Claim total
$751.47
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-12-05
- Stop
- 2018-12-05
The parties
- Patient
- patient Antonia George Gislason
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Humana
Record id
0dbf2ba6-39af-b055-fdc9-133f88c10eaa