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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 /> 114 wET MOi;NT/KOH OL OL 1 12.00 <br /> i71 URINALYSIS OL OL 5 14.00 <br /> 112 URINE DIPSTICK OL OL 1 8.00 <br /> 167 MONOSPOT OL OL 1 25.00 <br /> 85651 SED KATE BLOOD WORK OL 0 15.00 <br /> 164 GRAM STAIN OL OL 1 20.00 <br /> 161 FINGERSTICK BS 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 /> 83118 HDL CHOLESTEROL STUDY HDL OL 5 21.00 <br /> 155 URINE CULTURE 87086 OL 1 35.00 <br /> 82952(X2) GTT OL 1 20.00 <br /> 140 LIPID PROFILE OL OL i 21.00 <br /> 82948 GLUCOSE, FINGERSTICK 82948 OL 5 11.00 <br /> 84520 BUN (URIC NITROGEN) URIC OL 1 18.00 <br /> 168 ENZYME IMMONOASSAY FOR INFECT AG OL OL 0 16.00 <br /> 86317 IMMUNOASSAY-INFEC. AGENT ANTIGEN RAPID STRE OL 5 19.00 <br /> 36,500 ARTERIAL PUNCTURE OL 0 55.00 <br /> 82565 CREATINIE OL 5 18.00 <br /> 84:32 POTASSIUM OL OL i 21.00 <br /> 80019 MULTICHEM PANEL 80019 OL 5 29.00 <br /> 131 BLOOD COLLECT ON-IN HOUSE BLOOD-IN OL 1 3.00 <br /> 166 HEMOCCULT Xl X 3 OL OL 1 3.50 <br /> 165 HEMA-OCRIT 93040 OL 5 11.00 <br /> :,220 KOH PREP OL 5 12.00 <br /> :76 PEAK F,-OW PEAK FLOW OL 0 18.00 <br /> 38 HEMOGLOBIN A-1C OL OL 5 18.00 <br /> .75 GC CJLTLRE OL OL 1 20.00 <br /> 160 EKS WITH INTERPRETATION OL OL 1 45.00 <br /> 756:0 PROTr XIN TIME BLOOD WORK OL 1 30.00 <br /> .44 POTASSIUM OL OL 5 14.00 <br /> :1C THROAT CULTURE OL OL 5 12.00 <br /> 169 SED RATE OL OL 1 15.00 <br /> 3F410 VENIPUNCT'URE,NEEDING MD SKILL OL 0 35.00 <br /> 13 URINE PREGNANCY TEST OL OL 1 16.00 <br /> 33036 HEMOGLOBIN, GLYCOSYLATED ALC OL 0 31.00 <br /> 344'8 TR?GLYCERIDES OL OL 5 19.00 <br /> 364:5 VENIPUNCTURE, ROUTINE OL 5 3.00 <br /> 82465 TOTAL CHOLESTEROL OL OL 5 19.00 <br /> 151 OERMOPATH RL RL 99 45.00 <br /> 88305 SURGICAL PATH SURD. PATH RL 0 85.00 <br /> 006049 BLOOD TYPE BLOOD WORK RL 1 .00 <br /> 86006 HEP B 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 />