Claim total
$204.90
base $93.39 · payer covered $169.90
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2017-04-10
- Stop
- 2017-04-10
The parties
- Patient
- patient Rosaria Golden Bashirian
- Provider
- provider Antonietta Purdy
- Payer
- payer Dual Eligible
Record id
015dd051-d88b-0f3d-32cf-e548d0027ed2