Claim total
$1,181.40
base $93.83 · payer covered $1,181.40
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-04-06
- Stop
- 2026-04-06
The parties
- Patient
- patient Rosaria Golden Bashirian
- Provider
- provider Ramiro Boehm
- Payer
- payer Dual Eligible
Record id
015dd051-d88b-0f3d-3665-9d014f04fb37