Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2019-02-12
- Stop
- 2019-02-12
The parties
- Patient
- patient Queen Sharika Fay
- Provider
- provider Daryl Farrell
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
02c148c0-182c-a5fd-5cdf-8c3cefd32416