Claim total
$967.65
base $93.83 · payer covered $967.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-06-12
- Stop
- 2023-06-12
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-ff63-2f703b40d8ec