Claim total
$2,623.46
base $155.66 · payer covered $2,588.46
The visit
- Class
- Ambulatory
- Code
- 36228007
- Reason
- —
- Start
- 2019-07-27
- Stop
- 2019-07-27
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Eldora Denesik
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-b9e5-d9b05dd2cf6b