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ORANGE FAMILY MEDICAL CENTER <br /> FEE SCHEDULE <br /> LABORATORY PROCEDURES <br /> PROCEDURE CPT CODE AMOUNT <br /> GC CULTURE 87070 8, 00 <br /> GLUCOSE 82947 6. 00 <br /> GRAM STAIN 87205 10. 00 <br /> HEMA TOCR I T 85014 5. 00 <br /> MONO TEST 86300 10. 00 <br /> OCCULT BLOOD 82270 2. 00 each <br /> PAP SMEAR 88150 12. 00 <br /> PREGNANCY TEST 84139 6. 00 <br /> SED. RATE 85650 8. 00 <br /> KOH PREP. 87220 7. 00 <br /> THROAT CULTURE 87060 6. 00 <br /> UA COMPLETE 81000 10. 00 <br /> UA DIPSTICK ONLY 81005 4. 00 <br /> VAGINAL DROP ( WET PREP) 87210 6. 00 <br /> WBC 85048 7. 00 <br /> DIFFERENTIAL 85009 12. 00 <br /> • <br /> t <br /> Effective 9/1/86 <br />