Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2026-04-16
- Stop
- 2026-04-16
The parties
- Patient
- patient Kendrick Jewell Jerde
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
020a56e3-5d79-5c72-17d2-660ee0f11d46