Claim total
$780.15
base $93.83 · payer covered $630.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2000-05-12
- Stop
- 2000-05-12
The parties
- Patient
- patient Bernard Chance Dach
- Provider
- provider Luisa Wilkinson
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
1c7e8426-4002-fe7b-9a61-8e2e786d6f9a