Claim total
$566.96
base $155.66 · payer covered $516.96
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2022-12-31
- Stop
- 2022-12-31
The parties
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-0bb9-044e60788604