Claim total
$564.31
base $93.39 · payer covered $514.31
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2021-05-29
- Stop
- 2021-05-29
The parties
- Patient
- patient Simonne Karol Waters
- Provider
- provider Troy Leannon
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
0bf434c4-3a7d-8f3d-e9e2-3fddcf102895