Claim total
$1,131.65
base $93.83 · payer covered $981.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1986-02-28
- Stop
- 1986-02-28
The parties
- Patient
- patient Harold Grant
- Provider
- provider Criselda Bartell
- Payer
- payer Medicaid
Record id
14e15864-fa5b-18f5-2c61-3c90a1d69c98