Claim total
$751.47
base $93.39 · payer covered $681.61
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2025-12-02
- Stop
- 2025-12-02
The parties
- Patient
- patient Dannette Tonya Jacobson
- Provider
- provider Darnell Reynolds
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
39772979-843a-a410-366c-d15f68ae6546