Claim total
$4,382.21
base $155.66 · payer covered $4,232.21
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2018-05-09
- Stop
- 2018-05-09
The parties
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-4f64-84e29febf163