Claim total
$3,556.90
base $93.39 · payer covered $3,506.90
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2014-09-06
- Stop
- 2014-09-07
The parties
- Patient
- patient Gerardo Marvin Johns
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
01513b97-46a6-1303-8041-4248d1ba0be4