Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-05-18
- Stop
- 2021-05-18
The parties
- Patient
- patient An Wenona Rau
- Provider
- provider Leonora Bechtelar
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
04682680-f77d-0a00-f3cf-7cc9eb2550bb