Claim total
$2,736.30
base $155.66 · payer covered $2,686.30
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Blighted ovum35999006
- Start
- 1995-10-31
- Stop
- 1995-10-31
The parties
- Patient
- patient Amanda Kelsey Daugherty
- Provider
- provider Pedro Effertz
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
00a2ce2f-1e05-ab20-9561-86d3e2dc18c5