Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- Allergic disposition609328004
- Start
- 1975-08-05
- Stop
- 1975-08-05
The parties
- Patient
- patient Flor Georgina Pollich
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
35733c37-83e7-4a67-b7a4-9dda98aadb67