Laserfiche WebLink
<br />ß5/,ß5/2ßß3 <br /> <br />ß8:58 <br /> <br />g4g-83ß2324 <br /> <br />DENNIS COLUCCI MA <br /> <br />PAGE <br /> <br />ßI/ßl <br /> <br />Dennis A. Colucci, M.A., FAAA <br /> <br />D¡'gno,tlc Audiology 8nd "Armg Rendilittlllon <br />SfMrd C,rtifl«lln AUdiology <br /> <br />Patient: <br /> <br />Date: <br /> <br />24902 Moulton Parkw~y <br />Laguna Wooda, Ca 92853 <br />849 830.5770 941 830-2324 FAX <br />licen... AU 348/ HA 1028 <br /> <br />55N: <br /> <br />DaB: <br /> <br />Physician <br /> <br />M.D. UPIN: <br /> <br />Lie. <br /> <br /> <br /> <br />0 92557 Comprehcn:ç,jvc Hearing E"atuulOO 10.00 0 92582 PedÎltTÌc Bv,ru3rjon 155.00 <br />0 92552 Air Conduction Test 2900 0 92583 PiCtUre Selection T~st 58.00 <br />0 92553 Air 8(\d BOf'le Conduction Tcs~ 5800 0 92506 Au.dltory Pcrcepuon Evah,l8llion 110.00 <br />0 92562 ABLB nOD 0 92507 AudiMry Therapy Number of UnitS <br /> - - <br />0 92563 Tone Decay T~$ts 2500 0 92579 Visual ,Rcu-.forcement Alldiomefry 125.00 <br />0 92565 Stenger, Pu~ Tone 2600 0 92596 Ear Protection ArttnlJ.lor Mceures 39.00 <br />0 92577 Speech S"na"' 47.00 0 92572 Stacs''''d Spond.ic Word Tes' (SSW) 75.00 <br />0 92567 Tympaoom<:h'y 4500 0 92576 Synlhcric; Sen(enct Identification Teu (551) M.OO <br />0 92568 ACOl1StiC Rct1~u 3500 0 92571 Filh:rcd Speech T~t 4000 <br />0 92569 Aroush.c Refle" Decsy 35.00 0 92589 Comoel;na S IC<Ch T ", (ICM) 45.00 <br />0 92584 ElcctrocochltQgt8phy 200.00 0 92589 Binaural ScpBMlltion TeSt (CCM) 45.00 <br />0 92586 Auditory BrainSltm Evoked POlennaJs (LUl'ulcd) 200 00 0 92589 Pitch Pancrn Percc;ptiol1 Test 45.00 <br />0 92585 Auditory Brain!itcm Bvalred Potenti.l. (Complex) 250.00 0 92589 Sequential Di¡ib Test 45.00 <br />0 92531 R.ecOtdcd Fjstula Test 9000 0 92589 Hunng In Noise Test (HINT) 4 150.00 <br />0 92541 Sponl.n.eouS Nystagmus 1'<:,ts 91.00 0 692.10 Cerumen M.I..MI¡cn\elu Procedurc $J5 I $45 1 - <br />0 92542 PositiON! Nystagmus T cau 9200 0 99243 ConsultatlOrl. 1Ðt, Exam, Decision, CaJcuJanon!i 1 - <br />0 92543 Bithcm'lalCalorics 4 18000 0 9259ß Hearing Aid Ev,luation, MOI1lJJtt.l ) 15000 <br />0 92544 Optolcinetic Teate 75.00 0 92591 Beanng Aid EvaJuation, Bjnauf,l 300.00 <br />0 92545 Oscillatlog Tflckmg Tests 6900 0 92592 Hearing Aid Conformity Bvalulllon, Mooaural 250.00 <br />0 91546 Sinusoidal Vertical/HotÌzornal Axis Rotation Tu(S 6 240.00 0 92593 Heacins Aid Conformity Evaluacion. Binauul 500.00 <br />0 92547 0 92594 Elc:erro-Acouscic Or Probe Mic Testing, Monaural 50.00 <br /> 0 92595 ElectrO-Acoustic or Probe Mic Te,lins, Binaural ]00.00 <br /> 0 92599 He81jng Aid Cle8O.Íns MOI1ôWraI 25.00 <br />0 225.1 A,cou!tic Neurom. 0 92599 Hcarldg Aid CJellling Binaural 4000 <br />0 38602 ActiVe: Meniere's DiseNe 0 <br /> 92599 Earmold, MonlutaJ 65.00 <br />0 388.43 Auditory DlScriJnnacion ~fcc;il <br />0 38914 Central .onfhe$$ 0 92599.22 EatTholds 8maural 130.00 <br />0 3890 Conductive Hearing Lon 0 99202 New patient Office Vi,it 7000 <br />0 8728 Ear Trauma 0 992'2 RepClt Office VI'II 40.00 <br />0 381 81 Eust8c.hian Tuhe Dy,funttlon 0 92599 lo-lio.,. Repair $25 I $35/ $45 I $55 I $100 <br />0 38841 Hyperaeu9¡' <br /> 0 92599 factory RepaIr 1200 / $250 I $300 / $350 <br />0 380.4 JmpSCled CerumcJ1 <br />0 3892 Muced Hcuißg Loss 0 92599 S8tœritS 10 312 13 675 x <br />0 38912 Neurøl He..,;"! Loss 0 99002 P,oduet DI'pen.9ing <br />0 3801 OtitíJExtema 0 92599 <br />0 382.9 OlEtr. Media 0 92599 <br />0 3872 OfosclerOf;9 <br />0 384.2 Perforated i)mp,,,ic Mc:mbrane <br />0 389.1I SenSOry Hearing Lo" CHARGES <br />0 389.13 Sensory tnd Neural Hearing Lou <br />0 388.31 Subjective Tlnnitu9 AMOUNT PAlO <br />0 388.2 Sudden Sen~orineural Hearing Lou SA LAl'iCE DUE <br />0 780.4 v. !Disc 1.1- llnum <br /> <br />