Claim total
$319.61
base $93.39 · payer covered $269.61
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2021-11-11
- Stop
- 2021-11-11
The parties
- Patient
- patient Maia Chelsie Runolfsson
- Provider
- provider Rosina Schaden
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
171169a6-b136-3c65-99a3-b959fd7682f0