Claim total
$155.66
base $155.66 · payer covered $93.40
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2025-02-17
- Stop
- 2025-02-17
The parties
- Patient
- patient Cyndi Tromp
- Provider
- provider Tomas Fisher
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Humana
Record id
01936333-6290-e7a2-6d4a-ef62439488ad