Claim total
$57,948.19
base $155.66 · payer covered $57,798.19
The visit
- Class
- Ambulatory
- Code
- 424441002
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2017-12-21
- Stop
- 2017-12-21
The parties
- Patient
- patient Dona Fabiola Mohr
- Provider
- provider Silas Conn
- Payer
- payer Medicaid
Record id
08d3dad9-c063-9835-167a-d593d3b554ec