Claim total
$155.66
base $155.66 · payer covered $120.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2016-07-05
- Stop
- 2016-07-05
The parties
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Dual Eligible
Record id
021142be-3a32-af72-601c-3c55e4510f90