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
4619748 INSULIN 300 0 89.82 4010 4619755 LD, BODY FLUID 300 0 47.43 4010 4619763 LACTOFERRIN 300 0 155.79 4010 4619771 LEAD, BLOOD, ADULT 300 0 95 4010 4619789 LEAD, BLOOD, PEDIATRIC 300 0 95 4010 4619797 L/S RATIO 300 0 172.6 4010 4619805 LIPOPROTEIN(A) 300 0 102.78 4010 4619813 IODINE, SERUM OR PLASMA 300 0 141.8 4010 4619821 PG, A F 300 0 129.76 4010 4619839 LIPID-ASSOCIATED SIALIC ACID 300 0 105.44 4010 4619847 IMMUNOFIXATION, URINE 300 0 232.94 4010 4619854 INSULIN ANTIBODIES 300 0 130.39 4010 4619862 INTRINSIC FACTOR ABS, SERUM 300 0 118.35 4010 4619870 LEGIONELLA PNEUMOPHILIA ABS 300 0 120.15 4010 4619888 L. PNEUMOPHILA SEROGP 1 UR AG 300 0 94.19 4010 4619896 HLA B 27 DISEASE ASSOCIATION 300 0 63 4010 4619904 IL28B POLYMORPHISM GENOTYPE 300 0 120 4010 4619912 ALBUMIN, SERUM 300 0 35.8 4010 4619920 ALBUMIN, CSF 300 0 40.61 4010 4619938 ARSENIC, 24 HR URINE 300 0 148.97 4010 4619946 CREATININE, 24 HR URINE 300 0 40.61 4010 4619953 IMMUNOGLOBULIN, QN 300 0 73.01 4010 4619987 IGG, SUBCLASS 300 0 108.36 4010 4619995 HISTAMINE, PLASMA 300 0 231.86 4010 4620019 HOMOCYST(E)INE, PLASMA 300 0 132.44 4010 4620027 IGF-BP3 300 0 101.63 4010 4620035 INHIBIN B 300 0 101.63 4010 4620043 LEAD, 24 HR URINE 300 0 95 4010 4620050 MERCURY, 24 HR URINE 300 0 127.67 4010 4620068 HYDROCODONE + METABOLITES, U 300 0 152.78 4010 4620076 HYDROCODONE AND METABOLITE 300 0 152.78 4010 4620084 IGF-1 300 0 166.91 4010 4620092 HEPARIN ANTI-XA 300 0 68.69 4010 4620100 HGB SOLUBILITY 300 0 40.79 4010 4620118 HEPARIN INDUCED PLATELET 300 0 144.18 4010 4620126 IND ANTIPLATELET ALLOANTIBODY 300 0 144.18 4010 4620134 IMMUNOFIXATION ELECTROPHORESIS 300 0 175.39 4010 4620142 INHIBIN A, ULTRASENSITIVE 300 0 371.57 4010 4620159 HELICOBACTER PYLORI, IGA 300 0 113.92 4010 4620167 HELICOBACTER PYLORI, IGM AB 300 0 113.92 4010 4620175 HSV, IGM I/II COMBINATION 300 0 152.66 4010 4620183 HEP B CORE AB, TOT 300 0 94.66 4010 4620191 HEP B CORE AB, IGM 300 0 92.43 4010 4620209 HEP B SURFACE AB 300 0 84.31 4010 4620217 HEP BE AB 300 0 90.79 4010 4620225 HEPATITIS A AB, IGM 300 0 97.27 4010 4620233 HSV CULTURE AND TYPING 300 0 268.79 4010
4620241 HEP BE AG 300 0 90.45 4010 4620258 HISTOPLASMA ANTIGEN, URINE 300 0 94.19 4010 4620266 HCV GENOTYPING NON REFLEX 300 0 898.34 4010 4620274 HSV 1/2 PCR 300 0 275.54 4010 4620308 PHENOBARBITAL, SERUM 300 0 59.96 4010 4620316 PRIMIDONE 300 0 86.85 4010 4620324 VANCOMYCIN TROUGH, SERUM 300 0 70.91 4010 4620332 ZONISAMIDE(ZONEGRAN), SERUM 300 0 94.53 4010 4620340 PORPHOBILINOGEN, QN, RANDOM UR 300 0 44.24 4010 4620357 PREALBUMIN 300 0 76.35 4010 4620365 PROGESTERONE 300 0 109.2 4010 4620373 PROINSULIN 300 0 88.14 4010 4620381 ZINC, PLASMA, OR SERUM 300 0 59.61 4010 4620399 PROTEIN C ANTIGEN 300 0 62.91 4010 4620407 PROTEIN C FUNCTIONAL 300 0 72.38 4010 4620415 PROTEIN S, TOTAL 300 0 60.68 4010 4620423 PROTEIN S, FREE 300 0 80.22 4010 4620431 PROTEIN S FUNCTIONAL 300 0 80.22 4010 4620449 PNEUMOCYSTIS SMEAR, DFA 300 0 62.79 4010 4620456 NICOTINE METABOLITE, URINE 300 0 72.08 4010 4620464 PHENOBARBITAL, SERUM 300 0 59.96 4010 4620472 PHENYTOIN, FREE, SERUM 300 0 72.08 4010 4620480 MTHFR 300 0 157.5 4010 4620498 OLANZAPINE(ZYPREXA) 300 0 94.53 4010 4620506 OXCARBAZEPINE (TRILEPTAL),S 300 0 94.53 4010 4620514 MITOCHONDRIAL (M2) ANTIBODY 300 0 60.41 4010 4620522 NMO IGG AUTOANTIBODIES 300 0 67.76 4010 4620530 MAGNESIUM, RBC 300 0 35.07 4010 4620548 MAGNESIUM, URINE 300 0 35.07 4010 4620555 MERCURY, BLOOD 300 0 85.11 4010 4620563 METANEPHRINES, FRAC, QN, 24-HR 300 0 88.67 4010 4620571 METANEPHRINES, FRAC., PL. FREE 300 0 88.67 4010 4620589 METHADONE (DOLOPHINE), SERUM 300 0 85.44 4010 4620597 MYELIN BASIC PROTEIN, CSF 300 0 90.06 4010 4620605 MYOGLOBIN, SERUM 300 0 67.58 4010 4620613 MYOGLOBIN, URINE 300 0 67.58 4010 4620621 OLIGOCLONAL BANDING 300 0 105.26 4010 4620639 ORGANIC ACID ANALYSIS, URINE 300 0 86.16 4010 4620647 METHYLMALONIC ACID, SERUM 300 0 86.16 4010 4620654 OXYCODONE AND METABOLITE 300 0 101.85 4010 4620662 OXYCODONE AND METABOLITE 300 0 101.85 4010 4620670 OXALATE, QUANT, 24-HOUR URINE 300 0 67.43 4010 4620688 PH, STOOL 300 0 18.75 4010 4620696 LYSOZYME, SERUM 300 0 98.18 4010 4620704 PLATELET AUTOANTIBODY PANEL 300 0 78.48 4010 4620712 PNEUMOCOCCAL IMMUNITY 14 TYPE 300 0 78.48 4010 4620720 LIVER-KIDNEY MICROSOMAL AB 300 0 65.72 4010
- 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: 4619177 ALDOLASE 300 0 76.25 4010 4
- 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
4619748 INSULIN 300 0 89.82 4010<br />
4619755 LD, BODY FLUID 300 0 47.43 4010<br />
4619763 LA<strong>CT</strong>OFERRIN 300 0 155.79 4010<br />
4619771 LEAD, BLOOD, ADULT 300 0 95 4010<br />
4619789 LEAD, BLOOD, PEDIATRIC 300 0 95 4010<br />
4619797 L/S RATIO 300 0 172.6 4010<br />
4619805 LIPOPROTEIN(A) 300 0 102.78 4010<br />
4619813 IODINE, SERUM OR PLASMA 300 0 141.8 4010<br />
4619821 PG, A F 300 0 129.76 4010<br />
4619839 LIPID-ASSOCIATED SIALIC ACID 300 0 105.44 4010<br />
4619847 IMMUNOFIXATION, URINE 300 0 232.94 4010<br />
4619854 INSULIN ANTIBODIES 300 0 130.39 4010<br />
4619862 INTRINSIC FA<strong>CT</strong>OR ABS, SERUM 300 0 118.35 4010<br />
4619870 LEGIONELLA PNEUMOPHILIA ABS 300 0 120.15 4010<br />
4619888 L. PNEUMOPHILA SEROGP 1 UR AG 300 0 94.19 4010<br />
4619896 HLA B 27 DISEASE ASSOCIATION 300 0 63 4010<br />
4619904 IL28B POLYMORPHISM GENOTYPE 300 0 120 4010<br />
4619912 ALBUMIN, SERUM 300 0 35.8 4010<br />
4619920 ALBUMIN, CSF 300 0 40.61 4010<br />
4619938 ARSENIC, 24 HR URINE 300 0 148.97 4010<br />
4619946 CREATININE, 24 HR URINE 300 0 40.61 4010<br />
4619953 IMMUNOGLOBULIN, QN 300 0 73.01 4010<br />
4619987 IGG, SUBCLASS 300 0 108.36 4010<br />
4619995 HISTAMINE, PLASMA 300 0 231.86 4010<br />
4620019 HOMOCYST(E)INE, PLASMA 300 0 132.44 4010<br />
4620027 IGF-BP3 300 0 101.63 4010<br />
4620035 INHIBIN B 300 0 101.63 4010<br />
4620043 LEAD, 24 HR URINE 300 0 95 4010<br />
4620050 MERCURY, 24 HR URINE 300 0 127.67 4010<br />
4620068 HYDROCODONE + METABOLITES, U 300 0 152.78 4010<br />
4620076 HYDROCODONE AND METABOLITE 300 0 152.78 4010<br />
4620084 IGF-1 300 0 166.91 4010<br />
4620092 HEPARIN ANTI-XA 300 0 68.69 4010<br />
4620100 HGB SOLUBILITY 300 0 40.79 4010<br />
4620118 HEPARIN INDUCED PLATELET 300 0 144.18 4010<br />
4620126 IND ANTIPLATELET ALLOANTIBODY 300 0 144.18 4010<br />
4620134 IMMUNOFIXATION ELE<strong>CT</strong>ROPHORESIS 300 0 175.39 4010<br />
4620142 INHIBIN A, ULTRASENSITIVE 300 0 371.57 4010<br />
4620159 HELICOBA<strong>CT</strong>ER PYLORI, IGA 300 0 113.92 4010<br />
4620167 HELICOBA<strong>CT</strong>ER PYLORI, IGM AB 300 0 113.92 4010<br />
4620175 HSV, IGM I/II COMBINATION 300 0 152.66 4010<br />
4620183 HEP B CORE AB, TOT 300 0 94.66 4010<br />
4620191 HEP B CORE AB, IGM 300 0 92.43 4010<br />
4620209 HEP B SURFACE AB 300 0 84.31 4010<br />
4620217 HEP BE AB 300 0 90.79 4010<br />
4620225 HEPATITIS A AB, IGM 300 0 97.27 4010<br />
4620233 HSV CULTURE AND TYPING 300 0 268.79 4010
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