- 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
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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
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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
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4605101 ASPERGILLUS FUMIGAT. 300 0
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4606471 PARIETAL CELL AB 300 0 90.8
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4607453 IGG,SERUM (CSFI) 300 0 70.9
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4608477 IGG B2 GLYCOPROTEIN 300 0 1
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4609616 SACCHAROMYCES IGG AB 300 0
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4610648 PLASMINOGEN ACT INH1 300 0
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4611703 HYPERCOAG. NON-PREG 300 0 0
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4613063 TISSUE PREP 300 0 82.42 401
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4614095 LIDOCAINE AUTO ABS 300 0 26
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4615340 INCUBATION SERUM & DRUGS, E
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4619177 ALDOLASE 300 0 76.25 4010 4
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4620241 HEP BE AG 300 0 90.45 4010
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4621207 FETOMATERNAL HEMORRHAGE SCR
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4622148 THYROID STIM IMMUNOGLOBULIN
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4623146 RUBEOLA ANTIBODIES, IGG 300
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4624086 MUCOR RACEMOSUS, IGE 300 0
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4800041 SPE COLL TRAVEL/MILE 300 0
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5600689 MRI KEN HIP W/CONT RT 610 0
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5800313 MULTIPLE SLEEP LATENCY TEST
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6103758 BONE DENSITY FX EVAL 320 0
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6108906 CYSTO SCOUT FILM 320 0 108.
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6113864 SHLDR-ARTH PRO/INS-RT 761 0
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6201206 MYO-IMAGING-INFARCT 340 0 9
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6702245 CT UP EXT W/ CON-RT 352 0 1
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6901607 FINGER 2 OR MORE RT 320 0 1
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7000094 MRI-CHEST W/WO CONTR PLF 61
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7001084 MRI-LOEX NO JT W/WO RT-PLF
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7500820 ASPIRIN 325 MG TAB 250 0 0
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7501794 CHOLESTYRAMINE/SUCRO PACKET
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7502768 DULOXETINE 30MG. CAP EC 250
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7503741 HALOPERIDOL LACTATE VIAL 63
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7504723 LIDOCAINE HCL/D7.5W INJ 250
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7505704 MULTIVITAMINS THERAP 250 0
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7506645 PHENAZOPYRIDINE HCL TAB 250
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7507601 SODIUM BICARBONATE SYRINGE
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7508583 ISOPROPYL ALCOHOL SOLN 250
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7509532 ISOSORBIDE MONONITRA T SR 2
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7510506 SUMATRIPTAN SUCCINAT TAB 25
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7511488 BUPROPION HCL 100 MG TAB 25
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7512486 LANTUS INSULIN VIAL 636 0 0
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7513500 POVIDONE-IODINE 10% SOLN 25
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7514649 PYRAZINAMIDE 500MG TAB 250
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7515620 BUSPIRONE 2.5 MG TAB 250 0
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7517618 TETANUS AND DIPTHERIA TOX .
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7600398 CONTAINER EMPTY 500 270 0 0
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7690001 RED CAP LUER LOCK MED SUPPL
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8201709 PROSTETIC TRAIN PER 15 MIN
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8403214 WHFOWOJT L3808 274 0 509.69
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8701500 IONTOPHORESIS PER 15 MIN DL
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9003112 INITIAL PSYCH EVAL MD 900 0
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9300518 SWALLOW GOAL STATUS 440 0 0
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9301441 LANG EXPRESS GOAL STATUS 44
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9302381 MOBILITY GOAL STATUS 420 0
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9303330 OTHER PT/OT D/C STATUS 420
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9702796 MIC MEDICAID INTGRTY ALLOWA
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9704602 UNITED HLTHCR/UNITED HLTHCR
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9822297 STATE INCOME TAXES WITHHELD
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9826116 RENTAL INCOME LLC - VAN LEA
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9827627 HC HOSPICE MED SUPLS MED/SU
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9829565 MATERIAL MGMT-NON-MED SUP S
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9915646 SUPP TRICARE PAYMENT 0 0 10
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9940453 CT CARPENTERS HEALTH FUND P
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9945072 PSYCH DKH CIGNA BEHAV PAYME
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501205 LARYNGOSCOPY 361 0 0 3720 50
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1301993 LY NECK EXTS 20.1-30 450 0
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1304385 EXCIS OF X THORB HEM 450 0
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1402759 THUMB FX W/MAN 456 0 0 3780
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1800150 JAMSHIDI NEEDLE 270 0 0 375
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2525640 EYE RETROBULBAR NDL 270 0 0
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2600153 AMNIO SUPPLIES 270 0 0 3800
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4100384 BENZODIAZEPINES 300 0 0 401
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4605929 MUTATION ID ALLELE S 300 0
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4612685 CX 26 DNA SEQUENCING 300 0
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5600812 MRI KEN UPEX NO JT WO RT 61
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6500052 MRI-SPECIAL 352 0 0 4270 65
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7600570 POTASSIUM ACETATE 2 258 0 0
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8403263 EWHORTHO L3763 274 0 0 4370
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8603557 JOINT JACK 274 0 0 4390 860
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9944786 NATIONAL HEALTH INS NASE PA
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ART FASTFIX KNT PSHR2 2 ART FASTFIX
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LAP UNIV TROCAR SLVE 14 5MM 14 ART
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MIS DRAIN BAKER JEJUN 0 0 MIS DRAIN
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TKA X3 TRIATHLON CS 0 INS 0 TOPAZ W
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STAPLE PURSESTRING0 0 STAPLE PURSTR
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URO CATH SILIC 22/3WAY* 0 0 URO CAT
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THA ACCOLADE C CS 0127NK 0 THA ACCO
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ETOPOSIDE 20 MG/ML 450 VIAL 450 FLU
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CYTO SPUTUM 0 0 CYTO URINE 6 6 CYTO
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BILIRUBIN TOTAL 25 25 BILIRUBIN DIR
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GASTRIC PH 0 0 CSF GLUCOSE 7 7 FLUI
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DIFFERENTIAL/MANUAL 797 797 SMEAR R
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WOUND CULTURE124 124 BLOOD CULTURE
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PH URINE 0 0 SPEC.GRAVITY URINE0 0
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ECHOVIRUS AB 0 0 HLA A,B TYPING DNA
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IGA 26 26 IGM 26 26 PORPHYRINS, RAN
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PTH N TERM INTACT 0 0 SEROTONIN-SER
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IBT RAST ALLERGEN 24 12 24 SGPG 0 0
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METHADONE,UR 0 0 HEPATITIS E IGM 0
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ANTI-STREPTOLYSIN O3 3 S.CEREVISIAE
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RUBEOLA AB,IGG 28 28 SEX HORMONE BI
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COXSACKIE B2 AB 0 0 COXSACKIE B3 AB
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N.GONORRHOEAE RNA 0 0 CORTISONE,SER
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ALBUMIN 0 0 YERSINIA AB 1 1 JANUS K
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GLYCOMARK 0 0 STREPTOMYCIN 0 0 THYR
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CHROMAGRANIN A 3 3 CMV DNA QUANT RT
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ANTI MULLERIAN HORMONE 0 0 TSH ANTI
- Page 564 and 565:
INSULIN 0 0 LD, BODY FLUID 0 0 LACT
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MUMPS ANTIBODIES, 0IGG 0 MYCOPLASMA
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C1 ESTERASE INHIB, FUNC 0 0 CCP ANT
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COCONUT, IGE 0 0 ONIONS, IGE 0 0 PI
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PARAINFLUENZA TYPE 0 I 0 PARAINFLUE
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MRI KEN KNEE WO CONT 9 LT 9 MRI KEN
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MRI KEN UPEXT W/WO 0 CON RT 0 MRI K
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PRO FEE STRESS MD SUPERVS 0 0 PRO F
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LOWER LEG-LEFT 7 7 LOWER LEG-RIGHT
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GASTRO TUBE REPLACEMENT 1 1 INSERT
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MAMMO DUCT PROC-RT 1 1 HIP-2 VIEWS
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PYROPHOSPHATE 7 7 I 123 - 200 2 2 S
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US-BIOPSY PROC-PANCR 0 0 US-BIOPSY-
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MRI-LS SPINE W/O CON 43 43 MRI-LS S
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CT CHEST HIGH RESOLU 0 W/O 0 CT CHE
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CT INTRAPERI CATHETER 0 0 CT INTRAP
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FOOT LT(2 VIEWS) 0 0 FOOT RT(2 VIEW
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CERV SPINE TWO VIEW0 0 CERV SPINE W
- Page 602 and 603:
LS SPINE&OBL&FLEX&EX 0 6 VW 0 LS SP
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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
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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
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TOBRAMYCIN 80 MG/2ML 11 VIAL11 TOBR
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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
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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
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BACITRACIN 50 MU INJ 4 VIAL 4 DRONE
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ACETAMINOPH 100MG/ML 0 DROP0 REPAGL
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FLUCONAZOLE 400 MG/200 0 ML 0 ZOSYN
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SP-CANCEL VISIT DLS0 0 SP-ABSENT DL
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CHCKOT ORTH PROS 0PER 15 0 WHEELCHA
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OT AQUATIC REHAB/15 0 MIN 0 OT ORTH
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HIP STRAP (PROC) PLF0 0 SENSORY INT
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M V V 0 0 METHACHOLINE EVAL5 5 ARTE
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SWALLOW D/C STATUS 1 1 SWALLOW D/C
- Page 656 and 657:
VOICE CURRENT STATUS 0 0 VOICE CURR
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CARRY CURRENT STATUS 2 2 CARRY CURR
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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
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