Claim total
$3,883.80
base $155.66 · payer covered $3,833.80
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2025-10-21
- Stop
- 2025-10-21
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Stuart Bergnaum
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-6163-ff909c19bf4a