Claim total
$9,683.68
base $93.39 · payer covered $9,633.68
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-05-09
- Stop
- 2018-05-09
The parties
- Patient
- patient Sammy Denis Dooley
- Provider
- provider Belkis Blick
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
36a2d409-ef1c-3246-2c82-194e6f5723f8