Claim total
$3,922.57
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2019-05-24
- Stop
- 2019-05-24
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer No insurance
Record id
032e4024-8595-f612-bea0-74916e4acc9d