Claim total
$199.51
base $93.39 · payer covered $149.51
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2021-07-21
- Stop
- 2021-07-21
The parties
- Patient
- patient Bruce Oscar Rath
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
38d7b5e6-2762-29d7-c510-cf575f0d7539