Claim total
$631.69
base $93.83 · payer covered $631.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-06-26
- Stop
- 2026-06-26
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Anneliese Bradtke
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-6804-55a5486722f5