Claim total
$504.69
base $93.39 · payer covered $469.69
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- diagnosis concept Dependent drug abuse6525002
- Start
- 2024-09-15
- Stop
- 2024-09-15
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-eeaf-886c6eacb1a9