Claim total
$219.52
base $93.39 · payer covered $169.52
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-10-22
- Stop
- 2018-10-22
The parties
- Patient
- patient Kam Ching Pollich
- Provider
- provider Belkis Blick
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
0681ce4b-c984-7822-72ab-72ae2d489a23