Claim total
$916.15
base $93.83 · payer covered $916.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-04-04
- Stop
- 2018-04-04
The parties
- Patient
- patient Adella Mitchell Erdman
- Provider
- provider Florentino Boehm
- Payer
- payer Dual Eligible
Record id
37dacb37-2dca-f6a0-2a5f-1257c976e8ce