Claim total
$774.56
base $93.39 · payer covered $624.56
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2018-11-10
- Stop
- 2018-11-10
The parties
- Patient
- patient Le Rosella Marks
- Provider
- provider Rosina Schaden
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
08d0bbfe-3183-9cfc-2db4-77f99aafd610