Claim total
$3,883.80
base $155.66 · payer covered $3,107.04
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2020-10-04
- Stop
- 2020-10-04
The parties
- Patient
- patient Cristy Exie Pouros
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicare
Record id
034e20ab-aae7-ddf8-08a8-d95284892492