Claim total
$780.15
base $93.83 · payer covered $680.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-02-10
- Stop
- 2018-02-10
The parties
- Patient
- patient Helga Darci Dicki
- Provider
- provider Luisa Wilkinson
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
232ea8f4-93f6-3362-c6d8-7a470ef76ca9