Claim total
$711.28
base $93.39 · payer covered $661.28
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2018-03-25
- Stop
- 2018-03-25
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-5b0e-bf6bb631512d