Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2021-09-10
- Stop
- 2021-09-10
The parties
- Provider
- provider Clyde Beier
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-b31c-c08c3dd5fb0f