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l <br /> 1 <br /> ORANGE FAMILY MEDICAL GROUP PA <br /> 06/15/93 PROCEDURE FEES PAGE 3 <br /> PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE <br /> ---- - - ------------------------------------------------------------------------------------------------- <br /> 82746 FOLATE BLOOD WORK RL 0 61.75 <br /> 80099 UNLISTED PANEL BLOODWORK RL 5 .00 <br /> 84;55 PROTEIN BLOODWORK RL 5 <br /> 82370 ;TONE ANAYLIS 8LOOD WORK RL 1 43.15 <br /> 82 C75 CREATININE CLEARANCE BLOOD WORK RL 0 41.75 <br /> 84703 PREG. SERIUM RL RL 1 19.00 <br /> :07831 QUINIDINE QUANT. BLOOD WORK RL 1 .00 <br /> 93690 LIPASE BLOOD WORK RL 1 .00 <br /> X96925 1D PANEL IV BLOOD WORK RL 0 154.00 <br /> APB ANEMIA PROFILE B PROFILE RL 5 84.50 <br /> 84403 TESTERONE BLOOD WORK RL 1 .00 <br /> 145 PRENATAL PANEL RL RL 99 37.00 <br /> 82552 CPK ISOENZYME BLOOD WORK RL 1 .00 <br /> 85025 CBC & DIFF BLOODWORK RL 0 .00 <br /> 80009 LIVER PANEL RL 0 25.18 <br /> 86291 ANTI-HBS BLOOD WORK RL 1 60.00 <br /> 80073A RENAL PANEL RL RL 99 24.05 <br /> 87252 VIRAL CULTURE RL 1 39.00 <br /> 83655 LEAD BLOOD WORK RL 1 32.85 <br /> 88304 SURGICAL PATH - SKIN,CYST,TAG/DEBRID. SURG. PATH RL 0 4C.00 <br /> 87178(X2) DNA PROBE GC/CHLAMYDIA RL 99 38.45 <br /> 81000 URINALSIS, COMPLETE -AB WORK RL 0 14.00 <br /> 82768 FOLATE BLOOD WORK RL 0 .00 <br /> /HELPER P T-LYMPHOSYTE SUPP./HELP:R PROFILE BLOOD WORK RL 0 '154.00 <br /> 81570 24 HR. URINE CREAT. RL 0 .00 <br /> 33053 HEMOGLOBIN S (SICKLE CELL) BLOODWORK RL 1 36.00 <br /> 87230 C. DIFF. TOXIN BLOOD WORK RL 1 90.75 <br /> 98,150 PAP SMEAR RL 0 28.00 <br /> 84146 PROLACTIN BLOOD WORK RL 0 93.25 <br /> :;o STOOL CULTURE RL RL 99 60.00 <br /> 84999 UNLISTED CHEMISTRY OR TOXI PROC. BLOODWORK RL 5 .00 <br /> X6593 VDRL, SPINAL FLUID SLOODWORK RL 5 39.50 <br /> 88105 SPUTUM CYTOLOGY RL 0 .00 <br /> ;4443 TSH BLOODWORK RL 5 .00 <br /> 43 PAP SMEAR RL RL 99. Z8.00 <br /> 153 THEOPH LEVEL RL RL 99 59.00 <br /> 36:5: CEA RL 0 68.50 <br /> ANEMIA PROFILE A RL RL 99 35.00 <br /> °d4'8A TRIGLYCERIDES RL RL 99 31.75 <br /> :2383 FRACTIONATED CATECHMMINES BLOOD WORK RL 1 .00 <br /> 371163 STOOL, CULTURE 81163 RL 0 63.00 <br /> 32.'94 IGM LEVELS RL 0 .00 <br /> 84479 THYROID PANEL W/TSH BLOOD WORK RL 0 40.68 <br /> 30003 ELECTROLYTES RL 1 .00 <br /> 82435 CHLORIDE RL 99 .00 <br /> 137 GLUCOSE RL RL 99 23.00 <br /> 82060 ETHANOL BLOOD WORK RL 1 .00 <br /> 84030 PKU RL 0 18.00 <br /> 86080 BLOOD TYPE BLOOD WORK RL 1 .00 <br /> 80085 ANEMIA PROFILE BLOOD WORK RL 0 30.80 <br /> 041780 URINE BLOOD BLOOD WORK RL 1 58.75 <br /> 84231 DRUG SCREEN RL 1 34.00 <br /> 134 DIGOXIN LEVEL RL RL 99 51.00 <br />