Professional Documents
Culture Documents
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 1
13/12/2011
Procedimento/Cd.Intercmbio/Participao
/10101012
Obs.
Qtd/Partic
1/0
83,07
83,07
Total:
0468000003000
0468000003000
Vl.Cob
310000145
/40306674
1/0
29,50
310000145
/40307026
1/0
33,72
310000145
/40311210
1/0
11,20
210000879
30/11/2011
/40901297
1/0
147,34
310000145
/40316114
1/0
35,29
310000145
1/0
11,78
310000145
/40307760
1/0
9,99
310000145
/40307832
1/0
29,50
310000145
40316408 Progesterona
/40316408
1/0
31,43
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
/40307182
1/0
45,07
310000145
/40306666
1/0
24,29
310000145
/40307824
1/0
24,29
310000145
/40301150
1/0
5,28
210000879
30/11/2011
1 FILME
0,34 / 0
7,72
310000145
2 UCO
/90000021
21,856 / 0
0,00
210000879
30/11/2011
2 UCO
/90000021
3,82 / 0
0,00
Total:
0468000008001
0468000008001
451,68
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 2
Atendimento/Lote/Nota
11001700
21/12/2011
110000443
110000443
0468000008010
Procedimento/Cd.Intercmbio/Participao
10101012 Em consultrio (no horrio normal ou
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
1/0
15,35
/90000021
0,75 / 0
2 UCO
0,00
2603
13/12/2011
/10101012
1/0
83,07
3197
05/12/2011
/10101012
1/0
83,07
264,56
Total:
0468000010006
0468000010510
310000242
40302040 Glicose
/40302040
2/0
10,55
310000242
/40302512
1/0
9,76
310000242
/40302733
1/0
44,71
310000242
/40302750
1/0
22,46
310000242
/90000021
4,761 / 0
2 UCO
87,48
Total:
0468000011002
0468000011002
5064
01/12/2011
/10101012
1/0
Total:
0468000013005
0468000013099
0,00
83,07
83,07
310000110
/ Lab.De Investigacao
25/11/2011
/40302512
1/0
9,76
310000110
/ Lab.De Investigacao
25/11/2011
40301281 Amilase
/40301281
1/0
9,76
310000110
/ Lab.De Investigacao
25/11/2011
40302199 Lipase
/40302199
1/0
9,76
310000110
/ Lab.De Investigacao
25/11/2011
1/0
11,78
310000110
/ Lab.De Investigacao
25/11/2011
/40308383
1/0
15,82
310000110
/ Lab.De Investigacao
25/11/2011
/40302504
1/0
9,76
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 3
Atendimento/Lote/Nota
310000110
/ Lab.De Investigacao
25/11/2011
310000110
/ Lab.De Investigacao
25/11/2011
310000110
/ Lab.De Investigacao
25/11/2011
0468000013102
Obs.
Qtd/Partic
1/0
5,28
2 UCO
/90000021
1,557 / 0
0,00
2 UCO
/90000021
3,75 / 0
0,00
06/12/2011
/10101012
1/0
1341576
29/11/2011
310000145
310000145
0468000015105
1360554
/10101012
1/0
83,07
1/0
9,63
/90000021
0,693 / 0
0,00
/10101012
1/0
2 UCO
07/12/2011
83,07
175,77
Total:
0468000016004
0468000016004
83,07
154,99
Total:
0468000014001
0468000014001
Vl.Cob
/40304370
4994
Procedimento/Cd.Intercmbio/Participao
310000242
40316530 Tireoglobulina
/40316530
1/0
52,78
310000242
/40301150
1/0
5,28
310000242
/40316521
1/0
27,52
310000242
40302040 Glicose
/40302040
1/0
5,28
310000242
40316491 T4 livre
/40316491
1/0
34,39
310000242
1/0
11,78
310000242
40301630 Creatinina
/40301630
1/0
5,28
310000242
/40316106
1/0
52,78
310000242
/40302750
1/0
22,46
310000242
/90000021
14,421 / 0
2 UCO
Total:
0,00
217,55
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 4
05/12/2011
1400963
0468000019119
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
/40201023
1/0
23,03
210020543
/10101039
1/0
40,95
310000030
15/12/2011
1/0
11,78
310000030
15/12/2011
/40308391
1/0
36,82
210020560
/10101039
1/0
52,65
310000030
15/12/2011
/90000021
0,87 / 0
2 UCO
248,30
Total:
0468000021008
0468000021008
0,00
Antomar Barbosa
Antomar Barbosa
3369
/20102011
1/0
30,70
3369
/40101029
1/0
15,35
25204
/40701131
/Clinico
1/1
0,00
25204
/40701069
/Clinico
1/1
0,00
210002332
2 UCO
/90000021
38,852 / 0
0,00
3369
2 UCO
/90000021
9,94 / 0
0,00
210002332
1 FILME
1,14 / 0
25,88
210002332
0 Materiais em Geral
/90000021
1/0
11,38
210002332
0 Medicamentos em Geral
/90000013
1/0
560,34
643,65
Total:
0468000022004
0468000022004
11002006
14/12/2011
/10101012
1/0
83,07
11001883
30/11/2011
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 5
Atendimento/Lote/Nota
17449
25/11/2011
11001883
11001883
0468000022519
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
/41301102
/Clinico
1/1
0,00
/90000021
2,78 / 0
0,00
2 UCO
17449
25/11/2011
/10101012
1/0
83,07
11002146
15/12/2011
/10101012
1/0
83,07
11002030
01/12/2011
/10101012
1/0
83,07
2013
07/12/2011
/10101012
1/0
83,07
11002006
14/12/2011
/10101012
1/0
83,07
310000145
40301630 Creatinina
/40301630
1/0
5,28
310000145
40302580 Uria
/40302580
1/0
5,28
310000145
40302318 Potssio
/40302318
1/0
5,28
310000145
/40308391
1/0
36,82
310000145
40302423 Sdio
/40302423
1/0
5,28
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
/40301150
1/0
5,28
11002030
/20104065
1/0
17,06
110000079
1/0
25,45
310000145
1/0
11,78
310000145
/40302750
1/0
22,46
310000145
2 UCO
/90000021
3,192 / 0
0,00
110000079
2 UCO
/90000021
0,75 / 0
0,00
Total:
0468000023000
0468000023108
809,81
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 6
/ Unimed Teresina
99
0468000023302
89000099
7250
13/10/2011
Atendimento/Lote/Nota
7650883 / 223086 / 2234941
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
/10101012
1/0
58,97
/20102070
1/0
167,17
/ Unimed Teresina
99
226,14
Total:
0468000025003
0468000025003
37504
07/12/2011
37504
210000828
210000828
/10101012
1/0
83,07
/41301323
/Clinico
1/1
22,08
/ Pro-Visao S/C
/41301250
2/0
69,22
/ Pro-Visao S/C
/90000021
1,08 / 0
/10101012
1/0
0468000025100
2 UCO
01/12/2011
83,07
257,44
Total:
0468000026000
0468000026000
0,00
4712
Vl.Cob
Antonio J S da Silva
Antonio J S da Silva
11001107
25/11/2011
/10101012
1/0
83,07
1160970
20/12/2011
/10101012
1/0
83,07
110000079
1/0
25,45
110000079
/90000021
0,75 / 0
0468000026107
2 UCO
0,00
Mariana de F A da Silva
11001620
/ Maria Da Conceicao M De
12/12/2011
/10101012
1/0
83,07
17848
30/11/2011
/10101012
1/0
83,07
5064
30/11/2011
/10101012
1/0
83,07
310000030
15/12/2011
/40601110
1/0
58,42
5064
/30210127
1/0
106,59
5064
/30101298
1/0
53,29
5064
/80051510
1/0
45,45
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 7
Atendimento/Lote/Nota
5064
5064
310000030
15/12/2011
5064
5064
5064
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/80051510
1/0
45,45
0 Materiais em Geral
/90000021
1/0
32,74
2 UCO
/90000021
2,06 / 0
0,00
0 Materiais em Geral
/90000021
1/0
5,70
0 Medicamentos em Geral
/90000013
1/0
6,75
0 Medicamentos em Geral
/90000013
1/0
6,75
Total:
0468000028002
0468000028320
801,94
310000242
/40302628
1/0
28,97
310000242
40301400 Clcio
/40301400
1/0
5,28
310000242
40303110 Parasitolgico
/40303110
1/0
12,78
310000242
/40305015
1/0
72,47
310000242
/40303039
1/0
21,61
310000242
1/0
11,78
310000242
/40303055
1/0
37,00
310000242
1/0
45,07
310000242
40301931 Fsforo
/40301931
1/0
5,28
310000242
40316270 Ferritina
/40316270
1/0
27,61
310000242
0 Materiais em Geral
/90000021
1/0
56,04
310000242
2 UCO
/90000021
19,65 / 0
/80000037
36 / 0
0468000028517
0,00
Aurelia M de Souza
89000080
80
600093
16/09/2011
89000080
80
600093
16/09/2011
/77826906
200 / 0
89000080
80
600093
16/09/2011
8/0
1.097,65
140,40
7,39
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 8
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000080
80
600093
16/09/2011
20 / 0
20,59
89000080
80
600093
16/09/2011
/79923593
21 / 0
140,29
89000080
80
600093
16/09/2011
/90000021
10 / 0
96,17
0 Materiais em Geral
1.826,38
Total:
0468000031003
0468000031003
110000052
40804011 Bacia
/40804011
1/0
15,35
110000052
40804054 Joelho
/40804054
1/0
15,35
110000052
40803090 Cotovelo
/40803090
2/0
30,70
110000052
/40805018
1/0
15,35
110000052
/40802019
1/0
15,35
110000052
/10101039
1/0
94,77
110000052
/10101039
1/0
94,77
110000052
40803104 Antebrao
/40803104
2/0
30,70
110000052
/10101039
1/0
94,77
110000052
2 UCO
/90000021
9,46 / 0
110000052
1 FILME
1,0424 / 0
23,66
430,77
Total:
0468000032000
0468000032000
0,00
11001360
06/12/2011
310000242
310000242
/10101012
1/0
83,07
1/0
11,78
/40304590
1/0
7,70
310000242
/40302504
1/0
9,76
310000242
/40302512
1/0
9,76
310000242
/40301990
1/0
9,76
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 9
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000242
/40307760
1/0
9,99
310000242
40302040 Glicose
/40302040
1/0
5,28
310000242
/40304370
1/0
5,28
310000242
/40302750
1/0
22,46
310000242
/90000021
5,091 / 0
2 UCO
174,84
Total:
0468000034002
0468000034010
110000079
110000079
110000079
/40901360
1/0
2 UCO
/90000021
8,26 / 0
0,00
1 FILME
0,68 / 0
15,43
1360490
25/11/2011
1100153
/10101012
1/0
83,07
/10101012
1/0
83,07
166,14
Total:
0468000036005
0468000036315
14465
02/12/2011
/10101012
1/0
3921
19/12/2011
/10101012
1/0
11000518
83,07
83,07
Total:
0468000040002
0468000040002
83,07
83,07
Total:
0468000037001
0468000037001
226,27
241,70
Total:
0468000035009
0468000035017
0,00
28/11/2011
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 10
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Total:
0468000041009
0468000041106
Vl.Cob
83,07
310000030
25/11/2011
/40308391
1/0
36,82
310000030
25/11/2011
1/0
11,78
310000030
25/11/2011
0,87 / 0
2 UCO
/90000021
48,60
Total:
0468000042005
0468000042315
0,00
1937
06/12/2011
210020314
210020314
/10101012
1/0
83,07
40803104 Antebrao
/40803104
1/0
15,35
40803104 Antebrao
/40803104
1/0
15,35
310000030
07/12/2011
40302040 Glicose
/40302040
1/0
5,28
210020314
40803082 Brao
/40803082
1/0
15,35
210020314
40803112 Punho
/40803112
1/0
15,35
210020314
40803090 Cotovelo
/40803090
1/0
15,35
210020314
40803082 Brao
/40803082
1/0
15,35
310000030
07/12/2011
1/0
11,78
210020314
40803090 Cotovelo
/40803090
1/0
15,35
210020314
40803090 Cotovelo
/40803090
1/0
15,35
1937
/30712017
/Cirurgiao
1/1
14,98
1937
/30712017
/Cirurgiao
1/1
14,98
310000030
07/12/2011
/40304922
1/0
33,50
210020314
/80031005
1/0
10,64
210020314
/80031005
1/0
10,64
210020314
/90000021
4,97 / 0
2 UCO
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 11
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
210020314
2 UCO
/90000021
1,22 / 0
0,00
210020314
2 UCO
/90000021
3,75 / 0
0,00
210020314
0 Materiais em Geral
/90000021
1/0
32,53
210020314
1 FILME
0,5472 / 0
12,42
210020314
1 FILME
0,0864 / 0
1,96
210020314
1 FILME
0,3744 / 0
8,50
210020314
0 Materiais em Geral
/90000021
1/0
310000030
07/12/2011
2 UCO
/90000021
3,741 / 0
0,00
395,61
Total:
0468000043001
0468000043001
32,53
Catia A A Rocha
Catia A A Rocha
110000079
40901114 Mamas
/40901114
1/0
86,31
110000079
40808033 MAMOGRAFIA
/40808033
1/0
85,11
110000079
1 FILME
0,34 / 0
7,72
110000079
2 UCO
/90000021
3,42 / 0
0,00
110000079
2 UCO
/90000021
2,76 / 0
0,00
110000079
1 FILME
1,2 / 0
27,24
0468000043109
Gustavo A Rocha
310000242
1/0
11,78
310000242
40302040 Glicose
/40302040
1/0
5,28
310000242
/40316521
1/0
27,52
310000242
/40316203
1/0
31,43
310000242
/40302750
1/0
22,46
310000242
/90000021
5,627 / 0
2 UCO
Total:
0468000046000
0,00
304,85
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 12
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000145
1/0
11,78
310000145
1/0
11,78
110000052
/20104308
1/0
23,03
110000052
/20104294
1/0
115,13
21002622
/Anestesis
1/1
151,22
4832
/Cirurgiao
1/1
115,13
110000052
TE33 QUIMIOTERAPIA
/80031706
1/0
45,03
110000052
/80053122
1/0
303,24
110000052
/80061400
1/0
12,26
110000052
/80031501
1/0
39,42
110000052
TC12 PORTE II
/80021026
1/0
205,49
110000052
TE33 QUIMIOTERAPIA
/80031706
1/0
45,03
110000052
/80990029
1/0
0,00
110000052
/80051537
1/0
36,39
110000052
/80051537
1/0
36,39
110000052
/80031501
1/0
39,42
110090957
0 Materiais em Geral
/90000021
1/0
1.404,00
110000052
0 Materiais em Geral
/90000021
1/0
2.395,80
110000052
0 Materiais em Geral
/90000021
1/0
48,45
110000052
0 Materiais em Geral
/90000021
1/0
2.055,28
110000052
0 Materiais em Geral
/90000021
1/0
26,40
310000145
2 UCO
/90000021
0,87 / 0
110000052
0 Materiais em Geral
/90000021
1/0
310000145
2 UCO
/90000021
0,87 / 0
0,00
206,95
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 13
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
110000052
0 Medicamentos em Geral
/90000013
1/0
37,67
110000052
0 Medicamentos em Geral
/90000013
1/0
9.385,37
110000052
0 Medicamentos em Geral
/90000013
1/0
34,00
110000052
0 Medicamentos em Geral
/90000013
1/0
113,88
110000052
0 Medicamentos em Geral
/90000013
1/0
8.562,42
25.460,96
Total:
0468000049000
0468000049018
210000763
210000763
/90000021
8/0
3,76 / 0
0,00
234,84
Total:
0468000052000
0468000052000
234,84
210020314
/20103492
9/0
276,31
210020314
/20103492
1/0
30,70
5064
/30101298
6/0
319,76
5064
/30210127
1/0
106,59
5064
/80051510
1/0
45,45
5064
0 Materiais em Geral
/90000021
1/0
66,43
210020314
2 UCO
/90000021
6/0
0,00
5064
0 Medicamentos em Geral
/90000013
1/0
47,26
/10101012
1/0
83,07
/10101012
1/0
83,07
0468000052108
5064
0468000052302
1937
29/11/2011
12/12/2011
Total:
0468000055000
1.058,64
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 14
13/12/2011
210020314
210020314
Atendimento/Lote/Nota
7655650 / 99999 / 10251287
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
/40802035
1/0
15,35
40804011 Bacia
/40804011
1/0
15,35
210020314
/40802019
1/0
15,35
210020314
/40802051
1/0
15,35
210020314
1 FILME
0,8356 / 0
18,97
210020314
2 UCO
/90000021
5,33 / 0
163,44
Total:
0468000056006
0468000056502
0,00
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
/40302750
1/0
22,46
310000145
/40302733
1/0
44,71
310000145
/90000021
4,041 / 0
/10101012
1/0
83,07
0468000056510
2 UCO
0,00
1341665
12/12/2011
110010198
/40901300
1/0
91,69
110010198
/40601137
1/0
29,21
110010198
40901114 Mamas
/40901114
1/0
86,31
210001638
12/12/2011
1/0
25,45
110010198
/41301102
1/0
62,98
210001638
12/12/2011
2 UCO
/90000021
0,75 / 0
0,00
110010198
1 FILME
0,17 / 0
3,86
110010198
2 UCO
/90000021
3,82 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 15
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
110010198
1 FILME
0,34 / 0
7,72
110010198
2 UCO
/90000021
3,42 / 0
0,00
110010198
2 UCO
/90000021
2,78 / 0
0,00
110010198
2 UCO
/90000021
1,03 / 0
0,00
Total:
0468000058009
0468000058114
21002629
468,02
/ M D De Macedo Caldas
/10101144
10 / 0
280,80
Total:
0468000063002
0468000063096
280,80
310000030
28/11/2011
1/0
11,78
310000030
28/11/2011
/40308391
1/0
36,82
310000030
28/11/2011
/90000021
0,87 / 0
0468000063517
2 UCO
0,00
Marinete da P R Fontenel
11866
09/12/2011
/10101012
1/0
83,07
11000690
15/12/2011
/10101012
1/0
83,07
210000291
40804054 Joelho
/40804054
1/0
31,77
210000291
40804054 Joelho
/40804054
1/0
31,77
210000143
/20103492
10 / 0
387,74
210000143
2 UCO
/90000021
6/0
0,00
210000291
2 UCO
/90000021
2,44 / 0
0,00
210000291
1 FILME
0,288 / 0
6,54
672,56
Total:
0468000064009
0468000064017
11000488
12/12/2011
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 16
14/12/2011
310000242
310000242
Atendimento/Lote/Nota
7672645 / 99999 / 10251710
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
40302580 Uria
/40302580
1/0
5,28
/40311210
1/0
11,20
310000242
/40301150
1/0
5,28
310000242
/40301125
1/0
28,97
310000242
40301630 Creatinina
/40301630
1/0
5,28
310000242
/40311180
3/0
19,06
310000242
/40311015
1/0
28,97
310000242
/40301508
1/0
14,47
310000242
/90000021
8,568 / 0
2 UCO
284,65
Total:
0468000066001
0468000066109
0,00
1400386
07/12/2011
/10101012
1/0
83,07
310000030
13/12/2011
1/0
11,78
310000030
13/12/2011
/40307441
1/0
49,19
310000030
13/12/2011
/40314120
1/0
405,12
310000030
13/12/2011
1/0
49,19
1400386
/40201023
1/0
23,03
110000419
/ Clin. De Proctologia Do
/40201082
/Clinico
1/1
191,88
1221163
/40201082
/Anestesis
1/1
151,22
110000419
/ Clin. De Proctologia Do
2 UCO
/90000021
14,798 / 0
110000419
/ Clin. De Proctologia Do
0 Materiais em Geral
/90000021
1/0
310000030
13/12/2011
2 UCO
/90000021
38,04 / 0
110000419
/ Clin. De Proctologia Do
0 Medicamentos em Geral
/90000013
1/0
0,00
28,71
0,00
58,04
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 17
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Total:
0468000070009
0468000070009
Vl.Cob
1.051,23
3197
06/12/2011
/10101012
1/0
83,07
2178
25/11/2011
/10101012
1/0
83,07
/10101012
1/0
83,07
0468000070092
6008
0468000070513
29/11/2011
950000970
10/12/2011
/10101012
1/0
83,07
3612
19/12/2011
/10101012
1/0
83,07
3197
20/12/2011
/10101012
1/0
83,07
310000030
28/11/2011
40302318 Potssio
/40302318
1/0
5,28
310000030
28/11/2011
/40301885
1/0
9,76
310000030
28/11/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
28/11/2011
40303110 Parasitolgico
/40303110
1/0
12,78
310000030
28/11/2011
40302580 Uria
/40302580
1/0
5,28
310000030
28/11/2011
40301630 Creatinina
/40301630
1/0
5,28
210000372
/ Cent.De Densitom.Ossea Do
/40808130
1/0
185,89
310000030
28/11/2011
40316491 T4 livre
/40316491
1/0
34,39
310000030
28/11/2011
/40316521
1/0
27,52
310000030
28/11/2011
40302423 Sdio
/40302423
1/0
5,28
310000030
28/11/2011
/40302512
1/0
9,76
310000030
14/12/2011
/40303136
1/0
12,78
310000030
28/11/2011
/40308391
1/0
36,82
310000030
28/11/2011
40301222 Albumina
/40301222
1/0
5,28
310000030
28/11/2011
40301931 Fsforo
/40301931
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 18
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
28/11/2011
/40304370
1/0
5,28
310000030
28/11/2011
/40305465
1/0
91,48
310000030
28/11/2011
/40302504
1/0
9,76
310000030
28/11/2011
40301400 Clcio
/40301400
1/0
5,28
310000030
28/11/2011
40311171 Microalbuminria
/40311171
1/0
24,49
310000030
28/11/2011
1/0
11,78
310000030
28/11/2011
/40302750
1/0
22,46
310000030
28/11/2011
/40302733
1/0
44,71
310000030
14/12/2011
2 UCO
/90000021
0,927 / 0
0,00
310000030
28/11/2011
2 UCO
/90000021
10,077 / 0
0,00
210000372
/ Cent.De Densitom.Ossea Do
2 UCO
/90000021
10,25 / 0
0,00
310000030
28/11/2011
2 UCO
/90000021
13,644 / 0
0,00
1.080,32
Total:
0468000073008
0468000073016
11002235
29/11/2011
/10101012
1/0
83,07
3612
12/12/2011
/10101012
1/0
83,07
310000145
40316491 T4 livre
/40316491
1/0
34,39
310000145
/40316521
1/0
27,52
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
40316360 Insulina
/40316360
1/0
29,27
310000145
/40301648
1/0
14,47
310000145
/40302750
1/0
22,46
310000145
/90000021
8,2 / 0
2 UCO
Total:
0468000075000
0,00
299,53
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 19
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
4590
25/11/2011
/10101012
1/0
83,07
21002595
25/11/2011
/41301323
1/0
22,08
21002595
29/11/2011
/41301269
2/0
177,49
21002595
29/11/2011
/41301080
2/0
151,66
21002595
29/11/2011
/41501128
2/0
75,39
21002595
29/11/2011
/41301250
2/0
69,22
21002595
25/11/2011
2 UCO
/90000021
0,5 / 0
0,00
21002595
29/11/2011
2 UCO
/90000021
11,82 / 0
0,00
/10101012
1/0
83,07
0468000075302
4825
13/12/2011
4825
/41301250
2/0
61,40
4825
/41301323
1/0
15,35
4825
/41501128
2/0
61,40
4825
/90000021
2,12 / 0
2 UCO
800,13
Total:
0468000076007
0468000076007
0,00
310000030
26/11/2011
/40302512
1/0
9,76
310000030
26/11/2011
/40308391
1/0
36,82
310000030
26/11/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
26/11/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
26/11/2011
/40301885
1/0
9,76
310000030
26/11/2011
40301281 Amilase
/40301281
1/0
9,76
310000030
29/11/2011
40301281 Amilase
/40301281
1/0
9,76
310000030
29/11/2011
1/0
11,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 20
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
26/11/2011
/40302504
1/0
9,76
310000030
26/11/2011
40302199 Lipase
/40302199
1/0
9,76
310000030
26/11/2011
/40311210
1/0
11,20
310000030
26/11/2011
40302580 Uria
/40302580
1/0
5,28
310000030
26/11/2011
40302318 Potssio
/40302318
1/0
5,28
310000030
26/11/2011
1/0
11,78
310000030
26/11/2011
40302423 Sdio
/40302423
1/0
5,28
310000030
26/11/2011
1/0
11,78
310000030
29/11/2011
/40302512
1/0
9,76
310000030
26/11/2011
/40302504
1/0
9,76
310000030
26/11/2011
/40301990
1/0
9,76
310000030
29/11/2011
/40301990
1/0
9,76
310000030
29/11/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
29/11/2011
/40601110
1/0
58,42
310000030
26/11/2011
40301281 Amilase
/40301281
1/0
9,76
310000030
29/11/2011
/40302504
1/0
9,76
310000030
26/11/2011
/40302512
1/0
9,76
310000030
26/11/2011
/40301990
1/0
9,76
310000030
26/11/2011
/40308391
1/0
36,82
310000030
26/11/2011
40302199 Lipase
/40302199
1/0
9,76
310000030
29/11/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
29/11/2011
/40301885
1/0
9,76
310000030
29/11/2011
/40308391
1/0
36,82
310000030
29/11/2011
2 UCO
/90000021
5,244 / 0
0,00
310000030
26/11/2011
2 UCO
/90000021
5,19 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 21
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
29/11/2011
2 UCO
/90000021
2,06 / 0
0,00
310000030
26/11/2011
2 UCO
/90000021
7,215 / 0
0,00
/41301323
0468000076325
89000025
25
56435
1/0
418,67
Total:
0468000078000
0468000078506
89000063
0468000078514
63
6506
/10101012
1/0
58,97
/10101012
1/0
58,97
/40601137
1/0
20,64
89000063
63
3943
89000063
63
138,58
Total:
0468000083003
0468000083003
10,13
310000030
40302040 Glicose
/40302040
1/0
5,28
310000030
40301630 Creatinina
/40301630
1/0
5,28
310000030
/40316149
1/0
32,99
310000030
40302580 Uria
/40302580
1/0
5,28
310000030
/40311210
1/0
11,20
310000030
/40301885
1/0
9,76
310000030
/40301150
1/0
5,28
310000030
/40302512
1/0
9,76
310000030
1/0
11,78
310000030
/40301990
1/0
9,76
310000030
/40302504
1/0
9,76
310000030
/40302750
1/0
22,46
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 22
0468000083305
Procedimento/Cd.Intercmbio/Participao
2 UCO
Qtd/Partic
Vl.Cob
/90000021
Obs.
8,538 / 0
0,00
/10101012
1/0
5559
Atendimento/Lote/Nota
23/11/2011
221,66
Total:
0468000084000
0468000084000
83,07
310000242
/40601110
1/0
58,42
310000242
/40306917
1/0
39,02
950000970
1/0
157,75
310000242
2 UCO
/90000021
4,904 / 0
0,00
950000970
2 UCO
/90000021
13,67 / 0
0,00
950000970
0 Materiais em Geral
/90000021
1/0
13,86
/10101012
1/0
83,07
0468000084018
11002952
21/12/2011
11000399
/10101012
1/0
83,07
110000443
/40101045
1/0
30,70
11002952
/41301102
1/0
25,58
21002625
1/0
599,84
21002625
2 UCO
/90000021
37,45 / 0
0,00
11002952
2 UCO
/90000021
2,78 / 0
0,00
21002625
1 FILME
2,5 / 0
56,75
110000443
2 UCO
/90000021
7,16 / 0
0,00
0468000084301
11000739
21/12/2011
/10101012
1/0
83,07
11001298
21/12/2011
/10101012
1/0
83,07
1342092
25/11/2011
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 23
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000242
/40304108
1/0
8,55
310000250
/40307832
1/0
29,50
310000242
/40301397
1/0
5,28
310000250
/40307824
1/0
24,29
310000242
/40301397
1/0
5,28
310000242
/40304299
1/0
8,55
210020438
/40103463
1/0
59,96
310000250
2 UCO
/90000021
3,987 / 0
0,00
210020438
2 UCO
/90000021
1,462 / 0
0,00
310000242
2 UCO
/90000021
1,647 / 0
0,00
310000242
2 UCO
/90000021
0,387 / 0
0,00
1.538,68
Total:
0468000088005
0468000088005
11000917
12/12/2011
/10101012
1/0
83,07
1340340
13/12/2011
/10101012
1/0
83,07
210000291
40808033 MAMOGRAFIA
/40808033
1/0
85,11
1340340
/41301102
1/0
25,58
110000443
1/0
15,35
210000291
/40901300
1/0
91,69
210000291
2 UCO
/90000021
6,58 / 0
0,00
210000291
1 FILME
1,37 / 0
31,10
110000443
2 UCO
/90000021
0,75 / 0
0,00
1340340
2 UCO
/90000021
2,78 / 0
0,00
0468000088102
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 24
0468000088110
15/12/2011
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
1111120
/10101012
1/0
83,07
1111120
15/12/2011
/10101012
1/0
83,07
664,18
Total:
0468000091006
0468000091014
21002602
/ Centerfisio - Clnica De
/20103646
5/0
1.038,08
21002602
/ Centerfisio - Clnica De
/20103646
5/0
1.038,08
21002602
/ Centerfisio - Clnica De
2 UCO
/90000021
41,5 / 0
0,00
21002602
/ Centerfisio - Clnica De
2 UCO
/90000021
41,5 / 0
0,00
2.076,16
Total:
0468000092002
0468000092002
11000909
30/11/2011
310000145
310000145
/10101012
1/0
83,07
40302040 Glicose
/40302040
1/0
5,28
40316491 T4 livre
/40316491
1/0
34,39
310000145
/40316521
1/0
27,52
310000226
/40601137
1/0
29,21
310000145
40316157 Anti-TIPO
/40316157
1/0
42,41
11000909
/41301102
1/0
25,58
310000145
/40311210
1/0
11,20
310000145
1/0
11,78
310000145
40316246 Estradiol
/40316246
1/0
40,84
310000145
/40304922
1/0
33,50
310000145
/40302750
1/0
22,46
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 25
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
11000909
2 UCO
/90000021
2,78 / 0
0,00
310000145
2 UCO
/90000021
15,301 / 0
0,00
310000226
2 UCO
/90000021
1,03 / 0
0,00
/10101012
1/0
83,07
0468000092304
11000909
30/11/2011
11000909
/41301102
1/0
25,58
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
1/0
11,78
310000145
/40316521
1/0
27,52
310000145
/40311210
1/0
11,20
310000145
/40302750
1/0
22,46
310000145
2 UCO
/90000021
4,107 / 0
0,00
11000909
2 UCO
/90000021
2,78 / 0
0,00
Total:
0468000095001
0468000095001
554,13
Heloiza de F J L Rocha
Heloiza de F J L Rocha
310000030
20/12/2011
/40308391
1/0
36,82
310000030
20/12/2011
1/0
11,78
310000030
20/12/2011
/40311210
1/0
11,20
310000030
20/12/2011
1/0
24,52
310000030
20/12/2011
/90000021
3,48 / 0
/10101012
1/0
0468000095095
1130583
2 UCO
Total:
0468000096008
0468000096008
0,00
83,07
167,39
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 26
Atendimento/Lote/Nota
110000079
110000079
110000079
0468000096016
Procedimento/Cd.Intercmbio/Participao
40901203 rgos superficiais (tireide ou escroto
Obs.
Qtd/Partic
Vl.Cob
/40901203
1/0
76,72
2 UCO
/90000021
3,42 / 0
0,00
1 FILME
0,17 / 0
3,86
1342173
/10101012
1/0
83,07
1342173
/41301099
1/0
7,68
1342173
/41301102
1/0
25,58
310000145
/40601137
1/0
29,21
110000052
/10101039
1/0
94,77
1221163
/40201082
/Anestesis
1/1
151,22
110000419
/ Clin. De Proctologia Do
/40201082
/Clinico
1/1
191,88
110000419
/ Clin. De Proctologia Do
2 UCO
/90000021
14,798 / 0
0,00
310000145
2 UCO
/90000021
1,03 / 0
0,00
110000419
/ Clin. De Proctologia Do
0 Materiais em Geral
/90000021
1/0
1342173
2 UCO
/90000021
2,78 / 0
110000419
/ Clin. De Proctologia Do
0 Medicamentos em Geral
/90000013
1/0
58,04
0468000096300
28,71
0,00
1342173
/10101012
1/0
83,07
3612
16/12/2011
/10101012
1/0
83,07
1342173
/41301099
1/0
7,68
310000145
1/0
9,63
1342173
/41301102
1/0
25,58
5263
1/0
28,08
1342173
2 UCO
/90000021
2,78 / 0
0,00
310000145
2 UCO
/90000021
0,693 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 27
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
1342173
/10101012
1/0
83,07
1342173
/41301099
1/0
7,68
310000145
1/0
9,63
1342173
/41301102
1/0
25,58
310000145
2 UCO
/90000021
0,693 / 0
0,00
1342173
2 UCO
/90000021
2,78 / 0
0,00
1.113,81
Total:
0468000099007
0468000099007
Ivan Porto De Sa
Ivan Porto De Sa
310000145
310000145
0468000099015
/40310400
1/0
/90000021
4,977 / 0
/10101012
1/0
83,07
/40601137
1/0
29,21
/90000021
1,03 / 0
2 UCO
67,72
0,00
1341339
06/12/2011
310000242
310000242
0468000099503
2 UCO
0,00
47224
01/12/2011
/10101012
1/0
83,07
310000030
21/11/2011
1/0
11,78
11003061
/20102011
1/0
30,70
310000030
21/11/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
21/11/2011
40302580 Uria
/40302580
1/0
5,28
310000030
21/11/2011
/40316149
1/0
32,99
11003061
/40901106
1/0
239,62
21002609
/20104286
1/0
12,17
21002609
/20104294
1/0
115,13
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 28
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
21002609
0 Materiais em Geral
/90000021
1/0
9,27
310000030
21/11/2011
2 UCO
/90000021
4,074 / 0
0,00
11003061
2 UCO
/90000021
8,1 / 0
0,00
21002609
0 Medicamentos em Geral
/90000013
1/0
2.265,48
/10101012
1/0
83,07
0468000099511
Maria Porto De Sa
3583
24/11/2011
210000291
/40801063
1/0
35,14
3583
/20102038
1/0
30,70
3583
1/0
15,35
210000291
/40805026
1/0
31,23
3583
/40901360
1/0
115,13
3583
2 UCO
/90000021
0,75 / 0
0,00
3583
1 FILME
0,68 / 0
15,43
210000291
1 FILME
0,4376 / 0
9,93
3583
2 UCO
/90000021
20,26 / 0
0,00
210000291
2 UCO
/90000021
2,65 / 0
0,00
3.326,75
Total:
0468000100005
0468000100307
89000098
/ Unimed Imperatriz
98
/10101039
1/0
43,00
89000098
/ Unimed Imperatriz
98
17354
/10101039
1/0
43,00
89000098
/ Unimed Imperatriz
98
/80041868
1/0
12,29
89000098
/ Unimed Imperatriz
98
1/0
37,43
89000098
/ Unimed Imperatriz
98
/80041868
1/0
12,29
89000098
/ Unimed Imperatriz
98
/90000021
1/0
10,52
0 Materiais em Geral
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 29
/ Unimed Imperatriz
98
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
0 Medicamentos em Geral
/90000013
Obs.
/
Qtd/Partic
1/0
11,01
169,54
Total:
0468000106003
0468000106003
Vl.Cob
4990
01/12/2011
4990
24240
/10101012
1/0
83,07
/41301323
/Clinico
1/1
22,08
1/0
157,75
210000828
/ Pro-Visao S/C
/41301250
2/0
69,22
210000828
/ Pro-Visao S/C
2 UCO
/90000021
1,08 / 0
0,00
24240
2 UCO
/90000021
13,67 / 0
0,00
24240
0 Materiais em Geral
/90000021
1/0
6,86
24240
0 Medicamentos em Geral
/90000013
1/0
7,01
0468000106011
6422
20/12/2011
/10101012
1/0
83,07
34696
07/12/2011
/10101012
1/0
83,07
0468000106305
110000052
/10101039
1/0
94,77
310000145
/40310337
1/0
24,52
310000145
1/0
11,78
310000145
/40308391
1/0
36,82
310000145
40303110 Parasitolgico
/40303110
1/0
12,78
310000145
2 UCO
/90000021
3,597 / 0
0468000106755
0,00
310000145
/40310337
1/0
24,52
310000145
40302423 Sdio
/40302423
1/0
5,28
310000145
/40303136
1/0
12,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 30
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000145
1/0
11,78
310000145
/40308391
1/0
36,82
310000145
40303110 Parasitolgico
/40303110
1/0
12,78
310000145
/40303098
1/0
5,99
310000145
40302318 Potssio
/40302318
1/0
5,28
310000145
/40311210
1/0
11,20
310000145
/90000021
6,531 / 0
2 UCO
819,23
Total:
0468000109002
0468000109002
0,00
110000346
/40301605
1/0
0,07
110000346
1/0
0,07
110000346
/40805026
1/0
15,35
110000346
40302580 Uria
/40302580
1/0
0,07
110000346
40302547 Triglicerdeos
/40302547
1/0
0,07
110000346
/40307760
1/0
0,30
110000346
40303110 Parasitolgico
/40303110
1/0
0,30
110000346
/40306615
1/0
0,30
110000346
40301630 Creatinina
/40301630
1/0
0,07
110000346
40302040 Glicose
/40302040
1/0
0,07
110000346
/40304299
1/0
0,07
110000346
/40306623
1/0
0,30
110000346
/40311210
1/0
0,30
110000346
1 FILME
0,308 / 0
6,99
110000346
2 UCO
/90000021
11,212 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 31
0468000109517
28/11/2011
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
/10101012
1/0
83,07
210001611
03/11/2011
210000674
/20103492
10 / 0
387,74
210001611
03/11/2011
/41301323
1/0
22,08
210001611
03/11/2011
2 UCO
/90000021
0,5 / 0
0,00
210000674
2 UCO
/90000021
6/0
0,00
600,29
Total:
0468000111007
0468000111007
89000098
/ Unimed Imperatriz
0468000111503
42189
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
52689
15/09/2011
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
52689
20/10/2011
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
/40805026
1/0
15,03
89000098
/ Unimed Imperatriz
98
40301400 Clcio
/40301400
1/0
4,13
89000098
/ Unimed Imperatriz
98
40301630 Creatinina
/40301630
1/0
4,13
89000098
/ Unimed Imperatriz
98
/40301885
1/0
5,31
89000098
/ Unimed Imperatriz
98
40302318 Potssio
/40302318
1/0
4,13
89000098
/ Unimed Imperatriz
98
40302580 Uria
/40302580
1/0
4,13
89000098
/ Unimed Imperatriz
98
/40901122
1/0
98,77
89000098
/ Unimed Imperatriz
98
/40301990
1/0
5,90
89000098
/ Unimed Imperatriz
98
40301400 Clcio
/40301400
1/0
4,13
89000098
/ Unimed Imperatriz
98
40301630 Creatinina
/40301630
1/0
4,13
89000098
/ Unimed Imperatriz
98
40302580 Uria
/40302580
1/0
4,13
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 32
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
/40301885
1/0
5,31
89000098
/ Unimed Imperatriz
98
40302423 Sdio
/40302423
1/0
4,13
89000098
/ Unimed Imperatriz
98
1/0
8,85
89000098
/ Unimed Imperatriz
98
/20203047
10 / 0
88,45
89000098
/ Unimed Imperatriz
98
1/0
8,85
89000098
/ Unimed Imperatriz
98
/20104235
12 / 0
35,38
89000098
/ Unimed Imperatriz
98
52689
/10101039
1/0
43,00
89000098
/ Unimed Imperatriz
98
/10102019
2/0
171,99
89000098
/ Unimed Imperatriz
98
0 Materiais em Geral
/90000021
1/0
42,39
89000098
/ Unimed Imperatriz
98
1 FILME
0,3078 / 0
7,34
89000098
/ Unimed Imperatriz
98
1 FILME
0,7599 / 0
18,11
89000098
/ Unimed Imperatriz
98
0 Materiais em Geral
/90000021
1/0
76,07
89000098
/ Unimed Imperatriz
98
0 Medicamentos em Geral
/90000013
1/0
670,47
89000098
/ Unimed Imperatriz
98
0 Medicamentos em Geral
/90000013
1/0
13,15
/10101012
1/0
58,97
/40103315
1/0
243,24
0468000111511
89000098
/ Unimed Imperatriz
98
7294
24/10/2011
89000098
/ Unimed Imperatriz
98
Total:
0468000112003
0468000112518
1932
1.826,53
17/12/2011
/10101012
1/0
83,07
Total:
0468000118001
0468000118001
83,07
Jose de R De A Bezerra
Jose de R De A Bezerra
310000065
310000065
/40601110
1/0
/90000021
2,06 / 0
58,42
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 33
05/12/2011
210000020
210000020
Atendimento/Lote/Nota
7670665 / 99999 / 10245892
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
/40901203
1/0
76,72
/40809099
1/0
66,20
210000020
2 UCO
/90000021
3,42 / 0
0,00
210000020
1 FILME
0,17 / 0
3,86
288,27
Total:
0468000121002
0468000121010
14806
13/12/2011
/10101012
1/0
83,07
310000030
26/11/2011
/40302504
1/0
9,76
310000030
26/11/2011
/40311210
1/0
11,20
310000030
26/11/2011
40301281 Amilase
/40301281
1/0
9,76
310000030
26/11/2011
/40308391
1/0
36,82
310000030
26/11/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
26/11/2011
40302199 Lipase
/40302199
1/0
9,76
310000030
26/11/2011
/40301990
1/0
9,76
310000030
26/11/2011
40302423 Sdio
/40302423
1/0
5,28
310000030
26/11/2011
40302580 Uria
/40302580
1/0
5,28
310000030
26/11/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
26/11/2011
40302571 Troponina
/40302571
1/0
44,71
310000030
26/11/2011
1/0
11,78
310000030
26/11/2011
/40301648
1/0
14,47
310000030
26/11/2011
/40301885
1/0
9,76
310000030
26/11/2011
/40301397
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 34
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
26/11/2011
/40302512
1/0
9,76
310000030
26/11/2011
40302318 Potssio
/40302318
1/0
5,28
310000030
26/11/2011
/40301656
1/0
44,71
310000030
26/11/2011
2 UCO
/90000021
8,322 / 0
0,00
310000030
26/11/2011
2 UCO
/90000021
7,587 / 0
0,00
0468000121304
310000030
02/12/2011
1/0
11,78
310000030
02/12/2011
/40308391
1/0
36,82
310000030
02/12/2011
/90000021
0,87 / 0
2 UCO
385,60
Total:
0468000122009
0468000122009
0,00
25956
28/11/2011
/10101012
1/0
83,07
11002103
05/12/2011
/10101012
1/0
83,07
310000145
/40311210
1/0
11,20
25956
/41301323
1/0
15,35
25956
2 UCO
/90000021
0,5 / 0
0,00
310000145
2 UCO
/90000021
0,81 / 0
0,00
0468000122017
11001646
14/12/2011
/10101012
1/0
83,07
310000030
12/12/2011
1/0
11,78
310000030
12/12/2011
/40301990
1/0
9,76
310000030
12/12/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
12/12/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
12/12/2011
/40302512
1/0
9,76
310000030
12/12/2011
/40301150
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 35
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
12/12/2011
40302580 Uria
/40302580
1/0
5,28
310000030
12/12/2011
/40301885
1/0
9,76
310000030
12/12/2011
/40302504
1/0
9,76
310000030
12/12/2011
/40301729
1/0
9,76
310000030
12/12/2011
40301400 Clcio
/40301400
1/0
5,28
210001590
/80031706
1/0
28,03
310000030
12/12/2011
2 UCO
/90000021
6,405 / 0
210001590
0 Materiais em Geral
/90000021
1/0
71,73
210001590
0 Medicamentos em Geral
/90000013
1/0
1.381,48
TE33 QUIMIOTERAPIA
1.843,98
Total:
0468000124001
0468000124001
0,00
5064
28/11/2011
/10101012
1/0
83,07
5064
/30101298
3/0
159,88
5064
/80051510
1/0
45,45
5064
0 Materiais em Geral
/90000021
1/0
17,09
5064
0 Medicamentos em Geral
/90000013
1/0
20,25
/10101012
1/0
83,07
0468000124010
5064
28/11/2011
310000145
40302040 Glicose
/40302040
1/0
5,28
310000242
/40601137
1/0
29,21
310000145
/40302504
1/0
9,76
310000145
/40301990
1/0
9,76
310000145
/40316521
1/0
27,52
310000145
40301630 Creatinina
/40301630
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 36
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000145
/40302512
1/0
9,76
310000145
40302580 Uria
/40302580
1/0
5,28
310000145
1/0
11,78
310000145
40316491 T4 livre
/40316491
1/0
34,39
310000145
/40302750
1/0
22,46
5064
/30101298
1/0
53,29
5064
/80051510
1/0
45,45
5064
0 Materiais em Geral
/90000021
1/0
5,70
310000242
2 UCO
/90000021
1,03 / 0
0,00
310000145
2 UCO
/90000021
8,781 / 0
0,00
5064
0 Medicamentos em Geral
/90000013
1/0
6,75
0468000124311
5064
28/11/2011
/10101012
1/0
83,07
5064
/30101255
2/0
68,21
5064
0 Materiais em Geral
/90000021
1/0
11,40
5064
0 Medicamentos em Geral
/90000013
1/0
13,50
866,66
Total:
0468000126004
0468000126004
310000030
13/12/2011
/40301885
1/0
9,76
310000030
13/12/2011
40302199 Lipase
/40302199
1/0
9,76
310000030
13/12/2011
1/0
11,78
310000030
13/12/2011
/40302512
1/0
9,76
310000030
13/12/2011
/40302504
1/0
9,76
310000030
13/12/2011
/40301990
1/0
9,76
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 37
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
13/12/2011
40301281 Amilase
/40301281
1/0
9,76
310000030
13/12/2011
/40301397
1/0
5,28
310000030
13/12/2011
/40308391
1/0
36,82
310000030
13/12/2011
/90000021
5,577 / 0
/10101012
1/0
83,07
0468000126020
2 UCO
0,00
14465
01/12/2011
210000062
40901114 Mamas
/40901114
1/0
86,31
310030141
01/12/2011
1/0
9,63
14465
/41301102
1/0
25,58
310030141
01/12/2011
/40310019
1/0
9,63
310000145
/40310400
1/0
67,72
310000145
2 UCO
/90000021
4,977 / 0
0,00
210000062
1 FILME
0,34 / 0
7,72
14465
2 UCO
/90000021
2,78 / 0
0,00
310030141
01/12/2011
2 UCO
/90000021
1,386 / 0
0,00
210000062
2 UCO
/90000021
3,42 / 0
0,00
/10101012
1/0
83,07
0468000126144
1130583
13/12/2011
310000145
/40310400
1/0
67,72
310000145
/40310400
1/0
67,72
310000145
/90000021
9,954 / 0
2 UCO
620,61
Total:
0468000127000
0468000127000
0,00
310000242
1/0
24,52
11001654
31103090 Cistolitotomia
/Cirurgiao
1/1
191,88
/31103090
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 38
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
11001654
/31103219
/Cirurgiao
1/1
383,76
21002622
/31103219
/Anestesis
1/1
447,62
21002622
31103090 Cistolitotomia
/31103090
/Anestesis
1/1
151,22
110000052
11/11/2011
DA02 APARTAMENTO
/80011020
1/0
245,48
110000052
/80061400
2/0
24,52
110000052
/80021034
1/0
278,68
310000242
2 UCO
/90000021
1,8 / 0
110000052
0 Materiais em Geral
/90000021
1/0
891,56
110000052
0 Medicamentos em Geral
/90000013
1/0
397,41
/10101012
1/0
83,07
0468000127019
15/12/2011
Total:
0468000129003
0468000129011
0,00
3484
3.119,72
310000242
1/0
11,78
310000242
/40302504
1/0
9,76
310000242
/40302512
1/0
9,76
310000242
/40302750
1/0
22,46
310000242
/90000021
2,31 / 0
2 UCO
53,76
Total:
0468000130001
0468000130095
1130460
0468000130109
14/12/2011
0468000130516
89000099
/ Unimed Teresina
/10101012
1/0
83,07
/10101012
1/0
83,07
/41301323
1/0
10,13
4825
0,00
01/12/2011
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 39
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000265
/10101039
1/0
40,15
89000099
/ Unimed Teresina
99
/30306027
1/0
884,52
89000265
/10102019
1/0
70,08
89000265
/80011039
1/0
0,00
89000099
/ Unimed Teresina
99
/80061400
1/0
15,97
89000099
/ Unimed Teresina
99
/80053327
1/0
43,00
89000099
/ Unimed Teresina
99
/80051510
1/0
24,57
89000099
/ Unimed Teresina
99
TC15 PORTE V
/80021050
1/0
348,89
89000265
/80031005
1/0
16,43
89000265
1/0
7,99
89000265
2/0
3,53
89000099
/ Unimed Teresina
99
/90000021
1/0
1.140,05
89000265
/79923070
1/0
3,79
89000265
/70037124
1/0
2,43
89000265
/90228260
2/0
10,95
89000265
/90143540
2/0
3,35
89000265
/90228324
2/0
1,50
89000265
/90196538
3/0
12,64
89000265
/90380037
2/0
3,09
89000265
/90193423
1/0
0,70
89000265
/92395511
2/0
50,85
0 Materiais em Geral
53218 CATETER INTRAVASCULAR
Total:
0468000131008
0468000131105
89000098
/ Unimed Imperatriz
2.860,75
16811
/10101012
1/0
58,97
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 40
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
/10101039
1/0
43,00
89000098
/ Unimed Imperatriz
98
1/0
14,24
89000098
/ Unimed Imperatriz
98
0 Materiais em Geral
/90000021
1/0
7,50
89000098
/ Unimed Imperatriz
98
0 Medicamentos em Geral
/90000013
1/0
27,09
Total:
0468000135003
0468000135305
150,80
11003061
/40901106
1/0
239,62
11003061
/20102038
1/0
30,70
11003061
/40101045
1/0
30,70
11003061
/90000021
19,16 / 0
2 UCO
301,02
Total:
0468000137006
0468000137103
0,00
Justino C de Almeida
Fabio C de Almeida
1100153
20/12/2011
/10101012
1/0
83,07
1360554
06/12/2011
/10101012
1/0
83,07
0468000137120
210020543
/10101039
1/0
40,95
310000030
07/12/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
07/12/2011
/40302504
1/0
9,76
310000030
07/12/2011
1/0
11,78
310000030
07/12/2011
/40302512
1/0
9,76
310000030
07/12/2011
40302423 Sdio
/40302423
1/0
5,28
210002590
/40801063
1/0
35,14
310000030
07/12/2011
40302318 Potssio
/40302318
1/0
5,28
310000030
07/12/2011
/40308391
1/0
36,82
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 41
Atendimento/Lote/Nota
210020560
210002590
210002590
310000030
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
1/0
2 UCO
/90000021
1,47 / 0
0,00
1 FILME
0,1296 / 0
2,94
07/12/2011
2 UCO
/90000021
3,471 / 0
0,00
Total:
0468000139009
0468000139092
52,65
381,78
310000145
310000145
/40601110
1/0
/90000021
2,06 / 0
58,42
0,00
58,42
Total:
0468000141003
0468000141003
Vl.Cob
/10101039
210000518
40103749 Vectoeletronistagmografia -
/40103749
1/0
131,79
210000518
1/0
105,56
210000518
/40103650
1/0
90,58
210000518
/90000021
11,537 / 0
0468000141100
2 UCO
0,00
11003053
25/11/2011
/10101012
1/0
83,07
11002103
25/11/2011
/10101012
1/0
83,07
110000052
40804011 Bacia
/40804011
1/0
15,35
110000052
40804097 P ou pododctilo
/40804097
2/0
30,70
110000052
40804054 Joelho
/40804054
2/0
30,70
110000052
1 FILME
0,73 / 0
16,57
110000052
2 UCO
/90000021
6,1 / 0
0,00
Total:
0468000142000
0468000142000
587,39
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 42
15/12/2011
Atendimento/Lote/Nota
7675695 / 99999 / 10252715
Procedimento/Cd.Intercmbio/Participao
10101012 Em consultrio (no horrio normal ou
/10101012
Obs.
Qtd/Partic
1/0
1340120
0468000143510
16/12/2011
/10101012
1/0
83,07
/40601137
1/0
29,21
/90000021
1,03 / 0
310000250
310000250
2 UCO
Total:
0468000145009
0468000145513
83,07
83,07
Total:
0468000143006
0468000143006
Vl.Cob
0,00
112,28
11000909
07/12/2011
11000909
310000226
/10101012
1/0
83,07
/41301102
1/0
25,58
/40601137
1/0
29,21
11000909
2 UCO
/90000021
2,78 / 0
0,00
310000226
2 UCO
/90000021
1,03 / 0
0,00
Total:
0468000147001
0468000147001
3921
137,86
01/12/2011
/10101012
1/0
83,07
Total:
0468000148008
0468000148512
83,07
Lidia F de A Santos
Jesuina B de A Santos
11000739
09/12/2011
210000291
310030141
310030141
/10101012
1/0
83,07
/41001010
1/0
341,42
09/12/2011
/40311210
1/0
11,20
09/12/2011
/40316556
1/0
54,57
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 43
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
210000291
/40808130
1/0
185,89
310030141
09/12/2011
40302040 Glicose
/40302040
1/0
5,28
310030141
09/12/2011
40316491 T4 livre
/40316491
1/0
34,39
210000291
40808033 MAMOGRAFIA
/40808033
1/0
85,11
310030141
09/12/2011
40303110 Parasitolgico
/40303110
1/0
12,78
210000291
/40901203
1/0
76,72
310030141
09/12/2011
/40601137
1/0
29,21
310030141
09/12/2011
/40316521
1/0
27,52
310030141
09/12/2011
/40316548
1/0
27,52
310030141
09/12/2011
1/0
11,78
310030141
09/12/2011
/40302750
1/0
22,46
210000291
2 UCO
/90000021
16,43 / 0
0,00
210000291
2 UCO
/90000021
19,1 / 0
0,00
210000291
1 FILME
1/0
22,70
210000291
1 FILME
1,37 / 0
31,10
310030141
09/12/2011
2 UCO
/90000021
14,654 / 0
1.062,72
Total:
0468000149004
0468000149004
5440
0468000149012
11002030
12/12/2011
/10101012
1/0
83,07
/10101012
1/0
83,07
15/12/2011
166,14
Total:
0468000150002
0468000150002
4186
0,00
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 44
0468000150096
Atendimento/Lote/Nota
28/11/2011
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
210020438
/20103506
1/0
26,66
210020438
/20103506
3/0
79,99
110000079
/41101227
1/0
731,55
110000079
/41101227
1/0
731,55
3737
/40103315
1/0
140,69
110000079
2 UCO
/90000021
94,48 / 0
110000079
1 FILME
8/0
210020438
2 UCO
/90000021
1,08 / 0
0,00
3737
2 UCO
/90000021
9,6 / 0
0,00
/10101012
1/0
0468000150100
11002049
09/12/2011
17449
19/12/2011
17449
17449
/10101012
1/0
83,07
/41301250
2/0
61,40
/90000021
0,58 / 0
2 UCO
Total:
310000242
0468000156019
144,47
1/0
7,57
/90000021
0,54 / 0
0,00
/10101012
1/0
0468000156302
0,00
310000242
11000909
83,07
2.141,23
Total:
0468000156000
0468000156000
181,58
0468000152102
0468000152315
0,00
14/12/2011
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 45
14/12/2011
310000145
310000145
310000145
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
40316416 Prolactina
/40316416
2/0
74,95
40316416 Prolactina
/40316416
1/0
37,48
/90000021
8,34 / 0
0468000156507
2 UCO
0,00
11001808
14/12/2011
/10101012
1/0
83,07
4473
06/12/2011
/10101012
1/0
83,07
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
/40302512
1/0
9,76
310000145
/40306992
1/0
24,52
310000145
/40301885
1/0
9,76
310000145
/40302504
1/0
9,76
310000145
/40301990
1/0
9,76
310000145
/40304590
1/0
7,70
110000443
1/0
15,35
310000145
/40302750
1/0
22,46
110000443
2 UCO
/90000021
0,75 / 0
0,00
310000145
2 UCO
/90000021
5,634 / 0
0,00
566,63
Total:
0468000157007
0468000157015
310000145
/40311210
1/0
11,20
310000145
/40302512
1/0
9,76
310000145
/40302504
1/0
9,76
310000145
40302040 Glicose
/40302040
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 46
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000145
1/0
11,78
310000145
/40316521
1/0
27,52
310000145
/40301150
1/0
5,28
310000145
/40307760
1/0
9,99
310000145
/40302750
1/0
22,46
310000145
2 UCO
/90000021
4,44 / 0
0,00
310000145
2 UCO
/90000021
2,214 / 0
0,00
0468000157511
Doralice G M Araujo
17449
02/12/2011
/10101012
1/0
83,07
11003010
30/11/2011
/10101012
1/0
83,07
4473
06/12/2011
/10101012
1/0
83,07
17449
/41301269
2/0
95,94
310000030
14/12/2011
1/0
24,52
310000030
14/12/2011
/40304590
1/0
7,70
310000030
14/12/2011
/40301885
1/0
9,76
310000030
14/12/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
14/12/2011
/40306992
1/0
24,52
310000030
14/12/2011
40316270 Ferritina
/40316270
1/0
27,61
310000030
14/12/2011
/40316114
1/0
35,29
310000030
14/12/2011
/40307026
1/0
33,72
310000030
14/12/2011
/40301761
1/0
24,49
310000030
14/12/2011
/40301397
1/0
5,28
310000030
14/12/2011
/40301990
1/0
9,76
310000030
14/12/2011
/40302512
1/0
9,76
17449
/41301323
1/0
15,35
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 47
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
110000079
/40901130
1/0
99,91
310000030
14/12/2011
/40302504
1/0
9,76
310000030
14/12/2011
/40302750
1/0
22,46
310000030
14/12/2011
2 UCO
/90000021
16,716 / 0
0,00
17449
2 UCO
/90000021
0,5 / 0
0,00
17449
2 UCO
/90000021
6,06 / 0
0,00
110000079
2 UCO
/90000021
3,86 / 0
0,00
110000079
1 FILME
0,51 / 0
11,58
834,93
Total:
0468000159000
0468000159093
Luzia A R de Oliveira
Francisco De Assis De Oliveira
14148
14148
/90000021
1/0
0,75 / 0
0,00
15,35
Total:
0468000163007
0468000163007
15,35
1937
02/12/2011
210020314
210020314
/10101012
1/0
83,07
5/0
153,50
/40803066
1/0
15,35
210020314
/40803074
1/0
15,35
210020314
/40805018
1/0
15,35
210020314
40803082 Brao
/40803082
1/0
15,35
210020314
/20103492
5/0
153,50
210020314
2 UCO
/90000021
4,76 / 0
210020314
1 FILME
0,4708 / 0
210020314
2 UCO
/90000021
10,8 / 0
0,00
10,69
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 48
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
11001298
25/11/2011
/10101012
1/0
83,07
1110710
28/11/2011
/10101012
1/0
83,07
210020438
/40103463
1/0
59,96
210020438
/90000021
1,462 / 0
2 UCO
688,26
Total:
0468000165000
0468000165000
0,00
310000145
/40301885
1/0
9,76
310000145
40302318 Potssio
/40302318
1/0
5,28
310000145
40302423 Sdio
/40302423
1/0
5,28
310000145
/40301990
1/0
9,76
310000145
40301630 Creatinina
/40301630
1/0
5,28
310000145
/90000021
2,601 / 0
0,00
/10101012
1/0
0468000165026
3813
2 UCO
02/12/2011
118,43
Total:
0468000167002
0468000167118
210020543
/10101039
1/0
52,65
52,65
Total:
0468000170003
0468000170003
83,07
950000970
1/0
157,75
950000970
/40202550
1/0
362,40
950000970
0 Materiais em Geral
/90000021
1/0
13,86
950000970
2 UCO
/90000021
13,67 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 49
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
2 UCO
/90000021
Obs.
Qtd/Partic
14,806 / 0
11002103
30/11/2011
/10101012
1/0
5440
22/12/2011
310000145
310000145
/10101012
1/0
83,07
/40311210
1/0
11,20
/90000021
0,81 / 0
2 UCO
Total:
0468000173002
0468000173509
83,07
83,07
Total:
0468000172006
0468000172006
0,00
534,01
Total:
0468000171000
0468000171107
Vl.Cob
0,00
94,27
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
1/0
11,78
310000145
/40302733
1/0
44,71
310000145
/40302750
1/0
22,46
310000145
/90000021
4,911 / 0
2 UCO
89,51
Total:
0468000174009
0468000174009
18305
07/12/2011
18305
18305
/10101012
1/0
83,07
/41301102
1/0
25,58
/90000021
2,78 / 0
2 UCO
Total:
0468000177008
0,00
0,00
108,65
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 50
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000088
88
10000096 30/09/2011
/40301583
1/0
8,85
89000088
88
10000096 30/09/2011
/40301591
1/0
11,79
89000088
88
10000096 30/09/2011
/40316521
1/0
25,06
89000088
88
10000096 30/09/2011
/40302512
1/0
4,13
89000088
88
10000096 30/09/2011
40302318 Potssio
/40302318
1/0
4,13
89000088
88
10000096 30/09/2011
1/0
8,85
89000088
88
10000096 30/09/2011
40302040 Glicose
/40302040
1/0
4,13
89000088
88
10000096 30/09/2011
/40301605
1/0
4,13
89000088
88
10000096 30/09/2011
/40311210
1/0
5,90
89000088
88
10000096 30/09/2011
/40302504
1/0
4,13
89000088
88
10000096 30/09/2011
40316491 T4 livre
/40316491
1/0
25,06
89000088
88
10000096 30/09/2011
40302547 Triglicerdeos
/40302547
1/0
5,90
Total:
0468000178004
0468000178004
112,06
310000030
/40316521
1/0
27,52
310000030
/40301150
1/0
5,28
310000030
/40302512
1/0
9,76
310000030
40316491 T4 livre
/40316491
1/0
34,39
310000030
/40308391
1/0
36,82
310000030
40302580 Uria
/40302580
1/0
5,28
310000030
/40302504
1/0
9,76
310000030
1/0
11,78
310000030
40302040 Glicose
1/0
5,28
/40302040
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 51
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
40302423 Sdio
/40302423
1/0
5,28
310000030
/40301990
1/0
9,76
310000030
40301630 Creatinina
/40301630
1/0
5,28
310000030
/40316556
1/0
54,57
310000030
/40302733
1/0
44,71
310000030
/40302750
1/0
22,46
310000030
/90000021
16,822 / 0
2 UCO
287,93
Total:
0468000180009
0468000180009
0,00
1201804
19/12/2011
/10101012
1/0
83,07
21002604
/ F C Leite - Me
29/11/2011
10 / 0
293,55
21002604
/ F C Leite - Me
29/11/2011
4,7 / 0
0,00
2 UCO
/90000021
376,62
Total:
0468000182001
0468000182001
310000145
/40302504
1/0
9,76
310000145
40316491 T4 livre
/40316491
1/0
34,39
310000145
40302580 Uria
/40302580
1/0
5,28
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
/40302512
1/0
9,76
310000145
1/0
11,78
310000145
/40316521
1/0
27,52
310000145
40301630 Creatinina
/40301630
1/0
5,28
110000052
/40901211
1/0
30,70
310000145
/40311210
1/0
11,20
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 52
Atendimento/Lote/Nota
310000145
110000052
110000052
310000145
Procedimento/Cd.Intercmbio/Participao
40302750 Perfil lipdico / lipidograma (lpidios
Obs.
Qtd/Partic
1/0
2 UCO
/90000021
3,42 / 0
0,00
1 FILME
0,17 / 0
3,86
2 UCO
/90000021
8,871 / 0
0,00
Total:
0468000183008
0468000183008
110000079
177,27
/40901076
1/0
/90000021
28 / 0
0,00
/ Unimed Recife
34
/40316149
1/0
Total:
0468000185000
0468000185701
466,53
466,53
Total:
89000034
22,46
110000079
0468000184004
0468000184098
Vl.Cob
/40302750
44,23
44,23
11001751
/40201120
1/0
127,90
310030249
/40601110
3/0
175,25
21002622
/40201120
/Anestesis
1/1
223,81
11001751
/40201120
/Clinico
1/1
115,13
310030249
/40601269
3/0
87,64
110000052
/80021034
1/0
278,68
110000052
/80061400
1/0
12,26
11001751
2 UCO
/90000021
12,585 / 0
0,00
310030249
2 UCO
/90000021
9,27 / 0
0,00
110000052
0 Materiais em Geral
/90000021
1/0
110000052
2 UCO
/90000021
12,585 / 0
119,74
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 53
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
11001751
0 Medicamentos em Geral
/90000013
1/0
13,86
110000052
0 Medicamentos em Geral
/90000013
1/0
58,61
Total:
0468000187003
0468000187003
12919
1.212,88
Mario G de J B Pereira
Mario G de J B Pereira
30/11/2011
/10101012
1/0
83,07
Total:
0468000193003
0468000193003
83,07
Moacir Santos
Moacir Santos
110010198
/40601200
2/0
178,14
110010198
2/0
116,84
110010198
/30101522
2/0
736,82
110010198
/80051510
1/0
45,45
110010198
/80000037
1/0
22,82
110010198
TC14 PORTE IV
/80021042
1/0
183,95
110010198
2 UCO
/90000021
7,52 / 0
110010198
0 Materiais em Geral
/90000021
1/0
129,51
110010198
0 Medicamentos em Geral
/90000013
1/0
63,11
1.476,64
Total:
0468000195006
0468000195090
0,00
3393
24/11/2011
310000242
3393
/10101012
1/0
83,07
/40316149
1/0
32,99
/40201066
1/0
93,80
310000242
40302040 Glicose
/40302040
1/0
5,28
3393
/41301340
1/0
140,69
310000242
40302580 Uria
/40302580
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 54
06/12/2011
3393
310000242
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/40901173
1/0
86,18
/41301340
1/0
117,23
40301630 Creatinina
/40301630
1/0
5,28
3393
/40201066
1/0
162,45
210000879
06/12/2011
1 FILME
0,51 / 0
11,58
310000242
2 UCO
/90000021
3,591 / 0
0,00
210000879
06/12/2011
2 UCO
/90000021
3,41 / 0
0,00
3393
2 UCO
/90000021
13,39 / 0
0,00
/10101012
1/0
0468000195316
1111120
826,90
Total:
0468000196002
0468000196002
83,07
11001115
13/12/2011
210001530
/ Cegine-Centro
11001115
/10101012
1/0
83,07
/40808041
1/0
135,16
1/0
15,35
11001115
2 UCO
/90000021
0,75 / 0
0,00
210001530
/ Cegine-Centro
2 UCO
/90000021
6,48 / 0
0,00
210001530
/ Cegine-Centro
1 FILME
1,2 / 0
27,24
260,82
Total:
0468000197009
0468000197009
11000364
12/12/2011
/10101012
1/0
83,07
Total:
0468000198005
0468000198005
310000030
83,07
40301931 Fsforo
/40301931
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 55
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
09/12/2011
40316165 Calcitonia
/40316165
1/0
94,00
310000030
29/11/2011
/40304590
1/0
7,70
310000030
29/11/2011
1/0
7,70
310000030
29/11/2011
40301222 Albumina
/40301222
1/0
5,28
310000030
06/12/2011
/40302016
1/0
24,49
310000030
29/11/2011
40302423 Sdio
/40302423
1/0
5,28
310000030
29/11/2011
40302237 Magnsio
/40302237
1/0
5,28
310000030
29/11/2011
40301931 Fsforo
/40301931
1/0
5,28
310000030
09/12/2011
/40302016
1/0
24,49
310000030
29/11/2011
/40301419
1/0
14,47
310000030
29/11/2011
40302580 Uria
/40302580
1/0
5,28
310000030
09/12/2011
1/0
11,78
310000030
10/12/2011
40301400 Clcio
/40301400
1/0
5,28
310000030
10/12/2011
/40302016
1/0
24,49
310000030
06/12/2011
/40302016
1/0
24,49
310000030
10/12/2011
40302423 Sdio
/40302423
1/0
5,28
310000030
10/12/2011
40302237 Magnsio
/40302237
1/0
5,28
310000030
10/12/2011
40302318 Potssio
/40302318
1/0
5,28
310000030
01/12/2011
/40310400
1/0
67,72
310000030
29/11/2011
40302318 Potssio
/40302318
1/0
5,28
310000030
29/11/2011
/40301397
1/0
5,28
310000030
29/11/2011
/40308391
1/0
36,82
310000030
29/11/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
06/12/2011
/40302016
1/0
24,49
310000030
29/11/2011
1/0
11,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 56
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
29/11/2011
/40302512
1/0
9,76
310000030
01/12/2011
1/0
11,78
310000030
29/11/2011
/40302504
1/0
9,76
310000030
01/12/2011
40302687 Procalcitonina
/40302687
1/0
202,09
310000030
10/12/2011
2 UCO
/90000021
3,699 / 0
0,00
310000030
09/12/2011
2 UCO
/90000021
1,764 / 0
0,00
310000030
06/12/2011
2 UCO
/90000021
1,764 / 0
0,00
310000030
29/11/2011
2 UCO
/90000021
7,593 / 0
0,00
310000030
06/12/2011
2 UCO
/90000021
1,764 / 0
0,00
310000030
06/12/2011
2 UCO
/90000021
1,764 / 0
0,00
310000030
09/12/2011
2 UCO
/90000021
7,8 / 0
0,00
310000030
01/12/2011
2 UCO
/90000021
20,589 / 0
0,00
676,45
Total:
0468000199001
0468000199010
310000145
/40311210
1/0
11,20
310000145
40301630 Creatinina
/40301630
1/0
5,28
310000145
1/0
11,78
310000145
/40302504
1/0
9,76
110000079
/40901203
1/0
76,72
310000145
/40302512
1/0
9,76
310000145
40302040 Glicose
/40302040
1/0
5,28
110000079
/40901211
1/0
76,72
310000145
/40302750
1/0
22,46
110000079
/90000021
6,84 / 0
2 UCO
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 57
Qtd/Partic
Vl.Cob
310000145
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
2 UCO
/90000021
Obs.
3,894 / 0
0,00
110000079
1 FILME
0,34 / 0
7,72
Total:
0468000200000
0468000200000
236,68
21002618
/40901300
1/0
91,69
21002618
40901114 Mamas
/40901114
1/0
86,31
21002618
1 FILME
0,51 / 0
11,58
21002618
2 UCO
/90000021
7,24 / 0
0,00
0468000200026
310000242
40302040 Glicose
/40302040
1/0
5,28
310000242
/40302512
1/0
9,76
310000242
/40301990
1/0
9,76
310000242
/40301150
1/0
5,28
310000242
/40302504
1/0
9,76
310000242
/40301885
1/0
9,76
310000242
40301630 Creatinina
/40301630
1/0
5,28
310000242
1/0
11,78
310000242
40302580 Uria
/40302580
1/0
5,28
310000242
/40316149
1/0
32,99
310000242
/40302750
1/0
22,46
310000242
2 UCO
/90000021
7,728 / 0
0,00
0468000200107
310000242
40302580 Uria
/40302580
1/0
5,28
310000242
/40302504
1/0
9,76
310000242
1/0
11,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 58
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000242
/40302512
1/0
9,76
310000242
40302040 Glicose
/40302040
1/0
5,28
310000242
/40311210
1/0
11,20
310000242
40316491 T4 livre
/40316491
1/0
34,39
310000242
40316246 Estradiol
/40316246
1/0
40,84
310000242
/40316289
1/0
29,27
310000242
40301630 Creatinina
/40301630
1/0
5,28
310000242
/40316335
1/0
29,27
310000242
/40316521
1/0
27,52
310000242
/40307760
1/0
9,99
310000242
/40316513
1/0
40,84
310000242
/40302750
1/0
22,46
310000242
/90000021
19,991 / 0
2 UCO
609,89
Total:
0468000201006
0468000201758
0,00
310000030
19/11/2011
/40316335
1/0
29,27
310000030
19/11/2011
40316017 17 - alfa-hidroxiprogesterona
/40316017
1/0
40,44
310000030
19/11/2011
40316076 Androstenediona
/40316076
1/0
64,75
310000030
19/11/2011
40316246 Estradiol
/40316246
1/0
40,84
310000030
19/11/2011
/40316289
1/0
29,27
310000030
19/11/2011
/90000021
15,16 / 0
2 UCO
Total:
0468000206008
0468000206016
2178
0,00
204,57
06/12/2011
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 59
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310030250
/40311210
1/0
11,20
110000079
1/0
25,45
310030250
40301621 Creatina
/40301621
1/0
9,76
310030250
1/0
11,78
310030250
40303110 Parasitolgico
/40303110
1/0
12,78
310030250
40302040 Glicose
/40302040
1/0
5,28
310030250
40302580 Uria
/40302580
1/0
5,28
310030250
/40302750
1/0
22,46
310030250
/40304922
1/0
33,50
110000079
2 UCO
/90000021
0,75 / 0
0,00
310030250
2 UCO
/90000021
6,585 / 0
0,00
220,56
Total:
0468000207004
0468000207004
2461
0468000207012
29/11/2011
/10101012
1/0
83,07
368
09/12/2011
/10101012
1/0
83,07
310000030
15/12/2011
/40311210
1/0
11,20
310000030
15/12/2011
40301630 Creatinina
/40301630
1/0
5,28
110000079
1/0
25,45
310000030
15/12/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
15/12/2011
/40316521
1/0
27,52
310000030
15/12/2011
/40301150
1/0
5,28
310000030
15/12/2011
/40302750
1/0
22,46
310000030
15/12/2011
/90000021
4,011 / 0
2 UCO
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 60
0468000207101
Atendimento/Lote/Nota
2 UCO
Obs.
Qtd/Partic
Vl.Cob
/90000021
0,75 / 0
0,00
/10101012
1/0
83,07
1/0
25,45
/90000021
0,75 / 0
/10101012
1/0
83,07
368
09/12/2011
110000079
110000079
0468000207110
Procedimento/Cd.Intercmbio/Participao
2 UCO
0,00
368
09/12/2011
310000242
/40301842
1/0
7,34
310000242
1/0
11,78
310000242
/40316521
1/0
27,52
310000242
/40306313
1/0
24,52
310000242
40316491 T4 livre
/40316491
1/0
34,39
210000020
/40803139
1/0
31,77
310000242
40301400 Clcio
/40301400
1/0
5,28
310000242
40301931 Fsforo
/40301931
1/0
5,28
110000052
/10101039
1/0
94,77
310000242
/40316203
5/0
157,13
310000242
/40316440
1/0
72,47
310000242
/40311210
1/0
11,20
310000242
1/0
72,47
310000242
/40306305
1/0
33,72
310000242
2 UCO
/90000021
34,178 / 0
0,00
210000020
1 FILME
0,072 / 0
1,63
210000020
2 UCO
/90000021
1,22 / 0
0,00
310000242
0 Materiais em Geral
/90000021
1/0
204,73
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 61
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
43800
/10101012
1/0
58,97
89000099
/ Unimed Teresina
99
30434
13/10/2011
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
/40304299
1/0
8,85
89000098
/ Unimed Imperatriz
98
/40301583
1/0
8,85
89000098
/ Unimed Imperatriz
98
/40301605
1/0
4,13
89000098
/ Unimed Imperatriz
98
40302547 Triglicerdeos
/40302547
1/0
5,90
89000098
/ Unimed Imperatriz
98
1/0
8,85
89000098
/ Unimed Imperatriz
98
40302040 Glicose
/40302040
1/0
4,13
89000098
/ Unimed Imperatriz
98
/40304922
1/0
17,69
1.432,54
Total:
0468000209007
0468000209007
89000098
/ Unimed Imperatriz
98
42189
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
44572
17/10/2011
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
/41401492
1/0
121,62
89000098
/ Unimed Imperatriz
98
40103439 Impedanciometria
/40103439
1/0
36,49
89000098
/ Unimed Imperatriz
98
1/0
16,22
89000098
/ Unimed Imperatriz
98
2/0
445,21
89000098
/ Unimed Imperatriz
98
/40103072
1/0
36,49
89000098
/ Unimed Imperatriz
98
1/0
81,08
89000098
/ Unimed Imperatriz
98
/40103480
1/0
40,54
89000098
/ Unimed Imperatriz
98
2,0898 / 0
49,81
/10101012
1/0
58,97
/41401492
1/0
121,62
0468000209015
1 FILME
89000098
/ Unimed Imperatriz
98
44572
17/10/2011
89000098
/ Unimed Imperatriz
98
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 62
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
/40103480
1/0
40,54
89000098
/ Unimed Imperatriz
98
1/0
81,08
/10101012
1/0
58,97
0468000209104
89000098
/ Unimed Imperatriz
98
44572
89000098
/ Unimed Imperatriz
98
1/0
16,22
89000098
/ Unimed Imperatriz
98
40103439 Impedanciometria
/40103439
1/0
36,49
89000098
/ Unimed Imperatriz
98
/40103072
1/0
36,49
89000098
/ Unimed Imperatriz
98
/40103455
1/0
57,79
/10101012
1/0
58,97
0468000209325
17/10/2011
89000098
/ Unimed Imperatriz
98
44572
89000098
/ Unimed Imperatriz
98
/40103072
1/0
36,49
89000098
/ Unimed Imperatriz
98
1/0
17,69
89000098
/ Unimed Imperatriz
98
40103439 Impedanciometria
/40103439
1/0
36,49
89000098
/ Unimed Imperatriz
98
1/0
18,58
89000098
/ Unimed Imperatriz
98
/41401069
1/0
17,69
89000098
/ Unimed Imperatriz
98
/41401387
1/0
18,58
89000098
/ Unimed Imperatriz
98
/40103455
1/0
57,79
89000098
/ Unimed Imperatriz
98
/41401395
1/0
18,58
89000098
/ Unimed Imperatriz
98
/41401409
1/0
18,58
89000098
/ Unimed Imperatriz
98
1/0
18,58
89000098
/ Unimed Imperatriz
98
/90000021
1/0
1,42
0468000209503
17/10/2011
0 Materiais em Geral
89000034
/ Unimed Recife
34
40302040 Glicose
/40302040
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
/40301885
1/0
5,31
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 63
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
/40901122
1/0
98,77
89000034
/ Unimed Recife
34
40301281 Amilase
/40301281
1/0
4,13
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
/40301729
1/0
8,85
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302040 Glicose
/40302040
1/0
4,13
89000034
/ Unimed Recife
34
/40304590
1/0
4,42
89000034
/ Unimed Recife
34
40302571 Troponina
/40302571
1/0
25,35
89000034
/ Unimed Recife
34
40302040 Glicose
/40302040
1/0
4,13
89000034
/ Unimed Recife
34
/40301885
1/0
5,31
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 64
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
/40310400
1/0
17,69
89000034
/ Unimed Recife
34
102673
/40901165
1/0
64,86
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40301400 Clcio
/40301400
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 65
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
40316491 T4 livre
/40316491
1/0
25,06
89000034
/ Unimed Recife
34
/40302512
1/0
4,13
89000034
/ Unimed Recife
34
40302040 Glicose
/40302040
1/0
4,13
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
/40808017
1/0
20,04
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
/40302504
1/0
4,13
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 66
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
/40301990
1/0
5,90
89000034
/ Unimed Recife
34
/40301648
1/0
14,74
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
/40308391
1/0
19,75
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
/40304370
1/0
2,95
89000034
/ Unimed Recife
34
/40301729
1/0
8,85
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
/40302377
1/0
4,13
89000034
/ Unimed Recife
34
/40302377
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
/40301729
1/0
8,85
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
/40301990
1/0
5,90
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 67
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
40302237 Magnsio
/40302237
1/0
4,72
89000034
/ Unimed Recife
34
40302571 Troponina
/40302571
1/0
25,35
89000034
/ Unimed Recife
34
/40304590
1/0
4,42
89000034
/ Unimed Recife
34
/40805018
5/0
67,80
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40301400 Clcio
/40301400
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
/40301397
1/0
4,42
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
/40316521
1/0
25,06
89000034
/ Unimed Recife
34
/40301664
1/0
29,48
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
/40308391
1/0
19,75
89000034
/ Unimed Recife
34
/40308391
1/0
19,75
89000034
/ Unimed Recife
34
/40308391
1/0
19,75
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 68
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40301630 Creatinina
/40301630
1/0
4,13
89000034
/ Unimed Recife
34
40302318 Potssio
/40302318
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
/40302407
1/0
4,13
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
1/0
8,85
89000034
/ Unimed Recife
34
40301559 Cloro
/40301559
1/0
4,13
89000034
/ Unimed Recife
34
40301931 Fsforo
/40301931
1/0
4,13
89000034
/ Unimed Recife
34
/40302016
1/0
19,75
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302423 Sdio
/40302423
1/0
4,13
89000034
/ Unimed Recife
34
40302040 Glicose
/40302040
1/0
4,13
89000034
/ Unimed Recife
34
40302199 Lipase
/40302199
1/0
4,42
89000034
/ Unimed Recife
34
40302580 Uria
/40302580
1/0
4,13
89000034
/ Unimed Recife
34
/40202534
1/0
98,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 69
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
/40901360
1/0
212,28
89000034
/ Unimed Recife
34
/10101039
1/0
31,45
89000034
/ Unimed Recife
34
/10102019
4/0
171,99
89000034
/ Unimed Recife
34
/10104020
20 / 0
1.965,60
89000034
/ Unimed Recife
34
/80017010
10 / 0
11.486,48
89000034
/ Unimed Recife
34
/80061435
11530 / 0
89000034
/ Unimed Recife
34
/80061400
1530 / 0
89000034
/ Unimed Recife
34
80052762 Ecodopler
/80052762
1/0
47,91
89000034
/ Unimed Recife
34
1/0
62,65
89000034
/ Unimed Recife
34
0 Materiais em Geral
/90000021
1/0
150,33
89000034
/ Unimed Recife
34
1 FILME
2,4438 / 0
58,24
89000034
/ Unimed Recife
34
0 Materiais em Geral
/90000021
1/0
50,12
89000034
/ Unimed Recife
34
102673
1 FILME
0,38 / 0
89000034
/ Unimed Recife
34
0 Medicamentos em Geral
/90000013
1/0
922,51
89000034
/ Unimed Recife
34
0 Medicamentos em Geral
/90000013
1/0
368,99
662,34
9,06
26.174,51
Total:
0468000210005
0468000210005
6.745,05
210000712
/20103492
9/0
348,96
210000712
1/0
51,69
210000712
/20103492
1/0
38,77
210000712
9/0
465,22
210000712
21,6 / 0
2 UCO
/90000021
Total:
0468000213004
0468000213012
0,00
904,64
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 70
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
1342173
/10101012
1/0
83,07
1381748
06/12/2011
/10101012
1/0
83,07
310000242
40316491 T4 livre
/40316491
1/0
34,39
310000242
/40316521
1/0
27,52
1342173
/41301099
1/0
7,68
310030249
/40601137
1/0
29,21
310000242
1/0
11,78
310000242
40302040 Glicose
/40302040
1/0
5,28
1342173
/41301102
1/0
25,58
310000242
/40302750
1/0
22,46
310000242
2 UCO
/90000021
5,847 / 0
0,00
310030249
2 UCO
/90000021
1,03 / 0
0,00
1342173
2 UCO
/90000021
2,78 / 0
0,00
330,04
Total:
0468000216003
0468000216003
310000145
/40311180
1/0
6,35
310000145
40311171 Microalbuminria
/40311171
1/0
24,49
310000145
/90000021
2,214 / 0
2 UCO
30,84
Total:
0468000217000
0468000217301
0,00
1341576
01/12/2011
/10101012
1/0
83,07
11002944
15/12/2011
/10101012
1/0
83,07
310000030
24/11/2011
/40304051
1/0
11,56
310000030
02/12/2011
/40311210
1/0
11,20
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 71
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
310000030
02/12/2011
310000030
02/12/2011
2 UCO
310000030
24/11/2011
0468000217506
Obs.
Qtd/Partic
Vl.Cob
1/0
24,52
/90000021
2,61 / 0
0,00
2 UCO
/90000021
0,837 / 0
0,00
Raimundo S Goncalves
310000030
21/11/2011
40302580 Uria
/40302580
1/0
5,28
310000030
21/11/2011
/40304590
1/0
7,70
310000030
21/11/2011
40301931 Fsforo
/40301931
1/0
5,28
310000030
21/11/2011
1/0
11,78
310000030
21/11/2011
40302318 Potssio
/40302318
1/0
5,28
310000030
21/11/2011
/40301109
1/0
9,76
310000030
21/11/2011
/40302016
1/0
24,49
310000030
21/11/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
21/11/2011
/40308391
1/0
36,82
310000030
21/11/2011
/40301419
1/0
14,47
310000030
21/11/2011
40302423 Sdio
/40302423
1/0
5,28
310000030
21/11/2011
/40302016
1/0
24,49
310000030
21/11/2011
1/0
7,70
310000030
24/11/2011
/40302016
1/0
24,49
310000030
21/11/2011
40302237 Magnsio
/40302237
1/0
5,28
310000030
21/11/2011
2 UCO
/90000021
7,863 / 0
0,00
310000030
21/11/2011
2 UCO
/90000021
1,764 / 0
0,00
310000030
24/11/2011
2 UCO
/90000021
1,764 / 0
0,00
Total:
0468000218006
0468000218006
406,80
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 72
12/12/2011
Atendimento/Lote/Nota
7658009 / 99999 / 171521
Procedimento/Cd.Intercmbio/Participao
10101012 Em consultrio (no horrio normal ou
/10101012
Obs.
Qtd/Partic
1/0
83,07
83,07
Total:
0468000219002
0468000219002
Vl.Cob
11001662
28/11/2011
210000755
210000755
/10101012
1/0
83,07
40901114 Mamas
/40901114
1/0
86,31
/40901300
1/0
91,69
210000755
2 UCO
/90000021
3,82 / 0
0,00
210000755
1 FILME
0,34 / 0
7,72
210000755
2 UCO
/90000021
3,42 / 0
0,00
210000755
1 FILME
0,17 / 0
3,86
/10101012
1/0
83,07
1/0
92,23
0468000219304
3485
13/12/2011
210000755
210000755
1 FILME
0,51 / 0
11,58
210000755
2 UCO
/90000021
3,86 / 0
0,00
0468000219517
89000063
63
5527
/10101012
1/0
61,43
89000063
63
5527
/41301323
1/0
10,13
Total:
0468000222003
0468000222011
11001336
531,09
0468000222305
09/12/2011
/10101012
1/0
83,07
/40901300
1/0
91,69
21002606
/ Centro De Diagnostico Da
21002606
/ Centro De Diagnostico Da
1 FILME
0,17 / 0
3,86
21002606
/ Centro De Diagnostico Da
2 UCO
/90000021
3,82 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 73
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Total:
0468000223000
0468000223000
Vl.Cob
178,62
11001280
02/12/2011
/10101012
1/0
83,07
11000585
30/11/2011
/10101012
1/0
83,07
950000970
1/0
157,75
21002607
/ Instituto De Hipertenso Do
1/0
25,45
950000970
0 Materiais em Geral
/90000021
1/0
13,86
21002607
/ Instituto De Hipertenso Do
2 UCO
/90000021
0,75 / 0
0,00
950000970
2 UCO
/90000021
13,67 / 0
0,00
363,20
Total:
0468000225002
0468000225002
89000062
62
/40301842
1/0
5,31
89000062
62
1/0
8,85
89000062
62
/40302377
1/0
4,13
89000062
62
40313328 Zinco
/40313328
1/0
35,38
89000062
62
40316270 Ferritina
/40316270
1/0
36,86
89000062
62
40302237 Magnsio
/40302237
1/0
4,72
89000062
62
/40301990
1/0
5,90
89000062
62
/40302504
1/0
4,13
89000062
62
40302423 Sdio
/40302423
1/0
4,13
89000062
62
/40301885
1/0
5,31
89000062
62
/40302512
1/0
4,13
89000062
62
40302318 Potssio
/40302318
1/0
4,13
0468000225096
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 74
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000062
62
21000053 07/10/2011
0 Materiais em Geral
/90000021
1/0
29,85
89000062
62
21000053 07/10/2011
0 Medicamentos em Geral
/90000013
1/0
301,85
/40103323
1/0
243,24
0468000225509
89000099
/ Unimed Teresina
99
11000020 05/09/2011
697,92
Total:
0468000227005
0468000227013
Rogerio C de M Viana
Sandra Marboure De Melo Viana
5064
5064
5064
5064
/30101298
1/0
53,29
/80051510
1/0
45,45
0 Materiais em Geral
/90000021
1/0
5,70
0 Medicamentos em Geral
/90000013
1/0
6,75
111,19
Total:
0468000229008
0468000229512
17490
28/11/2011
210020314
210020314
/10101012
1/0
83,07
40804054 Joelho
/40804054
1/0
15,35
/20103492
9/0
276,31
210020314
10 / 0
230,26
210020314
/20103492
1/0
30,70
210020314
40804062 Patela
/40804062
1/0
15,35
210020314
1 FILME
0,3312 / 0
7,52
210020314
2 UCO
/90000021
4,7 / 0
0,00
210020314
2 UCO
/90000021
6/0
0,00
210020314
2 UCO
/90000021
2,53 / 0
0,00
Total:
0468000231002
0468000231002
Rosenira Pires
Rosenira Pires
658,56
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 75
Atendimento/Lote/Nota
11001107
22/11/2011
110000079
110000079
0468000231517
89000088
Procedimento/Cd.Intercmbio/Participao
10101012 Em consultrio (no horrio normal ou
Obs.
Qtd/Partic
1/0
83,07
1/0
25,45
/90000021
0,75 / 0
/10101012
2 UCO
0,00
88
15303
1/0
58,97
167,49
Total:
0468000232009
0468000232009
Vl.Cob
/10101012
1360562
06/12/2011
1360562
1360562
0468000232092
/10101012
1/0
83,07
/41301323
1/0
15,35
/90000021
0,5 / 0
/10101012
1/0
83,07
2 UCO
0,00
11000518
20/12/2011
4665
/10101012
1/0
83,07
110000079
/40901211
1/0
76,72
110000079
1 FILME
0,17 / 0
3,86
110000079
2 UCO
/90000021
3,42 / 0
0,00
0468000232106
1360562
0468000232300
1360562
06/12/2011
/10101012
1/0
83,07
/10101012
1/0
83,07
06/12/2011
511,28
Total:
0468000233005
0468000233005
5490
/10101012
1/0
83,07
5490
/40201023
1/0
23,03
0468000233307
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 76
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
29/11/2011
1/0
11,78
310000030
29/11/2011
/40311210
1/0
11,20
310000030
29/11/2011
/90000021
1,68 / 0
2 UCO
129,08
Total:
0468000234001
0468000234109
0,00
520
/10101012
1/0
83,07
210020160
/ Cotrauma-Clin.Orto.Traum.Ma
/40805026
1/0
15,35
210020160
/ Cotrauma-Clin.Orto.Traum.Ma
2 UCO
/90000021
1,18 / 0
0,00
210020160
/ Cotrauma-Clin.Orto.Traum.Ma
1 FILME
0,308 / 0
6,99
/10101012
1/0
0468000234117
4268
06/12/2011
Total:
0468000235008
0468000235008
188,48
4825
83,07
0468000235512
28/11/2011
/10101012
1/0
83,07
310000145
40301931 Fsforo
/40301931
1/0
5,28
310000145
40301400 Clcio
/40301400
1/0
5,28
310000145
/40301885
1/0
9,76
310000145
/90000021
1,494 / 0
0,00
2 UCO
103,39
Total:
0468000238007
0468000238511
310000030
20/12/2011
40302423 Sdio
/40302423
1/0
5,28
310000030
20/12/2011
/40302512
1/0
9,76
310000030
20/12/2011
1/0
7,70
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 77
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
16/12/2011
40302237 Magnsio
/40302237
1/0
5,28
310000030
16/12/2011
/40311210
1/0
11,20
310000030
20/12/2011
40302237 Magnsio
/40302237
1/0
5,28
310000030
20/12/2011
/40301109
1/0
9,76
310000030
16/12/2011
/40302504
1/0
9,76
310000030
20/12/2011
40301931 Fsforo
/40301931
1/0
5,28
310000030
16/12/2011
/40301990
1/0
9,76
310000030
20/12/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
16/12/2011
40302580 Uria
/40302580
1/0
5,28
310000030
20/12/2011
1/0
11,78
310000030
16/12/2011
1/0
11,78
310000030
16/12/2011
/40302512
1/0
9,76
310000030
16/12/2011
40302423 Sdio
/40302423
1/0
5,28
310000030
16/12/2011
40301400 Clcio
/40301400
1/0
5,28
310000030
16/12/2011
/40301885
1/0
9,76
310000030
16/12/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
20/12/2011
40302318 Potssio
/40302318
1/0
5,28
310000030
16/12/2011
40302318 Potssio
/40302318
1/0
5,28
310000030
20/12/2011
/40302504
1/0
9,76
310000030
20/12/2011
/40304590
1/0
7,70
310000030
20/12/2011
/40301419
1/0
14,47
310000030
20/12/2011
/40601110
1/0
58,42
310000030
20/12/2011
/40308391
1/0
36,82
310000030
16/12/2011
/40308391
1/0
36,82
310000030
20/12/2011
/40302016
2/0
48,98
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 78
Qtd/Partic
Vl.Cob
310000030
16/12/2011
Atendimento/Lote/Nota
7619429 / 99999 / 30508558
Procedimento/Cd.Intercmbio/Participao
2 UCO
/90000021
Obs.
0,387 / 0
0,00
310000030
20/12/2011
2 UCO
/90000021
2,06 / 0
0,00
310000030
16/12/2011
2 UCO
/90000021
6,495 / 0
0,00
310000030
20/12/2011
2 UCO
/90000021
10,68 / 0
0,00
Total:
0468000239003
0468000239011
372,07
110000079
40901114 Mamas
/40901114
1/0
86,31
110000079
40808033 MAMOGRAFIA
/40808033
1/0
85,11
110000079
1 FILME
1,54 / 0
34,95
110000079
2 UCO
/90000021
6,18 / 0
0,00
206,37
Total:
0468000240001
0468000240109
310000145
/40310400
1/0
67,72
310000145
/40307760
1/0
9,99
310000145
/40311210
1/0
11,20
310000145
/40310400
2/0
135,44
310000145
/40307182
1/0
45,07
310000145
/90000021
19,755 / 0
2 UCO
269,42
Total:
0468000241008
0468000241008
1201804
28/11/2011
/10101012
1/0
Total:
0468000243000
0468000243302
0,00
83,07
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 79
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000333
333 4246
/10101012
1/0
61,43
89000333
333 3888
/10101012
1/0
61,43
89000333
/10101039
1/0
63,88
186,74
Total:
0468000245003
0468000245011
1341762
25/11/2011
/10101012
1/0
83,07
110000052
/10101039
1/0
94,77
110000079
/40901297
1/0
147,34
110000052
/30101484
1/0
40,29
110000079
1 FILME
0,34 / 0
7,72
110000079
2 UCO
/90000021
3,82 / 0
0,00
/10101012
1/0
83,07
0468000245100
1110981
16/12/2011
210020543
/10101039
1/0
40,95
210020560
/10101039
1/0
68,45
565,66
Total:
0468000246000
0468000246000
1340340
0468000246310
07/12/2011
/10101012
1/0
83,07
310000030
17/12/2011
/40311210
1/0
11,20
310000030
17/12/2011
/40308391
1/0
36,82
310000030
17/12/2011
1/0
11,78
310000030
17/12/2011
/90000021
1,68 / 0
/10101012
1/0
0468000246514
11000690
2 UCO
0,00
Ana de J V Pitombeira
12/12/2011
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 80
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
110000079
/40802035
1/0
34,19
110000079
/40803074
1/0
32,98
110000079
/40901220
1/0
86,31
110000079
/40802019
1/0
32,98
110000079
1 FILME
0,34 / 0
7,72
110000079
1 FILME
0,456 / 0
10,35
110000079
2 UCO
/90000021
4,02 / 0
0,00
110000079
2 UCO
/90000021
3,42 / 0
0,00
/10101012
1/0
0468000246603
1340340
07/12/2011
513,54
Total:
0468000250007
0468000250007
83,07
110000052
/10101039
1/0
94,77
110000052
/10101039
1/0
94,77
189,54
Total:
0468000252000
0468000252000
4350
16/12/2011
/10101012
1/0
83,07
1430013
04/10/2011
/10101012
1/0
83,07
0468000252018
25204
01/12/2011
/10101012
1/0
83,07
1430013
03/10/2011
/10101012
1/0
83,07
/10101012
1/0
83,07
0468000252107
25204
Total:
0468000255009
415,35
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 81
14/12/2011
Atendimento/Lote/Nota
7676150 / 99999 / 10251604
Procedimento/Cd.Intercmbio/Participao
10101012 Em consultrio (no horrio normal ou
/10101012
Obs.
Qtd/Partic
1/0
83,07
83,07
Total:
0468000260002
0468000260002
Vl.Cob
11000518
/10101012
1/0
83,07
26340
/41301250
1/0
30,70
26340
/41501128
1/0
30,70
3583
/40901106
1/0
239,62
3583
/40101045
1/0
30,70
26340
1/0
30,70
26340
/41301129
1/0
40,29
3583
/40901360
1/0
115,13
26340
1/0
30,70
26340
2 UCO
/90000021
1,68 / 0
0,00
3583
2 UCO
/90000021
7,16 / 0
0,00
3583
2 UCO
/90000021
8,26 / 0
0,00
3583
1 FILME
0,68 / 0
15,43
26340
2 UCO
/90000021
5,54 / 0
0,00
/40311210
1/0
11,20
0468000260304
310000030
12/12/2011
210020543
/10101039
1/0
40,95
310000030
12/12/2011
1/0
11,78
210020543
/10101039
1/0
40,95
310000030
12/12/2011
/40308391
1/0
36,82
210020560
/10101039
1/0
68,45
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 82
12/12/2011
Atendimento/Lote/Nota
7627032 / 99999 / 687658
Procedimento/Cd.Intercmbio/Participao
2 UCO
/90000021
Obs.
Qtd/Partic
1,68 / 0
89000006
89000006
/10101039
1/0
63,88
/80031005
1/0
4,20
68,08
Total:
0468000263001
0468000263001
0,00
857,19
Total:
0468000261009
0468000261106
Vl.Cob
28547
14/12/2011
/10101012
1/0
83,07
4712
15/12/2011
/10101012
1/0
83,07
0468000263095
310000145
40301630 Creatinina
/40301630
1/0
5,28
110000052
/10101039
1/0
94,77
310000145
1/0
11,78
110000052
/40805026
1/0
15,35
310000145
/40302512
1/0
9,76
310000145
/40308391
1/0
36,82
310000145
40302318 Potssio
/40302318
1/0
5,28
310000145
40302580 Uria
/40302580
1/0
5,28
310000145
/40301990
1/0
9,76
310000145
/40302504
1/0
9,76
310000145
40302423 Sdio
/40302423
1/0
5,28
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
2 UCO
/90000021
4,965 / 0
0,00
110000052
1 FILME
0,308 / 0
6,99
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 83
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
2 UCO
/90000021
Obs.
Qtd/Partic
1,18 / 0
1101893
0,00
387,53
Total:
0468000265004
0468000265012
Vl.Cob
0468000265101
16/12/2011
/10101012
1/0
83,07
89000099
/ Unimed Teresina
99
31000022 16/09/2011
40301630 Creatinina
/40301630
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
/40311210
1/0
5,90
89000099
/ Unimed Teresina
99
31000022 16/09/2011
/40302636
1/0
2,95
89000099
/ Unimed Teresina
99
31000022 16/09/2011
/40301150
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
40302040 Glicose
/40302040
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
/40302512
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
/40302504
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
/40301605
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
1/0
8,85
89000099
/ Unimed Teresina
99
31000022 16/09/2011
40302580 Uria
/40302580
1/0
4,13
89000099
/ Unimed Teresina
99
/40310124
1/0
14,74
89000099
/ Unimed Teresina
99
31000022 16/09/2011
/40308391
1/0
24,77
89000099
/ Unimed Teresina
99
31000022 16/09/2011
40302547 Triglicerdeos
/40302547
1/0
5,90
89000099
/ Unimed Teresina
99
31000022 16/09/2011
/40307760
1/0
5,90
89000099
/ Unimed Teresina
99
31000022 16/09/2011
/40307182
1/0
58,97
0468000265110
1101893
16/12/2011
/10101012
1/0
83,07
310000030
28/11/2011
/40310400
1/0
67,72
310000030
26/11/2011
1/0
11,78
310000030
22/11/2011
1/0
11,20
/40311210
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 84
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
22/11/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
28/11/2011
/40303098
1/0
5,99
310000030
22/11/2011
/40302512
1/0
9,76
310000030
22/11/2011
1/0
11,78
310000030
26/11/2011
/40304370
1/0
5,28
310000030
22/11/2011
/40304370
1/0
5,28
310000030
22/11/2011
/40310337
1/0
24,52
310000030
22/11/2011
/40303152
1/0
5,99
310000030
28/11/2011
/40310337
1/0
24,52
310000030
22/11/2011
/40303098
1/0
5,99
310000030
28/11/2011
/40304329
1/0
5,51
310000030
22/11/2011
/40302504
1/0
9,76
310000030
26/11/2011
/40308391
1/0
36,82
310000030
22/11/2011
/40310230
1/0
9,63
310000030
28/11/2011
40303110 Parasitolgico
/40303110
1/0
12,78
310000030
22/11/2011
/40308391
1/0
36,82
310000030
28/11/2011
2 UCO
/90000021
3,537 / 0
0,00
310000030
28/11/2011
2 UCO
/90000021
4,977 / 0
0,00
310000030
26/11/2011
2 UCO
/90000021
1,257 / 0
0,00
310000030
22/11/2011
2 UCO
/90000021
7,233 / 0
0,00
/10101012
1/0
0468000265128
1110981
30/11/2011
Total:
0468000266000
0468000266019
83,07
712,51
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 85
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
20/12/2011
/40311210
1/0
11,20
310000030
20/12/2011
/40308391
1/0
36,82
310000030
20/12/2011
1/0
24,52
310000030
20/12/2011
1/0
11,78
310000030
20/12/2011
/90000021
3,48 / 0
0,00
0468000266515
2 UCO
89000088
88
10000479 19/10/2011
1/0
8,85
89000088
88
10000479 21/10/2011
/40301605
1/0
4,13
89000088
88
10018368 03/11/2011
/40901106
1/0
147,42
89000088
88
10000479 21/10/2011
/40301583
1/0
8,85
89000088
88
10018368 20/10/2011
1/0
17,69
89000088
88
10000479 21/10/2011
40301630 Creatinina
/40301630
1/0
4,13
89000088
88
10000479 19/10/2011
40302040 Glicose
/40302040
1/0
4,13
89000088
88
10000479 21/10/2011
40302547 Triglicerdeos
/40302547
1/0
5,90
89000088
88
10000479 19/10/2011
/40304922
1/0
17,69
Total:
0468000268003
0468000268100
89000098
303,11
/ Unimed Imperatriz
98
12980
/10101012
1/0
58,97
Total:
0468000273007
0468000273104
58,97
310000145
/40303098
1/0
5,99
310000145
/40303152
1/0
5,99
310000145
/40308391
1/0
36,82
310000145
/40311210
1/0
11,20
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 86
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000145
/40303039
1/0
21,61
310000145
1/0
11,78
310000145
/40310337
1/0
24,52
310000145
40303110 Parasitolgico
/40303110
1/0
12,78
110000052
/10101039
1/0
94,77
310000145
/40303136
1/0
12,78
310000145
/90000021
7,764 / 0
2 UCO
238,24
Total:
0468000275000
0468000275107
0,00
310000030
/40311210
1/0
11,20
310000030
1/0
11,78
310000030
40303110 Parasitolgico
/40303110
1/0
12,78
310000030
2 UCO
/90000021
2,607 / 0
/10101012
1/0
83,07
0468000275514
0,00
11000011
28/11/2011
310000242
/40601110
1/0
58,42
11000011
1/0
157,75
310000242
2 UCO
/90000021
2,06 / 0
0,00
11000011
0 Materiais em Geral
/90000021
1/0
6,86
11000011
2 UCO
/90000021
13,67 / 0
0,00
11000011
0 Medicamentos em Geral
/90000013
1/0
7,01
348,87
Total:
0468000285005
0468000285005
110000079
/40901106
1/0
299,80
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 87
Atendimento/Lote/Nota
110000079
110000079
Procedimento/Cd.Intercmbio/Participao
20102038 Monitorizao ambulatorial da presso
2 UCO
Obs.
Qtd/Partic
/20102038
1/0
/90000021
12 / 0
Total:
0468000286001
0468000286095
110000052
192,16
0,00
491,96
/10101039
1/0
94,77
94,77
Total:
0468000287008
0468000287008
Vl.Cob
1360473
25/11/2011
1360473
1360473
/10101012
1/0
83,07
/41301080
2/0
95,94
/41301323
1/0
15,35
1360473
/41301269
2/0
95,94
1360473
/41501128
2/0
61,40
36605
/41301250
2/0
61,40
1360473
2 UCO
/90000021
0,5 / 0
0,00
1360473
2 UCO
/90000021
11,24 / 0
0,00
36605
2 UCO
/90000021
0,58 / 0
0,00
413,10
Total:
0468000288004
0468000288101
11000569
15/12/2011
/10101012
1/0
83,07
Total:
0468000291005
0468000291005
11000720
09/12/2011
/10101012
1/0
Total:
0468000292001
83,07
83,07
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 88
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000242
/40601110
1/0
58,42
950000970
1/0
157,75
310000242
/40306917
1/0
39,02
310000242
2 UCO
/90000021
4,904 / 0
950000970
0 Materiais em Geral
/90000021
1/0
950000970
2 UCO
/90000021
13,67 / 0
/10101012
1/0
83,07
1/0
15,35
/90000021
0,75 / 0
/10101012
1/0
0468000292095
16/12/2011
110000443
110000443
0468000292516
2 UCO
12/12/2011
83,07
1/0
28,08
28,08
Total:
0468000294004
0468000294306
0,00
450,54
Total:
21002620
0,00
0468000293008
0468000293016
13,86
11001808
1852
0,00
89000178
178 3839
89000178
89000178
05/12/2011
/10101012
1/0
61,43
1/0
8,85
/10101039
1/0
63,88
89000178
/80031005
3/0
12,71
89000178
/70438471
1/0
0,43
89000178
/75600021
1/0
0,39
89000178
/79908039
1/0
0,01
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 89
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000178
10 / 0
0,23
89000178
/71600213
1/0
1,52
89000178
0 Medicamentos em Geral
/90000013
1/0
0,01
89000178
/90193571
3/0
2,98
89000178
3/0
22,85
89000178
/90196015
2/0
6,20
0468000294314
89000098
/ Unimed Imperatriz
98
17796
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
35999
/10101012
1/0
58,97
89000178
/40901220
1/0
62,12
89000098
/ Unimed Imperatriz
98
10724
/10101039
1/0
43,00
89000098
/ Unimed Imperatriz
98
/20104235
2/0
5,90
89000098
/ Unimed Imperatriz
98
1/0
37,43
89000178
1 FILME
0,0005 / 0
89000098
/ Unimed Imperatriz
98
0 Materiais em Geral
/90000021
1/0
11,22
89000098
/ Unimed Imperatriz
98
0 Medicamentos em Geral
/90000013
1/0
31,61
490,72
Total:
0468000296007
0468000168092
3657
19/12/2011
/10101012
1/0
83,07
83,07
Total:
0468000299006
0468000299006
0,01
89000098
/ Unimed Imperatriz
98
/40307760
1/0
5,90
89000098
/ Unimed Imperatriz
98
/40307182
1/0
58,97
89000098
/ Unimed Imperatriz
98
40316416 Prolactina
/40316416
1/0
25,06
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 90
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
40316491 T4 livre
/40316491
1/0
25,06
89000098
/ Unimed Imperatriz
98
/40316521
1/0
25,06
89000098
/ Unimed Imperatriz
98
/40311210
1/0
5,90
89000098
/ Unimed Imperatriz
98
/40316289
1/0
19,16
89000098
/ Unimed Imperatriz
98
1/0
8,85
89000098
/ Unimed Imperatriz
98
/40307026
1/0
58,97
89000098
/ Unimed Imperatriz
98
40302040 Glicose
/40302040
1/0
4,13
89000098
/ Unimed Imperatriz
98
/40307018
1/0
20,64
89000098
/ Unimed Imperatriz
98
/40316335
1/0
18,58
89000098
/ Unimed Imperatriz
98
/40302750
1/0
20,64
0468000299022
89000098
/ Unimed Imperatriz
98
12972
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
39348
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
52395
03/10/2011
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
40316416 Prolactina
/40316416
1/0
25,06
89000098
/ Unimed Imperatriz
98
/40601137
1/0
20,64
89000098
/ Unimed Imperatriz
98
/40307760
1/0
5,90
89000098
/ Unimed Imperatriz
98
/40307026
1/0
58,97
89000098
/ Unimed Imperatriz
98
40316246 Estradiol
/40316246
1/0
29,48
89000098
/ Unimed Imperatriz
98
/40311210
1/0
5,90
89000098
/ Unimed Imperatriz
98
40302040 Glicose
/40302040
1/0
4,13
89000098
/ Unimed Imperatriz
98
1/0
8,85
89000098
/ Unimed Imperatriz
98
/40307018
1/0
20,64
89000098
/ Unimed Imperatriz
98
/40316289
1/0
19,16
89000098
/ Unimed Imperatriz
98
/40316335
1/0
18,58
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 91
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
/40316521
1/0
25,06
89000098
/ Unimed Imperatriz
98
/40901300
1/0
58,97
89000098
/ Unimed Imperatriz
98
/40307182
1/0
58,97
89000098
/ Unimed Imperatriz
98
/40316548
1/0
19,16
89000098
/ Unimed Imperatriz
98
39348
/30101492
1/0
97,30
89000098
/ Unimed Imperatriz
98
/40302750
1/0
20,64
89000098
/ Unimed Imperatriz
98
39348
/80031609
1/0
12,29
89000098
/ Unimed Imperatriz
98
1 FILME
0,19 / 0
89000098
/ Unimed Imperatriz
98
39348
0 Materiais em Geral
/90000021
1/0
73,10
89000098
/ Unimed Imperatriz
98
39348
0 Medicamentos em Geral
/90000013
1/0
13,02
1.074,18
Total:
0468000300004
0468000300004
4,53
11002103
28/11/2011
/10101012
1/0
83,07
310000030
23/11/2011
/40316289
1/0
29,27
210000062
/40901300
1/0
91,69
310000030
23/11/2011
40316246 Estradiol
/40316246
1/0
40,84
310000030
23/11/2011
/40316335
1/0
29,27
310000030
23/11/2011
2 UCO
/90000021
7,37 / 0
0,00
210000062
1 FILME
0,17 / 0
3,86
210000062
2 UCO
/90000021
3,82 / 0
0,00
/10101012
1/0
0468000300098
11002103
28/11/2011
Total:
0468000302007
0468000302007
83,07
361,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 92
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
110000079
110000079
2 UCO
110000079
1 FILME
Obs.
Qtd/Partic
1/0
/90000021
3,86 / 0
0,00
0,51 / 0
11,58
1111120
28/11/2011
310000242
310000242
310000242
/10101012
1/0
83,07
/40307255
4/0
118,92
/40307271
1/0
27,54
/90000021
10,789 / 0
/10101012
1/0
0468000305308
1111120
92,23
103,81
Total:
0468000305006
0468000305111
Vl.Cob
2 UCO
28/11/2011
Total:
0468000306002
0468000306002
0,00
83,07
312,60
89000098
/ Unimed Imperatriz
98
36286
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
36286
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
14789
31/10/2011
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
/40316149
1/0
44,23
89000098
/ Unimed Imperatriz
98
/40316130
1/0
61,03
89000098
/ Unimed Imperatriz
98
40302040 Glicose
/40302040
1/0
4,13
89000098
/ Unimed Imperatriz
98
/40311210
1/0
5,90
89000098
/ Unimed Imperatriz
98
/40316513
1/0
30,96
89000098
/ Unimed Imperatriz
98
/40301150
1/0
4,13
89000098
/ Unimed Imperatriz
98
1/0
8,85
89000098
/ Unimed Imperatriz
98
40303110 Parasitolgico
1/0
5,90
/40303110
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 93
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
/41301323
1/0
10,13
89000098
/ Unimed Imperatriz
98
/40307166
1/0
58,97
89000098
/ Unimed Imperatriz
98
1/0
17,69
89000098
/ Unimed Imperatriz
98
/40302750
1/0
20,64
0468000306010
89000098
/ Unimed Imperatriz
98
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
/41301102
1/0
24,32
89000098
/ Unimed Imperatriz
98
/40901300
1/0
58,97
89000098
/ Unimed Imperatriz
98
/41301374
1/0
24,32
89000098
/ Unimed Imperatriz
98
/40601110
3/0
123,83
89000098
/ Unimed Imperatriz
98
2/0
1.238,33
89000098
/ Unimed Imperatriz
98
/31307027
2/0
2.317,44
89000098
/ Unimed Imperatriz
98
/31303102
2/0
2.476,66
89000098
/ Unimed Imperatriz
98
/80011039
1/0
0,00
89000098
/ Unimed Imperatriz
98
/80021050
1/0
311,81
89000098
/ Unimed Imperatriz
98
0 Materiais em Geral
/90000021
1/0
401,95
89000098
/ Unimed Imperatriz
98
1 FILME
0,19 / 0
89000098
/ Unimed Imperatriz
98
0 Medicamentos em Geral
/90000013
1/0
433,68
/10101012
1/0
58,97
0468000306100
89000098
/ Unimed Imperatriz
TC15 PORTE V
44572
20/10/2011
7.983,25
Total:
0468000307009
0468000307009
4,53
89000098
/ Unimed Imperatriz
98
/10101039
1/0
43,00
89000098
/ Unimed Imperatriz
98
/80031609
1/0
19,70
89000098
/ Unimed Imperatriz
98
0 Materiais em Geral
/90000021
1/0
4,24
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 94
/ Unimed Imperatriz
98
0468000307017
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
0 Medicamentos em Geral
Obs.
Qtd/Partic
1/0
6,70
/40901122
1/0
98,77
0,7599 / 0
18,11
/10101039
1/0
43,00
1/0
37,43
1/0
14,41
89000098
/ Unimed Imperatriz
98
89000098
/ Unimed Imperatriz
98
0468000307106
89000098
/ Unimed Imperatriz
98
15491
89000098
/ Unimed Imperatriz
98
89000098
/ Unimed Imperatriz
98
0 Medicamentos em Geral
/90000013
285,36
Total:
0468000310000
0468000310000
Vl.Cob
/90000013
14806
19/12/2011
/10101012
1/0
83,07
1381446
16/12/2011
/10101012
1/0
83,07
21002618
40901114 Mamas
/40901114
1/0
86,31
21002618
1 FILME
0,34 / 0
7,72
21002618
2 UCO
/90000021
3,42 / 0
0,00
0468000310093
89000063
63
6506
/10101012
1/0
61,43
89000063
63
6506
/20104294
1/0
132,68
454,28
Total:
0468000311006
0468000311103
110000052
/10101039
1/0
Total:
0468000314005
0468000314013
110000052
94,77
94,77
/10101039
1/0
94,77
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 95
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000145
/40308391
1/0
36,82
310000145
/40311210
1/0
11,20
310000030
13/12/2011
1/0
24,52
310000145
/40310400
1/0
67,72
310000030
13/12/2011
/40311210
1/0
11,20
310000145
1/0
11,78
310000030
13/12/2011
2 UCO
/90000021
2,61 / 0
0,00
310000145
2 UCO
/90000021
6,657 / 0
0,00
0468000314102
310000145
1/0
11,78
110000052
/10101039
1/0
94,77
310000145
/40311210
1/0
11,20
310000145
/90000021
1,68 / 0
2 UCO
Total:
0468000553000
0468000553000
375,76
110000346
110000346
110000346
/40901300
1/0
1 FILME
0,17 / 0
3,86
2 UCO
/90000021
3,82 / 0
0,00
40,29
44,15
Total:
0468003501000
0468003501000
0,00
89000099
/ Unimed Teresina
99
89000099
/ Unimed Teresina
99
89000099
/ Unimed Teresina
99
89000099
/ Unimed Teresina
99
/10101039
1/0
55,90
/70525048
1/0
2,20
/70438609
1/0
0,25
/71600213
1/0
3,63
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 96
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000099
/ Unimed Teresina
99
/70801690
1/0
1,66
89000099
/ Unimed Teresina
99
37 CLORETO DE SODIO 0 9%
/90120450
1/0
3,11
89000099
/ Unimed Teresina
99
1/0
0,64
89000099
/ Unimed Teresina
99
/90285859
2/0
2,93
89000099
/ Unimed Teresina
99
/90000013
1/0
2,93
89000099
/ Unimed Teresina
99
2/0
2,43
1/0
83,07
0468003501019
25204
SIST
0 Medicamentos em Geral
05/12/2011
/10101012
158,75
Total:
0468052026000
0468052026000
89000098
/ Unimed Imperatriz
98
21238
31/10/2011
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
21238
05/10/2011
/10101012
1/0
58,97
89000098
/ Unimed Imperatriz
98
/40307018
1/0
20,64
89000098
/ Unimed Imperatriz
98
/40307760
1/0
5,90
89000098
/ Unimed Imperatriz
98
/40316548
1/0
19,16
89000098
/ Unimed Imperatriz
98
/40316521
1/0
25,06
89000098
/ Unimed Imperatriz
98
/40901300
1/0
58,97
89000098
/ Unimed Imperatriz
98
/40307824
1/0
17,69
89000098
/ Unimed Imperatriz
98
1/0
8,85
89000098
/ Unimed Imperatriz
98
/40901262
1/0
71,35
89000098
/ Unimed Imperatriz
98
40302040 Glicose
/40302040
1/0
4,13
89000098
/ Unimed Imperatriz
98
/40307182
1/0
58,97
89000098
/ Unimed Imperatriz
98
/40307832
1/0
10,32
89000098
/ Unimed Imperatriz
98
/10101039
1/0
43,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 97
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
/40302750
1/0
20,64
89000098
/ Unimed Imperatriz
98
1/0
37,43
89000098
/ Unimed Imperatriz
98
0 Materiais em Geral
/90000021
1/0
14,39
89000098
/ Unimed Imperatriz
98
1 FILME
0,19 / 0
4,53
89000098
/ Unimed Imperatriz
98
1 FILME
0,3402 / 0
8,11
89000098
/ Unimed Imperatriz
98
0 Medicamentos em Geral
/90000013
1/0
16,89
/10101012
1/0
58,97
/10101012
1/0
58,97
0468052026302
89000098
/ Unimed Imperatriz
98
0468052026515
89000098
17354
17/10/2011
/ Unimed Imperatriz
98
21238
26/10/2011
681,91
Total:
0468052031004
0468052031012
89000099
/ Unimed Teresina
99
16127
20/10/2011
/10101012
1/0
58,97
89000099
/ Unimed Teresina
99
17476
24/10/2011
/10101012
1/0
58,97
10 / 0
516,91
15,6 / 0
0468052031500
210000674
210000674
2 UCO
/90000021
634,85
Total:
0468052054004
0468052054012
11003096
0,00
0468052054101
/10101012
1/0
83,07
11003096
/10101012
1/0
83,07
310000145
/40303039
1/0
21,61
310000145
40303110 Parasitolgico
/40303110
1/0
12,78
310000145
2 UCO
/90000021
2,511 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 98
Atendimento/Lote/Nota
5064
5064
5064
5064
Procedimento/Cd.Intercmbio/Participao
30210127 Exrese de tumor benigno, cisto ou
Obs.
Qtd/Partic
/30210127
1/0
106,59
/80051510
1/0
45,45
0 Materiais em Geral
/90000021
1/0
32,74
0 Medicamentos em Geral
/90000013
1/0
6,75
392,06
Total:
0468052077004
0468052077004
Vl.Cob
310000242
/40310019
1/0
9,63
310000242
1/0
9,63
310000242
/90000021
1,386 / 0
0,00
1/0
0,75 / 0
0468052077500
2 UCO
14148
14148
2 UCO
/90000021
0,00
34,61
Total:
0468052085007
0468052085015
15,35
89000099
/ Unimed Teresina
99
13160
17/10/2011
/10101012
1/0
58,97
89000099
/ Unimed Teresina
99
25819
17/10/2011
/10101012
1/0
58,97
89000099
/ Unimed Teresina
99
/40601137
1/0
20,64
89000099
/ Unimed Teresina
99
/41301102
1/0
24,32
162,90
Total:
0468052096009
0468052096009
89000099
/ Unimed Teresina
/40601137
Total:
0468052104001
0468052104117
1/0
20,64
20,64
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 99
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
110000346
/40302512
1/0
0,07
110000346
40302040 Glicose
/40302040
1/0
0,07
110000346
/40302504
1/0
0,07
110000346
/40302750
1/0
22,46
110000346
/90000021
1,827 / 0
2 UCO
22,67
Total:
0468052112004
0468052112004
0,00
210000518
40103439 Impedanciometria
/40103439
1/0
50,79
210000518
1/0
27,60
210000518
/40103072
1/0
41,20
21002620
1/0
28,08
210000518
/90000021
2,47 / 0
0468052112012
2 UCO
0,00
110000052
/40805034
1/0
15,35
110000052
/10101039
1/0
94,77
110000052
2 UCO
/90000021
1,22 / 0
0,00
110000052
1 FILME
0,462 / 0
10,49
/10101012
1/0
83,07
0468052112101
11003150
19/12/2011
351,35
Total:
0468052114007
0468052114007
89000099
/ Unimed Teresina
89000099
/ Unimed Teresina
0468052114015
89000099
/ Unimed Teresina
29339
17/10/2011
/10101012
1/0
58,97
/31601014
1/0
515,97
/10101012
1/0
58,97
12636
31/10/2011
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 100
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Total:
0468052125009
0468052125009
1100420
0468052125017
20/12/2011
/10101012
1/0
83,07
/10101012
1/0
83,07
/41301102
1/0
25,58
/90000021
2,78 / 0
11000909
07/12/2011
11000909
11000909
2 UCO
Total:
0468052127001
0468052127001
1342181
0,00
191,72
20/12/2011
/10101012
1/0
83,07
83,07
Total:
0468052136000
0468052136019
Vl.Cob
633,91
89000062
62
/40901203
1/0
53,07
89000062
62
4560
/40809099
2/0
421,04
89000062
62
1/0
54,84
89000062
62
0,19 / 0
1 FILME
533,48
Total:
0468314602003
0468314602305
4,53
1342173
14/12/2011
1342173
1342173
/10101012
1/0
83,07
/41301099
1/0
7,68
/41301102
1/0
25,58
310000145
/40601137
1/0
29,21
1342173
/90000021
2,78 / 0
2 UCO
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 101
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
2 UCO
/90000021
Obs.
Qtd/Partic
1,03 / 0
0,00
145,54
Total:
0468314603000
0468314603018
Vl.Cob
89000063
63
1239
/10101012
1/0
61,43
89000063
63
5910
/10101012
1/0
61,43
89000063
63
/40901122
1/0
98,77
89000063
63
40302040 Glicose
/40302040
1/0
4,13
89000063
63
40302580 Uria
/40302580
1/0
4,13
89000063
63
/40301150
1/0
4,13
89000063
63
/40311210
1/0
5,90
89000063
63
/40901246
1/0
88,45
89000063
63
/40808017
1/0
20,04
89000063
63
1/0
8,85
89000063
63
40301630 Creatinina
/40301630
1/0
4,13
89000063
63
/40805026
1/0
15,03
89000063
63
/40304922
1/0
17,69
89000063
63
/40901505
1/0
68,98
89000063
63
1 FILME
1,2223 / 0
29,13
89000063
63
1 FILME
0,5096 / 0
12,15
89000063
63
1 FILME
0,3402 / 0
8,11
512,48
Total:
0468321407008
0468321407008
110000290
07/11/2011
110000290
07/11/2011
/10101039
1/0
68,45
/80031005
1/0
10,64
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 102
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
110000290
07/11/2011
0 Materiais em Geral
/90000021
1/0
7,59
110000290
07/11/2011
0 Medicamentos em Geral
/90000013
1/0
26,62
/10101039
1/0
52,65
0468321407105
110000290
0468321407300
310000145
40316270 Ferritina
/40316270
1/0
27,61
310000145
/40301842
1/0
7,34
310000145
1/0
11,78
110000290
/10101039
1/0
52,65
110000290
/80031005
1/0
10,64
110000290
0 Materiais em Geral
/90000021
1/0
5,22
310000145
2 UCO
/90000021
3,457 / 0
0,00
110000290
0 Medicamentos em Geral
/90000013
1/0
7,06
288,25
Total:
0468321408004
0468321408004
310000145
40302199 Lipase
/40302199
1/0
9,76
310000145
/40302504
1/0
9,76
310000145
/40302512
1/0
9,76
310000145
/40303098
1/0
5,99
310000030
07/12/2011
/40302504
1/0
9,76
310000030
07/12/2011
/40302512
1/0
9,76
310000030
07/12/2011
1/0
11,78
310000145
40302318 Potssio
/40302318
1/0
5,28
310000145
40302423 Sdio
/40302423
1/0
5,28
310000145
/40303136
1/0
12,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 103
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
07/12/2011
/40314090
1/0
145,85
310000030
07/12/2011
/40301150
1/0
5,28
110000052
/10101039
1/0
94,77
310000145
/40310337
1/0
24,52
310000145
/40307891
1/0
9,99
310000145
1/0
11,78
110000052
/10102019
3/0
184,20
110000052
28/11/2011
/80011020
3/0
736,43
310000145
2 UCO
/90000021
7,674 / 0
0,00
310000030
07/12/2011
2 UCO
/90000021
13,398 / 0
0,00
110000052
0 Materiais em Geral
/90000021
1/0
171,08
110000052
0 Medicamentos em Geral
/90000013
1/0
797,57
0468321408012
DA02 APARTAMENTO
210000240
/41301250
2/0
69,22
210000240
/41301323
1/0
22,08
210020314
3/0
92,10
210020314
1/0
30,70
210000240
2 UCO
/90000021
1,08 / 0
0,00
210020314
2 UCO
/90000021
6,24 / 0
0,00
0468321408101
3657
19/12/2011
/10101012
1/0
83,07
310000030
14/12/2011
/40302504
1/0
9,76
310000030
14/12/2011
1/0
11,78
310000030
14/12/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
14/12/2011
1/0
40,73
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 104
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
14/12/2011
/40302512
1/0
9,76
310000030
14/12/2011
/40301885
1/0
9,76
310000030
14/12/2011
40302580 Uria
/40302580
1/0
5,28
310000030
14/12/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
14/12/2011
/40302750
1/0
22,46
310000030
14/12/2011
/40304922
1/0
33,50
310000030
14/12/2011
/90000021
8,345 / 0
/10101012
1/0
0468321408110
3657
2 UCO
19/12/2011
83,07
2.805,21
Total:
0468352026006
0468352026006
0,00
89000063
63
11005026 29/09/2011
1/0
3,24
89000063
63
11005026 29/09/2011
1/0
0,23
89000063
63
11005026 29/09/2011
1/0
1,54
89000063
63
11005026 29/09/2011
/70525528
1/0
1,05
89000063
63
11005026 29/09/2011
1/0
2,91
89000063
63
11005026 29/09/2011
1/0
0,56
89000063
63
11005026 29/09/2011
1/0
4,33
/90281292
13,86
Total:
0468352051000
0468352051000
4127
19/12/2011
/10101012
1/0
83,07
Total:
0468352060000
0468352030100
1240648
83,07
15/12/2011
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 105
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
110000079
/40803139
1/0
31,77
1240648
1/0
23,03
1240648
/41401387
1/0
23,03
1240648
1/0
23,03
1240648
/41401409
1/0
23,03
1240648
/41401395
1/0
23,03
110000079
2 UCO
/90000021
1,22 / 0
0,00
110000079
1 FILME
0,072 / 0
1,63
231,62
Total:
0468352067004
0468352067004
11002316
0468352067012
19/12/2011
/10101012
1/0
83,07
/10101012
1/0
83,07
1341614
05/12/2011
1221163
/31303170
/Anestesis
1/1
332,69
1341576
/31303170
/1o.
1/1
105,92
1340898
/31303170
/Cirurgiao
1/1
353,06
110000133
1/0
524,52
110000133
TC14 PORTE IV
/80021042
1/0
332,16
110000133
/80061400
1/0
23,41
110000133
0 Materiais em Geral
/90000021
1/0
91,13
110000133
0 Medicamentos em Geral
/90000013
1/0
65,38
/10101012
1/0
83,07
0468352067500
Martinho Pereira
11000313
29/11/2011
11000313
/20104111
1/0
53,29
11000313
/20104111
1/0
127,53
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 106
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
11000313
1341665
1101125
110000028
17/11/2011
110000028
110000028
/31104223
Obs.
Qtd/Partic
Vl.Cob
1/0
176,53
/1o.
1/1
379,64
/Cirurgiao
1/1
1.265,47
DA02 APARTAMENTO
/80011020
1/0
245,48
/80053122
1/0
315,55
TE34 HEMODINAMICA
/80031412
1/0
630,63
11000313
0 Materiais em Geral
/90000021
1/0
691,66
110090957
0 Materiais em Geral
/90000021
1/0
12.090,78
110000028
0 Materiais em Geral
/90000021
1/0
1.017,00
11000313
0 Medicamentos em Geral
/90000013
1/0
65,70
110000028
0 Medicamentos em Geral
/90000013
1/0
45,31
19.182,05
Total:
0468752040006
0468752040006
89000098
/ Unimed Imperatriz
44082
10/10/2011
/10101012
1/0
58,97
Total:
0468752041002
0468752041100
58,97
89000098
/ Unimed Imperatriz
98
45704
89000098
/ Unimed Imperatriz
98
89000098
/ Unimed Imperatriz
89000098
05/10/2011
/10101012
1/0
58,97
/20103220
10 / 0
94,30
98
33472
/10101039
1/0
43,00
/ Unimed Imperatriz
98
/40702103
1/0
168,06
89000098
/ Unimed Imperatriz
98
1/0
159,21
89000098
/ Unimed Imperatriz
98
1 FILME
1,3299 / 0
89000098
/ Unimed Imperatriz
98
0 Medicamentos em Geral
/90000013
1/0
Total:
31,70
309,61
864,85
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 107
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
89000099
/ Unimed Teresina
99
/40201252
1/0
118,38
89000099
/ Unimed Teresina
99
/10101039
1/0
43,00
161,38
Total:
0468752045008
0468752045504
310000145
/40316513
1/0
40,84
110000079
/40901106
1/0
299,80
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
/40301150
1/0
5,28
310000145
/40316149
1/0
32,99
110000079
1/0
25,45
310000145
1/0
11,78
310000145
40302040 Glicose
/40302040
1/0
5,28
310000145
40302580 Uria
/40302580
1/0
5,28
110000079
/40101045
1/0
127,04
310000145
40301630 Creatinina
/40301630
1/0
5,28
310000145
/40302750
1/0
22,46
310000145
/40302733
1/0
44,71
110000079
2 UCO
/90000021
0,75 / 0
0,00
310000145
2 UCO
/90000021
11,532 / 0
0,00
631,47
Total:
0468752046004
0468752046004
1360473
/41501128
2/0
61,40
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 108
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
07/12/2011
/40304523
1/0
19,68
310000030
07/12/2011
/40316548
1/0
27,52
1360473
/41301080
2/0
95,94
310000030
07/12/2011
/40316521
1/0
27,52
310000030
07/12/2011
40316270 Ferritina
/40316270
1/0
27,61
310000030
07/12/2011
/40301150
1/0
5,28
1360473
/41301269
2/0
95,94
310000030
07/12/2011
/40301842
1/0
7,34
310000030
07/12/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
14/12/2011
1/0
11,78
310000030
07/12/2011
/40302504
1/0
9,76
310000030
07/12/2011
/40316572
1/0
23,81
310000030
07/12/2011
/40301761
1/0
24,49
310000030
07/12/2011
/40316556
1/0
54,57
310000030
07/12/2011
/40302512
1/0
9,76
310000030
14/12/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
07/12/2011
40302580 Uria
/40302580
1/0
5,28
310000030
07/12/2011
1/0
11,78
310000030
07/12/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
07/12/2011
/40301087
1/0
24,49
310000030
07/12/2011
40301400 Clcio
/40301400
1/0
5,28
310000030
14/12/2011
/40311210
1/0
11,20
310000030
07/12/2011
40301567 Cobre
/40301567
1/0
44,71
310000030
07/12/2011
/40302750
1/0
22,46
310000030
07/12/2011
/40302733
1/0
44,71
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 109
Atendimento/Lote/Nota
310000030
14/12/2011
310000030
14/12/2011
310000030
07/12/2011
1360473
310000030
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
/40304922
1/0
2 UCO
/90000021
4,551 / 0
0,00
2 UCO
/90000021
20,213 / 0
0,00
2 UCO
/90000021
11,24 / 0
0,00
07/12/2011
2 UCO
/90000021
7,965 / 0
0,00
0468752046020
33,50
89000222
222 25457
31/10/2011
/10101012
1/0
58,97
89000222
222 644
07/11/2011
/10101187
1/0
29,48
810,10
Total:
0468752048007
0468752048007
89000099
/ Unimed Teresina
99
40804097 P ou pododctilo
/40804097
1/0
17,40
89000099
/ Unimed Teresina
99
/10101039
1/0
43,00
89000099
/ Unimed Teresina
99
0,1438 / 0
3,43
89000099
/ Unimed Teresina
99
/70438625
1/0
0,42
89000099
/ Unimed Teresina
99
/90000013
2/0
3,46
89000099
/ Unimed Teresina
99
/90248767
1/0
0,56
89000099
/ Unimed Teresina
99
/90171152
1/0
1,21
0468752048023
1 FILME
26313 AGULHA 40X12 DESC
0 Medicamentos em Geral
89000099
/ Unimed Teresina
99
/20103492
10 / 0
147,42
89000099
/ Unimed Teresina
99
/40601137
1/0
20,64
Total:
0468752049003
0468752049518
237,54
1100145
13/12/2011
/10101012
1/0
83,07
18305
09/12/2011
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 110
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000110
/ Lab.De Investigacao
13/12/2011
40302040 Glicose
/40302040
2/0
10,55
310000110
/ Lab.De Investigacao
13/12/2011
/40302733
1/0
24,49
310000110
/ Lab.De Investigacao
13/12/2011
1/0
11,78
18305
/41301102
1/0
25,58
310000110
/ Lab.De Investigacao
13/12/2011
/40302750
1/0
22,46
310000110
/ Lab.De Investigacao
13/12/2011
2 UCO
/90000021
3,408 / 0
0,00
18305
2 UCO
/90000021
2,78 / 0
0,00
261,00
Total:
0468752051008
0468752051300
210000291
/40801063
1/0
210000291
2 UCO
/90000021
1,47 / 0
0,00
210000291
1 FILME
0,1296 / 0
2,94
/10101039
1/0
0468752051512
110000052
94,77
132,85
Total:
0468752055003
0468752055003
35,14
1100153
20/12/2011
/10101012
1/0
83,07
1121690
16/12/2011
/10101012
1/0
83,07
210000879
15/12/2011
40901114 Mamas
/40901114
1/0
86,31
210000879
15/12/2011
/40901122
1/0
144,92
210000879
15/12/2011
1 FILME
0,68 / 0
15,43
210000879
15/12/2011
1 FILME
0,34 / 0
7,72
210000879
15/12/2011
2 UCO
/90000021
3,42 / 0
0,00
210000879
15/12/2011
2 UCO
/90000021
5,85 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 111
Atendimento/Lote/Nota
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
1360562
17/12/2011
/10101012
1/0
83,07
310000030
30/11/2011
/40301990
1/0
9,76
310000030
30/11/2011
/40301885
1/0
9,76
310000030
30/11/2011
40302199 Lipase
/40302199
1/0
9,76
310000030
30/11/2011
40301281 Amilase
/40301281
1/0
9,76
310000030
30/11/2011
/40308391
1/0
36,82
310000030
30/11/2011
40301630 Creatinina
/40301630
1/0
5,28
310000030
30/11/2011
/40302512
1/0
9,76
310000030
30/11/2011
/40302504
1/0
9,76
210000879
15/12/2011
/40901300
1/0
91,69
310000030
30/11/2011
1/0
11,78
1100331
/30303010
/Cirurgiao
1/1
140,69
1100331
/30303060
/Cirurgiao
1/1
106,59
1360562
1/0
0,00
310000030
30/11/2011
2 UCO
/90000021
5,577 / 0
0,00
210000879
15/12/2011
1 FILME
0,17 / 0
3,86
210000879
15/12/2011
2 UCO
/90000021
3,82 / 0
0,00
958,86
Total:
0468752057006
0468752057006
89000099
/ Unimed Teresina
0468752057103
21325
31/10/2011
/10101012
1/0
58,97
89000099
/ Unimed Teresina
99
/20103492
10 / 0
147,42
89000099
/ Unimed Teresina
99
/20103492
10 / 0
147,42
Total:
353,81
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 112
Procedimento/Cd.Intercmbio/Participao
Obs.
Qtd/Partic
Vl.Cob
310000030
30/11/2011
1/0
11,78
310000030
30/11/2011
40302040 Glicose
/40302040
1/0
5,28
310000030
30/11/2011
/40302750
1/0
22,46
310000030
30/11/2011
/90000021
1,257 / 0
0468752059017
2 UCO
0,00
1130583
16/12/2011
/10101012
1/0
83,07
310000030
17/12/2011
1/0
40,73
310000030
17/12/2011
1,67 / 0
2 UCO
/90000021
163,32
Total:
0468752061003
0468752061003
3570
13/12/2011
/10101012
1/0
1360473
20/12/2011
/10101012
1/0
83,07
83,07
Total:
0486000313007
0486000313104
83,07
83,07
Total:
0468752062000
0468752062000
0,00
11000933
06/12/2011
/10101012
1/0
83,07
1381748
09/12/2011
/10101012
1/0
83,07
Total:
Total do Contrato:
166,14
164.208,98