Free Healthcare Billing Sheet Template
Healthcare Billing Sheet
[YOUR COMPANY NAME] — [YOUR COMPANY ADDRESS]
Patient Name: Dayton Rohan
Date of Service: 05/15/2055
Invoice Number: INV-2055-00123
|
Service Description |
Code |
Quantity |
Unit Price |
Total |
|---|---|---|---|---|
|
General Consultation |
99213 |
1 |
$150.00 |
$150.00 |
|
Blood Test Panel |
80053 |
1 |
$200.00 |
$200.00 |
Subtotal: $350.00
Tax (if applicable): $0.00
Total Amount Due: $350.00
Payment Due By: 06/15/2055
Payment Methods Accepted: Credit Card, Debit Card, Online Payment
