Claim total
$155.66
base $155.66 · payer covered $5.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2019-10-20
- Stop
- 2019-10-20
The parties
- Patient
- patient Johnny Mattie Skiles
- Provider
- provider Jo Stiedemann
- Payer
- payer Medicaid
Record id
01f72a06-0d81-377c-62c8-b1da6592a6c8