Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2002-06-07
- Stop
- 2002-06-07
The parties
- Patient
- patient Helga Darci Dicki
- Provider
- provider Leila Thiel
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
232ea8f4-93f6-3362-0e53-b2331555c893