Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2003-07-14
- Stop
- 2003-07-14
The parties
- Patient
- patient Arlean Deena Stoltenberg
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
08d65f8d-3561-01de-a4b1-b36a8e1e7cce