Claim total
$5,194.17
base $155.66 · payer covered $5,044.17
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2026-08-15
- Stop
- 2026-08-15
The parties
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-e93d-df03b654244c