Claim total
$566.96
base $155.66 · payer covered $531.96
The visit
- Class
- Ambulatory
- Code
- 170837001
- Reason
- Allergic disposition609328004
- Start
- 2013-10-18
- Stop
- 2013-10-18
The parties
- Patient
- patient Ericka Norma Cole
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
25907c4a-2f11-4f5b-be38-33fe887e76b9