Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Ambulatory
- Code
- 394701000
- Reason
- diagnosis concept Childhood asthma233678006
- Start
- 2016-12-27
- Stop
- 2016-12-27
The parties
- Patient
- patient Cecil Norberto Franecki
- Provider
- provider Burton O'Conner
- Payer
- payer Medicaid
Record id
05e47734-a2d3-8a46-86ed-1bf08095df69