Claim total
$486.30
base $75.00 · payer covered $389.04
The visit
- Class
- Virtual
- Code
- 390906007
- Reason
- diagnosis concept Cerebral palsy128188000
- Start
- 2024-01-29
- Stop
- 2024-01-29
The parties
- Patient
- patient Amalia Ana María Soliz
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicare
Record id
007eb971-e9c1-129f-f7e3-ec26f3110a16