Claim total
$14,059.20
base $155.66 · payer covered $11,247.36
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 1990-11-04
- Stop
- 1990-11-04
The parties
- Patient
- patient Lucie Shayla Metz
- Provider
- provider Leonora Bechtelar
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
0095f26f-6c35-6a9c-1dfd-0e320ce7451d