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Home My WebLink About20093331.tiffRESOLUTION RE: CANCELLATION OF 2009 OUTSTANDING ACCOUNTS RECEIVABLE FOR THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, a list of 2009 Department of Public Health and Environment accounts has been submitted to the Accounting Department of Weld County, Colorado, and WHEREAS, said accounts have been deemed uncollectible in accordance with guidelines adopted by the City of Greeley and County of Weld, a copy of said list being attached hereto and incorporated herein by reference, and WHEREAS, the Accounting Department has recommended the cancellation of said list of uncollectible debts due and owing the Department of Public Health and Environment in the amount of $19,073.96. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the aforementioned list of uncollectible accounts in the amount of $19,073.96, be, and hereby is, approved for cancellation. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 21st day of December, A.D., 2009. ATTEST: •ino,G Weld County Clerk to the B APP ft) Dep4ty Cle unty Attorney ORM: Date of signature: BOARD OF COUNTY COMMISSIONERS ELD COUNTY, COLORADO cris�� - x ,.� A4' ougla Radema her, Pro-Tem Sean P. Conway EXCUSED B rt?ara Kirkmeyer David E. Lo g C_ Act -t, i4 2009-3331 HL0019 Of i(ct.(/O i&tt; COLORADO Memorandum TO: William F. Garcia, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH, Director Department of Public Health and Environment DATE: December 16, 2009 1Mo J& C l0 0 c SUBJECT: Cancellation of Outstanding Accounts Receivable The Department of Public Health and Environment is requesting the Board of County Commissioners' approval to write off balances of individual client accounts which have had no payment activity since before July 1, 2009. These accounts are recorded in the Centricity patient management system and have been billed monthly. The enclosed report lists the ticket number, date and amount of last payment, and the outstanding balance of each ticket. The total amount requested to be written off is $19,073.96. Enclosure cc: Barb Connolly, Controller 2009-3331 WARNING This report can make data changes in your system. Please read these instructions carefully. This report gives you the opportunity to writeoff old patient balances in your database When you close this window you will be prompted by the system to update your database If you select Yes the balance write-offs will occur. If you are not sure you want to proceed with the writeoffs then select No. Criteria used for the write-off: Write off the patient balance for all visits where the visit date is before Create these write-off transactions as conveyances for the payor. Create these write-off transactions in the batch Create these write-off transactions as adjustments of type Company: Weld County Dept of Public Health and Environment- Last Payment Date before: 07/01/2009 Patient Name Last Payment 06/26/2009 06/16/2009 08/20/2008 12/18/2008 Last Payment $1.10 $6.90 $30.00 $10.00 07/09/2008 $19.00 02/03/2009 03/25/2009 06/23/2009 $10.00 $12.00 $41.00 03/24/2009 $10.00 10/09/2008 $30.00 09/08/2008 03/12/2009 08/27/2008 04/28/2009 06/03/2009 06/29/2009 12/11/2008 12/30/2008 05/27/2009 08/14/2008 10/27/2008 01/26/2009 $20.00 $16.00 $33.40 $20.00 $10.00 $15.00 $19.00 $50.00 $10.00 $10.00 $40.00 $38.00 04/27/2009 $12.55 02/19/2009 $20.00 05/22/2009 $7.25 09/19/2008 05/05/2009 04/30/2009 06/24/2009 $10.00 $25.00 $20.00 $10.00 Ticket Number FPN023400 FPN019425 MDN000630 FPN018739 FPN020341 FPN019033 FPN018599 FPN0 18158 FPN018415 FPN020990 FPN021762 FPN023262 FPN021829 FPN022335 FPN022409 FPN020072 FPN014262 FPN019373 FPN018972 FPN020167 FPN015016 FPN018838 FPN022354 FPN022959 FPN023104 FPN020236 FPN020452 FPN022833 FPN018651 FPN019626 FPN020854 IZCN012093 IZCN010818 FPN021089 FPN014894 FPN019960 FPN021222 FPN022781 IZCN0 11938 FPN0 19130 FPN021761 FPN022387 FPN023345 07/01/2009 Old Balance Write -Off jnero_20091216 Write Off Patient Balance $44.40 $12.30 $83.00 $18.90 $17.60 $49.80 $19.50 $107.25 $6.90 $7.25 $28.25 $9.75 $11.50 $122.50 $41.00 $9.00 $8.70 $22.50 $23.20 $4.70 $20.60 $19.50 $15.00 $30.75 $5.00 $39.60 $76.30 $12.00 $35.90 $3.20 $8.25 $58.80 $14.70 $17.50 $71.05 $57.75 $25.50 $10.00 $29.40 $33.20 $30.00 $4.50 $19.75 Patient Name Last Payment 02/19/2009 07/24/2008 01/21/2009 08/19/2008 08/13/2008 10/30/2008 02/02/2009 08/05/2008 08/29/2008 09/29/2008 02/10/2009 04/08/2009 03/24/2009 04/23/2009 06/29/2009 07/28/2008 10/06/2008 02/02/2009 11/10/2008 04/24/2009 06/26/2009 02/09/2009 06/30/2009 05/19/2009 04/13/2009 05/22/2009 04/21/2009 11/10/2008 06/30/2009 07/14/2008 06/05/2009 11/10/2008 04/10/2009 06/29/2009 12/10/2008 D3/31/2009 Last Payment Ticket Number Patient Balance $10.00 FPN021229 $22.00 FPN020290 $20.70 $25.00 IZCN010758 $19.10 FPN022026 $5.00 $14.70 IZCN012312 $14.70 $29.40 MIZC001657 $44.10 $20.00 FPN018634 $0.70 $30.00 FPN019693 $6.00 $20.00 FPN020946 $26.00 $10.00 FPN015368 $58.75 $60.00 FPN017683 $5.40 $12.50 FPN019241 $1.00 FPN020132 $19.00 IZCN012208 $29.40 Tv FPN020450 $14.25 IZCN012303 $14.70 FPN021544 $57.50 M IZC001643 $29.40 $20.00 FPN021095 $32.25 $36.00 MDN000706 $16.00 FPN023208 $88.00 $20.00 FPN021727 $14.50 $25.00 FPN022283 $48.50 FPN022936 $28.00 $18.80 FPN019599 $34.90 IZCN011060 $58.80 $10.00 FPN018387 $56.00 FPN019253 $46.50 $10.00 001220 $10.40 $22.70 FPN018150 $4.90 $22.00 FPN019832 $34.70 $20.00 FPN022287 $169.00 $5.00 FPN023411 $29.50 IZCN011873 $88.20 FPN019095 $17.10 $39.00 FPN021082 $19.50 FPN019922 $13.50 FPN020079 $22.50 $178.00 MDN000835 $75.00 $25.00 IZCN012754 $33.80 $16.00 FPN020726 $41.50 FPN020528 $25.25 $20.00 FPN022768 $14.75 $20.00 FPN022206 $14.75 FPN023169 $24.50 $10.00 IZCN011768 $48.80 FPN020637 $99.00 $20.00 FPN023451 $40.50 $11.60 FPN014534 $41.20 FPN020349 $34.80 FPN021317 $11.50 $30.00 FPN023012 $37.00 $10.00 FPN015103 $19.00 FPN021176 $27.00 $10.00 FPN022032 $31.00 IZCN012197 $20.00 IZCN012960 $14.70 $116.25 FPN022223 $80.50 IZCN010969 $14.70 $5.50 FPN020214 $8.90 $20.00 MIZC001825 $9.40 FPN020781 $73.00 'Patient Name Last Payment 03/24/2009 01/21/2009 11/17/2008 04/08/2009 08/27/2008 02/24/2009 09/19/2008 03/20/2009 08/22/2008 03/10/2009 03/11/2009 07/10/2008 09/05/2008 02/03/2009 06/23/2009 08/06/2008 04/22/2009 11/06/2008 11/21/2008 06/11/2009 10/21/2008 11/21/2008 09/09/2008 01/16/2009 07/31/2008 12/01/2008 10/15/2008 11/06/2008 12/09/2008 03/18/2009 05/06/2009 02/27/2009 11/25/2008 Last Payment Ticket Number FPN020414 FPN019765 $1.20 IZCN012088 IZCN012807 MIZC001896 $14.70 IZCN012311 IZCN012164 IZCN0 11308 $25.00 IZCN011828 $5.00 FPN021974 FPN022639 $20.00 FPN018835 FPN0 18144 IZCN013111 /FPS001425 $2.50 FPS001505 $20.00 FPN019140 $58.80 IZCN012663 $20.00 IZCN011066 IZCN011717 IZCN011716 $3.00 FPN019144 $7.00 FPN018129 FPN018276 $30.00 FPN016885 FPN018172 $20.00 FPN018941 $10.00 FPN020994 $20.00 FPN023322 FPN018443 FPN018693 $15.00 FPN017424 $10.00 FPN022244 FPN022377 $40.00 FPN015436 FPN020736 $20.00 IZCN011850 IZCN011916 FPN018247 FPN019501 $10.00 FPN021534 $10.00 FPN019549 $10.00 FPN019991 $30.00 FPN018983 IZCN012158 $30.10 IZCN012284 $10.00 IZCN010810 FPN021955 $10.00 FPN017545 FPN018382 $5.00 FPN019459 FPN018233 $29.40 IZCN011719 FPN020027 $50.00 FPN020207 $5.00 FPN021634 STDN000121 IZCN010909 $10.00 FPN022494 $8.00 IZCN010384 $10.00 IZCN011907 IZCN011528 Patient Balance $34.50 $7.00 $28.20 $14.70 $29.40 $14.70 $58.80 $58.80 $4.40 $83.50 $9.00 $14.80 $16.80 $88.20 $19.00 $12.50 $26.80 $14.70 $53.50 $14.70 $14.70 $24.60 $3.50 $156.90 $123.90 $17.10 $33.70 $16.25 $3.00 $19.00 $48.00 $9.00 $12.00 $40.25 $5.60 $27.00 $24.10 $14.70 $6.90 $60.60 $5.50 $27.80 $29.60 $116.40 $29.40 $14.00 $63.50 $36.00 $7.10 $35.10 $37.90 $45.90 $29.40 $63.70 $83.30 $7.25 $10.00 $29.40 $21.00 $6.70 $48.80 $44.10 Patient Name Last Payment 03/18/2009 05/20/2009 06/23/2009 04/16/2009 04/30/2009 01/14/2009 10/31/2008 05/28/2009 01/09/2009 08/20/2008 08/20/2008 02/17/2009 05/20/2009 05/27/2009 04/23/2009 05/19/2009 11/20/2008 07/31/2008 04/24/2009 09/11/2008 02/20/2009 05/05/2009 08/15/2008 05/26/2009 12/05/2008 01/28/2009 03/24/2009 01/14/2009 04/06/2009 08/18/2008 Last Payment Ticket Number $20.00 FPN021639 FPN022979 $20.00 FPN022723 $20.00 FPN023331 $6.00 FPN022128 IZCN012159 $20.00 FPN022396 FPN023350 FPN018202 FPN019924 MIZC001753 $5.00 FPN020671 $40.00 FPN019711 $4.50 FPN020023 IZCN0 11643 $25.00 IZCN012221 FPN021479 $30.00 IZCS000486 $30.00 IZCS000485 IZCN010928 $22.00 IZCN012099 $29.75 FPN022710 $10.00 FPN022826 FPN022856 FPN019347 FPN020850 MDN000734 $22.00 FPN021935 $20.00 FPN022703 IZCN0 12686 CDPN000186 FPN022433 FPN019823 FPN020540 IZCN012637 FPN018896 IZCN011193 $20.00 IZCN011849 $20.00 IZCN010819 $3.10 FPN019470 $8.00 FPN019034 $10.00 FPS001502 $26.30 FPN018730 $28.00 FPN018686 IZCN011398 $5.00 FPN022797 $20.00 FPN020152 $178.00 FPN020884 FPN019298 $50.00 IZCN011459 IZCN012087 IZCN012806 $15.00 FPN020672 $15.00 FPN021948 MIZC001832 FPN0 18254 $20.00 FPN018712 FPN020355 IZCN0 11852 FPN022842 IZCN012721 IZCN012377 Patient Balance $20.50 $15.50 $26.75 $24.00 $17.00 $73.50 $26.75 $17.50 $41.25 $37.80 $29.40 $137.50 $247.65 $100.00 $14.70 $19.10 $77.50 $43.50 $14.10 $29.40 $22.10 $2.50 $7.50 $14.75 $10.00 $38.00 $57.00 $29.00 $9.50 $14.70 $120.70 $12.25 $36.30 $16.75 $44.10 $33.00 $73.50 $9.40 $9.40 $95.35 $12.70 $50.75 $100.00 $95.15 $29.40 $1.00 $10.00 $75.00 $62.50 $8.80 $29.40 $14.70 $12.00 $11.25 $29.40 $45.00 $7.60 $104.50 $14.70 $12.25 $73.50 $14.70 Patient Name Last Payment 02/20/2009 10/16/2008 02/18/2009 09/10/2008 03/18/2009 12/10/2008 03/02/2009 10/22/2008 07/31/2008 07/24/2008 04/16/2009 05/27/2009 03/09/2009 06/29/2009 11/20/2008 03/25/2009 04/13/2009 02/02/2009 11/12/2008 09/25/2008 12/17/2008 09/29/2008 01/16/2009 05/06/2009 06/24/2009 08/22/2008 Last Payment Ticket Number $10.00 FPN021242 FPN020886 FPS001534 FPS001614 $54.25 FPS001020 FPS001457 IZCNO 12607 $2.50 FPN019978 IZCN011071 $3.90 FPN016813 FPN019161 FPN023110 IZCN0 11818 IZCN0 11819 FPN021296 FPN020356 FPN018736 $2.00 FPN019888 FPN021119 $55.00 FPN006889 FPN020428 $76.00 FPN019589 $15.00 FPN019567 $20.00 FPN018451 $13.90 FPN014287 FPN018366 $27.25 FPN022147 $178.00 FPN022824 FPN019598 FPN020750 $25.00 FPN018274 $2.50 FPN021925 IZCN0 11372 $10.00 FPN019970 FPN021684 $36.00 FPN021760 $20.00 FPN022058 FPN019830 $15.00 FPN020981 FPS001484 FPS001627 IZCN011644 MDN000707 FPN022052 FPS001552 $20.00 IZCN011792 $20.00 FPN019206 $50.00 FPN019630 $27.00 FPN019240 FPN018351 MDN000629 $12.00 IZCN012281 IZNA002024 $10.00 FPN018104 FPNO 19068 FPN021355 FPN019109 FPN020433 $10.00 FPN023346 IZCN012470 $40.10 IZCN010742 IZCN0 12001 Patient Balance $67.50 $50.00 $27.00 $9.00 $0.75 $33.50 $14.70 $21.80 $14.70 $55.50 $38.40 $11.50 $44.10 $44.10 $65.75 $5.00 $17.10 $5.00 $20.00 $59.56 $5.00 $7.00 $15.00 $4.00 $16.10 $51.30 $19.25 $77.50 $27.30 $36.00 $9.00 $33.50 $73.50 $10.00 $6.00 $14.75 $8.25 $59.40 $12.00 $54.00 $18.00 $73.50 $44.00 $22.00 $6.00 $24.10 $22.00 $37.10 $54.00 $13.50 $83.00 $76.20 $68.00 $146.90 $13.50 $11.50 $58.50 $34.20 $2.25 $73.50 $4.00 $29.40 Last Patient Name Last Payment Payment Ticket Number FPN023283 FPN0 18110 FPN019497 FPN019746 03/09/2009 $50.00 FPN012366 05/06/2009 $30.00 FPN022483 IZCN011445 FPN018319 IZCN0 11081 MCDP000108 06/03/2009 $25.00 FPN016936 FPN018456 02/09/2009 $25.00 FPN021035 FPN022368 04/29/2009 $15.50 A FPN018458 FPN019202 11/12/2008 $21.30 FPN019863 FPN021103 03/02/2009 $45.00 FPN021369 05/22/2009 $20.00 FPN022782 06/25/2009 $15.00 FPN020873 07/31/2008 $10.00 IZCN010809 IZCN010805 FPN021013 IZNA001948 08/25/2008 $17.10 FPN018805 03/23/2009 $20.00 FPN021700 04/14/2009 $10.00 FPN022085 01/22/2009 $10.00 FPN020805 03/11/2009 $20.00 IZCN012619 MIZC001767 01/23/2009 $10.60 IZCN012323 08/20/2008 $10.00 FPN018753 10/02/2008 $20.00 FPN019222 07/17/2008 $20.00 FPN018273 08/25/2008 $3.00 FPN018815 05/26/2009 $9.00 FPN018988 IZCN0 11168 04/28/2009 $7.00 FPN020082 IZCN0 11208 FPN0 18591 FPN018804 FPN019134 IZCN012064 IZCN012850 02/10/2009 $29.40 IZCN012433 FPN0 19925 FPN021212 IZCN013105 10/02/2008 $19.00 FPN019255 10/01/2008 $40.00 IZCN010906 IZCN0 11401 IZCN0 11438 01/16/2009 $35.00 IZCN012285 05/08/2009 $20.00 IZCN012901 IZCN0 11402 IZCN012652 FPN019750 IZCN012645 IZCN012354 IZCN012466 FPN019163 Patient Balance $20.75 $156.90 $20.10 $54.00 $1.70 $30.50 $44.10 $19.00 $58.80 $18.00 $30.50 $31.20 $13.25 $17.50 $4.00 $10.50 $3.00 $17.25 $20.50 $16.75 $16.00 $63.50 $58.80 $23.00 $29.40 $34.80 $55.75 $81.00 $24.50 $38.80 $50.00 $18.80 $7.10 $102.70 $24.70 $7.00 $211.00 $73.50 $22.00 $58.80 $36.00 $20.40 $13.50 $29.40 $14.70 $29.40 $19.50 $40.00 $29.40 $12.00 $33.50 $29.40 $29.40 $38.50 $20.00 $44.10 $58.80 $35.00 $73.50 $44.10 $58.80 $74.85 Last Patient Name Last Payment Payment Ticket Number FPN020016 FPN019839 02/24/2009 $20.00 FPN021282 IZCN012635 06/18/2009 $10.00 FPN023238 MIZC001638 IZCN012618 IZCN010738 IZCN010941 IZCN010940 01/14/2009 $50.00 IZCN012249 09/15/2008 $14.70 IZCS000519 FPN021239 07/31/2008 $30.00 FPN018459 IZCN011435 02/06/2009 $14.70 IZCN012408 IZCN011780 FPN019499 09/04/2008 $75.00 MDN000604 FPN021120 03/11/2009 $178.00 MDN000723 FPN020070 FPN020586 FPN019169 12/16/2008 $13.00 FPN020291 07/02/2008 $50.00 FPN017722 FPN018118 09/16/2008 $20.00 FPN019016 01/16/2009 $20.00 FPN020704 FPN022612 FPN019662 10/16/2008 $4.00 FPN019490 IZCN012353 IZCN0 11043 IZCN0 11042 04/29/2009 $10.00 FPN022382 IZNA001932 07/24/2008 $25.00 IZCN010757 IZCN010804 FPN018989 IZNA001946 08/04/2008 $36.75 IZCN010849 IZCN0 11264 08/15/2008 $30.00 IZCN011013 IZCN012913 IZNA001945 IZNA001921 IZCN0 11748 FPN018692 FPN018825 IZCN012508 IZCN012509 MIZC001644 IZCN0 11057 IZCN0 11058 IZCN011061 IZCN011074 08/22/2008 $14.70 IZCN011072 08/21/2008 $10.00 IZCN011064 IZCN0 11115 09/11/2008 $20.00 IZCN011271 FPS001414 Patient Balance $91.30 $154.00 $15.00 $88.20 $1.50 $73.50 $44.10 $29.40 $73.50 $58.80 $38.20 $14.70 $46.50 $42.10 $14.70 $14.70 $44.10 $29.00 $217.00 $27.75 $286.00 $26.10 $57.50 $26.10 $0.50 $30.70 $19.50 $9.10 $6.50 $48.50 $93.30 $26.90 $58.80 $58.80 $58.80 $2.25 $58.80 $19.10 $58.80 $103.00 $44.10 $51.45 $73.50 $28.80 $73.50 $73.50 $14.70 $88.20 $49.80 $33.00 $14.70 $14.70 $73.50 $29.40 $44.10 $58.80 $14.70 $14.70 $19.40 $14.70 $38.80 $27.00 Patient Name Last Last Payment Payment Ticket Number IZCN012112 IZCN0 11160 08/27/2008 $14.70 IZCN011141 IZNA001986 MIZC001789 FPN022140 MIZC001679 12/03/2008 $20.00 IZCN011955 IZCN0 11269 IZCS000530 09/19/2008 $26.00 FPN019132 09/19/2008 $10.00 MIZC001731 FPN022988 IZCN011390 FPN022249 IZCN011726 10/03/2008 $30.60 IZCN011454 10/22/2008 $40.00 IZCN011617 10/16/2008 $14.70 IZCN011577 10/08/2008 $5.30 IZCN011474 10/08/2008 $14.70 IZCN011473 IZCN0 12603 IZCN011499 05/15/2009 $14.70 IZCN012936 11/12/2008 $14.70 IZCN011796 FPN019303 05/29/2009 $20.00 FPN022864 IZCN0 11598 FPN022388 FPN019709 FPN021011 IZCN012204 03/16/2009 $12.00 IZCN012638 11/14/2008 $100.00 FPN019893 FPN022122 IZCN0 11906 FPNO 19731 11/21/2008 $10.00 FPN019996 02/04/2009 $178.00 FPN021000 FPN022464 IZCN0 11934 12/03/2008 $30.00 IZCN011943 FPN021993 04/08/2009 $10.00 FPN021998 IZCNO12019 12/15/2008 $50.00 IZCN0 12056 IZCN012092 IZCN012104 IZCN012892 IZCN012295 04/24/2009 $29.40 IZCN012832 IZCN0 12296 04/24/2009 $29.40 IZCN012833 IZCN0 11968 12/18/2008 $15.00 FPN020326 04/28/2009 $178.00 FPN021969 01/29/2009 $29.40 IZCN012359 IZCN0 12066 IZCN012195 IZCN0 12237 IZCN012210 IZCN012209 Patient Balance $14.70 $29.40 $14.70 $14.70 $29.40 $12.25 $58.80 $38.80 $44.10 $29.40 $0.40 $34.10 $40.75 $58.80 $8.00 $58.80 $28.20 $18.80 $29.40 $24.10 $14.70 $29.40 $29.40 $14.70 $44.10 $6.00 $16.75 $44.10 $12.25 $82.50 $31.00 $14.70 $2.70 $59.80 $16.75 $44.10 $38.00 $17.00 $85.00 $25.00 $58.80 $14.10 $11.25 $25.50 $14.70 $52.90 $58.80 $44.10 $44.10 $44.10 $29.40 $44.10 $14.70 $29.40 $20.00 $75.00 $29.40 $14.70 $44.10 $29.40 $29.40 $14.70 Patient Name Last Payment 06/11/2009 01/16/2009 02/17/2009 ' 01/22/2009 02/13/2009 03/25/2009 03/06/2009 05/04/2009 04/29/2009 03/30/2009 04/22/2009 05/20/2009 04/15/2009 05/15/2009 05/18/2009 05/12/2009 06/15/2009 06/25/2009 Last Payment Ticket Number IZCN012521 IZCN012478 IZCN012477 $27.00 IZCS000732 IZCN012286 IZCN012534 IZCN012305 $17.00 IZCN012283 IZCS000676 $14.70 IZCN012461 IZCN0 12399 IZCN012762 $5.00 FPN020795 IZCN012381 FPN021847 MIZC001795 IZCN012501 IZCN013009 $14.70 IZCN012450 IZCN012479 IZCN012503 $4.00 FPN021746 IZCN012969 IZCN012968 IZCN012781 FPN022954 $36.75 IZCN012599 $30.10 IZCN012614 MIZC001834 IZCN012631 FPN021714 $2.00 FPN0223°58 IZCN013150 $14.70 IZCN012712 $10.00 FPN022243 $10.00 FPN022711 $20.00 FPN022102 $20.00 FPN022614 $20.00 FPN022679 FPN022232 FPN022137 IZCN013072 IZCN012798 MIZC001846 MIZC001862 MIZC001844 FPN022446 TBN011854 IZCN012857 MIZC001900 MIZC001897 MIZC001899 $15.00 FPN022579 $10.00 FPN023185 TBN0 12007 $2.00 FPN023379 IZCN0 13026 FPN023377 Patient Balance $14.70 $14.70 $44.10 $2.40 $14.70 $29.40 $14.70 $12.40 $14.70 $14.70 $58.80 $44.10 $17.00 $44.10 $9.00 $25.00 $58.80 $29.40 $58.80 $50.00 $29.40 $5.00 $29.40 $14.70 $14.70 $29.50 $36.75 $14.00 $14.70 $44.10 $16.00 $4.00 $73.50 $14.70 $21.00 $12.00 $76.50 $37.75 $21.00 $6.00 $20.00 $44.10 $88.20 $14.70 $14.70 $29.40 $36.00 $20.00 $44.10 $44.10 $58.80 $44.10 $10.00 $27.50 $90.00 $20.00 $29.40 $12.25 $19,073.96 Hello