Claim total
$3,034.76
base $155.66 · payer covered $2,999.76
The visit
- Class
- Ambulatory
- Code
- 36228007
- Reason
- diagnosis concept Diabetes mellitus type 244054006
- Start
- 1985-05-23
- Stop
- 1985-05-23
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Hazel Effertz
- Payer
- payer Dual Eligible
Record id
04371635-b149-02a5-d5ce-b6fd4d9019a5