EFTA00797928.pdf

Page 10/2 Quest Do not use address below: Laboratory Invoice For worker not Included in your physic Ian's bill pi cs. fiNNstm MOnC65673-7306 Invoice Date: Amount Due: Due Date: Sep. 07, 2018 $1,726.30 Sep. 28, 2018 AB 01 077326 93142 B 202 A ONO Lab Code TAM TM 78300020 0006136 6196490611 0 Patient Name: JEFFREY EPSTEIN JEFFREY EPSTEIN Responsible Party: JEFFREY EPSTEIN 358 EL BRILLO WAY Date of Service: August 30, 2018 PALM BEACH, FL 33480-4730 Lab Results and Diagnosis Questions Must Be Answered By Your Physician. Customer Service LOG ON NOW at COMO. OuosiDlagnostics.comThIll to conveniently Laboratory Tests Were Requested By: pay your invoice, provide updated Insurance information, or lake a Referring Physician: k4OSKOWITZ,BRUCE W patient survey. PhySiCianAddreSS: 1411 N FLAGLER DR WEST PALM BEACH, FL 33401 Phone: 1400.4884890 MONTH 8:30AM-5:00PM:FRI 09:00 AM • 04:00 PM EST Most Recent Insurance Claim Filed To: Se Habla Espanol! Instrance Name: Insurance ID: Group Number: Please have your Invoice available for reference. This Invoice is for laboratory tests performed at the request of the referring physician. These charges are separate from your doctor's fees. If you have insurance coverage for the date of service listed, please contact us to provide your policy Information. If payment is not received by the due date, we reserve the right to bill with any information we may have on file for you. Dole CPT Code' Test Description insurance Patient Paid Patient Charge Adjustment Reason Pald Responsibility 0,8/30/18 82485 CHOLESTEROL $38.24 06/30/18 82746 FOLIC ACID (SR) $118.11 06/30/16 83718 LIPOPROTEPI, DIRECT: HDL $66.36 08/30/18 83825 MERCURY $155.23 06/30/18 85652 SW RATE,AUTOMATED $37.12 08/30/18 84479 7-3, RESIN UPTAKE $50.62 06/30/18 84430 THYROXINE $49.49 08/30/18 84478 TRIGLYCERIDES $42.74 08/30/18 84443 TSH $130.49 Continued on Next Page Tax ID: 38-2084239 ICD Codes: E55.9 E78.5110.1(42.9 R73.0$ ex in Ca#te ga. Ca n-ct Services Performed by CUE ST CrAemosTics MIAMI MIRAMAR. FL Services Pedonned by. GUEST DAGNOSTICS ATLANTA TUCKER GA iv vie LO veva,' f..3 Services Panorama QUEST DtAGNOS71CS TAMPA TAMPA FL Meet' cat ' The CPT code provided are for information purposes only and are based on AMA guidelines wilnem regard specific payer requirements Co cicAcr • - /6 93 kt, c'cfece (Ile cc ve--4 ( #1- 9 74 H t ,IOsA •Phigeo kid and tear along peforaton and remitwit Mtn. in rho erreaop.prowled • Lab Code: TAM Quest Amount Due: $1,726.30 d efi • Diagnostics I/ d 0( 3 l Due Date: Sep. 28, 2018 Invoice Number: mo &12_ 1 LOG ON NOW. Pay your bill online securely at I re Patient Name: JEFFREY EPSTEIN WWW QUESTDIAGNOSTICs COMMII LING or call 1-800-488.8890. Amount Enclosed: $ /CCP, M a you received an explanation of boallan showing your tesponslemy is lees then the Quest Diagnostics also accepts: amount shown on this be please pay the lesser amount. To Any MSC*e your awoke. please cameo a copy of your explanation of benefits. VISA DI$SYet MAIL PAYMENTS ONLY TO: QUEST DIAGNOSTICS Please make checks payable to Quest Diagnostics. P.O. BOX 740781 Be sure to Include Invoice number on your check. CINCINNATI, OH 45274- 0781 j Check here if address has changed. Please provide your new address Information on the back. 11'l'll"iuiiilll"ill"Illlrlrtllrlrl„rilliiill'lll'lhllVlllll asst ogerrosers reserves roo Ogre* assign ran wens* ts *nye, PS rebates OITAM580161964906110017263050907133 41910135890000007 EFTA00797928  4 Page 2012 Do not use address below: Laboratory Invoice For services not Included In your malaise's em O.O. Sox Me 111°) Dialige nossics- Ho.Mar. MO 65673.7308 Invoice Date: Amount Due: Due Date: Sep. 07, 2018 81,728.30 Sep. 28, 2018 Invoice Number Lab Code 6196490611 TAM Lab Results and Diagnosis Questions Must Be Patient Name: JEFFREY EPSTEIN Answered By Your Physician. Responsible Party: JEFFREY EPSTEIN Date of Service: August 30, 2018 Oslo CPT Code' Test Description Insurance Patlent Charge Adjustment Patient Paid Reason Paid Responsibility 08.00/18 84550 URIC ACID (SR) $42/4 08/30/18 82607 VITAMIN B-12 $120.36 08/30/18 86140 C.REACTIVE PROTEIN $75.37 08/30'18 64153 PROSTATE SPECIFIC AG $148.48 08/30'18 85025 CBC. PIT, DIFF $45.50 08/3018 86141 CRP: HIGH SENSITIVITY $50.00 08/30/18 82306 25.0H VITAMIN 0-3 $241.84 08/30(18 83090 HOMOCYSTEINE $227.22 08/30/18 83895 LIPOPROTEIN A $25.00 08/30/18 84100 PHOSPHORUS $5.39 08130/18 82947 GLUCOSE (ON) $448 08/3018 84520 UREA NITROGEN (ON) $4.49 08/3018 82505 CREATININE (BL) $582 08/30/18 80051 ELECTROLYTE PANEL $7.98 085018 84155 PROTEIN $4.17 08/30/18 82040 ALBUMIN (SR) $5.62 08/30'18 62247 BILIRUBIN, TOTAL 55.70 08/30'18 84075 ALK PHOSPHATASE $5.88 011/3018 14450 MT (SCOT) 115.88 n 08/0018 84460 ALT (SGPT) $8.00 s Tax ID: 38-2084239 LCD Codes: E55.9 E78.5110. N42.9 R73.09 $1,728.30 $0.00 $0.00 $0.00 $1,726.30 Service. Performed by. QUEST DIACNOSMS MIAMI MI . FL SONIC'S Pflmed by. QUEST DIAGNOSTICS ATLANTA 1UCKER GA Services Performed by. GUEST CIAGNOGGC$ TAMPA TAMPA FL • The CPT codes provided are to Inlormallort purposes any and are based on AMA Guidelines werout regard 10 speedo payer reqtreements EFTA00797929