Claim total
$6,072.64
base $155.66 · payer covered $4,858.11
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 1991-12-24
- Stop
- 1991-12-24
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-987e-d4f4b0b53e8b