Claim total
$19,685.62
base $155.66 · payer covered $11,811.38
The visit
- Class
- Ambulatory
- Code
- 371883000
- Reason
- Allergic disposition609328004
- Start
- 2022-12-09
- Stop
- 2022-12-09
The parties
- Patient
- patient Temple Joe Beer
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
031e9e86-1ff9-e433-1d06-b79a51b80310