Statement of Account MITCHELL A KLINE, MD PC 700 PARK AVENUE NEW ue NY 10021 JEFFREY EPSTEIN 9 EAST 71ST STREET NEW YORK, NY 10021 Paidby — Paid By Charges Insurance _— Patient Adj. Balance 01/11/2019 | 17000 | Dest Ben/Premalig 1st 01/11/2019 | 17003 | Dest Ben/Premal 2-14 Statement Date: 02/26/2019 Please remit payment of $199.88 payable to: MITCHELL A KLINE, MD PC EFTA00292227

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Statement of Account MITCHELL A KLINE, MD PC 700 PARK AVENUE NEW YORK, NY 10021 Date fT 92/01/2019 oooocoso8 «| 1 Last Payment 08/10/2016 JEFFREY EPSTEIN 9 EAST 71ST STREET NEW YORK, NY 10021 Paid by — Paid By . Date Procedure Description Charges Insurance Patient Adj. Balance 01/11/2019 | 99212 Established Pt Visit Straightfwrd 01/11/2019 | 17000 |Dest Ben/Premalig ist 01/11/2019 | 17003 | Dest Ben/Premal 2-14 Ee | | i I I 0-30 Days | 31-60 Days | 61 - 90 Days |91 - 120 Days} > 120 Days Current Past Due Past Due Past Due Past Due | $650.00 $0.00 CUT ON DOTTED LINE AND SEND WITH PAYMENT EPSTEIN, JEFFREY ACCOUNT NO. 0000008048 Statement Date: 02/01/2019 Notes: FOR BILLING INQUIRIES CONTACT [i Please remit payment of $650.00 payable to: EFTA00292228

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Statement of Account MITCHELL A KLINE, MD PC 700 PARK AVENUE NEW YORK, NY 10021 JEFFREY EPSTEIN 9 EAST 71ST STREET NEW YORK, NY 10021 02/26/2019 | 99212 | Established Pt Visit Straightfwrd ELECTRODESICCATION CUT ON DOTTED LINE AND SEND WITH PA\ FOR BILLING INQUIRIES CONTACT [I Statement Date: 02/26/2019 Please remit payment of $407.27 payable to: MITCHELL A KLINE, MD PC EFTA00292229