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    Bilirubin, Indirect
    3 X $22.50 = $67.50
    Glucose, Fasting, Plasma
    1 X $21.00 = $21.00
    Immunoglobulins G, A, M
    1 X $65.50 = $65.50
    Uric Acid, Serum
    1 X $18.00 = $18.00