Theresa Coffey

 
 Emergency Visit to Ochsner Baptist - A Campus of Ochsner Medical Center (Acct 
 #83000069737 for Amanda Garrison) 
 2019-02-07 
 Svc Date 
 Code 
 Description 
 Qty 
 Amount 
 Charges 
 Charges for visit with Brian A. Ogden, MD 
 07/29/13 
 76705 
 PR US, Abdomen Limited 
 1 
 57.00 
 Insurance Payments and Adjustments 
 08/13/13 
 10226 
 Contractual Write-Off 
 1 
 -3.77 

 Emergency Visit to Ochsner Baptist - A Campus of Ochsner Medical Center (Acct 
 #83057070157 for Amanda Garrison) 
 July 29, 2013 to July 30, 2013 
 Svc Date 
 Code 
 Description 
 Qty 
 Amount 
 Charges 
 Charges for visit with Matthew H Leboeuf, MD 
 07/29/13 
 99285 
 PR Emergency Dept Visit,Level V 
 1 
 333.00 
 Insurance Payments and Adjustments 
 08/13/13 
 10226 
 Contractual Write-Off 
 1 
 -97.10 
 Surgery to Baptist - Surgery (Magnolia) (Acct #83000072128 for Karan 
 Service Dates: 2021-16-01; Diagnosis: 574.10 
 Svc Date 
 Qty 
 Amount 
 Charges 
 08/09/13 
 25000003 
 Glycopyrrolate 0.2 Mg/MI Soin 1 MI Vial (0517-4601-25) 
 4 
 18.75 
 08/09/13 
 25000003 
 Lactated Ringers Solp 1,000 MI Bag (0264-7750-00) 
 
  
