Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-12-06
- Stop
- 2017-12-06
The parties
- Patient
- patient Tillie Zana Jacobi
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer No insurance
Record id
35351f5f-7cc9-c898-551e-9f97f68c96eb