Claim total
$2,601.09
base $93.39 · payer covered $2,498.69
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2024-11-03
- Stop
- 2024-11-03
The parties
- Patient
- patient Al Osvaldo Torphy
- Provider
- provider Pasquale Grimes
- Payer
- payer Medicaid
Record id
2d20e4a5-a8a1-5b87-807a-ddbaff15a415