Claim total
$3,013.30
base $93.39 · payer covered $2,963.30
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 1966-06-05
- Stop
- 1966-06-05
The parties
- Patient
- patient Maurice Fletcher Purdy
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
359652b4-936c-ae33-8dab-0377cf1fa97e