Claim total
$291.66
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-07-13
- Stop
- 2021-07-13
The parties
- Patient
- patient Sherill Ingeborg Wyman
- Provider
- provider Charlena Adams
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
03eccc4c-a1c4-14ad-7193-8380a6cf4d36