Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2017-09-12
- Stop
- 2017-09-12
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Chance Wisoky
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-098a-5eaeb19610d1