Claim total
$1,589.85
base $93.39 · payer covered $1,539.85
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2008-02-16
- Stop
- 2008-02-16
The parties
- Patient
- patient Gerardo Marvin Johns
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
01513b97-46a6-1303-355c-5622c61adaab