Claim total
$174.38
base $93.39 · payer covered $124.38
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2017-07-14
- Stop
- 2017-07-14
The parties
- Provider
- provider Tiffany Smitham
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
1b00e6e0-7b06-f7dc-cd95-dd1a14b3a95f