Claim total
$631.25
base $93.39 · payer covered $596.25
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2025-02-21
- Stop
- 2025-02-21
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-5128-f043e953b4bc