Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Inpatient
- Code
- 56876005
- Reason
- diagnosis concept Dependent drug abuse6525002
- Start
- 2018-09-17
- Stop
- 2018-09-18
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Jerrod Roob
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0465c17f-66cb-2155-e8b8-56cec9cac580