Claim total
$711.72
base $93.83 · payer covered $561.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-07-13
- Stop
- 2004-07-13
The parties
- Patient
- patient Wilfred Dylan Stracke
- Provider
- provider David Klein
- Payer
- payer Medicaid
Record id
12af9e1b-7bdb-0614-f1a3-c26e25d5475d