Claim total
$5,702.18
base $155.66 · payer covered $5,652.18
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2022-11-30
- Stop
- 2022-11-30
The parties
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-2a38-c1a0db78bc71