Claim total
$12,073.00
base $155.66 · payer covered $12,023.00
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2026-05-16
- Stop
- 2026-05-16
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-4fcc-01e6ff7df3ea