Claim total
$566.96
base $155.66 · payer covered $416.96
The visit
- Class
- Ambulatory
- Code
- 170837001
- Reason
- Allergic disposition609328004
- Start
- 2020-09-02
- Stop
- 2020-09-02
The parties
- Patient
- patient Jerome Gaylord Lueilwitz
- Provider
- provider Boris Lynch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
1326c004-812d-82f3-90c1-0ddb17e0271d