Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2021-03-22
- Stop
- 2021-03-22
The parties
- Patient
- patient Belva Nadene Kuphal
- Provider
- provider Pedro Effertz
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
0430ce7c-cb64-da75-6e3a-634863f88309