Claim total
$978.26
base $155.66 · payer covered $943.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2020-08-22
- Stop
- 2020-08-22
The parties
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
021142be-3a32-af72-97ec-412fef68f4a3