Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-05-25
- Stop
- 2020-05-25
The parties
- Patient
- patient María del Carmen Berríos
- Provider
- provider Danica Stracke
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Dual Eligible
Record id
016a1a5e-4450-7aaa-1d31-a12134a0def3