Claim total
$751.47
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2026-04-17
- Stop
- 2026-04-17
The parties
- Patient
- patient Shonna Tamra Sawayn
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer No insurance
Record id
17973d7f-d648-48c7-d183-9bdd5122ab3f