Claim total
$4,060.85
base $155.66 · payer covered $1,203.78
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2015-12-22
- Stop
- 2015-12-22
The parties
- Patient
- patient Tamica Sarita Robel
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
Record id
03563bad-3832-f030-84fc-dc6c660adc15