Claim total
$93.39
base $93.39 · payer covered $43.39
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2017-03-10
- Stop
- 2017-03-10
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Vanessa Prosacco
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-12ca-2e512dadd05b