Claim total
$35,974.80
base $155.66 · payer covered $35,924.80
The visit
- Class
- Ambulatory
- Code
- 424441002
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2021-10-21
- Stop
- 2021-10-21
The parties
- Patient
- patient Dona Fabiola Mohr
- Provider
- provider Liz Kozey
- Payer
- payer Medicaid
Record id
08d3dad9-c063-9835-892d-db8260491a2b