MSI

Submitted $238.00

Paid $234.00

Outstanding $316.00

Blue Cross

Submitted $95.00

Paid $120.00

Outstanding $190.00

Green Shield

Submitted $0.00

Paid $0.00

Outstanding $0.00

Private Pay

Submitted $0.00

Paid $95.00

Outstanding $95.00

Case	Payer	Amount	Status	Submitted	Paid	Actions
Dorothy Chen	Blue Cross	$95.00	Not Submitted	—	—
Dorothy Chen	Blue Cross	$95.00	Submitted	Mar 7	—
Dorothy Chen	Blue Cross	$120.00	Paid	Feb 21	Mar 7