Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-03-26
- Stop
- 2021-03-26
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-d9f2-76d25dd16477