Claim total
$751.47
base $93.39 · payer covered $701.47
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2020-03-18
- Stop
- 2020-03-18
The parties
- Patient
- patient Sidney Champlin
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
33cb6c8c-a991-8f91-955a-b3fa39fa71f2