Claim total
$219.36
base $93.39 · payer covered $169.36
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2024-12-17
- Stop
- 2024-12-17
The parties
- Patient
- patient Nicky Kristi Wiegand
- Provider
- provider Stuart Bergnaum
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
0358d022-e88b-b208-ac63-4acdc32edd8b