Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-08-03
- Stop
- 2021-08-03
The parties
- Patient
- patient Queen Sharika Fay
- Provider
- provider Ines Kautzer
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
02c148c0-182c-a5fd-b0aa-a0f2f803af6d