Charged
$123.00
$123.00 paid
The claim
- Patient
- patient Ronnie Ina Gusikowski
- Serviced
- 1975-06-04illness from the same day
- Status
- Closedlast billed 1975-06-04 · 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
003b30a0-7fd2-f42c-dec4-97b006d91683