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Date: <br />Treatment <br />Recommendation Therapy <br />Estimated <br />Charge Per <br />Session or <br />Service <br />(No Print) <br />Insurance <br />Allowed <br />Amount <br />(No Print) <br />Expanded <br />Estimated <br />Total <br />Charges <br />Patient Co- <br />pay <br />Patient Co- <br />insurance <br />Estimated Patient <br />Responsibility <br />1 99213 - Office/Outpatient (Established)$132.00 $87.55 $87.55 $87.55 0%$0.00 <br />12 1010T Pressure Wave Therapy $120.00 $1,440.00 $1,440.00 <br />1 Wharton's Jelly - Stem Cell Injection $3,800.00 $3,800.00 $3,800.00 <br />Expected from Insurance $87.55 Estimated Pat Portion (W/Ded)$5,240.00 <br />Total Insurance Payable after CoPays $0.00 <br />Total Expected from Insurance $87.55 <br />Regenerative Injection and Pressure Wave Treatment Plan Estimate for:2/23/2026