Claim total
$93.39
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Chronic pain82423001
- Start
- 2025-05-26
- Stop
- 2025-05-26
The parties
- Patient
- patient Gwenn Xochitl Pollich
- Provider
- provider Rosina Schaden
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
36bd080b-6e6b-6abc-4547-3ccbf3e9a1c3