Claim total
$5,204.81
base $155.66 · payer covered $5,154.81
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2025-04-09
- Stop
- 2025-04-09
The parties
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-d26e-728a66ad86b6