Claim total
$428.32
base $93.39 · payer covered $393.32
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2025-12-30
- Stop
- 2025-12-30
The parties
- Patient
- patient Clinton Milton Farrell
- Provider
- provider Morton Boyer
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
08e8a4a7-f9de-c053-ee63-f4e1928fa431