Claim total
$310.21
base $93.39 · payer covered $260.21
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2016-10-22
- Stop
- 2016-10-22
The parties
- Patient
- patient Desire Suzie Simonis
- Provider
- provider Leonora Bechtelar
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
307966cc-34e1-e48c-1760-3b2e31cc2542