Claim total
$1,212.29
base $155.66 · payer covered $383.36
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2021-09-28
- Stop
- 2021-09-28
The parties
- Patient
- patient Cyndi Tromp
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
01936333-6290-e7a2-091c-70def9d1be06