Billing Version 0.0089897

My Payment Activity Details

11/11/2018   11:22:10 AM
Patient ID
Patient Name
Date of
Service
CPT
Charges
Balance
From
Insurance
Payments
Payment
Code
Adjustment
Adjustment
Code
Transfer
Transfer
Insurance
Payment
Method
Check/Credit
Card Number
245435 Robertson245425, Anjanidadam COPAY 3423 $0.00 $43.00 0 $43.00 PIOF $0.00 6765 $0.00 0 Check 8988-9090-9090
245435 Robertson245425, Anjanidadam COPAY 3423 $0.00 $43.00 0 $43.00 PIOF $0.00 6765 $0.00 0 Check 8988-9090-9090
245435 Robertson245425, Anjanidadam COPAY 4534 $0.00 $43.00 0 $43.00 PIOF $0.00 6765 $0.00 0 Check 8988-9090-9090
245435 Robertson245425, Anjanidadam COPAY 5434 $0.00 $43.00 0 $43.00 PIOF $0.00 6765 $0.00 0 Check 8988-9090-9090
Total $0.00 $43.00 0 $43.00 $0.00 $0.00