Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2024-09-26
- Stop
- 2024-09-26
The parties
- Patient
- patient Johnny Mattie Skiles
- Provider
- provider Jo Stiedemann
- Payer
- payer Medicaid
Record id
01f72a06-0d81-377c-f74f-34ee68b46f00