Claim total
$476.80
base $93.39 · payer covered $381.44
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-03-14
- Stop
- 2018-03-14
The parties
- Patient
- patient Rufus Milford Koelpin
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
3a95383e-dcb8-456a-7f8c-88f41902f9dc