Claim total
$3,883.80
base $155.66 · payer covered $3,733.80
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2017-08-16
- Stop
- 2017-08-16
The parties
- Patient
- patient Mandy Christie Stracke
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00aca497-ef30-85f4-90fc-d17aac94a98c