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
2515773 LAP UNIV TROCAR SLEEVE 5MM 270 0 42.69 3800 2515781 ART PUSHLOCK 4.5X18.5 MM 278 0 680 3800 2515807 URO URETAL STENT 4.8 X 26 278 0 308.16 3800 2515815 URO APOGEE SLING 278 0 2990 3800 2520005 EXFIX EBI DRILL 2.0 270 0 554 3800 2520021 EXFIX EBI DRILL 2.7 270 0 554 3800 2520047 EXFIX EBI FIXA 04103 270 0 5318 3800 2520104 EXFIX EBI PIN 270 0 284 3800 2520120 EXFIX MON DRILL 2.2 270 0 269.2 3800 2520161 EXFIX MON PIN 270 0 148.3 3800 2520187 EXFIX MON ROD 15x200 278 0 280.15 3800 2520203 EXFIX MON ROD 15x250 278 0 295.31 3800 2520245 EXFIX MON TRIAX CLMP 278 0 675.7 3800 2525020 EYE ANT CHAMB MAINTAINER 270 0 96 3800 2525046 EYE CONFORMER 270 0 46.35 3800 2525061 EYE CORNEAL PROTECT 270 0 83.45 3800 2525160 EYE DRAPE INCISE POUCH 270 0 45.75 3800 2525228 EYE HEMOS ERAS 18GA* 270 0 0 3800 2525244 EYE HEMOS ERAS 23GA 270 0 100.6 3800 2525269 EYE I&A CANNULA 270 0 232 3800 2525277 EYE TORIC LENS 276 0 345 3800 2525285 EYE IOL STANDARD 276 0 300 3800 2525293 EYE MULTIFOCAL LENS 276 0 745 3800 2525301 EYE KNIFE 15 DEGREE 270 0 43.25 3800 2525327 EYE KNIFE 3.5 ANGLE 270 0 74.15 3800 2525343 EYE KNIFE 5.7 270 0 76.45 3800 2525368 EYE KNIFE FEATHER 270 0 93.8 3800 2525384 EYE KNIFE GRIESHABER 270 0 94.25 3800 2525400 EYE KNIFE KELLAN 270 0 90.65 3800 2525426 EYE KNIFE, 4.0 ANGLED 270 0 84.45 3800 2525442 EYE LACRIMAL INT CRWFRD 270 0 209.05 3800 2525566 EYE PACK INFINITY FMS 270 0 262.65 3800 2525624 EYE RETRCTOR IRIS 270 0 85 3800 2525707 EYE SPHERE-SILICONE 270 0 52.65 3800 2525723 EYE VARI CAUTERY* 270 0 0 3800 2530004 GYN DERMABOND PEN 270 0 99.4 3800 2530020 GYN FALOP BAND (2) 270 0 133.9 3800 2530046 GYN HYST BAG URO CAT 270 0 55.6 3800 2530061 GYN HYST ROLL BALL 22 270 0 301.3 3800 2530087 GYN HYST Y TUBE 270 0 42.85 3800 2530103 GYN HYSTCOPE LOOP 22 270 0 301.3 3800 2530129 GYN HYSTCOPE TUBING 270 0 234.85 3800 2530145 GYN INTERCEED 278 0 411.9 3800 2530160 GYN LOOP ELEC T-STYL 270 0 41.7 3800 2530186 GYN STAC VAC TUB SM/LG 270 0 55.8 3800 2530202 GYN THERMAL ABLATOR 270 0 1266.9 3800 2530228 GYN UTERINE MANIPUL 270 0 139.05 3800
2530244 GYN VAG PACKING* 270 0 0 3800 2535003 LAP CHOLE CATH KUMAR 270 0 92.7 3800 2535029 LAP END LINCUT 45 278 0 614.6 3800 2535045 LAP END LINCUT 45DLU 278 0 241.78 3800 2535060 LAP ENDO CLOSE 270 0 78.4 3800 2535086 LAP ENDO RETRACT 270 0 270.3 3800 2535102 LAP ENDOCLIP 10MM 278 0 208 3800 2535128 LAP ENDOCLIP 5MM 278 0 287.75 3800 2535144 LAP ENDOCLOSE 270 0 79.75 3800 2535169 LAP ENDODISSECT 270 0 322.3 3800 2535185 LAP ENDODISSECTOR 270 0 230.35 3800 2535227 LAP ENDOPOUCH 270 0 266.65 3800 2535243 LAP ENDORETRACT 270 0 278.15 3800 2535268 LAP ENDOSCISSOR 270 0 252.6 3800 2535300 LAP TROCAR 12MM 270 0 211.8 3800 2535326 LAP TROCAR 5MM 270 0 160.05 3800 2535342 LAP TROCAR 7/8MM 270 0 175.15 3800 2535367 LAP TROCAR HASSON 270 0 278.75 3800 2535383 LAP VERES NDL 120MM 270 0 66 3800 2535409 LAP VERES NDL 150MM 270 0 72.1 3800 2540003 MESH DULEX OVAL 278 0 1130.95 3800 2540029 MESH DULEX RECTANGUL 278 0 1424 3800 2540045 MESH KUG COMP 7X9OVL 278 0 1807.65 3800 2540060 MESH KUGEL LG OVAL 278 0 1335.15 3800 2540086 MESH KUGEL MD OVAL 278 0 1263.8 3800 2540102 MESH KUGEL SM OVAL 278 0 855.95 3800 2540128 MESH KUGEL XLG OVAL 278 0 2142.4 3800 2540144 MESH MARLE 10X14 278 0 452.05 3800 2540169 MESH MARLEX 1X4 278 0 238.95 3800 2540227 MESH PERFIX, X-LG 278 0 976.45 3800 2540243 MESH SURGIPRO 3X5 278 0 98.65 3800 2540268 MESH SURGPRO 6X6 278 0 192.8 3800 2540284 MESH VENTRALEX MED 278 0 947.6 3800 2540300 MESH VENTRALEX SMALL 278 0 793.1 3800 2545002 MIS A-LINE TRANS KIT 270 0 86.5 3800 2545028 MIS BAIR HUGGER ALL 270 0 46.35 3800 2545044 MIS BILE BAG* 270 0 0 3800 2545069 MIS CATH EMBBOLECTOMY 278 0 49.95 3800 2545085 MIS CATH FOLEY 270 0 43.25 3800 2545101 MIS CATH FOLEY BAG* 270 0 0 3800 2545127 MIS CATH FOLEY KIT 270 0 290.45 3800 2545143 MIS CATH TRIPLE LUMEN 278 0 178.45 3800 2545168 MIS CHOLANG CATH* 270 0 0 3800 2545200 MIS CORNWALL SYRINGE* 270 0 0 3800 2545242 MIS CYSTO TUBING* 270 0 0 3800 2545267 MIS DERMATOME blade 270 0 257.5 3800 2545283 MIS DISP VEIN STRIPP 270 0 119.9 3800
- 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 and 16: 1400050 PC FACILITY FEE-MIN 456 0 1
- Page 17 and 18: 1403344 EPISTX ANT CMPLX PKG 456 0
- Page 19 and 20: 2201713 MIDLINE CATHETER 278 0 130
- Page 21: 2510360 ASNIS 6.5 THD G/WIRE 270 0
- 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
- Page 67 and 68: 4608477 IGG B2 GLYCOPROTEIN 300 0 1
- Page 69 and 70: 4609616 SACCHAROMYCES IGG AB 300 0
- Page 71 and 72: 4610648 PLASMINOGEN ACT INH1 300 0
2515773 LAP UNIV TROCAR SLEEVE 5MM 270 0 42.69 3800<br />
2515781 ART PUSHLOCK 4.5X18.5 MM 278 0 680 3800<br />
2515807 URO URETAL STENT 4.8 X 26 278 0 308.16 3800<br />
2515815 URO APOGEE SLING 278 0 2990 3800<br />
2520005 EXFIX EBI DRILL 2.0 270 0 554 3800<br />
2520021 EXFIX EBI DRILL 2.7 270 0 554 3800<br />
2520047 EXFIX EBI FIXA 04103 270 0 5318 3800<br />
2520104 EXFIX EBI PIN 270 0 284 3800<br />
2520120 EXFIX MON DRILL 2.2 270 0 269.2 3800<br />
2520161 EXFIX MON PIN 270 0 148.3 3800<br />
2520187 EXFIX MON ROD 15x200 278 0 280.15 3800<br />
2520203 EXFIX MON ROD 15x250 278 0 295.31 3800<br />
2520245 EXFIX MON TRIAX CLMP 278 0 675.7 3800<br />
2525020 EYE ANT CHAMB MAINTAINER 270 0 96 3800<br />
2525046 EYE CONFORMER 270 0 46.35 3800<br />
2525061 EYE CORNEAL PROTE<strong>CT</strong> 270 0 83.45 3800<br />
2525160 EYE DRAPE INCISE POUCH 270 0 45.75 3800<br />
2525228 EYE HEMOS ERAS 18GA* 270 0 0 3800<br />
2525244 EYE HEMOS ERAS 23GA 270 0 100.6 3800<br />
2525269 EYE I&A CANNULA 270 0 232 3800<br />
2525277 EYE TORIC LENS 276 0 345 3800<br />
2525285 EYE IOL STANDARD 276 0 300 3800<br />
2525293 EYE MULTIFOCAL LENS 276 0 745 3800<br />
2525301 EYE KNIFE 15 DEGREE 270 0 43.25 3800<br />
2525327 EYE KNIFE 3.5 ANGLE 270 0 74.15 3800<br />
2525343 EYE KNIFE 5.7 270 0 76.45 3800<br />
2525368 EYE KNIFE FEATHER 270 0 93.8 3800<br />
2525384 EYE KNIFE GRIESHABER 270 0 94.25 3800<br />
2525400 EYE KNIFE KELLAN 270 0 90.65 3800<br />
2525426 EYE KNIFE, 4.0 ANGLED 270 0 84.45 3800<br />
2525442 EYE LACRIMAL INT CRWFRD 270 0 209.05 3800<br />
2525566 EYE PACK INFINITY FMS 270 0 262.65 3800<br />
2525624 EYE RETR<strong>CT</strong>OR IRIS 270 0 85 3800<br />
2525707 EYE SPHERE-SILICONE 270 0 52.65 3800<br />
2525723 EYE VARI CAUTERY* 270 0 0 3800<br />
2530004 GYN DERMABOND PEN 270 0 99.4 3800<br />
2530020 GYN FALOP BAND (2) 270 0 133.9 3800<br />
2530046 GYN HYST BAG URO CAT 270 0 55.6 3800<br />
2530061 GYN HYST ROLL BALL 22 270 0 301.3 3800<br />
2530087 GYN HYST Y TUBE 270 0 42.85 3800<br />
2530103 GYN HYSTCOPE LOOP 22 270 0 301.3 3800<br />
2530129 GYN HYSTCOPE TUBING 270 0 234.85 3800<br />
2530145 GYN INTERCEED 278 0 411.9 3800<br />
2530160 GYN LOOP ELEC T-STYL 270 0 41.7 3800<br />
2530186 GYN STAC VAC TUB SM/LG 270 0 55.8 3800<br />
2530202 GYN THERMAL ABLATOR 270 0 1266.9 3800<br />
2530228 GYN UTERINE MANIPUL 270 0 139.05 3800
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