Claim total
$1,755.20
base $155.66 · payer covered $1,705.20
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2023-06-24
- Stop
- 2023-06-24
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-db96-fff8b1cc8ff6