Claim total
$93.39
base $93.39 · payer covered $74.71
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Cerebral palsy128188000
- Start
- 2014-09-03
- Stop
- 2014-09-03
The parties
- Patient
- patient Amalia Ana María Soliz
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
007eb971-e9c1-129f-a730-594b125cca2d