Claim total
$751.47
base $93.39 · payer covered $701.47
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2025-05-27
- Stop
- 2025-05-27
The parties
- Patient
- patient Humberto Milo Mitchell
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
1f081ea7-4272-5474-3b2c-7bb560dddc60