Claim total
$616.49
base $93.39 · payer covered $566.49
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-01-31
- Stop
- 2018-01-31
The parties
- Patient
- patient Mandy Larita King
- Provider
- provider Yasmine Shanahan
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
3b0845bc-f6dd-a2fa-b8b5-73adcb50a42c