Claim total
$4,382.21
base $155.66 · payer covered $4,332.21
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2019-03-25
- Stop
- 2019-03-25
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Pasquale Grimes
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-13da-3ea6518901ee