Claim total
$291.66
base $155.66 · payer covered $256.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-04-12
- Stop
- 2021-04-12
The parties
- Patient
- patient María del Carmen Berríos
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
016a1a5e-4450-7aaa-b373-e1d0cb799ebf