Claim total
$10,365.40
base $155.66 · payer covered $10,365.40
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2015-11-20
- Stop
- 2015-11-20
The parties
- Provider
- provider Donette Hilpert
- Care site
- care site FAIRVIEW HEALTH SERVICES
Record id
05f1dbc7-3ebc-37ee-6570-703db197ab9f