Claim total
$757.81
base $93.39 · payer covered $707.81
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 1993-04-23
- Stop
- 1993-04-23
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-f0bd-eb2f79771078