Payment Details
Payment Priority
1000
Payment Priority Note
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error_outlineBilling Details
| Income Type | Catalog Price (฿) |
Discount / Addition (฿) |
Billable Amount (฿) |
Microsoft 1 C.C (Payment By Company) | Aviva 2 INS | Self Pay (฿) 3 SP | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Stmt. Amt. (฿) | Coverage (฿) | Actual Amt. (฿) | Stmt. Amt. (฿) | Coverage (฿) | Actual Amt. (฿) | Stmt. Amt. (฿) / VAT Item Total |
Actual Amt. (฿) | |||||
| 1.1 Hospital Medical Expenses | 3000.00 | - 35.00 | 2700.00 | 2000.00 | 700.00 | 00.00 00.00 |
||||||
| 1.2 Health Professional Fees | 2000.00 | - 40.00 | 1800.00 | 1000.00 | 800.00 | 00.00 00.00 |
||||||
| 1.1.1 Drugs and Parenteral Nutrition | 5000.00 | - 300.00 | 4500.00 | 1000.00 | 1500.00 | 2000.00 00.00 |
||||||
| 1.1.14 (1) Lorem Ipsum Medical Pack... | 2500.00 | - 250.00 | 2250.00 | 1000.00 | 1000.00 | 250.00 00.00 |
||||||
| Total | 12,500.00 | - 525.00 | 11,975.00 | 5,000.00 | 5,000 | 4,000.00 | 4,000 | 2,250.00 | 2,250 | |||
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Billing Note
Billing Note
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam nunc lorem, viverra vel nulla a, convallis sagittis felis. Sed hendrerit odio sit amet sapien rhoncus feugiat.
error_outlineLorem ipsum dolor sit amet, consectetur adipiscing elit. Nam nunc lorem, viverra vel nulla a.
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