Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Blighted ovum35999006
- Start
- 1984-07-25
- Stop
- 1984-07-25
The parties
- Patient
- patient María del Carmen Berríos
- Provider
- provider Darnell Reynolds
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
016a1a5e-4450-7aaa-c968-ba7ddd1b568f