Claim total
$291.66
base $155.66 · payer covered $141.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-12-15
- Stop
- 2021-12-15
The parties
- Patient
- patient Mandy Christie Stracke
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00aca497-ef30-85f4-f91a-4b9ff308186a