Claim total
$2,623.46
base $155.66 · payer covered $2,588.46
The visit
- Class
- Ambulatory
- Code
- 36228007
- Reason
- —
- Start
- 1987-05-07
- Stop
- 1987-05-07
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Rosio Gleason
- Payer
- payer Dual Eligible
Record id
04371635-b149-02a5-4113-fd35976239f9