Claim total
$93.39
base $93.39 · payer covered $25.31
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2024-03-28
- Stop
- 2024-03-28
The parties
- Patient
- patient Dorotea Yolanda Palomo
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
04ad2732-b952-4fbb-3273-fc62aad78d38