Claim total
$155.66
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2021-03-22
- Stop
- 2021-03-22
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-b147-d09eef92e29e