Claim total
$155.66
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 698314001
- Reason
- Contraception care389095005
- Start
- 2017-07-04
- Stop
- 2017-07-04
The parties
- Patient
- patient Reatha Victor O'Conner
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Aetna
Record id
0521a0be-ba7b-b4e6-f2cf-c5858ddbceda