86 / 93
86
1
P
46
SP F
40-49
R079
CHEST PAIN, UNSPECIFIED
10
3/8/2017
$53,287
$10,868
$64,155
1
P
47
CH M
1-17
K219
GASTRO-ESOPHAGEALREFLUX DISEASE WITHOUT ESOPHAGITIS
10
12/29/2016
$6,316
$35,388
$41,703
1
P
48
EE F
50-59
M1611
UNILATERAL PRIMARY OSTEOARTHRITIS,RIGHT HIP
10
12/15/2016
$150
$28,575
$28,726
1
P
49
EE M
50-59
K353
ACUTE APPENDICITIS WITH LOCALIZED PERITONITIS
10
2/13/2017
$0
$44,515
$44,515
1
P
50
EE F
50-59
K529
NONINFECTIVE GASTROENTERITIS AND COLITIS, UNSPECIFIED
10
4/10/2017
$1,674
$23,115
$24,788
1
P
50
EE F
60-64
PH
PHARMACY
*
4/17/2017
$496
$0
$496
MEMBER ID Total
$2,169
$23,115
$25,284
1
P
51
SP M
50-59
I639
CEREBRAL INFARCTION, UNSPECIFIED
10
4/18/2017
$3,020
$93,910
$96,930
1
P
52
SP F
40-49
K599
FUNCTIONAL INTESTINAL DISORDER, UNSPECIFIED
10
4/6/2017
$47,975
$219,187
$267,162
1
P
53
CH M
18-29
K352
ACUTE APPENDICITIS WITH GENERALIZED PERITONITIS
10
3/3/2017
$254
$37,993
$38,247
1
P
54
SP F
50-59
H539
UNSPECIFIED VISUAL DISTURBANCE
10
4/20/2017
$17,490
$65,075
$82,565
Grand Total
$860,451
$4,440,476
$5,300,927