Claim total
$14,283.80
base $155.66 · payer covered $11,427.04
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2025-10-12
- Stop
- 2025-10-12
The parties
- Patient
- patient Cristy Exie Pouros
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicare
Record id
034e20ab-aae7-ddf8-b6ee-2826464457f9