Billing Version 0.0089897

835 Detail

11/11/2018   11:22:10 AM
Claim
Date
Date of
Service
CPT
Billed
Allow
Pay
Adj
Deduct
Reason
Group
Code
CARC
RARC
835 Date
Check #
Ins Name
09/10/2018 09/10/2018 97112 $55.00 $0.00 $0.00 $0.00 $0.00 CO 45 09/22/2008 885234156 Medicare Part B
09/10/2018 09/10/2018 97112 $55.00 $0.00 $0.00 $0.00 $0.00 CO 45 09/22/2008 885234156 Medicare Part B
09/10/2018 09/10/2018 97112 $55.00 $0.00 $0.00 $0.00 $0.00 CO 45 09/22/2008 885234156 Medicare Part B
09/10/2018 09/10/2018 97112 $55.00 $0.00 $0.00 $0.00 $0.00 CO 45 09/22/2008 885234156 Medicare Part B
09/10/2018 09/10/2018 97112 $55.00 $0.00 $0.00 $0.00 $0.00 CO 45 09/22/2008 885234156 Medicare Part B
09/10/2018 09/10/2018 97112 $55.00 $0.00 $0.00 $0.00 $0.00 CO 45 09/22/2008 885234156 Medicare Part B
Total $330.00 $0.00 $0.00 $0.00 $0.00