Claim total
$830.53
base $93.39 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2013-11-21
- Stop
- 2013-11-21
The parties
- Patient
- patient Domenic Ivory Bartoletti
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
2caefad2-5d5c-2c45-8895-895fdb6bec88