Claim total
$11,427.27
base $155.66 · payer covered $11,377.27
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2020-04-03
- Stop
- 2020-04-03
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Mathew Jones
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-d480-e99566ee360e