Claim total
$982.78
base $93.83 · payer covered $882.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-06-30
- Stop
- 2017-06-30
The parties
- Patient
- patient Lee Scot Rosenbaum
- Provider
- provider Ruben Farrell
- Payer
- payer Medicaid
Record id
027e2621-860b-6019-8d10-4bc10fccbe92