Claim total
$978.26
base $155.66 · payer covered $828.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2025-04-04
- Stop
- 2025-04-04
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-33dd-5c8f5ed03c74