Claim total
$126.29
base $93.39 · payer covered $76.29
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2021-03-30
- Stop
- 2021-03-30
The parties
- Patient
- patient Jerome Gaylord Lueilwitz
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
1326c004-812d-82f3-def7-86f017f1ee6e