Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Childhood asthma233678006
- Start
- 1970-07-02
- Stop
- 1970-07-02
The parties
- Patient
- patient Courtney Clifton Roberts
- Provider
- provider Lawrence Lemke
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
15a85dbf-71f7-c524-28c6-4921856db9ce