Patient & Insurance
- Patient
- Ethan Sun
- DOB
- 1990-07-15
- Payer
- Aetna
- Clinic
- Bay Area Lymphedema Clinic
- Therapist
- Ethan Sun
- Ship to
- 210 Market Street, San Francisco, CA 94105
Order Items
| Product | HCPCS | Vendor | Qty | Cost | Billable |
|---|---|---|---|---|---|
| Compression Arm Sleeve, Class II | A6531 | Medi | 1 | $45.00 | $72.00 |
| Compression Gauntlet | A6530 | Juzo | 1 | $38.00 | $56.00 |
Financial Summary
Total Cost
$83.00
Billable Amount
$128.00
Margin
35.2%
Patient Owes
$0.00
Document generation — coming in Sprint 2
Encounter form, patient invoice with Stripe payment link, and proof of delivery will be generated from this order automatically.