Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Outpatient
- Code
- 185345009
- Reason
- diagnosis concept Otitis media65363002
- Start
- 2025-05-14
- Stop
- 2025-05-14
The parties
- Patient
- patient Kendrick Jewell Jerde
- Provider
- provider Rebeca Lomeli
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
020a56e3-5d79-5c72-f868-bb1ae3819ceb