Claim total
$985.36
base $93.39 · payer covered $907.57
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2015-06-23
- Stop
- 2015-06-23
The parties
- Patient
- patient Marylynn Cathryn Lehner
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
074da286-03f5-1f7b-c20d-f4c0e1d65efd