Claim total
$5,038.15
base $155.66 · payer covered $4,030.52
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 1990-03-14
- Stop
- 1990-03-14
The parties
- Patient
- patient Lucie Shayla Metz
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
0095f26f-6c35-6a9c-57de-f4f9c870508a