Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Ambulatory
- Code
- 394701000
- Reason
- diagnosis concept Childhood asthma233678006
- Start
- 2020-08-10
- Stop
- 2020-08-10
The parties
- Provider
- provider Liz Kozey
- Payer
- payer Medicaid
Record id
014b9cfb-a71a-d032-00fd-b0ec1d080b7d