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Copay/Misc. Payment – $10
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10
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Copay/Misc. Payment $15
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15
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Copay/Misc. Payment $20
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20
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Copay/Misc. Payment – $25
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25
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Copay/Misc. Payment – $30
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30
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Copay/Misc. Payment – $40
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40
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Copay/Misc. Payment – $50
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50
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Short Form Completion
$
35
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Extensive Form Completion
$
75
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Short Letter/Report
$
60
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