Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Glycine max256355007
- Start
- 2021-06-25
- Stop
- 2021-06-25
The parties
- Patient
- patient Mel Jame Hackett
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
1f2b14a0-778a-b473-7c32-f68915d528b5