Claim total
$12,584.82
base $155.66 · payer covered $10,067.86
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 1990-12-17
- Stop
- 1990-12-17
The parties
- Patient
- patient Lucie Shayla Metz
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
0095f26f-6c35-6a9c-9a0c-daaae5b02595