Claim total
$2,601.09
base $93.39 · payer covered $159.85
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 1997-03-02
- Stop
- 1997-03-03
The parties
- Patient
- patient Jacqulyn Lavonna Legros
- Provider
- provider Earle Keeling
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Humana
Record id
28e07049-ca1f-fcfe-f154-be83054c791d