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Visit # 2 : The patient is sent for routine annual blood work panel. The provider's normal fee for this service is $ 2 1

Visit #2: The patient is sent for routine annual blood work panel. The provider's normal fee for this service
is $218.00. The payer's fee schedule shows an allowed amount of $147.00. The patient is not required to
pay a copay for this visit.
a. Enter the amount of the patient's deductible at the beginning of this visit:
b. Enter the amount the patient pays against their deductible for this visit:
c. Enter the remaining amount owed to the provider: $
+2-cos
d. Enter the amount of coinsurance to be paid by the patient: $
e. Enter the amount of coinsurance to be paid by the payer: $1
f. Enter the TOTAL amount that is paid by the patient: $
]
g. Enter the amount the provider "writes off" the account: $71.00
h. Enter the total amount the provider will be reimbursed for this service:
i. Enter the amount of the patient's deductible at the end of this visit: $
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