Claim total
$155.66
base $155.66 · payer covered $124.53
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2016-12-07
- Stop
- 2016-12-07
The parties
- Patient
- patient Vella Divina Renner
- Provider
- provider Pasquale Grimes
- Payer
- payer UnitedHealthcare
Record id
02404bb7-0f7d-3a30-69bc-2601a26b0a04