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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 /> 94:55 PROTEIN BLOODWORK RL 5 <br /> 82370 STONE ANAYLIS BLOOD WORK RL 1 43.15 <br /> 825,715 CREATININE CLEARANCE BLOOD WORK RL 0 41.75 <br /> 84703 PREG. SERIUM RL RL 1 19.00 <br /> :07831 OUINIDINE QUANT, 81000 WORK RL 1 .00 <br /> 33690 LIPASE BLOOD WORK RL 1 .00 <br /> 196925 ID 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-MBS 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 <br /> 88304 SURGICAL PATH - SKIN,CYST,TAG/DEBRID. SURG, PATH RL 0 40.00 <br /> 87178(X2) DNA PROBE GC/CHLAMYDIA RL 99 38.45 <br /> 81000 URINALSIS, COMPLCTE LAB WORK RL 0 14.00 <br /> 92768 FOLATE BLOOD WORK RL 0 .00 <br /> /HELPER P T-LYMPHOSYTE SUPP./HELPER PROFILE BLOOD WORK RL 0 '154.00 <br /> 82570 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 /> 93'150 PAP SMEAR RL 0 28.00 <br /> 84146 PROLACTIN BLOOD WORK RL 0 93.25 <br /> 150 STOOL CULTURE RL RL 99 60.00 <br /> 84999 UNLISTED CHEMISTRY OR TOXI PROC. BLOODWORK RL 5 .00 <br /> 6593 VDRL, SPINAL FLUID BLOODWORK RL 5 39.50 <br /> 98105 SPUTUM CYTOLOGY RL 0 .00 <br /> "4443 TSH SLOODWORK RL 5 .00 <br /> 43 PAP SMEAR RL RL 99• 28.00 <br /> 153 THEOPH LEVEL RL RL 99 59.00 <br /> 9545. CEA RL 0 68.50 <br /> '�9 ANEMIA PROFILE A RL RL 99 35.00 <br /> ,:1478A TRIGLYCERIDES RL RL 99 31.75 <br /> :2383 FRACTIONATED CATECHOLANINES BLOOD WORK RL 1 .00 <br /> 37'163 STOOL, CULTURE 87163 RL 0 63.00 <br /> 92784 !GM LEVELS RL 0 .00 <br /> 84479 THYROID PANEL W/TSH BLOOD WORK RL 0 40,68 <br /> :0003 ELECTROLYTES RL 1 .00 <br /> ,,2435 CHLORIDE RL 99 .00 <br /> 137 GLUCOSE RL RL 99 23.00 <br /> 82060 ETHANOL BLOOD WORK RL 1 .00 <br /> 84030 PKU RL O 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 />