Claim total
$126.29
base $93.39 · payer covered $76.29
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2019-10-07
- Stop
- 2019-10-07
The parties
- Patient
- patient Susanne Jenna Hahn
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
0ba36fae-b9a3-10c0-1177-6530fb506a69