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
3090743 FASLODEX 50MG/ML 636 0 0 4290 3090776 DEPOCYT 50MG 5ML 636 0 0 4290 3090800 PLENAXIS 100MG. 636 0 0 4290 3090875 ALEMTUZUMAB 30MG 636 0 0 4290 3090909 ABRAXANE 100MG 636 0 0 4290 3090917 CARBOPLATIN 450 MG/45ML VL 636 0 0 4290 3090941 ROFERON-A 3MM U/0.5ML KIT 636 0 0 4290 3090958 LEUPROLIDE 30 MG DEPOT 4MO 636 0 0 4290 3090966 DAUNORUBICIN 20 MG VIAL 636 0 0 4290 3091121 EPINEPHRINE 1MG/ML PRES FREE 1ML AM 636 0 0 4290 3303906 PULSE OXIMETRY MULTI 460 0 0 4130 3340106 SUPERVISED LEVEL III PULMONARY 940 0 0 4130 3340304 P/R MANIP-CHEST CUP 410 0 0 4130 3350220 CR PHASE IV-PLFD 460 0 0 4130 3500014 NEEDLE OCULOELECTROMYOGRAPHY 920 0 0 4200 3500022 NDL ELECTROMYOGRAPHY 1 EXTREMITY 920 0 0 4200 3500030 NDL ELECTROMYOGRAPHY, 2 EXTREMITIES 922 0 0 4200 3500048 NDL ELECTROMYOGRAPHY, 3 EXTREMITIES 0 0 4200 3500055 NDL ELECTROMYOGRAPHY 4 EXTREMITIES 922 0 0 4200 3500063 NDL ELECTROMYOGRAPHY LARYNX 922 0 0 4200 3500071 NDL ELECTROMYO HEMIDIAPHRAGM 922 0 0 4200 3500089 NDL ELECTROMYO CRANIAL NERVE UNI 922 0 0 4200 3500097 NDL ELECTROMYO CRANIAL NERVE BILAT 922 0 0 4200 3500105 NDL ELECTROMYO THORACIC PARASPINAL 922 0 0 4200 3500113 NDL ELECTROMYO LMTD STUDY 922 0 0 4200 3500121 NDL ELECTROMYO SINGLE FIBER 922 0 0 4200 3500139 MOTOR W/O F WAVE 1 TO 2 SITES 922 0 0 4200 3500147 MOTOR WITH F WAVE 1 TO 2 SITES 922 0 0 4200 3500162 MOTOR & OR SENSORY NERVE CONDUCTION 922 0 0 4200 3500188 H FLEX, GASTROC/SOLEUS 922 0 0 4200 3500196 H FLEX OTHER 920 0 0 4200 3500204 CURRNT PERCEPTION THRESH PER LIMB 920 0 0 4200 3502218 H FLEX, GASTROC/SOLEUS BILATERAL 922 0 0 4200 3502226 MOTOR W/O F WAVE EACH ADD'L 922 0 0 4200 3502234 MOTOR W/F WAVE EACH ADD'L 922 0 0 4200 3502242 EEG EXTENDED MONITORING 41 60 MIN 920 0 0 4200 3502309 MOTOR W/O F WAVE 3 TO 4 STUDIES 922 0 0 4200 3502317 MOTOR W/O F WAVE 5 TO 6 STUDIES 922 0 0 4200 3502325 MOTOR W/O F WAVE 7 TO 8 STUDIES 922 0 0 4200 3502333 MOTOR WITH F WAVE 3 TO 4 STUDIES 922 0 0 4200 3502341 MOTOR WITH F WAVE 5 TO 6 STUDIES 922 0 0 4200 3502358 MOTOR WITH F WAVE 7 TO 8 STUDIES 922 0 0 4200 4100152 QUINIDINE 300 0 0 4010 4100343 AMPHETAMINE 300 0 0 4010 4100350 COCAINE 300 0 0 4010 4100368 TETRAHYDROCANNABINOL 300 0 0 4010 4100376 BARBITURATES 300 0 0 4010
4100384 BENZODIAZEPINES 300 0 0 4010 4100392 PCP 300 0 0 4010 4100400 OPIATES 300 0 0 4010 4100962 CARDIAC PANEL 300 0 0 4010 4101200 ARTHRITIS PANEL 300 0 0 4010 4102067 BLOOD GAS W/TEMP 300 0 0 4010 4102141 HEPATITIS C AB 300 0 0 4010 4102158 HEP B CORE IGM 300 0 0 4010 4102166 HEP B SURFACE AG 300 0 0 4010 4102174 HEP B SURFACE AB 300 0 0 4010 4102224 HEPATITIS A AB, TOTAL 300 0 0 4010 4112165 ITEL NON BILLABLE OBS PER HR 099 0 0 3140 4200366 LE PREP 300 0 0 4010 4300018 LYME EIA (IGG & IGM) 310 0 0 4010 4300042 H.PYLORI AB 300 0 0 4010 4300133 ROTAVIRUS 300 0 0 4010 4300141 CHLAMYDIA DNA PROBE 300 0 0 4010 4300158 GC DNA PROBE 300 0 0 4010 4300224 AFFIRM 300 0 0 4010 4300448 CHLAMYDIA 300 0 0 4010 4300455 TRICHOMONAS 300 0 0 4010 4300463 GARDNERELLA 300 0 0 4010 4300471 CANDIDA SPECIES 300 0 0 4010 4300596 TRICHOMONAS (AFFIRM) 300 0 0 4010 4300604 GARDNERELLA (AFFIRM) 300 0 0 4010 4300612 CANDIDA SPECIES (AFF 300 0 0 4010 4314340 RECESSIVE HSP EVAL ATHENA 652 300 0 0 4010 4400149 FIBRINOGEN 300 0 0 4010 4400248 PROTHROMBIN TIME 300 0 0 4010 4400255 PTT 300 0 0 4010 4500245 RA SCREEN 300 0 0 4010 4601282 TICK ID & LYME/ PCR 300 0 0 4010 4602371 LIPASE 300 0 0 4010 4602512 HEPATITIS PNL,ACUTE 300 0 0 4010 4602793 HEPATITIS BE AG 300 0 0 4010 4602934 CSF HERPES, PCR 300 0 0 4010 4603213 TETANUS TITER 300 0 0 4010 4603221 RETROVIRAL SEROLOGY 300 0 0 4010 4603387 LYME BY PCR (UCONN) 300 0 0 4010 4603437 YO AUTOANTIBODY 300 0 0 4010 4603445 HU AUTOANTIBODY 300 0 0 4010 4603668 DIRECT LDL 300 0 0 4010 4603700 NUCL.MOL.ISOLATION 300 0 0 4010 4603718 NUCL.MOL.ENZ.DIGEST. 300 0 0 4010 4603726 NUCL.MOL.SEPARATION 300 0 0 4010 4603734 NUCL.MOL.NUCL. ACID 300 0 0 4010 4603742 NUCL.MOL.AMPLIFICATION 300 0 0 4010
- 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
- Page 213 and 214: 2525640 EYE RETROBULBAR NDL 270 0 0
- Page 215: 2600153 AMNIO SUPPLIES 270 0 0 3800
- 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
- Page 233 and 234: 8603557 JOINT JACK 274 0 0 4390 860
- Page 235 and 236: 8803306 PLFD OT WHFOADDTHUM L3810 2
- Page 237 and 238: 9742503 TCORS AUTO ALOOWANCE 0 0 52
- Page 239 and 240: 9944786 NATIONAL HEALTH INS NASE PA
- Page 241 and 242: 9709817 CHARITY MEDICARE B/D-COINS
- Page 243 and 244: 90460 0 23000086 A A 35109990 35109
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- Page 247 and 248: 10060 0 A A 37309990 37309990 10061
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3090743 FASLODEX 50MG/ML 636 0 0 4290<br />
3090776 DEPOCYT 50MG 5ML 636 0 0 4290<br />
3090800 PLENAXIS 100MG. 636 0 0 4290<br />
3090875 ALEMTUZUMAB 30MG 636 0 0 4290<br />
3090909 ABRAXANE 100MG 636 0 0 4290<br />
3090917 CARBOPLATIN 450 MG/45ML VL 636 0 0 4290<br />
3090941 ROFERON-A 3MM U/0.5ML KIT 636 0 0 4290<br />
3090958 LEUPROLIDE 30 MG DEPOT 4MO 636 0 0 4290<br />
3090966 DAUNORUBICIN 20 MG VIAL 636 0 0 4290<br />
3091121 EPINEPHRINE 1MG/ML PRES FREE 1ML AM 636 0 0 4290<br />
3303906 PULSE OXIMETRY MULTI 460 0 0 4130<br />
3340106 SUPERVISED LEVEL III PULMONARY 940 0 0 4130<br />
3340304 P/R MANIP-CHEST CUP 410 0 0 4130<br />
3350220 CR PHASE IV-PLFD 460 0 0 4130<br />
3500014 NEEDLE OCULOELE<strong>CT</strong>ROMYOGRAPHY 920 0 0 4200<br />
3500022 NDL ELE<strong>CT</strong>ROMYOGRAPHY 1 EXTREMITY 920 0 0 4200<br />
3500030 NDL ELE<strong>CT</strong>ROMYOGRAPHY, 2 EXTREMITIES 922 0 0 4200<br />
3500048 NDL ELE<strong>CT</strong>ROMYOGRAPHY, 3 EXTREMITIES 0 0 4200<br />
3500055 NDL ELE<strong>CT</strong>ROMYOGRAPHY 4 EXTREMITIES 922 0 0 4200<br />
3500063 NDL ELE<strong>CT</strong>ROMYOGRAPHY LARYNX 922 0 0 4200<br />
3500071 NDL ELE<strong>CT</strong>ROMYO HEMIDIAPHRAGM 922 0 0 4200<br />
3500089 NDL ELE<strong>CT</strong>ROMYO CRANIAL NERVE UNI 922 0 0 4200<br />
3500097 NDL ELE<strong>CT</strong>ROMYO CRANIAL NERVE BILAT 922 0 0 4200<br />
3500105 NDL ELE<strong>CT</strong>ROMYO THORACIC PARASPINAL 922 0 0 4200<br />
3500113 NDL ELE<strong>CT</strong>ROMYO LMTD STUDY 922 0 0 4200<br />
3500121 NDL ELE<strong>CT</strong>ROMYO SINGLE FIBER 922 0 0 4200<br />
3500139 MOTOR W/O F WAVE 1 TO 2 SITES 922 0 0 4200<br />
3500147 MOTOR WITH F WAVE 1 TO 2 SITES 922 0 0 4200<br />
3500162 MOTOR & OR SENSORY NERVE CONDU<strong>CT</strong>ION 922 0 0 4200<br />
3500188 H FLEX, GASTROC/SOLEUS 922 0 0 4200<br />
3500196 H FLEX OTHER 920 0 0 4200<br />
3500204 CURRNT PERCEPTION THRESH PER LIMB 920 0 0 4200<br />
3502218 H FLEX, GASTROC/SOLEUS BILATERAL 922 0 0 4200<br />
3502226 MOTOR W/O F WAVE EACH ADD'L 922 0 0 4200<br />
3502234 MOTOR W/F WAVE EACH ADD'L 922 0 0 4200<br />
3502242 EEG EXTENDED MONITORING 41 60 MIN 920 0 0 4200<br />
3502309 MOTOR W/O F WAVE 3 TO 4 STUDIES 922 0 0 4200<br />
3502317 MOTOR W/O F WAVE 5 TO 6 STUDIES 922 0 0 4200<br />
3502325 MOTOR W/O F WAVE 7 TO 8 STUDIES 922 0 0 4200<br />
3502333 MOTOR WITH F WAVE 3 TO 4 STUDIES 922 0 0 4200<br />
3502341 MOTOR WITH F WAVE 5 TO 6 STUDIES 922 0 0 4200<br />
3502358 MOTOR WITH F WAVE 7 TO 8 STUDIES 922 0 0 4200<br />
4100152 QUINIDINE 300 0 0 4010<br />
4100343 AMPHETAMINE 300 0 0 4010<br />
4100350 COCAINE 300 0 0 4010<br />
4100368 TETRAHYDROCANNABINOL 300 0 0 4010<br />
4100376 BARBITURATES 300 0 0 4010
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