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
9704065 GOLDEN RULE ALLOW 0 0 5210 9704073 GREAT WEST LIFE INS ALLOWANCE 0 0 5210 9704081 HEALTH ADVANTAGE ALLOW 0 0 5210 9704099 HEALTH CHOICE ALLOW 0 0 5210 9704107 HEALTHNET FOXWOODS ALLOWANCE 0 0 5210 9704115 INTERACTIVE BENEFIT CORP ALLOW 0 0 5210 9704123 JOHN ALDEN INS ALLOWANCE 0 0 5210 9704131 N E DIRECT HEALTH ALLOWANCE 0 0 5210 9704149 NEW ENGLAND INS ALLOWANCE 0 0 5210 9704156 OXFORD HEALTH ALLOWANCE 0 0 5210 9704164 OXFORD/OXFORD ALLOWANCE 0 0 5210 9704172 ORTHONET ALLOWANCE 0 0 5210 9704180 US HEALTHCARE ALLOWANCE 0 0 5210 9704198 FOXWOODS BOLLORE ALLOW 0 0 5210 9704206 PSYCH VALUE OPTIONS ALLOWANCE 0 0 5210 9704289 PSYCH UNITED BEHAVORIAL HLTH ALLOW 0 0 5210 9704297 AARP ALLOWANCE 0 0 5210 9704305 AETNA ALLOWANCE 0 0 5210 9704313 AETNA/AETNA ALLOWANCE 0 0 5210 9704321 ALLIED BENEFIT ALLOWANCE 0 0 5210 9704339 AMERIHEALTH ALLOWANCE 0 0 5210 9704347 APWU AMER POSTAL WORKERS ALLOWANCE 0 0 5210 9704354 ASSOCIATION & SOCIETY ALLOWANCE 0 0 5210 9704362 ASSURANT HEALTH ALLOWANCE 0 0 5210 9704370 BCI BENEFIT CONCEPTS ALLOWANCE 0 0 5210 9704388 BENEFIT PLANNERS ALLOWANCE 0 0 5210 9704396 BENESIGHT ALLOWANCE 0 0 5210 9704404 CBA ALLOWANCE 0 0 5210 9704412 CHRISTIAN BROTHERS ALLOWANCE 0 0 5210 9704420 CNA INSURANCE ALLOWANCE 0 0 5210 9704438 COMMONWEALTH SERVICE CTR ALLOW 0 0 5210 9704446 CONSOLIDATED HEALTH ALLOWANCE 0 0 5210 9704453 CT CARPENTERS HEALTH ALLOWANCE 0 0 5210 9704461 DEFINITY HEALTH ALLOWANCE 0 0 5210 9704479 EMPLOYER SERVICE CENTER ALLOWANCE 0 0 5210 9704487 FORTIS HEALTHCARE ALLOWANCE 0 0 5210 9704495 GROUP BENEFIT SERVICE ALLOWANCE 0 0 5210 9704503 HEALTHCARE VALUE MGMT ALLOWANCE 0 0 5210 9704511 HMC PPO ALLOWANCE 0 0 5210 9704529 HUMANA INSURANCE ALLOWANCE 0 0 5210 9704537 IRONWORKERS ALLOWANCE 0 0 5210 9704545 LOCAL 371 AMAL WELF/TRUST ALLOW 0 0 5210 9704552 MUTUAL OF OMAHA INS ALLOWANCE 0 0 5210 9704560 NE HEALTHCARE EMP WELF ALLOWANCE 0 0 5210 9704578 STIRLING & STIRLING ALLOWANCE 0 0 5210 9704586 TRAVELERS ALLOWANCE 0 0 5210 9704594 UNITED HEALTHCARE ALLOWANCE 0 0 5210
9704602 UNITED HLTHCR/UNITED HLTHCR ALLOW 0 0 5210 9704610 WALMART ALLOWANCE 0 0 5210 9704628 HEALTH PARTNERS ALLOWANCE 0 0 5210 9704636 MVP OF NY ALLOWANCE 0 0 5210 9704644 UMR ALLOWANCE 0 0 5210 9704651 ULTRABENEFITS ALLOWANCE 0 0 5210 9704669 STOP SHOP HEALTHCARE STRAT ALLOWANC 0 0 5210 9704677 MEDICAL MUTUAL ALLOWANCE 0 0 5210 9704719 PSYCH MHN/PHS CARVEOUT ALLOWANCE 0 0 5210 9704727 PSYCH VALUE BEHAVORIAL ALLOWANCE 0 0 5210 9704735 DIVERSIFIED ADMIN ALLOWANCE 0 0 5210 9704743 DIVERSIFIED GROUP BROKERAGE ALLOW 0 0 5210 9704750 GUARDIAN LIFE ALLOWANCE 0 0 5210 9704768 HEALTHNET (PHS) ALLOWANCE 0 0 5210 9704776 HEALTHNET/HEALTHNET ALLOWANCE 0 0 5210 9704784 KANAWHA HEALTHCARE SOLUTIONS ALLOW 0 0 5210 9704792 MAILHANDLERS BENEFIT FD ALLOWANCE 0 0 5210 9704800 H/L COMM TIMELY FILING 0 0 5210 9704818 H/L COMMERCIAL REGISTRATION ERROR 0 0 5210 9704826 H/L COMMERCIAL OTHER 0 0 5210 9704834 H/L COMMERCIAL NON CREDENTIAL 0 0 5210 9704842 H/L COMMERCIAL CLINICAL ERROR 0 0 5210 9704859 H/L COMMERCIAL NO AUTH ON FILE 0 0 5210 9704867 H/L COMMERCIAL MEDICAL NECESSITY 0 0 5210 9704875 H/L COMMERCIAL DAYS DENIED 0 0 5210 9704883 H/L COMMERCIAL AUTH/SVC MISMATCH 0 0 5210 9704891 H/L COMMERCIAL NON COVERED SERVICE 0 0 5210 9704909 H/L COMM ADMINISTRATION ALLOW 0 0 5210 9704917 H/L COMM PATIENT/MEMBER ALLOW 0 0 5210 9704958 H/L COMM PRO FEE CREDENTIAL ISSUE 0 0 5210 9704966 H/L COM PRO FEE OTHER 0 0 5210 9704974 H/L COM PRO FEE MED NEC 0 0 5210 9704982 H/L COM PRO FEE TIMELY FILING 0 0 5210 9704990 H/L COM PRO FEE NO AUTH 0 0 0 9705005 SAGA ALLOWANCE 0 0 5250 9705013 PSYCH ADVANCE BEHAV HEALTH ALLOW 0 0 5250 9705021 H/L BC PRO FEE MED NEC 0 0 5170 9705807 H/L SAGA TIMELY FILING 0 0 5250 9705815 H/L SAGA REGISTRATION ERROR 0 0 5250 9705823 H/L SAGA OTHER 0 0 5250 9705831 H/L SAGA NON CREDENTIAL 0 0 5250 9705849 H/L SAGA CLINICAL ERROR 0 0 5250 9705856 H/L SAGA NO AUTH ON FILE 0 0 5250 9705864 H/L SAGA MEDICAL NECESSITY 0 0 5250 9705872 H/L SAGA DAYS DENIED 0 0 5250 9705880 H/L SAGA AUTH/SVC MISMATCH 0 0 5250 9705898 H/L SAGA NON COVERED SERVICE 0 0 5250
- 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
- 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: 9702796 MIC MEDICAID INTGRTY ALLOWA
- 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
- Page 213 and 214: 2525640 EYE RETROBULBAR NDL 270 0 0
- Page 215 and 216: 2600153 AMNIO SUPPLIES 270 0 0 3800
- Page 217 and 218: 4100384 BENZODIAZEPINES 300 0 0 401
- Page 219 and 220: 4605929 MUTATION ID ALLELE S 300 0
- Page 221 and 222: 4612685 CX 26 DNA SEQUENCING 300 0
- Page 223 and 224: 5600812 MRI KEN UPEX NO JT WO RT 61
- Page 225 and 226: 6500052 MRI-SPECIAL 352 0 0 4270 65
- Page 227 and 228: 7600570 POTASSIUM ACETATE 2 258 0 0
- Page 229 and 230: 8203465 DLSN HFOWOJT L3913 274 0 0
- Page 231 and 232: 8403263 EWHORTHO L3763 274 0 0 4370
9704065 GOLDEN RULE ALLOW 0 0 5210<br />
9704073 GREAT WEST LIFE INS ALLOWANCE 0 0 5210<br />
9704081 HEALTH ADVANTAGE ALLOW 0 0 5210<br />
9704099 HEALTH CHOICE ALLOW 0 0 5210<br />
9704107 HEALTHNET FOXWOODS ALLOWANCE 0 0 5210<br />
9704115 INTERA<strong>CT</strong>IVE BENEFIT CORP ALLOW 0 0 5210<br />
9704123 JOHN ALDEN INS ALLOWANCE 0 0 5210<br />
9704131 N E DIRE<strong>CT</strong> HEALTH ALLOWANCE 0 0 5210<br />
9704149 NEW ENGLAND INS ALLOWANCE 0 0 5210<br />
9704156 OXFORD HEALTH ALLOWANCE 0 0 5210<br />
9704164 OXFORD/OXFORD ALLOWANCE 0 0 5210<br />
9704172 ORTHONET ALLOWANCE 0 0 5210<br />
9704180 US HEALTHCARE ALLOWANCE 0 0 5210<br />
9704198 FOXWOODS BOLLORE ALLOW 0 0 5210<br />
9704206 PSYCH VALUE OPTIONS ALLOWANCE 0 0 5210<br />
9704289 PSYCH UNITED BEHAVORIAL HLTH ALLOW 0 0 5210<br />
9704297 AARP ALLOWANCE 0 0 5210<br />
9704305 AETNA ALLOWANCE 0 0 5210<br />
9704313 AETNA/AETNA ALLOWANCE 0 0 5210<br />
9704321 ALLIED BENEFIT ALLOWANCE 0 0 5210<br />
9704339 AMERIHEALTH ALLOWANCE 0 0 5210<br />
9704347 APWU AMER POSTAL WORKERS ALLOWANCE 0 0 5210<br />
9704354 ASSOCIATION & SOCIETY ALLOWANCE 0 0 5210<br />
9704362 ASSURANT HEALTH ALLOWANCE 0 0 5210<br />
9704370 BCI BENEFIT CONCEPTS ALLOWANCE 0 0 5210<br />
9704388 BENEFIT PLANNERS ALLOWANCE 0 0 5210<br />
9704396 BENESIGHT ALLOWANCE 0 0 5210<br />
9704404 CBA ALLOWANCE 0 0 5210<br />
9704412 CHRISTIAN BROTHERS ALLOWANCE 0 0 5210<br />
9704420 CNA INSURANCE ALLOWANCE 0 0 5210<br />
9704438 COMMONWEALTH SERVICE <strong>CT</strong>R ALLOW 0 0 5210<br />
9704446 CONSOLIDATED HEALTH ALLOWANCE 0 0 5210<br />
9704453 <strong>CT</strong> CARPENTERS HEALTH ALLOWANCE 0 0 5210<br />
9704461 DEFINITY HEALTH ALLOWANCE 0 0 5210<br />
9704479 EMPLOYER SERVICE CENTER ALLOWANCE 0 0 5210<br />
9704487 FORTIS HEALTHCARE ALLOWANCE 0 0 5210<br />
9704495 GROUP BENEFIT SERVICE ALLOWANCE 0 0 5210<br />
9704503 HEALTHCARE VALUE MGMT ALLOWANCE 0 0 5210<br />
9704511 HMC PPO ALLOWANCE 0 0 5210<br />
9704529 HUMANA INSURANCE ALLOWANCE 0 0 5210<br />
9704537 IRONWORKERS ALLOWANCE 0 0 5210<br />
9704545 LOCAL 371 AMAL WELF/TRUST ALLOW 0 0 5210<br />
9704552 MUTUAL OF OMAHA INS ALLOWANCE 0 0 5210<br />
9704560 NE HEALTHCARE EMP WELF ALLOWANCE 0 0 5210<br />
9704578 STIRLING & STIRLING ALLOWANCE 0 0 5210<br />
9704586 TRAVELERS ALLOWANCE 0 0 5210<br />
9704594 UNITED HEALTHCARE ALLOWANCE 0 0 5210
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