asked again.
$0.00 | $0.00 | $633.55 | ||||||
Your Responsibility: $633.55 | ||||||||
Hospital Incidentals | $108.75 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Hospital Incidentals | $19.25 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Hospital Incidentals | $6,160.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Hospital Incidentals | $732.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Hospital Incidentals | $2,886.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Lab Services | $392.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Lab Services | $25.00 | $25.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Lab Services | $149.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Lab Services | $120.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Lab Services | $147.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Lab Services | $164.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Hospital Incidentals | $3,718.00 | $416.75 | $333.40 | $0.00 | $0.00 | $0.00 | $83.35 | |
03/25/2009 Hospital Incidentals | $7,360.00 | $1,834.00 | $1,467.20 | $0.00 | $0.00 | $0.00 | $366.80 | |
03/25/2009 X-Ray or Lab Services | $17,527.00 | $917.00 | $733.60 | $0.00 | $0.00 | $0.00 | $183.40 | |
03/25/2009 Hospital Incidentals | $3.75 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 Hospital Incidentals | $4.25 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
03/25/2009 X-Ray or Lab Services | $314.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
Total | $39,830.00 | $3,192.75 | $2,534.20 | $0.00 | $0.00 | $0.00 | $633.55 | |
Your Responsibility: $633.55 | ||||||||

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