Claim total
$1,068.20
base $93.83 · payer covered $1,068.20
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-06-14
- Stop
- 2024-06-14
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Anneliese Bradtke
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-b462-ed2b7dd59699