Claim total
$1,191.45
base $93.83 · payer covered $1,191.45
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-01-19
- Stop
- 2016-01-19
The parties
- Patient
- patient Shandra Rosalina Wyman
- Provider
- provider In Reichert
- Payer
- payer Dual Eligible
Record id
32f5456f-364a-5a66-4fb0-b2479cfe2020