Claim total
$840.41
base $93.83 · payer covered $745.39
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-04-27
- Stop
- 2009-04-27
The parties
- Patient
- patient Jeramy Quitzon
- Provider
- provider Andria Spinka
- Payer
- payer Medicaid
Record id
39ff36a1-4189-afbb-2e2b-f9c0047a0575