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
2545309 MIS DRAIN BAKER JEJUN 270 0 298.3 3800 2545325 MIS DRAIN HEMOVAC 270 0 49.05 3800 2545341 MIS DRAIN J P 270 0 163.9 3800 2545366 MIS DRAIN SALEM SUMP* 270 0 0 3800 2545382 MIS DRAIN T TUBE 10FR* 270 0 0 3800 2545408 MIS DRAIN T TUBE 12FR* 270 0 0 3800 2545465 MIS DRAPES C/ARM* 270 0 0 3800 2545481 MIS ESU SMOKE/P FILTER* 270 0 0 3800 2545507 MIS ESU SMOKE/PENCIL 270 0 59.9 3800 2545523 MIS ESU SMOKE/TUBING 270 0 43.25 3800 2545549 MIS FRED ANTIFOG* 270 0 0 3800 2545564 MIS GEL FOAM 100 270 0 85.35 3800 2545580 MIS GEL FOAM 12 -7* 270 0 0 3800 2545606 MIS GIGLI SAW BLADE 270 0 64.7 3800 2545622 MIS HICKMAN DUAL 278 0 354.3 3800 2545648 MIS HICKMAN SINGLE 278 0 418 3800 2545663 MIS HOLLISTER KIT 270 0 41.2 3800 2545689 MIS LEVEEN SHUNT 270 0 915.4 3800 2545705 LIGASURE V 270 0 973.35 3800 2545721 MIS LIGASURE MAX 270 0 278.1 3800 2545747 MIS LIGASURE STD 270 0 316.1 3800 2545762 MIS LIGASURE XTD 270 0 335.25 3800 2545788 MIS LVL I ANES 270 0 97.3 3800 2545804 MIS MICROSCOPE DRAPE* 270 0 0 3800 2545820 MIS PUDDLE VAC 270 0 80.35 3800 2545861 MIS SQ PORT DBL LMN 278 0 1081.5 3800 2545887 MIS SQ PORT SNGL LMN 278 0 515 3800 2545903 MIS SURGICEL 4X8 270 0 130.65 3800 2545929 MIS TAPE UMBILICAL 270 0 56.3 3800 2545945 MIS THOROCEAL 270 0 145.9 3800 2545960 MIS TRACH TUBE 270 0 209.3 3800 2546000 MIS TRU-CUT NEEDLE 270 0 94.2 3800 2546042 MIS U-DRAPE* 270 0 0 3800 2546083 MIS URIMETER* 270 0 0 3800 2546125 MIS VEIN PIK 270 0 61.8 3800 2546141 MIS VEIN STRIPPER DISPO 270 0 80.35 3800 2546166 MIS VENA CAVA CLIPS 270 0 396.75 3800 2546208 MIS VESSSEL LOOP RED* 270 0 0 3800 2546216 APLIGRAF PER SQ CM 636 0 77.44 3800 2550002 ORT BLADE INDI TOME 270 0 317.25 3800 2550028 ORT CAST ARM LONG 270 0 82.4 3800 2550044 ORT CAST ARM SHORT 270 0 61.8 3800 2550069 ORT CAST HIP SPICA 270 0 288.4 3800 2550085 ORT CAST LEG LONG 270 0 154.5 3800 2550101 ORT CAST LEG SHORT 270 0 78.8 3800 2550127 ORT CAST SPLINT ARM 270 0 82.4 3800 2550143 ORT CAST SPLINT LEG 270 0 92.7 3800
2550226 ORT CRV-TC CART MED 270 0 780.25 3800 2550242 ORT CRV-TC NDL MED* 270 0 0 3800 2550267 ORT CURV-TECH CART LG 270 0 780.25 3800 2550283 ORT CURV-TECH NDL LG* 270 0 0 3800 2550309 ORT DALL-MILE CBL BD 278 0 696.9 3800 2550325 ORT DALL-MILE CBL SS 1.6 278 0 402.3 3800 2550341 ORT DALL-MILE CBL VI 278 0 658.4 3800 2550366 ORT DALL-MILE G/C LG 278 0 1380.25 3800 2550382 ORT DALL-MILE G/C MD 278 0 1403.2 3800 2550465 ORT DALL-MILES CBL SS 2.0 278 0 501.32 3800 2550481 ORT DALL-MILES G/C 5MM 278 0 1380.25 3800 2550507 ORT DALL-MILES PL 8" 278 0 711.65 3800 2550523 ORT FLEX OSTEO CRV 12 270 0 268.85 3800 2550549 ORT FLEX OSTEO CRV 15 270 0 268.85 3800 2550564 ORT FLEX OSTEO FLT 10 270 0 268.85 3800 2550580 ORT FLEX OSTEO FLT 12 270 0 268.85 3800 2550606 ORT FLEX OSTEO FLT 15 270 0 268.85 3800 2550622 ORT FLEX OSTEOTOMES 270 0 580.9 3800 2550648 ORT FLEXI LUM 270 0 86.5 3800 2550689 ORT GRAFT CAN/CORT 270 0 737.5 3800 2550705 ORT Graft DBM 10cc 278 0 2231.92 3800 2550721 ORT Graft DBM 2cc 278 0 573.6 3800 2550747 ORT Graft DBM 5cc 278 0 1275.12 3800 2550762 ORT GRAFT PRO-OS 15CC 278 0 1468.32 3800 2550788 ORT GRAFT PRO-OS 30CC 278 0 1990.88 3800 2550804 ORT GRAFT PRO-OS 500 278 0 2340 3800 2550820 ORT JURGAN BALL .045* 278 0 13.32 3800 2550846 ORT JURGAN BALL .062* 278 0 13.32 3800 2550861 ORT JURGAN BALL 3/32* 278 0 13.32 3800 2550887 ORT JURGAN BALL 5/32* 278 0 13.32 3800 2550903 ORT JURGAN BALL 5/64* 278 0 13.32 3800 2550929 ORT JURGAN BALL X003* 278 0 13.32 3800 2550945 ORT JURGAN BALL X006* 278 0 13.32 3800 2550960 ORT KNEE IMMOB 18" 270 0 139.05 3800 2550986 ORT KNEE IMMOB 23" 270 0 166.85 3800 2551000 ORT KNEE IMMOB 28 270 0 213.2 3800 2551026 ORT KNEE IMMOBILIZER 13" 274 0 98.9 3800 2551042 ORT K-WIRE SMTH .035* 278 0 7.5 3800 2551067 ORT K-WIRE SMTH .045* 278 0 15 3800 2551083 ORT K-WIRE SMTH .054* 278 0 7.5 3800 2551109 ORT K-WIRE SMTH .062* 278 0 7.5 3800 2551125 ORT K-WIRE THD .062 278 0 52.85 3800 2551141 ORT LAMIN PILLOW* 270 0 0 3800 2551166 ORT MINI C/ARM DRAPE* 270 0 0 3800 2551208 ORT MITEK GII 278 0 560.3 3800 2551224 ORT MITEK MICRO 278 0 568.55 3800 2551240 ORT MITEK MINI 278 0 558.25 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 and 22: 2510360 ASNIS 6.5 THD G/WIRE 270 0
- Page 23: 2530244 GYN VAG PACKING* 270 0 0 38
- 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
- Page 73 and 74: 4611703 HYPERCOAG. NON-PREG 300 0 0
2545309 MIS DRAIN BAKER JEJUN 270 0 298.3 3800<br />
2545325 MIS DRAIN HEMOVAC 270 0 49.05 3800<br />
2545341 MIS DRAIN J P 270 0 163.9 3800<br />
2545366 MIS DRAIN SALEM SUMP* 270 0 0 3800<br />
2545382 MIS DRAIN T TUBE 10FR* 270 0 0 3800<br />
2545408 MIS DRAIN T TUBE 12FR* 270 0 0 3800<br />
2545465 MIS DRAPES C/ARM* 270 0 0 3800<br />
2545481 MIS ESU SMOKE/P FILTER* 270 0 0 3800<br />
2545507 MIS ESU SMOKE/PENCIL 270 0 59.9 3800<br />
2545523 MIS ESU SMOKE/TUBING 270 0 43.25 3800<br />
2545549 MIS FRED ANTIFOG* 270 0 0 3800<br />
2545564 MIS GEL FOAM 100 270 0 85.35 3800<br />
2545580 MIS GEL FOAM 12 -7* 270 0 0 3800<br />
2545606 MIS GIGLI SAW BLADE 270 0 64.7 3800<br />
2545622 MIS HICKMAN DUAL 278 0 354.3 3800<br />
2545648 MIS HICKMAN SINGLE 278 0 418 3800<br />
2545663 MIS HOLLISTER KIT 270 0 41.2 3800<br />
2545689 MIS LEVEEN SHUNT 270 0 915.4 3800<br />
2545705 LIGASURE V 270 0 973.35 3800<br />
2545721 MIS LIGASURE MAX 270 0 278.1 3800<br />
2545747 MIS LIGASURE STD 270 0 316.1 3800<br />
2545762 MIS LIGASURE XTD 270 0 335.25 3800<br />
2545788 MIS LVL I ANES 270 0 97.3 3800<br />
2545804 MIS MICROSCOPE DRAPE* 270 0 0 3800<br />
2545820 MIS PUDDLE VAC 270 0 80.35 3800<br />
2545861 MIS SQ PORT DBL LMN 278 0 1081.5 3800<br />
2545887 MIS SQ PORT SNGL LMN 278 0 515 3800<br />
2545903 MIS SURGICEL 4X8 270 0 130.65 3800<br />
2545929 MIS TAPE UMBILICAL 270 0 56.3 3800<br />
2545945 MIS THOROCEAL 270 0 145.9 3800<br />
2545960 MIS TRACH TUBE 270 0 209.3 3800<br />
2546000 MIS TRU-CUT NEEDLE 270 0 94.2 3800<br />
2546042 MIS U-DRAPE* 270 0 0 3800<br />
2546083 MIS URIMETER* 270 0 0 3800<br />
2546125 MIS VEIN PIK 270 0 61.8 3800<br />
2546141 MIS VEIN STRIPPER DISPO 270 0 80.35 3800<br />
2546166 MIS VENA CAVA CLIPS 270 0 396.75 3800<br />
2546208 MIS VESSSEL LOOP RED* 270 0 0 3800<br />
2546216 APLIGRAF PER SQ CM 636 0 77.44 3800<br />
2550002 ORT BLADE INDI TOME 270 0 317.25 3800<br />
2550028 ORT CAST ARM LONG 270 0 82.4 3800<br />
2550044 ORT CAST ARM SHORT 270 0 61.8 3800<br />
2550069 ORT CAST HIP SPICA 270 0 288.4 3800<br />
2550085 ORT CAST LEG LONG 270 0 154.5 3800<br />
2550101 ORT CAST LEG SHORT 270 0 78.8 3800<br />
2550127 ORT CAST SPLINT ARM 270 0 82.4 3800<br />
2550143 ORT CAST SPLINT LEG 270 0 92.7 3800
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