Claim total
$978.26
base $155.66 · payer covered $828.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2018-07-04
- Stop
- 2018-07-04
The parties
- Patient
- patient Mandy Christie Stracke
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00aca497-ef30-85f4-8468-9a24253f221a