Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2025-06-28
- Stop
- 2025-06-28
The parties
- Patient
- patient Coretta Philomena Boyle
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
06293262-0c72-c029-5bd8-16eb2adb2b2f