Claim total
$37,862.44
base $155.66 · payer covered $37,812.44
The visit
- Class
- Ambulatory
- Code
- 424441002
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2025-06-18
- Stop
- 2025-06-18
The parties
- Patient
- patient Salley Donna Jacobi
- Provider
- provider Pedro Effertz
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
378b5b63-42a4-2859-1947-36c1c50d2e9d