Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Outpatient
- Code
- 185345009
- Reason
- diagnosis concept Otitis media65363002
- Start
- 2020-06-28
- Stop
- 2020-06-28
The parties
- Patient
- patient Adam Alfonzo Stokes
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
056ed411-c295-a5c9-542a-92a5f04e7538