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90746 Hepatitis B Vaccine $ 55.75 <br />90703 Tetanus Vaccine, IM $ 26.00 <br />90658 Influenza Vaccine $ 12.00 <br />90732 Pneumonia Vaccine $ 29.00 <br />90636 Hepatitis A & B Vaccine combo $ 91.80 <br />Service <br />18000 Fit Testing <br />$ 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 added 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 monthly Invoice for any reference <br />laboratory services furnished to eligible employees. All lab services'will be itemized and <br />totaled each month and submitted to Employer on one invoice for payment. <br /> Client Charge/ <br />Item No. Description each <br />182761 ADACEL TDAP VACCINE X6.63 <br />66012 ANKLE-AIR STIRRUP LT 22.77 <br />66010 ANKLE-AIR STIRRUP RT 22.77 <br /> BANDAGE ELAS 2" DLX <br />53199 VELCR LF 5.59 <br /> BANDAGE ELAS 3" DLX <br />53200 VELCR LF 7.56 <br /> BANDAGE ELAS 4" DLX <br />53201 VELCR LF 9.06 <br /> CAST SPLINT 3" J-SPLINT <br />5910 ROLL 113.36 <br />184058 CEFTRIAZONE 1GM VL 5.42 <br /> CRUTCH WOOD ADULT <br />141175 6/CS 17.54 <br /> ENGERIX-B l OMCG LK <br />183331 SYR PF SB 27.88 <br /> ENGERIX-B 20MCG LK <br />181348 SYR PF SB 68.10 <br /> FINGER SPLINT FOLD <br />11808 OVER LG 1.67 <br /> FINGER SPLINT FOLD <br />11807 OVER MED 1.67 <br /> FINGER SPLINT FOLD <br />11806 OVER SM 1.67 <br /> GARDASIL VACCINE SDV <br />165076 .SML 163.30 <br /> HAVRIX 1440 ELU SYR PF <br />184564 SBX 81.90 <br />F-8 <br />