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
7507080 PROCAINAMIDE 500MG. SR TAB 250 0 0 4300 7507775 TEGASEROD 6MG. 250 0 0 4300 7507882 THEOPHYLLINE/DEXTROS 400 MG INJ 636 0 0 4300 7508286 TRIMETHOBENZAMIDE HC 250 0 0 4300 7508302 TRIMETHOBENZAMIDE HC SUPP 250 0 0 4300 7508724 FERROUS SULFATE 75 MG DROPS 250 0 0 4300 7509599 MESNA 100 MG 250 0 0 4300 7509847 SANDOSTATIN 20MG LAR 636 0 0 4300 7509987 PIPERACILL NA/TAZOBA 636 0 0 4300 7510647 FELODIPINE 2.5MG. TAB 250 0 0 4300 7510787 ROSIGLITAZONE MALEAT TAB 250 0 0 4300 7510886 INTERFERON ALFA-2A R 250 0 0 4300 7511108 LEUPROLIDE ACETATE 3 250 0 0 4300 7511827 ALENDRONATE SODIUM 1 250 0 0 4300 7511926 DAUNORUBICIN HCL 5 M 250 0 0 4300 7511942 ROSIGLITAZONE MALEAT TAB 250 0 0 4300 7511991 AMINO ACIDS 8% 0 250 0 0 4300 7512361 BETAXOLOL HCL DROPS 250 0 0 4300 7512379 CEFOTETAN DISODIUM 1GM 250 0 0 4300 7512635 NEPHROCAPS 250 0 0 4300 7513161 IPECAC SYRUP 30ML BOTTLE 250 0 0 4300 7513211 NEUTRA PHOS-K PWD PACKET 250 0 0 4300 7513302 LEUCOVORIN 50 MG VIAL 636 0 0 4300 7514466 ATENOLOL 0.5MG/ML INJ 250 0 0 4300 7514508 TORISEL KIT-25MG 636 0 0 4300 7514912 BACTRIM SUSP 5 ML ORAL SYRINGE 250 0 0 0 7515059 DANTROLENE 50 MG CAP 636 0 0 4300 7515075 H1N1 VACCINE 636 0 0 4300 7515356 ROSIGLITAZONE 2 MG TAB 250 0 0 4300 7515661 E E S 200 MG/5ML 250 0 0 4300 7516107 CEFAZOLIN 2 GM/100ML IVPB 636 0 0 4300 7516545 CEFEPIME 1 GM/50 ML D5W 636 0 0 4300 7516552 CEFEPIME 2 GM/50 ML D5W 636 0 0 4300 7517568 BENDAMUSTINE 25 MG VIAL 636 0 0 4300 7550015 ISOMETHEPTENE/APAP/D 250 0 0 4300 7550130 FLEET BAGENEMA 270 0 0 4300 7579998 PRE ADMIN SERVICES-IVIG 636 0 0 4300 7600067 ASCORBATE SODIUM 500 258 0 0 4310 7600075 ALCO/DEXT 5-5% 258 0 0 4310 7600083 CEFAZOLIN SODIUM 10 258 0 0 4310 7600414 POTASSIUM CHLORIDE 2 258 0 0 4310 7600422 POTASSIUM CHLORIDE 2 258 0 0 4310 7600430 POTASSIUM CHLORIDE 2 258 0 0 4310 7600448 POTASSIUM CHLORIDE 2 258 0 0 4310 7600489 ZNSO4 HEP/NAI/CU/MAN 258 0 0 4310 7600497 MULTIVITAMINS 258 0 0 4310 7600562 POTASSIUM PHOS M-BAS 258 0 0 4310
7600570 POTASSIUM ACETATE 2 258 0 0 4310 7600620 IV EQUIPMENT 258 0 0 4310 7600638 MALE ADAPTER 258 0 0 4310 7600646 IV ADMINISTRATION SE 258 0 0 4310 7600653 IV ADMIN EXTENSION S 258 0 0 4310 7600703 NITRO PLUMB SET 270 0 0 4310 7600737 PRIMARY IV SET 270 0 0 4310 7600786 CLAVE CONNECTOR 11956 270 0 0 4310 7601636 METRONIDAZOLE 500 MG IV 250 0 0 4300 7601644 FLUCONAZOLE 200 MG IV 636 0 0 4300 7601750 MAGNESIUM 20 GM/500 ML 250 0 0 4300 7690035 MALE ADAPTOR PLUG - 11391 270 0 0 4310 7690043 IV ADMINISTRATION SET-CLAM ML 270 0 0 4310 7690050 EXT SET RESEAL 11957 270 0 0 4310 7690068 DIAL A FLOW W/EXT 19140 270 0 0 4310 7690076 MACRO SET 11961 270 0 0 4310 7690084 7 HIGH PRESSURE SET SS-461 270 0 0 4310 7690092 BLOOD IV SET TYPE Y - 12434 270 0 0 4310 7690100 SURGICAL IV SET 12664 270 0 0 4310 7690118 PUMP FILTERED SET 12030 270 0 0 4310 7690126 NITROGLYCERIN PLUMSET-11878 270 0 0 4310 7690134 BLOOD IV SET - 4602 270 0 0 4310 7690142 SECONDARY SET 32IN 11953 270 0 0 4310 7690159 FLTR SET HIGH-PRES 12273 1SET 270 0 0 4310 7690167 IV SET PRIMARY 11962 270 0 0 4310 7690175 CLAVE CONNECTOR - 11956 270 0 0 4310 7690183 EPIDURAL PUMP TUBING #13514 270 0 0 4310 7690589 PCA PUMP SET 270 0 0 4310 7700065 RE-EVAL COMPX SPEECH&LANG CTCARE 444 0 0 4380 7700305 AAC THER SERVICE NON SPEECH (PROC) 440 0 0 4380 7790074 DEVELOPMENT, COG SKILLS PER 15 MIN 440 0 0 4371 7790751 TREATMENT, SP/LANG, GRP 440 0 0 4371 7790777 EVAL, VOICE PROSTHETIC DEVICE 444 0 0 4371 7800063 RE-EVAL CMPLX SP&LANG CT CARE DLS 444 0 0 4380 7800253 AAC EVAL NON SPEECH (PROC) DLS 444 0 0 4380 7800303 AAC THER NON SPEECH (PROC)DLS 440 0 0 4380 7800352 AAC EVAL SPEECH 1ST HR DLS 444 0 0 4380 7800402 AAC 30 ADD'L MIN DLS 440 0 0 4380 7800501 AAC THER SERVICE (PROC) DLS 440 0 0 4380 7900061 PLFD RE-EVAL CMPLX SP&LANG CT CARE 444 0 0 4380 7900301 AAC THER NON SPEECH (PROC) PLF 440 0 0 4380 8000150 ICU MONITORED 1ST 1/2 HR 370 0 0 4350 8000168 ICU MONITORED ANES EA ADD'L 15 MIN 370 0 0 4350 8000309 INTERSCALENE BLOCK 370 0 0 4350 8012809 H/L MEDICAID B/D ALLOWANCE 0 0 5130 8200156 DLSN RE-EVAL COMPLEX CT CARE (PROC) 424 0 0 4370 8201154 WHIRLPOOL (PROC) DLS 420 0 0 4370
- 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 and 222: 4612685 CX 26 DNA SEQUENCING 300 0
- Page 223 and 224: 5600812 MRI KEN UPEX NO JT WO RT 61
- Page 225: 6500052 MRI-SPECIAL 352 0 0 4270 65
- 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
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7600570 POTASSIUM ACETATE 2 258 0 0 4310<br />
7600620 IV EQUIPMENT 258 0 0 4310<br />
7600638 MALE ADAPTER 258 0 0 4310<br />
7600646 IV ADMINISTRATION SE 258 0 0 4310<br />
7600653 IV ADMIN EXTENSION S 258 0 0 4310<br />
7600703 NITRO PLUMB SET 270 0 0 4310<br />
7600737 PRIMARY IV SET 270 0 0 4310<br />
7600786 CLAVE CONNE<strong>CT</strong>OR 11956 270 0 0 4310<br />
7601636 METRONIDAZOLE 500 MG IV 250 0 0 4300<br />
7601644 FLUCONAZOLE 200 MG IV 636 0 0 4300<br />
7601750 MAGNESIUM 20 GM/500 ML 250 0 0 4300<br />
7690035 MALE ADAPTOR PLUG - 11391 270 0 0 4310<br />
7690043 IV ADMINISTRATION SET-CLAM ML 270 0 0 4310<br />
7690050 EXT SET RESEAL 11957 270 0 0 4310<br />
7690068 DIAL A FLOW W/EXT 19140 270 0 0 4310<br />
7690076 MACRO SET 11961 270 0 0 4310<br />
7690084 7 HIGH PRESSURE SET SS-461 270 0 0 4310<br />
7690092 BLOOD IV SET TYPE Y - 12434 270 0 0 4310<br />
7690100 SURGICAL IV SET 12664 270 0 0 4310<br />
7690118 PUMP FILTERED SET 12030 270 0 0 4310<br />
7690126 NITROGLYCERIN PLUMSET-11878 270 0 0 4310<br />
7690134 BLOOD IV SET - 4602 270 0 0 4310<br />
7690142 SECONDARY SET 32IN 11953 270 0 0 4310<br />
7690159 FLTR SET HIGH-PRES 12273 1SET 270 0 0 4310<br />
7690167 IV SET PRIMARY 11962 270 0 0 4310<br />
7690175 CLAVE CONNE<strong>CT</strong>OR - 11956 270 0 0 4310<br />
7690183 EPIDURAL PUMP TUBING #13514 270 0 0 4310<br />
7690589 PCA PUMP SET 270 0 0 4310<br />
7700065 RE-EVAL COMPX SPEECH&LANG <strong>CT</strong>CARE 444 0 0 4380<br />
7700305 AAC THER SERVICE NON SPEECH (PROC) 440 0 0 4380<br />
7790074 DEVELOPMENT, COG SKILLS PER 15 MIN 440 0 0 4371<br />
7790751 TREATMENT, SP/LANG, GRP 440 0 0 4371<br />
7790777 EVAL, VOICE PROSTHETIC DEVICE 444 0 0 4371<br />
7800063 RE-EVAL CMPLX SP&LANG <strong>CT</strong> CARE DLS 444 0 0 4380<br />
7800253 AAC EVAL NON SPEECH (PROC) DLS 444 0 0 4380<br />
7800303 AAC THER NON SPEECH (PROC)DLS 440 0 0 4380<br />
7800352 AAC EVAL SPEECH 1ST HR DLS 444 0 0 4380<br />
7800402 AAC 30 ADD'L MIN DLS 440 0 0 4380<br />
7800501 AAC THER SERVICE (PROC) DLS 440 0 0 4380<br />
7900061 PLFD RE-EVAL CMPLX SP&LANG <strong>CT</strong> CARE 444 0 0 4380<br />
7900301 AAC THER NON SPEECH (PROC) PLF 440 0 0 4380<br />
8000150 ICU MONITORED 1ST 1/2 HR 370 0 0 4350<br />
8000168 ICU MONITORED ANES EA ADD'L 15 MIN 370 0 0 4350<br />
8000309 INTERSCALENE BLOCK 370 0 0 4350<br />
8012809 H/L MEDICAID B/D ALLOWANCE 0 0 5130<br />
8200156 DLSN RE-EVAL COMPLEX <strong>CT</strong> CARE (PROC) 424 0 0 4370<br />
8201154 WHIRLPOOL (PROC) DLS 420 0 0 4370
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