Claim total
$4,291.67
base $93.39 · payer covered $4,241.67
The visit
- Class
- Outpatient
- Code
- 185347001
- Reason
- diagnosis concept Primary small cell malignant neoplasm of lung, TNM stage 167811000119102
- Start
- 1991-05-02
- Stop
- 1991-05-02
The parties
- Patient
- patient Andree Agatha Krajcik
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
115c2159-d4c7-04f2-8aed-e12d6ae19564