Claim total
$126.64
base $93.39 · payer covered $76.64
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2026-05-07
- Stop
- 2026-05-07
The parties
- Patient
- patient Millie Latrina Franecki
- Provider
- provider Tiffany Smitham
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
293b5046-ff66-69d2-bd3b-0e454f969f2b