Claim total
$2,836.26
base $155.66 · payer covered $2,786.26
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2017-05-26
- Stop
- 2017-05-26
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-2fcd-2f6608b306ba