Claim total
$283.74
base $93.39 · payer covered $248.74
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2019-11-14
- Stop
- 2019-11-14
The parties
- Patient
- patient Lamar Mark Connelly
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
050746ba-be7e-c592-959c-b0e6b370b3ae