Billing Version 0.0089897

Payment Audit Summary

11/11/2018   11:22:10 AM
Patient
ID
Patient
Date of
Service
Location
CPT Code
Charges
Balance
From
Insurance
Payments
Payment
Code
Adjustment
Adjustment
Code
Transfer
Transfer
Insurance
Money
Type
Check Number / Credit
Card Authorization
2635632 Testing123894705309, CCflow COPAY BMS LOC4 - $0.00 $15.00 SELF $15.00 PIOF $0.00 - $0.00 0 Cash
2635632 Testing123894705309, CCflow COPAY BMS LOC4 - $0.00 $15.00 SELF $15.00 PIOF $0.00 - $0.00 0 Cash
2635632 Testing123894705309, CCflow COPAY BMS LOC4 - $0.00 $15.00 SELF $15.00 PIOF $0.00 - $0.00 0 Cash
2635632 Testing123894705309, CCflow COPAY BMS LOC4 - $0.00 $15.00 SELF $15.00 PIOF $0.00 - $0.00 0 Cash
Total $0.00 $60.00 $60.00 $0.00 $0.00