Claim total
$219.95
base $93.39 · payer covered $169.95
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- —
- Start
- 2004-12-05
- Stop
- 2004-12-05
The parties
- Patient
- patient Sidney Champlin
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
33cb6c8c-a991-8f91-ab3c-8527e1c67845