CLAIM NUMBER
00002
PATIENT NAME	PATIENT ADDRESS
GEORGE CLINTON	1 BIMMINY ROAD

                       

CPT CODE	CENTER	DATE	DESCRIPTION	AMOUNT
70470			CATSCAN ORBITS SELLA	4049
20203			CATSCAN SPINAL	3040.5
70032			X-RAY FEMAR	1000.75
70032			X-RAY FEMAR	1000.75
70032			X-RAY FEMAR	1000.75
30890			CATSCAN FEMAR	1125
30890			CATSCAN FEMAR	1125
30890			CATSCAN FEMAR	1125
20203			CATSCAN SPINAL	3040.5
00000				0
			Total Charges	16507.25
			Total Payments	851
			Balance	15656.25

 

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                            Last modified: January 20, 2010