Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2025-05-15
- Stop
- 2025-05-15
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-afac-893a7f2d8d92