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<br />86695 Herpes Simplox Type 1 IGG $
<br />86695 Expl Herpes Simp Type 1&2 IGG $
<br />86696 Herpes Simplex Type 2 IGG $
<br />86708 Hepatitis A Antibody $
<br />86708 Expl Hepatitis A Panel $
<br />86749 Hepa#itis A Antibody, IGM $ ..,,, ,
<br />86747.1 PARVOVIRUS ANTIBODY, IGG $ 49.50
<br />86787.2 VARICELLA-ZOSTER ANTIBODY$ 30.00
<br />87040 Culture, Blood $ 48.00
<br />87045 Culture, Stool $ 19.50
<br />87070.1 Culture, Ear $ 35,40
<br />87070.2 Culture, Eye ::$, 35.00
<br />87070.3 Culture, Fiuid ='.;~~` $ ` 35.00
<br />87070.4 Culture, Genital -'~ '- '~.~.:
<br />,.: $ 19.50
<br />87070.5 Culture, Lower Resp. (Sputym} ~~~ '
<br />~ 20:00
<br />87070.6 Culture, Nasal Sinus ~~~
<br />~~~~
<br />:;5.00
<br />87070.7 .
<br />Culture, Nasopharyn~eal ~ ~~ $ ~,'~~s~t)
<br />87070.8 Culture, Tissue .,:..-' k $ 5U~p
<br />
<br />87070.9 ,
<br />Culture, Wound ' ~~:;.,;
<br />f..
<br />$ ~,_,.
<br />35.00;x.
<br />87075 .
<br />.
<br />Culture, Anerobic '~~~~~ :;,,., ~'" "'~~
<br />.,.£
<br />~, $ 19.SU
<br />87076 ,
<br />Anaerobic Identificatiorf~~~'~ $ 25,00
<br />87077 Aerobio~deptification '~';,
<br />, $ 25.00
<br />87081.1 Culture, ~~~bi~Ye~, (GC}
<br />~~°~`: `'-_
<br />. ~ $ 25.00
<br />87081.3 .:,t.
<br />Culture, T1~oat "~~TL~;;;_., ~:' $ 10.50
<br />87088
<br />,~
<br />Culture, Uring, IsQ~BPr~~t.~U $ 10.00
<br />87102 ~ ~.: culture, Fun~iT()ther Sou'rc~ $ 36.00
<br />87109 ~ ~ ~ ~ ~ t/i~lture, Myco~lasma $ 59.93
<br />87203: ~= Sti~i~ar, Gram Stain $ 7.50
<br />87205.2=: :: Ssal':
<br />Gram Sta~i~"(GC Only) $ 7.50
<br />;$7206 _
<br />':.;:~4iiiiear ~A~1rI. ;Fast`
<br />~ $ 15.00
<br />'8~'~;.;-,, ~~I~QH Frep
<br />'~ ` ~ $ 5.50
<br />8725~a;a~~,, ltuze, herpes $ 30.50
<br />87252.2~'~ ''~ Cul~ttTt!~~-Ierpes Simplex Virus $ 73,50
<br />87252.3 ~ Herpes Simplex Culture & Typing $ 56.50
<br />'8~Z275 ::~~ Influenza B (DFA) $ 28.88
<br />~~~~-~~6 a` Influenza A (DFA) $ 28.88
<br />8~§~~ _ .: ~`°`' Clostridium Difficile Toxin $ 45.00
<br />8734,E ' Hepatitis B Surface An#igen $ 15.00
<br />87420'' Respiratory Syncytial Virus, AG $ 26.49
<br />87434 Strep Screen, Direct $ 10.20
<br />87621 Human Papilloma Virus, DNA Probe $ 81.98
<br />88141 Cyto, CervicaUVaginal Interp $ 20.10
<br />88300 Tissue Exam I $ 33.20
<br />88302 Tissue Exam II $ 42.00
<br />89055 Stool for WBC $ 4,00
<br />Immunizations
<br />90632 Hepatitis A Vaccine $ 68.50
<br />F-8
<br />Attachment number 1
<br />Page 249 of 433
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