3/14/01 22:06:22 Paul Quickhealer, M.D. Page 1
Production Revenue Report
All Providers Combined Transactions 8328 to 8695
Code Description # Amount # Reverse Amt
-----------------------------------------------------------------------
Charges
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90669 PREVNAR (PNEUMOCOCCA 1 $100.00 0 $0.00
90700 DPT 1 $55.00 0 $0.00
90713 POLIO VACCINE INJ 1 $43.00 0 $0.00
90732 PNEUMOCOCCAL 2 $60.00 0 $0.00
J0704 CELESTONE (6MG X ) 1 $6.50 0 $0.00
J2000 LIDOCAINE 2 $16.50 0 $0.00
J3302 MARCAINE 1 $6.50 0 $0.00
Type of Service I 9 $287.50 0 $0.00
81000 URINE DIP & MICROSCO 1 $30.00 0 $0.00
81002 URINALYSIS DIP 5 $75.00 0 $0.00
81025 PREGNANCY TEST 1 $28.00 0 $0.00
82270 GUIAC (STOOL) 2 $30.00 0 $0.00
82962 BLOOD SUGAR 5 $100.00 0 $0.00
82985 GLYCOPROTEIN 5 $325.00 0 $0.00
86580 PPD 2 $56.00 0 $0.00
87081 STREP SCREEN (QUICK 7 $245.00 0 $0.00
Type of Service L 28 $889.00 0 $0.00
99201 BRIEF NEW PT OFFICE 1 $67.00 0 $0.00
99202 LIMITED NEW PT O.V. 7 $672.00 0 $0.00
99203 INTERM NEW PT O.V. 3 $405.00 0 $0.00
99211 MINIMAL O.V. EST PT 3 $93.00 0 $0.00
99212 BRIEF O.V. EST PT 3 $156.00 0 $0.00
99213 LIMITED O.V. - ESTPT 39 $2808.00 0 $0.00
99214 INTERMED O.V. EST PT 18 $1980.00 0 $0.00
99244 OFFICE CONSULT/MOD-H 1 $187.00 0 $0.00
99311 NURSING HOME VISIT 12 $660.00 0 $0.00
99312 NURSING HOME VISIT 11 $990.00 0 $0.00
99313 NURSING HOME CARE EX 1 $100.00 0 $0.00
99348 EST PT HOME VISIT -L 1 $80.00 0 $0.00
99391 PREVENT CARE EST PT 1 $90.00 0 $0.00
99392 PREVENT CARE EST PT 1 $105.00 0 $0.00
Type of Service M 102 $8393.00 0 $0.00
90471 ADMIN 0NE IMMUNIZATI 2 $50.00 0 $0.00
90472 ADMIN IMMUNIZATIONS 1 $50.00 0 $0.00
92081 VISUAL FIELD EXAM 1 $25.00 0 $0.00
94760 OXIMETRY SINGLE 1 $30.00 0 $0.00
A4329 CATHETAR KIT 1 $50.00 0 $0.00
A4550 SURGICAL TRAY 6 $240.00 0 $0.00
G0009 ADMIN PNEUMONIA (MCA 2 $20.00 0 $0.00
Type of Service O 14 $465.00 0 $0.00
11042 DEBRIDE SKIN & SUBQ 1 $347.00 0 $0.00
11055 SHAVING/PARING BENIG 1 $55.00 0 $0.00
11307 SHAVE LESION 1.1-2.0 1 $138.00 0 $0.00
11400 EXCISION BENIGN LESI 1 $110.00 0 $0.00
11402 EXC BENIGN LESION 1. 1 $180.00 0 $0.00
11422 EXC BENIGN 1.1-2.0 C 1 $235.00 0 $0.00
17000 DESTRUCTION 1" BENIG 1 $93.00 0 $0.00
(Continued on next page)
3/14/01 22:06:22 Paul Quickhealer, M.D. Page 2
Production Revenue Report
All Providers Combined Transactions 8328 to 8695
Code Description # Amount # Reverse Amt
-----------------------------------------------------------------------
17003 DESTRUC 2ND-14TH LES 1 $30.00 0 $0.00
20550 TRIGGER POINT INJECT 1 $92.00 0 $0.00
45378 COLONOSCOPY 1 $560.00 0 $0.00
45380 COLONOSCOPY W/BIOPSY 1 $615.00 0 $0.00
46221 HEMORRHOIDECTOMY 1 $220.00 0 $0.00
53670 PLACEMENT URETHRA CA 1 $60.00 0 $0.00
Type of Service S 13 $2735.00 0 $0.00
1 BAD CHECK CHARGE 1 $20.00 0 $0.00
Type of Service Z 1 $20.00 0 $0.00
Total Charges 167 $12789.50 0 $0.00
Payments
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1 Cash 23 ($293.00) 0 $0.00
1 PVT PAY CASH PMT 1 ($120.00) 0 $0.00
2 PERSONAL CHECK 16 ($302.42) 0 $0.00
206 MEDICARE 9 ($540.19) 0 $0.00
253 AARP CLAIM UNIT 5 ($171.03) 0 $0.00
354 BLUE CROSS CALIFORNI 1 ($165.11) 0 $0.00
373 BLUE CROSS OF CALIF 1 ($34.75) 0 $0.00
386 BLUE CROSS PERS CARE 1 ($52.06) 0 $0.00
427 BLUE SHIELD OF CA PR 4 ($57.68) 0 $0.00
447 CAL FARM LIFE INS CO 1 ($95.56) 0 $0.00
504 COASTAL HEALTHCARE A 1 ($7.01) 0 $0.00
624 LIFEGUARD 42 ($2076.61) 0 $0.00
852 UNITED HEALTH CARE 2 ($66.40) 0 $0.00
920 R/R MEDICARE 1 ($38.52) 0 $0.00
1065 JT2 INTEGRATED SERVI 1 ($68.85) 0 $0.00
1066 UNITED HEALTHCARE 1 ($27.96) 0 $0.00
Total Payments 110 ($4117.15) 0 $0.00
Refunds
-----------
Total Refunds 0 $0.00 0 $0.00
Adjustments
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100 ADJUSTMENT 76 ($3531.35) 1 $.01
100 BAD CHECK#5761 0 $0.00 1 $15.00
Total Adjustments 76 ($3531.35) 2 $15.01
Regular + Reverse = Net
Charges $12789.50 $0.00 $12789.50
Payments ($4117.15) $0.00 ($4117.15)
Refunds $0.00 $0.00 $0.00
Adjustments ($3531.35) $15.01 ($3516.34)
Change in Accounts Receivable $5156.01
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