Claim total
$9,768.81
base $93.83 · payer covered $9,733.81
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1979-03-15
- Stop
- 1979-03-15
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Ramiro Boehm
- Payer
- payer Dual Eligible
Record id
04371635-b149-02a5-2e5a-244733144c7b