Claim total
$566.96
base $155.66 · payer covered $416.96
The visit
- Class
- Ambulatory
- Code
- 170837001
- Reason
- Allergic disposition609328004
- Start
- 2022-10-02
- Stop
- 2022-10-02
The parties
- Patient
- patient Carolina Mayte Rael
- Provider
- provider Earle Keeling
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
2abfba6d-130d-6d06-4ade-df17fd635524