Claim total
$19,685.62
base $155.66 · payer covered $19,635.62
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2017-11-11
- Stop
- 2017-11-11
The parties
- Patient
- patient Cecil Norberto Franecki
- Provider
- provider Dale Mertz
- Payer
- payer Medicaid
Record id
05e47734-a2d3-8a46-1247-593a7e6eaa77