Claim total
$934.90
base $93.83 · payer covered $934.90
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-11-14
- Stop
- 2014-11-14
The parties
- Patient
- patient Winford Jermaine Bode
- Provider
- provider Harry Gottlieb
- Care site
- care site WRIGHT MEDICAL CARE PLLC
- Payer
- payer Medicaid
Record id
32a7c5c0-d154-0176-a453-7146f5a206fc