Claim total
$126.29
base $93.39 · payer covered $101.03
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-05-03
- Stop
- 2018-05-03
The parties
- Patient
- patient Minnie Glenna Hilpert
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
164073e3-ecac-90a2-9bf3-d9cfa2b18af8