Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-03-23
- Stop
- 2021-03-23
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-a0d2-04598a364860