Claim total
$5,407.19
base $93.39 · payer covered $5,357.19
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2019-12-25
- Stop
- 2019-12-25
The parties
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
1d67c7f6-af39-6a8b-8c91-b6420b07da49