Claim total
$978.26
base $155.66 · payer covered $978.26
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Tubal pregnancy79586000
- Start
- 2012-05-13
- Stop
- 2012-05-13
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Marcus Douglas
- Payer
- payer Cigna Health
Record id
03f9d33d-12ca-f1a8-c822-4372a453605d