Claim total
$5,538.21
base $155.66 · payer covered $5,488.21
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2024-11-23
- Stop
- 2024-11-23
The parties
- Patient
- patient Angele Khalilah Kuphal
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
044947be-396f-8eb7-155a-47a032542c10