Claim total
$93.39
base $93.39 · payer covered $58.39
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2024-06-28
- Stop
- 2024-06-28
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-6569-2a05f67e3ca5