Claim total
$2,601.09
base $93.39 · payer covered $2,551.09
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2015-06-25
- Stop
- 2015-06-25
The parties
- Patient
- patient Tamra Darlena Feeney
- Provider
- provider Leonora Bechtelar
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
39f891f2-42e3-2507-50e1-bf5a3702e95c