Claim total
$14,037.30
base $155.66 · payer covered $13,987.30
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2015-11-04
- Stop
- 2015-11-04
The parties
- Patient
- patient Mandy Christie Stracke
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00aca497-ef30-85f4-b069-3c36fb0db1e6