Claim total
$504.69
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2010-08-31
- Stop
- 2010-08-31
The parties
- Patient
- patient Jeremy Gregory Jacobson
- Provider
- provider Stuart Bergnaum
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
Record id
04f9baea-0c64-12b2-d1c0-4b7d2cbb0136