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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

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3300712 GLUCOSE STRIP SUBSEQ 300 0 9.94 4130<br />

3340056 PULM REHAB LEVEL 4 940 0 44.82 4130<br />

3340114 PULMONARY EVAL 510 0 97.56 4130<br />

3340205 P/R MD INT DOSE INHL 460 0 70.46 4130<br />

3340403 P/R ONE TO ONE WALK MONITOR 948 0 148.46 4130<br />

3340502 P/R ONE TO ONE STAIRS MONITOR 948 0 148.46 4130<br />

3340601 P/R GRP A<strong>CT</strong>IVITY 948 0 148.46 4130<br />

3400223 CARDIAC REHAB PHASE IV-PLAINFIELD 940 0 44.82 4130<br />

3400504 CARDIAC EVAL 940 0 81.3 4130<br />

3500170 BLINK REFLEX, ORBICULARIS OCULI 922 0 112.56 4200<br />

3500212 REPETITIVE STIM, NEUROMUSC JUN<strong>CT</strong>ION 922 0 246.56 4200<br />

3500220 SENSORY 1 TO 2 SITES 922 0 225.12 4200<br />

3502366 SENSORY 3 TO 4 STUDIES 922 0 450.24 4200<br />

3502374 SENSORY 5 TO 6 STUDIES 922 0 675.36 4200<br />

3502382 SENSORY 7 TO 8 STUDIES 922 0 900.48 4200<br />

3502390 SENSORY 9 TO 10 STUDIES 922 0 1125.6 4200<br />

3502408 SENSORY 11 TO 12 STUDIES 922 0 1350.72 4200<br />

3502416 SENSORY 13 OR MORE STUDIES 922 0 1463.28 4200<br />

4000014 LEVEL 4 GROSS/MICRO 310 0 124.76 4010<br />

4000022 BM SMEAR INTERPRE 300 0 200.09 4010<br />

4000030 LEVEL 1 GROSS EXAM 310 0 29.93 4010<br />

4000048 LEVEL 2 GROSS/MICRO 310 0 47.1 4010<br />

4000055 LEVEL 3 GROSS/MICRO 310 0 73.72 4010<br />

4000063 LEVEL 5 GROSS/MICRO 310 0 169.09 4010<br />

4000071 LEVEL 6 GROSS/MICRO 310 0 275.62 4010<br />

4000089 DECALCIFICATION 310 0 187.39 4010<br />

4000097 SPECIAL STAIN GP I 310 0 108.36 4010<br />

4000105 SPECIAL STAIN GP II 310 0 115.25 4010<br />

4000113 MD COMPLETE CONSULT 999 0 0 4010<br />

4000121 CONSULT DURING SURG 999 0 0 4010<br />

4000139 FIRST FROZEN SE<strong>CT</strong>ION 310 0 146.74 4010<br />

4000147 ADDITIONAL FROZEN 310 0 76.56 4010<br />

4000154 PAP SCREEN 311 0 65.65 4010<br />

4000162 PAP SMEAR MD 999 0 0 4010<br />

4000170 PAP DIAGNOSTIC 311 0 61.82 4010<br />

4000188 SMEAR TZANK 310 0 101.53 4010<br />

4000196 SMEAR SEMEN 310 0 232.05 4010<br />

4000204 SMEAR BREAST DISC 310 0 151.13 4010<br />

4000212 CYTO THINPREP SCREEN 311 0 90.09 4010<br />

4000220 THIN PREP MD 999 0 0 4010<br />

4000238 CYTO THINPREP DIAG 311 0 90.09 4010<br />

4000246 CYTO GASTRIC BRUSH 310 0 140.99 4010<br />

4000253 CYTO BREAST CYST 310 0 175.57 4010<br />

4000261 CYTO BREAST ASPIRATE 310 0 175.57 4010<br />

4000279 CYTO BRONCH BRUSH 310 0 207.6 4010<br />

4000287 CYTO CSF 310 0 214.5 4010<br />

4000295 CYTO OVARY CYST 310 0 144.24 4010

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