Claim total
$122.41
base $93.39 · payer covered $97.93
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2014-04-04
- Stop
- 2014-04-04
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
0400ef40-232f-be7a-e8ac-81f3d0a88355