EFTA00313693.pdf

Laboratory Bill LaiSOrP IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII BALANCE NOW DUE Payments made via an online banking service must include this invoice * tvoIce/Factura: 41581647 ) TAX ID; : 84-0611484 Amount Due: $367.00 5 Patient Name: Invoice Date: 06/02/17 711728612370 wit Important Notice THIS BILL IS FOR LABORATORY SERVICES REQUESTED BY YOUR PHYSICIAN. PAYMENT IN FULL IS EXPECTED UPON RECEIPT OF THIS INVOICE. SEE THE BACK FOR CREDIT CARD AND INSURANCE Taat nanaleatmet Ilw. OPTIONS. TENEMOS AGENTES BILINGUE DISPONIBLES PARA ASISTIR. Summary of Activity Medicare/ Insurance Patient Date of Service Desaiption Chars.: s Adjustments Medicaid Paid Paid Paid You Pay 283.00 283 00 84.00 84 00 WPORTANTE: Tenemos agentes bilingoes disponibles para asiVirfe. 367.00 $367.00 Llamenos ahem para resolver su situachon. tabCorp reserves the ngtit to reuse laboratory services for failure to pay for past sonless. Only your doctor can answer questions regarding testing. diagnosis ana res..rts To request a copy of your laboratory report Cali =MO TEST PERFORMED BY 1ABCORPfl We accept the Payment arrangements can be made with no additional fee ley ca mg 1-800-8454167 VISA following credit cards: from Sam - 8pm EST Monday - Friday, or visit lall0Orp.00I111billing IIllIlIllIlIllIll11111 11111 IIIII11111 IlIllIlIllIllIl11111 11111 11111111 Return this portion with payment Involce/Factura: 41581647 DO NOT SEND CASH Make check or money order payable to: Amount Due: $367.00 www.labcorp.com/billing oratory Corporation of America Holdings FAX Payments made via an online banking service must include Invoice # 41581647 x*** 7/172861 2370**** 1 0367004 EFTA00313693