Claim total
$291.66
base $155.66 · payer covered $256.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-06-29
- Stop
- 2021-06-29
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Jo Stiedemann
- Payer
- payer Dual Eligible
Record id
0274bb53-c777-eb96-4be4-023adee7c2fe