Billing Version 0.0089897

Electronic EOB Detail for Hotfintom


11/11/2018   11:22:10 AM
Patient ID
First Name
Last Name
Date of
Service
CPT
Mod 1
Mod 2
Units
Billed
Amount
Allowed
Amount
Paid
Amount
Adjustment
Amount
Deductible
Amount
CARC
1956034 Doyle Hudson 05/25/2016 0 $0.00 $0.00 $255.00 $0.00
1956034 Doyle Hudson 05/25/2016 0 $0.00 $0.00 $138.53 $0.00 CO-45
1956034 Doyle Hudson 05/25/2016 0 $0.00 $0.00 $1.86 $0.00 CO - 253
Total 0 $0.00 $0.00 $0.00 $0.00