Claim total
$1,179.53
base $93.83 · payer covered $1,129.53
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1992-12-01
- Stop
- 1992-12-02
The parties
- Patient
- patient Nieves Runolfsson
- Provider
- provider Luisa Wilkinson
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
28ec1e9a-2fa3-fde4-4556-6b36b6b82a4b