Claim total
$4,382.21
base $155.66 · payer covered $4,332.21
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2024-06-29
- Stop
- 2024-06-29
The parties
- Patient
- patient Belva Nadene Kuphal
- Provider
- provider Pedro Effertz
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
0430ce7c-cb64-da75-f236-4e555e098ccb