Claim total
$420.88
base $93.39 · payer covered $370.88
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2017-09-10
- Stop
- 2017-09-10
The parties
- Patient
- patient Javier Gregorio Mares
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
2d487497-28fb-9da5-fbf0-89625cf843e9