Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1957-06-07
- Stop
- 1957-06-07
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Lowell Blick
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-eb82-2ecee384d0a7