Charged
$432.95
$432.95 paid
The claim
- Patient
- patient Salvador Hernán Marrero
- Serviced
- 2025-05-29illness from the same day
- Status
- Closedlast billed 2025-05-29 · type 2
- Diagnoses
- diagnosis concept Viral sinusitiscode 444814009
- Billed for
- medication concept Amoxicillin 250 MG / Clavulanate 125 MG Oral Tabletcode 562251
Settlement
- Coverage
- payer Medicaid no secondary insurer
- Outstanding
- Nothing outstandingsettled in full
Record id
003934f5-fa99-8d07-88db-c8818d872451