Invoice Radiologist in United States Miami –Free Word Template Download with AI
1200 Brickell Avenue, Suite 800
Miami, FL 33131, United States
Phone: (305) 555-0199 | Fax: (305) 555-0198
Email: [email protected]
NPI: 1234567890 | FL Tax ID: 20-1234567
Invoice Number: INV-2023-10-045
Date Issued: October 24, 2023
Due Date: November 24, 2023
Service Period: October 1, 2023 - October 20, 2023
Bill To:
Dr. Elena Rodriguez
South Florida Orthopedic Group
888 SW 8th Street, Suite 200
Miami, FL 33130, United States
Account #: SFO-998877
Pay To:
Miami Advanced Radiology Associates
Bank: Bank of America
Routing #: 026009593
Account #: 9876543210
Reference: Invoice INV-2023-10-045
| Date | Description of Radiological Services | CPT Code | Qty | Unit Price | Total |
|---|---|---|---|---|---|
| Oct 02 | MRI of the Lumbar Spine without contrast, performed by board-certified Radiologist. Includes detailed interpretation and report. | 72148 | 1 | $1,200.00 | $1,200.00 |
| Oct 05 | CT Scan of the Chest with contrast. High-resolution imaging for pulmonary evaluation. Radiologist interpretation included. | 71260 | 1 | $950.00 | $950.00 |
| Oct 08 | Mammography, bilateral, diagnostic. Performed by specialized Radiologist in Miami facility. Includes consultation. | 77065 | 1 | $600.00 | $600.00 |
| Oct 12 | Ultrasound of the Abdomen, complete. Real-time imaging with Radiologist supervision and diagnostic report. | 76700 | 1 | $450.00 | $450.00 |
| Oct 15 | X-Ray of the Knee, 2 views. Digital radiography with immediate Radiologist interpretation. | 73562 | 1 | $150.00 | $150.00 |
| Oct 18 | Professional Fee: Radiologist consultation for complex case review and second opinion on MRI findings. | 99245 | 1 | $350.00 | $350.00 |
Terms and Conditions
1. Payment is due within 30 days of the invoice date. Late payments may incur a 1.5% monthly interest charge.
2. All services were performed by licensed Radiologists in compliance with Florida state regulations and United States federal healthcare standards.
3. Please include the invoice number as a reference when making payments.
4. For questions regarding this invoice or the radiological services provided, please contact our billing department at (305) 555-0199.
5. This invoice is valid for services rendered in Miami, FL. Out-of-network rates may apply.
Authorized by:
Dr. James Carter, MD
Chief Radiologist
Miami Advanced Radiology Associates
Received by:
__________________________
Date: ____________________
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