Claim total
$147.24
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-09-30
- Stop
- 2018-09-30
The parties
- Patient
- patient Gary Carolynn Bergstrom
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
286699ff-b159-7b1a-e5e6-26aa9084cc4e