Service Account
Resume:
QUEST DIAGNOSTICS
PO BOX ******
CINCINNATI, OH *5274-0795
mydocbill.com/quest
**************@*********.***
Amount Due
$48.44
ACCOUNT OWNER
ALVARO BATIS MAYORAL
STATEMENT CREATED
4/19/2022
DUE DATE
Upon Receipt
INVOICE #
23550202
ACCOUNT NUMBER
15282195-QQUD1
PAYMENTS IN THE LAST 30 DAYS
$0.00
STATEMENT AMOUNT DUE
$48.44
PENDING INSURANCE
$0.00
TOTAL AMOUNT BALANCE
$48.44
General Info
ALVARO BATIS MAYORAL
713 W B ST
ONTARIO, CA 91762
Primary Insurance Info
INSURANCE PROVIDER
ADDRESS
,
GROUP/PLAN
ID NUMBER
Secondary Insurance Info
None
We have filed to your insurance already. You can pay for the statement amount due in MyDocBill. Account Summary
Guarantor Info
Page 1 of 2
PATIENT RENDERING PROVIDER REFERRING PROVIDER
ALVARO BATIS MAYORAL Quest Diagnostics Provider RYAN ZANE DOS Proc Code Units Service Activity Charges Pay/ADJ Pending Insur Balance 2/18/2022 85025 1 COMPLETE CBC W/AUTO DIFF WBC $26.45 2/18/2022 80053 1 COMPREHEN METABOLIC PANEL $21.99 2/18/2022 TOTAL SERVICES $48.44 $0.00 $0.00 $48.44 3/20/2022 GUARANTOR RESPONSIBILITY DATE
3/21/2022 Payment
3/21/2022 Payment
CURRENT
$0.00
31-60 DAYS
$48.44
61-90 DAYS
$0.00
OVER 90 DAYS
$0.00
Summary of Service Charges
Late Payment Breakdown
We have filed to your insurance already. You can pay for the statement amount due in MyDocBill. If your insurance has issued payment directly to you, please send us this payment immediately to stop the collection efforts. Please disregard this notice if you believe you have received it in error or if payment has already been made. Page 2 of 2
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