Claim total
$291.66
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-05-31
- Stop
- 2021-05-31
The parties
- Patient
- patient Chantay Victorina Koepp
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
00c59201-9d52-fccb-5116-d0ef291292a4