Claim total
$751.47
base $93.39 · payer covered $701.47
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2024-11-03
- Stop
- 2024-11-03
The parties
- Patient
- patient Earle Chester Zboncak
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
0d3c3fe6-7543-8a1c-f290-86be9315dbc0