Claim total
$495.19
base $93.39 · payer covered $445.19
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2017-04-05
- Stop
- 2017-04-05
The parties
- Patient
- patient Sue Hickle
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
201c3454-6429-089f-5aeb-7288ef321ce6