Claim total
$1,229.57
base $155.66 · payer covered $1,179.57
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2016-11-09
- Stop
- 2016-11-09
The parties
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-a3cf-561f26ede0a2