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8 <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 /> 33715 ' IPOPROTEIN BLOODWORK RL 5 .00 <br /> 84144 PROGCSTERONE LEVEL RL 1 73,00 <br /> 86319 CARBAMA?OPINE LEVEL BLOOD WORK RL 1 .00 <br /> 84175 PROTEIN CSF RL 1 .00 <br /> 07220 TOXICOLOGY SCREEN BLOOD WORK RL 1 ,10 <br /> 87211Y WET PREP RL 0 12.00 <br /> 87070 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 HER 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 /> 144A POTASSIUM RL RL 99 22.25 <br /> 86293 HEP BE AG BLOOD WORK RL 0 .00 <br /> 82550 CPK BLOOD WORK RL 1 .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 /> 99001 HANDLING SPEC.-PT TO LAB RL 0 10.00 <br /> 87177 STOOL D & P D & P RL 0 62.00 <br /> 84701 PRENATAL PANEL 08 RL 0 36.00 <br /> 84436 THYROID PROFILE BLOOD RL 1 .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 /> 82470 CHOLESTEROL & ESTERS. BLOOD WORK RL 1 .00 <br /> 84420 THEOPHYLLINE LEVEL BLOOD WORK RL 0 63.00 <br /> 84681 C-PEPTIDE BLOOD WORK RL 1 .00 <br /> 86082 BLOOD TYPE & RH BLOOD WORK RL 5 ,00 <br /> 154 THYROID PANEL W/TSH RL RL 99 41.00 <br /> 80053 EXECUTIVE D WITH TSH RL 1 60.00 <br /> 86295 HEP BE AB BLOOD WORK RL 0 .00 <br /> 82205Y PHENOBARBITAL RL 0 ,00 <br /> 86280 ANTITHYROID ANTIBODIES BLOOD WORK RL 1 ,00 <br /> 82374 CARBON DIOXIDE BLOOD WORK RL 1 .00 <br /> 87075 ANARAIC CULTURE RL 1 .00 <br /> 84185 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,l 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 />