Claim total
$470.87
base $93.39 · payer covered $435.87
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2022-11-13
- Stop
- 2022-11-13
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-14a9-3aafb458ae51