Claim total
$44,659.69
base $155.66 · payer covered $44,609.69
The visit
- Class
- Ambulatory
- Code
- 424441002
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2023-04-29
- Stop
- 2023-04-29
The parties
- Patient
- patient Alica Tracie Gottlieb
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
384ec93e-e42b-5355-b240-48b28839aebd