Claim total
$5,931.50
base $155.66 · payer covered $383.22
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2022-03-17
- Stop
- 2022-03-17
The parties
- Patient
- patient Marilynn Jaimie Pouros
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
0126af27-a469-d3f6-7297-0d719df6ce63