Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2018-01-06
- Stop
- 2018-01-06
The parties
- Patient
- patient Mason Jeffry Vandervort
- Provider
- provider Eldon Conn
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Medicaid
Record id
1a73a6e9-3ff1-67cc-9ba9-aa83dff9af65