Claim total
$2,601.09
base $93.39 · payer covered $2,551.09
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2019-04-03
- Stop
- 2019-04-03
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Boris Lynch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00e3929f-91f8-0715-6dbc-c7eb744d2eff