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�t <br /> ORANGE FAMILY MEJICA, GROUP PA <br /> 36/15/93 PROCEDURE FEES <br /> PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE <br /> ------------------------------------------------------------------------------------------------------------------------------------ <br /> 83715 LIPOPROTEIN BLOODWORK RL 5 .00 <br /> 84144 PROGESTERONE LEVEL RL 1 78.00 <br /> 8619 CARBAMAIOPINE LEVEL BLOOD WORK RL i .00 <br /> 41]5 PROTEIN CSF RL 1 .00 <br /> '220 TOXICOLOGY SCREEN BLOOD WORK RL 1 .00 <br /> 7211Y WET PREP RL 0 12.00 <br /> 37070 CULTURE, ANY OTHER SOURCE RL 1 .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 /> 38180 T-CELL HEL./SUPP. PROF. BLOOD WORK RL 0 188.00 <br /> 4006 PROSTATIC ACID PHOS. BLOOD WORK RL 1 55.00 <br /> 36430 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 /> 34702 BETA HCG OUANT RL RL 99 31.00 <br /> 87256 CHLAMYDIA IOG 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 .00 <br /> 35240 FACTOR VIII BLOOD WORK RL 0 .00 <br /> 85544 L E CELL PREP BLOOD WORK RL i .00 <br /> 135 DILANTIN RL RL 99 56.25 <br /> �9001 HANDLING SPEC.-PT TO LAB RL 0 10.00 <br /> 31171 STOOL 0 & P D & P RL 0 62.00 <br /> 34701 PRENATAL PANEL 08 RL 0 36.00 <br /> ,34436 THYROID PROFILE BLOOD RL 1 .00 <br /> 30050 EXECUTIVE III BLOOD WORK RL 0 53.00 <br /> 32728 FERRITIN BLOOD WORK RL 1 58.50 <br /> 36300 MONOSPOT 86300 RL 5 34.25 <br /> 87076 AMA RL 0 .00 <br /> ,312270 HEMOCCULT BLOOD WORK RL 0 3.50 <br /> 3 470 CHOLESTEROL & ESTERS. BLOOD WORK RL 1 .00 <br /> TmEOPHYLLINE LEVEL BLOOD WORK RL 0 63.00 <br /> C-PEPTIDE BLOOD WORK RL 1 .00 <br /> -i2 3LJ00 TYPE & RH BLOOD WORK RL 5 .00 <br /> ,54 THYROID PANEL W/TSH RL RL 99 41.00 <br /> _X;CU7:VE D WITH TSH RL 1 60.00 <br /> :695 HEP BE AB BLOOD WORK RL 0 .00 <br /> :=-"c v P,,Eh08ARBITAL RL 0 .00 <br /> :^ 80 ANTITHYROIO ANTIBODIES BLOOD WORK RL 1 .00 <br /> CARBON DIOXIDE BLOOD WORK RL 1 .00 <br /> 5 A,NARAIC CULTURE RL 1 .00 <br /> =.85 34CE ONES PROTEIN BLOOD WORK RL 1 .00 <br /> ::311 VIRAL CULTURE RL 1 173.75 <br /> ;B:C? CYTOLOGY JOINT FLUID BLOOD WORK RL 1 .00 <br /> 2'v'8 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 /> 3100 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 /> s <br />