Claim total
$1,357.72
base $93.83 · payer covered $1,357.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-04-10
- Stop
- 2022-04-10
The parties
- Patient
- patient Adrian Arden Haag
- Provider
- provider Luisa Wilkinson
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Dual Eligible
Record id
341d0f9d-7d8e-e18c-0892-64e23650beec