Claims
48 claims loaded for Riley Sandoval from Acme Health Plan (synthetic)
spanning 2025-01-06 to 2026-06-27
| Type | Provider | Service date | Billed | Plan paid | Your share | |
|---|---|---|---|---|---|---|
| pharmacy | MediSave Rx | 2026-06-27 | $51.29 | $41.29 | $10.00 | view → |
| professional | Riverbend Orthopedics | 2026-06-09 | $640.00 | $288.00 | $352.00 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2026-05-07 | $28.29 | $18.29 | $10.00 | view → |
| professional | Midtown Imaging Center | 2026-04-11 | $663.66 | $330.93 | $332.73 | view → |
| pharmacy | Corner Pharmacy #204 | 2026-04-03 | $56.78 | $46.78 | $10.00 | view → |
| professional | Riverbend Orthopedics | 2026-03-19 | $876.56 | $141.25 | $735.31 | view → |
| pharmacy | Corner Pharmacy #204 | 2026-03-18 | $52.00 | $7.00 | $45.00 | view → |
| pharmacy | Corner Pharmacy #204 | 2026-03-15 | $34.46 | $24.46 | $10.00 | view → |
| professional | Riverbend Orthopedics | 2026-03-08 | $359.03 | $279.68 | $79.35 | view → |
| institutional | Harborview Surgical Pavilion | 2026-02-25 | $1,115.43 | $212.34 | $903.09 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2026-02-23 | $266.33 | $226.33 | $40.00 | view → |
| institutional | St. Aurelia Medical Center | 2026-02-21 | $2,340.00 | $0.00 | $2,340.00 | view → |
| professional | Northgate Urgent Care | 2026-02-13 | $410.00 | $93.50 | $316.50 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2026-01-22 | $465.00 | $425.00 | $40.00 | view → |
| institutional | Harborview Surgical Pavilion | 2026-01-19 | $1,080.67 | $144.54 | $936.13 | view → |
| professional | Midtown Imaging Center | 2026-01-11 | $280.37 | $212.81 | $67.56 | view → |
| pharmacy | MediSave Rx | 2026-01-07 | $391.60 | $351.60 | $40.00 | view → |
| professional | Lakeview Family Medicine | 2025-12-11 | $581.80 | $469.03 | $112.77 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2025-12-02 | $354.00 | $314.00 | $40.00 | view → |
| professional | Cedar Grove Dermatology | 2025-11-27 | $271.37 | $205.16 | $66.21 | view → |
| pharmacy | Corner Pharmacy #204 | 2025-11-26 | $29.18 | $19.18 | $10.00 | view → |
| professional | Lakeview Family Medicine | 2025-11-06 | $285.00 | $255.00 | $30.00 | view → |
| professional | Lakeview Family Medicine | 2025-11-06 | $285.00 | $255.00 | $30.00 | view → |
| professional | Northgate Urgent Care | 2025-10-20 | $688.97 | $560.12 | $128.85 | view → |
| professional | Cedar Grove Dermatology | 2025-10-08 | $165.00 | $135.00 | $30.00 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2025-10-04 | $28.10 | $18.10 | $10.00 | view → |
| professional | Midtown Imaging Center | 2025-09-14 | $1,480.00 | $0.00 | $1,480.00 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2025-09-04 | $44.07 | $34.07 | $10.00 | view → |
| institutional | St. Aurelia Medical Center | 2025-08-24 | $3,683.97 | $3,131.37 | $552.60 | view → |
| pharmacy | Corner Pharmacy #204 | 2025-08-07 | $47.29 | $37.29 | $10.00 | view → |
| pharmacy | Corner Pharmacy #204 | 2025-07-12 | $299.42 | $259.42 | $40.00 | view → |
| professional | Midtown Imaging Center | 2025-07-07 | $121.04 | $77.38 | $43.66 | view → |
| professional | Lakeview Family Medicine | 2025-06-19 | $213.60 | $156.06 | $57.54 | view → |
| pharmacy | MediSave Rx | 2025-06-14 | $260.31 | $220.31 | $40.00 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2025-05-14 | $204.75 | $164.75 | $40.00 | view → |
| professional | Lakeview Family Medicine | 2025-05-13 | $328.28 | $155.87 | $172.41 | view → |
| professional | Cedar Grove Dermatology | 2025-04-27 | $238.58 | $106.32 | $132.26 | view → |
| pharmacy | MediSave Rx | 2025-04-05 | $54.10 | $44.10 | $10.00 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2025-03-21 | $277.59 | $237.59 | $40.00 | view → |
| professional | Cedar Grove Dermatology | 2025-03-11 | $165.00 | $135.00 | $30.00 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2025-03-08 | $25.52 | $15.52 | $10.00 | view → |
| professional | Riverbend Orthopedics | 2025-03-06 | $377.47 | $183.06 | $194.41 | view → |
| professional | Lakeview Family Medicine | 2025-02-12 | $262.01 | $119.26 | $142.75 | view → |
| pharmacy | MediSave Rx | 2025-02-10 | $40.56 | $30.56 | $10.00 | view → |
| pharmacy | MediSave Rx | 2025-02-06 | $303.64 | $263.64 | $40.00 | view → |
| pharmacy | Acme Mail Order Pharmacy | 2025-01-23 | $51.36 | $41.36 | $10.00 | view → |
| pharmacy | MediSave Rx | 2025-01-22 | $432.69 | $392.69 | $40.00 | view → |
| professional | Midtown Imaging Center | 2025-01-06 | $374.65 | $181.49 | $193.16 | view → |
Raw claim feed. Analysis of what should not have left your pocket arrives in the next release.