Claim total
$733.94
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2016-10-29
- Stop
- 2016-10-29
The parties
- Patient
- patient Roy Russ Bergstrom
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
13201b82-c84d-0844-6682-4360bb93a2b9