Claim total
$978.26
base $155.66 · payer covered $0.00
The visit
- Class
- Ambulatory
- Code
- 424619006
- Reason
- diagnosis concept Blighted ovum35999006
- Start
- 1996-05-08
- Stop
- 1996-05-08
The parties
- Patient
- patient Loma Tawanna Ferry
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer No insurance
Record id
04384da7-7311-e99a-3015-d344f8bcba3d