Claim total
$704.41
base $93.83 · payer covered $604.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-11-18
- Stop
- 2019-11-18
The parties
- Patient
- patient Chester Richie Aufderhar
- Provider
- provider Samuel Boyle
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
080b069b-5108-46b6-ce10-ff981725e416