Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 1993-07-22
- Stop
- 1993-07-22
The parties
- Patient
- patient Cristy Exie Pouros
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
034e20ab-aae7-ddf8-8324-70150e7d7307