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Do not use address below. Laboratory Invoice For service* sot Included Avow *Pima s bin Invoice Date: Pagel& 1 Amount Due: Due Date: Quest e y • - Diagnostic, AB 01 007010 381 61 B 27 A 08837 TBR 1 75128588 Laboratory Tests Were Requested By: Referring Physicia Physician Address Most Recent Mamma" Claim Filed To: Insurance Name: Insurance ID: Group Number Sep. 03, 2017 Invoice Number 175128588 Patient Name: Responsible Party Date of Service: 5336.34 Lab Code TBR Sep. 26, 2017 Bill Code 1044 Lab Results and Diagnosis Questions Must Be Answered By Your Physician. Customer Service LOO ON NOW at 1101MlaileIMMISSainallib ccmeNenly pay your Invoice, provide updaled Insurance intormation, or take a patient survey. Pay by Plane 24 hours( 7 days) Questions: Please have your invoice waist* for reference WEEKDAYS 8.30 AM - SOO PM EST 5o Habla Espanol! Please have your invoice available for reference. Those charges aro for tests ordered by the referring physician listed and are separate from the physician's foes. We did not receive enough information to file a claim to an Insurance carrier. Please provide your correct Insurance policy information or make payment In the amount due. Thank you for using 'Quest Diagnostics. d gipii Quest e , Diagnostics Palientallinellablp plibfatal re nnr WM Wren! r The eriebbe vaned.& LOG ON NOW. Pay yus aims sear* anytime - day or n4tt aallallINDSOINGLINtall Quela VISA ee: DisS1/4.-Yet Please make cracks payable to Quest Diagnostics. Be sure to include nvoce number on your check J GnecK here if address nas changed Passe proycle your new address wilonnabon on the back cr.ovc...nrci-ts rsa-ess ••• nr" sugn? S Marl Sib* '0 ivy cr em.e!ei Amount Due: Late ."..ep 28, 2017 Lab Code TBR $336.34 Invoice Number: 175128588 Patient Name Amount Enclosed: $ if you received en expination of benefits shown2 your responatily is foss Man nn fl ied Mown on tray as mese pe to inset smart To nay meow you awn pease pion a copy a' your arpianeNan dente OWL PAYMENTS ONLY TO: QUEST DIAGNOSTICS OITBR 150 10175128588000336345090301002126441960000009 EFTA00313722