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
4617353 PCR BY IMUGEN 300 0 0 4010 4617379 A PHAGOCYTOPHILUM, PCR 300 0 0 4010 4617395 LYME, PCR 300 0 0 4010 4617478 E CHAFFEENSIS, PCR 300 0 0 4010 4618807 TAPENTADOL, QUANT, URINE 098 0 0 4010 4700126 CHROMOSOME (UCONN) 310 0 0 4010 4700175 PKU SCREEN 300 0 0 4010 4700233 CMV (URINE) 300 0 0 4010 4700258 SSB ANTI-LA TITER 300 0 0 4010 4700498 HSV ON CSF BY PCR 300 0 0 4010 4700514 ATAXIA PROF INTERP 300 0 0 4010 4700548 SMEAR ECC 310 0 0 4010 4700555 SMEAR DIAPHRAM SCRAP 310 0 0 4010 4700563 ST EVAL FNA/ADEQUACY 310 0 0 4010 4700571 SMEAR NGYN 310 0 0 4010 4700589 CYTO BRONCH SPUTUM 310 0 0 4010 5050018 MED/SURG ROUTINE 270 0 0 370 5500012 PLATELETS, 5 UNITS 390 0 0 4100 5500038 CELLS,WBC-REDUCED,4U 390 0 0 4100 5500053 PLTS,WBC-REDU,IRR,2U 390 0 0 4100 5500061 PLTS,WBC-REDU,IRR,3U 390 0 0 4100 5500087 CELLS,WBC REDU,IR,2U 390 0 0 4100 5500095 ALBUMIN 25%/50ML 2UN 390 0 0 4100 5500103 FRSH FRZ PLASMA,2UNI 390 0 0 4100 5500111 CRYOPRECIP, 2 UNITS 390 0 0 4100 5500137 CELLS,WBC/REDUCED,6U 390 0 0 4100 5500145 CELLS,WBC REDUCED,3U 390 0 0 4100 5500178 AUTOLOGOUS PROCESS 391 0 0 4100 5500202 CELLS,WBC REDUCED,5U 390 0 0 4100 5500236 CELLS,WBC REDUCED,2U 390 0 0 4100 5500244 CRYOPRECIP. 3 UNITS 390 0 0 4100 5500269 13080 UNITS FACTOR 8 636 0 0 4100 5500277 6540 UNITS FACTOR 8 636 0 0 4100 5500285 3150 UNITS FACTOR 8 636 0 0 4100 5500293 3387 UNITS FACTOR 8 636 0 0 4100 5500319 ALBUMIN 5%/250ML 390 0 0 4100 5500376 PLTS,WBC REDU,IRR,6U 390 0 0 4100 5500384 SEPACELL FILTERS (2) 270 0 0 4100 5500392 PLATELETS, TEN UNITS 390 0 0 4100 5500400 SEPACELL FILTER (1) 270 0 0 4100 5500418 2 PLT INFUSION SETS 270 0 0 4100 5500426 CRYOPRECIP. 4 UNITS 390 0 0 4100 5500434 WBC FILTER/PLATELET 270 0 0 4100 5600069 MRI KEN L SPINE W WO CONTRAST 612 0 0 4275 5600192 MRI KEN SHLDR ARTHRO LT 610 0 0 4275 5600200 MRI KEN SHLDR ARTHRO RT 610 0 0 4275 5600804 MRI KEN UPEX NO JT WO LT 610 0 0 4275
5600812 MRI KEN UPEX NO JT WO RT 610 0 0 4275 5600929 MRI KEN LOEX NOJT W/O LT 610 0 0 4275 5600945 MRI KEN LOEX NO JT W LT 610 0 0 4275 5800057 SLEEP STUDY REQUEST 270 0 0 4100 5800107 S.S. SCREEN (UNAT.4) 270 0 0 4100 5800156 S.S. SCREEN (ATT.4) 270 0 0 4100 5977707 EEG MISC 922 0 0 4140 6000764 E.R. EKG 730 0 0 4120 6090518 INJ REGADENOSON, .1 MG 636 0 0 4120 6107908 GALLBLADDER SERIES 320 0 0 4210 6108708 PORTABLE RADIOGRAPHY 320 0 0 4210 6108955 CONSULT-OUTSIDE FILM 320 0 0 4210 6109003 VENOGRAM BILATERAL 320 0 0 4210 6110050 MAMMO DIAG BILAT 401 0 0 4210 6110258 MAMMO-UNILAT/BIOPSY 320 0 0 4210 6110407 MAMMO DIAG UNI-LT 401 0 0 4210 6110415 MAMMO DIAG UNI-RT 401 0 0 4210 6110464 MAMMO PADS 621 0 0 4210 6110472 LOC NEEDLES 270 0 0 4210 6110480 STEREO TRAY 270 0 0 4210 6111603 VENOGRAM UNILAT-LT 761 0 0 4210 6111652 VENOGRAM UNILAT-RT 761 0 0 4210 6112809 MAMMO SCREEN 403 0 0 4210 6114201 VENOGRAM INS-LT 761 0 0 4210 6114219 VENOGRAM INS-RT 761 0 0 4210 6116164 MAMMO NEEDLE LOC ADD'L UNIL-RT 401 0 0 4211 6116172 GREENFIELD FILTER REMOVAL 761 0 0 4211 6116180 GREENFIELD FILTER REMOVAL PROC 761 0 0 4211 6116198 GREENFIELD FILTER INTRODUCTION 761 0 0 4211 6170005 PORTABLE RADIOGRAPHY 320 0 0 4211 6170039 RIGHT KNEE-WO-OTIS-IMPLANT 320 0 0 4210 6170047 LEFT KNEE-WO-OTIS-IMPLANT 320 0 0 4210 6170054 RIGHT KNEE-WO-OTIS IMPLANT 320 0 0 4210 6191001 VISIP320MG-LOCM@50ML 636 0 0 4210 6191050 VISIP320-LOCM@100ML 636 0 0 4210 6191100 VISIP320-LOCM@150ML 636 0 0 4210 6191159 OMNIP180-LOCM@20ML 636 0 0 4210 6191209 OMNIP300-LOCM@50ML 636 0 0 4210 6191258 OMNIP300-LOCM@100ML 636 0 0 4210 6191308 OMNIP300-LOCM@150ML 636 0 0 4210 6191357 OMNIP350-LOCM@50ML 636 0 0 4210 6191407 OMNIP350-LOCM@100ML 636 0 0 4210 6191456 OMNIP350-LOCM@125ML 636 0 0 4210 6192025 MAMMO PAD 098 0 0 4211 6192058 BIOP SOFT TIS KNEE/THIGH SUPERFSCL 320 0 0 4210 6200257 1ST PASS BLOOD POOL 340 0 0 4240 6201008 GALLIUM STUDY SCAN 340 0 0 4240
- 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 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: 4612685 CX 26 DNA SEQUENCING 300 0
- Page 225 and 226: 6500052 MRI-SPECIAL 352 0 0 4270 65
- Page 227 and 228: 7600570 POTASSIUM ACETATE 2 258 0 0
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- Page 235 and 236: 8803306 PLFD OT WHFOADDTHUM L3810 2
- Page 237 and 238: 9742503 TCORS AUTO ALOOWANCE 0 0 52
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5600812 MRI KEN UPEX NO JT WO RT 610 0 0 4275<br />
5600929 MRI KEN LOEX NOJT W/O LT 610 0 0 4275<br />
5600945 MRI KEN LOEX NO JT W LT 610 0 0 4275<br />
5800057 SLEEP STUDY REQUEST 270 0 0 4100<br />
5800107 S.S. SCREEN (UNAT.4) 270 0 0 4100<br />
5800156 S.S. SCREEN (ATT.4) 270 0 0 4100<br />
5977707 EEG MISC 922 0 0 4140<br />
6000764 E.R. EKG 730 0 0 4120<br />
6090518 INJ REGADENOSON, .1 MG 636 0 0 4120<br />
6107908 GALLBLADDER SERIES 320 0 0 4210<br />
6108708 PORTABLE RADIOGRAPHY 320 0 0 4210<br />
6108955 CONSULT-OUTSIDE FILM 320 0 0 4210<br />
6109003 VENOGRAM BILATERAL 320 0 0 4210<br />
6110050 MAMMO DIAG BILAT 401 0 0 4210<br />
6110258 MAMMO-UNILAT/BIOPSY 320 0 0 4210<br />
6110407 MAMMO DIAG UNI-LT 401 0 0 4210<br />
6110415 MAMMO DIAG UNI-RT 401 0 0 4210<br />
6110464 MAMMO PADS 621 0 0 4210<br />
6110472 LOC NEEDLES 270 0 0 4210<br />
6110480 STEREO TRAY 270 0 0 4210<br />
6111603 VENOGRAM UNILAT-LT 761 0 0 4210<br />
6111652 VENOGRAM UNILAT-RT 761 0 0 4210<br />
6112809 MAMMO SCREEN 403 0 0 4210<br />
6114201 VENOGRAM INS-LT 761 0 0 4210<br />
6114219 VENOGRAM INS-RT 761 0 0 4210<br />
6116164 MAMMO NEEDLE LOC ADD'L UNIL-RT 401 0 0 4211<br />
6116172 GREENFIELD FILTER REMOVAL 761 0 0 4211<br />
6116180 GREENFIELD FILTER REMOVAL PROC 761 0 0 4211<br />
6116198 GREENFIELD FILTER INTRODU<strong>CT</strong>ION 761 0 0 4211<br />
6170005 PORTABLE RADIOGRAPHY 320 0 0 4211<br />
6170039 RIGHT KNEE-WO-OTIS-IMPLANT 320 0 0 4210<br />
6170047 LEFT KNEE-WO-OTIS-IMPLANT 320 0 0 4210<br />
6170054 RIGHT KNEE-WO-OTIS IMPLANT 320 0 0 4210<br />
6191001 VISIP320MG-LOCM@50ML 636 0 0 4210<br />
6191050 VISIP320-LOCM@100ML 636 0 0 4210<br />
6191100 VISIP320-LOCM@150ML 636 0 0 4210<br />
6191159 OMNIP180-LOCM@20ML 636 0 0 4210<br />
6191209 OMNIP300-LOCM@50ML 636 0 0 4210<br />
6191258 OMNIP300-LOCM@100ML 636 0 0 4210<br />
6191308 OMNIP300-LOCM@150ML 636 0 0 4210<br />
6191357 OMNIP350-LOCM@50ML 636 0 0 4210<br />
6191407 OMNIP350-LOCM@100ML 636 0 0 4210<br />
6191456 OMNIP350-LOCM@125ML 636 0 0 4210<br />
6192025 MAMMO PAD 098 0 0 4211<br />
6192058 BIOP SOFT TIS KNEE/THIGH SUPERFSCL 320 0 0 4210<br />
6200257 1ST PASS BLOOD POOL 340 0 0 4240<br />
6201008 GALLIUM STUDY SCAN 340 0 0 4240
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