Claim total
$2,114.53
base $155.66 · payer covered $2,064.53
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Blighted ovum35999006
- Start
- 1984-08-13
- Stop
- 1984-08-13
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Darline Franecki
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
0465c17f-66cb-2155-525c-d51200c1fff2