Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Childhood asthma233678006
- Start
- 2001-02-03
- Stop
- 2001-02-03
The parties
- Patient
- patient Antonia Sherwood Schmitt
- Provider
- provider Lawrence Lemke
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
1888bd1d-48de-7570-d9a7-e8ecf0be796e