DIAGNOSIS DAYS EPSOT OR RENDERING MM DD YY MM DO YY GERNICE EMG CPTHCPCS MODIFIER POINTER $ CHARGES LIMITS PROVIDER 10 Ihealyou, DO 05 05 19 05 05 19 11 99214 1,2,3 175.00 NPI 9876543210 NPI NPI NPI NPI NPI
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Get it written →DATES) OF SERVICE L. D. PROCEDURES, SERVICES, OR SUPPLIES G H. From To PLACE OF (Explain Unusual Circumstances)] DIAGNOSIS DAYS EPSOT OR RENDERING MM DD YY MM DO YY GERNICE EMG CPTHCPCS MODIFIER POINTER $ CHARGES LIMITS PROVIDER 10 Ihealyou, DO 05 05 19 05 05 19 11 99214 1,2,3 175.00 NPI 9876543210 NPI NPI NPI NPI NPI
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