Claim total
$566.96
base $155.66 · payer covered $416.96
The visit
- Class
- Ambulatory
- Code
- 170837001
- Reason
- Allergic disposition609328004
- Start
- 2019-12-07
- Stop
- 2019-12-07
The parties
- Patient
- patient Keven Pouros
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
35738f47-113e-1cfd-7c10-6c83744566a9