Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-03-27
- Stop
- 2021-03-27
The parties
- Provider
- provider Hazel Effertz
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-acca-21302a90d720