Claim total
$4,468.28
base $155.66 · payer covered $4,418.28
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2024-11-12
- Stop
- 2024-11-12
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Trinity Mraz
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-0d69-2c9ce711b616