Claim total
$566.96
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2024-10-23
- Stop
- 2024-10-23
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-2202-3adcff546967