Claim total
$1,463.73
base $93.83 · payer covered $1,313.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1965-08-23
- Stop
- 1965-08-23
The parties
- Patient
- patient Alyson Janie Marquardt
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
00faac37-85e6-9663-9ac4-4f4ac03ba0e7