Eh?mrrag
Respirat?ry Panel 2 -

 

IIJFJ.

mainFIm-Dmcam

til?gFl?E'

 

Run Summary

Sample ID: Hasdun. Alexa-

Hatvts?ttawm



 

Detected:
Equjgucal:

Hm Detected
Hut Selected
Nut Detected
Hut 
Hm Detected
Nut DutL-Etud
Nut Dele?tmt
Nat Detected
Hut Detected
Hut 
Hat Dem-Emu
Hut Detected
Detentilrt
Nat Detected

Hat Detected
Hat Detectnd
Detected

 

I Ftun Details

Punch:
Run Status:


.



Harm
Nqne



RP

Cmniiutmi

Viruses
Ittitenn'qiru?'.
229E
Ccmnauirus 
Curm?rauims HLEH
{?343
Human Mutaprruurttuvirus

Human 

tn?tmnza It.

lr?h?u?rtza E5

FHHJIHHLJEHEH "Jams 

Parninfluenzn Utru? 2

Fitrnirt?u?nza Uiru? 3

tiarnin?uenrn Virus it



Bacteria

,rmr?pertusm's {15 Will 
pmtussis [?3th
praumnaur'm:

Butt

SHED F. [-551
i-nTIe-r-z Eli: 
[ash-:2 
fir-.1 

I I I.-

J-. 
H?ni sz'utr'Jl 

.L..


Prutncal:

 r15trurnenl:

 

ELM Date: 11 Dut??t?

1:30 PM
Pn?scd
?ritts'iu?" 



 

 

 

Payment Due

Please cemplete payment intermatmn.

Aeceun He . Statern ent Date

Manhattan Specialty Care

 

 

 

 

 

 

 

121W 3TH ST F- - 3.019'11'31 25365.24
STE 534 . 
NEW tilt? l?CIi'Jl Hall Fa? :r?lter Payment Amount 

I Ch Pay-Still} Epee Elity lIare :hvack
SESSESTES ht EC 

Fer Billing Inquiries Call: 343-332?3545

Patient: Alexa Leig Hasdan

I 'h



Check. if yaur billing inf-armatian itaS changed.

Provide update?s} EIIJEW-E at an the reyeree 

 

 

 

 

Manhattan Specialty Gate

121 2'i'Tli ST
STE 5'34

Detach and return tar.- perti?r?l with payment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Statement Detail Statement Date 2019-11-01 Ma-

Elairn Me. Visit Date Activity Etate at Service ChargeS Payments Balance
Sate?tam SStS-tS-te Claim:?3231. Prayider: Saya Fatheliahi
73231 2013-13-10 324133 Cl PNEUM, DNA, AMP 324.25
2313-13-10 2313-10-13 UNIS, SMP PEDEE 1520.33
T3331 3319?13?13 12319?1313 Seeai STSEP a. SMP 
T3231 32233 DETECT SEEN-F NUS. DNA. AMP 
23231 2013?13-13 2313?1 [1-10 33333 RESP VIRUS 12?25 TARGETS 132713.33
T3231 2319?13?13 3319?13?24 [:ilue Payment 
T3331 3319-13-13 2313-13-33 Slue EreSS-MGaStr'e Payment 3.3-3
23231 2111 3?1 2313-11411 Cheek ta ad}UStment 2533.23
33E3t 2313?13-13 2319?11?31 eheel?: te rnerntier: $23,333.23.
F323t 2313-13-13 3319-11-31 ?T'Sur Salanee Due Cin These Semieea 23333.24


Aging Current 3'1213 1 Payment
.. USS 3.33m Due

Manhattan Specialty Sara 121w 23TH ST STE SS4 NEW malt. Ht? mam 25355.24

 

 

   Biueerss
. . BlueSlueld

nnesora
n; muffle . m1 

Contact Lustome' Service at

"888-2794210
OI TIY at 7'1

 

10/23/2019

Summavy
*otai Bll'ed: 52839550
Total Benei'iis Approved: $28,395'50

Total Amount Paid to Subscriber: 525.865 )4
Amount You Owe Provider $2,530.26

 

a and 5m: le' are nunpzum incepmdenr came; 0' the-Sine [unwind 3m Sim: Assooanon

BluQerss
. BlueSlueld Date 10/23/2019
mew 

Pay lo 

vow; ~07 wrfi.)

   

 

 

 

 

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THOUSAND WE AND 24 


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