Claim total
$4,245.41
base $93.83 · payer covered $4,245.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-08-15
- Stop
- 2025-08-15
The parties
- Patient
- patient Pamula Ellan Kiehn
- Provider
- provider Luisa Wilkinson
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Dual Eligible
Record id
3a501eb2-e422-6d85-b196-8b830de9b6c8