Claim total
$779.71
base $93.39 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 1972-02-28
- Stop
- 1972-02-28
The parties
- Patient
- patient Kelvin Johnny Hirthe
- Provider
- provider Grant Mitchell
- Care site
- care site FAIRVIEW SOUTHDALE HOSPITAL
- Payer
- payer No insurance
Record id
292b5aae-02fc-4e2f-81a3-5cbafc6b4db2