Claim total
$906.71
base $93.83 · payer covered $906.71
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-10-11
- Stop
- 2010-10-11
The parties
- Patient
- patient Jamie Hector Marvin
- Provider
- provider Concepcion Reichert
- Care site
- care site DAKOTA CHILD AND FAMILY CLINIC
- Payer
- payer Dual Eligible
Record id
0957d7e0-06ff-ed0e-3218-64873b59b524