Claim total
$126.29
base $93.39 · payer covered $91.29
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2025-12-03
- Stop
- 2025-12-03
The parties
- Provider
- provider Charlie Tillman
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Dual Eligible
Record id
0da4d500-73bd-541a-47b9-a36278651579