Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Childhood asthma233678006
- Start
- 2024-12-14
- Stop
- 2024-12-14
The parties
- Patient
- patient Diedre Ellan Nicolas
- Provider
- provider Lawrence Lemke
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
157157f9-9be3-6636-59cf-d67a3a957250