Claim total
$1,290.49
base $93.39 · payer covered $1,240.49
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 1976-05-21
- Stop
- 1976-05-21
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Boris Lynch
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-3088-d271df847041