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
7890031 SP-CANCEL VISIT DLS 999 0 0 4372 7890049 SP-ABSENT DLS 999 0 0 4372 7900053 PLFD SPEECH & LANGUAGE EVAL (PROC) 444 0 430.14 4373 7900103 SPEECH & LANGUAGE TX (PROC) PLF 440 0 304 4373 7900152 SWALLOW EVAL (PROC) PLF 444 0 415.88 4373 7900202 SWALLOW TX (PROC) PLF 440 0 284.8 4373 7900251 AAC EVAL NON SPEECH (PROC) PLF 444 0 447.5 4373 7900350 AAC EVAL SPEECH 1ST HR PLF 444 0 458 4373 7900400 AAC 30 ADD'L MINUTES PLF 440 0 197 4373 7900509 AAC THER SERVICE (PROC) PLF 440 0 300.55 4373 7900517 DVLPMT , COGITIVE SKILLS PER 15 PLF 440 0 57.52 4373 7900673 EVAL, AAC NON SPEECH EA ADD'L 30 MN 444 0 141.87 4373 7990005 SP-STROKE SCREEN PLF 999 0 0 4373 7990013 SP-OUTPAT VISIT PLF 999 0 0 4373 7990021 SP-CANCEL VISIT PLF 999 0 0 4373 7990039 SP-CANCEL-DISCH PLF 999 0 0 4373 7990047 SP-ABSENT PLF 999 0 0 4373 8000051 SPINAL ANESTHESIA 1ST 1/2 HR 370 0 127.47 4350 8000069 SPINAL ANES EA ADD'L 15 MIN 370 0 15.39 4350 8000101 MONITORED ANESTHESIA 1ST 1/2 HR 370 0 191.19 4350 8000119 MONITORED ANESTHESIA EA ADD'L 15MIN 370 0 26.08 4350 8000200 OB EPIDURAL ANES 370 0 718.72 4350 8000218 OB SPINAL ANESTHESIA EA ADD'L 15MIN 370 0 15.39 4350 8000226 OB SPINAL ANESTHESIA 1ST 1/2 HR 370 0 112.82 4350 8000259 GENERAL ANESTHESIA 1ST 1/2 HR 370 0 382.39 4350 8000267 GENERAL ANESTHESIA EA ADD'L 15 MIN 370 0 52.15 4350 8000358 IV REGIONAL BLOCK 1ST 1/2 HR 370 0 63.73 4350 8000366 IV REGIONAL BLOCK EA ADD'L 15 MIN 370 0 8.69 4350 8000408 OR EPIDURAL ANES 1ST 1/2 HR 370 0 254.93 4350 8000416 OR EPIDURAL ANES EA ADD'L 15 MIN 370 0 34.77 4350 8000424 PRE OP PAIN BLOCK 710 0 725.69 4350 8200057 EVALUATION (PROC) DLS 424 0 172.6 4372 8200107 RE-EVALUATION (PROC) DLS 424 0 91.86 4372 8201006 GAIT TRAINING PER 15 MIN DLS 420 0 58.47 4372 8201055 THERAPEUTIC EX PER 15 MIN DLS 420 0 67.74 4372 8201105 ULTRASOUND PER 15 MIN DLS 420 0 28.14 4372 8201204 PARAFIN (PROC) DLS 420 0 17.62 4372 8201303 E-STIM, MANUAL ATTEND/15 MIN DLS 420 0 43.62 4372 8201352 ESTIM INTER UNATTENDED (PROC) DLS 420 0 116 4372 8201402 TENS (PROC) DLS 420 0 32.14 4372 8201451 ADL PER 15 MIN DLS 420 0 76.09 4372 8201469 THERAPEUTIC PROCEDURE GROUP DLS 420 0 45.48 4372 8201477 CHCKOT ORTH PROS PER 15 MIN DLS 420 0 109.27 4372 8201501 IONTOPHORESIS PER 15 MIN DLS 420 0 43.62 4372 8201550 MECHANICAL TRACTION (PROC) DLS 420 0 34.33 4372 8201600 NEURO MUSC RE-ED PER 15 MIN DLS 420 0 70.51 4372 8201659 MANUAL THER TECHN PER 15 MIN DLS 420 0 63.1 4372
8201709 PROSTETIC TRAIN PER 15 MIN DLS 420 0 114.5 4372 8201758 THERAPEUTIC ACTIVITY PER 15MIN DLS 420 0 84.43 4372 8202251 KNEE STRAPPING (PROC)DLS 420 0 133.91 4372 8202301 ANKLE/FOOT STRAPPING (PROC) DLS 420 0 121.74 4372 8202459 HIP STRAPPING (PROC) DLS 420 0 180.95 4372 8202657 CONTRAST BATHS PER 15 MIN DLS 420 0 33.4 4372 8202855 WHEELCHAIR MGMT PER 15 MIN DLS 420 0 63.1 4372 8203499 DLSN FOWOJT L3933 274 0 257.42 4372 8203523 THERAPEUTIC PROCEDURE, GROUP 420 0 45.48 4372 8203531 CHECKOUT, ORTH/PROS USE, PER 15 MIN 420 0 109.27 4372 8205007 DLSN PT VASOPNEUMATIC DEVICE 420 0 30.61 4372 8280257 DLSN ELECTRODES 270 0 14.4 4372 8280307 DLSN PUTTY 270 0 5.15 4372 8280356 DLSN TENS UNIT 270 0 51.5 4372 8280406 DLSN THERABAND 270 0 5.15 4372 8280455 DLSN GAUZE 2X2 270 0 6.2 4372 8280505 DLSN GAUZE 4X4 270 0 7.2 4372 8280554 DLSN KERLIX ROLLS 270 0 22.65 4372 8280604 DLSN KERLIX SPONGE 270 0 3.1 4372 8280653 DLSN TELFA 8X3 270 0 18.55 4372 8280703 DLSN PADS ABD 10X8 270 0 8.25 4372 8290009 DLSN-STROKE SCREEN 999 0 0 4372 8290017 DLSN-OUTPATIENT VISIT 999 0 0 4372 8290025 DLSN-OP NO CHARGE 999 0 0 4372 8290033 DLSN-ABSENT 999 0 0 4372 8290041 DLSN/CANCELLED VISIT 999 0 0 4372 8290058 DLSN/CANCELLED-DSCHG 999 0 0 4372 8300055 EVALUATION (PROC) PLF 424 0 172.6 4373 8300105 PLFD RE-EVALUATION (PROC) 424 0 91.86 4373 8301004 GAIT TRAINING PER 15 MIN PLF 420 0 58.47 4373 8301053 THERAPEUTIC EXERCISE PER 15MIN PLF 420 0 67.74 4373 8301103 ULTRASOUND PER 15 MIN PLF 420 0 28.14 4373 8301152 WHIRLPOOL (PROC) PLF 420 0 40.81 4373 8301202 PARAFIN (PROC) PLF 420 0 17.62 4373 8301301 ELECTRICAL STIM(ATTENDED)15MIN PLF 420 0 43.62 4373 8301350 ELECTRICAL STIM(UNATTENDED)) PLF 420 0 116 4373 8301400 TENS APPLICATION PLF 420 0 32.14 4373 8301459 SELF CARE HOME MGMT(ADL) PER 15 MIN 420 0 76.09 4373 8301509 IONTOPHORESIS PER 15 MIN DLS 420 0 37.12 4373 8301558 MECHANICAL TRACTION (PROC) DLS 420 0 34.33 4373 8301608 NEURO MUSC RE-EDUC PER 15 MIN PLF 420 0 70.51 4373 8301657 MANUAL THERAPY PER 15 MIN PLF 420 0 63.1 4373 8301707 PROSTHETIC TRAINING PER 15 MIN PLF 420 0 114.5 4373 8301756 THERAPEUTIC ACTIVITY PER 15MIN PLF 420 0 84.43 4373 8301806 PHYS PERFTEST(FTE) PER 15 MIN PLF 420 0 65.88 4373 8302309 ANKLE/FOOT STRAPPING (PROC) PLF 420 0 121.74 4373 8302812 THERAPEUTIC PROCEDURE GROUP PLF 420 0 45.48 4373
- 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 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: 7690001 RED CAP LUER LOCK MED SUPPL
- 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
- Page 173 and 174: 9301441 LANG EXPRESS GOAL STATUS 44
- Page 175 and 176: 9302381 MOBILITY GOAL STATUS 420 0
- Page 177 and 178: 9303330 OTHER PT/OT D/C STATUS 420
- Page 179 and 180: 9304296 SUB PT/OT GOAL STATUS 430 0
- Page 181 and 182: 9702796 MIC MEDICAID INTGRTY ALLOWA
- Page 183 and 184: 9704602 UNITED HLTHCR/UNITED HLTHCR
- Page 185 and 186: 9707886 TR PAUL ALLOWANCE 0 0 5210
- Page 187 and 188: 9805813 H/L SAGA B/D I/P ALLOWANCE
- Page 189 and 190: 9822297 STATE INCOME TAXES WITHHELD
- Page 191 and 192: 9826116 RENTAL INCOME LLC - VAN LEA
- Page 193 and 194: 9827627 HC HOSPICE MED SUPLS MED/SU
- Page 195 and 196: 9829565 MATERIAL MGMT-NON-MED SUP S
- Page 197 and 198: 9915646 SUPP TRICARE PAYMENT 0 0 10
- Page 199 and 200: 9940453 CT CARPENTERS HEALTH FUND P
- Page 201 and 202: 9945072 PSYCH DKH CIGNA BEHAV PAYME
- Page 203 and 204: 501205 LARYNGOSCOPY 361 0 0 3720 50
- Page 205 and 206: 1301993 LY NECK EXTS 20.1-30 450 0
- Page 207 and 208: 1304385 EXCIS OF X THORB HEM 450 0
- Page 209 and 210: 1402759 THUMB FX W/MAN 456 0 0 3780
- Page 211 and 212: 1800150 JAMSHIDI NEEDLE 270 0 0 375
8201709 PROSTETIC TRAIN PER 15 MIN DLS 420 0 114.5 4372<br />
8201758 THERAPEUTIC A<strong>CT</strong>IVITY PER 15MIN DLS 420 0 84.43 4372<br />
8202251 KNEE STRAPPING (PROC)DLS 420 0 133.91 4372<br />
8202301 ANKLE/FOOT STRAPPING (PROC) DLS 420 0 121.74 4372<br />
8202459 HIP STRAPPING (PROC) DLS 420 0 180.95 4372<br />
8202657 CONTRAST BATHS PER 15 MIN DLS 420 0 33.4 4372<br />
8202855 WHEELCHAIR MGMT PER 15 MIN DLS 420 0 63.1 4372<br />
8203499 DLSN FOWOJT L3933 274 0 257.42 4372<br />
8203523 THERAPEUTIC PROCEDURE, GROUP 420 0 45.48 4372<br />
8203531 CHECKOUT, ORTH/PROS USE, PER 15 MIN 420 0 109.27 4372<br />
8205007 DLSN PT VASOPNEUMATIC DEVICE 420 0 30.61 4372<br />
8280257 DLSN ELE<strong>CT</strong>RODES 270 0 14.4 4372<br />
8280307 DLSN PUTTY 270 0 5.15 4372<br />
8280356 DLSN TENS UNIT 270 0 51.5 4372<br />
8280406 DLSN THERABAND 270 0 5.15 4372<br />
8280455 DLSN GAUZE 2X2 270 0 6.2 4372<br />
8280505 DLSN GAUZE 4X4 270 0 7.2 4372<br />
8280554 DLSN KERLIX ROLLS 270 0 22.65 4372<br />
8280604 DLSN KERLIX SPONGE 270 0 3.1 4372<br />
8280653 DLSN TELFA 8X3 270 0 18.55 4372<br />
8280703 DLSN PADS ABD 10X8 270 0 8.25 4372<br />
8290009 DLSN-STROKE SCREEN 999 0 0 4372<br />
8290017 DLSN-OUTPATIENT VISIT 999 0 0 4372<br />
8290025 DLSN-OP NO CHARGE 999 0 0 4372<br />
8290033 DLSN-ABSENT 999 0 0 4372<br />
8290041 DLSN/CANCELLED VISIT 999 0 0 4372<br />
8290058 DLSN/CANCELLED-DSCHG 999 0 0 4372<br />
8300055 EVALUATION (PROC) PLF 424 0 172.6 4373<br />
8300105 PLFD RE-EVALUATION (PROC) 424 0 91.86 4373<br />
8301004 GAIT TRAINING PER 15 MIN PLF 420 0 58.47 4373<br />
8301053 THERAPEUTIC EXERCISE PER 15MIN PLF 420 0 67.74 4373<br />
8301103 ULTRASOUND PER 15 MIN PLF 420 0 28.14 4373<br />
8301152 WHIRLPOOL (PROC) PLF 420 0 40.81 4373<br />
8301202 PARAFIN (PROC) PLF 420 0 17.62 4373<br />
8301301 ELE<strong>CT</strong>RICAL STIM(ATTENDED)15MIN PLF 420 0 43.62 4373<br />
8301350 ELE<strong>CT</strong>RICAL STIM(UNATTENDED)) PLF 420 0 116 4373<br />
8301400 TENS APPLICATION PLF 420 0 32.14 4373<br />
8301459 SELF CARE HOME MGMT(ADL) PER 15 MIN 420 0 76.09 4373<br />
8301509 IONTOPHORESIS PER 15 MIN DLS 420 0 37.12 4373<br />
8301558 MECHANICAL TRA<strong>CT</strong>ION (PROC) DLS 420 0 34.33 4373<br />
8301608 NEURO MUSC RE-EDUC PER 15 MIN PLF 420 0 70.51 4373<br />
8301657 MANUAL THERAPY PER 15 MIN PLF 420 0 63.1 4373<br />
8301707 PROSTHETIC TRAINING PER 15 MIN PLF 420 0 114.5 4373<br />
8301756 THERAPEUTIC A<strong>CT</strong>IVITY PER 15MIN PLF 420 0 84.43 4373<br />
8301806 PHYS PERFTEST(FTE) PER 15 MIN PLF 420 0 65.88 4373<br />
8302309 ANKLE/FOOT STRAPPING (PROC) PLF 420 0 121.74 4373<br />
8302812 THERAPEUTIC PROCEDURE GROUP PLF 420 0 45.48 4373
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