Claim total
$1,212.29
base $155.66 · payer covered $1,162.29
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2019-02-22
- Stop
- 2019-02-22
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-c5c0-189d93de2d1a