Claim total
$3,405.31
base $155.66 · payer covered $3,355.31
The visit
- Class
- Outpatient
- Code
- 308335008
- Reason
- Contraception care389095005
- Start
- 2017-11-24
- Stop
- 2017-11-24
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-cf48-cb92aaf351a2