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    Glucose, Gestational, 1Hr
    1 X $22.00 = $22.00
    RPR W/ Reflex to (1357 Syphilis & 337 RPR Titer)
    1 X $48.00 = $48.00
    Sm/RNP Abs
    1 X $51.50 = $51.50
    Measles, Mumps, Rubella
    1 X $76.00 = $76.00
    Subtotal $197.50
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