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0 %j <br />ORANGE FAMILY MEDICAL CENTER <br />FEE SCHEDULE <br />REFERENCE LABORATORY PROCEDURES <br />THE FOLLOWING LABORATORY PROCEDURES ARE PERFORMED BY A REFERENCE <br />LABORATORY. THE ORANGE FAMILY MEDICAL CENTER CHARGES A $10.00 FEE <br />FOR COLLECTION AND HANDLING IN ADDITION TO THE PROCEDURAL FEES <br />LISTEN BELOW: <br />nr�nnrni inr <br />PANEL 1249 <br />80019 <br />12.50 <br />DIGOXIN <br />82643 <br />24.00 <br />PANEL 1 144 <br />80019 <br />15.00 <br />D I LANT I N <br />84045 <br />26.50 <br />LIVER PANEL <br />80010 <br />19.30 <br />GLUCOSE TOLERANCE <br />82951 <br />25.00 <br />PANEL 1039 <br />80018 <br />13.00 <br />FSH SERUM <br />83001 <br />42.70 <br />PRENATAL PROFILE <br />80055 <br />1-5.15 <br />FOLIC ACID <br />82746 <br />29.40 <br />ELECTROLYTE PANEL <br />80004 <br />11.00 <br />HEPA T I T 1 S PANEL <br />80059 <br />68.10 <br />ANEMIA PROFILE 11 <br />80086 <br />23.20 <br />IRON BINDING CAP. <br />83550 <br />13.00 <br />ARTHRITIS PANEL (RA) <br />80072 <br />27.40 <br />PINWORM PREP <br />87208 <br />3.00 <br />LIPID PANEL 1 <br />80061 <br />20.10 <br />OVA & PARASITES <br />87211 <br />14.80 <br />CBC & DIFFERENTIAL <br />85022 <br />6.95 <br />RH ANTIBODY TITER <br />86025 <br />12.80 <br />THYROID PANEL <br />80070 <br />37.00 <br />URIC ACID <br />84550 <br />6.30 <br />CHOLESTEROL <br />82465 <br />8.00 <br />VITAMIN B-12 <br />82607 <br />38.00 <br />TRIGLYCERIDES <br />84478 <br />11.20 <br />ALPHA FETOPROTEIN <br />86244 <br />35.00 <br />SEROLOGY (RPR) <br />86592 <br />8.00 <br />STREP TEST <br />86045 <br />8.00 <br />PROTHROMBIN (PT) <br />85610 <br />8.00 <br />BLOOD GROUP & RH <br />86082 <br />9.90 <br />PART. THROMBOPLAST IN <br />CULTURE & SENS 1 T 1 V. <br />87086 <br />20.00 <br />TIME ( PTT) <br />85730 <br />11.90 <br />FUNGUS CULTURE <br />87102 <br />32.10 <br />LITHIUM <br />83725 <br />17.00 <br />HERPES CULTURE <br />87250 <br />31.20 <br />THEOPHYLLINE <br />84420 <br />31.00 <br />CHLAMYDIA CULTURE <br />87206 <br />10.80 <br />PLATELET COUNT <br />85580 <br />8.00 <br />ROUTINE CULTURE <br />PHENOBARB 1 TAL <br />82210 <br />32.00 <br />( STOOL, SPUTUM) <br />87082 <br />20.00 <br />Effective 311185 <br />