Claim total
$312.03
base $93.39 · payer covered $262.03
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2019-12-19
- Stop
- 2019-12-19
The parties
- Patient
- patient Aubrey Sal Champlin
- Provider
- provider Leonora Bechtelar
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
1bcbe4dd-bbdd-c343-d65e-04e71a3cb76c