Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Inpatient
- Code
- 56876005
- Reason
- diagnosis concept Dependent drug abuse6525002
- Start
- 2025-07-10
- Stop
- 2025-07-13
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Richie Bergstrom
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-cab3-110480490aeb