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ORANGE FAMILY MEDICAL GROUP PA <br /> 06/115/93 PROCEDURE FEES PAGE 2 <br /> PROCEDURE DESCRIPTION ALT. OESC. DEPT T.O.S. STD. FEE <br /> ------------------------------------------------------------------------------------------------------------------------------------ <br /> 152 SURGICAL PATH (COMP.) RL RL 99 85.00 <br /> 363;5 PROSIAIE SPECIFIC ANTIGEN RL 0 36.00 <br /> 82951 D'S�LLIVAN i:NCLGDES GLUCOSE) RL 0 .00 <br /> 39 HEPATITIS PANEL RL RL 99 .00 <br /> 116':40 :9P BLOOD WORK RL 0 .00 <br /> 83001 FS1 BLOOD RL 81.75 <br /> 37063 ,PP:R RES?.CUL',J E 81000 WORK RL 1 .00 <br /> 82135 :MNUNEGLOBINS BLOOD WORK RL 1 .00 <br /> :2486 NORTRIP':YLINE BLOOD WORK RL 1 .00 <br /> 83002 LH BLOOD WORK RL O 81.00 <br /> 83750 MAGNESIUM BLOOD WORK RL 1 39.00 <br /> 31,825 MERCURY 6LOOD MURK RL 1 .00 <br /> 84066 ACID PHOS. RL 1 .00 <br /> 36255 MUMPS TITER RL 1 .00 <br /> 35999 ANEMIA PROFILE 8 BLOOD WORK RL 1 30.80 <br /> 85014 HEMATOCRIT BLOOD WORK RL 0 11.00 <br /> 81205 GRAM STAIN 87205 RL 0 20.00 <br /> 138A HEMOGLOBIN A-1C RL 99 45.04 <br /> 86262 VAL?ORIC ACID RL 1 67.00 <br /> 80118 DNA PROBE (x2) RL 0 .00 <br /> 82705 FECAL cAT RL 1 .00 <br /> 89051 CELL COUNT RL RL 1 35.00 <br /> 701149 T4 81000 WORK RL <br /> 37086 URINE CULTURE 87086 RL 5 372 <br /> 37106 FUNGAL CULTURE RL <br /> 34231-GP DRUG SCREEN RL 1 10.00 <br /> 37206 CHLAMYDIA MICROTRAK BLOODWORK RL 5 38.00 <br /> 36357 T&8 LYMPH PROFILE BLOOD WORK RL 0 .00 <br /> ""A COLLECTION, LAB SPECIMEN RL RL 99 1$.00 <br /> 34132A P^TASSIUM RL RL 99 22.25 <br /> 3625: ANA ANA RL 5 .00 <br /> 32:50 AMYLASE BLOODWORK RL 5 32.00 <br /> BLOOD WORK RL 1 .00 <br /> �e130ii3) T-LYMPHOSYTE SUPP./HELPER PROFILE BLOOD WORK RL 0 154.00 <br /> cuC04 EC'ROLYTES BLOOD WORK RL 0 23.20 <br /> 39060 CRYSTAL ANALYSIS BLOOD WORK RL 1 .Do <br /> 312 VITAMIN LAB RL 1 70.50 <br /> 32947 SERUM GLUCOSE ROOD WORK RL 1 .00 <br /> 34015 ALKALINE PHO. RL 0 31.50 <br /> 33125 LITHIUM LEVEL RL 99 41.00 <br /> RMSF TITER ROOD WORK RL 1 95.75 <br /> ?.533 CARTISOL AN RL 99 89.25 <br /> ? 28 iUBELtA RL 1 36.00 <br /> 1040 BLOOD CULTURE BLOOOMORK RL 99 60.00 <br /> :2:50 TOTAL BILI. BLOOD WORK RL 1 .00 <br /> 799007 URINE TOK SCREEN DRUG SCR. RL 1 55.00 <br /> 146 PROTIME RL RL 99 28.00 <br /> 86278 HEP 8 SAG BLOOD ,Nat RL 1 .00 <br /> 86312 HIV TITER BLOOD WORK RL 1 36.00 <br /> 86517 VARCELLA ZOSTER IQG RL 0 70.50 <br /> APA ANEMIA PROFILE A APA RL 5 27.80 <br /> 82468 NARTRIPTHLINE BLOOD WORK RL 1 .00 <br /> 88302 SURD. PATHOLOGY RL 99 .00 <br />