Claim total
$566.96
base $155.66 · payer covered $416.96
The visit
- Class
- Ambulatory
- Code
- 170837001
- Reason
- Allergic disposition609328004
- Start
- 2018-05-23
- Stop
- 2018-05-23
The parties
- Patient
- patient Elenore Astrid Ryan
- Provider
- provider Kiyoko Predovic
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
2b192cee-fe62-521f-d4e9-166583f60bfd