Claim total
$155.66
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2016-01-27
- Stop
- 2016-01-27
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-a250-2ce26e28f606