Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1987-10-24
- Stop
- 1987-10-24
The parties
- Patient
- patient Reatha Victor O'Conner
- Provider
- provider Danica Stracke
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
0521a0be-ba7b-b4e6-a830-f32e725e0d1c