phe) Quest 4 ad Do not use address below * Diagnostics é pyeicien's b FS Invoice Date Amount Due: Due Dat | Aug. 24,2017 $702.23 Sep. 18 AB 01 026671 29887 8 77 A Invoice Number Lab Code Bill Code poof floval agg Mfoveet ff ygyegl Leeda L geet fade tyett ly 175717816 TBR 1000 3837 TBR 8 Patient Name Responsible Party Date of Service sly 26, ZU Lab Results and Diagnosis Questions Must Be Answered By Your Physician Customer Service NOW at www, Quest Laboratory Tests Were Requested By: Oo se typ tnd eieonaaien yeician pay your invoice, provide updated insurance patient survey idress | eee Most Recent Insurance Claim Filed To: Reternng Physiciar P 8 Please have your invoice available for reference. These tests were ordered by the referring physician, who requested that we bill you directly. If you have insurance coverage for the service date, please contact us to provide your policy information. If payment is not received by the due date and we locate insurance information, we will submit a claim for payment. Thank you for using Quest Diagnostics. a ‘ os ) ab Code: TBR LEY Diagnos $702.23 S&S ete. 'e Date: Sep. 18,2017 ‘Invoice Number: 175717816 LOG ON NOW. Pay your bil online s¢ day or night at www. QuestDiagnostics.com/bill MAIL PAYMENTS ONLY TO QUEST DIAGNOSTI Please make checks payable to Quest Diagnostics 4 Uefa A Lyy HEE taf fong EA fgg tetenng tafe tel getfeneg AEE NLTRRELENLALIS? 1 EFTA00313726