Claim total
$97.23
base $93.39 · payer covered $47.23
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2021-12-04
- Stop
- 2021-12-04
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-d388-314b46d34b77