Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2008-07-28
- Stop
- 2008-07-28
The parties
- Patient
- patient Slyvia Natosha Zboncak
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
0725e104-ee96-c3d4-740e-fbecf530da18