Claim total
$1,666.03
base $93.83 · payer covered $1,516.03
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1987-05-13
- Stop
- 1987-05-13
The parties
- Patient
- patient Kallie Roxane Rodriguez
- Provider
- provider Lizeth Schiller
- Payer
- payer Medicaid
Record id
294b84dd-0309-41d1-4d7a-212186f3f8c0