Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 1978-09-09
- Stop
- 1978-09-09
The parties
- Patient
- patient Ricky Michal Wisozk
- Provider
- provider Jarvis Braun
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
1ed700c5-df9c-e290-429f-a232d0edcf8a