Claim total
$4,162.65
base $93.39 · payer covered $4,127.65
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2020-11-25
- Stop
- 2020-11-25
The parties
- Patient
- patient Ted Claude O'Conner
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
2ef29fe0-cf19-e6ae-0d95-2a03fb3e088e