EFTA00304570.pdf

HARRY FISCH, MD (PIN #D91790) ID Number: 944 Park Avenue (212) 879-0800 New York, NY 10028 Patient Name:lers-CAS'el EPSI-CIA/ Date of Service: Date of Birth: Unit Number: OFFICE VISIT FEE DI HY FEE New Patient Level II 99202 Bladder Scan 51798 New Patient Level III 4-*******-- 99203 Li25 Cystoscopy 52000 Transrectal Prostate 76872 Established Patient Visit Level II 99212 Testicular (Scrotal) 76870 Established Patient Visit Level III 99213 Testicular w/Doppler 93975 Ultrasound Bladder 76856 SURGICAL PROCEDURES FEE DIAGNOSIS Biopsy of Testis (Needle) 54500 Acute Prostatitis 601.0 Biopsy of Testis (Incisional} 54505 Azoospermia 606.0 Epididymovastostomy (Unilateral) 54900 BPH 600.00 Epididymovastostomy (Bilateral) 54901 Chronic Prostatitis 601.1 Hydrocelectomy {Unilateral} 55040 Condyloma of Penis 078.10 Hydrocelectomy (Bilateral) 55041 Hematuria 599.7 TUR Ejaculatory Ducts 52402 Hydrocele 603.9 Varicocelectomy (Unilateral) 55530 Infertility, Male 606.9 Varicocelectomy (Bilateral} 55530(50) Orchitis/Epicliclymitis 604.9 Vasovasostomy {Unilateral} 55400 Peyronie's Disease 607.85 Vasovasostomy {Bilateral) 55400(50) Pituitary Dysfunction 253.8 Vasectomy 55250 Prostate Cancer 185.0 Renal Stone 592.0 DIAGNOSTIC TEST TO BE SCHEDULED Testicular Failure >c , 257.2 Transrectal Prostate Sonogram 1111 Testicular Pain 608.9 Testicular Sonogram till 599.0 Testicular Sonogram w/Doppler Varicocele 456.4 Penile Duplex Doppler Voluntary Sterilization V25.2 Bladder Ultrasound Cystoscopy CHARGE PYMT CASH CHECK RECEIVED Sao I certify that I have rendered the above service: EFTA00304570