Claim total
$12,054.52
base $155.66 · payer covered $11,904.52
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2024-10-26
- Stop
- 2024-10-26
The parties
- Patient
- patient Angele Khalilah Kuphal
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
044947be-396f-8eb7-4d70-2cf081ba14fa