Claim total
$213.63
base $93.39 · payer covered $163.63
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2016-08-10
- Stop
- 2016-08-10
The parties
- Patient
- patient Mandy Larita King
- Provider
- provider Joshua Dickens
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
3b0845bc-f6dd-a2fa-235b-1f06fe55bb02