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EFTA00520767
I Guided Breast Biopsy o MRI Guided Wire Localization $ 2,200.00 $ 3,600.00 $ 2,700.00 Patient's Signature:1( Date: EFTA00520770 SCHAFFER, SCHONHOLZ & DROSSNIAN, LLP 315 West 57th Street - LL4 New York, NY 10019 Patient's Name: Date of Exam: .Bwkayfrilirgigytscmgittiqp.HEn (Plen,. print legibly) Mc 0:
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