Claim total
$566.96
base $155.66 · payer covered $416.96
The visit
- Class
- Ambulatory
- Code
- 170837001
- Reason
- Allergic disposition609328004
- Start
- 2012-12-22
- Stop
- 2012-12-22
The parties
- Patient
- patient Helga Darci Dicki
- Provider
- provider Kiyoko Predovic
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
232ea8f4-93f6-3362-0a4e-e8f16739acc5