Claim total
$93.39
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Chronic pain82423001
- Start
- 2014-03-23
- Stop
- 2014-03-23
The parties
- Patient
- patient Chang Larry Hermiston
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Humana
Record id
3a43a35d-fb85-2922-5fa4-88171879d9df