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1 <br /> 4 <br /> r <br /> ORANGE FAMILY MEDICAL GROUP PA <br /> 06%15%93 PROCEDURE FEES PAGE 5 <br /> PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE <br /> ------------------------------------------------------------------------------------------------------------------------------------ <br /> 83115 LIPOPROTEIN BLOODWORK RL 5 .00 <br /> 84144 PROGESTERONE LEVEL RL 1 78.00 <br /> 86319 CARBAMAZOPINE LEVEL' BLOOD WORK RL : .00 <br /> u4175 PROTEIN CSF RL 1 .00 <br /> 07220 TOXICOLOGY SCREEN BLOOD WORK RL 1 .00 <br /> 87211Y WET PREP RL 0 12.00 <br /> 870170 CULTURE, ANY OTHER SOURCE RL i .00 <br /> 84550 URIC ACID BLOOD WORK RL 1 .00 <br /> 83525 INSULIN BLOOD WORK RL 1 .00 <br /> 86289 HEP 8 CORE BLOOD WORK RL 1 .00 <br /> 88180 T-CELL HEL./SUPP. PROF. BLOOD WORK RL 0 188.00 <br /> 84006 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 IQG RL 0 82.75 <br /> :44A POTASSIUM RL RL 99 22.25 <br /> 86293 HEP BE AG BLOOD WORK RL 0 .00 <br /> 82550 CPK BLOOD WORK RL i .00 <br /> 85240 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 /> 39001, IANDLING SPEC.-PT TO LAB RL 0 10.00 <br /> 87.177 STOOL D & P D & P RL 0 62.00 <br /> 84701 PRENATAL PANEL OB RL 0 36.00 <br /> 84436 THYROID PROFILE BLOOD RL i .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 /> 87076 AMA RL 0 .00 <br /> 82270 HEMOCCULT 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 /> 8468i C-PEPTIDE BLOOD WORK RL 1 .00 <br /> 801182 BLOOD TYPE & RH BLOOD WORK RL 5 .00 <br /> 154 THYROID PANEL W/TSH RL RL 99 41.00 <br /> Bf,OS3 EXECUTIVE D WITH TSH RL 1 60.00 <br /> 36295 HEP BE AB BLOOD WORK RL 0 .00 <br /> 82205Y PHENOBARBITAL RL 0 .00 <br /> 96280 ANTITHYROID ANTIBODIES BLOOD WORK RL 1 .00 <br /> 32374 CARBON DIOXIDE BLOOD WORK RL 1 .00 <br /> 87075 ANARAIC CULTURE RL 1 .00 <br /> °4:85 BENCE JONES PROTEIN BLOOD WORK RL 1 .00 <br /> 83317 VIRAL CULTURE RL 1 173.75 <br /> 88107 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 /> 73100 WRIST XRAY 1 VIEW XRAY XR 0 .00 <br /> 252 XRAY MANDIBLE 4 V W/INTERPRET XR XR 31 .00 <br /> 218 XRAY, CLAVICLE,I 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 />