Claim total
$2,712.98
base $155.66 · payer covered $2,594.73
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2020-08-28
- Stop
- 2020-08-28
The parties
- Patient
- patient Angele Khalilah Kuphal
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
044947be-396f-8eb7-a3d8-af5582a3d5f0