Charged
$104.72
$104.72 paid
The claim
- Patient
- patient Salvador Hernán Marrero
- Serviced
- 2022-05-17illness from the same day
- Status
- Closedlast billed 2022-05-17 · type 2
- Diagnoses
- diagnosis concept Acute bronchitiscode 10509002
- Billed for
- medication concept Acetaminophen 325 MG Oral Tabletcode 313782
Settlement
- Coverage
- payer Medicaid no secondary insurer
- Outstanding
- Nothing outstandingsettled in full
Record id
003934f5-fa99-8d07-0699-6b1ead052f8d