Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Blighted ovum35999006
- Start
- 2010-08-31
- Stop
- 2010-08-31
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Jo Stiedemann
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-69e3-7559b98c3077