Claim total
$504.69
base $93.39 · payer covered $469.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- diagnosis concept Dependent drug abuse6525002
- Start
- 2022-11-26
- Stop
- 2022-11-26
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0465c17f-66cb-2155-6a29-5a3ea1a26863