Claim total
$566.96
base $155.66 · payer covered $416.96
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2016-11-08
- Stop
- 2016-11-08
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Troy Leannon
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-e09e-e363755217b0