Claim total
$263.83
base $93.39 · payer covered $213.83
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-01-11
- Stop
- 2018-01-11
The parties
- Patient
- patient Brock Josiah Gaylord
- Provider
- provider Trinity Mraz
- Payer
- payer Medicaid
Record id
2d5d1e2a-d4d9-a177-b47c-d455346d0ebe