Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 2021-11-02
- Stop
- 2021-11-02
The parties
- Patient
- patient Marco Hong Zboncak
- Provider
- provider Trinidad Quitzon
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
2f19dc97-67f3-a9cc-833c-cc49c6e59e12