Claim total
$1,122.92
base $93.83 · payer covered $972.92
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1954-09-16
- Stop
- 1954-09-16
The parties
- Patient
- patient Orval Hershel Dietrich
- Provider
- provider Samuel Boyle
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
1a1f128e-0964-8a74-669b-f0bcee2ccc9f