Claim total
$4,334.31
base $127.17 · payer covered $4,284.31
The visit
- Class
- Inpatient
- Code
- 305408004
- Reason
- diagnosis concept Sterilization requested183996000
- Start
- 2020-08-04
- Stop
- 2020-08-05
The parties
- Patient
- patient Kylie Alysa Herzog
- Provider
- provider Daryl Farrell
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
097fc80f-e956-12e7-1b22-2ca2e2afa87c