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ADMINISTRATOR |
| |
Bills By Provider |
| |
Page -1 of 1 |
| |
From: 7/7/2004 To: 9/9/2004 |
|
Primary Insurance Balance |
|
Secondary Insurance Balance |
|
|
Printed On: 9/9/2004 |
| |
Patient Responsibility |
|
|
| |
Patient ID |
|
Patient Name |
|
Bill Date |
|
|
|
|
Description |
|
Bill Amount |
| |
| Kyle, Bryan C |
| |
10705 |
|
Abrams, Gail |
|
7/15/2004 |
$450.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Botox Injection Crow's Feet |
$450.00 |
| |
10705 |
|
Abrams, Gail |
|
7/22/2004 |
$1,050.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Botox - Extra |
$1,050.00 |
| |
8917 |
|
Archer, Sandra |
|
7/20/2004 |
$6,500.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Breast Augment |
$6,500.00 |
| |
10032 |
|
Bourne, Kimberly B |
|
7/20/2004 |
$12,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (1 of 1) |
$12,000.00 |
| |
995645 |
|
Daniel, Ed |
|
7/15/2004 |
$6,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Liposuction 5 areas |
$6,000.00 |
| |
995783 |
|
Dole, Carolyn |
|
7/21/2004 |
$25.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Conditioning Body Lotion |
$25.00 |
| |
996082 |
|
Hickman, Jamie |
|
7/20/2004 |
$750.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Restalyne |
$750.00 |
| |
996082 |
|
Hickman, Jamie |
|
7/21/2004 |
$15,150.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Abdominoplasty |
$15,150.00 |
| |
Provider Total: |
|
$41,925.00 |
| |
Percentage: |
|
38.83% |
| McDermott, Phillip F |
| |
995864 |
|
Cecil, Jean |
|
7/8/2004 |
$4,100.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Liposuction 3 areas |
$4,100.00 |
| |
8908 |
|
Quinter, Mary K |
|
7/29/2004 |
$600.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Botox Injection Axillary (2 of 5) |
$600.00 |
| |
Provider Total: |
|
$4,700.00 |
| |
Percentage: |
|
4.35% |
| Winslow, Cynthia J |
| |
10404 |
|
Altman, Nelson B |
|
7/14/2004 |
$5,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Rhinoplasty |
$5,000.00 |
| |
995876 |
|
Bourne, Josh |
|
7/20/2004 |
$1,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (1 of 6) |
$1,000.00 |
| |
995876 |
|
Bourne, Josh |
|
7/20/2004 |
$1,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (2 of 6) |
$1,000.00 |
| |
995812 |
|
Johns, Janet |
|
7/18/2004 |
$5,750.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Breast Augment |
$5,750.00 |
| |
Provider Total: |
|
$12,750.00 |
| |
Percentage: |
|
11.81% |
| Lewis, April J |
| |
9712 |
|
Ackerson, Norman P |
|
9/3/2004 |
$385.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
EXCISIONAL PREP RECIP SITE/FREE GRT |
$385.00 |
| |
9712 |
|
Ackerson, Norman P |
|
9/3/2004 |
$385.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
EXCISIONAL PREP RECIP SITE/FREE GRT |
$385.00 |
| |
9747 |
|
Arnold, Nicole H |
|
7/20/2004 |
$7,250.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Breast Augment |
$7,250.00 |
| |
9803 |
|
Bourne, Marisa L |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (1 of 6) |
$2,000.00 |
| |
9803 |
|
Bourne, Marisa L |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (2 of 6) |
$2,000.00 |
| |
9803 |
|
Bourne, Marisa L |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (3 of 6) |
$2,000.00 |
| |
9803 |
|
Bourne, Marisa L |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (4 of 6) |
$2,000.00 |
| |
9803 |
|
Bourne, Marisa L |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (5 of 6) |
$2,000.00 |
| |
9803 |
|
Bourne, Marisa L |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (6 of 6) |
$2,000.00 |
| |
995687 |
|
Bourne, Marsha |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (1 of 6) |
$2,000.00 |
| |
995687 |
|
Bourne, Marsha |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (2 of 6) |
$2,000.00 |
| |
995687 |
|
Bourne, Marsha |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (3 of 6) |
$2,000.00 |
| |
995687 |
|
Bourne, Marsha |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (4 of 6) |
$2,000.00 |
| |
995687 |
|
Bourne, Marsha |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (5 of 6) |
$2,000.00 |
| |
995687 |
|
Bourne, Marsha |
|
7/20/2004 |
$2,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Collagen Injection (6 of 6) |
$2,000.00 |
| |
10527 |
|
Cecil, Ashley W |
|
7/16/2004 |
$6,000.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Liposuction 5 areas |
$6,000.00 |
| |
995664 |
|
Daniel, Martha |
|
7/20/2004 |
$7,200.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Liposuction 5 areas |
$7,200.00 |
| |
9778 |
|
Dillow, Benda V |
|
9/2/2004 |
$2,600.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Bleph 4 Lid |
$2,600.00 |
| |
995783 |
|
Dole, Carolyn |
|
7/21/2004 |
$25.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Conditioning Body Lotion |
$25.00 |
| |
995783 |
|
Dole, Carolyn |
|
7/22/2004 |
$80.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Make-Up Lesson |
$80.00 |
| |
10362 |
|
Gyuty, Robert H |
|
7/14/2004 |
$25.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Conditioning Solution |
$25.00 |
| |
10528 |
|
Quinter, Annette C |
|
8/3/2004 |
$160.00 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Compression Massage |
$160.00 |
| |
Provider Total: |
|
$48,110.00 |
| |
Percentage: |
|
44.56% |
| Smith, Jan |
| |
10648 |
|
Parrott, MD, Rita K |
|
7/8/2004 |
$113.42 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Vitamin-C Cream |
$113.42 |
| |
9898 |
|
Ruby, Joan S |
|
7/14/2004 |
$72.08 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Makeup Remover |
$72.08 |
| |
995907 |
|
Sample, Mary Ann |
|
7/14/2004 |
$133.56 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Conditioning Hand Cream |
$133.56 |
| |
10343 |
|
Schnurr, Amber T |
|
7/14/2004 |
$174.37 |
|
$0.00 |
|
$0.00 |
|
$0.00 |
|
Micro Massage Exfoliating Wash |
$174.37 |
| |
Provider Total: |
|
$493.43 |
| |
Percentage: |
|
0.46% |
| |
Report Total: |
|
$107,978.43 |
| |