Claim total
$19,685.62
base $155.66 · payer covered $19,685.62
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 1991-06-03
- Stop
- 1991-06-03
The parties
- Patient
- patient Lucie Shayla Metz
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
0095f26f-6c35-6a9c-896c-50f54d67092e