Claim total
$19,685.62
base $155.66 · payer covered $15,748.50
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 1992-01-28
- Stop
- 1992-01-28
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-de32-f058a1618de7