Claim total
$751.47
base $93.39 · payer covered $701.47
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-11-24
- Stop
- 2018-11-24
The parties
- Patient
- patient Le Rosella Marks
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
08d0bbfe-3183-9cfc-2a09-020a7792ef7f