Invoice Radiologist in Canada Vancouver –Free Word Template Download with AI
1234 Burrard Street, Suite 500
Vancouver, BC V6Z 2C7
Canada
Phone: (604) 555-0198
Email: [email protected]
Business Number: 123456789RC0001
Invoice Number: INV-2024-0892
Date Issued: October 15, 2024
Due Date: November 15, 2024
Service Period: October 1-15, 2024
Bill To:
Dr. Sarah Mitchell, MD
Internal Medicine Specialist
4567 Granville Street, Suite 300
Vancouver, BC V6H 3J8
Canada
Phone: (604) 555-0234
Email: [email protected]
Medical License: BC-12345
| Item # | Description of Radiology Services | Quantity | Unit Price (CAD) | Total (CAD) |
|---|---|---|---|---|
| 1 |
Magnetic Resonance Imaging (MRI) - Brain with Contrast Performed by: Dr. James Chen, Radiologist Patient: John Doe (DOB: 1965-03-12) Date of Service: October 3, 2024 CCI Code: 3.1.0020.001 Detailed interpretation and diagnostic report provided in accordance with Canadian College of Radiologists standards. |
1 | $850.00 | $850.00 |
| 2 |
Computed Tomography (CT) Scan - Chest with Contrast Performed by: Dr. Emily Wong, Radiologist Patient: Jane Smith (DOB: 1978-07-25) Date of Service: October 5, 2024 CCI Code: 3.2.0010.001 Comprehensive analysis including pulmonary embolism protocol assessment. |
1 | $720.00 | $720.00 |
| 3 |
Ultrasound - Abdominal Complete Performed by: Dr. Michael Park, Radiologist Patient: Robert Johnson (DOB: 1952-11-08) Date of Service: October 7, 2024 CCI Code: 3.3.0030.001 Evaluation of liver, gallbladder, pancreas, spleen, kidneys, and major vessels. |
1 | $450.00 | $450.00 |
| 4 |
Mammography - Diagnostic Bilateral Performed by: Dr. Lisa Thompson, Radiologist Patient: Mary Williams (DOB: 1960-04-15) Date of Service: October 9, 2024 CCI Code: 3.4.0010.001 BI-RADS assessment included with detailed findings and recommendations. |
1 | $380.00 | $380.00 |
| 5 |
X-Ray - Lumbar Spine (3 Views) Performed by: Dr. David Lee, Radiologist Patient: Thomas Brown (DOB: 1945-09-30) Date of Service: October 10, 2024 CCI Code: 3.5.0020.001 Assessment for degenerative changes and alignment abnormalities. |
1 | $180.00 | $180.00 |
| 6 |
Interventional Radiology - Image-Guided Biopsy Performed by: Dr. James Chen, Radiologist Patient: Patricia Davis (DOB: 1970-06-22) Date of Service: October 12, 2024 CCI Code: 3.6.0010.001 Ultrasound-guided core needle biopsy of thyroid nodule with specimen handling. |
1 | $1,200.00 | $1,200.00 |
| 7 |
Consultation - Complex Case Review Performed by: Dr. Emily Wong, Radiologist Date of Service: October 14, 2024 Multidisciplinary tumor board consultation regarding metastatic disease imaging findings. 60-minute consultation including review of prior imaging studies. |
1 | $350.00 | $350.00 |
| 8 |
After-Hours Emergency Interpretation Fee Performed by: Dr. Michael Park, Radiologist Date of Service: October 11, 2024 Urgent CT head interpretation for stroke protocol outside regular business hours. Report delivered within 30 minutes of image acquisition. |
1 | $250.00 | $250.00 |
| Subtotal: | $4,380.00 |
| HST (5% - BC Provincial Rate): | $219.00 |
| Total Amount Due (CAD): | $4,599.00 |
Payment Terms and Important Information:
Payment Due: Payment is due within 30 days of the invoice date. Please reference invoice number INV-2024-0892 with all payments.
Payment Methods: Payments can be made via electronic funds transfer (EFT), cheque, or credit card. For EFT details, please contact our billing department at [email protected].
Insurance Billing: If this invoice is to be submitted to your medical insurance provider, please ensure all patient information and CCI codes are verified for coverage under your plan. West Coast Radiology Associates is registered with all major Canadian health insurance providers operating in British Columbia.
Disputes: If you have any questions or disputes regarding this invoice, please contact our billing department within 15 days of receipt. All disputes must be submitted in writing with supporting documentation.
Late Payment: A late fee of 1.5% per month will be applied to outstanding balances after the due date, in accordance with British Columbia commercial practices.
Privacy: All patient information included in this invoice is handled in strict accordance with the Personal Information Protection and Electronic Documents Act (PIPEDA) and British Columbia's Freedom of Information and Protection of Privacy Act (FIPPA).
Currency: All amounts are quoted in Canadian Dollars (CAD). Foreign currency conversions are the responsibility of the payer.
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