Claim total
$1,473.10
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-10-07
- Stop
- 2015-10-07
The parties
- Patient
- patient Elvera Lona Eichmann
- Provider
- provider Adelia Dickens
- Care site
- care site WELLNESS CENTERS, PLLC
- Payer
- payer Humana
Record id
20e28446-8e46-8d4a-8385-58949109d2ea