20ML SOLN 2 ML VIAL per1 mg,636,1 ,$12.25 ,$8.09 ,$0.13 ,$12.25 , N/A ,$0.20 ,$0.14 , N/A ,$7.35 ,$10.41 ,$8.58 , N/A , N/A ,$11.64 ,$9.31 ,$9.19 ,$0.15 ,$10.41 , N/A ,$0.15 ,$0.15 ,$8.58 ,$7.46 , N/A , N/A , N/A , N/A , N/A ,$10.41 , N/A ,$11.27 ,$8.58 ,$0.13 ,$0.13 ,$7.46 ,$0.13 ,$8.46 ,$11.03 ,$8.37 , N/A ,$9.68 , N/A , N/A , N/A , N/A , N/A ,$8.82 ,$7.60 ,$8.82 ,$8.82 ,$9.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2405,ONDANSETRON 40 MG/20ML SOLN 20 ML VIAL per1 mg,636,1 ,$6.13 ,$4.05 ,$0.13 ,$6.13 , N/A ,$0.20 ,$0.14 , N/A ,$3.68 ,$5.21 ,$4.29 , N/A , N/A ,$5.82 ,$4.66 ,$4.60 ,$0.15 ,$5.21 , N/A ,$0.15 ,$0.15 ,$4.29 ,$3.73 , N/A , N/A , N/A , N/A , N/A ,$5.21 , N/A ,$5.64 ,$4.29 ,$0.13 ,$0.13 ,$3.73 ,$0.13 ,$4.24 ,$5.52 ,$4.19 , N/A ,$4.84 , N/A , N/A , N/A , N/A , N/A ,$4.41 ,$3.80 ,$4.41 ,$4.41 ,$4.90 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2407,ORITAVANCIN 400 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$80.43 ,$53.08 ,$26.14 ,$80.43 ,$47.85 ,$60.01 ,$40.01 ,$26.67 ,$48.26 ,$68.37 ,$56.30 ,$47.85 ,$47.85 ,$76.41 ,$61.13 ,$60.32 ,$44.22 ,$68.37 ,$26.67 ,$44.22 ,$44.22 ,$56.30 ,$48.98 ,$47.85 ,$26.67 ,$26.14 ,$53.34 ,$50.72 ,$68.37 ,$60.00 ,$74.00 ,$56.30 ,$38.67 ,$38.67 ,$48.98 ,$38.67 ,$55.58 ,$72.39 ,$54.95 ,$26.40 ,$63.54 ,$50.72 ,$42.92 ,$42.92 ,$26.14 ,$42.92 ,$57.91 ,$49.87 ,$57.91 ,$57.91 ,$64.34 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2590,OXYTOCIN 10 UNIT/ML SOLN 1 ML VIAL per10 Units,636,1 ,$49.00 ,$32.34 ,$1.29 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.29 ,$41.65 , N/A ,$1.29 ,$1.29 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2590,OXYTOCIN 10 UNIT/ML SOLN per10 Units,636,1 ,$16.33 ,$10.78 ,$1.29 ,$16.33 , N/A ,$11.19 ,$11.19 , N/A ,$9.80 ,$13.88 ,$11.43 , N/A , N/A ,$15.51 ,$12.41 ,$12.25 ,$1.29 ,$13.88 , N/A ,$1.29 ,$1.29 ,$11.43 ,$9.95 , N/A , N/A , N/A , N/A , N/A ,$13.88 , N/A ,$15.02 ,$11.43 ,$8.28 ,$9.94 ,$9.95 ,$9.94 ,$11.28 ,$14.70 ,$11.16 , N/A ,$12.90 , N/A , N/A , N/A , N/A , N/A ,$11.76 ,$10.12 ,$11.76 ,$11.76 ,$13.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2590,OXYTOCIN 30-0.9 UT/500ML-% SOLN per10 Units,636,1 ,$60.53 ,$39.95 ,$1.29 ,$60.53 , N/A ,$41.49 ,$41.49 , N/A ,$36.32 ,$51.45 ,$42.37 , N/A , N/A ,$57.50 ,$46.00 ,$45.40 ,$1.29 ,$51.45 , N/A ,$1.29 ,$1.29 ,$42.37 ,$36.86 , N/A , N/A , N/A , N/A , N/A ,$51.45 , N/A ,$55.69 ,$42.37 ,$30.70 ,$36.84 ,$36.86 ,$36.84 ,$41.83 ,$54.48 ,$41.35 , N/A ,$47.82 , N/A , N/A , N/A , N/A , N/A ,$43.58 ,$37.53 ,$43.58 ,$43.58 ,$48.42 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9267,PACLITAXEL 300 MG/50ML CONC 50 ML VIAL per1 mg,636,1 ,$1.44 ,$0.95 ,$0.20 ,$1.44 , N/A ,$0.38 ,$0.26 , N/A ,$0.86 ,$1.22 ,$1.01 , N/A , N/A ,$1.37 ,$1.09 ,$1.08 ,$0.20 ,$1.22 , N/A ,$0.20 ,$0.20 ,$1.01 ,$0.88 , N/A , N/A , N/A , N/A , N/A ,$1.22 , N/A ,$1.32 ,$1.01 ,$0.25 ,$0.25 ,$0.88 ,$0.25 ,$1.00 ,$1.30 ,$0.98 , N/A ,$1.14 , N/A , N/A , N/A , N/A , N/A ,$1.04 ,$0.89 ,$1.04 ,$1.04 ,$1.15 
ST NICHOLAS HOSPITAL - ACUTE,63600002,C9113,PANTOPRAZOLE 40 MG SOLR 1 EACH VIAL per1 vial,636,1 ,$522.75 ,$345.02 ,$6.61 ,$522.75 , N/A ,$358.29 ,$358.29 , N/A ,$313.65 ,$444.34 ,$365.93 , N/A , N/A ,$496.61 ,$397.29 ,$392.06 ,$6.61 ,$444.34 , N/A ,$6.61 ,$6.61 ,$365.93 ,$318.35 , N/A , N/A , N/A , N/A , N/A ,$444.34 , N/A ,$480.93 ,$365.93 ,$265.14 ,$318.20 ,$318.35 ,$318.20 ,$361.22 ,$470.48 ,$357.14 , N/A ,$412.97 , N/A , N/A , N/A , N/A , N/A ,$376.38 ,$324.11 ,$376.38 ,$376.38 ,$418.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2506,PEGFILGRASTIM 6 MG/0.6ML SOSY per6 mg,636,1 ,"$2,021.67 ","$1,334.30 ",$71.25 ,"$2,021.67 ",$71.25 ,$246.80 ,$164.54 ,$109.69 ,"$1,213.00 ","$1,718.42 ","$1,415.17 ",$71.25 ,$71.25 ,"$1,920.59 ","$1,536.47 ","$1,516.25 ",$229.79 ,"$1,718.42 ",$109.69 ,$229.79 ,$229.79 ,"$1,415.17 ","$1,231.20 ",$71.25 ,$109.69 ,$107.50 ,$219.38 ,$75.53 ,"$1,718.42 ",$246.79 ,"$1,859.94 ","$1,415.17 ",$159.05 ,$159.05 ,"$1,231.20 ",$159.05 ,"$1,396.97 ","$1,819.50 ","$1,381.20 ",$108.57 ,"$1,597.12 ",$75.53 ,$223.03 ,$223.03 ,$107.50 ,$223.03 ,"$1,455.60 ","$1,253.44 ","$1,455.60 ","$1,455.60 ","$1,617.34 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q5122,PEGFILGRASTIM-APGF 6 MG/0.6ML SOSY per0.5 mg,636,1 ,"$1,236.38 ",$816.01 ,$115.47 ,"$1,236.38 ",$115.47 ,$281.95 ,$187.97 ,$125.31 ,$741.83 ,"$1,050.92 ",$865.47 ,$115.47 ,$115.47 ,"$1,174.56 ",$939.65 ,$927.29 ,$249.31 ,"$1,050.92 ",$125.31 ,$249.31 ,$249.31 ,$865.47 ,$752.96 ,$115.47 ,$125.31 ,$122.80 ,$250.62 ,$122.40 ,"$1,050.92 ",$281.96 ,"$1,137.47 ",$865.47 ,$181.70 ,$181.70 ,$752.96 ,$181.70 ,$854.34 ,"$1,112.74 ",$844.69 ,$124.03 ,$976.74 ,$122.40 ,$241.97 ,$241.97 ,$122.80 ,$241.97 ,$890.19 ,$766.56 ,$890.19 ,$890.19 ,$989.10 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q5120,PEGFILGRASTIM-BMEZ 6 MG/0.6ML SOSY per0.5 mg,636,1 ,"$1,236.55 ",$816.12 ,$78.46 ,"$1,236.55 ",$115.47 ,$180.14 ,$120.09 ,$80.06 ,$741.93 ,"$1,051.07 ",$865.59 ,$115.47 ,$115.47 ,"$1,174.72 ",$939.78 ,$927.41 ,$152.90 ,"$1,051.07 ",$80.06 ,$152.90 ,$152.90 ,$865.59 ,$753.06 ,$115.47 ,$80.06 ,$78.46 ,$160.12 ,$122.40 ,"$1,051.07 ",$180.14 ,"$1,137.63 ",$865.59 ,$116.09 ,$116.09 ,$753.06 ,$116.09 ,$854.46 ,"$1,112.90 ",$844.81 ,$79.24 ,$976.87 ,$122.40 ,$148.40 ,$148.40 ,$78.46 ,$148.40 ,$890.32 ,$766.66 ,$890.32 ,$890.32 ,$989.24 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q5108,PEGFILGRASTIM-JMDB 6 MG/0.6ML SOSY per0.5 mg,636,1 ,"$1,315.13 ",$867.99 ,$71.25 ,"$1,315.13 ",$71.25 ,$298.17 ,$198.78 ,$132.52 ,$789.08 ,"$1,117.86 ",$920.59 ,$71.25 ,$71.25 ,"$1,249.37 ",$999.50 ,$986.35 ,$232.12 ,"$1,117.86 ",$132.52 ,$232.12 ,$232.12 ,$920.59 ,$800.91 ,$71.25 ,$132.52 ,$129.87 ,$265.04 ,$75.53 ,"$1,117.86 ",$298.16 ,"$1,209.92 ",$920.59 ,$192.15 ,$192.15 ,$800.91 ,$192.15 ,$908.75 ,"$1,183.62 ",$898.50 ,$131.17 ,"$1,038.95 ",$75.53 ,$225.29 ,$225.29 ,$129.87 ,$225.29 ,$946.89 ,$815.38 ,$946.89 ,$946.89 ,"$1,052.10 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9271,PEMBROLIZUMAB 100 MG/4ML SOLN 4 ML VIAL per1 mg,636,1 ,$152.55 ,$100.68 ,$54.31 ,$289.09 ,$272.73 ,$124.70 ,$83.13 ,$55.42 ,$91.53 ,$129.67 ,$106.79 ,$272.73 ,$152.55 ,$144.92 ,$115.94 ,$114.41 ,$91.65 ,$129.67 ,$55.42 ,$91.65 ,$91.65 ,$106.79 ,$92.90 ,$272.73 ,$55.42 ,$54.31 ,$110.84 ,$161.70 ,$129.67 ,$124.69 ,$140.35 ,$106.79 ,$80.36 ,$80.36 ,$92.90 ,$80.36 ,$105.41 ,$137.30 ,$104.22 ,$54.85 ,$120.51 ,$289.09 ,$88.95 ,$88.95 ,$54.31 ,$88.95 ,$109.84 ,$94.58 ,$109.84 ,$109.84 ,$122.04 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0561,PENICILLIN G BENZATHINE 1200000 UNIT/2ML SUSY per100000 Units,636,1 ,$86.45 ,$57.06 ,$1.81 ,$86.45 ,$1.81 ,$41.83 ,$27.89 ,$18.59 ,$51.87 ,$73.48 ,$60.52 ,$1.81 ,$1.81 ,$82.13 ,$65.70 ,$64.84 ,$30.79 ,$73.48 ,$18.59 ,$30.79 ,$30.79 ,$60.52 ,$52.65 ,$1.81 ,$18.59 ,$18.22 ,$37.18 ,$1.92 ,$73.48 ,$41.83 ,$79.53 ,$60.52 ,$26.96 ,$26.96 ,$52.65 ,$26.96 ,$59.74 ,$77.81 ,$59.06 ,$18.40 ,$68.30 ,$1.92 ,$29.88 ,$29.88 ,$18.22 ,$29.88 ,$62.24 ,$53.60 ,$62.24 ,$62.24 ,$69.16 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0558,PENICILLIN G BENZATHINE-PROCAINE 1200000 UNIT/2ML SUSP per100000 Units,636,1 ,$70.50 ,$46.53 ,$1.81 ,$70.50 ,$1.81 ,$32.45 ,$21.63 ,$14.42 ,$42.30 ,$59.93 ,$49.35 ,$1.81 ,$1.81 ,$66.98 ,$53.58 ,$52.88 ,$23.60 ,$59.93 ,$14.42 ,$23.60 ,$23.60 ,$49.35 ,$42.93 ,$1.81 ,$14.42 ,$14.13 ,$28.84 ,$1.92 ,$59.93 ,$32.44 ,$64.86 ,$49.35 ,$20.91 ,$20.91 ,$42.93 ,$20.91 ,$48.72 ,$63.45 ,$48.17 ,$14.27 ,$55.70 ,$1.92 ,$22.90 ,$22.90 ,$14.13 ,$22.90 ,$50.76 ,$43.71 ,$50.76 ,$50.76 ,$56.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2540,PENICILLIN G POTASSIUM 5000000 UNITS SOLR 1 EACH VIAL per600000 Units,636,1 ,$13.86 ,$9.15 ,$1.10 ,$13.86 , N/A ,$1.71 ,$1.14 , N/A ,$8.32 ,$11.78 ,$9.70 , N/A , N/A ,$13.17 ,$10.53 ,$10.40 ,$1.33 ,$11.78 , N/A ,$1.33 ,$1.33 ,$9.70 ,$8.44 , N/A , N/A , N/A , N/A , N/A ,$11.78 , N/A ,$12.75 ,$9.70 ,$1.10 ,$1.10 ,$8.44 ,$1.10 ,$9.58 ,$12.47 ,$9.47 , N/A ,$10.95 , N/A , N/A , N/A , N/A , N/A ,$9.98 ,$8.59 ,$9.98 ,$9.98 ,$11.09 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2540,PENICILLIN G POTASSIUM IN DEXTROSE 5 % 50 ML 60000 UNIT/ML SOLN per600000 Units,636,1 ,$21.99 ,$14.51 ,$1.10 ,$21.99 , N/A ,$1.71 ,$1.14 , N/A ,$13.19 ,$18.69 ,$15.39 , N/A , N/A ,$20.89 ,$16.71 ,$16.49 ,$1.33 ,$18.69 , N/A ,$1.33 ,$1.33 ,$15.39 ,$13.39 , N/A , N/A , N/A , N/A , N/A ,$18.69 , N/A ,$20.23 ,$15.39 ,$1.10 ,$1.10 ,$13.39 ,$1.10 ,$15.20 ,$19.79 ,$15.02 , N/A ,$17.37 , N/A , N/A , N/A , N/A , N/A ,$15.83 ,$13.63 ,$15.83 ,$15.83 ,$17.59 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2560,PHENOBARBITAL 65 MG/ML SOLN per120 mg,636,1 ,$194.50 ,$128.37 ,$38.25 ,$194.50 , N/A ,$87.82 ,$58.55 ,$39.03 ,$116.70 ,$165.33 ,$136.15 , N/A , N/A ,$184.78 ,$147.82 ,$145.88 ,$77.96 ,$165.33 ,$39.03 ,$77.96 ,$77.96 ,$136.15 ,$118.45 , N/A ,$39.03 ,$38.25 ,$78.06 , N/A ,$165.33 ,$87.82 ,$178.94 ,$136.15 ,$56.59 ,$56.59 ,$118.45 ,$56.59 ,$134.40 ,$175.05 ,$132.88 ,$38.63 ,$153.66 , N/A ,$75.67 ,$75.67 ,$38.25 ,$75.67 ,$140.04 ,$120.59 ,$140.04 ,$140.04 ,$155.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2370,PHENYLEPHRINE 10 MG/ML SOLN 1 ML VIAL per1 mL,636,1 ,$49.00 ,$32.34 ,$4.76 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$4.76 ,$41.65 , N/A ,$4.76 ,$4.76 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2370,PHENYLEPHRINE 10 MG/ML SOLN 5 ML VIAL per1 mL,636,1 ,$32.48 ,$21.44 ,$4.76 ,$32.48 , N/A ,$22.26 ,$22.26 , N/A ,$19.49 ,$27.61 ,$22.74 , N/A , N/A ,$30.86 ,$24.68 ,$24.36 ,$4.76 ,$27.61 , N/A ,$4.76 ,$4.76 ,$22.74 ,$19.78 , N/A , N/A , N/A , N/A , N/A ,$27.61 , N/A ,$29.88 ,$22.74 ,$16.47 ,$19.77 ,$19.78 ,$19.77 ,$22.44 ,$29.23 ,$22.19 , N/A ,$25.66 , N/A , N/A , N/A , N/A , N/A ,$23.39 ,$20.14 ,$23.39 ,$23.39 ,$25.98 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2370,PHENYLEPHRINE SOLN per1 mL,636,1 ,$4.90 ,$3.23 ,$2.49 ,$4.90 , N/A ,$3.36 ,$3.36 , N/A ,$2.94 ,$4.17 ,$3.43 , N/A , N/A ,$4.66 ,$3.72 ,$3.68 ,$4.76 ,$4.17 , N/A ,$4.76 ,$4.76 ,$3.43 ,$2.98 , N/A , N/A , N/A , N/A , N/A ,$4.17 , N/A ,$4.51 ,$3.43 ,$2.49 ,$2.98 ,$2.98 ,$2.98 ,$3.39 ,$4.41 ,$3.35 , N/A ,$3.87 , N/A , N/A , N/A , N/A , N/A ,$3.53 ,$3.04 ,$3.53 ,$3.53 ,$3.92 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3430,PHYTONADIONE (ADULT) 10 MG/ML SOLN 1 ML AMPULE per1 mg,636,1 ,$35.42 ,$23.38 ,$4.35 ,$35.42 , N/A ,$6.75 ,$4.50 , N/A ,$21.25 ,$30.11 ,$24.79 , N/A , N/A ,$33.65 ,$26.92 ,$26.57 ,$5.42 ,$30.11 , N/A ,$5.42 ,$5.42 ,$24.79 ,$21.57 , N/A , N/A , N/A , N/A , N/A ,$30.11 , N/A ,$32.59 ,$24.79 ,$4.35 ,$4.35 ,$21.57 ,$4.35 ,$24.48 ,$31.88 ,$24.20 , N/A ,$27.98 , N/A , N/A , N/A , N/A , N/A ,$25.50 ,$21.96 ,$25.50 ,$25.50 ,$28.34 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3430,PHYTONADIONE (PEDS) 1 MG/0.5ML SOLN per1 mg,636,1 ,$182.55 ,$120.48 ,$4.35 ,$182.55 , N/A ,$6.75 ,$4.50 , N/A ,$109.53 ,$155.17 ,$127.79 , N/A , N/A ,$173.42 ,$138.74 ,$136.91 ,$5.42 ,$155.17 , N/A ,$5.42 ,$5.42 ,$127.79 ,$111.17 , N/A , N/A , N/A , N/A , N/A ,$155.17 , N/A ,$167.95 ,$127.79 ,$4.35 ,$4.35 ,$111.17 ,$4.35 ,$126.14 ,$164.30 ,$124.72 , N/A ,$144.21 , N/A , N/A , N/A , N/A , N/A ,$131.44 ,$113.18 ,$131.44 ,$131.44 ,$146.04 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3430,PHYTONADIONE 10 MG/ML SOLN 1 ML AMPULE per1 mg,636,1 ,$36.14 ,$23.85 ,$4.35 ,$36.14 , N/A ,$6.75 ,$4.50 , N/A ,$21.68 ,$30.72 ,$25.30 , N/A , N/A ,$34.33 ,$27.47 ,$27.11 ,$5.42 ,$30.72 , N/A ,$5.42 ,$5.42 ,$25.30 ,$22.01 , N/A , N/A , N/A , N/A , N/A ,$30.72 , N/A ,$33.25 ,$25.30 ,$4.35 ,$4.35 ,$22.01 ,$4.35 ,$24.97 ,$32.53 ,$24.69 , N/A ,$28.55 , N/A , N/A , N/A , N/A , N/A ,$26.02 ,$22.41 ,$26.02 ,$26.02 ,$28.91 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3430,PHYTONADIONE 10 MG/ML SOLN per1 mg,636,1 ,$31.57 ,$20.84 ,$4.35 ,$31.57 , N/A ,$6.75 ,$4.50 , N/A ,$18.94 ,$26.83 ,$22.10 , N/A , N/A ,$29.99 ,$23.99 ,$23.68 ,$5.42 ,$26.83 , N/A ,$5.42 ,$5.42 ,$22.10 ,$19.23 , N/A , N/A , N/A , N/A , N/A ,$26.83 , N/A ,$29.04 ,$22.10 ,$4.35 ,$4.35 ,$19.23 ,$4.35 ,$21.81 ,$28.41 ,$21.57 , N/A ,$24.94 , N/A , N/A , N/A , N/A , N/A ,$22.73 ,$19.57 ,$22.73 ,$22.73 ,$25.26 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2543,PIPERACILLIN-TAZOBACTAM 3.375 (3-0.375) G SOLR 1 EACH VIAL per1.125 g,636,1 ,$44.60 ,$29.44 ,$1.94 ,$44.60 , N/A ,$3.02 ,$2.01 , N/A ,$26.76 ,$37.91 ,$31.22 , N/A , N/A ,$42.37 ,$33.90 ,$33.45 ,$2.58 ,$37.91 , N/A ,$2.58 ,$2.58 ,$31.22 ,$27.16 , N/A , N/A , N/A , N/A , N/A ,$37.91 , N/A ,$41.03 ,$31.22 ,$1.94 ,$1.94 ,$27.16 ,$1.94 ,$30.82 ,$40.14 ,$30.47 , N/A ,$35.23 , N/A , N/A , N/A , N/A , N/A ,$32.11 ,$27.65 ,$32.11 ,$32.11 ,$35.68 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2543,PIPERACILLIN-TAZOBACTAM 4.5 (4-0.5) G SOLR 1 EACH VIAL per1.125 g,636,1 ,$42.36 ,$27.96 ,$1.94 ,$42.36 , N/A ,$3.02 ,$2.01 , N/A ,$25.42 ,$36.01 ,$29.65 , N/A , N/A ,$40.24 ,$32.19 ,$31.77 ,$2.58 ,$36.01 , N/A ,$2.58 ,$2.58 ,$29.65 ,$25.80 , N/A , N/A , N/A , N/A , N/A ,$36.01 , N/A ,$38.97 ,$29.65 ,$1.94 ,$1.94 ,$25.80 ,$1.94 ,$29.27 ,$38.12 ,$28.94 , N/A ,$33.46 , N/A , N/A , N/A , N/A , N/A ,$30.50 ,$26.26 ,$30.50 ,$30.50 ,$33.89 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90670,PNEUMOCOCCAL SUSP per0.5 mL,636,1 ,$855.45 ,$564.60 ,$3.86 ,$855.45 ,$3.86 ,$580.48 ,$386.99 ,$153.98 ,$513.27 ,$727.13 ,$598.82 ,$3.86 ,$3.86 ,$812.68 ,$650.14 ,$641.59 ,$438.58 ,$727.13 ,$153.98 ,$438.58 ,$438.58 ,$598.82 ,$520.97 ,$3.86 ,$153.98 ,$150.90 ,$307.96 ,$4.09 ,$727.13 ,$346.46 ,$787.01 ,$598.82 ,$374.09 ,$374.09 ,$520.97 ,$374.09 ,$591.12 ,$769.91 ,$584.44 ,$152.41 ,$675.81 ,$4.09 ,$425.68 ,$425.68 ,$150.90 ,$425.68 ,$615.92 ,$530.38 ,$615.92 ,$615.92 ,$684.36 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90732,PNEUMOCOCCAL VACCINE 25 MCG/0.5ML INJ per0.5 mL,636,1 ,$555.00 ,$366.30 ,$0.95 ,$555.00 ,$0.95 ,$300.31 ,$200.21 ,$99.90 ,$333.00 ,$471.75 ,$388.50 ,$0.95 ,$0.95 ,$527.25 ,$421.80 ,$416.25 ,$226.90 ,$471.75 ,$99.90 ,$226.90 ,$226.90 ,$388.50 ,$338.00 ,$0.95 ,$99.90 ,$97.90 ,$199.80 ,$1.01 ,$471.75 ,$224.78 ,$510.60 ,$388.50 ,$193.53 ,$193.53 ,$338.00 ,$193.53 ,$383.51 ,$499.50 ,$379.18 ,$98.88 ,$438.45 ,$1.01 ,$220.23 ,$220.23 ,$97.90 ,$220.23 ,$399.60 ,$344.10 ,$399.60 ,$399.60 ,$444.00 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3480,POTASSIUM CHLORIDE 10 MEQ/100ML SOLN per2 mEq,636,1 ,$13.32 ,$8.79 ,$0.16 ,$13.32 , N/A ,$0.25 ,$0.17 , N/A ,$7.99 ,$11.32 ,$9.32 , N/A , N/A ,$12.65 ,$10.12 ,$9.99 ,$0.24 ,$11.32 , N/A ,$0.24 ,$0.24 ,$9.32 ,$8.11 , N/A , N/A , N/A , N/A , N/A ,$11.32 , N/A ,$12.25 ,$9.32 ,$0.16 ,$0.16 ,$8.11 ,$0.16 ,$9.20 ,$11.99 ,$9.10 , N/A ,$10.52 , N/A , N/A , N/A , N/A , N/A ,$9.59 ,$8.26 ,$9.59 ,$9.59 ,$10.66 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3480,POTASSIUM CHLORIDE 2 MEQ/ML SOLN 10 ML VIAL per2 mEq,636,1 ,$9.80 ,$6.47 ,$0.16 ,$9.80 , N/A ,$0.25 ,$0.17 , N/A ,$5.88 ,$8.33 ,$6.86 , N/A , N/A ,$9.31 ,$7.45 ,$7.35 ,$0.24 ,$8.33 , N/A ,$0.24 ,$0.24 ,$6.86 ,$5.97 , N/A , N/A , N/A , N/A , N/A ,$8.33 , N/A ,$9.02 ,$6.86 ,$0.16 ,$0.16 ,$5.97 ,$0.16 ,$6.77 ,$8.82 ,$6.70 , N/A ,$7.74 , N/A , N/A , N/A , N/A , N/A ,$7.06 ,$6.08 ,$7.06 ,$7.06 ,$7.84 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3480,POTASSIUM CHLORIDE 2 MEQ/ML SOLN 20 ML VIAL per2 mEq,636,1 ,$2.45 ,$1.62 ,$0.16 ,$2.45 , N/A ,$0.25 ,$0.17 , N/A ,$1.47 ,$2.08 ,$1.72 , N/A , N/A ,$2.33 ,$1.86 ,$1.84 ,$0.24 ,$2.08 , N/A ,$0.24 ,$0.24 ,$1.72 ,$1.49 , N/A , N/A , N/A , N/A , N/A ,$2.08 , N/A ,$2.25 ,$1.72 ,$0.16 ,$0.16 ,$1.49 ,$0.16 ,$1.69 ,$2.21 ,$1.67 , N/A ,$1.94 , N/A , N/A , N/A , N/A , N/A ,$1.76 ,$1.52 ,$1.76 ,$1.76 ,$1.96 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3480,POTASSIUM CHLORIDE 2 MEQ/ML SOLN 5 ML VIAL per2 mEq,636,1 ,$6.35 ,$4.19 ,$0.16 ,$6.35 , N/A ,$0.25 ,$0.17 , N/A ,$3.81 ,$5.40 ,$4.45 , N/A , N/A ,$6.03 ,$4.83 ,$4.76 ,$0.24 ,$5.40 , N/A ,$0.24 ,$0.24 ,$4.45 ,$3.87 , N/A , N/A , N/A , N/A , N/A ,$5.40 , N/A ,$5.84 ,$4.45 ,$0.16 ,$0.16 ,$3.87 ,$0.16 ,$4.39 ,$5.72 ,$4.34 , N/A ,$5.02 , N/A , N/A , N/A , N/A , N/A ,$4.57 ,$3.94 ,$4.57 ,$4.57 ,$5.08 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3480,POTASSIUM CHLORIDE 20 MEQ/100ML SOLN per2 mEq,636,1 ,$6.11 ,$4.03 ,$0.16 ,$6.11 , N/A ,$0.25 ,$0.17 , N/A ,$3.67 ,$5.19 ,$4.28 , N/A , N/A ,$5.80 ,$4.64 ,$4.58 ,$0.24 ,$5.19 , N/A ,$0.24 ,$0.24 ,$4.28 ,$3.72 , N/A , N/A , N/A , N/A , N/A ,$5.19 , N/A ,$5.62 ,$4.28 ,$0.16 ,$0.16 ,$3.72 ,$0.16 ,$4.22 ,$5.50 ,$4.17 , N/A ,$4.83 , N/A , N/A , N/A , N/A , N/A ,$4.40 ,$3.79 ,$4.40 ,$4.40 ,$4.89 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3480,POTASSIUM CHLORIDE 20 MEQ/50ML SOLN per2 mEq,636,1 ,$6.78 ,$4.47 ,$0.16 ,$6.78 , N/A ,$0.25 ,$0.17 , N/A ,$4.07 ,$5.76 ,$4.75 , N/A , N/A ,$6.44 ,$5.15 ,$5.09 ,$0.24 ,$5.76 , N/A ,$0.24 ,$0.24 ,$4.75 ,$4.13 , N/A , N/A , N/A , N/A , N/A ,$5.76 , N/A ,$6.24 ,$4.75 ,$0.16 ,$0.16 ,$4.13 ,$0.16 ,$4.69 ,$6.10 ,$4.63 , N/A ,$5.36 , N/A , N/A , N/A , N/A , N/A ,$4.88 ,$4.20 ,$4.88 ,$4.88 ,$5.42 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7510,PREDNISOLONE 15 MG/5ML SOLN per5 mg,636,1 ,$2.67 ,$1.76 ,$0.38 ,$2.67 , N/A ,$0.59 ,$0.39 , N/A ,$1.60 ,$2.27 ,$1.87 , N/A , N/A ,$2.54 ,$2.03 ,$2.00 ,$0.39 ,$2.27 , N/A ,$0.39 ,$0.39 ,$1.87 ,$1.63 , N/A , N/A , N/A , N/A , N/A ,$2.27 , N/A ,$2.46 ,$1.87 ,$0.38 ,$0.38 ,$1.63 ,$0.38 ,$1.85 ,$2.40 ,$1.82 , N/A ,$2.11 , N/A , N/A , N/A , N/A , N/A ,$1.92 ,$1.66 ,$1.92 ,$1.92 ,$2.14 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7512,PREDNISONE 1 MG TABS per1 mg,636,1 ,$2.00 ,$1.32 ,$0.01 ,$2.00 , N/A ,$0.02 ,$0.02 , N/A ,$1.20 ,$1.70 ,$1.40 , N/A , N/A ,$1.90 ,$1.52 ,$1.50 ,$0.03 ,$1.70 , N/A ,$0.03 ,$0.03 ,$1.40 ,$1.22 , N/A , N/A , N/A , N/A , N/A ,$1.70 , N/A ,$1.84 ,$1.40 ,$0.01 ,$0.01 ,$1.22 ,$0.01 ,$1.38 ,$1.80 ,$1.37 , N/A ,$1.58 , N/A , N/A , N/A , N/A , N/A ,$1.44 ,$1.24 ,$1.44 ,$1.44 ,$1.60 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7512,PREDNISONE 2.5 MG TABS per1 mg,636,1 ,$1.33 ,$0.88 ,$0.01 ,$1.33 , N/A ,$0.02 ,$0.02 , N/A ,$0.80 ,$1.13 ,$0.93 , N/A , N/A ,$1.26 ,$1.01 ,$1.00 ,$0.03 ,$1.13 , N/A ,$0.03 ,$0.03 ,$0.93 ,$0.81 , N/A , N/A , N/A , N/A , N/A ,$1.13 , N/A ,$1.22 ,$0.93 ,$0.01 ,$0.01 ,$0.81 ,$0.01 ,$0.92 ,$1.20 ,$0.91 , N/A ,$1.05 , N/A , N/A , N/A , N/A , N/A ,$0.96 ,$0.82 ,$0.96 ,$0.96 ,$1.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7512,PREDNISONE 20 MG TABS per1 mg,636,1 ,$0.40 ,$0.26 ,$0.01 ,$0.40 , N/A ,$0.02 ,$0.02 , N/A ,$0.24 ,$0.34 ,$0.28 , N/A , N/A ,$0.38 ,$0.30 ,$0.30 ,$0.03 ,$0.34 , N/A ,$0.03 ,$0.03 ,$0.28 ,$0.24 , N/A , N/A , N/A , N/A , N/A ,$0.34 , N/A ,$0.37 ,$0.28 ,$0.01 ,$0.01 ,$0.24 ,$0.01 ,$0.28 ,$0.36 ,$0.27 , N/A ,$0.32 , N/A , N/A , N/A , N/A , N/A ,$0.29 ,$0.25 ,$0.29 ,$0.29 ,$0.32 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7512,PREDNISONE 10 MG TABS per1 mg,636,1 ,$0.40 ,$0.26 ,$0.01 ,$0.40 , N/A ,$0.02 ,$0.02 , N/A ,$0.24 ,$0.34 ,$0.28 , N/A , N/A ,$0.38 ,$0.30 ,$0.30 ,$0.03 ,$0.34 , N/A ,$0.03 ,$0.03 ,$0.28 ,$0.24 , N/A , N/A , N/A , N/A , N/A ,$0.34 , N/A ,$0.37 ,$0.28 ,$0.01 ,$0.01 ,$0.24 ,$0.01 ,$0.28 ,$0.36 ,$0.27 , N/A ,$0.32 , N/A , N/A , N/A , N/A , N/A ,$0.29 ,$0.25 ,$0.29 ,$0.29 ,$0.32 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7512,PREDNISONE 5 MG TABS per1 mg,636,1 ,$0.80 ,$0.53 ,$0.01 ,$0.80 , N/A ,$0.02 ,$0.02 , N/A ,$0.48 ,$0.68 ,$0.56 , N/A , N/A ,$0.76 ,$0.61 ,$0.60 ,$0.03 ,$0.68 , N/A ,$0.03 ,$0.03 ,$0.56 ,$0.49 , N/A , N/A , N/A , N/A , N/A ,$0.68 , N/A ,$0.74 ,$0.56 ,$0.01 ,$0.01 ,$0.49 ,$0.01 ,$0.55 ,$0.72 ,$0.55 , N/A ,$0.63 , N/A , N/A , N/A , N/A , N/A ,$0.58 ,$0.50 ,$0.58 ,$0.58 ,$0.64 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7512,PREDNISONE 50 MG TABS per1 mg,636,1 ,$0.08 ,$0.05 ,$0.01 ,$0.08 , N/A ,$0.02 ,$0.02 , N/A ,$0.05 ,$0.07 ,$0.06 , N/A , N/A ,$0.08 ,$0.06 ,$0.06 ,$0.03 ,$0.07 , N/A ,$0.03 ,$0.03 ,$0.06 ,$0.05 , N/A , N/A , N/A , N/A , N/A ,$0.07 , N/A ,$0.07 ,$0.06 ,$0.01 ,$0.01 ,$0.05 ,$0.01 ,$0.06 ,$0.07 ,$0.05 , N/A ,$0.06 , N/A , N/A , N/A , N/A , N/A ,$0.06 ,$0.05 ,$0.06 ,$0.06 ,$0.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0780,PROCHLORPERAZINE 10 MG/2ML SOLN per10 mg,636,1 ,$66.45 ,$43.86 ,$4.32 ,$66.45 , N/A ,$6.71 ,$4.47 , N/A ,$39.87 ,$56.48 ,$46.52 , N/A , N/A ,$63.13 ,$50.50 ,$49.84 ,$5.02 ,$56.48 , N/A ,$5.02 ,$5.02 ,$46.52 ,$40.47 , N/A , N/A , N/A , N/A , N/A ,$56.48 , N/A ,$61.13 ,$46.52 ,$4.32 ,$4.32 ,$40.47 ,$4.32 ,$45.92 ,$59.81 ,$45.40 , N/A ,$52.50 , N/A , N/A , N/A , N/A , N/A ,$47.84 ,$41.20 ,$47.84 ,$47.84 ,$53.16 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2550,PROMETHAZINE 25 MG/ML SOLN 1 ML VIAL per50 mg,636,1 ,$49.00 ,$32.34 ,$4.51 ,$49.00 , N/A ,$7.00 ,$4.67 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$5.47 ,$41.65 , N/A ,$5.47 ,$5.47 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$4.51 ,$4.51 ,$29.84 ,$4.51 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2550,PROMETHAZINE 25 MG/ML SOLN 1 ML AMPULE per50 mg,636,1 ,$49.00 ,$32.34 ,$4.51 ,$49.00 , N/A ,$7.00 ,$4.67 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$5.47 ,$41.65 , N/A ,$5.47 ,$5.47 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$4.51 ,$4.51 ,$29.84 ,$4.51 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2704,PROPOFOL 1000 MG/100ML EMUL per10 mg,636,1 ,$2.52 ,$1.66 ,$0.19 ,$2.52 , N/A ,$0.29 ,$0.20 , N/A ,$1.51 ,$2.14 ,$1.76 , N/A , N/A ,$2.39 ,$1.92 ,$1.89 ,$0.24 ,$2.14 , N/A ,$0.24 ,$0.24 ,$1.76 ,$1.53 , N/A , N/A , N/A , N/A , N/A ,$2.14 , N/A ,$2.32 ,$1.76 ,$0.19 ,$0.19 ,$1.53 ,$0.19 ,$1.74 ,$2.27 ,$1.72 , N/A ,$1.99 , N/A , N/A , N/A , N/A , N/A ,$1.81 ,$1.56 ,$1.81 ,$1.81 ,$2.02 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2704,PROPOFOL 200 MG/20ML EMUL per10 mg,636,1 ,$3.76 ,$2.48 ,$0.19 ,$3.76 , N/A ,$0.29 ,$0.20 , N/A ,$2.26 ,$3.20 ,$2.63 , N/A , N/A ,$3.57 ,$2.86 ,$2.82 ,$0.24 ,$3.20 , N/A ,$0.24 ,$0.24 ,$2.63 ,$2.29 , N/A , N/A , N/A , N/A , N/A ,$3.20 , N/A ,$3.46 ,$2.63 ,$0.19 ,$0.19 ,$2.29 ,$0.19 ,$2.60 ,$3.38 ,$2.57 , N/A ,$2.97 , N/A , N/A , N/A , N/A , N/A ,$2.71 ,$2.33 ,$2.71 ,$2.71 ,$3.01 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2704,PROPOFOL 500 MG/50ML EMUL per10 mg,636,1 ,$2.83 ,$1.87 ,$0.19 ,$2.83 , N/A ,$0.29 ,$0.20 , N/A ,$1.70 ,$2.41 ,$1.98 , N/A , N/A ,$2.69 ,$2.15 ,$2.12 ,$0.24 ,$2.41 , N/A ,$0.24 ,$0.24 ,$1.98 ,$1.72 , N/A , N/A , N/A , N/A , N/A ,$2.41 , N/A ,$2.60 ,$1.98 ,$0.19 ,$0.19 ,$1.72 ,$0.19 ,$1.96 ,$2.55 ,$1.93 , N/A ,$2.24 , N/A , N/A , N/A , N/A , N/A ,$2.04 ,$1.75 ,$2.04 ,$2.04 ,$2.26 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2720,PROTAMINE 10 MG/ML SOLN 5 ML VIAL per10 mg,636,1 ,$19.87 ,$13.11 ,$1.26 ,$19.87 , N/A ,$1.96 ,$1.31 , N/A ,$11.92 ,$16.89 ,$13.91 , N/A , N/A ,$18.88 ,$15.10 ,$14.90 ,$1.73 ,$16.89 , N/A ,$1.73 ,$1.73 ,$13.91 ,$12.10 , N/A , N/A , N/A , N/A , N/A ,$16.89 , N/A ,$18.28 ,$13.91 ,$1.26 ,$1.26 ,$12.10 ,$1.26 ,$13.73 ,$17.88 ,$13.58 , N/A ,$15.70 , N/A , N/A , N/A , N/A , N/A ,$14.31 ,$12.32 ,$14.31 ,$14.31 ,$15.90 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2720,PROTAMINE 10 MG/ML SOLN per10 mg,636,1 ,$11.91 ,$7.86 ,$1.26 ,$11.91 , N/A ,$1.96 ,$1.31 , N/A ,$7.15 ,$10.12 ,$8.34 , N/A , N/A ,$11.31 ,$9.05 ,$8.93 ,$1.73 ,$10.12 , N/A ,$1.73 ,$1.73 ,$8.34 ,$7.25 , N/A , N/A , N/A , N/A , N/A ,$10.12 , N/A ,$10.96 ,$8.34 ,$1.26 ,$1.26 ,$7.25 ,$1.26 ,$8.23 ,$10.72 ,$8.14 , N/A ,$9.41 , N/A , N/A , N/A , N/A , N/A ,$8.58 ,$7.38 ,$8.58 ,$8.58 ,$9.53 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7168,PROTHROMBIN COMPLEX CONCENTRATE (HUMAN) 500 UNITS KIT per1 Int'l Units,636,1 ,$7.84 ,$5.17 ,$2.14 ,$75.53 ,$71.25 ,$5.37 ,$5.37 ,$2.18 ,$4.70 ,$6.66 ,$5.49 ,$71.25 ,$7.84 ,$7.45 ,$5.96 ,$5.88 ,$4.05 ,$6.66 ,$2.18 ,$4.05 ,$4.05 ,$5.49 ,$4.77 ,$71.25 ,$2.18 ,$2.14 ,$4.36 ,$8.31 ,$6.66 ,$4.91 ,$7.21 ,$5.49 ,$3.98 ,$4.77 ,$4.77 ,$4.77 ,$5.42 ,$7.06 ,$5.36 ,$2.16 ,$6.19 ,$75.53 ,$3.45 ,$3.45 ,$2.14 ,$3.45 ,$5.64 ,$4.86 ,$5.64 ,$5.64 ,$6.27 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7168,PROTHROMBIN COMPLEX CONCENTRATE (HUMAN) 1000 UNITS KIT per1 Int'l Units,636,1 ,$7.84 ,$5.17 ,$2.14 ,$75.53 ,$71.25 ,$5.37 ,$5.37 ,$2.18 ,$4.70 ,$6.66 ,$5.49 ,$71.25 ,$7.84 ,$7.45 ,$5.96 ,$5.88 ,$4.05 ,$6.66 ,$2.18 ,$4.05 ,$4.05 ,$5.49 ,$4.77 ,$71.25 ,$2.18 ,$2.14 ,$4.36 ,$8.31 ,$6.66 ,$4.91 ,$7.21 ,$5.49 ,$3.98 ,$4.77 ,$4.77 ,$4.77 ,$5.42 ,$7.06 ,$5.36 ,$2.16 ,$6.19 ,$75.53 ,$3.45 ,$3.45 ,$2.14 ,$3.45 ,$5.64 ,$4.86 ,$5.64 ,$5.64 ,$6.27 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3415,PYRIDOXINE 100 MG/ML SOLN per100 mg,636,1 ,$61.15 ,$40.36 ,$8.15 ,$61.15 , N/A ,$12.65 ,$8.43 , N/A ,$36.69 ,$51.98 ,$42.81 , N/A , N/A ,$58.09 ,$46.47 ,$45.86 ,$21.59 ,$51.98 , N/A ,$21.59 ,$21.59 ,$42.81 ,$37.24 , N/A , N/A , N/A , N/A , N/A ,$51.98 , N/A ,$56.26 ,$42.81 ,$8.15 ,$8.15 ,$37.24 ,$8.15 ,$42.25 ,$55.04 ,$41.78 , N/A ,$48.31 , N/A , N/A , N/A , N/A , N/A ,$44.03 ,$37.91 ,$44.03 ,$44.03 ,$48.92 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90376,RABIES IMMUNE GLOBULIN 300 UNIT/2ML SOLN per1 mL,636,1 ,"$1,267.20 ",$836.35 ,$47.85 ,"$1,267.20 ",$47.85 ,$667.67 ,$445.11 ,$296.74 ,$760.32 ,"$1,077.12 ",$887.04 ,$47.85 ,$47.85 ,"$1,203.84 ",$963.07 ,$950.40 ,$545.46 ,"$1,077.12 ",$296.74 ,$545.46 ,$545.46 ,$887.04 ,$771.72 ,$47.85 ,$296.74 ,$290.81 ,$593.48 ,$50.72 ,"$1,077.12 ",$667.67 ,"$1,165.82 ",$887.04 ,$430.27 ,$430.27 ,$771.72 ,$430.27 ,$875.64 ,"$1,140.48 ",$865.75 ,$293.72 ,"$1,001.09 ",$50.72 ,$529.42 ,$529.42 ,$290.81 ,$529.42 ,$912.38 ,$785.66 ,$912.38 ,$912.38 ,"$1,013.76 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,90375,RABIES IMMUNE GLOBULIN 300 UNIT/ML SOLN per150 Units,636,1 ,$985.55 ,$650.46 ,$47.85 ,$985.55 ,$47.85 ,$756.45 ,$504.30 ,$336.20 ,$591.33 ,$837.72 ,$689.89 ,$47.85 ,$47.85 ,$936.27 ,$749.02 ,$739.16 ,$473.01 ,$837.72 ,$336.20 ,$473.01 ,$473.01 ,$689.89 ,$600.20 ,$47.85 ,$336.20 ,$329.48 ,$672.40 ,$50.72 ,$837.72 ,$756.45 ,$906.71 ,$689.89 ,$487.49 ,$487.49 ,$600.20 ,$487.49 ,$681.02 ,$887.00 ,$673.33 ,$332.77 ,$778.58 ,$50.72 ,$459.10 ,$459.10 ,$329.48 ,$459.10 ,$709.60 ,$611.04 ,$709.60 ,$709.60 ,$788.44 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90375,RABIES IMMUNE GLOBULIN 1500 UNIT/5ML SOLN per150 Units,636,1 ,$985.55 ,$650.46 ,$47.85 ,$985.55 ,$47.85 ,$756.45 ,$504.30 ,$336.20 ,$591.33 ,$837.72 ,$689.89 ,$47.85 ,$47.85 ,$936.27 ,$749.02 ,$739.16 ,$473.01 ,$837.72 ,$336.20 ,$473.01 ,$473.01 ,$689.89 ,$600.20 ,$47.85 ,$336.20 ,$329.48 ,$672.40 ,$50.72 ,$837.72 ,$756.45 ,$906.71 ,$689.89 ,$487.49 ,$487.49 ,$600.20 ,$487.49 ,$681.02 ,$887.00 ,$673.33 ,$332.77 ,$778.58 ,$50.72 ,$459.10 ,$459.10 ,$329.48 ,$459.10 ,$709.60 ,$611.04 ,$709.60 ,$709.60 ,$788.44 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90675,RABIES VACCINE SUSR per1 mL,636,1 ,"$1,796.70 ","$1,185.82 ",$3.86 ,"$1,796.70 ",$3.86 ,$770.00 ,$513.33 ,$342.22 ,"$1,078.02 ","$1,527.20 ","$1,257.69 ",$3.86 ,$3.86 ,"$1,706.87 ","$1,365.49 ","$1,347.53 ",$603.87 ,"$1,527.20 ",$342.22 ,$603.87 ,$603.87 ,"$1,257.69 ","$1,094.19 ",$3.86 ,$342.22 ,$335.38 ,$684.44 ,$4.09 ,"$1,527.20 ",$770.00 ,"$1,652.96 ","$1,257.69 ",$496.22 ,$496.22 ,"$1,094.19 ",$496.22 ,"$1,241.52 ","$1,617.03 ","$1,227.51 ",$338.73 ,"$1,419.39 ",$4.09 ,$586.11 ,$586.11 ,$335.38 ,$586.11 ,"$1,293.62 ","$1,113.95 ","$1,293.62 ","$1,293.62 ","$1,437.36 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,90675,RABIES VIRUS VACCINE INJ per1 mL,636,1 ,"$1,920.50 ","$1,267.53 ",$3.86 ,"$1,920.50 ",$3.86 ,$770.00 ,$513.33 ,$342.22 ,"$1,152.30 ","$1,632.43 ","$1,344.35 ",$3.86 ,$3.86 ,"$1,824.48 ","$1,459.58 ","$1,440.38 ",$603.87 ,"$1,632.43 ",$342.22 ,$603.87 ,$603.87 ,"$1,344.35 ","$1,169.58 ",$3.86 ,$342.22 ,$335.38 ,$684.44 ,$4.09 ,"$1,632.43 ",$770.00 ,"$1,766.86 ","$1,344.35 ",$496.22 ,$496.22 ,"$1,169.58 ",$496.22 ,"$1,327.07 ","$1,728.45 ","$1,312.09 ",$338.73 ,"$1,517.20 ",$4.09 ,$586.11 ,$586.11 ,$335.38 ,$586.11 ,"$1,382.76 ","$1,190.71 ","$1,382.76 ","$1,382.76 ","$1,536.40 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2785,REGADENOSON 0.4 MG/5ML SOLN per0.1 mg,636,1 ,$461.71 ,$304.73 ,$89.89 ,$461.71 , N/A ,$139.48 ,$92.99 , N/A ,$277.03 ,$392.45 ,$323.20 , N/A , N/A ,$438.62 ,$350.90 ,$346.28 ,$103.96 ,$392.45 , N/A ,$103.96 ,$103.96 ,$323.20 ,$281.18 , N/A , N/A , N/A , N/A , N/A ,$392.45 , N/A ,$424.77 ,$323.20 ,$89.89 ,$89.89 ,$281.18 ,$89.89 ,$319.04 ,$415.54 ,$315.44 , N/A ,$364.75 , N/A , N/A , N/A , N/A , N/A ,$332.43 ,$286.26 ,$332.43 ,$332.43 ,$369.37 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0248,REMDESIVIR 100 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$15.29 ,$10.09 ,$5.40 ,$15.29 ,$5.51 ,$12.40 ,$8.27 ,$5.51 ,$9.17 ,$13.00 ,$10.70 ,$5.51 ,$5.51 ,$14.53 ,$11.62 ,$11.47 ,$9.37 ,$13.00 ,$5.51 ,$9.37 ,$9.37 ,$10.70 ,$9.31 ,$5.51 ,$5.51 ,$5.40 ,$11.02 ,$5.84 ,$13.00 ,$12.40 ,$14.07 ,$10.70 ,$7.99 ,$7.99 ,$9.31 ,$7.99 ,$10.57 ,$13.76 ,$10.45 ,$5.46 ,$12.08 ,$5.84 ,$9.09 ,$9.09 ,$5.40 ,$9.09 ,$11.01 ,$9.48 ,$11.01 ,$11.01 ,$12.23 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2791,RHO D IMMUNE GLOBULIN 1500 UNIT/2ML SOSY per100 Units,636,1 ,$78.91 ,$52.08 ,$1.81 ,$78.91 ,$1.81 ,$11.12 ,$7.41 , N/A ,$47.35 ,$67.07 ,$55.24 ,$1.81 ,$1.81 ,$74.96 ,$59.97 ,$59.18 ,$8.47 ,$67.07 , N/A ,$8.47 ,$8.47 ,$55.24 ,$48.06 ,$1.81 , N/A , N/A , N/A ,$1.92 ,$67.07 , N/A ,$72.60 ,$55.24 ,$7.16 ,$7.16 ,$48.06 ,$7.16 ,$54.53 ,$71.02 ,$53.91 , N/A ,$62.34 ,$1.92 , N/A , N/A , N/A , N/A ,$56.82 ,$48.92 ,$56.82 ,$56.82 ,$63.13 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9312,RITUXIMAB 100 MG/10ML SOLN per10 mg,636,1 ,$434.06 ,$286.48 ,$79.57 ,$434.06 ,$115.47 ,$182.68 ,$121.79 ,$81.19 ,$260.44 ,$368.95 ,$303.84 ,$115.47 ,$115.47 ,$412.36 ,$329.89 ,$325.55 ,$138.98 ,$368.95 ,$81.19 ,$138.98 ,$138.98 ,$303.84 ,$264.34 ,$115.47 ,$81.19 ,$79.57 ,$162.38 ,$122.40 ,$368.95 ,$182.67 ,$399.34 ,$303.84 ,$117.73 ,$117.73 ,$264.34 ,$117.73 ,$299.94 ,$390.65 ,$296.55 ,$80.36 ,$342.91 ,$122.40 ,$134.89 ,$134.89 ,$79.57 ,$134.89 ,$312.52 ,$269.12 ,$312.52 ,$312.52 ,$347.25 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9312,RITUXIMAB 500 MG/50ML SOLN per10 mg,636,1 ,$435.29 ,$287.29 ,$79.57 ,$435.29 ,$115.47 ,$182.68 ,$121.79 ,$81.19 ,$261.17 ,$370.00 ,$304.70 ,$115.47 ,$115.47 ,$413.53 ,$330.82 ,$326.47 ,$138.98 ,$370.00 ,$81.19 ,$138.98 ,$138.98 ,$304.70 ,$265.09 ,$115.47 ,$81.19 ,$79.57 ,$162.38 ,$122.40 ,$370.00 ,$182.67 ,$400.47 ,$304.70 ,$117.73 ,$117.73 ,$265.09 ,$117.73 ,$300.79 ,$391.76 ,$297.39 ,$80.36 ,$343.88 ,$122.40 ,$134.89 ,$134.89 ,$79.57 ,$134.89 ,$313.41 ,$269.88 ,$313.41 ,$313.41 ,$348.23 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q5119,RITUXIMAB-PVVR 100 MG/10ML SOLN per10 mg,636,1 ,$352.67 ,$232.76 ,$29.37 ,$352.67 ,$170.93 ,$67.43 ,$44.96 ,$29.97 ,$211.60 ,$299.77 ,$246.87 ,$170.93 ,$170.93 ,$335.04 ,$268.03 ,$264.50 ,$55.56 ,$299.77 ,$29.97 ,$55.56 ,$55.56 ,$246.87 ,$214.78 ,$170.93 ,$29.97 ,$29.37 ,$59.94 ,$181.19 ,$299.77 ,$67.44 ,$324.46 ,$246.87 ,$43.46 ,$43.46 ,$214.78 ,$43.46 ,$243.70 ,$317.40 ,$240.94 ,$29.66 ,$278.61 ,$181.19 ,$53.92 ,$53.92 ,$29.37 ,$53.92 ,$253.92 ,$218.66 ,$253.92 ,$253.92 ,$282.14 
ST NICHOLAS HOSPITAL - ACUTE,63600002,Q5119,RITUXIMAB-PVVR 500 MG/50ML SOLN per10 mg,636,1 ,$353.90 ,$233.57 ,$29.37 ,$353.90 ,$170.93 ,$67.43 ,$44.96 ,$29.97 ,$212.34 ,$300.82 ,$247.73 ,$170.93 ,$170.93 ,$336.21 ,$268.96 ,$265.43 ,$55.56 ,$300.82 ,$29.97 ,$55.56 ,$55.56 ,$247.73 ,$215.53 ,$170.93 ,$29.97 ,$29.37 ,$59.94 ,$181.19 ,$300.82 ,$67.44 ,$325.59 ,$247.73 ,$43.46 ,$43.46 ,$215.53 ,$43.46 ,$244.54 ,$318.51 ,$241.78 ,$29.66 ,$279.58 ,$181.19 ,$53.92 ,$53.92 ,$29.37 ,$53.92 ,$254.81 ,$219.42 ,$254.81 ,$254.81 ,$283.12 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J2795,ROPIVACAINE 0.2 % 2 MG/ML SOLN per1 mg,636,1 ,$1.43 ,$0.94 ,$0.12 ,$1.43 , N/A ,$0.18 ,$0.12 , N/A ,$0.86 ,$1.22 ,$1.00 , N/A , N/A ,$1.36 ,$1.09 ,$1.07 ,$0.12 ,$1.22 , N/A ,$0.12 ,$0.12 ,$1.00 ,$0.87 , N/A , N/A , N/A , N/A , N/A ,$1.22 , N/A ,$1.32 ,$1.00 ,$0.12 ,$0.12 ,$0.87 ,$0.12 ,$0.99 ,$1.29 ,$0.98 , N/A ,$1.13 , N/A , N/A , N/A , N/A , N/A ,$1.03 ,$0.89 ,$1.03 ,$1.03 ,$1.14 
ST NICHOLAS HOSPITAL - ACUTE,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 , N/A ,$0.83 ,$1.18 ,$0.97 , N/A , N/A ,$1.32 ,$1.06 ,$1.04 ,$0.12 ,$1.18 , N/A ,$0.12 ,$0.12 ,$0.97 ,$0.85 , N/A , N/A , N/A , N/A , N/A ,$1.18 , N/A ,$1.28 ,$0.97 ,$0.12 ,$0.12 ,$0.85 ,$0.12 ,$0.96 ,$1.25 ,$0.95 , N/A ,$1.10 , N/A , N/A , N/A , N/A , N/A ,$1.00 ,$0.86 ,$1.00 ,$1.00 ,$1.11 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7999,ROPIVACAINE-CLONIDINE-KETOROLAC 123-0.04-15 MG/50 ML SOSY per50 mL,636,1 ,$369.00 ,$243.54 ,$187.16 ,$369.00 , N/A ,$252.91 ,$252.91 , N/A ,$221.40 ,$313.65 ,$258.30 , N/A , N/A ,$350.55 ,$280.44 ,$276.75 , N/A ,$313.65 , N/A , N/A , N/A ,$258.30 ,$224.72 , N/A , N/A , N/A , N/A , N/A ,$313.65 , N/A ,$339.48 ,$258.30 ,$187.16 ,$224.61 ,$224.72 ,$224.61 ,$254.98 ,$332.10 ,$252.10 , N/A ,$291.51 , N/A , N/A , N/A , N/A , N/A ,$265.68 ,$228.78 ,$265.68 ,$265.68 ,$295.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7030,SODIUM CHLORIDE 0.9% SOLN per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.74 ,$106.00 , N/A ,$5.81 ,$3.87 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$4.49 ,$90.10 , N/A ,$4.49 ,$4.49 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$3.74 ,$3.74 ,$64.55 ,$3.74 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7030,SODIUM CHLORIDE 0.9 % SOLN 10 ML VIAL per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.74 ,$106.00 , N/A ,$5.81 ,$3.87 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$4.49 ,$90.10 , N/A ,$4.49 ,$4.49 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$3.74 ,$3.74 ,$64.55 ,$3.74 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7030,SODIUM CHLORIDE 0.9 % SOLN 20 ML VIAL per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.74 ,$106.00 , N/A ,$5.81 ,$3.87 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$4.49 ,$90.10 , N/A ,$4.49 ,$4.49 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$3.74 ,$3.74 ,$64.55 ,$3.74 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7030,SODIUM CHLORIDE 0.9 % SOLN 50 ML VIAL per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.74 ,$106.00 , N/A ,$5.81 ,$3.87 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A , N/A ,$100.70 ,$80.56 ,$79.50 ,$4.49 ,$90.10 , N/A ,$4.49 ,$4.49 ,$74.20 ,$64.55 , N/A , N/A , N/A , N/A , N/A ,$90.10 , N/A ,$97.52 ,$74.20 ,$3.74 ,$3.74 ,$64.55 ,$3.74 ,$73.25 ,$95.40 ,$72.42 , N/A ,$83.74 , N/A , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7131,SODIUM CHLORIDE 3 % SOLN per1 mL,636,1 ,$0.21 ,$0.14 ,$0.07 ,$0.21 , N/A ,$0.14 ,$0.14 , N/A ,$0.13 ,$0.18 ,$0.15 , N/A , N/A ,$0.20 ,$0.16 ,$0.16 ,$0.07 ,$0.18 , N/A ,$0.07 ,$0.07 ,$0.15 ,$0.13 , N/A , N/A , N/A , N/A , N/A ,$0.18 , N/A ,$0.19 ,$0.15 ,$0.11 ,$0.13 ,$0.13 ,$0.13 ,$0.15 ,$0.19 ,$0.14 , N/A ,$0.17 , N/A , N/A , N/A , N/A , N/A ,$0.15 ,$0.13 ,$0.15 ,$0.15 ,$0.17 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7131,SODIUM CHLORIDE 3% per1 mL,636,1 ,$2.12 ,$1.40 ,$0.07 ,$2.12 , N/A ,$1.45 ,$1.45 , N/A ,$1.27 ,$1.80 ,$1.48 , N/A , N/A ,$2.01 ,$1.61 ,$1.59 ,$0.07 ,$1.80 , N/A ,$0.07 ,$0.07 ,$1.48 ,$1.29 , N/A , N/A , N/A , N/A , N/A ,$1.80 , N/A ,$1.95 ,$1.48 ,$1.08 ,$1.29 ,$1.29 ,$1.29 ,$1.46 ,$1.91 ,$1.45 , N/A ,$1.67 , N/A , N/A , N/A , N/A , N/A ,$1.53 ,$1.31 ,$1.53 ,$1.53 ,$1.70 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0330,SUCCINYLCHOLINE 100 MG/5ML SOSY per20 mg,636,1 ,$36.90 ,$24.35 ,$1.55 ,$36.90 , N/A ,$25.29 ,$25.29 , N/A ,$22.14 ,$31.37 ,$25.83 , N/A , N/A ,$35.06 ,$28.04 ,$27.68 ,$1.55 ,$31.37 , N/A ,$1.55 ,$1.55 ,$25.83 ,$22.47 , N/A , N/A , N/A , N/A , N/A ,$31.37 , N/A ,$33.95 ,$25.83 ,$18.72 ,$22.46 ,$22.47 ,$22.46 ,$25.50 ,$33.21 ,$25.21 , N/A ,$29.15 , N/A , N/A , N/A , N/A , N/A ,$26.57 ,$22.88 ,$26.57 ,$26.57 ,$29.52 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J0330,SUCCINYLCHOLINE 20 MG/ML SOLN per20 mg,636,1 ,$14.75 ,$9.74 ,$1.55 ,$14.75 , N/A ,$10.11 ,$10.11 , N/A ,$8.85 ,$12.54 ,$10.33 , N/A , N/A ,$14.01 ,$11.21 ,$11.06 ,$1.55 ,$12.54 , N/A ,$1.55 ,$1.55 ,$10.33 ,$8.98 , N/A , N/A , N/A , N/A , N/A ,$12.54 , N/A ,$13.57 ,$10.33 ,$7.48 ,$8.98 ,$8.98 ,$8.98 ,$10.19 ,$13.28 ,$10.08 , N/A ,$11.65 , N/A , N/A , N/A , N/A , N/A ,$10.62 ,$9.15 ,$10.62 ,$10.62 ,$11.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3030,SUMATRIPTAN SUCCINATE 6 MG/0.5ML SOLN per6 mg,636,1 ,$352.75 ,$232.82 ,$37.20 ,$352.75 , N/A ,$241.77 ,$241.77 , N/A ,$211.65 ,$299.84 ,$246.93 , N/A , N/A ,$335.11 ,$268.09 ,$264.56 ,$37.20 ,$299.84 , N/A ,$37.20 ,$37.20 ,$246.93 ,$214.82 , N/A , N/A , N/A , N/A , N/A ,$299.84 , N/A ,$324.53 ,$246.93 ,$178.91 ,$214.72 ,$214.82 ,$214.72 ,$243.75 ,$317.48 ,$241.00 , N/A ,$278.67 , N/A , N/A , N/A , N/A , N/A ,$253.98 ,$218.71 ,$253.98 ,$253.98 ,$282.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7507,TACROLIMUS 0.5 MG CAPS per1 mg,636,1 ,$8.00 ,$5.28 ,$0.51 ,$8.00 , N/A ,$0.79 ,$0.53 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$0.51 ,$6.80 , N/A ,$0.51 ,$0.51 ,$5.60 ,$4.87 , N/A , N/A , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$0.51 ,$0.51 ,$4.87 ,$0.51 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A , N/A , N/A , N/A , N/A ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J7507,TACROLIMUS 1 MG CAPS per1 mg,636,1 ,$15.20 ,$10.03 ,$0.51 ,$15.20 , N/A ,$0.79 ,$0.53 , N/A ,$9.12 ,$12.92 ,$10.64 , N/A , N/A ,$14.44 ,$11.55 ,$11.40 ,$0.51 ,$12.92 , N/A ,$0.51 ,$0.51 ,$10.64 ,$9.26 , N/A , N/A , N/A , N/A , N/A ,$12.92 , N/A ,$13.98 ,$10.64 ,$0.51 ,$0.51 ,$9.26 ,$0.51 ,$10.50 ,$13.68 ,$10.38 , N/A ,$12.01 , N/A , N/A , N/A , N/A , N/A ,$10.94 ,$9.42 ,$10.94 ,$10.94 ,$12.16 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1447,TBO-FILGRASTIM 300 MCG/0.5ML SOSY per1 mcg,636,1 ,$3.15 ,$2.08 ,$0.38 ,$9.64 ,$9.09 ,$0.88 ,$0.59 ,$0.39 ,$1.89 ,$2.68 ,$2.21 ,$9.09 ,$3.15 ,$2.99 ,$2.39 ,$2.36 ,$0.70 ,$2.68 ,$0.39 ,$0.70 ,$0.70 ,$2.21 ,$1.92 ,$9.09 ,$0.39 ,$0.38 ,$0.78 ,$3.34 ,$2.68 ,$0.87 ,$2.90 ,$2.21 ,$0.57 ,$0.57 ,$1.92 ,$0.57 ,$2.18 ,$2.84 ,$2.15 ,$0.38 ,$2.49 ,$9.64 ,$0.68 ,$0.68 ,$0.38 ,$0.68 ,$2.27 ,$1.95 ,$2.27 ,$2.27 ,$2.52 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J1447,TBO-FILGRASTIM 480 MCG/0.8ML SOSY per1 mcg,636,1 ,$3.15 ,$2.08 ,$0.38 ,$9.64 ,$9.09 ,$0.88 ,$0.59 ,$0.39 ,$1.89 ,$2.68 ,$2.21 ,$9.09 ,$3.15 ,$2.99 ,$2.39 ,$2.36 ,$0.70 ,$2.68 ,$0.39 ,$0.70 ,$0.70 ,$2.21 ,$1.92 ,$9.09 ,$0.39 ,$0.38 ,$0.78 ,$3.34 ,$2.68 ,$0.87 ,$2.90 ,$2.21 ,$0.57 ,$0.57 ,$1.92 ,$0.57 ,$2.18 ,$2.84 ,$2.15 ,$0.38 ,$2.49 ,$9.64 ,$0.68 ,$0.68 ,$0.38 ,$0.68 ,$2.27 ,$1.95 ,$2.27 ,$2.27 ,$2.52 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90715,TDAP 5-2.5-18.5 LF-MCG/0.5 SUSY per0.5 mL,636,1 ,$221.25 ,$146.03 ,$0.95 ,$221.25 ,$0.95 ,$84.67 ,$56.45 , N/A ,$132.75 ,$188.06 ,$154.88 ,$0.95 ,$0.95 ,$210.19 ,$168.15 ,$165.94 ,$63.75 ,$188.06 , N/A ,$63.75 ,$63.75 ,$154.88 ,$134.74 ,$0.95 , N/A , N/A , N/A ,$1.01 ,$188.06 , N/A ,$203.55 ,$154.88 ,$54.56 ,$54.56 ,$134.74 ,$54.56 ,$152.88 ,$199.13 ,$151.16 , N/A ,$174.79 ,$1.01 , N/A , N/A , N/A , N/A ,$159.30 ,$137.18 ,$159.30 ,$159.30 ,$177.00 
ST NICHOLAS HOSPITAL - ACUTE,63600002,90715,TDAP 5-2.5-18.5 LF-MCG/0.5 SUSP per0.5 mL,636,1 ,$221.25 ,$146.03 ,$0.95 ,$221.25 ,$0.95 ,$84.67 ,$56.45 , N/A ,$132.75 ,$188.06 ,$154.88 ,$0.95 ,$0.95 ,$210.19 ,$168.15 ,$165.94 ,$63.75 ,$188.06 , N/A ,$63.75 ,$63.75 ,$154.88 ,$134.74 ,$0.95 , N/A , N/A , N/A ,$1.01 ,$188.06 , N/A ,$203.55 ,$154.88 ,$54.56 ,$54.56 ,$134.74 ,$54.56 ,$152.88 ,$199.13 ,$151.16 , N/A ,$174.79 ,$1.01 , N/A , N/A , N/A , N/A ,$159.30 ,$137.18 ,$159.30 ,$159.30 ,$177.00 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3101,TENECTEPLASE 50 MG KIT per1 mg,636,1 ,$407.36 ,$268.86 ,$140.82 ,$407.36 ,$170.93 ,$323.30 ,$215.54 ,$143.69 ,$244.42 ,$346.26 ,$285.15 ,$170.93 ,$170.93 ,$386.99 ,$309.59 ,$305.52 ,$244.21 ,$346.26 ,$143.69 ,$244.21 ,$244.21 ,$285.15 ,$248.08 ,$170.93 ,$143.69 ,$140.82 ,$287.38 ,$181.19 ,$346.26 ,$323.31 ,$374.77 ,$285.15 ,$208.35 ,$208.35 ,$248.08 ,$208.35 ,$281.49 ,$366.62 ,$278.31 ,$142.23 ,$321.81 ,$181.19 ,$237.02 ,$237.02 ,$140.82 ,$237.02 ,$293.30 ,$252.56 ,$293.30 ,$293.30 ,$325.89 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3105,TERBUTALINE 1 MG/ML SOLN per1 mg,636,1 ,$49.00 ,$32.34 ,$1.22 ,$49.00 , N/A ,$1.89 ,$1.26 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$2.24 ,$41.65 , N/A ,$2.24 ,$2.24 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.22 ,$1.22 ,$29.84 ,$1.22 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3411,THIAMINE 100 MG/ML SOLN 2 ML VIAL per100 mg,636,1 ,$49.00 ,$32.34 ,$3.19 ,$49.00 , N/A ,$4.95 ,$3.30 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$4.76 ,$41.65 , N/A ,$4.76 ,$4.76 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$3.19 ,$3.19 ,$29.84 ,$3.19 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3590,THROMBIN 5000 UNIT SOLR 1 EACH VIAL per1 Units,636,1 ,$532.35 ,$351.35 ,$270.01 ,$532.35 , N/A ,$364.87 ,$364.87 , N/A ,$319.41 ,$452.50 ,$372.65 , N/A , N/A ,$505.73 ,$404.59 ,$399.26 , N/A ,$452.50 , N/A , N/A , N/A ,$372.65 ,$324.20 , N/A , N/A , N/A , N/A , N/A ,$452.50 , N/A ,$489.76 ,$372.65 ,$270.01 ,$324.04 ,$324.20 ,$324.04 ,$367.85 ,$479.12 ,$363.70 , N/A ,$420.56 , N/A , N/A , N/A , N/A , N/A ,$383.29 ,$330.06 ,$383.29 ,$383.29 ,$425.88 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3590,THROMBIN 5000 UNITS KIT 1 EACH BOX per1 Units,636,1 ,$0.11 ,$0.07 ,$0.06 ,$0.11 , N/A ,$0.08 ,$0.08 , N/A ,$0.07 ,$0.09 ,$0.08 , N/A , N/A ,$0.10 ,$0.08 ,$0.08 , N/A ,$0.09 , N/A , N/A , N/A ,$0.08 ,$0.07 , N/A , N/A , N/A , N/A , N/A ,$0.09 , N/A ,$0.10 ,$0.08 ,$0.06 ,$0.07 ,$0.07 ,$0.07 ,$0.08 ,$0.10 ,$0.08 , N/A ,$0.09 , N/A , N/A , N/A , N/A , N/A ,$0.08 ,$0.07 ,$0.08 ,$0.08 ,$0.09 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3260,TOBRAMYCIN 1.2 G SOLR per80 mg,636,1 ,$41.00 ,$27.06 ,$3.39 ,$41.00 , N/A ,$5.27 ,$3.51 , N/A ,$24.60 ,$34.85 ,$28.70 , N/A , N/A ,$38.95 ,$31.16 ,$30.75 ,$4.62 ,$34.85 , N/A ,$4.62 ,$4.62 ,$28.70 ,$24.97 , N/A , N/A , N/A , N/A , N/A ,$34.85 , N/A ,$37.72 ,$28.70 ,$3.39 ,$3.39 ,$24.97 ,$3.39 ,$28.33 ,$36.90 ,$28.01 , N/A ,$32.39 , N/A , N/A , N/A , N/A , N/A ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3262,TOCILIZUMAB 162 MG/0.9ML SOSY 0.9 ML SYRINGE per1 mg,636,1 ,$19.53 ,$12.89 ,$5.74 ,$41.86 ,$39.49 ,$13.19 ,$8.79 ,$5.86 ,$11.72 ,$16.60 ,$13.67 ,$39.49 ,$19.53 ,$18.55 ,$14.84 ,$14.65 ,$10.18 ,$16.60 ,$5.86 ,$10.18 ,$10.18 ,$13.67 ,$11.89 ,$39.49 ,$5.86 ,$5.74 ,$11.72 ,$20.70 ,$16.60 ,$13.19 ,$17.97 ,$13.67 ,$8.50 ,$8.50 ,$11.89 ,$8.50 ,$13.50 ,$17.58 ,$13.34 ,$5.80 ,$15.43 ,$41.86 ,$9.88 ,$9.88 ,$5.74 ,$9.88 ,$14.06 ,$12.11 ,$14.06 ,$14.06 ,$15.62 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3262,TOCILIZUMAB 400 MG/20ML SOLN 20 ML VIAL per1 mg,636,1 ,$25.05 ,$16.53 ,$5.74 ,$41.86 ,$39.49 ,$13.19 ,$8.79 ,$5.86 ,$15.03 ,$21.29 ,$17.54 ,$39.49 ,$25.05 ,$23.80 ,$19.04 ,$18.79 ,$10.18 ,$21.29 ,$5.86 ,$10.18 ,$10.18 ,$17.54 ,$15.26 ,$39.49 ,$5.86 ,$5.74 ,$11.72 ,$26.55 ,$21.29 ,$13.19 ,$23.05 ,$17.54 ,$8.50 ,$8.50 ,$15.26 ,$8.50 ,$17.31 ,$22.55 ,$17.11 ,$5.80 ,$19.79 ,$41.86 ,$9.88 ,$9.88 ,$5.74 ,$9.88 ,$18.04 ,$15.53 ,$18.04 ,$18.04 ,$20.04 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3262,TOCILIZUMAB 400 MG/20ML SOLN 10 ML VIAL per1 mg,636,1 ,$25.05 ,$16.53 ,$5.74 ,$41.86 ,$39.49 ,$13.19 ,$8.79 ,$5.86 ,$15.03 ,$21.29 ,$17.54 ,$39.49 ,$25.05 ,$23.80 ,$19.04 ,$18.79 ,$10.18 ,$21.29 ,$5.86 ,$10.18 ,$10.18 ,$17.54 ,$15.26 ,$39.49 ,$5.86 ,$5.74 ,$11.72 ,$26.55 ,$21.29 ,$13.19 ,$23.05 ,$17.54 ,$8.50 ,$8.50 ,$15.26 ,$8.50 ,$17.31 ,$22.55 ,$17.11 ,$5.80 ,$19.79 ,$41.86 ,$9.88 ,$9.88 ,$5.74 ,$9.88 ,$18.04 ,$15.53 ,$18.04 ,$18.04 ,$20.04 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3262,TOCILIZUMAB 80 MG/4ML SOLN per1 mg,636,1 ,$23.52 ,$15.52 ,$5.74 ,$41.86 ,$39.49 ,$13.19 ,$8.79 ,$5.86 ,$14.11 ,$19.99 ,$16.46 ,$39.49 ,$23.52 ,$22.34 ,$17.88 ,$17.64 ,$10.18 ,$19.99 ,$5.86 ,$10.18 ,$10.18 ,$16.46 ,$14.32 ,$39.49 ,$5.86 ,$5.74 ,$11.72 ,$24.93 ,$19.99 ,$13.19 ,$21.64 ,$16.46 ,$8.50 ,$8.50 ,$14.32 ,$8.50 ,$16.25 ,$21.17 ,$16.07 ,$5.80 ,$18.58 ,$41.86 ,$9.88 ,$9.88 ,$5.74 ,$9.88 ,$16.93 ,$14.58 ,$16.93 ,$16.93 ,$18.82 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3301,TRIAMCINOLONE ACETONIDE 10 MG/ML SUSP per10 mg,636,1 ,$49.00 ,$32.34 ,$1.62 ,$49.00 , N/A ,$2.52 ,$1.68 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.80 ,$41.65 , N/A ,$1.80 ,$1.80 ,$34.30 ,$29.84 , N/A , N/A , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$1.62 ,$1.62 ,$29.84 ,$1.62 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A , N/A , N/A , N/A , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3301,TRIAMCINOLONE ACETONIDE 40 MG/ML SUSP per10 mg,636,1 ,$17.28 ,$11.40 ,$1.62 ,$17.28 , N/A ,$2.52 ,$1.68 , N/A ,$10.37 ,$14.69 ,$12.10 , N/A , N/A ,$16.42 ,$13.13 ,$12.96 ,$1.80 ,$14.69 , N/A ,$1.80 ,$1.80 ,$12.10 ,$10.52 , N/A , N/A , N/A , N/A , N/A ,$14.69 , N/A ,$15.90 ,$12.10 ,$1.62 ,$1.62 ,$10.52 ,$1.62 ,$11.94 ,$15.55 ,$11.81 , N/A ,$13.65 , N/A , N/A , N/A , N/A , N/A ,$12.44 ,$10.71 ,$12.44 ,$12.44 ,$13.82 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3358,USTEKINUMAB 130 MG/26ML SOLN 26 ML VIAL per1 mg,636,1 ,$64.18 ,$42.36 ,$12.00 ,$122.40 ,$115.47 ,$27.56 ,$18.38 ,$12.25 ,$38.51 ,$54.55 ,$44.93 ,$115.47 ,$64.18 ,$60.97 ,$48.78 ,$48.14 ,$20.83 ,$54.55 ,$12.25 ,$20.83 ,$20.83 ,$44.93 ,$39.09 ,$115.47 ,$12.25 ,$12.00 ,$24.50 ,$68.03 ,$54.55 ,$27.55 ,$59.05 ,$44.93 ,$17.76 ,$17.76 ,$39.09 ,$17.76 ,$44.35 ,$57.76 ,$43.85 ,$12.12 ,$50.70 ,$122.40 ,$20.21 ,$20.21 ,$12.00 ,$20.21 ,$46.21 ,$39.79 ,$46.21 ,$46.21 ,$51.34 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3370,VANCOMYCIN 1 G SOLR 1 EACH VIAL per500 mg,636,1 ,$59.20 ,$39.07 ,$3.61 ,$59.20 , N/A ,$5.60 ,$3.74 , N/A ,$35.52 ,$50.32 ,$41.44 , N/A , N/A ,$56.24 ,$44.99 ,$44.40 ,$4.86 ,$50.32 , N/A ,$4.86 ,$4.86 ,$41.44 ,$36.05 , N/A , N/A , N/A , N/A , N/A ,$50.32 , N/A ,$54.46 ,$41.44 ,$3.61 ,$3.61 ,$36.05 ,$3.61 ,$40.91 ,$53.28 ,$40.45 , N/A ,$46.77 , N/A , N/A , N/A , N/A , N/A ,$42.62 ,$36.70 ,$42.62 ,$42.62 ,$47.36 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3370,VANCOMYCIN 1.25 G SOLR 1 EACH VIAL per500 mg,636,1 ,$49.45 ,$32.64 ,$3.61 ,$49.45 , N/A ,$5.60 ,$3.74 , N/A ,$29.67 ,$42.03 ,$34.62 , N/A , N/A ,$46.98 ,$37.58 ,$37.09 ,$4.86 ,$42.03 , N/A ,$4.86 ,$4.86 ,$34.62 ,$30.12 , N/A , N/A , N/A , N/A , N/A ,$42.03 , N/A ,$45.49 ,$34.62 ,$3.61 ,$3.61 ,$30.12 ,$3.61 ,$34.17 ,$44.51 ,$33.78 , N/A ,$39.07 , N/A , N/A , N/A , N/A , N/A ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3370,VANCOMYCIN 500 MG SOLR 1 EACH VIAL per500 mg,636,1 ,$59.35 ,$39.17 ,$3.61 ,$59.35 , N/A ,$5.60 ,$3.74 , N/A ,$35.61 ,$50.45 ,$41.55 , N/A , N/A ,$56.38 ,$45.11 ,$44.51 ,$4.86 ,$50.45 , N/A ,$4.86 ,$4.86 ,$41.55 ,$36.14 , N/A , N/A , N/A , N/A , N/A ,$50.45 , N/A ,$54.60 ,$41.55 ,$3.61 ,$3.61 ,$36.14 ,$3.61 ,$41.01 ,$53.42 ,$40.55 , N/A ,$46.89 , N/A , N/A , N/A , N/A , N/A ,$42.73 ,$36.80 ,$42.73 ,$42.73 ,$47.48 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3370,VANCOMYCIN 1.5 G SOLR 1 EACH VIAL per500 mg,636,1 ,$59.35 ,$39.17 ,$3.61 ,$59.35 , N/A ,$5.60 ,$3.74 , N/A ,$35.61 ,$50.45 ,$41.55 , N/A , N/A ,$56.38 ,$45.11 ,$44.51 ,$4.86 ,$50.45 , N/A ,$4.86 ,$4.86 ,$41.55 ,$36.14 , N/A , N/A , N/A , N/A , N/A ,$50.45 , N/A ,$54.60 ,$41.55 ,$3.61 ,$3.61 ,$36.14 ,$3.61 ,$41.01 ,$53.42 ,$40.55 , N/A ,$46.89 , N/A , N/A , N/A , N/A , N/A ,$42.73 ,$36.80 ,$42.73 ,$42.73 ,$47.48 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3370,VANCOMYCIN 750 MG SOLR 1 EACH VIAL per500 mg,636,1 ,$35.78 ,$23.61 ,$3.61 ,$35.78 , N/A ,$5.60 ,$3.74 , N/A ,$21.47 ,$30.41 ,$25.05 , N/A , N/A ,$33.99 ,$27.19 ,$26.84 ,$4.86 ,$30.41 , N/A ,$4.86 ,$4.86 ,$25.05 ,$21.79 , N/A , N/A , N/A , N/A , N/A ,$30.41 , N/A ,$32.92 ,$25.05 ,$3.61 ,$3.61 ,$21.79 ,$3.61 ,$24.72 ,$32.20 ,$24.44 , N/A ,$28.27 , N/A , N/A , N/A , N/A , N/A ,$25.76 ,$22.18 ,$25.76 ,$25.76 ,$28.62 
ST NICHOLAS HOSPITAL - ACUTE,63600002,C9399,VASOPRESSIN 0.2 UNIT/ML SOLN per20 Units,636,1 ,"$1,598.55 ","$1,055.04 ",$810.78 ,"$1,598.55 ", N/A ,"$1,095.65 ","$1,095.65 ", N/A ,$959.13 ,"$1,358.77 ","$1,118.99 ", N/A , N/A ,"$1,518.62 ","$1,214.90 ","$1,198.91 ", N/A ,"$1,358.77 ", N/A , N/A , N/A ,"$1,118.99 ",$973.52 , N/A , N/A , N/A , N/A , N/A ,"$1,358.77 ",$959.13 ,"$1,470.67 ","$1,118.99 ",$810.78 ,$973.04 ,$973.52 ,$973.04 ,"$1,104.60 ","$1,438.70 ","$1,092.13 ", N/A ,"$1,262.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,150.96 ",$991.10 ,"$1,150.96 ","$1,150.96 ","$1,278.84 "
ST NICHOLAS HOSPITAL - ACUTE,63600002,C9399,VASOPRESSIN 20 UNIT/ML SOLN 1 ML VIAL per1 mL,636,1 ,"$1,006.70 ",$664.42 ,$510.60 ,"$1,006.70 ", N/A ,$689.99 ,$689.99 , N/A ,$604.02 ,$855.70 ,$704.69 , N/A , N/A ,$956.37 ,$765.09 ,$755.03 , N/A ,$855.70 , N/A , N/A , N/A ,$704.69 ,$613.08 , N/A , N/A , N/A , N/A , N/A ,$855.70 ,$604.02 ,$926.16 ,$704.69 ,$510.60 ,$612.78 ,$613.08 ,$612.78 ,$695.63 ,$906.03 ,$687.78 , N/A ,$795.29 , N/A , N/A , N/A , N/A , N/A ,$724.82 ,$624.15 ,$724.82 ,$724.82 ,$805.36 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3380,VEDOLIZUMAB 300 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$75.59 ,$49.89 ,$21.40 ,$181.19 ,$170.93 ,$49.14 ,$32.76 ,$21.84 ,$45.35 ,$64.25 ,$52.91 ,$170.93 ,$75.59 ,$71.81 ,$57.45 ,$56.69 ,$36.89 ,$64.25 ,$21.84 ,$36.89 ,$36.89 ,$52.91 ,$46.03 ,$170.93 ,$21.84 ,$21.40 ,$43.68 ,$80.13 ,$64.25 ,$49.14 ,$69.54 ,$52.91 ,$31.67 ,$31.67 ,$46.03 ,$31.67 ,$52.23 ,$68.03 ,$51.64 ,$21.62 ,$59.72 ,$181.19 ,$35.81 ,$35.81 ,$21.40 ,$35.81 ,$54.42 ,$46.87 ,$54.42 ,$54.42 ,$60.47 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J9370,VINCRISTINE 1 MG/ML SOLN 2 ML VIAL per1 mg,636,1 ,$57.58 ,$38.00 ,$7.03 ,$57.58 , N/A ,$10.91 ,$7.28 , N/A ,$34.55 ,$48.94 ,$40.31 , N/A , N/A ,$54.70 ,$43.76 ,$43.19 ,$8.40 ,$48.94 , N/A ,$8.40 ,$8.40 ,$40.31 ,$35.07 , N/A , N/A , N/A , N/A , N/A ,$48.94 , N/A ,$52.97 ,$40.31 ,$7.03 ,$7.03 ,$35.07 ,$7.03 ,$39.79 ,$51.82 ,$39.34 , N/A ,$45.49 , N/A , N/A , N/A , N/A , N/A ,$41.46 ,$35.70 ,$41.46 ,$41.46 ,$46.06 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3486,ZIPRASIDONE 20 MG SOLR per10 mg,636,1 ,$211.65 ,$139.69 ,$14.67 ,$211.65 , N/A ,$22.77 ,$15.18 , N/A ,$126.99 ,$179.90 ,$148.16 , N/A , N/A ,$201.07 ,$160.85 ,$158.74 ,$17.27 ,$179.90 , N/A ,$17.27 ,$17.27 ,$148.16 ,$128.89 , N/A , N/A , N/A , N/A , N/A ,$179.90 , N/A ,$194.72 ,$148.16 ,$14.67 ,$14.67 ,$128.89 ,$14.67 ,$146.25 ,$190.49 ,$144.60 , N/A ,$167.20 , N/A , N/A , N/A , N/A , N/A ,$152.39 ,$131.22 ,$152.39 ,$152.39 ,$169.32 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3489,ZOLEDRONIC ACID 4 MG/5ML CONC 5 ML VIAL per1 mg,636,1 ,$869.75 ,$574.04 ,$11.75 ,$869.75 , N/A ,$18.23 ,$12.15 , N/A ,$521.85 ,$739.29 ,$608.83 , N/A , N/A ,$826.26 ,$661.01 ,$652.31 ,$18.94 ,$739.29 , N/A ,$18.94 ,$18.94 ,$608.83 ,$529.68 , N/A , N/A , N/A , N/A , N/A ,$739.29 , N/A ,$800.17 ,$608.83 ,$11.75 ,$11.75 ,$529.68 ,$11.75 ,$601.00 ,$782.78 ,$594.21 , N/A ,$687.10 , N/A , N/A , N/A , N/A , N/A ,$626.22 ,$539.25 ,$626.22 ,$626.22 ,$695.80 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3489,ZOLEDRONIC ACID 5 MG/100ML SOLN 100 ML BAG per1 mg,636,1 ,$162.36 ,$107.16 ,$11.75 ,$162.36 , N/A ,$18.23 ,$12.15 , N/A ,$97.42 ,$138.01 ,$113.65 , N/A , N/A ,$154.24 ,$123.39 ,$121.77 ,$18.94 ,$138.01 , N/A ,$18.94 ,$18.94 ,$113.65 ,$98.88 , N/A , N/A , N/A , N/A , N/A ,$138.01 , N/A ,$149.37 ,$113.65 ,$11.75 ,$11.75 ,$98.88 ,$11.75 ,$112.19 ,$146.12 ,$110.92 , N/A ,$128.26 , N/A , N/A , N/A , N/A , N/A ,$116.90 ,$100.66 ,$116.90 ,$116.90 ,$129.89 
ST NICHOLAS HOSPITAL - ACUTE,63600002,J3489,ZOLEDRONIC ACID 5 MG/100ML SOLN per1 mg,636,1 ,$442.80 ,$292.25 ,$11.75 ,$442.80 , N/A ,$18.23 ,$12.15 , N/A ,$265.68 ,$376.38 ,$309.96 , N/A , N/A ,$420.66 ,$336.53 ,$332.10 ,$18.94 ,$376.38 , N/A ,$18.94 ,$18.94 ,$309.96 ,$269.67 , N/A , N/A , N/A , N/A , N/A ,$376.38 , N/A ,$407.38 ,$309.96 ,$11.75 ,$11.75 ,$269.67 ,$11.75 ,$305.97 ,$398.52 ,$302.52 , N/A ,$349.81 , N/A , N/A , N/A , N/A , N/A ,$318.82 ,$274.54 ,$318.82 ,$318.82 ,$354.24 
ST NICHOLAS HOSPITAL - ACUTE,63600003,Q4102,HC OASIS PER SQ CENTIMETER,636,1 ,$32.55 ,$21.48 ,$18.43 ,$32.55 , N/A ,$28.60 ,$19.07 , N/A ,$19.53 ,$27.67 ,$22.79 , N/A , N/A ,$30.92 ,$24.74 ,$24.41 ,$21.62 ,$27.67 , N/A ,$21.62 ,$21.62 ,$22.79 ,$19.82 , N/A , N/A , N/A , N/A , N/A ,$27.67 , N/A ,$29.95 ,$22.79 ,$18.43 ,$18.43 ,$19.82 ,$18.43 ,$22.49 ,$29.30 ,$22.24 , N/A ,$25.71 , N/A , N/A , N/A , N/A , N/A ,$23.44 ,$20.18 ,$23.44 ,$23.44 ,$26.04 
ST NICHOLAS HOSPITAL - ACUTE,63600006,Q4106,HC DERMAGRAFT PER SQ CM,636,1 ,$92.40 ,$60.98 ,$23.56 ,$92.40 , N/A ,$36.56 ,$24.38 , N/A ,$55.44 ,$78.54 ,$64.68 , N/A , N/A ,$87.78 ,$70.22 ,$69.30 ,$27.63 ,$78.54 , N/A ,$27.63 ,$27.63 ,$64.68 ,$56.27 , N/A , N/A , N/A , N/A , N/A ,$78.54 , N/A ,$85.01 ,$64.68 ,$23.56 ,$23.56 ,$56.27 ,$23.56 ,$63.85 ,$83.16 ,$63.13 , N/A ,$73.00 , N/A , N/A , N/A , N/A , N/A ,$66.53 ,$57.29 ,$66.53 ,$66.53 ,$73.92 
ST NICHOLAS HOSPITAL - ACUTE,63600007,Q4107,HC GRAFT JACKET PER SQ CM,636,1 ,$385.35 ,$254.33 ,$119.31 ,$385.35 , N/A ,$208.33 ,$138.89 , N/A ,$231.21 ,$327.55 ,$269.75 , N/A , N/A ,$366.08 ,$292.87 ,$289.01 ,$119.31 ,$327.55 , N/A ,$119.31 ,$119.31 ,$269.75 ,$234.68 , N/A , N/A , N/A , N/A , N/A ,$327.55 , N/A ,$354.52 ,$269.75 ,$134.26 ,$134.26 ,$234.68 ,$134.26 ,$266.28 ,$346.82 ,$263.27 , N/A ,$304.43 , N/A , N/A , N/A , N/A , N/A ,$277.45 ,$238.92 ,$277.45 ,$277.45 ,$308.28 
ST NICHOLAS HOSPITAL - ACUTE,63600008,Q4121,HC THERASKIN PER SQ CM,636,1 ,$82.95 ,$54.75 ,$49.77 ,$82.95 , N/A ,$82.95 ,$68.94 , N/A ,$49.77 ,$70.51 ,$58.07 , N/A , N/A ,$78.80 ,$63.04 ,$62.21 ,$75.33 ,$70.51 , N/A ,$75.33 ,$75.33 ,$58.07 ,$50.52 , N/A , N/A , N/A , N/A , N/A ,$70.51 , N/A ,$76.31 ,$58.07 ,$66.64 ,$66.64 ,$50.52 ,$66.64 ,$57.32 ,$74.66 ,$56.67 , N/A ,$65.53 , N/A , N/A , N/A , N/A , N/A ,$59.72 ,$51.43 ,$59.72 ,$59.72 ,$66.36 
ST NICHOLAS HOSPITAL - ACUTE,63600009,Q4186,HC EPIFIX PER SQ CM,636,1 ,$900.75 ,$594.50 ,$218.04 ,$900.75 , N/A ,$338.33 ,$225.56 , N/A ,$540.45 ,$765.64 ,$630.53 , N/A , N/A ,$855.71 ,$684.57 ,$675.56 ,$260.88 ,$765.64 , N/A ,$260.88 ,$260.88 ,$630.53 ,$548.56 , N/A , N/A , N/A , N/A , N/A ,$765.64 , N/A ,$828.69 ,$630.53 ,$218.04 ,$218.04 ,$548.56 ,$218.04 ,$622.42 ,$810.68 ,$615.39 , N/A ,$711.59 , N/A , N/A , N/A , N/A , N/A ,$648.54 ,$558.47 ,$648.54 ,$648.54 ,$720.60 
ST NICHOLAS HOSPITAL - ACUTE,63600010,Q4124,HC OASIS TRI LAYER ULTRA,636,1 ,$32.55 ,$21.48 ,$14.70 ,$32.55 , N/A ,$22.82 ,$15.21 , N/A ,$19.53 ,$27.67 ,$22.79 , N/A , N/A ,$30.92 ,$24.74 ,$24.41 ,$15.49 ,$27.67 , N/A ,$15.49 ,$15.49 ,$22.79 ,$19.82 , N/A , N/A , N/A , N/A , N/A ,$27.67 , N/A ,$29.95 ,$22.79 ,$14.70 ,$14.70 ,$19.82 ,$14.70 ,$22.49 ,$29.30 ,$22.24 , N/A ,$25.71 , N/A , N/A , N/A , N/A , N/A ,$23.44 ,$20.18 ,$23.44 ,$23.44 ,$26.04 
ST NICHOLAS HOSPITAL - ACUTE,63600011,Q4113,HC GRAFT JACKET EXPRESS PER 1CC,636,1 ,"$3,145.80 ","$2,076.23 ","$1,333.35 ","$3,145.80 ", N/A ,"$2,068.99 ","$1,379.33 ", N/A ,"$1,887.48 ","$2,673.93 ","$2,202.06 ", N/A , N/A ,"$2,988.51 ","$2,390.81 ","$2,359.35 ","$1,563.24 ","$2,673.93 ", N/A ,"$1,563.24 ","$1,563.24 ","$2,202.06 ","$1,915.79 ", N/A , N/A , N/A , N/A , N/A ,"$2,673.93 ", N/A ,"$2,894.14 ","$2,202.06 ","$1,333.35 ","$1,333.35 ","$1,915.79 ","$1,333.35 ","$2,173.75 ","$2,831.22 ","$2,149.21 ", N/A ,"$2,485.18 ", N/A , N/A , N/A , N/A , N/A ,"$2,264.98 ","$1,950.40 ","$2,264.98 ","$2,264.98 ","$2,516.64 "
ST NICHOLAS HOSPITAL - ACUTE,63600012,Q9963,DIATRIZOATE MEGLUMINE  AND  SODIUM 66-10 % SOLN per1 mL,636,1 ,$2.08 ,$1.37 ,$0.30 ,$2.08 , N/A ,$0.47 ,$0.32 , N/A ,$1.25 ,$1.77 , N/A , N/A , N/A ,$1.98 ,$1.58 ,$1.56 ,$0.36 ,$1.77 , N/A ,$0.36 ,$0.36 ,$1.46 ,$1.27 , N/A , N/A , N/A , N/A , N/A ,$1.77 , N/A ,$1.91 ,$1.46 ,$0.30 ,$0.30 ,$1.27 ,$0.30 ,$1.44 ,$1.87 ,$1.42 , N/A ,$1.64 , N/A , N/A , N/A , N/A , N/A ,$1.50 ,$1.29 ,$1.50 ,$1.50 ,$1.66 
ST NICHOLAS HOSPITAL - ACUTE,63600012,A9577,GADOBENATE DIMEGLUMINE 529 MG/ML SOLN 10 ML VIAL per1 mL,636,1 ,$15.01 ,$9.91 ,$2.65 ,$15.01 , N/A ,$4.12 ,$2.75 , N/A ,$9.01 ,$12.76 , N/A , N/A , N/A ,$14.26 ,$11.41 ,$11.26 ,$3.13 ,$12.76 , N/A ,$3.13 ,$3.13 ,$10.51 ,$9.14 , N/A , N/A , N/A , N/A , N/A ,$12.76 , N/A ,$13.81 ,$10.51 ,$2.65 ,$2.65 ,$9.14 ,$2.65 ,$10.37 ,$13.51 ,$10.25 , N/A ,$11.86 , N/A , N/A , N/A , N/A , N/A ,$10.81 ,$9.31 ,$10.81 ,$10.81 ,$12.01 
ST NICHOLAS HOSPITAL - ACUTE,63600012,A9577,GADOBENATE DIMEGLUMINE 529 MG/ML SOLN 5 ML VIAL per1 mL,636,1 ,$15.30 ,$10.10 ,$2.65 ,$15.30 , N/A ,$4.12 ,$2.75 , N/A ,$9.18 ,$13.01 , N/A , N/A , N/A ,$14.54 ,$11.63 ,$11.48 ,$3.13 ,$13.01 , N/A ,$3.13 ,$3.13 ,$10.71 ,$9.32 , N/A , N/A , N/A , N/A , N/A ,$13.01 , N/A ,$14.08 ,$10.71 ,$2.65 ,$2.65 ,$9.32 ,$2.65 ,$10.57 ,$13.77 ,$10.45 , N/A ,$12.09 , N/A , N/A , N/A , N/A , N/A ,$11.02 ,$9.49 ,$11.02 ,$11.02 ,$12.24 
ST NICHOLAS HOSPITAL - ACUTE,63600012,A9577,GADOBENATE DIMEGLUMINE 529 MG/ML SOLN per1 mL,636,1 ,$14.64 ,$9.66 ,$2.65 ,$14.64 , N/A ,$4.12 ,$2.75 , N/A ,$8.78 ,$12.44 , N/A , N/A , N/A ,$13.91 ,$11.13 ,$10.98 ,$3.13 ,$12.44 , N/A ,$3.13 ,$3.13 ,$10.25 ,$8.92 , N/A , N/A , N/A , N/A , N/A ,$12.44 , N/A ,$13.47 ,$10.25 ,$2.65 ,$2.65 ,$8.92 ,$2.65 ,$10.12 ,$13.18 ,$10.00 , N/A ,$11.57 , N/A , N/A , N/A , N/A , N/A ,$10.54 ,$9.08 ,$10.54 ,$10.54 ,$11.71 
ST NICHOLAS HOSPITAL - ACUTE,63600012,A9581,GADOXETATE DISODIUM 0.25 MOL/L SOLN per1 mL,636,1 ,$36.63 ,$24.18 ,$21.33 ,$36.63 , N/A ,$33.10 ,$22.07 , N/A ,$21.98 ,$31.14 , N/A , N/A , N/A ,$34.80 ,$27.84 ,$27.47 ,$25.08 ,$31.14 , N/A ,$25.08 ,$25.08 ,$25.64 ,$22.31 , N/A , N/A , N/A , N/A , N/A ,$31.14 , N/A ,$33.70 ,$25.64 ,$21.33 ,$21.33 ,$22.31 ,$21.33 ,$25.31 ,$32.97 ,$25.03 , N/A ,$28.94 , N/A , N/A , N/A , N/A , N/A ,$26.37 ,$22.71 ,$26.37 ,$26.37 ,$29.30 
ST NICHOLAS HOSPITAL - ACUTE,63600012,Q9966,IOPAMIDOL 41 % SOLN per1 mL,636,1 ,$16.68 ,$11.01 ,$0.74 ,$16.68 , N/A ,$1.15 ,$0.77 , N/A ,$10.01 ,$14.18 , N/A , N/A , N/A ,$15.85 ,$12.68 ,$12.51 ,$0.82 ,$14.18 , N/A ,$0.82 ,$0.82 ,$11.68 ,$10.16 , N/A , N/A , N/A , N/A , N/A ,$14.18 , N/A ,$15.35 ,$11.68 ,$0.74 ,$0.74 ,$10.16 ,$0.74 ,$11.53 ,$15.01 ,$11.40 , N/A ,$13.18 , N/A , N/A , N/A , N/A , N/A ,$12.01 ,$10.34 ,$12.01 ,$12.01 ,$13.34 
ST NICHOLAS HOSPITAL - ACUTE,63600012,Q9966,IOPAMIDOL 51 % SOLN per1 mL,636,1 ,$1.98 ,$1.31 ,$0.74 ,$1.98 , N/A ,$1.15 ,$0.77 , N/A ,$1.19 ,$1.68 , N/A , N/A , N/A ,$1.88 ,$1.50 ,$1.49 ,$0.82 ,$1.68 , N/A ,$0.82 ,$0.82 ,$1.39 ,$1.21 , N/A , N/A , N/A , N/A , N/A ,$1.68 , N/A ,$1.82 ,$1.39 ,$0.74 ,$0.74 ,$1.21 ,$0.74 ,$1.37 ,$1.78 ,$1.35 , N/A ,$1.56 , N/A , N/A , N/A , N/A , N/A ,$1.43 ,$1.23 ,$1.43 ,$1.43 ,$1.58 
ST NICHOLAS HOSPITAL - ACUTE,63600012,Q9967,IOPAMIDOL 61 % SOLN 100 ML GLASS CONT per1 mL,636,1 ,$1.18 ,$0.78 ,$0.25 ,$1.18 , N/A ,$0.38 ,$0.26 , N/A ,$0.71 ,$1.00 , N/A , N/A , N/A ,$1.12 ,$0.90 ,$0.89 ,$0.29 ,$1.00 , N/A ,$0.29 ,$0.29 ,$0.83 ,$0.72 , N/A , N/A , N/A , N/A , N/A ,$1.00 , N/A ,$1.09 ,$0.83 ,$0.25 ,$0.25 ,$0.72 ,$0.25 ,$0.82 ,$1.06 ,$0.81 , N/A ,$0.93 , N/A , N/A , N/A , N/A , N/A ,$0.85 ,$0.73 ,$0.85 ,$0.85 ,$0.94 
ST NICHOLAS HOSPITAL - ACUTE,63600012,Q9967,IOPAMIDOL 61 % SOLN 30 ML VIAL per1 mL,636,1 ,$1.90 ,$1.25 ,$0.25 ,$1.90 , N/A ,$0.38 ,$0.26 , N/A ,$1.14 ,$1.62 , N/A , N/A , N/A ,$1.81 ,$1.44 ,$1.43 ,$0.29 ,$1.62 , N/A ,$0.29 ,$0.29 ,$1.33 ,$1.16 , N/A , N/A , N/A , N/A , N/A ,$1.62 , N/A ,$1.75 ,$1.33 ,$0.25 ,$0.25 ,$1.16 ,$0.25 ,$1.31 ,$1.71 ,$1.30 , N/A ,$1.50 , N/A , N/A , N/A , N/A , N/A ,$1.37 ,$1.18 ,$1.37 ,$1.37 ,$1.52 
ST NICHOLAS HOSPITAL - ACUTE,63600012,Q9967,IOPAMIDOL 61 % SOLN per1 mL,636,1 ,$14.77 ,$9.75 ,$0.25 ,$14.77 , N/A ,$0.38 ,$0.26 , N/A ,$8.86 ,$12.55 , N/A , N/A , N/A ,$14.03 ,$11.23 ,$11.08 ,$0.29 ,$12.55 , N/A ,$0.29 ,$0.29 ,$10.34 ,$8.99 , N/A , N/A , N/A , N/A , N/A ,$12.55 , N/A ,$13.59 ,$10.34 ,$0.25 ,$0.25 ,$8.99 ,$0.25 ,$10.21 ,$13.29 ,$10.09 , N/A ,$11.67 , N/A , N/A , N/A , N/A , N/A ,$10.63 ,$9.16 ,$10.63 ,$10.63 ,$11.82 
ST NICHOLAS HOSPITAL - ACUTE,63600012,Q9967,IOPAMIDOL 76 % SOLN per1 mL,636,1 ,$2.58 ,$1.70 ,$0.25 ,$2.58 , N/A ,$0.38 ,$0.26 , N/A ,$1.55 ,$2.19 , N/A , N/A , N/A ,$2.45 ,$1.96 ,$1.94 ,$0.29 ,$2.19 , N/A ,$0.29 ,$0.29 ,$1.81 ,$1.57 , N/A , N/A , N/A , N/A , N/A ,$2.19 , N/A ,$2.37 ,$1.81 ,$0.25 ,$0.25 ,$1.57 ,$0.25 ,$1.78 ,$2.32 ,$1.76 , N/A ,$2.04 , N/A , N/A , N/A , N/A , N/A ,$1.86 ,$1.60 ,$1.86 ,$1.86 ,$2.06 
ST NICHOLAS HOSPITAL - ACUTE,63600012,Q9957,PERFLUTREN LIPID MICROSPHERE 6.52 MG/ML SUSP per1 mL,636,1 ,$392.30 ,$258.92 ,$71.14 ,$392.30 , N/A ,$110.39 ,$73.59 , N/A ,$235.38 ,$333.46 , N/A , N/A , N/A ,$372.69 ,$298.15 ,$294.23 ,$77.83 ,$333.46 , N/A ,$77.83 ,$77.83 ,$274.61 ,$238.91 , N/A , N/A , N/A , N/A , N/A ,$333.46 , N/A ,$360.92 ,$274.61 ,$71.14 ,$71.14 ,$238.91 ,$71.14 ,$271.08 ,$353.07 ,$268.02 , N/A ,$309.92 , N/A , N/A , N/A , N/A , N/A ,$282.46 ,$243.23 ,$282.46 ,$282.46 ,$313.84 
ST NICHOLAS HOSPITAL - ACUTE,63600013,Q4133,HC GRAFIX PER SQ CENTIMETER,636,1 ,$494.55 ,$326.40 ,$192.55 ,$494.55 , N/A ,$298.78 ,$199.19 , N/A ,$296.73 ,$420.37 ,$346.19 , N/A , N/A ,$469.82 ,$375.86 ,$370.91 ,$228.19 ,$420.37 , N/A ,$228.19 ,$228.19 ,$346.19 ,$301.18 , N/A , N/A , N/A , N/A , N/A ,$420.37 , N/A ,$454.99 ,$346.19 ,$192.55 ,$192.55 ,$301.18 ,$192.55 ,$341.73 ,$445.10 ,$337.88 , N/A ,$390.69 , N/A , N/A , N/A , N/A , N/A ,$356.08 ,$306.62 ,$356.08 ,$356.08 ,$395.64 
ST NICHOLAS HOSPITAL - ACUTE,63600014,Q4196,HC PURAPLY ANTIMICROBIAL PER SQ CENTIMETER,636,1 ,$277.20 ,$182.95 ,$157.09 ,$277.20 , N/A ,$243.77 ,$162.51 , N/A ,$166.32 ,$235.62 ,$194.04 , N/A , N/A ,$263.34 ,$210.67 ,$207.90 ,$186.59 ,$235.62 , N/A ,$186.59 ,$186.59 ,$194.04 ,$168.81 , N/A , N/A , N/A , N/A , N/A ,$235.62 , N/A ,$255.02 ,$194.04 ,$157.09 ,$157.09 ,$168.81 ,$157.09 ,$191.55 ,$249.48 ,$189.38 , N/A ,$218.99 , N/A , N/A , N/A , N/A , N/A ,$199.58 ,$171.86 ,$199.58 ,$199.58 ,$221.76 
ST NICHOLAS HOSPITAL - ACUTE,63600150,90686,HC COMMUNITY FLU VACCINE SNS,636,1 ,$22.05 ,$14.55 ,$0.95 ,$22.05 ,$0.95 ,$22.05 ,$22.05 ,$3.97 ,$13.23 ,$18.74 ,$15.44 ,$0.95 ,$0.95 ,$20.95 ,$16.76 ,$16.54 ,$22.05 ,$18.74 ,$3.97 ,$22.05 ,$22.05 ,$15.44 ,$13.43 ,$0.95 ,$3.97 ,$3.89 ,$7.94 ,$1.01 ,$18.74 ,$8.93 ,$20.29 ,$15.44 ,$22.05 ,$22.05 ,$13.43 ,$22.05 ,$15.24 ,$19.85 ,$15.06 ,$3.93 ,$17.42 ,$1.01 ,$22.05 ,$22.05 ,$3.89 ,$22.05 ,$15.88 ,$13.67 ,$15.88 ,$15.88 ,$17.64 
ST NICHOLAS HOSPITAL - ACUTE,63600175,Q9967,HC CONTRAST ISOVUE 300-399 PER ML,636,1 ,$3.36 ,$2.22 ,$0.25 ,$3.36 , N/A ,$0.38 ,$0.26 , N/A ,$2.02 ,$2.86 , N/A , N/A , N/A ,$3.19 ,$2.55 ,$2.52 ,$0.29 ,$2.86 , N/A ,$0.29 ,$0.29 ,$2.35 ,$2.05 , N/A , N/A , N/A , N/A , N/A ,$2.86 , N/A ,$3.09 ,$2.35 ,$0.25 ,$0.25 ,$2.05 ,$0.25 ,$2.32 ,$3.02 ,$2.30 , N/A ,$2.65 , N/A , N/A , N/A , N/A , N/A ,$2.42 ,$2.08 ,$2.42 ,$2.42 ,$2.69 
ST NICHOLAS HOSPITAL - ACUTE,63600177,Q9967,HC CONTRAST VISIPAQUE 300-399 PER ML,636,1 ,$3.36 ,$2.22 ,$0.25 ,$3.36 , N/A ,$0.38 ,$0.26 , N/A ,$2.02 ,$2.86 , N/A , N/A , N/A ,$3.19 ,$2.55 ,$2.52 ,$0.29 ,$2.86 , N/A ,$0.29 ,$0.29 ,$2.35 ,$2.05 , N/A , N/A , N/A , N/A , N/A ,$2.86 , N/A ,$3.09 ,$2.35 ,$0.25 ,$0.25 ,$2.05 ,$0.25 ,$2.32 ,$3.02 ,$2.30 , N/A ,$2.65 , N/A , N/A , N/A , N/A , N/A ,$2.42 ,$2.08 ,$2.42 ,$2.42 ,$2.69 
ST NICHOLAS HOSPITAL - ACUTE,63600178,J1644,HC HEPARIN SODIUM PER 1000 UNITS,636,1 ,$13.34 ,$8.80 ,$0.22 ,$13.34 , N/A ,$0.59 ,$0.39 , N/A ,$8.00 ,$11.34 ,$9.34 , N/A , N/A ,$12.67 ,$10.14 ,$10.01 ,$0.22 ,$11.34 , N/A ,$0.22 ,$0.22 ,$9.34 ,$8.12 , N/A , N/A , N/A , N/A , N/A ,$11.34 , N/A ,$12.27 ,$9.34 ,$0.38 ,$0.38 ,$8.12 ,$0.38 ,$9.22 ,$12.01 ,$9.11 , N/A ,$10.54 , N/A , N/A , N/A , N/A , N/A ,$9.60 ,$8.27 ,$9.60 ,$9.60 ,$10.67 
ST NICHOLAS HOSPITAL - ACUTE,63600190,Q4160,HC NUSHIELD PER SQ CM USED - JC,636,1 ,$727.65 ,$480.25 ,$139.21 ,$727.65 , N/A ,$216.02 ,$144.02 , N/A ,$436.59 ,$618.50 ,$509.36 , N/A , N/A ,$691.27 ,$553.01 ,$545.74 ,$159.90 ,$618.50 , N/A ,$159.90 ,$159.90 ,$509.36 ,$443.14 , N/A , N/A , N/A , N/A , N/A ,$618.50 , N/A ,$669.44 ,$509.36 ,$139.21 ,$139.21 ,$443.14 ,$139.21 ,$502.81 ,$654.89 ,$497.13 , N/A ,$574.84 , N/A , N/A , N/A , N/A , N/A ,$523.91 ,$451.14 ,$523.91 ,$523.91 ,$582.12 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAZOLAMIDE 250 MG TABS,637,1 ,$14.25 ,$9.41 ,$7.23 ,$14.25 , N/A ,$9.77 ,$9.77 , N/A ,$8.55 ,$12.11 ,$9.98 , N/A , N/A ,$13.54 ,$10.83 ,$10.69 ,$9.26 ,$12.11 , N/A ,$9.26 ,$9.26 ,$9.98 ,$8.68 , N/A ,$14.25 , N/A , N/A , N/A ,$12.11 , N/A ,$13.11 ,$9.98 ,$7.23 ,$8.67 ,$8.68 ,$8.67 ,$9.85 ,$12.83 ,$9.74 , N/A ,$11.26 , N/A ,$8.41 ,$8.41 , N/A ,$8.41 ,$10.26 ,$8.84 ,$10.26 ,$10.26 ,$11.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAZOLAMIDE ER 500 MG CP12,637,1 ,$19.45 ,$12.84 ,$9.87 ,$19.45 , N/A ,$13.33 ,$13.33 , N/A ,$11.67 ,$16.53 ,$13.62 , N/A , N/A ,$18.48 ,$14.78 ,$14.59 ,$12.64 ,$16.53 , N/A ,$12.64 ,$12.64 ,$13.62 ,$11.85 , N/A ,$19.45 , N/A , N/A , N/A ,$16.53 , N/A ,$17.89 ,$13.62 ,$9.87 ,$11.84 ,$11.85 ,$11.84 ,$13.44 ,$17.51 ,$13.29 , N/A ,$15.37 , N/A ,$11.48 ,$11.48 , N/A ,$11.48 ,$14.00 ,$12.06 ,$14.00 ,$14.00 ,$15.56 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT AERS,637,1 ,$150.28 ,$99.18 ,$76.22 ,$150.28 , N/A ,$103.00 ,$103.00 , N/A ,$90.17 ,$127.74 ,$105.20 , N/A , N/A ,$142.77 ,$114.21 ,$112.71 ,$97.68 ,$127.74 , N/A ,$97.68 ,$97.68 ,$105.20 ,$91.52 , N/A ,$150.28 , N/A , N/A , N/A ,$127.74 , N/A ,$138.26 ,$105.20 ,$76.22 ,$91.48 ,$91.52 ,$91.48 ,$103.84 ,$135.25 ,$102.67 , N/A ,$118.72 , N/A ,$88.67 ,$88.67 , N/A ,$88.67 ,$108.20 ,$93.17 ,$108.20 ,$108.20 ,$120.22 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ALOGLIPTIN 12.5 MG TABS,637,1 ,$26.55 ,$17.52 ,$13.47 ,$26.55 , N/A ,$18.20 ,$18.20 , N/A ,$15.93 ,$22.57 ,$18.59 , N/A , N/A ,$25.22 ,$20.18 ,$19.91 ,$17.26 ,$22.57 , N/A ,$17.26 ,$17.26 ,$18.59 ,$16.17 , N/A ,$26.55 , N/A , N/A , N/A ,$22.57 , N/A ,$24.43 ,$18.59 ,$13.47 ,$16.16 ,$16.17 ,$16.16 ,$18.35 ,$23.90 ,$18.14 , N/A ,$20.97 , N/A ,$15.66 ,$15.66 , N/A ,$15.66 ,$19.12 ,$16.46 ,$19.12 ,$19.12 ,$21.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ALVIMOPAN 12 MG CAPS,637,1 ,$698.30 ,$460.88 ,$354.18 ,$698.30 , N/A ,$478.61 ,$478.61 , N/A ,$418.98 ,$593.56 ,$488.81 , N/A , N/A ,$663.39 ,$530.71 ,$523.73 ,$453.90 ,$593.56 , N/A ,$453.90 ,$453.90 ,$488.81 ,$425.26 , N/A ,$698.30 , N/A , N/A , N/A ,$593.56 , N/A ,$642.44 ,$488.81 ,$354.18 ,$425.06 ,$425.26 ,$425.06 ,$482.53 ,$628.47 ,$477.08 , N/A ,$551.66 , N/A ,$412.00 ,$412.00 , N/A ,$412.00 ,$502.78 ,$432.95 ,$502.78 ,$502.78 ,$558.64 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMOXICILLIN-CLAVULANATE 400-57 MG/5ML SUSR,637,1 ,$16.30 ,$10.76 ,$8.27 ,$16.30 , N/A ,$11.17 ,$11.17 , N/A ,$9.78 ,$13.86 ,$11.41 , N/A , N/A ,$15.49 ,$12.39 ,$12.23 ,$10.60 ,$13.86 , N/A ,$10.60 ,$10.60 ,$11.41 ,$9.93 , N/A ,$16.30 , N/A , N/A , N/A ,$13.86 , N/A ,$15.00 ,$11.41 ,$8.27 ,$9.92 ,$9.93 ,$9.92 ,$11.26 ,$14.67 ,$11.14 , N/A ,$12.88 , N/A ,$9.62 ,$9.62 , N/A ,$9.62 ,$11.74 ,$10.11 ,$11.74 ,$11.74 ,$13.04 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMOXICILLIN-CLAVULANATE 500-125 MG TABS,637,1 ,$12.90 ,$8.51 ,$6.54 ,$12.90 , N/A ,$8.84 ,$8.84 , N/A ,$7.74 ,$10.97 ,$9.03 , N/A , N/A ,$12.26 ,$9.80 ,$9.68 ,$8.39 ,$10.97 , N/A ,$8.39 ,$8.39 ,$9.03 ,$7.86 , N/A ,$12.90 , N/A , N/A , N/A ,$10.97 , N/A ,$11.87 ,$9.03 ,$6.54 ,$7.85 ,$7.86 ,$7.85 ,$8.91 ,$11.61 ,$8.81 , N/A ,$10.19 , N/A ,$7.61 ,$7.61 , N/A ,$7.61 ,$9.29 ,$8.00 ,$9.29 ,$9.29 ,$10.32 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMOXICILLIN-CLAVULANATE 600-42.9 MG/5ML SUSR,637,1 ,$14.15 ,$9.34 ,$7.18 ,$14.15 , N/A ,$9.70 ,$9.70 , N/A ,$8.49 ,$12.03 ,$9.91 , N/A , N/A ,$13.44 ,$10.75 ,$10.61 ,$9.20 ,$12.03 , N/A ,$9.20 ,$9.20 ,$9.91 ,$8.62 , N/A ,$14.15 , N/A , N/A , N/A ,$12.03 , N/A ,$13.02 ,$9.91 ,$7.18 ,$8.61 ,$8.62 ,$8.61 ,$9.78 ,$12.74 ,$9.67 , N/A ,$11.18 , N/A ,$8.35 ,$8.35 , N/A ,$8.35 ,$10.19 ,$8.77 ,$10.19 ,$10.19 ,$11.32 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMOXICILLIN-CLAVULANATE 875-125 MG TABS,637,1 ,$17.25 ,$11.39 ,$8.75 ,$17.25 , N/A ,$11.82 ,$11.82 , N/A ,$10.35 ,$14.66 ,$12.08 , N/A , N/A ,$16.39 ,$13.11 ,$12.94 ,$11.21 ,$14.66 , N/A ,$11.21 ,$11.21 ,$12.08 ,$10.51 , N/A ,$17.25 , N/A , N/A , N/A ,$14.66 , N/A ,$15.87 ,$12.08 ,$8.75 ,$10.50 ,$10.51 ,$10.50 ,$11.92 ,$15.53 ,$11.79 , N/A ,$13.63 , N/A ,$10.18 ,$10.18 , N/A ,$10.18 ,$12.42 ,$10.70 ,$12.42 ,$12.42 ,$13.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ANALGESIC OINT 120 G TUBE,637,1 ,"$1,660.20 ","$1,095.73 ",$842.05 ,"$1,660.20 ", N/A ,"$1,137.90 ","$1,137.90 ", N/A ,$996.12 ,"$1,411.17 ","$1,162.14 ", N/A , N/A ,"$1,577.19 ","$1,261.75 ","$1,245.15 ","$1,079.13 ","$1,411.17 ", N/A ,"$1,079.13 ","$1,079.13 ","$1,162.14 ","$1,011.06 ", N/A ,"$1,660.20 ", N/A , N/A , N/A ,"$1,411.17 ", N/A ,"$1,527.38 ","$1,162.14 ",$842.05 ,"$1,010.56 ","$1,011.06 ","$1,010.56 ","$1,147.20 ","$1,494.18 ","$1,134.25 ", N/A ,"$1,311.56 ", N/A ,$979.52 ,$979.52 , N/A ,$979.52 ,"$1,195.34 ","$1,029.32 ","$1,195.34 ","$1,195.34 ","$1,328.16 "
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ANASTROZOLE 1 MG TABS,637,1 ,$45.25 ,$29.87 ,$22.95 ,$45.25 , N/A ,$31.01 ,$31.01 , N/A ,$27.15 ,$38.46 ,$31.68 , N/A , N/A ,$42.99 ,$34.39 ,$33.94 ,$29.41 ,$38.46 , N/A ,$29.41 ,$29.41 ,$31.68 ,$27.56 , N/A ,$45.25 , N/A , N/A , N/A ,$38.46 , N/A ,$41.63 ,$31.68 ,$22.95 ,$27.54 ,$27.56 ,$27.54 ,$31.27 ,$40.73 ,$30.91 , N/A ,$35.75 , N/A ,$26.70 ,$26.70 , N/A ,$26.70 ,$32.58 ,$28.06 ,$32.58 ,$32.58 ,$36.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,APIXABAN 5 MG TABS,637,1 ,$36.00 ,$23.76 ,$18.26 ,$36.00 , N/A ,$24.67 ,$24.67 , N/A ,$21.60 ,$30.60 ,$25.20 , N/A , N/A ,$34.20 ,$27.36 ,$27.00 ,$23.40 ,$30.60 , N/A ,$23.40 ,$23.40 ,$25.20 ,$21.92 , N/A ,$36.00 , N/A , N/A , N/A ,$30.60 , N/A ,$33.12 ,$25.20 ,$18.26 ,$21.91 ,$21.92 ,$21.91 ,$24.88 ,$32.40 ,$24.60 , N/A ,$28.44 , N/A ,$21.24 ,$21.24 , N/A ,$21.24 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ARIPIPRAZOLE 2 MG TABS,637,1 ,$109.07 ,$71.99 ,$55.32 ,$109.07 , N/A ,$74.76 ,$74.76 , N/A ,$65.44 ,$92.71 ,$76.35 , N/A , N/A ,$103.62 ,$82.89 ,$81.80 ,$70.90 ,$92.71 , N/A ,$70.90 ,$70.90 ,$76.35 ,$66.42 , N/A ,$109.07 , N/A , N/A , N/A ,$92.71 , N/A ,$100.34 ,$76.35 ,$55.32 ,$66.39 ,$66.42 ,$66.39 ,$75.37 ,$98.16 ,$74.52 , N/A ,$86.17 , N/A ,$64.35 ,$64.35 , N/A ,$64.35 ,$78.53 ,$67.62 ,$78.53 ,$78.53 ,$87.26 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ARIPIPRAZOLE 5 MG TABS,637,1 ,$108.80 ,$71.81 ,$55.18 ,$108.80 , N/A ,$74.57 ,$74.57 , N/A ,$65.28 ,$92.48 ,$76.16 , N/A , N/A ,$103.36 ,$82.69 ,$81.60 ,$70.72 ,$92.48 , N/A ,$70.72 ,$70.72 ,$76.16 ,$66.26 , N/A ,$108.80 , N/A , N/A , N/A ,$92.48 , N/A ,$100.10 ,$76.16 ,$55.18 ,$66.23 ,$66.26 ,$66.23 ,$75.18 ,$97.92 ,$74.33 , N/A ,$85.95 , N/A ,$64.19 ,$64.19 , N/A ,$64.19 ,$78.34 ,$67.46 ,$78.34 ,$78.34 ,$87.04 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ARTIFICIAL TEARS 83-15 % OINT 3.5 G TUBE,637,1 ,$33.05 ,$21.81 ,$16.76 ,$33.05 , N/A ,$22.65 ,$22.65 , N/A ,$19.83 ,$28.09 ,$23.14 , N/A , N/A ,$31.40 ,$25.12 ,$24.79 ,$21.48 ,$28.09 , N/A ,$21.48 ,$21.48 ,$23.14 ,$20.13 , N/A ,$33.05 , N/A , N/A , N/A ,$28.09 , N/A ,$30.41 ,$23.14 ,$16.76 ,$20.12 ,$20.13 ,$20.12 ,$22.84 ,$29.75 ,$22.58 , N/A ,$26.11 , N/A ,$19.50 ,$19.50 , N/A ,$19.50 ,$23.80 ,$20.49 ,$23.80 ,$23.80 ,$26.44 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ARTIFICIAL TEARS OINT 3.5 G TUBE,637,1 ,$30.60 ,$20.20 ,$15.52 ,$30.60 , N/A ,$20.97 ,$20.97 , N/A ,$18.36 ,$26.01 ,$21.42 , N/A , N/A ,$29.07 ,$23.26 ,$22.95 ,$19.89 ,$26.01 , N/A ,$19.89 ,$19.89 ,$21.42 ,$18.64 , N/A ,$30.60 , N/A , N/A , N/A ,$26.01 , N/A ,$28.15 ,$21.42 ,$15.52 ,$18.63 ,$18.64 ,$18.63 ,$21.14 ,$27.54 ,$20.91 , N/A ,$24.17 , N/A ,$18.05 ,$18.05 , N/A ,$18.05 ,$22.03 ,$18.97 ,$22.03 ,$22.03 ,$24.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AZITHROMYCIN 250 MG TABS,637,1 ,$26.50 ,$17.49 ,$13.44 ,$26.50 , N/A ,$18.16 ,$18.16 , N/A ,$15.90 ,$22.53 ,$18.55 , N/A , N/A ,$25.18 ,$20.14 ,$19.88 ,$17.23 ,$22.53 , N/A ,$17.23 ,$17.23 ,$18.55 ,$16.14 , N/A ,$26.50 , N/A , N/A , N/A ,$22.53 , N/A ,$24.38 ,$18.55 ,$13.44 ,$16.13 ,$16.14 ,$16.13 ,$18.31 ,$23.85 ,$18.10 , N/A ,$20.94 , N/A ,$15.64 ,$15.64 , N/A ,$15.64 ,$19.08 ,$16.43 ,$19.08 ,$19.08 ,$21.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BACITRACIN 500 UNIT/GM OINT 28.4 G TUBE,637,1 ,$24.35 ,$16.07 ,$12.35 ,$24.35 , N/A ,$16.69 ,$16.69 , N/A ,$14.61 ,$20.70 ,$17.05 , N/A , N/A ,$23.13 ,$18.51 ,$18.26 ,$15.83 ,$20.70 , N/A ,$15.83 ,$15.83 ,$17.05 ,$14.83 , N/A ,$24.35 , N/A , N/A , N/A ,$20.70 , N/A ,$22.40 ,$17.05 ,$12.35 ,$14.82 ,$14.83 ,$14.82 ,$16.83 ,$21.92 ,$16.64 , N/A ,$19.24 , N/A ,$14.37 ,$14.37 , N/A ,$14.37 ,$17.53 ,$15.10 ,$17.53 ,$17.53 ,$19.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OINT 3.5 G TUBE,637,1 ,$97.45 ,$64.32 ,$49.43 ,$97.45 , N/A ,$66.79 ,$66.79 , N/A ,$58.47 ,$82.83 ,$68.22 , N/A , N/A ,$92.58 ,$74.06 ,$73.09 ,$63.34 ,$82.83 , N/A ,$63.34 ,$63.34 ,$68.22 ,$59.35 , N/A ,$97.45 , N/A , N/A , N/A ,$82.83 , N/A ,$89.65 ,$68.22 ,$49.43 ,$59.32 ,$59.35 ,$59.32 ,$67.34 ,$87.71 ,$66.58 , N/A ,$76.99 , N/A ,$57.50 ,$57.50 , N/A ,$57.50 ,$70.16 ,$60.42 ,$70.16 ,$70.16 ,$77.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BACLOFEN 10 MG TABS,637,1 ,$8.45 ,$5.58 ,$4.29 ,$8.45 , N/A ,$5.79 ,$5.79 , N/A ,$5.07 ,$7.18 ,$5.92 , N/A , N/A ,$8.03 ,$6.42 ,$6.34 ,$5.49 ,$7.18 , N/A ,$5.49 ,$5.49 ,$5.92 ,$5.15 , N/A ,$8.45 , N/A , N/A , N/A ,$7.18 , N/A ,$7.77 ,$5.92 ,$4.29 ,$5.14 ,$5.15 ,$5.14 ,$5.84 ,$7.61 ,$5.77 , N/A ,$6.68 , N/A ,$4.99 ,$4.99 , N/A ,$4.99 ,$6.08 ,$5.24 ,$6.08 ,$6.08 ,$6.76 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BENZOCAINE 20 % OINT 28 G TUBE,637,1 ,$28.85 ,$19.04 ,$14.63 ,$28.85 , N/A ,$19.77 ,$19.77 , N/A ,$17.31 ,$24.52 ,$20.20 , N/A , N/A ,$27.41 ,$21.93 ,$21.64 ,$18.75 ,$24.52 , N/A ,$18.75 ,$18.75 ,$20.20 ,$17.57 , N/A ,$28.85 , N/A , N/A , N/A ,$24.52 , N/A ,$26.54 ,$20.20 ,$14.63 ,$17.56 ,$17.57 ,$17.56 ,$19.94 ,$25.97 ,$19.71 , N/A ,$22.79 , N/A ,$17.02 ,$17.02 , N/A ,$17.02 ,$20.77 ,$17.89 ,$20.77 ,$20.77 ,$23.08 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BACITRACIN 500 UNIT/GM OINT 28 G TUBE,637,1 ,$28.85 ,$19.04 ,$14.63 ,$28.85 , N/A ,$19.77 ,$19.77 , N/A ,$17.31 ,$24.52 ,$20.20 , N/A , N/A ,$27.41 ,$21.93 ,$21.64 ,$18.75 ,$24.52 , N/A ,$18.75 ,$18.75 ,$20.20 ,$17.57 , N/A ,$28.85 , N/A , N/A , N/A ,$24.52 , N/A ,$26.54 ,$20.20 ,$14.63 ,$17.56 ,$17.57 ,$17.56 ,$19.94 ,$25.97 ,$19.71 , N/A ,$22.79 , N/A ,$17.02 ,$17.02 , N/A ,$17.02 ,$20.77 ,$17.89 ,$20.77 ,$20.77 ,$23.08 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BENZONATATE 100 MG CAPS,637,1 ,$8.55 ,$5.64 ,$4.34 ,$8.55 , N/A ,$5.86 ,$5.86 , N/A ,$5.13 ,$7.27 ,$5.99 , N/A , N/A ,$8.12 ,$6.50 ,$6.41 ,$5.56 ,$7.27 , N/A ,$5.56 ,$5.56 ,$5.99 ,$5.21 , N/A ,$8.55 , N/A , N/A , N/A ,$7.27 , N/A ,$7.87 ,$5.99 ,$4.34 ,$5.20 ,$5.21 ,$5.20 ,$5.91 ,$7.70 ,$5.84 , N/A ,$6.75 , N/A ,$5.04 ,$5.04 , N/A ,$5.04 ,$6.16 ,$5.30 ,$6.16 ,$6.16 ,$6.84 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BETAMETHASONE DIPROPIONATE 0.05 % CREA 15 G TUBE,637,1 ,$141.45 ,$93.36 ,$71.74 ,$141.45 , N/A ,$96.95 ,$96.95 , N/A ,$84.87 ,$120.23 ,$99.02 , N/A , N/A ,$134.38 ,$107.50 ,$106.09 ,$91.94 ,$120.23 , N/A ,$91.94 ,$91.94 ,$99.02 ,$86.14 , N/A ,$141.45 , N/A , N/A , N/A ,$120.23 , N/A ,$130.13 ,$99.02 ,$71.74 ,$86.10 ,$86.14 ,$86.10 ,$97.74 ,$127.31 ,$96.64 , N/A ,$111.75 , N/A ,$83.46 ,$83.46 , N/A ,$83.46 ,$101.84 ,$87.70 ,$101.84 ,$101.84 ,$113.16 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BETAMETHASONE VALERATE OINTMENT 0.1 % OINT 45 G TUBE,637,1 ,$16.15 ,$10.66 ,$8.19 ,$16.15 , N/A ,$11.07 ,$11.07 , N/A ,$9.69 ,$13.73 ,$11.31 , N/A , N/A ,$15.34 ,$12.27 ,$12.11 ,$10.50 ,$13.73 , N/A ,$10.50 ,$10.50 ,$11.31 ,$9.84 , N/A ,$16.15 , N/A , N/A , N/A ,$13.73 , N/A ,$14.86 ,$11.31 ,$8.19 ,$9.83 ,$9.84 ,$9.83 ,$11.16 ,$14.54 ,$11.03 , N/A ,$12.76 , N/A ,$9.53 ,$9.53 , N/A ,$9.53 ,$11.63 ,$10.01 ,$11.63 ,$11.63 ,$12.92 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BRIMONIDINE-TIMOLOL 0.2-0.5 % SOLN 5 ML BOTTLE,637,1 ,$832.90 ,$549.71 ,$422.45 ,$832.90 , N/A ,$570.87 ,$570.87 , N/A ,$499.74 ,$707.97 ,$583.03 , N/A , N/A ,$791.26 ,$633.00 ,$624.68 ,$541.39 ,$707.97 , N/A ,$541.39 ,$541.39 ,$583.03 ,$507.24 , N/A ,$832.90 , N/A , N/A , N/A ,$707.97 , N/A ,$766.27 ,$583.03 ,$422.45 ,$506.99 ,$507.24 ,$506.99 ,$575.53 ,$749.61 ,$569.04 , N/A ,$657.99 , N/A ,$491.41 ,$491.41 , N/A ,$491.41 ,$599.69 ,$516.40 ,$599.69 ,$599.69 ,$666.32 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUPRENORPHINE 10 MCG/HR PTWK,637,1 ,$367.25 ,$242.39 ,$186.27 ,$367.25 , N/A ,$251.71 ,$251.71 , N/A ,$220.35 ,$312.16 ,$257.08 , N/A , N/A ,$348.89 ,$279.11 ,$275.44 ,$238.71 ,$312.16 , N/A ,$238.71 ,$238.71 ,$257.08 ,$223.66 , N/A ,$367.25 , N/A , N/A , N/A ,$312.16 , N/A ,$337.87 ,$257.08 ,$186.27 ,$223.55 ,$223.66 ,$223.55 ,$253.77 ,$330.53 ,$250.91 , N/A ,$290.13 , N/A ,$216.68 ,$216.68 , N/A ,$216.68 ,$264.42 ,$227.70 ,$264.42 ,$264.42 ,$293.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUPRENORPHINE 2 MG SUBL,637,1 ,$8.34 ,$5.50 ,$4.23 ,$8.34 , N/A ,$5.72 ,$5.72 , N/A ,$5.00 ,$7.09 ,$5.84 , N/A , N/A ,$7.92 ,$6.34 ,$6.26 ,$5.42 ,$7.09 , N/A ,$5.42 ,$5.42 ,$5.84 ,$5.08 , N/A ,$8.34 , N/A , N/A , N/A ,$7.09 , N/A ,$7.67 ,$5.84 ,$4.23 ,$5.08 ,$5.08 ,$5.08 ,$5.76 ,$7.51 ,$5.70 , N/A ,$6.59 , N/A ,$4.92 ,$4.92 , N/A ,$4.92 ,$6.00 ,$5.17 ,$6.00 ,$6.00 ,$6.67 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUPRENORPHINE 8 MG SUBL,637,1 ,$28.80 ,$19.01 ,$14.61 ,$28.80 , N/A ,$19.74 ,$19.74 , N/A ,$17.28 ,$24.48 ,$20.16 , N/A , N/A ,$27.36 ,$21.89 ,$21.60 ,$18.72 ,$24.48 , N/A ,$18.72 ,$18.72 ,$20.16 ,$17.54 , N/A ,$28.80 , N/A , N/A , N/A ,$24.48 , N/A ,$26.50 ,$20.16 ,$14.61 ,$17.53 ,$17.54 ,$17.53 ,$19.90 ,$25.92 ,$19.68 , N/A ,$22.75 , N/A ,$16.99 ,$16.99 , N/A ,$16.99 ,$20.74 ,$17.86 ,$20.74 ,$20.74 ,$23.04 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUPROPION XL 150 MG TB24,637,1 ,$17.75 ,$11.72 ,$9.00 ,$17.75 , N/A ,$12.17 ,$12.17 , N/A ,$10.65 ,$15.09 ,$12.43 , N/A , N/A ,$16.86 ,$13.49 ,$13.31 ,$11.54 ,$15.09 , N/A ,$11.54 ,$11.54 ,$12.43 ,$10.81 , N/A ,$17.75 , N/A , N/A , N/A ,$15.09 , N/A ,$16.33 ,$12.43 ,$9.00 ,$10.80 ,$10.81 ,$10.80 ,$12.27 ,$15.98 ,$12.13 , N/A ,$14.02 , N/A ,$10.47 ,$10.47 , N/A ,$10.47 ,$12.78 ,$11.01 ,$12.78 ,$12.78 ,$14.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CALCITONIN 200 UNIT/ACT SOLN 3.7 ML BOTTLE,637,1 ,$403.05 ,$266.01 ,$204.43 ,$403.05 , N/A ,$276.25 ,$276.25 , N/A ,$241.83 ,$342.59 ,$282.14 , N/A , N/A ,$382.90 ,$306.32 ,$302.29 ,$261.98 ,$342.59 , N/A ,$261.98 ,$261.98 ,$282.14 ,$245.46 , N/A ,$403.05 , N/A , N/A , N/A ,$342.59 , N/A ,$370.81 ,$282.14 ,$204.43 ,$245.34 ,$245.46 ,$245.34 ,$278.51 ,$362.75 ,$275.36 , N/A ,$318.41 , N/A ,$237.80 ,$237.80 , N/A ,$237.80 ,$290.20 ,$249.89 ,$290.20 ,$290.20 ,$322.44 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARBAMAZEPINE 100 MG/5ML SUSP,637,1 ,$15.55 ,$10.26 ,$7.89 ,$15.55 , N/A ,$10.66 ,$10.66 , N/A ,$9.33 ,$13.22 ,$10.89 , N/A , N/A ,$14.77 ,$11.82 ,$11.66 ,$10.11 ,$13.22 , N/A ,$10.11 ,$10.11 ,$10.89 ,$9.47 , N/A ,$15.55 , N/A , N/A , N/A ,$13.22 , N/A ,$14.31 ,$10.89 ,$7.89 ,$9.47 ,$9.47 ,$9.47 ,$10.75 ,$14.00 ,$10.62 , N/A ,$12.28 , N/A ,$9.17 ,$9.17 , N/A ,$9.17 ,$11.20 ,$9.64 ,$11.20 ,$11.20 ,$12.44 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARBAMAZEPINE XR 200 MG TB12,637,1 ,$13.75 ,$9.08 ,$6.97 ,$13.75 , N/A ,$9.42 ,$9.42 , N/A ,$8.25 ,$11.69 ,$9.63 , N/A , N/A ,$13.06 ,$10.45 ,$10.31 ,$8.94 ,$11.69 , N/A ,$8.94 ,$8.94 ,$9.63 ,$8.37 , N/A ,$13.75 , N/A , N/A , N/A ,$11.69 , N/A ,$12.65 ,$9.63 ,$6.97 ,$8.37 ,$8.37 ,$8.37 ,$9.50 ,$12.38 ,$9.39 , N/A ,$10.86 , N/A ,$8.11 ,$8.11 , N/A ,$8.11 ,$9.90 ,$8.53 ,$9.90 ,$9.90 ,$11.00 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CEFDINIR 300 MG CAPS,637,1 ,$17.40 ,$11.48 ,$8.83 ,$17.40 , N/A ,$11.93 ,$11.93 , N/A ,$10.44 ,$14.79 ,$12.18 , N/A , N/A ,$16.53 ,$13.22 ,$13.05 ,$11.31 ,$14.79 , N/A ,$11.31 ,$11.31 ,$12.18 ,$10.60 , N/A ,$17.40 , N/A , N/A , N/A ,$14.79 , N/A ,$16.01 ,$12.18 ,$8.83 ,$10.59 ,$10.60 ,$10.59 ,$12.02 ,$15.66 ,$11.89 , N/A ,$13.75 , N/A ,$10.27 ,$10.27 , N/A ,$10.27 ,$12.53 ,$10.79 ,$12.53 ,$12.53 ,$13.92 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CEFPROZIL 250 MG TABS,637,1 ,$14.90 ,$9.83 ,$7.56 ,$14.90 , N/A ,$10.21 ,$10.21 , N/A ,$8.94 ,$12.67 ,$10.43 , N/A , N/A ,$14.16 ,$11.32 ,$11.18 ,$9.69 ,$12.67 , N/A ,$9.69 ,$9.69 ,$10.43 ,$9.07 , N/A ,$14.90 , N/A , N/A , N/A ,$12.67 , N/A ,$13.71 ,$10.43 ,$7.56 ,$9.07 ,$9.07 ,$9.07 ,$10.30 ,$13.41 ,$10.18 , N/A ,$11.77 , N/A ,$8.79 ,$8.79 , N/A ,$8.79 ,$10.73 ,$9.24 ,$10.73 ,$10.73 ,$11.92 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CEFUROXIME 250 MG TABS,637,1 ,$19.30 ,$12.74 ,$9.79 ,$19.30 , N/A ,$13.23 ,$13.23 , N/A ,$11.58 ,$16.41 ,$13.51 , N/A , N/A ,$18.34 ,$14.67 ,$14.48 ,$12.55 ,$16.41 , N/A ,$12.55 ,$12.55 ,$13.51 ,$11.75 , N/A ,$19.30 , N/A , N/A , N/A ,$16.41 , N/A ,$17.76 ,$13.51 ,$9.79 ,$11.75 ,$11.75 ,$11.75 ,$13.34 ,$17.37 ,$13.19 , N/A ,$15.25 , N/A ,$11.39 ,$11.39 , N/A ,$11.39 ,$13.90 ,$11.97 ,$13.90 ,$13.90 ,$15.44 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CEFUROXIME 500 MG TABS,637,1 ,$37.75 ,$24.92 ,$19.15 ,$37.75 , N/A ,$25.87 ,$25.87 , N/A ,$22.65 ,$32.09 ,$26.43 , N/A , N/A ,$35.86 ,$28.69 ,$28.31 ,$24.54 ,$32.09 , N/A ,$24.54 ,$24.54 ,$26.43 ,$22.99 , N/A ,$37.75 , N/A , N/A , N/A ,$32.09 , N/A ,$34.73 ,$26.43 ,$19.15 ,$22.98 ,$22.99 ,$22.98 ,$26.09 ,$33.98 ,$25.79 , N/A ,$29.82 , N/A ,$22.27 ,$22.27 , N/A ,$22.27 ,$27.18 ,$23.41 ,$27.18 ,$27.18 ,$30.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CELECOXIB 100 MG CAPS,637,1 ,$15.70 ,$10.36 ,$7.96 ,$15.70 , N/A ,$10.76 ,$10.76 , N/A ,$9.42 ,$13.35 ,$10.99 , N/A , N/A ,$14.92 ,$11.93 ,$11.78 ,$10.21 ,$13.35 , N/A ,$10.21 ,$10.21 ,$10.99 ,$9.56 , N/A ,$15.70 , N/A , N/A , N/A ,$13.35 , N/A ,$14.44 ,$10.99 ,$7.96 ,$9.56 ,$9.56 ,$9.56 ,$10.85 ,$14.13 ,$10.73 , N/A ,$12.40 , N/A ,$9.26 ,$9.26 , N/A ,$9.26 ,$11.30 ,$9.73 ,$11.30 ,$11.30 ,$12.56 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARBIDOPA-LEVODOPA ER 48.75-195 MG CPCR,637,1 ,$15.70 ,$10.36 ,$7.96 ,$15.70 , N/A ,$10.76 ,$10.76 , N/A ,$9.42 ,$13.35 ,$10.99 , N/A , N/A ,$14.92 ,$11.93 ,$11.78 ,$10.21 ,$13.35 , N/A ,$10.21 ,$10.21 ,$10.99 ,$9.56 , N/A ,$15.70 , N/A , N/A , N/A ,$13.35 , N/A ,$14.44 ,$10.99 ,$7.96 ,$9.56 ,$9.56 ,$9.56 ,$10.85 ,$14.13 ,$10.73 , N/A ,$12.40 , N/A ,$9.26 ,$9.26 , N/A ,$9.26 ,$11.30 ,$9.73 ,$11.30 ,$11.30 ,$12.56 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CELECOXIB 200 MG CAPS,637,1 ,$25.75 ,$17.00 ,$13.06 ,$25.75 , N/A ,$17.65 ,$17.65 , N/A ,$15.45 ,$21.89 ,$18.03 , N/A , N/A ,$24.46 ,$19.57 ,$19.31 ,$16.74 ,$21.89 , N/A ,$16.74 ,$16.74 ,$18.03 ,$15.68 , N/A ,$25.75 , N/A , N/A , N/A ,$21.89 , N/A ,$23.69 ,$18.03 ,$13.06 ,$15.67 ,$15.68 ,$15.67 ,$17.79 ,$23.18 ,$17.59 , N/A ,$20.34 , N/A ,$15.19 ,$15.19 , N/A ,$15.19 ,$18.54 ,$15.97 ,$18.54 ,$18.54 ,$20.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CHOLESTYRAMINE 4 G PACK,637,1 ,$11.50 ,$7.59 ,$5.83 ,$11.50 , N/A ,$7.88 ,$7.88 , N/A ,$6.90 ,$9.78 ,$8.05 , N/A , N/A ,$10.93 ,$8.74 ,$8.63 ,$7.48 ,$9.78 , N/A ,$7.48 ,$7.48 ,$8.05 ,$7.00 , N/A ,$11.50 , N/A , N/A , N/A ,$9.78 , N/A ,$10.58 ,$8.05 ,$5.83 ,$7.00 ,$7.00 ,$7.00 ,$7.95 ,$10.35 ,$7.86 , N/A ,$9.09 , N/A ,$6.79 ,$6.79 , N/A ,$6.79 ,$8.28 ,$7.13 ,$8.28 ,$8.28 ,$9.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CIPROFLOXACIN 500 MG TABS,637,1 ,$19.00 ,$12.54 ,$9.64 ,$19.00 , N/A ,$13.02 ,$13.02 , N/A ,$11.40 ,$16.15 ,$13.30 , N/A , N/A ,$18.05 ,$14.44 ,$14.25 ,$12.35 ,$16.15 , N/A ,$12.35 ,$12.35 ,$13.30 ,$11.57 , N/A ,$19.00 , N/A , N/A , N/A ,$16.15 , N/A ,$17.48 ,$13.30 ,$9.64 ,$11.57 ,$11.57 ,$11.57 ,$13.13 ,$17.10 ,$12.98 , N/A ,$15.01 , N/A ,$11.21 ,$11.21 , N/A ,$11.21 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$15.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CITALOPRAM 10 MG TABS,637,1 ,$8.28 ,$5.46 ,$4.20 ,$8.28 , N/A ,$5.68 ,$5.68 , N/A ,$4.97 ,$7.04 ,$5.80 , N/A , N/A ,$7.87 ,$6.29 ,$6.21 ,$5.38 ,$7.04 , N/A ,$5.38 ,$5.38 ,$5.80 ,$5.04 , N/A ,$8.28 , N/A , N/A , N/A ,$7.04 , N/A ,$7.62 ,$5.80 ,$4.20 ,$5.04 ,$5.04 ,$5.04 ,$5.72 ,$7.45 ,$5.66 , N/A ,$6.54 , N/A ,$4.89 ,$4.89 , N/A ,$4.89 ,$5.96 ,$5.13 ,$5.96 ,$5.96 ,$6.62 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CITRIC ACID-SODIUM CITRATE 500-334 MG/5ML SOLN,637,1 ,$18.90 ,$12.47 ,$9.59 ,$18.90 , N/A ,$12.95 ,$12.95 , N/A ,$11.34 ,$16.07 ,$13.23 , N/A , N/A ,$17.96 ,$14.36 ,$14.18 ,$12.29 ,$16.07 , N/A ,$12.29 ,$12.29 ,$13.23 ,$11.51 , N/A ,$18.90 , N/A , N/A , N/A ,$16.07 , N/A ,$17.39 ,$13.23 ,$9.59 ,$11.50 ,$11.51 ,$11.50 ,$13.06 ,$17.01 ,$12.91 , N/A ,$14.93 , N/A ,$11.15 ,$11.15 , N/A ,$11.15 ,$13.61 ,$11.72 ,$13.61 ,$13.61 ,$15.12 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLARITHROMYCIN 250 MG TABS,637,1 ,$20.48 ,$13.52 ,$10.39 ,$20.48 , N/A ,$14.04 ,$14.04 , N/A ,$12.29 ,$17.41 ,$14.34 , N/A , N/A ,$19.46 ,$15.56 ,$15.36 ,$13.31 ,$17.41 , N/A ,$13.31 ,$13.31 ,$14.34 ,$12.47 , N/A ,$20.48 , N/A , N/A , N/A ,$17.41 , N/A ,$18.84 ,$14.34 ,$10.39 ,$12.47 ,$12.47 ,$12.47 ,$14.15 ,$18.43 ,$13.99 , N/A ,$16.18 , N/A ,$12.08 ,$12.08 , N/A ,$12.08 ,$14.75 ,$12.70 ,$14.75 ,$14.75 ,$16.38 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLOBAZAM 10 MG TABS,637,1 ,$64.60 ,$42.64 ,$32.77 ,$64.60 , N/A ,$44.28 ,$44.28 , N/A ,$38.76 ,$54.91 ,$45.22 , N/A , N/A ,$61.37 ,$49.10 ,$48.45 ,$41.99 ,$54.91 , N/A ,$41.99 ,$41.99 ,$45.22 ,$39.34 , N/A ,$64.60 , N/A , N/A , N/A ,$54.91 , N/A ,$59.43 ,$45.22 ,$32.77 ,$39.32 ,$39.34 ,$39.32 ,$44.64 ,$58.14 ,$44.13 , N/A ,$51.03 , N/A ,$38.11 ,$38.11 , N/A ,$38.11 ,$46.51 ,$40.05 ,$46.51 ,$46.51 ,$51.68 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLONIDINE 0.1 MG/24HR PTWK,637,1 ,$112.75 ,$74.42 ,$57.19 ,$112.75 , N/A ,$77.28 ,$77.28 , N/A ,$67.65 ,$95.84 ,$78.93 , N/A , N/A ,$107.11 ,$85.69 ,$84.56 ,$73.29 ,$95.84 , N/A ,$73.29 ,$73.29 ,$78.93 ,$68.66 , N/A ,$112.75 , N/A , N/A , N/A ,$95.84 , N/A ,$103.73 ,$78.93 ,$57.19 ,$68.63 ,$68.66 ,$68.63 ,$77.91 ,$101.48 ,$77.03 , N/A ,$89.07 , N/A ,$66.52 ,$66.52 , N/A ,$66.52 ,$81.18 ,$69.91 ,$81.18 ,$81.18 ,$90.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLOPIDOGREL 75 MG TABS,637,1 ,$23.20 ,$15.31 ,$11.77 ,$23.20 , N/A ,$15.90 ,$15.90 , N/A ,$13.92 ,$19.72 ,$16.24 , N/A , N/A ,$22.04 ,$17.63 ,$17.40 ,$15.08 ,$19.72 , N/A ,$15.08 ,$15.08 ,$16.24 ,$14.13 , N/A ,$23.20 , N/A , N/A , N/A ,$19.72 , N/A ,$21.34 ,$16.24 ,$11.77 ,$14.12 ,$14.13 ,$14.12 ,$16.03 ,$20.88 ,$15.85 , N/A ,$18.33 , N/A ,$13.69 ,$13.69 , N/A ,$13.69 ,$16.70 ,$14.38 ,$16.70 ,$16.70 ,$18.56 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLOTRIMAZOLE 1 % CREA 30 G TUBE,637,1 ,$37.45 ,$24.72 ,$18.99 ,$37.45 , N/A ,$25.67 ,$25.67 , N/A ,$22.47 ,$31.83 ,$26.22 , N/A , N/A ,$35.58 ,$28.46 ,$28.09 ,$24.34 ,$31.83 , N/A ,$24.34 ,$24.34 ,$26.22 ,$22.81 , N/A ,$37.45 , N/A , N/A , N/A ,$31.83 , N/A ,$34.45 ,$26.22 ,$18.99 ,$22.80 ,$22.81 ,$22.80 ,$25.88 ,$33.71 ,$25.59 , N/A ,$29.59 , N/A ,$22.10 ,$22.10 , N/A ,$22.10 ,$26.96 ,$23.22 ,$26.96 ,$26.96 ,$29.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLOTRIMAZOLE 10 MG TROC,637,1 ,$10.95 ,$7.23 ,$5.55 ,$10.95 , N/A ,$7.51 ,$7.51 , N/A ,$6.57 ,$9.31 ,$7.67 , N/A , N/A ,$10.40 ,$8.32 ,$8.21 ,$7.12 ,$9.31 , N/A ,$7.12 ,$7.12 ,$7.67 ,$6.67 , N/A ,$10.95 , N/A , N/A , N/A ,$9.31 , N/A ,$10.07 ,$7.67 ,$5.55 ,$6.67 ,$6.67 ,$6.67 ,$7.57 ,$9.86 ,$7.48 , N/A ,$8.65 , N/A ,$6.46 ,$6.46 , N/A ,$6.46 ,$7.88 ,$6.79 ,$7.88 ,$7.88 ,$8.76 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % CREA 15 G TUBE,637,1 ,$191.10 ,$126.13 ,$96.93 ,$191.10 , N/A ,$130.98 ,$130.98 , N/A ,$114.66 ,$162.44 ,$133.77 , N/A , N/A ,$181.55 ,$145.24 ,$143.33 ,$124.22 ,$162.44 , N/A ,$124.22 ,$124.22 ,$133.77 ,$116.38 , N/A ,$191.10 , N/A , N/A , N/A ,$162.44 , N/A ,$175.81 ,$133.77 ,$96.93 ,$116.32 ,$116.38 ,$116.32 ,$132.05 ,$171.99 ,$130.56 , N/A ,$150.97 , N/A ,$112.75 ,$112.75 , N/A ,$112.75 ,$137.59 ,$118.48 ,$137.59 ,$137.59 ,$152.88 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLOZAPINE 100 MG TABS,637,1 ,$11.78 ,$7.77 ,$5.97 ,$11.78 , N/A ,$8.07 ,$8.07 , N/A ,$7.07 ,$10.01 ,$8.25 , N/A , N/A ,$11.19 ,$8.95 ,$8.84 ,$7.66 ,$10.01 , N/A ,$7.66 ,$7.66 ,$8.25 ,$7.17 , N/A ,$11.78 , N/A , N/A , N/A ,$10.01 , N/A ,$10.84 ,$8.25 ,$5.97 ,$7.17 ,$7.17 ,$7.17 ,$8.14 ,$10.60 ,$8.05 , N/A ,$9.31 , N/A ,$6.95 ,$6.95 , N/A ,$6.95 ,$8.48 ,$7.30 ,$8.48 ,$8.48 ,$9.42 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,COLCHICINE 0.6 MG CAPS,637,1 ,$27.75 ,$18.32 ,$14.07 ,$27.75 , N/A ,$19.02 ,$19.02 , N/A ,$16.65 ,$23.59 ,$19.43 , N/A , N/A ,$26.36 ,$21.09 ,$20.81 ,$18.04 ,$23.59 , N/A ,$18.04 ,$18.04 ,$19.43 ,$16.90 , N/A ,$27.75 , N/A , N/A , N/A ,$23.59 , N/A ,$25.53 ,$19.43 ,$14.07 ,$16.89 ,$16.90 ,$16.89 ,$19.18 ,$24.98 ,$18.96 , N/A ,$21.92 , N/A ,$16.37 ,$16.37 , N/A ,$16.37 ,$19.98 ,$17.21 ,$19.98 ,$19.98 ,$22.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,COLCHICINE 0.6 MG TABS,637,1 ,$37.95 ,$25.05 ,$19.25 ,$37.95 , N/A ,$26.01 ,$26.01 , N/A ,$22.77 ,$32.26 ,$26.57 , N/A , N/A ,$36.05 ,$28.84 ,$28.46 ,$24.67 ,$32.26 , N/A ,$24.67 ,$24.67 ,$26.57 ,$23.11 , N/A ,$37.95 , N/A , N/A , N/A ,$32.26 , N/A ,$34.91 ,$26.57 ,$19.25 ,$23.10 ,$23.11 ,$23.10 ,$26.22 ,$34.16 ,$25.93 , N/A ,$29.98 , N/A ,$22.39 ,$22.39 , N/A ,$22.39 ,$27.32 ,$23.53 ,$27.32 ,$27.32 ,$30.36 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,COLESEVELAM 625 MG TABS,637,1 ,$13.47 ,$8.89 ,$6.83 ,$13.47 , N/A ,$9.23 ,$9.23 , N/A ,$8.08 ,$11.45 ,$9.43 , N/A , N/A ,$12.80 ,$10.24 ,$10.10 ,$8.76 ,$11.45 , N/A ,$8.76 ,$8.76 ,$9.43 ,$8.20 , N/A ,$13.47 , N/A , N/A , N/A ,$11.45 , N/A ,$12.39 ,$9.43 ,$6.83 ,$8.20 ,$8.20 ,$8.20 ,$9.31 ,$12.12 ,$9.20 , N/A ,$10.64 , N/A ,$7.95 ,$7.95 , N/A ,$7.95 ,$9.70 ,$8.35 ,$9.70 ,$9.70 ,$10.78 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CONJUGATED ESTROGENS 0.625 MG/GM CREA 30 G TUBE,637,1 ,"$1,697.80 ","$1,120.55 ",$861.12 ,"$1,697.80 ", N/A ,"$1,163.67 ","$1,163.67 ", N/A ,"$1,018.68 ","$1,443.13 ","$1,188.46 ", N/A , N/A ,"$1,612.91 ","$1,290.33 ","$1,273.35 ","$1,103.57 ","$1,443.13 ", N/A ,"$1,103.57 ","$1,103.57 ","$1,188.46 ","$1,033.96 ", N/A ,"$1,697.80 ", N/A , N/A , N/A ,"$1,443.13 ", N/A ,"$1,561.98 ","$1,188.46 ",$861.12 ,"$1,033.45 ","$1,033.96 ","$1,033.45 ","$1,173.18 ","$1,528.02 ","$1,159.94 ", N/A ,"$1,341.26 ", N/A ,"$1,001.70 ","$1,001.70 ", N/A ,"$1,001.70 ","$1,222.42 ","$1,052.64 ","$1,222.42 ","$1,222.42 ","$1,358.24 "
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DABIGATRAN 75 MG CAPS,637,1 ,$33.75 ,$22.28 ,$17.12 ,$33.75 , N/A ,$23.13 ,$23.13 , N/A ,$20.25 ,$28.69 ,$23.63 , N/A , N/A ,$32.06 ,$25.65 ,$25.31 ,$21.94 ,$28.69 , N/A ,$21.94 ,$21.94 ,$23.63 ,$20.55 , N/A ,$33.75 , N/A , N/A , N/A ,$28.69 , N/A ,$31.05 ,$23.63 ,$17.12 ,$20.54 ,$20.55 ,$20.54 ,$23.32 ,$30.38 ,$23.06 , N/A ,$26.66 , N/A ,$19.91 ,$19.91 , N/A ,$19.91 ,$24.30 ,$20.93 ,$24.30 ,$24.30 ,$27.00 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DAPSONE 100 MG TABS,637,1 ,$10.30 ,$6.80 ,$5.22 ,$10.30 , N/A ,$7.06 ,$7.06 , N/A ,$6.18 ,$8.76 ,$7.21 , N/A , N/A ,$9.79 ,$7.83 ,$7.73 ,$6.70 ,$8.76 , N/A ,$6.70 ,$6.70 ,$7.21 ,$6.27 , N/A ,$10.30 , N/A , N/A , N/A ,$8.76 , N/A ,$9.48 ,$7.21 ,$5.22 ,$6.27 ,$6.27 ,$6.27 ,$7.12 ,$9.27 ,$7.04 , N/A ,$8.14 , N/A ,$6.08 ,$6.08 , N/A ,$6.08 ,$7.42 ,$6.39 ,$7.42 ,$7.42 ,$8.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIBUCAINE 1 % OINT 28 G TUBE,637,1 ,$20.00 ,$13.20 ,$10.14 ,$20.00 , N/A ,$13.71 ,$13.71 , N/A ,$12.00 ,$17.00 ,$14.00 , N/A , N/A ,$19.00 ,$15.20 ,$15.00 ,$13.00 ,$17.00 , N/A ,$13.00 ,$13.00 ,$14.00 ,$12.18 , N/A ,$20.00 , N/A , N/A , N/A ,$17.00 , N/A ,$18.40 ,$14.00 ,$10.14 ,$12.17 ,$12.18 ,$12.17 ,$13.82 ,$18.00 ,$13.66 , N/A ,$15.80 , N/A ,$11.80 ,$11.80 , N/A ,$11.80 ,$14.40 ,$12.40 ,$14.40 ,$14.40 ,$16.00 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DICLOFENAC SODIUM 1 % GEL 100 G TUBE,637,1 ,$198.60 ,$131.08 ,$100.73 ,$198.60 , N/A ,$136.12 ,$136.12 , N/A ,$119.16 ,$168.81 ,$139.02 , N/A , N/A ,$188.67 ,$150.94 ,$148.95 ,$129.09 ,$168.81 , N/A ,$129.09 ,$129.09 ,$139.02 ,$120.95 , N/A ,$198.60 , N/A , N/A , N/A ,$168.81 , N/A ,$182.71 ,$139.02 ,$100.73 ,$120.89 ,$120.95 ,$120.89 ,$137.23 ,$178.74 ,$135.68 , N/A ,$156.89 , N/A ,$117.17 ,$117.17 , N/A ,$117.17 ,$142.99 ,$123.13 ,$142.99 ,$142.99 ,$158.88 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DILTIAZEM SR 60 MG CP12,637,1 ,$13.50 ,$8.91 ,$6.85 ,$13.50 , N/A ,$9.25 ,$9.25 , N/A ,$8.10 ,$11.48 ,$9.45 , N/A , N/A ,$12.83 ,$10.26 ,$10.13 ,$8.78 ,$11.48 , N/A ,$8.78 ,$8.78 ,$9.45 ,$8.22 , N/A ,$13.50 , N/A , N/A , N/A ,$11.48 , N/A ,$12.42 ,$9.45 ,$6.85 ,$8.22 ,$8.22 ,$8.22 ,$9.33 ,$12.15 ,$9.22 , N/A ,$10.67 , N/A ,$7.97 ,$7.97 , N/A ,$7.97 ,$9.72 ,$8.37 ,$9.72 ,$9.72 ,$10.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DILTIAZEM SR 90 MG CP12,637,1 ,$12.33 ,$8.14 ,$6.25 ,$12.33 , N/A ,$8.45 ,$8.45 , N/A ,$7.40 ,$10.48 ,$8.63 , N/A , N/A ,$11.71 ,$9.37 ,$9.25 ,$8.01 ,$10.48 , N/A ,$8.01 ,$8.01 ,$8.63 ,$7.51 , N/A ,$12.33 , N/A , N/A , N/A ,$10.48 , N/A ,$11.34 ,$8.63 ,$6.25 ,$7.51 ,$7.51 ,$7.51 ,$8.52 ,$11.10 ,$8.42 , N/A ,$9.74 , N/A ,$7.27 ,$7.27 , N/A ,$7.27 ,$8.88 ,$7.64 ,$8.88 ,$8.88 ,$9.86 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIPHENHYDRAMINE-ZINC 2-0.1 % CREA 28 G TUBE,637,1 ,$14.80 ,$9.77 ,$7.51 ,$14.80 , N/A ,$10.14 ,$10.14 , N/A ,$8.88 ,$12.58 ,$10.36 , N/A , N/A ,$14.06 ,$11.25 ,$11.10 ,$9.62 ,$12.58 , N/A ,$9.62 ,$9.62 ,$10.36 ,$9.01 , N/A ,$14.80 , N/A , N/A , N/A ,$12.58 , N/A ,$13.62 ,$10.36 ,$7.51 ,$9.01 ,$9.01 ,$9.01 ,$10.23 ,$13.32 ,$10.11 , N/A ,$11.69 , N/A ,$8.73 ,$8.73 , N/A ,$8.73 ,$10.66 ,$9.18 ,$10.66 ,$10.66 ,$11.84 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIVALPROEX ER 250 MG TB24,637,1 ,$8.35 ,$5.51 ,$4.24 ,$8.35 , N/A ,$5.72 ,$5.72 , N/A ,$5.01 ,$7.10 ,$5.85 , N/A , N/A ,$7.93 ,$6.35 ,$6.26 ,$5.43 ,$7.10 , N/A ,$5.43 ,$5.43 ,$5.85 ,$5.09 , N/A ,$8.35 , N/A , N/A , N/A ,$7.10 , N/A ,$7.68 ,$5.85 ,$4.24 ,$5.08 ,$5.09 ,$5.08 ,$5.77 ,$7.52 ,$5.70 , N/A ,$6.60 , N/A ,$4.93 ,$4.93 , N/A ,$4.93 ,$6.01 ,$5.18 ,$6.01 ,$6.01 ,$6.68 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIVALPROEX ER 500 MG TB24,637,1 ,$13.05 ,$8.61 ,$6.62 ,$13.05 , N/A ,$8.94 ,$8.94 , N/A ,$7.83 ,$11.09 ,$9.14 , N/A , N/A ,$12.40 ,$9.92 ,$9.79 ,$8.48 ,$11.09 , N/A ,$8.48 ,$8.48 ,$9.14 ,$7.95 , N/A ,$13.05 , N/A , N/A , N/A ,$11.09 , N/A ,$12.01 ,$9.14 ,$6.62 ,$7.94 ,$7.95 ,$7.94 ,$9.02 ,$11.75 ,$8.92 , N/A ,$10.31 , N/A ,$7.70 ,$7.70 , N/A ,$7.70 ,$9.40 ,$8.09 ,$9.40 ,$9.40 ,$10.44 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DORZOLAMIDE 2 % SOLN 10 ML BOTTLE,637,1 ,$227.15 ,$149.92 ,$115.21 ,$227.15 , N/A ,$155.69 ,$155.69 , N/A ,$136.29 ,$193.08 ,$159.01 , N/A , N/A ,$215.79 ,$172.63 ,$170.36 ,$147.65 ,$193.08 , N/A ,$147.65 ,$147.65 ,$159.01 ,$138.33 , N/A ,$227.15 , N/A , N/A , N/A ,$193.08 , N/A ,$208.98 ,$159.01 ,$115.21 ,$138.27 ,$138.33 ,$138.27 ,$156.96 ,$204.44 ,$155.19 , N/A ,$179.45 , N/A ,$134.02 ,$134.02 , N/A ,$134.02 ,$163.55 ,$140.83 ,$163.55 ,$163.55 ,$181.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML SOLN 10 ML BOTTLE,637,1 ,$416.85 ,$275.12 ,$211.43 ,$416.85 , N/A ,$285.71 ,$285.71 , N/A ,$250.11 ,$354.32 ,$291.80 , N/A , N/A ,$396.01 ,$316.81 ,$312.64 ,$270.95 ,$354.32 , N/A ,$270.95 ,$270.95 ,$291.80 ,$253.86 , N/A ,$416.85 , N/A , N/A , N/A ,$354.32 , N/A ,$383.50 ,$291.80 ,$211.43 ,$253.74 ,$253.86 ,$253.74 ,$288.04 ,$375.17 ,$284.79 , N/A ,$329.31 , N/A ,$245.94 ,$245.94 , N/A ,$245.94 ,$300.13 ,$258.45 ,$300.13 ,$300.13 ,$333.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DOXYCYCLINE HYCLATE 100 MG CAPS,637,1 ,$18.85 ,$12.44 ,$9.56 ,$18.85 , N/A ,$12.92 ,$12.92 , N/A ,$11.31 ,$16.02 ,$13.20 , N/A , N/A ,$17.91 ,$14.33 ,$14.14 ,$12.25 ,$16.02 , N/A ,$12.25 ,$12.25 ,$13.20 ,$11.48 , N/A ,$18.85 , N/A , N/A , N/A ,$16.02 , N/A ,$17.34 ,$13.20 ,$9.56 ,$11.47 ,$11.48 ,$11.47 ,$13.03 ,$16.97 ,$12.88 , N/A ,$14.89 , N/A ,$11.12 ,$11.12 , N/A ,$11.12 ,$13.57 ,$11.69 ,$13.57 ,$13.57 ,$15.08 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DULOXETINE 20 MG CPEP,637,1 ,$27.80 ,$18.35 ,$14.10 ,$27.80 , N/A ,$19.05 ,$19.05 , N/A ,$16.68 ,$23.63 ,$19.46 , N/A , N/A ,$26.41 ,$21.13 ,$20.85 ,$18.07 ,$23.63 , N/A ,$18.07 ,$18.07 ,$19.46 ,$16.93 , N/A ,$27.80 , N/A , N/A , N/A ,$23.63 , N/A ,$25.58 ,$19.46 ,$14.10 ,$16.92 ,$16.93 ,$16.92 ,$19.21 ,$25.02 ,$18.99 , N/A ,$21.96 , N/A ,$16.40 ,$16.40 , N/A ,$16.40 ,$20.02 ,$17.24 ,$20.02 ,$20.02 ,$22.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DULOXETINE 30 MG CPEP,637,1 ,$26.70 ,$17.62 ,$13.54 ,$26.70 , N/A ,$18.30 ,$18.30 , N/A ,$16.02 ,$22.70 ,$18.69 , N/A , N/A ,$25.37 ,$20.29 ,$20.03 ,$17.36 ,$22.70 , N/A ,$17.36 ,$17.36 ,$18.69 ,$16.26 , N/A ,$26.70 , N/A , N/A , N/A ,$22.70 , N/A ,$24.56 ,$18.69 ,$13.54 ,$16.25 ,$16.26 ,$16.25 ,$18.45 ,$24.03 ,$18.24 , N/A ,$21.09 , N/A ,$15.75 ,$15.75 , N/A ,$15.75 ,$19.22 ,$16.55 ,$19.22 ,$19.22 ,$21.36 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DUTASTERIDE 0.5 MG CAPS,637,1 ,$20.60 ,$13.60 ,$10.45 ,$20.60 , N/A ,$14.12 ,$14.12 , N/A ,$12.36 ,$17.51 ,$14.42 , N/A , N/A ,$19.57 ,$15.66 ,$15.45 ,$13.39 ,$17.51 , N/A ,$13.39 ,$13.39 ,$14.42 ,$12.55 , N/A ,$20.60 , N/A , N/A , N/A ,$17.51 , N/A ,$18.95 ,$14.42 ,$10.45 ,$12.54 ,$12.55 ,$12.54 ,$14.23 ,$18.54 ,$14.07 , N/A ,$16.27 , N/A ,$12.15 ,$12.15 , N/A ,$12.15 ,$14.83 ,$12.77 ,$14.83 ,$14.83 ,$16.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,EMOLLIENT OINT 100 G JAR,637,1 ,$17.35 ,$11.45 ,$8.80 ,$17.35 , N/A ,$11.89 ,$11.89 , N/A ,$10.41 ,$14.75 ,$12.15 , N/A , N/A ,$16.48 ,$13.19 ,$13.01 ,$11.28 ,$14.75 , N/A ,$11.28 ,$11.28 ,$12.15 ,$10.57 , N/A ,$17.35 , N/A , N/A , N/A ,$14.75 , N/A ,$15.96 ,$12.15 ,$8.80 ,$10.56 ,$10.57 ,$10.56 ,$11.99 ,$15.62 ,$11.85 , N/A ,$13.71 , N/A ,$10.24 ,$10.24 , N/A ,$10.24 ,$12.49 ,$10.76 ,$12.49 ,$12.49 ,$13.88 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,EMPAGLIFLOZIN 10 MG TABS,637,1 ,$77.60 ,$51.22 ,$39.36 ,$77.60 , N/A ,$53.19 ,$53.19 , N/A ,$46.56 ,$65.96 ,$54.32 , N/A , N/A ,$73.72 ,$58.98 ,$58.20 ,$50.44 ,$65.96 , N/A ,$50.44 ,$50.44 ,$54.32 ,$47.26 , N/A ,$77.60 , N/A , N/A , N/A ,$65.96 , N/A ,$71.39 ,$54.32 ,$39.36 ,$47.24 ,$47.26 ,$47.24 ,$53.62 ,$69.84 ,$53.02 , N/A ,$61.30 , N/A ,$45.78 ,$45.78 , N/A ,$45.78 ,$55.87 ,$48.11 ,$55.87 ,$55.87 ,$62.08 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,EPINEPHRINE 0.3 MG/0.3ML SOAJ,637,1 ,$778.15 ,$513.58 ,$394.68 ,$778.15 , N/A ,$533.34 ,$533.34 , N/A ,$466.89 ,$661.43 ,$544.71 , N/A , N/A ,$739.24 ,$591.39 ,$583.61 ,$505.80 ,$661.43 , N/A ,$505.80 ,$505.80 ,$544.71 ,$473.89 , N/A ,$778.15 , N/A , N/A , N/A ,$661.43 , N/A ,$715.90 ,$544.71 ,$394.68 ,$473.66 ,$473.89 ,$473.66 ,$537.70 ,$700.34 ,$531.63 , N/A ,$614.74 , N/A ,$459.11 ,$459.11 , N/A ,$459.11 ,$560.27 ,$482.45 ,$560.27 ,$560.27 ,$622.52 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ERYTHROMYCIN 5 MG/GM OINT 1 G TUBE,637,1 ,$42.25 ,$27.89 ,$21.43 ,$42.25 , N/A ,$28.96 ,$28.96 , N/A ,$25.35 ,$35.91 ,$29.58 , N/A , N/A ,$40.14 ,$32.11 ,$31.69 ,$27.46 ,$35.91 , N/A ,$27.46 ,$27.46 ,$29.58 ,$25.73 , N/A ,$42.25 , N/A , N/A , N/A ,$35.91 , N/A ,$38.87 ,$29.58 ,$21.43 ,$25.72 ,$25.73 ,$25.72 ,$29.19 ,$38.03 ,$28.87 , N/A ,$33.38 , N/A ,$24.93 ,$24.93 , N/A ,$24.93 ,$30.42 ,$26.20 ,$30.42 ,$30.42 ,$33.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ESCITALOPRAM 20 MG TABS,637,1 ,$15.65 ,$10.33 ,$7.94 ,$15.65 , N/A ,$10.73 ,$10.73 , N/A ,$9.39 ,$13.30 ,$10.96 , N/A , N/A ,$14.87 ,$11.89 ,$11.74 ,$10.17 ,$13.30 , N/A ,$10.17 ,$10.17 ,$10.96 ,$9.53 , N/A ,$15.65 , N/A , N/A , N/A ,$13.30 , N/A ,$14.40 ,$10.96 ,$7.94 ,$9.53 ,$9.53 ,$9.53 ,$10.81 ,$14.09 ,$10.69 , N/A ,$12.36 , N/A ,$9.23 ,$9.23 , N/A ,$9.23 ,$11.27 ,$9.70 ,$11.27 ,$11.27 ,$12.52 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ESCITALOPRAM 5 MG TABS,637,1 ,$14.08 ,$9.29 ,$7.14 ,$14.08 , N/A ,$9.65 ,$9.65 , N/A ,$8.45 ,$11.97 ,$9.86 , N/A , N/A ,$13.38 ,$10.70 ,$10.56 ,$9.15 ,$11.97 , N/A ,$9.15 ,$9.15 ,$9.86 ,$8.57 , N/A ,$14.08 , N/A , N/A , N/A ,$11.97 , N/A ,$12.95 ,$9.86 ,$7.14 ,$8.57 ,$8.57 ,$8.57 ,$9.73 ,$12.67 ,$9.62 , N/A ,$11.12 , N/A ,$8.31 ,$8.31 , N/A ,$8.31 ,$10.14 ,$8.73 ,$10.14 ,$10.14 ,$11.26 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,EZETIMIBE 10 MG TABS,637,1 ,$35.15 ,$23.20 ,$17.83 ,$35.15 , N/A ,$24.09 ,$24.09 , N/A ,$21.09 ,$29.88 ,$24.61 , N/A , N/A ,$33.39 ,$26.71 ,$26.36 ,$22.85 ,$29.88 , N/A ,$22.85 ,$22.85 ,$24.61 ,$21.41 , N/A ,$35.15 , N/A , N/A , N/A ,$29.88 , N/A ,$32.34 ,$24.61 ,$17.83 ,$21.40 ,$21.41 ,$21.40 ,$24.29 ,$31.64 ,$24.01 , N/A ,$27.77 , N/A ,$20.74 ,$20.74 , N/A ,$20.74 ,$25.31 ,$21.79 ,$25.31 ,$25.31 ,$28.12 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FEBUXOSTAT 40 MG TABS,637,1 ,$42.10 ,$27.79 ,$21.35 ,$42.10 , N/A ,$28.86 ,$28.86 , N/A ,$25.26 ,$35.79 ,$29.47 , N/A , N/A ,$40.00 ,$32.00 ,$31.58 ,$27.37 ,$35.79 , N/A ,$27.37 ,$27.37 ,$29.47 ,$25.64 , N/A ,$42.10 , N/A , N/A , N/A ,$35.79 , N/A ,$38.73 ,$29.47 ,$21.35 ,$25.63 ,$25.64 ,$25.63 ,$29.09 ,$37.89 ,$28.76 , N/A ,$33.26 , N/A ,$24.84 ,$24.84 , N/A ,$24.84 ,$30.31 ,$26.10 ,$30.31 ,$30.31 ,$33.68 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FENOFIBRATE 145 MG TABS,637,1 ,$19.50 ,$12.87 ,$9.89 ,$19.50 , N/A ,$13.37 ,$13.37 , N/A ,$11.70 ,$16.58 ,$13.65 , N/A , N/A ,$18.53 ,$14.82 ,$14.63 ,$12.68 ,$16.58 , N/A ,$12.68 ,$12.68 ,$13.65 ,$11.88 , N/A ,$19.50 , N/A , N/A , N/A ,$16.58 , N/A ,$17.94 ,$13.65 ,$9.89 ,$11.87 ,$11.88 ,$11.87 ,$13.47 ,$17.55 ,$13.32 , N/A ,$15.41 , N/A ,$11.51 ,$11.51 , N/A ,$11.51 ,$14.04 ,$12.09 ,$14.04 ,$14.04 ,$15.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FENTANYL 100 MCG/HR PT72,637,1 ,$181.45 ,$119.76 ,$92.03 ,$181.45 , N/A ,$124.37 ,$124.37 , N/A ,$108.87 ,$154.23 ,$127.02 , N/A , N/A ,$172.38 ,$137.90 ,$136.09 ,$117.94 ,$154.23 , N/A ,$117.94 ,$117.94 ,$127.02 ,$110.50 , N/A ,$181.45 , N/A , N/A , N/A ,$154.23 , N/A ,$166.93 ,$127.02 ,$92.03 ,$110.45 ,$110.50 ,$110.45 ,$125.38 ,$163.31 ,$123.97 , N/A ,$143.35 , N/A ,$107.06 ,$107.06 , N/A ,$107.06 ,$130.64 ,$112.50 ,$130.64 ,$130.64 ,$145.16 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FENTANYL 12 MCG/HR PT72,637,1 ,$69.05 ,$45.57 ,$35.02 ,$69.05 , N/A ,$47.33 ,$47.33 , N/A ,$41.43 ,$58.69 ,$48.34 , N/A , N/A ,$65.60 ,$52.48 ,$51.79 ,$44.88 ,$58.69 , N/A ,$44.88 ,$44.88 ,$48.34 ,$42.05 , N/A ,$69.05 , N/A , N/A , N/A ,$58.69 , N/A ,$63.53 ,$48.34 ,$35.02 ,$42.03 ,$42.05 ,$42.03 ,$47.71 ,$62.15 ,$47.18 , N/A ,$54.55 , N/A ,$40.74 ,$40.74 , N/A ,$40.74 ,$49.72 ,$42.81 ,$49.72 ,$49.72 ,$55.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FENTANYL 50 MCG/HR PT72,637,1 ,$132.20 ,$87.25 ,$67.05 ,$132.20 , N/A ,$90.61 ,$90.61 , N/A ,$79.32 ,$112.37 ,$92.54 , N/A , N/A ,$125.59 ,$100.47 ,$99.15 ,$85.93 ,$112.37 , N/A ,$85.93 ,$85.93 ,$92.54 ,$80.51 , N/A ,$132.20 , N/A , N/A , N/A ,$112.37 , N/A ,$121.62 ,$92.54 ,$67.05 ,$80.47 ,$80.51 ,$80.47 ,$91.35 ,$118.98 ,$90.32 , N/A ,$104.44 , N/A ,$78.00 ,$78.00 , N/A ,$78.00 ,$95.18 ,$81.96 ,$95.18 ,$95.18 ,$105.76 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FIDAXOMICIN 200 MG TABS,637,1 ,$819.00 ,$540.54 ,$415.40 ,$819.00 , N/A ,$561.34 ,$561.34 , N/A ,$491.40 ,$696.15 ,$573.30 , N/A , N/A ,$778.05 ,$622.44 ,$614.25 ,$532.35 ,$696.15 , N/A ,$532.35 ,$532.35 ,$573.30 ,$498.77 , N/A ,$819.00 , N/A , N/A , N/A ,$696.15 , N/A ,$753.48 ,$573.30 ,$415.40 ,$498.53 ,$498.77 ,$498.53 ,$565.93 ,$737.10 ,$559.54 , N/A ,$647.01 , N/A ,$483.21 ,$483.21 , N/A ,$483.21 ,$589.68 ,$507.78 ,$589.68 ,$589.68 ,$655.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FINASTERIDE 5 MG TABS,637,1 ,$10.65 ,$7.03 ,$5.40 ,$10.65 , N/A ,$7.30 ,$7.30 , N/A ,$6.39 ,$9.05 ,$7.46 , N/A , N/A ,$10.12 ,$8.09 ,$7.99 ,$6.92 ,$9.05 , N/A ,$6.92 ,$6.92 ,$7.46 ,$6.49 , N/A ,$10.65 , N/A , N/A , N/A ,$9.05 , N/A ,$9.80 ,$7.46 ,$5.40 ,$6.48 ,$6.49 ,$6.48 ,$7.36 ,$9.59 ,$7.28 , N/A ,$8.41 , N/A ,$6.28 ,$6.28 , N/A ,$6.28 ,$7.67 ,$6.60 ,$7.67 ,$7.67 ,$8.52 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUCONAZOLE 10 MG/ML SUSR,637,1 ,$69.80 ,$46.07 ,$35.40 ,$69.80 , N/A ,$47.84 ,$47.84 , N/A ,$41.88 ,$59.33 ,$48.86 , N/A , N/A ,$66.31 ,$53.05 ,$52.35 ,$45.37 ,$59.33 , N/A ,$45.37 ,$45.37 ,$48.86 ,$42.51 , N/A ,$69.80 , N/A , N/A , N/A ,$59.33 , N/A ,$64.22 ,$48.86 ,$35.40 ,$42.49 ,$42.51 ,$42.49 ,$48.23 ,$62.82 ,$47.69 , N/A ,$55.14 , N/A ,$41.18 ,$41.18 , N/A ,$41.18 ,$50.26 ,$43.28 ,$50.26 ,$50.26 ,$55.84 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUCONAZOLE 100 MG TABS,637,1 ,$81.60 ,$53.86 ,$41.39 ,$81.60 , N/A ,$55.93 ,$55.93 , N/A ,$48.96 ,$69.36 ,$57.12 , N/A , N/A ,$77.52 ,$62.02 ,$61.20 ,$53.04 ,$69.36 , N/A ,$53.04 ,$53.04 ,$57.12 ,$49.69 , N/A ,$81.60 , N/A , N/A , N/A ,$69.36 , N/A ,$75.07 ,$57.12 ,$41.39 ,$49.67 ,$49.69 ,$49.67 ,$56.39 ,$73.44 ,$55.75 , N/A ,$64.46 , N/A ,$48.14 ,$48.14 , N/A ,$48.14 ,$58.75 ,$50.59 ,$58.75 ,$58.75 ,$65.28 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUCONAZOLE 40 MG/ML SUSR,637,1 ,$12.67 ,$8.36 ,$6.43 ,$12.67 , N/A ,$8.68 ,$8.68 , N/A ,$7.60 ,$10.77 ,$8.87 , N/A , N/A ,$12.04 ,$9.63 ,$9.50 ,$8.24 ,$10.77 , N/A ,$8.24 ,$8.24 ,$8.87 ,$7.72 , N/A ,$12.67 , N/A , N/A , N/A ,$10.77 , N/A ,$11.66 ,$8.87 ,$6.43 ,$7.71 ,$7.72 ,$7.71 ,$8.76 ,$11.40 ,$8.66 , N/A ,$10.01 , N/A ,$7.48 ,$7.48 , N/A ,$7.48 ,$9.12 ,$7.86 ,$9.12 ,$9.12 ,$10.14 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUCONAZOLE 50 MG TABS,637,1 ,$19.05 ,$12.57 ,$9.66 ,$19.05 , N/A ,$13.06 ,$13.06 , N/A ,$11.43 ,$16.19 ,$13.34 , N/A , N/A ,$18.10 ,$14.48 ,$14.29 ,$12.38 ,$16.19 , N/A ,$12.38 ,$12.38 ,$13.34 ,$11.60 , N/A ,$19.05 , N/A , N/A , N/A ,$16.19 , N/A ,$17.53 ,$13.34 ,$9.66 ,$11.60 ,$11.60 ,$11.60 ,$13.16 ,$17.15 ,$13.02 , N/A ,$15.05 , N/A ,$11.24 ,$11.24 , N/A ,$11.24 ,$13.72 ,$11.81 ,$13.72 ,$13.72 ,$15.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUOXETINE 10 MG CAPS,637,1 ,$8.25 ,$5.45 ,$4.18 ,$8.25 , N/A ,$5.65 ,$5.65 , N/A ,$4.95 ,$7.01 ,$5.78 , N/A , N/A ,$7.84 ,$6.27 ,$6.19 ,$5.36 ,$7.01 , N/A ,$5.36 ,$5.36 ,$5.78 ,$5.02 , N/A ,$8.25 , N/A , N/A , N/A ,$7.01 , N/A ,$7.59 ,$5.78 ,$4.18 ,$5.02 ,$5.02 ,$5.02 ,$5.70 ,$7.43 ,$5.64 , N/A ,$6.52 , N/A ,$4.87 ,$4.87 , N/A ,$4.87 ,$5.94 ,$5.12 ,$5.94 ,$5.94 ,$6.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUOXETINE 20 MG CAPS,637,1 ,$9.08 ,$5.99 ,$4.61 ,$9.08 , N/A ,$6.22 ,$6.22 , N/A ,$5.45 ,$7.72 ,$6.36 , N/A , N/A ,$8.63 ,$6.90 ,$6.81 ,$5.90 ,$7.72 , N/A ,$5.90 ,$5.90 ,$6.36 ,$5.53 , N/A ,$9.08 , N/A , N/A , N/A ,$7.72 , N/A ,$8.35 ,$6.36 ,$4.61 ,$5.53 ,$5.53 ,$5.53 ,$6.27 ,$8.17 ,$6.20 , N/A ,$7.17 , N/A ,$5.36 ,$5.36 , N/A ,$5.36 ,$6.54 ,$5.63 ,$6.54 ,$6.54 ,$7.26 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUTICASONE 110 MCG/ACT AERO,637,1 ,$18.65 ,$12.31 ,$9.46 ,$18.65 , N/A ,$12.78 ,$12.78 , N/A ,$11.19 ,$15.85 ,$13.06 , N/A , N/A ,$17.72 ,$14.17 ,$13.99 ,$12.12 ,$15.85 , N/A ,$12.12 ,$12.12 ,$13.06 ,$11.36 , N/A ,$18.65 , N/A , N/A , N/A ,$15.85 , N/A ,$17.16 ,$13.06 ,$9.46 ,$11.35 ,$11.36 ,$11.35 ,$12.89 ,$16.79 ,$12.74 , N/A ,$14.73 , N/A ,$11.00 ,$11.00 , N/A ,$11.00 ,$13.43 ,$11.56 ,$13.43 ,$13.43 ,$14.92 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUTICASONE PROPIONATE 220 MCG/ACT AERO,637,1 ,$14.50 ,$9.57 ,$7.35 ,$14.50 , N/A ,$9.94 ,$9.94 , N/A ,$8.70 ,$12.33 ,$10.15 , N/A , N/A ,$13.78 ,$11.02 ,$10.88 ,$9.43 ,$12.33 , N/A ,$9.43 ,$9.43 ,$10.15 ,$8.83 , N/A ,$14.50 , N/A , N/A , N/A ,$12.33 , N/A ,$13.34 ,$10.15 ,$7.35 ,$8.83 ,$8.83 ,$8.83 ,$10.02 ,$13.05 ,$9.91 , N/A ,$11.46 , N/A ,$8.56 ,$8.56 , N/A ,$8.56 ,$10.44 ,$8.99 ,$10.44 ,$10.44 ,$11.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUTICASONE PROPIONATE 44 MCG/ACT AERO,637,1 ,$13.95 ,$9.21 ,$7.08 ,$13.95 , N/A ,$9.56 ,$9.56 , N/A ,$8.37 ,$11.86 ,$9.77 , N/A , N/A ,$13.25 ,$10.60 ,$10.46 ,$9.07 ,$11.86 , N/A ,$9.07 ,$9.07 ,$9.77 ,$8.50 , N/A ,$13.95 , N/A , N/A , N/A ,$11.86 , N/A ,$12.83 ,$9.77 ,$7.08 ,$8.49 ,$8.50 ,$8.49 ,$9.64 ,$12.56 ,$9.53 , N/A ,$11.02 , N/A ,$8.23 ,$8.23 , N/A ,$8.23 ,$10.04 ,$8.65 ,$10.04 ,$10.04 ,$11.16 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUTICASONE PROPIONATE 50 MCG/ACT SUSP 16 G BOTTLE,637,1 ,$289.90 ,$191.33 ,$147.04 ,$289.90 , N/A ,$198.70 ,$198.70 , N/A ,$173.94 ,$246.42 ,$202.93 , N/A , N/A ,$275.41 ,$220.32 ,$217.43 ,$188.44 ,$246.42 , N/A ,$188.44 ,$188.44 ,$202.93 ,$176.55 , N/A ,$289.90 , N/A , N/A , N/A ,$246.42 , N/A ,$266.71 ,$202.93 ,$147.04 ,$176.46 ,$176.55 ,$176.46 ,$200.32 ,$260.91 ,$198.06 , N/A ,$229.02 , N/A ,$171.04 ,$171.04 , N/A ,$171.04 ,$208.73 ,$179.74 ,$208.73 ,$208.73 ,$231.92 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUTICASONE-SALMETEROL 230-21 MCG/ACT AERO,637,1 ,$44.15 ,$29.14 ,$22.39 ,$44.15 , N/A ,$30.26 ,$30.26 , N/A ,$26.49 ,$37.53 ,$30.91 , N/A , N/A ,$41.94 ,$33.55 ,$33.11 ,$28.70 ,$37.53 , N/A ,$28.70 ,$28.70 ,$30.91 ,$26.89 , N/A ,$44.15 , N/A , N/A , N/A ,$37.53 , N/A ,$40.62 ,$30.91 ,$22.39 ,$26.87 ,$26.89 ,$26.87 ,$30.51 ,$39.74 ,$30.16 , N/A ,$34.88 , N/A ,$26.05 ,$26.05 , N/A ,$26.05 ,$31.79 ,$27.37 ,$31.79 ,$31.79 ,$35.32 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUTICASONE-SALMETEROL 45-21 MCG/ACT AERO,637,1 ,$29.80 ,$19.67 ,$15.11 ,$29.80 , N/A ,$20.42 ,$20.42 , N/A ,$17.88 ,$25.33 ,$20.86 , N/A , N/A ,$28.31 ,$22.65 ,$22.35 ,$19.37 ,$25.33 , N/A ,$19.37 ,$19.37 ,$20.86 ,$18.15 , N/A ,$29.80 , N/A , N/A , N/A ,$25.33 , N/A ,$27.42 ,$20.86 ,$15.11 ,$18.14 ,$18.15 ,$18.14 ,$20.59 ,$26.82 ,$20.36 , N/A ,$23.54 , N/A ,$17.58 ,$17.58 , N/A ,$17.58 ,$21.46 ,$18.48 ,$21.46 ,$21.46 ,$23.84 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUTICASONE-SALMETEROL 115-21 MCG/ACT AERO,637,1 ,$29.80 ,$19.67 ,$15.11 ,$29.80 , N/A ,$20.42 ,$20.42 , N/A ,$17.88 ,$25.33 ,$20.86 , N/A , N/A ,$28.31 ,$22.65 ,$22.35 ,$19.37 ,$25.33 , N/A ,$19.37 ,$19.37 ,$20.86 ,$18.15 , N/A ,$29.80 , N/A , N/A , N/A ,$25.33 , N/A ,$27.42 ,$20.86 ,$15.11 ,$18.14 ,$18.15 ,$18.14 ,$20.59 ,$26.82 ,$20.36 , N/A ,$23.54 , N/A ,$17.58 ,$17.58 , N/A ,$17.58 ,$21.46 ,$18.48 ,$21.46 ,$21.46 ,$23.84 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUVOXAMINE 50 MG TABS,637,1 ,$8.77 ,$5.79 ,$4.45 ,$8.77 , N/A ,$6.01 ,$6.01 , N/A ,$5.26 ,$7.45 ,$6.14 , N/A , N/A ,$8.33 ,$6.67 ,$6.58 ,$5.70 ,$7.45 , N/A ,$5.70 ,$5.70 ,$6.14 ,$5.34 , N/A ,$8.77 , N/A , N/A , N/A ,$7.45 , N/A ,$8.07 ,$6.14 ,$4.45 ,$5.34 ,$5.34 ,$5.34 ,$6.06 ,$7.89 ,$5.99 , N/A ,$6.93 , N/A ,$5.17 ,$5.17 , N/A ,$5.17 ,$6.31 ,$5.44 ,$6.31 ,$6.31 ,$7.02 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GENTAMICIN 0.1 % OINT 30 G TUBE,637,1 ,$335.80 ,$221.63 ,$170.32 ,$335.80 , N/A ,$230.16 ,$230.16 , N/A ,$201.48 ,$285.43 ,$235.06 , N/A , N/A ,$319.01 ,$255.21 ,$251.85 ,$218.27 ,$285.43 , N/A ,$218.27 ,$218.27 ,$235.06 ,$204.50 , N/A ,$335.80 , N/A , N/A , N/A ,$285.43 , N/A ,$308.94 ,$235.06 ,$170.32 ,$204.40 ,$204.50 ,$204.40 ,$232.04 ,$302.22 ,$229.42 , N/A ,$265.28 , N/A ,$198.12 ,$198.12 , N/A ,$198.12 ,$241.78 ,$208.20 ,$241.78 ,$241.78 ,$268.64 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML SOLN,637,1 ,$16.75 ,$11.06 ,$8.50 ,$16.75 , N/A ,$11.48 ,$11.48 , N/A ,$10.05 ,$14.24 ,$11.73 , N/A , N/A ,$15.91 ,$12.73 ,$12.56 ,$10.89 ,$14.24 , N/A ,$10.89 ,$10.89 ,$11.73 ,$10.20 , N/A ,$16.75 , N/A , N/A , N/A ,$14.24 , N/A ,$15.41 ,$11.73 ,$8.50 ,$10.20 ,$10.20 ,$10.20 ,$11.57 ,$15.08 ,$11.44 , N/A ,$13.23 , N/A ,$9.88 ,$9.88 , N/A ,$9.88 ,$12.06 ,$10.39 ,$12.06 ,$12.06 ,$13.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCORTISONE 1 % CREA 28 G TUBE,637,1 ,$13.65 ,$9.01 ,$6.92 ,$13.65 , N/A ,$9.36 ,$9.36 , N/A ,$8.19 ,$11.60 ,$9.56 , N/A , N/A ,$12.97 ,$10.37 ,$10.24 ,$8.87 ,$11.60 , N/A ,$8.87 ,$8.87 ,$9.56 ,$8.31 , N/A ,$13.65 , N/A , N/A , N/A ,$11.60 , N/A ,$12.56 ,$9.56 ,$6.92 ,$8.31 ,$8.31 ,$8.31 ,$9.43 ,$12.29 ,$9.33 , N/A ,$10.78 , N/A ,$8.05 ,$8.05 , N/A ,$8.05 ,$9.83 ,$8.46 ,$9.83 ,$9.83 ,$10.92 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCORTISONE 2.5 % CREA 28 G TUBE,637,1 ,$36.75 ,$24.26 ,$18.64 ,$36.75 , N/A ,$25.19 ,$25.19 , N/A ,$22.05 ,$31.24 ,$25.73 , N/A , N/A ,$34.91 ,$27.93 ,$27.56 ,$23.89 ,$31.24 , N/A ,$23.89 ,$23.89 ,$25.73 ,$22.38 , N/A ,$36.75 , N/A , N/A , N/A ,$31.24 , N/A ,$33.81 ,$25.73 ,$18.64 ,$22.37 ,$22.38 ,$22.37 ,$25.39 ,$33.08 ,$25.11 , N/A ,$29.03 , N/A ,$21.68 ,$21.68 , N/A ,$21.68 ,$26.46 ,$22.79 ,$26.46 ,$26.46 ,$29.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCORTISONE 2.5 % CREA 28.35 G TUBE,637,1 ,$32.90 ,$21.71 ,$16.69 ,$32.90 , N/A ,$22.55 ,$22.55 , N/A ,$19.74 ,$27.97 ,$23.03 , N/A , N/A ,$31.26 ,$25.00 ,$24.68 ,$21.39 ,$27.97 , N/A ,$21.39 ,$21.39 ,$23.03 ,$20.04 , N/A ,$32.90 , N/A , N/A , N/A ,$27.97 , N/A ,$30.27 ,$23.03 ,$16.69 ,$20.03 ,$20.04 ,$20.03 ,$22.73 ,$29.61 ,$22.48 , N/A ,$25.99 , N/A ,$19.41 ,$19.41 , N/A ,$19.41 ,$23.69 ,$20.40 ,$23.69 ,$23.69 ,$26.32 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCORTISONE 2.5 % CREA 30 G TUBE,637,1 ,$282.75 ,$186.62 ,$143.41 ,$282.75 , N/A ,$193.80 ,$193.80 , N/A ,$169.65 ,$240.34 ,$197.93 , N/A , N/A ,$268.61 ,$214.89 ,$212.06 ,$183.79 ,$240.34 , N/A ,$183.79 ,$183.79 ,$197.93 ,$172.19 , N/A ,$282.75 , N/A , N/A , N/A ,$240.34 , N/A ,$260.13 ,$197.93 ,$143.41 ,$172.11 ,$172.19 ,$172.11 ,$195.38 ,$254.48 ,$193.17 , N/A ,$223.37 , N/A ,$166.82 ,$166.82 , N/A ,$166.82 ,$203.58 ,$175.31 ,$203.58 ,$203.58 ,$226.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCORTISONE 25 MG SUPP,637,1 ,$49.05 ,$32.37 ,$24.88 ,$49.05 , N/A ,$33.62 ,$33.62 , N/A ,$29.43 ,$41.69 ,$34.34 , N/A , N/A ,$46.60 ,$37.28 ,$36.79 ,$31.88 ,$41.69 , N/A ,$31.88 ,$31.88 ,$34.34 ,$29.87 , N/A ,$49.05 , N/A , N/A , N/A ,$41.69 , N/A ,$45.13 ,$34.34 ,$24.88 ,$29.86 ,$29.87 ,$29.86 ,$33.89 ,$44.15 ,$33.51 , N/A ,$38.75 , N/A ,$28.94 ,$28.94 , N/A ,$28.94 ,$35.32 ,$30.41 ,$35.32 ,$35.32 ,$39.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FENTANYL 25 MCG/HR PT72,637,1 ,$49.05 ,$32.37 ,$24.88 ,$49.05 , N/A ,$33.62 ,$33.62 , N/A ,$29.43 ,$41.69 ,$34.34 , N/A , N/A ,$46.60 ,$37.28 ,$36.79 ,$31.88 ,$41.69 , N/A ,$31.88 ,$31.88 ,$34.34 ,$29.87 , N/A ,$49.05 , N/A , N/A , N/A ,$41.69 , N/A ,$45.13 ,$34.34 ,$24.88 ,$29.86 ,$29.87 ,$29.86 ,$33.89 ,$44.15 ,$33.51 , N/A ,$38.75 , N/A ,$28.94 ,$28.94 , N/A ,$28.94 ,$35.32 ,$30.41 ,$35.32 ,$35.32 ,$39.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROXYCHLOROQUINE 200 MG TABS,637,1 ,$14.95 ,$9.87 ,$7.58 ,$14.95 , N/A ,$10.25 ,$10.25 , N/A ,$8.97 ,$12.71 ,$10.47 , N/A , N/A ,$14.20 ,$11.36 ,$11.21 ,$9.72 ,$12.71 , N/A ,$9.72 ,$9.72 ,$10.47 ,$9.10 , N/A ,$14.95 , N/A , N/A , N/A ,$12.71 , N/A ,$13.75 ,$10.47 ,$7.58 ,$9.10 ,$9.10 ,$9.10 ,$10.33 ,$13.46 ,$10.21 , N/A ,$11.81 , N/A ,$8.82 ,$8.82 , N/A ,$8.82 ,$10.76 ,$9.27 ,$10.76 ,$10.76 ,$11.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,J1815,INSULIN GLARGINE 100 UNIT/ML SOLN per5 Units,637,1 ,$16.33 ,$10.78 ,$1.53 ,$16.33 , N/A ,$11.19 ,$11.19 , N/A ,$9.80 ,$13.88 ,$11.43 , N/A , N/A ,$15.51 ,$12.41 ,$12.25 ,$1.53 ,$13.88 , N/A ,$1.53 ,$1.53 ,$11.43 ,$9.95 , N/A ,$16.33 , N/A , N/A , N/A ,$13.88 , N/A ,$15.02 ,$11.43 ,$8.28 ,$9.94 ,$9.95 ,$9.94 ,$11.28 ,$14.70 ,$11.16 , N/A ,$12.90 , N/A ,$9.63 ,$9.63 , N/A ,$9.63 ,$11.76 ,$10.12 ,$11.76 ,$11.76 ,$13.06 
ST NICHOLAS HOSPITAL - ACUTE,63700001,J1815,INSULIN GLARGINE 100 UNIT/ML SOPN per5 Units,637,1 ,$10.47 ,$6.91 ,$1.53 ,$10.47 , N/A ,$7.18 ,$7.18 , N/A ,$6.28 ,$8.90 ,$7.33 , N/A , N/A ,$9.95 ,$7.96 ,$7.85 ,$1.53 ,$8.90 , N/A ,$1.53 ,$1.53 ,$7.33 ,$6.38 , N/A ,$10.47 , N/A , N/A , N/A ,$8.90 , N/A ,$9.63 ,$7.33 ,$5.31 ,$6.37 ,$6.38 ,$6.37 ,$7.23 ,$9.42 ,$7.15 , N/A ,$8.27 , N/A ,$6.18 ,$6.18 , N/A ,$6.18 ,$7.54 ,$6.49 ,$7.54 ,$7.54 ,$8.38 
ST NICHOLAS HOSPITAL - ACUTE,63700001,J1815,INSULIN LISPRO PROTAMINE-INSULIN LISPRO (75-25) 100 UNIT/ML SUSP per5 Units,637,1 ,$10.51 ,$6.94 ,$1.53 ,$10.51 , N/A ,$7.20 ,$7.20 , N/A ,$6.31 ,$8.93 ,$7.36 , N/A , N/A ,$9.98 ,$7.99 ,$7.88 ,$1.53 ,$8.93 , N/A ,$1.53 ,$1.53 ,$7.36 ,$6.40 , N/A ,$10.51 , N/A , N/A , N/A ,$8.93 , N/A ,$9.67 ,$7.36 ,$5.33 ,$6.40 ,$6.40 ,$6.40 ,$7.26 ,$9.46 ,$7.18 , N/A ,$8.30 , N/A ,$6.20 ,$6.20 , N/A ,$6.20 ,$7.57 ,$6.52 ,$7.57 ,$7.57 ,$8.41 
ST NICHOLAS HOSPITAL - ACUTE,63700001,J1815,INSULIN NPH-INSULIN REGULAR (70-30) 100 UNIT/ML SUSP per5 Units,637,1 ,$24.50 ,$16.17 ,$1.53 ,$24.50 , N/A ,$16.79 ,$16.79 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$1.53 ,$20.83 , N/A ,$1.53 ,$1.53 ,$17.15 ,$14.92 , N/A ,$24.50 , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$12.43 ,$14.91 ,$14.92 ,$14.91 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A ,$14.46 ,$14.46 , N/A ,$14.46 ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,J1815,INSULIN NPH 100 UNIT/ML SUSP per5 Units,637,1 ,$24.50 ,$16.17 ,$1.53 ,$24.50 , N/A ,$16.79 ,$16.79 , N/A ,$14.70 ,$20.83 ,$17.15 , N/A , N/A ,$23.28 ,$18.62 ,$18.38 ,$1.53 ,$20.83 , N/A ,$1.53 ,$1.53 ,$17.15 ,$14.92 , N/A ,$24.50 , N/A , N/A , N/A ,$20.83 , N/A ,$22.54 ,$17.15 ,$12.43 ,$14.91 ,$14.92 ,$14.91 ,$16.93 ,$22.05 ,$16.74 , N/A ,$19.36 , N/A ,$14.46 ,$14.46 , N/A ,$14.46 ,$17.64 ,$15.19 ,$17.64 ,$17.64 ,$19.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,J1815,INSULIN REGULAR (CONCENTRATED) 500 UNIT/ML SOLN per5 Units,637,1 ,$5.49 ,$3.62 ,$1.53 ,$5.49 , N/A ,$3.76 ,$3.76 , N/A ,$3.29 ,$4.67 ,$3.84 , N/A , N/A ,$5.22 ,$4.17 ,$4.12 ,$1.53 ,$4.67 , N/A ,$1.53 ,$1.53 ,$3.84 ,$3.34 , N/A ,$5.49 , N/A , N/A , N/A ,$4.67 , N/A ,$5.05 ,$3.84 ,$2.78 ,$3.34 ,$3.34 ,$3.34 ,$3.79 ,$4.94 ,$3.75 , N/A ,$4.34 , N/A ,$3.24 ,$3.24 , N/A ,$3.24 ,$3.95 ,$3.40 ,$3.95 ,$3.95 ,$4.39 
ST NICHOLAS HOSPITAL - ACUTE,63700001,J1815,INSULIN REGULAR (CONCENTRATED) 500 UNIT/ML SOPN per5 Units,637,1 ,$4.77 ,$3.15 ,$1.53 ,$4.77 , N/A ,$3.27 ,$3.27 , N/A ,$2.86 ,$4.05 ,$3.34 , N/A , N/A ,$4.53 ,$3.63 ,$3.58 ,$1.53 ,$4.05 , N/A ,$1.53 ,$1.53 ,$3.34 ,$2.90 , N/A ,$4.77 , N/A , N/A , N/A ,$4.05 , N/A ,$4.39 ,$3.34 ,$2.42 ,$2.90 ,$2.90 ,$2.90 ,$3.30 ,$4.29 ,$3.26 , N/A ,$3.77 , N/A ,$2.81 ,$2.81 , N/A ,$2.81 ,$3.43 ,$2.96 ,$3.43 ,$3.43 ,$3.82 
ST NICHOLAS HOSPITAL - ACUTE,63700001,J1815,INSULIN REGULAR 100 UNIT/ML SOLN per5 Units,637,1 ,$49.00 ,$32.34 ,$1.53 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.53 ,$41.65 , N/A ,$1.53 ,$1.53 ,$34.30 ,$29.84 , N/A ,$49.00 , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,J1815,INSULIN LISPRO 100 UNIT/ML SOLN per5 Units,637,1 ,$49.00 ,$32.34 ,$1.53 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$1.53 ,$41.65 , N/A ,$1.53 ,$1.53 ,$34.30 ,$29.84 , N/A ,$49.00 , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,IPRATROPIUM 17 MCG/ACT AERS 12.9 G INHALER,637,1 ,"$1,815.45 ","$1,198.20 ",$920.80 ,"$1,815.45 ", N/A ,"$1,244.31 ","$1,244.31 ", N/A ,"$1,089.27 ","$1,543.13 ","$1,270.82 ", N/A , N/A ,"$1,724.68 ","$1,379.74 ","$1,361.59 ","$1,180.04 ","$1,543.13 ", N/A ,"$1,180.04 ","$1,180.04 ","$1,270.82 ","$1,105.61 ", N/A ,"$1,815.45 ", N/A , N/A , N/A ,"$1,543.13 ", N/A ,"$1,670.21 ","$1,270.82 ",$920.80 ,"$1,105.06 ","$1,105.61 ","$1,105.06 ","$1,254.48 ","$1,633.91 ","$1,240.32 ", N/A ,"$1,434.21 ", N/A ,"$1,071.12 ","$1,071.12 ", N/A ,"$1,071.12 ","$1,307.12 ","$1,125.58 ","$1,307.12 ","$1,307.12 ","$1,452.36 "
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,IPRATROPIUM-ALBUTEROL 20-100 MCG/ACT AERS 4 G INHALER,637,1 ,"$1,771.20 ","$1,168.99 ",$898.35 ,"$1,771.20 ", N/A ,"$1,213.98 ","$1,213.98 ", N/A ,"$1,062.72 ","$1,505.52 ","$1,239.84 ", N/A , N/A ,"$1,682.64 ","$1,346.11 ","$1,328.40 ","$1,151.28 ","$1,505.52 ", N/A ,"$1,151.28 ","$1,151.28 ","$1,239.84 ","$1,078.66 ", N/A ,"$1,771.20 ", N/A , N/A , N/A ,"$1,505.52 ", N/A ,"$1,629.50 ","$1,239.84 ",$898.35 ,"$1,078.13 ","$1,078.66 ","$1,078.13 ","$1,223.90 ","$1,594.08 ","$1,210.08 ", N/A ,"$1,399.25 ", N/A ,"$1,045.01 ","$1,045.01 ", N/A ,"$1,045.01 ","$1,275.26 ","$1,098.14 ","$1,275.26 ","$1,275.26 ","$1,416.96 "
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ISOSORBIDE MONONITRATE ER 30 MG TB24,637,1 ,$11.40 ,$7.52 ,$5.78 ,$11.40 , N/A ,$7.81 ,$7.81 , N/A ,$6.84 ,$9.69 ,$7.98 , N/A , N/A ,$10.83 ,$8.66 ,$8.55 ,$7.41 ,$9.69 , N/A ,$7.41 ,$7.41 ,$7.98 ,$6.94 , N/A ,$11.40 , N/A , N/A , N/A ,$9.69 , N/A ,$10.49 ,$7.98 ,$5.78 ,$6.94 ,$6.94 ,$6.94 ,$7.88 ,$10.26 ,$7.79 , N/A ,$9.01 , N/A ,$6.73 ,$6.73 , N/A ,$6.73 ,$8.21 ,$7.07 ,$8.21 ,$8.21 ,$9.12 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CHOLESTYRAMINE LIGHT 4 G PACK,637,1 ,$11.40 ,$7.52 ,$5.78 ,$11.40 , N/A ,$7.81 ,$7.81 , N/A ,$6.84 ,$9.69 ,$7.98 , N/A , N/A ,$10.83 ,$8.66 ,$8.55 ,$7.41 ,$9.69 , N/A ,$7.41 ,$7.41 ,$7.98 ,$6.94 , N/A ,$11.40 , N/A , N/A , N/A ,$9.69 , N/A ,$10.49 ,$7.98 ,$5.78 ,$6.94 ,$6.94 ,$6.94 ,$7.88 ,$10.26 ,$7.79 , N/A ,$9.01 , N/A ,$6.73 ,$6.73 , N/A ,$6.73 ,$8.21 ,$7.07 ,$8.21 ,$8.21 ,$9.12 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,KETOROLAC 0.5 % SOLN 5 ML BOTTLE,637,1 ,$363.40 ,$239.84 ,$184.32 ,$363.40 , N/A ,$249.07 ,$249.07 , N/A ,$218.04 ,$308.89 ,$254.38 , N/A , N/A ,$345.23 ,$276.18 ,$272.55 ,$236.21 ,$308.89 , N/A ,$236.21 ,$236.21 ,$254.38 ,$221.31 , N/A ,$363.40 , N/A , N/A , N/A ,$308.89 , N/A ,$334.33 ,$254.38 ,$184.32 ,$221.20 ,$221.31 ,$221.20 ,$251.11 ,$327.06 ,$248.27 , N/A ,$287.09 , N/A ,$214.41 ,$214.41 , N/A ,$214.41 ,$261.65 ,$225.31 ,$261.65 ,$261.65 ,$290.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LACOSAMIDE 100 MG TABS,637,1 ,$74.70 ,$49.30 ,$37.89 ,$74.70 , N/A ,$51.20 ,$51.20 , N/A ,$44.82 ,$63.50 ,$52.29 , N/A , N/A ,$70.97 ,$56.77 ,$56.03 ,$48.56 ,$63.50 , N/A ,$48.56 ,$48.56 ,$52.29 ,$45.49 , N/A ,$74.70 , N/A , N/A , N/A ,$63.50 , N/A ,$68.72 ,$52.29 ,$37.89 ,$45.47 ,$45.49 ,$45.47 ,$51.62 ,$67.23 ,$51.04 , N/A ,$59.01 , N/A ,$44.07 ,$44.07 , N/A ,$44.07 ,$53.78 ,$46.31 ,$53.78 ,$53.78 ,$59.76 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LACTULOSE 10 GM/15ML SOLN 473 ML BOTTLE,637,1 ,$78.55 ,$51.84 ,$39.84 ,$78.55 , N/A ,$53.84 ,$53.84 , N/A ,$47.13 ,$66.77 ,$54.99 , N/A , N/A ,$74.62 ,$59.70 ,$58.91 ,$51.06 ,$66.77 , N/A ,$51.06 ,$51.06 ,$54.99 ,$47.84 , N/A ,$78.55 , N/A , N/A , N/A ,$66.77 , N/A ,$72.27 ,$54.99 ,$39.84 ,$47.81 ,$47.84 ,$47.81 ,$54.28 ,$70.70 ,$53.67 , N/A ,$62.05 , N/A ,$46.34 ,$46.34 , N/A ,$46.34 ,$56.56 ,$48.70 ,$56.56 ,$56.56 ,$62.84 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LANTHANUM 500 MG CHEW,637,1 ,$49.00 ,$32.34 ,$24.85 ,$49.00 , N/A ,$33.58 ,$33.58 , N/A ,$29.40 ,$41.65 ,$34.30 , N/A , N/A ,$46.55 ,$37.24 ,$36.75 ,$31.85 ,$41.65 , N/A ,$31.85 ,$31.85 ,$34.30 ,$29.84 , N/A ,$49.00 , N/A , N/A , N/A ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$33.48 , N/A ,$38.71 , N/A ,$28.91 ,$28.91 , N/A ,$28.91 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LATANOPROST 0.005 % SOLN 2.5 ML BOTTLE,637,1 ,$323.00 ,$213.18 ,$163.83 ,$323.00 , N/A ,$221.38 ,$221.38 , N/A ,$193.80 ,$274.55 ,$226.10 , N/A , N/A ,$306.85 ,$245.48 ,$242.25 ,$209.95 ,$274.55 , N/A ,$209.95 ,$209.95 ,$226.10 ,$196.71 , N/A ,$323.00 , N/A , N/A , N/A ,$274.55 , N/A ,$297.16 ,$226.10 ,$163.83 ,$196.61 ,$196.71 ,$196.61 ,$223.19 ,$290.70 ,$220.67 , N/A ,$255.17 , N/A ,$190.57 ,$190.57 , N/A ,$190.57 ,$232.56 ,$200.26 ,$232.56 ,$232.56 ,$258.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEFLUNOMIDE 10 MG TABS,637,1 ,$20.40 ,$13.46 ,$10.35 ,$20.40 , N/A ,$13.98 ,$13.98 , N/A ,$12.24 ,$17.34 ,$14.28 , N/A , N/A ,$19.38 ,$15.50 ,$15.30 ,$13.26 ,$17.34 , N/A ,$13.26 ,$13.26 ,$14.28 ,$12.42 , N/A ,$20.40 , N/A , N/A , N/A ,$17.34 , N/A ,$18.77 ,$14.28 ,$10.35 ,$12.42 ,$12.42 ,$12.42 ,$14.10 ,$18.36 ,$13.94 , N/A ,$16.12 , N/A ,$12.04 ,$12.04 , N/A ,$12.04 ,$14.69 ,$12.65 ,$14.69 ,$14.69 ,$16.32 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIBUCAINE (PERIANAL) 1 % OINT 28 G TUBE,637,1 ,$20.40 ,$13.46 ,$10.35 ,$20.40 , N/A ,$13.98 ,$13.98 , N/A ,$12.24 ,$17.34 ,$14.28 , N/A , N/A ,$19.38 ,$15.50 ,$15.30 ,$13.26 ,$17.34 , N/A ,$13.26 ,$13.26 ,$14.28 ,$12.42 , N/A ,$20.40 , N/A , N/A , N/A ,$17.34 , N/A ,$18.77 ,$14.28 ,$10.35 ,$12.42 ,$12.42 ,$12.42 ,$14.10 ,$18.36 ,$13.94 , N/A ,$16.12 , N/A ,$12.04 ,$12.04 , N/A ,$12.04 ,$14.69 ,$12.65 ,$14.69 ,$14.69 ,$16.32 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVETIRACETAM 500 MG TABS,637,1 ,$11.95 ,$7.89 ,$6.06 ,$11.95 , N/A ,$8.19 ,$8.19 , N/A ,$7.17 ,$10.16 ,$8.37 , N/A , N/A ,$11.35 ,$9.08 ,$8.96 ,$7.77 ,$10.16 , N/A ,$7.77 ,$7.77 ,$8.37 ,$7.28 , N/A ,$11.95 , N/A , N/A , N/A ,$10.16 , N/A ,$10.99 ,$8.37 ,$6.06 ,$7.27 ,$7.28 ,$7.27 ,$8.26 ,$10.76 ,$8.16 , N/A ,$9.44 , N/A ,$7.05 ,$7.05 , N/A ,$7.05 ,$8.60 ,$7.41 ,$8.60 ,$8.60 ,$9.56 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVOFLOXACIN 250 MG TABS,637,1 ,$50.10 ,$33.07 ,$25.41 ,$50.10 , N/A ,$34.34 ,$34.34 , N/A ,$30.06 ,$42.59 ,$35.07 , N/A , N/A ,$47.60 ,$38.08 ,$37.58 ,$32.57 ,$42.59 , N/A ,$32.57 ,$32.57 ,$35.07 ,$30.51 , N/A ,$50.10 , N/A , N/A , N/A ,$42.59 , N/A ,$46.09 ,$35.07 ,$25.41 ,$30.50 ,$30.51 ,$30.50 ,$34.62 ,$45.09 ,$34.23 , N/A ,$39.58 , N/A ,$29.56 ,$29.56 , N/A ,$29.56 ,$36.07 ,$31.06 ,$36.07 ,$36.07 ,$40.08 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVOFLOXACIN 500 MG TABS,637,1 ,$57.20 ,$37.75 ,$29.01 ,$57.20 , N/A ,$39.20 ,$39.20 , N/A ,$34.32 ,$48.62 ,$40.04 , N/A , N/A ,$54.34 ,$43.47 ,$42.90 ,$37.18 ,$48.62 , N/A ,$37.18 ,$37.18 ,$40.04 ,$34.83 , N/A ,$57.20 , N/A , N/A , N/A ,$48.62 , N/A ,$52.62 ,$40.04 ,$29.01 ,$34.82 ,$34.83 ,$34.82 ,$39.53 ,$51.48 ,$39.08 , N/A ,$45.19 , N/A ,$33.75 ,$33.75 , N/A ,$33.75 ,$41.18 ,$35.46 ,$41.18 ,$41.18 ,$45.76 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LINACLOTIDE 145 MCG CAPS,637,1 ,$66.73 ,$44.04 ,$33.85 ,$66.73 , N/A ,$45.74 ,$45.74 , N/A ,$40.04 ,$56.72 ,$46.71 , N/A , N/A ,$63.39 ,$50.71 ,$50.05 ,$43.37 ,$56.72 , N/A ,$43.37 ,$43.37 ,$46.71 ,$40.64 , N/A ,$66.73 , N/A , N/A , N/A ,$56.72 , N/A ,$61.39 ,$46.71 ,$33.85 ,$40.62 ,$40.64 ,$40.62 ,$46.11 ,$60.06 ,$45.59 , N/A ,$52.72 , N/A ,$39.37 ,$39.37 , N/A ,$39.37 ,$48.05 ,$41.37 ,$48.05 ,$48.05 ,$53.38 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LUBIPROSTONE 24 MCG CAPS,637,1 ,$25.25 ,$16.67 ,$12.81 ,$25.25 , N/A ,$17.31 ,$17.31 , N/A ,$15.15 ,$21.46 ,$17.68 , N/A , N/A ,$23.99 ,$19.19 ,$18.94 ,$16.41 ,$21.46 , N/A ,$16.41 ,$16.41 ,$17.68 ,$15.38 , N/A ,$25.25 , N/A , N/A , N/A ,$21.46 , N/A ,$23.23 ,$17.68 ,$12.81 ,$15.37 ,$15.38 ,$15.37 ,$17.45 ,$22.73 ,$17.25 , N/A ,$19.95 , N/A ,$14.90 ,$14.90 , N/A ,$14.90 ,$18.18 ,$15.66 ,$18.18 ,$18.18 ,$20.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LUBIPROSTONE 8 MCG CAPS,637,1 ,$22.75 ,$15.02 ,$11.54 ,$22.75 , N/A ,$15.59 ,$15.59 , N/A ,$13.65 ,$19.34 ,$15.93 , N/A , N/A ,$21.61 ,$17.29 ,$17.06 ,$14.79 ,$19.34 , N/A ,$14.79 ,$14.79 ,$15.93 ,$13.85 , N/A ,$22.75 , N/A , N/A , N/A ,$19.34 , N/A ,$20.93 ,$15.93 ,$11.54 ,$13.85 ,$13.85 ,$13.85 ,$15.72 ,$20.48 ,$15.54 , N/A ,$17.97 , N/A ,$13.42 ,$13.42 , N/A ,$13.42 ,$16.38 ,$14.11 ,$16.38 ,$16.38 ,$18.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LURASIDONE 40 MG TABS,637,1 ,$192.95 ,$127.35 ,$97.86 ,$192.95 , N/A ,$132.25 ,$132.25 , N/A ,$115.77 ,$164.01 ,$135.07 , N/A , N/A ,$183.30 ,$146.64 ,$144.71 ,$125.42 ,$164.01 , N/A ,$125.42 ,$125.42 ,$135.07 ,$117.51 , N/A ,$192.95 , N/A , N/A , N/A ,$164.01 , N/A ,$177.51 ,$135.07 ,$97.86 ,$117.45 ,$117.51 ,$117.45 ,$133.33 ,$173.66 ,$131.82 , N/A ,$152.43 , N/A ,$113.84 ,$113.84 , N/A ,$113.84 ,$138.92 ,$119.63 ,$138.92 ,$138.92 ,$154.36 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MAGNESIUM HYDROXIDE 400 MG/5ML SUSP,637,1 ,$9.00 ,$5.94 ,$4.56 ,$9.00 , N/A ,$6.17 ,$6.17 , N/A ,$5.40 ,$7.65 ,$6.30 , N/A , N/A ,$8.55 ,$6.84 ,$6.75 ,$5.85 ,$7.65 , N/A ,$5.85 ,$5.85 ,$6.30 ,$5.48 , N/A ,$9.00 , N/A , N/A , N/A ,$7.65 , N/A ,$8.28 ,$6.30 ,$4.56 ,$5.48 ,$5.48 ,$5.48 ,$6.22 ,$8.10 ,$6.15 , N/A ,$7.11 , N/A ,$5.31 ,$5.31 , N/A ,$5.31 ,$6.48 ,$5.58 ,$6.48 ,$6.48 ,$7.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MAGNESIUM-ALUMINUM-SIMETHICONE 400-400-40 MG/5ML SUSP 30 ML CUP,637,1 ,$13.40 ,$8.84 ,$6.80 ,$13.40 , N/A ,$9.18 ,$9.18 , N/A ,$8.04 ,$11.39 ,$9.38 , N/A , N/A ,$12.73 ,$10.18 ,$10.05 ,$8.71 ,$11.39 , N/A ,$8.71 ,$8.71 ,$9.38 ,$8.16 , N/A ,$13.40 , N/A , N/A , N/A ,$11.39 , N/A ,$12.33 ,$9.38 ,$6.80 ,$8.16 ,$8.16 ,$8.16 ,$9.26 ,$12.06 ,$9.15 , N/A ,$10.59 , N/A ,$7.91 ,$7.91 , N/A ,$7.91 ,$9.65 ,$8.31 ,$9.65 ,$9.65 ,$10.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DEXTROSE 40 % GEL 37.5 G PACKAGE,637,1 ,$13.40 ,$8.84 ,$6.80 ,$13.40 , N/A ,$9.18 ,$9.18 , N/A ,$8.04 ,$11.39 ,$9.38 , N/A , N/A ,$12.73 ,$10.18 ,$10.05 ,$8.71 ,$11.39 , N/A ,$8.71 ,$8.71 ,$9.38 ,$8.16 , N/A ,$13.40 , N/A , N/A , N/A ,$11.39 , N/A ,$12.33 ,$9.38 ,$6.80 ,$8.16 ,$8.16 ,$8.16 ,$9.26 ,$12.06 ,$9.15 , N/A ,$10.59 , N/A ,$7.91 ,$7.91 , N/A ,$7.91 ,$9.65 ,$8.31 ,$9.65 ,$9.65 ,$10.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DEXTROSE 40 % GEL 37.5 G TUBE,637,1 ,$13.40 ,$8.84 ,$6.80 ,$13.40 , N/A ,$9.18 ,$9.18 , N/A ,$8.04 ,$11.39 ,$9.38 , N/A , N/A ,$12.73 ,$10.18 ,$10.05 ,$8.71 ,$11.39 , N/A ,$8.71 ,$8.71 ,$9.38 ,$8.16 , N/A ,$13.40 , N/A , N/A , N/A ,$11.39 , N/A ,$12.33 ,$9.38 ,$6.80 ,$8.16 ,$8.16 ,$8.16 ,$9.26 ,$12.06 ,$9.15 , N/A ,$10.59 , N/A ,$7.91 ,$7.91 , N/A ,$7.91 ,$9.65 ,$8.31 ,$9.65 ,$9.65 ,$10.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MELOXICAM 7.5 MG TABS,637,1 ,$10.55 ,$6.96 ,$5.35 ,$10.55 , N/A ,$7.23 ,$7.23 , N/A ,$6.33 ,$8.97 ,$7.39 , N/A , N/A ,$10.02 ,$8.02 ,$7.91 ,$6.86 ,$8.97 , N/A ,$6.86 ,$6.86 ,$7.39 ,$6.43 , N/A ,$10.55 , N/A , N/A , N/A ,$8.97 , N/A ,$9.71 ,$7.39 ,$5.35 ,$6.42 ,$6.43 ,$6.42 ,$7.29 ,$9.50 ,$7.21 , N/A ,$8.33 , N/A ,$6.22 ,$6.22 , N/A ,$6.22 ,$7.60 ,$6.54 ,$7.60 ,$7.60 ,$8.44 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MENTHOL-METHYL SALICYLATE 10-15 % CREA 85 G TUBE,637,1 ,$11.85 ,$7.82 ,$6.01 ,$11.85 , N/A ,$8.12 ,$8.12 , N/A ,$7.11 ,$10.07 ,$8.30 , N/A , N/A ,$11.26 ,$9.01 ,$8.89 ,$7.70 ,$10.07 , N/A ,$7.70 ,$7.70 ,$8.30 ,$7.22 , N/A ,$11.85 , N/A , N/A , N/A ,$10.07 , N/A ,$10.90 ,$8.30 ,$6.01 ,$7.21 ,$7.22 ,$7.21 ,$8.19 ,$10.67 ,$8.10 , N/A ,$9.36 , N/A ,$6.99 ,$6.99 , N/A ,$6.99 ,$8.53 ,$7.35 ,$8.53 ,$8.53 ,$9.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMANTADINE 100 MG CAPS,637,1 ,$11.85 ,$7.82 ,$6.01 ,$11.85 , N/A ,$8.12 ,$8.12 , N/A ,$7.11 ,$10.07 ,$8.30 , N/A , N/A ,$11.26 ,$9.01 ,$8.89 ,$7.70 ,$10.07 , N/A ,$7.70 ,$7.70 ,$8.30 ,$7.22 , N/A ,$11.85 , N/A , N/A , N/A ,$10.07 , N/A ,$10.90 ,$8.30 ,$6.01 ,$7.21 ,$7.22 ,$7.21 ,$8.19 ,$10.67 ,$8.10 , N/A ,$9.36 , N/A ,$6.99 ,$6.99 , N/A ,$6.99 ,$8.53 ,$7.35 ,$8.53 ,$8.53 ,$9.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MESALAMINE EC 1.2 G TBEC,637,1 ,$42.45 ,$28.02 ,$21.53 ,$42.45 , N/A ,$29.10 ,$29.10 , N/A ,$25.47 ,$36.08 ,$29.72 , N/A , N/A ,$40.33 ,$32.26 ,$31.84 ,$27.59 ,$36.08 , N/A ,$27.59 ,$27.59 ,$29.72 ,$25.85 , N/A ,$42.45 , N/A , N/A , N/A ,$36.08 , N/A ,$39.05 ,$29.72 ,$21.53 ,$25.84 ,$25.85 ,$25.84 ,$29.33 ,$38.21 ,$29.00 , N/A ,$33.54 , N/A ,$25.05 ,$25.05 , N/A ,$25.05 ,$30.56 ,$26.32 ,$30.56 ,$30.56 ,$33.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MICONAZOLE 2 % POWD 71 G BOTTLE,637,1 ,$23.70 ,$15.64 ,$12.02 ,$23.70 , N/A ,$16.24 ,$16.24 , N/A ,$14.22 ,$20.15 ,$16.59 , N/A , N/A ,$22.52 ,$18.01 ,$17.78 ,$15.41 ,$20.15 , N/A ,$15.41 ,$15.41 ,$16.59 ,$14.43 , N/A ,$23.70 , N/A , N/A , N/A ,$20.15 , N/A ,$21.80 ,$16.59 ,$12.02 ,$14.43 ,$14.43 ,$14.43 ,$16.38 ,$21.33 ,$16.19 , N/A ,$18.72 , N/A ,$13.98 ,$13.98 , N/A ,$13.98 ,$17.06 ,$14.69 ,$17.06 ,$17.06 ,$18.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MIDAZOLAM 2 MG/ML SYRP,637,1 ,$24.95 ,$16.47 ,$12.65 ,$24.95 , N/A ,$17.10 ,$17.10 , N/A ,$14.97 ,$21.21 ,$17.47 , N/A , N/A ,$23.70 ,$18.96 ,$18.71 ,$16.22 ,$21.21 , N/A ,$16.22 ,$16.22 ,$17.47 ,$15.19 , N/A ,$24.95 , N/A , N/A , N/A ,$21.21 , N/A ,$22.95 ,$17.47 ,$12.65 ,$15.19 ,$15.19 ,$15.19 ,$17.24 ,$22.46 ,$17.05 , N/A ,$19.71 , N/A ,$14.72 ,$14.72 , N/A ,$14.72 ,$17.96 ,$15.47 ,$17.96 ,$17.96 ,$19.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MIDODRINE 5 MG TABS,637,1 ,$15.30 ,$10.10 ,$7.76 ,$15.30 , N/A ,$10.49 ,$10.49 , N/A ,$9.18 ,$13.01 ,$10.71 , N/A , N/A ,$14.54 ,$11.63 ,$11.48 ,$9.95 ,$13.01 , N/A ,$9.95 ,$9.95 ,$10.71 ,$9.32 , N/A ,$15.30 , N/A , N/A , N/A ,$13.01 , N/A ,$14.08 ,$10.71 ,$7.76 ,$9.31 ,$9.32 ,$9.31 ,$10.57 ,$13.77 ,$10.45 , N/A ,$12.09 , N/A ,$9.03 ,$9.03 , N/A ,$9.03 ,$11.02 ,$9.49 ,$11.02 ,$11.02 ,$12.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MINERAL OIL OIL 10 ML VIAL,637,1 ,$62.20 ,$41.05 ,$31.55 ,$62.20 , N/A ,$42.63 ,$42.63 , N/A ,$37.32 ,$52.87 ,$43.54 , N/A , N/A ,$59.09 ,$47.27 ,$46.65 ,$40.43 ,$52.87 , N/A ,$40.43 ,$40.43 ,$43.54 ,$37.88 , N/A ,$62.20 , N/A , N/A , N/A ,$52.87 , N/A ,$57.22 ,$43.54 ,$31.55 ,$37.86 ,$37.88 ,$37.86 ,$42.98 ,$55.98 ,$42.50 , N/A ,$49.14 , N/A ,$36.70 ,$36.70 , N/A ,$36.70 ,$44.78 ,$38.56 ,$44.78 ,$44.78 ,$49.76 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MIRABEGRON ER 25 MG TB24,637,1 ,$58.45 ,$38.58 ,$29.65 ,$58.45 , N/A ,$40.06 ,$40.06 , N/A ,$35.07 ,$49.68 ,$40.92 , N/A , N/A ,$55.53 ,$44.42 ,$43.84 ,$37.99 ,$49.68 , N/A ,$37.99 ,$37.99 ,$40.92 ,$35.60 , N/A ,$58.45 , N/A , N/A , N/A ,$49.68 , N/A ,$53.77 ,$40.92 ,$29.65 ,$35.58 ,$35.60 ,$35.58 ,$40.39 ,$52.61 ,$39.93 , N/A ,$46.18 , N/A ,$34.49 ,$34.49 , N/A ,$34.49 ,$42.08 ,$36.24 ,$42.08 ,$42.08 ,$46.76 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MODAFINIL 100 MG TABS,637,1 ,$89.70 ,$59.20 ,$45.50 ,$89.70 , N/A ,$61.48 ,$61.48 , N/A ,$53.82 ,$76.25 ,$62.79 , N/A , N/A ,$85.22 ,$68.17 ,$67.28 ,$58.31 ,$76.25 , N/A ,$58.31 ,$58.31 ,$62.79 ,$54.63 , N/A ,$89.70 , N/A , N/A , N/A ,$76.25 , N/A ,$82.52 ,$62.79 ,$45.50 ,$54.60 ,$54.63 ,$54.60 ,$61.98 ,$80.73 ,$61.28 , N/A ,$70.86 , N/A ,$52.92 ,$52.92 , N/A ,$52.92 ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MORPHINE CR 30 MG TBCR,637,1 ,$11.33 ,$7.48 ,$5.75 ,$11.33 , N/A ,$7.77 ,$7.77 , N/A ,$6.80 ,$9.63 ,$7.93 , N/A , N/A ,$10.76 ,$8.61 ,$8.50 ,$7.36 ,$9.63 , N/A ,$7.36 ,$7.36 ,$7.93 ,$6.90 , N/A ,$11.33 , N/A , N/A , N/A ,$9.63 , N/A ,$10.42 ,$7.93 ,$5.75 ,$6.90 ,$6.90 ,$6.90 ,$7.83 ,$10.20 ,$7.74 , N/A ,$8.95 , N/A ,$6.68 ,$6.68 , N/A ,$6.68 ,$8.16 ,$7.02 ,$8.16 ,$8.16 ,$9.06 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MORPHINE SULFATE 100 MG/5ML SOLN,637,1 ,$8.10 ,$5.35 ,$4.11 ,$8.10 , N/A ,$5.55 ,$5.55 , N/A ,$4.86 ,$6.89 ,$5.67 , N/A , N/A ,$7.70 ,$6.16 ,$6.08 ,$5.27 ,$6.89 , N/A ,$5.27 ,$5.27 ,$5.67 ,$4.93 , N/A ,$8.10 , N/A , N/A , N/A ,$6.89 , N/A ,$7.45 ,$5.67 ,$4.11 ,$4.93 ,$4.93 ,$4.93 ,$5.60 ,$7.29 ,$5.53 , N/A ,$6.40 , N/A ,$4.78 ,$4.78 , N/A ,$4.78 ,$5.83 ,$5.02 ,$5.83 ,$5.83 ,$6.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MAGNESIUM CITRATE 1.745 GM/30ML SOLN,637,1 ,$8.10 ,$5.35 ,$4.11 ,$8.10 , N/A ,$5.55 ,$5.55 , N/A ,$4.86 ,$6.89 ,$5.67 , N/A , N/A ,$7.70 ,$6.16 ,$6.08 ,$5.27 ,$6.89 , N/A ,$5.27 ,$5.27 ,$5.67 ,$4.93 , N/A ,$8.10 , N/A , N/A , N/A ,$6.89 , N/A ,$7.45 ,$5.67 ,$4.11 ,$4.93 ,$4.93 ,$4.93 ,$5.60 ,$7.29 ,$5.53 , N/A ,$6.40 , N/A ,$4.78 ,$4.78 , N/A ,$4.78 ,$5.83 ,$5.02 ,$5.83 ,$5.83 ,$6.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METHENAMINE MANDELATE 1 G TABS,637,1 ,$8.10 ,$5.35 ,$4.11 ,$8.10 , N/A ,$5.55 ,$5.55 , N/A ,$4.86 ,$6.89 ,$5.67 , N/A , N/A ,$7.70 ,$6.16 ,$6.08 ,$5.27 ,$6.89 , N/A ,$5.27 ,$5.27 ,$5.67 ,$4.93 , N/A ,$8.10 , N/A , N/A , N/A ,$6.89 , N/A ,$7.45 ,$5.67 ,$4.11 ,$4.93 ,$4.93 ,$4.93 ,$5.60 ,$7.29 ,$5.53 , N/A ,$6.40 , N/A ,$4.78 ,$4.78 , N/A ,$4.78 ,$5.83 ,$5.02 ,$5.83 ,$5.83 ,$6.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MUPIROCIN 2 % OINT 22 G TUBE,637,1 ,$145.35 ,$95.93 ,$73.72 ,$145.35 , N/A ,$99.62 ,$99.62 , N/A ,$87.21 ,$123.55 ,$101.75 , N/A , N/A ,$138.08 ,$110.47 ,$109.01 ,$94.48 ,$123.55 , N/A ,$94.48 ,$94.48 ,$101.75 ,$88.52 , N/A ,$145.35 , N/A , N/A , N/A ,$123.55 , N/A ,$133.72 ,$101.75 ,$73.72 ,$88.47 ,$88.52 ,$88.47 ,$100.44 ,$130.82 ,$99.30 , N/A ,$114.83 , N/A ,$85.76 ,$85.76 , N/A ,$85.76 ,$104.65 ,$90.12 ,$104.65 ,$104.65 ,$116.28 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$112.95 ,$222.70 , N/A ,$152.64 ,$152.64 , N/A ,$133.62 ,$189.30 ,$155.89 , N/A , N/A ,$211.57 ,$169.25 ,$167.03 ,$144.76 ,$189.30 , N/A ,$144.76 ,$144.76 ,$155.89 ,$135.62 , N/A ,$222.70 , N/A , N/A , N/A ,$189.30 , N/A ,$204.88 ,$155.89 ,$112.95 ,$135.56 ,$135.62 ,$135.56 ,$153.89 ,$200.43 ,$152.15 , N/A ,$175.93 , N/A ,$131.39 ,$131.39 , N/A ,$131.39 ,$160.34 ,$138.07 ,$160.34 ,$160.34 ,$178.16 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$225.88 ,$445.35 , N/A ,$305.24 ,$305.24 , N/A ,$267.21 ,$378.55 ,$311.75 , N/A , N/A ,$423.08 ,$338.47 ,$334.01 ,$289.48 ,$378.55 , N/A ,$289.48 ,$289.48 ,$311.75 ,$271.22 , N/A ,$445.35 , N/A , N/A , N/A ,$378.55 , N/A ,$409.72 ,$311.75 ,$225.88 ,$271.08 ,$271.22 ,$271.08 ,$307.74 ,$400.82 ,$304.26 , N/A ,$351.83 , N/A ,$262.76 ,$262.76 , N/A ,$262.76 ,$320.65 ,$276.12 ,$320.65 ,$320.65 ,$356.28 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NALTREXONE 50 MG TABS,637,1 ,$14.55 ,$9.60 ,$7.38 ,$14.55 , N/A ,$9.97 ,$9.97 , N/A ,$8.73 ,$12.37 ,$10.19 , N/A , N/A ,$13.82 ,$11.06 ,$10.91 ,$9.46 ,$12.37 , N/A ,$9.46 ,$9.46 ,$10.19 ,$8.86 , N/A ,$14.55 , N/A , N/A , N/A ,$12.37 , N/A ,$13.39 ,$10.19 ,$7.38 ,$8.86 ,$8.86 ,$8.86 ,$10.05 ,$13.10 ,$9.94 , N/A ,$11.49 , N/A ,$8.58 ,$8.58 , N/A ,$8.58 ,$10.48 ,$9.02 ,$10.48 ,$10.48 ,$11.64 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % SOLN 15 ML BOTTLE,637,1 ,$30.70 ,$20.26 ,$15.57 ,$30.70 , N/A ,$21.04 ,$21.04 , N/A ,$18.42 ,$26.10 ,$21.49 , N/A , N/A ,$29.17 ,$23.33 ,$23.03 ,$19.96 ,$26.10 , N/A ,$19.96 ,$19.96 ,$21.49 ,$18.70 , N/A ,$30.70 , N/A , N/A , N/A ,$26.10 , N/A ,$28.24 ,$21.49 ,$15.57 ,$18.69 ,$18.70 ,$18.69 ,$21.21 ,$27.63 ,$20.97 , N/A ,$24.25 , N/A ,$18.11 ,$18.11 , N/A ,$18.11 ,$22.10 ,$19.03 ,$22.10 ,$22.10 ,$24.56 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NEBIVOLOL 5 MG TABS,637,1 ,$23.00 ,$15.18 ,$11.67 ,$23.00 , N/A ,$15.76 ,$15.76 , N/A ,$13.80 ,$19.55 ,$16.10 , N/A , N/A ,$21.85 ,$17.48 ,$17.25 ,$14.95 ,$19.55 , N/A ,$14.95 ,$14.95 ,$16.10 ,$14.01 , N/A ,$23.00 , N/A , N/A , N/A ,$19.55 , N/A ,$21.16 ,$16.10 ,$11.67 ,$14.00 ,$14.01 ,$14.00 ,$15.89 ,$20.70 ,$15.71 , N/A ,$18.17 , N/A ,$13.57 ,$13.57 , N/A ,$13.57 ,$16.56 ,$14.26 ,$16.56 ,$16.56 ,$18.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 5-400-5000 OINT 28 G TUBE,637,1 ,$19.75 ,$13.04 ,$10.02 ,$19.75 , N/A ,$13.54 ,$13.54 , N/A ,$11.85 ,$16.79 ,$13.83 , N/A , N/A ,$18.76 ,$15.01 ,$14.81 ,$12.84 ,$16.79 , N/A ,$12.84 ,$12.84 ,$13.83 ,$12.03 , N/A ,$19.75 , N/A , N/A , N/A ,$16.79 , N/A ,$18.17 ,$13.83 ,$10.02 ,$12.02 ,$12.03 ,$12.02 ,$13.65 ,$17.78 ,$13.49 , N/A ,$15.60 , N/A ,$11.65 ,$11.65 , N/A ,$11.65 ,$14.22 ,$12.25 ,$14.22 ,$14.22 ,$15.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 5-400-5000 OINT 28.4 G TUBE,637,1 ,$25.90 ,$17.09 ,$13.14 ,$25.90 , N/A ,$17.75 ,$17.75 , N/A ,$15.54 ,$22.02 ,$18.13 , N/A , N/A ,$24.61 ,$19.68 ,$19.43 ,$16.84 ,$22.02 , N/A ,$16.84 ,$16.84 ,$18.13 ,$15.77 , N/A ,$25.90 , N/A , N/A , N/A ,$22.02 , N/A ,$23.83 ,$18.13 ,$13.14 ,$15.77 ,$15.77 ,$15.77 ,$17.90 ,$23.31 ,$17.69 , N/A ,$20.46 , N/A ,$15.28 ,$15.28 , N/A ,$15.28 ,$18.65 ,$16.06 ,$18.65 ,$18.65 ,$20.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NEOMYCIN-POLYMYXIN-HYDROCORTISONE 3.5-10000-1 SOLN 10 ML BOTTLE,637,1 ,$356.60 ,$235.36 ,$180.87 ,$356.60 , N/A ,$244.41 ,$244.41 , N/A ,$213.96 ,$303.11 ,$249.62 , N/A , N/A ,$338.77 ,$271.02 ,$267.45 ,$231.79 ,$303.11 , N/A ,$231.79 ,$231.79 ,$249.62 ,$217.17 , N/A ,$356.60 , N/A , N/A , N/A ,$303.11 , N/A ,$328.07 ,$249.62 ,$180.87 ,$217.06 ,$217.17 ,$217.06 ,$246.41 ,$320.94 ,$243.63 , N/A ,$281.71 , N/A ,$210.39 ,$210.39 , N/A ,$210.39 ,$256.75 ,$221.09 ,$256.75 ,$256.75 ,$285.28 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NIACIN CR 500 MG TBCR,637,1 ,$14.40 ,$9.50 ,$7.30 ,$14.40 , N/A ,$9.87 ,$9.87 , N/A ,$8.64 ,$12.24 ,$10.08 , N/A , N/A ,$13.68 ,$10.94 ,$10.80 ,$9.36 ,$12.24 , N/A ,$9.36 ,$9.36 ,$10.08 ,$8.77 , N/A ,$14.40 , N/A , N/A , N/A ,$12.24 , N/A ,$13.25 ,$10.08 ,$7.30 ,$8.77 ,$8.77 ,$8.77 ,$9.95 ,$12.96 ,$9.84 , N/A ,$11.38 , N/A ,$8.50 ,$8.50 , N/A ,$8.50 ,$10.37 ,$8.93 ,$10.37 ,$10.37 ,$11.52 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MEGESTROL 400 MG/10ML SUSP,637,1 ,$14.40 ,$9.50 ,$7.30 ,$14.40 , N/A ,$9.87 ,$9.87 , N/A ,$8.64 ,$12.24 ,$10.08 , N/A , N/A ,$13.68 ,$10.94 ,$10.80 ,$9.36 ,$12.24 , N/A ,$9.36 ,$9.36 ,$10.08 ,$8.77 , N/A ,$14.40 , N/A , N/A , N/A ,$12.24 , N/A ,$13.25 ,$10.08 ,$7.30 ,$8.77 ,$8.77 ,$8.77 ,$9.95 ,$12.96 ,$9.84 , N/A ,$11.38 , N/A ,$8.50 ,$8.50 , N/A ,$8.50 ,$10.37 ,$8.93 ,$10.37 ,$10.37 ,$11.52 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NICOTINE 21 MG/24HR PT24,637,1 ,$8.75 ,$5.78 ,$4.44 ,$8.75 , N/A ,$6.00 ,$6.00 , N/A ,$5.25 ,$7.44 ,$6.13 , N/A , N/A ,$8.31 ,$6.65 ,$6.56 ,$5.69 ,$7.44 , N/A ,$5.69 ,$5.69 ,$6.13 ,$5.33 , N/A ,$8.75 , N/A , N/A , N/A ,$7.44 , N/A ,$8.05 ,$6.13 ,$4.44 ,$5.33 ,$5.33 ,$5.33 ,$6.05 ,$7.88 ,$5.98 , N/A ,$6.91 , N/A ,$5.16 ,$5.16 , N/A ,$5.16 ,$6.30 ,$5.43 ,$6.30 ,$6.30 ,$7.00 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NITROFURANTOIN (MACROCRYSTAL-MONOHYDRATE) 100 MG CAPS,637,1 ,$12.05 ,$7.95 ,$6.11 ,$12.05 , N/A ,$8.26 ,$8.26 , N/A ,$7.23 ,$10.24 ,$8.44 , N/A , N/A ,$11.45 ,$9.16 ,$9.04 ,$7.83 ,$10.24 , N/A ,$7.83 ,$7.83 ,$8.44 ,$7.34 , N/A ,$12.05 , N/A , N/A , N/A ,$10.24 , N/A ,$11.09 ,$8.44 ,$6.11 ,$7.33 ,$7.34 ,$7.33 ,$8.33 ,$10.85 ,$8.23 , N/A ,$9.52 , N/A ,$7.11 ,$7.11 , N/A ,$7.11 ,$8.68 ,$7.47 ,$8.68 ,$8.68 ,$9.64 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NYSTATIN 100000 UNIT/GM OINT 15 G TUBE,637,1 ,$59.55 ,$39.30 ,$30.20 ,$59.55 , N/A ,$40.82 ,$40.82 , N/A ,$35.73 ,$50.62 ,$41.69 , N/A , N/A ,$56.57 ,$45.26 ,$44.66 ,$38.71 ,$50.62 , N/A ,$38.71 ,$38.71 ,$41.69 ,$36.27 , N/A ,$59.55 , N/A , N/A , N/A ,$50.62 , N/A ,$54.79 ,$41.69 ,$30.20 ,$36.25 ,$36.27 ,$36.25 ,$41.15 ,$53.60 ,$40.68 , N/A ,$47.04 , N/A ,$35.13 ,$35.13 , N/A ,$35.13 ,$42.88 ,$36.92 ,$42.88 ,$42.88 ,$47.64 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NYSTATIN 100000 UNIT/GM CREA 15 G TUBE,637,1 ,$59.55 ,$39.30 ,$30.20 ,$59.55 , N/A ,$40.82 ,$40.82 , N/A ,$35.73 ,$50.62 ,$41.69 , N/A , N/A ,$56.57 ,$45.26 ,$44.66 ,$38.71 ,$50.62 , N/A ,$38.71 ,$38.71 ,$41.69 ,$36.27 , N/A ,$59.55 , N/A , N/A , N/A ,$50.62 , N/A ,$54.79 ,$41.69 ,$30.20 ,$36.25 ,$36.27 ,$36.25 ,$41.15 ,$53.60 ,$40.68 , N/A ,$47.04 , N/A ,$35.13 ,$35.13 , N/A ,$35.13 ,$42.88 ,$36.92 ,$42.88 ,$42.88 ,$47.64 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% CREA 15 G TUBE,637,1 ,$380.65 ,$251.23 ,$193.07 ,$380.65 , N/A ,$260.90 ,$260.90 , N/A ,$228.39 ,$323.55 ,$266.46 , N/A , N/A ,$361.62 ,$289.29 ,$285.49 ,$247.42 ,$323.55 , N/A ,$247.42 ,$247.42 ,$266.46 ,$231.82 , N/A ,$380.65 , N/A , N/A , N/A ,$323.55 , N/A ,$350.20 ,$266.46 ,$193.07 ,$231.70 ,$231.82 ,$231.70 ,$263.03 ,$342.59 ,$260.06 , N/A ,$300.71 , N/A ,$224.58 ,$224.58 , N/A ,$224.58 ,$274.07 ,$236.00 ,$274.07 ,$274.07 ,$304.52 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OLANZAPINE 5 MG TABS,637,1 ,$44.95 ,$29.67 ,$22.80 ,$44.95 , N/A ,$30.81 ,$30.81 , N/A ,$26.97 ,$38.21 ,$31.47 , N/A , N/A ,$42.70 ,$34.16 ,$33.71 ,$29.22 ,$38.21 , N/A ,$29.22 ,$29.22 ,$31.47 ,$27.37 , N/A ,$44.95 , N/A , N/A , N/A ,$38.21 , N/A ,$41.35 ,$31.47 ,$22.80 ,$27.36 ,$27.37 ,$27.36 ,$31.06 ,$40.46 ,$30.71 , N/A ,$35.51 , N/A ,$26.52 ,$26.52 , N/A ,$26.52 ,$32.36 ,$27.87 ,$32.36 ,$32.36 ,$35.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OMEPRAZOLE 2 MG/ML SUSP,637,1 ,$31.30 ,$20.66 ,$15.88 ,$31.30 , N/A ,$21.45 ,$21.45 , N/A ,$18.78 ,$26.61 ,$21.91 , N/A , N/A ,$29.74 ,$23.79 ,$23.48 ,$20.35 ,$26.61 , N/A ,$20.35 ,$20.35 ,$21.91 ,$19.06 , N/A ,$31.30 , N/A , N/A , N/A ,$26.61 , N/A ,$28.80 ,$21.91 ,$15.88 ,$19.05 ,$19.06 ,$19.05 ,$21.63 ,$28.17 ,$21.38 , N/A ,$24.73 , N/A ,$18.47 ,$18.47 , N/A ,$18.47 ,$22.54 ,$19.41 ,$22.54 ,$22.54 ,$25.04 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ONDANSETRON 4 MG TBDP,637,1 ,$78.60 ,$51.88 ,$39.87 ,$78.60 , N/A ,$53.87 ,$53.87 , N/A ,$47.16 ,$66.81 ,$55.02 , N/A , N/A ,$74.67 ,$59.74 ,$58.95 ,$51.09 ,$66.81 , N/A ,$51.09 ,$51.09 ,$55.02 ,$47.87 , N/A ,$78.60 , N/A , N/A , N/A ,$66.81 , N/A ,$72.31 ,$55.02 ,$39.87 ,$47.84 ,$47.87 ,$47.84 ,$54.31 ,$70.74 ,$53.70 , N/A ,$62.09 , N/A ,$46.37 ,$46.37 , N/A ,$46.37 ,$56.59 ,$48.73 ,$56.59 ,$56.59 ,$62.88 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ONDANSETRON 4 MG/5ML SOLN,637,1 ,$38.70 ,$25.54 ,$19.63 ,$38.70 , N/A ,$26.53 ,$26.53 , N/A ,$23.22 ,$32.90 ,$27.09 , N/A , N/A ,$36.77 ,$29.41 ,$29.03 ,$25.16 ,$32.90 , N/A ,$25.16 ,$25.16 ,$27.09 ,$23.57 , N/A ,$38.70 , N/A , N/A , N/A ,$32.90 , N/A ,$35.60 ,$27.09 ,$19.63 ,$23.56 ,$23.57 ,$23.56 ,$26.74 ,$34.83 ,$26.44 , N/A ,$30.57 , N/A ,$22.83 ,$22.83 , N/A ,$22.83 ,$27.86 ,$23.99 ,$27.86 ,$27.86 ,$30.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OPIUM-BELLADONNA 16.2-60 MG SUPP,637,1 ,$113.75 ,$75.08 ,$57.69 ,$113.75 , N/A ,$77.96 ,$77.96 , N/A ,$68.25 ,$96.69 ,$79.63 , N/A , N/A ,$108.06 ,$86.45 ,$85.31 ,$73.94 ,$96.69 , N/A ,$73.94 ,$73.94 ,$79.63 ,$69.27 , N/A ,$113.75 , N/A , N/A , N/A ,$96.69 , N/A ,$104.65 ,$79.63 ,$57.69 ,$69.24 ,$69.27 ,$69.24 ,$78.60 ,$102.38 ,$77.71 , N/A ,$89.86 , N/A ,$67.11 ,$67.11 , N/A ,$67.11 ,$81.90 ,$70.53 ,$81.90 ,$81.90 ,$91.00 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OSELTAMIVIR 30 MG CAPS,637,1 ,$48.25 ,$31.85 ,$24.47 ,$48.25 , N/A ,$33.07 ,$33.07 , N/A ,$28.95 ,$41.01 ,$33.78 , N/A , N/A ,$45.84 ,$36.67 ,$36.19 ,$31.36 ,$41.01 , N/A ,$31.36 ,$31.36 ,$33.78 ,$29.38 , N/A ,$48.25 , N/A , N/A , N/A ,$41.01 , N/A ,$44.39 ,$33.78 ,$24.47 ,$29.37 ,$29.38 ,$29.37 ,$33.34 ,$43.43 ,$32.96 , N/A ,$38.12 , N/A ,$28.47 ,$28.47 , N/A ,$28.47 ,$34.74 ,$29.92 ,$34.74 ,$34.74 ,$38.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OSELTAMIVIR 6 MG/ML SUSR,637,1 ,$9.93 ,$6.55 ,$5.04 ,$9.93 , N/A ,$6.81 ,$6.81 , N/A ,$5.96 ,$8.44 ,$6.95 , N/A , N/A ,$9.43 ,$7.55 ,$7.45 ,$6.45 ,$8.44 , N/A ,$6.45 ,$6.45 ,$6.95 ,$6.05 , N/A ,$9.93 , N/A , N/A , N/A ,$8.44 , N/A ,$9.14 ,$6.95 ,$5.04 ,$6.04 ,$6.05 ,$6.04 ,$6.86 ,$8.94 ,$6.78 , N/A ,$7.84 , N/A ,$5.86 ,$5.86 , N/A ,$5.86 ,$7.15 ,$6.16 ,$7.15 ,$7.15 ,$7.94 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OSELTAMIVIR 75 MG CAPS,637,1 ,$52.60 ,$34.72 ,$26.68 ,$52.60 , N/A ,$36.05 ,$36.05 , N/A ,$31.56 ,$44.71 ,$36.82 , N/A , N/A ,$49.97 ,$39.98 ,$39.45 ,$34.19 ,$44.71 , N/A ,$34.19 ,$34.19 ,$36.82 ,$32.03 , N/A ,$52.60 , N/A , N/A , N/A ,$44.71 , N/A ,$48.39 ,$36.82 ,$26.68 ,$32.02 ,$32.03 ,$32.02 ,$36.35 ,$47.34 ,$35.94 , N/A ,$41.55 , N/A ,$31.03 ,$31.03 , N/A ,$31.03 ,$37.87 ,$32.61 ,$37.87 ,$37.87 ,$42.08 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXCARBAZEPINE 300 MG TABS,637,1 ,$9.40 ,$6.20 ,$4.77 ,$9.40 , N/A ,$6.44 ,$6.44 , N/A ,$5.64 ,$7.99 ,$6.58 , N/A , N/A ,$8.93 ,$7.14 ,$7.05 ,$6.11 ,$7.99 , N/A ,$6.11 ,$6.11 ,$6.58 ,$5.72 , N/A ,$9.40 , N/A , N/A , N/A ,$7.99 , N/A ,$8.65 ,$6.58 ,$4.77 ,$5.72 ,$5.72 ,$5.72 ,$6.50 ,$8.46 ,$6.42 , N/A ,$7.43 , N/A ,$5.55 ,$5.55 , N/A ,$5.55 ,$6.77 ,$5.83 ,$6.77 ,$6.77 ,$7.52 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYBUTYNIN XL 5 MG TB24,637,1 ,$10.45 ,$6.90 ,$5.30 ,$10.45 , N/A ,$7.16 ,$7.16 , N/A ,$6.27 ,$8.88 ,$7.32 , N/A , N/A ,$9.93 ,$7.94 ,$7.84 ,$6.79 ,$8.88 , N/A ,$6.79 ,$6.79 ,$7.32 ,$6.36 , N/A ,$10.45 , N/A , N/A , N/A ,$8.88 , N/A ,$9.61 ,$7.32 ,$5.30 ,$6.36 ,$6.36 ,$6.36 ,$7.22 ,$9.41 ,$7.14 , N/A ,$8.26 , N/A ,$6.17 ,$6.17 , N/A ,$6.17 ,$7.52 ,$6.48 ,$7.52 ,$7.52 ,$8.36 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYCODONE 5 MG/5ML SOLN,637,1 ,$25.10 ,$16.57 ,$12.73 ,$25.10 , N/A ,$17.20 ,$17.20 , N/A ,$15.06 ,$21.34 ,$17.57 , N/A , N/A ,$23.85 ,$19.08 ,$18.83 ,$16.32 ,$21.34 , N/A ,$16.32 ,$16.32 ,$17.57 ,$15.29 , N/A ,$25.10 , N/A , N/A , N/A ,$21.34 , N/A ,$23.09 ,$17.57 ,$12.73 ,$15.28 ,$15.29 ,$15.28 ,$17.34 ,$22.59 ,$17.15 , N/A ,$19.83 , N/A ,$14.81 ,$14.81 , N/A ,$14.81 ,$18.07 ,$15.56 ,$18.07 ,$18.07 ,$20.08 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYCODONE ER 10 MG T12A,637,1 ,$19.55 ,$12.90 ,$9.92 ,$19.55 , N/A ,$13.40 ,$13.40 , N/A ,$11.73 ,$16.62 ,$13.69 , N/A , N/A ,$18.57 ,$14.86 ,$14.66 ,$12.71 ,$16.62 , N/A ,$12.71 ,$12.71 ,$13.69 ,$11.91 , N/A ,$19.55 , N/A , N/A , N/A ,$16.62 , N/A ,$17.99 ,$13.69 ,$9.92 ,$11.90 ,$11.91 ,$11.90 ,$13.51 ,$17.60 ,$13.36 , N/A ,$15.44 , N/A ,$11.53 ,$11.53 , N/A ,$11.53 ,$14.08 ,$12.12 ,$14.08 ,$14.08 ,$15.64 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYCODONE ER 20 MG T12A,637,1 ,$36.38 ,$24.01 ,$18.45 ,$36.38 , N/A ,$24.93 ,$24.93 , N/A ,$21.83 ,$30.92 ,$25.47 , N/A , N/A ,$34.56 ,$27.65 ,$27.29 ,$23.65 ,$30.92 , N/A ,$23.65 ,$23.65 ,$25.47 ,$22.16 , N/A ,$36.38 , N/A , N/A , N/A ,$30.92 , N/A ,$33.47 ,$25.47 ,$18.45 ,$22.14 ,$22.16 ,$22.14 ,$25.14 ,$32.74 ,$24.85 , N/A ,$28.74 , N/A ,$21.46 ,$21.46 , N/A ,$21.46 ,$26.19 ,$22.56 ,$26.19 ,$26.19 ,$29.10 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYCODONE-ACETAMINOPHEN 10-325 MG TABS,637,1 ,$12.15 ,$8.02 ,$6.16 ,$12.15 , N/A ,$8.33 ,$8.33 , N/A ,$7.29 ,$10.33 ,$8.51 , N/A , N/A ,$11.54 ,$9.23 ,$9.11 ,$7.90 ,$10.33 , N/A ,$7.90 ,$7.90 ,$8.51 ,$7.40 , N/A ,$12.15 , N/A , N/A , N/A ,$10.33 , N/A ,$11.18 ,$8.51 ,$6.16 ,$7.40 ,$7.40 ,$7.40 ,$8.40 ,$10.94 ,$8.30 , N/A ,$9.60 , N/A ,$7.17 ,$7.17 , N/A ,$7.17 ,$8.75 ,$7.53 ,$8.75 ,$8.75 ,$9.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYCODONE-ACETAMINOPHEN 7.5-325 MG TABS,637,1 ,$9.35 ,$6.17 ,$4.74 ,$9.35 , N/A ,$6.41 ,$6.41 , N/A ,$5.61 ,$7.95 ,$6.55 , N/A , N/A ,$8.88 ,$7.11 ,$7.01 ,$6.08 ,$7.95 , N/A ,$6.08 ,$6.08 ,$6.55 ,$5.69 , N/A ,$9.35 , N/A , N/A , N/A ,$7.95 , N/A ,$8.60 ,$6.55 ,$4.74 ,$5.69 ,$5.69 ,$5.69 ,$6.46 ,$8.42 ,$6.39 , N/A ,$7.39 , N/A ,$5.52 ,$5.52 , N/A ,$5.52 ,$6.73 ,$5.80 ,$6.73 ,$6.73 ,$7.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYMETAZOLINE 0.05 % SOLN 30 ML SPRAY BOTTLE,637,1 ,$8.40 ,$5.54 ,$4.26 ,$8.40 , N/A ,$5.76 ,$5.76 , N/A ,$5.04 ,$7.14 ,$5.88 , N/A , N/A ,$7.98 ,$6.38 ,$6.30 ,$5.46 ,$7.14 , N/A ,$5.46 ,$5.46 ,$5.88 ,$5.12 , N/A ,$8.40 , N/A , N/A , N/A ,$7.14 , N/A ,$7.73 ,$5.88 ,$4.26 ,$5.11 ,$5.12 ,$5.11 ,$5.80 ,$7.56 ,$5.74 , N/A ,$6.64 , N/A ,$4.96 ,$4.96 , N/A ,$4.96 ,$6.05 ,$5.21 ,$6.05 ,$6.05 ,$6.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PALIPERIDONE ER 3 MG TB24,637,1 ,$103.95 ,$68.61 ,$52.72 ,$103.95 , N/A ,$71.25 ,$71.25 , N/A ,$62.37 ,$88.36 ,$72.77 , N/A , N/A ,$98.75 ,$79.00 ,$77.96 ,$67.57 ,$88.36 , N/A ,$67.57 ,$67.57 ,$72.77 ,$63.31 , N/A ,$103.95 , N/A , N/A , N/A ,$88.36 , N/A ,$95.63 ,$72.77 ,$52.72 ,$63.27 ,$63.31 ,$63.27 ,$71.83 ,$93.56 ,$71.02 , N/A ,$82.12 , N/A ,$61.33 ,$61.33 , N/A ,$61.33 ,$74.84 ,$64.45 ,$74.84 ,$74.84 ,$83.16 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PANCRELIPASE (LIP-PROT-AMYL) 10000-32000 UNITS CPEP,637,1 ,$15.60 ,$10.30 ,$7.91 ,$15.60 , N/A ,$10.69 ,$10.69 , N/A ,$9.36 ,$13.26 ,$10.92 , N/A , N/A ,$14.82 ,$11.86 ,$11.70 ,$10.14 ,$13.26 , N/A ,$10.14 ,$10.14 ,$10.92 ,$9.50 , N/A ,$15.60 , N/A , N/A , N/A ,$13.26 , N/A ,$14.35 ,$10.92 ,$7.91 ,$9.50 ,$9.50 ,$9.50 ,$10.78 ,$14.04 ,$10.66 , N/A ,$12.32 , N/A ,$9.20 ,$9.20 , N/A ,$9.20 ,$11.23 ,$9.67 ,$11.23 ,$11.23 ,$12.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PANCRELIPASE (LIP-PROT-AMYL) 20000-63000 UNITS CPEP,637,1 ,$30.53 ,$20.15 ,$15.48 ,$30.53 , N/A ,$20.93 ,$20.93 , N/A ,$18.32 ,$25.95 ,$21.37 , N/A , N/A ,$29.00 ,$23.20 ,$22.90 ,$19.84 ,$25.95 , N/A ,$19.84 ,$19.84 ,$21.37 ,$18.59 , N/A ,$30.53 , N/A , N/A , N/A ,$25.95 , N/A ,$28.09 ,$21.37 ,$15.48 ,$18.58 ,$18.59 ,$18.58 ,$21.10 ,$27.48 ,$20.86 , N/A ,$24.12 , N/A ,$18.01 ,$18.01 , N/A ,$18.01 ,$21.98 ,$18.93 ,$21.98 ,$21.98 ,$24.42 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PANCRELIPASE (LIP-PROT-AMYL) 24000 UNIT CPEP,637,1 ,$30.50 ,$20.13 ,$15.47 ,$30.50 , N/A ,$20.90 ,$20.90 , N/A ,$18.30 ,$25.93 ,$21.35 , N/A , N/A ,$28.98 ,$23.18 ,$22.88 ,$19.83 ,$25.93 , N/A ,$19.83 ,$19.83 ,$21.35 ,$18.57 , N/A ,$30.50 , N/A , N/A , N/A ,$25.93 , N/A ,$28.06 ,$21.35 ,$15.47 ,$18.57 ,$18.57 ,$18.57 ,$21.08 ,$27.45 ,$20.84 , N/A ,$24.10 , N/A ,$18.00 ,$18.00 , N/A ,$18.00 ,$21.96 ,$18.91 ,$21.96 ,$21.96 ,$24.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PANTOPRAZOLE EC 20 MG TBEC,637,1 ,$17.95 ,$11.85 ,$9.10 ,$17.95 , N/A ,$12.30 ,$12.30 , N/A ,$10.77 ,$15.26 ,$12.57 , N/A , N/A ,$17.05 ,$13.64 ,$13.46 ,$11.67 ,$15.26 , N/A ,$11.67 ,$11.67 ,$12.57 ,$10.93 , N/A ,$17.95 , N/A , N/A , N/A ,$15.26 , N/A ,$16.51 ,$12.57 ,$9.10 ,$10.93 ,$10.93 ,$10.93 ,$12.40 ,$16.16 ,$12.26 , N/A ,$14.18 , N/A ,$10.59 ,$10.59 , N/A ,$10.59 ,$12.92 ,$11.13 ,$12.92 ,$12.92 ,$14.36 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PHENAZOPYRIDINE 100 MG TABS,637,1 ,$9.20 ,$6.07 ,$4.67 ,$9.20 , N/A ,$6.31 ,$6.31 , N/A ,$5.52 ,$7.82 ,$6.44 , N/A , N/A ,$8.74 ,$6.99 ,$6.90 ,$5.98 ,$7.82 , N/A ,$5.98 ,$5.98 ,$6.44 ,$5.60 , N/A ,$9.20 , N/A , N/A , N/A ,$7.82 , N/A ,$8.46 ,$6.44 ,$4.67 ,$5.60 ,$5.60 ,$5.60 ,$6.36 ,$8.28 ,$6.29 , N/A ,$7.27 , N/A ,$5.43 ,$5.43 , N/A ,$5.43 ,$6.62 ,$5.70 ,$6.62 ,$6.62 ,$7.36 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CITALOPRAM 20 MG TABS,637,1 ,$9.20 ,$6.07 ,$4.67 ,$9.20 , N/A ,$6.31 ,$6.31 , N/A ,$5.52 ,$7.82 ,$6.44 , N/A , N/A ,$8.74 ,$6.99 ,$6.90 ,$5.98 ,$7.82 , N/A ,$5.98 ,$5.98 ,$6.44 ,$5.60 , N/A ,$9.20 , N/A , N/A , N/A ,$7.82 , N/A ,$8.46 ,$6.44 ,$4.67 ,$5.60 ,$5.60 ,$5.60 ,$6.36 ,$8.28 ,$6.29 , N/A ,$7.27 , N/A ,$5.43 ,$5.43 , N/A ,$5.43 ,$6.62 ,$5.70 ,$6.62 ,$6.62 ,$7.36 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PHENYLEPHRINE-MINERAL OIL-PETROLATUM 0.25-14-74.9 % OINT 57 G TUBE,637,1 ,$10.10 ,$6.67 ,$5.12 ,$10.10 , N/A ,$6.92 ,$6.92 , N/A ,$6.06 ,$8.59 ,$7.07 , N/A , N/A ,$9.60 ,$7.68 ,$7.58 ,$6.57 ,$8.59 , N/A ,$6.57 ,$6.57 ,$7.07 ,$6.15 , N/A ,$10.10 , N/A , N/A , N/A ,$8.59 , N/A ,$9.29 ,$7.07 ,$5.12 ,$6.15 ,$6.15 ,$6.15 ,$6.98 ,$9.09 ,$6.90 , N/A ,$7.98 , N/A ,$5.96 ,$5.96 , N/A ,$5.96 ,$7.27 ,$6.26 ,$7.27 ,$7.27 ,$8.08 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,POLYETHYLENE GLYCOL PACK,637,1 ,$9.50 ,$6.27 ,$4.82 ,$9.50 , N/A ,$6.51 ,$6.51 , N/A ,$5.70 ,$8.08 ,$6.65 , N/A , N/A ,$9.03 ,$7.22 ,$7.13 ,$6.18 ,$8.08 , N/A ,$6.18 ,$6.18 ,$6.65 ,$5.79 , N/A ,$9.50 , N/A , N/A , N/A ,$8.08 , N/A ,$8.74 ,$6.65 ,$4.82 ,$5.78 ,$5.79 ,$5.78 ,$6.56 ,$8.55 ,$6.49 , N/A ,$7.51 , N/A ,$5.61 ,$5.61 , N/A ,$5.61 ,$6.84 ,$5.89 ,$6.84 ,$6.84 ,$7.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PAROXETINE 20 MG TABS,637,1 ,$9.50 ,$6.27 ,$4.82 ,$9.50 , N/A ,$6.51 ,$6.51 , N/A ,$5.70 ,$8.08 ,$6.65 , N/A , N/A ,$9.03 ,$7.22 ,$7.13 ,$6.18 ,$8.08 , N/A ,$6.18 ,$6.18 ,$6.65 ,$5.79 , N/A ,$9.50 , N/A , N/A , N/A ,$8.08 , N/A ,$8.74 ,$6.65 ,$4.82 ,$5.78 ,$5.79 ,$5.78 ,$6.56 ,$8.55 ,$6.49 , N/A ,$7.51 , N/A ,$5.61 ,$5.61 , N/A ,$5.61 ,$6.84 ,$5.89 ,$6.84 ,$6.84 ,$7.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,POTASSIUM CHLORIDE 20 MEQ/15ML (10%) SOLN,637,1 ,$56.83 ,$37.51 ,$28.82 ,$56.83 , N/A ,$38.95 ,$38.95 , N/A ,$34.10 ,$48.31 ,$39.78 , N/A , N/A ,$53.99 ,$43.19 ,$42.62 ,$36.94 ,$48.31 , N/A ,$36.94 ,$36.94 ,$39.78 ,$34.61 , N/A ,$56.83 , N/A , N/A , N/A ,$48.31 , N/A ,$52.28 ,$39.78 ,$28.82 ,$34.59 ,$34.61 ,$34.59 ,$39.27 ,$51.15 ,$38.83 , N/A ,$44.90 , N/A ,$33.53 ,$33.53 , N/A ,$33.53 ,$40.92 ,$35.23 ,$40.92 ,$40.92 ,$45.46 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,POTASSIUM CITRATE CR 10 MEQ (1080 MG) TBCR,637,1 ,$9.85 ,$6.50 ,$5.00 ,$9.85 , N/A ,$6.75 ,$6.75 , N/A ,$5.91 ,$8.37 ,$6.90 , N/A , N/A ,$9.36 ,$7.49 ,$7.39 ,$6.40 ,$8.37 , N/A ,$6.40 ,$6.40 ,$6.90 ,$6.00 , N/A ,$9.85 , N/A , N/A , N/A ,$8.37 , N/A ,$9.06 ,$6.90 ,$5.00 ,$6.00 ,$6.00 ,$6.00 ,$6.81 ,$8.87 ,$6.73 , N/A ,$7.78 , N/A ,$5.81 ,$5.81 , N/A ,$5.81 ,$7.09 ,$6.11 ,$7.09 ,$7.09 ,$7.88 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PRAMIPEXOLE 0.5 MG TABS,637,1 ,$10.05 ,$6.63 ,$5.10 ,$10.05 , N/A ,$6.89 ,$6.89 , N/A ,$6.03 ,$8.54 ,$7.04 , N/A , N/A ,$9.55 ,$7.64 ,$7.54 ,$6.53 ,$8.54 , N/A ,$6.53 ,$6.53 ,$7.04 ,$6.12 , N/A ,$10.05 , N/A , N/A , N/A ,$8.54 , N/A ,$9.25 ,$7.04 ,$5.10 ,$6.12 ,$6.12 ,$6.12 ,$6.94 ,$9.05 ,$6.87 , N/A ,$7.94 , N/A ,$5.93 ,$5.93 , N/A ,$5.93 ,$7.24 ,$6.23 ,$7.24 ,$7.24 ,$8.04 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PRAMIPEXOLE 0.125 MG TABS,637,1 ,$10.05 ,$6.63 ,$5.10 ,$10.05 , N/A ,$6.89 ,$6.89 , N/A ,$6.03 ,$8.54 ,$7.04 , N/A , N/A ,$9.55 ,$7.64 ,$7.54 ,$6.53 ,$8.54 , N/A ,$6.53 ,$6.53 ,$7.04 ,$6.12 , N/A ,$10.05 , N/A , N/A , N/A ,$8.54 , N/A ,$9.25 ,$7.04 ,$5.10 ,$6.12 ,$6.12 ,$6.12 ,$6.94 ,$9.05 ,$6.87 , N/A ,$7.94 , N/A ,$5.93 ,$5.93 , N/A ,$5.93 ,$7.24 ,$6.23 ,$7.24 ,$7.24 ,$8.04 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PRASUGREL 10 MG TABS,637,1 ,$56.10 ,$37.03 ,$28.45 ,$56.10 , N/A ,$38.45 ,$38.45 , N/A ,$33.66 ,$47.69 ,$39.27 , N/A , N/A ,$53.30 ,$42.64 ,$42.08 ,$36.47 ,$47.69 , N/A ,$36.47 ,$36.47 ,$39.27 ,$34.16 , N/A ,$56.10 , N/A , N/A , N/A ,$47.69 , N/A ,$51.61 ,$39.27 ,$28.45 ,$34.15 ,$34.16 ,$34.15 ,$38.77 ,$50.49 ,$38.33 , N/A ,$44.32 , N/A ,$33.10 ,$33.10 , N/A ,$33.10 ,$40.39 ,$34.78 ,$40.39 ,$40.39 ,$44.88 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PRAVASTATIN 10 MG TABS,637,1 ,$10.90 ,$7.19 ,$5.53 ,$10.90 , N/A ,$7.47 ,$7.47 , N/A ,$6.54 ,$9.27 ,$7.63 , N/A , N/A ,$10.36 ,$8.28 ,$8.18 ,$7.09 ,$9.27 , N/A ,$7.09 ,$7.09 ,$7.63 ,$6.64 , N/A ,$10.90 , N/A , N/A , N/A ,$9.27 , N/A ,$10.03 ,$7.63 ,$5.53 ,$6.63 ,$6.64 ,$6.63 ,$7.53 ,$9.81 ,$7.45 , N/A ,$8.61 , N/A ,$6.43 ,$6.43 , N/A ,$6.43 ,$7.85 ,$6.76 ,$7.85 ,$7.85 ,$8.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PRAVASTATIN 20 MG TABS,637,1 ,$11.08 ,$7.31 ,$5.62 ,$11.08 , N/A ,$7.59 ,$7.59 , N/A ,$6.65 ,$9.42 ,$7.76 , N/A , N/A ,$10.53 ,$8.42 ,$8.31 ,$7.20 ,$9.42 , N/A ,$7.20 ,$7.20 ,$7.76 ,$6.75 , N/A ,$11.08 , N/A , N/A , N/A ,$9.42 , N/A ,$10.19 ,$7.76 ,$5.62 ,$6.74 ,$6.75 ,$6.74 ,$7.66 ,$9.97 ,$7.57 , N/A ,$8.75 , N/A ,$6.54 ,$6.54 , N/A ,$6.54 ,$7.98 ,$6.87 ,$7.98 ,$7.98 ,$8.86 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PREGABALIN 25 MG CAPS,637,1 ,$36.80 ,$24.29 ,$18.67 ,$36.80 , N/A ,$25.22 ,$25.22 , N/A ,$22.08 ,$31.28 ,$25.76 , N/A , N/A ,$34.96 ,$27.97 ,$27.60 ,$23.92 ,$31.28 , N/A ,$23.92 ,$23.92 ,$25.76 ,$22.41 , N/A ,$36.80 , N/A , N/A , N/A ,$31.28 , N/A ,$33.86 ,$25.76 ,$18.67 ,$22.40 ,$22.41 ,$22.40 ,$25.43 ,$33.12 ,$25.14 , N/A ,$29.07 , N/A ,$21.71 ,$21.71 , N/A ,$21.71 ,$26.50 ,$22.82 ,$26.50 ,$26.50 ,$29.44 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PREGABALIN 75 MG CAPS,637,1 ,$40.45 ,$26.70 ,$20.52 ,$40.45 , N/A ,$27.72 ,$27.72 , N/A ,$24.27 ,$34.38 ,$28.32 , N/A , N/A ,$38.43 ,$30.74 ,$30.34 ,$26.29 ,$34.38 , N/A ,$26.29 ,$26.29 ,$28.32 ,$24.63 , N/A ,$40.45 , N/A , N/A , N/A ,$34.38 , N/A ,$37.21 ,$28.32 ,$20.52 ,$24.62 ,$24.63 ,$24.62 ,$27.95 ,$36.41 ,$27.64 , N/A ,$31.96 , N/A ,$23.87 ,$23.87 , N/A ,$23.87 ,$29.12 ,$25.08 ,$29.12 ,$29.12 ,$32.36 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PROBENECID 500 MG TABS,637,1 ,$12.70 ,$8.38 ,$6.44 ,$12.70 , N/A ,$8.70 ,$8.70 , N/A ,$7.62 ,$10.80 ,$8.89 , N/A , N/A ,$12.07 ,$9.65 ,$9.53 ,$8.26 ,$10.80 , N/A ,$8.26 ,$8.26 ,$8.89 ,$7.73 , N/A ,$12.70 , N/A , N/A , N/A ,$10.80 , N/A ,$11.68 ,$8.89 ,$6.44 ,$7.73 ,$7.73 ,$7.73 ,$8.78 ,$11.43 ,$8.68 , N/A ,$10.03 , N/A ,$7.49 ,$7.49 , N/A ,$7.49 ,$9.14 ,$7.87 ,$9.14 ,$9.14 ,$10.16 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PROMETHAZINE 25 MG SUPP,637,1 ,$60.20 ,$39.73 ,$30.53 ,$60.20 , N/A ,$41.26 ,$41.26 , N/A ,$36.12 ,$51.17 ,$42.14 , N/A , N/A ,$57.19 ,$45.75 ,$45.15 ,$39.13 ,$51.17 , N/A ,$39.13 ,$39.13 ,$42.14 ,$36.66 , N/A ,$60.20 , N/A , N/A , N/A ,$51.17 , N/A ,$55.38 ,$42.14 ,$30.53 ,$36.64 ,$36.66 ,$36.64 ,$41.60 ,$54.18 ,$41.13 , N/A ,$47.56 , N/A ,$35.52 ,$35.52 , N/A ,$35.52 ,$43.34 ,$37.32 ,$43.34 ,$43.34 ,$48.16 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PYRIDOSTIGMINE CR 180 MG TBCR,637,1 ,$84.45 ,$55.74 ,$42.83 ,$84.45 , N/A ,$57.88 ,$57.88 , N/A ,$50.67 ,$71.78 ,$59.12 , N/A , N/A ,$80.23 ,$64.18 ,$63.34 ,$54.89 ,$71.78 , N/A ,$54.89 ,$54.89 ,$59.12 ,$51.43 , N/A ,$84.45 , N/A , N/A , N/A ,$71.78 , N/A ,$77.69 ,$59.12 ,$42.83 ,$51.40 ,$51.43 ,$51.40 ,$58.36 ,$76.01 ,$57.70 , N/A ,$66.72 , N/A ,$49.83 ,$49.83 , N/A ,$49.83 ,$60.80 ,$52.36 ,$60.80 ,$60.80 ,$67.56 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,QUETIAPINE 100 MG TABS,637,1 ,$22.03 ,$14.54 ,$11.17 ,$22.03 , N/A ,$15.10 ,$15.10 , N/A ,$13.22 ,$18.73 ,$15.42 , N/A , N/A ,$20.93 ,$16.74 ,$16.52 ,$14.32 ,$18.73 , N/A ,$14.32 ,$14.32 ,$15.42 ,$13.42 , N/A ,$22.03 , N/A , N/A , N/A ,$18.73 , N/A ,$20.27 ,$15.42 ,$11.17 ,$13.41 ,$13.42 ,$13.41 ,$15.22 ,$19.83 ,$15.05 , N/A ,$17.40 , N/A ,$13.00 ,$13.00 , N/A ,$13.00 ,$15.86 ,$13.66 ,$15.86 ,$15.86 ,$17.62 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,QUETIAPINE 25 MG TABS,637,1 ,$12.85 ,$8.48 ,$6.52 ,$12.85 , N/A ,$8.81 ,$8.81 , N/A ,$7.71 ,$10.92 ,$9.00 , N/A , N/A ,$12.21 ,$9.77 ,$9.64 ,$8.35 ,$10.92 , N/A ,$8.35 ,$8.35 ,$9.00 ,$7.83 , N/A ,$12.85 , N/A , N/A , N/A ,$10.92 , N/A ,$11.82 ,$9.00 ,$6.52 ,$7.82 ,$7.83 ,$7.82 ,$8.88 ,$11.57 ,$8.78 , N/A ,$10.15 , N/A ,$7.58 ,$7.58 , N/A ,$7.58 ,$9.25 ,$7.97 ,$9.25 ,$9.25 ,$10.28 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,RANOLAZINE ER 500 MG TB12,637,1 ,$27.98 ,$18.47 ,$14.19 ,$27.98 , N/A ,$19.18 ,$19.18 , N/A ,$16.79 ,$23.78 ,$19.59 , N/A , N/A ,$26.58 ,$21.26 ,$20.99 ,$18.19 ,$23.78 , N/A ,$18.19 ,$18.19 ,$19.59 ,$17.04 , N/A ,$27.98 , N/A , N/A , N/A ,$23.78 , N/A ,$25.74 ,$19.59 ,$14.19 ,$17.03 ,$17.04 ,$17.03 ,$19.33 ,$25.18 ,$19.12 , N/A ,$22.10 , N/A ,$16.51 ,$16.51 , N/A ,$16.51 ,$20.15 ,$17.35 ,$20.15 ,$20.15 ,$22.38 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,RIFAXIMIN 550 MG TABS,637,1 ,$202.35 ,$133.55 ,$102.63 ,$202.35 , N/A ,$138.69 ,$138.69 , N/A ,$121.41 ,$172.00 ,$141.65 , N/A , N/A ,$192.23 ,$153.79 ,$151.76 ,$131.53 ,$172.00 , N/A ,$131.53 ,$131.53 ,$141.65 ,$123.23 , N/A ,$202.35 , N/A , N/A , N/A ,$172.00 , N/A ,$186.16 ,$141.65 ,$102.63 ,$123.17 ,$123.23 ,$123.17 ,$139.82 ,$182.12 ,$138.25 , N/A ,$159.86 , N/A ,$119.39 ,$119.39 , N/A ,$119.39 ,$145.69 ,$125.46 ,$145.69 ,$145.69 ,$161.88 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,RISPERIDONE 0.25 MG TABS,637,1 ,$13.25 ,$8.75 ,$6.72 ,$13.25 , N/A ,$9.08 ,$9.08 , N/A ,$7.95 ,$11.26 ,$9.28 , N/A , N/A ,$12.59 ,$10.07 ,$9.94 ,$8.61 ,$11.26 , N/A ,$8.61 ,$8.61 ,$9.28 ,$8.07 , N/A ,$13.25 , N/A , N/A , N/A ,$11.26 , N/A ,$12.19 ,$9.28 ,$6.72 ,$8.07 ,$8.07 ,$8.07 ,$9.16 ,$11.93 ,$9.05 , N/A ,$10.47 , N/A ,$7.82 ,$7.82 , N/A ,$7.82 ,$9.54 ,$8.22 ,$9.54 ,$9.54 ,$10.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,RISPERIDONE 1 MG TABS,637,1 ,$15.50 ,$10.23 ,$7.86 ,$15.50 , N/A ,$10.62 ,$10.62 , N/A ,$9.30 ,$13.18 ,$10.85 , N/A , N/A ,$14.73 ,$11.78 ,$11.63 ,$10.08 ,$13.18 , N/A ,$10.08 ,$10.08 ,$10.85 ,$9.44 , N/A ,$15.50 , N/A , N/A , N/A ,$13.18 , N/A ,$14.26 ,$10.85 ,$7.86 ,$9.43 ,$9.44 ,$9.43 ,$10.71 ,$13.95 ,$10.59 , N/A ,$12.25 , N/A ,$9.15 ,$9.15 , N/A ,$9.15 ,$11.16 ,$9.61 ,$11.16 ,$11.16 ,$12.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,RIVAROXABAN 10 MG TABS,637,1 ,$70.30 ,$46.40 ,$35.66 ,$70.30 , N/A ,$48.18 ,$48.18 , N/A ,$42.18 ,$59.76 ,$49.21 , N/A , N/A ,$66.79 ,$53.43 ,$52.73 ,$45.70 ,$59.76 , N/A ,$45.70 ,$45.70 ,$49.21 ,$42.81 , N/A ,$70.30 , N/A , N/A , N/A ,$59.76 , N/A ,$64.68 ,$49.21 ,$35.66 ,$42.79 ,$42.81 ,$42.79 ,$48.58 ,$63.27 ,$48.03 , N/A ,$55.54 , N/A ,$41.48 ,$41.48 , N/A ,$41.48 ,$50.62 ,$43.59 ,$50.62 ,$50.62 ,$56.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,RIVASTIGMINE 1.5 MG CAPS,637,1 ,$15.90 ,$10.49 ,$8.06 ,$15.90 , N/A ,$10.90 ,$10.90 , N/A ,$9.54 ,$13.52 ,$11.13 , N/A , N/A ,$15.11 ,$12.08 ,$11.93 ,$10.34 ,$13.52 , N/A ,$10.34 ,$10.34 ,$11.13 ,$9.68 , N/A ,$15.90 , N/A , N/A , N/A ,$13.52 , N/A ,$14.63 ,$11.13 ,$8.06 ,$9.68 ,$9.68 ,$9.68 ,$10.99 ,$14.31 ,$10.86 , N/A ,$12.56 , N/A ,$9.38 ,$9.38 , N/A ,$9.38 ,$11.45 ,$9.86 ,$11.45 ,$11.45 ,$12.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,RIVASTIGMINE 4.6 MG/24HR PT24,637,1 ,$93.30 ,$61.58 ,$47.32 ,$93.30 , N/A ,$63.95 ,$63.95 , N/A ,$55.98 ,$79.31 ,$65.31 , N/A , N/A ,$88.64 ,$70.91 ,$69.98 ,$60.65 ,$79.31 , N/A ,$60.65 ,$60.65 ,$65.31 ,$56.82 , N/A ,$93.30 , N/A , N/A , N/A ,$79.31 , N/A ,$85.84 ,$65.31 ,$47.32 ,$56.79 ,$56.82 ,$56.79 ,$64.47 ,$83.97 ,$63.74 , N/A ,$73.71 , N/A ,$55.05 ,$55.05 , N/A ,$55.05 ,$67.18 ,$57.85 ,$67.18 ,$67.18 ,$74.64 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,RIVASTIGMINE 9.5 MG/24HR PT24,637,1 ,$57.45 ,$37.92 ,$29.14 ,$57.45 , N/A ,$39.38 ,$39.38 , N/A ,$34.47 ,$48.83 ,$40.22 , N/A , N/A ,$54.58 ,$43.66 ,$43.09 ,$37.34 ,$48.83 , N/A ,$37.34 ,$37.34 ,$40.22 ,$34.99 , N/A ,$57.45 , N/A , N/A , N/A ,$48.83 , N/A ,$52.85 ,$40.22 ,$29.14 ,$34.97 ,$34.99 ,$34.97 ,$39.70 ,$51.71 ,$39.25 , N/A ,$45.39 , N/A ,$33.90 ,$33.90 , N/A ,$33.90 ,$41.36 ,$35.62 ,$41.36 ,$41.36 ,$45.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ROFLUMILAST 500 MCG TABS,637,1 ,$56.90 ,$37.55 ,$28.86 ,$56.90 , N/A ,$39.00 ,$39.00 , N/A ,$34.14 ,$48.37 ,$39.83 , N/A , N/A ,$54.06 ,$43.24 ,$42.68 ,$36.99 ,$48.37 , N/A ,$36.99 ,$36.99 ,$39.83 ,$34.65 , N/A ,$56.90 , N/A , N/A , N/A ,$48.37 , N/A ,$52.35 ,$39.83 ,$28.86 ,$34.64 ,$34.65 ,$34.64 ,$39.32 ,$51.21 ,$38.87 , N/A ,$44.95 , N/A ,$33.57 ,$33.57 , N/A ,$33.57 ,$40.97 ,$35.28 ,$40.97 ,$40.97 ,$45.52 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ROPINIROLE 0.5 MG TABS,637,1 ,$8.50 ,$5.61 ,$4.31 ,$8.50 , N/A ,$5.83 ,$5.83 , N/A ,$5.10 ,$7.23 ,$5.95 , N/A , N/A ,$8.08 ,$6.46 ,$6.38 ,$5.53 ,$7.23 , N/A ,$5.53 ,$5.53 ,$5.95 ,$5.18 , N/A ,$8.50 , N/A , N/A , N/A ,$7.23 , N/A ,$7.82 ,$5.95 ,$4.31 ,$5.17 ,$5.18 ,$5.17 ,$5.87 ,$7.65 ,$5.81 , N/A ,$6.72 , N/A ,$5.02 ,$5.02 , N/A ,$5.02 ,$6.12 ,$5.27 ,$6.12 ,$6.12 ,$6.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CETIRIZINE 10 MG TABS,637,1 ,$8.50 ,$5.61 ,$4.31 ,$8.50 , N/A ,$5.83 ,$5.83 , N/A ,$5.10 ,$7.23 ,$5.95 , N/A , N/A ,$8.08 ,$6.46 ,$6.38 ,$5.53 ,$7.23 , N/A ,$5.53 ,$5.53 ,$5.95 ,$5.18 , N/A ,$8.50 , N/A , N/A , N/A ,$7.23 , N/A ,$7.82 ,$5.95 ,$4.31 ,$5.17 ,$5.18 ,$5.17 ,$5.87 ,$7.65 ,$5.81 , N/A ,$6.72 , N/A ,$5.02 ,$5.02 , N/A ,$5.02 ,$6.12 ,$5.27 ,$6.12 ,$6.12 ,$6.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GUAIFENESIN-DEXTROMETHORPHAN 100-10 MG/5ML SYRP,637,1 ,$8.50 ,$5.61 ,$4.31 ,$8.50 , N/A ,$5.83 ,$5.83 , N/A ,$5.10 ,$7.23 ,$5.95 , N/A , N/A ,$8.08 ,$6.46 ,$6.38 ,$5.53 ,$7.23 , N/A ,$5.53 ,$5.53 ,$5.95 ,$5.18 , N/A ,$8.50 , N/A , N/A , N/A ,$7.23 , N/A ,$7.82 ,$5.95 ,$4.31 ,$5.17 ,$5.18 ,$5.17 ,$5.87 ,$7.65 ,$5.81 , N/A ,$6.72 , N/A ,$5.02 ,$5.02 , N/A ,$5.02 ,$6.12 ,$5.27 ,$6.12 ,$6.12 ,$6.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ROSUVASTATIN 10 MG TABS,637,1 ,$24.30 ,$16.04 ,$12.33 ,$24.30 , N/A ,$16.66 ,$16.66 , N/A ,$14.58 ,$20.66 ,$17.01 , N/A , N/A ,$23.09 ,$18.47 ,$18.23 ,$15.80 ,$20.66 , N/A ,$15.80 ,$15.80 ,$17.01 ,$14.80 , N/A ,$24.30 , N/A , N/A , N/A ,$20.66 , N/A ,$22.36 ,$17.01 ,$12.33 ,$14.79 ,$14.80 ,$14.79 ,$16.79 ,$21.87 ,$16.60 , N/A ,$19.20 , N/A ,$14.34 ,$14.34 , N/A ,$14.34 ,$17.50 ,$15.07 ,$17.50 ,$17.50 ,$19.44 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ROSUVASTATIN 40 MG TABS,637,1 ,$30.40 ,$20.06 ,$15.42 ,$30.40 , N/A ,$20.84 ,$20.84 , N/A ,$18.24 ,$25.84 ,$21.28 , N/A , N/A ,$28.88 ,$23.10 ,$22.80 ,$19.76 ,$25.84 , N/A ,$19.76 ,$19.76 ,$21.28 ,$18.51 , N/A ,$30.40 , N/A , N/A , N/A ,$25.84 , N/A ,$27.97 ,$21.28 ,$15.42 ,$18.50 ,$18.51 ,$18.50 ,$21.01 ,$27.36 ,$20.77 , N/A ,$24.02 , N/A ,$17.94 ,$17.94 , N/A ,$17.94 ,$21.89 ,$18.85 ,$21.89 ,$21.89 ,$24.32 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SACUBITRIL-VALSARTAN 24-26 MG TABS,637,1 ,$43.26 ,$28.55 ,$21.94 ,$43.26 , N/A ,$29.65 ,$29.65 , N/A ,$25.96 ,$36.77 ,$30.28 , N/A , N/A ,$41.10 ,$32.88 ,$32.45 ,$28.12 ,$36.77 , N/A ,$28.12 ,$28.12 ,$30.28 ,$26.35 , N/A ,$43.26 , N/A , N/A , N/A ,$36.77 , N/A ,$39.80 ,$30.28 ,$21.94 ,$26.33 ,$26.35 ,$26.33 ,$29.89 ,$38.93 ,$29.56 , N/A ,$34.18 , N/A ,$25.52 ,$25.52 , N/A ,$25.52 ,$31.15 ,$26.82 ,$31.15 ,$31.15 ,$34.61 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SALIVA SUBSTITUTE SOLN 120 ML BOTTLE,637,1 ,$34.70 ,$22.90 ,$17.60 ,$34.70 , N/A ,$23.78 ,$23.78 , N/A ,$20.82 ,$29.50 ,$24.29 , N/A , N/A ,$32.97 ,$26.37 ,$26.03 ,$22.56 ,$29.50 , N/A ,$22.56 ,$22.56 ,$24.29 ,$21.13 , N/A ,$34.70 , N/A , N/A , N/A ,$29.50 , N/A ,$31.92 ,$24.29 ,$17.60 ,$21.12 ,$21.13 ,$21.12 ,$23.98 ,$31.23 ,$23.71 , N/A ,$27.41 , N/A ,$20.47 ,$20.47 , N/A ,$20.47 ,$24.98 ,$21.51 ,$24.98 ,$24.98 ,$27.76 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SEVELAMER CARBONATE 800 MG TABS,637,1 ,$20.75 ,$13.70 ,$10.52 ,$20.75 , N/A ,$14.22 ,$14.22 , N/A ,$12.45 ,$17.64 ,$14.53 , N/A , N/A ,$19.71 ,$15.77 ,$15.56 ,$13.49 ,$17.64 , N/A ,$13.49 ,$13.49 ,$14.53 ,$12.64 , N/A ,$20.75 , N/A , N/A , N/A ,$17.64 , N/A ,$19.09 ,$14.53 ,$10.52 ,$12.63 ,$12.64 ,$12.63 ,$14.34 ,$18.68 ,$14.18 , N/A ,$16.39 , N/A ,$12.24 ,$12.24 , N/A ,$12.24 ,$14.94 ,$12.87 ,$14.94 ,$14.94 ,$16.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SILVER SULFADIAZINE 1 % CREA 50 G JAR,637,1 ,$51.35 ,$33.89 ,$26.04 ,$51.35 , N/A ,$35.20 ,$35.20 , N/A ,$30.81 ,$43.65 ,$35.95 , N/A , N/A ,$48.78 ,$39.03 ,$38.51 ,$33.38 ,$43.65 , N/A ,$33.38 ,$33.38 ,$35.95 ,$31.27 , N/A ,$51.35 , N/A , N/A , N/A ,$43.65 , N/A ,$47.24 ,$35.95 ,$26.04 ,$31.26 ,$31.27 ,$31.26 ,$35.48 ,$46.22 ,$35.08 , N/A ,$40.57 , N/A ,$30.30 ,$30.30 , N/A ,$30.30 ,$36.97 ,$31.84 ,$36.97 ,$36.97 ,$41.08 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SILVER SULFADIAZINE 1 % CREA 50 G TUBE,637,1 ,$50.70 ,$33.46 ,$25.72 ,$50.70 , N/A ,$34.75 ,$34.75 , N/A ,$30.42 ,$43.10 ,$35.49 , N/A , N/A ,$48.17 ,$38.53 ,$38.03 ,$32.96 ,$43.10 , N/A ,$32.96 ,$32.96 ,$35.49 ,$30.88 , N/A ,$50.70 , N/A , N/A , N/A ,$43.10 , N/A ,$46.64 ,$35.49 ,$25.72 ,$30.86 ,$30.88 ,$30.86 ,$35.03 ,$45.63 ,$34.64 , N/A ,$40.05 , N/A ,$29.91 ,$29.91 , N/A ,$29.91 ,$36.50 ,$31.43 ,$36.50 ,$36.50 ,$40.56 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SODIUM ZIRCONIUM CYCLOSILICATE 10 G PACK,637,1 ,$99.25 ,$65.51 ,$50.34 ,$99.25 , N/A ,$68.03 ,$68.03 , N/A ,$59.55 ,$84.36 ,$69.48 , N/A , N/A ,$94.29 ,$75.43 ,$74.44 ,$64.51 ,$84.36 , N/A ,$64.51 ,$64.51 ,$69.48 ,$60.44 , N/A ,$99.25 , N/A , N/A , N/A ,$84.36 , N/A ,$91.31 ,$69.48 ,$50.34 ,$60.41 ,$60.44 ,$60.41 ,$68.58 ,$89.33 ,$67.81 , N/A ,$78.41 , N/A ,$58.56 ,$58.56 , N/A ,$58.56 ,$71.46 ,$61.54 ,$71.46 ,$71.46 ,$79.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SOLIFENACIN 5 MG TABS,637,1 ,$44.58 ,$29.42 ,$22.61 ,$44.58 , N/A ,$30.56 ,$30.56 , N/A ,$26.75 ,$37.89 ,$31.21 , N/A , N/A ,$42.35 ,$33.88 ,$33.44 ,$28.98 ,$37.89 , N/A ,$28.98 ,$28.98 ,$31.21 ,$27.15 , N/A ,$44.58 , N/A , N/A , N/A ,$37.89 , N/A ,$41.01 ,$31.21 ,$22.61 ,$27.14 ,$27.15 ,$27.14 ,$30.80 ,$40.12 ,$30.46 , N/A ,$35.22 , N/A ,$26.30 ,$26.30 , N/A ,$26.30 ,$32.10 ,$27.64 ,$32.10 ,$32.10 ,$35.66 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SOLIFENACIN SUCCINATE 10 MG TABS,637,1 ,$44.60 ,$29.44 ,$22.62 ,$44.60 , N/A ,$30.57 ,$30.57 , N/A ,$26.76 ,$37.91 ,$31.22 , N/A , N/A ,$42.37 ,$33.90 ,$33.45 ,$28.99 ,$37.91 , N/A ,$28.99 ,$28.99 ,$31.22 ,$27.16 , N/A ,$44.60 , N/A , N/A , N/A ,$37.91 , N/A ,$41.03 ,$31.22 ,$22.62 ,$27.15 ,$27.16 ,$27.15 ,$30.82 ,$40.14 ,$30.47 , N/A ,$35.23 , N/A ,$26.31 ,$26.31 , N/A ,$26.31 ,$32.11 ,$27.65 ,$32.11 ,$32.11 ,$35.68 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SOTALOL 80 MG TABS,637,1 ,$8.73 ,$5.76 ,$4.43 ,$8.73 , N/A ,$5.98 ,$5.98 , N/A ,$5.24 ,$7.42 ,$6.11 , N/A , N/A ,$8.29 ,$6.63 ,$6.55 ,$5.67 ,$7.42 , N/A ,$5.67 ,$5.67 ,$6.11 ,$5.32 , N/A ,$8.73 , N/A , N/A , N/A ,$7.42 , N/A ,$8.03 ,$6.11 ,$4.43 ,$5.31 ,$5.32 ,$5.31 ,$6.03 ,$7.86 ,$5.96 , N/A ,$6.90 , N/A ,$5.15 ,$5.15 , N/A ,$5.15 ,$6.29 ,$5.41 ,$6.29 ,$6.29 ,$6.98 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SUCRALFATE 1 G TABS,637,1 ,$18.35 ,$12.11 ,$9.31 ,$18.35 , N/A ,$12.58 ,$12.58 , N/A ,$11.01 ,$15.60 ,$12.85 , N/A , N/A ,$17.43 ,$13.95 ,$13.76 ,$11.93 ,$15.60 , N/A ,$11.93 ,$11.93 ,$12.85 ,$11.18 , N/A ,$18.35 , N/A , N/A , N/A ,$15.60 , N/A ,$16.88 ,$12.85 ,$9.31 ,$11.17 ,$11.18 ,$11.17 ,$12.68 ,$16.52 ,$12.54 , N/A ,$14.50 , N/A ,$10.83 ,$10.83 , N/A ,$10.83 ,$13.21 ,$11.38 ,$13.21 ,$13.21 ,$14.68 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SUCRALFATE 1 GM/10ML SUSP,637,1 ,$37.10 ,$24.49 ,$18.82 ,$37.10 , N/A ,$25.43 ,$25.43 , N/A ,$22.26 ,$31.54 ,$25.97 , N/A , N/A ,$35.25 ,$28.20 ,$27.83 ,$24.12 ,$31.54 , N/A ,$24.12 ,$24.12 ,$25.97 ,$22.59 , N/A ,$37.10 , N/A , N/A , N/A ,$31.54 , N/A ,$34.13 ,$25.97 ,$18.82 ,$22.58 ,$22.59 ,$22.58 ,$25.64 ,$33.39 ,$25.35 , N/A ,$29.31 , N/A ,$21.89 ,$21.89 , N/A ,$21.89 ,$26.71 ,$23.00 ,$26.71 ,$26.71 ,$29.68 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SUMATRIPTAN 50 MG TABS,637,1 ,$85.50 ,$56.43 ,$43.37 ,$85.50 , N/A ,$58.60 ,$58.60 , N/A ,$51.30 ,$72.68 ,$59.85 , N/A , N/A ,$81.23 ,$64.98 ,$64.13 ,$55.58 ,$72.68 , N/A ,$55.58 ,$55.58 ,$59.85 ,$52.07 , N/A ,$85.50 , N/A , N/A , N/A ,$72.68 , N/A ,$78.66 ,$59.85 ,$43.37 ,$52.04 ,$52.07 ,$52.04 ,$59.08 ,$76.95 ,$58.41 , N/A ,$67.55 , N/A ,$50.45 ,$50.45 , N/A ,$50.45 ,$61.56 ,$53.01 ,$61.56 ,$61.56 ,$68.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SODIUM POLYSTYRENE 15 GM/60ML SUSP,637,1 ,$85.50 ,$56.43 ,$43.37 ,$85.50 , N/A ,$58.60 ,$58.60 , N/A ,$51.30 ,$72.68 ,$59.85 , N/A , N/A ,$81.23 ,$64.98 ,$64.13 ,$55.58 ,$72.68 , N/A ,$55.58 ,$55.58 ,$59.85 ,$52.07 , N/A ,$85.50 , N/A , N/A , N/A ,$72.68 , N/A ,$78.66 ,$59.85 ,$43.37 ,$52.04 ,$52.07 ,$52.04 ,$59.08 ,$76.95 ,$58.41 , N/A ,$67.55 , N/A ,$50.45 ,$50.45 , N/A ,$50.45 ,$61.56 ,$53.01 ,$61.56 ,$61.56 ,$68.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TAMSULOSIN 0.4 MG CAPS,637,1 ,$14.35 ,$9.47 ,$7.28 ,$14.35 , N/A ,$9.84 ,$9.84 , N/A ,$8.61 ,$12.20 ,$10.05 , N/A , N/A ,$13.63 ,$10.91 ,$10.76 ,$9.33 ,$12.20 , N/A ,$9.33 ,$9.33 ,$10.05 ,$8.74 , N/A ,$14.35 , N/A , N/A , N/A ,$12.20 , N/A ,$13.20 ,$10.05 ,$7.28 ,$8.73 ,$8.74 ,$8.73 ,$9.92 ,$12.92 ,$9.80 , N/A ,$11.34 , N/A ,$8.47 ,$8.47 , N/A ,$8.47 ,$10.33 ,$8.90 ,$10.33 ,$10.33 ,$11.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ALFUZOSIN ER 10 MG TB24,637,1 ,$14.35 ,$9.47 ,$7.28 ,$14.35 , N/A ,$9.84 ,$9.84 , N/A ,$8.61 ,$12.20 ,$10.05 , N/A , N/A ,$13.63 ,$10.91 ,$10.76 ,$9.33 ,$12.20 , N/A ,$9.33 ,$9.33 ,$10.05 ,$8.74 , N/A ,$14.35 , N/A , N/A , N/A ,$12.20 , N/A ,$13.20 ,$10.05 ,$7.28 ,$8.73 ,$8.74 ,$8.73 ,$9.92 ,$12.92 ,$9.80 , N/A ,$11.34 , N/A ,$8.47 ,$8.47 , N/A ,$8.47 ,$10.33 ,$8.90 ,$10.33 ,$10.33 ,$11.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TICAGRELOR 90 MG TABS,637,1 ,$28.95 ,$19.11 ,$14.68 ,$28.95 , N/A ,$19.84 ,$19.84 , N/A ,$17.37 ,$24.61 ,$20.27 , N/A , N/A ,$27.50 ,$22.00 ,$21.71 ,$18.82 ,$24.61 , N/A ,$18.82 ,$18.82 ,$20.27 ,$17.63 , N/A ,$28.95 , N/A , N/A , N/A ,$24.61 , N/A ,$26.63 ,$20.27 ,$14.68 ,$17.62 ,$17.63 ,$17.62 ,$20.00 ,$26.06 ,$19.78 , N/A ,$22.87 , N/A ,$17.08 ,$17.08 , N/A ,$17.08 ,$20.84 ,$17.95 ,$20.84 ,$20.84 ,$23.16 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TIMOLOL 0.25 % SOLN 5 ML BOTTLE,637,1 ,$51.00 ,$33.66 ,$25.87 ,$51.00 , N/A ,$34.96 ,$34.96 , N/A ,$30.60 ,$43.35 ,$35.70 , N/A , N/A ,$48.45 ,$38.76 ,$38.25 ,$33.15 ,$43.35 , N/A ,$33.15 ,$33.15 ,$35.70 ,$31.06 , N/A ,$51.00 , N/A , N/A , N/A ,$43.35 , N/A ,$46.92 ,$35.70 ,$25.87 ,$31.04 ,$31.06 ,$31.04 ,$35.24 ,$45.90 ,$34.84 , N/A ,$40.29 , N/A ,$30.09 ,$30.09 , N/A ,$30.09 ,$36.72 ,$31.62 ,$36.72 ,$36.72 ,$40.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TIMOLOL 0.5 % SOLN 15 ML BOTTLE,637,1 ,$165.75 ,$109.40 ,$84.07 ,$165.75 , N/A ,$113.61 ,$113.61 , N/A ,$99.45 ,$140.89 ,$116.03 , N/A , N/A ,$157.46 ,$125.97 ,$124.31 ,$107.74 ,$140.89 , N/A ,$107.74 ,$107.74 ,$116.03 ,$100.94 , N/A ,$165.75 , N/A , N/A , N/A ,$140.89 , N/A ,$152.49 ,$116.03 ,$84.07 ,$100.89 ,$100.94 ,$100.89 ,$114.53 ,$149.18 ,$113.24 , N/A ,$130.94 , N/A ,$97.79 ,$97.79 , N/A ,$97.79 ,$119.34 ,$102.77 ,$119.34 ,$119.34 ,$132.60 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TIMOLOL 0.5 % SOLN 5 ML BOTTLE,637,1 ,$57.80 ,$38.15 ,$29.32 ,$57.80 , N/A ,$39.62 ,$39.62 , N/A ,$34.68 ,$49.13 ,$40.46 , N/A , N/A ,$54.91 ,$43.93 ,$43.35 ,$37.57 ,$49.13 , N/A ,$37.57 ,$37.57 ,$40.46 ,$35.20 , N/A ,$57.80 , N/A , N/A , N/A ,$49.13 , N/A ,$53.18 ,$40.46 ,$29.32 ,$35.18 ,$35.20 ,$35.18 ,$39.94 ,$52.02 ,$39.49 , N/A ,$45.66 , N/A ,$34.10 ,$34.10 , N/A ,$34.10 ,$41.62 ,$35.84 ,$41.62 ,$41.62 ,$46.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TIOTROPIUM 2.5 MCG/ACT AERS 4 G INHALER,637,1 ,$61.20 ,$40.39 ,$31.04 ,$61.20 , N/A ,$41.95 ,$41.95 , N/A ,$36.72 ,$52.02 ,$42.84 , N/A , N/A ,$58.14 ,$46.51 ,$45.90 ,$39.78 ,$52.02 , N/A ,$39.78 ,$39.78 ,$42.84 ,$37.27 , N/A ,$61.20 , N/A , N/A , N/A ,$52.02 , N/A ,$56.30 ,$42.84 ,$31.04 ,$37.25 ,$37.27 ,$37.25 ,$42.29 ,$55.08 ,$41.81 , N/A ,$48.35 , N/A ,$36.11 ,$36.11 , N/A ,$36.11 ,$44.06 ,$37.94 ,$44.06 ,$44.06 ,$48.96 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TOBRAMYCIN 0.3 % SOLN 5 ML BOTTLE,637,1 ,$49.55 ,$32.70 ,$25.13 ,$49.55 , N/A ,$33.96 ,$33.96 , N/A ,$29.73 ,$42.12 ,$34.69 , N/A , N/A ,$47.07 ,$37.66 ,$37.16 ,$32.21 ,$42.12 , N/A ,$32.21 ,$32.21 ,$34.69 ,$30.18 , N/A ,$49.55 , N/A , N/A , N/A ,$42.12 , N/A ,$45.59 ,$34.69 ,$25.13 ,$30.16 ,$30.18 ,$30.16 ,$34.24 ,$44.60 ,$33.85 , N/A ,$39.14 , N/A ,$29.23 ,$29.23 , N/A ,$29.23 ,$35.68 ,$30.72 ,$35.68 ,$35.68 ,$39.64 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TOLVAPTAN 15 MG TABS,637,1 ,"$1,810.30 ","$1,194.80 ",$918.18 ,"$1,810.30 ", N/A ,"$1,240.78 ","$1,240.78 ", N/A ,"$1,086.18 ","$1,538.76 ","$1,267.21 ", N/A , N/A ,"$1,719.79 ","$1,375.83 ","$1,357.73 ","$1,176.70 ","$1,538.76 ", N/A ,"$1,176.70 ","$1,176.70 ","$1,267.21 ","$1,102.47 ", N/A ,"$1,810.30 ", N/A , N/A , N/A ,"$1,538.76 ", N/A ,"$1,665.48 ","$1,267.21 ",$918.18 ,"$1,101.93 ","$1,102.47 ","$1,101.93 ","$1,250.92 ","$1,629.27 ","$1,236.80 ", N/A ,"$1,430.14 ", N/A ,"$1,068.08 ","$1,068.08 ", N/A ,"$1,068.08 ","$1,303.42 ","$1,122.39 ","$1,303.42 ","$1,303.42 ","$1,448.24 "
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TOPIRAMATE 100 MG TABS,637,1 ,$23.68 ,$15.63 ,$12.01 ,$23.68 , N/A ,$16.23 ,$16.23 , N/A ,$14.21 ,$20.13 ,$16.58 , N/A , N/A ,$22.50 ,$18.00 ,$17.76 ,$15.39 ,$20.13 , N/A ,$15.39 ,$15.39 ,$16.58 ,$14.42 , N/A ,$23.68 , N/A , N/A , N/A ,$20.13 , N/A ,$21.79 ,$16.58 ,$12.01 ,$14.41 ,$14.42 ,$14.41 ,$16.36 ,$21.31 ,$16.18 , N/A ,$18.71 , N/A ,$13.97 ,$13.97 , N/A ,$13.97 ,$17.05 ,$14.68 ,$17.05 ,$17.05 ,$18.94 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TRANEXAMIC ACID 1000 MG/10ML SOLN,637,1 ,$204.00 ,$134.64 ,$103.47 ,$204.00 , N/A ,$139.82 ,$139.82 , N/A ,$122.40 ,$173.40 ,$142.80 , N/A , N/A ,$193.80 ,$155.04 ,$153.00 ,$132.60 ,$173.40 , N/A ,$132.60 ,$132.60 ,$142.80 ,$124.24 , N/A ,$204.00 , N/A , N/A , N/A ,$173.40 , N/A ,$187.68 ,$142.80 ,$103.47 ,$124.17 ,$124.24 ,$124.17 ,$140.96 ,$183.60 ,$139.37 , N/A ,$161.16 , N/A ,$120.36 ,$120.36 , N/A ,$120.36 ,$146.88 ,$126.48 ,$146.88 ,$146.88 ,$163.20 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TRIAMCINOLONE 0.1 % CREA 15 G TUBE,637,1 ,$18.75 ,$12.38 ,$9.51 ,$18.75 , N/A ,$12.85 ,$12.85 , N/A ,$11.25 ,$15.94 ,$13.13 , N/A , N/A ,$17.81 ,$14.25 ,$14.06 ,$12.19 ,$15.94 , N/A ,$12.19 ,$12.19 ,$13.13 ,$11.42 , N/A ,$18.75 , N/A , N/A , N/A ,$15.94 , N/A ,$17.25 ,$13.13 ,$9.51 ,$11.41 ,$11.42 ,$11.41 ,$12.96 ,$16.88 ,$12.81 , N/A ,$14.81 , N/A ,$11.06 ,$11.06 , N/A ,$11.06 ,$13.50 ,$11.63 ,$13.50 ,$13.50 ,$15.00 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MONTELUKAST 10 MG TABS,637,1 ,$18.75 ,$12.38 ,$9.51 ,$18.75 , N/A ,$12.85 ,$12.85 , N/A ,$11.25 ,$15.94 ,$13.13 , N/A , N/A ,$17.81 ,$14.25 ,$14.06 ,$12.19 ,$15.94 , N/A ,$12.19 ,$12.19 ,$13.13 ,$11.42 , N/A ,$18.75 , N/A , N/A , N/A ,$15.94 , N/A ,$17.25 ,$13.13 ,$9.51 ,$11.41 ,$11.42 ,$11.41 ,$12.96 ,$16.88 ,$12.81 , N/A ,$14.81 , N/A ,$11.06 ,$11.06 , N/A ,$11.06 ,$13.50 ,$11.63 ,$13.50 ,$13.50 ,$15.00 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TRIFLURIDINE 1 % SOLN 7.5 ML BOTTLE,637,1 ,$758.00 ,$500.28 ,$384.46 ,$758.00 , N/A ,$519.53 ,$519.53 , N/A ,$454.80 ,$644.30 ,$530.60 , N/A , N/A ,$720.10 ,$576.08 ,$568.50 ,$492.70 ,$644.30 , N/A ,$492.70 ,$492.70 ,$530.60 ,$461.62 , N/A ,$758.00 , N/A , N/A , N/A ,$644.30 , N/A ,$697.36 ,$530.60 ,$384.46 ,$461.39 ,$461.62 ,$461.39 ,$523.78 ,$682.20 ,$517.87 , N/A ,$598.82 , N/A ,$447.22 ,$447.22 , N/A ,$447.22 ,$545.76 ,$469.96 ,$545.76 ,$545.76 ,$606.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TRIMETHOPRIM-POLYMYXIN B 10000-0.1 UNIT/ML-% SOLN 10 ML BOTTLE,637,1 ,$59.25 ,$39.11 ,$30.05 ,$59.25 , N/A ,$40.61 ,$40.61 , N/A ,$35.55 ,$50.36 ,$41.48 , N/A , N/A ,$56.29 ,$45.03 ,$44.44 ,$38.51 ,$50.36 , N/A ,$38.51 ,$38.51 ,$41.48 ,$36.08 , N/A ,$59.25 , N/A , N/A , N/A ,$50.36 , N/A ,$54.51 ,$41.48 ,$30.05 ,$36.07 ,$36.08 ,$36.07 ,$40.94 ,$53.33 ,$40.48 , N/A ,$46.81 , N/A ,$34.96 ,$34.96 , N/A ,$34.96 ,$42.66 ,$36.74 ,$42.66 ,$42.66 ,$47.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,UREA 10% 10 % CREA 85 G TUBE,637,1 ,$49.75 ,$32.84 ,$25.23 ,$49.75 , N/A ,$34.10 ,$34.10 , N/A ,$29.85 ,$42.29 ,$34.83 , N/A , N/A ,$47.26 ,$37.81 ,$37.31 ,$32.34 ,$42.29 , N/A ,$32.34 ,$32.34 ,$34.83 ,$30.30 , N/A ,$49.75 , N/A , N/A , N/A ,$42.29 , N/A ,$45.77 ,$34.83 ,$25.23 ,$30.28 ,$30.30 ,$30.28 ,$34.38 ,$44.78 ,$33.99 , N/A ,$39.30 , N/A ,$29.35 ,$29.35 , N/A ,$29.35 ,$35.82 ,$30.85 ,$35.82 ,$35.82 ,$39.80 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,UREA 20 % CREA 85 G TUBE,637,1 ,$49.45 ,$32.64 ,$25.08 ,$49.45 , N/A ,$33.89 ,$33.89 , N/A ,$29.67 ,$42.03 ,$34.62 , N/A , N/A ,$46.98 ,$37.58 ,$37.09 ,$32.14 ,$42.03 , N/A ,$32.14 ,$32.14 ,$34.62 ,$30.12 , N/A ,$49.45 , N/A , N/A , N/A ,$42.03 , N/A ,$45.49 ,$34.62 ,$25.08 ,$30.10 ,$30.12 ,$30.10 ,$34.17 ,$44.51 ,$33.78 , N/A ,$39.07 , N/A ,$29.18 ,$29.18 , N/A ,$29.18 ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VALACYCLOVIR 500 MG TABS,637,1 ,$54.38 ,$35.89 ,$27.58 ,$54.38 , N/A ,$37.27 ,$37.27 , N/A ,$32.63 ,$46.22 ,$38.07 , N/A , N/A ,$51.66 ,$41.33 ,$40.79 ,$35.35 ,$46.22 , N/A ,$35.35 ,$35.35 ,$38.07 ,$33.12 , N/A ,$54.38 , N/A , N/A , N/A ,$46.22 , N/A ,$50.03 ,$38.07 ,$27.58 ,$33.10 ,$33.12 ,$33.10 ,$37.58 ,$48.94 ,$37.15 , N/A ,$42.96 , N/A ,$32.08 ,$32.08 , N/A ,$32.08 ,$39.15 ,$33.72 ,$39.15 ,$39.15 ,$43.50 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VANCOMYCIN 125 MG CAPS,637,1 ,$106.45 ,$70.26 ,$53.99 ,$106.45 , N/A ,$72.96 ,$72.96 , N/A ,$63.87 ,$90.48 ,$74.52 , N/A , N/A ,$101.13 ,$80.90 ,$79.84 ,$69.19 ,$90.48 , N/A ,$69.19 ,$69.19 ,$74.52 ,$64.83 , N/A ,$106.45 , N/A , N/A , N/A ,$90.48 , N/A ,$97.93 ,$74.52 ,$53.99 ,$64.80 ,$64.83 ,$64.80 ,$73.56 ,$95.81 ,$72.73 , N/A ,$84.10 , N/A ,$62.81 ,$62.81 , N/A ,$62.81 ,$76.64 ,$66.00 ,$76.64 ,$76.64 ,$85.16 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VANCOMYCIN 50 MG/ML SOLN,637,1 ,$24.65 ,$16.27 ,$12.50 ,$24.65 , N/A ,$16.90 ,$16.90 , N/A ,$14.79 ,$20.95 ,$17.26 , N/A , N/A ,$23.42 ,$18.73 ,$18.49 ,$16.02 ,$20.95 , N/A ,$16.02 ,$16.02 ,$17.26 ,$15.01 , N/A ,$24.65 , N/A , N/A , N/A ,$20.95 , N/A ,$22.68 ,$17.26 ,$12.50 ,$15.00 ,$15.01 ,$15.00 ,$17.03 ,$22.19 ,$16.84 , N/A ,$19.47 , N/A ,$14.54 ,$14.54 , N/A ,$14.54 ,$17.75 ,$15.28 ,$17.75 ,$17.75 ,$19.72 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VARENICLINE 0.5 MG TABS,637,1 ,$31.55 ,$20.82 ,$16.00 ,$31.55 , N/A ,$21.62 ,$21.62 , N/A ,$18.93 ,$26.82 ,$22.09 , N/A , N/A ,$29.97 ,$23.98 ,$23.66 ,$20.51 ,$26.82 , N/A ,$20.51 ,$20.51 ,$22.09 ,$19.21 , N/A ,$31.55 , N/A , N/A , N/A ,$26.82 , N/A ,$29.03 ,$22.09 ,$16.00 ,$19.20 ,$19.21 ,$19.20 ,$21.80 ,$28.40 ,$21.56 , N/A ,$24.92 , N/A ,$18.61 ,$18.61 , N/A ,$18.61 ,$22.72 ,$19.56 ,$22.72 ,$22.72 ,$25.24 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VENLAFAXINE XR 37.5 MG CP24,637,1 ,$14.20 ,$9.37 ,$7.20 ,$14.20 , N/A ,$9.73 ,$9.73 , N/A ,$8.52 ,$12.07 ,$9.94 , N/A , N/A ,$13.49 ,$10.79 ,$10.65 ,$9.23 ,$12.07 , N/A ,$9.23 ,$9.23 ,$9.94 ,$8.65 , N/A ,$14.20 , N/A , N/A , N/A ,$12.07 , N/A ,$13.06 ,$9.94 ,$7.20 ,$8.64 ,$8.65 ,$8.64 ,$9.81 ,$12.78 ,$9.70 , N/A ,$11.22 , N/A ,$8.38 ,$8.38 , N/A ,$8.38 ,$10.22 ,$8.80 ,$10.22 ,$10.22 ,$11.36 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VENLAFAXINE XR 75 MG CP24,637,1 ,$14.30 ,$9.44 ,$7.25 ,$14.30 , N/A ,$9.80 ,$9.80 , N/A ,$8.58 ,$12.16 ,$10.01 , N/A , N/A ,$13.59 ,$10.87 ,$10.73 ,$9.30 ,$12.16 , N/A ,$9.30 ,$9.30 ,$10.01 ,$8.71 , N/A ,$14.30 , N/A , N/A , N/A ,$12.16 , N/A ,$13.16 ,$10.01 ,$7.25 ,$8.70 ,$8.71 ,$8.70 ,$9.88 ,$12.87 ,$9.77 , N/A ,$11.30 , N/A ,$8.44 ,$8.44 , N/A ,$8.44 ,$10.30 ,$8.87 ,$10.30 ,$10.30 ,$11.44 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VILAZODONE 40 MG TABS,637,1 ,$42.90 ,$28.31 ,$21.76 ,$42.90 , N/A ,$29.40 ,$29.40 , N/A ,$25.74 ,$36.47 ,$30.03 , N/A , N/A ,$40.76 ,$32.60 ,$32.18 ,$27.89 ,$36.47 , N/A ,$27.89 ,$27.89 ,$30.03 ,$26.13 , N/A ,$42.90 , N/A , N/A , N/A ,$36.47 , N/A ,$39.47 ,$30.03 ,$21.76 ,$26.11 ,$26.13 ,$26.11 ,$29.64 ,$38.61 ,$29.31 , N/A ,$33.89 , N/A ,$25.31 ,$25.31 , N/A ,$25.31 ,$30.89 ,$26.60 ,$30.89 ,$30.89 ,$34.32 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ZINC OXIDE 20 % OINT 28.4 G TUBE,637,1 ,$13.10 ,$8.65 ,$6.64 ,$13.10 , N/A ,$8.98 ,$8.98 , N/A ,$7.86 ,$11.14 ,$9.17 , N/A , N/A ,$12.45 ,$9.96 ,$9.83 ,$8.52 ,$11.14 , N/A ,$8.52 ,$8.52 ,$9.17 ,$7.98 , N/A ,$13.10 , N/A , N/A , N/A ,$11.14 , N/A ,$12.05 ,$9.17 ,$6.64 ,$7.97 ,$7.98 ,$7.97 ,$9.05 ,$11.79 ,$8.95 , N/A ,$10.35 , N/A ,$7.73 ,$7.73 , N/A ,$7.73 ,$9.43 ,$8.12 ,$9.43 ,$9.43 ,$10.48 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ZIPRASIDONE 20 MG CAPS,637,1 ,$30.48 ,$20.12 ,$15.46 ,$30.48 , N/A ,$20.89 ,$20.89 , N/A ,$18.29 ,$25.91 ,$21.34 , N/A , N/A ,$28.96 ,$23.16 ,$22.86 ,$19.81 ,$25.91 , N/A ,$19.81 ,$19.81 ,$21.34 ,$18.56 , N/A ,$30.48 , N/A , N/A , N/A ,$25.91 , N/A ,$28.04 ,$21.34 ,$15.46 ,$18.55 ,$18.56 ,$18.55 ,$21.06 ,$27.43 ,$20.82 , N/A ,$24.08 , N/A ,$17.98 ,$17.98 , N/A ,$17.98 ,$21.95 ,$18.90 ,$21.95 ,$21.95 ,$24.38 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ZONISAMIDE 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MORPHINE 15 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MORPHINE CR 15 MG TBCR,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MULTI VITAMIN/MINERALS TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MULTIPLE VITAMINS-MINERALS CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NAPROXEN 250 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 5-400-5000 OINT 1 EACH BOX,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NICOTINE 14 MG/24HR PT24,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NICOTINE 7 MG/24HR PT24,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NIFEDIPINE 10 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NIFEDIPINE ER 30 MG TB24,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NITROFURANTOIN 50 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NITROGLYCERIN 0.1 MG/HR PT24,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NITROGLYCERIN 0.4 MG SUBL,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NITROGLYCERIN 2 % OINT,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NORTRIPTYLINE 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,NYSTATIN 100000 UNIT/ML SUSP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OPIUM 10 MG/ML TINC,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYBUTYNIN 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYCODONE IMMEDIATE RELEASE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYCODONE-ACETAMINOPHEN 5-325 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYMETAZOLINE 0.05 % SOLN 15 ML BOTTLE,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OXYMETAZOLINE 0.05 % SOLN 30 ML BOTTLE,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,OYSTER SHELL CALCIUM 500 MG (ELEMENTAL) 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PANCRELIPASE (LIP-PROT-AMYL) 5000-24000 UNITS CPEP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PANTOPRAZOLE EC 40 MG TBEC,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PAROXETINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PERPHENAZINE 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PHENOBARBITAL 30 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PHENYTOIN 50 MG CHEW,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PHENYTOIN ER 100 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,POLYCARBOPHIL 625 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,POTASSIUM  AND  SODIUM PHOSPHATES 280-160-250 MG PACK,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,POTASSIUM BICARBONATE-CITRIC ACID 20 MEQ TBEF,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,POTASSIUM CHLORIDE CR 10 MEQ TBCR,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,POTASSIUM CHLORIDE CR 20 MEQ TBCR,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PRAZOSIN 1 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PRENATAL 28-0.8 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PRIMIDONE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PROCHLORPERAZINE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PROMETHAZINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PROMETHAZINE-CODEINE 6.25-10 MG/5ML SOLN,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PROPAFENONE 150 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PROPRANOLOL 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PSEUDOEPHEDRINE 30 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PSEUDOEPHEDRINE ER 120 MG TB12,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PSYLLIUM 58.12 % PACK,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,PYRIDOSTIGMINE 60 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,RIFAMPIN 300 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAMINOPHEN 120 MG SUPP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAMINOPHEN 160 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAMINOPHEN 325 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAMINOPHEN 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,"ACETAMINOPHEN 500 MG TABS 1,000 EACH BOTTLE",637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAMINOPHEN 500 MG TABS 100 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAMINOPHEN 650 MG SUPP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAMINOPHEN-CODEINE 120-12 MG/5ML SOLN,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACETAMINOPHEN-CODEINE 300-30 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACYCLOVIR 200 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ACYCLOVIR 400 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ALLOPURINOL 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ALLOPURINOL 300 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ALPRAZOLAM 0.25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ALPRAZOLAM 0.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ALUMINUM HYDROXIDE-MAGNESIUM CARBONATE 95-358 MG/15ML SUSP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMILORIDE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMIODARONE 200 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMITRIPTYLINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMITRIPTYLINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMITRIPTYLINE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMLODIPINE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMLODIPINE 5 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMOXICILLIN 250 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMOXICILLIN 250 MG/5ML SUSR,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMOXICILLIN 500 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMOXICILLIN 875 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,AMOXICILLIN-CLAVULANATE 250-62.5 MG/5ML SUSR,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ANALGESIC OINT 28 G TUBE,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ASPIRIN 300 MG SUPP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ASPIRIN 325 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ASPIRIN 81 MG CHEW,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ASPIRIN EC 81 MG TBEC,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ASPIRIN-ACETAMINOPHEN-CAFFEINE 250-250-65 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ATENOLOL 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ATENOLOL 50 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ATORVASTATIN 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ATORVASTATIN 40 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,B COMPLEX-C-FOLIC ACID 0.8 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BACITRACIN 500 UNIT/GM OINT 28.35 G TUBE,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OINT 1 EACH PACKET,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,"BENADRYL,MAALOX,LIDOCAINE 0.68%,SIMETHICONE SUSP",637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BENZTROPINE 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BISACODYL 10 MG SUPP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BISACODYL EC 5 MG TBEC,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BISMUTH SUBSALICYLATE 262 MG/15ML SUSP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BISMUTH SUBSALICYLATE 525 MG/15ML SUSP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUDESONIDE EC 3 MG CPEP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUMETANIDE 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUPROPION 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUPROPION 75 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUPROPION SR 100 MG TB12,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUPROPION SR 150 MG TB12,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUSPIRONE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50-325-40 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CAFFEINE 200 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CALCITRIOL 0.25 MCG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CALCITRIOL 0.5 MCG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CALCIUM ACETATE (PHOS BINDER) 667 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CALCIUM CARBONATE 500 MG CHEW,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CALCIUM CARBONATE-VITAMIN D 600-400 MG-UNIT TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CALCIUM CITRATE-VITAMIN D 315 MG-250 UNIT 315-250 MG-UNIT TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CAPTOPRIL 12.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARBAMAZEPINE 200 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARBIDOPA-LEVODOPA 10-100 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARBIDOPA-LEVODOPA 25-100 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARBIDOPA-LEVODOPA 25-250 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARBIDOPA-LEVODOPA CR 50-200 MG TBCR,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARBOXYMETHYLCELLULOSE PF 1 % GEL,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARISOPRODOL 350 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARVEDILOL 12.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARVEDILOL 3.125 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CARVEDILOL 6.25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CEPHALEXIN 250 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CEPHALEXIN 250 MG/5ML SUSR,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CHLORDIAZEPOXIDE 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CHLORDIAZEPOXIDE 5 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CHLORTHALIDONE 25 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CILOSTAZOL 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLINDAMYCIN 150 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLINDAMYCIN 75 MG/5ML SOLR,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLONAZEPAM 0.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLONAZEPAM 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CLONIDINE 0.1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CODEINE 30 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,COLESTIPOL 1 G TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,CYCLOBENZAPRINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DANTROLENE 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIAZEPAM 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIAZEPAM 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DICYCLOMINE 10 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIGOXIN 0.125 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DILTIAZEM 30 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DILTIAZEM 60 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DILTIAZEM CD 120 MG CP24 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DILTIAZEM CD 180 MG CP24 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIPHENHYDRAMINE 12.5 MG/5ML LIQD,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIPHENHYDRAMINE 25 MG CAPS 100 EACH BOX,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIPHENOXYLATE-ATROPINE 2.5-0.025 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIVALPROEX DR SPRINKLE 125 MG CSDR,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DIVALPROEX EC 125 MG TBEC,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DOCUSATE 50 MG/5ML LIQD,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DOCUSATE SODIUM 100 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DONEPEZIL 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DOXAZOSIN 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DOXAZOSIN 4 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DOXEPIN 10 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DOXEPIN 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DRONABINOL 2.5 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,DRY MOUTH LIQD 237 ML BOTTLE,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ESTRADIOL 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FAMOTIDINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FAMOTIDINE 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FENOFIBRATE 48 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FERROUS GLUCONATE 324 (37.5 FE) MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FERROUS SULFATE (65 MG ELEMENTAL) 325 (65 FE) MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FISH OIL 1000 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLECAINIDE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FLUDROCORTISONE 0.1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FOLIC ACID 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FUROSEMIDE 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,FUROSEMIDE 40 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GABAPENTIN 100 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GABAPENTIN 300 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GABAPENTIN 400 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GEMFIBROZIL 600 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GLIMEPIRIDE 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GLIPIZIDE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GLUCOSE CHEWABLE 4 GM CHEW,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GLYCERIN (ADULT) 2 G SUPP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GLYCERIN (PEDS/INFANT) 1 G SUPP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GLYCOPYRROLATE 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GUAIFENESIN 100 MG/5ML SOLN,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GUAIFENESIN ER 600 MG TB12,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,GUAIFENESIN-CODEINE 100-10 MG/5ML SOLN,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HALOPERIDOL 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HALOPERIDOL 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDRALAZINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDRALAZINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCHLOROTHIAZIDE 12.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCHLOROTHIAZIDE 25 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCHLOROTHIAZIDE 25 MG TABS 100 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCODONE-ACETAMINOPHEN 10-325 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCODONE-ACETAMINOPHEN 5-325 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCODONE-ACETAMINOPHEN 7.5-325 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROCORTISONE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROMORPHONE 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROXYUREA 500 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROXYZINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYDROXYZINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,HYOSCYAMINE 0.125 MG SUBL,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,IBUPROFEN 100 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,IBUPROFEN 200 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,IMIPRAMINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ISOSORBIDE DINITRATE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,KETOROLAC 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LABETALOL 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LACTASE 3000 UNITS TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LACTOBACILLUS CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LACTULOSE 10 GM/15ML SOLN 30 ML CUP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LAMOTRIGINE 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LAMOTRIGINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LANOLIN CREA 9 ML BOX,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEUCOVORIN 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVETIRACETAM 250 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ROPINIROLE 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SACCHAROMYCES BOULARDII 250 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SALINE (FLEET) PEDIATRIC 3.5-9.5 GM/59ML ENEM,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SALINE ENEMA ADULT 7-19 GM/118ML ENEM,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SENNA 8.6 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SENNA-DOCUSATE 8.6-50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SERTRALINE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SIMETHICONE 80 MG CHEW,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SODIUM BICARBONATE 650 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SODIUM CHLORIDE 0.65 % SOLN 44 ML BOTTLE,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SODIUM CHLORIDE 1 GM TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SPIRONOLACTONE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SUCROSE 24 % SUSP,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,SULFASALAZINE 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TAMOXIFEN 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TERAZOSIN 1 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TERAZOSIN 5 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TETRACAINE HCL POWD,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TIZANIDINE 4 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TOPIRAMATE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TORSEMIDE 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TRAMADOL 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TRAZODONE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,TRIAMTERENE-HYDROCHLOROTHIAZIDE 37.5-25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,URSODIOL 300 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VENLAFAXINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VENLAFAXINE 75 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VERAPAMIL 80 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VERAPAMIL ER 120 MG CP24,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VITAMIN B-1 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VITAMIN B-12 250 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VITAMIN B-6 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VITAMIN C 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VITAMIN D3 (CHOLECALCIFEROL) 10 MCG (400 UNIT) TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,VITAMIN D3 (CHOLECALCIFEROL) 1000 UNIT TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,WARFARIN 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,WARFARIN 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,WARFARIN 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,WARFARIN 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ZINC SULFATE 220 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ZOLPIDEM 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,ZONISAMIDE 100 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVOTHYROXINE 100 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVOTHYROXINE 112 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVOTHYROXINE 125 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVOTHYROXINE 25 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVOTHYROXINE 50 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LEVOTHYROXINE 88 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LIOTHYRONINE 5 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LISINOPRIL 10 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LISINOPRIL 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LISINOPRIL 20 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LISINOPRIL 20 MG TABS 100 EACH BOX,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LISINOPRIL 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LITHIUM 150 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LOPERAMIDE 2 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LORAZEPAM 0.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LORAZEPAM 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LOSARTAN 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LOSARTAN 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LOSARTAN 50 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,LOSARTAN 50 MG TABS 90 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MAGNESIUM CHLORIDE EC 64 MG TBEC,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MAGNESIUM OXIDE 400 (240 MG) MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MAGNESIUM OXIDE 400 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MECLIZINE 12.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MEDROXYPROGESTERONE 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MELATONIN 3 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MELATONIN 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MEMANTINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MEMANTINE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METFORMIN 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METFORMIN 850 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METHADONE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METHADONE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METHADONE 5 MG/5ML SOLN,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METHENAMINE 1 G TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METHIMAZOLE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METHYLDOPA 250 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METHYLPHENIDATE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METOCLOPRAMIDE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METOCLOPRAMIDE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METOLAZONE 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METOPROLOL SUCCINATE ER 100 MG TB24,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METOPROLOL SUCCINATE ER 25 MG TB24,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METOPROLOL SUCCINATE ER 50 MG TB24,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METOPROLOL TARTRATE 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METOPROLOL TARTRATE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METOPROLOL TARTRATE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METRONIDAZOLE 250 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,METRONIDAZOLE 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MINOCYCLINE 50 MG CAPS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MINOXIDIL 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MINOXIDIL 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MIRTAZAPINE 15 MG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MISOPROSTOL 100 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,63700001,N/A,MISOPROSTOL 200 MCG TABS,637,1 ,$8.00 ,$5.28 ,$4.06 ,$8.00 , N/A ,$5.48 ,$5.48 , N/A ,$4.80 ,$6.80 ,$5.60 , N/A , N/A ,$7.60 ,$6.08 ,$6.00 ,$5.20 ,$6.80 , N/A ,$5.20 ,$5.20 ,$5.60 ,$4.87 , N/A ,$8.00 , N/A , N/A , N/A ,$6.80 , N/A ,$7.36 ,$5.60 ,$4.06 ,$4.87 ,$4.87 ,$4.87 ,$5.53 ,$7.20 ,$5.47 , N/A ,$6.32 , N/A ,$4.72 ,$4.72 , N/A ,$4.72 ,$5.76 ,$4.96 ,$5.76 ,$5.76 ,$6.40 
ST NICHOLAS HOSPITAL - ACUTE,68200002,N/A,HC LEVEL 2 TRAUMA ACTIVATION <30 MINS,682,1 ,"$3,864.00 ","$2,550.24 ","$1,959.82 ","$3,864.00 ", N/A ,"$2,648.39 ","$2,648.39 ", N/A ,"$2,318.40 ","$3,284.40 ","$2,704.80 ", N/A , N/A ,"$3,670.80 ","$2,936.64 ","$2,898.00 ","$2,511.60 ","$3,284.40 ", N/A ,"$2,511.60 ","$2,511.60 ","$2,704.80 ","$2,353.18 ", N/A , N/A , N/A , N/A , N/A ,"$3,284.40 ", N/A ,"$3,554.88 ","$2,704.80 ","$1,959.82 ","$2,352.02 ","$2,353.18 ","$2,352.02 ","$2,670.02 ","$3,477.60 ","$2,639.88 ", N/A ,"$3,052.56 ", N/A ,"$2,279.76 ","$2,279.76 ", N/A ,"$2,279.76 ","$2,782.08 ","$2,395.68 ","$2,782.08 ","$2,782.08 ","$3,091.20 "
ST NICHOLAS HOSPITAL - ACUTE,68400002,G0390,HC LEVEL 2 TRAUMA  ACTIVATION,684,1 ,"$3,348.80 ","$2,210.21 ",$4.33 ,"$3,348.80 ",$4.33 ,"$2,295.27 ","$2,295.27 ", N/A ,"$2,009.28 ","$2,846.48 ","$2,344.16 ",$4.33 ,$4.33 ,"$3,181.36 ","$2,545.09 ","$2,511.60 ","$2,176.72 ","$2,846.48 ", N/A ,"$2,176.72 ","$2,176.72 ","$2,344.16 ","$2,039.42 ",$4.33 , N/A , N/A , N/A ,$4.59 ,"$2,846.48 ", N/A ,"$3,080.90 ","$2,344.16 ","$1,698.51 ","$2,038.41 ","$2,039.42 ","$2,038.41 ","$2,314.02 ","$3,013.92 ","$2,287.90 ", N/A ,"$2,645.55 ",$4.59 ,"$1,975.79 ","$1,975.79 ", N/A ,"$1,975.79 ","$2,411.14 ","$2,076.26 ","$2,411.14 ","$2,411.14 ","$2,679.04 "
ST NICHOLAS HOSPITAL - ACUTE,71000002,N/A,HC RECOVERY CLASS 2 PER 15 MINS,710,1 ,$584.85 ,$386.00 ,$296.64 ,$584.85 , N/A ,$400.86 ,$400.86 , N/A ,$350.91 ,$497.12 ,$409.40 , N/A , N/A ,$555.61 ,$444.49 ,$438.64 ,$380.15 ,$497.12 , N/A ,$380.15 ,$380.15 ,$409.40 ,$356.17 , N/A , N/A , N/A , N/A , N/A ,$497.12 , N/A ,$538.06 ,$409.40 ,$296.64 ,$356.00 ,$356.17 ,$356.00 ,$404.13 ,$526.37 ,$399.57 , N/A ,$462.03 , N/A ,$345.06 ,$345.06 , N/A ,$345.06 ,$421.09 ,$362.61 ,$421.09 ,$421.09 ,$467.88 
ST NICHOLAS HOSPITAL - ACUTE,71000003,N/A,HC RECOVERY CLASS 3 PER 15 MINS,710,1 ,$695.10 ,$458.77 ,$352.55 ,$695.10 , N/A ,$476.42 ,$476.42 , N/A ,$417.06 ,$590.84 ,$486.57 , N/A , N/A ,$660.35 ,$528.28 ,$521.33 ,$451.82 ,$590.84 , N/A ,$451.82 ,$451.82 ,$486.57 ,$423.32 , N/A , N/A , N/A , N/A , N/A ,$590.84 , N/A ,$639.49 ,$486.57 ,$352.55 ,$423.11 ,$423.32 ,$423.11 ,$480.31 ,$625.59 ,$474.89 , N/A ,$549.13 , N/A ,$410.11 ,$410.11 , N/A ,$410.11 ,$500.47 ,$430.96 ,$500.47 ,$500.47 ,$556.08 
ST NICHOLAS HOSPITAL - ACUTE,71000004,N/A,HC RECOVERY CLASS 4 PER 15 MINS,710,1 ,$815.85 ,$538.46 ,$413.80 ,$815.85 , N/A ,$559.18 ,$559.18 , N/A ,$489.51 ,$693.47 ,$571.10 , N/A , N/A ,$775.06 ,$620.05 ,$611.89 ,$530.30 ,$693.47 , N/A ,$530.30 ,$530.30 ,$571.10 ,$496.85 , N/A , N/A , N/A , N/A , N/A ,$693.47 , N/A ,$750.58 ,$571.10 ,$413.80 ,$496.61 ,$496.85 ,$496.61 ,$563.75 ,$734.27 ,$557.39 , N/A ,$644.52 , N/A ,$481.35 ,$481.35 , N/A ,$481.35 ,$587.41 ,$505.83 ,$587.41 ,$587.41 ,$652.68 
ST NICHOLAS HOSPITAL - ACUTE,71000005,N/A,HC RECOVERY PER HOUR-ICU PATIENT,710,1 ,"$2,337.30 ","$1,542.62 ","$1,185.48 ","$2,337.30 ", N/A ,"$1,601.99 ","$1,601.99 ", N/A ,"$1,402.38 ","$1,986.71 ","$1,636.11 ", N/A , N/A ,"$2,220.44 ","$1,776.35 ","$1,752.98 ","$1,519.25 ","$1,986.71 ", N/A ,"$1,519.25 ","$1,519.25 ","$1,636.11 ","$1,423.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,986.71 ", N/A ,"$2,150.32 ","$1,636.11 ","$1,185.48 ","$1,422.71 ","$1,423.42 ","$1,422.71 ","$1,615.07 ","$2,103.57 ","$1,596.84 ", N/A ,"$1,846.47 ", N/A ,"$1,379.01 ","$1,379.01 ", N/A ,"$1,379.01 ","$1,682.86 ","$1,449.13 ","$1,682.86 ","$1,682.86 ","$1,869.84 "
ST NICHOLAS HOSPITAL - ACUTE,71000006,N/A,HC SHORT STAY EXTENDED,710,1 ,"$1,212.75 ",$800.42 ,$615.11 ,"$1,212.75 ", N/A ,$831.22 ,$831.22 , N/A ,$727.65 ,"$1,030.84 ",$848.93 , N/A , N/A ,"$1,152.11 ",$921.69 ,$909.56 ,$788.29 ,"$1,030.84 ", N/A ,$788.29 ,$788.29 ,$848.93 ,$738.56 , N/A , N/A , N/A , N/A , N/A ,"$1,030.84 ", N/A ,"$1,115.73 ",$848.93 ,$615.11 ,$738.20 ,$738.56 ,$738.20 ,$838.01 ,"$1,091.48 ",$828.55 , N/A ,$958.07 , N/A ,$715.52 ,$715.52 , N/A ,$715.52 ,$873.18 ,$751.91 ,$873.18 ,$873.18 ,$970.20 
ST NICHOLAS HOSPITAL - ACUTE,71000009,N/A,HC GI RECOVERY PER HOUR,710,1 ,$823.62 ,$543.59 ,$417.74 ,$823.62 , N/A ,$564.51 ,$564.51 , N/A ,$494.17 ,$700.08 ,$576.53 , N/A , N/A ,$782.44 ,$625.95 ,$617.72 ,$535.35 ,$700.08 , N/A ,$535.35 ,$535.35 ,$576.53 ,$501.58 , N/A , N/A , N/A , N/A , N/A ,$700.08 , N/A ,$757.73 ,$576.53 ,$417.74 ,$501.34 ,$501.58 ,$501.34 ,$569.12 ,$741.26 ,$562.70 , N/A ,$650.66 , N/A ,$485.94 ,$485.94 , N/A ,$485.94 ,$593.01 ,$510.64 ,$593.01 ,$593.01 ,$658.90 
ST NICHOLAS HOSPITAL - ACUTE,71000013,N/A,HC RECOVERY PER HOUR-L AND D SURGICAL,710,1 ,$590.42 ,$389.68 ,$299.46 ,$590.42 , N/A ,$404.67 ,$404.67 , N/A ,$354.25 ,$501.86 ,$413.29 , N/A , N/A ,$560.90 ,$448.72 ,$442.82 ,$383.77 ,$501.86 , N/A ,$383.77 ,$383.77 ,$413.29 ,$359.57 , N/A , N/A , N/A , N/A , N/A ,$501.86 , N/A ,$543.19 ,$413.29 ,$299.46 ,$359.39 ,$359.57 ,$359.39 ,$407.98 ,$531.38 ,$403.37 , N/A ,$466.43 , N/A ,$348.35 ,$348.35 , N/A ,$348.35 ,$425.10 ,$366.06 ,$425.10 ,$425.10 ,$472.34 
ST NICHOLAS HOSPITAL - ACUTE,71000015,N/A,HC PHASE II RECOVERY 1 HOUR,710,1 ,$556.50 ,$367.29 ,$282.26 ,$556.50 , N/A ,$381.43 ,$381.43 , N/A ,$333.90 ,$473.03 ,$389.55 , N/A , N/A ,$528.68 ,$422.94 ,$417.38 ,$361.73 ,$473.03 , N/A ,$361.73 ,$361.73 ,$389.55 ,$338.91 , N/A , N/A , N/A , N/A , N/A ,$473.03 , N/A ,$511.98 ,$389.55 ,$282.26 ,$338.74 ,$338.91 ,$338.74 ,$384.54 ,$500.85 ,$380.20 , N/A ,$439.64 , N/A ,$328.34 ,$328.34 , N/A ,$328.34 ,$400.68 ,$345.03 ,$400.68 ,$400.68 ,$445.20 
ST NICHOLAS HOSPITAL - ACUTE,71000025,N/A,HC GI RECOVERY EA  ADDN'T HOUR,710,1 ,$111.30 ,$73.46 ,$56.45 ,$111.30 , N/A ,$76.29 ,$76.29 , N/A ,$66.78 ,$94.61 ,$77.91 , N/A , N/A ,$105.74 ,$84.59 ,$83.48 ,$72.35 ,$94.61 , N/A ,$72.35 ,$72.35 ,$77.91 ,$67.78 , N/A , N/A , N/A , N/A , N/A ,$94.61 , N/A ,$102.40 ,$77.91 ,$56.45 ,$67.75 ,$67.78 ,$67.75 ,$76.91 ,$100.17 ,$76.04 , N/A ,$87.93 , N/A ,$65.67 ,$65.67 , N/A ,$65.67 ,$80.14 ,$69.01 ,$80.14 ,$80.14 ,$89.04 
ST NICHOLAS HOSPITAL - ACUTE,71000100,N/A,HC SHORT STAY 1 HR SURGERY,710,1 ,"$1,224.30 ",$808.04 ,$620.97 ,"$1,224.30 ", N/A ,$839.14 ,$839.14 , N/A ,$734.58 ,"$1,040.66 ",$857.01 , N/A , N/A ,"$1,163.09 ",$930.47 ,$918.23 ,$795.80 ,"$1,040.66 ", N/A ,$795.80 ,$795.80 ,$857.01 ,$745.60 , N/A , N/A , N/A , N/A , N/A ,"$1,040.66 ", N/A ,"$1,126.36 ",$857.01 ,$620.97 ,$745.23 ,$745.60 ,$745.23 ,$845.99 ,"$1,101.87 ",$836.44 , N/A ,$967.20 , N/A ,$722.34 ,$722.34 , N/A ,$722.34 ,$881.50 ,$759.07 ,$881.50 ,$881.50 ,$979.44 
ST NICHOLAS HOSPITAL - ACUTE,71000101,N/A,HC SHORT STAY ADDN HR SURGERY,710,1 ,$467.46 ,$308.52 ,$237.10 ,$467.46 , N/A ,$320.40 ,$320.40 , N/A ,$280.48 ,$397.34 ,$327.22 , N/A , N/A ,$444.09 ,$355.27 ,$350.60 ,$303.85 ,$397.34 , N/A ,$303.85 ,$303.85 ,$327.22 ,$284.68 , N/A , N/A , N/A , N/A , N/A ,$397.34 , N/A ,$430.06 ,$327.22 ,$237.10 ,$284.54 ,$284.68 ,$284.54 ,$323.01 ,$420.71 ,$319.37 , N/A ,$369.29 , N/A ,$275.80 ,$275.80 , N/A ,$275.80 ,$336.57 ,$289.83 ,$336.57 ,$336.57 ,$373.97 
ST NICHOLAS HOSPITAL - ACUTE,71000102,N/A,HC SHORT STAY 5 > HR SURGERY,710,1 ,$467.46 ,$308.52 ,$237.10 ,$467.46 , N/A ,$320.40 ,$320.40 , N/A ,$280.48 ,$397.34 ,$327.22 , N/A , N/A ,$444.09 ,$355.27 ,$350.60 ,$303.85 ,$397.34 , N/A ,$303.85 ,$303.85 ,$327.22 ,$284.68 , N/A , N/A , N/A , N/A , N/A ,$397.34 , N/A ,$430.06 ,$327.22 ,$237.10 ,$284.54 ,$284.68 ,$284.54 ,$323.01 ,$420.71 ,$319.37 , N/A ,$369.29 , N/A ,$275.80 ,$275.80 , N/A ,$275.80 ,$336.57 ,$289.83 ,$336.57 ,$336.57 ,$373.97 
ST NICHOLAS HOSPITAL - ACUTE,71000200,N/A,HC RECOVERY CLASS 2 INIT,710,1 ,$701.72 ,$463.14 ,$355.91 ,$701.72 , N/A ,$480.96 ,$480.96 , N/A ,$421.03 ,$596.46 ,$491.20 , N/A , N/A ,$666.63 ,$533.31 ,$526.29 ,$456.12 ,$596.46 , N/A ,$456.12 ,$456.12 ,$491.20 ,$427.35 , N/A , N/A , N/A , N/A , N/A ,$596.46 , N/A ,$645.58 ,$491.20 ,$355.91 ,$427.14 ,$427.35 ,$427.14 ,$484.89 ,$631.55 ,$479.42 , N/A ,$554.36 , N/A ,$414.01 ,$414.01 , N/A ,$414.01 ,$505.24 ,$435.07 ,$505.24 ,$505.24 ,$561.38 
ST NICHOLAS HOSPITAL - ACUTE,71000201,N/A,HC RECOVERY CLASS 2 ADDL,710,1 ,$467.46 ,$308.52 ,$237.10 ,$467.46 , N/A ,$320.40 ,$320.40 , N/A ,$280.48 ,$397.34 ,$327.22 , N/A , N/A ,$444.09 ,$355.27 ,$350.60 ,$303.85 ,$397.34 , N/A ,$303.85 ,$303.85 ,$327.22 ,$284.68 , N/A , N/A , N/A , N/A , N/A ,$397.34 , N/A ,$430.06 ,$327.22 ,$237.10 ,$284.54 ,$284.68 ,$284.54 ,$323.01 ,$420.71 ,$319.37 , N/A ,$369.29 , N/A ,$275.80 ,$275.80 , N/A ,$275.80 ,$336.57 ,$289.83 ,$336.57 ,$336.57 ,$373.97 
ST NICHOLAS HOSPITAL - ACUTE,71000202,N/A,HC RECOVERY CLASS 3 INIT,710,1 ,$934.92 ,$617.05 ,$474.19 ,$934.92 , N/A ,$640.79 ,$640.79 , N/A ,$560.95 ,$794.68 ,$654.44 , N/A , N/A ,$888.17 ,$710.54 ,$701.19 ,$607.70 ,$794.68 , N/A ,$607.70 ,$607.70 ,$654.44 ,$569.37 , N/A , N/A , N/A , N/A , N/A ,$794.68 , N/A ,$860.13 ,$654.44 ,$474.19 ,$569.09 ,$569.37 ,$569.09 ,$646.03 ,$841.43 ,$638.74 , N/A ,$738.59 , N/A ,$551.60 ,$551.60 , N/A ,$551.60 ,$673.14 ,$579.65 ,$673.14 ,$673.14 ,$747.94 
ST NICHOLAS HOSPITAL - ACUTE,71000203,N/A,HC RECOVERY CLASS 3 ADDL,710,1 ,$467.46 ,$308.52 ,$237.10 ,$467.46 , N/A ,$320.40 ,$320.40 , N/A ,$280.48 ,$397.34 ,$327.22 , N/A , N/A ,$444.09 ,$355.27 ,$350.60 ,$303.85 ,$397.34 , N/A ,$303.85 ,$303.85 ,$327.22 ,$284.68 , N/A , N/A , N/A , N/A , N/A ,$397.34 , N/A ,$430.06 ,$327.22 ,$237.10 ,$284.54 ,$284.68 ,$284.54 ,$323.01 ,$420.71 ,$319.37 , N/A ,$369.29 , N/A ,$275.80 ,$275.80 , N/A ,$275.80 ,$336.57 ,$289.83 ,$336.57 ,$336.57 ,$373.97 
ST NICHOLAS HOSPITAL - ACUTE,71000204,N/A,HC RECOVERY CLASS 4 INIT,710,1 ,"$1,224.30 ",$808.04 ,$620.97 ,"$1,224.30 ", N/A ,$839.14 ,$839.14 , N/A ,$734.58 ,"$1,040.66 ",$857.01 , N/A , N/A ,"$1,163.09 ",$930.47 ,$918.23 ,$795.80 ,"$1,040.66 ", N/A ,$795.80 ,$795.80 ,$857.01 ,$745.60 , N/A , N/A , N/A , N/A , N/A ,"$1,040.66 ", N/A ,"$1,126.36 ",$857.01 ,$620.97 ,$745.23 ,$745.60 ,$745.23 ,$845.99 ,"$1,101.87 ",$836.44 , N/A ,$967.20 , N/A ,$722.34 ,$722.34 , N/A ,$722.34 ,$881.50 ,$759.07 ,$881.50 ,$881.50 ,$979.44 
ST NICHOLAS HOSPITAL - ACUTE,71000205,N/A,HC RECOVERY CLASS 4 ADDL,710,1 ,$701.72 ,$463.14 ,$355.91 ,$701.72 , N/A ,$480.96 ,$480.96 , N/A ,$421.03 ,$596.46 ,$491.20 , N/A , N/A ,$666.63 ,$533.31 ,$526.29 ,$456.12 ,$596.46 , N/A ,$456.12 ,$456.12 ,$491.20 ,$427.35 , N/A , N/A , N/A , N/A , N/A ,$596.46 , N/A ,$645.58 ,$491.20 ,$355.91 ,$427.14 ,$427.35 ,$427.14 ,$484.89 ,$631.55 ,$479.42 , N/A ,$554.36 , N/A ,$414.01 ,$414.01 , N/A ,$414.01 ,$505.24 ,$435.07 ,$505.24 ,$505.24 ,$561.38 
ST NICHOLAS HOSPITAL - ACUTE,71101072,71101,HC XR RIBS CHEST MIN 3 VIEW-PRV 72 HR,320,1 ,$594.06 ,$392.08 ,$1.93 ,$594.06 ,$1.93 ,$120.97 ,$98.45 ,$104.31 ,$356.44 ,$504.95 ,$415.84 ,$1.93 ,$1.93 ,$564.36 ,$451.49 ,$445.55 ,$58.28 ,$504.95 ,$104.31 ,$58.28 ,$58.28 ,$415.84 ,$361.78 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$504.95 ,$234.71 ,$546.54 ,$415.84 ,$342.19 ,$342.19 ,$361.78 ,$342.19 ,$410.50 ,$534.65 ,$405.86 ,$103.24 ,$469.31 ,$2.05 ,$459.00 ,$459.00 ,$102.22 ,$459.00 ,$427.72 ,$368.32 ,$427.72 ,$427.72 ,$475.25 
ST NICHOLAS HOSPITAL - ACUTE,72000008,59412,HC EXTERNAL CEPHALIC VERSION,720,1 ,"$2,760.00 ","$1,821.60 ",$22.60 ,"$6,209.06 ",$22.60 ,"$1,891.70 ","$1,891.70 ","$2,759.58 ","$1,656.00 ","$2,346.00 ","$1,932.00 ",$22.60 ,$22.60 ,"$2,622.00 ","$2,097.60 ","$2,070.00 ","$1,794.00 ","$2,346.00 ","$2,759.58 ","$1,794.00 ","$1,794.00 ","$1,932.00 ","$1,680.84 ",$22.60 ,"$2,759.58 ","$2,704.39 ","$2,760.00 ",$23.96 ,"$2,346.00 ","$6,209.06 ","$2,539.20 ","$1,932.00 ","$2,747.95 ","$3,435.21 ","$1,680.84 ","$3,435.21 ","$1,907.16 ","$2,484.00 ","$1,885.63 ","$2,731.44 ","$2,180.40 ",$23.96 ,"$1,343.00 ","$1,343.00 ","$2,704.39 ","$1,343.00 ","$1,987.20 ","$1,711.20 ","$1,987.20 ","$1,987.20 ","$2,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,72000009,99464,HC ATTEND HIGH RISK DELIVERY,720,1 ,$343.85 ,$226.94 ,$174.40 ,$343.85 , N/A ,$235.67 ,$235.67 , N/A ,$206.31 ,$292.27 ,$240.70 , N/A , N/A ,$326.66 ,$261.33 ,$257.89 ,$223.50 ,$292.27 , N/A ,$223.50 ,$223.50 ,$240.70 ,$209.40 , N/A , N/A , N/A , N/A , N/A ,$292.27 , N/A ,$316.34 ,$240.70 ,$174.40 ,$209.30 ,$209.40 ,$209.30 ,$237.60 ,$309.47 ,$234.92 , N/A ,$271.64 , N/A ,$343.85 ,$343.85 , N/A ,$343.85 ,$247.57 ,$213.19 ,$247.57 ,$247.57 ,$275.08 
ST NICHOLAS HOSPITAL - ACUTE,72000024,59410,HC VAGINAL DELIVERY ONLY INCLUDES POSTPARTUM CARE,720,1 ,"$3,013.00 ","$1,988.58 ",$75.38 ,"$3,013.00 ",$75.38 ,"$2,065.11 ","$2,065.11 ", N/A ,"$1,807.80 ","$2,561.05 ","$2,109.10 ",$75.38 ,$75.38 ,"$2,862.35 ","$2,289.88 ","$2,259.75 ","$1,958.45 ","$2,561.05 ", N/A ,"$1,958.45 ","$1,958.45 ","$2,109.10 ","$1,834.92 ",$75.38 , N/A , N/A , N/A ,$79.90 ,"$2,561.05 ", N/A ,"$2,771.96 ","$2,109.10 ","$1,528.19 ","$1,834.01 ","$1,834.92 ","$1,834.01 ","$2,081.98 ","$2,711.70 ","$2,058.48 ", N/A ,"$2,380.27 ",$79.90 ,"$1,343.00 ","$1,343.00 ", N/A ,"$1,343.00 ","$2,169.36 ","$1,868.06 ","$2,169.36 ","$2,169.36 ","$2,410.40 "
ST NICHOLAS HOSPITAL - ACUTE,72082072,72082,HC XR SPINE/CERV SCOLIOSIS 2-3 VW-PREV 72 HR,320,1 ,$388.50 ,$256.41 ,$1.93 ,$388.50 ,$1.93 ,$188.12 ,$188.12 ,$104.31 ,$233.10 ,$330.23 ,$271.95 ,$1.93 ,$1.93 ,$369.08 ,$295.26 ,$291.38 ,$109.12 ,$330.23 ,$104.31 ,$109.12 ,$109.12 ,$271.95 ,$236.60 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$330.23 ,$234.71 ,$357.42 ,$271.95 ,$370.51 ,$370.51 ,$236.60 ,$370.51 ,$268.45 ,$349.65 ,$265.42 ,$103.24 ,$306.92 ,$2.05 ,$388.50 ,$388.50 ,$102.22 ,$388.50 ,$279.72 ,$240.87 ,$279.72 ,$279.72 ,$310.80 
ST NICHOLAS HOSPITAL - ACUTE,72100001,N/A,HC LABOR LEVEL I PER HOUR,721,1 ,$113.42 ,$74.86 ,$57.53 ,$113.42 , N/A ,$77.74 ,$77.74 , N/A ,$68.05 ,$96.41 ,$79.39 , N/A , N/A ,$107.75 ,$86.20 ,$85.07 ,$73.72 ,$96.41 , N/A ,$73.72 ,$73.72 ,$79.39 ,$69.07 , N/A , N/A , N/A , N/A , N/A ,$96.41 , N/A ,$104.35 ,$79.39 ,$57.53 ,$69.04 ,$69.07 ,$69.04 ,$78.37 ,$102.08 ,$77.49 , N/A ,$89.60 , N/A ,$113.42 ,$113.42 , N/A ,$113.42 ,$81.66 ,$70.32 ,$81.66 ,$81.66 ,$90.74 
ST NICHOLAS HOSPITAL - ACUTE,72100002,N/A,HC LABOR LEVEL II PER HOUR,721,1 ,$169.60 ,$111.94 ,$86.02 ,$169.60 , N/A ,$116.24 ,$116.24 , N/A ,$101.76 ,$144.16 ,$118.72 , N/A , N/A ,$161.12 ,$128.90 ,$127.20 ,$110.24 ,$144.16 , N/A ,$110.24 ,$110.24 ,$118.72 ,$103.29 , N/A , N/A , N/A , N/A , N/A ,$144.16 , N/A ,$156.03 ,$118.72 ,$86.02 ,$103.24 ,$103.29 ,$103.24 ,$117.19 ,$152.64 ,$115.87 , N/A ,$133.98 , N/A ,$169.60 ,$169.60 , N/A ,$169.60 ,$122.11 ,$105.15 ,$122.11 ,$122.11 ,$135.68 
ST NICHOLAS HOSPITAL - ACUTE,72100003,N/A,HC LABOR LEVEL III PER HOUR,721,1 ,$190.80 ,$125.93 ,$96.77 ,$190.80 , N/A ,$130.77 ,$130.77 , N/A ,$114.48 ,$162.18 ,$133.56 , N/A , N/A ,$181.26 ,$145.01 ,$143.10 ,$124.02 ,$162.18 , N/A ,$124.02 ,$124.02 ,$133.56 ,$116.20 , N/A , N/A , N/A , N/A , N/A ,$162.18 , N/A ,$175.54 ,$133.56 ,$96.77 ,$116.14 ,$116.20 ,$116.14 ,$131.84 ,$171.72 ,$130.35 , N/A ,$150.73 , N/A ,$190.80 ,$190.80 , N/A ,$190.80 ,$137.38 ,$118.30 ,$137.38 ,$137.38 ,$152.64 
ST NICHOLAS HOSPITAL - ACUTE,72200002,N/A,HC DELIVERY CHARGE LEVEL I,722,1 ,"$2,309.74 ","$1,524.43 ","$1,171.50 ","$2,309.74 ", N/A ,"$1,583.10 ","$1,583.10 ", N/A ,"$1,385.84 ","$1,963.28 ","$1,616.82 ", N/A , N/A ,"$2,194.25 ","$1,755.40 ","$1,732.31 ","$1,501.33 ","$1,963.28 ", N/A ,"$1,501.33 ","$1,501.33 ","$1,616.82 ","$1,406.63 ", N/A , N/A , N/A , N/A , N/A ,"$1,963.28 ", N/A ,"$2,124.96 ","$1,616.82 ","$1,171.50 ","$1,405.94 ","$1,406.63 ","$1,405.94 ","$1,596.03 ","$2,078.77 ","$1,578.01 ", N/A ,"$1,824.69 ", N/A ,"$1,343.00 ","$1,343.00 ", N/A ,"$1,343.00 ","$1,663.01 ","$1,432.04 ","$1,663.01 ","$1,663.01 ","$1,847.79 "
ST NICHOLAS HOSPITAL - ACUTE,72200003,N/A,HC DELIVERY CHARGE LEVEL II,722,1 ,"$4,340.70 ","$2,864.86 ","$1,343.00 ","$4,340.70 ", N/A ,"$2,975.12 ","$2,975.12 ", N/A ,"$2,604.42 ","$3,689.60 ","$3,038.49 ", N/A , N/A ,"$4,123.67 ","$3,298.93 ","$3,255.53 ","$2,821.46 ","$3,689.60 ", N/A ,"$2,821.46 ","$2,821.46 ","$3,038.49 ","$2,643.49 ", N/A , N/A , N/A , N/A , N/A ,"$3,689.60 ", N/A ,"$3,993.44 ","$3,038.49 ","$2,201.60 ","$2,642.18 ","$2,643.49 ","$2,642.18 ","$2,999.42 ","$3,906.63 ","$2,965.57 ", N/A ,"$3,429.15 ", N/A ,"$1,343.00 ","$1,343.00 ", N/A ,"$1,343.00 ","$3,125.30 ","$2,691.23 ","$3,125.30 ","$3,125.30 ","$3,472.56 "
ST NICHOLAS HOSPITAL - ACUTE,72200004,N/A,HC DELIVERY CHARGE LEVEL III,722,1 ,"$4,674.60 ","$3,085.24 ","$1,343.00 ","$4,674.60 ", N/A ,"$3,203.97 ","$3,203.97 ", N/A ,"$2,804.76 ","$3,973.41 ","$3,272.22 ", N/A , N/A ,"$4,440.87 ","$3,552.70 ","$3,505.95 ","$3,038.49 ","$3,973.41 ", N/A ,"$3,038.49 ","$3,038.49 ","$3,272.22 ","$2,846.83 ", N/A , N/A , N/A , N/A , N/A ,"$3,973.41 ", N/A ,"$4,300.63 ","$3,272.22 ","$2,370.96 ","$2,845.43 ","$2,846.83 ","$2,845.43 ","$3,230.15 ","$4,207.14 ","$3,193.69 ", N/A ,"$3,692.93 ", N/A ,"$1,343.00 ","$1,343.00 ", N/A ,"$1,343.00 ","$3,365.71 ","$2,898.25 ","$3,365.71 ","$3,365.71 ","$3,739.68 "
ST NICHOLAS HOSPITAL - ACUTE,72200005,N/A,HC C-SECT INIT 1 HR SINGLE,722,1 ,"$4,674.60 ","$3,085.24 ","$1,343.00 ","$4,674.60 ", N/A ,"$3,203.97 ","$3,203.97 ", N/A ,"$2,804.76 ","$3,973.41 ","$3,272.22 ", N/A , N/A ,"$4,440.87 ","$3,552.70 ","$3,505.95 ","$3,038.49 ","$3,973.41 ", N/A ,"$3,038.49 ","$3,038.49 ","$3,272.22 ","$2,846.83 ", N/A , N/A , N/A , N/A , N/A ,"$3,973.41 ", N/A ,"$4,300.63 ","$3,272.22 ","$2,370.96 ","$2,845.43 ","$2,846.83 ","$2,845.43 ","$3,230.15 ","$4,207.14 ","$3,193.69 ", N/A ,"$3,692.93 ", N/A ,"$1,343.00 ","$1,343.00 ", N/A ,"$1,343.00 ","$3,365.71 ","$2,898.25 ","$3,365.71 ","$3,365.71 ","$3,739.68 "
ST NICHOLAS HOSPITAL - ACUTE,72200008,N/A,HC C-SECT ADDL 1/2 HR,722,1 ,$467.46 ,$308.52 ,$237.10 ,$467.46 , N/A ,$320.40 ,$320.40 , N/A ,$280.48 ,$397.34 ,$327.22 , N/A , N/A ,$444.09 ,$355.27 ,$350.60 ,$303.85 ,$397.34 , N/A ,$303.85 ,$303.85 ,$327.22 ,$284.68 , N/A , N/A , N/A , N/A , N/A ,$397.34 , N/A ,$430.06 ,$327.22 ,$237.10 ,$284.54 ,$284.68 ,$284.54 ,$323.01 ,$420.71 ,$319.37 , N/A ,$369.29 , N/A ,$467.46 ,$467.46 , N/A ,$467.46 ,$336.57 ,$289.83 ,$336.57 ,$336.57 ,$373.97 
ST NICHOLAS HOSPITAL - ACUTE,72200010,N/A,HC OUTPATIENT DELIVERY LEVEL 1,722,1 ,"$3,895.50 ","$2,571.03 ","$1,343.00 ","$3,895.50 ", N/A ,"$2,669.98 ","$2,669.98 ", N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ","$2,532.08 ","$3,311.18 ", N/A ,"$2,532.08 ","$2,532.08 ","$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A ,"$1,343.00 ","$1,343.00 ", N/A ,"$1,343.00 ","$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,72200011,N/A,HC OUTPATIENT DELIVERY LEVEL 2,722,1 ,"$4,118.10 ","$2,717.95 ","$1,343.00 ","$4,118.10 ", N/A ,"$2,822.55 ","$2,822.55 ", N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ","$2,676.77 ","$3,500.39 ", N/A ,"$2,676.77 ","$2,676.77 ","$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A ,"$1,343.00 ","$1,343.00 ", N/A ,"$1,343.00 ","$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,72200012,N/A,HC OUTPATIENT DELIVERY LEVEL 3,360,1 ,"$4,452.00 ","$2,938.32 ","$2,258.05 ","$4,452.00 ", N/A , N/A , N/A , N/A ,"$2,671.20 ","$3,784.20 ","$3,116.40 ", N/A , N/A ,"$4,229.40 ","$3,383.52 ","$3,339.00 ", N/A ,"$3,784.20 ", N/A , N/A , N/A ,"$3,116.40 ","$2,711.27 ", N/A , N/A , N/A , N/A , N/A ,"$3,784.20 ", N/A ,"$4,095.84 ","$3,116.40 ","$2,258.05 ","$2,709.93 ","$2,711.27 ","$2,709.93 ","$3,076.33 ","$4,006.80 ","$3,041.61 ", N/A ,"$3,517.08 ", N/A , N/A , N/A , N/A , N/A ,"$3,205.44 ","$2,760.24 ","$3,205.44 ","$3,205.44 ","$3,561.60 "
ST NICHOLAS HOSPITAL - ACUTE,72300001,N/A,HC CIRCUMCISION IP,723,1 ,$104.94 ,$69.26 ,$53.23 ,$104.94 , N/A ,$71.93 ,$71.93 , N/A ,$62.96 ,$89.20 ,$73.46 , N/A , N/A ,$99.69 ,$79.75 ,$78.71 ,$68.21 ,$89.20 , N/A ,$68.21 ,$68.21 ,$73.46 ,$63.91 , N/A , N/A , N/A , N/A , N/A ,$89.20 , N/A ,$96.54 ,$73.46 ,$53.23 ,$63.88 ,$63.91 ,$63.88 ,$72.51 ,$94.45 ,$71.70 , N/A ,$82.90 , N/A ,$61.91 ,$61.91 , N/A ,$61.91 ,$75.56 ,$65.06 ,$75.56 ,$75.56 ,$83.95 
ST NICHOLAS HOSPITAL - ACUTE,73000002,93005,HC EKG,730,1 ,$232.30 ,$153.32 ,$0.91 ,$232.30 ,$0.91 ,$159.22 ,$159.22 ,$56.10 ,$139.38 ,$197.46 ,$162.61 ,$0.91 ,$0.91 ,$220.69 ,$176.55 ,$174.23 ,$151.00 ,$197.46 ,$56.10 ,$151.00 ,$151.00 ,$162.61 ,$141.47 ,$0.91 ,$56.10 ,$54.98 ,$112.20 ,$0.96 ,$197.46 ,$126.23 ,$213.72 ,$162.61 ,$96.16 ,$96.16 ,$141.47 ,$96.16 ,$160.52 ,$209.07 ,$158.71 ,$55.53 ,$183.52 ,$0.96 ,$145.00 ,$145.00 ,$54.98 ,$145.00 ,$167.26 ,$144.03 ,$167.26 ,$167.26 ,$185.84 
ST NICHOLAS HOSPITAL - ACUTE,73000003,93041,HC EKG RHYTHM STRIP TRACING,730,1 ,$193.20 ,$127.51 ,$0.91 ,$193.20 ,$0.91 ,$132.42 ,$132.42 ,$56.10 ,$115.92 ,$164.22 ,$135.24 ,$0.91 ,$0.91 ,$183.54 ,$146.83 ,$144.90 ,$125.58 ,$164.22 ,$56.10 ,$125.58 ,$125.58 ,$135.24 ,$117.66 ,$0.91 ,$56.10 ,$54.98 ,$112.20 ,$0.96 ,$164.22 ,$126.23 ,$177.74 ,$135.24 ,$189.46 ,$189.46 ,$117.66 ,$189.46 ,$133.50 ,$173.88 ,$131.99 ,$55.53 ,$152.63 ,$0.96 ,$145.00 ,$145.00 ,$54.98 ,$145.00 ,$139.10 ,$119.78 ,$139.10 ,$139.10 ,$154.56 
ST NICHOLAS HOSPITAL - ACUTE,73000004,93242,HC EXT ECG >48HR LESS THN EQUAL TO 7D RECORDING,731,1 ,$131.10 ,$86.53 ,$2.27 ,$131.10 ,$2.27 ,$89.86 ,$89.86 ,$33.15 ,$78.66 ,$111.44 ,$91.77 ,$2.27 ,$2.27 ,$124.55 ,$99.64 ,$98.33 ,$85.22 ,$111.44 ,$33.15 ,$85.22 ,$85.22 ,$91.77 ,$79.84 ,$2.27 ,$33.15 ,$32.49 ,$66.30 ,$2.41 ,$111.44 ,$74.58 ,$120.61 ,$91.77 ,$66.49 ,$79.80 ,$79.84 ,$79.80 ,$90.59 ,$117.99 ,$89.57 ,$32.81 ,$103.57 ,$2.41 ,$131.10 ,$131.10 ,$32.49 ,$131.10 ,$94.39 ,$81.28 ,$94.39 ,$94.39 ,$104.88 
ST NICHOLAS HOSPITAL - ACUTE,73000005,93243,HC EXT ECG >48HR LESS THN EQUAL TO 7D SCAN A/R,731,1 ,$215.05 ,$141.93 ,$2.27 ,$254.98 ,$2.27 ,$147.40 ,$147.40 ,$113.32 ,$129.03 ,$182.79 ,$150.54 ,$2.27 ,$2.27 ,$204.30 ,$163.44 ,$161.29 ,$139.78 ,$182.79 ,$113.32 ,$139.78 ,$139.78 ,$150.54 ,$130.97 ,$2.27 ,$113.32 ,$111.05 ,$215.05 ,$2.41 ,$182.79 ,$254.98 ,$197.85 ,$150.54 ,$109.07 ,$130.90 ,$130.97 ,$130.90 ,$148.60 ,$193.55 ,$146.92 ,$112.16 ,$169.89 ,$2.41 ,$215.05 ,$215.05 ,$111.05 ,$215.05 ,$154.84 ,$133.33 ,$154.84 ,$154.84 ,$172.04 
ST NICHOLAS HOSPITAL - ACUTE,73000006,93246,HC EXT ECG >7D<15D RECORDING,730,1 ,$215.05 ,$141.93 ,$2.27 ,$215.05 ,$2.27 ,$147.40 ,$147.40 ,$56.10 ,$129.03 ,$182.79 ,$150.54 ,$2.27 ,$2.27 ,$204.30 ,$163.44 ,$161.29 ,$139.78 ,$182.79 ,$56.10 ,$139.78 ,$139.78 ,$150.54 ,$130.97 ,$2.27 ,$56.10 ,$54.98 ,$112.20 ,$2.41 ,$182.79 ,$126.23 ,$197.85 ,$150.54 ,$109.07 ,$130.90 ,$130.97 ,$130.90 ,$148.60 ,$193.55 ,$146.92 ,$55.53 ,$169.89 ,$2.41 ,$145.00 ,$145.00 ,$54.98 ,$145.00 ,$154.84 ,$133.33 ,$154.84 ,$154.84 ,$172.04 
ST NICHOLAS HOSPITAL - ACUTE,73000007,93247,HC EXT ECG >7D<15D SCAN A/R,731,1 ,$432.40 ,$285.38 ,$2.27 ,$432.40 ,$2.27 ,$296.37 ,$296.37 ,$113.32 ,$259.44 ,$367.54 ,$302.68 ,$2.27 ,$2.27 ,$410.78 ,$328.62 ,$324.30 ,$281.06 ,$367.54 ,$113.32 ,$281.06 ,$281.06 ,$302.68 ,$263.33 ,$2.27 ,$113.32 ,$111.05 ,$226.64 ,$2.41 ,$367.54 ,$254.98 ,$397.81 ,$302.68 ,$219.31 ,$263.20 ,$263.33 ,$263.20 ,$298.79 ,$389.16 ,$295.42 ,$112.16 ,$341.60 ,$2.41 ,$432.40 ,$432.40 ,$111.05 ,$432.40 ,$311.33 ,$268.09 ,$311.33 ,$311.33 ,$345.92 
ST NICHOLAS HOSPITAL - ACUTE,73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,$566.95 ,$374.19 ,$2.27 ,$566.95 ,$2.27 ,$388.59 ,$388.59 ,$113.32 ,$340.17 ,$481.91 ,$396.87 ,$2.27 ,$2.27 ,$538.60 ,$430.88 ,$425.21 ,$368.52 ,$481.91 ,$113.32 ,$368.52 ,$368.52 ,$396.87 ,$345.27 ,$2.27 ,$113.32 ,$111.05 ,$226.64 ,$2.41 ,$481.91 ,$254.98 ,$521.59 ,$396.87 ,$287.56 ,$345.10 ,$345.27 ,$345.10 ,$391.76 ,$510.26 ,$387.34 ,$112.16 ,$447.89 ,$2.41 ,$551.00 ,$551.00 ,$111.05 ,$551.00 ,$408.20 ,$351.51 ,$408.20 ,$408.20 ,$453.56 
ST NICHOLAS HOSPITAL - ACUTE,73100001,93226,HC HOLTER SCAN  AND  REPORT 24 HR,731,1 ,$721.05 ,$475.89 ,$2.27 ,$721.05 ,$2.27 ,$494.21 ,$494.21 ,$113.32 ,$432.63 ,$612.89 ,$504.74 ,$2.27 ,$2.27 ,$685.00 ,$548.00 ,$540.79 ,$468.68 ,$612.89 ,$113.32 ,$468.68 ,$468.68 ,$504.74 ,$439.12 ,$2.27 ,$113.32 ,$111.05 ,$226.64 ,$2.41 ,$612.89 ,$254.98 ,$663.37 ,$504.74 ,$365.72 ,$438.90 ,$439.12 ,$438.90 ,$498.25 ,$648.95 ,$492.62 ,$112.16 ,$569.63 ,$2.41 ,$551.00 ,$551.00 ,$111.05 ,$551.00 ,$519.16 ,$447.05 ,$519.16 ,$519.16 ,$576.84 
ST NICHOLAS HOSPITAL - ACUTE,73100002,93226,HC HOLTER SCAN  AND  REPORT 48 HR,731,1 ,$824.55 ,$544.20 ,$2.27 ,$824.55 ,$2.27 ,$565.15 ,$565.15 ,$113.32 ,$494.73 ,$700.87 ,$577.19 ,$2.27 ,$2.27 ,$783.32 ,$626.66 ,$618.41 ,$535.96 ,$700.87 ,$113.32 ,$535.96 ,$535.96 ,$577.19 ,$502.15 ,$2.27 ,$113.32 ,$111.05 ,$226.64 ,$2.41 ,$700.87 ,$254.98 ,$758.59 ,$577.19 ,$418.21 ,$501.90 ,$502.15 ,$501.90 ,$569.76 ,$742.10 ,$563.33 ,$112.16 ,$651.39 ,$2.41 ,$551.00 ,$551.00 ,$111.05 ,$551.00 ,$593.68 ,$511.22 ,$593.68 ,$593.68 ,$659.64 
ST NICHOLAS HOSPITAL - ACUTE,73100004,93270,HC CARDIAC EVENT RECORDER,731,1 ,$322.00 ,$212.52 ,$2.27 ,$322.00 ,$2.27 ,$220.70 ,$220.70 ,$34.16 ,$193.20 ,$273.70 ,$225.40 ,$2.27 ,$2.27 ,$305.90 ,$244.72 ,$241.50 ,$209.30 ,$273.70 ,$34.16 ,$209.30 ,$209.30 ,$225.40 ,$196.10 ,$2.27 ,$34.16 ,$33.48 ,$68.32 ,$2.41 ,$273.70 ,$76.86 ,$296.24 ,$225.40 ,$163.32 ,$196.00 ,$196.10 ,$196.00 ,$222.50 ,$289.80 ,$219.99 ,$33.81 ,$254.38 ,$2.41 ,$322.00 ,$322.00 ,$33.48 ,$322.00 ,$231.84 ,$199.64 ,$231.84 ,$231.84 ,$257.60 
ST NICHOLAS HOSPITAL - ACUTE,73100006,0296T,HC HOLTER MONITOR RECORDING EXTENDED >48HRS <21DAYS,731,1 ,$721.05 ,$475.89 ,$365.72 ,$721.05 , N/A ,$494.21 ,$494.21 , N/A ,$432.63 ,$612.89 ,$504.74 , N/A , N/A ,$685.00 ,$548.00 ,$540.79 ,$468.68 ,$612.89 , N/A ,$468.68 ,$468.68 ,$504.74 ,$439.12 , N/A , N/A , N/A , N/A , N/A ,$612.89 , N/A ,$663.37 ,$504.74 ,$365.72 ,$438.90 ,$439.12 ,$438.90 ,$498.25 ,$648.95 ,$492.62 , N/A ,$569.63 , N/A ,$551.00 ,$551.00 , N/A ,$551.00 ,$519.16 ,$447.05 ,$519.16 ,$519.16 ,$576.84 
ST NICHOLAS HOSPITAL - ACUTE,73100007,0297T,HC HOLTER MONITOR SCAN  AND  REPORT EXTENDED >48HRS <21DAYS,731,1 ,$824.55 ,$544.20 ,$418.21 ,$824.55 , N/A ,$565.15 ,$565.15 , N/A ,$494.73 ,$700.87 ,$577.19 , N/A , N/A ,$783.32 ,$626.66 ,$618.41 ,$535.96 ,$700.87 , N/A ,$535.96 ,$535.96 ,$577.19 ,$502.15 , N/A , N/A , N/A , N/A , N/A ,$700.87 , N/A ,$758.59 ,$577.19 ,$418.21 ,$501.90 ,$502.15 ,$501.90 ,$569.76 ,$742.10 ,$563.33 , N/A ,$651.39 , N/A ,$551.00 ,$551.00 , N/A ,$551.00 ,$593.68 ,$511.22 ,$593.68 ,$593.68 ,$659.64 
ST NICHOLAS HOSPITAL - ACUTE,73522072,73522,HC XR HIP W/PELVIS BIL 3-4 VIEWS-PREV 72 HR,983,1 ,$338.15 ,$223.18 ,$1.93 ,$338.15 ,$1.93 ,$231.77 ,$231.77 ,$104.31 ,$202.89 ,$287.43 ,$236.71 ,$1.93 ,$1.93 ,$321.24 ,$256.99 ,$253.61 ,$219.80 ,$287.43 ,$104.31 ,$219.80 ,$219.80 ,$236.71 ,$205.93 ,$1.93 ,$104.31 ,$102.22 ,$208.62 ,$2.05 ,$287.43 ,$234.71 ,$311.10 ,$236.71 ,$338.15 ,$338.15 ,$205.93 ,$338.15 ,$233.66 ,$304.34 ,$231.02 ,$103.24 ,$267.14 ,$2.05 , N/A , N/A ,$102.22 , N/A ,$243.47 ,$209.65 ,$243.47 ,$243.47 ,$270.52 
ST NICHOLAS HOSPITAL - ACUTE,73660072,73660,HC XRAY TOE MIN 2 VIEW-PRV 72 HR,320,1 ,$392.50 ,$259.05 ,$1.93 ,$392.50 ,$1.93 ,$93.26 ,$84.65 ,$84.79 ,$235.50 ,$333.63 ,$274.75 ,$1.93 ,$1.93 ,$372.88 ,$298.30 ,$294.38 ,$45.10 ,$333.63 ,$84.79 ,$45.10 ,$45.10 ,$274.75 ,$239.03 ,$1.93 ,$84.79 ,$83.09 ,$169.58 ,$2.05 ,$333.63 ,$190.79 ,$361.10 ,$274.75 ,$215.92 ,$215.92 ,$239.03 ,$215.92 ,$271.22 ,$353.25 ,$268.16 ,$83.93 ,$310.08 ,$2.05 ,$392.50 ,$392.50 ,$83.09 ,$392.50 ,$282.60 ,$243.35 ,$282.60 ,$282.60 ,$314.00 
ST NICHOLAS HOSPITAL - ACUTE,74000001,95803,HC ACTIGRAPHY TESTING 72HR TO 14 DAYS,740,1 ,$623.39 ,$411.44 ,$2.27 ,$623.39 ,$2.27 ,$623.39 ,$623.39 ,$56.10 ,$374.03 ,$529.88 ,$436.37 ,$2.27 ,$2.27 ,$592.22 ,$473.78 ,$467.54 ,$405.20 ,$529.88 ,$56.10 ,$405.20 ,$405.20 ,$436.37 ,$379.64 ,$2.27 ,$56.10 ,$54.98 ,$112.20 ,$2.41 ,$529.88 ,$126.23 ,$573.52 ,$436.37 ,$316.18 ,$379.46 ,$379.64 ,$379.46 ,$430.76 ,$561.05 ,$425.90 ,$55.53 ,$492.48 ,$2.41 ,$462.00 ,$462.00 ,$54.98 ,$462.00 ,$448.84 ,$386.50 ,$448.84 ,$448.84 ,$498.71 
ST NICHOLAS HOSPITAL - ACUTE,74000002,95805,HC MULTIPLE SLEEP LATENCY,740,1 ,"$3,740.34 ","$2,468.62 ",$26.33 ,"$3,740.34 ",$26.33 ,"$3,438.00 ","$2,979.00 ",$471.83 ,"$2,244.20 ","$3,179.29 ","$2,618.24 ",$26.33 ,$26.33 ,"$3,553.32 ","$2,842.66 ","$2,805.26 ","$2,431.22 ","$3,179.29 ",$471.83 ,"$2,431.22 ","$2,431.22 ","$2,618.24 ","$2,277.87 ",$26.33 ,$471.83 ,$462.39 ,$943.66 ,$27.91 ,"$3,179.29 ","$1,061.61 ","$3,441.11 ","$2,618.24 ","$1,897.10 ","$2,276.75 ","$2,277.87 ","$2,276.75 ","$2,584.57 ","$3,366.31 ","$2,555.40 ",$467.02 ,"$2,954.87 ",$27.91 ,"$3,665.00 ","$3,665.00 ",$462.39 ,"$3,665.00 ","$2,693.04 ","$2,319.01 ","$2,693.04 ","$2,693.04 ","$2,992.27 "
ST NICHOLAS HOSPITAL - ACUTE,74000003,95806,HC SLEEP STUDY UNATTENDED,740,1 ,$654.56 ,$432.01 ,$5.00 ,$654.56 ,$5.00 ,$654.56 ,$654.56 ,$141.94 ,$392.74 ,$556.38 ,$458.19 ,$5.00 ,$5.00 ,$621.83 ,$497.47 ,$490.92 ,$425.46 ,$556.38 ,$141.94 ,$425.46 ,$425.46 ,$458.19 ,$398.63 ,$5.00 ,$141.94 ,$139.10 ,$283.88 ,$5.30 ,$556.38 ,$319.36 ,$602.20 ,$458.19 ,$331.99 ,$398.43 ,$398.63 ,$398.43 ,$452.30 ,$589.10 ,$447.20 ,$140.49 ,$517.10 ,$5.30 ,$654.56 ,$654.56 ,$139.10 ,$654.56 ,$471.28 ,$405.83 ,$471.28 ,$471.28 ,$523.65 
ST NICHOLAS HOSPITAL - ACUTE,74000006,95810,HC SLEEP STUDY,740,1 ,"$4,779.33 ","$3,154.36 ",$26.33 ,"$4,779.33 ",$26.33 ,"$3,438.00 ","$2,979.00 ",$455.98 ,"$2,867.60 ","$4,062.43 ","$3,345.53 ",$26.33 ,$26.33 ,"$4,540.36 ","$3,632.29 ","$3,584.50 ","$3,106.56 ","$4,062.43 ",$455.98 ,"$3,106.56 ","$3,106.56 ","$3,345.53 ","$2,910.61 ",$26.33 ,$455.98 ,$446.86 ,$911.96 ,$27.91 ,"$4,062.43 ","$1,025.95 ","$4,396.98 ","$3,345.53 ","$2,424.08 ","$2,909.18 ","$2,910.61 ","$2,909.18 ","$3,302.52 ","$4,301.40 ","$3,265.24 ",$451.33 ,"$3,775.67 ",$27.91 ,"$3,665.00 ","$3,665.00 ",$446.86 ,"$3,665.00 ","$3,441.12 ","$2,963.18 ","$3,441.12 ","$3,441.12 ","$3,823.46 "
ST NICHOLAS HOSPITAL - ACUTE,74000006,95810,HC SLEEP STUDY,740,1 ,"$4,779.33 ","$3,154.36 ",$26.33 ,"$4,779.33 ",$26.33 ,"$3,438.00 ","$2,979.00 ",$455.98 ,"$2,867.60 ","$4,062.43 ","$3,345.53 ",$26.33 ,$26.33 ,"$4,540.36 ","$3,632.29 ","$3,584.50 ","$3,106.56 ","$4,062.43 ",$455.98 ,"$3,106.56 ","$3,106.56 ","$3,345.53 ","$2,910.61 ",$26.33 ,$455.98 ,$446.86 ,$911.96 ,$27.91 ,"$4,062.43 ","$1,025.95 ","$4,396.98 ","$3,345.53 ","$2,424.08 ","$2,909.18 ","$2,910.61 ","$2,909.18 ","$3,302.52 ","$4,301.40 ","$3,265.24 ",$451.33 ,"$3,775.67 ",$27.91 ,"$3,665.00 ","$3,665.00 ",$446.86 ,"$3,665.00 ","$3,441.12 ","$2,963.18 ","$3,441.12 ","$3,441.12 ","$3,823.46 "
ST NICHOLAS HOSPITAL - ACUTE,74000008,95810,HC SLEEP STUDY ONE ON ONE,740,1 ,"$5,091.02 ","$3,360.07 ",$26.33 ,"$5,091.02 ",$26.33 ,"$3,438.00 ","$2,979.00 ",$911.95 ,"$3,054.61 ","$4,327.37 ","$3,563.71 ",$26.33 ,$26.33 ,"$4,836.47 ","$3,869.18 ","$3,818.27 ","$3,309.16 ","$4,327.37 ",$911.95 ,"$3,309.16 ","$3,309.16 ","$3,563.71 ","$3,100.43 ",$26.33 ,$911.95 ,$893.71 ,"$1,823.90 ",$27.91 ,"$4,327.37 ","$2,051.90 ","$4,683.74 ","$3,563.71 ","$2,582.17 ","$3,098.90 ","$3,100.43 ","$3,098.90 ","$3,517.89 ","$4,581.92 ","$3,478.18 ",$902.65 ,"$4,021.91 ",$27.91 ,"$3,665.00 ","$3,665.00 ",$893.71 ,"$3,665.00 ","$3,665.53 ","$3,156.43 ","$3,665.53 ","$3,665.53 ","$4,072.82 "
ST NICHOLAS HOSPITAL - ACUTE,74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$5,091.02 ","$3,360.07 ",$26.33 ,"$5,091.02 ",$26.33 ,"$3,438.00 ","$2,979.00 ",$455.98 ,"$3,054.61 ","$4,327.37 ","$3,563.71 ",$26.33 ,$26.33 ,"$4,836.47 ","$3,869.18 ","$3,818.27 ","$3,309.16 ","$4,327.37 ",$455.98 ,"$3,309.16 ","$3,309.16 ","$3,563.71 ","$3,100.43 ",$26.33 ,$455.98 ,$446.86 ,$911.96 ,$27.91 ,"$4,327.37 ","$1,025.95 ","$4,683.74 ","$3,563.71 ","$2,582.17 ","$3,098.90 ","$3,100.43 ","$3,098.90 ","$3,517.89 ","$4,581.92 ","$3,478.18 ",$451.33 ,"$4,021.91 ",$27.91 ,"$3,665.00 ","$3,665.00 ",$446.86 ,"$3,665.00 ","$3,665.53 ","$3,156.43 ","$3,665.53 ","$3,665.53 ","$4,072.82 "
ST NICHOLAS HOSPITAL - ACUTE,74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$5,091.02 ","$3,360.07 ",$26.33 ,"$5,091.02 ",$26.33 ,"$3,438.00 ","$2,979.00 ",$455.98 ,"$3,054.61 ","$4,327.37 ","$3,563.71 ",$26.33 ,$26.33 ,"$4,836.47 ","$3,869.18 ","$3,818.27 ","$3,309.16 ","$4,327.37 ",$455.98 ,"$3,309.16 ","$3,309.16 ","$3,563.71 ","$3,100.43 ",$26.33 ,$455.98 ,$446.86 ,$911.96 ,$27.91 ,"$4,327.37 ","$1,025.95 ","$4,683.74 ","$3,563.71 ","$2,582.17 ","$3,098.90 ","$3,100.43 ","$3,098.90 ","$3,517.89 ","$4,581.92 ","$3,478.18 ",$451.33 ,"$4,021.91 ",$27.91 ,"$3,665.00 ","$3,665.00 ",$446.86 ,"$3,665.00 ","$3,665.53 ","$3,156.43 ","$3,665.53 ","$3,665.53 ","$4,072.82 "
ST NICHOLAS HOSPITAL - ACUTE,74000012,95812,HC EEG MONITOR 41-60 MIN,740,1 ,"$1,107.45 ",$730.92 ,$16.13 ,"$1,107.45 ",$16.13 ,$759.05 ,$759.05 ,$273.34 ,$664.47 ,$941.33 ,$775.22 ,$16.13 ,$16.13 ,"$1,052.08 ",$841.66 ,$830.59 ,$719.84 ,$941.33 ,$273.34 ,$719.84 ,$719.84 ,$775.22 ,$674.44 ,$16.13 ,$273.34 ,$267.87 ,$546.68 ,$17.10 ,$941.33 ,$615.01 ,"$1,018.85 ",$775.22 ,$561.70 ,$674.10 ,$674.44 ,$674.10 ,$765.25 ,$996.71 ,$756.61 ,$270.55 ,$874.89 ,$17.10 ,$462.00 ,$462.00 ,$267.87 ,$462.00 ,$797.36 ,$686.62 ,$797.36 ,$797.36 ,$885.96 
ST NICHOLAS HOSPITAL - ACUTE,74000013,95813,HC EEG MONITOR > 1 HR,740,1 ,"$1,932.00 ","$1,275.12 ",$16.13 ,"$1,932.00 ",$16.13 ,"$1,324.19 ","$1,324.19 ",$273.34 ,"$1,159.20 ","$1,642.20 ","$1,352.40 ",$16.13 ,$16.13 ,"$1,835.40 ","$1,468.32 ","$1,449.00 ","$1,255.80 ","$1,642.20 ",$273.34 ,"$1,255.80 ","$1,255.80 ","$1,352.40 ","$1,176.59 ",$16.13 ,$273.34 ,$267.87 ,$546.68 ,$17.10 ,"$1,642.20 ",$615.01 ,"$1,777.44 ","$1,352.40 ",$979.91 ,"$1,176.01 ","$1,176.59 ","$1,176.01 ","$1,335.01 ","$1,738.80 ","$1,319.94 ",$270.55 ,"$1,526.28 ",$17.10 ,$462.00 ,$462.00 ,$267.87 ,$462.00 ,"$1,391.04 ","$1,197.84 ","$1,391.04 ","$1,391.04 ","$1,545.60 "
ST NICHOLAS HOSPITAL - ACUTE,74000014,95816,HC EEG AWAKE/DROWSY,740,1 ,$978.65 ,$645.91 ,$12.43 ,$978.65 ,$12.43 ,$670.77 ,$670.77 ,$273.34 ,$587.19 ,$831.85 ,$685.06 ,$12.43 ,$12.43 ,$929.72 ,$743.77 ,$733.99 ,$636.12 ,$831.85 ,$273.34 ,$636.12 ,$636.12 ,$685.06 ,$596.00 ,$12.43 ,$273.34 ,$267.87 ,$546.68 ,$13.18 ,$831.85 ,$615.01 ,$900.36 ,$685.06 ,$496.37 ,$595.70 ,$596.00 ,$595.70 ,$676.25 ,$880.79 ,$668.61 ,$270.55 ,$773.13 ,$13.18 ,$462.00 ,$462.00 ,$267.87 ,$462.00 ,$704.63 ,$606.76 ,$704.63 ,$704.63 ,$782.92 
ST NICHOLAS HOSPITAL - ACUTE,74000016,95819,HC EEG AWAKE/ASLEEP,740,1 ,"$1,932.00 ","$1,275.12 ",$12.43 ,"$1,932.00 ",$12.43 ,"$1,324.19 ","$1,324.19 ",$273.34 ,"$1,159.20 ","$1,642.20 ","$1,352.40 ",$12.43 ,$12.43 ,"$1,835.40 ","$1,468.32 ","$1,449.00 ","$1,255.80 ","$1,642.20 ",$273.34 ,"$1,255.80 ","$1,255.80 ","$1,352.40 ","$1,176.59 ",$12.43 ,$273.34 ,$267.87 ,$546.68 ,$13.18 ,"$1,642.20 ",$615.01 ,"$1,777.44 ","$1,352.40 ",$979.91 ,"$1,176.01 ","$1,176.59 ","$1,176.01 ","$1,335.01 ","$1,738.80 ","$1,319.94 ",$270.55 ,"$1,526.28 ",$13.18 ,$462.00 ,$462.00 ,$267.87 ,$462.00 ,"$1,391.04 ","$1,197.84 ","$1,391.04 ","$1,391.04 ","$1,545.60 "
ST NICHOLAS HOSPITAL - ACUTE,74000020,95824,HC EEG CEREBRAL DEATH EVAL,740,1 ,"$1,236.25 ",$815.93 ,$12.43 ,"$1,236.25 ",$12.43 ,$847.33 ,$847.33 ,$471.83 ,$741.75 ,"$1,050.81 ",$865.38 ,$12.43 ,$12.43 ,"$1,174.44 ",$939.55 ,$927.19 ,$803.56 ,"$1,050.81 ",$471.83 ,$803.56 ,$803.56 ,$865.38 ,$752.88 ,$12.43 ,$471.83 ,$462.39 ,$943.66 ,$13.18 ,"$1,050.81 ","$1,061.61 ","$1,137.35 ",$865.38 ,$627.03 ,$752.51 ,$752.88 ,$752.51 ,$854.25 ,"$1,112.63 ",$844.61 ,$467.02 ,$976.64 ,$13.18 ,$462.00 ,$462.00 ,$462.39 ,$462.00 ,$890.10 ,$766.48 ,$890.10 ,$890.10 ,$989.00 
ST NICHOLAS HOSPITAL - ACUTE,74000032,95957,HC EEG DIGITAL ANLYS,740,1 ,$760.15 ,$501.70 ,$1.27 ,$760.15 ,$1.27 ,$521.01 ,$521.01 , N/A ,$456.09 ,$646.13 ,$532.11 ,$1.27 ,$1.27 ,$722.14 ,$577.71 ,$570.11 ,$494.10 ,$646.13 , N/A ,$494.10 ,$494.10 ,$532.11 ,$462.93 ,$1.27 , N/A , N/A , N/A ,$1.35 ,$646.13 , N/A ,$699.34 ,$532.11 ,$385.55 ,$462.70 ,$462.93 ,$462.70 ,$525.26 ,$684.14 ,$519.33 , N/A ,$600.52 ,$1.35 ,$462.00 ,$462.00 , N/A ,$462.00 ,$547.31 ,$471.29 ,$547.31 ,$547.31 ,$608.12 
ST NICHOLAS HOSPITAL - ACUTE,74000033,95939,HC TCMEP UPPER AND LOWER,740,1 ,$830.61 ,$548.20 ,$4.77 ,"$2,051.90 ",$4.77 ,$569.30 ,$569.30 ,$911.95 ,$498.37 ,$706.02 ,$581.43 ,$4.77 ,$4.77 ,$789.08 ,$631.26 ,$622.96 ,$539.90 ,$706.02 ,$911.95 ,$539.90 ,$539.90 ,$581.43 ,$505.84 ,$4.77 ,$911.95 ,$893.71 ,$830.61 ,$5.06 ,$706.02 ,"$2,051.90 ",$764.16 ,$581.43 ,$421.29 ,$505.59 ,$505.84 ,$505.59 ,$573.95 ,$747.55 ,$567.47 ,$902.65 ,$656.18 ,$5.06 ,$462.00 ,$462.00 ,$893.71 ,$462.00 ,$598.04 ,$514.98 ,$598.04 ,$598.04 ,$664.49 
ST NICHOLAS HOSPITAL - ACUTE,74000033,95939,HC TCMEP UPPER AND LOWER,740,1 ,$360.00 ,$237.60 ,$4.77 ,"$2,051.90 ",$4.77 ,$246.74 ,$246.74 ,$911.95 ,$216.00 ,$306.00 ,$252.00 ,$4.77 ,$4.77 ,$342.00 ,$273.60 ,$270.00 ,$234.00 ,$306.00 ,$911.95 ,$234.00 ,$234.00 ,$252.00 ,$219.24 ,$4.77 ,$911.95 ,$893.71 ,$360.00 ,$5.06 ,$306.00 ,"$2,051.90 ",$331.20 ,$252.00 ,$182.59 ,$219.13 ,$219.24 ,$219.13 ,$248.76 ,$324.00 ,$245.95 ,$902.65 ,$284.40 ,$5.06 ,$360.00 ,$360.00 ,$893.71 ,$360.00 ,$259.20 ,$223.20 ,$259.20 ,$259.20 ,$288.00 
ST NICHOLAS HOSPITAL - ACUTE,74000035,G0399,HC SLEEP STUDY HOME ADULT,740,1 ,$675.93 ,$446.11 ,$5.00 ,$675.93 ,$5.00 ,$675.93 ,$675.93 ,$141.94 ,$405.56 ,$574.54 ,$473.15 ,$5.00 ,$5.00 ,$642.13 ,$513.71 ,$506.95 ,$439.35 ,$574.54 ,$141.94 ,$439.35 ,$439.35 ,$473.15 ,$411.64 ,$5.00 ,$141.94 ,$139.10 ,$283.88 ,$5.30 ,$574.54 ,$319.36 ,$621.86 ,$473.15 ,$342.83 ,$411.44 ,$411.64 ,$411.44 ,$467.07 ,$608.34 ,$461.80 ,$140.49 ,$533.98 ,$5.30 ,$675.93 ,$675.93 ,$139.10 ,$675.93 ,$486.67 ,$419.08 ,$486.67 ,$486.67 ,$540.74 
ST NICHOLAS HOSPITAL - ACUTE,74000043,95940,HC NEURO TEST INTRAOP PER 15 MIN,740,1 ,$175.00 ,$115.50 ,$88.76 ,$175.00 , N/A ,$119.95 ,$119.95 , N/A ,$105.00 ,$148.75 ,$122.50 , N/A , N/A ,$166.25 ,$133.00 ,$131.25 ,$113.75 ,$148.75 , N/A ,$113.75 ,$113.75 ,$122.50 ,$106.58 , N/A , N/A , N/A , N/A , N/A ,$148.75 , N/A ,$161.00 ,$122.50 ,$88.76 ,$106.52 ,$106.58 ,$106.52 ,$120.93 ,$157.50 ,$119.56 , N/A ,$138.25 , N/A ,$175.00 ,$175.00 , N/A ,$175.00 ,$126.00 ,$108.50 ,$126.00 ,$126.00 ,$140.00 
ST NICHOLAS HOSPITAL - ACUTE,74000043,95940,HC NEURO TEST INTRAOPER PER 15MIN,740,1 ,$260.63 ,$172.02 ,$132.19 ,$260.63 , N/A ,$178.64 ,$178.64 , N/A ,$156.38 ,$221.54 ,$182.44 , N/A , N/A ,$247.60 ,$198.08 ,$195.47 ,$169.41 ,$221.54 , N/A ,$169.41 ,$169.41 ,$182.44 ,$158.72 , N/A , N/A , N/A , N/A , N/A ,$221.54 , N/A ,$239.78 ,$182.44 ,$132.19 ,$158.65 ,$158.72 ,$158.65 ,$180.10 ,$234.57 ,$178.06 , N/A ,$205.90 , N/A ,$260.63 ,$260.63 , N/A ,$260.63 ,$187.65 ,$161.59 ,$187.65 ,$187.65 ,$208.50 
ST NICHOLAS HOSPITAL - ACUTE,74000082,95700,HC EEG CONT RECORDING W/VIDEO ADMIN TECH MINIMUM 8 CHANNELS,740,1 ,"$3,606.40 ","$2,380.22 ",$12.43 ,"$3,606.40 ",$12.43 ,"$2,471.83 ","$2,471.83 ",$141.94 ,"$2,163.84 ","$3,065.44 ","$2,524.48 ",$12.43 ,$12.43 ,"$3,426.08 ","$2,740.86 ","$2,704.80 ","$2,344.16 ","$3,065.44 ",$141.94 ,"$2,344.16 ","$2,344.16 ","$2,524.48 ","$2,196.30 ",$12.43 ,$141.94 ,$139.10 ,$283.88 ,$13.18 ,"$3,065.44 ",$319.36 ,"$3,317.89 ","$2,524.48 ","$1,829.17 ","$2,195.22 ","$2,196.30 ","$2,195.22 ","$2,492.02 ","$3,245.76 ","$2,463.89 ",$140.49 ,"$2,849.06 ",$13.18 ,$462.00 ,$462.00 ,$139.10 ,$462.00 ,"$2,596.61 ","$2,235.97 ","$2,596.61 ","$2,596.61 ","$2,885.12 "
ST NICHOLAS HOSPITAL - ACUTE,74000083,95705,HC EEG W/O VIDEO BY TECH 2-12 HOURS UNMONITORED,740,1 ,"$3,477.60 ","$2,295.22 ",$12.43 ,"$3,477.60 ",$12.43 ,"$2,383.55 ","$2,383.55 ",$141.94 ,"$2,086.56 ","$2,955.96 ","$2,434.32 ",$12.43 ,$12.43 ,"$3,303.72 ","$2,642.98 ","$2,608.20 ","$2,260.44 ","$2,955.96 ",$141.94 ,"$2,260.44 ","$2,260.44 ","$2,434.32 ","$2,117.86 ",$12.43 ,$141.94 ,$139.10 ,$283.88 ,$13.18 ,"$2,955.96 ",$319.36 ,"$3,199.39 ","$2,434.32 ","$1,763.84 ","$2,116.82 ","$2,117.86 ","$2,116.82 ","$2,403.02 ","$3,129.84 ","$2,375.90 ",$140.49 ,"$2,747.30 ",$13.18 ,$462.00 ,$462.00 ,$139.10 ,$462.00 ,"$2,503.87 ","$2,156.11 ","$2,503.87 ","$2,503.87 ","$2,782.08 "
ST NICHOLAS HOSPITAL - ACUTE,74000084,95706,HC EEG W/O VIDEO BY TECH 2-12 HOURS W/INTERMITTENT MONITORING,740,1 ,"$3,864.00 ","$2,550.24 ",$12.43 ,"$3,864.00 ",$12.43 ,"$2,648.39 ","$2,648.39 ",$273.34 ,"$2,318.40 ","$3,284.40 ","$2,704.80 ",$12.43 ,$12.43 ,"$3,670.80 ","$2,936.64 ","$2,898.00 ","$2,511.60 ","$3,284.40 ",$273.34 ,"$2,511.60 ","$2,511.60 ","$2,704.80 ","$2,353.18 ",$12.43 ,$273.34 ,$267.87 ,$546.68 ,$13.18 ,"$3,284.40 ",$615.01 ,"$3,554.88 ","$2,704.80 ","$1,959.82 ","$2,352.02 ","$2,353.18 ","$2,352.02 ","$2,670.02 ","$3,477.60 ","$2,639.88 ",$270.55 ,"$3,052.56 ",$13.18 ,$462.00 ,$462.00 ,$267.87 ,$462.00 ,"$2,782.08 ","$2,395.68 ","$2,782.08 ","$2,782.08 ","$3,091.20 "
ST NICHOLAS HOSPITAL - ACUTE,74000085,95707,HC EEG W/O VIDEO BY TECH 2-12 HOURS W/CONTINUOUS REAL-TIME MONITORING,740,1 ,"$4,508.00 ","$2,975.28 ",$12.43 ,"$4,508.00 ",$12.43 ,"$3,089.78 ","$3,089.78 ",$273.34 ,"$2,704.80 ","$3,831.80 ","$3,155.60 ",$12.43 ,$12.43 ,"$4,282.60 ","$3,426.08 ","$3,381.00 ","$2,930.20 ","$3,831.80 ",$273.34 ,"$2,930.20 ","$2,930.20 ","$3,155.60 ","$2,745.37 ",$12.43 ,$273.34 ,$267.87 ,$546.68 ,$13.18 ,"$3,831.80 ",$615.01 ,"$4,147.36 ","$3,155.60 ","$2,286.46 ","$2,744.02 ","$2,745.37 ","$2,744.02 ","$3,115.03 ","$4,057.20 ","$3,079.87 ",$270.55 ,"$3,561.32 ",$13.18 ,$462.00 ,$462.00 ,$267.87 ,$462.00 ,"$3,245.76 ","$2,794.96 ","$3,245.76 ","$3,245.76 ","$3,606.40 "
ST NICHOLAS HOSPITAL - ACUTE,74000086,95708,HC EEG W/O VIDEO BY TECH 12-26 HOURS EACH INCREMENT UNMONITORED,740,1 ,"$6,440.00 ","$4,250.40 ",$16.13 ,"$6,440.00 ",$16.13 ,"$4,413.98 ","$4,413.98 ",$471.83 ,"$3,864.00 ","$5,474.00 ","$4,508.00 ",$16.13 ,$16.13 ,"$6,118.00 ","$4,894.40 ","$4,830.00 ","$4,186.00 ","$5,474.00 ",$471.83 ,"$4,186.00 ","$4,186.00 ","$4,508.00 ","$3,921.96 ",$16.13 ,$471.83 ,$462.39 ,$943.66 ,$17.10 ,"$5,474.00 ","$1,061.61 ","$5,924.80 ","$4,508.00 ","$3,266.37 ","$3,920.03 ","$3,921.96 ","$3,920.03 ","$4,450.04 ","$5,796.00 ","$4,399.81 ",$467.02 ,"$5,087.60 ",$17.10 ,$462.00 ,$462.00 ,$462.39 ,$462.00 ,"$4,636.80 ","$3,992.80 ","$4,636.80 ","$4,636.80 ","$5,152.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000087,95709,HC EEG W/O VIDEO BY TECH 12-26 HOURS EACH INCREMENT W/INTERMITTENT MONITORING,740,1 ,"$6,826.40 ","$4,505.42 ",$16.13 ,"$6,826.40 ",$16.13 ,"$4,678.81 ","$4,678.81 ",$471.83 ,"$4,095.84 ","$5,802.44 ","$4,778.48 ",$16.13 ,$16.13 ,"$6,485.08 ","$5,188.06 ","$5,119.80 ","$4,437.16 ","$5,802.44 ",$471.83 ,"$4,437.16 ","$4,437.16 ","$4,778.48 ","$4,157.28 ",$16.13 ,$471.83 ,$462.39 ,$943.66 ,$17.10 ,"$5,802.44 ","$1,061.61 ","$6,280.29 ","$4,778.48 ","$3,462.35 ","$4,155.23 ","$4,157.28 ","$4,155.23 ","$4,717.04 ","$6,143.76 ","$4,663.80 ",$467.02 ,"$5,392.86 ",$17.10 ,$462.00 ,$462.00 ,$462.39 ,$462.00 ,"$4,915.01 ","$4,232.37 ","$4,915.01 ","$4,915.01 ","$5,461.12 "
ST NICHOLAS HOSPITAL - ACUTE,74000089,95711,HC VEEG W/VIDEO BY TECH 2-12 HOURS UNMONITORED,740,1 ,"$3,477.60 ","$2,295.22 ",$12.43 ,"$3,477.60 ",$12.43 ,"$2,383.55 ","$2,383.55 ",$273.34 ,"$2,086.56 ","$2,955.96 ","$2,434.32 ",$12.43 ,$12.43 ,"$3,303.72 ","$2,642.98 ","$2,608.20 ","$2,260.44 ","$2,955.96 ",$273.34 ,"$2,260.44 ","$2,260.44 ","$2,434.32 ","$2,117.86 ",$12.43 ,$273.34 ,$267.87 ,$546.68 ,$13.18 ,"$2,955.96 ",$615.01 ,"$3,199.39 ","$2,434.32 ","$1,763.84 ","$2,116.82 ","$2,117.86 ","$2,116.82 ","$2,403.02 ","$3,129.84 ","$2,375.90 ",$270.55 ,"$2,747.30 ",$13.18 ,$462.00 ,$462.00 ,$267.87 ,$462.00 ,"$2,503.87 ","$2,156.11 ","$2,503.87 ","$2,503.87 ","$2,782.08 "
ST NICHOLAS HOSPITAL - ACUTE,74000090,95712,HC VEEG W/VIDEO BY TECH 2-12 HOURS W/INTERMITTENT MONITORING,740,1 ,"$3,864.00 ","$2,550.24 ",$12.43 ,"$3,864.00 ",$12.43 ,"$2,648.39 ","$2,648.39 ",$273.34 ,"$2,318.40 ","$3,284.40 ","$2,704.80 ",$12.43 ,$12.43 ,"$3,670.80 ","$2,936.64 ","$2,898.00 ","$2,511.60 ","$3,284.40 ",$273.34 ,"$2,511.60 ","$2,511.60 ","$2,704.80 ","$2,353.18 ",$12.43 ,$273.34 ,$267.87 ,$546.68 ,$13.18 ,"$3,284.40 ",$615.01 ,"$3,554.88 ","$2,704.80 ","$1,959.82 ","$2,352.02 ","$2,353.18 ","$2,352.02 ","$2,670.02 ","$3,477.60 ","$2,639.88 ",$270.55 ,"$3,052.56 ",$13.18 ,$462.00 ,$462.00 ,$267.87 ,$462.00 ,"$2,782.08 ","$2,395.68 ","$2,782.08 ","$2,782.08 ","$3,091.20 "
ST NICHOLAS HOSPITAL - ACUTE,74000091,95713,HC VEEG W/VIDEO BY TECH 2-12 HOURS W/CONTINUOUS REAL-TIME MONITORING,740,1 ,"$4,508.00 ","$2,975.28 ",$12.43 ,"$4,508.00 ",$12.43 ,"$3,089.78 ","$3,089.78 ",$471.83 ,"$2,704.80 ","$3,831.80 ","$3,155.60 ",$12.43 ,$12.43 ,"$4,282.60 ","$3,426.08 ","$3,381.00 ","$2,930.20 ","$3,831.80 ",$471.83 ,"$2,930.20 ","$2,930.20 ","$3,155.60 ","$2,745.37 ",$12.43 ,$471.83 ,$462.39 ,$943.66 ,$13.18 ,"$3,831.80 ","$1,061.61 ","$4,147.36 ","$3,155.60 ","$2,286.46 ","$2,744.02 ","$2,745.37 ","$2,744.02 ","$3,115.03 ","$4,057.20 ","$3,079.87 ",$467.02 ,"$3,561.32 ",$13.18 ,$462.00 ,$462.00 ,$462.39 ,$462.00 ,"$3,245.76 ","$2,794.96 ","$3,245.76 ","$3,245.76 ","$3,606.40 "
ST NICHOLAS HOSPITAL - ACUTE,74000092,95714,HC VEEG W/VIDEO BY TECH 12-26 HOURS EACH INCREMENT UNMONITORED,740,1 ,"$6,440.00 ","$4,250.40 ",$16.13 ,"$6,440.00 ",$16.13 ,"$4,413.98 ","$4,413.98 ",$471.83 ,"$3,864.00 ","$5,474.00 ","$4,508.00 ",$16.13 ,$16.13 ,"$6,118.00 ","$4,894.40 ","$4,830.00 ","$4,186.00 ","$5,474.00 ",$471.83 ,"$4,186.00 ","$4,186.00 ","$4,508.00 ","$3,921.96 ",$16.13 ,$471.83 ,$462.39 ,$943.66 ,$17.10 ,"$5,474.00 ","$1,061.61 ","$5,924.80 ","$4,508.00 ","$3,266.37 ","$3,920.03 ","$3,921.96 ","$3,920.03 ","$4,450.04 ","$5,796.00 ","$4,399.81 ",$467.02 ,"$5,087.60 ",$17.10 ,$462.00 ,$462.00 ,$462.39 ,$462.00 ,"$4,636.80 ","$3,992.80 ","$4,636.80 ","$4,636.80 ","$5,152.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000093,95715,HC VEEG W/VIDEO BY TECH 12-26 HOURS EACH INCREMENT W/INTERMITTENT MONITORING,740,1 ,"$6,826.40 ","$4,505.42 ",$16.13 ,"$6,826.40 ",$16.13 ,"$4,678.81 ","$4,678.81 ",$471.83 ,"$4,095.84 ","$5,802.44 ","$4,778.48 ",$16.13 ,$16.13 ,"$6,485.08 ","$5,188.06 ","$5,119.80 ","$4,437.16 ","$5,802.44 ",$471.83 ,"$4,437.16 ","$4,437.16 ","$4,778.48 ","$4,157.28 ",$16.13 ,$471.83 ,$462.39 ,$943.66 ,$17.10 ,"$5,802.44 ","$1,061.61 ","$6,280.29 ","$4,778.48 ","$3,462.35 ","$4,155.23 ","$4,157.28 ","$4,155.23 ","$4,717.04 ","$6,143.76 ","$4,663.80 ",$467.02 ,"$5,392.86 ",$17.10 ,$462.00 ,$462.00 ,$462.39 ,$462.00 ,"$4,915.01 ","$4,232.37 ","$4,915.01 ","$4,915.01 ","$5,461.12 "
ST NICHOLAS HOSPITAL - ACUTE,74000095,95800,HC SLP STDY UNATTENDED,740,1 ,$435.33 ,$287.32 ,$5.00 ,$435.33 ,$5.00 ,$435.33 ,$435.33 ,$141.94 ,$261.20 ,$370.03 ,$304.73 ,$5.00 ,$5.00 ,$413.56 ,$330.85 ,$326.50 ,$282.96 ,$370.03 ,$141.94 ,$282.96 ,$282.96 ,$304.73 ,$265.12 ,$5.00 ,$141.94 ,$139.10 ,$283.88 ,$5.30 ,$370.03 ,$319.36 ,$400.50 ,$304.73 ,$220.80 ,$264.99 ,$265.12 ,$264.99 ,$300.81 ,$391.80 ,$297.42 ,$140.49 ,$343.91 ,$5.30 ,$435.33 ,$435.33 ,$139.10 ,$435.33 ,$313.44 ,$269.90 ,$313.44 ,$313.44 ,$348.26 
ST NICHOLAS HOSPITAL - ACUTE,74000096,G0400,HC SLEEP STUDY UNATTENDED WATCHPAT,740,1 ,$675.93 ,$446.11 ,$5.00 ,$675.93 ,$5.00 ,$675.93 ,$675.93 ,$273.34 ,$405.56 ,$574.54 ,$473.15 ,$5.00 ,$5.00 ,$642.13 ,$513.71 ,$506.95 ,$439.35 ,$574.54 ,$273.34 ,$439.35 ,$439.35 ,$473.15 ,$411.64 ,$5.00 ,$273.34 ,$267.87 ,$546.68 ,$5.30 ,$574.54 ,$615.01 ,$621.86 ,$473.15 ,$342.83 ,$411.44 ,$411.64 ,$411.44 ,$467.07 ,$608.34 ,$461.80 ,$270.55 ,$533.98 ,$5.30 ,$675.93 ,$675.93 ,$267.87 ,$675.93 ,$486.67 ,$419.08 ,$486.67 ,$486.67 ,$540.74 
ST NICHOLAS HOSPITAL - ACUTE,75000001,N/A,HC COLONOSCOPY,750,1 ,"$3,672.90 ","$2,424.11 ","$1,862.89 ","$3,672.90 ", N/A , N/A , N/A , N/A ,"$2,203.74 ","$3,121.97 ","$2,571.03 ", N/A , N/A ,"$3,489.26 ","$2,791.40 ","$2,754.68 ", N/A ,"$3,121.97 ", N/A , N/A , N/A ,"$2,571.03 ","$2,236.80 ", N/A , N/A , N/A , N/A , N/A ,"$3,121.97 ", N/A ,"$3,379.07 ","$2,571.03 ","$1,862.89 ","$2,235.69 ","$2,236.80 ","$2,235.69 ","$2,537.97 ","$3,305.61 ","$2,509.33 ", N/A ,"$2,901.59 ", N/A , N/A , N/A , N/A , N/A ,"$2,644.49 ","$2,277.20 ","$2,644.49 ","$2,644.49 ","$2,938.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000002,N/A,HC COLONOSCOPY W/BX,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000003,N/A,HC COLONOSCOPY W/ SNARE,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000004,N/A,HC COLONOSCOPY W HOT BX,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000005,N/A,HC COLONOSCOPY W/CONTROL BLEEDING OR ERBE,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000007,N/A,HC COLONOSCOPY W/ REMOVAL FB,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000008,N/A,HC COLONOSCOPY W/ BALLOON DILATION,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000009,N/A,HC COLONOSCOPY/DECOMP,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000010,N/A,HC COLONOSCOPY W/STENT,750,1 ,"$6,455.40 ","$4,260.56 ","$3,274.18 ","$6,455.40 ", N/A , N/A , N/A , N/A ,"$3,873.24 ","$5,487.09 ","$4,518.78 ", N/A , N/A ,"$6,132.63 ","$4,906.10 ","$4,841.55 ", N/A ,"$5,487.09 ", N/A , N/A , N/A ,"$4,518.78 ","$3,931.34 ", N/A , N/A , N/A , N/A , N/A ,"$5,487.09 ", N/A ,"$5,938.97 ","$4,518.78 ","$3,274.18 ","$3,929.40 ","$3,931.34 ","$3,929.40 ","$4,460.68 ","$5,809.86 ","$4,410.33 ", N/A ,"$5,099.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,647.89 ","$4,002.35 ","$4,647.89 ","$4,647.89 ","$5,164.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000011,N/A,HC COLONOSCOPY W/ SUBMUCOSAL INJ,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000013,N/A,HC CAPSULE ENDOSCOPY,750,1 ,"$3,227.70 ","$2,130.28 ","$1,637.09 ","$3,227.70 ", N/A , N/A , N/A , N/A ,"$1,936.62 ","$2,743.55 ","$2,259.39 ", N/A , N/A ,"$3,066.32 ","$2,453.05 ","$2,420.78 ", N/A ,"$2,743.55 ", N/A , N/A , N/A ,"$2,259.39 ","$1,965.67 ", N/A , N/A , N/A , N/A , N/A ,"$2,743.55 ", N/A ,"$2,969.48 ","$2,259.39 ","$1,637.09 ","$1,964.70 ","$1,965.67 ","$1,964.70 ","$2,230.34 ","$2,904.93 ","$2,205.16 ", N/A ,"$2,549.88 ", N/A , N/A , N/A , N/A , N/A ,"$2,323.94 ","$2,001.17 ","$2,323.94 ","$2,323.94 ","$2,582.16 "
ST NICHOLAS HOSPITAL - ACUTE,75000014,N/A,HC EGD,750,1 ,"$3,450.30 ","$2,277.20 ","$1,749.99 ","$3,450.30 ", N/A , N/A , N/A , N/A ,"$2,070.18 ","$2,932.76 ","$2,415.21 ", N/A , N/A ,"$3,277.79 ","$2,622.23 ","$2,587.73 ", N/A ,"$2,932.76 ", N/A , N/A , N/A ,"$2,415.21 ","$2,101.23 ", N/A , N/A , N/A , N/A , N/A ,"$2,932.76 ", N/A ,"$3,174.28 ","$2,415.21 ","$1,749.99 ","$2,100.20 ","$2,101.23 ","$2,100.20 ","$2,384.16 ","$3,105.27 ","$2,357.25 ", N/A ,"$2,725.74 ", N/A , N/A , N/A , N/A , N/A ,"$2,484.22 ","$2,139.19 ","$2,484.22 ","$2,484.22 ","$2,760.24 "
ST NICHOLAS HOSPITAL - ACUTE,75000015,N/A,HC EGD/BIOPSY,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000016,N/A,HC EGD/ERBE,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000017,N/A,HC EGD/HEMOSTASIS,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000018,N/A,HC EGD/BANDING,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000019,N/A,HC EGD W/DILAT ESOPH BALLOON,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000020,N/A,HC EGD/FB REMOVAL,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000021,N/A,HC EGD/PEG PLACEMENT,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000022,N/A,HC EGD W/DILAT ESOPH GD WIRE,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000023,N/A,HC EGD/HOT BX,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000024,N/A,HC EGD/PYLORIC DILATION,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000025,N/A,HC EGD/SCLEROTHERAPY,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000026,N/A,HC EGD/SNARE,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000028,N/A,HC EGD/STENT,750,1 ,"$6,455.40 ","$4,260.56 ","$3,274.18 ","$6,455.40 ", N/A , N/A , N/A , N/A ,"$3,873.24 ","$5,487.09 ","$4,518.78 ", N/A , N/A ,"$6,132.63 ","$4,906.10 ","$4,841.55 ", N/A ,"$5,487.09 ", N/A , N/A , N/A ,"$4,518.78 ","$3,931.34 ", N/A , N/A , N/A , N/A , N/A ,"$5,487.09 ", N/A ,"$5,938.97 ","$4,518.78 ","$3,274.18 ","$3,929.40 ","$3,931.34 ","$3,929.40 ","$4,460.68 ","$5,809.86 ","$4,410.33 ", N/A ,"$5,099.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,647.89 ","$4,002.35 ","$4,647.89 ","$4,647.89 ","$5,164.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000029,N/A,HC ENTEROSCOPY BALLOON,750,1 ,"$4,006.80 ","$2,644.49 ","$2,032.25 ","$4,006.80 ", N/A , N/A , N/A , N/A ,"$2,404.08 ","$3,405.78 ","$2,804.76 ", N/A , N/A ,"$3,806.46 ","$3,045.17 ","$3,005.10 ", N/A ,"$3,405.78 ", N/A , N/A , N/A ,"$2,804.76 ","$2,440.14 ", N/A , N/A , N/A , N/A , N/A ,"$3,405.78 ", N/A ,"$3,686.26 ","$2,804.76 ","$2,032.25 ","$2,438.94 ","$2,440.14 ","$2,438.94 ","$2,768.70 ","$3,606.12 ","$2,737.45 ", N/A ,"$3,165.37 ", N/A , N/A , N/A , N/A , N/A ,"$2,884.90 ","$2,484.22 ","$2,884.90 ","$2,884.90 ","$3,205.44 "
ST NICHOLAS HOSPITAL - ACUTE,75000030,N/A,HC ENTEROSCOPY BALLOON/HEMOSTASIS,750,1 ,"$4,006.80 ","$2,644.49 ","$2,032.25 ","$4,006.80 ", N/A , N/A , N/A , N/A ,"$2,404.08 ","$3,405.78 ","$2,804.76 ", N/A , N/A ,"$3,806.46 ","$3,045.17 ","$3,005.10 ", N/A ,"$3,405.78 ", N/A , N/A , N/A ,"$2,804.76 ","$2,440.14 ", N/A , N/A , N/A , N/A , N/A ,"$3,405.78 ", N/A ,"$3,686.26 ","$2,804.76 ","$2,032.25 ","$2,438.94 ","$2,440.14 ","$2,438.94 ","$2,768.70 ","$3,606.12 ","$2,737.45 ", N/A ,"$3,165.37 ", N/A , N/A , N/A , N/A , N/A ,"$2,884.90 ","$2,484.22 ","$2,884.90 ","$2,884.90 ","$3,205.44 "
ST NICHOLAS HOSPITAL - ACUTE,75000031,N/A,HC BRAVO PH STUDY,750,1 ,"$1,892.10 ","$1,248.79 ",$959.67 ,"$1,892.10 ", N/A , N/A , N/A , N/A ,"$1,135.26 ","$1,608.29 ","$1,324.47 ", N/A , N/A ,"$1,797.50 ","$1,438.00 ","$1,419.08 ", N/A ,"$1,608.29 ", N/A , N/A , N/A ,"$1,324.47 ","$1,152.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,608.29 ", N/A ,"$1,740.73 ","$1,324.47 ",$959.67 ,"$1,151.72 ","$1,152.29 ","$1,151.72 ","$1,307.44 ","$1,702.89 ","$1,292.68 ", N/A ,"$1,494.76 ", N/A , N/A , N/A , N/A , N/A ,"$1,362.31 ","$1,173.10 ","$1,362.31 ","$1,362.31 ","$1,513.68 "
ST NICHOLAS HOSPITAL - ACUTE,75000032,N/A,HC HEMORRHOID BAND WITH SCOPE,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000033,N/A,HC STOMA COLONOSCOPY,750,1 ,"$3,672.90 ","$2,424.11 ","$1,862.89 ","$3,672.90 ", N/A , N/A , N/A , N/A ,"$2,203.74 ","$3,121.97 ","$2,571.03 ", N/A , N/A ,"$3,489.26 ","$2,791.40 ","$2,754.68 ", N/A ,"$3,121.97 ", N/A , N/A , N/A ,"$2,571.03 ","$2,236.80 ", N/A , N/A , N/A , N/A , N/A ,"$3,121.97 ", N/A ,"$3,379.07 ","$2,571.03 ","$1,862.89 ","$2,235.69 ","$2,236.80 ","$2,235.69 ","$2,537.97 ","$3,305.61 ","$2,509.33 ", N/A ,"$2,901.59 ", N/A , N/A , N/A , N/A , N/A ,"$2,644.49 ","$2,277.20 ","$2,644.49 ","$2,644.49 ","$2,938.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000034,N/A,HC STOMA COLONOSCOPY W/ HOT BX,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000035,N/A,HC STOMA COLONOSCOPY W/ SNARE,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000036,N/A,HC STOMA COLONOSCOPY W/BX,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000037,N/A,HC STOMA COLONOSCOPY W/ HEMOSTASIS,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000038,N/A,HC EGD/EMR,750,1 ,"$2,337.30 ","$1,542.62 ","$1,185.48 ","$2,337.30 ", N/A , N/A , N/A , N/A ,"$1,402.38 ","$1,986.71 ","$1,636.11 ", N/A , N/A ,"$2,220.44 ","$1,776.35 ","$1,752.98 ", N/A ,"$1,986.71 ", N/A , N/A , N/A ,"$1,636.11 ","$1,423.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,986.71 ", N/A ,"$2,150.32 ","$1,636.11 ","$1,185.48 ","$1,422.71 ","$1,423.42 ","$1,422.71 ","$1,615.07 ","$2,103.57 ","$1,596.84 ", N/A ,"$1,846.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.86 ","$1,449.13 ","$1,682.86 ","$1,682.86 ","$1,869.84 "
ST NICHOLAS HOSPITAL - ACUTE,75000039,N/A,HC ENTEROSCOPY,750,1 ,"$3,672.90 ","$2,424.11 ","$1,862.89 ","$3,672.90 ", N/A , N/A , N/A , N/A ,"$2,203.74 ","$3,121.97 ","$2,571.03 ", N/A , N/A ,"$3,489.26 ","$2,791.40 ","$2,754.68 ", N/A ,"$3,121.97 ", N/A , N/A , N/A ,"$2,571.03 ","$2,236.80 ", N/A , N/A , N/A , N/A , N/A ,"$3,121.97 ", N/A ,"$3,379.07 ","$2,571.03 ","$1,862.89 ","$2,235.69 ","$2,236.80 ","$2,235.69 ","$2,537.97 ","$3,305.61 ","$2,509.33 ", N/A ,"$2,901.59 ", N/A , N/A , N/A , N/A , N/A ,"$2,644.49 ","$2,277.20 ","$2,644.49 ","$2,644.49 ","$2,938.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000040,N/A,HC ENTEROSCOPY W/ HOT BX,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000041,N/A,HC ENTEROSCOPY W/HEMOSTATIS,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000042,N/A,HC ENTEROSCOPY W/ BIOPSY,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000043,N/A,HC ENTEROSCOPY W/ ABLATION,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000044,N/A,HC ENTEROSCOPY W/SNARE,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000045,N/A,HC ENTEROSCOPY W/ STENT,750,1 ,"$6,455.40 ","$4,260.56 ","$3,274.18 ","$6,455.40 ", N/A , N/A , N/A , N/A ,"$3,873.24 ","$5,487.09 ","$4,518.78 ", N/A , N/A ,"$6,132.63 ","$4,906.10 ","$4,841.55 ", N/A ,"$5,487.09 ", N/A , N/A , N/A ,"$4,518.78 ","$3,931.34 ", N/A , N/A , N/A , N/A , N/A ,"$5,487.09 ", N/A ,"$5,938.97 ","$4,518.78 ","$3,274.18 ","$3,929.40 ","$3,931.34 ","$3,929.40 ","$4,460.68 ","$5,809.86 ","$4,410.33 ", N/A ,"$5,099.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,647.89 ","$4,002.35 ","$4,647.89 ","$4,647.89 ","$5,164.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000046,N/A,HC ERCP,750,1 ,"$5,342.40 ","$3,525.98 ","$2,709.67 ","$5,342.40 ", N/A , N/A , N/A , N/A ,"$3,205.44 ","$4,541.04 ","$3,739.68 ", N/A , N/A ,"$5,075.28 ","$4,060.22 ","$4,006.80 ", N/A ,"$4,541.04 ", N/A , N/A , N/A ,"$3,739.68 ","$3,253.52 ", N/A , N/A , N/A , N/A , N/A ,"$4,541.04 ", N/A ,"$4,915.01 ","$3,739.68 ","$2,709.67 ","$3,251.92 ","$3,253.52 ","$3,251.92 ","$3,691.60 ","$4,808.16 ","$3,649.93 ", N/A ,"$4,220.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,846.53 ","$3,312.29 ","$3,846.53 ","$3,846.53 ","$4,273.92 "
ST NICHOLAS HOSPITAL - ACUTE,75000047,N/A,HC ERCP W/ STENT PLACEMENT,750,1 ,"$6,455.40 ","$4,260.56 ","$3,274.18 ","$6,455.40 ", N/A , N/A , N/A , N/A ,"$3,873.24 ","$5,487.09 ","$4,518.78 ", N/A , N/A ,"$6,132.63 ","$4,906.10 ","$4,841.55 ", N/A ,"$5,487.09 ", N/A , N/A , N/A ,"$4,518.78 ","$3,931.34 ", N/A , N/A , N/A , N/A , N/A ,"$5,487.09 ", N/A ,"$5,938.97 ","$4,518.78 ","$3,274.18 ","$3,929.40 ","$3,931.34 ","$3,929.40 ","$4,460.68 ","$5,809.86 ","$4,410.33 ", N/A ,"$5,099.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,647.89 ","$4,002.35 ","$4,647.89 ","$4,647.89 ","$5,164.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000048,N/A,HC ERCP W/ FB REMOVAL OR STENT REMOVAL,750,1 ,"$6,455.40 ","$4,260.56 ","$3,274.18 ","$6,455.40 ", N/A , N/A , N/A , N/A ,"$3,873.24 ","$5,487.09 ","$4,518.78 ", N/A , N/A ,"$6,132.63 ","$4,906.10 ","$4,841.55 ", N/A ,"$5,487.09 ", N/A , N/A , N/A ,"$4,518.78 ","$3,931.34 ", N/A , N/A , N/A , N/A , N/A ,"$5,487.09 ", N/A ,"$5,938.97 ","$4,518.78 ","$3,274.18 ","$3,929.40 ","$3,931.34 ","$3,929.40 ","$4,460.68 ","$5,809.86 ","$4,410.33 ", N/A ,"$5,099.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,647.89 ","$4,002.35 ","$4,647.89 ","$4,647.89 ","$5,164.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000049,N/A,HC ERCP W/ BALLOON DILATION,750,1 ,"$5,342.40 ","$3,525.98 ","$2,709.67 ","$5,342.40 ", N/A , N/A , N/A , N/A ,"$3,205.44 ","$4,541.04 ","$3,739.68 ", N/A , N/A ,"$5,075.28 ","$4,060.22 ","$4,006.80 ", N/A ,"$4,541.04 ", N/A , N/A , N/A ,"$3,739.68 ","$3,253.52 ", N/A , N/A , N/A , N/A , N/A ,"$4,541.04 ", N/A ,"$4,915.01 ","$3,739.68 ","$2,709.67 ","$3,251.92 ","$3,253.52 ","$3,251.92 ","$3,691.60 ","$4,808.16 ","$3,649.93 ", N/A ,"$4,220.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,846.53 ","$3,312.29 ","$3,846.53 ","$3,846.53 ","$4,273.92 "
ST NICHOLAS HOSPITAL - ACUTE,75000050,N/A,HC ERCP W/ BIOPSY,750,1 ,"$5,342.40 ","$3,525.98 ","$2,709.67 ","$5,342.40 ", N/A , N/A , N/A , N/A ,"$3,205.44 ","$4,541.04 ","$3,739.68 ", N/A , N/A ,"$5,075.28 ","$4,060.22 ","$4,006.80 ", N/A ,"$4,541.04 ", N/A , N/A , N/A ,"$3,739.68 ","$3,253.52 ", N/A , N/A , N/A , N/A , N/A ,"$4,541.04 ", N/A ,"$4,915.01 ","$3,739.68 ","$2,709.67 ","$3,251.92 ","$3,253.52 ","$3,251.92 ","$3,691.60 ","$4,808.16 ","$3,649.93 ", N/A ,"$4,220.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,846.53 ","$3,312.29 ","$3,846.53 ","$3,846.53 ","$4,273.92 "
ST NICHOLAS HOSPITAL - ACUTE,75000051,N/A,HC ERCP W/LITHOTRIPSY,750,1 ,"$5,342.40 ","$3,525.98 ","$2,709.67 ","$5,342.40 ", N/A , N/A , N/A , N/A ,"$3,205.44 ","$4,541.04 ","$3,739.68 ", N/A , N/A ,"$5,075.28 ","$4,060.22 ","$4,006.80 ", N/A ,"$4,541.04 ", N/A , N/A , N/A ,"$3,739.68 ","$3,253.52 ", N/A , N/A , N/A , N/A , N/A ,"$4,541.04 ", N/A ,"$4,915.01 ","$3,739.68 ","$2,709.67 ","$3,251.92 ","$3,253.52 ","$3,251.92 ","$3,691.60 ","$4,808.16 ","$3,649.93 ", N/A ,"$4,220.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,846.53 ","$3,312.29 ","$3,846.53 ","$3,846.53 ","$4,273.92 "
ST NICHOLAS HOSPITAL - ACUTE,75000052,N/A,HC ERCP W/ SPHINCTEROTOMY,750,1 ,"$5,342.40 ","$3,525.98 ","$2,709.67 ","$5,342.40 ", N/A , N/A , N/A , N/A ,"$3,205.44 ","$4,541.04 ","$3,739.68 ", N/A , N/A ,"$5,075.28 ","$4,060.22 ","$4,006.80 ", N/A ,"$4,541.04 ", N/A , N/A , N/A ,"$3,739.68 ","$3,253.52 ", N/A , N/A , N/A , N/A , N/A ,"$4,541.04 ", N/A ,"$4,915.01 ","$3,739.68 ","$2,709.67 ","$3,251.92 ","$3,253.52 ","$3,251.92 ","$3,691.60 ","$4,808.16 ","$3,649.93 ", N/A ,"$4,220.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,846.53 ","$3,312.29 ","$3,846.53 ","$3,846.53 ","$4,273.92 "
ST NICHOLAS HOSPITAL - ACUTE,75000053,N/A,HC ERCP W/ STONE REMOVAL,750,1 ,"$5,342.40 ","$3,525.98 ","$2,709.67 ","$5,342.40 ", N/A , N/A , N/A , N/A ,"$3,205.44 ","$4,541.04 ","$3,739.68 ", N/A , N/A ,"$5,075.28 ","$4,060.22 ","$4,006.80 ", N/A ,"$4,541.04 ", N/A , N/A , N/A ,"$3,739.68 ","$3,253.52 ", N/A , N/A , N/A , N/A , N/A ,"$4,541.04 ", N/A ,"$4,915.01 ","$3,739.68 ","$2,709.67 ","$3,251.92 ","$3,253.52 ","$3,251.92 ","$3,691.60 ","$4,808.16 ","$3,649.93 ", N/A ,"$4,220.50 ", N/A , N/A , N/A , N/A , N/A ,"$3,846.53 ","$3,312.29 ","$3,846.53 ","$3,846.53 ","$4,273.92 "
ST NICHOLAS HOSPITAL - ACUTE,75000055,N/A,HC ESOPHAGOSCOPY,750,1 ,"$3,339.00 ","$2,203.74 ","$1,693.54 ","$3,339.00 ", N/A , N/A , N/A , N/A ,"$2,003.40 ","$2,838.15 ","$2,337.30 ", N/A , N/A ,"$3,172.05 ","$2,537.64 ","$2,504.25 ", N/A ,"$2,838.15 ", N/A , N/A , N/A ,"$2,337.30 ","$2,033.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,838.15 ", N/A ,"$3,071.88 ","$2,337.30 ","$1,693.54 ","$2,032.45 ","$2,033.45 ","$2,032.45 ","$2,307.25 ","$3,005.10 ","$2,281.20 ", N/A ,"$2,637.81 ", N/A , N/A , N/A , N/A , N/A ,"$2,404.08 ","$2,070.18 ","$2,404.08 ","$2,404.08 ","$2,671.20 "
ST NICHOLAS HOSPITAL - ACUTE,75000056,N/A,HC ESOPHAGOSCOPY 360 ABLATION HALO,750,1 ,"$5,231.10 ","$3,452.53 ","$2,653.21 ","$5,231.10 ", N/A , N/A , N/A , N/A ,"$3,138.66 ","$4,446.44 ","$3,661.77 ", N/A , N/A ,"$4,969.55 ","$3,975.64 ","$3,923.33 ", N/A ,"$4,446.44 ", N/A , N/A , N/A ,"$3,661.77 ","$3,185.74 ", N/A , N/A , N/A , N/A , N/A ,"$4,446.44 ", N/A ,"$4,812.61 ","$3,661.77 ","$2,653.21 ","$3,184.17 ","$3,185.74 ","$3,184.17 ","$3,614.69 ","$4,707.99 ","$3,573.89 ", N/A ,"$4,132.57 ", N/A , N/A , N/A , N/A , N/A ,"$3,766.39 ","$3,243.28 ","$3,766.39 ","$3,766.39 ","$4,184.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000057,N/A,HC ESOPHAGOSCOPY 90 ABLATION HALO,750,1 ,"$5,231.10 ","$3,452.53 ","$2,653.21 ","$5,231.10 ", N/A , N/A , N/A , N/A ,"$3,138.66 ","$4,446.44 ","$3,661.77 ", N/A , N/A ,"$4,969.55 ","$3,975.64 ","$3,923.33 ", N/A ,"$4,446.44 ", N/A , N/A , N/A ,"$3,661.77 ","$3,185.74 ", N/A , N/A , N/A , N/A , N/A ,"$4,446.44 ", N/A ,"$4,812.61 ","$3,661.77 ","$2,653.21 ","$3,184.17 ","$3,185.74 ","$3,184.17 ","$3,614.69 ","$4,707.99 ","$3,573.89 ", N/A ,"$4,132.57 ", N/A , N/A , N/A , N/A , N/A ,"$3,766.39 ","$3,243.28 ","$3,766.39 ","$3,766.39 ","$4,184.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000058,N/A,HC ENDOSCOPIC ULTRASOUND,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000059,N/A,HC ESOPHAGOSCOPY W/ FB REMOVAL,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000060,N/A,HC ESOPHAGOSCOPY W/ STENT PLACEMENT,750,1 ,"$6,455.40 ","$4,260.56 ","$3,274.18 ","$6,455.40 ", N/A , N/A , N/A , N/A ,"$3,873.24 ","$5,487.09 ","$4,518.78 ", N/A , N/A ,"$6,132.63 ","$4,906.10 ","$4,841.55 ", N/A ,"$5,487.09 ", N/A , N/A , N/A ,"$4,518.78 ","$3,931.34 ", N/A , N/A , N/A , N/A , N/A ,"$5,487.09 ", N/A ,"$5,938.97 ","$4,518.78 ","$3,274.18 ","$3,929.40 ","$3,931.34 ","$3,929.40 ","$4,460.68 ","$5,809.86 ","$4,410.33 ", N/A ,"$5,099.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,647.89 ","$4,002.35 ","$4,647.89 ","$4,647.89 ","$5,164.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000061,N/A,HC FISSURE INJECTION,750,1 ,"$2,337.30 ","$1,542.62 ","$1,185.48 ","$2,337.30 ", N/A , N/A , N/A , N/A ,"$1,402.38 ","$1,986.71 ","$1,636.11 ", N/A , N/A ,"$2,220.44 ","$1,776.35 ","$1,752.98 ", N/A ,"$1,986.71 ", N/A , N/A , N/A ,"$1,636.11 ","$1,423.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,986.71 ", N/A ,"$2,150.32 ","$1,636.11 ","$1,185.48 ","$1,422.71 ","$1,423.42 ","$1,422.71 ","$1,615.07 ","$2,103.57 ","$1,596.84 ", N/A ,"$1,846.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.86 ","$1,449.13 ","$1,682.86 ","$1,682.86 ","$1,869.84 "
ST NICHOLAS HOSPITAL - ACUTE,75000063,N/A,HC EUS W/ FNA AND CORE NEEDLE,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000064,N/A,HC EUS W/ FNA AND ECHOTIP,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000066,N/A,HC HYDROGEN BREATH TEST,750,1 ,$634.94 ,$419.06 ,$322.04 ,$634.94 , N/A , N/A , N/A , N/A ,$380.96 ,$539.70 ,$444.46 , N/A , N/A ,$603.19 ,$482.55 ,$476.21 , N/A ,$539.70 , N/A , N/A , N/A ,$444.46 ,$386.68 , N/A , N/A , N/A , N/A , N/A ,$539.70 , N/A ,$584.14 ,$444.46 ,$322.04 ,$386.49 ,$386.68 ,$386.49 ,$438.74 ,$571.45 ,$433.79 , N/A ,$501.60 , N/A , N/A , N/A , N/A , N/A ,$457.16 ,$393.66 ,$457.16 ,$457.16 ,$507.95 
ST NICHOLAS HOSPITAL - ACUTE,75000067,N/A,HC ILEOSCOPY STOMA,750,1 ,"$3,561.60 ","$2,350.66 ","$1,806.44 ","$3,561.60 ", N/A , N/A , N/A , N/A ,"$2,136.96 ","$3,027.36 ","$2,493.12 ", N/A , N/A ,"$3,383.52 ","$2,706.82 ","$2,671.20 ", N/A ,"$3,027.36 ", N/A , N/A , N/A ,"$2,493.12 ","$2,169.01 ", N/A , N/A , N/A , N/A , N/A ,"$3,027.36 ", N/A ,"$3,276.67 ","$2,493.12 ","$1,806.44 ","$2,167.95 ","$2,169.01 ","$2,167.95 ","$2,461.07 ","$3,205.44 ","$2,433.29 ", N/A ,"$2,813.66 ", N/A , N/A , N/A , N/A , N/A ,"$2,564.35 ","$2,208.19 ","$2,564.35 ","$2,564.35 ","$2,849.28 "
ST NICHOLAS HOSPITAL - ACUTE,75000068,N/A,HC ILEOSCOPY STOMA W/ BX,750,1 ,"$4,006.80 ","$2,644.49 ","$2,032.25 ","$4,006.80 ", N/A , N/A , N/A , N/A ,"$2,404.08 ","$3,405.78 ","$2,804.76 ", N/A , N/A ,"$3,806.46 ","$3,045.17 ","$3,005.10 ", N/A ,"$3,405.78 ", N/A , N/A , N/A ,"$2,804.76 ","$2,440.14 ", N/A , N/A , N/A , N/A , N/A ,"$3,405.78 ", N/A ,"$3,686.26 ","$2,804.76 ","$2,032.25 ","$2,438.94 ","$2,440.14 ","$2,438.94 ","$2,768.70 ","$3,606.12 ","$2,737.45 ", N/A ,"$3,165.37 ", N/A , N/A , N/A , N/A , N/A ,"$2,884.90 ","$2,484.22 ","$2,884.90 ","$2,884.90 ","$3,205.44 "
ST NICHOLAS HOSPITAL - ACUTE,75000069,N/A,HC LIVER BIOPSY,750,1 ,"$1,892.10 ","$1,248.79 ",$959.67 ,"$1,892.10 ", N/A , N/A , N/A , N/A ,"$1,135.26 ","$1,608.29 ","$1,324.47 ", N/A , N/A ,"$1,797.50 ","$1,438.00 ","$1,419.08 ", N/A ,"$1,608.29 ", N/A , N/A , N/A ,"$1,324.47 ","$1,152.29 ", N/A , N/A , N/A , N/A , N/A ,"$1,608.29 ", N/A ,"$1,740.73 ","$1,324.47 ",$959.67 ,"$1,151.72 ","$1,152.29 ","$1,151.72 ","$1,307.44 ","$1,702.89 ","$1,292.68 ", N/A ,"$1,494.76 ", N/A , N/A , N/A , N/A , N/A ,"$1,362.31 ","$1,173.10 ","$1,362.31 ","$1,362.31 ","$1,513.68 "
ST NICHOLAS HOSPITAL - ACUTE,75000070,N/A,HC POUCHOSCOPY,750,1 ,"$3,672.90 ","$2,424.11 ","$1,862.89 ","$3,672.90 ", N/A , N/A , N/A , N/A ,"$2,203.74 ","$3,121.97 ","$2,571.03 ", N/A , N/A ,"$3,489.26 ","$2,791.40 ","$2,754.68 ", N/A ,"$3,121.97 ", N/A , N/A , N/A ,"$2,571.03 ","$2,236.80 ", N/A , N/A , N/A , N/A , N/A ,"$3,121.97 ", N/A ,"$3,379.07 ","$2,571.03 ","$1,862.89 ","$2,235.69 ","$2,236.80 ","$2,235.69 ","$2,537.97 ","$3,305.61 ","$2,509.33 ", N/A ,"$2,901.59 ", N/A , N/A , N/A , N/A , N/A ,"$2,644.49 ","$2,277.20 ","$2,644.49 ","$2,644.49 ","$2,938.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000071,N/A,HC POUCHOSCOPY W/BX,750,1 ,"$4,006.80 ","$2,644.49 ","$2,032.25 ","$4,006.80 ", N/A , N/A , N/A , N/A ,"$2,404.08 ","$3,405.78 ","$2,804.76 ", N/A , N/A ,"$3,806.46 ","$3,045.17 ","$3,005.10 ", N/A ,"$3,405.78 ", N/A , N/A , N/A ,"$2,804.76 ","$2,440.14 ", N/A , N/A , N/A , N/A , N/A ,"$3,405.78 ", N/A ,"$3,686.26 ","$2,804.76 ","$2,032.25 ","$2,438.94 ","$2,440.14 ","$2,438.94 ","$2,768.70 ","$3,606.12 ","$2,737.45 ", N/A ,"$3,165.37 ", N/A , N/A , N/A , N/A , N/A ,"$2,884.90 ","$2,484.22 ","$2,884.90 ","$2,884.90 ","$3,205.44 "
ST NICHOLAS HOSPITAL - ACUTE,75000073,N/A,HC SIGMOIDOSCOPY,750,1 ,"$2,114.70 ","$1,395.70 ","$1,072.58 ","$2,114.70 ", N/A , N/A , N/A , N/A ,"$1,268.82 ","$1,797.50 ","$1,480.29 ", N/A , N/A ,"$2,008.97 ","$1,607.17 ","$1,586.03 ", N/A ,"$1,797.50 ", N/A , N/A , N/A ,"$1,480.29 ","$1,287.85 ", N/A , N/A , N/A , N/A , N/A ,"$1,797.50 ", N/A ,"$1,945.52 ","$1,480.29 ","$1,072.58 ","$1,287.22 ","$1,287.85 ","$1,287.22 ","$1,461.26 ","$1,903.23 ","$1,444.76 ", N/A ,"$1,670.61 ", N/A , N/A , N/A , N/A , N/A ,"$1,522.58 ","$1,311.11 ","$1,522.58 ","$1,522.58 ","$1,691.76 "
ST NICHOLAS HOSPITAL - ACUTE,75000074,N/A,HC SIGMOIDOSCOPY W/BX,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000075,N/A,HC SIGMOIDOSCOPY W/ HOT BX,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000076,N/A,HC SIGMOIDOSCOPY  W/ FB REMOVAL,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000077,N/A,HC SIGMOIDOSCOPY  W/ SNARE,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000078,N/A,HC SIGMOIDOSCOPY  W/ HEMOSTASIS,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000079,N/A,HC SIGMOIDOSCOPY  W/ DECOMPRESSION,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000080,N/A,HC SIGMOIDOSCOPY W/ ABLATION,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000081,N/A,HC SIGMOIDOSCOPY SEDATED W/ SUBMUCOSAL INJ,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000082,N/A,HC SIGMOIDOSCOPY SEDATED W/ BALLOON DIL,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000083,N/A,HC SIGMOIDOSCOPY SEDATED W/ STENT,750,1 ,"$6,455.40 ","$4,260.56 ","$3,274.18 ","$6,455.40 ", N/A , N/A , N/A , N/A ,"$3,873.24 ","$5,487.09 ","$4,518.78 ", N/A , N/A ,"$6,132.63 ","$4,906.10 ","$4,841.55 ", N/A ,"$5,487.09 ", N/A , N/A , N/A ,"$4,518.78 ","$3,931.34 ", N/A , N/A , N/A , N/A , N/A ,"$5,487.09 ", N/A ,"$5,938.97 ","$4,518.78 ","$3,274.18 ","$3,929.40 ","$3,931.34 ","$3,929.40 ","$4,460.68 ","$5,809.86 ","$4,410.33 ", N/A ,"$5,099.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,647.89 ","$4,002.35 ","$4,647.89 ","$4,647.89 ","$5,164.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000084,N/A,HC SIGMOIDOSCOPY  W/ ERBE,750,1 ,"$4,118.10 ","$2,717.95 ","$2,088.70 ","$4,118.10 ", N/A , N/A , N/A , N/A ,"$2,470.86 ","$3,500.39 ","$2,882.67 ", N/A , N/A ,"$3,912.20 ","$3,129.76 ","$3,088.58 ", N/A ,"$3,500.39 ", N/A , N/A , N/A ,"$2,882.67 ","$2,507.92 ", N/A , N/A , N/A , N/A , N/A ,"$3,500.39 ", N/A ,"$3,788.65 ","$2,882.67 ","$2,088.70 ","$2,506.69 ","$2,507.92 ","$2,506.69 ","$2,845.61 ","$3,706.29 ","$2,813.49 ", N/A ,"$3,253.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,965.03 ","$2,553.22 ","$2,965.03 ","$2,965.03 ","$3,294.48 "
ST NICHOLAS HOSPITAL - ACUTE,75000085,N/A,HC EUS RECTAL ULTRASOUND,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000092,N/A,HC TATTOOING/ENDOSCOPIC,750,1 ,"$2,003.40 ","$1,322.24 ","$1,016.12 ","$2,003.40 ", N/A , N/A , N/A , N/A ,"$1,202.04 ","$1,702.89 ","$1,402.38 ", N/A , N/A ,"$1,903.23 ","$1,522.58 ","$1,502.55 ", N/A ,"$1,702.89 ", N/A , N/A , N/A ,"$1,402.38 ","$1,220.07 ", N/A , N/A , N/A , N/A , N/A ,"$1,702.89 ", N/A ,"$1,843.13 ","$1,402.38 ","$1,016.12 ","$1,219.47 ","$1,220.07 ","$1,219.47 ","$1,384.35 ","$1,803.06 ","$1,368.72 ", N/A ,"$1,582.69 ", N/A , N/A , N/A , N/A , N/A ,"$1,442.45 ","$1,242.11 ","$1,442.45 ","$1,442.45 ","$1,602.72 "
ST NICHOLAS HOSPITAL - ACUTE,75000093,N/A,HC EGD/ SUBMUCOSAL INJ,750,1 ,"$3,895.50 ","$2,571.03 ","$1,975.80 ","$3,895.50 ", N/A , N/A , N/A , N/A ,"$2,337.30 ","$3,311.18 ","$2,726.85 ", N/A , N/A ,"$3,700.73 ","$2,960.58 ","$2,921.63 ", N/A ,"$3,311.18 ", N/A , N/A , N/A ,"$2,726.85 ","$2,372.36 ", N/A , N/A , N/A , N/A , N/A ,"$3,311.18 ", N/A ,"$3,583.86 ","$2,726.85 ","$1,975.80 ","$2,371.19 ","$2,372.36 ","$2,371.19 ","$2,691.79 ","$3,505.95 ","$2,661.41 ", N/A ,"$3,077.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,804.76 ","$2,415.21 ","$2,804.76 ","$2,804.76 ","$3,116.40 "
ST NICHOLAS HOSPITAL - ACUTE,75000094,N/A,HC PEG TUBE CHANGE,750,1 ,$422.94 ,$279.14 ,$214.52 ,$422.94 , N/A , N/A , N/A , N/A ,$253.76 ,$359.50 ,$296.06 , N/A , N/A ,$401.79 ,$321.43 ,$317.21 , N/A ,$359.50 , N/A , N/A , N/A ,$296.06 ,$257.57 , N/A , N/A , N/A , N/A , N/A ,$359.50 , N/A ,$389.10 ,$296.06 ,$214.52 ,$257.44 ,$257.57 ,$257.44 ,$292.25 ,$380.65 ,$288.95 , N/A ,$334.12 , N/A , N/A , N/A , N/A , N/A ,$304.52 ,$262.22 ,$304.52 ,$304.52 ,$338.35 
ST NICHOLAS HOSPITAL - ACUTE,75000097,91034,HC ACID REFLUX TEST NASAL PH ELEC,750,1 ,$991.30 ,$654.26 ,$16.75 ,"$1,061.61 ",$16.75 ,$991.30 ,$991.30 ,$471.83 ,$594.78 ,$842.61 ,$693.91 ,$16.75 ,$16.75 ,$941.74 ,$753.39 ,$743.48 ,$991.30 ,$842.61 ,$471.83 ,$991.30 ,$991.30 ,$693.91 ,$603.70 ,$16.75 ,$471.83 ,$462.39 ,$943.66 ,$17.76 ,$842.61 ,"$1,061.61 ",$912.00 ,$693.91 ,$502.79 ,$603.40 ,$603.70 ,$603.40 ,$684.99 ,$892.17 ,$677.26 ,$467.02 ,$783.13 ,$17.76 ,$991.30 ,$991.30 ,$462.39 ,$991.30 ,$713.74 ,$614.61 ,$713.74 ,$713.74 ,$793.04 
ST NICHOLAS HOSPITAL - ACUTE,75000098,49083,HC PARACENTESIS W/IMAGING,750,1 ,"$2,070.00 ","$1,366.20 ",$25.31 ,"$2,070.00 ",$25.31 ,"$2,070.00 ","$2,070.00 ",$805.70 ,"$1,242.00 ","$1,759.50 ","$1,449.00 ",$25.31 ,$25.31 ,"$1,966.50 ","$1,573.20 ","$1,552.50 ","$2,070.00 ","$1,759.50 ",$805.70 ,"$2,070.00 ","$2,070.00 ","$1,449.00 ","$1,260.63 ",$25.31 ,$805.70 ,$789.59 ,"$1,611.40 ",$26.83 ,"$1,759.50 ","$1,812.82 ","$1,904.40 ","$1,449.00 ","$1,998.41 ","$2,070.00 ","$1,260.63 ","$2,070.00 ","$1,430.37 ","$1,863.00 ","$1,414.22 ",$797.48 ,"$1,635.30 ",$26.83 ,"$2,070.00 ","$2,070.00 ",$789.59 ,"$2,070.00 ","$1,490.40 ","$1,283.40 ","$1,490.40 ","$1,490.40 ","$1,656.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000102,N/A,HC SECONDARY GI PROC COLONOSCOPY,750,1 ,"$2,337.30 ","$1,542.62 ","$1,185.48 ","$2,337.30 ", N/A , N/A , N/A , N/A ,"$1,402.38 ","$1,986.71 ","$1,636.11 ", N/A , N/A ,"$2,220.44 ","$1,776.35 ","$1,752.98 ", N/A ,"$1,986.71 ", N/A , N/A , N/A ,"$1,636.11 ","$1,423.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,986.71 ", N/A ,"$2,150.32 ","$1,636.11 ","$1,185.48 ","$1,422.71 ","$1,423.42 ","$1,422.71 ","$1,615.07 ","$2,103.57 ","$1,596.84 ", N/A ,"$1,846.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.86 ","$1,449.13 ","$1,682.86 ","$1,682.86 ","$1,869.84 "
ST NICHOLAS HOSPITAL - ACUTE,75000103,N/A,HC SECONDARY GI PROC EGD,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000104,N/A,HC SECONDARY GI PROC ERCP,750,1 ,"$3,005.10 ","$1,983.37 ","$1,524.19 ","$3,005.10 ", N/A , N/A , N/A , N/A ,"$1,803.06 ","$2,554.34 ","$2,103.57 ", N/A , N/A ,"$2,854.85 ","$2,283.88 ","$2,253.83 ", N/A ,"$2,554.34 ", N/A , N/A , N/A ,"$2,103.57 ","$1,830.11 ", N/A , N/A , N/A , N/A , N/A ,"$2,554.34 ", N/A ,"$2,764.69 ","$2,103.57 ","$1,524.19 ","$1,829.20 ","$1,830.11 ","$1,829.20 ","$2,076.52 ","$2,704.59 ","$2,053.08 ", N/A ,"$2,374.03 ", N/A , N/A , N/A , N/A , N/A ,"$2,163.67 ","$1,863.16 ","$2,163.67 ","$2,163.67 ","$2,404.08 "
ST NICHOLAS HOSPITAL - ACUTE,75000105,N/A,HC SECONDARY GI PROC EUS,750,1 ,"$2,448.60 ","$1,616.08 ","$1,241.93 ","$2,448.60 ", N/A , N/A , N/A , N/A ,"$1,469.16 ","$2,081.31 ","$1,714.02 ", N/A , N/A ,"$2,326.17 ","$1,860.94 ","$1,836.45 ", N/A ,"$2,081.31 ", N/A , N/A , N/A ,"$1,714.02 ","$1,491.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,081.31 ", N/A ,"$2,252.71 ","$1,714.02 ","$1,241.93 ","$1,490.46 ","$1,491.20 ","$1,490.46 ","$1,691.98 ","$2,203.74 ","$1,672.88 ", N/A ,"$1,934.39 ", N/A , N/A , N/A , N/A , N/A ,"$1,762.99 ","$1,518.13 ","$1,762.99 ","$1,762.99 ","$1,958.88 "
ST NICHOLAS HOSPITAL - ACUTE,75000106,N/A,HC SECONDARY GI PROC ENTEROSCOPY,750,1 ,"$2,337.30 ","$1,542.62 ","$1,185.48 ","$2,337.30 ", N/A , N/A , N/A , N/A ,"$1,402.38 ","$1,986.71 ","$1,636.11 ", N/A , N/A ,"$2,220.44 ","$1,776.35 ","$1,752.98 ", N/A ,"$1,986.71 ", N/A , N/A , N/A ,"$1,636.11 ","$1,423.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,986.71 ", N/A ,"$2,150.32 ","$1,636.11 ","$1,185.48 ","$1,422.71 ","$1,423.42 ","$1,422.71 ","$1,615.07 ","$2,103.57 ","$1,596.84 ", N/A ,"$1,846.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.86 ","$1,449.13 ","$1,682.86 ","$1,682.86 ","$1,869.84 "
ST NICHOLAS HOSPITAL - ACUTE,75000107,N/A,HC SECONDARY PROCEDURE SIGMOIDOSCOPY,750,1 ,"$2,337.30 ","$1,542.62 ","$1,185.48 ","$2,337.30 ", N/A , N/A , N/A , N/A ,"$1,402.38 ","$1,986.71 ","$1,636.11 ", N/A , N/A ,"$2,220.44 ","$1,776.35 ","$1,752.98 ", N/A ,"$1,986.71 ", N/A , N/A , N/A ,"$1,636.11 ","$1,423.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,986.71 ", N/A ,"$2,150.32 ","$1,636.11 ","$1,185.48 ","$1,422.71 ","$1,423.42 ","$1,422.71 ","$1,615.07 ","$2,103.57 ","$1,596.84 ", N/A ,"$1,846.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.86 ","$1,449.13 ","$1,682.86 ","$1,682.86 ","$1,869.84 "
ST NICHOLAS HOSPITAL - ACUTE,75000114,N/A,HC ERCP W/STENT REPLACEMENT,750,1 ,"$6,455.40 ","$4,260.56 ","$3,274.18 ","$6,455.40 ", N/A , N/A , N/A , N/A ,"$3,873.24 ","$5,487.09 ","$4,518.78 ", N/A , N/A ,"$6,132.63 ","$4,906.10 ","$4,841.55 ", N/A ,"$5,487.09 ", N/A , N/A , N/A ,"$4,518.78 ","$3,931.34 ", N/A , N/A , N/A , N/A , N/A ,"$5,487.09 ", N/A ,"$5,938.97 ","$4,518.78 ","$3,274.18 ","$3,929.40 ","$3,931.34 ","$3,929.40 ","$4,460.68 ","$5,809.86 ","$4,410.33 ", N/A ,"$5,099.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,647.89 ","$4,002.35 ","$4,647.89 ","$4,647.89 ","$5,164.32 "
ST NICHOLAS HOSPITAL - ACUTE,75000115,46999,HC ANOSCOPY/INJECTION SOLESTA,750,1 ,"$2,415.00 ","$1,593.90 ",$51.36 ,"$2,415.00 ",$51.36 ,"$2,415.00 ","$2,415.00 ",$811.10 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$51.36 ,$51.36 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,415.00 ","$2,052.75 ",$811.10 ,"$2,415.00 ","$2,415.00 ","$1,690.50 ","$1,470.74 ",$51.36 ,$811.10 ,$794.88 ,"$1,622.20 ",$54.44 ,"$2,052.75 ","$1,824.96 ","$2,221.80 ","$1,690.50 ","$1,771.14 ","$2,213.66 ","$1,470.74 ","$2,213.66 ","$1,668.77 ","$2,173.50 ","$1,649.93 ",$802.83 ,"$1,907.85 ",$54.44 ,"$2,415.00 ","$2,415.00 ",$794.88 ,"$2,415.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000510,49082,HC PARACENTESIS W/O IMAGING,750,1 ,"$1,265.00 ",$834.90 ,$25.31 ,"$1,812.82 ",$25.31 ,"$1,265.00 ","$1,265.00 ",$805.70 ,$759.00 ,"$1,075.25 ",$885.50 ,$25.31 ,$25.31 ,"$1,201.75 ",$961.40 ,$948.75 ,"$1,265.00 ","$1,075.25 ",$805.70 ,"$1,265.00 ","$1,265.00 ",$885.50 ,$770.39 ,$25.31 ,$805.70 ,$789.59 ,"$1,265.00 ",$26.83 ,"$1,075.25 ","$1,812.82 ","$1,163.80 ",$885.50 ,"$1,265.00 ","$1,265.00 ",$770.39 ,"$1,265.00 ",$874.12 ,"$1,138.50 ",$864.25 ,$797.48 ,$999.35 ,$26.83 ,"$1,265.00 ","$1,265.00 ",$789.59 ,"$1,265.00 ",$910.80 ,$784.30 ,$910.80 ,$910.80 ,"$1,012.00 "
ST NICHOLAS HOSPITAL - ACUTE,75001004,N/A,HC ESOPHAGEAL MOTILITY/MANOMETRY,750,1 ,"$2,337.30 ","$1,542.62 ","$1,185.48 ","$2,337.30 ", N/A , N/A , N/A , N/A ,"$1,402.38 ","$1,986.71 ","$1,636.11 ", N/A , N/A ,"$2,220.44 ","$1,776.35 ","$1,752.98 ", N/A ,"$1,986.71 ", N/A , N/A , N/A ,"$1,636.11 ","$1,423.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,986.71 ", N/A ,"$2,150.32 ","$1,636.11 ","$1,185.48 ","$1,422.71 ","$1,423.42 ","$1,422.71 ","$1,615.07 ","$2,103.57 ","$1,596.84 ", N/A ,"$1,846.47 ", N/A , N/A , N/A , N/A , N/A ,"$1,682.86 ","$1,449.13 ","$1,682.86 ","$1,682.86 ","$1,869.84 "
ST NICHOLAS HOSPITAL - ACUTE,75001005,99215,HC PEG REMOVAL W/SEDATION (GI),750,1 ,$462.30 ,$305.12 ,$4.33 ,$462.30 ,$4.33 , N/A , N/A , N/A ,$277.38 ,$392.96 ,$323.61 ,$4.33 ,$4.33 ,$439.19 ,$351.35 ,$346.73 ,$462.30 ,$392.96 , N/A ,$462.30 ,$462.30 ,$323.61 ,$281.54 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$392.96 , N/A ,$425.32 ,$323.61 ,$234.48 ,$281.40 ,$281.54 ,$281.40 ,$319.45 ,$416.07 ,$315.84 , N/A ,$365.22 ,$4.59 , N/A , N/A , N/A , N/A ,$332.86 ,$286.63 ,$332.86 ,$332.86 ,$369.84 
ST NICHOLAS HOSPITAL - ACUTE,75001052,N/A,HC COLONSCOPY FLEX W/BAND LIGATION,750,1 ,"$6,455.40 ","$4,260.56 ","$3,274.18 ","$6,455.40 ", N/A , N/A , N/A , N/A ,"$3,873.24 ","$5,487.09 ","$4,518.78 ", N/A , N/A ,"$6,132.63 ","$4,906.10 ","$4,841.55 ", N/A ,"$5,487.09 ", N/A , N/A , N/A ,"$4,518.78 ","$3,931.34 ", N/A , N/A , N/A , N/A , N/A ,"$5,487.09 ", N/A ,"$5,938.97 ","$4,518.78 ","$3,274.18 ","$3,929.40 ","$3,931.34 ","$3,929.40 ","$4,460.68 ","$5,809.86 ","$4,410.33 ", N/A ,"$5,099.77 ", N/A , N/A , N/A , N/A , N/A ,"$4,647.89 ","$4,002.35 ","$4,647.89 ","$4,647.89 ","$5,164.32 "
ST NICHOLAS HOSPITAL - ACUTE,75001066,N/A,HC ESOPHAGOSCOPY FLEXIBLE DX W/BRUSH/WASH -43200,750,1 ,"$2,493.12 ","$1,645.46 ","$1,264.51 ","$2,493.12 ", N/A , N/A , N/A , N/A ,"$1,495.87 ","$2,119.15 ","$1,745.18 ", N/A , N/A ,"$2,368.46 ","$1,894.77 ","$1,869.84 ", N/A ,"$2,119.15 ", N/A , N/A , N/A ,"$1,745.18 ","$1,518.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,119.15 ", N/A ,"$2,293.67 ","$1,745.18 ","$1,264.51 ","$1,517.56 ","$1,518.31 ","$1,517.56 ","$1,722.75 ","$2,243.81 ","$1,703.30 ", N/A ,"$1,969.56 ", N/A , N/A , N/A , N/A , N/A ,"$1,795.05 ","$1,545.73 ","$1,795.05 ","$1,795.05 ","$1,994.50 "
ST NICHOLAS HOSPITAL - ACUTE,75001076,N/A,HC EGD W/BIOPSY SGL/MULT - 43239,750,1 ,"$2,574.53 ","$1,699.19 ","$1,305.80 ","$2,574.53 ", N/A , N/A , N/A , N/A ,"$1,544.72 ","$2,188.35 ","$1,802.17 ", N/A , N/A ,"$2,445.80 ","$1,956.64 ","$1,930.90 ", N/A ,"$2,188.35 ", N/A , N/A , N/A ,"$1,802.17 ","$1,567.89 ", N/A , N/A , N/A , N/A , N/A ,"$2,188.35 ", N/A ,"$2,368.57 ","$1,802.17 ","$1,305.80 ","$1,567.12 ","$1,567.89 ","$1,567.12 ","$1,779.00 ","$2,317.08 ","$1,758.92 ", N/A ,"$2,033.88 ", N/A , N/A , N/A , N/A , N/A ,"$1,853.66 ","$1,596.21 ","$1,853.66 ","$1,853.66 ","$2,059.62 "
ST NICHOLAS HOSPITAL - ACUTE,75001096,N/A,HC ERCP W/SPHINCTEROTOMY - 43262,750,1 ,"$9,488.33 ","$6,262.30 ","$4,812.48 ","$9,488.33 ", N/A , N/A , N/A , N/A ,"$5,693.00 ","$8,065.08 ","$6,641.83 ", N/A , N/A ,"$9,013.91 ","$7,211.13 ","$7,116.25 ", N/A ,"$8,065.08 ", N/A , N/A , N/A ,"$6,641.83 ","$5,778.39 ", N/A , N/A , N/A , N/A , N/A ,"$8,065.08 ", N/A ,"$8,729.26 ","$6,641.83 ","$4,812.48 ","$5,775.55 ","$5,778.39 ","$5,775.55 ","$6,556.44 ","$8,539.50 ","$6,482.43 ", N/A ,"$7,495.78 ", N/A , N/A , N/A , N/A , N/A ,"$6,831.60 ","$5,882.76 ","$6,831.60 ","$6,831.60 ","$7,590.66 "
ST NICHOLAS HOSPITAL - ACUTE,75001106,N/A,HC ESOPHAGUS DILATION UNGUIDED SGL/MULT PASS - 43450,750,1 ,"$3,784.20 ","$2,497.57 ","$1,919.35 ","$3,784.20 ", N/A , N/A , N/A , N/A ,"$2,270.52 ","$3,216.57 ","$2,648.94 ", N/A , N/A ,"$3,594.99 ","$2,875.99 ","$2,838.15 ", N/A ,"$3,216.57 ", N/A , N/A , N/A ,"$2,648.94 ","$2,304.58 ", N/A , N/A , N/A , N/A , N/A ,"$3,216.57 ", N/A ,"$3,481.46 ","$2,648.94 ","$1,919.35 ","$2,303.44 ","$2,304.58 ","$2,303.44 ","$2,614.88 ","$3,405.78 ","$2,585.37 ", N/A ,"$2,989.52 ", N/A , N/A , N/A , N/A , N/A ,"$2,724.62 ","$2,346.20 ","$2,724.62 ","$2,724.62 ","$3,027.36 "
ST NICHOLAS HOSPITAL - ACUTE,75001138,N/A,HC PREPARE FECAL MICROBIOTA - 44705,750,1 ,"$1,669.50 ","$1,101.87 ",$846.77 ,"$1,669.50 ", N/A , N/A , N/A , N/A ,"$1,001.70 ","$1,419.08 ","$1,168.65 ", N/A , N/A ,"$1,586.03 ","$1,268.82 ","$1,252.13 ", N/A ,"$1,419.08 ", N/A , N/A , N/A ,"$1,168.65 ","$1,016.73 ", N/A , N/A , N/A , N/A , N/A ,"$1,419.08 ", N/A ,"$1,535.94 ","$1,168.65 ",$846.77 ,"$1,016.22 ","$1,016.73 ","$1,016.22 ","$1,153.62 ","$1,502.55 ","$1,140.60 ", N/A ,"$1,318.91 ", N/A , N/A , N/A , N/A , N/A ,"$1,202.04 ","$1,035.09 ","$1,202.04 ","$1,202.04 ","$1,335.60 "
ST NICHOLAS HOSPITAL - ACUTE,75001176,N/A,HC ANOSCOPY W/BIOPSY SGL/MULT - 46606,750,1 ,"$3,203.32 ","$2,114.19 ","$1,624.72 ","$3,203.32 ", N/A , N/A , N/A , N/A ,"$1,921.99 ","$2,722.82 ","$2,242.32 ", N/A , N/A ,"$3,043.15 ","$2,434.52 ","$2,402.49 ", N/A ,"$2,722.82 ", N/A , N/A , N/A ,"$2,242.32 ","$1,950.82 ", N/A , N/A , N/A , N/A , N/A ,"$2,722.82 ", N/A ,"$2,947.05 ","$2,242.32 ","$1,624.72 ","$1,949.86 ","$1,950.82 ","$1,949.86 ","$2,213.49 ","$2,882.99 ","$2,188.51 ", N/A ,"$2,530.62 ", N/A , N/A , N/A , N/A , N/A ,"$2,306.39 ","$1,986.06 ","$2,306.39 ","$2,306.39 ","$2,562.66 "
ST NICHOLAS HOSPITAL - ACUTE,75001193,91035,HC ACID REFLUX TEST MUCOSAL ELECTRODE- 91035,750,1 ,"$1,660.60 ","$1,096.00 ",$16.75 ,"$1,660.60 ",$16.75 ,"$1,660.60 ","$1,660.60 ",$471.83 ,$996.36 ,"$1,411.51 ","$1,162.42 ",$16.75 ,$16.75 ,"$1,577.57 ","$1,262.06 ","$1,245.45 ","$1,660.60 ","$1,411.51 ",$471.83 ,"$1,660.60 ","$1,660.60 ","$1,162.42 ","$1,011.31 ",$16.75 ,$471.83 ,$462.39 ,$943.66 ,$17.76 ,"$1,411.51 ","$1,061.61 ","$1,527.75 ","$1,162.42 ",$842.26 ,"$1,010.81 ","$1,011.31 ","$1,010.81 ","$1,147.47 ","$1,494.54 ","$1,134.52 ",$467.02 ,"$1,311.87 ",$17.76 ,"$1,660.60 ","$1,660.60 ",$462.39 ,"$1,660.60 ","$1,195.63 ","$1,029.57 ","$1,195.63 ","$1,195.63 ","$1,328.48 "
ST NICHOLAS HOSPITAL - ACUTE,75001223,N/A,HC SMALL BOWEL ENDOSCOPY- 44378,750,1 ,"$2,126.36 ","$1,403.40 ","$1,078.49 ","$2,126.36 ", N/A , N/A , N/A , N/A ,"$1,275.82 ","$1,807.41 ","$1,488.45 ", N/A , N/A ,"$2,020.04 ","$1,616.03 ","$1,594.77 ", N/A ,"$1,807.41 ", N/A , N/A , N/A ,"$1,488.45 ","$1,294.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,807.41 ", N/A ,"$1,956.25 ","$1,488.45 ","$1,078.49 ","$1,294.32 ","$1,294.95 ","$1,294.32 ","$1,469.31 ","$1,913.72 ","$1,452.73 ", N/A ,"$1,679.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,530.98 ","$1,318.34 ","$1,530.98 ","$1,530.98 ","$1,701.09 "
ST NICHOLAS HOSPITAL - ACUTE,76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,"$1,362.75 ",$899.42 ,$30.03 ,"$1,414.97 ",$30.03 ,$934.03 ,$934.03 ,$628.88 ,$817.65 ,"$1,158.34 ",$953.93 ,$30.03 ,$30.03 ,"$1,294.61 ","$1,035.69 ","$1,022.06 ",$885.79 ,"$1,158.34 ",$628.88 ,$885.79 ,$885.79 ,$953.93 ,$829.91 ,$30.03 ,$628.88 ,$616.30 ,"$1,257.76 ",$31.83 ,"$1,158.34 ","$1,414.97 ","$1,253.73 ",$953.93 ,"$1,362.75 ","$1,362.75 ",$829.91 ,"$1,362.75 ",$941.66 ,"$1,226.48 ",$931.03 ,$622.47 ,"$1,076.57 ",$31.83 ,$804.02 ,$804.02 ,$616.30 ,$804.02 ,$981.18 ,$844.91 ,$981.18 ,$981.18 ,"$1,090.20 "
ST NICHOLAS HOSPITAL - ACUTE,76100001,29700,HC REMOVE/REVISION CAST,761,1 ,$272.55 ,$179.88 ,$6.17 ,$526.84 ,$6.17 ,$272.55 ,$272.55 ,$234.15 ,$163.53 ,$231.67 ,$190.79 ,$6.17 ,$6.17 ,$258.92 ,$207.14 ,$204.41 ,$272.55 ,$231.67 ,$234.15 ,$272.55 ,$272.55 ,$190.79 ,$165.98 ,$6.17 ,$234.15 ,$229.47 ,$272.55 ,$6.54 ,$231.67 ,$526.84 ,$250.75 ,$190.79 ,$138.24 ,$165.90 ,$165.98 ,$165.90 ,$188.33 ,$245.30 ,$186.21 ,$231.76 ,$215.31 ,$6.54 ,$160.80 ,$160.80 ,$229.47 ,$160.80 ,$196.24 ,$168.98 ,$196.24 ,$196.24 ,$218.04 
ST NICHOLAS HOSPITAL - ACUTE,76100054,64999,HC GANGLION IMPAR BLOCK,761,1 ,"$1,529.50 ","$1,009.47 ",$13.98 ,"$1,529.50 ",$13.98 ,"$1,529.50 ","$1,529.50 ",$265.36 ,$917.70 ,"$1,300.08 ","$1,070.65 ",$13.98 ,$13.98 ,"$1,453.03 ","$1,162.42 ","$1,147.13 ","$1,529.50 ","$1,300.08 ",$265.36 ,"$1,529.50 ","$1,529.50 ","$1,070.65 ",$931.47 ,$13.98 ,$265.36 ,$260.05 ,$530.72 ,$14.82 ,"$1,300.08 ",$597.07 ,"$1,407.14 ","$1,070.65 ",$775.76 ,$931.01 ,$931.47 ,$931.01 ,"$1,056.88 ","$1,376.55 ","$1,044.95 ",$262.65 ,"$1,208.31 ",$14.82 ,$902.41 ,$902.41 ,$260.05 ,$902.41 ,"$1,101.24 ",$948.29 ,"$1,101.24 ","$1,101.24 ","$1,223.60 "
ST NICHOLAS HOSPITAL - ACUTE,76200004,G0378,HC CDTU LV I PER HOUR,762,1 ,$190.90 ,$125.99 ,$96.82 ,$190.90 , N/A ,$190.90 ,$190.90 , N/A ,$114.54 ,$162.27 ,$133.63 , N/A , N/A ,$181.36 ,$145.08 ,$143.18 ,$124.09 ,$162.27 , N/A ,$124.09 ,$124.09 ,$133.63 ,$116.26 , N/A , N/A , N/A , N/A , N/A ,$162.27 , N/A ,$175.63 ,$133.63 ,$96.82 ,$116.20 ,$116.26 ,$116.20 ,$131.91 ,$171.81 ,$130.42 , N/A ,$150.81 , N/A ,$190.90 ,$190.90 , N/A ,$190.90 ,$137.45 ,$118.36 ,$137.45 ,$137.45 ,$152.72 
ST NICHOLAS HOSPITAL - ACUTE,76200005,G0378,HC CDTU LV II PER HOUR,762,1 ,$238.05 ,$157.11 ,$120.74 ,$238.05 , N/A ,$238.05 ,$238.05 , N/A ,$142.83 ,$202.34 ,$166.64 , N/A , N/A ,$226.15 ,$180.92 ,$178.54 ,$154.73 ,$202.34 , N/A ,$154.73 ,$154.73 ,$166.64 ,$144.97 , N/A , N/A , N/A , N/A , N/A ,$202.34 , N/A ,$219.01 ,$166.64 ,$120.74 ,$144.90 ,$144.97 ,$144.90 ,$164.49 ,$214.25 ,$162.64 , N/A ,$188.06 , N/A ,$238.05 ,$238.05 , N/A ,$238.05 ,$171.40 ,$147.59 ,$171.40 ,$171.40 ,$190.44 
ST NICHOLAS HOSPITAL - ACUTE,76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,$440.45 ,$290.70 ,$4.33 ,$440.45 ,$4.33 ,$440.45 ,$440.45 , N/A ,$264.27 ,$374.38 ,$308.32 ,$4.33 ,$4.33 ,$418.43 ,$334.74 ,$330.34 ,$286.29 ,$374.38 , N/A ,$286.29 ,$286.29 ,$308.32 ,$268.23 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$374.38 , N/A ,$405.21 ,$308.32 ,$223.40 ,$268.10 ,$268.23 ,$268.10 ,$304.35 ,$396.41 ,$300.92 , N/A ,$347.96 ,$4.59 ,$440.45 ,$440.45 , N/A ,$440.45 ,$317.12 ,$273.08 ,$317.12 ,$317.12 ,$352.36 
ST NICHOLAS HOSPITAL - ACUTE,76200013,N/A,HC OBSERVATION PER HOUR NO CODE,762,1 ,$440.45 ,$290.70 ,$223.40 ,$440.45 , N/A ,$440.45 ,$440.45 , N/A ,$264.27 ,$374.38 ,$308.32 , N/A , N/A ,$418.43 ,$334.74 ,$330.34 ,$286.29 ,$374.38 , N/A ,$286.29 ,$286.29 ,$308.32 ,$268.23 , N/A , N/A , N/A , N/A , N/A ,$374.38 , N/A ,$405.21 ,$308.32 ,$223.40 ,$268.10 ,$268.23 ,$268.10 ,$304.35 ,$396.41 ,$300.92 , N/A ,$347.96 , N/A ,$440.45 ,$440.45 , N/A ,$440.45 ,$317.12 ,$273.08 ,$317.12 ,$317.12 ,$352.36 
ST NICHOLAS HOSPITAL - ACUTE,77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$89.70 ,$59.20 ,$1.37 ,$148.16 ,$1.37 ,$61.48 ,$61.48 ,$65.85 ,$53.82 ,$76.25 ,$62.79 ,$1.37 ,$1.37 ,$85.22 ,$68.17 ,$67.28 ,$58.31 ,$76.25 ,$65.85 ,$58.31 ,$58.31 ,$62.79 ,$54.63 ,$1.37 ,$65.85 ,$64.53 ,$89.70 ,$1.45 ,$76.25 ,$148.16 ,$82.52 ,$62.79 ,$45.50 ,$54.60 ,$54.63 ,$54.60 ,$61.98 ,$80.73 ,$61.28 ,$65.18 ,$70.86 ,$1.45 , N/A , N/A ,$64.53 , N/A ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,77100001,90471,HC RABIES VACC ADMIN IM,771,1 ,$89.70 ,$59.20 ,$1.37 ,$148.16 ,$1.37 ,$61.48 ,$61.48 ,$65.85 ,$53.82 ,$76.25 ,$62.79 ,$1.37 ,$1.37 ,$85.22 ,$68.17 ,$67.28 ,$58.31 ,$76.25 ,$65.85 ,$58.31 ,$58.31 ,$62.79 ,$54.63 ,$1.37 ,$65.85 ,$64.53 ,$89.70 ,$1.45 ,$76.25 ,$148.16 ,$82.52 ,$62.79 ,$45.50 ,$54.60 ,$54.63 ,$54.60 ,$61.98 ,$80.73 ,$61.28 ,$65.18 ,$70.86 ,$1.45 , N/A , N/A ,$64.53 , N/A ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,77100002,90472,HC IMMUN ADMIN EA ADD VACC,771,1 ,$60.95 ,$40.23 ,$1.37 ,$60.95 ,$1.37 ,$41.78 ,$41.78 , N/A ,$36.57 ,$51.81 ,$42.67 ,$1.37 ,$1.37 ,$57.90 ,$46.32 ,$45.71 ,$39.62 ,$51.81 , N/A ,$39.62 ,$39.62 ,$42.67 ,$37.12 ,$1.37 , N/A , N/A , N/A ,$1.45 ,$51.81 , N/A ,$56.07 ,$42.67 ,$30.91 ,$37.10 ,$37.12 ,$37.10 ,$42.12 ,$54.86 ,$41.64 , N/A ,$48.15 ,$1.45 , N/A , N/A , N/A , N/A ,$43.88 ,$37.79 ,$43.88 ,$43.88 ,$48.76 
ST NICHOLAS HOSPITAL - ACUTE,77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$89.70 ,$59.20 ,$1.37 ,$93.04 ,$1.37 ,$61.48 ,$61.48 ,$41.35 ,$53.82 ,$76.25 ,$62.79 ,$1.37 ,$1.37 ,$85.22 ,$68.17 ,$67.28 ,$58.31 ,$76.25 ,$41.35 ,$58.31 ,$58.31 ,$62.79 ,$54.63 ,$1.37 ,$41.35 ,$40.52 ,$82.70 ,$1.45 ,$76.25 ,$93.04 ,$82.52 ,$62.79 ,$45.50 ,$54.60 ,$54.63 ,$54.60 ,$61.98 ,$80.73 ,$61.28 ,$40.92 ,$70.86 ,$1.45 , N/A , N/A ,$40.52 , N/A ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,77100004,G0008,HC ADMIN INFLUENZA COMMUNITY VACCINE,771,1 ,$89.70 ,$59.20 ,$1.37 ,$93.04 ,$1.37 ,$61.48 ,$61.48 ,$41.35 ,$53.82 ,$76.25 ,$62.79 ,$1.37 ,$1.37 ,$85.22 ,$68.17 ,$67.28 ,$58.31 ,$76.25 ,$41.35 ,$58.31 ,$58.31 ,$62.79 ,$54.63 ,$1.37 ,$41.35 ,$40.52 ,$82.70 ,$1.45 ,$76.25 ,$93.04 ,$82.52 ,$62.79 ,$45.50 ,$54.60 ,$54.63 ,$54.60 ,$61.98 ,$80.73 ,$61.28 ,$40.92 ,$70.86 ,$1.45 , N/A , N/A ,$40.52 , N/A ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$103.50 ,$68.31 ,$1.37 ,$103.50 ,$1.37 ,$70.94 ,$70.94 ,$41.35 ,$62.10 ,$87.98 ,$72.45 ,$1.37 ,$1.37 ,$98.33 ,$78.66 ,$77.63 ,$67.28 ,$87.98 ,$41.35 ,$67.28 ,$67.28 ,$72.45 ,$63.03 ,$1.37 ,$41.35 ,$40.52 ,$82.70 ,$1.45 ,$87.98 ,$93.04 ,$95.22 ,$72.45 ,$52.50 ,$63.00 ,$63.03 ,$63.00 ,$71.52 ,$93.15 ,$70.71 ,$40.92 ,$81.77 ,$1.45 , N/A , N/A ,$40.52 , N/A ,$74.52 ,$64.17 ,$74.52 ,$74.52 ,$82.80 
ST NICHOLAS HOSPITAL - ACUTE,77100006,G0010,HC INJECTION-HEPATITIS B VACCINE,771,1 ,$89.70 ,$59.20 ,$1.37 ,$93.04 ,$1.37 ,$61.48 ,$61.48 ,$41.35 ,$53.82 ,$76.25 ,$62.79 ,$1.37 ,$1.37 ,$85.22 ,$68.17 ,$67.28 ,$58.31 ,$76.25 ,$41.35 ,$58.31 ,$58.31 ,$62.79 ,$54.63 ,$1.37 ,$41.35 ,$40.52 ,$82.70 ,$1.45 ,$76.25 ,$93.04 ,$82.52 ,$62.79 ,$45.50 ,$54.60 ,$54.63 ,$54.60 ,$61.98 ,$80.73 ,$61.28 ,$40.92 ,$70.86 ,$1.45 , N/A , N/A ,$40.52 , N/A ,$64.58 ,$55.61 ,$64.58 ,$64.58 ,$71.76 
ST NICHOLAS HOSPITAL - ACUTE,77100009,0001A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML FIRST DOSE,771,1 ,$115.00 ,$75.90 ,$39.71 ,$115.00 , N/A ,$78.82 ,$78.82 ,$40.52 ,$69.00 ,$97.75 ,$80.50 , N/A , N/A ,$109.25 ,$87.40 ,$86.25 ,$74.75 ,$97.75 ,$40.52 ,$74.75 ,$74.75 ,$80.50 ,$70.04 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$97.75 ,$91.18 ,$105.80 ,$80.50 ,$115.00 ,$115.00 ,$70.04 ,$115.00 ,$79.47 ,$103.50 ,$78.57 ,$40.11 ,$90.85 , N/A , N/A , N/A ,$39.71 , N/A ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,77100010,0002A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML SECOND DOSE,771,1 ,$115.00 ,$75.90 ,$39.71 ,$115.00 , N/A ,$78.82 ,$78.82 ,$40.52 ,$69.00 ,$97.75 ,$80.50 , N/A , N/A ,$109.25 ,$87.40 ,$86.25 ,$74.75 ,$97.75 ,$40.52 ,$74.75 ,$74.75 ,$80.50 ,$70.04 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$97.75 ,$91.18 ,$105.80 ,$80.50 ,$115.00 ,$115.00 ,$70.04 ,$115.00 ,$79.47 ,$103.50 ,$78.57 ,$40.11 ,$90.85 , N/A , N/A , N/A ,$39.71 , N/A ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,77100011,0011A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5ML FIRST DOSE,771,1 ,$115.00 ,$75.90 ,$39.71 ,$115.00 , N/A ,$78.82 ,$78.82 ,$40.52 ,$69.00 ,$97.75 ,$80.50 , N/A , N/A ,$109.25 ,$87.40 ,$86.25 ,$74.75 ,$97.75 ,$40.52 ,$74.75 ,$74.75 ,$80.50 ,$70.04 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$97.75 ,$91.18 ,$105.80 ,$80.50 ,$115.00 ,$115.00 ,$70.04 ,$115.00 ,$79.47 ,$103.50 ,$78.57 ,$40.11 ,$90.85 , N/A , N/A , N/A ,$39.71 , N/A ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,77100012,0012A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5M SECOND DOSE,771,1 ,$115.00 ,$75.90 ,$39.71 ,$115.00 , N/A ,$78.82 ,$78.82 ,$40.52 ,$69.00 ,$97.75 ,$80.50 , N/A , N/A ,$109.25 ,$87.40 ,$86.25 ,$74.75 ,$97.75 ,$40.52 ,$74.75 ,$74.75 ,$80.50 ,$70.04 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$97.75 ,$91.18 ,$105.80 ,$80.50 ,$115.00 ,$115.00 ,$70.04 ,$115.00 ,$79.47 ,$103.50 ,$78.57 ,$40.11 ,$90.85 , N/A , N/A , N/A ,$39.71 , N/A ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,77100013,0021A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$100.00 ,$66.00 ,$60.00 ,$100.00 , N/A ,$68.54 ,$68.54 , N/A ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$65.00 ,$70.00 ,$60.90 , N/A , N/A , N/A , N/A , N/A ,$85.00 , N/A ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 , N/A ,$79.00 , N/A , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100014,0022A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML SECOND DOSE,771,1 ,$100.00 ,$66.00 ,$60.00 ,$100.00 , N/A ,$68.54 ,$68.54 , N/A ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$65.00 ,$70.00 ,$60.90 , N/A , N/A , N/A , N/A , N/A ,$85.00 , N/A ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 , N/A ,$79.00 , N/A , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100015,0031A,HC ADMINISTRATION SARS-COV-2 VACCINE AD26 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$100.00 ,$66.00 ,$39.71 ,$100.00 , N/A ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 , N/A , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100016,0041A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML FIRST DOSE,771,1 ,$100.00 ,$66.00 ,$1.37 ,$100.00 ,$1.37 ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 ,$1.37 ,$1.37 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100017,0042A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML SECOND DOSE,771,1 ,$100.00 ,$66.00 ,$1.37 ,$100.00 ,$1.37 ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 ,$1.37 ,$1.37 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100018,0003A,HC ADM SARSCOV2 30MCG/0.3ML 3RD - PFIZER,771,1 ,$100.00 ,$66.00 ,$1.37 ,$100.00 ,$1.37 ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 ,$1.37 ,$1.37 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100019,0013A,HC ADM SARSCOV2 100MCG/0.5ML 3RD - MODERNA,771,1 ,$100.00 ,$66.00 ,$1.37 ,$100.00 ,$1.37 ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 ,$1.37 ,$1.37 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100020,0051A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, FIRST DOSE",771,1 ,$100.00 ,$66.00 ,$39.71 ,$100.00 , N/A ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 , N/A , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100021,0052A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, SECOND DOSE",771,1 ,$100.00 ,$66.00 ,$39.71 ,$100.00 , N/A ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 , N/A , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100022,0053A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, THIRD DOSE",771,1 ,$100.00 ,$66.00 ,$39.71 ,$100.00 , N/A ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 , N/A , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100024,0054A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, BOOSTER DOSE",771,1 ,$100.00 ,$66.00 ,$39.71 ,$100.00 , N/A ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 , N/A , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100025,0064A,"HC ADMIN SARS-COV-2 VACCINE 50MCG/0.25ML, BOOSTER DOSE",771,1 ,$100.00 ,$66.00 ,$1.37 ,$100.00 ,$1.37 ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 ,$1.37 ,$1.37 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100028,0034A,"HC ADMIN SARS-COV-2 VACCINE JOHNSON  AND  JOHNSON, BOOSTER DOSE",771,1 ,$100.00 ,$66.00 ,$39.71 ,$100.00 , N/A ,$68.54 ,$68.54 ,$40.52 ,$60.00 ,$85.00 ,$70.00 , N/A , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.52 ,$65.00 ,$65.00 ,$70.00 ,$60.90 , N/A ,$40.52 ,$39.71 ,$81.04 , N/A ,$85.00 ,$91.18 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$68.32 ,$40.11 ,$79.00 , N/A , N/A , N/A ,$39.71 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100029,M0220,"HC INTRAVENOUS INFUSION,  TIXAGEVIMAB AND CILGAVIMAB ADMINISTRATION",771,1 ,$115.00 ,$75.90 ,$58.33 ,$330.50 ,$115.00 ,$78.82 ,$78.82 ,$146.89 ,$69.00 ,$97.75 ,$80.50 ,$115.00 ,$115.00 ,$109.25 ,$87.40 ,$86.25 ,$74.75 ,$97.75 ,$146.89 ,$74.75 ,$74.75 ,$80.50 ,$70.04 ,$115.00 ,$146.89 ,$143.95 ,$115.00 ,$121.90 ,$97.75 ,$330.50 ,$105.80 ,$80.50 ,$58.33 ,$70.00 ,$70.04 ,$70.00 ,$79.47 ,$103.50 ,$78.57 ,$145.39 ,$90.85 ,$121.90 , N/A , N/A ,$143.95 , N/A ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,77100031,M0222,HC INTRAVENOUS INJECTION BEBTELOVIMAB ADMINISTRATION,260,1 ,$105.00 ,$69.30 ,$51.45 ,$769.70 ,$105.00 ,$71.97 ,$71.97 ,$342.09 ,$63.00 ,$89.25 ,$73.50 ,$105.00 ,$105.00 ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 ,$342.09 ,$68.25 ,$68.25 ,$73.50 ,$63.95 ,$105.00 ,$342.09 ,$335.25 ,$105.00 ,$111.30 ,$89.25 ,$769.70 ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 ,$338.60 ,$82.95 ,$111.30 ,$51.45 ,$51.45 ,$335.25 ,$51.45 ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,77100034,0074A,HC ADMIN-COV-2 10MCG/.2ML BOOSTER DOSE,771,1 ,$105.00 ,$69.30 ,$1.37 ,$105.00 ,$1.37 ,$71.97 ,$71.97 ,$40.52 ,$63.00 ,$89.25 ,$73.50 ,$1.37 ,$1.37 ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 ,$40.52 ,$68.25 ,$68.25 ,$73.50 ,$63.95 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$89.25 ,$91.18 ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 ,$40.11 ,$82.95 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,77100035,0104A,HC ADMIN-COV-2 5MCG/.5ML BOOSTER DOSE,771,1 ,$105.00 ,$69.30 ,$1.37 ,$105.00 ,$1.37 ,$71.97 ,$71.97 , N/A ,$63.00 ,$89.25 ,$73.50 ,$1.37 ,$1.37 ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 , N/A ,$68.25 ,$68.25 ,$73.50 ,$63.95 ,$1.37 , N/A , N/A , N/A ,$1.45 ,$89.25 , N/A ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 , N/A ,$82.95 ,$1.45 , N/A , N/A , N/A , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,77100036,0134A,HC ADMIN SARS-COV-2 VACCINE SPIKE PROTEIN BIVALENT 50MCG/0.5ML,771,1 ,$105.00 ,$69.30 ,$1.37 ,$105.00 ,$1.37 ,$71.97 ,$71.97 ,$40.52 ,$63.00 ,$89.25 ,$73.50 ,$1.37 ,$1.37 ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 ,$40.52 ,$68.25 ,$68.25 ,$73.50 ,$63.95 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$89.25 ,$91.18 ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 ,$40.11 ,$82.95 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,77100037,0144A,HC ADMIN SARS-COV-2 VACCINE SPIKE PROTEIN BIVALENT 25MCG/0.25ML,771,1 ,$105.00 ,$69.30 ,$1.37 ,$105.00 ,$1.37 ,$71.97 ,$71.97 ,$40.52 ,$63.00 ,$89.25 ,$73.50 ,$1.37 ,$1.37 ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 ,$40.52 ,$68.25 ,$68.25 ,$73.50 ,$63.95 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$89.25 ,$91.18 ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 ,$40.11 ,$82.95 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,77100038,0124A,HC ADMIN SARS-COV-2 VACCINE SPIKE PROTEIN BIVALENT TRI-SUCROSE 30MCG/0.3ML,771,1 ,$105.00 ,$69.30 ,$1.37 ,$105.00 ,$1.37 ,$71.97 ,$71.97 ,$40.52 ,$63.00 ,$89.25 ,$73.50 ,$1.37 ,$1.37 ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 ,$40.52 ,$68.25 ,$68.25 ,$73.50 ,$63.95 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$89.25 ,$91.18 ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 ,$40.11 ,$82.95 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,77100039,0154A,HC ADMIN SARS-COV-2 VACCINE SPIKE PROTEIN BIVALENT TRI-SUCROSE 10MCG/0.2ML,771,1 ,$105.00 ,$69.30 ,$1.37 ,$105.00 ,$1.37 ,$71.97 ,$71.97 ,$40.52 ,$63.00 ,$89.25 ,$73.50 ,$1.37 ,$1.37 ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 ,$40.52 ,$68.25 ,$68.25 ,$73.50 ,$63.95 ,$1.37 ,$40.52 ,$39.71 ,$81.04 ,$1.45 ,$89.25 ,$91.18 ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 ,$40.11 ,$82.95 ,$1.45 , N/A , N/A ,$39.71 , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,78000001,Q3014,HC TELEHEALTH ORIGINATING FAC FEE,780,1 ,$250.00 ,$165.00 ,$0.69 ,$250.00 ,$0.69 ,$171.35 ,$171.35 ,$28.64 ,$150.00 ,$212.50 ,$175.00 ,$0.69 ,$0.69 ,$237.50 ,$190.00 ,$187.50 ,$54.91 ,$212.50 ,$28.64 ,$54.91 ,$54.91 ,$175.00 ,$152.25 ,$0.69 ,$28.64 ,$28.07 ,$57.28 ,$0.73 ,$212.50 ,$64.44 ,$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$152.18 ,$172.75 ,$225.00 ,$170.80 ,$28.35 ,$197.50 ,$0.73 ,$28.00 ,$28.00 ,$28.07 ,$28.00 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,78000085,99202,PC CLINIC VISIT LIMITED NEW- 95,961,1 ,$200.00 ,$132.00 ,$4.33 ,$200.00 ,$4.33 ,$137.08 ,$137.08 , N/A ,$120.00 ,$170.00 ,$140.00 ,$4.33 ,$4.33 ,$190.00 ,$152.00 ,$150.00 ,$130.00 ,$170.00 , N/A ,$130.00 ,$130.00 ,$140.00 ,$121.80 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$170.00 , N/A ,$184.00 ,$140.00 ,$101.44 ,$121.74 ,$121.80 ,$121.74 ,$138.20 ,$180.00 ,$136.64 , N/A ,$158.00 ,$4.59 , N/A , N/A , N/A , N/A ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,78000086,99203,PC CLINIC VISIT INTERM NEW - 95,961,1 ,$240.00 ,$158.40 ,$4.33 ,$240.00 ,$4.33 ,$164.50 ,$164.50 , N/A ,$144.00 ,$204.00 ,$168.00 ,$4.33 ,$4.33 ,$228.00 ,$182.40 ,$180.00 ,$156.00 ,$204.00 , N/A ,$156.00 ,$156.00 ,$168.00 ,$146.16 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$204.00 , N/A ,$220.80 ,$168.00 ,$121.73 ,$146.09 ,$146.16 ,$146.09 ,$165.84 ,$216.00 ,$163.97 , N/A ,$189.60 ,$4.59 , N/A , N/A , N/A , N/A ,$172.80 ,$148.80 ,$172.80 ,$172.80 ,$192.00 
ST NICHOLAS HOSPITAL - ACUTE,78000087,99204,PC CLINIC VISIT COMPLEX NEW - 95,961,1 ,$290.00 ,$191.40 ,$4.33 ,$290.00 ,$4.33 ,$198.77 ,$198.77 , N/A ,$174.00 ,$246.50 ,$203.00 ,$4.33 ,$4.33 ,$275.50 ,$220.40 ,$217.50 ,$188.50 ,$246.50 , N/A ,$188.50 ,$188.50 ,$203.00 ,$176.61 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$246.50 , N/A ,$266.80 ,$203.00 ,$147.09 ,$176.52 ,$176.61 ,$176.52 ,$200.39 ,$261.00 ,$198.13 , N/A ,$229.10 ,$4.59 , N/A , N/A , N/A , N/A ,$208.80 ,$179.80 ,$208.80 ,$208.80 ,$232.00 
ST NICHOLAS HOSPITAL - ACUTE,78000088,99205,PC CLINIC VISIT COMPREH NEW - 95,961,1 ,$375.00 ,$247.50 ,$4.33 ,$375.00 ,$4.33 ,$257.03 ,$257.03 , N/A ,$225.00 ,$318.75 ,$262.50 ,$4.33 ,$4.33 ,$356.25 ,$285.00 ,$281.25 ,$243.75 ,$318.75 , N/A ,$243.75 ,$243.75 ,$262.50 ,$228.38 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$318.75 , N/A ,$345.00 ,$262.50 ,$190.20 ,$228.26 ,$228.38 ,$228.26 ,$259.13 ,$337.50 ,$256.20 , N/A ,$296.25 ,$4.59 , N/A , N/A , N/A , N/A ,$270.00 ,$232.50 ,$270.00 ,$270.00 ,$300.00 
ST NICHOLAS HOSPITAL - ACUTE,78000089,99211,PC CLINIC VISIT BRIEF ESTAB - 95,961,1 ,$185.00 ,$122.10 ,$4.33 ,$185.00 ,$4.33 ,$126.80 ,$126.80 , N/A ,$111.00 ,$157.25 ,$129.50 ,$4.33 ,$4.33 ,$175.75 ,$140.60 ,$138.75 ,$120.25 ,$157.25 , N/A ,$120.25 ,$120.25 ,$129.50 ,$112.67 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$157.25 , N/A ,$170.20 ,$129.50 ,$93.83 ,$112.61 ,$112.67 ,$112.61 ,$127.84 ,$166.50 ,$126.39 , N/A ,$146.15 ,$4.59 , N/A , N/A , N/A , N/A ,$133.20 ,$114.70 ,$133.20 ,$133.20 ,$148.00 
ST NICHOLAS HOSPITAL - ACUTE,78000090,99212,PC CLINIC VISIT LIMITED ESTAB - 95,961,1 ,$195.00 ,$128.70 ,$4.33 ,$195.00 ,$4.33 ,$133.65 ,$133.65 , N/A ,$117.00 ,$165.75 ,$136.50 ,$4.33 ,$4.33 ,$185.25 ,$148.20 ,$146.25 ,$126.75 ,$165.75 , N/A ,$126.75 ,$126.75 ,$136.50 ,$118.76 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$165.75 , N/A ,$179.40 ,$136.50 ,$98.90 ,$118.70 ,$118.76 ,$118.70 ,$134.75 ,$175.50 ,$133.22 , N/A ,$154.05 ,$4.59 , N/A , N/A , N/A , N/A ,$140.40 ,$120.90 ,$140.40 ,$140.40 ,$156.00 
ST NICHOLAS HOSPITAL - ACUTE,78000091,99213,PC CLINIC VISIT INTERM ESTAB - 95,961,1 ,$235.00 ,$155.10 ,$4.33 ,$235.00 ,$4.33 ,$161.07 ,$161.07 , N/A ,$141.00 ,$199.75 ,$164.50 ,$4.33 ,$4.33 ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 , N/A ,$152.75 ,$152.75 ,$164.50 ,$143.12 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$160.55 , N/A ,$185.65 ,$4.59 , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,78000092,99214,PC CLINIC VISIT COMPLEX ESTAB - 95,961,1 ,$260.00 ,$171.60 ,$4.33 ,$260.00 ,$4.33 ,$178.20 ,$178.20 , N/A ,$156.00 ,$221.00 ,$182.00 ,$4.33 ,$4.33 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 , N/A ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$221.00 , N/A ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 , N/A ,$205.40 ,$4.59 , N/A , N/A , N/A , N/A ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,78000093,99215,PC CLINIC VISIT COMPREH ESTAB - 95,983,1 ,$325.00 ,$214.50 ,$4.33 ,$325.00 ,$4.33 ,$222.76 ,$222.76 , N/A ,$195.00 ,$276.25 ,$227.50 ,$4.33 ,$4.33 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 , N/A ,$211.25 ,$211.25 ,$227.50 ,$197.93 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$276.25 , N/A ,$299.00 ,$227.50 ,$164.84 ,$197.83 ,$197.93 ,$197.83 ,$224.58 ,$292.50 ,$222.04 , N/A ,$256.75 ,$4.59 , N/A , N/A , N/A , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,78000098,99221,PC TELEHEALTH INITIAL HOSP INP/OBS CARE LVL 1 LOW 40MIN - 95,960,1 ,$249.90 ,$164.93 ,$4.33 ,$249.90 ,$4.33 ,$171.28 ,$171.28 , N/A ,$149.94 ,$212.42 ,$174.93 ,$4.33 ,$4.33 ,$237.41 ,$189.92 ,$187.43 ,$162.44 ,$212.42 , N/A ,$162.44 ,$162.44 ,$174.93 ,$152.19 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$212.42 , N/A ,$229.91 ,$174.93 ,$126.75 ,$152.11 ,$152.19 ,$152.11 ,$172.68 ,$224.91 ,$170.73 , N/A ,$197.42 ,$4.59 , N/A , N/A , N/A , N/A ,$179.93 ,$154.94 ,$179.93 ,$179.93 ,$199.92 
ST NICHOLAS HOSPITAL - ACUTE,78000099,99222,PC TELEHEALTH INITIAL HOSP INP/OBS CARE LVL 2 MODERATE 55 MIN -95,960,1 ,$337.05 ,$222.45 ,$4.33 ,$337.05 ,$4.33 ,$231.01 ,$231.01 , N/A ,$202.23 ,$286.49 ,$235.94 ,$4.33 ,$4.33 ,$320.20 ,$256.16 ,$252.79 ,$219.08 ,$286.49 , N/A ,$219.08 ,$219.08 ,$235.94 ,$205.26 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$286.49 , N/A ,$310.09 ,$235.94 ,$170.95 ,$205.16 ,$205.26 ,$205.16 ,$232.90 ,$303.35 ,$230.27 , N/A ,$266.27 ,$4.59 , N/A , N/A , N/A , N/A ,$242.68 ,$208.97 ,$242.68 ,$242.68 ,$269.64 
ST NICHOLAS HOSPITAL - ACUTE,78000100,99223,PC TELEHEALTH INITIAL HOSP INP/OBS CARE LVL 3 HIGH 75 MIN -95,960,1 ,$489.30 ,$322.94 ,$4.33 ,$489.30 ,$4.33 ,$335.37 ,$335.37 , N/A ,$293.58 ,$415.91 ,$342.51 ,$4.33 ,$4.33 ,$464.84 ,$371.87 ,$366.98 ,$318.05 ,$415.91 , N/A ,$318.05 ,$318.05 ,$342.51 ,$297.98 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$415.91 , N/A ,$450.16 ,$342.51 ,$248.17 ,$297.84 ,$297.98 ,$297.84 ,$338.11 ,$440.37 ,$334.29 , N/A ,$386.55 ,$4.59 , N/A , N/A , N/A , N/A ,$352.30 ,$303.37 ,$352.30 ,$352.30 ,$391.44 
ST NICHOLAS HOSPITAL - ACUTE,78000104,99231,PC TELEHEALTH SUBSQ HOSP INP/OBS CARE  LVL 1 LOW 25 MIN - 95,960,1 ,$119.70 ,$79.00 ,$4.33 ,$119.70 ,$4.33 ,$82.04 ,$82.04 , N/A ,$71.82 ,$101.75 ,$83.79 ,$4.33 ,$4.33 ,$113.72 ,$90.97 ,$89.78 ,$77.81 ,$101.75 , N/A ,$77.81 ,$77.81 ,$83.79 ,$72.90 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$101.75 , N/A ,$110.12 ,$83.79 ,$60.71 ,$72.86 ,$72.90 ,$72.86 ,$82.71 ,$107.73 ,$81.78 , N/A ,$94.56 ,$4.59 , N/A , N/A , N/A , N/A ,$86.18 ,$74.21 ,$86.18 ,$86.18 ,$95.76 
ST NICHOLAS HOSPITAL - ACUTE,78000105,99232,PC TELEHEALTH SUBSQ HOSP INP/OBS CARE  LVL 2 MODERATE 35 MIN - 95,960,1 ,$184.80 ,$121.97 ,$4.33 ,$184.80 ,$4.33 ,$126.66 ,$126.66 , N/A ,$110.88 ,$157.08 ,$129.36 ,$4.33 ,$4.33 ,$175.56 ,$140.45 ,$138.60 ,$120.12 ,$157.08 , N/A ,$120.12 ,$120.12 ,$129.36 ,$112.54 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$157.08 , N/A ,$170.02 ,$129.36 ,$93.73 ,$112.49 ,$112.54 ,$112.49 ,$127.70 ,$166.32 ,$126.26 , N/A ,$145.99 ,$4.59 , N/A , N/A , N/A , N/A ,$133.06 ,$114.58 ,$133.06 ,$133.06 ,$147.84 
ST NICHOLAS HOSPITAL - ACUTE,78000106,99233,PC TELEHEALTH SUBSQ HOSP INP/OBS CARE  LVL 3 HIGH 50 MIN - 95,960,1 ,$255.15 ,$168.40 ,$4.33 ,$255.15 ,$4.33 ,$174.88 ,$174.88 , N/A ,$153.09 ,$216.88 ,$178.61 ,$4.33 ,$4.33 ,$242.39 ,$193.91 ,$191.36 ,$165.85 ,$216.88 , N/A ,$165.85 ,$165.85 ,$178.61 ,$155.39 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$216.88 , N/A ,$234.74 ,$178.61 ,$129.41 ,$155.31 ,$155.39 ,$155.31 ,$176.31 ,$229.64 ,$174.32 , N/A ,$201.57 ,$4.59 , N/A , N/A , N/A , N/A ,$183.71 ,$158.19 ,$183.71 ,$183.71 ,$204.12 
ST NICHOLAS HOSPITAL - ACUTE,78000107,99234,PC TELEHEALTH HOSP INP/OBS CARE SAME DATE LOW 45 MIN- 95,960,1 ,$516.60 ,$340.96 ,$4.33 ,$516.60 ,$4.33 ,$354.08 ,$354.08 , N/A ,$309.96 ,$439.11 ,$361.62 ,$4.33 ,$4.33 ,$490.77 ,$392.62 ,$387.45 ,$335.79 ,$439.11 , N/A ,$335.79 ,$335.79 ,$361.62 ,$314.61 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$439.11 , N/A ,$475.27 ,$361.62 ,$262.02 ,$314.45 ,$314.61 ,$314.45 ,$356.97 ,$464.94 ,$352.94 , N/A ,$408.11 ,$4.59 , N/A , N/A , N/A , N/A ,$371.95 ,$320.29 ,$371.95 ,$371.95 ,$413.28 
ST NICHOLAS HOSPITAL - ACUTE,78000108,99235,PC TELEHEALTH HOSP INP/OBS CARE SAME DATE MODERATE 70 MIN-95,960,1 ,$652.05 ,$430.35 ,$4.33 ,$652.05 ,$4.33 ,$446.92 ,$446.92 , N/A ,$391.23 ,$554.24 ,$456.44 ,$4.33 ,$4.33 ,$619.45 ,$495.56 ,$489.04 ,$423.83 ,$554.24 , N/A ,$423.83 ,$423.83 ,$456.44 ,$397.10 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$554.24 , N/A ,$599.89 ,$456.44 ,$330.72 ,$396.90 ,$397.10 ,$396.90 ,$450.57 ,$586.85 ,$445.48 , N/A ,$515.12 ,$4.59 , N/A , N/A , N/A , N/A ,$469.48 ,$404.27 ,$469.48 ,$469.48 ,$521.64 
ST NICHOLAS HOSPITAL - ACUTE,78000109,99236,PC TELEHEALTH HOSP INP/OBS CARE SAME DATE HIGH 85 MIN-95,960,1 ,$836.85 ,$552.32 ,$4.33 ,$836.85 ,$4.33 ,$573.58 ,$573.58 , N/A ,$502.11 ,$711.32 ,$585.80 ,$4.33 ,$4.33 ,$795.01 ,$636.01 ,$627.64 ,$543.95 ,$711.32 , N/A ,$543.95 ,$543.95 ,$585.80 ,$509.64 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$711.32 , N/A ,$769.90 ,$585.80 ,$424.45 ,$509.39 ,$509.64 ,$509.39 ,$578.26 ,$753.17 ,$571.74 , N/A ,$661.11 ,$4.59 , N/A , N/A , N/A , N/A ,$602.53 ,$518.85 ,$602.53 ,$602.53 ,$669.48 
ST NICHOLAS HOSPITAL - ACUTE,78000110,99238,PC TELEHEALTH HOSP INP/OBS DISCHARGE DAY <31MIN- 95,960,1 ,$282.45 ,$186.42 ,$3.07 ,$282.45 ,$3.07 ,$193.59 ,$193.59 , N/A ,$169.47 ,$240.08 ,$197.72 ,$3.07 ,$3.07 ,$268.33 ,$214.66 ,$211.84 ,$183.59 ,$240.08 , N/A ,$183.59 ,$183.59 ,$197.72 ,$172.01 ,$3.07 , N/A , N/A , N/A ,$3.25 ,$240.08 , N/A ,$259.85 ,$197.72 ,$143.26 ,$171.93 ,$172.01 ,$171.93 ,$195.17 ,$254.21 ,$192.97 , N/A ,$223.14 ,$3.25 , N/A , N/A , N/A , N/A ,$203.36 ,$175.12 ,$203.36 ,$203.36 ,$225.96 
ST NICHOLAS HOSPITAL - ACUTE,78000111,99239,PC TELEHEALTH HOSP INP/OBS DISCHARGE DAY >30MIN- 95,960,1 ,$412.65 ,$272.35 ,$3.07 ,$412.65 ,$3.07 ,$282.83 ,$282.83 , N/A ,$247.59 ,$350.75 ,$288.86 ,$3.07 ,$3.07 ,$392.02 ,$313.61 ,$309.49 ,$268.22 ,$350.75 , N/A ,$268.22 ,$268.22 ,$288.86 ,$251.30 ,$3.07 , N/A , N/A , N/A ,$3.25 ,$350.75 , N/A ,$379.64 ,$288.86 ,$209.30 ,$251.18 ,$251.30 ,$251.18 ,$285.14 ,$371.39 ,$281.92 , N/A ,$325.99 ,$3.25 , N/A , N/A , N/A , N/A ,$297.11 ,$255.84 ,$297.11 ,$297.11 ,$330.12 
ST NICHOLAS HOSPITAL - ACUTE,78000176,G0425,PC TELEHEALTH ED/IP CONSULT 30 MIN - 95,960,1 ,$350.00 ,$231.00 ,$4.33 ,$350.00 ,$4.33 ,$239.89 ,$239.89 , N/A ,$210.00 ,$297.50 ,$245.00 ,$4.33 ,$4.33 ,$332.50 ,$266.00 ,$262.50 ,$227.50 ,$297.50 , N/A ,$227.50 ,$227.50 ,$245.00 ,$213.15 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$297.50 , N/A ,$322.00 ,$245.00 ,$177.52 ,$213.05 ,$213.15 ,$213.05 ,$241.85 ,$315.00 ,$239.12 , N/A ,$276.50 ,$4.59 , N/A , N/A , N/A , N/A ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,78000177,G0426,PC TELEHEALTH ED/IP CONSULT 50 MIN - 95,960,1 ,$450.00 ,$297.00 ,$4.33 ,$450.00 ,$4.33 ,$308.43 ,$308.43 , N/A ,$270.00 ,$382.50 ,$315.00 ,$4.33 ,$4.33 ,$427.50 ,$342.00 ,$337.50 ,$292.50 ,$382.50 , N/A ,$292.50 ,$292.50 ,$315.00 ,$274.05 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 ,$4.59 , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,78000178,G0427,PC TELEHEALTH ED/IP CONSULT 70 MIN - 95,960,1 ,$550.00 ,$363.00 ,$4.33 ,$550.00 ,$4.33 ,$376.97 ,$376.97 , N/A ,$330.00 ,$467.50 ,$385.00 ,$4.33 ,$4.33 ,$522.50 ,$418.00 ,$412.50 ,$357.50 ,$467.50 , N/A ,$357.50 ,$357.50 ,$385.00 ,$334.95 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$467.50 , N/A ,$506.00 ,$385.00 ,$278.96 ,$334.79 ,$334.95 ,$334.79 ,$380.05 ,$495.00 ,$375.76 , N/A ,$434.50 ,$4.59 , N/A , N/A , N/A , N/A ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$440.00 
ST NICHOLAS HOSPITAL - ACUTE,78000191,G0508,PC TELEHEALTH CRITICAL CARE CONSULT 60 MIN - 95,960,1 ,$650.00 ,$429.00 ,$4.33 ,$650.00 ,$4.33 ,$445.51 ,$445.51 , N/A ,$390.00 ,$552.50 ,$455.00 ,$4.33 ,$4.33 ,$617.50 ,$494.00 ,$487.50 ,$422.50 ,$552.50 , N/A ,$422.50 ,$422.50 ,$455.00 ,$395.85 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$552.50 , N/A ,$598.00 ,$455.00 ,$329.68 ,$395.66 ,$395.85 ,$395.66 ,$449.15 ,$585.00 ,$444.08 , N/A ,$513.50 ,$4.59 , N/A , N/A , N/A , N/A ,$468.00 ,$403.00 ,$468.00 ,$468.00 ,$520.00 
ST NICHOLAS HOSPITAL - ACUTE,78000192,G0509,PC TELEHEALTH CRITICAL CARE CONSULT 50 MIN - 95,960,1 ,$650.00 ,$429.00 ,$4.33 ,$650.00 ,$4.33 ,$445.51 ,$445.51 , N/A ,$390.00 ,$552.50 ,$455.00 ,$4.33 ,$4.33 ,$617.50 ,$494.00 ,$487.50 ,$422.50 ,$552.50 , N/A ,$422.50 ,$422.50 ,$455.00 ,$395.85 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$552.50 , N/A ,$598.00 ,$455.00 ,$329.68 ,$395.66 ,$395.85 ,$395.66 ,$449.15 ,$585.00 ,$444.08 , N/A ,$513.50 ,$4.59 , N/A , N/A , N/A , N/A ,$468.00 ,$403.00 ,$468.00 ,$468.00 ,$520.00 
ST NICHOLAS HOSPITAL - ACUTE,78000224,G0425,PC TELEHEALTH STROKE ED/IP CONSULT 30 MIN - G0,960,1 ,$350.00 ,$231.00 ,$4.33 ,$350.00 ,$4.33 ,$239.89 ,$239.89 , N/A ,$210.00 ,$297.50 ,$245.00 ,$4.33 ,$4.33 ,$332.50 ,$266.00 ,$262.50 ,$227.50 ,$297.50 , N/A ,$227.50 ,$227.50 ,$245.00 ,$213.15 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$297.50 , N/A ,$322.00 ,$245.00 ,$177.52 ,$213.05 ,$213.15 ,$213.05 ,$241.85 ,$315.00 ,$239.12 , N/A ,$276.50 ,$4.59 , N/A , N/A , N/A , N/A ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,78000225,G0426,PC TELEHEALTH STROKE ED/IP CONSULT 50 MIN - G0,960,1 ,$450.00 ,$297.00 ,$4.33 ,$450.00 ,$4.33 ,$308.43 ,$308.43 , N/A ,$270.00 ,$382.50 ,$315.00 ,$4.33 ,$4.33 ,$427.50 ,$342.00 ,$337.50 ,$292.50 ,$382.50 , N/A ,$292.50 ,$292.50 ,$315.00 ,$274.05 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 ,$4.59 , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,78000226,G0427,PC TELEHEALTH STROKE ED/IP CONSULT 70 MIN - G0,960,1 ,$550.00 ,$363.00 ,$4.33 ,$550.00 ,$4.33 ,$376.97 ,$376.97 , N/A ,$330.00 ,$467.50 ,$385.00 ,$4.33 ,$4.33 ,$522.50 ,$418.00 ,$412.50 ,$357.50 ,$467.50 , N/A ,$357.50 ,$357.50 ,$385.00 ,$334.95 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$467.50 , N/A ,$506.00 ,$385.00 ,$278.96 ,$334.79 ,$334.95 ,$334.79 ,$380.05 ,$495.00 ,$375.76 , N/A ,$434.50 ,$4.59 , N/A , N/A , N/A , N/A ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$440.00 
ST NICHOLAS HOSPITAL - ACUTE,78000227,G0508,PC TELEHEALTH STROKE CRITICAL CARE CONSULT 60 MIN - G0,960,1 ,$650.00 ,$429.00 ,$4.33 ,$650.00 ,$4.33 ,$445.51 ,$445.51 , N/A ,$390.00 ,$552.50 ,$455.00 ,$4.33 ,$4.33 ,$617.50 ,$494.00 ,$487.50 ,$422.50 ,$552.50 , N/A ,$422.50 ,$422.50 ,$455.00 ,$395.85 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$552.50 , N/A ,$598.00 ,$455.00 ,$329.68 ,$395.66 ,$395.85 ,$395.66 ,$449.15 ,$585.00 ,$444.08 , N/A ,$513.50 ,$4.59 , N/A , N/A , N/A , N/A ,$468.00 ,$403.00 ,$468.00 ,$468.00 ,$520.00 
ST NICHOLAS HOSPITAL - ACUTE,78000228,G0509,PC TELEHEALTH STROKE CRITICAL CARE CONSULT 50 MIN -G0,960,1 ,$650.00 ,$429.00 ,$4.33 ,$650.00 ,$4.33 ,$445.51 ,$445.51 , N/A ,$390.00 ,$552.50 ,$455.00 ,$4.33 ,$4.33 ,$617.50 ,$494.00 ,$487.50 ,$422.50 ,$552.50 , N/A ,$422.50 ,$422.50 ,$455.00 ,$395.85 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$552.50 , N/A ,$598.00 ,$455.00 ,$329.68 ,$395.66 ,$395.85 ,$395.66 ,$449.15 ,$585.00 ,$444.08 , N/A ,$513.50 ,$4.59 , N/A , N/A , N/A , N/A ,$468.00 ,$403.00 ,$468.00 ,$468.00 ,$520.00 
ST NICHOLAS HOSPITAL - ACUTE,80100000,90999,HC RENAL DIALYSIS IP,801,1 ,$730.00 ,$481.80 ,$30.01 ,$730.00 ,$30.01 ,$500.34 ,$500.34 , N/A ,$438.00 ,$620.50 ,$511.00 ,$30.01 ,$30.01 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$444.57 ,$30.01 , N/A , N/A , N/A ,$31.81 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$498.74 , N/A ,$576.70 ,$31.81 ,$430.70 ,$430.70 , N/A ,$430.70 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,80100008,G0491,HC RENAL DIALYSIS W/KIDNEY INJ W/O ESRD IP,801,1 ,$730.00 ,$481.80 ,$30.01 ,$730.00 ,$30.01 ,$500.34 ,$500.34 , N/A ,$438.00 ,$620.50 ,$511.00 ,$30.01 ,$30.01 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$444.57 ,$30.01 , N/A , N/A , N/A ,$31.81 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$498.74 , N/A ,$576.70 ,$31.81 ,$430.70 ,$430.70 , N/A ,$430.70 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,80100009,G0492,HC RENAL DIALYSIS W/KIDNEY INJ W/O ESRD W/PHY EVAL IP,801,1 ,$730.00 ,$481.80 ,$30.01 ,$730.00 ,$30.01 ,$500.34 ,$500.34 , N/A ,$438.00 ,$620.50 ,$511.00 ,$30.01 ,$30.01 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$444.57 ,$30.01 , N/A , N/A , N/A ,$31.81 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$498.74 , N/A ,$576.70 ,$31.81 ,$430.70 ,$430.70 , N/A ,$430.70 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,82100000,90999,HC RENAL DIALYSIS OP,821,1 ,$730.00 ,$481.80 ,$30.01 ,$730.00 ,$30.01 ,$730.00 ,$730.00 , N/A ,$438.00 ,$620.50 ,$511.00 ,$30.01 ,$30.01 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$444.57 ,$30.01 , N/A , N/A , N/A ,$31.81 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$498.74 , N/A ,$576.70 ,$31.81 ,$462.00 ,$462.00 , N/A ,$462.00 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,82100003,G0491,HC RENAL DIALYSIS W/KIDNEY INJ W/O ESRD OP,821,1 ,$730.00 ,$481.80 ,$30.01 ,$730.00 ,$30.01 ,$730.00 ,$730.00 , N/A ,$438.00 ,$620.50 ,$511.00 ,$30.01 ,$30.01 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$444.57 ,$30.01 , N/A , N/A , N/A ,$31.81 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$498.74 , N/A ,$576.70 ,$31.81 ,$462.00 ,$462.00 , N/A ,$462.00 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,82100004,G0492,HC RENAL DIALYSIS W/KIDNEY INJ W/O ESRD W/PHY EVAL OP,821,1 ,$730.00 ,$481.80 ,$30.01 ,$730.00 ,$30.01 ,$730.00 ,$730.00 , N/A ,$438.00 ,$620.50 ,$511.00 ,$30.01 ,$30.01 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$444.57 ,$30.01 , N/A , N/A , N/A ,$31.81 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$498.74 , N/A ,$576.70 ,$31.81 ,$462.00 ,$462.00 , N/A ,$462.00 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,84112072,84112,HC PLACENTAL ALPHA MICROGLOBULIN-1- PREV 72 HR,301,1 ,$517.65 ,$341.65 ,$90.57 ,$517.65 ,$90.57 ,$343.39 ,$343.39 ,$98.11 ,$310.59 ,$440.00 ,$362.36 ,$90.57 ,$90.57 ,$491.77 ,$393.41 ,$388.24 ,$166.79 ,$440.00 ,$98.11 ,$166.79 ,$166.79 ,$362.36 ,$315.25 ,$90.57 ,$98.11 ,$96.15 ,$196.22 ,$96.00 ,$440.00 ,$220.75 ,$476.24 ,$362.36 ,$321.95 ,$321.95 ,$315.25 ,$321.95 ,$357.70 ,$465.89 ,$353.66 ,$97.11 ,$408.94 ,$96.00 ,$117.73 ,$117.73 ,$96.15 ,$117.73 ,$372.71 ,$320.94 ,$372.71 ,$372.71 ,$414.12 
ST NICHOLAS HOSPITAL - ACUTE,87426072,87426,HC CORONAVIRUS AG AI PREVEA 72HR,300,1 ,$96.60 ,$63.76 ,$34.62 ,$96.60 ,$35.33 ,$96.60 ,$96.60 ,$35.33 ,$57.96 ,$82.11 ,$67.62 ,$35.33 ,$35.33 ,$91.77 ,$73.42 ,$72.45 ,$60.06 ,$82.11 ,$35.33 ,$60.06 ,$60.06 ,$67.62 ,$58.83 ,$35.33 ,$35.33 ,$34.62 ,$70.66 ,$37.45 ,$82.11 ,$79.49 ,$88.87 ,$67.62 ,$96.60 ,$96.60 ,$58.83 ,$96.60 ,$66.75 ,$86.94 ,$66.00 ,$34.97 ,$76.31 ,$37.45 ,$54.44 ,$54.44 ,$34.62 ,$54.44 ,$69.55 ,$59.89 ,$69.55 ,$69.55 ,$77.28 
ST NICHOLAS HOSPITAL - ACUTE,92000001,59020,HC TEST STRESS FETAL,920,1 ,$619.85 ,$409.10 ,$6.59 ,$619.85 ,$6.59 ,$424.85 ,$424.85 ,$173.85 ,$371.91 ,$526.87 ,$433.90 ,$6.59 ,$6.59 ,$588.86 ,$471.09 ,$464.89 ,$402.90 ,$526.87 ,$173.85 ,$402.90 ,$402.90 ,$433.90 ,$377.49 ,$6.59 ,$173.85 ,$170.37 ,$347.70 ,$6.99 ,$526.87 ,$391.17 ,$570.26 ,$433.90 ,$314.39 ,$377.30 ,$377.49 ,$377.30 ,$428.32 ,$557.87 ,$423.48 ,$172.08 ,$489.68 ,$6.99 ,$459.00 ,$459.00 ,$170.37 ,$459.00 ,$446.29 ,$384.31 ,$446.29 ,$446.29 ,$495.88 
ST NICHOLAS HOSPITAL - ACUTE,92000002,59025,HC TEST NON STRESS FETAL,920,1 ,$519.80 ,$343.07 ,$6.59 ,$519.80 ,$6.59 ,$356.27 ,$356.27 ,$173.85 ,$311.88 ,$441.83 ,$363.86 ,$6.59 ,$6.59 ,$493.81 ,$395.05 ,$389.85 ,$337.87 ,$441.83 ,$173.85 ,$337.87 ,$337.87 ,$363.86 ,$316.56 ,$6.59 ,$173.85 ,$170.37 ,$347.70 ,$6.99 ,$441.83 ,$391.17 ,$478.22 ,$363.86 ,$263.64 ,$316.40 ,$316.56 ,$316.40 ,$359.18 ,$467.82 ,$355.13 ,$172.08 ,$410.64 ,$6.99 ,$459.00 ,$459.00 ,$170.37 ,$459.00 ,$374.26 ,$322.28 ,$374.26 ,$374.26 ,$415.84 
ST NICHOLAS HOSPITAL - ACUTE,92100001,N/A,HC PULSE VOLUME RECORD BI,921,1 ,$289.38 ,$190.99 ,$146.77 ,$289.38 , N/A ,$198.34 ,$198.34 , N/A ,$173.63 ,$245.97 ,$202.57 , N/A , N/A ,$274.91 ,$219.93 ,$217.04 ,$188.10 ,$245.97 , N/A ,$188.10 ,$188.10 ,$202.57 ,$176.23 , N/A , N/A , N/A , N/A , N/A ,$245.97 , N/A ,$266.23 ,$202.57 ,$146.77 ,$176.15 ,$176.23 ,$176.15 ,$199.96 ,$260.44 ,$197.70 , N/A ,$228.61 , N/A ,$289.38 ,$289.38 , N/A ,$289.38 ,$208.35 ,$179.42 ,$208.35 ,$208.35 ,$231.50 
ST NICHOLAS HOSPITAL - ACUTE,92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$1,356.35 ",$895.19 ,$5.75 ,"$1,356.35 ",$5.75 ,$929.64 ,$929.64 ,$227.92 ,$813.81 ,"$1,152.90 ",$949.45 ,$5.75 ,$5.75 ,"$1,288.53 ","$1,030.83 ","$1,017.26 ",$881.63 ,"$1,152.90 ",$227.92 ,$881.63 ,$881.63 ,$949.45 ,$826.02 ,$5.75 ,$227.92 ,$223.36 ,$455.84 ,$6.10 ,"$1,152.90 ",$512.81 ,"$1,247.84 ",$949.45 ,$687.94 ,$825.61 ,$826.02 ,$825.61 ,$937.24 ,"$1,220.72 ",$926.66 ,$225.60 ,"$1,071.52 ",$6.10 ,$475.00 ,$475.00 ,$223.36 ,$475.00 ,$976.57 ,$840.94 ,$976.57 ,$976.57 ,"$1,085.08 "
ST NICHOLAS HOSPITAL - ACUTE,92100003,93882,HC DUPLEX CAROTID UNI,921,1 ,$666.87 ,$440.13 ,$3.71 ,$666.87 ,$3.71 ,$457.07 ,$457.07 ,$104.31 ,$400.12 ,$566.84 ,$466.81 ,$3.71 ,$3.71 ,$633.53 ,$506.82 ,$500.15 ,$433.47 ,$566.84 ,$104.31 ,$433.47 ,$433.47 ,$466.81 ,$406.12 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$566.84 ,$234.71 ,$613.52 ,$466.81 ,$338.24 ,$405.92 ,$406.12 ,$405.92 ,$460.81 ,$600.18 ,$455.61 ,$103.24 ,$526.83 ,$3.93 ,$475.00 ,$475.00 ,$102.22 ,$475.00 ,$480.15 ,$413.46 ,$480.15 ,$480.15 ,$533.50 
ST NICHOLAS HOSPITAL - ACUTE,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$510.66 ,$337.04 ,$3.71 ,$510.66 ,$3.71 ,$350.01 ,$350.01 ,$56.66 ,$306.40 ,$434.06 ,$357.46 ,$3.71 ,$3.71 ,$485.13 ,$388.10 ,$383.00 ,$331.93 ,$434.06 ,$56.66 ,$331.93 ,$331.93 ,$357.46 ,$310.99 ,$3.71 ,$56.66 ,$55.53 ,$113.32 ,$3.93 ,$434.06 ,$127.49 ,$469.81 ,$357.46 ,$259.01 ,$310.84 ,$310.99 ,$310.84 ,$352.87 ,$459.59 ,$348.88 ,$56.09 ,$403.42 ,$3.93 ,$475.00 ,$475.00 ,$55.53 ,$475.00 ,$367.68 ,$316.61 ,$367.68 ,$367.68 ,$408.53 
ST NICHOLAS HOSPITAL - ACUTE,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$510.66 ,$337.04 ,$3.71 ,$510.66 ,$3.71 ,$350.01 ,$350.01 ,$56.66 ,$306.40 ,$434.06 ,$357.46 ,$3.71 ,$3.71 ,$485.13 ,$388.10 ,$383.00 ,$331.93 ,$434.06 ,$56.66 ,$331.93 ,$331.93 ,$357.46 ,$310.99 ,$3.71 ,$56.66 ,$55.53 ,$113.32 ,$3.93 ,$434.06 ,$127.49 ,$469.81 ,$357.46 ,$259.01 ,$310.84 ,$310.99 ,$310.84 ,$352.87 ,$459.59 ,$348.88 ,$56.09 ,$403.42 ,$3.93 ,$475.00 ,$475.00 ,$55.53 ,$475.00 ,$367.68 ,$316.61 ,$367.68 ,$367.68 ,$408.53 
ST NICHOLAS HOSPITAL - ACUTE,92100006,93922,HC TCPO2/SPP UNILATERAL 1-2 LEVELS W/FULL STUDY - 93922,921,1 ,$510.66 ,$337.04 ,$3.71 ,$510.66 ,$3.71 ,$350.01 ,$350.01 ,$113.32 ,$306.40 ,$434.06 ,$357.46 ,$3.71 ,$3.71 ,$485.13 ,$388.10 ,$383.00 ,$331.93 ,$434.06 ,$113.32 ,$331.93 ,$331.93 ,$357.46 ,$310.99 ,$3.71 ,$113.32 ,$111.05 ,$226.64 ,$3.93 ,$434.06 ,$254.98 ,$469.81 ,$357.46 ,$259.01 ,$310.84 ,$310.99 ,$310.84 ,$352.87 ,$459.59 ,$348.88 ,$112.16 ,$403.42 ,$3.93 ,$475.00 ,$475.00 ,$111.05 ,$475.00 ,$367.68 ,$316.61 ,$367.68 ,$367.68 ,$408.53 
ST NICHOLAS HOSPITAL - ACUTE,92100007,93922,HC TCPO2/SPP UNILATERAL 3 OR MORE LEVEL - 93922,921,1 ,$510.66 ,$337.04 ,$3.71 ,$510.66 ,$3.71 ,$350.01 ,$350.01 ,$113.32 ,$306.40 ,$434.06 ,$357.46 ,$3.71 ,$3.71 ,$485.13 ,$388.10 ,$383.00 ,$331.93 ,$434.06 ,$113.32 ,$331.93 ,$331.93 ,$357.46 ,$310.99 ,$3.71 ,$113.32 ,$111.05 ,$226.64 ,$3.93 ,$434.06 ,$254.98 ,$469.81 ,$357.46 ,$259.01 ,$310.84 ,$310.99 ,$310.84 ,$352.87 ,$459.59 ,$348.88 ,$112.16 ,$403.42 ,$3.93 ,$475.00 ,$475.00 ,$111.05 ,$475.00 ,$367.68 ,$316.61 ,$367.68 ,$367.68 ,$408.53 
ST NICHOLAS HOSPITAL - ACUTE,92100011,93922,HC TCPO2 UNLIATERAL 1-2 LEVEL - 93922-52,921,1 ,$510.66 ,$337.04 ,$3.71 ,$510.66 ,$3.71 ,$350.01 ,$350.01 ,$56.66 ,$306.40 ,$434.06 ,$357.46 ,$3.71 ,$3.71 ,$485.13 ,$388.10 ,$383.00 ,$331.93 ,$434.06 ,$56.66 ,$331.93 ,$331.93 ,$357.46 ,$310.99 ,$3.71 ,$56.66 ,$55.53 ,$113.32 ,$3.93 ,$434.06 ,$127.49 ,$469.81 ,$357.46 ,$259.01 ,$310.84 ,$310.99 ,$310.84 ,$352.87 ,$459.59 ,$348.88 ,$56.09 ,$403.42 ,$3.93 ,$475.00 ,$475.00 ,$55.53 ,$475.00 ,$367.68 ,$316.61 ,$367.68 ,$367.68 ,$408.53 
ST NICHOLAS HOSPITAL - ACUTE,92100023,93923,HC TCPO2/ABI/PPG MULT LEVELS,921,1 ,$723.61 ,$477.58 ,$5.78 ,$723.61 ,$5.78 ,$495.96 ,$495.96 ,$141.94 ,$434.17 ,$615.07 ,$506.53 ,$5.78 ,$5.78 ,$687.43 ,$549.94 ,$542.71 ,$470.35 ,$615.07 ,$141.94 ,$470.35 ,$470.35 ,$506.53 ,$440.68 ,$5.78 ,$141.94 ,$139.10 ,$283.88 ,$6.13 ,$615.07 ,$319.36 ,$665.72 ,$506.53 ,$367.02 ,$440.46 ,$440.68 ,$440.46 ,$500.01 ,$651.25 ,$494.37 ,$140.49 ,$571.65 ,$6.13 ,$475.00 ,$475.00 ,$139.10 ,$475.00 ,$521.00 ,$448.64 ,$521.00 ,$521.00 ,$578.89 
ST NICHOLAS HOSPITAL - ACUTE,92100026,93923,HC TCPO2/SPP BIL 1-2 LEVELS W/FULL STUDY -93923,921,1 ,$723.61 ,$477.58 ,$5.78 ,$723.61 ,$5.78 ,$495.96 ,$495.96 ,$141.94 ,$434.17 ,$615.07 ,$506.53 ,$5.78 ,$5.78 ,$687.43 ,$549.94 ,$542.71 ,$470.35 ,$615.07 ,$141.94 ,$470.35 ,$470.35 ,$506.53 ,$440.68 ,$5.78 ,$141.94 ,$139.10 ,$283.88 ,$6.13 ,$615.07 ,$319.36 ,$665.72 ,$506.53 ,$367.02 ,$440.46 ,$440.68 ,$440.46 ,$500.01 ,$651.25 ,$494.37 ,$140.49 ,$571.65 ,$6.13 ,$475.00 ,$475.00 ,$139.10 ,$475.00 ,$521.00 ,$448.64 ,$521.00 ,$521.00 ,$578.89 
ST NICHOLAS HOSPITAL - ACUTE,92100027,93923,HC TCPO2/SPP BIL 3 OR MORE LEVELS - 93923,921,1 ,$723.61 ,$477.58 ,$5.78 ,$723.61 ,$5.78 ,$495.96 ,$495.96 ,$141.94 ,$434.17 ,$615.07 ,$506.53 ,$5.78 ,$5.78 ,$687.43 ,$549.94 ,$542.71 ,$470.35 ,$615.07 ,$141.94 ,$470.35 ,$470.35 ,$506.53 ,$440.68 ,$5.78 ,$141.94 ,$139.10 ,$283.88 ,$6.13 ,$615.07 ,$319.36 ,$665.72 ,$506.53 ,$367.02 ,$440.46 ,$440.68 ,$440.46 ,$500.01 ,$651.25 ,$494.37 ,$140.49 ,$571.65 ,$6.13 ,$475.00 ,$475.00 ,$139.10 ,$475.00 ,$521.00 ,$448.64 ,$521.00 ,$521.00 ,$578.89 
ST NICHOLAS HOSPITAL - ACUTE,92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,$723.61 ,$477.58 ,$5.78 ,$723.61 ,$5.78 ,$495.96 ,$495.96 ,$141.94 ,$434.17 ,$615.07 ,$506.53 ,$5.78 ,$5.78 ,$687.43 ,$549.94 ,$542.71 ,$470.35 ,$615.07 ,$141.94 ,$470.35 ,$470.35 ,$506.53 ,$440.68 ,$5.78 ,$141.94 ,$139.10 ,$283.88 ,$6.13 ,$615.07 ,$319.36 ,$665.72 ,$506.53 ,$367.02 ,$440.46 ,$440.68 ,$440.46 ,$500.01 ,$651.25 ,$494.37 ,$140.49 ,$571.65 ,$6.13 ,$475.00 ,$475.00 ,$139.10 ,$475.00 ,$521.00 ,$448.64 ,$521.00 ,$521.00 ,$578.89 
ST NICHOLAS HOSPITAL - ACUTE,92100031,93923,HC RESTING ARTERIAL UPPER BILATERAL,921,1 ,$723.61 ,$477.58 ,$5.78 ,$723.61 ,$5.78 ,$495.96 ,$495.96 ,$141.94 ,$434.17 ,$615.07 ,$506.53 ,$5.78 ,$5.78 ,$687.43 ,$549.94 ,$542.71 ,$470.35 ,$615.07 ,$141.94 ,$470.35 ,$470.35 ,$506.53 ,$440.68 ,$5.78 ,$141.94 ,$139.10 ,$283.88 ,$6.13 ,$615.07 ,$319.36 ,$665.72 ,$506.53 ,$367.02 ,$440.46 ,$440.68 ,$440.46 ,$500.01 ,$651.25 ,$494.37 ,$140.49 ,$571.65 ,$6.13 ,$475.00 ,$475.00 ,$139.10 ,$475.00 ,$521.00 ,$448.64 ,$521.00 ,$521.00 ,$578.89 
ST NICHOLAS HOSPITAL - ACUTE,92100032,93924,HC DOPPLER ARTERY LWR EXT STRESS,921,1 ,"$1,305.25 ",$861.47 ,$3.71 ,"$1,305.25 ",$3.71 ,$894.62 ,$894.62 ,$273.34 ,$783.15 ,"$1,109.46 ",$913.68 ,$3.71 ,$3.71 ,"$1,239.99 ",$991.99 ,$978.94 ,$848.41 ,"$1,109.46 ",$273.34 ,$848.41 ,$848.41 ,$913.68 ,$794.90 ,$3.71 ,$273.34 ,$267.87 ,$546.68 ,$3.93 ,"$1,109.46 ",$615.01 ,"$1,200.83 ",$913.68 ,$662.02 ,$794.51 ,$794.90 ,$794.51 ,$901.93 ,"$1,174.73 ",$891.75 ,$270.55 ,"$1,031.15 ",$3.93 ,$475.00 ,$475.00 ,$267.87 ,$475.00 ,$939.78 ,$809.26 ,$939.78 ,$939.78 ,"$1,044.20 "
ST NICHOLAS HOSPITAL - ACUTE,92100033,93924,HC DOPPLER ARTERY UPP EXT STRESS,921,1 ,"$1,305.25 ",$861.47 ,$3.71 ,"$1,305.25 ",$3.71 ,$894.62 ,$894.62 ,$273.34 ,$783.15 ,"$1,109.46 ",$913.68 ,$3.71 ,$3.71 ,"$1,239.99 ",$991.99 ,$978.94 ,$848.41 ,"$1,109.46 ",$273.34 ,$848.41 ,$848.41 ,$913.68 ,$794.90 ,$3.71 ,$273.34 ,$267.87 ,$546.68 ,$3.93 ,"$1,109.46 ",$615.01 ,"$1,200.83 ",$913.68 ,$662.02 ,$794.51 ,$794.90 ,$794.51 ,$901.93 ,"$1,174.73 ",$891.75 ,$270.55 ,"$1,031.15 ",$3.93 ,$475.00 ,$475.00 ,$267.87 ,$475.00 ,$939.78 ,$809.26 ,$939.78 ,$939.78 ,"$1,044.20 "
ST NICHOLAS HOSPITAL - ACUTE,92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$1,400.00 ",$924.00 ,$5.75 ,"$1,400.00 ",$5.75 ,$959.56 ,$959.56 ,$227.92 ,$840.00 ,"$1,190.00 ",$980.00 ,$5.75 ,$5.75 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$910.00 ,"$1,190.00 ",$227.92 ,$910.00 ,$910.00 ,$980.00 ,$852.60 ,$5.75 ,$227.92 ,$223.36 ,$455.84 ,$6.10 ,"$1,190.00 ",$512.81 ,"$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$852.18 ,$967.40 ,"$1,260.00 ",$956.48 ,$225.60 ,"$1,106.00 ",$6.10 ,$475.00 ,$475.00 ,$223.36 ,$475.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,92100035,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT,921,1 ,$840.00 ,$554.40 ,$3.71 ,$840.00 ,$3.71 ,$575.74 ,$575.74 ,$104.31 ,$504.00 ,$714.00 ,$588.00 ,$3.71 ,$3.71 ,$798.00 ,$638.40 ,$630.00 ,$546.00 ,$714.00 ,$104.31 ,$546.00 ,$546.00 ,$588.00 ,$511.56 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$714.00 ,$234.71 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$511.31 ,$580.44 ,$756.00 ,$573.89 ,$103.24 ,$663.60 ,$3.93 ,$475.00 ,$475.00 ,$102.22 ,$475.00 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$672.00 
ST NICHOLAS HOSPITAL - ACUTE,92100036,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT PSEUD,921,1 ,$840.00 ,$554.40 ,$3.71 ,$840.00 ,$3.71 ,$575.74 ,$575.74 ,$104.31 ,$504.00 ,$714.00 ,$588.00 ,$3.71 ,$3.71 ,$798.00 ,$638.40 ,$630.00 ,$546.00 ,$714.00 ,$104.31 ,$546.00 ,$546.00 ,$588.00 ,$511.56 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$714.00 ,$234.71 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$511.31 ,$580.44 ,$756.00 ,$573.89 ,$103.24 ,$663.60 ,$3.93 ,$475.00 ,$475.00 ,$102.22 ,$475.00 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$672.00 
ST NICHOLAS HOSPITAL - ACUTE,92100037,93930,HC DUPLEX ARTERIAL UPR EXT BI,921,1 ,"$1,100.00 ",$726.00 ,$3.71 ,"$1,100.00 ",$3.71 ,$753.94 ,$753.94 ,$227.92 ,$660.00 ,$935.00 ,$770.00 ,$3.71 ,$3.71 ,"$1,045.00 ",$836.00 ,$825.00 ,$715.00 ,$935.00 ,$227.92 ,$715.00 ,$715.00 ,$770.00 ,$669.90 ,$3.71 ,$227.92 ,$223.36 ,$455.84 ,$3.93 ,$935.00 ,$512.81 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$669.57 ,$760.10 ,$990.00 ,$751.52 ,$225.60 ,$869.00 ,$3.93 ,$475.00 ,$475.00 ,$223.36 ,$475.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,92100038,93931,HC DUPLEX ARTRL UPR EXT UNI/LMT,921,1 ,$760.00 ,$501.60 ,$3.71 ,$760.00 ,$3.71 ,$520.90 ,$520.90 ,$104.31 ,$456.00 ,$646.00 ,$532.00 ,$3.71 ,$3.71 ,$722.00 ,$577.60 ,$570.00 ,$494.00 ,$646.00 ,$104.31 ,$494.00 ,$494.00 ,$532.00 ,$462.84 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$646.00 ,$234.71 ,$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$462.61 ,$525.16 ,$684.00 ,$519.23 ,$103.24 ,$600.40 ,$3.93 ,$475.00 ,$475.00 ,$102.22 ,$475.00 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,92100039,93931,HC DUPLEX ARTRL UPR EXT PSEUD ONLY,921,1 ,$760.00 ,$501.60 ,$3.71 ,$760.00 ,$3.71 ,$520.90 ,$520.90 ,$104.31 ,$456.00 ,$646.00 ,$532.00 ,$3.71 ,$3.71 ,$722.00 ,$577.60 ,$570.00 ,$494.00 ,$646.00 ,$104.31 ,$494.00 ,$494.00 ,$532.00 ,$462.84 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$646.00 ,$234.71 ,$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$462.61 ,$525.16 ,$684.00 ,$519.23 ,$103.24 ,$600.40 ,$3.93 ,$475.00 ,$475.00 ,$102.22 ,$475.00 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,92100041,93970,HC DUPLEX VENOUS EXT BI,921,1 ,"$1,400.00 ",$924.00 ,$5.75 ,"$1,400.00 ",$5.75 ,$959.56 ,$959.56 ,$227.92 ,$840.00 ,"$1,190.00 ",$980.00 ,$5.75 ,$5.75 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$910.00 ,"$1,190.00 ",$227.92 ,$910.00 ,$910.00 ,$980.00 ,$852.60 ,$5.75 ,$227.92 ,$223.36 ,$455.84 ,$6.10 ,"$1,190.00 ",$512.81 ,"$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$852.18 ,$967.40 ,"$1,260.00 ",$956.48 ,$225.60 ,"$1,106.00 ",$6.10 ,$475.00 ,$475.00 ,$223.36 ,$475.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,92100042,93970,HC DUPLEX VENOUS EXT BI UPPER,921,1 ,"$1,400.00 ",$924.00 ,$5.75 ,"$1,400.00 ",$5.75 ,$959.56 ,$959.56 ,$227.92 ,$840.00 ,"$1,190.00 ",$980.00 ,$5.75 ,$5.75 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$910.00 ,"$1,190.00 ",$227.92 ,$910.00 ,$910.00 ,$980.00 ,$852.60 ,$5.75 ,$227.92 ,$223.36 ,$455.84 ,$6.10 ,"$1,190.00 ",$512.81 ,"$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$852.18 ,$967.40 ,"$1,260.00 ",$956.48 ,$225.60 ,"$1,106.00 ",$6.10 ,$475.00 ,$475.00 ,$223.36 ,$475.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,$860.00 ,$567.60 ,$3.71 ,$860.00 ,$3.71 ,$589.44 ,$589.44 ,$104.31 ,$516.00 ,$731.00 ,$602.00 ,$3.71 ,$3.71 ,$817.00 ,$653.60 ,$645.00 ,$559.00 ,$731.00 ,$104.31 ,$559.00 ,$559.00 ,$602.00 ,$523.74 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$731.00 ,$234.71 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 ,$103.24 ,$679.40 ,$3.93 ,$475.00 ,$475.00 ,$102.22 ,$475.00 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,92100044,93971,HC VENOUS REFLUX ASSESSMENT UNILAT,921,1 ,$860.00 ,$567.60 ,$3.71 ,$860.00 ,$3.71 ,$589.44 ,$589.44 ,$104.31 ,$516.00 ,$731.00 ,$602.00 ,$3.71 ,$3.71 ,$817.00 ,$653.60 ,$645.00 ,$559.00 ,$731.00 ,$104.31 ,$559.00 ,$559.00 ,$602.00 ,$523.74 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$731.00 ,$234.71 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 ,$103.24 ,$679.40 ,$3.93 ,$475.00 ,$475.00 ,$102.22 ,$475.00 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,92100045,93971,HC DUPLEX VENOUS EXT UNI/LMTD UPPER,921,1 ,$860.00 ,$567.60 ,$3.71 ,$860.00 ,$3.71 ,$589.44 ,$589.44 ,$104.31 ,$516.00 ,$731.00 ,$602.00 ,$3.71 ,$3.71 ,$817.00 ,$653.60 ,$645.00 ,$559.00 ,$731.00 ,$104.31 ,$559.00 ,$559.00 ,$602.00 ,$523.74 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$731.00 ,$234.71 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$587.55 ,$103.24 ,$679.40 ,$3.93 ,$475.00 ,$475.00 ,$102.22 ,$475.00 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,92100046,93990,HC DUPLEX HEMODIALYSIS ACCESS,921,1 ,$700.00 ,$462.00 ,$3.71 ,$700.00 ,$3.71 ,$479.78 ,$479.78 ,$104.31 ,$420.00 ,$595.00 ,$490.00 ,$3.71 ,$3.71 ,$665.00 ,$532.00 ,$525.00 ,$455.00 ,$595.00 ,$104.31 ,$455.00 ,$455.00 ,$490.00 ,$426.30 ,$3.71 ,$104.31 ,$102.22 ,$208.62 ,$3.93 ,$595.00 ,$234.71 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$426.09 ,$483.70 ,$630.00 ,$478.24 ,$103.24 ,$553.00 ,$3.93 ,$475.00 ,$475.00 ,$102.22 ,$475.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,92200001,95861,HC EMG TWO EXTREMITIES,922,1 ,$669.30 ,$441.74 ,$4.77 ,$669.30 ,$4.77 ,$458.74 ,$458.74 ,$113.32 ,$401.58 ,$568.91 ,$468.51 ,$4.77 ,$4.77 ,$635.84 ,$508.67 ,$501.98 ,$435.05 ,$568.91 ,$113.32 ,$435.05 ,$435.05 ,$468.51 ,$407.60 ,$4.77 ,$113.32 ,$111.05 ,$226.64 ,$5.06 ,$568.91 ,$254.98 ,$615.76 ,$468.51 ,$339.47 ,$407.40 ,$407.60 ,$407.40 ,$462.49 ,$602.37 ,$457.27 ,$112.16 ,$528.75 ,$5.06 ,$669.30 ,$669.30 ,$111.05 ,$669.30 ,$481.90 ,$414.97 ,$481.90 ,$481.90 ,$535.44 
ST NICHOLAS HOSPITAL - ACUTE,92200001,95861,HC EMG TWO EXTREMITIES,922,1 ,$450.00 ,$297.00 ,$4.77 ,$450.00 ,$4.77 ,$308.43 ,$308.43 ,$113.32 ,$270.00 ,$382.50 ,$315.00 ,$4.77 ,$4.77 ,$427.50 ,$342.00 ,$337.50 ,$292.50 ,$382.50 ,$113.32 ,$292.50 ,$292.50 ,$315.00 ,$274.05 ,$4.77 ,$113.32 ,$111.05 ,$226.64 ,$5.06 ,$382.50 ,$254.98 ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 ,$112.16 ,$355.50 ,$5.06 ,$450.00 ,$450.00 ,$111.05 ,$450.00 ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,92200003,95867,HC EMG CRANIAL NERVE UNI,922,1 ,$350.00 ,$231.00 ,$4.77 ,$615.01 ,$4.77 ,$239.89 ,$239.89 ,$273.34 ,$210.00 ,$297.50 ,$245.00 ,$4.77 ,$4.77 ,$332.50 ,$266.00 ,$262.50 ,$227.50 ,$297.50 ,$273.34 ,$227.50 ,$227.50 ,$245.00 ,$213.15 ,$4.77 ,$273.34 ,$267.87 ,$350.00 ,$5.06 ,$297.50 ,$615.01 ,$322.00 ,$245.00 ,$177.52 ,$213.05 ,$213.15 ,$213.05 ,$241.85 ,$315.00 ,$239.12 ,$270.55 ,$276.50 ,$5.06 ,$350.00 ,$350.00 ,$267.87 ,$350.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,92200004,95872,HC EMG SINGLE FIBER DENSITY,922,1 ,$742.90 ,$490.31 ,$4.77 ,$742.90 ,$4.77 ,$509.18 ,$509.18 ,$141.94 ,$445.74 ,$631.47 ,$520.03 ,$4.77 ,$4.77 ,$705.76 ,$564.60 ,$557.18 ,$482.89 ,$631.47 ,$141.94 ,$482.89 ,$482.89 ,$520.03 ,$452.43 ,$4.77 ,$141.94 ,$139.10 ,$283.88 ,$5.06 ,$631.47 ,$319.36 ,$683.47 ,$520.03 ,$376.80 ,$452.20 ,$452.43 ,$452.20 ,$513.34 ,$668.61 ,$507.55 ,$140.49 ,$586.89 ,$5.06 ,$742.90 ,$742.90 ,$139.10 ,$742.90 ,$534.89 ,$460.60 ,$534.89 ,$534.89 ,$594.32 
ST NICHOLAS HOSPITAL - ACUTE,92200015,95938,HC SSEP UPPER AND LOWER,922,1 ,"$1,779.88 ","$1,174.72 ",$4.77 ,"$1,779.88 ",$4.77 ,"$1,219.93 ","$1,219.93 ",$471.83 ,"$1,067.93 ","$1,512.90 ","$1,245.92 ",$4.77 ,$4.77 ,"$1,690.89 ","$1,352.71 ","$1,334.91 ","$1,156.92 ","$1,512.90 ",$471.83 ,"$1,156.92 ","$1,156.92 ","$1,245.92 ","$1,083.95 ",$4.77 ,$471.83 ,$462.39 ,$943.66 ,$5.06 ,"$1,512.90 ","$1,061.61 ","$1,637.49 ","$1,245.92 ",$902.76 ,"$1,083.41 ","$1,083.95 ","$1,083.41 ","$1,229.90 ","$1,601.89 ","$1,216.01 ",$467.02 ,"$1,406.11 ",$5.06 ,$830.00 ,$830.00 ,$462.39 ,$830.00 ,"$1,281.51 ","$1,103.53 ","$1,281.51 ","$1,281.51 ","$1,423.90 "
ST NICHOLAS HOSPITAL - ACUTE,92200015,95938,HC SSEP UPPER AND LOWER,922,1 ,$815.00 ,$537.90 ,$4.77 ,"$1,061.61 ",$4.77 ,$558.60 ,$558.60 ,$471.83 ,$489.00 ,$692.75 ,$570.50 ,$4.77 ,$4.77 ,$774.25 ,$619.40 ,$611.25 ,$529.75 ,$692.75 ,$471.83 ,$529.75 ,$529.75 ,$570.50 ,$496.34 ,$4.77 ,$471.83 ,$462.39 ,$815.00 ,$5.06 ,$692.75 ,"$1,061.61 ",$749.80 ,$570.50 ,$413.37 ,$496.09 ,$496.34 ,$496.09 ,$563.17 ,$733.50 ,$556.81 ,$467.02 ,$643.85 ,$5.06 ,$815.00 ,$815.00 ,$462.39 ,$815.00 ,$586.80 ,$505.30 ,$586.80 ,$586.80 ,$652.00 
ST NICHOLAS HOSPITAL - ACUTE,92200028,95868,HC EMG CRANIAL NERVE BILAT,922,1 ,$681.95 ,$450.09 ,$4.77 ,$681.95 ,$4.77 ,$467.41 ,$467.41 ,$273.34 ,$409.17 ,$579.66 ,$477.37 ,$4.77 ,$4.77 ,$647.85 ,$518.28 ,$511.46 ,$443.27 ,$579.66 ,$273.34 ,$443.27 ,$443.27 ,$477.37 ,$415.31 ,$4.77 ,$273.34 ,$267.87 ,$546.68 ,$5.06 ,$579.66 ,$615.01 ,$627.39 ,$477.37 ,$345.89 ,$415.10 ,$415.31 ,$415.10 ,$471.23 ,$613.76 ,$465.91 ,$270.55 ,$538.74 ,$5.06 ,$681.95 ,$681.95 ,$267.87 ,$681.95 ,$491.00 ,$422.81 ,$491.00 ,$491.00 ,$545.56 
ST NICHOLAS HOSPITAL - ACUTE,92200028,95868,HC EMG CRANIAL NERVE BILATERAL,922,1 ,$450.00 ,$297.00 ,$4.77 ,$615.01 ,$4.77 ,$308.43 ,$308.43 ,$273.34 ,$270.00 ,$382.50 ,$315.00 ,$4.77 ,$4.77 ,$427.50 ,$342.00 ,$337.50 ,$292.50 ,$382.50 ,$273.34 ,$292.50 ,$292.50 ,$315.00 ,$274.05 ,$4.77 ,$273.34 ,$267.87 ,$450.00 ,$5.06 ,$382.50 ,$615.01 ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 ,$270.55 ,$355.50 ,$5.06 ,$450.00 ,$450.00 ,$267.87 ,$450.00 ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,92200029,95870,HC EMG NON LIMB,922,1 ,$188.00 ,$124.08 ,$4.77 ,$254.98 ,$4.77 ,$128.86 ,$128.86 ,$113.32 ,$112.80 ,$159.80 ,$131.60 ,$4.77 ,$4.77 ,$178.60 ,$142.88 ,$141.00 ,$122.20 ,$159.80 ,$113.32 ,$122.20 ,$122.20 ,$131.60 ,$114.49 ,$4.77 ,$113.32 ,$111.05 ,$188.00 ,$5.06 ,$159.80 ,$254.98 ,$172.96 ,$131.60 ,$95.35 ,$114.44 ,$114.49 ,$114.44 ,$129.91 ,$169.20 ,$128.44 ,$112.16 ,$148.52 ,$5.06 ,$188.00 ,$188.00 ,$111.05 ,$188.00 ,$135.36 ,$116.56 ,$135.36 ,$135.36 ,$150.40 
ST NICHOLAS HOSPITAL - ACUTE,92200029,95870,HC EMG NON LIMB,922,1 ,$259.90 ,$171.53 ,$4.77 ,$259.90 ,$4.77 ,$178.14 ,$178.14 ,$113.32 ,$155.94 ,$220.92 ,$181.93 ,$4.77 ,$4.77 ,$246.91 ,$197.52 ,$194.93 ,$168.94 ,$220.92 ,$113.32 ,$168.94 ,$168.94 ,$181.93 ,$158.28 ,$4.77 ,$113.32 ,$111.05 ,$226.64 ,$5.06 ,$220.92 ,$254.98 ,$239.11 ,$181.93 ,$131.82 ,$158.20 ,$158.28 ,$158.20 ,$179.59 ,$233.91 ,$177.56 ,$112.16 ,$205.32 ,$5.06 ,$259.90 ,$259.90 ,$111.05 ,$259.90 ,$187.13 ,$161.14 ,$187.13 ,$187.13 ,$207.92 
ST NICHOLAS HOSPITAL - ACUTE,93280072,93280,HC PRGM DEVICE EVAL DUAL PREVEA 72HR,480,1 ,$133.40 ,$88.04 ,$1.27 ,$133.40 ,$1.27 ,$91.43 ,$91.43 ,$34.16 ,$80.04 ,$113.39 ,$93.38 ,$1.27 ,$1.27 ,$126.73 ,$101.38 ,$100.05 ,$86.71 ,$113.39 ,$34.16 ,$86.71 ,$86.71 ,$93.38 ,$81.24 ,$1.27 ,$34.16 ,$33.48 ,$68.32 ,$1.35 ,$113.39 ,$76.86 ,$122.73 ,$93.38 ,$67.66 ,$81.20 ,$81.24 ,$81.20 ,$92.18 ,$120.06 ,$91.14 ,$33.81 ,$105.39 ,$1.35 ,$133.40 ,$133.40 ,$33.48 ,$133.40 ,$96.05 ,$82.71 ,$96.05 ,$96.05 ,$106.72 
ST NICHOLAS HOSPITAL - ACUTE,94000101,99195,HC PHLEBOTOMY THERAPEUTIC,940,1 ,$285.20 ,$188.23 ,$2.32 ,$285.20 ,$2.32 ,$195.48 ,$195.48 ,$113.32 ,$171.12 ,$242.42 ,$199.64 ,$2.32 ,$2.32 ,$270.94 ,$216.75 ,$213.90 ,$185.38 ,$242.42 ,$113.32 ,$185.38 ,$185.38 ,$199.64 ,$173.69 ,$2.32 ,$113.32 ,$111.05 ,$226.64 ,$2.46 ,$242.42 ,$254.98 ,$262.38 ,$199.64 ,$144.65 ,$173.60 ,$173.69 ,$173.60 ,$197.07 ,$256.68 ,$194.85 ,$112.16 ,$225.31 ,$2.46 ,$224.00 ,$224.00 ,$111.05 ,$224.00 ,$205.34 ,$176.82 ,$205.34 ,$205.34 ,$228.16 
ST NICHOLAS HOSPITAL - ACUTE,94200005,97802,HC NUTRITION THRPY EVAL 15 MIN,942,1 ,$118.45 ,$78.18 ,$7.67 ,$118.45 ,$7.67 ,$81.19 ,$81.19 ,$30.40 ,$71.07 ,$100.68 ,$82.92 ,$7.67 ,$7.67 ,$112.53 ,$90.02 ,$88.84 ,$76.99 ,$100.68 ,$30.40 ,$76.99 ,$76.99 ,$82.92 ,$72.14 ,$7.67 ,$30.40 ,$29.79 ,$60.80 ,$8.13 ,$100.68 ,$80.48 ,$108.97 ,$82.92 ,$60.08 ,$72.10 ,$72.14 ,$72.10 ,$81.85 ,$106.61 ,$80.93 ,$30.09 ,$93.58 ,$8.13 ,$118.45 ,$118.45 ,$29.79 ,$118.45 ,$85.28 ,$73.44 ,$85.28 ,$85.28 ,$94.76 
ST NICHOLAS HOSPITAL - ACUTE,94200006,97803,HC NUTRITION THRPY RE-EVAL 15 MIN,942,1 ,$100.05 ,$66.03 ,$7.67 ,$100.05 ,$7.67 ,$68.57 ,$68.57 ,$26.46 ,$60.03 ,$85.04 ,$70.04 ,$7.67 ,$7.67 ,$95.05 ,$76.04 ,$75.04 ,$65.03 ,$85.04 ,$26.46 ,$65.03 ,$65.03 ,$70.04 ,$60.93 ,$7.67 ,$26.46 ,$25.93 ,$52.92 ,$8.13 ,$85.04 ,$70.04 ,$92.05 ,$70.04 ,$50.75 ,$60.90 ,$60.93 ,$60.90 ,$69.13 ,$90.05 ,$68.35 ,$26.19 ,$79.04 ,$8.13 ,$100.05 ,$100.05 ,$25.93 ,$100.05 ,$72.04 ,$62.03 ,$72.04 ,$72.04 ,$80.04 
ST NICHOLAS HOSPITAL - ACUTE,94200008,99406,HC SMOKING CESSATION PULM 3-10MIN,942,1 ,$49.45 ,$32.64 ,$0.84 ,$65.18 ,$0.84 ,$33.89 ,$33.89 ,$28.97 ,$29.67 ,$42.03 ,$34.62 ,$0.84 ,$0.84 ,$46.98 ,$37.58 ,$37.09 ,$32.14 ,$42.03 ,$28.97 ,$32.14 ,$32.14 ,$34.62 ,$30.12 ,$0.84 ,$28.97 ,$28.39 ,$49.45 ,$0.89 ,$42.03 ,$65.18 ,$45.49 ,$34.62 ,$25.08 ,$30.10 ,$30.12 ,$30.10 ,$34.17 ,$44.51 ,$33.78 ,$28.67 ,$39.07 ,$0.89 ,$49.45 ,$49.45 ,$28.39 ,$49.45 ,$35.60 ,$30.66 ,$35.60 ,$35.60 ,$39.56 
ST NICHOLAS HOSPITAL - ACUTE,94200009,99407,HC SMOKING CESSATION PULM >10 MIN,942,1 ,$71.30 ,$47.06 ,$0.84 ,$71.30 ,$0.84 ,$48.87 ,$48.87 ,$28.97 ,$42.78 ,$60.61 ,$49.91 ,$0.84 ,$0.84 ,$67.74 ,$54.19 ,$53.48 ,$46.35 ,$60.61 ,$28.97 ,$46.35 ,$46.35 ,$49.91 ,$43.42 ,$0.84 ,$28.97 ,$28.39 ,$57.94 ,$0.89 ,$60.61 ,$65.18 ,$65.60 ,$49.91 ,$36.16 ,$43.40 ,$43.42 ,$43.40 ,$49.27 ,$64.17 ,$48.71 ,$28.67 ,$56.33 ,$0.89 ,$71.30 ,$71.30 ,$28.39 ,$71.30 ,$51.34 ,$44.21 ,$51.34 ,$51.34 ,$57.04 
ST NICHOLAS HOSPITAL - ACUTE,94200011,G0108,HC DIABETES SELF MGT ED 30 MIN,942,1 ,$160.00 ,$105.60 ,$2.44 ,$160.00 ,$2.44 ,$109.66 ,$109.66 ,$52.82 ,$96.00 ,$136.00 ,$112.00 ,$2.44 ,$2.44 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 ,$52.82 ,$104.00 ,$104.00 ,$112.00 ,$97.44 ,$2.44 ,$52.82 ,$51.76 ,$105.64 ,$2.59 ,$136.00 ,$118.85 ,$147.20 ,$112.00 ,$81.15 ,$97.39 ,$97.44 ,$97.39 ,$110.56 ,$144.00 ,$109.31 ,$52.28 ,$126.40 ,$2.59 ,$136.00 ,$136.00 ,$51.76 ,$136.00 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,94201000,N/A,HC NUTRITION SUPPORT IP,942,1 ,$61.48 ,$40.58 ,$31.18 ,$61.48 , N/A ,$42.14 ,$42.14 , N/A ,$36.89 ,$52.26 ,$43.04 , N/A , N/A ,$58.41 ,$46.72 ,$46.11 ,$39.96 ,$52.26 , N/A ,$39.96 ,$39.96 ,$43.04 ,$37.44 , N/A , N/A , N/A , N/A , N/A ,$52.26 , N/A ,$56.56 ,$43.04 ,$31.18 ,$37.42 ,$37.44 ,$37.42 ,$42.48 ,$55.33 ,$42.00 , N/A ,$48.57 , N/A ,$61.48 ,$61.48 , N/A ,$61.48 ,$44.27 ,$38.12 ,$44.27 ,$44.27 ,$49.18 
ST NICHOLAS HOSPITAL - ACUTE,94300004,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$82.80 ,$54.65 ,$5.14 ,$263.67 ,$5.14 ,$82.80 ,$82.80 ,$117.19 ,$49.68 ,$70.38 ,$57.96 ,$5.14 ,$5.14 ,$78.66 ,$62.93 ,$62.10 ,$53.82 ,$70.38 ,$117.19 ,$53.82 ,$53.82 ,$57.96 ,$50.43 ,$5.14 ,$117.19 ,$114.85 ,$82.80 ,$5.45 ,$70.38 ,$263.67 ,$76.18 ,$57.96 ,$42.00 ,$50.40 ,$50.43 ,$50.40 ,$57.21 ,$74.52 ,$56.57 ,$115.99 ,$65.41 ,$5.45 ,$82.80 ,$82.80 ,$114.85 ,$82.80 ,$59.62 ,$51.34 ,$59.62 ,$59.62 ,$66.24 
ST NICHOLAS HOSPITAL - ACUTE,94300005,93798,HC CARDIAC REHAB W/EKG SESSION (PH2),943,1 ,$438.15 ,$289.18 ,$5.14 ,$438.15 ,$5.14 ,$438.15 ,$438.15 ,$117.19 ,$262.89 ,$372.43 ,$306.71 ,$5.14 ,$5.14 ,$416.24 ,$332.99 ,$328.61 ,$284.80 ,$372.43 ,$117.19 ,$284.80 ,$284.80 ,$306.71 ,$266.83 ,$5.14 ,$117.19 ,$114.85 ,$234.38 ,$5.45 ,$372.43 ,$263.67 ,$403.10 ,$306.71 ,$222.23 ,$266.70 ,$266.83 ,$266.70 ,$302.76 ,$394.34 ,$299.34 ,$115.99 ,$346.14 ,$5.45 ,$438.15 ,$438.15 ,$114.85 ,$438.15 ,$315.47 ,$271.65 ,$315.47 ,$315.47 ,$350.52 
ST NICHOLAS HOSPITAL - ACUTE,94300009,93798,HC CARDIAC REHAB W/EKG SESSION (ASSESSMENT),943,1 ,$509.45 ,$336.24 ,$5.14 ,$509.45 ,$5.14 ,$509.45 ,$487.00 ,$117.19 ,$305.67 ,$433.03 ,$356.62 ,$5.14 ,$5.14 ,$483.98 ,$387.18 ,$382.09 ,$331.14 ,$433.03 ,$117.19 ,$331.14 ,$331.14 ,$356.62 ,$310.26 ,$5.14 ,$117.19 ,$114.85 ,$234.38 ,$5.45 ,$433.03 ,$263.67 ,$468.69 ,$356.62 ,$258.39 ,$310.10 ,$310.26 ,$310.10 ,$352.03 ,$458.51 ,$348.06 ,$115.99 ,$402.47 ,$5.45 ,$509.45 ,$509.45 ,$114.85 ,$509.45 ,$366.80 ,$315.86 ,$366.80 ,$366.80 ,$407.56 
ST NICHOLAS HOSPITAL - ACUTE,94300013,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$97.75 ,$64.52 ,$5.14 ,$263.67 ,$5.14 ,$97.75 ,$97.75 ,$117.19 ,$58.65 ,$83.09 ,$68.43 ,$5.14 ,$5.14 ,$92.86 ,$74.29 ,$73.31 ,$63.54 ,$83.09 ,$117.19 ,$63.54 ,$63.54 ,$68.43 ,$59.53 ,$5.14 ,$117.19 ,$114.85 ,$97.75 ,$5.45 ,$83.09 ,$263.67 ,$89.93 ,$68.43 ,$49.58 ,$59.50 ,$59.53 ,$59.50 ,$67.55 ,$87.98 ,$66.78 ,$115.99 ,$77.22 ,$5.45 ,$97.75 ,$97.75 ,$114.85 ,$97.75 ,$70.38 ,$60.61 ,$70.38 ,$70.38 ,$78.20 
ST NICHOLAS HOSPITAL - ACUTE,94300014,93798,HC CARD REHAB W/EKG SESS (PH2)-KX,943,1 ,$438.15 ,$289.18 ,$5.14 ,$438.15 ,$5.14 ,$438.15 ,$438.15 ,$117.19 ,$262.89 ,$372.43 ,$306.71 ,$5.14 ,$5.14 ,$416.24 ,$332.99 ,$328.61 ,$284.80 ,$372.43 ,$117.19 ,$284.80 ,$284.80 ,$306.71 ,$266.83 ,$5.14 ,$117.19 ,$114.85 ,$234.38 ,$5.45 ,$372.43 ,$263.67 ,$403.10 ,$306.71 ,$222.23 ,$266.70 ,$266.83 ,$266.70 ,$302.76 ,$394.34 ,$299.34 ,$115.99 ,$346.14 ,$5.45 ,$438.15 ,$438.15 ,$114.85 ,$438.15 ,$315.47 ,$271.65 ,$315.47 ,$315.47 ,$350.52 
ST NICHOLAS HOSPITAL - ACUTE,94800001,94625,HC PHY/QHP OP PULM RHB W/O MNTR,948,1 ,$171.63 ,$113.28 ,$1.19 ,$171.63 ,$1.19 ,$117.64 ,$117.64 ,$56.10 ,$102.98 ,$145.89 ,$120.14 ,$1.19 ,$1.19 ,$163.05 ,$130.44 ,$128.72 ,$111.56 ,$145.89 ,$56.10 ,$111.56 ,$111.56 ,$120.14 ,$104.52 ,$1.19 ,$56.10 ,$54.98 ,$112.20 ,$1.26 ,$145.89 ,$126.23 ,$157.90 ,$120.14 ,$87.05 ,$104.47 ,$104.52 ,$104.47 ,$118.60 ,$154.47 ,$117.26 ,$55.53 ,$135.59 ,$1.26 ,$84.10 ,$84.10 ,$54.98 ,$84.10 ,$123.57 ,$106.41 ,$123.57 ,$123.57 ,$137.30 
ST NICHOLAS HOSPITAL - ACUTE,94800002,94626,HC PHY/QHP OP PULM RHB W/MNTR,948,1 ,$171.63 ,$113.28 ,$1.19 ,$171.63 ,$1.19 ,$117.64 ,$117.64 ,$56.10 ,$102.98 ,$145.89 ,$120.14 ,$1.19 ,$1.19 ,$163.05 ,$130.44 ,$128.72 ,$111.56 ,$145.89 ,$56.10 ,$111.56 ,$111.56 ,$120.14 ,$104.52 ,$1.19 ,$56.10 ,$54.98 ,$112.20 ,$1.26 ,$145.89 ,$126.23 ,$157.90 ,$120.14 ,$87.05 ,$104.47 ,$104.52 ,$104.47 ,$118.60 ,$154.47 ,$117.26 ,$55.53 ,$135.59 ,$1.26 ,$84.10 ,$84.10 ,$54.98 ,$84.10 ,$123.57 ,$106.41 ,$123.57 ,$123.57 ,$137.30 
ST NICHOLAS HOSPITAL - ACUTE,96000044,G2061,PC NON PHYSICIAN EST PT 5-10 MIN,960,1 ,$25.00 ,$16.50 ,$12.68 ,$25.00 , N/A ,$17.14 ,$17.14 , N/A ,$15.00 ,$21.25 ,$17.50 , N/A , N/A ,$23.75 ,$19.00 ,$18.75 ,$16.25 ,$21.25 , N/A ,$16.25 ,$16.25 ,$17.50 ,$15.23 , N/A , N/A , N/A , N/A , N/A ,$21.25 , N/A ,$23.00 ,$17.50 ,$12.68 ,$15.22 ,$15.23 ,$15.22 ,$17.28 ,$22.50 ,$17.08 , N/A ,$19.75 , N/A , N/A , N/A , N/A , N/A ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,96000045,G2062,PC NON PHYSICIAN EST PT 11-20 MIN,960,1 ,$50.00 ,$33.00 ,$25.36 ,$50.00 , N/A ,$34.27 ,$34.27 , N/A ,$30.00 ,$42.50 ,$35.00 , N/A , N/A ,$47.50 ,$38.00 ,$37.50 ,$32.50 ,$42.50 , N/A ,$32.50 ,$32.50 ,$35.00 ,$30.45 , N/A , N/A , N/A , N/A , N/A ,$42.50 , N/A ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$30.44 ,$34.55 ,$45.00 ,$34.16 , N/A ,$39.50 , N/A , N/A , N/A , N/A , N/A ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,96000046,G2063,PC NON PHYSICIAN EST PT > 21 MIN,960,1 ,$75.00 ,$49.50 ,$38.04 ,$75.00 , N/A ,$51.41 ,$51.41 , N/A ,$45.00 ,$63.75 ,$52.50 , N/A , N/A ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 , N/A ,$48.75 ,$48.75 ,$52.50 ,$45.68 , N/A , N/A , N/A , N/A , N/A ,$63.75 , N/A ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$51.24 , N/A ,$59.25 , N/A , N/A , N/A , N/A , N/A ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,96000047,99421,PC ONLINE DIG E/M SVC 5-10 MIN-95,960,1 ,$35.00 ,$23.10 ,$17.75 ,$35.00 , N/A ,$23.99 ,$23.99 , N/A ,$21.00 ,$29.75 ,$24.50 , N/A , N/A ,$33.25 ,$26.60 ,$26.25 ,$22.75 ,$29.75 , N/A ,$22.75 ,$22.75 ,$24.50 ,$21.32 , N/A , N/A , N/A , N/A , N/A ,$29.75 , N/A ,$32.20 ,$24.50 ,$17.75 ,$21.30 ,$21.32 ,$21.30 ,$24.19 ,$31.50 ,$23.91 , N/A ,$27.65 , N/A , N/A , N/A , N/A , N/A ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,96000048,99422,PC ONLINE DIG E/M SVC 11-20 MIN-95,960,1 ,$70.00 ,$46.20 ,$35.50 ,$70.00 , N/A ,$47.98 ,$47.98 , N/A ,$42.00 ,$59.50 ,$49.00 , N/A , N/A ,$66.50 ,$53.20 ,$52.50 ,$45.50 ,$59.50 , N/A ,$45.50 ,$45.50 ,$49.00 ,$42.63 , N/A , N/A , N/A , N/A , N/A ,$59.50 , N/A ,$64.40 ,$49.00 ,$35.50 ,$42.61 ,$42.63 ,$42.61 ,$48.37 ,$63.00 ,$47.82 , N/A ,$55.30 , N/A , N/A , N/A , N/A , N/A ,$50.40 ,$43.40 ,$50.40 ,$50.40 ,$56.00 
ST NICHOLAS HOSPITAL - ACUTE,96000049,99423,PC ONLINE DIG E/M SVC 21+ MIN-95,960,1 ,$105.00 ,$69.30 ,$53.26 ,$105.00 , N/A ,$71.97 ,$71.97 , N/A ,$63.00 ,$89.25 ,$73.50 , N/A , N/A ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 , N/A ,$68.25 ,$68.25 ,$73.50 ,$63.95 , N/A , N/A , N/A , N/A , N/A ,$89.25 , N/A ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$71.74 , N/A ,$82.95 , N/A , N/A , N/A , N/A , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,96000051,G2012,PC BRIEF CHECK IN BY MD/QHP-95,960,1 ,$30.00 ,$19.80 ,$15.22 ,$30.00 , N/A ,$20.56 ,$20.56 , N/A ,$18.00 ,$25.50 ,$21.00 , N/A , N/A ,$28.50 ,$22.80 ,$22.50 ,$19.50 ,$25.50 , N/A ,$19.50 ,$19.50 ,$21.00 ,$18.27 , N/A , N/A , N/A , N/A , N/A ,$25.50 , N/A ,$27.60 ,$21.00 ,$15.22 ,$18.26 ,$18.27 ,$18.26 ,$20.73 ,$27.00 ,$20.50 , N/A ,$23.70 , N/A , N/A , N/A , N/A , N/A ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$24.00 
ST NICHOLAS HOSPITAL - ACUTE,96080010,57410,PC PELVIC EXAM UNDER ANEST 57410,960,1 ,$485.00 ,$320.10 ,$6.57 ,"$6,209.06 ",$6.57 ,$332.42 ,$332.42 ,"$2,759.58 ",$291.00 ,$412.25 ,$339.50 ,$6.57 ,$6.57 ,$460.75 ,$368.60 ,$363.75 ,$315.25 ,$412.25 ,"$2,759.58 ",$315.25 ,$315.25 ,$339.50 ,$295.37 ,$6.57 ,"$2,759.58 ","$2,704.39 ",$485.00 ,$6.96 ,$412.25 ,"$6,209.06 ",$446.20 ,$339.50 ,"$2,747.95 ","$3,435.21 ",$295.37 ,"$3,435.21 ",$335.14 ,$436.50 ,$331.35 ,"$2,731.44 ",$383.15 ,$6.96 , N/A , N/A ,"$2,704.39 ", N/A ,$349.20 ,$300.70 ,$349.20 ,$349.20 ,$388.00 
ST NICHOLAS HOSPITAL - ACUTE,96100003,90792,PC EVAL PSYCH DIAG W/MED SERVICE MD,961,1 ,$150.00 ,$99.00 ,$9.74 ,$319.96 ,$9.74 ,$102.81 ,$102.81 ,$142.20 ,$90.00 ,$127.50 ,$105.00 ,$9.74 ,$9.74 ,$142.50 ,$114.00 ,$112.50 ,$97.50 ,$127.50 ,$142.20 ,$97.50 ,$97.50 ,$105.00 ,$91.35 ,$9.74 ,$142.20 ,$139.36 ,$150.00 ,$10.32 ,$127.50 ,$319.96 ,$138.00 ,$105.00 ,$76.08 ,$91.31 ,$91.35 ,$91.31 ,$103.65 ,$135.00 ,$102.48 ,$140.75 ,$118.50 ,$10.32 , N/A , N/A ,$139.36 , N/A ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$120.00 
ST NICHOLAS HOSPITAL - ACUTE,97380047,57155,PC INSERTION TANDEM OR OVOID VAG BRACHYTHERAPY,973,1 ,"$1,240.00 ",$818.40 ,$78.71 ,"$10,178.70 ",$78.71 ,$849.90 ,$849.90 ,"$4,523.87 ",$744.00 ,"$1,054.00 ",$868.00 ,$78.71 ,$78.71 ,"$1,178.00 ",$942.40 ,$930.00 ,$806.00 ,"$1,054.00 ","$4,523.87 ",$806.00 ,$806.00 ,$868.00 ,$755.16 ,$78.71 ,"$4,523.87 ","$4,433.39 ","$1,240.00 ",$83.43 ,"$1,054.00 ","$10,178.70 ","$1,140.80 ",$868.00 ,"$1,240.00 ","$1,240.00 ",$755.16 ,"$1,240.00 ",$856.84 ,"$1,116.00 ",$847.17 ,"$4,477.73 ",$979.60 ,$83.43 , N/A , N/A ,"$4,433.39 ", N/A ,$892.80 ,$768.80 ,$892.80 ,$892.80 ,$992.00 
ST NICHOLAS HOSPITAL - ACUTE,97500079,G0121,PC COLONSCOPY CANCER SCREENING NOT HIGH RISK,975,1 ,"$1,170.00 ",$772.20 ,$34.52 ,"$1,824.96 ",$34.52 ,$801.92 ,$801.92 ,$811.10 ,$702.00 ,$994.50 ,$819.00 ,$34.52 ,$34.52 ,"$1,111.50 ",$889.20 ,$877.50 ,$760.50 ,$994.50 ,$811.10 ,$760.50 ,$760.50 ,$819.00 ,$712.53 ,$34.52 ,$811.10 ,$794.88 ,"$1,170.00 ",$36.59 ,$994.50 ,"$1,824.96 ","$1,076.40 ",$819.00 ,"$1,170.00 ","$1,170.00 ",$712.53 ,"$1,170.00 ",$808.47 ,"$1,053.00 ",$799.34 ,$802.83 ,$924.30 ,$36.59 , N/A , N/A ,$794.88 , N/A ,$842.40 ,$725.40 ,$842.40 ,$842.40 ,$936.00 
ST NICHOLAS HOSPITAL - ACUTE,98180479,69209,"PC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL",981,1 ,$40.00 ,$26.40 ,$20.29 ,$126.23 , N/A ,$27.42 ,$27.42 ,$56.10 ,$24.00 ,$34.00 ,$28.00 , N/A , N/A ,$38.00 ,$30.40 ,$30.00 ,$26.00 ,$34.00 ,$56.10 ,$26.00 ,$26.00 ,$28.00 ,$24.36 , N/A ,$56.10 ,$54.98 ,$40.00 , N/A ,$34.00 ,$126.23 ,$36.80 ,$28.00 ,$20.29 ,$24.35 ,$24.36 ,$24.35 ,$27.64 ,$36.00 ,$27.33 ,$55.53 ,$31.60 , N/A , N/A , N/A ,$54.98 , N/A ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,98180947,G0425,PC TELEHEALTH CONSULT 30 MIN,981,1 ,$300.00 ,$198.00 ,$4.33 ,$300.00 ,$4.33 ,$205.62 ,$205.62 , N/A ,$180.00 ,$255.00 ,$210.00 ,$4.33 ,$4.33 ,$285.00 ,$228.00 ,$225.00 ,$195.00 ,$255.00 , N/A ,$195.00 ,$195.00 ,$210.00 ,$182.70 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$255.00 , N/A ,$276.00 ,$210.00 ,$152.16 ,$182.61 ,$182.70 ,$182.61 ,$207.30 ,$270.00 ,$204.96 , N/A ,$237.00 ,$4.59 , N/A , N/A , N/A , N/A ,$216.00 ,$186.00 ,$216.00 ,$216.00 ,$240.00 
ST NICHOLAS HOSPITAL - ACUTE,98180948,G0426,PC TELEHEALTH CONSULT 50 MIN,981,1 ,$400.00 ,$264.00 ,$4.33 ,$400.00 ,$4.33 ,$274.16 ,$274.16 , N/A ,$240.00 ,$340.00 ,$280.00 ,$4.33 ,$4.33 ,$380.00 ,$304.00 ,$300.00 ,$260.00 ,$340.00 , N/A ,$260.00 ,$260.00 ,$280.00 ,$243.60 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$340.00 , N/A ,$368.00 ,$280.00 ,$202.88 ,$243.48 ,$243.60 ,$243.48 ,$276.40 ,$360.00 ,$273.28 , N/A ,$316.00 ,$4.59 , N/A , N/A , N/A , N/A ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$320.00 
ST NICHOLAS HOSPITAL - ACUTE,98180949,G0427,PC TELEHEALTH CONSULT 70 MIN,981,1 ,$500.00 ,$330.00 ,$4.33 ,$500.00 ,$4.33 ,$342.70 ,$342.70 , N/A ,$300.00 ,$425.00 ,$350.00 ,$4.33 ,$4.33 ,$475.00 ,$380.00 ,$375.00 ,$325.00 ,$425.00 , N/A ,$325.00 ,$325.00 ,$350.00 ,$304.50 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$425.00 , N/A ,$460.00 ,$350.00 ,$253.60 ,$304.35 ,$304.50 ,$304.35 ,$345.50 ,$450.00 ,$341.60 , N/A ,$395.00 ,$4.59 , N/A , N/A , N/A , N/A ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,98180978,G0508,PC TELEHEALTH CRITICAL CARE CONSULT 60 MIN,981,1 ,$600.00 ,$396.00 ,$4.33 ,$600.00 ,$4.33 ,$411.24 ,$411.24 , N/A ,$360.00 ,$510.00 ,$420.00 ,$4.33 ,$4.33 ,$570.00 ,$456.00 ,$450.00 ,$390.00 ,$510.00 , N/A ,$390.00 ,$390.00 ,$420.00 ,$365.40 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$510.00 , N/A ,$552.00 ,$420.00 ,$304.32 ,$365.22 ,$365.40 ,$365.22 ,$414.60 ,$540.00 ,$409.92 , N/A ,$474.00 ,$4.59 , N/A , N/A , N/A , N/A ,$432.00 ,$372.00 ,$432.00 ,$432.00 ,$480.00 
ST NICHOLAS HOSPITAL - ACUTE,98200003,99203,PC CLINIC VISIT INTERM NEW PRO,982,1 ,$240.00 ,$158.40 ,$4.33 ,$240.00 ,$4.33 ,$164.50 ,$164.50 , N/A ,$144.00 ,$204.00 ,$168.00 ,$4.33 ,$4.33 ,$228.00 ,$182.40 ,$180.00 ,$156.00 ,$204.00 , N/A ,$156.00 ,$156.00 ,$168.00 ,$146.16 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$204.00 , N/A ,$220.80 ,$168.00 ,$121.73 ,$146.09 ,$146.16 ,$146.09 ,$165.84 ,$216.00 ,$163.97 , N/A ,$189.60 ,$4.59 , N/A , N/A , N/A , N/A ,$172.80 ,$148.80 ,$172.80 ,$172.80 ,$192.00 
ST NICHOLAS HOSPITAL - ACUTE,98200004,99204,PC CLINIC VISIT COMPLEX NEW PRO,982,1 ,$290.00 ,$191.40 ,$4.33 ,$290.00 ,$4.33 ,$198.77 ,$198.77 , N/A ,$174.00 ,$246.50 ,$203.00 ,$4.33 ,$4.33 ,$275.50 ,$220.40 ,$217.50 ,$188.50 ,$246.50 , N/A ,$188.50 ,$188.50 ,$203.00 ,$176.61 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$246.50 , N/A ,$266.80 ,$203.00 ,$147.09 ,$176.52 ,$176.61 ,$176.52 ,$200.39 ,$261.00 ,$198.13 , N/A ,$229.10 ,$4.59 , N/A , N/A , N/A , N/A ,$208.80 ,$179.80 ,$208.80 ,$208.80 ,$232.00 
ST NICHOLAS HOSPITAL - ACUTE,98200005,99205,PC CLINIC VISIT COMPREH NEW PRO,982,1 ,$375.00 ,$247.50 ,$4.33 ,$375.00 ,$4.33 ,$257.03 ,$257.03 , N/A ,$225.00 ,$318.75 ,$262.50 ,$4.33 ,$4.33 ,$356.25 ,$285.00 ,$281.25 ,$243.75 ,$318.75 , N/A ,$243.75 ,$243.75 ,$262.50 ,$228.38 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$318.75 , N/A ,$345.00 ,$262.50 ,$190.20 ,$228.26 ,$228.38 ,$228.26 ,$259.13 ,$337.50 ,$256.20 , N/A ,$296.25 ,$4.59 , N/A , N/A , N/A , N/A ,$270.00 ,$232.50 ,$270.00 ,$270.00 ,$300.00 
ST NICHOLAS HOSPITAL - ACUTE,98200006,99211,PC CLINIC VISIT BRIEF EST PRO,982,1 ,$185.00 ,$122.10 ,$4.33 ,$185.00 ,$4.33 ,$126.80 ,$126.80 , N/A ,$111.00 ,$157.25 ,$129.50 ,$4.33 ,$4.33 ,$175.75 ,$140.60 ,$138.75 ,$120.25 ,$157.25 , N/A ,$120.25 ,$120.25 ,$129.50 ,$112.67 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$157.25 , N/A ,$170.20 ,$129.50 ,$93.83 ,$112.61 ,$112.67 ,$112.61 ,$127.84 ,$166.50 ,$126.39 , N/A ,$146.15 ,$4.59 , N/A , N/A , N/A , N/A ,$133.20 ,$114.70 ,$133.20 ,$133.20 ,$148.00 
ST NICHOLAS HOSPITAL - ACUTE,98200007,99212,PC CLINIC VISIT LIMIT EST PRO,982,1 ,$195.00 ,$128.70 ,$4.33 ,$195.00 ,$4.33 ,$133.65 ,$133.65 , N/A ,$117.00 ,$165.75 ,$136.50 ,$4.33 ,$4.33 ,$185.25 ,$148.20 ,$146.25 ,$126.75 ,$165.75 , N/A ,$126.75 ,$126.75 ,$136.50 ,$118.76 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$165.75 , N/A ,$179.40 ,$136.50 ,$98.90 ,$118.70 ,$118.76 ,$118.70 ,$134.75 ,$175.50 ,$133.22 , N/A ,$154.05 ,$4.59 , N/A , N/A , N/A , N/A ,$140.40 ,$120.90 ,$140.40 ,$140.40 ,$156.00 
ST NICHOLAS HOSPITAL - ACUTE,98200008,99213,PC CLINIC VISIT INTERM EST PRO,982,1 ,$235.00 ,$155.10 ,$4.33 ,$235.00 ,$4.33 ,$161.07 ,$161.07 , N/A ,$141.00 ,$199.75 ,$164.50 ,$4.33 ,$4.33 ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 , N/A ,$152.75 ,$152.75 ,$164.50 ,$143.12 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$160.55 , N/A ,$185.65 ,$4.59 , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,98200009,99214,PC CLINIC VISIT COMPLX EST PRO,982,1 ,$260.00 ,$171.60 ,$4.33 ,$260.00 ,$4.33 ,$178.20 ,$178.20 , N/A ,$156.00 ,$221.00 ,$182.00 ,$4.33 ,$4.33 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 , N/A ,$169.00 ,$169.00 ,$182.00 ,$158.34 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$221.00 , N/A ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$177.63 , N/A ,$205.40 ,$4.59 , N/A , N/A , N/A , N/A ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,98200010,99215,PC CLINIC VISIT COMPRH EST PRO,982,1 ,$325.00 ,$214.50 ,$4.33 ,$325.00 ,$4.33 ,$222.76 ,$222.76 , N/A ,$195.00 ,$276.25 ,$227.50 ,$4.33 ,$4.33 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 , N/A ,$211.25 ,$211.25 ,$227.50 ,$197.93 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$276.25 , N/A ,$299.00 ,$227.50 ,$164.84 ,$197.83 ,$197.93 ,$197.83 ,$224.58 ,$292.50 ,$222.04 , N/A ,$256.75 ,$4.59 , N/A , N/A , N/A , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,98200079,99417,PC PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN,982,1 ,$92.00 ,$60.72 ,$46.66 ,$92.00 , N/A ,$63.06 ,$63.06 , N/A ,$55.20 ,$78.20 ,$64.40 , N/A , N/A ,$87.40 ,$69.92 ,$69.00 ,$59.80 ,$78.20 , N/A ,$59.80 ,$59.80 ,$64.40 ,$56.03 , N/A , N/A , N/A , N/A , N/A ,$78.20 , N/A ,$84.64 ,$64.40 ,$46.66 ,$56.00 ,$56.03 ,$56.00 ,$63.57 ,$82.80 ,$62.85 , N/A ,$72.68 , N/A , N/A , N/A , N/A , N/A ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,98200215,99418,PC PROLONGED INPATIENT/OBSERVATION E/M SVC EA 15 MIN,982,1 ,$60.00 ,$39.60 ,$30.43 ,$60.00 , N/A ,$41.12 ,$41.12 , N/A ,$36.00 ,$51.00 ,$42.00 , N/A , N/A ,$57.00 ,$45.60 ,$45.00 ,$39.00 ,$51.00 , N/A ,$39.00 ,$39.00 ,$42.00 ,$36.54 , N/A , N/A , N/A , N/A , N/A ,$51.00 , N/A ,$55.20 ,$42.00 ,$30.43 ,$36.52 ,$36.54 ,$36.52 ,$41.46 ,$54.00 ,$40.99 , N/A ,$47.40 , N/A , N/A , N/A , N/A , N/A ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$48.00 
ST NICHOLAS HOSPITAL - ACUTE,98280006,99406,PC SMOKING/TOBACCO COUNSELING 3 TO 10 MIN.,982,1 ,$50.00 ,$33.00 ,$0.84 ,$65.18 ,$0.84 ,$34.27 ,$34.27 ,$28.97 ,$30.00 ,$42.50 ,$35.00 ,$0.84 ,$0.84 ,$47.50 ,$38.00 ,$37.50 ,$32.50 ,$42.50 ,$28.97 ,$32.50 ,$32.50 ,$35.00 ,$30.45 ,$0.84 ,$28.97 ,$28.39 ,$50.00 ,$0.89 ,$42.50 ,$65.18 ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$30.44 ,$34.55 ,$45.00 ,$34.16 ,$28.67 ,$39.50 ,$0.89 , N/A , N/A ,$28.39 , N/A ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,98280007,99407,PC SMOKING CESSATION > 10 MINUTES,982,1 ,$80.00 ,$52.80 ,$0.84 ,$80.00 ,$0.84 ,$54.83 ,$54.83 ,$28.97 ,$48.00 ,$68.00 ,$56.00 ,$0.84 ,$0.84 ,$76.00 ,$60.80 ,$60.00 ,$52.00 ,$68.00 ,$28.97 ,$52.00 ,$52.00 ,$56.00 ,$48.72 ,$0.84 ,$28.97 ,$28.39 ,$57.94 ,$0.89 ,$68.00 ,$65.18 ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$48.70 ,$55.28 ,$72.00 ,$54.66 ,$28.67 ,$63.20 ,$0.89 , N/A , N/A ,$28.39 , N/A ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,98280009,99441,PC TELEPHONE E/M 5-10 MINS OF MEDICAL DISCUSSION,982,1 ,$25.00 ,$16.50 ,$4.33 ,$25.00 ,$4.33 ,$17.14 ,$17.14 , N/A ,$15.00 ,$21.25 ,$17.50 ,$4.33 ,$4.33 ,$23.75 ,$19.00 ,$18.75 ,$16.25 ,$21.25 , N/A ,$16.25 ,$16.25 ,$17.50 ,$15.23 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$21.25 , N/A ,$23.00 ,$17.50 ,$12.68 ,$15.22 ,$15.23 ,$15.22 ,$17.28 ,$22.50 ,$17.08 , N/A ,$19.75 ,$4.59 , N/A , N/A , N/A , N/A ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,98280010,99442,PC TELEPHONE E/M 11-20 MINS OF MEDICAL DISCUSSION,982,1 ,$50.00 ,$33.00 ,$4.33 ,$50.00 ,$4.33 ,$34.27 ,$34.27 , N/A ,$30.00 ,$42.50 ,$35.00 ,$4.33 ,$4.33 ,$47.50 ,$38.00 ,$37.50 ,$32.50 ,$42.50 , N/A ,$32.50 ,$32.50 ,$35.00 ,$30.45 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$42.50 , N/A ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$30.44 ,$34.55 ,$45.00 ,$34.16 , N/A ,$39.50 ,$4.59 , N/A , N/A , N/A , N/A ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,98280011,99443,PC TELEPHONE E/M 21-30 MINS OF MEDICAL DISCUSSION,982,1 ,$75.00 ,$49.50 ,$4.33 ,$75.00 ,$4.33 ,$51.41 ,$51.41 , N/A ,$45.00 ,$63.75 ,$52.50 ,$4.33 ,$4.33 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 , N/A ,$48.75 ,$48.75 ,$52.50 ,$45.68 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$63.75 , N/A ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$51.24 , N/A ,$59.25 ,$4.59 , N/A , N/A , N/A , N/A ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,98300001,10060,PC I AND D ABSC SMP PRO,983,1 ,$375.00 ,$247.50 ,$5.80 ,$396.55 ,$5.80 ,$257.03 ,$257.03 ,$176.25 ,$225.00 ,$318.75 ,$262.50 ,$5.80 ,$5.80 ,$356.25 ,$285.00 ,$281.25 ,$243.75 ,$318.75 ,$176.25 ,$243.75 ,$243.75 ,$262.50 ,$228.38 ,$5.80 ,$176.25 ,$172.72 ,$352.50 ,$6.15 ,$318.75 ,$396.55 ,$345.00 ,$262.50 ,$190.20 ,$228.26 ,$228.38 ,$228.26 ,$259.13 ,$337.50 ,$256.20 ,$174.45 ,$296.25 ,$6.15 , N/A , N/A ,$172.72 , N/A ,$270.00 ,$232.50 ,$270.00 ,$270.00 ,$300.00 
ST NICHOLAS HOSPITAL - ACUTE,98300004,11042,PC DEBR SKIN/SUBQ TISS INIT 20CM PRO,983,1 ,$460.00 ,$303.60 ,$13.09 ,$819.26 ,$13.09 ,$315.28 ,$315.28 ,$364.12 ,$276.00 ,$391.00 ,$322.00 ,$13.09 ,$13.09 ,$437.00 ,$349.60 ,$345.00 ,$299.00 ,$391.00 ,$364.12 ,$299.00 ,$299.00 ,$322.00 ,$280.14 ,$13.09 ,$364.12 ,$356.84 ,$460.00 ,$13.88 ,$391.00 ,$819.26 ,$423.20 ,$322.00 ,$233.31 ,$280.00 ,$280.14 ,$280.00 ,$317.86 ,$414.00 ,$314.27 ,$360.40 ,$363.40 ,$13.88 , N/A , N/A ,$356.84 , N/A ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,98300005,11042,PC DEBR SKIN/SUBQ TISS/PROC INIT 20CM PRO,983,1 ,$460.00 ,$303.60 ,$13.09 ,$819.26 ,$13.09 ,$315.28 ,$315.28 ,$364.12 ,$276.00 ,$391.00 ,$322.00 ,$13.09 ,$13.09 ,$437.00 ,$349.60 ,$345.00 ,$299.00 ,$391.00 ,$364.12 ,$299.00 ,$299.00 ,$322.00 ,$280.14 ,$13.09 ,$364.12 ,$356.84 ,$460.00 ,$13.88 ,$391.00 ,$819.26 ,$423.20 ,$322.00 ,$233.31 ,$280.00 ,$280.14 ,$280.00 ,$317.86 ,$414.00 ,$314.27 ,$360.40 ,$363.40 ,$13.88 , N/A , N/A ,$356.84 , N/A ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,98300006,11043,PC DEBR SKIN/SUBQ TISSUE/MUSCLE PRO,983,1 ,$585.00 ,$386.10 ,$13.09 ,"$1,275.77 ",$13.09 ,$400.96 ,$400.96 ,$567.01 ,$351.00 ,$497.25 ,$409.50 ,$13.09 ,$13.09 ,$555.75 ,$444.60 ,$438.75 ,$380.25 ,$497.25 ,$567.01 ,$380.25 ,$380.25 ,$409.50 ,$356.27 ,$13.09 ,$567.01 ,$555.67 ,$585.00 ,$13.88 ,$497.25 ,"$1,275.77 ",$538.20 ,$409.50 ,$296.71 ,$356.09 ,$356.27 ,$356.09 ,$404.24 ,$526.50 ,$399.67 ,$561.23 ,$462.15 ,$13.88 , N/A , N/A ,$555.67 , N/A ,$421.20 ,$362.70 ,$421.20 ,$421.20 ,$468.00 
ST NICHOLAS HOSPITAL - ACUTE,98300008,11044,PC DEBR SKIN/SUB TIS/MUS/BONE INT 20 PRO,983,1 ,"$1,295.00 ",$854.70 ,$34.96 ,"$3,293.01 ",$34.96 ,$887.59 ,$887.59 ,"$1,463.56 ",$777.00 ,"$1,100.75 ",$906.50 ,$34.96 ,$34.96 ,"$1,230.25 ",$984.20 ,$971.25 ,$841.75 ,"$1,100.75 ","$1,463.56 ",$841.75 ,$841.75 ,$906.50 ,$788.66 ,$34.96 ,"$1,463.56 ","$1,434.29 ","$1,295.00 ",$37.06 ,"$1,100.75 ","$3,293.01 ","$1,191.40 ",$906.50 ,"$1,295.00 ","$1,295.00 ",$788.66 ,"$1,295.00 ",$894.85 ,"$1,165.50 ",$884.74 ,"$1,448.64 ","$1,023.05 ",$37.06 , N/A , N/A ,"$1,434.29 ", N/A ,$932.40 ,$802.90 ,$932.40 ,$932.40 ,"$1,036.00 "
ST NICHOLAS HOSPITAL - ACUTE,98300009,11044,PC DEBR SKIN/SUB TIS/MUS/BONE INT 20PROC PRO,983,1 ,"$1,295.00 ",$854.70 ,$34.96 ,"$3,293.01 ",$34.96 ,$887.59 ,$887.59 ,"$1,463.56 ",$777.00 ,"$1,100.75 ",$906.50 ,$34.96 ,$34.96 ,"$1,230.25 ",$984.20 ,$971.25 ,$841.75 ,"$1,100.75 ","$1,463.56 ",$841.75 ,$841.75 ,$906.50 ,$788.66 ,$34.96 ,"$1,463.56 ","$1,434.29 ","$1,295.00 ",$37.06 ,"$1,100.75 ","$3,293.01 ","$1,191.40 ",$906.50 ,"$1,295.00 ","$1,295.00 ",$788.66 ,"$1,295.00 ",$894.85 ,"$1,165.50 ",$884.74 ,"$1,448.64 ","$1,023.05 ",$37.06 , N/A , N/A ,"$1,434.29 ", N/A ,$932.40 ,$802.90 ,$932.40 ,$932.40 ,"$1,036.00 "
ST NICHOLAS HOSPITAL - ACUTE,98300010,11045,PC DEBR SKIN/SUBQ TIS EA ADL 20CM PRO,983,1 ,$110.00 ,$72.60 ,$34.96 ,$110.00 ,$34.96 ,$75.39 ,$75.39 , N/A ,$66.00 ,$93.50 ,$77.00 ,$34.96 ,$34.96 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 , N/A ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$34.96 , N/A , N/A , N/A ,$37.06 ,$93.50 , N/A ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 , N/A ,$86.90 ,$37.06 , N/A , N/A , N/A , N/A ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,98300011,11046,PC DEBR SKIN/SUBQ MUS/FAS ADL 20C PRO,983,1 ,$230.00 ,$151.80 ,$34.96 ,$230.00 ,$34.96 ,$157.64 ,$157.64 , N/A ,$138.00 ,$195.50 ,$161.00 ,$34.96 ,$34.96 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 , N/A ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$34.96 , N/A , N/A , N/A ,$37.06 ,$195.50 , N/A ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 , N/A ,$181.70 ,$37.06 , N/A , N/A , N/A , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98300012,11047,PC DEBR SKIN/SUB TIS/MUS/BN ADL 20C PRO,983,1 ,$385.00 ,$254.10 ,$34.96 ,$385.00 ,$34.96 ,$263.88 ,$263.88 , N/A ,$231.00 ,$327.25 ,$269.50 ,$34.96 ,$34.96 ,$365.75 ,$292.60 ,$288.75 ,$250.25 ,$327.25 , N/A ,$250.25 ,$250.25 ,$269.50 ,$234.47 ,$34.96 , N/A , N/A , N/A ,$37.06 ,$327.25 , N/A ,$354.20 ,$269.50 ,$195.27 ,$234.35 ,$234.47 ,$234.35 ,$266.04 ,$346.50 ,$263.03 , N/A ,$304.15 ,$37.06 , N/A , N/A , N/A , N/A ,$277.20 ,$238.70 ,$277.20 ,$277.20 ,$308.00 
ST NICHOLAS HOSPITAL - ACUTE,98300013,11055,PC PARING LESN BENIGN 1 PRO,983,1 ,$160.00 ,$105.60 ,$5.80 ,$396.55 ,$5.80 ,$109.66 ,$109.66 ,$176.25 ,$96.00 ,$136.00 ,$112.00 ,$5.80 ,$5.80 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 ,$176.25 ,$104.00 ,$104.00 ,$112.00 ,$97.44 ,$5.80 ,$176.25 ,$172.72 ,$160.00 ,$6.15 ,$136.00 ,$396.55 ,$147.20 ,$112.00 ,$81.15 ,$97.39 ,$97.44 ,$97.39 ,$110.56 ,$144.00 ,$109.31 ,$174.45 ,$126.40 ,$6.15 , N/A , N/A ,$172.72 , N/A ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,98300014,11056,PC PARING LESN BENIGN 2-4 PRO,983,1 ,$230.00 ,$151.80 ,$5.80 ,$396.55 ,$5.80 ,$157.64 ,$157.64 ,$176.25 ,$138.00 ,$195.50 ,$161.00 ,$5.80 ,$5.80 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$176.25 ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$5.80 ,$176.25 ,$172.72 ,$230.00 ,$6.15 ,$195.50 ,$396.55 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 ,$174.45 ,$181.70 ,$6.15 , N/A , N/A ,$172.72 , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98300019,15100,PC AUTOGRPH T A L 100SQCM< PRO,983,1 ,"$2,795.00 ","$1,844.70 ",$68.72 ,"$3,789.99 ",$68.72 ,"$1,915.69 ","$1,915.69 ","$1,684.44 ","$1,677.00 ","$2,375.75 ","$1,956.50 ",$68.72 ,$68.72 ,"$2,655.25 ","$2,124.20 ","$2,096.25 ","$1,816.75 ","$2,375.75 ","$1,684.44 ","$1,816.75 ","$1,816.75 ","$1,956.50 ","$1,702.16 ",$68.72 ,"$1,684.44 ","$1,650.75 ","$2,795.00 ",$72.84 ,"$2,375.75 ","$3,789.99 ","$2,571.40 ","$1,956.50 ","$1,998.41 ","$2,497.74 ","$1,702.16 ","$2,497.74 ","$1,931.35 ","$2,515.50 ","$1,909.54 ","$1,667.25 ","$2,208.05 ",$72.84 , N/A , N/A ,"$1,650.75 ", N/A ,"$2,012.40 ","$1,732.90 ","$2,012.40 ","$2,012.40 ","$2,236.00 "
ST NICHOLAS HOSPITAL - ACUTE,98300020,15101,PC AUTOGRPH T A L EA ADD100CM PRO,983,1 ,$880.00 ,$580.80 ,$68.72 ,$880.00 ,$68.72 ,$603.15 ,$603.15 , N/A ,$528.00 ,$748.00 ,$616.00 ,$68.72 ,$68.72 ,$836.00 ,$668.80 ,$660.00 ,$572.00 ,$748.00 , N/A ,$572.00 ,$572.00 ,$616.00 ,$535.92 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$748.00 , N/A ,$809.60 ,$616.00 ,$446.34 ,$535.66 ,$535.92 ,$535.66 ,$608.08 ,$792.00 ,$601.22 , N/A ,$695.20 ,$72.84 , N/A , N/A , N/A , N/A ,$633.60 ,$545.60 ,$633.60 ,$633.60 ,$704.00 
ST NICHOLAS HOSPITAL - ACUTE,98300021,15120,PC AUTOGRPH F F DG 100SQCM< PRO,983,1 ,"$4,495.00 ","$2,966.70 ",$68.72 ,"$7,143.68 ",$68.72 ,"$3,080.87 ","$3,080.87 ","$3,174.97 ","$2,697.00 ","$3,820.75 ","$3,146.50 ",$68.72 ,$68.72 ,"$4,270.25 ","$3,416.20 ","$3,371.25 ","$2,921.75 ","$3,820.75 ","$3,174.97 ","$2,921.75 ","$2,921.75 ","$3,146.50 ","$2,737.46 ",$68.72 ,"$3,174.97 ","$3,111.47 ","$4,495.00 ",$72.84 ,"$3,820.75 ","$7,143.68 ","$4,135.40 ","$3,146.50 ","$3,273.50 ","$4,091.88 ","$2,737.46 ","$4,091.88 ","$3,106.05 ","$4,045.50 ","$3,070.98 ","$3,142.59 ","$3,551.05 ",$72.84 , N/A , N/A ,"$3,111.47 ", N/A ,"$3,236.40 ","$2,786.90 ","$3,236.40 ","$3,236.40 ","$3,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,98300022,15121,PC AUTOGRPH F F DG EA ADD 100CM PRO,983,1 ,"$2,247.00 ","$1,483.02 ",$68.72 ,"$2,247.00 ",$68.72 ,"$1,540.09 ","$1,540.09 ", N/A ,"$1,348.20 ","$1,909.95 ","$1,572.90 ",$68.72 ,$68.72 ,"$2,134.65 ","$1,707.72 ","$1,685.25 ","$1,460.55 ","$1,909.95 ", N/A ,"$1,460.55 ","$1,460.55 ","$1,572.90 ","$1,368.42 ",$68.72 , N/A , N/A , N/A ,$72.84 ,"$1,909.95 ", N/A ,"$2,067.24 ","$1,572.90 ","$1,139.68 ","$1,367.75 ","$1,368.42 ","$1,367.75 ","$1,552.68 ","$2,022.30 ","$1,535.15 ", N/A ,"$1,775.13 ",$72.84 , N/A , N/A , N/A , N/A ,"$1,617.84 ","$1,393.14 ","$1,617.84 ","$1,617.84 ","$1,797.60 "
ST NICHOLAS HOSPITAL - ACUTE,98300028,16020,PC BURN DRESS  AND /OR DEBRIDE PRO <5%,983,1 ,$280.00 ,$184.80 ,$6.41 ,$396.55 ,$6.41 ,$191.91 ,$191.91 ,$176.25 ,$168.00 ,$238.00 ,$196.00 ,$6.41 ,$6.41 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$176.25 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$6.41 ,$176.25 ,$172.72 ,$280.00 ,$6.79 ,$238.00 ,$396.55 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$174.45 ,$221.20 ,$6.79 , N/A , N/A ,$172.72 , N/A ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,98300029,16020,PC BURN DRESS  AND OR DEBRD NWPT PRO<5%,983,1 ,$280.00 ,$184.80 ,$6.41 ,$396.55 ,$6.41 ,$191.91 ,$191.91 ,$176.25 ,$168.00 ,$238.00 ,$196.00 ,$6.41 ,$6.41 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$176.25 ,$182.00 ,$182.00 ,$196.00 ,$170.52 ,$6.41 ,$176.25 ,$172.72 ,$280.00 ,$6.79 ,$238.00 ,$396.55 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$191.30 ,$174.45 ,$221.20 ,$6.79 , N/A , N/A ,$172.72 , N/A ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,98300030,17250,PC CHEM CAUTERY/NWPT PRO,983,1 ,$270.00 ,$178.20 ,$5.80 ,$396.55 ,$5.80 ,$185.06 ,$185.06 ,$176.25 ,$162.00 ,$229.50 ,$189.00 ,$5.80 ,$5.80 ,$256.50 ,$205.20 ,$202.50 ,$175.50 ,$229.50 ,$176.25 ,$175.50 ,$175.50 ,$189.00 ,$164.43 ,$5.80 ,$176.25 ,$172.72 ,$270.00 ,$6.15 ,$229.50 ,$396.55 ,$248.40 ,$189.00 ,$136.94 ,$164.35 ,$164.43 ,$164.35 ,$186.57 ,$243.00 ,$184.46 ,$174.45 ,$213.30 ,$6.15 , N/A , N/A ,$172.72 , N/A ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,98300031,17250,PC CHEM CAUTERY PRO,983,1 ,$270.00 ,$178.20 ,$5.80 ,$396.55 ,$5.80 ,$185.06 ,$185.06 ,$176.25 ,$162.00 ,$229.50 ,$189.00 ,$5.80 ,$5.80 ,$256.50 ,$205.20 ,$202.50 ,$175.50 ,$229.50 ,$176.25 ,$175.50 ,$175.50 ,$189.00 ,$164.43 ,$5.80 ,$176.25 ,$172.72 ,$270.00 ,$6.15 ,$229.50 ,$396.55 ,$248.40 ,$189.00 ,$136.94 ,$164.35 ,$164.43 ,$164.35 ,$186.57 ,$243.00 ,$184.46 ,$174.45 ,$213.30 ,$6.15 , N/A , N/A ,$172.72 , N/A ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,98300032,97597,PC AWC WITH CHEM CAUTERY PRO,983,1 ,$270.00 ,$178.20 ,$6.41 ,$396.55 ,$6.41 ,$185.06 ,$185.06 ,$176.25 ,$162.00 ,$229.50 ,$189.00 ,$6.41 ,$6.41 ,$256.50 ,$205.20 ,$202.50 ,$175.50 ,$229.50 ,$176.25 ,$175.50 ,$175.50 ,$189.00 ,$164.43 ,$6.41 ,$176.25 ,$172.72 ,$270.00 ,$6.79 ,$229.50 ,$396.55 ,$248.40 ,$189.00 ,$136.94 ,$164.35 ,$164.43 ,$164.35 ,$186.57 ,$243.00 ,$184.46 ,$174.45 ,$213.30 ,$6.79 , N/A , N/A ,$172.72 , N/A ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,98300036,29580,PC UNNA BOOT APPLICATION PRO,983,1 ,$215.00 ,$141.90 ,$6.17 ,$320.09 ,$6.17 ,$147.36 ,$147.36 ,$142.26 ,$129.00 ,$182.75 ,$150.50 ,$6.17 ,$6.17 ,$204.25 ,$163.40 ,$161.25 ,$139.75 ,$182.75 ,$142.26 ,$139.75 ,$139.75 ,$150.50 ,$130.94 ,$6.17 ,$142.26 ,$139.41 ,$215.00 ,$6.54 ,$182.75 ,$320.09 ,$197.80 ,$150.50 ,$109.05 ,$130.87 ,$130.94 ,$130.87 ,$148.57 ,$193.50 ,$146.89 ,$140.81 ,$169.85 ,$6.54 , N/A , N/A ,$139.41 , N/A ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$172.00 
ST NICHOLAS HOSPITAL - ACUTE,98300038,29581,PC APPL MULTI COMP LOWER LEG PRO,983,1 ,$400.00 ,$264.00 ,$6.17 ,$400.00 ,$6.17 ,$274.16 ,$274.16 ,$142.26 ,$240.00 ,$340.00 ,$280.00 ,$6.17 ,$6.17 ,$380.00 ,$304.00 ,$300.00 ,$260.00 ,$340.00 ,$142.26 ,$260.00 ,$260.00 ,$280.00 ,$243.60 ,$6.17 ,$142.26 ,$139.41 ,$284.52 ,$6.54 ,$340.00 ,$320.09 ,$368.00 ,$280.00 ,$202.88 ,$243.48 ,$243.60 ,$243.48 ,$276.40 ,$360.00 ,$273.28 ,$140.81 ,$316.00 ,$6.54 , N/A , N/A ,$139.41 , N/A ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$320.00 
ST NICHOLAS HOSPITAL - ACUTE,98300039,29581,PC APPL BIL MULT COMP LOWLEG PRO,983,1 ,$600.00 ,$396.00 ,$9.25 ,$600.00 ,$9.25 ,$411.24 ,$411.24 ,$213.39 ,$360.00 ,$510.00 ,$420.00 ,$9.25 ,$9.25 ,$570.00 ,$456.00 ,$450.00 ,$390.00 ,$510.00 ,$213.39 ,$390.00 ,$390.00 ,$420.00 ,$365.40 ,$9.25 ,$213.39 ,$209.12 ,$426.78 ,$9.81 ,$510.00 ,$480.13 ,$552.00 ,$420.00 ,$304.32 ,$365.22 ,$365.40 ,$365.22 ,$414.60 ,$540.00 ,$409.92 ,$211.21 ,$474.00 ,$9.81 , N/A , N/A ,$209.12 , N/A ,$432.00 ,$372.00 ,$432.00 ,$432.00 ,$480.00 
ST NICHOLAS HOSPITAL - ACUTE,98300043,97597,PC DEBR SKIN INTL 20CM PRO,983,1 ,$205.00 ,$135.30 ,$6.41 ,$396.55 ,$6.41 ,$140.51 ,$140.51 ,$176.25 ,$123.00 ,$174.25 ,$143.50 ,$6.41 ,$6.41 ,$194.75 ,$155.80 ,$153.75 ,$133.25 ,$174.25 ,$176.25 ,$133.25 ,$133.25 ,$143.50 ,$124.85 ,$6.41 ,$176.25 ,$172.72 ,$205.00 ,$6.79 ,$174.25 ,$396.55 ,$188.60 ,$143.50 ,$103.98 ,$124.78 ,$124.85 ,$124.78 ,$141.66 ,$184.50 ,$140.06 ,$174.45 ,$161.95 ,$6.79 , N/A , N/A ,$172.72 , N/A ,$147.60 ,$127.10 ,$147.60 ,$147.60 ,$164.00 
ST NICHOLAS HOSPITAL - ACUTE,98300049,97598,PC DEBR SKIN PART THICKNESS EA ADDN>20CM PRO,983,1 ,$230.00 ,$151.80 ,$34.96 ,$230.00 ,$34.96 ,$157.64 ,$157.64 , N/A ,$138.00 ,$195.50 ,$161.00 ,$34.96 ,$34.96 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 , N/A ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$34.96 , N/A , N/A , N/A ,$37.06 ,$195.50 , N/A ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 , N/A ,$181.70 ,$37.06 , N/A , N/A , N/A , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98300050,97605,PC NWPT <50 SQ CM PRO,983,1 ,$120.00 ,$79.20 ,$6.41 ,$396.55 ,$6.41 ,$82.25 ,$82.25 ,$176.25 ,$72.00 ,$102.00 ,$84.00 ,$6.41 ,$6.41 ,$114.00 ,$91.20 ,$90.00 ,$78.00 ,$102.00 ,$176.25 ,$78.00 ,$78.00 ,$84.00 ,$73.08 ,$6.41 ,$176.25 ,$172.72 ,$120.00 ,$6.79 ,$102.00 ,$396.55 ,$110.40 ,$84.00 ,$60.86 ,$73.04 ,$73.08 ,$73.04 ,$82.92 ,$108.00 ,$81.98 ,$174.45 ,$94.80 ,$6.79 , N/A , N/A ,$172.72 , N/A ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,98300051,97606,PC NWPT >50 SQ CM PRO,983,1 ,$230.00 ,$151.80 ,$13.09 ,$819.26 ,$13.09 ,$157.64 ,$157.64 ,$364.12 ,$138.00 ,$195.50 ,$161.00 ,$13.09 ,$13.09 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$364.12 ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$13.09 ,$364.12 ,$356.84 ,$230.00 ,$13.88 ,$195.50 ,$819.26 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 ,$360.40 ,$181.70 ,$13.88 , N/A , N/A ,$356.84 , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98300054,G0127,PC TRIM NAILS DYSTROPHIC PRO,983,1 ,$45.00 ,$29.70 ,$2.25 ,$126.23 ,$2.25 ,$30.84 ,$30.84 ,$56.10 ,$27.00 ,$38.25 ,$31.50 ,$2.25 ,$2.25 ,$42.75 ,$34.20 ,$33.75 ,$29.25 ,$38.25 ,$56.10 ,$29.25 ,$29.25 ,$31.50 ,$27.41 ,$2.25 ,$56.10 ,$54.98 ,$45.00 ,$2.39 ,$38.25 ,$126.23 ,$41.40 ,$31.50 ,$22.82 ,$27.39 ,$27.41 ,$27.39 ,$31.10 ,$40.50 ,$30.74 ,$55.53 ,$35.55 ,$2.39 , N/A , N/A ,$54.98 , N/A ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$36.00 
ST NICHOLAS HOSPITAL - ACUTE,98300075,99183,PC HYPERBARIC 02 HSHS PRO FEE,983,1 ,$920.00 ,$607.20 ,$466.62 ,$920.00 , N/A ,$630.57 ,$630.57 , N/A ,$552.00 ,$782.00 ,$644.00 , N/A , N/A ,$874.00 ,$699.20 ,$690.00 ,$598.00 ,$782.00 , N/A ,$598.00 ,$598.00 ,$644.00 ,$560.28 , N/A , N/A , N/A , N/A , N/A ,$782.00 , N/A ,$846.40 ,$644.00 ,$466.62 ,$560.00 ,$560.28 ,$560.00 ,$635.72 ,$828.00 ,$628.54 , N/A ,$726.80 , N/A , N/A , N/A , N/A , N/A ,$662.40 ,$570.40 ,$662.40 ,$662.40 ,$736.00 
ST NICHOLAS HOSPITAL - ACUTE,98300080,15271,PC APL SKIN SUB TAL<100 INT 25CM PRO,983,1 ,$560.00 ,$369.60 ,$68.72 ,"$3,789.99 ",$68.72 ,$383.82 ,$383.82 ,"$1,684.44 ",$336.00 ,$476.00 ,$392.00 ,$68.72 ,$68.72 ,$532.00 ,$425.60 ,$420.00 ,$364.00 ,$476.00 ,"$1,684.44 ",$364.00 ,$364.00 ,$392.00 ,$341.04 ,$68.72 ,"$1,684.44 ","$1,650.75 ",$560.00 ,$72.84 ,$476.00 ,"$3,789.99 ",$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$382.59 ,"$1,667.25 ",$442.40 ,$72.84 , N/A , N/A ,"$1,650.75 ", N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,98300081,15271,PC APL SKIN SUB TAL<100 INT 25CM PRO W/PROC,983,1 ,$560.00 ,$369.60 ,$68.72 ,"$3,789.99 ",$68.72 ,$383.82 ,$383.82 ,"$1,684.44 ",$336.00 ,$476.00 ,$392.00 ,$68.72 ,$68.72 ,$532.00 ,$425.60 ,$420.00 ,$364.00 ,$476.00 ,"$1,684.44 ",$364.00 ,$364.00 ,$392.00 ,$341.04 ,$68.72 ,"$1,684.44 ","$1,650.75 ",$560.00 ,$72.84 ,$476.00 ,"$3,789.99 ",$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$382.59 ,"$1,667.25 ",$442.40 ,$72.84 , N/A , N/A ,"$1,650.75 ", N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,98300082,15272,PC APL SKIN SUB TAL<100 ADL 25CM PRO,983,1 ,$110.00 ,$72.60 ,$55.79 ,$110.00 ,$68.72 ,$75.39 ,$75.39 , N/A ,$66.00 ,$93.50 ,$77.00 ,$68.72 ,$68.72 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 , N/A ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$93.50 , N/A ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 , N/A ,$86.90 ,$72.84 , N/A , N/A , N/A , N/A ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,98300086,15275,PC APL SKIN SUB OTH<100 INT 25CM PRO,983,1 ,$605.00 ,$399.30 ,$68.72 ,"$3,789.99 ",$68.72 ,$414.67 ,$414.67 ,"$1,684.44 ",$363.00 ,$514.25 ,$423.50 ,$68.72 ,$68.72 ,$574.75 ,$459.80 ,$453.75 ,$393.25 ,$514.25 ,"$1,684.44 ",$393.25 ,$393.25 ,$423.50 ,$368.45 ,$68.72 ,"$1,684.44 ","$1,650.75 ",$605.00 ,$72.84 ,$514.25 ,"$3,789.99 ",$556.60 ,$423.50 ,$605.00 ,$605.00 ,$368.45 ,$605.00 ,$418.06 ,$544.50 ,$413.34 ,"$1,667.25 ",$477.95 ,$72.84 , N/A , N/A ,"$1,650.75 ", N/A ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$484.00 
ST NICHOLAS HOSPITAL - ACUTE,98300087,15275,PC APL SKIN SUB OTH<100 INT 25CM W/PROC PRO,983,1 ,$605.00 ,$399.30 ,$68.72 ,"$3,789.99 ",$68.72 ,$414.67 ,$414.67 ,"$1,684.44 ",$363.00 ,$514.25 ,$423.50 ,$68.72 ,$68.72 ,$574.75 ,$459.80 ,$453.75 ,$393.25 ,$514.25 ,"$1,684.44 ",$393.25 ,$393.25 ,$423.50 ,$368.45 ,$68.72 ,"$1,684.44 ","$1,650.75 ",$605.00 ,$72.84 ,$514.25 ,"$3,789.99 ",$556.60 ,$423.50 ,$605.00 ,$605.00 ,$368.45 ,$605.00 ,$418.06 ,$544.50 ,$413.34 ,"$1,667.25 ",$477.95 ,$72.84 , N/A , N/A ,"$1,650.75 ", N/A ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$484.00 
ST NICHOLAS HOSPITAL - ACUTE,98300088,15276,PC APL SKIN SUB OTH<100 ADL 25CM PRO,983,1 ,$145.00 ,$95.70 ,$68.72 ,$145.00 ,$68.72 ,$99.38 ,$99.38 , N/A ,$87.00 ,$123.25 ,$101.50 ,$68.72 ,$68.72 ,$137.75 ,$110.20 ,$108.75 ,$94.25 ,$123.25 , N/A ,$94.25 ,$94.25 ,$101.50 ,$88.31 ,$68.72 , N/A , N/A , N/A ,$72.84 ,$123.25 , N/A ,$133.40 ,$101.50 ,$73.54 ,$88.26 ,$88.31 ,$88.26 ,$100.20 ,$130.50 ,$99.06 , N/A ,$114.55 ,$72.84 , N/A , N/A , N/A , N/A ,$104.40 ,$89.90 ,$104.40 ,$104.40 ,$116.00 
ST NICHOLAS HOSPITAL - ACUTE,98300092,10140,PC I AND D HEMATOMA/SEROMA/FLUID PRO,983,1 ,$560.00 ,$369.60 ,$38.33 ,"$3,293.01 ",$38.33 ,$383.82 ,$383.82 ,"$1,463.56 ",$336.00 ,$476.00 ,$392.00 ,$38.33 ,$38.33 ,$532.00 ,$425.60 ,$420.00 ,$364.00 ,$476.00 ,"$1,463.56 ",$364.00 ,$364.00 ,$392.00 ,$341.04 ,$38.33 ,"$1,463.56 ","$1,434.29 ",$560.00 ,$40.63 ,$476.00 ,"$3,293.01 ",$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$382.59 ,"$1,448.64 ",$442.40 ,$40.63 , N/A , N/A ,"$1,434.29 ", N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,98300095,11057,PC PARING LESN BENIGN >4 PRO,983,1 ,$290.00 ,$191.40 ,$5.80 ,$396.55 ,$5.80 ,$198.77 ,$198.77 ,$176.25 ,$174.00 ,$246.50 ,$203.00 ,$5.80 ,$5.80 ,$275.50 ,$220.40 ,$217.50 ,$188.50 ,$246.50 ,$176.25 ,$188.50 ,$188.50 ,$203.00 ,$176.61 ,$5.80 ,$176.25 ,$172.72 ,$290.00 ,$6.15 ,$246.50 ,$396.55 ,$266.80 ,$203.00 ,$147.09 ,$176.52 ,$176.61 ,$176.52 ,$200.39 ,$261.00 ,$198.13 ,$174.45 ,$229.10 ,$6.15 , N/A , N/A ,$172.72 , N/A ,$208.80 ,$179.80 ,$208.80 ,$208.80 ,$232.00 
ST NICHOLAS HOSPITAL - ACUTE,98300122,11900,PC INJECT SKIN LESIONS </W 7 PRO,983,1 ,$100.00 ,$66.00 ,$5.80 ,$396.55 ,$5.80 ,$68.54 ,$68.54 ,$176.25 ,$60.00 ,$85.00 ,$70.00 ,$5.80 ,$5.80 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$176.25 ,$65.00 ,$65.00 ,$70.00 ,$60.90 ,$5.80 ,$176.25 ,$172.72 ,$100.00 ,$6.15 ,$85.00 ,$396.55 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$68.32 ,$174.45 ,$79.00 ,$6.15 , N/A , N/A ,$172.72 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,98300124,11730,PC AVULSION NAIL PLATE SINGLE PRO,983,1 ,$315.00 ,$207.90 ,$2.25 ,$396.55 ,$2.25 ,$215.90 ,$215.90 ,$176.25 ,$189.00 ,$267.75 ,$220.50 ,$2.25 ,$2.25 ,$299.25 ,$239.40 ,$236.25 ,$204.75 ,$267.75 ,$176.25 ,$204.75 ,$204.75 ,$220.50 ,$191.84 ,$2.25 ,$176.25 ,$172.72 ,$315.00 ,$2.39 ,$267.75 ,$396.55 ,$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$191.74 ,$217.67 ,$283.50 ,$215.21 ,$174.45 ,$248.85 ,$2.39 , N/A , N/A ,$172.72 , N/A ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$252.00 
ST NICHOLAS HOSPITAL - ACUTE,98300145,11102,PC BIOPSY SKIN TANGENTIAL INIT LESN,983,1 ,$325.00 ,$214.50 ,$15.19 ,$396.55 ,$15.19 ,$222.76 ,$222.76 ,$176.25 ,$195.00 ,$276.25 ,$227.50 ,$15.19 ,$15.19 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 ,$176.25 ,$211.25 ,$211.25 ,$227.50 ,$197.93 ,$15.19 ,$176.25 ,$172.72 ,$325.00 ,$16.10 ,$276.25 ,$396.55 ,$299.00 ,$227.50 ,$164.84 ,$197.83 ,$197.93 ,$197.83 ,$224.58 ,$292.50 ,$222.04 ,$174.45 ,$256.75 ,$16.10 , N/A , N/A ,$172.72 , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,98300146,11104,PC BIOPSY SKIN PUNCH INIT LESN,983,1 ,$325.00 ,$214.50 ,$15.19 ,$819.26 ,$15.19 ,$222.76 ,$222.76 ,$364.12 ,$195.00 ,$276.25 ,$227.50 ,$15.19 ,$15.19 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 ,$364.12 ,$211.25 ,$211.25 ,$227.50 ,$197.93 ,$15.19 ,$364.12 ,$356.84 ,$325.00 ,$16.10 ,$276.25 ,$819.26 ,$299.00 ,$227.50 ,$164.84 ,$197.83 ,$197.93 ,$197.83 ,$224.58 ,$292.50 ,$222.04 ,$360.40 ,$256.75 ,$16.10 , N/A , N/A ,$356.84 , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,98300147,11106,PC BIOPSY SKIN INCISIONAL INIT LESN,983,1 ,$325.00 ,$214.50 ,$15.19 ,"$1,275.77 ",$15.19 ,$222.76 ,$222.76 ,$567.01 ,$195.00 ,$276.25 ,$227.50 ,$15.19 ,$15.19 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 ,$567.01 ,$211.25 ,$211.25 ,$227.50 ,$197.93 ,$15.19 ,$567.01 ,$555.67 ,$325.00 ,$16.10 ,$276.25 ,"$1,275.77 ",$299.00 ,$227.50 ,$325.00 ,$325.00 ,$197.93 ,$325.00 ,$224.58 ,$292.50 ,$222.04 ,$561.23 ,$256.75 ,$16.10 , N/A , N/A ,$555.67 , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,98300148,11103,PC BIOPSY SKIN TANGENTIAL ADDL LESN,983,1 ,$160.00 ,$105.60 ,$15.19 ,$160.00 ,$15.19 ,$109.66 ,$109.66 , N/A ,$96.00 ,$136.00 ,$112.00 ,$15.19 ,$15.19 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 , N/A ,$104.00 ,$104.00 ,$112.00 ,$97.44 ,$15.19 , N/A , N/A , N/A ,$16.10 ,$136.00 , N/A ,$147.20 ,$112.00 ,$81.15 ,$97.39 ,$97.44 ,$97.39 ,$110.56 ,$144.00 ,$109.31 , N/A ,$126.40 ,$16.10 , N/A , N/A , N/A , N/A ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,98300149,11105,PC BIOPSY SKIN PUNCH ADDL LESN,983,1 ,$160.00 ,$105.60 ,$15.19 ,$160.00 ,$15.19 ,$109.66 ,$109.66 , N/A ,$96.00 ,$136.00 ,$112.00 ,$15.19 ,$15.19 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 , N/A ,$104.00 ,$104.00 ,$112.00 ,$97.44 ,$15.19 , N/A , N/A , N/A ,$16.10 ,$136.00 , N/A ,$147.20 ,$112.00 ,$81.15 ,$97.39 ,$97.44 ,$97.39 ,$110.56 ,$144.00 ,$109.31 , N/A ,$126.40 ,$16.10 , N/A , N/A , N/A , N/A ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,98300150,11107,PC BIOPSY SKIN INCISIONAL ADDL LESN,983,1 ,$160.00 ,$105.60 ,$15.19 ,$160.00 ,$15.19 ,$109.66 ,$109.66 , N/A ,$96.00 ,$136.00 ,$112.00 ,$15.19 ,$15.19 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 , N/A ,$104.00 ,$104.00 ,$112.00 ,$97.44 ,$15.19 , N/A , N/A , N/A ,$16.10 ,$136.00 , N/A ,$147.20 ,$112.00 ,$81.15 ,$97.39 ,$97.44 ,$97.39 ,$110.56 ,$144.00 ,$109.31 , N/A ,$126.40 ,$16.10 , N/A , N/A , N/A , N/A ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,98300151,43762,PC REPLACE GASTRO TUBE PERC,983,1 ,$420.00 ,$277.20 ,$16.75 ,$471.85 ,$16.75 ,$287.87 ,$287.87 ,$209.71 ,$252.00 ,$357.00 ,$294.00 ,$16.75 ,$16.75 ,$399.00 ,$319.20 ,$315.00 ,$273.00 ,$357.00 ,$209.71 ,$273.00 ,$273.00 ,$294.00 ,$255.78 ,$16.75 ,$209.71 ,$205.52 ,$419.42 ,$17.76 ,$357.00 ,$471.85 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$255.65 ,$290.22 ,$378.00 ,$286.94 ,$207.57 ,$331.80 ,$17.76 , N/A , N/A ,$205.52 , N/A ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,98300152,43763,PC REPLACE GASTRO TUBE PERC W/REVISE TRACT,983,1 ,$440.00 ,$290.40 ,$16.75 ,$471.85 ,$16.75 ,$301.58 ,$301.58 ,$209.71 ,$264.00 ,$374.00 ,$308.00 ,$16.75 ,$16.75 ,$418.00 ,$334.40 ,$330.00 ,$286.00 ,$374.00 ,$209.71 ,$286.00 ,$286.00 ,$308.00 ,$267.96 ,$16.75 ,$209.71 ,$205.52 ,$419.42 ,$17.76 ,$374.00 ,$471.85 ,$404.80 ,$308.00 ,$223.17 ,$267.83 ,$267.96 ,$267.83 ,$304.04 ,$396.00 ,$300.61 ,$207.57 ,$347.60 ,$17.76 , N/A , N/A ,$205.52 , N/A ,$316.80 ,$272.80 ,$316.80 ,$316.80 ,$352.00 
ST NICHOLAS HOSPITAL - ACUTE,98800013,99221,PC INITIAL HOSPITAL INP/OBSERV CARE LVL 1 LOW 40MIN,987,1 ,$230.00 ,$151.80 ,$4.33 ,$230.00 ,$4.33 ,$157.64 ,$157.64 , N/A ,$138.00 ,$195.50 ,$161.00 ,$4.33 ,$4.33 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 , N/A ,$149.50 ,$149.50 ,$161.00 ,$140.07 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$195.50 , N/A ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$157.14 , N/A ,$181.70 ,$4.59 , N/A , N/A , N/A , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98800015,99222,PC INITIAL HOSPITAL INP/OBSERV CARE LVL 2 MODERATE 55 MIN,987,1 ,$310.00 ,$204.60 ,$4.33 ,$310.00 ,$4.33 ,$212.47 ,$212.47 , N/A ,$186.00 ,$263.50 ,$217.00 ,$4.33 ,$4.33 ,$294.50 ,$235.60 ,$232.50 ,$201.50 ,$263.50 , N/A ,$201.50 ,$201.50 ,$217.00 ,$188.79 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$263.50 , N/A ,$285.20 ,$217.00 ,$157.23 ,$188.70 ,$188.79 ,$188.70 ,$214.21 ,$279.00 ,$211.79 , N/A ,$244.90 ,$4.59 , N/A , N/A , N/A , N/A ,$223.20 ,$192.20 ,$223.20 ,$223.20 ,$248.00 
ST NICHOLAS HOSPITAL - ACUTE,98800016,99223,PC INITIAL HOSPITAL INP/OBSERV CARE LVL 3 HIGH 75 MIN,987,1 ,$450.00 ,$297.00 ,$4.33 ,$450.00 ,$4.33 ,$308.43 ,$308.43 , N/A ,$270.00 ,$382.50 ,$315.00 ,$4.33 ,$4.33 ,$427.50 ,$342.00 ,$337.50 ,$292.50 ,$382.50 , N/A ,$292.50 ,$292.50 ,$315.00 ,$274.05 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$307.44 , N/A ,$355.50 ,$4.59 , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,98800017,99231,PC SUBSQ HOSPITAL INP/OBSERV CARE LVL 1 LOW 25 MIN,987,1 ,$110.00 ,$72.60 ,$4.33 ,$110.00 ,$4.33 ,$75.39 ,$75.39 , N/A ,$66.00 ,$93.50 ,$77.00 ,$4.33 ,$4.33 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 , N/A ,$71.50 ,$71.50 ,$77.00 ,$66.99 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$93.50 , N/A ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$75.15 , N/A ,$86.90 ,$4.59 , N/A , N/A , N/A , N/A ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,98800018,99232,PC SUBSQ HOSPITAL INP/OBSERV CARE LVL 2 MODERATE 35 MIN,987,1 ,$170.00 ,$112.20 ,$4.33 ,$170.00 ,$4.33 ,$116.52 ,$116.52 , N/A ,$102.00 ,$144.50 ,$119.00 ,$4.33 ,$4.33 ,$161.50 ,$129.20 ,$127.50 ,$110.50 ,$144.50 , N/A ,$110.50 ,$110.50 ,$119.00 ,$103.53 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$144.50 , N/A ,$156.40 ,$119.00 ,$86.22 ,$103.48 ,$103.53 ,$103.48 ,$117.47 ,$153.00 ,$116.14 , N/A ,$134.30 ,$4.59 , N/A , N/A , N/A , N/A ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,98800019,99233,PC SUBSQ HOSPITAL INP/OBSERV CARE LVL 3 HIGH 50 MIN,987,1 ,$235.00 ,$155.10 ,$4.33 ,$235.00 ,$4.33 ,$161.07 ,$161.07 , N/A ,$141.00 ,$199.75 ,$164.50 ,$4.33 ,$4.33 ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 , N/A ,$152.75 ,$152.75 ,$164.50 ,$143.12 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$160.55 , N/A ,$185.65 ,$4.59 , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,98880000,99251,PC INPATIENT CONSULTATION 1 LIMITED 20MIN,988,1 ,$235.00 ,$155.10 ,$119.19 ,$235.00 , N/A ,$161.07 ,$161.07 , N/A ,$141.00 ,$199.75 ,$164.50 , N/A , N/A ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 , N/A ,$152.75 ,$152.75 ,$164.50 ,$143.12 , N/A , N/A , N/A , N/A , N/A ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$160.55 , N/A ,$185.65 , N/A , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,98880001,99252,PC INP/OBSERV CONSULT NEW/ESTAB SF MED DEC PT LEVEL 2 - 35 MIN,988,1 ,$315.00 ,$207.90 ,$4.33 ,$315.00 ,$4.33 ,$215.90 ,$215.90 , N/A ,$189.00 ,$267.75 ,$220.50 ,$4.33 ,$4.33 ,$299.25 ,$239.40 ,$236.25 ,$204.75 ,$267.75 , N/A ,$204.75 ,$204.75 ,$220.50 ,$191.84 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$267.75 , N/A ,$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$191.74 ,$217.67 ,$283.50 ,$215.21 , N/A ,$248.85 ,$4.59 , N/A , N/A , N/A , N/A ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$252.00 
ST NICHOLAS HOSPITAL - ACUTE,98880002,99253,PC INP/OBSERV CONSULT NEW/ESTAB LOW MED DEC PT LEVEL 3 - 45 MIN,988,1 ,$395.00 ,$260.70 ,$4.33 ,$395.00 ,$4.33 ,$270.73 ,$270.73 , N/A ,$237.00 ,$335.75 ,$276.50 ,$4.33 ,$4.33 ,$375.25 ,$300.20 ,$296.25 ,$256.75 ,$335.75 , N/A ,$256.75 ,$256.75 ,$276.50 ,$240.56 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$335.75 , N/A ,$363.40 ,$276.50 ,$200.34 ,$240.44 ,$240.56 ,$240.44 ,$272.95 ,$355.50 ,$269.86 , N/A ,$312.05 ,$4.59 , N/A , N/A , N/A , N/A ,$284.40 ,$244.90 ,$284.40 ,$284.40 ,$316.00 
ST NICHOLAS HOSPITAL - ACUTE,98880003,99254,PC INP/OBSERV CONSULT NEW/ESTAB MOD MED DEC PT LEVEL 4 - 60 MIN,988,1 ,$545.00 ,$359.70 ,$4.33 ,$545.00 ,$4.33 ,$373.54 ,$373.54 , N/A ,$327.00 ,$463.25 ,$381.50 ,$4.33 ,$4.33 ,$517.75 ,$414.20 ,$408.75 ,$354.25 ,$463.25 , N/A ,$354.25 ,$354.25 ,$381.50 ,$331.91 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$463.25 , N/A ,$501.40 ,$381.50 ,$276.42 ,$331.74 ,$331.91 ,$331.74 ,$376.60 ,$490.50 ,$372.34 , N/A ,$430.55 ,$4.59 , N/A , N/A , N/A , N/A ,$392.40 ,$337.90 ,$392.40 ,$392.40 ,$436.00 
ST NICHOLAS HOSPITAL - ACUTE,98880004,99255,PC INP/OBSERV CONSULT NEW/ESTAB HIGH MED DEC PT LEVEL 5 - 80 MIN,988,1 ,$680.00 ,$448.80 ,$4.33 ,$680.00 ,$4.33 ,$466.07 ,$466.07 , N/A ,$408.00 ,$578.00 ,$476.00 ,$4.33 ,$4.33 ,$646.00 ,$516.80 ,$510.00 ,$442.00 ,$578.00 , N/A ,$442.00 ,$442.00 ,$476.00 ,$414.12 ,$4.33 , N/A , N/A , N/A ,$4.59 ,$578.00 , N/A ,$625.60 ,$476.00 ,$344.90 ,$413.92 ,$414.12 ,$413.92 ,$469.88 ,$612.00 ,$464.58 , N/A ,$537.20 ,$4.59 , N/A , N/A , N/A , N/A ,$489.60 ,$421.60 ,$489.60 ,$489.60 ,$544.00 
ST NICHOLAS HOSPITAL - ACUTE,98880005,G0296,PC CLINIC COUNSELING FOR LOW DOSE LUNG SCREEN,988,1 ,$115.00 ,$75.90 ,$4.33 ,$166.57 ,$4.33 ,$78.82 ,$78.82 ,$74.03 ,$69.00 ,$97.75 ,$80.50 ,$4.33 ,$4.33 ,$109.25 ,$87.40 ,$86.25 ,$74.75 ,$97.75 ,$74.03 ,$74.75 ,$74.75 ,$80.50 ,$70.04 ,$4.33 ,$74.03 ,$72.55 ,$115.00 ,$4.59 ,$97.75 ,$166.57 ,$105.80 ,$80.50 ,$58.33 ,$70.00 ,$70.04 ,$70.00 ,$79.47 ,$103.50 ,$78.57 ,$73.27 ,$90.85 ,$4.59 , N/A , N/A ,$72.55 , N/A ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00