Claim total
$775.00
base $93.83 · payer covered $675.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-09-16
- Stop
- 2007-09-16
The parties
- Patient
- patient Romana Ziemann
- Provider
- provider Dan Leuschke
- Care site
- care site WELLNESS CENTERS, PLLC
- Payer
- payer Medicaid
Record id
16726cc8-c8a2-64af-b9d8-9216529ccf39