Claim total
$291.66
base $155.66 · payer covered $185.05
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-11-09
- Stop
- 2021-11-09
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Jo Stiedemann
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-6368-8896ed892d49