Claim total
$1,242.84
base $93.39 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2013-05-30
- Stop
- 2013-05-30
The parties
- Patient
- patient Carmen Ramona Fonseca
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
2cc6efe0-8e4a-8ccd-f5ff-f2a486bd1023