Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-04-14
- Stop
- 2021-04-14
The parties
- Patient
- patient Adam Alfonzo Stokes
- Provider
- provider Forrest Hirthe
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
056ed411-c295-a5c9-9550-84832a3dea55