Carly Jarvis

 LON 
 ETH 
 INTERVENTIONAL PAIN CENTERS 
 Estimate 
 Name: Johnson, Karen 
 Date: 2022-02-06
 DOB: 2003-06-15 
 Order date 
 Activity 
 Amount 
 2022-05-28
 Professional Medical Services/Physician 
 $4864 
 Fees: 62364, Cervical ESI 
 2014-11-16 
 Professional Medical Services/Physician Fees: 
 $364 
 77003 Fluoroscopy for Needle Guidance 
 Total = 
 $5164 
 4213 Teuton Street Metairie, LA 70006 Phone 504xxxxx Fax 504xxxx
 www.lonsethpain.com
