Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-05-30
- Stop
- 2021-05-30
The parties
- Patient
- patient Cecil Norberto Franecki
- Provider
- provider Trinity Mraz
- Payer
- payer Medicaid
Record id
05e47734-a2d3-8a46-1c8d-7420c05facf4