Claim total
$4,468.28
base $155.66 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2018-05-23
- Stop
- 2018-05-23
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-d74b-972569d7f438