Claim total
$19,630.18
base $155.66 · payer covered $19,580.18
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2017-08-25
- Stop
- 2017-08-25
The parties
- Patient
- patient Cecil Norberto Franecki
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
05e47734-a2d3-8a46-ea48-a39033b97212