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
1402106 CMPLX SC EXTS EA ADD 456 0 159.43 3780 1402122 CMPLX FACE EXTS2.6-7 456 0 736.56 3780 1402155 CMPL NOS/LIPS1.1-2.5 456 0 838.51 3780 1402189 BURNS-SML W/O ANES 456 0 209.79 3780 1402197 BURNS-MED W/O ANES 456 0 174.82 3780 1402239 CHEM CAUT GRAN TISSU 456 0 293.59 3780 1402270 EXPL WOUND EXTREMITY 456 0 1841.03 3780 1402288 RMVL MUSC FC SMPL 456 0 848.42 3780 1402296 REM FB MUS/TEND COMP 456 0 2169.94 3780 1402312 ARTHROCENTESIS-SML 456 0 532.33 3780 1402320 ARTHROCENTESIS-INTM 456 0 286.64 3780 1402338 ARTHROCENTESIS-LRG 456 0 286.64 3780 1402361 TX NASAL FX W/O STAB 456 0 3689.86 3780 1402502 ELBOW DSL W/O ANES 456 0 165.7 3780 1402510 NURSEMAIDS SUB W/M 456 0 220.95 3780 1402528 FX RADIAL HEAD W/O M 456 0 341.95 3780 1402585 ULNAR SHFT FX W/MAN 456 0 708.51 3780 1402593 DISTAL RADIUS FX W/O 456 0 341.95 3780 1402601 DISTAL RADIUS FX W/M 456 0 3036.46 3780 1402668 DSTL RADIOULNAR W/M 456 0 341.95 3780 1402692 I&D ABSC FINGER SMPL 456 0 581.52 3780 1402700 I&D ABS FINGER CMPLX 456 0 2695.73 3780 1402718 REP EXT TEN HAND PRI 456 0 1914.46 3780 1402726 METACARPAL FX WO/MAN 456 0 341.95 3780 1402734 METACARPAL FX W/MAN 456 0 198.85 3780 1402775 IP JNT DISL W/M WO A 456 0 184.12 3780 1402783 PHALANGEAL FX W/O M 456 0 341.95 3780 1402791 PHALANGEAL FX W/MAN 456 0 184.12 3780 1402817 IP JOINT FX W/MAN 456 0 184.12 3780 1402825 PHALANX DISTAL FX WO 456 0 341.95 3780 1402833 DIST PHALANX FX W/M 456 0 184.12 3780 1402841 IP JT DIS W/M W/O A 456 0 305.72 3780 1402957 PATELLAR DSLOC W/O A 456 0 165.7 3780 1403039 TRIMALLEOLAR FX W/MA 456 0 708.51 3780 1403070 REMOVAL FB FOOT SUBC 456 0 1027.64 3780 1403146 FX TOE/PHANLANX W/MA 456 0 199.09 3780 1403161 FX PHALANX W/M 456 0 199.09 3780 1403179 MTP JNT DIS W/O ANES 456 0 341.95 3780 1403187 IP JNT DIS W/O ANES 456 0 184.12 3780 1403211 SPLINT LONG ARM 456 0 149.97 3780 1403229 SPLINT SHORT ARM 456 0 160.7 3780 1403237 SPLINT FINGER STATIC 456 0 149.97 3780 1403278 CAST SHORT LEG 456 0 520.2 3780 1403286 SPLINT LONG LEG 456 0 200.09 3780 1403294 SPLINT SHORT LEG 456 0 149.97 3780 1403328 RMVL FB NASAL 456 0 74.47 3780 1403336 EPISTX ANT SIMPLE 456 0 136.18 3780
1403344 EPISTX ANT CMPLX PKG 456 0 480.32 3780 1403351 EPISTX POST INITIAL 456 0 128.04 3780 1403492 PERICARDIOCEN INITIA 456 0 1090.64 3780 1403567 CHEILOPLASTY LIP 456 0 1061.61 3780 1403575 CHEILOPLASTY < V.HGT 456 0 781.32 3780 1403591 LAC VESTIBULE 2.5 CM 456 0 707.76 3780 1403617 LAC MOU/TONG < 2.5 456 0 115.24 3780 1403625 DRAIN ABSCESS CYST 456 0 227.1 3780 1403641 I&D PERITONSLR ABSC 456 0 342.99 3780 1403674 UNLTED PROC;NASO-PHA 456 0 222.13 3780 1403708 L&D LSCHIO/PERI ABSC 456 0 4962.78 3780 1403724 INC THRMBSCL HEM/EXT 456 0 513.94 3780 1403740 ANOSCOPY BY BRUSH/WA 456 0 138.31 3780 1403799 CATH URETHRA SMPL 456 0 125.74 3780 1403807 INSER TEMP FOLEYCATH 456 0 361.94 3780 1403831 I&D BARTHOLIN GLD/AB 456 0 351.42 3780 1403906 INJ ANES TRIGEMINAL 456 0 286.64 3780 1403922 INJ ANES PERIPHERAL 456 0 781.18 3780 1403930 RML FB EXT EYE/CONJL 456 0 107.61 3780 1403948 RML EMBED CONJCTL FB 456 0 199.86 3780 1403955 RML FB CORN W/O SLIT 456 0 96.86 3780 1403963 RML FB CORN W/SLIT 456 0 107.61 3780 1403989 RML FB EYELID 456 0 452.43 3780 1403997 DRAIN X EAR ABS/HEMA 456 0 162.82 3780 1404003 DRAIN X AUD CANAL AB 456 0 302.39 3780 1404011 RML FB EXT AUD W/O A 456 0 74.47 3780 1404029 RML IMPLD CERUMEN 456 0 121.04 3780 1404037 VACCINE INJECTION 940 0 77.55 3780 1404045 VACCINE INJ EA ADD'L 940 0 72.38 3780 1404052 IV TX HYDRAT 31-60 MIN 260 0 252.47 3780 1404060 IV TX HYDRA ADD'L HR 260 0 82.2 3780 1404078 IV THERAPY 1ST HOUR 260 0 415.28 3780 1404086 IV THERAPY ADD'L HR 260 0 80.14 3780 1404094 IV TX ADD'L SQ < 1 HR 260 0 112.56 3780 1404110 INJ PROPHYLACTIC DX 940 0 81.77 3780 1404128 IM ANTIBIOTIC 940 0 81.77 3780 1404136 IV INJECT INITIAL 940 0 123.27 3780 1404144 IVP EA ADD'L SEQ 940 0 82.2 3780 1404185 TEMP TRANSCUT PACING 456 0 491.7 3780 1404268 DRAIN ABCESS, PALATE, UVULA 456 0 707.76 3780 1404276 IVP SEQ SAME DRUG >30 MIN 940 0 121.32 3780 1404292 I&D UPPER ARM; BURSA 456 0 4149.4 3780 1404318 REPAIR FLEX TENDON PRIM W/O GRAFT 456 0 5992.59 3780 1404326 I&D INTRAORAL, SUBLINGUAL ABSCESS 456 0 707.76 3780 1404334 SHAVING SKIN LESION 1 (< .05CM) 456 0 124.16 3780 1404342 AVUL NAIL PLATE, SIMPLE, EA ADD'L 456 0 89.13 3780 1404359 OPEN TXT DISTAL PHALANGEAL FX FNGR 456 0 5445.73 3780
- Page 1 and 2: CHRG# CDSC CDEPT CSRV CUPR CREV# 30
- Page 3 and 4: 411124 ITEL IV TX HYDRA ADD'L HOUR
- Page 5 and 6: 590034 ACU VISIT 999 0 0 3720 59004
- Page 7 and 8: 800730 EX MAL LES FACE EAR EYE NOSE
- Page 9 and 10: 1000629 IV TX HYDRA ADD'L HR 260 0
- Page 11 and 12: 1302629 RADIAL SHFT FX W/MAN 450 0
- Page 13 and 14: 1304088 RML FB EXT EYE/CONJL 450 0
- Page 15: 1400050 PC FACILITY FEE-MIN 456 0 1
- Page 19 and 20: 2201713 MIDLINE CATHETER 278 0 130
- Page 21 and 22: 2510360 ASNIS 6.5 THD G/WIRE 270 0
- Page 23 and 24: 2530244 GYN VAG PACKING* 270 0 0 38
- Page 25 and 26: 2550226 ORT CRV-TC CART MED 270 0 7
- Page 27 and 28: 2552461 TIER 1 INSERTS 278 0 6250 3
- Page 29 and 30: 2555191 BALLOON SINUPLASTY 270 0 23
- Page 31 and 32: 2571529 SYN SM PL LCDCP 05 H 278 0
- Page 33 and 34: 2581445 URO STONE BSKT SEG 4 270 0
- Page 35 and 36: 2902096 BONE MARROW BIOPSY 761 0 63
- Page 37 and 38: 3091105 ARANESP 200MG 1.4ML 636 0 0
- Page 39 and 40: 3300712 GLUCOSE STRIP SUBSEQ 300 0
- Page 41 and 42: 4100046 DIGOXIN 300 0 50.41 4010 41
- Page 43 and 44: 4101077 OSMOLALITY SERUM 300 0 29.2
- Page 45 and 46: 4102026 TIME & VOLUME URINE 300 0 1
- Page 47 and 48: 4300216 TISSUE HOMOGENOUS 300 0 35.
- Page 49 and 50: 4400123 ANTI TITER-ALBUMIN 300 0 24
- Page 51 and 52: 4600094 TESTOSTERONE T & F 300 0 28
- Page 53 and 54: 4601035 FLUPHENAZINE 300 0 145.02 4
- Page 55 and 56: 4601985 RETROVIRAL SEROLOGY 300 0 4
- Page 57 and 58: 4602967 HTLV I/II AB 300 0 100.75 4
- Page 59 and 60: 4604096 ORG ID AEROBIC UMASS 300 0
- 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
1402106 CMPLX SC EXTS EA ADD 456 0 159.43 3780<br />
1402122 CMPLX FACE EXTS2.6-7 456 0 736.56 3780<br />
1402155 CMPL NOS/LIPS1.1-2.5 456 0 838.51 3780<br />
1402189 BURNS-SML W/O ANES 456 0 209.79 3780<br />
1402197 BURNS-MED W/O ANES 456 0 174.82 3780<br />
1402239 CHEM CAUT GRAN TISSU 456 0 293.59 3780<br />
1402270 EXPL WOUND EXTREMITY 456 0 1841.03 3780<br />
1402288 RMVL MUSC FC SMPL 456 0 848.42 3780<br />
1402296 REM FB MUS/TEND COMP 456 0 2169.94 3780<br />
1402312 ARTHROCENTESIS-SML 456 0 532.33 3780<br />
1402320 ARTHROCENTESIS-INTM 456 0 286.64 3780<br />
1402338 ARTHROCENTESIS-LRG 456 0 286.64 3780<br />
1402361 TX NASAL FX W/O STAB 456 0 3689.86 3780<br />
1402502 ELBOW DSL W/O ANES 456 0 165.7 3780<br />
1402510 NURSEMAIDS SUB W/M 456 0 220.95 3780<br />
1402528 FX RADIAL HEAD W/O M 456 0 341.95 3780<br />
1402585 ULNAR SHFT FX W/MAN 456 0 708.51 3780<br />
1402593 DISTAL RADIUS FX W/O 456 0 341.95 3780<br />
1402601 DISTAL RADIUS FX W/M 456 0 3036.46 3780<br />
1402668 DSTL RADIOULNAR W/M 456 0 341.95 3780<br />
1402692 I&D ABSC FINGER SMPL 456 0 581.52 3780<br />
1402700 I&D ABS FINGER CMPLX 456 0 2695.73 3780<br />
1402718 REP EXT TEN HAND PRI 456 0 1914.46 3780<br />
1402726 METACARPAL FX WO/MAN 456 0 341.95 3780<br />
1402734 METACARPAL FX W/MAN 456 0 198.85 3780<br />
1402775 IP JNT DISL W/M WO A 456 0 184.12 3780<br />
1402783 PHALANGEAL FX W/O M 456 0 341.95 3780<br />
1402791 PHALANGEAL FX W/MAN 456 0 184.12 3780<br />
1402817 IP JOINT FX W/MAN 456 0 184.12 3780<br />
1402825 PHALANX DISTAL FX WO 456 0 341.95 3780<br />
1402833 DIST PHALANX FX W/M 456 0 184.12 3780<br />
1402841 IP JT DIS W/M W/O A 456 0 305.72 3780<br />
1402957 PATELLAR DSLOC W/O A 456 0 165.7 3780<br />
1403039 TRIMALLEOLAR FX W/MA 456 0 708.51 3780<br />
1403070 REMOVAL FB FOOT SUBC 456 0 1027.64 3780<br />
1403146 FX TOE/PHANLANX W/MA 456 0 199.09 3780<br />
1403161 FX PHALANX W/M 456 0 199.09 3780<br />
1403179 MTP JNT DIS W/O ANES 456 0 341.95 3780<br />
1403187 IP JNT DIS W/O ANES 456 0 184.12 3780<br />
1403211 SPLINT LONG ARM 456 0 149.97 3780<br />
1403229 SPLINT SHORT ARM 456 0 160.7 3780<br />
1403237 SPLINT FINGER STATIC 456 0 149.97 3780<br />
1403278 CAST SHORT LEG 456 0 520.2 3780<br />
1403286 SPLINT LONG LEG 456 0 200.09 3780<br />
1403294 SPLINT SHORT LEG 456 0 149.97 3780<br />
1403328 RMVL FB NASAL 456 0 74.47 3780<br />
1403336 EPISTX ANT SIMPLE 456 0 136.18 3780