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ORANGE FAMILY MEDICAL CENTER <br />FEE SCHEDULE <br />LABORATORY PROCEDURES <br />PROCEDURE <br />CPT CODE <br />AMOUNT <br />GC CULTURE <br />87070 <br />10.00 <br />GLUCOSE <br />82947 <br />10.00 <br />GRAM STAIN <br />87205 <br />12.00 <br />HEMATOCRIT <br />85014 <br />Y0.00 <br />MONO TEST <br />86300 <br />13.00 <br />PAP SMEAR <br />88150 <br />26.00 <br />PREGNANCY TEST <br />84139 <br />11.00 <br />SED. RATE <br />85650 <br />13.00 <br />KOH PREP. <br />87220 <br />12.00 <br />THROAT CULTURE <br />87060 <br />12.00 <br />UA COMPLETE <br />81000 <br />12.00 <br />UA DIPSTICK ONLY <br />81005 <br />7.00 <br />VAGINAL DROP (WET PREP) <br />87210 <br />12.00 <br />WBC <br />85048 <br />15.00 <br />DIFFERENTIAL <br />85009 <br />14.00 <br />