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4 <br /> ORANGE FAMILY MEDICAL GROUP PA <br /> 06/15/93 PROCEDURE FEES PAGE 1 <br /> PROCEDURE DESCRIPTION ALT, DESC, DEPT T.O.S. STD, `EE <br /> 82954(X4) GTT OL 1 25,00 <br /> 829 O'SULLV,N OL OL 1 ,00 <br /> 3646 VENIPUNCTURE, UNDER AGE 3, OTHER VEIN 36406 OL 0 35,00 <br /> 17, WET MOUNT/KOH OL UL 1 12.00 <br /> 171 URI'NALYSI'S OL OL 5 14,00 <br /> 172 URINE DIPSTICK OL UL 1 8,00 <br /> 167 MONOSPOT OL OL 1 25,00 <br /> 85651 SED RATE BLOOD WORK OL 0 15.00 <br /> 164 GRAM STAIN OL OL 1 20.00 <br /> 161 FINGERSTICK BS 82948 OL 5 11,00 <br /> 99000 HAND, SPECIMEN TRANSFER(OFFICE TO LAB) OL 0 10.00 <br /> 80073 RENAL PROFILE OL OL 1 29.00 <br /> 162 GTT 3 HR 6 HR OL OL 1 45.00 <br /> 83718 HDL CHOLESTEROL STUDY HDL OL 5 21.00 <br /> 155 URINE CULTURE 87086 OL 1 35.00 <br /> 82952(X2) GTT OL 1 20.00 <br /> 140 LIPID PROFILE OL OL 1 27.00 <br /> 82948 GLUCOSE, FINGERSTICK 82948 OL 5 11.00 <br /> 84520 BUN (URIC NITROGEN) URIC OL 1 18,00 <br /> 168 ENZYME IMMONOASSAY FOR INFECT AG OL OL 0 16.00 <br /> 86317 IMMUNOASSAY-INFEC. AGENT ANTIGEN RAPID STRE OL 5 19.00 <br /> 36600 ARTERIAL PUNCTURE OL 0 55.00 <br /> 82565 CREATINIE OL 5 18.00 <br /> 84132 POTASSIUM OL OL 1 21.00 <br /> 80019 MULTICHEM PANEL 80019 OL 5 29.00 <br /> 131 BLOOD COLLECTION-IN HOUSE BLOOD-IN OL 1 3,00 <br /> 166 HEMOCCULT X1 X 3 OL OL 1 3.50 <br /> 165 HEMATOCRIT 93040 OL 5 11,00 <br /> 37220 KOH PREP OL 5 12.00 <br /> 176 PEAK FLOW PEAK FLOW OL 0 18.00 <br /> 138 HEMOGLOBIN A-1C OL OL 5 18,00 <br /> 175 GC CULTURE OL OL 1 20,00 <br /> 160 EKG WITH INTERPRETATION OL OL 1 45,00 <br /> 85610 PROTHOMBIN TIME BLOOD WORK OL 1 30,00 <br /> .44 POTASSIUM OL OL 5 14.00 <br /> 170 THROAT CULTURE OL OL 5 12.00 <br /> 169 SED RATE OL OL 1 15.00 <br /> 36410 VENIPUNCTURE,NEEDING MD SKILL OL 0 35.00 <br /> 173 URINE PREGNANCY TEST OL OL 1 16.00 <br /> 83036 HEMOGLOBIN, GLYCOSYLATED ALC OL 0 31,00 <br /> 34478 TRIGLYCERIDES OL OL 5 19,00 <br /> 36415 VENIPUNCTURE, ROUTINE OL 5 3.00 <br /> 82465 TOTAL CHOLESTEROL 0L OL 5 19.00 <br /> 151 DERMOPATH RL RL 99 45.00 <br /> 38305 SURGICAL PATH SURG. PATH RL 0 85.00 <br /> 006049 BLOOD TYPE BLOOD WORK RL 1 .00 <br /> 86006 HEP B S BLOOD WORK RL 1 .00 <br /> 85044 RETIC COUNT RL 0 .00 <br /> 82662 TEGRETOL ' BLOOD WORK RL 1 62.50 <br /> 82952 GLUCOSE TOLERANCE TEST GTT RL 1 48.00 <br /> 86592 VDRL, SERUM BL00DWORK RL 5 33,00 <br /> 133 CULTURE/SENSITIVITY RL RL 99 35.00 <br /> 88160 BREAST SECRETIONS BLOOD WORK RL 1 .00 <br />