Claim total
$978.26
base $155.66 · payer covered $978.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2017-03-26
- Stop
- 2017-03-26
The parties
- Patient
- patient Xuan Collier
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
002d4429-df26-5797-01c5-6349de42cd07