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ORANGE FAMILY MEDICAL GROUP PA <br /> 06/15/93 PROCEDURE FEES PAGE 2 <br /> PROCEDURE DESCRIPTION ALT. DESC, DEPT T.O.S. STD, FEE <br /> ------------------------------------------------------------------------------------------------------------------------------------ <br /> 152 SURGICAL PATH (COMP.) RL RL 99 85.00 <br /> 86316 PROSTATE SPECIFIC ANTIGEN RL 0 36.00 <br /> 82951 O'SULLIVAN ('INCLUDES GLUCOSE) RL 0 ,00 <br /> 139 HEPATITIS PANEL RL RL 99 .00 <br /> 861140 :RP BLOOD WORK RL 0 .00 <br /> 33001 FSH BLOOD RL 81.75 <br /> 37060 UPPER RESP.CULIcRE BLOOD WORK RL 1 .00 <br /> 82785 IMMUNEGLOBINS BLOOD WORK RL 1 .00 <br /> 2486 NORTRIPTYLiNE BLOOD WORK RL 1 .00 <br /> 83002 LH BLOOD WORK RL O 81.00 <br /> 83750 MAGNESIUM BLOOD WORK RL 1 39.00 <br /> 83825 MERCURY BLOOD WORK RL 1 .00 <br /> 84066 ACID PHOS. RL 1 .00 <br /> 86255 MUMPS TITER RL 1 .00 <br /> 85999 ANEMIA PROFILE 8 BLOOD WORK RL 1 30.80 <br /> 85014 HEMAIOCRIT BLOOD WORK RL 0 11.00 <br /> 87205 GRAM STAIN 87205 RL 0 20.00 <br /> 138A HEMOGLOBIN A-1C RL 99 45.00 <br /> 86262 VALPORIC ACID RL 1 67.00 <br /> 80178 DNA PROBE (X2) RL 0 .00 <br /> 82705 FECAL AT RL 1 .00 <br /> 89051 CELL COUNT RL RL 1 35.00 <br /> 001149 T4 BLOOD WORK RL 1 .00 <br /> 87086 URINE CULTURE 87086 RL 5 37.00 <br /> 37106 FUNGAL CULTURE RL <br /> 84231-GP DRUG SCREEN RL 1 20.00 <br /> 87206 CHLAMYDIA MICROTRAK BLOODWORK RL 5 38.00 <br /> 86351 T&B LYMPH PROFILE BLOOD WORK RL 0 .00 <br /> 131A COLLECTION, LAB SPECIMEN RL RL 99 18.00 <br /> 84132A PO ASSIUM RL RL 99 22.25 <br /> 86256 ANA ANA RL 5 ,00 <br /> S?:50 AMYLASE BLOODWORK RL 5 32.00 <br /> :4100 P`IOSPHOKUS BLOOD WORK RL 1 ,00 <br /> 88:80(13) T-LYMPHOSYTE SUPP./HELPER PROFILE BLOOD WORK RL 0 154.00 <br /> :0004 E,_ECTROLYTES BLOOD WORK RL 0 23.20 <br /> 89060 CRYSTAL ANALYSIS BLOOD WORK RL 1 .00 <br /> 32607 312 'VITAMIN LAB RL 1 70.50 <br /> 52947 SERUM GLUCOSE BLOOD WORK RL 1 ,00 <br /> 84075 ALKALINE PHO. RL 0 31.50 <br /> 83725 LITHIUM LEVEL RL 99 41.00 <br /> 35.256 RMSF TITER BLOOD WORK RL 1 95.75 <br /> ?2533 CARTISOL AM RL 99 89.25 <br /> 36228 RUBELLA RL 1 36.00 <br /> 37040 BLOOD CULTURE BLOODWORK RL 99 60.00 <br /> K2150 TOTAL BILI, BLOOD WORK RL 1 .00 <br /> 799007 URINE TOX SCREEN DRUG SCR. RL 1 55.00 <br /> 146 PROTIME RL RL 99 28.00 <br /> 86278 HEP B SAG BLOOD ,WOR 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 SURG, PATHOLOGY RL 99 .00 <br />