Claim total
$1,666.03
base $93.83 · payer covered $1,516.03
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1988-12-18
- Stop
- 1988-12-18
The parties
- Provider
- provider Maris Bauch
- Care site
- care site MEDICAL CARE SERVICES, PA
- Payer
- payer Medicaid
Record id
0ed67a32-bd3f-abe0-35d9-60702a31399e