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t <br />i <br />90746 Hepatitis B Vaccine $ 55.75 <br />90703 Tetanus Vaccine,lM $ 26.00 <br />90658 Influenza Vaccine $ 12.00 <br />90732 Pneumonia Vaccine $ 29.00 <br />90636 Hepatitis A & B Vaccine combo $ 91.80 <br />ervice <br />18400 la it Testing $ 24.00 <br />Costs related to number of services performed. Rates will be subject to change every 12 <br />months due to increase in unit cost. Additional services may be,alde~i and prices <br />negotiated as needed. If needed, additional lab test may be performed'at the clinic. <br />Employer shall pay Provider based on a consolidated morit~ly Invoice for any reference <br />laboratory services furnished to eligible employees.,:!#,ll;.lali_serv~c~s =~i!i~l be itemized and <br />totaled each month and submitted to Employer on.~tie invoice for payrle~}~. <br />.:, ;~;~: <br /> <br />•"i;~ ' <br />' ~ <br />~' <br />' <br />' <br />:, . <br />' <br />. <br />ri <br />`~^ <br />``~tI <br />'r. <br />~ <br />'~~-G:~ <br />gi's°~:_~ <br /> <br /> <br />t~~i <br />.i.~ ~: "i` <br />l <br /> <br />' <br />' ',y.,F. .~ ,.~~ <br />. .. <br />kL <br />'.t <br />~'>.~ i'~ <br />~: :}~ <br />•~• <br /> <br /> <br /> <br />Attachment number 1 <br />F_g Page 250 of 433 ' <br />