HARRY FISCH, MD (PIN #D91790)

HARRY FISCH, MD (PIN #D91790) 944 Park Avenue New York, NY 10028 Patient Name: 3a-c-c-R Ey5j n ew Date of Birth: OFFICE VISIT New Patient Level II 99202 FEE New Patient Level III 99203 Established Patient Visit Level II 99212 Established Patient Visit Level III 99213 SURGICAL PROCEDURES Biopsy of Testis (Needle) 54500 FEE Biopsy of Testis (IncIslonal) 54505 Epididymovastostomy (Unilateral) 54900 Epididymovastostomy {Bilateral} 54901 Hydrocelectomy (Unilateral) 55040 Hydrocelectomy (Bilateral) 55041 TUR Ejaculatory Ducts 52402 Varicocelectomy (Unilateral) 55530 Varicocelectomy (Bilateral) 55530(50) Vasovasostomy (Unilateral) 55400 Vasovasostomy (Bilateral) 55400(50} Vasectomy 55250 DIAGNOSTIC TEST TO BE SCHEDULED Transrectal Prostate Sonogram Testicular Sonogram Testicular Sonogram w/Doppler Penile Duplex Doppler Bladder Ultrasound Cystoscopy OTISID/EiTi ID Number:IIPIMInal (212) 879-0800 Date of Service: Unit Number ULTRASONOGRAPHY Bladder Scan 51798 FEE Cystoscopy 52000 Transrectal Prostate 76872 !SOO Testicular (Scrotal) 76870 Testicular w/Doppler 93975 Ultrasound Bladder se.---7 76856 /MO DIAGNOSIS Acute Prostatitis MS Azoospermia CIF BPH ills Chronic Prostatitis Gdii a Condyloma of Penis 01#118 Hematuria IS Hydrocele ila Infertility, Male MS Orchitis/Epididymitis a Peyronie's Disease it Pituitary Dysfunction 4MIIII Prostate Cancer a Renal Stone IS. Testicular Failure aStal 1-"*".. al Testicular Pain IS LITI Varicocele IIMIIP Voluntary Sterilization 40.11* CHARGE PYNIT CASH CHECK RECEIVED a`-too a LI oo I certify that I have rendered the above service: EFTA00304571