Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-01-17
- Stop
- 2021-01-17
The parties
- Patient
- patient Faustino Romeo Bauch
- Provider
- provider Antonetta Lubowitz
- Payer
- payer Medicaid
Record id
03e24eff-3793-eaeb-247c-7ee709872032