Claim total
$93.39
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Fracture of forearm65966004
- Start
- 2017-03-19
- Stop
- 2017-03-19
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-9c0f-7f5156430dfc