Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2001-03-06
- Stop
- 2001-03-06
The parties
- Patient
- patient Ericka Norma Cole
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
25907c4a-2f11-4f5b-af0c-9f809232ddbc