Claim total
$836.12
base $93.83 · payer covered $686.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1964-08-21
- Stop
- 1964-08-21
The parties
- Provider
- provider Garfield Eichmann
- Care site
- care site LIFE WELLNESS CENTER EAGAN PA
- Payer
- payer Medicaid
Record id
0da4d500-73bd-541a-a4e7-456b48eee6ab