Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-02-13
- Stop
- 2021-02-13
The parties
- Patient
- patient Gerardo Marvin Johns
- Provider
- provider Leonora Bechtelar
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
01513b97-46a6-1303-ea5e-3f9b5e2450d6