Claim total
$5,970.67
base $93.83 · payer covered $5,920.67
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-01-14
- Stop
- 1996-01-14
The parties
- Patient
- patient Violeta Mandi Schaefer
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
124c1515-c98a-6eca-5923-1888dd226326