Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Glycine max256355007
- Start
- 2004-06-03
- Stop
- 2004-06-03
The parties
- Patient
- patient Concetta Pat Boehm
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
1aab82e0-bdd8-4de0-3272-e5fed7744ca0