Claim total
$12,614.31
base $93.39 · payer covered $4,758.41
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-03-12
- Stop
- 2018-03-12
The parties
- Patient
- patient Williams Mauricio Boehm
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Humana
Record id
28bac566-789e-d07d-5d87-06a1edb11153