Claim total
$291.66
base $155.66 · payer covered $141.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-08-31
- Stop
- 2021-08-31
The parties
- Patient
- patient Queen Sharika Fay
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
02c148c0-182c-a5fd-a824-d0f19395178b