Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2020-01-08
- Stop
- 2020-01-08
The parties
- Patient
- patient Sha Robin Reilly
- Provider
- provider Jo Stiedemann
- Payer
- payer Medicaid
Record id
043d6e13-0cc7-07f3-3fe5-441b652b2223