Claim total
$980.65
base $93.83 · payer covered $880.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-04-02
- Stop
- 2010-04-02
The parties
- Patient
- patient Danial Hal Lang
- Provider
- provider Leo Bartoletti
- Payer
- payer Medicaid
Record id
06067a48-9015-34d7-c911-1d0ad07fb74f