Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2019-11-09
- Stop
- 2019-11-09
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Earle Keeling
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00e3929f-91f8-0715-b184-67c2eeadfa81