Claim total
$173.06
base $93.39 · payer covered $123.06
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2025-06-23
- Stop
- 2025-06-23
The parties
- Patient
- patient Tyrone Federico Runte
- Provider
- provider Rebeca Lomeli
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
2efa4584-c745-0aea-16a1-d03f9f7e1887