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    Free Thyroxine Index
    1 X $45.00 = $45.00
    Chloride
    1 X $18.00 = $18.00
    Glucose, Gestational, 1Hr
    1 X $22.00 = $22.00
    Obstetric Panel
    1 X $60.00 = $60.00
    Bilirubin, Indirect
    1 X $22.50 = $22.50
    CoQ10
    1 X $89.50 = $89.50
    Subtotal $257.00
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