Claim total
$9,655.94
base $155.66 · payer covered $9,605.94
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2021-10-18
- Stop
- 2021-10-18
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Noreen Hudson
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-fe3d-f7d44299cac3