Claim total
$8,710.77
base $155.66 · payer covered $8,660.77
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2023-09-23
- Stop
- 2023-09-23
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-5118-350e6b9d36e1