Claim total
$1,448.88
base $93.83 · payer covered $1,298.88
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1981-03-20
- Stop
- 1981-03-20
The parties
- Patient
- patient Otis Jed Price
- Provider
- provider Criselda Bartell
- Payer
- payer Medicaid
Record id
1d8b9eda-b86e-378b-9398-8f0bbf52aede