Claim total
$263.74
base $93.39 · payer covered $213.74
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2000-04-19
- Stop
- 2000-04-19
The parties
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
193e4bb3-7266-1ac6-a925-99252acdf420