Claim total
$12,625.40
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2023-03-06
- Stop
- 2023-03-06
The parties
- Patient
- patient Chantay Victorina Koepp
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
00c59201-9d52-fccb-3527-7120389fab90