Claim total
$291.66
base $155.66 · payer covered $233.33
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-11-14
- Stop
- 2021-11-14
The parties
- Patient
- patient Cristy Exie Pouros
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicare
Record id
034e20ab-aae7-ddf8-5903-39d467f067ff