Claim total
$566.96
base $155.66 · payer covered $416.96
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2019-12-10
- Stop
- 2019-12-10
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Pasquale Grimes
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-3aee-bc9bb012587b