Claim total
$1,212.29
base $155.66 · payer covered $1,062.29
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2026-07-19
- Stop
- 2026-07-19
The parties
- Patient
- patient Mandy Christie Stracke
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00aca497-ef30-85f4-161e-8e3df1411a0b