Claim total
$694.86
base $93.39 · payer covered $644.86
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2020-03-29
- Stop
- 2020-03-29
The parties
- Patient
- patient Sammy Denis Dooley
- Provider
- provider Yasmine Shanahan
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
36a2d409-ef1c-3246-f479-83ff965fd317