Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Ambulatory
- Code
- 394701000
- Reason
- diagnosis concept Asthma195967001
- Start
- 2017-10-26
- Stop
- 2017-10-26
The parties
- Patient
- patient Basil Josef Bosco
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
03478e49-59cf-7140-447e-02c8f9eb0813