Claim total
$352.10
base $93.39 · payer covered $317.10
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2017-05-22
- Stop
- 2017-05-22
The parties
- Patient
- patient María del Carmen Berríos
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
016a1a5e-4450-7aaa-61e9-275f58b3aa34