Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Congenital uterine anomaly37849005
- Start
- 2021-06-03
- Stop
- 2021-06-03
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Rosina Schaden
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-c24b-ed059610ec70