Claim total
$290.00
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2019-05-15
- Stop
- 2019-05-15
The parties
- Patient
- patient Hans Matthew Klocko
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
0dcefe69-a1de-dc0d-6578-317dbfc7cf10