Claim total
$566.96
base $155.66 · payer covered $416.96
The visit
- Class
- Ambulatory
- Code
- 170837001
- Reason
- Allergic disposition609328004
- Start
- 2015-09-25
- Stop
- 2015-09-25
The parties
- Patient
- patient Slyvia Natosha Zboncak
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
0725e104-ee96-c3d4-eae7-ae2426fe469b