Claim total
$901.56
base $93.83 · payer covered $901.56
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-09-20
- Stop
- 2012-09-20
The parties
- Patient
- patient Lamar Mark Connelly
- Provider
- provider Anneliese Bradtke
- Payer
- payer Dual Eligible
Record id
050746ba-be7e-c592-c3db-7ced8261e53f