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Product	Price	Quantity	Subtotal
ObusForme Back Belt for Women with Built-in Lumbar Support	$48.32	ObusForme Back Belt for Women with Built-in Lumbar Support quantity	$48.32
MEDNEB+ with Reusable and Disposable Neb Kits & Bag	$49.99	MEDNEB+ with Reusable and Disposable Neb Kits & Bag quantity	$49.99
Ice It! Headache and Migraine Kit	$38.44	Ice It! Headache and Migraine Kit quantity	$38.44
FreeStyle Libre 3 Reader Kit	$105.99	FreeStyle Libre 3 Reader Kit quantity	$105.99

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Subtotal	$242.74
Total	$242.74

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Mediciad

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Documents Section Upload (i.e. prescriptions)

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Agree

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Insurance Type

Medicare

Mediciad

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