Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2026-07-25
- Stop
- 2026-07-25
The parties
- Patient
- patient Amanda Rheba Mitchell
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
0363ed75-83f4-7675-62f7-3a3147e3bbed