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
6902076 LS SPINE&OBL&FLEX&EX 6 VIEWS 320 0 177.09 4213 6902084 LS SPINE SHOOT THRU 2 VIEWS 320 0 108.88 4213 6902092 LUMBAR SP W FLEX EXT 320 0 177.09 4213 6902100 MAMMO DIAG DIGITAL 401 0 535.08 4213 6902118 MAMMO DIAG DIGITAL LT 401 0 237.32 4213 6902126 MAMMO DIAG DIGITAL RIGHT 401 0 364.62 4213 6902134 PDC MAMMO SCREEN DIGITAL 403 0 468.2 4213 6902142 MANDIBLE 320 0 468.2 4213 6902159 MANDIBLE(LIMITED) 320 0 131.66 4213 6902167 MASTOIDS 320 0 131.66 4213 6902175 MASTOIDS(LIMITED) 320 0 108.88 4213 6902183 METASTATIC SERIES 320 0 219.26 4213 6902191 NASAL BONES 320 0 131.66 4213 6902209 NAVICULAR VIEWS LT 320 0 108.88 4213 6902217 NAVICULAR VIEWS RT 320 0 108.88 4213 6902225 NOSE TO RECTUM/FB 320 0 131.66 4213 6902233 ORBITS 320 0 131.66 4213 6902241 ORBITS/FOREIGN BODY 320 0 131.66 4213 6902258 ORBITS WATER VIEW 320 0 108.88 4212 6902266 PELVIS 1 OR 2 VIEWS 320 0 108.88 4213 6902274 RIBS BILATERAL R&L 320 0 337.32 4213 6902282 RIBS ONE SIDE LEFT 320 0 166.73 4213 6902290 RIBS ONE SIDE RIGHT 320 0 166.73 4213 6902308 SACROCCYGEAL SPINE 320 0 114.32 4213 6902316 SACROILIAC JOINTS 320 0 131.66 4213 6902324 SCAPULA LEFT 320 0 131.66 4213 6902332 SCAPULA RIGHT 320 0 131.66 4213 6902340 SHLDR NO TRAUMA LT 320 0 108.88 4213 6902357 SHLDR NO TRAUMA RT 320 0 108.88 4213 6902365 SHLDR TRAUMA LEFT 320 0 108.88 4213 6902373 SHLDR TRAUMA RIGHT 320 0 108.88 4213 6902381 SHOULDER 1 VIEW LT 320 0 108.88 4213 6902399 SHOULDER 1 VIEW RT 320 0 108.88 4213 6902407 MAMMO DIAG EXTRA VIEWS LT(PLAINFLD) 401 0 364.62 4213 6902415 MAMMO DIAG EXTRA VIEWS RT(PLNFIELD) 401 0 364.62 4213 6902423 MAMMO DIAG EXTRA VIEWS BILAT PLNFLD 401 0 535.08 4213 6902431 MAMMO SCREEN DIGITAL RT PDC 403 0 284.82 4213 6902449 MAMMO SCREEN DIGITAL LT PDC 403 0 284.82 4213 6902456 PDC MAMMO SCREENING IMPLANTS 403 0 468.2 4213 7000011 MRI-ABDOMEN W/O CONT PLF 610 0 1430 4273 7000029 MRI-ABDOMEN W/CONT PLF 610 0 2299.83 4273 7000037 MRI-ABDOMEN W/WO CON PLF 610 0 4516.22 4273 7000045 MRI-C SPINE W/O CONT PLF 612 0 1373.37 4273 7000052 MRI-C SPINE W CONTRA PLF 612 0 1646.07 4273 7000060 MRI-C SPINE W/WO CON PLF 612 0 3051.54 4273 7000078 MRI-CHEST W/O CONTR PLF 610 0 1373.37 4273 7000086 MRI-CHEST W/CONTRAST PLF 610 0 1373.37 4273
7000094 MRI-CHEST W/WO CONTR PLF 610 0 1373.37 4273 7000102 MRI-FACE W/O CONTRAS PLF 611 0 1352.39 4273 7000110 MRI-FACE W/CONTRAST PLF 611 0 1622.64 4273 7000128 MRI-FACE W/WO CONTRAST PLF 611 0 3003.41 4273 7000136 MRI-HEAD W/O CONTRAST PLF 611 0 1373.37 4273 7000144 MRI-HEAD W/CONTRAST PLF 611 0 1646.07 4273 7000151 MRI-HEAD W/WO CONTRAST PLF 611 0 3051.54 4273 7000169 MRI-IAC'S W/WO CONTRAST PLF 611 0 3051.54 4273 7000177 MRI-IAC'S WO CONTRAST PLF 611 0 1373.37 4273 7000185 MRI-PIT/SELLA W/WO CONT PLF 611 0 3051.54 4273 7000193 MRI-HIP WO CONT LT PLF 610 0 1839.86 4273 7000201 MRI-HIP WO CONT RT PLF 610 0 1839.86 4273 7000219 MRI-HIP W&WO CON LT 610 0 3003.41 4273 7000227 MRI-HIP W&WO CON RT PLF 610 0 3003.41 4273 7000235 MRI-HIP W/CONT RT PLF 610 0 2299.83 4273 7000243 MRI-HIP-W/CONT LT PLF 610 0 2299.83 4273 7000250 MRI-LS SPINE W/O CON PLF 612 0 1523.91 4273 7000268 MRI-LS SPINE W/CONT PLF 612 0 1646.07 4273 7000276 MRI-LS SPINE W/WO CO PLF 612 0 3051.54 4273 7000284 MRI MRCP PLF 610 0 1430 4273 7000292 MRI-NECK W/O CONTRAST PLF 611 0 1352.39 4273 7000300 MRI-NECK W/CONTRAST PLF 611 0 3003.41 4273 7000318 MRI-NECK W W/O CONTRAST PLF 611 0 1622.64 4273 7000326 MRI-ORBITS W/O CONTRAST PLF 611 0 1352.39 4273 7000334 MRI-ORBITS W/ CONTRAST PLF 611 0 1622.64 4273 7000342 MRI-ORBITS W W/O CONT PLF 611 0 3003.41 4273 7000359 MRI-PELVIS W/O CONT PLF 610 0 1358.58 4273 7000367 MRI-PELVIS W/CONT PLF 610 0 1627.56 4273 7000375 MRI-PELVIS W W/O CONT PLF 610 0 1627.56 4273 7000383 MRI-D SPINE W/O CONT PLF 612 0 1523.91 4273 7000391 MRI-D SPINE W / CONT PLF 612 0 1523.91 4273 7000409 MRI-D SPINE W W/O CON PLF 612 0 3051.54 4273 7000417 MRI-TMJ BILAT PLF 610 0 1373.37 4273 7000425 MRI-TMJ UNILAT LT PLF 610 0 1373.37 4273 7000433 MRI-TMJ UNILAT RT PLF 610 0 1373.37 4273 7000441 MRI-SHLDR W/O CON LT PLF 610 0 1839.86 4273 7000458 MRI-SHLDR WO CON RT PLF 610 0 1839.86 4273 7000466 MRI-SHLDR W CON LT PLF 610 0 2299.83 4273 7000474 MRI-SHLDR W CON RT PLF 610 0 2299.83 4273 7000482 MRI-SHLDR W W/O CON LT PLF 610 0 3003.41 4273 7000490 MRI-SHLDR W W/O CONT RT PLF 610 0 3003.41 4273 7000524 MRI-KNEE WO CONT LT PLF 610 0 1839.86 4273 7000532 MRI-KNEE WO CON RT PLF 610 0 1839.86 4273 7000540 MRI-KNEE W CONT LT PLF 610 0 2299.83 4273 7000557 MRI-KNEE W CONT RT PLF 610 0 2299.83 4273 7000565 MRI-KNEE W W/O CONT PLF 610 0 3003.41 4273 7000573 MRI-KNEE W W/O CONT RT PLF 610 0 3003.41 4273
- 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 and 114: 6702245 CT UP EXT W/ CON-RT 352 0 1
- Page 115 and 116: 6801187 CHEST INS & EXP LAT 320 0 1
- Page 117 and 118: 6802128 MAMMO DIAG DIGITAL RIGHT 40
- Page 119: 6901607 FINGER 2 OR MORE RT 320 0 1
- 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
- Page 165 and 166: 8403214 WHFOWOJT L3808 274 0 509.69
- Page 167 and 168: 8701500 IONTOPHORESIS PER 15 MIN DL
- Page 169 and 170: 9003112 INITIAL PSYCH EVAL MD 900 0
7000094 MRI-CHEST W/WO CONTR PLF 610 0 1373.37 4273<br />
7000102 MRI-FACE W/O CONTRAS PLF 611 0 1352.39 4273<br />
7000110 MRI-FACE W/CONTRAST PLF 611 0 1622.64 4273<br />
7000128 MRI-FACE W/WO CONTRAST PLF 611 0 3003.41 4273<br />
7000136 MRI-HEAD W/O CONTRAST PLF 611 0 1373.37 4273<br />
7000144 MRI-HEAD W/CONTRAST PLF 611 0 1646.07 4273<br />
7000151 MRI-HEAD W/WO CONTRAST PLF 611 0 3051.54 4273<br />
7000169 MRI-IAC'S W/WO CONTRAST PLF 611 0 3051.54 4273<br />
7000177 MRI-IAC'S WO CONTRAST PLF 611 0 1373.37 4273<br />
7000185 MRI-PIT/SELLA W/WO CONT PLF 611 0 3051.54 4273<br />
7000193 MRI-HIP WO CONT LT PLF 610 0 1839.86 4273<br />
7000201 MRI-HIP WO CONT RT PLF 610 0 1839.86 4273<br />
7000219 MRI-HIP W&WO CON LT 610 0 3003.41 4273<br />
7000227 MRI-HIP W&WO CON RT PLF 610 0 3003.41 4273<br />
7000235 MRI-HIP W/CONT RT PLF 610 0 2299.83 4273<br />
7000243 MRI-HIP-W/CONT LT PLF 610 0 2299.83 4273<br />
7000250 MRI-LS SPINE W/O CON PLF 612 0 1523.91 4273<br />
7000268 MRI-LS SPINE W/CONT PLF 612 0 1646.07 4273<br />
7000276 MRI-LS SPINE W/WO CO PLF 612 0 3051.54 4273<br />
7000284 MRI MRCP PLF 610 0 1430 4273<br />
7000292 MRI-NECK W/O CONTRAST PLF 611 0 1352.39 4273<br />
7000300 MRI-NECK W/CONTRAST PLF 611 0 3003.41 4273<br />
7000318 MRI-NECK W W/O CONTRAST PLF 611 0 1622.64 4273<br />
7000326 MRI-ORBITS W/O CONTRAST PLF 611 0 1352.39 4273<br />
7000334 MRI-ORBITS W/ CONTRAST PLF 611 0 1622.64 4273<br />
7000342 MRI-ORBITS W W/O CONT PLF 611 0 3003.41 4273<br />
7000359 MRI-PELVIS W/O CONT PLF 610 0 1358.58 4273<br />
7000367 MRI-PELVIS W/CONT PLF 610 0 1627.56 4273<br />
7000375 MRI-PELVIS W W/O CONT PLF 610 0 1627.56 4273<br />
7000383 MRI-D SPINE W/O CONT PLF 612 0 1523.91 4273<br />
7000391 MRI-D SPINE W / CONT PLF 612 0 1523.91 4273<br />
7000409 MRI-D SPINE W W/O CON PLF 612 0 3051.54 4273<br />
7000417 MRI-TMJ BILAT PLF 610 0 1373.37 4273<br />
7000425 MRI-TMJ UNILAT LT PLF 610 0 1373.37 4273<br />
7000433 MRI-TMJ UNILAT RT PLF 610 0 1373.37 4273<br />
7000441 MRI-SHLDR W/O CON LT PLF 610 0 1839.86 4273<br />
7000458 MRI-SHLDR WO CON RT PLF 610 0 1839.86 4273<br />
7000466 MRI-SHLDR W CON LT PLF 610 0 2299.83 4273<br />
7000474 MRI-SHLDR W CON RT PLF 610 0 2299.83 4273<br />
7000482 MRI-SHLDR W W/O CON LT PLF 610 0 3003.41 4273<br />
7000490 MRI-SHLDR W W/O CONT RT PLF 610 0 3003.41 4273<br />
7000524 MRI-KNEE WO CONT LT PLF 610 0 1839.86 4273<br />
7000532 MRI-KNEE WO CON RT PLF 610 0 1839.86 4273<br />
7000540 MRI-KNEE W CONT LT PLF 610 0 2299.83 4273<br />
7000557 MRI-KNEE W CONT RT PLF 610 0 2299.83 4273<br />
7000565 MRI-KNEE W W/O CONT PLF 610 0 3003.41 4273<br />
7000573 MRI-KNEE W W/O CONT RT PLF 610 0 3003.41 4273
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