| Patient Name/DOB | MRN | Insurance | Date of Service | Types of Service | Charge | Action |
|---|---|---|---|---|---|---|
| GOMEZ, JUAN | 14167 | 11/20/2019 | ATCIC | FOLLOW-UP | $50 |
|
| GOMEZ, JUAN | 14167 | 11/20/2019 | ATCIC | FOLLOW-UP | $50 |
|
| GOMEZ, JUAN | 14167 | 11/20/2019 | ATCIC | FOLLOW-UP | $50 |
|