Claim total
$1,463.73
base $93.83 · payer covered $1,463.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-02-28
- Stop
- 2016-02-28
The parties
- Patient
- patient Rex Jules Denesik
- Provider
- provider Danica Stracke
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
06303127-1d9c-5fa8-4a3d-2719830b021b