Claim total
$1,265.85
base $155.66 · payer covered $1,215.85
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2026-02-19
- Stop
- 2026-02-19
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-6d45-643c6644604f