Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-04-06
- Stop
- 2021-04-06
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Noreen Hudson
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-173d-077d811a62e6