Claim total
$780.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-01-30
- Stop
- 2021-01-30
The parties
- Patient
- patient Claudio Jacinto Dicki
- Provider
- provider Georgetta Kohler
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Cigna Health
Record id
120844ca-c593-fbeb-a277-0647e1472712