Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2022-03-09
- Stop
- 2022-03-09
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Pasquale Grimes
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-e12c-b9412a95df07