Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2018-12-07
- Stop
- 2018-12-07
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-00b9-a0137f1f3681