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ORANGE FAMILY MEDICAL GROUP PA <br /> 06%15/93 PROCEDURE FEES PAGE 5 <br /> PROCEDURE DESCRIPTION Alf. DESC. DEPT T.O.S. STD. FEE <br /> ------------------------------------------------------------------------------------------------------------------------------------ <br /> 83715 LIPOPROTEIN BLOOOWORK RL 5 .00 <br /> 84144 PROGESTERONE LEVEL RL 1 78.00 <br /> 86319 CARBAMAZOPINE LEVEL BLOOD WORK RL 1 .00 <br /> ?d175 PRO'EIY CSF RL 1 .00 <br /> 07220 TOXICOLOGY SCREEN BLOOD WORK RL 1 JO <br /> 31211Y WET PREP RL 0 12.00 <br /> 87010 CULTURE, ANY OTHER SOURCE RL 1 .00 <br /> 84550 URIC ACID BLOOD WORK RL 1 100 <br /> 83525 INSULIN BLOOD WORK RL 1 100 <br /> 96289 HEP B CORE BLOOD WORK RL 1 .00 <br /> 38180 T-CELL HEL./SUPP. PROF. BLOOD WORK RL 0 188.00 <br /> 4006 PROSTATIC ACID PHOS. BLOOD WORK RL 1 55.00 <br /> 86430 RHEUMATOID A BLOOD WORK RL 1 .00 <br /> 136 ELECTROLYTE PANEL RL RL 99 24.05 <br /> 148 RUBELLA TITER RL RL 99 42.00 <br /> 84702 BETA HCG QUANT RL RL 99 31.00 <br /> 87256 CHLAMYDIA 106 RL 0 82.75 <br /> 144A POTASSIUM RL RL 99 22.25 <br /> 86293 HEP BE AG BLOOD WORK RL 0 .00 <br /> 82550 CPK BLOOD WORK RL 1 100 <br /> 35240 FACTOR VIII BLOOD WORK RL 0 .00 <br /> 85544 L E CELL PREP BLOOD WORK RL 1 .00 <br /> 135 DILANTIN RL RL 99 56.25 <br /> 3900i 1ANDLING SPEC.-PT TO LAB RL 0 10.00 <br /> 81117 STOOL D & P D & P RL 0 62.00 <br /> 34701 PRENATAL PANEL OB RL 0 36.00 <br /> 34436 THYROID PROFILE BLOOD RL 1 .00 <br /> 80050 EXECUTIVE III BLOOD WORK RL 0 53.00 <br /> 82728 FERRITIN BLOOD WORK RL 1 58.50 <br /> 86300 MONOSPOT 86300 RL 5 34.25 <br /> 81016 AMA RL 0 .00 <br /> E2270 HEMOCCUL' BLOOD WORK RL 0 3.50 <br /> 32470 CHOLESTEROL & ESTERS. BLOOD WORK RL 1 .00 <br /> 94420 THEOPHYLLINE LEVEL BLOOD WORK RL 0 63.00 <br /> 34681 C-PEPTIDE BLOOD WORK RL 1 .00 <br /> cou92 BLOOD TYPE & RH BLOOD WORK RL 5 .00 <br /> 154 THYROID PANEL W/TSH RL RL 99 41.00. <br /> x;,53 EXECUTIVE 0 WITH TSH RL 1 60.00 <br /> ?!3295 HEP BE A8 BLOOD WORK RL 0 .00 <br /> 3' 05Y PHENOBARBITAL RL 0 .00 <br /> 36280 ANTITHYROID ANTIBODIES BLOOD WORK RL 1 .00 <br /> i2i14 CARBON DIOXIDE BLOOD WORK RL 1 .00 <br /> 37075 ANARAIC CULTURE RL 1 .00 <br /> 34:85 BENCE JONES PROTEIN BLOOD WORK RL 1 .00 <br /> 33317 VIRAL CULTURE RL 1 173.75 <br /> 38107 CYTOLOGY JOINT FLUID BLOOD WORK RL 1 .00 <br /> 208 XRAY THORACIC SPINE, 2 VIEWS W/INTERPRET XR XR 31 .00 <br /> 230 XRAY OPP.VIEW FOR COMPARISON W/INTERPRET XR XR 31 .00 <br /> 13100 WRIST XRAY 1 VIEW XRAY XR 0 .00 <br /> 252 XRAY MANDIBLE 4 V W/INTERPRET XR XR 31 .00 <br /> 218 XRAY, CLAVICLE,1 V W/INTERPRET XR XR 31 .00 <br /> 71020 XRAY,CHEST,2 VIEWS, W/INTERPRET. XR XR 31 71.00 <br /> 225 XRAY ELBOW, 3 VIEWS W/INTERPRETATION XR XR 31 .00 <br />