Claim total
$268.24
base $93.39 · payer covered $218.24
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2017-12-28
- Stop
- 2017-12-28
The parties
- Patient
- patient Roger Brain Homenick
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
289be5b0-48cc-7d34-16e6-cddf9a2c3613