Claim total
$1,212.29
base $155.66 · payer covered $1,162.29
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2023-03-12
- Stop
- 2023-03-12
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-deb9-0f31a63d3161