Claim total
$5,191.37
base $155.66 · payer covered $5,141.37
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2026-07-11
- Stop
- 2026-07-11
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-5d1d-693d43082ae0