Claim total
$291.66
base $155.66 · payer covered $256.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-06-22
- Stop
- 2021-06-22
The parties
- Patient
- patient Jacqui Bess Baumbach
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Dual Eligible
Record id
019cda32-2557-7f65-ac7b-d0035eeabde4