Claim total
$249.99
base $155.66 · payer covered $199.99
The visit
- Class
- Ambulatory
- Code
- 410410006
- Reason
- diagnosis concept Malignant neoplasm of breast254837009
- Start
- 2017-02-12
- Stop
- 2017-02-12
The parties
- Patient
- patient María del Carmen Berríos
- Provider
- provider Clyde Beier
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
016a1a5e-4450-7aaa-bc4b-ebfccb159b20