Claim total
$17,756.05
base $155.66 · payer covered $17,706.05
The visit
- Class
- Ambulatory
- Code
- 424441002
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2019-06-05
- Stop
- 2019-06-05
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Edmond Bauch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
00e3929f-91f8-0715-6928-21b94920e298