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5 <br /> ORANGE FAMILY MEDICAL GROUP PA <br /> 06/15/93 PROCEDURE FEES PAGE 2 <br /> °JCEDURE DESCRIPTION ALT, DESC, DEPT T.O.S. STD, FEE , <br /> 152 SURGICAL PATH (COMP.) RL RL 99 85,00 <br /> 86316 PROSTATE SFECIriC ANTIGEN RL 0 36.00 <br /> 82951 O'SULLIVAN (INCLUDES GLUCOSE) RL 0 ,00 <br /> 1:9 HEPATITIS PANEL RL RL 99 .00 <br /> 86140 CRP BLOOD WORK RL 0 ,00 <br /> 83001 FSH BLOOD RL 1 81.75 <br /> 37060 UPPER RESP,CULTURE BLOOD WORK RL 1 .00 <br /> 82785 IMMUNEGLOBINS BLOOD WORK RL 1 .00 <br /> 82486 NORTRIPTYLINE BLOOD WORK RL 1 .00 <br /> 83002 LH BLOOD WORK RL 0 81.00 <br /> 83750 MAGNESIUM BLOOD WORK RL 1 39,00 <br /> 83825 MERCURY BLOOD WORK RL 1 .00 <br /> 84066 ACID PHOS, RL 1 .00 <br /> 86255 MUMPS TITER RL 1 .00 <br /> 85999 ANEMIA PROFILE B BLOOD WORK RL 1 30.80 <br /> 85014 HEMATOCRIT BLOOD WORK RL 0 11.00 <br /> 87205 GRAM STAIN 87205 RL 0 20.00 <br /> 138A HEMOGLOBIN A-1C RL 99 45.00 <br /> 86262 VALPORIC ACID RL 1 67.00 <br /> 80178 DNA PROBE (X2) RL 0 .00 <br /> 82705 FECAL FAT RL 1 ,00 <br /> 89051 CELL COUNT RL RL 1 35,00 <br /> 001149 T4 BLOOD WORK RL 1 .00 <br /> 87086 URINE CULTURE 87086 RL 5 37.00 <br /> 87106 FUNGAL CULTURE RL 1 ,00 <br /> 84231-GP DRUG SCREEN RL 1 20.00 <br /> 87206 CHLAMYDIA MICROTRAK BL00DWORK RL 5 38.00 <br /> 86357 T&B LYMPH PROFILE BLOOD WORK RL 0 .00 <br /> 131A . COLLECTION, LAB SPECIMEN RL RL 99 18.00 <br /> 84132A POTASSIUM RL RL 99 22.25 <br /> 86256 ANA ANA RL 5 .00 <br /> 82150 AMYLASE BL00DWORK RL 5 32.00 <br /> 84100 PHOSPHORUS BLOOD WORK RL 1 .00 <br /> 88180(13) T-LYMPHOSYTE SUPP./HELPER PROFILE BLOOD WORK RL 0 154.00 <br /> 80004 ELECTROLYTES BLOOD WORK RL 0 23.20 <br /> 89060 CRYSTAL ANALYSIS BLOOD WORK RL 1 .00 <br /> 32607 312 VITAMIN LAB RL 1 70,50 <br /> 82947 SERUM GLUCOSE BLOOD WORK RL 1 .00 <br /> 84075 ALKALINE PHO. RL 0 31.50 <br /> 83725 LITHIUM LEVEL RL 99 41.00 <br /> 85256 RMSF TITER BLOOD WORK RL 1 95.75 <br /> 82533 CARTISOL AM RL 99 89.25 <br /> 86228 RUBELLA RL 1 36.00 <br /> 87040 BLOOD CULTURE BL00DWORK RL 99 60.00 <br /> 82250 TOTAL BILI. BLOOD WORK RL 1 .00 <br /> 799007 URINE TOX SCREEN DRUG SCR, RL 1 55.00 <br /> 146 PROTIME RL RL 99 28.00 <br /> 86278 HEP 8 SAG BLOOD ,WOR RL 1 .00 <br /> 86312 HIV TITER BLOOD WORK RL 1 36.00 <br /> 86517 VARCELLA ZOSTER IQG RL 0 70.50 <br /> APA ANEMIA PROFILE A APA RL 5 27.80 <br /> 82468 NARTRIPTYLINE BLOOD WORK RL 1 .00 <br /> 88302 SURG, PATHOLOGY RL 99 .00 <br />