Claim total
$126.29
base $93.39 · payer covered $91.29
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2017-01-22
- Stop
- 2017-01-22
The parties
- Patient
- patient Dione Anissa Jaskolski
- Provider
- provider Enoch Torp
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
24b7c6b0-4eef-ea68-148d-67ea5b37c8d0