Claim total
$3,627.57
base $127.17 · payer covered $3,577.57
The visit
- Class
- Inpatient
- Code
- 305408004
- Reason
- diagnosis concept Sterilization requested183996000
- Start
- 2013-08-28
- Stop
- 2013-08-29
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Pasquale Grimes
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-1f72-c6894476b98b