Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-07-13
- Stop
- 2021-07-13
The parties
- Patient
- patient Nicky Kristi Wiegand
- Provider
- provider Troy Leannon
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
0358d022-e88b-b208-9f8b-1776d5ceee60