Medical Tax Invoice 328223113005
Dr Vanessa Sammons
MBBS(Hons), BMPhil, FRACS
Provider Number290418DX
AHPRA:MED0001197425
ABN: 40 488 067 017
Neurosurgeon
P.O. Box 304 MAWSON ACT 2607
Toll Free: 1800 673 118
Invoice To: Angela Niven Fax: (02) 6223 5293
58 O'shea Circuit
[email protected] CESSNOCK NSW 2325 www.probills.com.au
MEMORANDUM OF FEES - Receipt
Patient: Angela Niven Invoice Number: 328223113005
Hospital: Gosford Private Hospital Invoice Date: 15/12/2023
Referring Dr: Not Required, (NR) Health Fund: AIA Health Insurance
Referral Date:
Referral Period:
Date Item Numbers Procedure Service Details
Gap payment fee for medical services. This is your out of pocket $6,600.00
expense based on health fund details listed above.
30/11/2023 45500 * Microvascular repair using microsurgical techniques, with restoration $1,200.10
of continuity of artery or vein of distal extremity or digit; cannot be
claimed by the same provider for both artery and vein (H) (Anaes.)
(Assist.)
30/11/2023 39321 * Transposition of nerve, excluding the ulnar nerve at the elbow, other $260.70
than a service associated with a service to which item 39330 applies
(H) (Anaes.) (Assist.)
30/11/2023 39321 * Transposition of nerve, excluding the ulnar nerve at the elbow, other $130.35
than a service associated with a service to which item 39330 applies
(H) (Anaes.) (Assist.)
30/11/2023 39321 * Transposition of nerve, excluding the ulnar nerve at the elbow, other $130.35
than a service associated with a service to which item 39330 applies
(H) (Anaes.) (Assist.)
30/11/2023 39321 * Transposition of nerve, excluding the ulnar nerve at the elbow, other $130.35
than a service associated with a service to which item 39330 applies
(H) (Anaes.) (Assist.)
30/11/2023 39321 * Transposition of nerve, excluding the ulnar nerve at the elbow, other $130.35
than a service associated with a service to which item 39330 applies
(H) (Anaes.) (Assist.)
30/11/2023 39321 * Transposition of nerve, excluding the ulnar nerve at the elbow, other $130.35
than a service associated with a service to which item 39330 applies
(H) (Anaes.) (Assist.)
Total Fee $8,712.55
RECEIPT DETAILS as at: 21/06/2024
Payment Date Detail Bank Amount
28/11/2023 EFT to PBA $3,600.00
29/11/2023 Credit Card $3,000.00
30/01/2024 Deposited by Dr Vanessa Sammons $1,486.65
Total Fee $8,712.55
Amount Received $8,086.65
Amount Outstanding $625.90
Charge to your credit card (including Probills Australia credit card surcharge) is $3,036.00
The services covered by this invoice are GST free
Please contact our office before making over the counter payments
To obtain information on our privacy statement call 1800 673 118 or visit www.probills.com.au
Non-payment of this account by due date may result in formal debt recovery action being initiated
Medical Tax Invoice 328223113005
Dr Vanessa Sammons
MBBS(Hons), BMPhil, FRACS
Provider Number290418DX
AHPRA:MED0001197425
ABN: 40 488 067 017
Neurosurgeon
P.O. Box 304 MAWSON ACT 2607
Toll Free: 1800 673 118
Invoice To: Angela Niven Fax: (02) 6223 5293
58 O'shea Circuit
[email protected] CESSNOCK NSW 2325 www.probills.com.au
MEMORANDUM OF FEES - Receipt
Patient: Angela Niven Invoice Number: 328223113005
Hospital: Gosford Private Hospital Invoice Date: 15/12/2023
Referring Dr: Not Required, (NR) Health Fund: AIA Health Insurance
Referral Date:
Referral Period:
Date Item Numbers Procedure Service Details
Payment Options
Credit Card Payments EFT Transfer Cheque or Money Order
(Mastercard or Visa ONLY)
Amount $625.90 Amount $625.90
1.2% Surcharge applies to all card payments
Bank Commonwealth Bank of Australia Made payable to
Amount $625.90 Account Probills Australia Pty Ltd - Holding Vanessa Sammons
Ref # 328223113005 BSB 062-908
Acc No 10781839
Online www.probills.com.au
Ref no. 328223113005
or The above reference number must be included Please mail to P.O. Box 304
Phone 1800 673 118 (business hours) on ALL EFT or Over the counter transactions MAWSON ACT 2607
ProBills Australia will show as the merchant on Cheques may take up to
For International Payments
your credit card statement 7 working days to process
BIC/Swift Code: CTBAAU2S
Charge to your credit card (including Probills Australia credit card surcharge) is $3,036.00
The services covered by this invoice are GST free
Please contact our office before making over the counter payments
To obtain information on our privacy statement call 1800 673 118 or visit www.probills.com.au
Non-payment of this account by due date may result in formal debt recovery action being initiated
