HealthCare Provider Name

Your Billing Statement

Service Details

You received an Annual Physical Examination on January 15, 2025. This comprehensive check-up included:

  • General physical exam and health history review
  • Blood pressure and heart rate check
  • Basic blood work (Complete Blood Count and Metabolic Panel)
  • Cholesterol screening
  • Body Mass Index (BMI) calculation
Total Cost of Services$500.00
Amount Covered by Your Insurance$400.00
Your Responsibility (Amount You Owe)$100.00

This is the portion of the bill that your insurance doesn't cover. It may include your deductible, co-pay, or co-insurance as specified by your insurance plan.