Claim total
$504.69
base $93.39 · payer covered $403.75
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Cerebral palsy128188000
- Start
- 2022-02-24
- Stop
- 2022-02-24
The parties
- Patient
- patient Amalia Ana María Soliz
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
007eb971-e9c1-129f-fc44-1fadaec9098f