Claim total
$1,107.19
base $93.83 · payer covered $1,107.19
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-12-29
- Stop
- 2018-12-29
The parties
- Provider
- provider Criselda Bartell
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-848c-546b742a470c