Claim total
$910.06
base $93.83 · payer covered $544.76
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-11-22
- Stop
- 2013-11-22
The parties
- Patient
- patient Sarah Grace Rodriguez
- Provider
- provider Nicky Veum
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer Medicare
Record id
0b148eae-85bf-c41d-a22c-19d3f7691b04