Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2021-03-14
- Stop
- 2021-03-14
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Trinity Mraz
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-285f-be004c55f103