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
7000581 MRI-WRIST WO CON LT PLF 610 0 1839.86 4273 7000599 MRI-WRIST WO CON RT PLF 610 0 1839.86 4273 7000607 MRI-WRIST W CON LT PLF 610 0 2299.83 4273 7000615 MRI-WRIST W CON RT PLF 610 0 2299.83 4273 7000623 MRI-WRIST W/WO CO LT PLF 610 0 3003.41 4273 7000631 MRI-WRIST W/WO CO RT PLF 610 0 3003.41 4273 7000649 MRI-ELBOW W0 CON LT PLF 610 0 1839.86 4273 7000656 MRI-ELBOW WO CON RT PLF 610 0 1839.86 4273 7000664 MRI-ELBOW W CON LT PLF 610 0 2299.83 4273 7000672 MRI-ELBOW W CON RT PLF 610 0 2299.83 4273 7000680 MRI-ELBOW W/WO CO LT PLF 610 0 3003.41 4273 7000698 MRI-ELBOW W/WO CO RT PLF 610 0 3003.41 4273 7000706 MRI-UPEX NO JT WO LT PLF 610 0 1352.39 4273 7000714 MRI-UPEX NO JT WO RT PLF 610 0 1352.39 4273 7000722 MRI-UP EX NO JT W-LT PLF 610 0 1622.64 4273 7000730 MRI-UP EX NO JT W-RT PLF 610 0 1622.64 4273 7000748 MRI-UPEX NOJT W/WO LT PLF 610 0 3003.41 4273 7000755 MRI-UPEX NOJT W/WO RT PLF 610 0 3003.41 4273 7000763 MRI-BREASTS W/WO CON PLF 610 0 4018.46 4273 7000771 MRI-BRST UNI W/WO LT PLF 610 0 3187.11 4273 7000789 MRI-BRST-UNI W/WO RT PLF 610 0 3187.11 4273 7000797 MRI-MAMMO-CAD 610 0 59.8 4273 7000805 MRI BREASTS W/O CON PLF 610 0 3226.24 4273 7000813 MRI PIT/SELLA W/O CONTRAST PLF 610 0 1373.37 4273 7000854 MRI-LOEX NO JT WO-LT PLF 610 0 1839.86 4273 7000862 MRI-LOEX NO JT WO-RT PLF 610 0 1839.86 4273 7000870 MRI-LO EX NO JT W-LT PLF 610 0 1622.64 4273 7000888 MRI-LO EX NO JT-W-RT PLF 610 0 1622.64 4273 7000896 MRI-UPEX NOJT W/WO-LT PLF 610 0 3003.41 4273 7000904 MRI-UPEX NOJT W/WO-RT PLF 610 0 3003.41 4273 7000912 MRI-ANKLE WO CON-LT PLF 610 0 1839.86 4273 7000920 MRI-ANKLE WO CON-RT PLF 610 0 1839.86 4273 7000938 MRI-ANKLE W CONT-LT PLF 610 0 2299.83 4273 7000946 MRI-ANKLE W CONT-RT PLF 610 0 2299.83 4273 7000953 MRI-ANKLE W/WO CO-LT PLF 610 0 3003.41 4273 7000961 MRI-ANKLE W/WO CO-RT PLF 610 0 3003.41 4273 7000979 MRI-UPEXT JOINT W/CON LT PLF 610 0 2299.83 4273 7000987 MRI-UPEXT JNT W/CON RT PLF 610 0 2299.83 4273 7000995 MRI-UPEXT JOINT W/O CON LT PLF 610 0 1839.86 4273 7001001 MRI-UPEXT JOINT W/O CON RT PLF 610 0 1839.86 4273 7001019 MRI-UPEXT W/WO CON LT PLF 610 0 3003.41 4273 7001027 MRI-UPEXT W/WO CON RT PLF 610 0 3003.41 4273 7001035 MRI-LOEX NO JT WO LT PLF 610 0 1839.86 4273 7001043 MRI-LOEX NO JT WO RT-PLF 610 0 1839.86 4273 7001050 MRI-LOEX NO JT W LT-PLF 610 0 2299.83 4273 7001068 MRI-LOEX NO JT W RT-PLF 610 0 2299.83 4273 7001076 MRI-LOEX NO JT W/WO LT-PLF 610 0 3003.41 4273
7001084 MRI-LOEX NO JT W/WO RT-PLF 610 0 3003.41 4273 7002009 MRA-LO EX W/WO CO-LT PLF 616 0 2060.06 4273 7002017 MRA-LO EX W/WO CO-RT PLF 616 0 2060.06 4273 7002025 MRA-LOWER EXT W/WO BILAT PLF 616 0 3190.4 4273 7002033 MRA-UP EX W/WO CO-LT PLF 618 0 775.62 4273 7002041 MRA-UP EX W/WO CO-RT PLF 618 0 775.62 4273 7002058 MRA-CHEST W/WO CONTR PLF 618 0 1897.94 4273 7002066 MRA-HEAD W/O CONTR PLF 615 0 1373.37 4273 7002074 MRA-HEAD W/CONTRAST PLF 615 0 1373.37 4273 7002082 MRA-HEAD W/WO CONTR PLF 615 0 2687.53 4273 7002090 MRA-NECK W/O CONTR PLF 615 0 1373.37 4273 7002108 MRA-NECK W/WO CONTR PLF 615 0 2687.53 4273 7002116 MRA-AB W/WO CONTRAST PLF 618 0 2536.31 4273 7002124 MRA-PELVIS W/WO CONT PLF 610 0 1373.37 4273 7500010 VIT A & D OINTMENT 250 0 0 4300 7500028 ZYPREXA 5MG ODT TAB LN 250 0 0 4300 7500036 ACEBUTOLOL HCL 200 M CAP 250 0 0 4300 7500044 ACETAZOLAMIDE SODIUM 500 MG VIAL 636 0 0 4300 7500051 ACETAZOLAMIDE 250 MG TAB 250 0 0 4300 7500069 GLUCOPHAGE 500MG.XR SR TAB 250 0 0 4300 7500077 PROTONIX 40MG I.V. VIAL 250 0 0 4300 7500085 OXAZEPAM 10MG. CAP 250 0 0 4300 7500093 ACETAMINOPHEN 160 MG SUSP 250 0 0 4300 7500101 DUONEB 3ML U.D. SOLN 250 0 0 4300 7500119 POLYCITRA PACKETS 250 0 0 4300 7500127 ACETIC ACID 1000CC IRRIG 250 0 0 4300 7500135 BETHANECHOL CHLORIDE 10 MG TAB 250 0 0 4300 7500143 ACETAMINOPHEN 325 MG SUPP 250 0 0 4300 7500150 ACETAMINOPHEN 120 MG SUPP 250 0 0 4300 7500168 ACETAMINOPHEN 650 MG SUPP 250 0 0 4300 7500176 ACETAMINOPHEN 500 MG TAB 250 0 0 4300 7500184 ACETAMINOPHEN 325 MG TAB 250 0 0 4300 7500192 ACETYLCYSTEINE 200 M 20% 6GM VIAL 250 0 0 4300 7500200 ACETONE LIQUID 250 0 0 4300 7500218 ACETYLCHOLINE CHLORI 30 MG/30ML KIT 250 0 0 4300 7500226 SODIUM PHOSPHATE VIAL 250 0 0 4300 7500234 PECTIN/ACIDOPHILUS CAP 250 0 0 4300 7500242 ACYCLOVIR 200 MG CAP 250 0 0 4300 7500259 ACYCLOVIR 0 OINTMENT 250 0 0 4300 7500267 ACYCLOVIR SODIUM 500 VIAL 636 0 0 4300 7500275 ALBUTEROL SULFATE 4 T SR 12 250 0 0 4300 7500283 ALBUTEROL SULFATE 2 TAB 250 0 0 4300 7500291 ALBUTEROL SULFATE 2 SYRUP 250 0 0 4300 7500309 ALBUTEROL SO4 U.D. SOLN 636 0 0 4300 7500317 ALBUTEROL 90 MCG AER 250 0 0 4300 7500325 ADENOSINE 6 MG/2ML VL 636 0 0 4300 7500333 ISOPROPYL ALCOHOL 0 SOLN 250 0 0 4300
- 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 and 120: 6901607 FINGER 2 OR MORE RT 320 0 1
- Page 121: 7000094 MRI-CHEST W/WO CONTR PLF 61
- 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
- Page 171 and 172: 9300518 SWALLOW GOAL STATUS 440 0 0
7001084 MRI-LOEX NO JT W/WO RT-PLF 610 0 3003.41 4273<br />
7002009 MRA-LO EX W/WO CO-LT PLF 616 0 2060.06 4273<br />
7002017 MRA-LO EX W/WO CO-RT PLF 616 0 2060.06 4273<br />
7002025 MRA-LOWER EXT W/WO BILAT PLF 616 0 3190.4 4273<br />
7002033 MRA-UP EX W/WO CO-LT PLF 618 0 775.62 4273<br />
7002041 MRA-UP EX W/WO CO-RT PLF 618 0 775.62 4273<br />
7002058 MRA-CHEST W/WO CONTR PLF 618 0 1897.94 4273<br />
7002066 MRA-HEAD W/O CONTR PLF 615 0 1373.37 4273<br />
7002074 MRA-HEAD W/CONTRAST PLF 615 0 1373.37 4273<br />
7002082 MRA-HEAD W/WO CONTR PLF 615 0 2687.53 4273<br />
7002090 MRA-NECK W/O CONTR PLF 615 0 1373.37 4273<br />
7002108 MRA-NECK W/WO CONTR PLF 615 0 2687.53 4273<br />
7002116 MRA-AB W/WO CONTRAST PLF 618 0 2536.31 4273<br />
7002124 MRA-PELVIS W/WO CONT PLF 610 0 1373.37 4273<br />
7500010 VIT A & D OINTMENT 250 0 0 4300<br />
7500028 ZYPREXA 5MG ODT TAB LN 250 0 0 4300<br />
7500036 ACEBUTOLOL HCL 200 M CAP 250 0 0 4300<br />
7500044 ACETAZOLAMIDE SODIUM 500 MG VIAL 636 0 0 4300<br />
7500051 ACETAZOLAMIDE 250 MG TAB 250 0 0 4300<br />
7500069 GLUCOPHAGE 500MG.XR SR TAB 250 0 0 4300<br />
7500077 PROTONIX 40MG I.V. VIAL 250 0 0 4300<br />
7500085 OXAZEPAM 10MG. CAP 250 0 0 4300<br />
7500093 ACETAMINOPHEN 160 MG SUSP 250 0 0 4300<br />
7500101 DUONEB 3ML U.D. SOLN 250 0 0 4300<br />
7500119 POLYCITRA PACKETS 250 0 0 4300<br />
7500127 ACETIC ACID 1000CC IRRIG 250 0 0 4300<br />
7500135 BETHANECHOL CHLORIDE 10 MG TAB 250 0 0 4300<br />
7500143 ACETAMINOPHEN 325 MG SUPP 250 0 0 4300<br />
7500150 ACETAMINOPHEN 120 MG SUPP 250 0 0 4300<br />
7500168 ACETAMINOPHEN 650 MG SUPP 250 0 0 4300<br />
7500176 ACETAMINOPHEN 500 MG TAB 250 0 0 4300<br />
7500184 ACETAMINOPHEN 325 MG TAB 250 0 0 4300<br />
7500192 ACETYLCYSTEINE 200 M 20% 6GM VIAL 250 0 0 4300<br />
7500200 ACETONE LIQUID 250 0 0 4300<br />
7500218 ACETYLCHOLINE CHLORI 30 MG/30ML KIT 250 0 0 4300<br />
7500226 SODIUM PHOSPHATE VIAL 250 0 0 4300<br />
7500234 PE<strong>CT</strong>IN/ACIDOPHILUS CAP 250 0 0 4300<br />
7500242 ACYCLOVIR 200 MG CAP 250 0 0 4300<br />
7500259 ACYCLOVIR 0 OINTMENT 250 0 0 4300<br />
7500267 ACYCLOVIR SODIUM 500 VIAL 636 0 0 4300<br />
7500275 ALBUTEROL SULFATE 4 T SR 12 250 0 0 4300<br />
7500283 ALBUTEROL SULFATE 2 TAB 250 0 0 4300<br />
7500291 ALBUTEROL SULFATE 2 SYRUP 250 0 0 4300<br />
7500309 ALBUTEROL SO4 U.D. SOLN 636 0 0 4300<br />
7500317 ALBUTEROL 90 MCG AER 250 0 0 4300<br />
7500325 ADENOSINE 6 MG/2ML VL 636 0 0 4300<br />
7500333 ISOPROPYL ALCOHOL 0 SOLN 250 0 0 4300
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