Claim total
$1,212.29
base $155.66 · payer covered $1,062.29
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2024-01-22
- Stop
- 2024-01-22
The parties
- Patient
- patient Nana Earlean Kuphal
- Provider
- provider Liz Kozey
- Payer
- payer Medicaid
Record id
01077a3b-80bd-4b83-230d-84ebec055724