Claim total
$5,990.74
base $93.39 · payer covered $5,940.74
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2021-01-21
- Stop
- 2021-01-21
The parties
- Patient
- patient Javier Gregorio Mares
- Provider
- provider Dale Mertz
- Payer
- payer Medicaid
Record id
2d487497-28fb-9da5-23c2-4e09b7e6dc73