Claim total
$741.21
base $93.39 · payer covered $706.21
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2021-01-16
- Stop
- 2021-01-16
The parties
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
021142be-3a32-af72-8bc6-9ebb4caf90c9