Claim total
$979.04
base $93.39 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2023-07-11
- Stop
- 2023-07-11
The parties
- Patient
- patient Janie Ranae Botsford
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer No insurance
Record id
041efb3a-8e81-3ea8-42c9-c9f1d05d482b