Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 1978-04-18
- Stop
- 1978-04-18
The parties
- Patient
- patient Benito Beau Keebler
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
21f14afd-a65c-85c6-55e1-a504186df3f0