Claim total
$1,065.13
base $93.39 · payer covered $1,030.13
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2024-09-27
- Stop
- 2024-09-27
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Enoch Torp
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-0d54-f44eec173a8a