Claim total
$93.53
base $93.39 · payer covered $58.53
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2024-06-14
- Stop
- 2024-06-14
The parties
- Patient
- patient Jewel Chi Harris
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
05c57aa9-c3e8-2f04-004d-15ca281043e8