Claim total
$1,117.95
base $93.83 · payer covered $967.95
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-08-07
- Stop
- 1997-08-07
The parties
- Provider
- provider Lowell Blick
- Payer
- payer Medicaid
Record id
06014704-4726-adb5-06a8-e28bbe3bfbd7