Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-03-17
- Stop
- 2013-03-17
The parties
- Patient
- patient Keith Marquis Ritchie
- Provider
- provider Anneliese Bradtke
- Payer
- payer Medicaid
Record id
30a39716-1c18-1f3a-6534-7b9062672e92