Claim total
$10,124.19
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2017-02-05
- Stop
- 2017-02-05
The parties
- Patient
- patient Kirk Ty Jacobs
- Provider
- provider Clyde Beier
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer No insurance
Record id
1e3196f8-1036-fdb0-a879-e1fd5004a274