Claim total
$978.26
base $155.66 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2018-11-07
- Stop
- 2018-11-07
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Krystal Strosin
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-8ca4-38f207b352a6