Claim total
$1,175.20
base $93.39 · payer covered $1,125.20
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2008-12-17
- Stop
- 2008-12-17
The parties
- Patient
- patient Sidney Champlin
- Provider
- provider Rosina Schaden
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
33cb6c8c-a991-8f91-f96a-f161752b4de2