Claim total
$527.03
base $93.39 · payer covered $477.03
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2014-12-11
- Stop
- 2014-12-11
The parties
- Patient
- patient Earl Jerome Schmidt
- Provider
- provider Earle Keeling
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
0d968990-4e91-8a45-1856-5f28c990822b