Claim total
$775.00
base $93.83 · payer covered $625.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2000-02-23
- Stop
- 2000-02-23
The parties
- Patient
- patient Kallie Roxane Rodriguez
- Provider
- provider Lizeth Schiller
- Payer
- payer Medicaid
Record id
294b84dd-0309-41d1-235e-7a567f59f030