Claim total
$2,777.09
base $127.17 · payer covered $2,727.09
The visit
- Class
- Emergency
- Code
- 183460006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2024-03-30
- Stop
- 2024-03-30
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-a119-6fc0c3da9cfe