Billing Version 0.0089897

Patient Billing History Detail

11/11/2018   11:22:10 AM
Charge
Active
Claim
Date
Date of
Service
Location
Provider
CPT
Dx1
Units
Chrg Amt
Pat Pay
Ins Pay
Pri Pay
Sec Pay
Ter Pay
Ins Adj
Balance
835 Detail
72314032 Yes 07/03/2003 06/04/2013 CLEARING HOUSE CAPARIO ELECTRONIC 5010 1556412 V2739 1 $55.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $55.00 835 Detail
72314032 Yes 07/03/2003 06/04/2013 CLEARING HOUSE CAPARIO ELECTRONIC 5010 1556412 V2739 1 $55.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $55.00 835 Detail
72314032 Yes 07/03/2003 06/04/2013 CLEARING HOUSE CAPARIO ELECTRONIC 5010 1556412 V2739 1 $55.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $55.00 835 Detail
72314032 Yes 07/03/2003 06/04/2013 CLEARING HOUSE CAPARIO ELECTRONIC 5010 1556412 V2739 1 $55.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $55.00 835 Detail
72314032 Yes 07/03/2003 06/04/2013 CLEARING HOUSE CAPARIO ELECTRONIC 5010 1556412 V2739 1 $55.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $55.00 835 Detail
72314032 Yes 07/03/2003 06/04/2013 CLEARING HOUSE CAPARIO ELECTRONIC 5010 1556412 V2739 1 $55.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $55.00 835 Detail
Total 6 $330.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $330.00