Claim total
$894.25
base $93.83 · payer covered $894.25
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-09-28
- Stop
- 2016-09-28
The parties
- Patient
- patient Gene Erin Wehner
- Provider
- provider Criselda Bartell
- Payer
- payer Dual Eligible
Record id
0324eea5-bb16-c29a-99a8-109ffe865c39