Claim total
$1,799.01
base $93.83 · payer covered $1,649.01
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-09-26
- Stop
- 2004-09-26
The parties
- Patient
- patient Roderick Lloyd Gottlieb
- Provider
- provider Elbert Schaefer
- Payer
- payer Medicaid
Record id
1bef94fd-46c7-91d1-d422-6bac772814c5