Jason Kirby

 LON 
 ETH 
 INTERVENTIONAL PAIN CENTERS 
 Estimate 
 Name: Johnson, Karen 
 Date: 19-10-2023
 DOB: 18-03-1993 
 Order date 
 Activity 
 Amount 
 15-06-2019
 Professional Medical Services/Physician 
 $4835 
 Fees: 62335, Cervical ESI 
 04-11-2016 
 Professional Medical Services/Physician Fees: 
 $335 
 77003 Fluoroscopy for Needle Guidance 
 Total = 
 $5135 
 4213 Teuton Street Metairie, LA 70006 Phone 504xxxxx Fax 504xxxx
 www.lonsethpain.com
