Claim total
$1,209.52
base $93.39 · payer covered $1,159.52
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2020-10-13
- Stop
- 2020-10-13
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Chance Wisoky
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-5942-772becc4c419