Claim total
$3,223.62
base $93.39 · payer covered $3,173.62
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-03-14
- Stop
- 2018-03-15
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-ec61-2475ef394fa1