Claim total
$155.66
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2025-06-28
- Stop
- 2025-06-28
The parties
- Patient
- patient Sherill Ingeborg Wyman
- Provider
- provider Donette Hilpert
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
03eccc4c-a1c4-14ad-13df-8b5ac20d1c57