Free Medical Bill

Date: October 15, 2050
Bill Number: MB2050-0156
Patient: Jerrell Lowe
Account Number: #123456789
Bill Summary | Quantity | Unit Price | Total |
|---|---|---|---|
Consultation Fee | 1 | $200.00 | $200.00 |
Blood Test | 1 | $150.00 | $150.00 |
X-Ray Imaging | 2 | $100.00 | $200.00 |
Medication (Antibiotics) | 1 | $50.00 | $50.00 |
Total Amount Due | $600.00 |
Insurance Information:
Insurance Provider: MindStove Insurance
Coverage: 80% of total bill
Amount Covered: $480.00
Amount Due from Patient: $120.00
Payment Instructions:
Account Name: Notable20 Bank
Account Number: 1234567890
Routing Number: 987654321
For any questions or payment inquiries, contact us at [YOUR COMPANY EMAIL] or call [YOUR COMPANY NUMBER].
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