Claim total
$5,696.72
base $93.39 · payer covered $837.27
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-12-21
- Stop
- 2018-12-21
The parties
- Patient
- patient Chang Larry Hermiston
- Provider
- provider Earle Keeling
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Humana
Record id
3a43a35d-fb85-2922-571a-19eb7d637970