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/U <br /> ORANGE FAMILY MEDICAL GROUP PA <br /> 06/15/93 PROCEDURE FEES PAGE 1 <br /> PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE <br /> -------------------------------------------------------------------------------------- <br /> 82954(X4) GTT OL 1 25.00 <br /> 829 O'SULL:VAN OL OL 1 .00 <br /> 36406 vENIPUNCTURE, UNDER AGE 3, OTHER VEIN 36406 OL 0 35.00 <br /> :74 sET MO NT/KOH. k OL 1 +� <br /> •c.JD <br /> URINALYSIS OL OL 5 14.00 <br /> 1'2 URINE )IPSTICK OL OL 1 8.00 <br /> 167 MONOSPOT OL OL 1 25.00 <br /> 8.651 SED RATE 8:000 WORK OL 0 15.00 <br /> 164 GRAM STAIN OL OL 20.00 <br /> i61 FINGERSTICK 8S 82948 OL 5 11.00 <br /> 99000 HAND. SPECIMEN TRANSFER(OFFICE TO LAB) OL 0 10.00 <br /> 80073 RENAL PROFILE OL OL i 29.00 <br /> 162 GTT 3 HR 6 HR OL OL i 45.00 <br /> 83718 HDL CHOLESTEROL STUDY HOL OL 5 21.00 <br /> 155 URINE CULTURE 81086 OL 1 35.00 <br /> 82952(X2) GTT OL 1 20.00 <br /> 140 LIPID PROFILE OL OL 1 27.00 <br /> 82948 GLUCOSE, FINGERSTICK 82948 OL 5 11.00 <br /> 34520 BUN (URIC NITROGEN) URIC OL 1 18.00 <br /> 168 ENZYME I4MONDASSAY FOR INFECT AG OL OL 0 16.00 <br /> 86317 IMMUNOASSAY-iNFEC. AGENT ANTIGEN RAPID STRE OL 5 19.00 <br /> 36600 ARTERIAL ?UNC"JRE OL 0 55.00 <br /> 82565 CREATINIE OL 5 18.00 <br /> 84132 POTASSIUM OL OL 1 21.00 <br /> 80019 MULTICHEM PANEL 80019 OL 5 29.00 <br /> .3l 3LOOD COLLECTION-IN HOUSE 8LOOD-IN OL 1 3.00 <br /> i66 HENOCCULT X1 X 3 OL OL 1 3.50 <br /> 165 rIEMArOCRIT 93040 OL 5 11.00 <br /> -20 KOH PREP OL 5 12.00 <br /> PEAK F+-Ow PEAK FLOW OL 0 18.00 <br /> :8 HEMOGLOBIN A-1C OL OL 5 18.00 <br /> .?`. GC CJLTLRE OL OL 1 20.00 <br /> .60 E<G WITH INTERPRETATION OL OL 1 45.00 <br /> ;56:'; ?ROT:,OMBIN TIME BLOOD WORK OL 1 30.00 <br /> 44 POTASSIUM OL OL 5 14.00 <br /> .10 'hROAT CULTURE OL OL 5 12.00 <br /> -9 SED RATE OL OL 1 15.00 <br /> 36410 'VE,NIPUNCT',RE,NEEDIN6 0 SKILL OL 0 35.00 <br /> .73 URINE PREGNANCY TEST OL OL 1 16.00 <br /> ?i 36 HEMOGLOBIN, GLYCOSYLATED ALC OL 0 31.00 <br /> 4478 rRIGLYCERIDES OL OL 5 19.00 <br /> ?:4:5 VENIPUNCTURE, ROUTINE OL 5 3.00 <br /> 32465 TOTAL CHOLESTEROL OL OL 5 19.00 <br /> 151 DERMOPATH RL RL 99 45.00 <br /> 88305 SURGICAL PATH SURD. PATH RL 0 85.00 <br /> !:06049 BLOOD TYPE BLOOD WORK RL 1 .00 <br /> 86006 HEP 8 S BLOOD WORK RL 1 .00 <br /> 85044 RETIC COUNT RL 0 .00 <br /> 82662 TEGRETOL BLOOD WORK RL 1 62.50 <br /> 82952 GLUCOSE TOLERANCE TEST GTT RL 1 48.00 <br /> 86592 VORL, SERUM BLOODWORK RL 5 33.00' <br /> 133 CULTURE/SENSITIVITY RL RL 99. 35.00 <br /> 88160 BREAST SECRETIONS BLOOD WORK RL 1 .00 <br />