Mary Hamilton

 
 2023 February 24 08:36 
 1 
 12 
 unknown 
 P 8/33 
 Laura Marquez
 Coastal Neurology 
 Page: 
 7 
 610 Trenia Ann I 
 725 W Granada Blvd. Ste 22 
 Date: 2023 February 24
 Orange City 
 FL 
 32763 
 Time: 
 Ormond Beach, FI 32174 
 7:50 AM 
 Patient: Patient ID is equal to 23633 
 Date: Service date of the Charge: 
 2018 March 28 
 CPT: 
 Description: 
 Charge 
 Primary 
 Primary 
 Secndry 
 Non Primary 
 Pt 
 Account 
 Amount 
 Pmnt 
 Adj 
 Pmnt 
 Adj 
 Pmnt 
 Balance 
 20551 
 Injection(s); single tendon 
 $350.00 
 $0.00 
 $0.00 
 $0.00 
 $0.00 
 $0.00 
 $350.00 
 20553 
 Injection(s): single or multiple 
 $380.00 
 $0.00 
 $0.00 
 $0.00 
 $0.00 
 $0.00 
 $380.00 
 
 Total Outstanding Balance for Date of Service: 
 $1,270.00 
 Date: Service date of the Charge: 
 2018 January 07
 CPT: 
 Description: 
 Charge 
 Primary 
 Primary 
 Secndry 
 Non Primary 
 Pt 
 Account 
 Amount 
 Pmnt 
 Adj 
 Pmnt 
 Adj 
 Pmnt 
 Balance 
 20553 
 Injection(s): single or multiple 
 $380.00 
 $0.00 
 $0.00 
 $0.00 
 $0.00 
 $0.00 
 $380.00 
 Total Outstanding Balance for Date of Service: 
 $920.00
 
 Date: Service date of the Charge: 
 10/24/2023 
 CPT: 
 Description: 
 Charge 
 Primary 
 Primary 
 Secndry 
 Non Primary 
 Pt 
 Account 
 Amount 
 Pmnt 
 Adj 
 Pmnt 
 Adj 
 Pmnt 
 Balance  
