Claim total
$291.66
base $155.66 · payer covered $256.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-04-30
- Stop
- 2021-04-30
The parties
- Patient
- patient Abe Adolph Berge
- Provider
- provider Eldon Conn
- Care site
- care site MERCY HOSPITAL
- Payer
- payer Dual Eligible
Record id
035310e6-92e0-05c1-b015-65f96eae791f