Claim total
$504.69
base $93.39 · payer covered $469.69
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Childhood asthma233678006
- Start
- 2003-10-10
- Stop
- 2003-10-10
The parties
- Patient
- patient Ericka Norma Cole
- Provider
- provider Rebeca Lomeli
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
25907c4a-2f11-4f5b-0f45-e808250531f9