Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2019-07-23
- Stop
- 2019-07-23
The parties
- Patient
- patient Sherill Ingeborg Wyman
- Provider
- provider Belkis Blick
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
03eccc4c-a1c4-14ad-b50f-323dc1f15011