Claim total
$4,382.21
base $155.66 · payer covered $4,332.21
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2018-05-25
- Stop
- 2018-05-25
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Morton Boyer
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-d3c9-5a15bb697bee