Claim total
$93.39
base $93.39 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Fracture of forearm65966004
- Start
- 2024-12-01
- Stop
- 2024-12-01
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-3736-90a30292585b