HomeMy WebLinkAboutAgenda - 06-28-1994 - VIII-N 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
Action Agenda
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ACTION AGENDA REM ABSTRACT Item No.
Meeting Date: June 28,1994
SUBJECT: JAIL MEDICAL SERVICES CONTRACT RENEWAL
DEPARTMENT: PURCHASING AND CENTRAL SERVICES PUBLIC HEARING:YES: NO:XX
ATTACHMENT(S): INFORMATION CONTACT:
PAM JONES, ext.2650
Renewal
Original Contract Telephone Number-
Fee Schedule Hillsborough 732-8181
Chapel Hill 967-9251
Mebane 227-2031
Durham 688-7331
PURPOSE: To consider renewing a contract with the Orange Family Medical Group for Jail Medical
services through June 30,1995.
BACKGROUND: Sike 1985 the County has contracted with this medical group to provide medical
services to the inmates of the Orange County Jas. We are mandated by State law to provide medical
care for any inmate In the custody of the Orange County Jail.
Orange Family Medical Group will renew the contract through June 30,11195 at the 1994 rob of$15,000
per yew.A copy of the terms and conditions as approved by the Board In July,1989 Is attached for your
information. This method of service delivery to Irnnstes continues to be the most economical and
efficient means of providing the service required.
The County will continue to be invoiced separably for testing and x-rays required as treatment for the
inmate. Historically,the costs for these services have been$2,00043,000 per year. The fee schedule
will remain at the 1994 rate and Is attached for your inforrnstion.
RECOMMENDATKft The ftknagar recorwrrrrds that the Board approve the renewal of the Jail Medical
Services contract with Orange Family Medical Group through June 30,INS for a sum of$15,000 per
year,and authorise the Chats to sign on behalf of the Board.
Z "
RENEWAL AGREEMENT BETWEEN
COUNTY OF ORANGE
AND
ORANGE FAMILY MEDICAL GROUP,PA
NORTH CAROLINA
COUNTY OF ORANGE
WHEREAS, an agreement was made and entered Into as of the 1st day of July, 1989 by and
between Orange County,hereinafter referred to as the"County"and Orange Family Medical Group,
PA., hereinafter referred to as "medical Group",for the provision of primary medical services for
the Orange County Jail.
WHEREAS, the COUNTY and the MEDICAL GROUP mutually agree to the following:
1. The agreement will be continued for a period beginning July 1,1994 and ending at 12:00
midnight on June 30,1993.
2. AN other terms and conditions shall remain the same.
FOR AND ON BEHALF OF
COUNTY OF ORANGE
Dab:
MOSES CAREY,JR.,CHAIR
FOR AND ON BEHALF OF
ORANGE FAMILY MEDICAL GROUP,P.A.
Dab:
DR.ARTHUR AXELBANK,PRESIDENT
This kw&urwt has Owl pnwn d In dw nanw squired by the Local Govennwd Budgd and Flseal CoM M Ad.
KAnnIh T.Chavlaw FYwm Disofor
AGREEMENT BETWEEN
ORANGE COUNTY
AND
ORANGE FAMILY MEDICAL GROUP, P.A.
This agreement is made and entered into this the 1st day of July,
1, 1989, by and between Orange County, a body politic and corporate
organized and existing pursuant to the Constitution and laws of the
State of North Carolina, hereinafter referred to as "County" and
Orange Family Medical Group, P.A. , a professional association
organized and existing pursuant to Chapters 55 and 55B of the North
Carolina General Statutes, hereinafter referred to as "Medical
Group. "
W I T N E S S E T H:
WHEREAS, County desires to contract with Medical Group for the
provision of primary medical services for the Orange County jail,
and
WHEREAS, Medical Group desires to provide those services,
NOW, THEREFORE, in consideration of the premises and of the
following mutual promises, covenants and conditions, County and
Medical Group agree as follows:
A) Medical Services: .
1) Medical Group shall provide medical personnel who are
qualified in their respective fields and who maintain
applicable licenses and registration to perform the
necessary medical practice required by this agreement.
2) Medical Group shall be responsible for the health program
of the jail. All medical procedures and decisions shall
be followed and made by the responsible physician, in
accordance with accepted methods and procedures, state
and federal law and consistent with any local health
ordinances.
3) Medical Group shall process inmate health complaints
daily. If it is necessary that Medical Group examine an
inmate, that examination will take place as soon as
practicable after determination is made that an
examination is necessary. All such examinations shall
take place at the jail, at the office of Medical Group,
or other health care facility at the discretion of the
attending physician after consultation with the sheriff
or his designee.
t
4) Medical Group shall conduct a sick call once per week at
the jail.
5) Medical Group shall conduct, at the jail, a health
appraisal of each inmate within 14 days after the
inmate's arrival at the jail.
6) Medical Group shall provide for administration of
injections to inmates in situations where the inmate
cannot administer his/her own injection.
7) All admissions for hospital or emergency care shall be
to the North Carolina Memorial Hospital at Chapel Hill,
Durham County General Hospital or such other qualified
hospital as designated by Medical Group.
8) County will provide adequate space, security and non-
medical supplies and equipment in the jail for Medical
Group to use in meeting the terms of this agreement.
9) County will perform receiving and screening on all
inmates upon their arrival at the jail.
B) Policies and Procedures:
1) Medical Group and County agree to negotiate a contract
for the preparation by Medical Group in cooperation with
County of a manual of written policies and defined
procedures which will meet Orange County's and the
sheriff of Orange County's responsibilities under N.C.
Gen. Stat. Sections 153A-224 and 153A-225. The points
of negotiation shall be limited to the time provided for
the preparation of the manual and the compensation to
Medical Group for its preparation. If the parties agree
to the time for and cost to County of the manual
preparation, they will reduce their agreement to writing.
The manual shall contain provisions for:
A) implementation and maintenance of medical services
as described in section a of this agreement;
B) health record patient folders on any inmate who
requires intervention after initial screening which
shall contain at a minimum:
patient authorization for release of all
information contained in the patient health
record;
completed receiving and screening forms, if
applicable;
a
health appraisal data forms;
all findings, diagnoses, treatments,
dispositions;
prescribed medications and their
administration;
laboratory, x-ray and diagnostic studies;
signature and title of each documenter;
consent and refusal forms;
place, date and time of health encounters;
discharge summary of hospitalizations;
health service reports (e.g. , dental,
psychiatric and other consultation) .
C) develop health record transfer practices and record
retention policy;
D) paper management of pharmaceuticals including the
following stipulations:
- adherence to state pharmacy law;
- adherence to federal controlled substance act;
- re-evaluation of prescriptions before renewal;
- maximum security of pharmaceuticals, syringes
and needles;
- prohibition of misuse of psychotropic
medication.
8) a training guide for jail employees which would
cover:
- action required for potential emergencies;
- signs and symptoms of an emergency;
- obtaining emergency care;
- patient transfer procedures;
- chemical dependency and emotional disturbance;
G
r
health and hygiene;
receiving and screening.
F) the following miscellaneous items:
standing orders for inmates in: isolation,
chemically dependent, detoxification, and
special medical care, hospitals, need of
preventative care, chronic care, convalescent
care;
- health kit contents, number, location and
inspection procedures;
- access to diagnostic services;
- notification of next of kin for serious
illness, injury or death;
- coordination/notification of medical examiner
for post-mortem exam;
- coordination with other County departments on
health inspections and the facility's disaster
plan;
- peer review;
- information sharing;
- psychiatric patient handling;
- transfer of ill patients.
2) County reserves the right to require any modifications
to the manual that it deems reasonably necessary to
provide adequate policies and procedures which meet its
responsibilities under federal, state and local laws.
3) The manual after completion will be the exclusive
property of County.
C) Reporting:
1) Medical Group shall meet at least quarterly with the
sheriff to discuss the inmates' health care status and
the facility health care plan.
2) Medical Group shall submit a quarterly report to the
sheriff which will include:
A) the effectiveness of the health care system;
B) description of any health environment factors of
importance;
C) program changes since last report.
3) Medical Group shall prepare an annual statistical report
which indicates the number of inmates receiving health
services by:
A) disease diagnosis category;
B) referral to specialists by specialist area;
C) hospital admission by reason;
D) injuries/accidents by type.
D) Insurance and Indemnification:
1) Medical Group will insure itself for general
comprehensive liability, professional liability and
errors and omissions coverage in the amount of $1,000,000
with county named as additional insured on the policy.
A certificate of insurance evidencing the above coverage
will be provided by Medical Group to County upon
execution of this agreement.
Each physician of Medical Group shall be covered by
professional liability insurance in the amount of
$1,000,000 or be self-insured for the same risks to an
equal or greater degree of coverage. A certificate of
insurance or satisfactory proof of self-insurance
evidencing this coverage will be provided by Medical
Group to county upon the execution of this agreement.
2) Medical Group shall indemnify and save harmless County,
its agents and its employees from and against any and
all suits, claims, actions, losses, costs, penalties,
and damages of whatsoever kind or nature arising out of
or in connection with its practice of medicine as
described in this agreement.
E) Payment:
1) Medical Group shall be compensated as follows:
A) Six Thousand Six Hundred Dollars ($6,600) per annum
to be paid in equal monthly installments of $550.00
each. This compensation is for all services
described in this agreement performed by Medical
Group during its normal business hours including the
52 sick calls and all other visits to the jail, the
office of Medical Group or such other health care
facility selected by the attending physician
pursuant to Section A of this agreement.
B) In the event a jail inmate requires treatment or
otherwise must be seen by Medical Group other than
during the normal business hours of Medical Group,
Medical Group must be compensated for each such
treatment or visit at the emergency services fee
schedule of Medical Group in effect July 1, 1989 .
Medical Group shall provide County with its normal
business hours and with a schedule of its emergency
service fees and its holidays for the period July
1, 1989 until June 30, 1990. Any changes in the
normal business hours or schedule of holidays during
the term of this agreement shall be provided to
County as soon as adopted by Medical Group.
C) Charges for laboratory fees, x-ray, suture
materials, sterilized instrument usage and
medication if purchased by Medical Group for use in
connection with this agreement will be invoiced
separately to County at cost.
F) Term:
1) This agreement shall run for one year from the 1st day
of July, 1989 to the 30th day of June, 1990, and shall
be renewable upon written notice executed by both
parties.
G) Termination:
This agreement or its renewals may be terminated at any time
without penalty by either party, provided that notice of such
termination is furnished to the other party in time to
properly arrange for professional coverage. In the event of
such termination, any payment due shall be prorated to the
date and time of termination.
This agreement contains the entire understanding of the
parties and cannot be altered, amended or modified, except by
an agreement in writing executed by the duly authorized
officials of both parties.
The laws of North Carolina shall govern the validity and
interpretation of this agreement.
IN WITNESS WHEREOF, the parties have hereunto signed this
agreement in their official capacities on the day and year
listed below.
ORANGE COUNTY ORANGE FAMILY MEDICAL GROUP, P.A.
MOSES CAREY, JR. ARTHUR AXEL
CHAIR, ORANGE CO PRESIDENT
BOARD OF COMMISSJONERS
THIS INSTRUMENT HAS BEEN PREAUDITED IN THE MANNER REQUIRED BY THE
LOCAL GOVERNMENT BUDGET AND FISCAL CONTROL ACT.
7 -
FINANCE DIRECTOR
i
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,
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ORANGE FAMILY MEDICAL GROUP PA
:6/15x'93 PROCEDURE FEES
PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE
------------------------------------------------------------------------------------------------------------------------------------
82954{X4) GTT OL 1 25.00
829 O'SULLiVAN OL OL 1 .00
36406 VENIPUNCTURE, UNDER AGE 3, OTHER VEIN 36406 OL 0 35.00
174 NET MOLNT/KOH OL OL 1 12.00
ill URINALYSIS OL OL 5 14.00
172 URINE DIPSTICK OL OL 1 8.00
167 MONOSPOT OL OL 1 25.00
35651 SED RATE BLOOD WORK OL 0 15.00
164 GRAM STAIN OL OL 1 20.00
161 FINGERSTICK BS 82948 OL 5 11.00
99000 HAND. SPECIMEN TRANSFER(OFFICE TO LAB) OL 0 10.00
80073 RENAL PROFILE OL OL i 29.00
162 GTT 3 HR 6 HR OL OL 1 45.00
83718 HDL CHOLESTEROL STUDY HOL OL 5 21.00
155 URINE CULTURE 87086 OL 1 35.00
82952(X2) GTT OL 1 20.00
140 LIPID PROFILE OL OL 1 27.00
32948 GLUCOSE, FINGERSTICK 52948 OL 5 11.00
94520 BUN (URIC NITROGEN) URIC OL 1 18.00
168 ENZYME IMMUNOASSAY FOR INFECT AG OL OL 0 16.00
86317 IMMUNOASSAY-INFEC. AGENT ANTIGEN RAPID STRE OL 5 19.00
36600 ARTERIAL PUNCTURE OL 0 55.00
82565 CREATINIE OL 5 18.00
84132 POTASSIUM OL OL 1 21.00
80019 MULTICHEM PANEL 80019 OL 5 29.00
131 3LOOD COLLECTION-IN HOUSE BLOOD-IN OL 1 3.00
166 HEMOCCULT Xl X 3 OL OL 1 3.50
165 HEMA70CRIT 93040 OL 5 11.00
51220 KOH PREP OL 5 12.00
'.76 PEAK F,-OW PEAK FLOW OL 0 18.00
.;o HEMOGLOBIN A-1C OL OL 5 18.00
%5 GC CJLTGRE OL OL 1 20.00
`U ECG WITH INTERPRETATION OL OL 1 45.00
PR IN TiME BLOOD WORK OL 1 30.00
.44 POTASSIUM OL OL 5 14.00
"0 'HROAT CUL'URE OL OL 5 12.00
:9 SED RATE OL OL 1 15.00
:0 10 4ENI'')UNCT'-RE,NEEDING ND SKILL OL 0 35.00
TRINE PREGNANCY TEST OL OL 1 16.00
GLYCOSYLATED ALC OL 0 31.00
:41=118 'RiGLYCERIDES OL OL 5 19.00
IENIP�'X j URE, ROUTINE OL 5 3.00
46; 737 AL CXLESTEROL OL OL 5 19.00
DERMOPA'H RL RL 99 45.00
8?O5 SURGICAL PATH SUR6. PATH RL 0 85.00
-06 49 BLOOD T'�PE BLOOD WORK RL 1 .00
36006 HEP 8 S BLOOD WORK RL 1 .00
35044 RETIC COUNT RL 0 .00
32662 TEGRETOL BLOOD WORK RL 1 62.50
82952 GLUCOSE TOLERANCE 'EST GTT RL 1 48.00
86592 VDRL, SERUM Bl00DWORK RL 5 33.00
133 CULTURE/SENSITIVITY RL RL 99 35.00
38160 BREAST SECRETIONS BLOOD WORK RL 1 .00
/I
;RANGE '-AMILY MEDICAL SRC:;P PA
Jo,:5i93 D,ROCEDURE FEES
-ROCEDURE DESCRIPTION ALT. DESC, DEPT I .O.S. STD. EE
------------------------------------------------------------------------------------------------------------------------------------
2 SURGICAL PATH (COMP.) RL RL 99 85.00
36316 PROSTATE SPECIFIC ANTIGEN RL 0 36.00
32951 O'SuLLIVAN (INCLUDES GLUCOSE) RL 0 .00
:39 HEPATITIS PANEL RL RL 99 .00
36140 CRP BLOOD WORK RL 0 .00
33001 FSH BLOOD RL 1 81.15
31-060 jPPER RESP.CULTURE BLOOD WORK RL 1 .00
32185 IMMUNEGLOBINS BLOOD WORK RL 1 .00
=2486 NORTRiPTYt-INE BLOOD WORK RL 1 .00
3302 :LH BLOOD WORK RL 0 81.00
33150 MAGNESIUM BLOOD WORK RL 1 39.00
j3825 MERCURY BLOOD WORK RL 1 .00
:1:6o ACID PHCS. RL 1 .00
30:55 MUMPS TITER RL 1 .00
35999 ANEMIA PROFILE B BLOOD WORK RL 1 30.80
:5v:4 HEMATOCRIT BLOOD WORK RL 0 11.00
31. 5 GRAM STAIN 87205 RL 0 20.00
.38A HEMOGLOBIN A-1C RL 99 45.00
'36262 JALPGRIC ACID RL 1 67.00
30178 DNA PROBE (X2) RL 0 .00
:1705 FECAL FAT iF RL 1 .00
31?051 CELL COUNT RL RL 1 35.00
':01149 7 BLOOD WORK RL 1 .00
:7086 URINE CULTURE 87086 RL 5 37.00
)7:05 UNGAL CULTURE RL 1 .00
X1231-:(' DRUG SCREEN RL 1 20.00
)1206 C,ILAMYDiA MICROTRAK BLOODWORK RL 5 38,00
30357 T&B LYMPH PROFILE BLOOD WORK RL 0 .00
.3:A COLLECTION, LAB SPECIMEN RL RL 99 18.00
?1132A P,D'ASSIUM RL RL 99 22.25
ANA ANA RL 5 .00
:?:50 AMYLASE BLOODWORK RL 5 32.00
�-OS�40�US BLOOD WORK RL 1 ,00
-13)3) -'20PHOSYTE S"PP./HELPER PROFILE BLOOD WORK RL 0 154.00
EC'RULY?ES BLOOD WORK RL 0 23.20
CRYSTAL ANALYSIS BLOOD WORK RL 1 .00
-AMIN LAB RL 1 70.50
: SE�JM CLVCCSE BLOOD WORK RL 1 .00
- ALKAL:NE MHO. RL 0 31.50
HIUM -EVEL RL 99 41.00
�'SF i'ER BLOOD WORK RL 1 95.75
-ARTI;OL AM RL 99 89.25
%;a---A RL 1 36.00
3�C2 C'117URE SLOODWORK RL 99 60.00
BLOOD WORK RL 1 .00
URINE TOX SCREEN DRUG SCR. RL 1 55.00
_ P<OTIME RL RL 99 28.00
)0278 HEP B SAG BLOOD ,WOR RL ? .00
1Iv TITER BLOOD WORK RL 1 36.00
=.0=11 VARCELLA 20STER iQG RL 0 10.50
;PA ANEMIA PROFI:_E A APA RL 5 27.80
:21468 NARTRIPTHLINE BLOOD WORK RL 1 .00
38302 SURG. PATHOLOGY RL 99 .00
2
ORANGE FAMILY MEDICAL GROUP PA
)6/15/93 PROCEDURE FEES
OROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S, STD. FEE
------------------------------------------------------------------------------------------------------------------------------------
32746 FOLATE BLOOD WORK RL 0 67.75
80099 UNLISTED PANEL BLOODWORK RL 5 .00
94155 PROTEIN BLOODWORK RL 5 �0
82310 STONE ANAYLIS BLOOD WORK RL 1 43.75
?2575 CREATININE CLEARANCE BLOOD WORK RL 0 41.75
:4103 PREG. SERIUM RL RL 1 19.00
:07831 QUINIDINE QUANT. BLOOD WORK RL 1 .00
;3690 LIPASE BLOOD WORK RL 1 .0D
.196925 ID PANEL IV BLOOD WORK RL 0 154.00
APB ANEMIA PROFILE B PROFILE RL 5 84.50
94403 TESTERONE BLOOD WORK RL 1 .00
145 PRENATAL PANEL RL RL 99 37.00
82552 CPK ISOENZYME BLOOD WORK RL 1 .00
35025 CBC & DIFF BLOODWORK RL 0 ,00
80009 LIVER PANEL RL 0 25.18
36291 ANTI-148S BLOOD WORK RL 1 60.00
20073A RENAL PANEL RL RL 99 24,05
87252 VIRAL CULTURE RL 1 39.00
83655 LEAD BLOOD WORK RL 1 32.85
38304 SURGICAL PATH - SKIN,CYST,TAG/DEBRID. SURG. PATH RL 0 40.00
87178(X2) DNA PROBE GC/CHLAMYDIA RL 99 38.45
81000 URINALSIS, COMPLETE LAB WORK RL 0 14.00
82768 FOLATE BLOOD WORK RL 0 .00
;HELPER P T-LYMPHOSYTE SUPP./HELPER PROFILE BLOOD WORK RL 0 154.00
82570 24 HR. URINE CREAT. RL 0 .00
33053 HEMOGLOBIN S (SICKLE CELL) BLOODWORK RL 1 36.00
87230 C. DIFF. TOXIN BLOOD WORK RL 1 90.75
58150 PAP SMEAR RL 0 28.00
34146 PROLACTIN BLOOD WORK RL 0 93.25
:50 STOOL CULTURE RL RL 99 60.00
84999 UNLISTED CHEMISTRY OR TOXI PROC. BLOODWORK RL 5 .00
;6593 VDRL, SPINAL FLUID BLOODWORK RL 5 39.50
9105 SPUTUM CYTOLOGY RL 0 .00
'4443 TSH BLOODWORK RL 5 .00
--3 PAP SMEAR RL RL 99 28.00
:53 74EOPH LEVEL RL RL 99 59.00
CE-A RL 0 68.50
9 ANEMIA PROFILE A RL RL 99 35.00
:;-'8A TP:GL'CERIDES RL RL 99 31.75
:_303 FRACTIONATED CATECHOLANINES BLOOD WORK RL 1 .00
:63 3'30L, CULTURE 87163 RL 0 63.00
:_=4 :;M -_VELS RL 0 .00
THYROID PANEL WiTSH BLOOD WORK RL 0 40.68
3 LEC'RGLY'�S RL 1 .00
CHLORIDE RL 99 .00
.37 GLUCOSE RL RL 99 23.00
2 060 -HANOL BLOOD WORK RL 1 .00
84030 ?KU RL 0 18.00
36080 3LOOD TYPE BLOOD WORK RL 1 .00
80085 ANEMIA PROFILE BLOOD WORK RL 0 30.80
041180 URINE BLOOD BLOOD WORK RL 1 58.75
44231 DRUG SCREEN RL 1 34,00
134 DIGOXIN LEVEL RL RL 99 51.00
/3
0?ANGE -AMILY MEDICAL GROUP PA
6/15/93 PROCEDURE FEES
DROCED''RE .ESCRIPTION ALT. DESC. DEPT T,O.S. STD. FEE
---------------------------------------------------------------------------------------------------------------------------------
32565A CREATiNiNE RL RL 99 28.50
98155 PAP M/ MATURATION INDEX MATURATION RL 0 36.00
38:72 BREAST CYTOLOGY RL 1 .00
85615 ESR RL 1 26.00
36650 F'A BLOOD WORK RL 0 .00
RPR RPR RL 1 23.00
34:65 IMMUNOGLCBULIN ELECTROPHORESIS BLOOD WORK RL 1 .00
31365 STONE ANALYSIS RL 57.00
33`15 IRON BINDING CAPACITY BLOOD WORK RL 1 .00
37208 STOOL 0 AND P RL 0 62.00
37211 WET PREP RL 5 12.00
22660 DRUG SCREEN BLOOD WORK RL 1 50.00
:r103 BETA STREP CULTURE RL 0 65.50
31J 1-GP JRINE DIPSTICK RL 1 8.00
3201:19 SERUM KETONES BLOOD WORK RL 1 .00
37081 THROAT CULTURE BLOOD WORK RL 1 14.00
:4 1A LiPID PROFILE RL RL 99 31.61
31117 AF8 CULTURE & SMEAR RL 5 65.00
93713A 'OLESTEROL, HDL RL RL 99 38.00
37101 SPUTUM FUNGAL CULTURE RL 0 .00
;47 RHEUM PANEL 8 RL RL 99 39.00
30072 RHEUM PANEL 8 BLOOD WORK RL 0 37.71
34520A BUN (URIC NITROGEN) URIC RL 99 27.75
3'955 66PD BLOODWORK RL 99 60.75
:2310 CALCIUM 82310 RL 0 33.00
31524 INSULIN TESTING BLOODWORK RL 99 .00
311-8 NA PROBE BLOOD WORK RL 0 38.45
3243 )IGOXIN LEVEL BLOOD WORK RL 0 58.00
5 MUMPS TITER BLOOD WORK RL 0 58.50
VALPORIC ACID RL 0 68.50
4i _:VER PANEL RL RL 99 16.00
;1145 SOD,UM RL 99 .00
RL 1 .00
=;:18 WBC BLOOD WORK RL 5 .00
C. )EF,CILE TOXIN RL 1 .00
?3_ '3 'Y70LOGY SPUTUM RL 0 .00
PROFILE BLOOD WORK RL 0 40.00
'�AFETOPROTEIN BLOODWORK RL 1 .00
=o.r� :iOLES'EROL, TOTAL RL RL 99 28.00
:._. �EPAT`T:S PANEL BLOOD WORK RL 0 .00
^4 -R. .,RINE PROTEIN RL 0 .00
-_nRIA BLOOD WORK RL 1 .00
":CK RL 0 8.00
_=a� S`_R M F�UCTOSAMINE BLOOD WORK RL 1 36.25
MULTICIEM PANEL 80019 RL 99 29.00
:--10 VARICELLA ZOSTER CULTURE BLOOD WORK RL 1 .00
-c')Y _:VER PROFILE BLOOD WORK RL 0 25.18
3; 30 PTT BLOOD WORK RL 1 37.00
3.'251 3ILI '&) BLOODWORK RL 99 .00
;7032 ANTIBODY SCREEN BLOOD WORK RL 0 36.00
33020 HEMOG:.)8114 ELECT. BLOOD WORK RL 1 .00
30082 BLOOD TYPING BLOOD WORK RL 1 .00
34045 DILANTIN LEVEL BLOOD WORK RL 0 60.00
�t
ORANGE FAMILY MEJICA, GROUP PA
36/15/93 PROCEDURE FEES
PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE
------------------------------------------------------------------------------------------------------------------------------------
83715 LIPOPROTEIN BLOODWORK RL 5 .00
84144 PROGESTERONE LEVEL RL 1 78.00
8619 CARBAMAIOPINE LEVEL BLOOD WORK RL i .00
41]5 PROTEIN CSF RL 1 .00
'220 TOXICOLOGY SCREEN BLOOD WORK RL 1 .00
7211Y WET PREP RL 0 12.00
37070 CULTURE, ANY OTHER SOURCE RL 1 .00
84550 URIC ACID BLOOD WORK RL 1 .00
83525 INSULIN BLOOD WORK RL 1 .00
86289 HEP 8 CORE BLOOD WORK RL 1 .00
38180 T-CELL HEL./SUPP. PROF. BLOOD WORK RL 0 188.00
4006 PROSTATIC ACID PHOS. BLOOD WORK RL 1 55.00
36430 RHEUMATOID A BLOOD WORK RL 1 .00
136 ELECTROLYTE PANEL RL RL 99 24.05
148 RUBELLA TITER RL RL 99 42.00
34702 BETA HCG OUANT RL RL 99 31.00
87256 CHLAMYDIA IOG RL 0 82.75
:44A POTASSIUM RL RL 99 22.25
86293 HEP BE AG BLOOD WORK RL 0 .00
82550 CPK BLOOD WORK RL .00
35240 FACTOR VIII BLOOD WORK RL 0 .00
85544 L E CELL PREP BLOOD WORK RL i .00
135 DILANTIN RL RL 99 56.25
�9001 HANDLING SPEC.-PT TO LAB RL 0 10.00
31171 STOOL 0 & P D & P RL 0 62.00
34701 PRENATAL PANEL 08 RL 0 36.00
,34436 THYROID PROFILE BLOOD RL 1 .00
30050 EXECUTIVE III BLOOD WORK RL 0 53.00
32728 FERRITIN BLOOD WORK RL 1 58.50
36300 MONOSPOT 86300 RL 5 34.25
87076 AMA RL 0 .00
,312270 HEMOCCULT BLOOD WORK RL 0 3.50
3 470 CHOLESTEROL & ESTERS. BLOOD WORK RL 1 .00
TmEOPHYLLINE LEVEL BLOOD WORK RL 0 63.00
C-PEPTIDE BLOOD WORK RL 1 .00
-i2 3LJ00 TYPE & RH BLOOD WORK RL 5 .00
,54 THYROID PANEL W/TSH RL RL 99 41.00
_X;CU7:VE D WITH TSH RL 1 60.00
:695 HEP BE AB BLOOD WORK RL 0 .00
:=-"c v P,,Eh08ARBITAL RL 0 .00
:^ 80 ANTITHYROIO ANTIBODIES BLOOD WORK RL 1 .00
CARBON DIOXIDE BLOOD WORK RL 1 .00
5 A,NARAIC CULTURE RL 1 .00
=.85 34CE ONES PROTEIN BLOOD WORK RL 1 .00
::311 VIRAL CULTURE RL 1 173.75
;B:C? CYTOLOGY JOINT FLUID BLOOD WORK RL 1 .00
2'v'8 XRAY THORACIC SPINE, 2 VIEWS W/INTERPRET XR XR 31 .00
230 XRAY OPP.VIEW FOR COMPARISON W/INTERPRET XR XR 31 .00
3100 WRIST XRAY 1 VIEW XRAY XR 0 .00
252 XRAY MANDIBLE 4 V W/INTERPRET XR XR 31 .00
218 XRAY, CLAVICLE,I V W/INTERPRET XR XR 31 .00
71020 XRAY,CHEST,2 VIEWS, W/INTERPRET. XR XR 31 71.00
225 XRAY ELBOW, 3 VIEWS W/INTERPRETATION XR XR 31 .00
s
l
.RANGE FAMILY MEDICAL GROUP PA
)6/15/93 PROCEDURE FEES
?QOCEDiRE DESCRIPTION ALT. DESC. DEPT I.O.S. STD. FEE
-----------------------------------------------------------------------------------------------------------------------------------
.030 XRAY,CHEST, 3 VIEWS,W/INTEEPRET, XR XR 0 96.00
[["51 XRAY SELLA TURCICA, 2 V W/INTERPRET XR XR 31 .00
_97 XRAY,CHEST,2 VIEWS, W/INTERPRET. XR XR 31 .00
226 XRAY FOREARM, 2 VIEWS W/INTERPRET XR XR 31 .00
223 XRAY ACROMIOCLAV.JOINTS W/INTERPRET XR XR 31 .00
258 XRAY FEMUR W/INTERPRET XR XR 31 .00
239 XRAY TIBIA&FIBULA W/INTERPRETATION XR XR 31 .00
220 XRAY SCAPULA, 3 V W/INTERPRETATION XR XR 31 .00
.05 XRAY STERNO-CLA'V.JOINTS,3VIEWS W/INTERPR XR XR 31 .00
205 XRAY CERVICAL SPINE, 2 VIEWS W/INTERPRET XR XR 31 .00
72110 XRAY,L/S SPINE,5 VIEWS W/INTERPRET. XR XR 0 128.00
98 XRAY,CHEST,3VIEWS,W/INTERPRET. XR XR 31 .00
203 XRAY RIBS,BILAT.W/CHEST PA & INTERPRET XR XR 31 ,00
229 XRAY FINGER, 3 V W/INTERPRET XR XR 31 .00
-45 XRAY SKULL 6 VIEWS W/INTERPRET XR XR 31 .00
:JO XRAY RIBS,UNILATERAL,3VIEWS W/INTERPRETY XR XR 3i .00
'2100 XRAY, L/S SPINE, 2 VIEWS W/INTERPRET. XR XR 0 96.00
255 TM.MANDIBULAR JOINT,BILAT,6 V WINTER. XR XR 31 .00
246 XRAY SKULL, 4 VIEWS W/INTERPRET XR XR 31 ,00
243 XRAY FOOT 2 VIEWS W/INTERPRET XR XR 31 .00
256 XRAY NECK SOFT TISSUE 2 V W/INTERPRET XR XR 31 .00
'1120 XRAY,STERUM, 3 VIEWS W/INTERPRET, XR XR 31 .00
71.021 CHEST APICAL LGRDOTIC X-RAY XR 1 47.00
.53 XRAY ZYGOMATIC ARCHES,6V W/FACIAL&INTERP XR XR 31 ,00
1010 XRAY,CHEST, 1 VIEW W/INTREPRET, XR XR 0 61.00
?.5 PELVIS, 3 VIEWS, W/INTERPRETATION XR XR 31 .00
.24 XRAY HUMERUS, 2 VIEWS W/INTERPRET XR XR 31 .00
40 XRAY ANKLE 2 VIEWS W/INTERPRET. XR XR 31 .00
SO XRAY SELLA TURCICA, 1 VIEW W/INTERPRET XR XR 31 .00
'09 XRAY, L/S SPINE 2 VIEWS W/INTERPRET XR XR 0 ,00
XRAY,CHESI,APICAL LGRDOTIC W/INTERPRET. XR XR 31 .00
'_u70 XRAY, THORASIC SPINE,2 VIEWS W/INTERPRET XR XR 0 77.00
XRAY ;ACROILIAC JOINTS,4 V,W/INTERPRET XR XR 31 .00
2' XRAY WRIST, 3 V W/INTERPRET XR XR 31 .00
:Ia Y?AY ABDOMEN, 2 V w/INTERPRET XR XR. 31 .00
_. XRAY PELVIS, STEREO,2 V W/INTERPRET XR XR 31 .00
- -EST,'VIEW W/ INTERPRETATION XR XR 31 .00
(RAY KNEE, 2 VIEWS WANTERPRETATION XR XR 31 .00
({Al NASAL 30NES 4 V W/INTERPRET XR XR 31 .00
X;0, SHOULDER, 3 V, W/INTERPRET XR XR 31 .00
PINE ,5 MEWS W/INTERPRETATION XR XR 31 .00
t-AV 70ES, W/INTERPRETATION XR XR 31 .00
CRAY _HCULDER, V, W/INTERPRETATION XR XR 31 .00
_ (.RAY NAVICULAR W/INTEPRET XR XR 31 .00
(RAY I.' -CLAV.JOTNTS,3VIEWS WINTER. XR XR 0 71.00
XRAY POST REDUCTION,2 V W/INTERPRET XR XR 31 .00
CHEST, 4 'VIEWS W/INTERPRETATION XR XR 31 .00
19 XRAY CLAVICLE, 2 V W/INTERPRETATION XR XR 31 .00
..8 PRAY HAND, 3 VIEWS W/INTERPET XR XR 31 .00
44 XRAY GS CAL CIS, 2 VIEWS W/INTERPRET XR XR 31 .00
238 XRAY KNEE 3 VI=r1S W/INTERPRETATION XR XR 31 .00
247 XRAY SINUSES, 4 VIEWS W/INTERPRET XR XR 31 .00
72.50 XRAY, CERVICAL SPINE,4-5 V W/INTERPRET, XR XR 0 116.00
ORANGE FAMILY MEDICAL GROUP PA
36/15/93 PROCEDURE FEES
PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE
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74000 XRAY ABDOMEN 1 VIEW (KUB) KUB XR 0 76.00
71110 XRAY,RIBS,BILAT. 6 VIEWS W/INTREPRET. XR XR 31 80.00
XRAY STERNUM, 3 VIEWS W/INTERPRET XR XR 31 .00
XRAY PELVIS & LAT HIP, 2 V. W/INTERPRET. XR XR 31 .00
1 XRAY FOOT, 2 VIEWS W/INTERPRET XR XR 31 .00
J7 XRAY CERVICAL SPINE,4-5 V W/INTERPRET XR XR 31 .00
'0220 SINUS SERIES XR 0 .00
12040 XRAY,CERVICAL SPINE, 2 VIEWS W INTERPRET XR XR 0 79.00
217 XRAY SACRUM & COCCYX W/INTERPRETATION XR XR 31 .00
241 XRAY ANKLE 3 VIEWS/W/INTERPRET. XR XR 31 .00
202 XRAY RIBS,BILAT. 6 VIEWS W/INTERPRET XR XR 31 .00
254 TEMP.MANDIBULAR JOINT,UNILAT 4 V W/INTER XR XR 31 .00
??` XRAY A8DOMEN,2 V W/PA CHEST & INTERPRET XR XR 31 .00
212 XRAY,PELVIS AP W/INTERPRETATION XR XR 31 .00
248 XRAY FACIAL BONES, 4 V W/INTERPRETATION XR XR 31 .00
101 XRAY RIBS,UNILAT.W/PA CHEST & INTERPRET XR XR 31 .00
257 XRAY SCOLIOSIS, 1 VIEW XR XR 31 .00
236 XRAY ABDOMEN, 3 V W/INTERPRET. XR XR 31 .00
211 XRAY SPINE, ENTIRE,AP & LAT W/INTERPRET XR XR 311 .00
233 XRAY ABDOMEN, SINGLE AP W/INTERPRET XR XR 31 .00