Claim total
$219.33
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2024-09-03
- Stop
- 2024-09-03
The parties
- Patient
- patient Amalia Ana María Soliz
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Anthem
Record id
007eb971-e9c1-129f-760d-d9de210f8bc1