Claim total
$37,177.26
base $155.66 · payer covered $37,027.26
The visit
- Class
- Ambulatory
- Code
- 424441002
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2016-12-30
- Stop
- 2016-12-30
The parties
- Patient
- patient Ashton Hisako Jaskolski
- Provider
- provider Daryl Farrell
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
2b9209bc-5607-5ae5-1127-cb320fe2f572