Claim total
$251.01
base $93.39 · payer covered $201.01
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2023-01-29
- Stop
- 2023-01-29
The parties
- Patient
- patient Tamra Darlena Feeney
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
39f891f2-42e3-2507-f6a6-6c996cd6e0d1