Claim total
$915.99
base $93.39 · payer covered $865.99
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Adolescent idiopathic scoliosis203646004
- Start
- 1990-03-17
- Stop
- 1990-03-17
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Ileana Prohaska
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-68aa-3c43b56c6c6e