Claim total
$339.60
base $93.39 · payer covered $289.60
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2021-10-11
- Stop
- 2021-10-11
The parties
- Patient
- patient Gwyn Priscilla Spinka
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
2bcfe7e7-608a-8690-cbf1-d135b72c48b2