Claim total
$711.72
base $93.83 · payer covered $711.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-01-21
- Stop
- 2023-01-21
The parties
- Provider
- provider Criselda Bartell
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-3f05-3780f108300b