Claim total
$5,702.18
base $155.66 · payer covered $5,552.18
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2020-03-06
- Stop
- 2020-03-06
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-0521-ece54a1b2bcb