Claim total
$10,124.19
base $93.39 · payer covered $10,074.19
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2019-07-28
- Stop
- 2019-07-28
The parties
- Patient
- patient Jerome Gaylord Lueilwitz
- Provider
- provider Earle Keeling
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
1326c004-812d-82f3-bd77-c48e397a8787