Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1978-10-20
- Stop
- 1978-10-20
The parties
- Patient
- patient Rosario Jim Braun
- Provider
- provider Florentino Boehm
- Payer
- payer Medicaid
Record id
023d14fa-8b29-07fb-27f5-33bf0c406991