Claim total
$2,891.91
base $155.66 · payer covered $2,856.91
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2020-10-16
- Stop
- 2020-10-16
The parties
- Patient
- patient Colby Wunsch
- Provider
- provider Charlie Tillman
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Dual Eligible
Record id
02d10ce5-acf0-36ed-3a59-cab7a8c47740