Claim total
$1,185.08
base $93.83 · payer covered $1,185.08
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-12-19
- Stop
- 2006-12-19
The parties
- Patient
- patient Hildred Melda Prohaska
- Provider
- provider Zofia Kub
- Payer
- payer Medicaid
Record id
0be9d3c3-0d2e-b0d7-ae10-e5abe6df243f