Claim total
$155.66
base $155.66 · payer covered $120.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2020-11-21
- Stop
- 2020-11-21
The parties
- Patient
- patient Colby Wunsch
- Provider
- provider Chance Wisoky
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Dual Eligible
Record id
02d10ce5-acf0-36ed-4d5c-a138620ef05a