Claim total
$7,692.22
base $155.66 · payer covered $7,657.22
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2025-12-26
- Stop
- 2025-12-26
The parties
- Patient
- patient Rosaria Golden Bashirian
- Provider
- provider Hazel Effertz
- Payer
- payer Dual Eligible
Record id
015dd051-d88b-0f3d-7126-247d83d9fd15