Claim total
$40,934.74
base $155.66 · payer covered $40,884.74
The visit
- Class
- Ambulatory
- Code
- 424441002
- Reason
- diagnosis concept Normal pregnancy72892002
- Start
- 2021-05-25
- Stop
- 2021-05-25
The parties
- Patient
- patient Dannette Tonya Jacobson
- Provider
- provider Arie Bruen
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer Medicaid
Record id
39772979-843a-a410-ad25-3b9553917dae