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Atrium Health

Post Office Box 71108
Chariolte, NC 28732-1108
CHS Pmeville

 

Matthew Gleason

October 30, 2018
This Is an itemization of the healthcare services (or:

Patient: Gleason, Matthew Admit Date: 10/04/18
Discharge Date 10/04/18

Location: OHS Pineville

Visit Coverages:
BCBS - BCBS NC BLUE OPTIONS
Current Account Balance: $3,561 42

Hosgival charges

Dk RevCode Desc
ENERAL

 
  

 

     

 

 

 

 

 

10mm; 0
EMERGENCY EDGE--GENERAL
odsu HC ED VISIT LEVEL 5 1 $2.560]
LABORATORY-GENERAL
10/04/13 113171 HC COMPREHENSIVE METABOLIC PANEL (LAB) 1 3377 15'
10/04/13 am He mopeum GHANTITAIIVE 1 $314.70
1111041111 ms HC cac wmum DIF (may 1 $203 an'
i mum/13 n3n7 HC URINALVSIS MICRO (LAB) 1 1 582.90}
mIoLoev-menosm--GENERAL 

 

 

1u/aA/1s 1 mm DX CHEST 2 VIEWS (RD) 1 sumo

 

Tolal Charges

   

Hos 'Ial Paymen's ann Adjustmems

 

Best! 11
ac Paymenis
Deaucuble. ,711.42

 

 

ac Adinsimenn 4597.16
Tom Insurance Payments and Adjustments $930.58
10104115 7 615nm)

 

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"you have any quesflons, please 
Si Ud no puedo leer e1 contemdo de esta en Ingies' parfavor namenos al (704)512-7171 opolon #2 Espanol,
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