Claim total
$555.65
base $93.39 · payer covered $444.52
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2017-02-14
- Stop
- 2017-02-14
The parties
- Patient
- patient Amalia Ana María Soliz
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
007eb971-e9c1-129f-2eaf-067e35c352ff