Claim total
$4,033.27
base $155.66 · payer covered $3,883.27
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2023-06-14
- Stop
- 2023-06-14
The parties
- Provider
- provider Boris Lynch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-f397-5ace36182135