Claim total
$291.66
base $155.66 · payer covered $256.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-02-03
- Stop
- 2021-02-03
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0465c17f-66cb-2155-0571-77524bc800f2