Claim total
$159.34
base $93.39 · payer covered $109.34
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2025-12-07
- Stop
- 2025-12-07
The parties
- Patient
- patient Theron Abdul Kertzmann
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
186be1ce-80f3-681d-8a6a-c37d48a4f908