Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2019-09-24
- Stop
- 2019-09-24
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Dale Mertz
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-349f-1ac68f88f9fe