chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov

More documents

Recommendations

Info

2505642 ART OATS 07mm 270 0 0 3800 2505667 ART OATS 08MM 270 0 0 3800 2505683 ART OATS 09mm 270 0 0 3800 2505709 ART OATS 10mm 270 0 0 3800 2506160 ART TENOSCREW TI4.75 270 0 0 3800 2506186 ART TENOSCREW TI5.5 270 0 0 3800 2506269 ART VULC 90 DEG HP 270 0 0 3800 2506285 ART VULC LIG CHIS CV 270 0 0 3800 2506301 ART VULC LIG CHIS HK 270 0 0 3800 2515005 ENT CAUTERY HI TEMP* 270 0 0 3800 2515633 CRUTCHES-BARIATRIC 270 0 0 3800 2525186 EYE FLUID FILTER 0.2* 270 0 0 3800 2525202 EYE FO ENDO ILLUMINATOR* 270 0 0 3800 2535284 LAP SURGIWAND 270 0 0 3800 2546182 MIS VESSEL LOOP BLUE* 270 0 0 3800 2551844 ORT STEIN PIN SM 5/64* 270 0 0 3800 2580520 URO FASCIAL DILAT 05.0* 270 0 0 3800 2580546 URO FASCIAL DILAT 06.0* 270 0 0 3800 2580561 URO FASCIAL DILAT 08.0* 270 0 0 3800 2580587 URO FASCIAL DILAT 10.0* 270 0 0 3800 2580603 URO FASCIAL DILAT 12.0* 270 0 0 3800 2581387 URO STERILE CORD* 270 0 0 3800 2591006 TKA DURACON AP LIPPED TIBIAL INSERT 278 0 0 3800 3002151 IV TX HYDRAT 31-60 MIN 260 0 0 3700 4500427 CRP 300 0 0 4010 4613543 IA - 2 AB 300 0 0 4010 4615167 CRP QUEST 300 0 0 4010 7507270 PROTIRELIN 500 MCG 636 0 0 4300 8201857 DLSN SPECIAL PROCEDURE (PROC) 420 0 0 4370 8202608 DLSN UNLST CASTING/STRAPPING (PROC) 420 0 0 4370 8301855 PLFD SPECIAL PROCEDURE (PROC) 420 0 0 4370 8302606 PLFD UNLISTED CAST/STRAPPING (PROC) 420 0 0 4370 8401853 SPECIAL PROCEDURE 420 0 0 4370 8402604 UNLST CASTING/STRAP(PROC) 420 0 0 4370 8601858 OT SPECIAL PROCEDURE 430 0 0 4371 8602609 OT UNLST CAST/STRAP (PROC) 430 0 0 4390 8701856 DLSN OT SPECIAL PROCEDURE (PROC) 430 0 0 4390 8702607 DLSN OT UNLST CAST/STRAPPING (PROC) 430 0 0 4390 8801854 PLFD OT SPECIAL PROCEDURE (PROC) 430 0 0 4390 8802605 PLFD OT UNLST CAST/STRAPPING (PROC) 430 0 0 4390 9700006 SELF PAY DISCOUNT ALLOWANCE 0 0 5050 9700055 PERSONAL PAYMENT PAYROLL 0 0 1210 9703927 UNASSIGNED 0 0 5170 9704925 UNASSIGNED 0 0 5210 9705922 UNASSIGNED 0 0 5250 9709106 RETURNED CHECK FEE ADJUSTMENT 0 0 5850 9709809 CHARITY MEDICARE B/D-DED ADJ 0 0 9880
9709817 CHARITY MEDICARE B/D-COINS ADJ 0 0 9880 9709825 CHARITY MEDICARE B/D-N/C ADJ 0 0 9880 9709841 STATE MEDICARE B/D-DED ADJ 0 0 9880 9709858 STATE MEDICARE B/D-COINS ADJ 0 0 9880 9709866 STATE MEDICARE B/D-N/C ADJ 0 0 9880 9720970 MAINE MEDICAID ALLOWANCE 0 0 5210 9800004 SELF PAY B/D O/P ALLOWANCE 0 0 5050 9800053 SELF PAY PAYROLL DEDU<strong>CT</strong>ION ADJ 0 0 1210 9800103 B/D RETURNED CHECK NSF 0 0 1000 9800152 B/D RETURNED CHECK FEE 0 0 5850 9800251 B/D PATIENT CASH TRANSFER 0 0 9900 9800301 B/D INSURANCE CASH TRANSFER 0 0 9900 9801101 MEDICARE MGD CARE B/D O/P ALLOW 0 0 5090 9801119 MEDICARE MGD CARE B/D I/P ALLOW 0 0 5090 9804402 CHAMPUS/TRICARE B/D ALLOWANCE 0 0 5210 9804519 EBPA B/D ALLOWANCE 0 0 5210 9809807 CHARITY B/D MEDICARE-DED ADJ 0 0 9880 9809815 CHARITY B/D MEDICARE-COINS ADJ 0 0 9880 9809823 CHARITY B/D MEDICARE-N/C ADJ 0 0 9880 9809849 STATE B/D MEDICARE-DED ADJ 0 0 9880 9809856 STATE B/D MEDICARE-COINS ADJ 0 0 9880 9809864 STATE B/D MEDICARE-N/C ADJ 0 0 9880 9809989 TFR MEDICARE B/D I/P COST REPORT 0 0 9880 9809997 TFR MEDICARE B/D O/P COST REPORT 0 0 9880 9810003 SELF PAY B/D PAYMENT 0 0 9900 9811100 MEDICARE MANAGED CARE B/D PYMT 0 0 9900 9819996 TFR MEDICARE B/D COST REPORT 0 0 9880 9940800 MEDICAL CLAIMS SERVICE PAYMENT 0 0 1000 9940818 MEDSPAN, INC. PAYMENT 0 0 1000
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 and 24:
2530244 GYN VAG PACKING* 270 0 0 38
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
Page 73 and 74:
4611703 HYPERCOAG. NON-PREG 300 0 0
Page 75 and 76:
4613063 TISSUE PREP 300 0 82.42 401
Page 77 and 78:
4614095 LIDOCAINE AUTO ABS 300 0 26
Page 79 and 80:
4615340 INCUBATION SERUM & DRUGS, E
Page 81 and 82:
4619177 ALDOLASE 300 0 76.25 4010 4
Page 83 and 84:
4620241 HEP BE AG 300 0 90.45 4010
Page 85 and 86:
4621207 FETOMATERNAL HEMORRHAGE SCR
Page 87 and 88:
4622148 THYROID STIM IMMUNOGLOBULIN
Page 89 and 90:
4623146 RUBEOLA ANTIBODIES, IGG 300
Page 91 and 92:
4624086 MUCOR RACEMOSUS, IGE 300 0
Page 93 and 94:
4800041 SPE COLL TRAVEL/MILE 300 0
Page 95 and 96:
5600689 MRI KEN HIP W/CONT RT 610 0
Page 97 and 98:
5800313 MULTIPLE SLEEP LATENCY TEST
Page 99 and 100:
6103758 BONE DENSITY FX EVAL 320 0
Page 101 and 102:
6108906 CYSTO SCOUT FILM 320 0 108.
Page 103 and 104:
6113864 SHLDR-ARTH PRO/INS-RT 761 0
Page 105 and 106:
6201206 MYO-IMAGING-INFARCT 340 0 9
Page 107 and 108:
6306005 COLOR FLOW DOPPLER 480 0 25
Page 109 and 110:
6390132 US-MIDLINE CATHETER 278 0 1
Page 111 and 112:
6502124 MRI-UP EX NO JT W-LT 610 0
Page 113 and 114:
6702245 CT UP EXT W/ CON-RT 352 0 1
Page 115 and 116:
6801187 CHEST INS & EXP LAT 320 0 1
Page 117 and 118:
6802128 MAMMO DIAG DIGITAL RIGHT 40
Page 119 and 120:
6901607 FINGER 2 OR MORE RT 320 0 1
Page 121 and 122:
7000094 MRI-CHEST W/WO CONTR PLF 61
Page 123 and 124:
7001084 MRI-LOEX NO JT W/WO RT-PLF
Page 125 and 126:
7500820 ASPIRIN 325 MG TAB 250 0 0
Page 127 and 128:
7501794 CHOLESTYRAMINE/SUCRO PACKET
Page 129 and 130:
7502768 DULOXETINE 30MG. CAP EC 250
Page 131 and 132:
7503741 HALOPERIDOL LACTATE VIAL 63
Page 133 and 134:
7504723 LIDOCAINE HCL/D7.5W INJ 250
Page 135 and 136:
7505704 MULTIVITAMINS THERAP 250 0
Page 137 and 138:
7506645 PHENAZOPYRIDINE HCL TAB 250
Page 139 and 140:
7507601 SODIUM BICARBONATE SYRINGE
Page 141 and 142:
7508583 ISOPROPYL ALCOHOL SOLN 250
Page 143 and 144:
7509532 ISOSORBIDE MONONITRA T SR 2
Page 145 and 146:
7510506 SUMATRIPTAN SUCCINAT TAB 25
Page 147 and 148:
7511488 BUPROPION HCL 100 MG TAB 25
Page 149 and 150:
7512486 LANTUS INSULIN VIAL 636 0 0
Page 151 and 152:
7513500 POVIDONE-IODINE 10% SOLN 25
Page 153 and 154:
7514649 PYRAZINAMIDE 500MG TAB 250
Page 155 and 156:
7515620 BUSPIRONE 2.5 MG TAB 250 0
Page 157 and 158:
7517618 TETANUS AND DIPTHERIA TOX .
Page 159 and 160:
7600398 CONTAINER EMPTY 500 270 0 0
Page 161 and 162:
7690001 RED CAP LUER LOCK MED SUPPL
Page 163 and 164:
8201709 PROSTETIC TRAIN PER 15 MIN
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 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 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: 9944786 NATIONAL HEALTH INS NASE PA
Page 243 and 244: 90460 0 23000086 A A 35109990 35109
Page 245 and 246: 99213 0 49000030 A A 37209990 37209
Page 247 and 248: 10060 0 A A 37309990 37309990 10061
Page 249 and 250: 0 A A 37309990 37309990 69287 0 A A
Page 251 and 252: 12002 0 26600071 A A 37809990 37809
Page 253 and 254: 28660 0 26600430 A A 37809990 37809
Page 255 and 256: 11305 0 A A 37809990 37809990 11732
Page 257 and 258: 13122 0 26700127 A A 37809990 37809
Page 259 and 260: 0 A A 37809990 37809990 24200 0 A A
Page 261 and 262: 0 A A 38009990 38009990 51059 C1713
Page 263 and 264: 0 A A 38009990 38009990 C1713 0 A A
Page 265 and 266: 0 27570070 A A 38009990 38009990 0
Page 267 and 268: C1713 0 27580842 A A 38009990 38009
Page 269 and 270: C1776 0 A A 38009990 38009990 0 A A
Page 271 and 272: C1713 0 27500061 A A 38009990 38009
Page 273 and 274: 0 27560350 A A 38009990 38009990 50
Page 275 and 276: C1776 0 A A 38009990 38009990 C1776
Page 277 and 278: J9181 0 28100027 A A 42909990 42909
Page 279 and 280: J0886 JW 0 A A 42909990 42909990 J0
Page 281 and 282: 88112 229.69 31791011 A A 40109990
Page 283 and 284: 82247 50.47 31122500 A A 40109990 4
Page 285 and 286: 83986 40.17 31153532 A A 40109990 4
Page 287 and 288: 0 31251522 A A 40109990 40109990 0
Page 289 and 290: 87070 112.27 31370935 A A 40109990
Page 291 and 292:
81003 18.54 31510043 A A 40109990 4
Page 293 and 294:
86658 221.45 31600198 A A 40109990
Page 295 and 296:
82784 95.79 31600539 A A 40109990 4
Page 297 and 298:
83970 335.78 31600719 A A 40109990
Page 299 and 300:
82205 192.61 31610103 A A 40109990
Page 301 and 302:
86003 62.83 31610294 A A 40109990 4
Page 303 and 304:
83840 135.96 31610549 A A 40109990
Page 305 and 306:
85732 19.57 31610663 A A 40109990 4
Page 307 and 308:
86060 90.64 31610780 A A 40109990 4
Page 309 and 310:
86765 179.22 31610938 A A 40109990
Page 311 and 312:
86658 118.45 31611081 A A 40109990
Page 313 and 314:
87591 211.15 31611185 A A 40109990
Page 315 and 316:
82040 25.75 31611304 A A 40109990 4
Page 317 and 318:
84378 184 A A 40109990 40109990 802
Page 319 and 320:
86316 0 A A 40109990 40109990 87497
Page 321 and 322:
83520 0 A A 40109990 40109990 83519
Page 323 and 324:
8325 0 A A 40109990 40109990 83615
Page 325 and 326:
86735 0 A A 40109990 40109990 86738
Page 327 and 328:
86161 0 A A 40109990 40109990 86200
Page 329 and 330:
87109 0 A A 40109990 40109990 87116
Page 331 and 332:
86003 0 A A 40109990 40109990 86003
Page 333 and 334:
86790 115.36 31800010 A A 40109990
Page 335 and 336:
73721 LT 0 A A 42759990 42759990 73
Page 337 and 338:
73223 RT 0 A A 42759990 42759990 A9
Page 339 and 340:
93016 0 A A 41209990 41209990 93018
Page 341 and 342:
73590 LT 3.502 34021330 A A 4211999
Page 343 and 344:
49450 0 A A 42119990 42119990 49440
Page 345 and 346:
19030 RT 1.566 34061993 A A 4211999
Page 347 and 348:
A9538 2.554 35303930 A A 42409990 4
Page 349 and 350:
40.17 36069628 A A 42519990 4251999
Page 351 and 352:
72148 17.757 45101136 A A 42709990
Page 353 and 354:
71250 6.798 46000905 A A 42609990 4
Page 355 and 356:
75989 0 A A 42609990 42609990 49421
Page 357 and 358:
73620 LT 2.348 A A 42129990 4212999
Page 359 and 360:
72040 2.884 A A 42139990 42139990 7
Page 361 and 362:
72114 7.004 A A 42139990 42139990 7
Page 363 and 364:
73221 LT 0 A A 42739990 42739990 73
Page 365 and 366:
J3490 0 37000039 A A 43009990 43009
Page 367 and 368:
J3490 0 37000193 A A 43009990 43009
Page 369 and 370:
J1100 0 37000371 A A 43009990 43009
Page 371 and 372:
J3490 0 37000527 A A 43009990 43009
Page 373 and 374:
J1815 0 37000670 A A 43009990 43009
Page 375 and 376:
J3490 0 37000848 A A 43009990 43009
Page 377 and 378:
J3490 0 37001005 A A 43009990 43009
Page 379 and 380:
J0780 0 37001148 A A 43009990 43009
Page 381 and 382:
J3260 0 37001333 A A 43009990 43009
Page 383 and 384:
J3490 0 37001596 A A 43009990 43009
Page 385 and 386:
J3490 0 37002285 A A 43009990 43009
Page 387 and 388:
J3490 0 37002628 A A 43009990 43009
Page 389 and 390:
J3490 0 37003982 A A 43009990 43009
Page 391 and 392:
J3490 0 37004115 A A 43009990 43009
Page 393 and 394:
J1335 0 A A 43009990 43009990 J3490
Page 395 and 396:
C9399 0 A A 43009990 43009990 90632
Page 397 and 398:
J3490 0 A A 43009990 43009990 J3490
Page 399 and 400:
J3490 0 37404139 A A 43009990 43009
Page 401 and 402:
J1450 0 A A 43109990 43109990 J2543
Page 403 and 404:
0 42400221 A A 43729990 43729990 0
Page 405 and 406:
97762 30 A A 43739990 43739990 9754
Page 407 and 408:
97113 15 48000144 A A 43719990 4371
Page 409 and 410:
29520 15 48300131 A A 43739990 4373
Page 411 and 412:
94200 426.42 47000062 A A 43409990
Page 413 and 414:
G8998 GN 0 A A 43719990 43719990 G8
Page 415 and 416:
G9171 GN 0 A A 43719990 43719990 G9
Page 417 and 418:
G8984 GP 0 A A 43719990 43719990 G8
Page 419 and 420:
G8986 GO 0 A A 43719990 43719990 G8
Page 421 and 422:
0 A A 51705010 51705220 0 A A 52105
Page 423 and 424:
0 A A 52105010 52105220 0 A A 52105
Page 425 and 426:
0 A A 52505010 52505220 0 A A 52505
Page 427 and 428:
0 A A 12001300 98809400 0 A A 98809
Page 429 and 430:
0 A A 10151000 10001000 0 A A 10061
Page 431 and 432:
0 A A 56205620 10001000 0 A A 56305
Page 433 and 434:
0 A A 70107960 10001000 0 A A 71307
Page 435 and 436:
0 A A 83107960 10001000 0 A A 83207
Page 437 and 438:
0 A A 12101300 12101300 0 A A 10001
Page 439 and 440:
0 A A 10001000 10001000 0 A A 10001
Page 441 and 442:
0 A A 10001000 10001000 0 A A 10001
Page 443 and 444:
0 A A 10001000 10001000 0 A A 10001
Page 445 and 446:
0 D D 43209990 43209990 0 D D 43209
Page 447 and 448:
27200 0 26600325 D D 37809990 37809
Page 449 and 450:
12054 0 26700112 D D 37809990 37809
Page 451 and 452:
32422 0 26700495 D D 37809990 37809
Page 453 and 454:
0 27300121 D D 37219990 37219990 0
Page 455 and 456:
0 27500066 D D 38009990 38009990 0
Page 457 and 458:
J9395 0 28100074 D D 42909990 42909
Page 459 and 460:
83912 36.05 31610152 D D 40109990 4
Page 461 and 462:
83912 142.14 31611065 D D 40109990
Page 463 and 464:
83890 0 D D 40109990 40109990 83890
Page 465 and 466:
78452 39.181 35091172 D D 42409990
Page 467 and 468:
J3490 0 37001142 D D 43009990 43009
Page 469 and 470:
97010 15 41200107 D D 43709990 4370
Page 471 and 472:
L3835 90 41300011 D D 43709990 4370
Page 473 and 474:
L0210 90 41000090 D D 43709990 4370
Page 475 and 476:
L3860 90 48200015 D D 43909990 4390
Page 477 and 478:
90847 0 D D 44709990 44709990 90849
Page 479 and 480:
0 D D 10001000 10001000 0 D D 10001
Page 481 and 482:
0 I I 38009990 38009990 51180 0 I I
Page 483 and 484:
CBDSC MTDQTY YTDQTY MED/SURG, SEMI-
Page 485 and 486:
ITEL IV TX HYDRA ADD'L 224 HR 224 I
Page 487 and 488:
ACU VISIT 5 5 ENDO DUAL VISIT 0 0 S
Page 489 and 490:
EX MAL LES FACE 4.0 0 CM 0 DEBRIDE
Page 491 and 492:
IV TX HYDRA ADD'L HR0 0 VACCINE INJ
Page 493:
RADIAL SHFT FX W/MAN 0 0 FX CARE W/
Page 496 and 497:
SHAVING SKIN LESION 0
Page 498 and 499:
CMPLX SC EXTS EA ADD 0 0 CMPLX FACE
Page 500 and 501:
SUTURE REMOVAL-DKH 0 0 REMOVAL FB U
Page 502 and 503:
ART FASTFIX KNT PSHR2 2 ART FASTFIX
Page 504 and 505:
LAP UNIV TROCAR SLVE 14 5MM 14 ART
Page 506 and 507:
MIS DRAIN BAKER JEJUN 0 0 MIS DRAIN
Page 508 and 509:
ORT MITEK SUPER 0 0 ORT PLATE HUMER
Page 510 and 511:
TKA X3 TRIATHLON CS 0 INS 0 TOPAZ W
Page 512 and 513:
STAPLE PURSESTRING0 0 STAPLE PURSTR
Page 514 and 515:
URO CATH SILIC 22/3WAY* 0 0 URO CAT
Page 516 and 517:
THA ACCOLADE C CS 0127NK 0 THA ACCO
Page 518 and 519:
ETOPOSIDE 20 MG/ML 450 VIAL 450 FLU
Page 520 and 521:
EPOGEN 1000 UNITS 0WASTAGE 0 EPOGEN
Page 522 and 523:
CYTO SPUTUM 0 0 CYTO URINE 6 6 CYTO
Page 524 and 525:
BILIRUBIN TOTAL 25 25 BILIRUBIN DIR
Page 526 and 527:
GASTRIC PH 0 0 CSF GLUCOSE 7 7 FLUI
Page 528 and 529:
DIFFERENTIAL/MANUAL 797 797 SMEAR R
Page 530 and 531:
WOUND CULTURE124 124 BLOOD CULTURE
Page 532 and 533:
PH URINE 0 0 SPEC.GRAVITY URINE0 0
Page 534 and 535:
ECHOVIRUS AB 0 0 HLA A,B TYPING DNA
Page 536 and 537:
IGA 26 26 IGM 26 26 PORPHYRINS, RAN
Page 538 and 539:
PTH N TERM INTACT 0 0 SEROTONIN-SER
Page 540 and 541:
BARBITURATES,SERUM0 0 BARBITURATES,
Page 542 and 543:
IBT RAST ALLERGEN 24 12 24 SGPG 0 0
Page 544 and 545:
METHADONE,UR 0 0 HEPATITIS E IGM 0
Page 546 and 547:
SUBSTITUTION PLASMA 0 0 RMSF IGG 0
Page 548 and 549:
ANTI-STREPTOLYSIN O3 3 S.CEREVISIAE
Page 550 and 551:
RUBEOLA AB,IGG 28 28 SEX HORMONE BI
Page 552 and 553:
COXSACKIE B2 AB 0 0 COXSACKIE B3 AB
Page 554 and 555:
N.GONORRHOEAE RNA 0 0 CORTISONE,SER
Page 556 and 557:
ALBUMIN 0 0 YERSINIA AB 1 1 JANUS K
Page 558 and 559:
GLYCOMARK 0 0 STREPTOMYCIN 0 0 THYR
Page 560 and 561:
CHROMAGRANIN A 3 3 CMV DNA QUANT RT
Page 562 and 563:
ANTI MULLERIAN HORMONE 0 0 TSH ANTI
Page 564 and 565:
INSULIN 0 0 LD, BODY FLUID 0 0 LACT
Page 566 and 567:
MUMPS ANTIBODIES, 0IGG 0 MYCOPLASMA
Page 568 and 569:
C1 ESTERASE INHIB, FUNC 0 0 CCP ANT
Page 570 and 571:
UREAPLASMA MYCOPLASMA 0 HOM 0 MYCOB
Page 572 and 573:
COCONUT, IGE 0 0 ONIONS, IGE 0 0 PI
Page 574 and 575:
PARAINFLUENZA TYPE 0 I 0 PARAINFLUE
Page 576 and 577:
MRI KEN KNEE WO CONT 9 LT 9 MRI KEN
Page 578 and 579:
MRI KEN UPEXT W/WO 0 CON RT 0 MRI K
Page 580 and 581:
PRO FEE STRESS MD SUPERVS 0 0 PRO F
Page 582 and 583:
LOWER LEG-LEFT 7 7 LOWER LEG-RIGHT
Page 584 and 585:
GASTRO TUBE REPLACEMENT 1 1 INSERT
Page 586 and 587:
MAMMO DUCT PROC-RT 1 1 HIP-2 VIEWS
Page 588 and 589:
PYROPHOSPHATE 7 7 I 123 - 200 2 2 S
Page 590 and 591:
US-BIOPSY PROC-PANCR 0 0 US-BIOPSY-
Page 592 and 593:
MRI-LS SPINE W/O CON 43 43 MRI-LS S
Page 594 and 595:
CT CHEST HIGH RESOLU 0 W/O 0 CT CHE
Page 596 and 597:
CT INTRAPERI CATHETER 0 0 CT INTRAP
Page 598 and 599:
FOOT LT(2 VIEWS) 0 0 FOOT RT(2 VIEW
Page 600 and 601:
CERV SPINE TWO VIEW0 0 CERV SPINE W
Page 602 and 603:
LS SPINE&OBL&FLEX&EX 0 6 VW 0 LS SP
Page 604 and 605:
MRI WRIST WO CON 0LT PLF 0 MRI-WRIS
Page 606 and 607:
CALCITRIOL 0.25 MCG 5 CAP 5 ALLOPUR
Page 608 and 609:
CALCIUM CHLORIDE 10% 0 VIAL 0 CANDE
Page 610 and 611:
DEXAMETHASONE 492 4MG/ML VIAL 492 D
Page 612 and 613:
FIORINAL CAP GENERIC 2 CAP 2 FLUNIS
Page 614 and 615:
HUMALOG MIX 75/250 INSULIN 0 ITRACO
Page 616 and 617:
METHENAMINE 1 GM 0TAB 0 METHOCARBAM
Page 618 and 619:
NITROGLYCERIN 0.4MG 0 SL SP 0 NITRO
Page 620 and 621:
PROCHLORPERAZINE 110 MG VI 1 PROCAI
Page 622 and 623:
TOBRAMYCIN 80 MG/2ML 11 VIAL11 TOBR
Page 624 and 625:
AMIODARONE 200 MG 16 TAB 16 CAFFEIN
Page 626 and 627:
VITAMIN E 200 UNIT 0CAP 0 LAMOTRIGI
Page 628 and 629:
ATORVASTATIN 40205 MG TAB 205 GUAIF
Page 630 and 631:
FLUVASTATIN 20 MG 0CAP 0 CASTOR OIL
Page 632 and 633:
PRAMIPEXOLE .25MG 0TAB 0 AMOXICILLI
Page 634 and 635:
ERTAPENEM 1GM ADDV 0 0 GLYCOPYRROLA
Page 636 and 637:
FOSPROPOFOL 1050MG/30ML 0 0 HAVRIX
Page 638 and 639:
BACITRACIN 50 MU INJ 4 VIAL 4 DRONE
Page 640 and 641:
ACETAMINOPH 100MG/ML 0 DROP0 REPAGL
Page 642 and 643:
FLUCONAZOLE 400 MG/200 0 ML 0 ZOSYN
Page 644 and 645:
SP-CANCEL VISIT DLS0 0 SP-ABSENT DL
Page 646 and 647:
CHCKOT ORTH PROS 0PER 15 0 WHEELCHA
Page 648 and 649:
OT AQUATIC REHAB/15 0 MIN 0 OT ORTH
Page 650 and 651:
HIP STRAP (PROC) PLF0 0 SENSORY INT
Page 652 and 653:
M V V 0 0 METHACHOLINE EVAL5 5 ARTE
Page 654 and 655:
SWALLOW D/C STATUS 1 1 SWALLOW D/C
Page 656 and 657:
VOICE CURRENT STATUS 0 0 VOICE CURR
Page 658 and 659:
CARRY CURRENT STATUS 2 2 CARRY CURR
Page 660 and 661:
CARRY D/C STATUS 0 0 SELF CARE CURR
Page 662 and 663:
SUPP BLUE CROSS -237 ALLOW -237 SUP
Page 664 and 665:
GOLDEN RULE ALLOW -38 -38 GREAT WES
Page 666 and 667:
H/L SAGA ADMINISTRATION 0 0 H/L SAG
Page 668 and 669:
TFR FROM B/D TO A/R3 3 TFR FROM A/R
Page 670 and 671:
PHYS PRAC ATHENA CASH 0 0 MEDICAL O
Page 672 and 673:
CAFETERIA SALES CAFE 0 0 CAFETERIA
Page 674 and 675:
LABORATORY - UTILITIES 0 0 CARDIA R
Page 676 and 677:
OPER OF PLANT-GAS0 0 NON MEDICAL SU
Page 678 and 679:
PERSONAL PYMT (P/R -37DED) -37 TCOR
Page 680 and 681:
BLUE CROSS OF RI PAYMENT -88 -88 OU
Page 682 and 683:
SEVEN CORNERS PAYMENT 0 0 IMG PAYME
Page 684 and 685:
ZZ OHM UNSPECIFIED 0PYMT 0 ZZ STERL
Page 686 and 687:
SITE ASSESSMENT 0 0 SITE ASSESSMENT
Page 688 and 689:
TX COCCYGEAL FX 0 0 HIP DISLOCW/O A
Page 690 and 691:
CL INTE FACE7.6-12.50 0 LYR FACE 12
Page 692 and 693:
THORACENTESIS W/TUBE 0 0 TUBE THOR
Page 694 and 695:
POST-OP SHOE 0 0 T-LOOP ELECTRODE 0
Page 696 and 697:
SYN L PL DCP BR 07 H0 0 SYN L PL DC
Page 698 and 699:
FULVESTRANT 125 MG 0 SYRING 0 CYTAR
Page 700 and 701:
KENNEDY DISEASE DNA 0 0 APOLIPO.E G
Page 702 and 703:
MEN2/FMTC MUTATIONS 0 0 COMPLETE CM
Page 704 and 705:
PCR BY IMUGEN 0 0 A PHAGOCYTOPHILUM
Page 706 and 707:
PLANAR CARDIAC RE&EX 0 0 PLANAR CAR
Page 708 and 709:
PROCAINAMIDE SR 500 MG TA 0 TEGASER
Page 710 and 711:
DLSN MOIST HEAT/CRYO(PROC 0 0 FUNCT
Page 712 and 713:
PLFD WHFOADDSPREXT 0 L3835 0 PLFD W
Page 714 and 715:
VIDEO FLUORO EVAL I0 0 OT REEVAL CP
Page 716 and 717:
DLSN OT WHFOADMPFLXIL3860 0 0 DLSN
Page 718 and 719:
PRO FEE FAMILY THERAPY 0 0 PROF FEE
Page 720 and 721:
MISC MEDICARE MCO 0 PMT 0 NATIONAL
Page 722 and 723:
ART OATS 07MM 0 0 ART OATS 08MM 0 0
show all

chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov

Create successful ePaper yourself

Delete template?

Save as template?