chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov
chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov
6700405 CT CHEST HIGH RESOLU W/O 352 0 1086.48 4260 6700454 CT CHEST W CONTRAST 352 0 1299.35 4260 6700462 CT CHEST W&W/O CONT 352 0 1625.1 4260 6700470 CT CHEST W/O CONTRAS 352 0 1086.48 4260 6700603 CT D SPINE W/CONTRAS 352 0 906.59 4260 6700652 CT DORSAL SPINE 352 0 1086.48 4260 6700702 CT FACIAL/MAND W/CONTRAST 351 0 1179.93 4260 6700710 CT FACIAL/MAND W/O CONTRAST 351 0 1179.93 4260 6700728 CT FACIAL/MAND W/WO CONTRAST 351 0 1474.91 4260 6700801 CT HEAD W & W/O CONT 351 0 1474.91 4260 6700819 CT HEAD W CONTRAST 351 0 1179.93 4260 6700827 CT HEAD W/O CONTRAST 351 0 1179.93 4260 6700900 CT I.A.M. W/CONTRAST 351 0 1474.91 4260 6700918 CT I.A.M. W/O CONTRA 351 0 1179.93 4260 6701007 CT LO EXT W /CON-LT 352 0 1474.91 4260 6701015 CT LO EXT W/CON RT 352 0 1179.93 4260 6701023 CT LO EXT WO CON-LT 352 0 1179.93 4260 6701031 CT LO EXT WO CON-RT 352 0 1179.93 4260 6701098 SCANOGRAM-LEGS 352 0 449.6 4260 6701106 CT LUMBAR SP W/CON 352 0 906.59 4260 6701114 CT LUMBAR SPINE W/O CONTRAST 352 0 1086.48 4260 6701205 CT NECK W/CONTRAST 351 0 1179.93 4260 6701213 CT NECK W/O CONTRAST 351 0 1179.93 4260 6701221 CT NECK W/WO CONTRAS 351 0 1474.91 4260 6701304 CT ORBITS W/CONTRAST 351 0 1474.91 4260 6701312 CT ORBITS W/O CONT 351 0 1179.93 4260 6701320 CT ORBITS W/WO CONTR 351 0 1474.91 4260 6701403 CT PELVIS W/CONTRAST 352 0 1258.62 4260 6701411 CT PELVIS W&W/O CONT 352 0 1558.49 4260 6701429 CT PELVIS W/O CONTRA 352 0 1086.48 4260 6701502 CT PITUITARY W/CONT 351 0 1474.91 4260 6701510 CT PITUITARY W/O CON 351 0 1179.93 4260 6701528 CT PITUITARY W/WO CONTRAST 351 0 1474.91 4260 6701809 CT SAC/COCC W/CONTRA 352 0 1258.62 4260 6701817 CT SAC/COCC W/O CONT 352 0 1086.48 4260 6701908 CT SI JTS W/CONTRAST 352 0 906.59 4260 6701916 CT SI JTS W/O CONTRA 352 0 674.12 4260 6702005 CT SINUS W/CONTRAST 351 0 1179.93 4260 6702013 CT SINUS W/O CONTRAS 351 0 1179.93 4260 6702021 CT SINUS W/WO CONTRA 351 0 1474.91 4260 6702104 CT TEMP BNS W/O CONT 351 0 1179.93 4260 6702112 CT TEMP BNS W/WO CON 351 0 1474.91 4260 6702120 CT TEMP BONES W/CONT 351 0 1474.91 4260 6702153 CT TM JOINTS 351 0 1179.93 4260 6702203 CT UP EX W/WO CO-LT 352 0 1004.25 4260 6702229 CT UP EX WO CON-LT 352 0 910.67 4260 6702237 CT UP EX WO CON-RT 352 0 910.67 4260
6702245 CT UP EXT W/ CON-RT 352 0 1086.48 4260 6702252 CT UP EXT W/CON-LT 352 0 1086.48 4260 6702351 CT-ANGIO ABDOMEN 352 0 1496.5 4260 6702369 CT ANGIO ABDOMEN & PELVIS W&W/O 352 0 1863.48 4260 6702450 CT-ANGIO CHEST 352 0 1179.02 4260 6702500 CT-ANGIO EXTR LOWER 352 0 1870.62 4260 6702559 CT-ANGIO EXTR UPPER 352 0 1036.36 4260 6702609 CT-ANGIO HEAD 351 0 1870.62 4260 6702658 CT-ANGIO LEGS RUNOFF 352 0 1870.62 4260 6702708 CT-ANGIO NECK 351 0 1870.62 4260 6702757 CT-ANGIO PELVIS 352 0 1036.36 4260 6705008 CT-BIOPSY ABD MASS 352 0 1080.9 4260 6705107 CT-BIOPSY ABD PROC. 360 0 1003.52 4260 6705206 CT-BIOPSY KID PRO-LT 761 0 1003.52 4260 6705214 CT-BIOPSY KID PRO-RT 761 0 1003.52 4260 6705305 CT-BIOPSY KIDNEY-LT 352 0 1080.9 4260 6705313 CT-BIOPSY KIDNEY-RT 352 0 1080.9 4260 6705404 CT-BIOPSY LIVER 352 0 1080.9 4260 6705412 CT-BIOPSY LIVER PROC 761 0 1863.68 4260 6705503 CT-BIOPSY LUNG 352 0 1080.9 4260 6705511 CT-BIOPSY LUNG PROC. 761 0 1748.79 4260 6705602 CT-BIOPSY PANC. PROC 761 0 1863.68 4260 6705610 CT-BIOPSY PANCREAS 352 0 1080.9 4260 6705701 CT-BIOPSY RETRO 352 0 1080.9 4260 6705800 CT-BONE BIOPSY 352 0 1080.9 4260 6705818 CT-BONE BIOPSY PROC 761 0 865.02 4260 6705909 CT-KID ABS/DR PRO-LT 761 0 4978.45 4260 6705917 CT-KID ABS/DR PRO-RT 761 0 4978.45 4260 6705925 CT-KIDN ABCESS/DR-LT 352 0 691.73 4260 6705933 CT-KIDN ABCESS/DR-RT 352 0 691.73 4260 6706014 CT-KIDNEY CYST PRO-LT 761 0 1863.68 4260 6706022 CT-KIDNEY CYST PRO-RT 761 0 1863.68 4260 6706105 CT-LIVER ABS/DR PROC 761 0 1863.68 4260 6706113 CT-LIVER ABSCESS/DR 352 0 1368.44 4260 6706204 CT-LUNG AB PUN/DR PR 761 0 1037.89 4260 6706212 CT-LUNG ABSCESS/DRA 352 0 1368.44 4260 6706303 CT-PANC ABS DRA PROC 761 0 618.61 4260 6706311 CT-PANCREAS ABS/DR 352 0 1368.44 4260 6706402 CT-PERITON ABS/DRAIN 352 0 1368.44 4260 6706410 CT-PERITON DRAIN PRO 761 0 506.16 4260 6706501 CT-RETRO ABS DRA PRO 761 0 506.16 4260 6706519 CT-RETRO ABS/DR 352 0 1368.44 4260 6706600 CT-SHLDR/ARTHRO-LT 352 0 697.38 4260 6706618 CT-SHLDR/ARTHRO-RT 352 0 1086.48 4260 6706709 CT-SUB/DI ABS DRA PR 761 0 506.16 4260 6706717 CT-SUB/DIA ABS/DRAIN 352 0 1368.44 4260 6706725 CT LOWER EXT BILAT W/CONTRAST 352 0 2877.88 4260
- Page 61 and 62: 4605101 ASPERGILLUS FUMIGAT. 300 0
- Page 63 and 64: 4606471 PARIETAL CELL AB 300 0 90.8
- Page 65 and 66: 4607453 IGG,SERUM (CSFI) 300 0 70.9
- Page 67 and 68: 4608477 IGG B2 GLYCOPROTEIN 300 0 1
- Page 69 and 70: 4609616 SACCHAROMYCES IGG AB 300 0
- Page 71 and 72: 4610648 PLASMINOGEN ACT INH1 300 0
- Page 73 and 74: 4611703 HYPERCOAG. NON-PREG 300 0 0
- Page 75 and 76: 4613063 TISSUE PREP 300 0 82.42 401
- Page 77 and 78: 4614095 LIDOCAINE AUTO ABS 300 0 26
- Page 79 and 80: 4615340 INCUBATION SERUM & DRUGS, E
- Page 81 and 82: 4619177 ALDOLASE 300 0 76.25 4010 4
- Page 83 and 84: 4620241 HEP BE AG 300 0 90.45 4010
- Page 85 and 86: 4621207 FETOMATERNAL HEMORRHAGE SCR
- Page 87 and 88: 4622148 THYROID STIM IMMUNOGLOBULIN
- Page 89 and 90: 4623146 RUBEOLA ANTIBODIES, IGG 300
- Page 91 and 92: 4624086 MUCOR RACEMOSUS, IGE 300 0
- Page 93 and 94: 4800041 SPE COLL TRAVEL/MILE 300 0
- Page 95 and 96: 5600689 MRI KEN HIP W/CONT RT 610 0
- Page 97 and 98: 5800313 MULTIPLE SLEEP LATENCY TEST
- Page 99 and 100: 6103758 BONE DENSITY FX EVAL 320 0
- Page 101 and 102: 6108906 CYSTO SCOUT FILM 320 0 108.
- Page 103 and 104: 6113864 SHLDR-ARTH PRO/INS-RT 761 0
- Page 105 and 106: 6201206 MYO-IMAGING-INFARCT 340 0 9
- Page 107 and 108: 6306005 COLOR FLOW DOPPLER 480 0 25
- Page 109 and 110: 6390132 US-MIDLINE CATHETER 278 0 1
- Page 111: 6502124 MRI-UP EX NO JT W-LT 610 0
- Page 115 and 116: 6801187 CHEST INS & EXP LAT 320 0 1
- Page 117 and 118: 6802128 MAMMO DIAG DIGITAL RIGHT 40
- Page 119 and 120: 6901607 FINGER 2 OR MORE RT 320 0 1
- Page 121 and 122: 7000094 MRI-CHEST W/WO CONTR PLF 61
- Page 123 and 124: 7001084 MRI-LOEX NO JT W/WO RT-PLF
- Page 125 and 126: 7500820 ASPIRIN 325 MG TAB 250 0 0
- Page 127 and 128: 7501794 CHOLESTYRAMINE/SUCRO PACKET
- Page 129 and 130: 7502768 DULOXETINE 30MG. CAP EC 250
- Page 131 and 132: 7503741 HALOPERIDOL LACTATE VIAL 63
- Page 133 and 134: 7504723 LIDOCAINE HCL/D7.5W INJ 250
- Page 135 and 136: 7505704 MULTIVITAMINS THERAP 250 0
- Page 137 and 138: 7506645 PHENAZOPYRIDINE HCL TAB 250
- Page 139 and 140: 7507601 SODIUM BICARBONATE SYRINGE
- Page 141 and 142: 7508583 ISOPROPYL ALCOHOL SOLN 250
- Page 143 and 144: 7509532 ISOSORBIDE MONONITRA T SR 2
- Page 145 and 146: 7510506 SUMATRIPTAN SUCCINAT TAB 25
- Page 147 and 148: 7511488 BUPROPION HCL 100 MG TAB 25
- Page 149 and 150: 7512486 LANTUS INSULIN VIAL 636 0 0
- Page 151 and 152: 7513500 POVIDONE-IODINE 10% SOLN 25
- Page 153 and 154: 7514649 PYRAZINAMIDE 500MG TAB 250
- Page 155 and 156: 7515620 BUSPIRONE 2.5 MG TAB 250 0
- Page 157 and 158: 7517618 TETANUS AND DIPTHERIA TOX .
- Page 159 and 160: 7600398 CONTAINER EMPTY 500 270 0 0
- Page 161 and 162: 7690001 RED CAP LUER LOCK MED SUPPL
6702245 <strong>CT</strong> UP EXT W/ CON-RT 352 0 1086.48 4260<br />
6702252 <strong>CT</strong> UP EXT W/CON-LT 352 0 1086.48 4260<br />
6702351 <strong>CT</strong>-ANGIO ABDOMEN 352 0 1496.5 4260<br />
6702369 <strong>CT</strong> ANGIO ABDOMEN & PELVIS W&W/O 352 0 1863.48 4260<br />
6702450 <strong>CT</strong>-ANGIO CHEST 352 0 1179.02 4260<br />
6702500 <strong>CT</strong>-ANGIO EXTR LOWER 352 0 1870.62 4260<br />
6702559 <strong>CT</strong>-ANGIO EXTR UPPER 352 0 1036.36 4260<br />
6702609 <strong>CT</strong>-ANGIO HEAD 351 0 1870.62 4260<br />
6702658 <strong>CT</strong>-ANGIO LEGS RUNOFF 352 0 1870.62 4260<br />
6702708 <strong>CT</strong>-ANGIO NECK 351 0 1870.62 4260<br />
6702757 <strong>CT</strong>-ANGIO PELVIS 352 0 1036.36 4260<br />
6705008 <strong>CT</strong>-BIOPSY ABD MASS 352 0 1080.9 4260<br />
6705107 <strong>CT</strong>-BIOPSY ABD PROC. 360 0 1003.52 4260<br />
6705206 <strong>CT</strong>-BIOPSY KID PRO-LT 761 0 1003.52 4260<br />
6705214 <strong>CT</strong>-BIOPSY KID PRO-RT 761 0 1003.52 4260<br />
6705305 <strong>CT</strong>-BIOPSY KIDNEY-LT 352 0 1080.9 4260<br />
6705313 <strong>CT</strong>-BIOPSY KIDNEY-RT 352 0 1080.9 4260<br />
6705404 <strong>CT</strong>-BIOPSY LIVER 352 0 1080.9 4260<br />
6705412 <strong>CT</strong>-BIOPSY LIVER PROC 761 0 1863.68 4260<br />
6705503 <strong>CT</strong>-BIOPSY LUNG 352 0 1080.9 4260<br />
6705511 <strong>CT</strong>-BIOPSY LUNG PROC. 761 0 1748.79 4260<br />
6705602 <strong>CT</strong>-BIOPSY PANC. PROC 761 0 1863.68 4260<br />
6705610 <strong>CT</strong>-BIOPSY PANCREAS 352 0 1080.9 4260<br />
6705701 <strong>CT</strong>-BIOPSY RETRO 352 0 1080.9 4260<br />
6705800 <strong>CT</strong>-BONE BIOPSY 352 0 1080.9 4260<br />
6705818 <strong>CT</strong>-BONE BIOPSY PROC 761 0 865.02 4260<br />
6705909 <strong>CT</strong>-KID ABS/DR PRO-LT 761 0 4978.45 4260<br />
6705917 <strong>CT</strong>-KID ABS/DR PRO-RT 761 0 4978.45 4260<br />
6705925 <strong>CT</strong>-KIDN ABCESS/DR-LT 352 0 691.73 4260<br />
6705933 <strong>CT</strong>-KIDN ABCESS/DR-RT 352 0 691.73 4260<br />
6706014 <strong>CT</strong>-KIDNEY CYST PRO-LT 761 0 1863.68 4260<br />
6706022 <strong>CT</strong>-KIDNEY CYST PRO-RT 761 0 1863.68 4260<br />
6706105 <strong>CT</strong>-LIVER ABS/DR PROC 761 0 1863.68 4260<br />
6706113 <strong>CT</strong>-LIVER ABSCESS/DR 352 0 1368.44 4260<br />
6706204 <strong>CT</strong>-LUNG AB PUN/DR PR 761 0 1037.89 4260<br />
6706212 <strong>CT</strong>-LUNG ABSCESS/DRA 352 0 1368.44 4260<br />
6706303 <strong>CT</strong>-PANC ABS DRA PROC 761 0 618.61 4260<br />
6706311 <strong>CT</strong>-PANCREAS ABS/DR 352 0 1368.44 4260<br />
6706402 <strong>CT</strong>-PERITON ABS/DRAIN 352 0 1368.44 4260<br />
6706410 <strong>CT</strong>-PERITON DRAIN PRO 761 0 506.16 4260<br />
6706501 <strong>CT</strong>-RETRO ABS DRA PRO 761 0 506.16 4260<br />
6706519 <strong>CT</strong>-RETRO ABS/DR 352 0 1368.44 4260<br />
6706600 <strong>CT</strong>-SHLDR/ARTHRO-LT 352 0 697.38 4260<br />
6706618 <strong>CT</strong>-SHLDR/ARTHRO-RT 352 0 1086.48 4260<br />
6706709 <strong>CT</strong>-SUB/DI ABS DRA PR 761 0 506.16 4260<br />
6706717 <strong>CT</strong>-SUB/DIA ABS/DRAIN 352 0 1368.44 4260<br />
6706725 <strong>CT</strong> LOWER EXT BILAT W/CONTRAST 352 0 2877.88 4260
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