Claim total
$11,677.41
base $155.66 · payer covered $11,627.41
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2017-05-16
- Stop
- 2017-05-16
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Chance Wisoky
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-915f-8349b0069fe0