Claim total
$4,382.21
base $155.66 · payer covered $4,332.21
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2017-02-15
- Stop
- 2017-02-15
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Rebeca Lomeli
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-10c0-bacd86741b29