Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Blighted ovum35999006
- Start
- 2019-06-15
- Stop
- 2019-06-15
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00e3929f-91f8-0715-1637-1a46234deeae