Claim total
$2,161.11
base $155.66 · payer covered $2,111.11
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2017-02-08
- Stop
- 2017-02-08
The parties
- Provider
- provider Leonora Bechtelar
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-c315-c5cf1ef92cdb