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
6706733 CT INTRAPERITONEAL CATHETER 352 0 1368.44 4260 6706741 CT INTRAPERITONEAL CATH PROC 761 0 5231.07 4260 6706758 CT INTRAPERI CATHETER REMOVAL 352 0 1368.44 4260 6706766 CT INTRAPERI CATH REMOVAL PROC 761 0 4649.84 4260 6706774 CT PLEURAL TUNNEL CATH REMOVAL 352 0 1368.44 4260 6706782 CT PLEURAL TUNNEL CATH REMOVAL PROC 761 0 455.91 4260 6706790 CT PLEURAL TUNNEL CATH PROC 761 0 4649.84 4260 6706808 CT PLEURAL TUNNEL CATHETER 352 0 1368.44 4260 6706816 CT BIOPSY NECK PROC 761 0 1342.01 4260 6706824 CT BIOPSY NECK 352 0 1080.9 4260 6706832 CT KIDNEY CYST ASPIRATION LT 352 0 1080.9 4260 6706840 CT KIDNEY CYST ASPIRATION RT 352 0 1080.9 4260 6706857 CT ABDOMEN & PELVIS W/CONTRAST 352 0 2949.82 4260 6706865 CT ABDOMEN & PELVIS W/O CONTRAST 352 0 1474.91 4260 6706873 CT AB AND PELVIS W , W/O CONTRAST 352 0 2949.82 4260 6706881 CT-SI JOINT INJECTION 761 0 1103.53 4260 6706899 CT LUMBAR FACET INJECTION 761 0 1352.47 4260 6706907 CT-SI JOINT NEEDLE GUIDANCE 352 0 1080.9 4260 6706915 CT BONE BX DEEP VERTEBRAL BODY 761 0 3222.05 4260 6706923 CT GUIDANCE 352 0 1080.9 4260 6706956 CT CHEST LIMITED STUDY 352 0 449.6 4260 6706964 3D RECONSTRUCTION CHARTE 350 0 631.49 4260 6706972 CT GUIDED CELIAC PLEXUS NEUROLYSIS 761 0 2130.95 4260 6790125 GASTROVIEW PER ML 636 0 0.39 4260 6790158 READICAT PER BOTTLE 255 0 14.4 4260 6790174 CT VACUUM BTL & DRAIN TUBING 270 0 128.25 4260 6790182 CT PLEURAL CATHETER SUPPLY 278 0 1181.25 4260 6790190 CT PERITONEAL CATHETER SUPPLY 278 0 1181.25 4260 6790208 CT BONE BIOPSY KIT 270 0 528.75 4260 6801005 ABDOMEN (KUB/FLAT) 320 0 108.88 4212 6801013 ABDOMEN FLAT & UPRIGHT 320 0 108.88 4212 6801021 ABDOMEN LATERAL & AP 320 0 108.88 4212 6801039 ABDOMEN W/ DECUBITIS 320 0 108.88 4212 6801047 ABDOMEN WITH LATERAL 320 0 131.66 4212 6801054 AC JTS, W&WO WTS R&L 320 0 131.66 4212 6801062 ANKLE RIGHT 320 0 131.66 4212 6801070 ANKLE LEFT 320 0 131.66 4212 6801088 ANKLE BILAT 320 0 194.4 4212 6801096 CERV SPINE TRAUMA 320 0 119.75 4212 6801104 CERV SPINE W/OBL 320 0 179.26 4212 6801112 CERV SPINE LAT ONLY 320 0 131.66 4212 6801120 CERV SPINE OBL ONLY 320 0 108.88 4212 6801138 CERV SPINE TWO VIEW 320 0 108.88 4212 6801146 CERV SPINE W FLEX EX 320 0 179.26 4212 6801153 CHEST PA & LAT 320 0 144.07 4212 6801161 CHEST AP OR LATERAL ONLY 320 0 108.88 4212 6801179 CHEST DECUB ONLY 320 0 131.66 4212
6801187 CHEST INS & EXP LAT 320 0 131.66 4212 6801195 CHEST PA INS & EXP 320 0 131.66 4212 6801203 CHEST W APICAL VIEW 320 0 131.66 4212 6801211 CHEST W OBLIQUES 320 0 108.88 4212 6801229 CHEST P A T 320 0 144.07 4212 6801237 CHEST / DECUBITIS R & L 320 0 108.88 4212 6801245 CLAVICLE LEFT 320 0 117.99 4212 6801252 CLAVICLE RIGHT 320 0 117.99 4212 6801260 DORSAL SPINE 320 0 108.88 4212 6801278 DORSAL SPINE 2 VIEWS 320 0 108.88 4212 6801286 ELBOW W/OBLIQ LEFT 320 0 108.88 4212 6801294 ELBOW W/ OBLIQUE RIGHT 320 0 108.88 4212 6801302 ELBOW(2 VIEWS)LT 320 0 108.88 4212 6801310 ELBOW(2 VIEWS) RT 320 0 108.88 4212 6801328 ENTIRE SPINE SURVEY 320 0 219.26 4212 6801336 FACIAL BONES 320 0 108.88 4212 6801344 FACIAL BONES(LTD) 320 0 108.88 4212 6801351 FEMUR BILAT 320 0 202.56 4212 6801369 FEMUR LEFT 320 0 131.66 4212 6801377 SHOULDER NO TRAUMA BILAT 320 0 202.56 4212 6801385 SHOULDER TRAUMA BILAT 320 0 202.56 4212 6801393 SI JOINTS 2 VIEWS 320 0 114.32 4212 6801401 SINUSES 320 0 108.88 4212 6801419 SKELETAL SURVEY 320 0 210.83 4212 6801427 SKULL 320 0 210.83 4212 6801435 SKULL AP & LAT 320 0 108.88 4212 6801443 SOFT TISSUE NECK 320 0 131.66 4212 6801450 STERNOCLAVICULAR JTS 320 0 131.66 4212 6801468 STERNUM 320 0 108.88 4212 6801476 TMJ BILATERAL 320 0 202.56 4212 6801484 TMJ UNILATERAL 320 0 108.88 4212 6801492 TOE LEFT 320 0 108.88 4212 6801500 TOE RIGHT 320 0 108.88 4212 6801518 UPPER EXT LT 320 0 108.88 4212 6801526 UPPER EXT RT 320 0 108.88 4212 6801534 WRIST LEFT 320 0 108.88 4212 6801542 WRIST RIGHT 320 0 108.88 4212 6801559 WRIST LT (2 VIEWS) 320 0 108.88 4212 6801567 WRIST RT (2 VIEWS) 320 0 108.88 4212 6801575 WRIST BILATERAL 320 0 202.56 4212 6801583 FEMUR RIGHT 320 0 131.66 4212 6801591 FINGER 2 OR MORE LT 320 0 108.88 4212 6801609 FINGER 2 OR MORE RT 320 0 108.88 4212 6801617 FINGER SINGLE LEFT 320 0 108.88 4212 6801625 FINGER SINGLE RIGHT 320 0 108.88 4212 6801633 FOOT LEFT 320 0 108.88 4212 6801641 FOOT RIGHT 320 0 108.88 4212
- 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 and 112: 6502124 MRI-UP EX NO JT W-LT 610 0
- Page 113: 6702245 CT UP EXT W/ CON-RT 352 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
- Page 163 and 164: 8201709 PROSTETIC TRAIN PER 15 MIN
6801187 CHEST INS & EXP LAT 320 0 131.66 4212<br />
6801195 CHEST PA INS & EXP 320 0 131.66 4212<br />
6801203 CHEST W APICAL VIEW 320 0 131.66 4212<br />
6801211 CHEST W OBLIQUES 320 0 108.88 4212<br />
6801229 CHEST P A T 320 0 144.07 4212<br />
6801237 CHEST / DECUBITIS R & L 320 0 108.88 4212<br />
6801245 CLAVICLE LEFT 320 0 117.99 4212<br />
6801252 CLAVICLE RIGHT 320 0 117.99 4212<br />
6801260 DORSAL SPINE 320 0 108.88 4212<br />
6801278 DORSAL SPINE 2 VIEWS 320 0 108.88 4212<br />
6801286 ELBOW W/OBLIQ LEFT 320 0 108.88 4212<br />
6801294 ELBOW W/ OBLIQUE RIGHT 320 0 108.88 4212<br />
6801302 ELBOW(2 VIEWS)LT 320 0 108.88 4212<br />
6801310 ELBOW(2 VIEWS) RT 320 0 108.88 4212<br />
6801328 ENTIRE SPINE SURVEY 320 0 219.26 4212<br />
6801336 FACIAL BONES 320 0 108.88 4212<br />
6801344 FACIAL BONES(LTD) 320 0 108.88 4212<br />
6801351 FEMUR BILAT 320 0 202.56 4212<br />
6801369 FEMUR LEFT 320 0 131.66 4212<br />
6801377 SHOULDER NO TRAUMA BILAT 320 0 202.56 4212<br />
6801385 SHOULDER TRAUMA BILAT 320 0 202.56 4212<br />
6801393 SI JOINTS 2 VIEWS 320 0 114.32 4212<br />
6801401 SINUSES 320 0 108.88 4212<br />
6801419 SKELETAL SURVEY 320 0 210.83 4212<br />
6801427 SKULL 320 0 210.83 4212<br />
6801435 SKULL AP & LAT 320 0 108.88 4212<br />
6801443 SOFT TISSUE NECK 320 0 131.66 4212<br />
6801450 STERNOCLAVICULAR JTS 320 0 131.66 4212<br />
6801468 STERNUM 320 0 108.88 4212<br />
6801476 TMJ BILATERAL 320 0 202.56 4212<br />
6801484 TMJ UNILATERAL 320 0 108.88 4212<br />
6801492 TOE LEFT 320 0 108.88 4212<br />
6801500 TOE RIGHT 320 0 108.88 4212<br />
6801518 UPPER EXT LT 320 0 108.88 4212<br />
6801526 UPPER EXT RT 320 0 108.88 4212<br />
6801534 WRIST LEFT 320 0 108.88 4212<br />
6801542 WRIST RIGHT 320 0 108.88 4212<br />
6801559 WRIST LT (2 VIEWS) 320 0 108.88 4212<br />
6801567 WRIST RT (2 VIEWS) 320 0 108.88 4212<br />
6801575 WRIST BILATERAL 320 0 202.56 4212<br />
6801583 FEMUR RIGHT 320 0 131.66 4212<br />
6801591 FINGER 2 OR MORE LT 320 0 108.88 4212<br />
6801609 FINGER 2 OR MORE RT 320 0 108.88 4212<br />
6801617 FINGER SINGLE LEFT 320 0 108.88 4212<br />
6801625 FINGER SINGLE RIGHT 320 0 108.88 4212<br />
6801633 FOOT LEFT 320 0 108.88 4212<br />
6801641 FOOT RIGHT 320 0 108.88 4212
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