Claim total
$1,388.98
base $93.39 · payer covered $1,353.98
The visit
- Class
- Ambulatory
- Code
- 185347001
- Reason
- diagnosis concept Ischemic heart disease414545008
- Start
- 2013-03-28
- Stop
- 2013-03-28
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Tiffany Sauer
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-595b-bc1c10386f8b