Claim total
$837.84
base $93.39 · payer covered $687.84
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2019-03-27
- Stop
- 2019-03-27
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00e3929f-91f8-0715-47d5-bebfbad414d7