Traffic was sent and received without issue prior to adding the ACL above.
Here is the sh access-list (IP's x'ed to protect the guilty)
Extended IP access list 101
10 deny ip 10.x.x.0 0.0.0.255 192.x.x.0
20 deny ip 10.x.x.0 0.0.0.255 199.x.x.0 0.0.0.255 (21353 matches)
30 permit ip 10.x.x.0 0.0.0.255 any (174131 matches)
Extended IP access list 111
10 permit udp any host 204.x.x.x eq isakmp (228 matches)
20 permit esp any host 204.x.x.x (45093 matches)
30 permit ip 192.x.x.0 0.0.0.255 10.10.10.0 0.0.0.255
40 permit gre any host 204.x.x.x
50 permit tcp any host 204.x.x.x eq
matches)
60 permit tcp any host 204.x.x.x eq 443 (72845 matches)
70 permit tcp any host 204.x.x.x eq smtp (71971 matches)
80 permit tcp any host 204.x.x.x eq 2004 (130549 matches)
90 permit tcp any host 204.x.x.x eq 443 (394745 matches)
100 permit tcp any host 204.x.x.x eq 1723 (12 matches)
110 permit udp host 170.x.x.x host 204.x.x.x eq snmp
120 permit tcp 206.x.x.0 0.0.0.255 host 204.x.x.x eq 1433
130 permit tcp 198.x.x.0 0.0.0.255 host 204.x.x.x eq 1433
140 permit icmp any any echo-reply (24 matches)
150 permit icmp any any administratively-prohibited (1737 matches)
160 permit icmp any any time-exceeded (342 matches)
170 permit icmp any any traceroute
180 permit icmp any any unreachable (10260 matches)
190 permit icmp any any packet-too-big
200 permit icmp any any echo (3104 matches)
210 permit udp host 204.x.x.x any eq non500-isakmp
220 permit udp any host 204.x.x.x eq non500-isakmp (177 matches)
230 permit tcp 65.x.x.0 0.0.0.255 host 204.x.x.x
240 permit udp host 192.x.x.0 host 204.x.x.x eq ntp (885 matches)
250 permit udp host 192.x.x.0 host 204.x.x.x eq ntp (711 matches)
260 permit udp 65.x.x.0 0.0.0.255 host 204.x.x.x eq 23
Extended IP access list 112
10 permit icmp any any echo-reply
20 permit icmp any any administratively-prohibited
30 permit icmp any any time-exceeded
40 permit icmp any any traceroute
50 permit icmp any any unreachable
60 permit icmp any any packet-too-big
70 permit icmp any any echo
Extended IP access list 115
10 permit ip 10.x.x.0 0.0.0.255 192.x.x.0 0.0.0.255
Extended IP access list 120
10 permit ip host 10.x.x.0 192.x.x.0 0.0.0.255
20 permit ip host 10.x.x.0 192.x.x.0 0.0.0.255 (39 matches)
30 permit ip host 10.x.x.0 192.x.x.0 0.0.0.255
Extended IP access list 125
10 permit ip 10.x.x.0 0.0.0.255 199.x.x.0 0.0.0.255 (45036 matches)
Extended IP access list group-lock
Extended IP access list idletime
Extended IP access list protocol
Extended IP access list tty66