Claim total
$10,124.19
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Acute bronchitis10509002
- Start
- 2018-04-16
- Stop
- 2018-04-16
The parties
- Patient
- patient Jewell Royal Krajcik
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
2f2181ad-74a6-3726-6265-a2a28da95806