Claim total
$751.47
base $93.39 · payer covered $701.47
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2023-11-05
- Stop
- 2023-11-05
The parties
- Patient
- patient Branden Milford Ullrich
- Provider
- provider Enoch Torp
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
10ef12fb-14dc-88af-32ce-40d9d56cc1d4