uest Do not use address below O10 38161 B 27 A iv lv ill: sll i Eafe teLMfedgetg eA AE gegg te gang attest 8837 TBR 1 5128588 Laboratory Invoice a te For services not included in your physician 6 Dill Invoice Date: Amount Due Due Date Sep. 03, 2017 $336.34 Sep. 26, 2017 | invoice Number Lab Code Bill Code 175128588 TBR 1044 Patient Name: Responsible Party Date of Service = Lab Results and Diagnosis Questions Must Bo Answered By Your Physician Customer Service uu voice, provide updated insurance information at tient su take a Pay by Phon: 4 hours/ 7 days) Questions. ns x invoice available f AYS 8:30 AM - &:00 PM ES ja Espanol! refere se Please have your invoice available for reference. These charges are for tests ordered by the referring physician listed and are separate from the physician's fees. 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. 4 Please fold anc tear siong p Quest ~ oS Diagnostics LOG ON NOW. Pay your bil on! day or night ne securely anytime al www. QuestDiagnostics.com/bill > accepts Ques! Dia 0178R1501017512656800033b3450903010021e2 Pate Lab Code: TBR __ $336.34] ate: Sep. 28, 2017 Invoice Number: 175128588 t Name ed an explanation of benefits showing you ty this b (0880 Day (he Sse" amount fully resoW capy of your explanation of benefits. MAIL PAYMENTS ONLY TO QUEST DIAGNOSTICS OO COTTE ELT TL GT TT Gee ee TT | b4419600000049 EFTA00313722 ently Laboratory Tests Were Requested By: oO: a shes moe at www.QuestDiagnostics.com/bill to conven)