Claim total
$505.28
base $93.39 · payer covered $355.28
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2025-01-30
- Stop
- 2025-01-30
The parties
- Patient
- patient Nelda Flo Smith
- Provider
- provider Nicolas Raynor
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
31763af1-0d0a-afc7-dffd-67133b102a3e