Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1965-06-29
- Stop
- 1965-06-29
The parties
- Patient
- patient Neil David Terry
- Provider
- provider Criselda Bartell
- Payer
- payer Medicaid
Record id
218a5e43-1a99-ea3e-0590-8233cfa66c0e