Claim total
$1,248.73
base $155.66 · payer covered $1,098.73
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2017-05-10
- Stop
- 2017-05-10
The parties
- Provider
- provider Enoch Torp
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-6585-4330dd07410b