Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1949-10-28
- Stop
- 1949-10-28
The parties
- Patient
- patient Demetra Katheryn Wisoky
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
08fe74ff-5d25-add3-512f-6351b5cfcd89